[Congressional Record Volume 172, Number 116 (Thursday, July 16, 2026)]
[House]
[Pages H4548-H4613]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
TAKE CARE OF AMERICA'S VETERANS ACT
Mr. BOST. Mr. Speaker, pursuant to House Resolution 1423, I call up
the bill (H.R. 9237) to amend titles 10 and 38, United States Code, and
other Federal laws, to improve benefits for veterans and the
administration of the Department of Veterans Affairs, and ask for its
immediate consideration in the House.
The Clerk read the title of the bill.
The SPEAKER pro tempore. Pursuant to House Resolution 1423, the
amendment printed in part B of House Report 119-749 is adopted, and the
bill, as amended, is considered read.
The text of the bill, as amended, is as follows:
H.R. 9237
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 ``Take Care
of America's Veterans Act''.
(b) Table of Contents.--The table of contents for this Act
is as follows:
Sec. 1. Short title; table of contents.
TITLE I--COMPENSATION
Sec. 101. Major Richard Star Act.
Sec. 102. Love Lives On Act.
Sec. 103. Extension of increased dependency and indemnity compensation
to surviving spouses of veterans who die from amyotrophic
lateral sclerosis.
Sec. 104. Sharri Briley and Eric Edmundson Veterans Benefits Expansion
Act of 2026.
Sec. 105. Claims: prohibition on denial solely for certain reason;
improved efficiency of adjudications and appeals.
Sec. 106. Annual report on causes of death among veterans.
Sec. 107. Plan for use of automation tools to process claims under laws
administered by the Secretary of Veterans Affairs.
Sec. 108. Reforms relating to Department of Veterans Affairs disability
ratings.
Sec. 109. Improvements to temporary licensure requirements for contract
health care professionals who perform medical disability
examinations for the Department of Veterans Affairs.
Sec. 110. Disability examinations: study on access in rural areas;
review of training; review of inadequate or unnecessary
examinations.
Sec. 111. Improvements to processing and outreach regarding claims
involving military sexual trauma.
Sec. 112. Independent assessment of notices that the Secretary of
Veterans Affairs sends to claimants.
Sec. 113. Independent assessment of forms that the Secretary of
Veterans Affairs sends to claimants.
TITLE II--EDUCATION AND ECONOMIC OPPORTUNITY
Sec. 201. Vets Opportunity Act.
Sec. 202. Improvements to process for making payments to automobile
sellers for automobiles purchased for certain disabled
veterans.
Sec. 203. Monthly housing stipend under the Post-9/11 Educational
Assistance Program for individuals who pursue summer
programs of education solely through distance learning.
Sec. 204. Clarification regarding inclusion of medically necessary
automobile adaptations in Department of Veterans Affairs
definition of ``medical services''.
Sec. 205. Digital communications: Solid Start program; educational
assistance.
Sec. 206. Improvements to Transition Assistance Program and
Skillbridge.
Sec. 207. Transition Assistance Program: presentation in preseparation
counseling to promote benefits available to veterans.
Sec. 208. Elimination of requirement that on-campus educational and
vocational counseling is provided by certain Department
of Veterans Affairs employees.
Sec. 209. Expansion of entitlement for payment for licensing or
certification tests for veterans entitled to educational
assistance.
Sec. 210. Increase of amount of educational assistance paid by the
Secretary of Veterans Affairs for first year of a full-
time program of apprenticeship or other on-job training.
Sec. 211. Improving emerging technology opportunities for veterans.
TITLE III--HEALTH CARE
Sec. 301. Extension and modification of transportation grant program of
Department of Veterans Affairs.
Sec. 302. Veteran Caregiver Reeducation, Reemployment, and Retirement
Act.
Sec. 303. Veterans TBI Breakthrough Exploration of Adaptive Care
Opportunities Nationwide Act.
Sec. 304. Department of Veterans Affairs assignment of traveling
physicians to serve territories and possessions.
Sec. 305. Inclusion of adaptive prostheses and terminal devices for
sports and other recreational activities in medical
services furnished to eligible veterans by the Secretary
of Veterans Affairs.
Sec. 306. Modifications to and reauthorization of Staff Sergeant Parker
Gordon Fox Suicide Prevention Grant Program of Department
of Veterans Affairs.
Sec. 307. Reports on the use of hyperbaric oxygen therapy.
Sec. 308. Department of Veterans Affairs pilot program to provide
grants to mental health care providers for the provision
of mental health care for veterans.
[[Page H4549]]
Sec. 309. Furnishing of certain health services to veterans in the
Freely Associated States.
Sec. 310. Modification of Precision Medicine for Veterans Initiative;
reporting on suicide by veterans and members of the Armed
Forces.
Sec. 311. Establishment of the Blast Overpressure Task Force of the
Department of Veterans Affairs.
Sec. 312. Extension of sharing of Department of Veterans Affairs and
Department of Defense Health Care Resources; resource
sharing oversight and implementation plan.
Sec. 313. Timely reporting of the death of a veteran.
Sec. 314. Expansion of access by veterans to critical access hospitals
and affiliated clinics under the Veterans Community Care
Program.
Sec. 315. Pilot platform for services for veterans; collection from
veterans of information related to social determinants of
health.
Sec. 316. Improvements to Department of Veterans Affairs prosthetic and
rehabilitative items and service.
Sec. 317. Improvement of submission of medical documentation to the
Secretary of Veterans Affairs by community care
providers.
Sec. 318. Implementation of and report on efforts of Department of
Veterans Affairs to improve health care appointment
scheduling.
Sec. 319. Pilot program on coordination of care between Department of
Veterans Affairs and Medicare program.
Sec. 320. Fisher House availability.
Sec. 321. Agreements between medical facilities of Department of
Veterans Affairs and rural medical facilities.
Sec. 322. Study on quality of care difference between mental health and
addiction therapy care provided by health care providers
of Department of Veterans Affairs compared to non-
Department providers.
Sec. 323. Lactation spaces in medical centers of the Department of
Veterans Affairs.
Sec. 324. Research related to menopause, perimenopause, and mid-life
women's health: report; plan.
Sec. 325. Pilot program on provision of opioid rescue medications to
veterans.
Sec. 326. Establishment of Veterans Health Administration Policy
Advisory Commission.
Sec. 327. Access to health care.
Sec. 328. Research on health conditions of descendants of toxic-exposed
veterans.
Sec. 329. Veterans Spinal Trauma Access to New Devices Act.
Sec. 330. Department of Veterans Affairs pilot program to award grants
for the provision of service dogs to veterans.
Sec. 331. Authorization of major medical facility project of Department
of Veterans Affairs for fiscal year 2027 in Manchester,
New Hampshire.
Sec. 332. Bowel and bladder care program of Department of Veterans
Affairs.
TITLE IV--ORGANIZATION
Sec. 401. Authorization of appropriations to the Office of Information
and Technology of the Department of Veterans Affairs for
certain purposes.
Sec. 402. Establishment of Under Secretary for Management and Chief
Financial Officer.
Sec. 403. Department of Veterans Affairs acquisition reform and cost
assessment.
Sec. 404. Improvement of telephone communication by Department of
Veterans Affairs.
Sec. 405. Advancing Department of Veterans Affairs emergency response
to crisis.
Sec. 406. Membership of Department of Veterans Affairs Geriatrics and
Gerontology Advisory Committee.
Sec. 407. Scheduling of appointments under the Veterans Community Care
Program.
TITLE V--MEMORIAL AFFAIRS
Sec. 501. Expansion of eligibility for Department of Veterans Affairs
memorial headstone or marker for certain individuals.
Sec. 502. Department of Veterans Affairs provision of additional burial
benefits when an urn or commemorative plaque is
furnished.
Sec. 503. Fallen Servicemembers Religious Heritage Restoration Program.
TITLE VI--VETERANS' ASSURING CRITICAL CARE EXPANSIONS TO SUPPORT
SERVICEMEMBERS
Subtitle A--Improvement of Veterans Community Care Program
Sec. 601. Codification of requirements for eligibility standards for
access to community care from Department of Veterans
Affairs.
Sec. 602. Requirement that Secretary notify veterans of eligibility for
care or denial of request for care under Veterans
Community Care Program.
Sec. 603. Consideration under Veterans Community Care Program of
continuity of care and need for caregiver or attendant.
Sec. 604. Discussion of telehealth options under Veterans Community
Care Program.
Sec. 605. Extension of deadline for submittal of claims by health care
entities and providers under prompt payment standard.
Sec. 606. Audit of representative sample of veterans receiving care and
services under Veterans Community Care Program.
Sec. 607. Information on wait time and drive time options for receipt
of care by veterans.
Sec. 608. Establishment of period during which a referral under
Veterans Community Care Program remains valid.
Sec. 609. Updates to contracting requirements under Veterans Community
Care Program.
Sec. 610. Publication of community care network sufficiency and payment
waiver requests and approvals.
Sec. 611. Requirements relating to quality of community care providers.
Sec. 612. Provider training.
Sec. 613. Oversight authority over community care.
Subtitle B--Mental Health Treatment Programs
Sec. 621. Veteran participation in certain mental health programs.
Sec. 622. Access to mental health residential rehabilitation treatment
programs for veterans with spinal cord injury or
disorder.
Subtitle C--Staffing Matters
Sec. 631. Treatment of psychologists.
Sec. 632. Mentorship program for executive leadership teams at medical
centers of the Department of Veterans Affairs.
Sec. 633. Requirement for equivalent role postings for vacant positions
at Department of Veterans Affairs.
Sec. 634. Improvements to Department of Veterans Affairs hiring
processes.
Sec. 635. Department of Veterans Affairs telework policy.
Sec. 636. Expansion of reimbursement of continuing professional
education expenses.
Sec. 637. Department of Veterans Affairs personnel transparency.
Sec. 638. Modification of authority of licensure of health care
professionals providing treatment via telemedicine.
Sec. 639. Provision of data on educational assistance programs of
Veterans Health Administration.
Subtitle D--Optimization of Workforce
Sec. 641. Department of Veterans Affairs strategic human capital plan.
Sec. 642. Department of Veterans Affairs reduction in force notice
requirement.
Sec. 643. Detailed plans and justifications for reorganization of
offices.
Sec. 644. Rule of construction.
Subtitle E--Veterans Infrastructure and Transformation
Sec. 651. Short title.
Sec. 652. Modification of authority for sharing of health-care
resources of Department of Veterans Affairs to include
flexible space utilization and streamlined service
agreements.
Sec. 653. Use of commercial construction and facilities code and
standards.
Sec. 654. Feasibility study for full-service hospital of Department of
Veterans Affairs in certain States.
Sec. 655. Report on strategic plan for infrastructure and capital
assets of Department of Veterans Affairs.
Sec. 656. Permanent extension of pilot program on acceptance by the
Department of Veterans affairs of donated facilities and
related improvements.
Sec. 657. Authority to accept donations of construction services, minor
construction or nonrecurring maintenance projects, and
targeted contributions.
Sec. 658. Report on use of additional authorities relating to
recruitment and retention of personnel.
Sec. 659. Reports on key capital asset investments, activities, and
performance of Department of Veterans Affairs.
Sec. 660. Development of streamlined procurement model; report.
Sec. 661. Submission and notification of cost estimates for medical
facility leases.
[[Page H4550]]
Sec. 662. Report on capital asset and information technology needs of
the research and development program of Department of
Veterans Affairs.
Sec. 663. Improving prevention, detection, and reporting of waste,
fraud, and abuse in Department of Veterans Affairs
capital asset projects and activities.
Sec. 664. Report on long-term care physical infrastructure needs of
Department of Veterans Affairs.
Subtitle F--Other Health Care Matters
Sec. 671. Prescription, delivery, distribution, and dispensation of
controlled substance medications by covered health care
professionals of Department of Veterans Affairs via
telemedicine.
Sec. 672. Copayments for limited supplies of medications.
Sec. 673. Plan on establishment of interactive, online self-service
module for care.
Sec. 674. Modification of requirements for Center for Innovation for
Care and Payment of the Department of Veterans Affairs
and transfer of authority.
Sec. 675. Report on improvements to clinical appeals process.
Sec. 676. Plan on increasing accessibility of care for veterans with
spinal cord injury or disorder.
TITLE I--COMPENSATION
SEC. 101. MAJOR RICHARD STAR ACT.
(a) Concurrent Receipt Generally.--Section 1414(b) of title
10, United States Code, is amended by striking paragraph (2)
and inserting the following new paragraphs:
``(2) Combat-related disability retirees.--
``(A) In general.--A member retired under chapter 61 of
this title with a combat-related disability who is entitled
for any month to retired pay under chapter 61 of this title
and is also entitled for that month to veterans' disability
compensation under title 38, is entitled to be paid both
without regard to sections 5304 and 5305 of title 38, as
provided by subparagraphs (B) and (C).
``(B) Career retirees.--In the case of a member retired
under chapter 61 of this title who has a combat-related
disability that is not a qualifying service-connected
disability (as defined in subsection (a)(2)) and who, at the
time of the member's retirement, had 20 years or more of
service otherwise creditable under section 1405 of this title
or at least 20 years of qualifying and equivalent service
computed under sections 12732 and 12733 of this title, the
member may receive, without regard to sections 5304 and 5305
of title 38, both--
``(i) the amount of retired pay to which the member would
have been entitled under any other provision of law based on
the member's service in the uniformed services if the member
had not been retired under chapter 61 of this title; and
``(ii) veterans' disability compensation under title 38.
``(C) Disability retirees with less than 20 years of
service.--In the case of a member retired under chapter 61 of
this title with a combat-related disability and who, at the
time of the member's retirement, had less than 20 years of
service otherwise creditable under section 1405 of this title
or less than 20 years of qualifying and equivalent service
computed under sections 12732 and 12733 of this title, the
member may receive, without regard to sections 5304 and 5305
of title 38, the lesser of--
``(i) both--
``(I) the retired pay for which the member is eligible
under chapter 61 of this title; and
``(II) veterans' disability compensation under title 38; or
``(ii) both--
``(I) an amount equal to the product of the retired pay
base computed under section 1406(b) or 1407 of this title and
the retired pay multiplier determined under section 1409 of
this title, as such base pay and multiplier would be computed
if the member had 20 years of service creditable under
section 1405 of this title; and
``(II) veterans' disability compensation under title 38.
``(D) Combat-related disability defined.--In this
paragraph, the term `combat-related disability' has the
meaning given that term in subsection (e) of section 1413a of
this title and as determined under the criteria and
procedures used for purposes of such section.
``(3) Exclusion of other retirees.--Subsection (a) does not
apply to a member retired under chapter 61 of this title if
the member is not covered by paragraph (1) or (2).''.
(b) Technical and Conforming Amendments.--
(1) Coordination with combat-related special compensation
program.--Section 1414(d) of title 10, United States Code, is
amended by striking ``qualified retiree under this section''
and inserting ``qualified retiree under subsection (a) or is
entitled to a payment under subsection (b)(2)''.
(2) Amendments reflecting end of concurrent receipt phase-
in period.--Section 1414 of title 10, United States Code, is
further amended--
(A) in subsection (a)(1)--
(i) by striking the second sentence; and
(ii) by striking subparagraphs (A) and (B);
(B) by striking subsection (c) and redesignating
subsections (d) and (e) as subsections (c) and (d),
respectively; and
(C) in subsection (d), as redesignated, by striking
paragraphs (3) and (4).
(3) Section heading.--The heading of section 1414 of such
title is amended to read as follows:
``Sec. 1414. Members eligible for retired pay who are also
eligible for veterans' disability compensation: concurrent
receipt''.
(4) Conforming amendment.--Section 1413a(f) of such title
is amended by striking ``Subsection (d)'' and inserting
``Subsection (c)''.
(c) Effective Date.--The amendments made by this section
shall apply to payments for months beginning on or after the
date of the enactment of the Take Care of America's Veterans
Act.
SEC. 102. LOVE LIVES ON ACT.
(a) Modification of Entitlement to Veterans Dependency and
Indemnity Compensation for Surviving Spouses Who Remarry.--
Section 103(d) of title 38, United States Code, is amended--
(1) in paragraph (2)(B)--
(A) by inserting ``(i)'' before ``The remarriage'';
(B) in clause (i), as designated by subparagraph (A), by
striking ``Notwithstanding the previous sentence'' and
inserting the following:
``(ii) Notwithstanding clause (i)''; and
(C) by adding at the end the following new clause:
``(iii) Notwithstanding clause (ii), the remarriage of a
surviving spouse shall not bar the furnishing of benefits
under section 1311 or 1562 of this title to the surviving
spouse of a veteran.''; and
(2) in paragraph (5)--
(A) by striking subparagraph (A); and
(B) by renumbering subparagraphs (B) through (E) as
subparagraphs (A) through (D), respectively.
(b) Continued Eligibility for Survivor Benefit Plan for
Surviving Spouses Who Remarry.--Section 1450 of title 10,
United States Code, is amended--
(1) in subsection (b)--
(A) in the section heading, by striking ``, Remarriage
Before Age 55, etc.'';
(B) in paragraph (2)--
(i) in the paragraph heading, by striking ``or remarriage
before age 55''; and
(ii) by striking ``or, if the surviving spouse or former
spouse remarries before reaching age 55, until the surviving
spouse or former spouse remarries''; and
(C) by striking paragraph (3) and inserting the following
new paragraphs:
``(3) Effect of termination of subsequent marriage.--If the
surviving spouse or former spouse remarries and is also
entitled to an annuity under the Plan based upon the
subsequent marriage when the subsequent marriage is
terminated, the surviving spouse or former spouse may not
receive both annuities and shall elect which annuity to
receive.
``(4) Restoration of annuity for certain surviving
spouses.--In the case of a surviving spouse who remarried
before reaching age 55 and before the date of the enactment
of this paragraph, the Secretary shall resume payment of the
annuity to that surviving spouse--
``(A) except as provided by subparagraph (B), for each
month that begins on or after the date that is one year after
such date of enactment; or
``(B) on the first day of the first month beginning after
such date of enactment, in the case of a surviving spouse who
elected to transfer payment of that annuity to a surviving
child or children under the provisions of section
1448(d)(2)(B) of title 10, United States Code, as in effect
on December 31, 2019.''; and
(2) in subsection (k)(1)--
(A) in the paragraph heading, by striking ``if beneficiary
55 years of age or more'';
(B) by striking ``subsequently loses'' and inserting
``lost''; and
(C) by striking ``, and if at the time of such remarriage
the surviving spouse or former spouse is 55 years of age or
more'' after ``former spouse''.
(c) Expansion of Definition of Dependent Under TRICARE
Program to Include a Remarried Widow or Widower Whose
Subsequent Marriage Has Ended.--Section 1072(2) of title 10,
United States Code, is amended--
(1) in subparagraph (H), by striking ``; and'' and
inserting a semicolon;
(2) in subparagraph (I)(v), by striking the period at the
end and inserting ``; and''; and
(3) by adding at the end the following new subparagraph:
``(J) a remarried widow or widower whose subsequent
marriage has ended due to death, divorce, or annulment.''.
SEC. 103. EXTENSION OF INCREASED DEPENDENCY AND INDEMNITY
COMPENSATION TO SURVIVING SPOUSES OF VETERANS
WHO DIE FROM AMYOTROPHIC LATERAL SCLEROSIS.
(a) Extension.--Section 1311(a)(2) of title 38, United
States Code, is amended--
(1) by inserting ``(A)'' before ``The rate''; and
(2) by adding at the end the following new subparagraph:
``(B) A veteran whom the Secretary determines died from
amyotrophic lateral sclerosis shall be treated as a veteran
described in subparagraph (A) without regard for how long the
veteran had such disease prior to death.''.
[[Page H4551]]
(b) Applicability.--Subparagraph (B) of section 1311(a)(2)
of title 38, United States Code, as added by subsection (a),
shall apply to a veteran who dies from amyotrophic lateral
sclerosis on or after October 1, 2022.
SEC. 104. SHARRI BRILEY AND ERIC EDMUNDSON VETERANS BENEFITS
EXPANSION ACT OF 2026.
(a) Increase in Rates of Certain Disability Compensation
and Dependency and Indemnity Compensation Under Laws
Administered by Secretary of Veterans Affairs.--
(1) Increase to rates of wartime disability compensation.--
(A) In general.--Section 1114 of title 38, United States
Code, is amended by adding at the end the following new
subsection:
``(u) In the case of a veteran eligible for a monthly aid
and attendance allowance under subsection (r) or subsection
(t) of this section, the Secretary shall, in addition to the
total amount of compensation for which the veteran is
eligible under this section, pay the veteran a supplemental
monthly allowance at the rate of $833.33.''.
(B) Effective date; applicability.--Subsection (u) of such
section (as added by subparagraph (A)) shall take effect on
December 1, 2026, and shall apply to months beginning on or
after such date.
(2) Increase to rates of dependency and indemnity
compensation.--Section 5312 of such title is amended by
adding at the end the following new subsection:
``(d)(1) Whenever there is an increase in benefit amounts
payable under title II of the Social Security Act (42 U.S.C.
401 et seq.) as a result of a determination made under
section 215(i) of such Act (42 U.S.C. 415(i)), the Secretary
shall, except as provided in paragraph (2), effective on the
date of such increase in benefit amounts, increase the dollar
amounts in effect for the payment of dependency and indemnity
compensation by the Secretary under paragraph (1) and
paragraph (3) of section 1311(a) of this title, as such
amounts were in effect immediately before the date of such
increase in benefit amounts payable under title II of the
Social Security Act, by a percentage equal to the sum of--
``(A) the percentage by which such benefit amounts are
increased; and
``(B) one percent.
``(2) Whenever there is an increase under paragraph (1) in
amounts in effect for the payment of dependency and indemnity
compensation, the Secretary shall publish such amounts, as
increased pursuant to such paragraph, in the Federal Register
at the same time as the material required by section
215(i)(2)(D) of the Social Security Act (42 U.S.C.
415(i)(2)(D)) is published by reason of a determination under
section 215(i) of such Act (42 U.S.C. 415(i)).
``(3) The requirement to increase, pursuant to paragraph
(1), the amounts in effect for the payment of dependency and
indemnity compensation under paragraph (1) and paragraph (3)
of section 1311 (a) of this title by the Secretary shall--
``(A) take effect on December 1, 2026, and shall apply with
respect to months beginning on or after such date; and
``(B) terminate after the date on which the third increase
to such amounts pursuant to such paragraph occurs.''.
(b) Modification of Waivers of Fees Collected for Housing
Loans Guaranteed, Insured, or Made by the Secretary of
Veterans Affairs.--
(1) Modification.--Section 3729(b)(2) of such title is
amended, in the loan fee table--
(A) in subparagraph (E), by striking ``0.50'' both places
it appears and inserting ``1.42''; and
(B) in subparagraph (I), by striking ``0.50'' each place it
appears and inserting ``1.0''.
(2) Effective date.--The amendments made by paragraph (1)
shall take effect on October 1, 2026.
(c) Home Affordability for Guard and Reserve.--
(1) Eligibility of certain members of the reserve
components and the national guard for guaranteed housing
loans.--
(A) Expanded definition of ``active duty'' for purposes of
housing loans.--Section 3701(b) of title 38, United States
Code, is amended by adding at the end the following new
paragraph:
``(9) The term `active duty' has the following meanings:
``(A) In the case of a member of the regular components of
the Armed Forces, the meaning given such term in section
101(21)(A) of this title.
``(B) In the case of members of the reserve components of
the Armed Forces--
``(i) service on active duty (as defined in section 101(d)
of title 10), inactive-duty training (as defined in section
101(d) of title 10), or annual training duty; or
``(ii) service on active duty under a call or order to
active duty under section 688, 12301(a), 12301(d), 12301(g),
12301(h), 12302, 12304, 12304a, or 12304b of title 10 or
section 713 of title 14, but not including inactive duty
training (as defined in section 101(d) of title 10) or annual
training duty.
``(C) In the case of a member of the Army National Guard of
the United States or Air National Guard of the United States,
in addition to service described in subparagraph (B)--
``(i) in the National Guard of a State for the purpose of
organizing, administering, recruiting, instructing, or
training the National Guard; or
``(ii) full-time National Guard duty (as defined in section
101 of title 32).''.
(B) Retroactive applicability to service performed.--The
amendments made by this subsection shall apply with respect
to any service performed on or after September 11, 2001.
(2) Expansion of eligibility for guaranteed housing loans
to certain additional personnel upon payment of additional
loan fee.--
(A) Expansion to individuals with at least 14 days of
service.--Section 3701(b) of title 38, United States Code, is
amended by inserting after paragraph (7) the following new
paragraph:
``(8) The term `veteran' also includes, for purposes of
home loans (subject to the additional loan fee in section
3729(b)(4)(J) of this title), an individual who--
``(A) is not otherwise eligible for the benefits of this
chapter;
``(B) has completed a total service of at least 14 days on
active duty under paragraph (B) or (C) of paragraph (9); and
``(C) following completion of such service, continued to
serve until the completion of entry level and skill training
(as defined in section 3301(3) of this title).''.
(B) Basic entitlement.--Section 3702(a)(2) of title 38,
United States Code, is amended by adding at the end the
following:
``(H) Each individual described in section 3701(b)(8) of
this title.''.
(C) Additional loan fee for such individuals.--Section
3729(b)(4) of title 38, United States Code, is amended by
adding at the end the following new subparagraph:
``(J) In the case of a housing loan in which the veteran
has eligibility under section 3701(b)(8) of this title and
does not otherwise have eligibility, the loan fee table in
paragraph (2) shall be applied to the veteran or other
obligor (as applicable) by adding 1.00 to the percentage in
the table.''.
(D) Notification to personnel.--The Secretary of Veterans
Affairs shall provide information about this benefit to the
Secretary of Defense to ensure that each member of a reserve
component or a member of the Army National Guard of the
United States or Air National Guard of the United States who
completes entry level and skill training (as defined in
section 3301(3) of title 38, United States Code) after the
date of the enactment of this Act is notified of their
eligibility for housing loan benefits under chapter 37 of
such title, including eligibility (subject to the additional
loan fee) under section 3701(b)(8) of such title.
SEC. 105. CLAIMS: PROHIBITION ON DENIAL SOLELY FOR CERTAIN
REASON; IMPROVED EFFICIENCY OF ADJUDICATIONS
AND APPEALS.
(a) Prohibition on Denial of Claims for Benefits Under Laws
Administered by Secretary of Veterans Affairs on Sole Basis
That Veteran Failed to Appear for Certain Medical
Examination.--Subsection (d) of section 5103A of title 38,
United States Code, is amended--
(1) in the heading, by striking ``Compensation Claims'' and
inserting ``Claims for Benefits'';
(2) in paragraph (2), by striking ``treat an examination or
opinion as being necessary to make a decision on a claim for
purposes of'' and inserting ``provide for a medical
examination or obtain a medical opinion under''; and
(3) by adding at the end the following new paragraph:
``(3) If a veteran fails to appear for a medical
examination provided by the Secretary in conjunction with a
claim for a benefit under a law administered by the
Secretary, the Secretary may not deny such claim on the sole
basis that such veteran failed to appear for such medical
examination.''.
(b) Improvements to Efficiency of Adjudications and Appeals
of Claims for Benefits Under Laws Administered by Secretary
of Veterans Affairs.--
(1) Annual report on length of adjudications.--
(A) In general.--Section 5109B of title 38, United States
Code, is amended--
(i) by striking ``The Secretary'' and inserting ``(a) In
General.--The Secretary''; and
(ii) by adding at the end the following new subsection:
``(b) Annual Report.--The Secretary shall submit to the
Committees on Veterans' Affairs of the House of
Representatives and the Senate an annual report that
includes, with respect to the period covered by the report--
``(1) the average length of time a claim (or an issue
within a claim) that was remanded by the Board of Veterans'
Appeals was or has been pending before the Secretary after
such remand;
``(2) the number of cases that advanced on the docket by
reason of a motion that was filed under section 7107(b) of
this title and on which the Board ruled, disaggregated by--
``(A) whether a motion was granted or denied; and
``(B) the reason provided for the motion; and
``(3) the number of appeals dismissed by the Board,
disaggregated by--
``(A) whether or not the dismissal was by reason of the
death of the appellant; and
``(B) in the case of a dismissal by reason of the death of
the appellant, whether or not such death was a result of
suicide.''.
(B) Deadline.--The Secretary of Veterans Affairs shall
submit the first report required by subsection (b) of section
5109B of such title (as added by subparagraph (A)) by not
later than one year after the date of the enactment of this
Act.
(2) Guidelines for advancement of cases on docket of
board.--Not later than one year after the date of the
enactment of this
[[Page H4552]]
Act, the Secretary of Veterans Affairs, in consultation with
the Board of Veterans' Appeals and the General Counsel of the
Department of Veterans Affairs, shall prescribe guidelines
for the advancement of a case on the docket of the Board on a
motion for earlier consideration and determination under
section 7107(b)(3) of title 38, United States Code. Such
guidelines shall include the type of evidence that may be
submitted with the motion for the advancement of the case to
show grounds for such a motion.
(3) Requirement to track certain claims for benefits.--
(A) In general.--Chapter 51 of title 38, United States
Code, is amended by inserting after section 5109B the
following new section:
``Sec. 5109C. Requirement to track and maintain information
on certain claims for benefits; notice of certain
assignments
``(a) In General.--The Secretary shall use technology to
track and maintain information (including information with
respect to timeliness) on--
``(1) claims for benefits under the laws administered by
the Secretary (including issues within such claims) that
are--
``(A) continuously pursued in accordance with--
``(i) sections 5104C(a) and 5110(a)(2) of this title; or
``(ii) any other policy established by the Secretary;
``(B) filed in the National Work Queue (or any successor
system) but have not been assigned to an office of the
Veterans Benefits Administration for adjudication;
``(C) afforded expeditious treatment by the Veterans
Benefits Administration pursuant to section 5109B of this
title or any other policy established by the Secretary;
``(D) remanded by the Board of Veterans' Appeals to the
Secretary pursuant to section 7104 of this title; or
``(E) pending a hearing by the Board of Veterans' Appeals
under section 7107 of this title;
``(2) instances in which an adjudicator of the Veterans
Benefits Administration does not comply with a relevant
decision of the Board of Veterans' Appeals to remand a claim
for benefits under the laws administered by the Secretary (or
an issue within such a claim), including any such instance in
which the relevant decision concerned a failure on the part
of the agency of original jurisdiction to satisfy the duty of
the Secretary to assist under section 5103A of this title;
``(3) supplemental claims under section 5108 of this title
that are filed--
``(A) in accordance with section 5104C(a) and section
5110(a)(2) of this title; and
``(B) after the date of the applicable final decision of
the Secretary with respect to a claim for benefits under the
laws administered by the Secretary (or an issue within such a
claim); and
``(4) first notices submitted to the Secretary of the death
of individuals in receipt of benefits under the laws
administered by the Secretary, disaggregated by such
individuals who were--
``(A) assigned a fiduciary; and
``(B) not assigned a fiduciary.
``(b) Annual Report.--(1) The Secretary shall submit to the
Committees on Veterans' Affairs of the House of
Representatives and the Senate an annual report that includes
all information maintained and tracked pursuant to subsection
(a).
``(2) The first report required by paragraph (1) shall be
submitted by not later than one year after the date of the
enactment of the Take Care of America's Veterans Act.''.
(B) Clerical amendment.--The table of sections at the
beginning of such chapter is amended by inserting after the
item relating to section 5109B the following new item:
``5109C. Requirement to track and maintain information on certain
claims for benefits; notice of certain assignments.''.
(4) Improvements to board of veterans' appeals.--
(A) Authority to aggregate claims.--Section 7104(a) of
title 38, United States Code, is amended--
(i) by inserting ``(1)'' before the first sentence; and
(ii) by adding at the end the following new paragraphs:
``2(A) Subject to subparagraph (B), the Chairman of the
Board may aggregate appeals that the Chairman determines
involve a common question of law or fact to decide such
question.
``(B) The authority under subparagraph (A) shall be
effective during the period of three years beginning on the
day that is 90 days after the Secretary submits to the
Committees on Veterans' Affairs of the Senate and House of
Representatives a copy of policies and procedures pursuant to
section 105(b)(7)(D)(i)(II) of the Take Care of America's
Veterans Act.''.
(B) Requirement to ensure substantial compliance with
certain decisions.--Such section is further amended--
(i) by redesignating subsection (f) as subsection (g); and
(ii) by inserting after subsection (e) the following new
subsection (f):
``(f)(1) The Secretary, acting through a member of the
Board, shall ensure substantial compliance with any decision
of the Board to remand a claim.
``(2) The agency of original adjudication may waive the
requirement under paragraph (1) with respect to a decision of
the Board to remand a claim to the Secretary, if a member of
the Board determines--
``(A) evidence added to the evidentiary record after the
date of such decision is sufficient to resolve the issues
underlying such decision; or
``(B) such decision was unnecessary.
``(3) If the Secretary waives such requirement, the
applicable member of the Board shall include, pursuant to
subsection (d), a determination of such waiver in the
decision of the Board.''.
(C) Definition of aggregate; report.--Such section is
further amended by adding at the end the following new
subsections:
``(h) Not later than three years after the date on which
the Secretary of Veterans Affairs completes the development
of the policies and procedures required under paragraph
(7)(D)(i)(II), and every five years thereafter, the Secretary
shall submit to the Committees on Veterans' Affairs of the
Senate and House of Representatives a report on the
aggregation of claims by the Board under subsection (a). Each
such report shall include--
``(1) an identification of each instance in which the Board
aggregated appeals during the period covered by the report,
including, for each such instance, the number of appeals that
were aggregated;
``(2) an assessment of whether the aggregation of appeals
has contributed to improved efficiency at the Board with
issuing decisions on appeals; and
``(3) such other matters as the Secretary determines
appropriate.
``(i) In this section, the term `aggregate'--
``(1) means any practice or procedure to collect common
issues, claims, or appeals by multiple parties for the
purposes of resolving such issues, claims, or appeals; and
``(2) includes the use of joinder, consolidation,
intervention, class actions, and any other multiparty
proceedings.''.
(5) Expansion of jurisdiction of court of appeals for
veterans claims.--Section 7252 of title 38, United States
Code, is amended--
(A) by redesignating subsections (b) and (c) as subsections
(d) and (e), respectively; and
(B) by inserting after subsection (a) the following new
subsections:
``(b)(1) In an appeal over which the Court has jurisdiction
pursuant to section 7266 of this title, if the appellant
files a request for class certification pursuant to the rules
prescribed by the Court pursuant to section 7264 of this
title, the Court shall have supplemental jurisdiction over
any claim for benefits under the laws administered by the
Secretary--
``(A) filed by a claimant who satisfies the definition of
the class contained in such request (including a claimant who
has filed a claim for benefits under such laws that are
specified in such request); and
``(B) regarding which--
``(i) the agency of original jurisdiction has issued a
nonfinal decision; and
``(ii) the claimant has filed a notice of disagreement
under section 5104C(a) or section 7105 of this title,
including any case in which a claimant has filed a
supplemental claim within one year of a Board decision under
section 5110(a)(2)(D) and 5108 of this title following a
notice of disagreement and decision of the Board.
``(2) A claimant may submit a request for administrative
review of such a claim under section 5104C(a) of this title
during the period beginning on the date on which the named
claimant of the motion for class action review submits to the
Court a motion for class action review and ending on the date
that is 60 days after the later of the following dates:
``(A) The date on which the Court issues a final decision
with respect to such claim.
``(B) The date on which the Court issues a final decision
with respect to such motion for class action review.
``(3) In the case of a claimant whose claim is decided by
the Board during the period when the Court is reviewing the
motion for class action review the deadline for such claimant
to file an appeal to the Court with respect to the decision
of the Board shall be tolled if the Court denies the motion
for class action review.
``(c)(1) In the case of a claim for benefits under the laws
administered by the Secretary, the Court may remand a matter
to the Board of Veterans' Appeals for the limited purpose of
ordering the Board to address a question of law or fact if
the Court determines the Board failed to--
``(A) address, in the relevant decision of the Board, an
issue that--
``(i) the claimant or the representative of the claimant
raised; or
``(ii) was reasonably raised by the evidentiary record of
the claim; or
``(B) provide adequate reasons or bases for the decision of
the Board with respect to such question.
``(2) The Court shall issue Rules that provide for each of
the following:
``(A) When and how a party to an appeal (either the
appellant or the Secretary) may request that the Court issue
a limited remand.
``(B) The period of time within which the Board is required
to issue a decision on the relevant question identified in a
limited remand.
``(C) Guidelines for when the Court may grant a request for
a limited remand.
``(D) Guidelines for when the Court may decide sua sponte
to issue a limited remand without a request from any party.
``(E) A requirement that the parties to an appeal for which
a limited remand is issued provide notice to the Court when
the Board
[[Page H4553]]
issues its decision on the relevant question identified in
the limited remand.
``(3) With respect to any matter remanded to the Board
pursuant to paragraph (1), the Court shall--
``(A) retain jurisdiction over such matter; and
``(B) stay the proceedings of the Court on such matter
until the date on which the Board issues the decision
required by such remand.''.
(6) Study and report on common questions of law or fact
before board of veterans' appeals.--
(A) Study.--The Chairman of the Board of Veterans' Appeals
shall carry out a study to identify questions of law or fact
the Board commonly considers when reviewing appeals pursuant
to section 7104 of title 38, United States Code, for which
precedential guidance would assist the Board in issuing final
decisions on such appeals. The Chairman may use artificial
intelligence and other technology in carrying out such study.
(B) Report.--Not later than one year after the date of the
enactment of this Act, the Chairman of the Board of Veterans
Appeals shall submit to the Committees on Veterans Affairs of
the House of Representatives and the Senate a report that
includes the findings of the study required by subparagraph
(A).
(7) Independent assessment of potential modifications to
authority of board of veterans' appeals.--
(A) Agreement.--Not later than 30 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall seek to enter into an agreement with an FFRDC under
which the FFRDC shall conduct an assessment of the
feasibility of modifying the authority of the Board of
Veterans' Appeals established under chapter 71 of title 38,
United States Code, to permit the Board to issue precedential
decisions with respect to questions of law or fact arising in
matters before the Board.
(B) Report; briefings.--If the Secretary fails to finalize
an agreement with an FFRDC under subparagraph (A) before the
date that is 180 days after the date on which the Secretary
enters negotiations with respect to such agreement, the
Secretary shall--
(i) submit to the Committees on Veterans' Affairs of the
House of Representatives and the Senate a report that
includes--
(I) an explanation of the reasons the Secretary failed to
satisfy such requirement; and
(II) an estimate of the date on which the Secretary will
finalize the agreement under subparagraph (A); and
(ii) not less frequently than once every 60 days after the
date on which the Secretary failed to satisfy such
requirement, provide to the Committees on Veterans' Affairs
of the House of Representatives and the Senate a briefing on
the progress of the Secretary toward finalizing such
agreement.
(C) Assessment.--An FFRDC that enters into an agreement
under subparagraph (A) shall, in consultation with veterans
service organizations, veterans' and survivors' advocate
groups, relevant legal experts, and the Chair of the
Administrative Conference of the United States (or the
designee or designees of such Chair) submit to the Secretary
a written assessment that includes the following:
(i) The determination of the FFRDC of whether modifying the
authority of the Board to permit the Board to issue
precedential decisions with respect to questions of law or
fact arising in matters before the Board is feasible.
(ii) An assessment of the authority of the Board of
Veterans' Appeals to aggregate, for review, more than one
appeal under chapter 71 of such title that involves common
questions of law or fact pursuant to section 7104 of such
title, as amended by paragraph (4)(A).
(iii)(I) The recommendations of the FFRDC with respect to
rules or principles to which the Board should adhere when
aggregating appeals for review pursuant to section 7104(a) of
title 38, United States Code, as so amended, including--
(aa) whether the use of an opt-out system is appropriate in
a class certification described in section 7104(a) of title
38, United States Code, as amended;
(bb) whether aggregation described in clause (ii) is better
carried out by one member, or a panel of members, of the
Board;
(cc) whether such aggregation may be accomplished in
accordance with section 7107 of title 38, United States Code;
and
(dd) how an accredited representative, attorney, or
authorized agent may be selected to represent a class before
the Board.
(II) The recommendations shall include, but not be limited
to, the following:
(aa) How the Board should provide notice to claimants of
the Board's intent to aggregate their claim.
(bb) This shall include standards for ensuring that
information provided to claimants regarding aggregation is
written in plain language and clearly explains the potential
effects of aggregation on adjudication timelines, appeal
rights, and participation options.
(cc) The options the Board should provide to claimants to
opt out of participation in aggregation of their claim.
(dd) The rights of the claimants to appeal decisions that
arise out of aggregation of claims, and whether or not such
rights may be limited by existing statute, regulation, or
judicial decisions.
(ee) Safeguards to ensure that aggregation of appeals does
not diminish the requirement that each appeal be decided
based on the individual facts, evidence, and circumstances
specific to the claimant.
(ff) Recommendations regarding quality review procedures
and oversight mechanisms to monitor the impact of aggregation
on claim accuracy, consistency, timeliness, and claimant
outcomes.
(D) Report; implementation.--
(i) In general.--Not later than 90 days after the Secretary
receives the assessment under subparagraph (C), the Secretary
shall--
(I) submit to the Committees on Veterans' Affairs of the
Senate and House of Representatives a copy of such
assessment; and
(II) begin developing policies and procedures to implement
the recommendations in the assessment with respect to the
authority of the Board of Veterans' Appeals referred to in
subparagraph (C).
(ii) Deadline.--The Secretary shall complete the
development of the policies and procedures required under
clause (i)(II) and submit to the Committees on Veterans'
Affairs of the Senate and House of Representatives a copy of
such policies and procedures not later than six months after
the date on which the Secretary begins developing such
policies and procedures.
(E) Definitions.--In this paragraph:
(i) The term ``FFRDC'' means a federally funded research
and development center.
(ii) The term ``veterans service organization'' means an
organization recognized by the Secretary for the
representation of veterans under section 5902 of title 38,
United States Code.
(c) Improvements to System for Adjudication of Claims for
Benefits Under Laws Administered by Secretary of Veterans
Affairs.--
(1) Program for quality assurance in decisions of board of
veterans' appeals; performance reviews.--
(A) In general.--Section 7101 of title 38, United States
Code, is amended by adding at the end the following new
subsection:
``(f)(1) The Chairman shall carry out a program to ensure
quality in the decisions of the Board. Under such program,
the Chairman shall--
``(A) develop policies and procedures for--
``(i) measuring quality in such decisions;
``(ii) maintaining data and identifying trends with respect
to--
``(I) errors in such decisions;
``(II) errors in decisions remanded or returned to the
Board by the Court of Appeals for Veterans Claims; and
``(III) specific members of the Board that issued decisions
that were subsequently vacated by the Court of Appeals for
Veterans Claims; and
``(iii) ensuring any such decision of the Board to remand a
claim for a benefit under a law administered by the Secretary
is necessary under any applicable law or regulation;
``(B) with respect to a claim for such a benefit that is
remanded to the Board by the Court of Appeals for Veterans
Claims--
``(i) inform any employee of the Board responsible for
drafting the decision of the Board with respect to such claim
that such decision was remanded;
``(ii) provide any such employee with a copy of the
relevant order of the Court of Appeals for Veterans Claims
(including a copy of any accompanying joint motion for
remand); and
``(iii) provide incentives to such employees to review such
relevant orders and joint motions for remand; and
``(C) ensure, to the maximum extent practicable, that any
error identified by the Board under such program is corrected
before the date on which the Board issues the final decision
associated with such error.
``(2) In developing policies and procedures to measure
quality in decisions of the Board pursuant to clause (i) of
subparagraph (A) of paragraph (1), the Chairman shall
consider the data and trends maintained and identified
pursuant to clause (ii) of such subparagraph.
``(3) The Chairman may use technology, including artificial
intelligence, to maintain such data and identify such trends.
``(4) The Secretary shall submit to the Committees on
Veterans' Affairs of the House of Representatives and the
Senate an annual report on the program required by this
subsection that includes, with respect to the period covered
by the report, an identification of--
``(A) elements, if any of the process of the Board for
reviewing an appeal under this chapter that lead to errors in
decisions of the Board; and
``(B) the most common reasons that a claim for a benefit
under a law administered by the Secretary was remanded to
such Board by the Court of Appeals for Veterans Claims.''.
(B) Deadline.--The Secretary shall submit the first report
required by paragraph (2) of such section (as added by
subparagraph (A)) by not later than one year after the date
of the enactment of this Act.
(2) Training program for certain employees of board of
veterans' appeals; performance reviews.--
(A) Training program.--
(i) In general.--Chapter 71 of such title (as amended by
paragraph (1)) is further amended by inserting after section
7101A the following new section:
[[Page H4554]]
``Sec. 7101B. Training program for members of Board on timely
and correct adjudication of appeals
``(a) In General.--The Secretary, in conjunction with the
Chairman of the Board of Veterans' Appeals, shall develop and
carry out a program to provide Members of the Board training
on timely and correct adjudication of appeals under this
chapter.
``(b) Required Considerations.--In carrying out the program
required by subsection (a), the Secretary shall consider the
following:
``(1) Feedback, if any, from members of the Board and
covered employees with respect to such program.
``(2) Data on errors in decisions of the Board maintained
pursuant to the program for quality assurance required by
subsection (f) of section 7101 of this title.
``(3) Any decision of the Court of Appeals for Veterans
Claims to remand a claim for benefits under the laws
administered by the Secretary to the Board for further
action, including a joint motion to remand such claim.
``(c) Assessments of Effectiveness.--The Secretary, in
conjunction with the Chairman of the Board of Veterans'
Appeals, shall develop a method to assess, on an annual
basis, the effectiveness of the training program under this
section. In developing such method, the Secretary shall
consider best practices for assessing the effectiveness of
training programs, including the Kirkpatrick evaluation
model.
``(d) Report.--The Secretary shall submit to the Committees
on Veterans' Affairs of the House of Representatives and the
Senate an annual report on the program required by subsection
(a) that includes, with respect to the period covered by the
report--
``(1) a statement of the topics of the training provided
pursuant to this section, disaggregated by--
``(A) mandatory training; and
``(B) non-mandatory training; and
``(2) the results of the assessment of the effectiveness of
such program required under subsection (c).
``(e) Covered Employee Defined.--In this section, the term
`covered employee' means an employee of the Board who is--
``(1) not a member of the Board; and
``(2) responsible for drafting decisions of the Board.''.
(ii) Clerical amendment.--The table of sections at the
beginning of such chapter is amended by inserting after the
item relating to section 7101A the following new item:
``7101B. Training program for Members of Board on timely and correct
adjudication of appeals.''.
(B) Performance reviews of members of the board.--Section
7101A of such title is amended--
(i) in subparagraph (B) of subsection (c)(1) by striking
``not less often than once every three years'' and inserting
``not less often than annually''; and
(ii) by adding at the end the following new subsection:
``(h)(1) With respect to any performance review of a
covered employee, the Secretary may not consider the
timeliness or quality of work of any Member of the Board.
``(2) In this subsection, the term `covered employee' has
the meaning given such term in section 7101B of this
title.''.
(3) Decisions of board to remand.--
(A) Information relating to decisions to remand.--Section
7104 of such title is amended in subsection (d)--
(i) by redesignating paragraphs (1) through (3) as
paragraphs (2) through (4), respectively; and
(ii) by inserting before paragraph (2) (as so
redesignated), the following new paragraph:
``(1) with respect to a claim that the Board remands for
further action, a statement of the specific reasons such
claim was remanded, including any failure on the part of the
Secretary to comply with--
``(A) the Secretary's duty to assist under section 5103A of
this title; and
``(B) the Secretary's duty to notify under section 5103 of
this title;''.
(B) Notice of remanded decision for certain employees.--
Such section is further amended in--
(i) subsection (e)--
(I) by redesignating paragraphs (1) through (3) as
subparagraphs (A) through (C), respectively;
(II) by striking ``After'' and inserting ``(1) After''; and
(III) by adding at the end the following new paragraph:
``(2) If, pursuant to a decision on an appeal, the Board
remands a claim for a benefit under a law administered by the
Secretary for further action, the Secretary shall, to the
maximum extent practicable, issue a copy of such decision to
each employee of the Veterans Benefits Administration who
committed the error resulting in the decision of the Board to
remand, when applicable.''; and
(ii) in subsection (g), as redesignated by subsection
(b)(4)(B)(i), by striking ``under subsection (e)'' and
inserting ``under paragraph (1) of subsection (e)''.
(4) Annual reports for board of veterans' appeals.--
(A) In general.--Chapter 71 of title 38, United States
Code, is amended by inserting after section 7114 the
following new section:
``Sec. 7115. Annual report on Board of Veterans' Appeals
``The Chairman of the Board shall submit to the Committees
on Veterans' Affairs of the House of Representatives and the
Senate an annual report that includes, for each decision of
the Board to remand a claim for a benefit under a law
administered by the Secretary to the Secretary for further
adjudication during the period covered by the report, a
statement of the reasons for such decision of the Board,
disaggregated by decisions on--
``(1) claims with a rating decision dated on or after
February 19, 2019; and
``(2) claims with a rating decision dated before such
date.''.
(B) Deadlines.--The Secretary shall submit the first
reports required by subsections (a) and (b) of section 7115
of such title (as added by paragraph (1)) by not later than
one year after the date of the enactment of this Act.
(C) Clerical amendment.--The table of sections at the
beginning of such chapter is amended by inserting after the
item relating to section 7114 the following new item:
``7115. Annual report on Board of Veterans' Appeals''.
(5) Plan for improvements to quality in decisions of
board.--
(A) In general.--Not later than six months after the date
of the enactment of this Act, the Secretary of Veterans
Affairs, in consultation with the Chairman of the Board of
Veterans' Appeals and the head of the Office of
Administrative Review of the Veterans Benefits
Administration, shall develop a plan to--
(i) improve the quality of decisions of the Board to
remand, pursuant to section 7104 of title 38, United States
Code, claims for a benefit under a law administered by the
Secretary to the Secretary for further action; and
(ii) mitigate the number of such decisions that are
unnecessary under any applicable law or regulation.
(B) Report.--The Secretary shall submit to the Committees
on Veterans' Affairs of the House of Representatives and the
Senate a report on such plan by not later than six months
after the date of the enactment of this Act.
(d) Notice of Avoidable Deferrals of Claims for Benefits
Under Laws Administered by the Secretary of Veterans Affairs;
Study and Report on Certain Opinions of Department of
Veterans Affairs Office of General Counsel.--
(1) Notice of avoidable deferrals.--Not later than one year
after the date of the enactment of this Act, the Secretary of
Veterans Affairs shall develop policies, procedures, and
technological capabilities to ensure that each employee of
the Veterans Benefits Administration that commits an
avoidable deferral with respect to a claim for benefits under
the laws administered by the Secretary of Veterans Affairs in
the National Work Queue is notified of any avoidable
deferrals that such employee commits with respect to the same
claim.
(2) Study and report on certain ogc opinions.--
(A) Study.--Not later than one year after the date of the
enactment of this Act, the Secretary of Veterans Affairs, in
consultation with the Office of the General Counsel of the
Department of Veterans Affairs and the Chairman of the Board
of Veterans' Appeals, shall complete a study to identify--
(i) issues about which an opinion from the Office of the
General Counsel of the Department would foster consistency in
the decisions of the Secretary with respect to claims for
benefits under the laws administered by the Secretary; and
(ii) issues raised in appeals of such decisions to the
United States Court of Appeals for Veterans Claims before the
date of the enactment of this Act about which the Office of
the General Counsel has had inconsistent opinions in matters
involving substantially similar questions of law or fact.
(B) 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 House of Representatives a report that includes--
(i) the findings of the study required by subparagraph (A);
(ii) a statement of which issues identified pursuant to
such study about which the Office of the General Counsel of
the Department intends to publish an opinion; and
(iii) a timeline for the publication of any such opinion.
SEC. 106. ANNUAL REPORT ON CAUSES OF DEATH AMONG VETERANS.
(a) In General.--Subchapter II of chapter 5 of title 38,
United States Code, is amended by adding at the end the
following new section:
``Sec. 534. Annual report on causes of death among veterans
``(a) In General.--The Secretary shall submit to the
Committees on Veterans' Affairs of the House of
Representatives and the Senate an annual report that contains
data and information on causes of death among veterans.
``(b) Elements.--Such report shall include--
``(1) for each veteran that died during the period covered
by the report an identification of--
``(A) whether such veteran had a service-connected
disability rated as total;
``(B) the primary cause of death;
``(C) the secondary cause of death, if applicable; and
``(D) the manner of death;
``(2) for each primary cause of death identified pursuant
to paragraph (1), a statement of the total number of veterans
that died from such primary cause of death during the period
covered by the report; and
[[Page H4555]]
``(3) for each manner of death identified pursuant to
paragraph (1), a statement of the total number of veterans
that died in such manner during the period covered by the
report.
``(c) Sunset.--This section shall terminate on the date
that is five years after the date of the enactment of the
Take Care of America's Veterans Act.''.
(b) Clerical Amendment.--The table of sections at the
beginning of chapter 5 of such title is amended by inserting
after the item relating to section 533 the following new
item:
``534. Annual report on causes of death among veterans''.
SEC. 107. PLAN FOR USE OF AUTOMATION TOOLS TO PROCESS CLAIMS
UNDER LAWS ADMINISTERED BY THE 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 submit to the Committees on Veterans' Affairs of the
Senate and House of Representatives the plan of the Secretary
to make available, to the maximum extent practicable, an
automation tool described in subsection (b) to elements of
the Department of Veterans Affairs for the purpose of
processing claims under laws administered by the Secretary.
(b) Automation Tool Described.--An automation tool
described in this subsection is a technology developed for
the Compensation Service of the Veterans Benefits
Administration that--
(1) automates the retrieval of the service record or health
records of a veteran;
(2) compiles evidence relevant to the determination of a
claim for benefits under laws administered by the Secretary;
(3) provides automated decision support relevant to such a
determination;
(4) automates information sharing between Federal agencies;
and
(5) assists in generating correspondence regarding such a
claim.
(c) Analysis.--In developing the plan required under
subsection (a), the Secretary shall conduct an analysis of
each of the following:
(1) The feasibility and benefits of the use of an
automation tool described in subsection (b) by elements of
the Department for the purpose of processing claims under
laws administered by the Secretary.
(2) Any modification to an existing automation tool that
could render such tool usable for such purpose by such an
element.
(3) Any requirement of any such element pertaining to such
purpose that cannot be addressed by using an automation tool.
(4) The extent to which the technology offices of such
elements may need to collaborate with the technology office
responsible for developing an automation tool in the course
of the development and use of the tool by the element for
such purpose.
(5) A timeline for modifying and implementing any
automation tool for use by such elements for such purpose.
(d) Priority.--In providing or expanding an automation tool
described in subsection (b) to elements of the Department
pursuant to the plan required under subsection (a), the
Secretary shall give priority to the following elements:
(1) The Compensation Service.
(2) The Pension and Fiduciary Service of the Veterans
Benefits Administration.
(3) The Education Service of the Veterans Benefits
Administration.
(4) Program offices of the Veterans Benefits
Administration, as determined by the Secretary.
(5) The Debt Management Center.
(6) The Board of Veterans' Appeals.
(e) Other Requirements Relating to Technology at Department
of Veterans Affairs.--
(1) Automatic notices regarding benefits for certain
children of veterans.--
(A) In general.--Not later than one year after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall implement policies, processes, and technological
capabilities, including in the National Work Queue (or
successor system), to ensure that, in the case of any covered
situation, a claims processor is made aware of, and assigned
to address, such covered situation.
(B) Definitions.--In this subsection:
(i) The term ``covered situation'' means--
(I) any increase in the amount of dependency compensation
paid to a beneficiary for a child under the laws administered
by the Secretary; and
(II) any educational assistance paid to the child of a
veteran under the laws administered by the Secretary.
(ii) The term ``child'' has the meaning given such term in
section 101(4)(A)(iii) of title 38, United States Code.
(2) Correct labeling of documents.--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
Senate and House of Representatives a plan to ensure that
documents in the Veterans Benefits Management System (or any
successor system) are correctly labeled when such documents
are uploaded, including when such documents are labeled using
automation tools.
SEC. 108. REFORMS RELATING TO DEPARTMENT OF VETERANS AFFAIRS
DISABILITY RATINGS.
(a) Ratings for Sleep Apnea.--
(1) In general.--The Secretary of Veterans Affairs shall
revise the schedule for rating disabilities adopted and
applied under section 1155 of title 38, United States Code,
as follows:
(A) A grade of disability of 0 percent shall be assigned
for sleep apnea syndrome when the syndrome is asymptomatic,
with or without treatment.
(B) A grade of disability of 10 percent shall be assigned
for sleep apnea syndrome when treatment yields incomplete
relief.
(C) A grade of disability of 50 percent shall be assigned
for sleep apnea syndrome only if--
(i) treatment is either ineffective or the veteran is
unable to use the prescribed treatment due to comorbid
conditions; and
(ii) there is no end-organ damage.
(D) A grade of disability of 100 percent shall be assigned
for sleep apnea syndrome only if there is also end-organ
damage.
(2) Qualifying comorbid conditions.--For purposes of
paragraph (1)(C)(i), a comorbid condition is a condition
that, in the opinion of a qualified medical provider,
directly impedes or prevents the use of, or implementation
of, a recognized form of treatment intervention normally
shown to be effective.
(b) Ratings for Tinnitus.--The Secretary of Veterans
Affairs shall revise the schedule for rating disabilities
adopted and applied under section 1155 of title 38, United
States Code, as follows:
(1) Except as provided in paragraph (2), tinnitus may not
be assigned a separate compensable disability rating.
(2) A grade of disability of 10 percent shall be assigned
for tinnitus only when tinnitus is diagnosed as associated
with service-connected (as defined in section 101(16) of
title 38, United States Code) hearing loss that is otherwise
noncompensable under the laws administered by the Secretary.
(c) Applicability.--
(1) In general.--The revisions to the schedule for rating
disabilities adopted and applied under section 1155 of title
38, United States Code, made pursuant to this section shall
apply with respect to claims filed on or after October 1,
2026.
(2) Protection of existing ratings.--The revisions to the
schedule for rating disabilities made pursuant to this
section may not serve as the basis for reducing,
discontinuing, or otherwise adversely affecting compensation
that was in effect on the day before the date of the
enactment of this Act.
SEC. 109. IMPROVEMENTS TO TEMPORARY LICENSURE REQUIREMENTS
FOR CONTRACT HEALTH CARE PROFESSIONALS WHO
PERFORM MEDICAL DISABILITY EXAMINATIONS FOR THE
DEPARTMENT OF VETERANS AFFAIRS.
(a) Expansion.--Section 504 of the Veterans' Benefits
Improvements Act of 1996 (Public Law 104-275; 38 U.S.C. 5101
note), as amended by paragraph (1) of subsection (a) of
section 2002 of the Johnny Isakson and David P. Roe, M.D.
Veterans Health Care and Benefits Improvement Act of 2020
(Public Law 116-315; 38 U.S.C. 5101 note), is further
amended, subject to the sunset in paragraph (4) of such
subsection, by striking paragraph (2) of subsection (c) and
inserting the following:
``(2) Health care professional described.--A health care
professional described in this paragraph is a person who is
eligible for appointment to a position in the Veterans Health
Administration covered by section 7402(b) of title 38, United
States Code, who--
``(A) has a current and unrestricted license to practice
the health care profession for which they are licensed;
``(B) is not barred from practicing such health care
profession in any State, the District of Columbia, or a
Commonwealth, territory, or possession of the United States;
and
``(C) is performing authorized duties for the Department
pursuant to a contract entered into under subsection (a).
``(3) Source of funds.--Expenses of carrying out this
section, including payments for examination travel and
incidental expenses under the terms and conditions set forth
by section 111 of this title, shall be reimbursed to the
accounts available for the general operating expenses of the
Veterans Benefits Administration and information technology
systems from amounts available to the Secretary for payment
of compensation and pensions.
``(4) Mechanism for transmittal of evidence introduced by
applicants during examinations.--The Secretary shall
establish a mechanism whereby a health care professional who
conducts medical examinations or opinions under section
5103A(d) of this title may transmit to a veteran's claims
file, evidence introduced by the applicant during a medical
examination or in conjunction with a medical opinion that
examiner used to inform such medical examination or
opinion.''.
(b) Delayed Sunset of Amendment.--Paragraph (4) of
subsection (a) of section 2002 of the Johnny Isakson and
David P. Roe, M.D. Veterans Health Care and Benefits
Improvement Act of 2020 (Public Law 116-315; 38 U.S.C. 5101
note) is amended by striking ``On the date that is five years
after the date of the enactment of this Act'' and inserting
``On September 30, 2033''.
(c) Conforming Amendment.--Paragraph (2) of such subsection
is amended by striking ``physicians assistants, nurse
practitioners, audiologists, and psychologists'' and
inserting ``health care professionals''.
(d) Report.--Not later than the day that is 15 months after
the date of the enactment of
[[Page H4556]]
this Act, the Secretary of Veterans Affairs shall submit to
the Committees on Veterans' Affairs of the Senate and House
of Representatives a report regarding the use of the
authority under section 504 of the Veterans' Benefits
Improvements Act of 1996 (Public Law 104-275; 38 U.S.C. 5101
note), as temporarily amended by section 2002(a)(1) of the
Johnny Isakson and David P. Roe, M.D. Veterans Health Care
and Benefits Improvement Act of 2020 (Public Law 116-315; 38
U.S.C. 5101 note) and this section. Such report shall
include, with respect to the one-year period after the date
of the enactment of this Act, the following elements:
(1) The number of examinations conducted pursuant to a
contract under such authority.
(2) The cost, timeliness, and legal adequacy of such
examinations, disaggregated by--
(A) health care professional; and
(B) contract.
(3) The number of such examinations conducted in each
State, the District of Columbia, or a Commonwealth,
territory, or possession of the United States.
(4) The numbers of each kind of health care professionals
who conducted such examinations.
(5) The number of examinations that were erroneously
conducted by a health care professional--
(A) without such a contract; or
(B) unauthorized to enter into such a contract.
(6) The plan of the Secretary to correct errors in the use
of such authority.
SEC. 110. DISABILITY EXAMINATIONS: STUDY ON ACCESS IN RURAL
AREAS; REVIEW OF TRAINING; REVIEW OF INADEQUATE
OR UNNECESSARY EXAMINATIONS.
(a) Study on Improvements to Department of Veterans Affairs
Covered Medical Disability Examinations in Rural Areas.--
(1) Study required.--Not later than one year after the date
of the enactment of this Act, the Secretary of Veterans
Affairs shall complete a study on access by veterans who
reside in rural and highly rural areas to covered medical
disability examinations.
(2) Elements.--
(A) In general.--The study conducted under paragraph (1)
shall include the following:
(i) A comparison of the average number of days to complete
covered medical disability examinations, disaggregated by
type of examination, for veterans who reside in rural and
highly rural areas compared to an average time for veterans
who reside in other areas to complete a covered medical
disability examination, by either contractors or employees of
the Department.
(ii) A root cause analysis of differences identified
pursuant to clause (i).
(iii) The plan of the Secretary for the following year to
improve access described in paragraph (1), which shall
include a plan for the pursuit of a commercial or industry-
standard solution or technology that could enable housebound
veterans or veterans who live in rural areas to receive
examinations without traveling long distances.
(B) Number of days to complete defined.--For purposes of
subparagraph (A)(i), the term ``number of days to complete''
means the number of days in the period--
(i) beginning on the date on which a contractor or employee
of the Department received a request from the Secretary to
conduct a covered medical disability examination; and
(ii) ending on the date on which the examination was
completed.
(3) Report on study.--Not later than one year after the
date of the enactment of this Act, the Secretary shall submit
to the Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of
Representatives a report on the findings of the Secretary
with respect to the study completed under paragraph (1).
(4) Definitions.--In this subsection:
(A) The term ``covered medical disability examination''
means a medical nexus examination or medical opinion for the
purposes of adjudicating a claim for a benefit under chapter
11 or 15 of title 38, United States Code, regardless of
whether conducted by an employee or a contractor of the
Department.
(B) The terms ``rural'' and ``highly rural'' have the
meanings given those terms under the rural-urban commuting
areas coding system of the Department of Agriculture.
(b) Review of Training for Veterans Service Representatives
and Rating Veterans Service Representatives.--
(1) Review required.--The Secretary of Veterans Affairs
shall conduct a comprehensive review of the training provided
to Veterans Service Representatives (VSRs) and Rating
Veterans Service Representatives (RVSRs) regarding covered
medical disability examinations for the purpose of claims
adjudication.
(2) Scope of review.--The review shall include, at minimum,
an evaluation of training and policies relating to--
(A) assessing the adequacy of covered medical disability
examinations for claims adjudication;
(B) determining the necessity of medical disability
examinations where claims can be adjudicated based on
existing evidence without ordering additional examinations;
(C) relevant statutes, judicial decisions, regulations, and
Department policies, including--
(i) the duty to assist claimants;
(ii) evidentiary standards regarding causation;
(iii) required elements and standards for covered medical
disability examinations, including the need for reasoned
medical opinions; and
(iv) the absence of statutory or regulatory presumptions of
service connection in covered medical disability
examinations; and
(D) input from impacted Department employees, including
duly appointed labor representatives.
(3) Second-level review for new employees.--The Secretary
shall evaluate the effectiveness of current policies
requiring a second level of review of claims decisions made
by new Veterans Service Representatives and Rating Veterans
Service Representatives before such employees are authorized
to order covered medical disability examinations, including
any applicable accuracy thresholds.
(4) Report to congress.--Not later than 180 days after the
date of the enactment of this Act, the Secretary shall submit
to the Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of
Representatives a report detailing the findings of the
Secretary with respect to the review conducted under
paragraph (1), the data used by the Secretary to support such
findings, and such recommendations as the Secretary may have
for improvements to training or policies.
(5) Comptroller general of the united states review of
findings.--Not later than 180 days after the date on which
the Secretary submits the report under paragraph (4), the
Comptroller General of the United States shall conduct a
review of the findings and recommendations contained in the
report.
(6) Modification of reports by the board of veterans'
appeals and united states court of appeals for veterans
claims.--
(A) Board of veterans' appeals.--Section 7101(d)(2) of
title 38, United States Code, is amended--
(i) in subparagraph (F), by striking ``; and'' and
inserting a semicolon;
(ii) in subparagraph (G), by striking the period at the end
and inserting ``; and''; and
(iii) by adding at the end the following new subparagraph:
``(H) a summary of recurring issues that result in the
Board remanding appeals back to the agency of original
jurisdiction.''.
(B) United states court of appeals for veterans claims.--
Section 7288(b) of title 38, United States Code, is amended
by adding at the end the following new paragraph:
``(16) A summary of recurring issues that result in
remands.''.
(7) Definition of covered medical disability examination.--
In this subsection, the term ``covered medical disability
examination'' means a medical examination or medical opinion
that the Secretary determines necessary for the purposes of
adjudicating a claim for a benefit under chapter 11 or 15 of
title 38, United States Code, regardless of whether conducted
by an employee or a contractor of the Department.
(c) Review and Priority Processing of Claims With
Inadequate or Unnecessary Examinations.--
(1) Review.--Not later than 1 year after the date of the
enactment of this Act and not less frequently than once every
three months thereafter, the Secretary of Veterans Affairs
shall review a random and representative sample of all
covered medical disability examinations completed during the
previous three-month period.
(2) Further sample requirements.--Under each review
required by paragraph (1), the Secretary shall ensure the
review includes--
(A) a statistically significant sample of covered medical
disability examinations completed by employees of the
Department of Veterans Affairs; and
(B) a statistically significant sample of covered medical
disability examinations completed by each contractor that
provides such examinations for the Department.
(3) Analysis.--Under each review required by paragraph (1),
the Secretary shall--
(A) analyze the samples specified in paragraph (2); and
(B) pursuant to such analysis, identify--
(i) the percentage of examinations that were adequate for
purposes of adjudicating the particular claim for a benefit
under chapter 11 or 15 of title 38, United States Code, for
which the examination was ordered by the Department; and
(ii) the percentage of examinations considered
overdeveloped for purposes of adjudicating claims for a
benefit under chapter 11 or 15 of title 38, United States
Code, for which the examination was ordered by the
Department.
(4) Priority processing.--
(A) In general.--Except as provided for in subparagraph
(B), if during a review under paragraph (1) the Secretary
finds any covered medical disability examination to be not
adequate for adjudicating a claim, the Secretary shall ensure
the claimant examined by that examination--
(i) receives another examination, if necessary, on a
priority basis; and
(ii) receives priority processing for the entirety of the
impacted claim.
(B) Exception.--The Secretary is not required to furnish an
additional examination under subparagraph (A) if the
Secretary determines such an examination to be unnecessary
for purposes of adjudicating the claim.
(5) Comptroller general of the united states study.--The
Comptroller General of the United States shall conduct a
review of
[[Page H4557]]
the methodology and effectiveness of the review required in
paragraph (1).
(6) Covered medical disability examination defined.--In
this subsection, the term ``covered medical disability
examination'' means a medical examination or opinion for the
purposes of adjudicating a claim for a benefit under chapter
11 or 15 of title 38, United States Code, regardless of
whether conducted by an employee or a contractor of the
Department.
(d) Review and Plan Regarding Department of Veterans
Affairs Scheduling of Medical Examinations.--
(1) Review required.--Not later than one year after the
date of the enactment of this Act, the Secretary of Veterans
Affairs shall complete a review of scheduling request tools,
contracts, and systems used by employees and contractors of
the Department of Veterans Affairs to order and conduct
medical disability examinations.
(2) Plan required.--Not later than one year after the date
of the enactment of this Act, the Secretary shall submit to
the Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of
Representatives a plan to ensure the following:
(A) Systems and processes used by the Department enable
seamless and clear communication of requirements between the
claims processors who request medical disability examinations
and the persons who conduct such examinations, including
through a contract.
(B) Medical disability examiners, including through a
contract, have access to the medical records and claims
information they need to conduct exams that are adequate for
purposes of rating claims for benefits under laws
administered by the Secretary.
(C) Claimants or appellants for whom a medical disability
examination is requested of the Department have agency in
determining when and where the examination is conducted.
(D) Claimants or appellants for whom a medical disability
examination is requested of the Department have a seamless
experience when scheduling their examinations without regard
to who conducts the examinations.
(E) The Department conducts customer satisfaction and
experience surveys of claimants or appellants who attend
medical disability examinations provided under laws
administered by the Secretary.
SEC. 111. IMPROVEMENTS TO PROCESSING AND OUTREACH REGARDING
CLAIMS INVOLVING MILITARY SEXUAL TRAUMA.
(a) Evaluation of Claims Involving Military Sexual
Trauma.--
(1) In general.--Subchapter VI of chapter 11 of such title
is amended by inserting after section 1166 the following new
section:
``Sec. 1166A. Evaluation of claims involving military sexual
trauma
``(a) Notice and Opportunity to Supply Evidence.--The
Secretary may not deny a claim of a veteran for compensation
under this chapter for military sexual trauma without first--
``(1) advising the veteran of the evidence that would
constitute credible corroborating evidence of the military
sexual trauma; and
``(2) allowing the veteran an opportunity to furnish such
corroborating evidence.
``(b) Point of Contact.--The Secretary shall ensure that
each document provided to a veteran relating to a claim for
compensation under this chapter for a military sexual trauma
includes contact information for an appropriate point of
contact with the Department.
``(c) Specialized Teams.--The Secretary shall ensure that
all claims for compensation under this chapter for a military
sexual trauma are reviewed and processed by a specialized
team established under section 1166 of this title.
``(1) The Secretary shall ensure that not less than
annually, the policies and procedures employed by the
specialized team established under section 1166 of this title
are reviewed by medical or mental health professionals as the
Secretary considers appropriate to determine whether the
current standard of evidentiary review for acceptable
documentation adequately evaluates the likelihood a military
sexual trauma occurred.
``(2) The Secretary shall also conduct periodic quality
reviews of claims processed by the specialized teams
established under section 1166 to identify inconsistencies,
training deficiencies, or procedural shortcomings and
implement corrective actions as appropriate.''.
(2) Outreach.--
(A) In general.--Not later than 180 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall implement, with input from the veteran community, an
informative outreach program for veterans regarding the
standard of proof for evaluation of claims relating to
military sexual trauma, including requirements for a medical
examination and opinion.
(B) Targeted outreach.--In implementing the program under
subparagraph (A), the Secretary shall, to the extent
practicable, target outreach to veterans who submitted a
claim relating to military sexual trauma that was denied.
(3) Clerical amendment.--The table of sections at the
beginning of chapter 11 of such title is amended by inserting
after the item relating to section 1166 the following new
item:
``1166A. Evaluation of claims involving military sexual trauma.''.
(b) Communications From the Department of Veterans Affairs
to Individuals Who Have Experienced Military Sexual Trauma.--
(1) Review working group.--
(A) In general.--The Secretary of Veterans Affairs shall
establish a working group to review correspondence relating
to military sexual trauma.
(B) Membership.--The working group established under
subparagraph (A) shall be composed of members who shall be
appointed by the Secretary from among employees of the
Department of Veterans Affairs who are experts in military
sexual trauma and mental health, of whom--
(i) one or more shall be appointed from among mental health
providers of the Veterans Health Administration;
(ii) one or more shall be appointed from among experts on
sexual assault and sexual harassment of the Veterans Benefits
Administration; and
(iii) one or more shall be appointed from among experts on
sexual assault and sexual harassment of the Board of
Veterans' Appeals.
(C) Duties.--The working group established under
subparagraph (A) shall--
(i) review standard correspondence, which may include
templates for notices under sections 5103, 5104, 5104B, and
7104 of title 38, United States Code, from the Department to
individuals who have experienced military sexual trauma for
sensitivity; and
(ii) ensure that the correspondence--
(I) treats such individuals with dignity and respect; and
(II) does not re-traumatize such individuals.
(D) Individual who has experienced military sexual trauma
defined.--In this subsection, the term ``individual who has
experienced military sexual trauma'' means--
(i) an individual who has filed a claim for compensation
under chapter 11 of title 38, United States Code, relating to
military sexual trauma;
(ii) a veteran who has been awarded compensation under such
chapter relating to military sexual trauma; or
(iii) a member of the Armed Forces (including a member of
the National Guard or Reserves), a former member of the Armed
Forces, or a veteran who is receiving care from the
Department relating to military sexual trauma.
(2) Contents of certain written communications to
individuals who have experienced military sexual trauma.--
(A) Notice to claimants of required information and
evidence.--Section 5103 of title 38, United States Code, is
amended by adding at the end the following new subsection:
``(c) Written Communications to Individuals Who Have
Experienced Military Sexual Trauma.--
``(1) The Secretary shall ensure that any written
communication under this section from the Department to an
individual who has experienced military sexual trauma
includes each of the following:
``(A) Contact information for each of the following:
``(i) The military sexual trauma coordinator of the
Veterans Benefits Administration.
``(ii) The military sexual trauma coordinator of the
Veterans Health Administration.
``(iii) The Veterans Crisis Line.
``(iv) The facility of the Veterans Health Administration
closest to where the individual resides.
``(v) The Readjustment Counseling Service location closest
to where the individual resides.
``(B) Information on the eligibility of the individual for
services provided through the Readjustment Counseling Service
location described in subparagraph (A)(v).
``(2) In this subsection:
``(A) The term `individual who has experienced military
sexual trauma' means--
``(i) an individual who has filed a claim for compensation
under chapter 11 of this title relating to military sexual
trauma;
``(ii) a veteran who has been awarded compensation under
such chapter relating to military sexual trauma; or
``(iii) a member of the Armed Forces (including a member of
the National Guard or Reserves), a former member of the Armed
Forces, or a veteran who is receiving care from the
Department relating to military sexual trauma.
``(B) The term `military sexual trauma' has the meaning
given that term in section 1166(d)(2) of this title.
``(C) The term `Veterans Crisis Line' means the toll-free
hotline for veterans established under section 1720F(h) of
this title.''.
(B) Decisions and notices of decisions.--Section 5104 of
title 38, United States Code, is amended by adding at the end
the following new subsection:
``(e)(1) The Secretary shall ensure that any written
communication under this section from the Department to an
individual who has experienced military sexual trauma
includes each of the following:
``(A) Contact information for each of the following:
``(i) The military sexual trauma coordinator of the
Veterans Health Administration.
``(ii) The Veterans Crisis Line.
[[Page H4558]]
``(iii) The facility of the Veterans Health Administration
closest to where the individual resides.
``(iv) The Readjustment Counseling Service location closest
to where the individual resides.
``(B) Information on the eligibility of the individual for
services provided through the Readjustment Counseling Service
location described in subparagraph (A)(iv).
``(2) The Secretary shall ensure that any written
communication under this section from the Department to an
individual who has experienced military sexual trauma that
includes notification of an award of compensation under
chapter 11 of this title relating to military sexual trauma
includes--
``(A) the contact information described in paragraph (1);
and
``(B) the contact information for the military sexual
trauma coordinator of the Veterans Benefits Administration.
``(3) In this subsection:
``(A) The term `individual who has experienced military
sexual trauma' means--
``(i) an individual who has filed a claim for compensation
under chapter 11 of this title relating to military sexual
trauma;
``(ii) a veteran who has been awarded compensation under
such chapter relating to military sexual trauma; or
``(iii) a member of the Armed Forces (including a member of
the National Guard or Reserves), a former member of the Armed
Forces, or a veteran who is receiving care from the
Department relating to military sexual trauma.
``(B) The term `military sexual trauma' has the meaning
given that term in section 1166(d)(2) of this title.
``(C) The term `Veterans Crisis Line' means the toll-free
hotline for veterans established under section 1720F(h) of
this title.''.
(C) Higher-level review by the agency of original
jurisdiction.--Section 5104B of title 38, United States Code,
is amended by adding at the end the following new subsection:
``(f) Written Communications to Individuals Who Have
Experienced Military Sexual Trauma.--
``(1) The Secretary shall ensure that any written
communication under this section from the Department to an
individual who has experienced military sexual trauma
includes each of the following:
``(A) Contact information for each of the following:
``(i) The military sexual trauma coordinator of the
Veterans Health Administration.
``(ii) The Veterans Crisis Line.
``(iii) The facility of the Veterans Health Administration
closest to where the individual resides.
``(iv) The Readjustment Counseling Service location closest
to where the individual resides.
``(B) Information on the eligibility of the individual for
services provided through the Readjustment Counseling Service
location described in subparagraph (A)(iv).
``(2) The Secretary shall ensure that any written
communication under this section from the Department to an
individual who has experienced military sexual trauma that
includes notification of an award of compensation under
chapter 11 of this title relating to military sexual trauma
includes--
``(A) the contact information described in paragraph (1);
and
``(B) the contact information for the military sexual
trauma coordinator of the Veterans Benefits Administration.
``(3) In this subsection:
``(A) The term `individual who has experienced military
sexual trauma' means--
``(i) an individual who has filed a claim for compensation
under chapter 11 of this title relating to military sexual
trauma;
``(ii) a veteran who has been awarded compensation under
such chapter relating to military sexual trauma; or
``(iii) a member of the Armed Forces (including a member of
the National Guard or Reserves), a former member of the Armed
Forces, or a veteran who is receiving care from the
Department relating to military sexual trauma.
``(B) The term `military sexual trauma' has the meaning
given that term in section 1166(d)(2) of this title.
``(C) The term `Veterans Crisis Line' means the toll-free
hotline for veterans established under section 1720F(h) of
this title.''.
(D) Board of veterans' appeals.--Section 7104 of title 38,
United States Code, is amended by adding at the end the
following new subsection:
``(g)(1) The Secretary shall ensure that any written
communication under this section from the Department to an
individual who has experienced military sexual trauma
includes each of the following:
``(A) Contact information for each of the following:
``(i) The military sexual trauma coordinator of the
Veterans Health Administration.
``(ii) The Veterans Crisis Line.
``(iii) The facility of the Veterans Health Administration
closest to where the individual resides.
``(iv) The Readjustment Counseling Service location closest
to where the individual resides.
``(B) Information on the eligibility of the individual for
services provided through the Readjustment Counseling Service
location described in subparagraph (A)(iv).
``(2) The Secretary shall ensure that any written
communication under this section from the Department to an
individual who has experienced military sexual trauma that
includes notification of an award of compensation under
chapter 11 of this title relating to military sexual trauma
includes--
``(A) the contact information described in paragraph (1);
and
``(B) the contact information for the military sexual
trauma coordinator of the Veterans Benefits Administration.
``(3) In this subsection:
``(A) The term `individual who has experienced military
sexual trauma' means--
``(i) an individual who has filed a claim for compensation
under chapter 11 of this title relating to military sexual
trauma;
``(ii) a veteran who has been awarded compensation under
such chapter relating to military sexual trauma; or
``(iii) a member of the Armed Forces (including a member of
the National Guard or Reserves), a former member of the Armed
Forces, or a veteran who is receiving care from the
Department relating to military sexual trauma.
``(B) The term `military sexual trauma' has the meaning
given that term in section 1166(d)(2) of this title.
``(C) The term `Veterans Crisis Line' means the toll-free
hotline for veterans established under section 1720F(h) of
this title.''.
(c) Study on Training and Processing Relating to Claims for
Disability Compensation Relating to Military Sexual Trauma.--
(1) Study required.--The Secretary of Veterans Affairs
shall conduct a study on--
(A) the quality of training provided to personnel of the
Department of Veterans Affairs who review claims for
disability compensation under chapter 11 of title 38, United
States Code, for disabilities relating to military sexual
trauma; and
(B) the quality of the procedures of the Department for
reviewing the accuracy of the processing of such claims.
(2) Elements.--The study required by subsection (a) shall
include the following:
(A) With respect to the quality of training described in
paragraph (1) of such subsection:
(i) Whether the Department ensures personnel complete such
training on time.
(ii) Whether the training has resulted in improvements to
the processing of claims described in such subsection and
issue-based accuracy.
(iii) Such recommendations as the Secretary may have for
improving the training.
(B) With respect to the quality of procedures described in
paragraph (2) of such subsection:
(i) Whether the procedures of the Department for reviewing
the accuracy of the processing of claims described in such
subsection comport with generally accepted statistical
methodologies to ensure reasonable accuracy of such reviews.
(ii) Whether such procedures adequately include mechanisms
to correct errors found in such reviews.
(iii) A summary of quality assurance reviews and reports
conducted as part of such procedures.
(iv) Such recommendations as the Secretary may have for
improving such procedures.
(3) Report required.--Not later than one year after the
date of the enactment of this Act, the Secretary shall submit
to the Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of
Representatives a report detailing the findings of the
Secretary with respect to the study conducted under paragraph
(1).
(d) Annual Special Focus Review of Claims for Disability
Compensation for Disabilities Relating to Military Sexual
Trauma.--
(1) Annual special focus review.--
(A) In general.--Each year, the Under Secretary for
Benefits of the Department of Veterans Affairs shall conduct
a special focus review on the accuracy of the processing of
claims for disability compensation under chapter 11 of title
38, United States Code, for disabilities relating to military
sexual trauma.
(B) Elements.--Each review conducted under subparagraph (A)
shall include a review of the following:
(i) A statistically significant, nationally representative
sample of all claims for benefits under the laws administered
by the Secretary of Veterans Affairs relating to military
sexual trauma filed during the fiscal year preceding the
fiscal year in which the report is submitted.
(ii) The accuracy of each decision made with respect to
each claim described in clause (i).
(iii) The types of benefit entitlement errors found,
disaggregated by category.
(iv) Trends from year to year.
(v) Training completion rates for personnel of the
Department who process claims described in subparagraph (A).
(2) Reprocessing of claims.--If the Under Secretary finds,
pursuant to a special focus review conducted under paragraph
(1)(A), that an error was made with respect to the
entitlement of a veteran to a benefit under the laws
administered by the Secretary, the Secretary shall return the
relevant claim of the veteran to the appropriate office of
the Department for reprocessing to ensure that the veteran
receives an accurate decision with respect to the claim.
(3) Report.--Section 5501(b) of the Johnny Isakson and
David P. Roe, M.D. Veterans Health Care and Benefits
Improvement Act
[[Page H4559]]
of 2020 (Public Law 116-315; 134 Stat. 5048) is amended--
(A) in paragraph (1), by striking ``through 2027'' and
inserting ``until the day described in section 109(d)(4) of
the Take Care of America's Veterans Act''; and
(B) in paragraph (2), by adding at the end the following
new subparagraph:
``(I) The findings of the most recent special focus review
conducted under subsection (d)(1)(A) of section 109 of the
Take Care of America's Veterans Act, including--
``(i) the elements under subsection (d)(1)(B) of such
section;
``(ii) the number of claims returned for reprocessing under
subsection (d)(2) of such section; and
``(iii) the number of claims described in clause (ii) for
which the decision relating to service-connection or
entitlement to compensation changed as a result of
reprocessing the claim.''.
(4) Sunset.--On the date that is 5 years after the
enactment of this Act, paragraph (1)(A) shall cease to be in
effect.
(e) Working Group on Medical Examinations for Claims for
Disability Compensation for Disabilities Relating to Military
Sexual Trauma.--
(1) In general.--Not later than 90 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall establish a working group on medical examinations for
claims for disability compensation under chapter 11 of title
38, United States Code, for disabilities relating to military
sexual trauma (in this section referred to as the ``working
group'').
(2) Membership.--The working group shall be composed of the
following:
(A) Staff of the operations center for military sexual
trauma of the Department of Veterans Affairs who have
experience reviewing the quality of medical examinations in
support of claims for disability compensation under chapter
11 of title 38, United States Code.
(B) Staff of the Medical Disability Examination Office of
the Department.
(C) Veterans service officers who have experience with
claims described in paragraph (1).
(D) Medical examiners who have experience with such claims.
(E) Staff of the Veterans Experience Office of the
Department.
(F) Such other individuals as the Secretary considers
appropriate.
(3) Duties.--Not later than 180 days after the date of the
enactment of this Act, the working group shall--
(A) review the quality of medical examinations described in
paragraph (1);
(B) review the feasibility of minimizing re-examinations
for conditions relating to military sexual trauma; and
(C) submit to the Under Secretary for Benefits of the
Department and the Secretary recommendations on how to--
(i) eliminate re-traumatization of individuals who file
claims described in paragraph (1); and
(ii) reduce the overdevelopment of such claims.
(4) Report.--Not later than one year after the date of the
enactment of this Act, the Secretary shall submit to Congress
a report that includes the following:
(A) The views of the working group on efforts by the
Department to eliminate re-traumatization of individuals who
file claims described in subsection (a).
(B) Legislative proposals to improve the experience of such
individuals in pursuing such claims.
(C) The recommendations submitted under paragraph (3)(C).
(D) The plan of the Under Secretary for Benefits of the
Department and the Secretary to implement such
recommendations.
(5) Review and implementation.--Not later than one year
after the date of the enactment of this Act, the Under
Secretary for Benefits of the Department and the Secretary
shall--
(A) review the recommendations submitted under paragraph
(3)(C); and
(B) implement the recommendations that, as determined by
the Under Secretary and the Secretary, would improve the
claims process for individuals who file claims described in
paragraph (1).
(f) Military Sexual Trauma Claims Performance Dashboard.--
(1) Establishment.--The Secretary of Veterans Affairs shall
establish an interactive performance dashboard displaying
information about claims relating to military sexual trauma
submitted to the Secretary for benefits under laws
administered by the Secretary.
(2) Elements.--The dashboard established pursuant to
paragraph (1) shall cover the following:
(A) Claims relating to military sexual trauma submitted to
the Secretary for benefits under laws administered by the
Secretary that have been submitted, completed, or appealed,
including appeals pending at the agency of jurisdiction and
at the Board of Veterans' Appeals.
(B) For comparison purposes with subparagraph (A), claims
not relating to military sexual trauma submitted to the
Secretary for benefits under laws administered by the
Secretary that have been submitted, completed, or appealed.
(C) Overall, cumulative information relating to claims
relating to military sexual trauma submitted to the Secretary
for benefits under laws administered by the Secretary,
including the following:
(i) Average number of days a claim is pending review.
(ii) Average number of days for completed adjudication.
(iii) Total number of pending claims, disaggregated by
whether the claims have been partially adjudicated or not
adjudicated at all.
(iv) Total number of claims completely adjudicated.
(v) Of the number specified in clause (iv), the percentage
that were approved, denied, or appealed.
(D) The total number of claims relating to military sexual
trauma submitted to the Secretary for benefits under laws
administered by the Secretary.
(E) The methods used for submittal of claims relating to
military sexual trauma to the Secretary for benefits under
laws administered by the Secretary.
(F) The most frequent reasons the Secretary denies a claim
relating to military sexual trauma submitted to the Secretary
for a benefit under a law administered by the Secretary.
(G) The most frequent conditions or disabilities for which
a claim relating to military sexual trauma is denied.
(H) The most frequent conditions or disabilities for which
a claim relating to military sexual trauma is submitted to
the Secretary for disability compensation under chapter 11 of
title 38, United States Code, including the grant rate for
such contentions.
(3) Additional resource information.--The Secretary shall
make available via the performance dashboard established
pursuant to subsection (a) the following information:
(A) Veterans Crisis Line contact information.
(B) Information regarding the availability of services from
military sexual trauma coordinators of the Veterans Health
Administration.
(C) Information regarding the availability of services from
military sexual trauma coordinators of the Veterans Benefits
Administration.
(D) Information on availability of specialized care,
services, and benefits from the Department for individuals
who have experienced military sexual trauma.
(E) Such additional information as the Secretary considers
appropriate.
(4) Availability.--The Secretary shall ensure that the
dashboard established pursuant to paragraph (1) is available
to the public from the website of the Department of Veterans
Affairs and is updated not less frequently than once every 30
days.
(5) Reporting requirements.--(A) Not later than 2 years
after the date of the enactment of this Act, the Secretary
shall submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a report detailing--
(i) the annual cost to implement the dashboard required by
paragraph (2);
(ii) areas for improvement of the dashboard; and
(iii) such additional information as the Secretary
considers appropriate.
(B) Not later than 180 days after the date of the enactment
of this Act, the Secretary shall commence providing, on a
quarterly basis, to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a quarterly briefing on the Department's
processing of military sexual trauma-related claims.
(6) Definition.--In this section, the term ``military
sexual trauma'' has the meaning given such term in section
1166(d)(2) of title 38, United States Code.
SEC. 112. INDEPENDENT ASSESSMENT OF NOTICES THAT THE
SECRETARY OF VETERANS AFFAIRS SENDS TO
CLAIMANTS.
(a) Agreement.--Not later than 30 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall seek to enter into an agreement with an FFRDC for an
assessment of notices that the Secretary sends to claimants.
(b) Assessment.--An FFRDC that enters into an agreement
under subsection (a) shall submit to the Secretary a written
assessment of such notices. The assessment shall include the
following:
(1) The determination of the FFRDC, made in consultation
with covered entities, whether each such notice may be
feasibly altered to reduce paper consumption by, and costs
to, the Federal Government.
(2) The recommendations of the FFRDC regarding how the
Secretary may make such notices clearer to claimants, better
organized, and more concise.
(c) Report; Implementation.--Not later than 90 days after
the Secretary receives the assessment under subsection (b),
the Secretary shall--
(1) submit to the Committees on Veterans' Affairs of the
Senate and House of Representatives a copy of such
assessment; and
(2) implement the recommendations in the assessment that
are in compliance with the laws administered by the
Secretary.
(d) Deadline for Implementation.--The Secretary shall
complete the implementation of such recommendations pursuant
to subsection (c)(2) by not later than one year after the
date on which the Secretary commences such implementation.
(e) Definitions.--In this section:
(1) The term ``FFRDC'' means a federally funded research
and development center.
(2) The term ``covered entities'' includes--
[[Page H4560]]
(A) the Secretary of Veterans Affairs;
(B) an expert in laws administered by the Secretary of
Veterans Affairs;
(C) a veterans service organization recognized under
section 5902 of title 38, United States Code;
(D) an entity that advocates for veterans; and
(E) an entity that advocates for the survivors of veterans.
(3) The terms ``claimant'' and ``notice'' have the meanings
given such terms in section 5100 of title 38, United States
Code.
SEC. 113. INDEPENDENT ASSESSMENT OF FORMS THAT THE SECRETARY
OF VETERANS AFFAIRS SENDS TO CLAIMANTS.
(a) Agreement.--Not later than 30 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall seek to enter into an agreement with an FFRDC for an
assessment of forms that the Secretary sends to claimants.
(b) Assessment.--An FFRDC that enters into an agreement
under subsection (a) shall submit to the Secretary a written
assessment, made in consultation with covered entities, of
such forms. The assessment shall include the recommendations
of the FFRDC regarding how the Secretary may make such forms
clearer to claimants and better organized.
(c) Report; Implementation.--Not later than 90 days after
the Secretary receives the assessment under subsection (b),
the Secretary shall--
(1) submit to the Committees on Veterans' Affairs of the
Senate and House of Representatives a copy of such
assessment; and
(2) implement the recommendations in the assessment that
are in compliance with the laws administered by the
Secretary.
(d) Deadline for Implementation.--The Secretary shall
complete the implementation of such recommendations pursuant
to subsection (c)(2) by not later than two years after the
date on which the Secretary commences such implementation.
(e) Definitions.--In this section:
(1) The term ``FFRDC'' means a federally funded research
and development center.
(2) The term ``covered entities'' includes--
(A) the Secretary of Veterans Affairs;
(B) an expert in laws administered by the Secretary of
Veterans Affairs;
(C) a veterans service organization recognized under
section 5902 of title 38, United States Code;
(D) an entity that advocates for veterans; and
(E) an entity that advocates for survivors of veterans.
(3) The term ``claimant'' has the meaning given such term
in section 5100 of title 38, United States Code.
TITLE II--EDUCATION AND ECONOMIC OPPORTUNITY
SEC. 201. VETS OPPORTUNITY ACT.
(a) Repayment of Members of the Armed Forces for
Contributions Towards Post-9/11 Educational Assistance:
Timing; Mechanism for Individuals Not Eligible for a Monthly
Housing Stipend.--
(1) In general.--Subsection (f) of section 3327 of title
38, United States Code, is amended--
(A) in paragraph (3), by striking ``together'' and all that
follows through ``before'' and inserting ``not later than 60
days after''; and
(B) by adding at the end the following new paragraph:
``(4) Additional assistance for an individual not eligible
for a monthly housing stipend.--In the case of an individual
making an election under subsection (a) who is described by
subparagraph (A), (C), or (E) of paragraph (1) of that
subsection, and who is not eligible for a monthly stipend
payable under section 3313(c) of this title, the educational
assistance payable to the individual under this chapter shall
be paid--
``(A) in a lump sum calculated by multiplying--
``(i) the total amount of contributions described in
paragraph (1)(A) with regards to such individual; and
``(ii) the sum of the number of months described in
subclauses (I) and (II) of paragraph (1)(B)(i) with regards
to such individual; and
``(B) to the individual not later than 60 days after the
exhaustion of the individual's entitlement to educational
assistance under this chapter.''.
(2) Technical corrections and conforming amendment.--Such
subsection is further amended--
(A) by striking ``paragraphs (2) through (7)'' and
inserting ``paragraphs (2) through (6)''; and
(B) in paragraph (1), in the heading, by inserting ``for an
individual eligible for a monthly housing stipend'' after
``Additional assistance''.
(3) Effective date.--The amendments made by this section
shall take effect on August 1, 2027.
(b) Treatment of Certain Independent Study Programs Under
Educational Assistance Programs of Department of Veterans
Affairs.--
(1) In general.--Section 3680A(a)(4)(A)(ii)(III) of such
title is amended--
(A) by inserting ``that requires regular and substantive
interaction between students and instructors'' after ``course
of study'';
(B) in item (aa), by striking ``; or'' and inserting a
semicolon;
(C) in item (bb), by striking ``; and'' and inserting ``;
or''; and
(D) by adding at the end the following new item:
``(cc) an institution of higher education, as such term is
defined in section 102 of the Higher Education Act of 1965
(20 U.S.C. 1002), that is approved to participate or is
participating in the student financial assistance programs
authorized by title IV of that Act; and''.
(2) Applicability.--The amendment made by paragraph (1)
shall apply with respect to a quarter, semester, or term, as
applicable, that begins on or after August 1, 2027.
(3) Oversight.--During the first six years beginning on the
date of enactment of this Act, the Secretary, in coordination
with State approving agencies, shall, every two years,
conduct risk-based surveys or reviews of institutions
approved pursuant to section 3680A(a)(4)(A)(ii)(III)(cc) of
title 38, United States Code, as added by paragraph (1).
(4) GAO report.--Not later than 3 years after the date of
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
oversight and implementation of the amendments made by
paragraph (1), including--
(A) the effectiveness of oversight activities conducted by
the Department of Veterans Affairs and State approving
agencies;
(B) institutional compliance with applicable requirements
under chapter 36 of title 38, United States Code;
(C) participation and outcomes of veterans enrolled in
programs approved pursuant to section
3680A(a)(4)(A)(ii)(III)(cc) of such title, as added by
paragraph (1); and
(D) any recommendations to improve oversight, program
integrity, or educational outcomes for veterans.
(5) Applicability.--To the extent practicable for any
program requiring practical, laboratory, clinical, shop, or
hands on competencies, the online portion of instruction may
not substitute for the supervised in person training
necessary to demonstrate such competencies.
(c) Absence From Certain Education Due to Certain
Service.--
(1) Options.--Section 3691A of such title is amended by
striking paragraph (1) of subsection (a) and inserting the
following:
``(1) A covered member may, after receiving orders to enter
a period of covered service--
``(A) withdraw from covered education;
``(B) take a leave of absence from covered education; or
``(C) subject to subsection (d), enter into an agreement
with the institution concerned to complete a course of
covered education to the satisfaction of such institution
concerned.''.
(2) Conforming amendment.--Such subsection is further
amended, in paragraph (2)(A), by striking ``or takes a leave
of absence'' and inserting ``, takes a leave of absence, or
enters into an agreement''.
(3) Agreement.--Such section is further amended--
(A) by redesignating subsection (d) as subsection (e); and
(B) by inserting, after subsection (c), the following new
subsection (d):
``(d) Agreement With Institution Concerned.--A covered
member may enter into an agreement under subsection (a) only
if the covered member has completed at least half of a course
of covered education.''.
(4) Section heading.--Such section is further amended by
striking the heading and inserting ``Absence from certain
education due to certain service''.
(5) Table of sections.--The table of sections at the
beginning of chapter 36 of such title is amended by striking
the item relating to section 3691A and inserting the
following new item:
``3691A. Absence from certain education due to certain service.''.
(d) Department of Veterans Affairs Compliance Surveys.--
Section 3693 of such title is amended--
(1) in subsection (c)--
(A) by striking ``not more than 10 business days of
notice'';
(B) by striking ``this section.'' and inserting ``this
section--''; and
(C) by adding at the end the following new paragraphs:
``(1) in the case of an educational institution or training
establishment with a time stamp database collection feature,
not fewer than 10, and not more than 15, business days of
notice; and
``(2) in the case of any other educational institution or
training establishment, not more than 10 business days of
notice.''; and
(2) by striking subsection (d) and inserting the following
new subsection (d):
``(d) Definitions.--In this section:
``(1) The terms `educational institution' and `training
establishment' have the meanings given such terms in section
3452 of this title.
``(2) The term `school certifying official' means an
employee of an educational institution with primary
responsibility for certifying veteran enrollment at the
educational institution.''.
(e) Notification of School Certifying Officials of Handbook
Updates.--
(1) In general.--Not later than 14 business days after
updating the school certifying official handbook of the
Department of Veterans Affairs, the Secretary of Veterans
Affairs shall provide notice to all school certifying
officials of such update.
(2) School certifying official defined.--The term ``school
certifying official'' means
[[Page H4561]]
an employee of an educational institution with primary
responsibility for certifying veteran enrollment at the
educational institution.
SEC. 202. IMPROVEMENTS TO PROCESS FOR MAKING PAYMENTS TO
AUTOMOBILE SELLERS FOR AUTOMOBILES PURCHASED
FOR CERTAIN DISABLED VETERANS.
(a) Timeliness of Payments.--Section 3902 of title 38,
United States Code, is amended, in subsection (a)--
(1) by inserting ``(1)'' before ``The Secretary''; and
(2) by adding at the end the following new paragraph:
``(2) The Secretary shall--
``(A) make payments under this section in compliance with
regulations prescribed under section 3903(a) of title 31,
except that no interest penalties shall be required to be
paid under this section; and
``(B) in the case of any payment under this section that is
not processed during the period of 30 days following receipt
by the Secretary of the final invoice for such payment, the
Secretary shall publish in the Federal Register the number of
days required to process the payment.''.
(b) Centralization of Process for Making Payments.--Such
section is amended by adding at the end the following new
subsection:
``(f)(1) The Secretary shall process payments under this
section through one office of the Department that the
Secretary determines has the capacity and expertise to make
such payments in compliance with regulations described in
subsection (a)(2).
``(2) The Secretary shall accurately track and resolve
payments due to sellers under this section that are more than
90 days overdue.''.
(c) Reporting.--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
accessible website of the Department of Veterans Affairs,
four semiannual reports after the date of the enactment of
this Act, regarding the administration of section 3902 of
title 38, United States Code, as amended by this section.
Each such report shall include, with respect to the period of
six months preceding the date of the report, the following
elements:
(1) The average and median number of days between receipt
of an invoice for payment under such section by the Claims
Intake Center of the Department and the day when the
Secretary makes such payment, disaggregated by whether the
claim was under review or being processed by--
(A) the Veterans Health Administration;
(B) the Veterans Benefits Administration; or
(C) the seller.
(2) Improvements to information technology of the
Department that the Secretary determines would reduce the
time required for such review or processing.
(d) GAO Report; Briefing.--
(1) Report.--Not later than 180 days after the date on
which the Secretary completes centralization under subsection
(f) of section 3902 of title 38, United States Code, as added
by this section, the Comptroller General of the United States
shall review such centralization and publish a report
containing the results of such review. Such report shall
include the determinations of the Comptroller General
regarding the following:
(A) The capacity of the office determined by the Secretary
under such subsection, to carry out processing described in
such subsection, including--
(i) a comprehensive assessment of employees of the
Department who carry out chapter 39 of such title;
(ii) a comprehensive skills assessment indicating what
resources the Secretary requires to otherwise improve such
centralization, including additional funds, employees, or
contractors; and
(iii) a review of systems of information technology,
including systems in use or to be acquired, to carry out such
centralization.
(B) Recommendations to improve such processing.
(C) Estimated costs to the United States to implement such
recommendations.
(2) Briefing.--Not later than 30 days after publishing the
report under paragraph (1), the Comptroller General shall
provide to the Committees on Veterans' Affairs of the House
of Representatives and the Senate a briefing on such report.
Such briefing shall include any response from the Secretary
to the Comptroller General regarding the recommendations in
the report.
SEC. 203. MONTHLY HOUSING STIPEND UNDER THE POST-9/11
EDUCATIONAL ASSISTANCE PROGRAM FOR INDIVIDUALS
WHO PURSUE SUMMER PROGRAMS OF EDUCATION SOLELY
THROUGH DISTANCE LEARNING.
(a) In General.--Section 3313(c)(1)(B) of title 38, United
States Code, is amended--
(1) in clause (i), by striking ``and (iii)'' and inserting
``, (iii), and (iv)'';
(2) by redesignating clause (iv) as clause (v); and
(3) by inserting after clause (iii) the following new
clause (iv):
``(iv) In the case of an individual pursuing, solely
through distance learning, a program of education that is
shorter than 12 weeks during the summer, for each month the
individual pursues the program of education, a monthly
housing stipend equal to the product of--
``(I) the national average of the monthly amount of the
basic allowance for housing payable under section 403 of
title 37 for a member with dependents in pay grade E-5,
multiplied by
``(II) the lesser of--
``(aa) 1.0 and
``(bb) the number of course hours borne by the individual
in pursuit of the program of education, divided by the
minimum number of course hours required for full-time pursuit
of the program of education, rounded to the nearest multiple
of 10.''.
(b) Effective Date.--The amendments made by subsection (a)
shall apply to a program of education beginning on or after
August 1, 2027.
SEC. 204. CLARIFICATION REGARDING INCLUSION OF MEDICALLY
NECESSARY AUTOMOBILE ADAPTATIONS IN DEPARTMENT
OF VETERANS AFFAIRS DEFINITION OF ``MEDICAL
SERVICES''.
Section 1701(6)(I) of title 38, United States Code, is
amended to read as follows:
``(I) The provision of any medically necessary automobile
adaptations for driver or passenger use, including--
``(i) ramp and kneeling systems;
``(ii) raised doors or lowered floors;
``(iii) raised roofs;
``(iv) air conditioning;
``(v) occupied and unoccupied mobility lifts;
``(vi) ingress or egress accessibility modifications;
``(vii) wheelchair tiedowns; and
``(viii) adapted seating.''.
SEC. 205. DIGITAL COMMUNICATIONS: SOLID START PROGRAM;
EDUCATIONAL ASSISTANCE.
(a) Improvement to Certain Outreach Under Solid Start
Program of Department of Veterans Affairs.--Section 6320(b)
of title 38, United States Code, is amended--
(1) in paragraph (1)(B)--
(A) by striking ``calling'' and inserting ``communicating
with''; and
(B) by inserting ``through the use of tailored lines of
communication, including mailings, text messaging, virtual
chatting, and other electronic forms of messaging'' after
``Armed Forces''; and
(2) in paragraph (2), by striking ``tailored mailings'' and
inserting ``tailored lines of communication, including
mailings, text messaging, virtual chatting, and other
electronic forms of messaging,''.
(b) Department of Veterans Affairs Use of Tailored Lines of
Communication for Correspondence Relating to Educational
Assistance Benefits.--Section 3680 of title 38, United States
Code, is amended by adding at the end the following new
subsection:
``(i) Mechanism for Tailored Lines of Communication.--(1)
The Secretary shall provide a mechanism by which an eligible
veteran or eligible person may use tailored lines of
communication to send and receive correspondence with the
Department related to entitlement to and use of educational
assistance benefits under the laws administered by the
Secretary. The Secretary shall ensure that an eligible
veteran or eligible person is provided with an opportunity to
opt into sending and receiving such correspondence using such
lines of communication rather than by mail.
``(2) The Secretary shall provide to eligible veterans and
eligible persons who are enrolled in a course or program of
education or training notice of the opportunity to opt in to
sending and receiving correspondence using tailored lines of
communication pursuant to paragraph (1).
``(3) In this subsection, the term `tailored lines of
communication' includes mailings, text messaging, virtual
chatting, and other electronic forms of messaging.''.
SEC. 206. IMPROVEMENTS TO TRANSITION ASSISTANCE PROGRAM AND
SKILLBRIDGE.
(a) Transition Assistance Program: Amendments; Pilot
Program; Reports.--
(1) Special operations forces.--Subsection (a) of section
1142 of title 10, United States Code, is amended, in
paragraph (1), by inserting ``(including each member of the
special operations forces)'' after ``armed forces''.
(2) Requirement of preseparation counseling: number of
days.--Such subsection is further amended, in paragraph (1)--
(A) by inserting ``(A)'' before ``Within''; and
(B) by adding at the end the following new subparagraph:
``(B) The Secretary concerned shall ensure that a member
described in subparagraph (A) receives preseparation
counseling in the following amounts:
``(i) In the case of a member who has accepted an offer of
full-time employment, or has enrolled in a program of
education or vocational training, that shall commence after
the member separates, retires, or is discharged, not fewer
than three days.
``(ii) In the case of a member other than a member
described in clause (i), not fewer than five days.''.
(3) Repeat attendance.--Such subsection is further amended
by adding at the end the following new paragraph:
``(6) A member who received preseparation counseling under
this section may, before separation, retirement, or
discharge, request to receive, on a space-available basis,
such preseparation counseling a second time.''.
(4) Pathways: standardization; establishment of pathway for
members of the reserve components.--Such section is further
amended, in paragraph (1) of subsection (c), in the matter
preceding subparagraph (A)(1)--
[[Page H4562]]
(A) by striking ``Each Secretary concerned'' and inserting
``The Secretaries of Defense and Homeland Security''; and
(B) by striking ``pathways for members of the military
department concerned'' and inserting ``pathways, standardized
across the armed forces''.
(5) Pathways: record of pathway assignment.--Such
subsection is further amended by adding at the end the
following new paragraph:
``(4) The Secretary concerned shall ensure that the pathway
in which a member is placed, and the reasons for such
placement, are noted in the service record of such member.''.
(6) Coordination between departments of defense, veterans
affairs, and labor.--Such section is further amended, in
subsection (d)--
(A) by striking the heading and inserting ``Transmission of
Certain Information to Other Departments'';
(B) by inserting ``(1)'' before ``In the case''; and
(C) by adding at the end the following new paragraphs:
``(2) Before a member described in subsection (a)
separates, retires, or is discharged, the Secretary concerned
shall transmit to the Secretary of Veterans Affairs the
Department of Defense Form DD-2648 regarding such member.
``(3)(A) Before a member described in subsection
(a)(1)(B)(ii) separates, retires, or is discharged, the
Secretary concerned shall provide such member with the
contact information of an employee of the Department of
Veterans Affairs and an employee of the Department of Labor;
and
``(B) Each employee described in subparagraph (A) shall
contact the member described in such subparagraph not later
than 60 days after such member separates, retires, or is
discharged.
``(C) The Secretary of Veterans Affairs and the Secretary
of Labor shall each submit to the Committees on Armed
Services and on Veterans' Affairs of the Senate and House of
Representatives an annual report that identifies the number
of times, and reasons why, an employee of the department
under the jurisdiction of such Secretary failed to carry out
subparagraph (B) in the year preceding the date of the
report.''.
(7) Report.--Not later than two years after the date of the
enactment of this Act and annually thereafter for four years,
the Secretary of Defense shall submit to the Committees on
Armed Services, and the Committees on Veterans' Affairs, of
the Senate and House of Representatives, a report on data
recorded with such tracking system during the year preceding
the date of such report. Such a report shall include a list
of the seven military installations located inside the
continental United States, and three military installations
located outside the continental United States, where members
are least likely to receive preseparation counseling in
accordance with such time periods. Such a report shall also
include the following.
(A) The number of members who, in the course of such
preseparation counseling, were referred to another Federal
agency or department.
(B) The Federal agencies or departments to which members
were so referred.
(C) The number of members who should have been, but were
not, so referred, and reasons why such referrals did not
occur.
(D) The number of members who receive such preseparation
counseling and apply for unemployment compensation under
subchapter II of chapter 85 of title 5, United States Code.
(E) The total amount of such unemployment compensation paid
to members separating from the Armed Forces.
(8) Contracting: standardization.--Such section is further
amended by adding at the end the following new subsection:
``(f) Contracting.--A Secretary concerned may enter into an
agreement with an entity under which such entity shall
provide preseparation counseling under this section. If more
than one Secretary seeks to enter into such an agreement,
such Secretaries concerned shall, to the extent practicable,
seek to enter into such agreements with the same entity.''.
(b) Skillbridge: GAO Study.--
(1) Study required.--The Comptroller General of the United
States shall conduct a study of the Skillbridge programs
under section 1143(e) of title 10, United States Code.
(2) Report.--Not later than two years after the date of the
enactment of this Act, the Comptroller General shall submit
to the Committees on Armed Services, and the Committees on
Veterans' Affairs, of the Senate and House of
Representatives, a report regarding such study. Such report
shall include observations and recommendations of the
Comptroller General regarding, with respect to members and
employers who participate in Skillbridge--
(A) differences in criteria for participation between the
Armed Forces;
(B) other differences in Skillbridge programs between the
Armed Forces;
(C) best practices in Skillbridge programs across the Armed
Forces, including--
(i) the selection of employers; and
(ii) the development of contracts; and
(D) the feasibility of making Skillbridge programs uniform
across the Armed Forces.
SEC. 207. TRANSITION ASSISTANCE PROGRAM: PRESENTATION IN
PRESEPARATION COUNSELING TO PROMOTE BENEFITS
AVAILABLE TO VETERANS.
(a) In General.--Section 1142(b) of title 10, United States
Code, is amended by adding at the end the following new
paragraph:
``(20) A presentation that promotes the benefits available
to veterans under the laws administered by the Secretary of
Veterans Affairs. Such presentation--
``(A) shall be standardized;
``(B) shall, before implementation, be reviewed and
approved by the Secretary of Veterans Affairs and Secretary
of Defense in collaboration with veterans service
organizations that provide claims assistance under the
benefits delivery at discharge program of the Department of
Veterans Affairs;
``(C) shall be submitted by the Secretary of Veterans
Affairs to the Committees on Veterans' Affairs and Armed
Services of the Senate and the House of Representatives for
review at least 90 days before implementation;
``(D) where available, shall be presented with the
participation of--
``(i) an employee or representative of the Department of
Veterans Affairs assisted by a representative of a veterans
service organization recognized under section 5902 of title
38; or
``(ii) an employee or representative of the Department of
Veterans Affairs assisted by an individual recognized under
section 5903 of such title and authorized by the Secretary
concerned to so participate;
``(E) shall include information on how a veterans service
organization may assist the member in filing a claim
described in paragraph (19);
``(F) may not encourage the member to join a particular
veterans service organization; and
``(G) may not be longer than one hour.''.
(b) Annual Report.--Not less frequently than once each year
after the date of the enactment of this Act, the Secretary of
Veterans Affairs shall submit, to the Committees on Armed
Services of the Senate and House of Representatives, and to
the Committees on Veterans' Affairs of the Senate and House
of Representatives, a report that--
(1) identifies each veterans service organization that
participated in a presentation under paragraph (20) of
section 1142(b) of title 10, United States Code, as added by
subsection (a);
(2) contains the number of members of the Armed Forces who
attended such presentations; and
(3) includes any recommendations of the Secretary regarding
changes to such presentation or to such paragraph.
SEC. 208. ELIMINATION OF REQUIREMENT THAT ON-CAMPUS
EDUCATIONAL AND VOCATIONAL COUNSELING IS
PROVIDED BY CERTAIN DEPARTMENT OF VETERANS
AFFAIRS EMPLOYEES.
(a) In General.--Section 3697B(a) of title 38, United
States Code, is amended--
(1) by striking the second sentence;
(2) by inserting ``(1)'' before ``The Secretary''; and
(3) by adding at the end the following new paragraph:
``(2) Any individual providing services under paragraph (1)
on behalf of the Department who is not an employee of the
Department shall be subject to the same oversight, training,
and accountability standards applicable to Department
employees providing such services.''.
(b) Expansion of VetSuccess on Campus Program to at Least
One Location in Each State.--
(1) In general.--The Secretary of Veterans Affairs shall
ensure that the VetSuccess on Campus program of the
Department of Veterans Affairs is located in every State.
(2) Counselors.--In carrying out paragraph (1), the
Secretary shall ensure that at least one counselor of the
VetSuccess on Campus program is located in each State,
notwithstanding the number of individuals in a State or at an
educational institution who may qualify to participate in the
program.
(3) Preference.--In carrying out this section, the
Secretary shall give preference to educational institutions
that have the largest populations of students who are
pursuing programs of education at such institutions with
educational assistance provided under laws administered by
the Secretary.
(4) State defined.--In this section, the term ``State'' has
the meaning given such term in section 101 of title 38,
United States Code.
SEC. 209. EXPANSION OF ENTITLEMENT FOR PAYMENT FOR LICENSING
OR CERTIFICATION TESTS FOR VETERANS ENTITLED TO
EDUCATIONAL ASSISTANCE.
Section 3315 of title 38, United States Code, is amended--
(1) in subsection (a), by striking ``educational assistance
under this chapter'' and inserting ``covered assistance'';
(2) in subsection (b)(3), by striking ``under this
chapter'' and inserting ``with respect to covered
assistance'';
(3) in subsection (c), in the matter preceding paragraph
(1), by striking ``under this chapter'' and inserting ``with
respect to covered assistance''; and
(4) by adding at the end the following new subsection:
``(d) Warnings.--Before providing any payment to or on
behalf of an individual described in subsection (a), the
Secretary shall provide notice to the individual a warning
that use of entitlement under this section for a licensing or
certification test may not lead to a license or
certification.
[[Page H4563]]
``(e) Covered Assistance Defined.--In this section, the
term `covered assistance' means educational assistance
available under--
``(1) this chapter, chapter 30 of this title, chapter 35 of
this title, or chapter 1606 of title 10; or
``(2) any other provision of law providing educational
assistance to a veteran, or to another individual in
connection with the service of a veteran in the Armed
Forces.''.
SEC. 210. INCREASE OF AMOUNT OF EDUCATIONAL ASSISTANCE PAID
BY THE SECRETARY OF VETERANS AFFAIRS FOR FIRST
YEAR OF A FULL-TIME PROGRAM OF APPRENTICESHIP
OR OTHER ON-JOB TRAINING.
Section 3313(g)(3)(B) of title 38, United States Code, is
amended--
(1) in the matter preceding clause (i), by inserting
``using educational assistance under this chapter''; and
(2) in clause (i)(II), by striking ``80 percent'' and
inserting ``100 percent''.
SEC. 211. IMPROVING EMERGING TECHNOLOGY OPPORTUNITIES FOR
VETERANS.
(a) Inclusion of Emerging Technologies in High Technology
Program.--
(1) In general.--Section 3699C of title 38, United States
Code, is amended--
(A) in the section heading by striking ``High technology''
and inserting ``High technology and emerging technology'';
(B) by striking ``high technology'' and inserting ``high
technology or emerging technology'' each place such term
appears; and
(C) in subsection (c)(4) by adding at the end the following
new subparagraph:
``(E) Such criteria shall also identify which technologies
of critical importance, such as artificial intelligence and
semiconductor manufacturing, shall be treated as emerging
technologies for purposes of this section.''.
(2) Clerical amendment.--The table of sections at the
beginning of chapter 36 of such title is amended by striking
the item relating to section 3699C and inserting the
following new item:
``3699C. High technology and emerging technology program.''.
(3) Conforming amendments.--Section 3680A of title 38,
United States Code, is amended in subsections (a)(4)(B) and
(d)(8) by striking ``high technology'' each place such term
appears and inserting ``high technology or emerging
technology''.
(b) Employment Rate Calculation for VET-TEC High Technology
and Emerging Technology Program.--Section 3699C of title 38,
United States Code, is amended--
(1) in subsection (f)--
(A) in the matter preceding paragraph (1) by inserting
after ``House of Representatives'' the following: ``, and
make available to the public,''; and
(B) in paragraph (3) by adding at the end the following:
``Such rate shall be calculated as a fraction, the
denominator of which is the number of covered individuals who
completed such a program during such year and the numerator
of which is the number of individuals counted in the
denominator who are employed on the date that is 180 days
after the date on which the individual completed the program,
and expressed as a percentage. Notwithstanding the previous
sentence, the numerator shall not count in a case in which
the individual is employed by the same organization that was
the provider of the individual's program of education or a
case in which the individual is employed, by a parent or
affiliate of such organization, as an instructor for a
substantially similar program of education. To the maximum
extent practicable, the Secretary shall also report the rates
of full-time employment, part-time employment, and self-
employment.''; and
(2) in subsection (g) by adding at the end the following
new paragraph:
``(3) The Secretary on an ongoing basis shall solicit,
collect, and analyze feedback about the program from covered
individuals who participate in the program and from the GI
Bill School Feedback Tool. The Secretary shall use such
feedback to evaluate and improve the implementation of the
program.''.
TITLE III--HEALTH CARE
SEC. 301. EXTENSION AND MODIFICATION OF TRANSPORTATION GRANT
PROGRAM OF DEPARTMENT OF VETERANS AFFAIRS.
Section 307 of the Caregivers and Veterans Omnibus Health
Services Act of 2010 (Public Law 111-163; 38 U.S.C. 1710
note) is amended--
(1) in subsection (a)--
(A) in paragraph (2), by adding at the end the following
new subparagraphs:
``(C) Indian tribes.
``(D) Tribal organizations.
``(E) Native Hawaiian organizations.
``(F) County veterans service organizations.'';
(B) in paragraph (3), in the matter preceding subparagraph
(A), by striking ``State veterans service agency or veterans
service organization awarded'' and inserting ``recipient
of''; and
(C) by amending paragraph (4) to read as follows:
``(4) Maximum amount.--
``(A) In general.--Except as provided in subparagraphs (B)
and (C), the amount of a grant under this section may not
exceed $50,000.
``(B) Off-road communities.--In the case of a county that
has more than five communities that are off the road system,
the amount of a grant awarded with respect to that county
under this section may be increased by an amount not to
exceed 50 percent of the amount specified in subparagraph
(A).
``(C) Purchasing a vehicle.--
``(i) Amount.--The amount of a grant awarded under this
section to a recipient may be increased by not more than
$80,000 if the recipient is purchasing a vehicle to comply
with requirements under the Americans with Disabilities Act
of 1990 (42 U.S.C. 12101 et seq.) in carrying out this
section.
``(ii) Limitations.--The Secretary may prescribe
limitations on the number of vehicles purchased by each
recipient under this section.'';
(2) by striking subsection (d);
(3) by redesignating subsections (b) and (c) as subsections
(d) and (e), respectively;
(4) by inserting after subsection (a) the following new
subsections:
``(b) Additional Services.--
``(1) Nearby rural areas.--In addition to providing
innovative transportation options to veterans in highly rural
areas, a recipient of a grant under this section may use
amounts provided under the grant to provide innovative
transportation options to veterans in nearby rural areas.
``(2) Priority.--A recipient of a grant under this section
shall prioritize the provision of innovative transportation
options to veterans in highly rural areas, and shall
demonstrate to the Secretary such priority, and may only
provide services under paragraph (1) to veterans in nearby
rural areas if--
``(A) it does not impede the services provided to veterans
in highly rural areas; and
``(B) the grantee has excess capacity and resources
available to provide such services to veterans in nearby
rural areas.
``(c) Eligibility of Previous Areas.--Areas eligible for
assistance under the grant program under this section on the
day before the date of the enactment of the Take Care of
America's Veterans Act shall remain eligible for such
assistance on and after such date of enactment.''; and
(5) in subsection (e), as redesignated by paragraph (3)--
(A) by redesignating paragraph (2) as paragraph (5); and
(B) by striking paragraph (1) and inserting the following:
``(1) Indian tribe; tribal organization.--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).
``(2) Native hawaiian organization.--The term `Native
Hawaiian organization' has the meaning given that term in
section 6207 of the Elementary and Secondary Education Act of
1965 (20 U.S.C. 7517).
``(3) Nearby.--The term `nearby', with respect to a rural
area, includes rural areas adjacent to a highly rural area
and rural areas geographically between the highly rural area
and the nearest Department of Veterans Affairs medical
center.
``(4) Rural; highly rural.--The terms `rural' and `highly
rural' have the meanings given those terms under the Rural-
Urban Commuting Areas (RUCA) coding system of the Department
of Agriculture.''.
SEC. 302. VETERAN CAREGIVER REEDUCATION, REEMPLOYMENT, AND
RETIREMENT ACT.
(a) Extension of Period of Medical Care Coverage for
Caregivers Designated as Primary Providers of Personal Care
Services for Veterans.--Section 1781(a)(4) of title 38,
United States Code, is amended by inserting before the comma
at the end the following: ``, including during the 180-day
period following discharge from the program under section
1720G(a) of this title unless the designation of the
individual was revoked due to fraud, abuse, mistreatment, or
other misconduct''.
(b) Employment and Other Benefits for Caregivers Designated
as Primary Providers of Personal Care Services for
Veterans.--
(1) Employment assistance.--Section 1720G of title 38,
United States Code, is amended--
(A) by redesignating subsection (d) as subsection (e); and
(B) by inserting after subsection (c) the following new
subsection (d):
``(d) Employment Assistance.--(1) The Secretary shall,
subject to paragraph (2), provide to an individual designated
as a primary provider of personal care services under
subsection (a)(7)(A) employment assistance as follows:
``(A) Reimbursement of fees associated with certifications
or relicensure necessary for such employment.
``(B) For purposes of gaining credit for continuing
professional education requirements, access to training
modules of the Department at no cost.
``(C) In consultation with the Secretary of Defense and the
Secretary of Labor, access to existing employment assistance
resources and programs as considered appropriate.
``(2) An individual described in paragraph (1) shall have
access to assistance described in such paragraph--
``(A) while participating in the program established under
subsection (a)(1); and
``(B) during the 180-day period following the date on which
the individual is no longer participating in such program
unless the designation of such individual under subsection
(a)(7)(A) was revoked for fraud, abuse, mistreatment, or
other misconduct.
``(3) The maximum lifetime amount that may be reimbursed
for an individual under paragraph (1)(A) is $1,000.''.
(2) Expansion of available services.--Subsection
(a)(3)(A)(ii) of such section is amended--
[[Page H4564]]
(A) in subclause (V), by striking ``; and'' and inserting a
semicolon;
(B) in subclause (VI)--
(i) in the matter preceding item (aa), by inserting ``or
agreements'' after ``contracts'';
(ii) in item (aa), by inserting ``, including retirement
planning services,'' after ``services''; and
(iii) in item (bb), by striking the period at the end and
inserting ``; and''; and
(C) by adding at the end the following new subclause:
``(VII) such instruction, preparation, training, and
support as the Secretary considers appropriate to assist in
transitioning away from caregiving during the 180-day period
following the date on which the family caregiver is no longer
participating in the program required by paragraph (1),
unless such designation was revoked for fraud, abuse, or
mistreatment, or other misconduct.''.
(3) Assistance returning to workforce.--Subclause (VI) of
such subsection is further amended--
(A) in item (aa), by striking ``; and'' and inserting a
semicolon; and
(B) by adding at the end the following new item:
``(cc) assistance returning to the workforce upon discharge
or dismissal from the program required by paragraph (1)
unless such designation was revoked for fraud, abuse,
mistreatment, or other misconduct; and''.
(4) Bereavement counseling and support.--Subsection
(a)(3)(A)(i)(III) of such section is amended by inserting
before the semicolon the following: ``, including bereavement
counseling and support following the death of the eligible
veteran''.
(5) Study on provision of returnship program.--
(A) In general.--Not later than one year after the date of
the enactment of this Act, the Secretary of Veterans Affairs,
in partnership with the Secretary of Labor, shall complete a
study on the feasibility and advisability of conducting a
returnship program to assist individuals who are designated
as a primary provider of personal care services under section
1720G(a)(7)(A) of title 38, United States Code, or who were
discharged from such program, in returning to the workforce.
(B) Report.--Not later than 180 days after completion of
the study 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 the study.
(6) Study on incorporating former caregivers into workforce
of department 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 complete a study on barriers and incentives to hiring
individuals who were designated as a primary provider of
personal care services under section 1720G(a)(7)(A) of title
38, United States Code, at facilities of the Department of
Veterans Affairs to address staffing needs.
(B) Report.--Not later than 180 days after completion of
the study 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 the study, which shall include--
(i) a plan for increasing employment opportunities at
facilities of the Department for individuals who were
designated as a primary provider of personal care services
under section 1720G(a)(7)(A) of title 38, United States Code;
and
(ii) such recommendations for legislative or administrative
action as the Secretary considers appropriate.
(c) Comptroller General Report on Efforts of Department of
Veterans Affairs in Supporting Family Caregivers
Transitioning Away From Caregiving.--Not later than two years
after the date of the enactment of this Act, the Comptroller
General of the United States shall submit to Congress a
report assessing the efforts of the Secretary of Veterans
Affairs to support individuals serving as family caregivers
under section 1720G(a) of title 38, United States Code, in
transitioning away from caregiving, either by assisting those
individuals with retirement planning or returning to work.
(d) Report on Feasibility and Advisability of Establishing
a Retirement Plan or Retirement Savings for Family Caregivers
of Certain Veterans.--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 the Treasury
and the heads of such other relevant entities as the
Secretary of Veterans Affairs determines necessary, shall
submit to Congress a report on the feasibility and
advisability of, for individuals serving as family caregivers
under section 1720G(a) of title 38, United States Code--
(1) establishing an individual retirement plan (as defined
in section 7701(a)(37) of the Internal Revenue Code of 1986
(26 U.S.C. 7701(a)(37))) or similar retirement plan; or
(2) permitting such individuals to join an already
established pathway to retirement savings.
SEC. 303. VETERANS TBI BREAKTHROUGH EXPLORATION OF ADAPTIVE
CARE OPPORTUNITIES NATIONWIDE ACT.
(a) Department of Veterans Affairs Grant Program for
Supplemental Neurorehabilitation Approaches to Chronic Mild
TBI Treatment.--
(1) Grant program.--
(A) In general.--The Secretary of Veterans Affairs shall
carry out a three-year program (to be known as the ``TBI
Innovation Grant Program'') under which the Secretary shall
award grants to eligible entities described in paragraph (2)
for the development, implementation, and evaluation of
approaches and methodologies for prospective randomized
control trials for neurorehabilitation treatments for the
treatment of chronic mild traumatic brain injury (in this Act
referred to as ``mTBI'') in veterans.
(B) Relationship to other department activities.--The grant
program required under subparagraph (A) shall be carried out
in a manner that--
(i) supplements, and does not supplant, other clinical care
and research of the Department of Veterans Affairs relating
to mTBI; and
(ii) facilitates, as practicable, coordination with
Veterans Health Administration facilities for referral,
continuity of care, and dissemination of findings.
(2) Eligible entities described.--An eligible entity
described in this paragraph is any of the following:
(A) A nonprofit organization with demonstrated capability
to conduct clinical trials and to deliver or research
effective neurorehabilitation treatments for mTBI, including
through patient care delivery.
(B) An academic institution that conducts significant
research on mTBI and has demonstrated capability to conduct
clinical trials relating to neurorehabilitation treatments.
(C) A non-Department health care provider with expertise in
neurorehabilitative therapies and demonstrated capability to
conduct clinical trials and to evaluate mTBI treatments
through patient care delivery.
(D) A partnership or consortium of two or more entities
described in subparagraphs (A) through (C).
(3) Use of funds.--An eligible entity in receipt of a grant
under this subsection shall use such grant to support
activities that include--
(A) designing and testing novel or integrative treatments
for mTBI that prioritize patient-centered care, including
non-pharmacological therapies;
(B) conducting clinical studies and assessments to measure
the effectiveness of funded approaches to--
(i) improve mental health outcomes among veterans;
(ii) reduce suicidality, and common risk factors for
completing suicide, including depression and substance use
disorders among veterans; and
(iii) mitigate long-term effects of mTBI and, to the extent
outcomes are collected under the applicable clinical
protocol, measure durability of outcomes at approximately six
months following completion of treatment;
(C) providing training for clinicians and outreach to
veterans and their families to improve awareness and
accessibility of innovative mTBI treatments, including
information on available Department resources and pathways to
access such resources; and
(D) establishing partnerships with community organizations,
academic institutions, and health care facilities, including,
as practicable, coordination with Veterans Health
Administration facilities to facilitate referral of eligible
veterans, continuity of care, and dissemination of aggregate
findings.
(4) Limitation on grant amount.--The Secretary may not
award an eligible entity a grant under this section in an
amount that exceeds $5,000,000 for any fiscal year.
(5) Program administration.--
(A) Applications.--An eligible entity desiring a grant
under this subsection shall submit to the Secretary an
application in such form, at such time, and containing such
information and assurances as the Secretary determines
appropriate, including a detailed description of--
(i) activities proposed to be conducted using the grant;
(ii) expected outcomes of such activities;
(iii) plans for evaluating the effectiveness of such
activities;
(iv) how the eligible entity will coordinate, as
practicable, with Veterans Health Administration facilities
for referral and continuity of care for veterans who
participate in activities carried out using grant funds, and
for dissemination of aggregate findings;
(v) the budget of the entity for the use of the grant,
including a narrative justification and an identification of
the estimated amount of grant funds to be used for
administrative or overhead costs; and
(vi) assurances of compliance with applicable Federal laws
and regulations relating to human subjects protections and
patient safety.
(B) Priority.--In awarding grants under this subsection,
the Secretary shall give priority to eligible entities that
have demonstrated the capacity to coordinate with the
Department to facilitate referral and continuity of care for
veterans who participate in activities carried out using
grant funds.
(C) Periodic reports.--As a condition of receiving a grant
under this section, an eligible entity shall, not less
frequently than annually during the grant period and not
later than 180 days after the end of the grant period, submit
to the Secretary a report that includes, with respect to the
period covered by the report--
[[Page H4565]]
(i) a description of how the eligible entity used such
grant;
(ii) a summary of the progress of activities funded with
amounts from such grant;
(iii) measured outcomes relating to such activities;
(iv) a detailed accounting of expenditures of grant funds,
including administrative or overhead costs;
(v) to the extent collected under the applicable clinical
protocol or in the ordinary course of care, a description of
any adverse events and serious adverse events, including
self-harm or suicide-related events; and
(vi) a description of actions taken pursuant to the
coordination plan described in subparagraph (A)(iv).
(D) Oversight; annual evaluations.--The Secretary shall--
(i) ensure rigorous oversight of the grant program under
this section, including by monitoring financial compliance
and timely receipt of the reports required under subparagraph
(B); and
(ii) on an annual basis until the termination date
specified in paragraph (9)(A), evaluate the efficacy of
activities carried out using grant funds based on the reports
submitted under subparagraph (B) and other appropriate
information.
(E) Rule of construction.--Nothing in this section shall be
construed to authorize the Secretary to require prior
approval of, or changes to, any clinical protocol, study
design, outcome measures, or follow-up schedule of an
eligible entity that receives a grant under this section,
except as necessary to ensure compliance with applicable
Federal laws and regulations relating to human subjects
protections and patient safety.
(F) Enforcement authority.--The Secretary may suspend,
modify, or terminate a grant awarded under this section, if
the Secretary determines that the recipient of such grant has
failed to comply with reporting requirements under
subparagraph (B) or other applicable terms and conditions of
the grant.
(6) Available amounts; authorization of appropriations.--
(A) Available amounts.--The Secretary may carry out the
program under this section using amounts available to the
Secretary for general mental health care programs, if the use
of such amounts supplements, and does not supplant, amounts
otherwise available for Department mental health and
traumatic brain injury programs.
(B) Authorization of appropriations.--There is authorized
to be appropriated to the Secretary $10,000,000 for each of
fiscal years 2026 through 2028 to carry out this section.
(7) Duration; annual review.--
(A) Duration.--The authority of the Secretary to carry out
the grant program under this section shall terminate on the
date that is three years after the date of the enactment of
this Act, except that the Secretary may continue to use
amounts made available to carry out this section after such
date solely for the purpose of administering activities and
obligations incurred before such termination date.
(B) Annual review.--During such three-year period, the
Secretary shall, on an annual basis, review the effectiveness
of the grant program to determine the potential of such grant
program for continuation or expansion.
(b) Department of Veterans Affairs Grant Program for
Independent Third-party Research Studies and Treatment With
Respect to Supplemental Neurorehabilitation Treatments for
MTBI.--
(1) Establishment.--The Secretary of Veterans Affairs shall
establish and carry out a research grant program to award
grants to eligible entities described in paragraph (2) to be
used to carry out studies and applied programs on approaches
and methodologies for the treatment of mTBI in veterans.
(2) Eligible entities described.--An eligible entity
described in this paragraph is any of the following:
(A) A nonprofit organization that has demonstrated the
capability to conduct clinical trials and to evaluate
traumatic brain injury treatments through patient care
delivery.
(B) An academic institution that conducts significant
research on traumatic brain injury and has demonstrated the
capability to conduct clinical trials relating to
neurorehabilitation treatments.
(C) A partnership or consortium of two or more entities
described in subparagraphs (A) and (B).
(3) Applications.--An eligible entity desiring a grant
under this section shall submit to the Secretary an
application in such form, at such time, and containing such
information and assurances as the Secretary determines
appropriate, including a summary of--
(A) the research and treatment activities proposed to be
carried out using grant funds;
(B) the methodology to be used for such activities;
(C) the expected outcomes of such activities;
(D) how the eligible entity will coordinate, as
practicable, with Veterans Health Administration facilities
for referral and continuity of care for veterans who
participate in activities carried out using grant funds, and
for dissemination of aggregate findings;
(E) the budget of the entity for the use of the grant,
including a narrative justification and an identification of
the estimated amount of grant funds to be used for
administrative or overhead costs; and
(F) assurances of compliance with applicable Federal laws
and regulations relating to human subjects protections and
patient safety.
(4) Administration.--
(A) Grant categories.--In carrying out the grant program
under this subsection, each fiscal year the Secretary shall--
(i) subject to the requirement under subparagraph (B),
award four grants for exploratory or pilot research and
treatment projects, each of which shall be in an amount of
not more than $625,000; and
(ii) award five grants for collaborative or
multidisciplinary research and treatment initiatives, each of
which shall be in an amount of not more than $1,500,000.
(B) Priority.--Of the grants awarded under subparagraph
(A)(i), the Secretary shall award not fewer than three to
nonprofit organizations.
(C) Enforcement authority.--The Secretary may suspend,
modify, or terminate a grant awarded under this subsection,
if the Secretary determines that the recipient of such grant
has failed to comply with the applicable terms and conditions
of the grant.
(5) Agreement with independent organization.--
(A) In general.--The Secretary shall seek to enter into an
agreement with an independent organization that is not a
component of the Department and that has demonstrated
expertise in randomized controlled trials,
neurorehabilitation outcomes evaluation, and research
integrity, under which the organization agrees to--
(i) administer the research grant program under this
subsection;
(ii) carry out studies and implement efforts that include--
(I) analyzing data from mTBI treatment methodologies
developed pursuant to the research grant program to assess
the effect, among veterans, of such methodologies on enhanced
brain health outcomes, mental health, and long-term recovery,
including, to the extent outcomes are collected under the
applicable clinical protocol, durability of outcomes at
approximately six months following completion of treatment;
(II) identifying data-driven best practices and providing
recommendations for further research or clinical application,
including recommendations for dissemination to Veterans
Health Administration clinicians and facilities (as
appropriate); and
(III) randomized, controlled clinical trials to--
(aa) validate and deliver treatments;
(bb) establish a standard of care; and
(cc) improve access to such treatments for veterans;
(iii) submit to the Secretary not less frequently than
annually a report describing activities carried out under
this section, including outcome data and methodology; and
(iv) make available to the Secretary all data and findings
from the grants made under this section, consistent with
applicable Federal law, regulation, and Department policies
relating to patient protections, data security, and privacy.
(B) Rule of construction.--Nothing in this section shall be
construed to authorize the Secretary, or an independent
organization that enters into an agreement with the Secretary
under subparagraph (A), to require prior approval of, or
changes to, any clinical protocol, study design, outcome
measures, or follow-up schedule established by an eligible
entity that receives a grant under this section, except as
necessary to ensure compliance with applicable Federal laws
and regulations relating to human subjects protections and
patient safety.
(C) Report.--An agreement under subparagraph (A) shall
include a requirement that the independent organization
submits to Congress and the Secretary a comprehensive report
that includes--
(i) the findings of the studies required under such
agreement;
(ii) recommendations with respect to the expansion of
successful TBI treatment methodologies and standard of care
recommendations, if any, developed pursuant to the research
grant program; and
(iii) to the extent available from the reports and study
materials of grant recipients, a summary of--
(I) the durability of outcomes at approximately six months
following completion of treatment, if collected under the
applicable clinical protocol;
(II) adverse events and serious adverse events, including
self-harm or suicide-related events, if collected under the
applicable clinical protocol or in the ordinary course of
care; and
(III) aggregate expenditures of grant funds, including
administrative or overhead costs.
(D) Surveys.--The Secretary may conduct surveys of any
independent organization that enters into an agreement with
the Secretary under subparagraph (A) in order to assess the
effectiveness of such organization in administering the
research grant program under this subsection.
(6) Available amounts; authorization of appropriations.--
(A) Available amounts.--The Secretary may use amounts
available to the Secretary for the operating budget of the
National Center for Posttraumatic Stress Disorder to carry
out the research grant program under this subsection, if the
use of such amounts supplements, and does not supplant,
amounts otherwise available for Department programs and
services.
(B) Authorization of appropriations.--There is authorized
to be appropriated to the Secretary $10,000,000 for each of
fiscal years 2026 through 2028 to carry out this subsection.
[[Page H4566]]
(7) Termination date.--The authority of the Secretary to
carry out the research grant program under this section shall
terminate on the date that is three years after the date of
the enactment of this Act.
(c) Reports to Congress.--Not later than two years after
the date on which the Secretary commences the research grant
program under subsection (a), and on an annual basis
thereafter until the termination date specified in paragraph
(8) of such subsection, the Secretary shall submit to
Congress a report on the grant programs under subsections (a)
and (b). Each such report shall include--
(1) the findings of the studies under subsection (a)(6)(B);
(2) a description of any agreement entered into by the
Secretary under subsection (b)(5)(A);
(3) recommendations of the Secretary with respect to policy
and programmatic improvements to services of the Department
to treat mTBI among veterans;
(4) any findings derived from surveys conducted under
subsection (b)(5)(D), including any recommendations of the
Secretary for improvements to the structure, oversight,
administration, or performance of the independent
organization that enters into an agreement with the Secretary
under subsection (b)(5)(A); and
(5) such other matters as the Secretary determines
appropriate.
(d) Definitions.--In this section:
(1) The terms ``chronic mild traumatic brain injury'' and
``mTBI'' mean a mild traumatic brain injury with symptoms
that persist for not fewer than six months after the inciting
injury, as determined using validated clinical criteria.
(2) The term ``nonprofit organization''--
(A) means an organization described in section 501(c)(3) of
the Internal Revenue Code of 1986 and exempt from taxation
under section 501(a) of such Code; and
(B) includes such an organization that is a hospital,
nonprofit health system, academic medical center, or clinic
that delivers neurorehabilitation care or conducts clinical
research relating to mTBI.
(3) The term ``veteran'' has the meaning given such term in
section 101 of title 38, United States Code.
SEC. 304. ASSIGNMENT OF TRAVELING PHYSICIANS TO SERVE
TERRITORIES, POSSESSIONS, AND FREELY ASSOCIATED
STATES.
(a) In General.--Subchapter I of chapter 74 of title 38,
United States Code, is amended by adding at the end the
following new section:
``Sec. 7415. Traveling physicians
``(a) In General.--(1) The Secretary may assign a physician
appointed under section 7401 or section 7431 of this title to
serve as a traveling physician for a period of not more than
one year at a time. A physician assigned to serve as a
traveling physician under this section may be assigned to
provide health care to veterans residing in American Samoa,
Guam, the Commonwealth of the Northern Mariana Islands, the
Commonwealth of Puerto Rico, the Virgin Islands of the United
States, or the Freely Associated States (as such term is
defined in section 1724(f) of this title), or any other
territory or possession of the United States at Department
facilities or other approved facilities located in such
territory, possession, or Freely Associated State.
``(2) The Secretary may assign multiple physicians to serve
as traveling physicians under this section and may assign
each such physician to serve in a specific territory or
possession.
``(b) Coordination of Care.--In providing care under this
section, traveling physicians shall coordinate with non-
Department medical providers to the extent practicable and
necessary to ensure high quality and coordinated care for
veterans receiving hospital care and medical services.
``(c) Pay.--In addition to pay under section 7431 of this
title, the Secretary shall provide a relocation or retention
bonus to traveling physicians under this section. Such
relocation or retention bonus shall be substantially similar
to a relocation or retention bonus offered under section
7410(a) of this title, as the Secretary considers
appropriate.''.
(b) Clerical Amendment.--The table of sections at the
beginning of such chapter is amended by inserting after the
item relating to section 7414 the following new item:
``7415. Traveling physicians.''.
(c) Technical and Conforming Amendments.--Title 38, United
States Code, is further amended as follows:
(1) In section 7410(a)(1), by--
(A) by striking ``retention allowances'' and inserting
``retention bonuses''; and
(B) by striking the second comma after ``section 7401(1) of
this title''; and
(2) In section 7431(e)(5)(B), by striking ``retention
allowances'' and inserting ``retention bonuses''.
SEC. 305. INCLUSION OF ADAPTIVE PROSTHESES AND TERMINAL
DEVICES FOR SPORTS AND OTHER RECREATIONAL
ACTIVITIES IN MEDICAL SERVICES FURNISHED TO
ELIGIBLE VETERANS BY THE SECRETARY OF VETERANS
AFFAIRS.
Section 1701 of title 38, United States Code, is amended,
in paragraph (6)(F)(i), by inserting ``(including adaptive
prostheses and terminal devices for sports and other
recreational activities that are determined to be clinically
appropriate by the Secretary)'' after ``artificial limbs''.
SEC. 306. MODIFICATIONS TO AND REAUTHORIZATION OF STAFF
SERGEANT PARKER GORDON FOX SUICIDE PREVENTION
GRANT PROGRAM OF DEPARTMENT OF VETERANS
AFFAIRS.
(a) Coordination by Secretary.--Subsection (b) of section
201 of the Commander John Scott Hannon Veterans Mental Health
Care Improvement Act of 2019 (Public Law 116-171; 38 U.S.C.
1720F note) is amended by striking the second sentence.
(b) Use of Grant Funds.--Subsection (c) of such section is
amended--
(1) in the subsection heading, by inserting ``; Use of
Grant Funds'' after ``Grants''; and
(2) by adding at the end the following new paragraphs:
``(3) Renewal of grant amounts.--
``(A) In general.--In determining whether to renew a grant
awarded under this section to an eligible entity, the
Secretary shall consider, among such other factors as the
Secretary may consider appropriate--
``(i) the compliance by the eligible entity in
administering pre- and post-intervention assessments required
under subsection (e)(6); and
``(ii) any demonstrated improvements in participant
outcomes.
``(B) Additional amounts.--Based on a consideration of the
factors described in subparagraph (A), the Secretary may
award amounts, not to exceed $250,000 per grantee per fiscal
year, to a grantee in addition to the maximum amount under
paragraph (2)(A) based on a performance-based metric
established by the Secretary.''.
(c) Priority for New Recipients.--Subsection (d) of such
section is amended--
(1) in the subsection heading, by striking ``and
Preference'' and inserting ``, Preference, and Priority'';
(2) in paragraph (1)(A)--
(A) in clause (iv), by striking the semi-colon at the end
and inserting ``; and'';
(B) by striking clause (v); and
(C) by redesignating clause (vi) as clause (v); and
(3) by adding at the end the following new paragraph:
``(3) Priority for new recipients.--To the maximum extent
practicable, the Secretary shall prioritize grants for
eligible entities that have satisfied the requirements
provided under subsection (f) and are located in States in
which a grant has not been awarded under this section.''.
(d) Requirements for Receipt of Grants.--Subsection (e) of
such section is amended--
(1) in paragraph (3)--
(A) by redesignating subparagraphs (B) and (C) as
subparagraphs (C) and (D), respectively; and
(B) by inserting after subparagraph (A) the following new
subparagraph (B):
``(B) coordinate with the Secretary to develop a plan for
communication between the entity and local mental health
providers of the Department regarding whether veterans
receiving assistance under this section from the entity are
attending appointments to ensure continuity of care;''; and
(2) by adding at the end the following new paragraphs:
``(6) Assessments.--An eligible entity receiving a grant
under this section shall conduct a pre- and post-intervention
assessment with respect to each eligible individual who
receives suicide prevention services pursuant to such grant
across all relevant metrics, as determined by the Secretary.
``(7) Metrics and outcomes.--An eligible entity receiving a
grant under this section shall collect and submit to the
Secretary such metrics and outcome data as the Secretary may
require, including--
``(A) throughput measures, including the number of veterans
screened, referred, connected to care, and retained in
services under the grant program;
``(B) reductions in severity scale measurements, including
reductions in suicidality identified through applicable
inventories or assessments; and
``(C) such other quantifiable metrics as the Secretary
determines appropriate.''.
(e) Training and Technical Assistance.--Subsection (g) of
such section is amended--
(1) in paragraph (1)--
(A) in the matter preceding subparagraph (A), by inserting
``, or interested in receiving such grants,'' after ``this
section''; and
(B) in subparagraph (A), by inserting ``, including
training on how to properly use the Columbia Protocol (also
known as the Columbia-Suicide Severity Rating Scale (C-SSRS))
and other screening tools selected by the Secretary'' after
``management''; and
(2) by adding at the end the following new paragraphs:
``(3) Training for department employees.--The Secretary
shall provide training to employees of the Department as the
Secretary considers appropriate on the grant program under
this section.''.
(f) Briefing for Local VAMCS.--Subsection (h) of such
section is amended by adding at the end the following new
paragraph:
``(5) Briefing for local vamcs.--Not less frequently than
once per year, unless the Secretary determines that such
frequency is not advisable, the Secretary shall provide, to
the appropriate personnel of each medical center of the
Department identified on the grantee's application under this
section, a briefing about the grant program under this
section in order to improve coordination between such
recipient and personnel.''.
[[Page H4567]]
(g) Duration.--Subsection (j) of such section is amended by
striking ``September 30, 2026'' and inserting ``September 30,
2029''.
(h) Reports.--Subsection (k)(2) is amended--
(1) in the paragraph heading, by striking ``Final report''
and inserting ``Annual reports''; and
(2) in subparagraph (B)--
(A) by redesignating clauses (iii) and (iv) as (v) and
(vi), respectively; and
(B) by adding the following new clauses (iii) and (iv):
``(iii) A description of the Secretary's compliance with
the requirement to train employees of the Department under
subsection (g)(3).
``(iv) An optional description and inclusion of subjective
or narrative stories of community or individual impact to
allow grant recipients to share meaningful
accomplishments.''.
(i) Referral for Care.--Subsection (m) of such section is
amended by adding at the end the following new paragraph:
``(4) Required response or action.--(A) If the Secretary
receives a referral under paragraph (1) for additional care,
the Secretary shall review such referral and contact the
veteran not later than 72-hours following the referral.
``(B) If the Secretary receives a referral under paragraph
(2) for emergent suicide care, the Secretary shall review
such referral and contact the veteran not later than 24 hours
following the referral by such entity under subsection
(m)(1).''.
(j) Reauthorization.--Subsection (p) of such section is
amended--
(1) by striking ``section a total'' and inserting
``section--
``(1) a total'';
(2) by striking the period at the end and inserting ``;
and''; and
(3) by adding at the end the following new paragraph:
``(2) a total of $200,000,000 for fiscal years 2027 through
2029.''.
(k) Technical Correction to Definitions.--Subsection (q)(5)
of such section is amended, in the first sentence--
(1) by striking ``Medical services'' and inserting ``The
term `emergency treatment' means medical services''; and
(2) by striking ``was rendered'' and inserting
``rendered''.
(l) Identification of Demand for Other Services and
Support.--Subsection (e) of such section, as amended, is
further amended--
(1) by redesignating paragraphs (5) and (6) as (6) and (7),
respectively; and
(2) by adding after paragraph (4) the following new
paragraph:
``(5) Demand for other services and support.--An entity
receiving a grant under this section shall submit to the
Secretary information concerning--
``(A) the number of individuals seeking services from the
entity who are not eligible individuals and the most common
reason such individuals are not eligible individuals;
``(B) a description of the types of services that eligible
individuals or individuals described in subparagraph (A)
require based on any screening conducted by the entity; and
``(C) any actions taken by the entity to provide the
services described in subparagraph (B) or to refer the
individual or eligible individual to another entity for the
receipt of such services.''.
(m) Suicide Prevention Services.--
(1) Required use of certain screening protocol.--Subsection
(q)(11)(A)(ii) of such section is amended by adding at the
end the following new sentence: ``In the case of a recipient
of a grant awarded under this section on or after the date of
the enactment of the Take Care of America's Veterans Act,
such screening shall be Columbia Protocol (also known as the
Columbia-Suicide Severity Rating Scale (C-SSRS)) or the
Patient Health Questionnaire-9 (PHQ9), or a successor
screening tool selected by the Secretary.'';
(2) Transportation.--Subsection (q)(11)(A) of such section
is amended--
(A) by redesignating clause (xi) as clause (xii); and
(B) by inserting after clause (x) the following new clause:
``(xi) Transportation and rideshare services for eligible
individuals to use for appointments.''.
(n) Eligible Individuals.--Subsection (q)(4)(C) of such
section is amended by striking ``clauses (i) through (iv)''
and inserting ``clauses (i) through (vi)''.
(o) Effective Date.--The amendments made by this section
shall take effect on--
(1) the effective date of award following the date the
Secretary publishes a notice of funding opportunity for the
program required by section 201(a) of the Commander John
Scott Hannon Veterans Mental Health Care Improvement Act of
2019 (Public Law 116-171; (38 U.S.C. 1720F)), if the
Secretary determines such amendments do not require
rulemaking; or
(2) the effective date of award following the date the
Secretary publishes a notice of funding opportunity following
the effective date of subsequent rulemaking, if the Secretary
determines such amendments do require rulemaking.
SEC. 307. REPORTS ON THE USE OF HYPERBARIC OXYGEN THERAPY.
(a) GAO Report on the Use of Hyperbaric Oxygen Therapy to
Treat Traumatic Brain Injury and Post-traumatic Stress
Disorder.--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 House of Representatives an update to the
report titled ``Research on Hyperbaric Oxygen Therapy to
Treat Traumatic Brain Injury and Post-Traumatic Stress
Disorder'' (GAO-16-154). Such report shall include the
assessment of the Comptroller General of clinical trials
conducted, since the publication of such report--
(1) regarding the use of hyperbaric oxygen therapy to treat
traumatic brain injury and post-traumatic stress disorder;
and
(2) by--
(A) the Secretary of Veterans Affairs;
(B) the Secretary of Defense; and
(C) private entities.
(b) Follow-up Study.--
(1) In general.--Not later than 180 days after the date of
the enactment of this Act, the Secretary shall conduct a
systematic review of published research literature on the
off-label use of hyperbaric oxygen therapy to treat post-
traumatic stress disorder and traumatic brain injury among
veterans and nonveterans.
(2) Elements.--The review conducted under paragraph (1)
shall include the following:
(A) An analysis of available research literature published
after the review completed pursuant to section 702 of the
Commander John Scott Hannon Veterans Mental Health Care
Improvement Act (Public Law 116-171);
(B) An assessment of the current parameters for research on
the use by the Department of Veterans Affairs of hyperbaric
oxygen therapy, including--
(i) tests and questionnaires used to determine the efficacy
of such therapy; and
(ii) metrics for determining the success of such therapy.
(C) A comparative analysis of tests and questionnaires used
to study post-traumatic stress disorder and traumatic brain
injury in other research conducted by the Department of
Veterans Affairs, other Federal agencies, and entities
outside the Federal Government.
(D) A market assessment of available hyperbaric oxygen
therapy facilities or units within facilities to assess the
most effective locations and practices, including--
(i) an analysis of whether multi-person chambers could
reduce per-veteran costs;
(ii) an analysis of areas with lower prices compared to a
national average; and
(iii) an identification of not fewer than two VISNs in
which the provision or furnishing of hyperbaric oxygen
therapy would benefit the most number of veterans at the
lowest cost to the Department.
SEC. 308. DEPARTMENT OF VETERANS AFFAIRS PILOT PROGRAM TO
PROVIDE GRANTS TO MENTAL HEALTH CARE PROVIDERS
FOR THE PROVISION OF MENTAL HEALTH CARE FOR
VETERANS.
(a) Establishment.--The Secretary of Veterans Affairs shall
carry out a three-year pilot program under which the
Secretary shall make grants to eligible mental health care
providers for the provision of mental health care, including
evidence-based mental health care delivered in person or via
telehealth.
(b) Eligibility.--To be eligible to receive a grant under
the pilot program, a mental health care provider shall--
(1) be a non-profit organization;
(2) have operated at least one outpatient mental health
facility in the United States for a continuous period of at
least three years;
(3) be licensed or certified under applicable state law to
provide outpatient mental health services;
(4) be accredited by--
(A) the Joint Commission on Accreditation of Healthcare
Organizations;
(B) the Commission on Accreditation of Rehabilitation
Facilities; or
(C) any other nationally recognized accrediting body the
Secretary determines appropriate; and
(5) submit to the Secretary an application that includes
such information and assurances as the Secretary may require,
including--
(A) an identification of the outpatient facility or
facilities where the mental health care services will be
provided;
(B) a plan for providing clinicians at each facility in
receipt of grant funds with units of continuing education
with respect to veterans issues; and
(C) an identification of the percentage of the operating
budget for each such facility that was provided through
Federal grants during the fiscal year preceding the year
during which the application is submitted.
(c) Use of Funds.--
(1) In general.--The recipient of a grant under the pilot
program shall use the grant--
(A) to deliver evidence-based mental health care for
veterans in person or via telehealth;
(B) to operate or expand an existing outpatient mental
health facility or establish a new outpatient mental health
facility for the purpose of providing such care;
(C) to encourage veterans who are eligible for enrollment
in the patient enrollment system under section 1705 of title
38, United States Code, to enroll in such system and to
receive medical services furnished by the Department of
Veterans Affairs;
(D) to support activities necessary to deliver or sustain
care, including--
(i) outreach;
[[Page H4568]]
(ii) care coordination;
(iii) veteran engagement;
(iv) clinician training;
(v) implementation support; and
(vi) program evaluation; and
(E) to support continuous quality improvement and outcomes
measurement activities, including the collection and
reporting of clinical outcomes and operational metrics; and
(F) to support activities of the program that are not
billable, reimbursable, or otherwise authorized by law,
including--
(i) outreach;
(ii) care coordination;
(iii) engagement;
(iv) implementation support; and
(v) program evaluation; and
(G) to provide services to individuals for which
reimbursement is not otherwise available, including such
individuals who are--
(i) uninsured;
(ii) ineligible for health care furnished by the Department
of Veterans Affairs; or
(iii) in receipt of health care that is not reimbursable as
of the date of the enactment of this Act.
(2) Limitations on use of grant funds.--The recipient of a
grant under the pilot program may not--
(A) charge an eligible veteran a fee associated with the
receipt of mental health care funded by such grant;
(B) refuse to provide mental health care to an eligible
veteran on the basis that the veteran is not eligible for
reimbursement for such care under another payer source; or
(C) use grant funds to--
(i) duplicate payments made under any contract or agreement
to which the Department is a party as of the date of the
enactment of this Act; or
(ii) pay for the same clinical services or service units
that are otherwise billable to a Federal payer, including the
Veterans Community Care Program under section 1703 of title
38, United States Code, or any other public or private health
plan.
(3) Rules of construction.--Nothing in this subsection may
be construed to--
(A) prohibit a grant recipient from seeking reimbursement
from non-Department payers for mental health services
provided by the grant recipient, except that grant funds
shall not be used to supplant or duplicate a reimbursement
otherwise available under Federal law; or
(B) authorize double billing or duplicate payments for the
same clinical service or unit of service.
(4) Spouse and dependent care.--A recipient may use grant
funds to provide care to spouses and dependent children of a
veteran when such services are integral to achieving a
successful clinical outcome. Permissible services include--
(A) family therapy;
(B) couples therapy;
(C) group therapy;
(D) family psychoeducation; and
(E) other counseling services the Secretary determines are
clinically necessary.
(d) Selection of Facilities.--In awarding grants under the
pilot program, the Secretary--
(1) shall ensure that grants are distributed geographically
evenly among rural and urban areas;
(2) may consider the proportion of veterans historically
served by the grant recipient; and
(3) may prioritize outpatient mental health facilities
located in areas that the Secretary determines--
(A) are medically underserved;
(B) have large veteran populations;
(C) are located near military installations; or
(D) have large numbers of veterans at high risk of suicide.
(e) Amount of Grant.--
(1) In general.--
(A) In general.--Except as provided in subparagraph (B), no
grant under the pilot program for a facility for any fiscal
year may exceed $1,500,000.
(B) Limitation.--In the case of an outpatient mental health
facility for which at least 50 percent of the operating
budget of the facility for the preceding fiscal year was
provided through Federal grants, no grant under the pilot
program for the facility for any fiscal year may exceed the
lesser of--
(i) 50 percent of the operating budget of the facility; or
(ii) $1,500,000.
(2) Multiple grants.--The recipient of a grant under the
pilot program--
(A) may apply for, and receive, grants for more than one
facility of the recipient for any fiscal year; and
(B) may apply for, and receive, a grant for a facility that
has already received a grant under the pilot program.
(f) Regulations; Accountability.--The Secretary shall
prescribe regulations to carry out this section, which shall
include a requirement that each recipient of a grant under
the pilot program shall--
(1) demonstrate the capacity to provide accountability;
(2) demonstrate clinical outcomes;
(3) justify the effective use of any private investment
funds or Federal grant funds through data collection and
reporting metrics; and
(4) collect standardized outcome measures including symptom
improvement and program completion.
(g) Continuity of Care.--A recipient of a grant under the
pilot program shall adhere to the continuity of care model
established by the Secretary to the Veterans Community Care
Program.
(h) Report.--Not later than 180 days after the completion
of the pilot program under this section, the Secretary shall
submit to Congress a report on the pilot program that
includes the following:
(1) The number of veterans who received mental health care
under the program.
(2) An identification of the types of mental health care
provided and the time period for which such care was
provided.
(3) An identification and summary of program outcomes.
(4) The number of veterans who received mental health care
under the program and subsequently enrolled in the patient
enrollment system under section 1705 of title 38, United
States Code.
(5) An identification of any obstacles faced by grant
recipients in providing mental health care under the program.
(6) A summary of clinical outcomes based on pre- and post-
client functioning--
(A) the number of veterans who improved clinically based on
relevant clinical evaluation metrics that the Secretary
determines appropriate;
(B) the degree of clinical improvement based on such
relevant clinical evaluation metrics;
(C) the total number of veterans participating in the
program; and
(D) any other outcome metrics as the Secretary determines
appropriate.
(7) Findings with respect to the sustainability of the
program.
(i) Authorization of Appropriations.--There is authorized
to be appropriated to the Secretary to carry out the pilot
program under this section $20,000,000 for each of fiscal
years 2027 through 2029.
SEC. 309. FURNISHING OF CERTAIN HEALTH SERVICES TO VETERANS
IN THE FREELY ASSOCIATED STATES.
(a) Agreements Required.--Consistent with section 1724(f)
of title 38, United States Code, and section 209(a)(4)(A) of
the Compact of Free Association Amendments Act of 2024 (48
U.S.C. 1988(a)(4)(A)), the Secretary of Veterans Affairs
shall work expeditiously with the governments of the Freely
Associated States to enter into the agreements described in
such sections.
(b) Inclusion of Telehealth and Mail Order Pharmacy
Services Required.--Consistent with such sections and with
the agreements required by subsection (a), the Secretary
shall furnish to veterans in the Freely Associated States
services that include, at a minimum--
(1) medical services authorized to be provided under
chapter 17 of title 38, United States Code, which can be
administered through telehealth; and
(2) pharmaceutical products authorized to be provided under
such chapter, delivered by mail.
(c) Implementation Dates.--In carrying out subsections (a)
and (b), the Secretary shall--
(1) initiate outreach to each such government not later
than 30 days after the date of the enactment of this Act;
(2) enter into each agreement required by paragraph (1) not
later than one year after the date of the enactment of this
Act; and
(3) begin furnishing the services required by paragraphs
(1) and (2) of subsection (b) not later than one year after
the date of the enactment of this Act.
(d) Beneficiary Travel.--Section 111(h)(1) of title 38,
United States Code, is amended by striking ``the Secretary
may make payments'' and inserting ``beginning not later than
one year after the date of the enactment of the Take Care of
America's Veterans Act, the Secretary shall make payments''.
(e) Reports.--Not less frequently than quarterly, the
Secretary shall submit to the appropriate committees of
Congress a report on the implementation of this section and
the cost of such implementation. Until the Secretary has
entered into the agreements required by subsection (a) and
begun furnishing the services required by paragraphs (1) and
(2) of subsection (b), the report shall also describe the
technical and logistical factors that have prevented or
impeded the Secretary from doing so.
(f) Definitions.--In this subsection:
(1) Appropriate committees of congress.--The term
``appropriate committees of Congress'' means--
(A) the Committee on Veterans' Affairs and the Committee on
Appropriations of the Senate; and
(B) the Committee on Veterans' Affairs and the Committee on
Appropriations of the House of Representatives.
(2) Freely associated states.--The term ``Freely Associated
States'' has the meaning given such term in section 1724(f)
of title 38, United States Code.
SEC. 310. MODIFICATION OF PRECISION MEDICINE FOR VETERANS
INITIATIVE; REPORTING ON SUICIDE BY VETERANS
AND MEMBERS OF THE ARMED FORCES.
(a) Modification of Precision Medicine for Veterans
Initiative.--Section 305 of the Commander John Scott Hannon
Veterans Mental Health Care Improvement Act of 2019 (Public
Law 116-171; 38 U.S.C. 1712A note) is amended--
(1) in subsection (a), by striking ``and such other mental
health conditions'' and inserting ``repetitive low-level
blast exposure, dementia, and such other brain and mental
health conditions'';
[[Page H4569]]
(2) in subsection (d)(4), by adding at the end the
following new subparagraph:
``(E) Data-sharing partnership.--
``(i) In general.--The Secretary shall work with the
Secretary of Defense to establish a data-sharing partnership
between the Department of Veterans Affairs and the Department
of Defense.
``(ii) Storage.--The partnership established under clause
(i) shall be stored in the open platform made available under
this paragraph.
``(iii) Data.--The data supplied by the Secretary of
Defense under the partnership established under clause (i)
shall include relevant data throughout the Department of
Defense relating to low-level repetitive blast exposure and
traumatic brain injury collected by the Armed Forces and
other appropriate entities, as determined jointly by the
Secretary of Defense and the Secretary of Veterans
Affairs.''; and
(3) by adding at the end the following new subsections:
``(f) Repetitive Low-level Blast Exposure Research.--In
carrying out the initiative under subsection (a), the
Secretary shall prioritize research--
``(1) to identify and validate biomarkers associated with
repetitive low-level blast exposure and traumatic brain
injury;
``(2) to evaluate clinical and non-clinical interventions
that improve cognitive function, quality of life, and mental
health outcomes among veterans with symptoms associated with
repetitive low-level blast exposure;
``(3) to improve the diagnosis, treatment, and care
coordination for veterans with a history of low-level
repetitive blast exposure or traumatic brain injury,
including veterans who performed duties or tasks associated
with increased risk of low-level repetitive blast exposure;
and
``(4) to develop evidence-based strategies to reduce
suicide risk among veterans with a history of low-level
repetitive blast exposure or traumatic brain injury.
``(g) Assistance and Report by National Academies of
Sciences, Engineering, and Medicine.--Not later than 180 days
after the date of the enactment of the Take Care of America's
Veterans Act, the Secretary of Veterans Affairs shall seek to
enter into a contract with the National Academies of
Sciences, Engineering, and Medicine under which the National
Academies shall--
``(1) work in tandem with the initiative under subsection
(a) on validation of brain and mental health biomarkers among
veterans; and
``(2) not less frequently than once every two years, 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 work completed under
paragraph (1).
``(h) Assessment.--
``(1) In general.--The Secretary of Veterans Affairs shall
conduct an assessment of all translational research studies
in progress and planned under the initiative under subsection
(a), including research under subsection (f).
``(2) Report.--Not later than 60 days after completion of
the assessment conducted under paragraph (1), the Secretary
shall submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a report on the assessment.
``(i) Reports.--
``(1) In general.--Not less frequently than once every two
years, the Secretary of Veterans Affairs shall submit to the
Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of
Representatives a report on the initiative under subsection
(a).
``(2) Recommendations.--Each report required by paragraph
(1) may include recommendations for immediate administrative
and legislative action to improve the initiative under
subsection (a).
``(j) Authorization of Appropriations.--There is authorized
to be appropriated to the Secretary of Veterans Affairs
$5,000,000 to carry out the initiative under subsection (a)
for each of fiscal years 2027 through 2032.''.
(b) Inclusion of Information in Reports on Suicide
Prevention Among Veterans and Members of the Armed Forces.--
(1) Inclusion of information in national veteran suicide
prevention annual report.--Section 149(a)(4)(B) of the
Senator Elizabeth Dole 21st Century Veterans Healthcare and
Benefits Improvement Act (Public Law 118-210; 38 U.S.C. 1709B
note) is amended by adding at the end the following:
``(iv) Military occupation data of veterans who attempt or
commit suicide.''.
(2) Inclusion of information in department of defense
annual report.--The Secretary of Defense shall include in the
annual report of the Defense Suicide Prevention Office, or
successor office, information on--
(A) occupational data of members of the Armed Forces who
attempt suicide; and
(B) outcomes of suicide prevention interventions among
members of the Armed Forces.
SEC. 311. ESTABLISHMENT OF THE BLAST OVERPRESSURE TASK FORCE
OF THE DEPARTMENT OF VETERANS AFFAIRS.
(a) Establishment.--Not later than 180 days after the date
of the enactment of this Act, the Secretary of Veterans
Affairs shall appoint, through the Department of Veterans
Affairs-Department of Defense Joint Executive Committee under
section 320 of title 38, United States Code, the Blast
Overpressure Task Force of the Department of Veterans Affairs
(in this section referred to as the ``Task Force'').
(b) Membership.--Each member of the Task Force appointed
under subsection (a) shall be a member of the Health
Executive Committee under subsection (b)(2) of such section
who, at the time of appointment, is involved in research
regarding the mitigation and treatment of blast overpressure
or blast exposure.
(c) Duties.--The duties of the Task Force are the
following:
(1) To improve how the Secretary of Veterans Affairs, in
consultation with the Secretary of Defense, provides health
care and other benefits to veterans or members of the Armed
Forces diagnosed with traumatic brain injury, post-traumatic
stress disorder, or other symptoms, from blast overpressure
or blast exposure.
(2) To align research agendas and acquisition strategies of
the Department regarding such health care.
(3) To establish physiological and cognitive performance
baselines for such veterans and members.
(4) To prioritize translational research regarding such
veterans and members, including research regarding--
(A) sleep therapy;
(B) blast-related gut health;
(C) mobile diagnostics;
(D) vestibular dysfunction and balance impairment;
(E) autonomic nervous system dysregulation;
(F) cumulative mild traumatic brain injury;
(G) neuroinflammation and glial activation; and
(H) any other issue determined appropriate by the
Secretary.
(5) To monitor sensory decline (including with regard to
vision, hearing, and vestibular function) and stress-related
impairments among such veterans and members.
(6) To support continuity of such care by integrating
mobile and longitudinal diagnostic tools.
(d) Reports.--The Task Force shall issue annual reports to
the Committees on Veterans' Affairs and on Armed Services of
the Senate and House of Representatives. Each such report
shall include the following elements:
(1) Details of research initiatives, coordination outcomes,
and clinical advancements of the Task Force.
(2) Recommendations of the Task Force regarding--
(A) how claims processors of the Department of Veterans
Affairs should evaluate evidence that links such conditions
to active military, naval, air, or space service; and
(B) best practices regarding the evaluation of neurological
injuries in examinations for benefits under chapters 11 or 15
of title 38, United States Code.
(e) Sunset.--The Task Force shall terminate on September
30, 2029.
SEC. 312. EXTENSION OF SHARING OF DEPARTMENT OF VETERANS
AFFAIRS AND DEPARTMENT OF DEFENSE HEALTH CARE
RESOURCES; RESOURCE SHARING OVERSIGHT AND
IMPLEMENTATION PLAN.
(a) Oversight.--
(1) Justification.--Section 8111 of title 38, United States
Code, is amended, in subsection (a)--
(A) by striking ``The Secretary'' and inserting ``(1) To
the extent practicable, the Secretary''; and
(B) by adding at the end the following new paragraph:
``(2) If the Secretary of Veterans Affairs elects not to
enter into such an agreement or contract, notwithstanding
paragraph (1), the Secretary and the Department of Veterans
Affairs-Department of Defense Joint Executive Committee shall
submit to the Committees on Veterans' Affairs of the House of
Representatives and the Senate a written justification for
such election.''.
(2) Information.--Such section is further amended by
inserting, after subsection (b), the following new subsection
(c):
``(c) Information.--(1) If the Committee on Veterans'
Affairs of the House of Representatives or the Senate
requests information from the Secretary of Veterans Affairs
regarding section, the Secretary shall provide such
information in the form requested by such committee,
including underlying records, datasets, methodologies,
contracts, and communications, and may not be limited to
summaries or briefing materials in lieu of original source
documents unless authorized by the requesting committee.
``(2) In response to such a request, no official or
employee of the Department of Veterans Affairs shall--
``(A) withhold, screen, or alter responsive information;
``(B) delay or condition production on initial clearance or
political review;
``(C) require a nondisclosure agreement unless required by
law;
``(D) substitute summaries for requested records; or
``(E) otherwise impede or interfere with direct
transmission of information to the Committee on Veterans'
Affairs of the House of Representatives or the Senate.
``(3) If, in responding to such a request, the Secretary
determines that any such information is classified, the
Secretary shall make arrangements to present such information
to the Chair and Ranking Member of such committee using
appropriate security measures.''.
(3) Extension.--Such section is further amended, in
subsection (d)(3), by striking
[[Page H4570]]
``September 30, 2026'' and inserting ``September 30, 2027''.
(c) Implementation Plan and Report.--
(1) Joint resource sharing implementation plan.--Not later
than 90 days after the date of the enactment of this Act, the
Secretary of Veterans Affairs, in coordination with the
Secretary of Defense, shall submit to the Committees on
Veterans' Affairs of the House of Representatives and the
Senate a Joint Resource Sharing Implementation Plan. Such
plan shall include--
(A) a comprehensive inventory of all agreements under
section 8111 of title 38, United States Code;
(B) a standardized reimbursement methodology;
(C) capacity assessments of Department of Veterans Affairs
and Department of Defense facilities; and
(D) identification of priority regions for expansion.
(2) Report.--Not later than 2 years after the date of the
enactment of this Act, the Comptroller General shall submit a
report to Congress on the implementation of section 8111 of
title 38, United States Code. Such report shall include--
(A) a description of use and effectiveness of agreements
under such section;
(B) a description of the role and output of the Joint
Executive Committee under such section;
(C) an evaluation of the effectiveness of coordination of
care and sharing of resources by the Department of Veterans
Affairs and the Department of Defense under such section; and
(D) a description of any statutory, operational, or
cultural barriers to the implementation of such section.
SEC. 313. TIMELY REPORTING OF THE DEATH OF A VETERAN.
(a) Findings.--Congress finds the following:
(1) States and counties have reported significant delays in
the signing of death certificates for veterans who pass away
from natural causes.
(2) Such delays, caused by the refusal of, or postponement
by, physicians of the Department of Veterans Affairs have, in
some cases, lasted as long as eight weeks.
(3) Such delays prevent the timely burial of deceased
veterans and access to survivor benefits.
(b) Timely Certification of the Death of a Veteran.--
(1) In general.--
(A) VA physician, nurse practitioner, or physician
assistant.--Subject to subparagraph (B), a physician, nurse
practitioner, or physician assistant employed by the
Secretary of Veterans Affairs who is the primary care
provider of a veteran who dies of natural causes shall
certify the death of such veteran not later than two business
days after such physician, nurse practitioner, or physician
assistant learns of such death.
(B) Coroner or medical examiner.--If a physician, nurse
practitioner, or physician assistant described in
subparagraph (A) cannot comply with such paragraph with
respect to a death described in such paragraph, a coroner or
medical examiner in the jurisdiction where such death
occurred may certify such death.
(2) Report.--
(A) In general.--Not later than one year after the date of
the enactment of this Act, and annually thereafter for the
following five years, 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 regarding compliance with paragraph
(1).
(B) Elements.--Each report required under subparagraph (A)
shall include, with respect to the year preceding the date of
the report, the following elements:
(i) The percentage of cases in which a physician, nurse
practitioner, or physician assistant employed by the
Secretary complied with paragraph (1)(A).
(ii) The number of cases in which such a physician, nurse
practitioner, or physician assistant could not so comply.
(iii) An identification of the most common reasons why such
a physician, nurse practitioner, or physician assistant could
not so comply.
(3) Rule of construction.--Nothing in this section shall be
construed to authorize a physician assistant or nurse
practitioner to certify a death in any State in which such
authority is not permitted under State or local law.
SEC. 314. EXPANSION OF ACCESS BY VETERANS TO CRITICAL ACCESS
HOSPITALS AND AFFILIATED CLINICS UNDER THE
VETERANS COMMUNITY CARE PROGRAM.
(a) Pilot Program to Improve Care Coordination for Veterans
From Critical Access Hospitals and Affiliated Clinics.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall commence a five-year pilot program to improve care
coordination for eligible veterans who receive care from a
critical access hospital or a provider-based rural health
clinic affiliated with such hospital (in this section
referred to as the ``pilot program'').
(2) Contracts, agreements, or other arrangements.--
(A) In general.--In carrying out the pilot program, the
Secretary shall enter into contracts, agreements, or other
arrangements with facilities participating in the pilot
program to reimburse critical access hospitals and affiliated
clinics for outpatient health care and medical services
provided to eligible veterans.
(B) Elements.--The Secretary, in coordination with
participating critical access hospitals, shall ensure that
any contract, agreement, or other arrangement entered into
under subparagraph (A) establishes criteria, as the Secretary
considers appropriate, to ensure--
(i) the provision of timely, safe, and high-quality health
care services to participants in the pilot program, including
through timely sharing of pertinent medical record and other
information between medical facilities participating in the
pilot program and medical facilities of the Department of
Veterans Affairs;
(ii) the provision of health care services through the
pilot program is in accordance with the medical benefits
package of the Department;
(iii) no additional charges are imposed on veterans
participating in the pilot program or the health care insurer
of such veterans for any medical service for which payment is
made by the Secretary;
(iv) appropriate reimbursement rates, including through the
consideration of cost-based reimbursements; and
(v) such other considerations as the Secretary considers
appropriate.
(3) Locations.--The Secretary shall ensure participation in
the pilot program is open to all qualified facilities located
in States that are designated by the Centers for Medicare &
Medicaid Services as frontier States.
(4) Authorization for care.--The Secretary shall provide
eligible veterans opting to participate in the pilot program
a one-year authorization from the Department to receive
outpatient services at facilities participating in the pilot
program.
(5) Outreach.--
(A) Eligible veterans.--Not less frequently than annually
during each year in which the pilot program is carried out,
the Secretary shall conduct direct outreach to eligible
veterans in areas in which the pilot program is carried out
to notify such veterans of their ability to participate in
the pilot program.
(B) Hospitals.--The Secretary shall conduct direct outreach
to critical access hospitals in areas in which the pilot
program is carried out to notify those hospitals of their
ability to participate in the pilot program.
(6) Staff.--The Secretary shall ensure that each medical
facility of the Department within the catchment area of a
location in which the pilot program is carried out has
sufficient dedicated staff to handle--
(A) administrative and technical challenges that arise from
the pilot program;
(B) care coordination and follow up with the veteran and
the facility participating in the pilot program after an
episode of care; and
(C) timely records return following an episode of care.
(7) Limitation.--The Secretary may not extend the pilot
program beyond the five-year period specified under
subsection (a) or expand the pilot program to additional
States or convert the pilot program into a permanent
authority unless expressly authorized by a subsequent Act of
Congress.
(8) Report.--
(A) In general.--Not later than one year after the date of
the enactment of this Act, and annually thereafter for the
duration of the pilot program, 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 pilot program.
(B) Elements.--
(i) In general.--Each report required under subparagraph
(A) shall contain the recommendation of the Secretary for the
expansion or continuation of the pilot program.
(ii) Initial report.--The initial report required under
clause (i) shall contain--
(I) a description of the outreach conducted to critical
access hospitals concerning the pilot program;
(II) a list of facilities that have opted to participate in
the pilot program;
(III) information, by facility, regarding total obligations
and expenditures, utilization, average time from
authorization to care, timeliness regarding medical records
return and claim payment, emergency department utilization,
veteran satisfaction, and any effect on care furnished by
Department facilities; and
(IV) a list of the barriers, if any, cited by facilities
that opted not to participate in the pilot program.
(iii) Subsequent reports.--Each report required under
clause (i) after the initial report shall contain--
(I) an updated list of facilities participating in the
pilot program;
(II) the number of veterans participating in the pilot
program, disaggregated by facility;
(III) an overview of the types of care received through the
pilot program;
(IV) feedback from the facilities participating in the
pilot program, with identifying information removed,
regarding the status of the pilot program, challenges in
participating in the pilot program, and the interest of the
facility in continued participation in such a program; and
(V) any additional information that the Secretary
determines relevant or necessary.
(9) Definitions.--In this subsection:
(A) Critical access hospital.--The term ``critical access
hospital'' has the meaning
[[Page H4571]]
given that term in section 1861(mm) of the Social Security
Act (42 U.S.C. 1395x(mm)).
(B) Eligible veteran.--The term ``eligible veteran'' means
a veteran--
(i) 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;
(ii) who has received care at a facility of the Department
or in-network provider under the Veterans Community Care
Program under section 1703 of such title during the previous
two-year period;
(iii) who lives within 35 miles of a critical access
hospital; and
(iv) who would be eligible for care or services under the
Veterans Community Care Program.
(b) Action Plan to Address Barriers to Care for Veterans
Living in Rural Areas.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall develop and submit to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans' Affairs
of the House of Representatives a comprehensive action plan
to identify, address, and eliminate barriers to accessing
care for veterans residing in rural, highly rural, and
frontier areas.
(2) Elements.--In developing the action plan required under
paragraph (1), the Secretary shall--
(A) consult with health care providers that provide care in
the community under the laws administered by the Secretary,
State Offices of Rural Health, Tribal health authorities, and
other relevant stakeholders in rural, highly rural, and
frontier areas as the Secretary determines appropriate;
(B) assess barriers to care in the community for veterans
residing in rural and highly rural areas, including
challenges with respect to--
(i) network adequacy;
(ii) provider participation;
(iii) geographic distance;
(iv) transportation;
(v) information technology;
(vi) physical infrastructure;
(vii) outreach and understanding of eligibility for such
care;
(viii) timeliness of referrals, authorization, and medical
documentation exchange; and
(ix) any other matter the Secretary determines appropriate;
(C) list specific and measurable strategies and actions to
address the barriers and challenges assessed under
subparagraph (B), to include the consideration of--
(i) expanding participation in the Veterans Community Care
Program under section 1703 of title 38, United States Code,
among providers in rural, highly rural, and frontier areas;
(ii) physically locating health care facilities of the
Department of Veterans Affairs within the same building or on
the campuses of other health care facilities located in
rural, highly rural, or frontier areas;
(iii) enhancing transportation assistance;
(iv) increasing reimbursement rates, including through
cost-based reimbursements; and
(v) improving coordination with State, Tribal, and local
partners; and
(D) assess legislative and regulatory barriers, if any, to
addressing the barriers assessed under subparagraph (B).
(3) Implementation.--Not later than 90 days after
submitting the action plan under paragraph (1), the Secretary
shall begin implementation of the plan and shall ensure full
implementation not later than two years after the date of the
enactment of this Act.
(c) Outreach.--
(1) Outreach to veterans.--Not later than one year after
the date of the enactment of this Act, and annually
thereafter, the Secretary of Veterans Affairs, through the
Office of Rural Health (or successor office) and the Office
of Integrated Veteran Care (or successor office), shall
conduct outreach to veterans residing in rural, highly rural,
and frontier areas regarding--
(A) opportunities to seek care through facilities and
programs of the Department of Veterans Affairs, including via
telehealth, existing programs provided through grantees or
contractors of the Department, Vet Centers (as defined in
section 1712A of title 38, United States Code), and volunteer
programs and services for transportation;
(B) opportunities to seek care though the Veterans
Community Care Program under section 1703 of title 38, United
States Code;
(C) opportunities to seek care at critical access hospitals
with contracts, partnerships, or agreements with the
Department of Veterans Affairs; and
(D) any other matters the Secretary considers appropriate.
(2) Outreach to providers.--Not later than one year after
the date of the enactment of this Act, and annually
thereafter, the Secretary of Veterans Affairs, through the
Office of Rural Health (or successor office) and the Office
of Integrated Veteran Care (or successor office), shall--
(A) conduct outreach to health care facilities and critical
access hospitals in rural areas regarding--
(i) the Veterans Community Care program under section 1703
of title 38, United States Code, and the pilot program under
subsection (a) of this section; and
(ii) any other matters the Secretary considers appropriate;
and
(B) seek to enter into contracts, partnerships, agreements,
or other arrangements with health care facilities and
critical access hospitals in rural areas.
(3) Critical access hospital defined.--In this section, the
term ``critical access hospital'' has the meaning given that
term in section 1861(mm) of the Social Security Act (42
U.S.C. 1395x(mm)).
SEC. 315. PILOT PLATFORM FOR SERVICES FOR VETERANS;
COLLECTION FROM VETERANS OF INFORMATION RELATED
TO SOCIAL DETERMINANTS OF HEALTH.
(a) Pilot Program on Establishment or Enhancement of
Community Integration Platform for Veterans.--
(1) In general.--Commencing not later than 18 months after
the date of the enactment of this Act, the Secretary of
Veterans Affairs, acting through the Center for Innovation
for Care and Payment of the Department of Veterans Affairs,
shall carry out a pilot program under which the Secretary
shall establish a new, or enhance an existing, interoperable
community integration platform to coordinate local support
services for veterans through other governmental and
nongovernmental organizations (in this section referred to as
the ``pilot program'').
(2) Elements of pilot program.--In carrying out the pilot
program, the Secretary shall ensure that the community
integration platform established or enhanced under the pilot
program--
(A) permits veterans to identify and connect with covered
entities that furnish covered services;
(B) permits covered entities to identify and connect with
veterans in need of covered services;
(C) utilizes, to the extent practicable, existing
interoperable technology networks;
(D) prioritizes connectivity with appropriate existing
technology networks developed by public or private
organizations that comply with, as applicable, standards
adopted by the Secretary of Health and Human Services under
section 3004 of the Public Health Service Act (42 U.S.C.
300jj-14), for the provision of covered services;
(E) ensures that--
(i) reasonable measures are taken to promote connectivity
and interoperable exchange among covered entities and between
covered entities and veterans; and
(ii) appropriate privacy and security protections are in
place, in accordance with applicable Federal and State
privacy law;
(F) is accessible by employees of the Department, covered
entities, and veterans;
(G) connects covered entities and veterans for purposes of
communication, service coordination, and consumer assistance,
referral and capacity management, outcome tracking and
reporting, and related services; and
(H) is accessible via a web-based platform for all veterans
and via a non-web-based alternative platform or process for
veterans who are unable to easily and reliably access the
web-based platform.
(3) Locations.--
(A) Initial locations.--The Secretary shall carry out the
pilot program at not fewer than five medical facilities of
the Department of Veterans Affairs selected by the Secretary
for purposes of the pilot program.
(B) Expansion.--The Secretary may expand beyond initial
sites for the pilot program selected under paragraph (1) not
before two years after the date of enactment, not before
thirty days after briefing the Committees on Veterans'
Affairs of the Senate and the House of the expansion plan,
and after demonstrated success.
(C) Variety of facilities.--In selecting facilities under
subparagraph (A), the Secretary shall ensure the selection of
a variety of different types of facilities, including--
(i) frontier facilities;
(ii) under-resourced facilities;
(iii) facilities at which there are existing efforts to
coordinate with community resources; and
(iv) facilities located in communities with an established
community-based veteran service coordination network capable
of integration with the pilot program.
(4) Procurement of technology.--In carrying out the pilot
program, the Secretary shall ensure full and open competition
in the procurement of any services or technology and shall
not enter into an exclusive national contract for the
operation of the community integration platform under the
pilot program. In procuring technology under this section,
the Secretary may prioritize, to the maximum extent
practicable, technologies, platforms, or capabilities that
are already deployed, validated, interoperable, or otherwise
in operational use within medical centers or other components
of the Department, unless the Secretary determines and
documents that an alternative solution would better achieve
the purposes of this section.
(5) Application process.--
(A) In general.--The Secretary may require covered entities
that seek to participate in the pilot program to submit to
the Secretary an application therefore in such form, in such
manner, and containing such commitments and information as
the Secretary considers necessary to carry out this section.
(B) Review.--
(i) In general.--The Secretary shall review the
applications of covered entities submitted under subparagraph
(A) to ensure that the participation of such entities would
be safe and appropriate for veterans participating in the
pilot program.
(ii) Due diligence.--In reviewing applications under clause
(i), the Secretary shall conduct due diligence consistent
with how
[[Page H4572]]
the Secretary conducts due diligence for public-private
partnerships under other laws administered by the Secretary.
(6) Screening and tracking of participants.--
(A) In general.--The Secretary shall require veterans
participating in the community integration platform under the
pilot program to provide information regarding social
determinants of health using the ICD-10 diagnostic codes Z55
through Z63 and Z75 (as in effect on the date of the
enactment of this Act) in a standardized risk assessment or
screening tool and such other information as the Secretary
considers necessary to administer the pilot program.
(B) Informed consent.--Information collected under the
pilot program with respect to a veteran shall be obtained
with the informed consent of the veteran and used solely for
purposes of care coordination, service delivery, or program
evaluation under the pilot program.
(C) Tracking of information.--
(i) In general.--The Secretary shall track--
(I) the number of referrals of veterans to covered entities
through the community integration platform under the pilot
program;
(II) the response time of covered entities to which such
veterans are referred; and
(III) the outcome of the initial meeting by a veteran and a
covered entity to which the veteran is referred, including a
description of the services that are provided to the veteran
by such entity.
(ii) Tracking by entities.--The Secretary may require
covered entities participating in the pilot program to track
the information required under clause (i) in a medium
determined appropriate by the Secretary.
(7) Coordination and integration of programs.--
(A) Coordination with existing networks.--In carrying out
the pilot program, the Secretary shall coordinate with
existing community networks.
(B) Coordination and integration with state medicaid
programs.--The Secretary may consult and coordinate with the
Secretary of Health and Human Services and with States
regarding existing Federal and State programs, but nothing in
this section shall be construed to authorize the Secretary of
Veterans Affairs to administer, direct, or modify a State
Medicaid program or waiver.
(8) Performance benchmarks.--The Secretary shall establish
performance benchmarks for the pilot program, including
measures of referral completion, timeliness of service
connection, and veteran-reported satisfaction.
(9) Report and briefings.--
(A) Report.--Not later than three years after the
commencement of the pilot program, the Secretary shall submit
to the appropriate committees of Congress a report analyzing
the needs of veterans for covered services reflected by the
use of such services under the community integration platform
under the pilot program, including an assessment of--
(i) the need for such services that is being met through
such platform; and
(ii) the need for such services that is not being met
through such platform.
(B) Briefing on entities not selected.--Not later than 180
days after the commencement of the pilot program, and not
less frequently than once every 180 days thereafter until the
conclusion of the pilot program, the Secretary shall brief
the appropriate committees of Congress on the covered
entities that submitted an application to participate in the
pilot program but were not selected for participation and the
reason those entities were not selected.
(10) Comptroller general evaluation, report, and
recommendations.--
(A) Evaluation.--The Comptroller General of the United
States shall conduct an evaluation that measures the overall
impact of the community integration platform established or
enhanced under the pilot program with respect to--
(i) changes in individual and population health outcomes
among veterans;
(ii) changes in access to health care or social services
among veterans; and
(iii) such other factors as the Comptroller General
considers appropriate.
(B) Report and recommendations.--
(i) In general.--Not later than four years after the
commencement of the pilot program, the Comptroller General
shall--
(I) submit to Congress a report on the evaluation conducted
under subparagraph (A);
(II) make such report publicly available; and
(III) based on such evaluation, make recommendations to the
Secretary on how to improve and sustain the community
integration platform established or enhanced under the pilot
program.
(ii) Elements of report.--The report under clause (i)(I)
shall include data on--
(I) what covered services under the pilot program are being
utilized the most;
(II) what requests for services under the pilot program
cannot be met; and
(III) the impact of the provision of services under the
pilot program on health outcomes of veterans.
(11) Limitations.--(A) The Secretary may not use the pilot
program established under subsection (a) to supplant services
otherwise required to be furnished by the Department under
title 38, United States Code.
(B) No covered entity participating in the pilot program
established under subsection (a) may receive access to
personally identifiable information, protected health
information, or social determinants information of a veteran
without the veteran's informed written consent, and such
information may be used only for the specific referral or
service authorized by the veteran.
(12) Definitions.--In this subsection:
(A) Appropriate committees of congress.--The term
``appropriate committees of Congress'' means the Committee on
Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives.
(B) Community integration platform.--The term ``community
integration platform'' means an interoperable platform or
network of interoperable systems used to enable the
coordination, alignment, and connection of covered entities
and veterans at the local level for purposes of
communication, service coordination, and referral management
of covered services.
(C) Covered entity.--The term ``covered entity'' means any
of the following entities or providers that have entered into
an agreement with the Secretary to participate in the pilot
program:
(i) A community-based organization that--
(I) accepts referrals from health care organizations; and
(II) provides covered services.
(ii) A public or private health care provider organization.
(iii) A public or private funded payor of health care
services, including home- or community-based services.
(iv) A State, local, territorial, or Tribal health or
social services agency.
(v) A State public housing authority or housing finance
agency.
(vi) A public health information exchange or public health
information network, as defined by the Secretary.
(vii) A faith-based service provider.
(viii) Any other similar entity, as determined by the
Secretary.
(D) Covered services.--The term ``covered services'' means
any of the following:
(i) Nutritional assistance.
(ii) Housing.
(iii) Health care, including preventive health
intervention, chronic disease management, and behavioral
health care.
(iv) Transportation.
(v) Job training and employment.
(vi) Child development or care.
(vii) Caregiving and respite care.
(viii) Disability assistance.
(ix) Suicide prevention.
(x) Sexual assault services.
(xi) Legal aid.
(xii) Transition assistance for veterans newly separated or
discharged from active military, naval, air, or space service
(as defined in section 101(24) of title 38, United States
Code).
(xiii) Assistance with utilities necessary for safe
habitation.
(xiv) Other services directly related to health care
access, suicide prevention, homelessness prevention, food
insecurity, transportation to health care, or assistance
separating from military service and reentering civilian
life, as expressly authorized under laws administered by the
Secretary.
(E) Secretary.--The term ``Secretary'' means the Secretary
of Veterans Affairs.
(F) State.--The term ``State'' has the meaning given that
term in section 101 of title 38, United States Code.
(b) Collection of Information From Veterans Related to
Social Determinants of Health.--
(1) In general.--The Secretary of Veterans Affairs shall
collect from 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, as part of routine screenings of such
veterans under the laws administered by the Secretary,
information related to social determinants that may factor
into the health of such veterans.
(2) Social determinants of health.--
(A) In general.--The information collected under paragraph
(1) shall include standardized definitions for identifying
social determinants of health needs identified in the ICD-10
diagnostic codes Z55 through Z63 and Z75 (as in effect on the
date of enactment of this Act).
(B) Incorporation of measures.--Definitions included under
subparagraph (A) with respect to identifying social
determinants of health needs shall incorporate measures for
quantifying the relative severity of any such social
determinant of health need identified in an individual.
SEC. 316. IMPROVEMENTS TO DEPARTMENT OF VETERANS AFFAIRS
PROSTHETIC AND REHABILITATIVE ITEMS AND
SERVICE.
(a) Prosthetic and Rehabilitative Items and Services
Formulary.--
(1) In general.--Chapter 17 of title 38, United States
Code, is amended by inserting after section 1709C the
following new section:
``Sec. 1709D. Prosthetic and Rehabilitative Items and
Services Formulary
``(a) In General.--The Secretary shall establish a list of
prosthetic and rehabilitative items and services, which may
be referred to as the `Prosthetic and Rehabilitative Items
and Services Formulary' or the `Formulary', for purposes of
furnishing medical services under section 1701(6)(F) of this
title pursuant to section 1710 of this title.
``(b) Requirements.--
``(1) Input.--In developing the Formulary, the Secretary
shall solicit input from veterans and the public.
[[Page H4573]]
``(2) Availability of items.--The Secretary shall ensure
that all items and services included in the Formulary are
available at or through all facilities of the Department.
``(3) Items to be included.--In developing the Formulary,
the Secretary shall rely on the best available evidence to
identify which items and services should be included on the
Formulary.
``(c) Publication and Communication.--
``(1) Publication and update.--The Secretary shall publish
the Formulary on a website of the Department and shall update
the Formulary periodically.
``(2) Communication.--The Secretary shall communicate to
veterans the contents of the Formulary and information about
how to appeal decisions regarding the provision of items and
services on the Formulary.
``(d) Contracts.--The Secretary shall enter into such
contracts as the Secretary considers necessary to support the
availability of items and services included in the Formulary.
``(e) Training.--The Secretary shall ensure the
availability of training on the Formulary for clinicians and
other staff of the Department.
``(f) Exceptions.--
``(1) In general.--The Secretary shall establish a process
for clinicians of the Department to request, prescribe, and
furnish prosthetic and rehabilitative items and services that
are not included on the Formulary when medically necessary.
``(2) Monitoring of non-formulary items and services.--The
Secretary shall monitor requests and prescriptions for and
the furnishing of prosthetic and rehabilitative items and
services under paragraph (1)--
``(A) to ensure that such items and services are being
consistently and appropriately prescribed at all facilities
of the Department; and
``(B) to determine whether such items or services should be
added to the Formulary.
``(3) Prior authorization for non-formulary procurement.--
The Secretary shall establish a prior authorization process
for the procurement of prosthetic and rehabilitative items
that are not included on the Formulary or available through a
national contract.
``(4) Open market procurement.--The Secretary shall ensure
that procurement of items that are not included on the
Formulary or available through a national contract is
permitted only if a clinician determines the item is
medically necessary.
``(g) Consideration.--In developing the Formulary, the
Secretary shall consider how the approach of the Pharmacy
Benefits Management Services of the Department for formulary
management and medication safety can be adapted to support
the efficient and effective administration of the Formulary.
``(h) Enterprise Procurement and Ordering System.--
``(1) In general.--The Secretary shall implement an
enterprise electronic ordering system for prosthetic and
rehabilitative items and services furnished under this
section.
``(2) Systems elements.--The system required under
paragraph (1) shall--
``(A) enable the automated ordering of items included on
the Formulary;
``(B) provide visibility of contract pricing and
availability across all facilities of the Department;
``(C) allow enterprise loading of nationally contracted
products;
``(D) provide procurement analytics to monitor compliance
with national contracts and reduce open market purchasing;
and
``(E) contain all data elements required for the Federal
Electronic Healthcare Record in a searchable format.
``(3) Implementation.--The Secretary shall ensure that the
system required under paragraph (1) is implemented across all
medical centers of the Department by not later than three
years after the date of the enactment of this section.
``(i) Program Management.--
``(1) In general.--The Secretary shall ensure that the
Prosthetic and Sensory Aids Service of the Department
maintains adequate staffing to administer the Formulary and
associated procurement programs.
``(2) Staffing included.--Staffing required under paragraph
(1) shall include--
``(A) dedicated program managers for major prosthetic
product categories; and
``(B) full-time clinical staff responsible for clinical
evaluations and practice recommendations.
``(j) Report to Congress.--Not later than two years after
the date of the enactment of this section, and annually
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
describing--
``(1) rates of compliance by the Department with national
prosthetic contracts;
``(2) open market purchasing trends of the Department;
``(3) utilization of the Formulary across facilities of the
Department; and
``(4) steps taken by the Department to improve enterprise
procurement efficiency.''.
(2) Clerical amendment.--The table of sections at the
beginning of such chapter is amended by inserting after the
item relating to section 1709C the following new item:
``1709D. Prosthetic and rehabilitative items and services formulary''.
(b) Report.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a report containing a comprehensive,
independent, operational, and technology assessment for the
implementation of the Prosthetic and Rehabilitative Items and
Services Formulary established under section 1709D of title
38, United States Code, as added by subsection (a).
(2) Elements.--The report required by paragraph (1) shall
identify potential impacts of the Prosthetic and
Rehabilitative Items and Services Formulary on--
(A) access by veterans to prosthetic and rehabilitative
items and services;
(B) clinician workload;
(C) procurement timelines; and
(D) innovation adoption.
SEC. 317. IMPROVEMENT OF SUBMISSION OF MEDICAL DOCUMENTATION
TO THE SECRETARY OF VETERANS AFFAIRS BY
COMMUNITY CARE PROVIDERS.
(a) In General.--The Secretary of Veterans Affairs shall
ensure that each contract, agreement, or other arrangement
through which the Secretary furnishes hospital care, medical
services, or extended care services to eligible veterans
through non-Department of Veterans Affairs entities or
providers includes clear requirements, including requirements
regarding timeliness, regarding the submission of medical
documentation to the Secretary after a veteran receives such
care or services from the non-Department entity or provider.
(b) Internal Measures.--The Secretary shall establish such
goals and related performance measures for medical centers of
the Department as the Secretary determines appropriate in
obtaining medical documentation from non-Department entities
or providers under subsection (a).
(c) Training.--The Secretary may establish goals and
related performance measures for the completion by non-
Department entities or providers of core training related to
the submission to the Secretary of medical documentation
under subsection (a) and may monitor the completion of such
training.
(d) Outreach.--The Secretary shall ensure that
communications by the Secretary with non-Department entities
or providers contain clear and accurate information regarding
requirements for submitting medical documentation under
subsection (a) and completing the core training described in
subsection (c).
(e) Submission of Goals, Measures, and Materials.--Not
later than one year after the date of the enactment of this
Act, and not less frequently than annually thereafter for the
following five years, the Secretary shall submit to the
Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of
Representatives copies of any goals, performance measures,
training materials, or outreach materials pertaining to the
submission of medical documentation under this section.
SEC. 318. IMPLEMENTATION OF AND REPORT ON EFFORTS OF
DEPARTMENT OF VETERANS AFFAIRS TO IMPROVE
HEALTH CARE APPOINTMENT SCHEDULING.
(a) In General.--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 plan
to improve the process for scheduling appointments for health
care from the Department of Veterans Affairs, including
improvements for both patients and employees of the
Department responsible for scheduling such appointments.
(b) Elements of Plan.--
(1) In general.--The plan required by subsection (a) shall
include--
(A) such actions, resources, technology, and process
improvements as the Secretary determines necessary to ensure
the Department achieves, in a timely manner, improved
delivery of health care, access to health care, customer
experience and service relating to the receipt of health
care, and efficiency with respect to the delivery of health
care; and
(B) a proposed schedule and timeline to carry out such
plan.
(2) Objectives.--
(A) In general.--The Secretary shall ensure that the plan
required by subsection (a) addresses the following
objectives:
(i) To develop or continue the development of a scheduling
system that enables both personnel and patients of the
Department to view available appointments for care furnished
by the Department, including primary care, mental health
care, and all forms of specialty care.
(ii) To develop or continue the development of a self-
service scheduling platform, available for use by all
patients of the Department, which shall--
(I) enable such patients to view available appointments
and, subject to the process described in clause (iii), fully
schedule appointments for all care furnished by the
Department;
(II) if a referral is required for an appointment, provide
a method for the patient to request a referral and
subsequently book an appointment if the referral is approved;
and
(III) provide such patients with the ability to cancel or
reschedule appointments.
(iii) To create a process through which all patients of the
Department can telephonically speak with a scheduler who can
assist the patient to determine appointment availability and
can fully schedule appointments on behalf of the patient for
all care furnished by the Department.
(iv) To carry out such other functions, oversight, metric
development and tracking,
[[Page H4574]]
change management, cross-Department coordination, and other
related matters, including improvements to employee-facing
information technology, training, and processes, as the
Secretary determines appropriate as it relates to scheduling
tools, functions, and operations with respect to health care
appointments furnished by the Department.
(B) Explanation of inability to implement certain
objectives, features, or services.--If the Secretary
determines that an objective under subparagraph (A), or any
feature or service in connection with that objective, cannot
be implemented or otherwise incorporated into a final product
pursuant to the plan required by subsection (a), the
Secretary shall include with the plan submitted under such
subsection a report containing--
(i) an explanation as to why that objective, feature, or
service cannot be implemented or incorporated, as the case
may be; and
(ii) a plan for implementing the plan required by
subsection (a) without that objective, feature, or service.
(c) Implementation.--Not later than two years after
submitting to the appropriate committees of Congress the plan
required by subsection (a), the Secretary shall fully
implement the plan.
(d) Coordination With Electronic Health Record
Modernization Program.--In developing the plan required by
subsection (a), the Secretary shall ensure that the elements
and objectives of such plan set forth under subsection (b)
are developed in consideration of the deployment schedule and
capabilities of the Electronic Health Record Modernization
Program of the Department to ensure a smooth transition to
using the tools and features under such plan as relevant and
appropriate.
(e) Implementation Reports.--Not later than each of one
year and two years after the date on which the Secretary
submits the plan required by subsection (a), the Secretary
shall submit to the appropriate committees of Congress a
report on the progress of the Secretary in implementing such
plan, including--
(1) the costs incurred to implement the plan as of the date
of the report;
(2) the expected costs to complete implementation of the
plan (including costs for management and technology);
(3) the schedule for deployment of any capabilities
developed pursuant to the plan; and
(4) the goals and metrics achieved, challenges, and lessons
learned in implementing the plan.
(f) Rule of Construction.--Nothing in this section shall be
construed to require the Secretary to include in the plan
required by subsection (a) any technology or process that
would preclude or impede the ability of a veteran to contact
or schedule an appointment directly with a facility or
provider through a non-online scheduling process, should the
veteran choose to do so.
(g) Definitions.--In this section:
(1) Appropriate committees of congress.--The term
``appropriate committees of Congress'' means the Committee on
Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives.
(2) Fully schedule.--The term ``fully schedule'', with
respect to an appointment for health care, means that the
appointment booking is completed, rather than simply
requested.
SEC. 319. PILOT PROGRAM ON COORDINATION OF CARE BETWEEN
DEPARTMENT OF VETERANS AFFAIRS AND MEDICARE
PROGRAM.
(a) In General.--The Secretary, in consultation with the
Secretary of Health and Human Services, shall carry out a
pilot program (in this section referred to as the ``pilot
program'') to coordinate, navigate, and manage care and
benefits for covered veterans.
(b) Purposes of Pilot Program.--The purposes of the pilot
program are as follows:
(1) To improve access to health care services for covered
veterans from the Department of Veterans Affairs and under
the Medicare program under title XVIII of the Social Security
Act (42 U.S.C. 1395 et seq.).
(2) To improve satisfaction with care received by covered
veterans.
(3) To improve quality of care received by covered
veterans.
(4) To lower costs to the Federal Government for care
received by covered veterans.
(5) To reduce gaps in care and duplication of services and
expenses for covered veterans.
(6) To improve care coordination for covered veterans,
including coordination of patient information and medical
records between providers and between the Department and the
Centers for Medicare & Medicaid Services.
(c) Locations.--The Secretary shall carry out the pilot
program in not fewer than three but not more than five
Veterans Integrated Service Networks with a significant
number of covered veterans and geographic diversity,
including--
(1) locations that are in rural or highly rural areas, as
determined through the use of the Rural-Urban Continuum Codes
of the Department of Agriculture; and
(2) locations that are in medically underserved communities
(as defined in section 799B of the Public Health Service Act
(42 U.S.C. 295p)).
(d) Case Manager.--In carrying out the pilot program, the
Secretary shall assign each covered veteran participating in
the pilot program a case manager responsible for--
(1) coordinating with the veteran, the primary care team of
the veteran, and any relevant care coordinators already
assisting the veteran to develop an individualized needs
assessment for the veteran and, based on such assessment, a
care coordination plan with defined treatment goals; and
(2) navigating the systems of care under the laws
administered by the Secretary and under the Medicare program
under title XVIII of the Social Security Act (42 U.S.C. 1395
et seq.).
(e) Use of Existing Models.--In designing the pilot
program, the Secretary may use existing models used by
commercial health care programs to improve access, health
outcomes, quality, and customer experience and lower per
capita costs.
(f) Contracting With Private Sector Entities.--
(1) In general.--The Secretary, to the extent practicable,
shall consider entering into contracts or agreements with
private sector entities carrying out commercial health care
programs for assistance in designing, implementing, and
managing care and benefits under the pilot program, to
include providing care coordination.
(2) Notification.--If the Secretary determines that
entering into contracts or agreements with private sector
entities under paragraph (1) is not necessary or practicable,
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) a notification of that determination;
(B) a description of the steps, if any, the Secretary has
taken to attempt to enter into a contract or an agreement
with a private sector entity;
(C) a justification for why the Secretary has determined
that such contract or agreement is not necessary or
practicable; and
(D) a plan for how the Secretary will carry out the pilot
program without entering into a contract or an agreement with
a private sector entity, including through the use of
employees of the Department of Veterans Affairs or other
government agencies, nonprofit organizations, or other
entities.
(g) Metrics.--
(1) In general.--The Secretary shall track metrics under
the pilot program, including the following:
(A) The number of veterans participating in the pilot
program, disaggregated by Veterans Integrated Service
Network.
(B) Reliance on health care services administered by the
Secretary.
(C) Reliance on health care services administered under the
Medicare program under title XVIII of the Social Security Act
(42 U.S.C. 1395 et seq.).
(D) Quality of care, including patient outcomes.
(E) Cost of care.
(F) Access to care, including under the designated access
standards developed by the Secretary under section 1703B of
title 38, United States Code.
(G) Patient satisfaction.
(H) Provider satisfaction.
(I) Care coordination, including timely information sharing
and medical documentation return.
(2) Elements.--In tracking metrics under paragraph (1), the
Secretary shall track information relating to--
(A) whether care received by a covered veteran is related
to a service-connected disability (as defined in section 101
of title 38, United States Code);
(B) the priority group under section 1705(a) of title 38,
United States Code, through which each covered veteran was
enrolled in the system of annual patient enrollment of the
Department of Veterans Affairs under such section;
(C) the type of care and services provided to covered
veterans; and
(D) the demographics of covered veterans participating in
the pilot program, including age.
(h) Supplement Not Supplant.--The services provided under
the pilot program shall supplement, not supplant, the
services provided under the education program under section
121 of the VA MISSION Act of 2018 (Public Law 115-182; 38
U.S.C. 1701 note).
(i) Duration.--The Secretary shall carry out the pilot
program for a three-year period beginning on the commencement
of the pilot program.
(j) Reports.--
(1) Development, implementation, results, and design of
pilot program.--
(A) In general.--Not less frequently than biannually during
the two-year period beginning on the date of the enactment of
this Act, the Secretary shall submit to the Committee on
Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives a report on
the development, implementation, results, and design of the
pilot program, including information on the metrics tracked
under subsection (g).
(B) Final design.--One of the reports required under
subparagraph (A) shall contain a description of the final
design of the pilot program.
(2) Results of pilot program.--
(A) In general.--Not later than one year after the
submission of the final report under paragraph (1), and not
less frequently than annually thereafter during the duration
of the pilot program, the Secretary shall submit to the
Committee on Veterans' Affairs of
[[Page H4575]]
the Senate and the Committee on Veterans' Affairs of the
House of Representatives a report on the results of the pilot
program.
(B) Final report.--In the final report submitted under
subparagraph (A), the Secretary shall include the
recommendation of the Secretary for whether the pilot program
should be extended or made permanent.
(k) Definitions.--In this section:
(1) Covered veteran.--The term ``covered veteran'' means a
veteran who is enrolled in both the Medicare program under
title XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.) and the system of annual patient enrollment of the
Department of Veterans Affairs under section 1705(a) of title
38, United States Code.
(2) Secretary.--The term ``Secretary'' means the Secretary
of Veterans Affairs.
SEC. 320. FISHER HOUSE AVAILABILITY.
Section 1708 of title 38, United States Code, is amended--
(1) in subsection (a), by striking ``in connection with''
and all that follows through the period at the end and
inserting ``in accordance with this section.'';
(2) in subsection (b)--
(A) in paragraph (2)--
(i) by inserting ``described in paragraph (1)'' after
``family of a veteran''; and
(ii) by inserting ``such'' after ``accompany''; and
(B) by adding at the end the following new paragraphs:
``(3) On a space-available basis, a covered beneficiary who
must travel a significant distance to receive care or
services at a Department or non-Department facility.
``(4) On a space-available basis, a member of the family of
a covered beneficiary described in paragraph (3) and others
who accompany such a covered beneficiary who is receiving
care or services and provide the equivalent of familial
support for such beneficiary when the covered beneficiary or
the family member is traveling to receive care or services at
a Department or non-Department facility.
``(5) On a space-available basis, a veteran and a member of
the family of a veteran and others who must travel a
significant distance for a member of the veteran's family to
receive care or services at a Department or non-Department
facility.
``(6) On a space available basis, a covered beneficiary and
a member of the family of a covered beneficiary and others
who must travel a significant distance for a member of the
covered beneficiary's family to receive care or services at a
Department or non-Department facility.'';
(3) by striking subsection (c) and redesignating
subsections (d) and (e) as subsections (c) and (d),
respectively;
(4) in subsection (d), as so redesignated--
(A) in paragraph (2), by striking ``subsection (d)'' and
inserting ``subsection (c)'';
(B) in paragraph (3), by striking ``under subsection
(b)(2)'' and inserting ``or a covered beneficiary under
subsection (b)'';
(C) in paragraph (4), by striking ``and'' after the
semicolon;
(D) by redesignating paragraph (5) as paragraph (6); and
(E) by inserting after paragraph (4) the following new
paragraph (5):
``(5) establishing criteria for providing access to
temporary lodging facilities on a space-available basis under
paragraphs (3) through (6) of subsection (b); and''; and
(5) by adding at the end the following new subsection:
``(e) In this section:
``(1) The term `covered beneficiary' means a member of the
uniformed services.
``(2) The term `Fisher House' means a housing facility
that--
``(A) is located at, or in proximity to, a Department
medical facility;
``(B) is available for residential use on a temporary basis
by patients of that facility and others described in
subsection (b); and
``(C) is constructed by, and donated to the Secretary by,
the Zachary and Elizabeth M. Fisher Armed Services Foundation
or the Fisher House Foundation.''.
SEC. 321. STUDY ON QUALITY OF MENTAL HEALTH AND ADDICTION
THERAPY CARE PROVIDED BY HEALTH CARE PROVIDERS
OF DEPARTMENT OF VETERANS AFFAIRS COMPARED TO
NON-DEPARTMENT PROVIDERS.
(a) In General.--Not later than 90 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall seek to enter into an agreement with an independent and
objective academic organization or research institute with
demonstrated expertise in evaluating health outcomes inside
and outside the Department of Veterans Affairs under which
that organization shall--
(1) conduct a comparative study, subject to applicable
Federal privacy laws, that evaluates the quality of mental
health and addiction therapy care furnished under laws
administered by the Secretary, by providers of the Department
and by non-Department providers, across a range of treatment
modalities, including telehealth, in-patient, intensive out-
patient, out-patient, and residential treatment; and
(2) submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives, and publish on a publicly available website,
a report containing the final results of such study.
(b) Timing.--The Secretary shall ensure that the
organization with which the Secretary enters into an
agreement pursuant to subsection (a) completes the study and
submits the required report not later than 18 months after
the date on which the agreement is executed.
(c) Elements.--The report submitted pursuant to subsection
(a)(2) shall include an assessment of the following:
(1) The degree of symptom improvement among veterans
receiving care from such Department and non-Department
providers across telehealth, in-patient, intensive
outpatient, outpatient, and residential modalities. For each
setting, symptom changes shall be measured between intake and
discharge (for inpatient, intensive-outpatient, and
residential programs) and between initiation of care and five
months thereafter (for outpatient programs). Symptom scores
shall be obtained for--
(A) Post-traumatic stress disorder, using the Clinician-
Administered PTSD Scale and the PTSD Checklist;
(B) depression, using the Patient Health Questionnaire-9;
(C) substance use disorder, using the Brief Addiction
Monitor; and
(D) suicidality, using the Columbia-Suicide Severity Rating
Scale.
(2) Treatment-fidelity scores, derived from electronic
health record documentation, assessing the extent to which
such Department and non-Department providers adhere to
evidenced-based practices in delivering mental health and
addiction therapy care, as measured against criteria
established by the VA/DOD Clinical Practice Guidelines and
other nationally recognized, evidence-based standards,
including those of the American Society of Addiction Medicine
and the American Psychiatric Association.
(3) Identification of any gaps or delays in coordination
between such Department and non-Department providers in
responding to veterans seeking mental health or addiction
therapy services, including the timeliness and completeness
of health record exchange and communication of care plans.
(4) Measures of patient satisfaction with care received
from such Department and non-Department providers.
(5) The number and percentage of such Department and non-
Department providers who have completed Department or other
accredited condition-specific training relevant to the
veterans they treat, including training on military culture
and trauma-informed care.
(6) The extent to which veterans with co-occurring mental-
health and substance-use conditions receive coordinated,
integrated care addressing the full range of their clinical
needs, regardless of provider affiliation.
(7) Whether such Department and non-Department providers
monitor and document health-outcome measures throughout the
course of treatment and at regular intervals during the three
years following the initiation of treatment.
(8) The number of veterans receiving treatment from such
Department and non-Department providers across all levels of
care, including inpatient, residential, intensive outpatient,
and standard outpatient programs.
(9) The proportion of veterans described in paragraph (8)
whose treatment progress is documented in their electronic
health records as follows:
(A) For inpatient, residential, and intensive outpatient
programs, entry and exit symptom-assessment data and
discharge summaries shall be recorded not later than one year
following admission.
(B) For outpatient programs, initial symptom-assessment
data shall be entered not later than one month of intake, and
follow-up data shall be recorded not later than one year
thereafter.
(10) The average elapsed time for such Department and non-
Department providers, between receipt of referral for care or
veteran outreach and completion of the initial appointment or
admission.
(11) The percentage of such Department and non-Department
providers who undergo formal peer-review or clinical-quality
review at least once every six months.
SEC. 322. LACTATION SPACES IN MEDICAL CENTERS OF THE
DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--Subchapter II of chapter 17 of title 38,
United States Code, is amended by adding at the end the
following new section:
``Sec. 1720M. Lactation spaces in medical centers of the
Department
``(a) Lactation Space Required.--The Secretary shall ensure
that each medical center of the Department contains a
lactation space.
``(b) No Unauthorized Entry.--Nothing in this section shall
be construed to authorize an individual to enter a medical
center of the Department or portion thereof that the
individual is not otherwise authorized to enter.
``(c) Lactation Space Defined.--In this section, the term
`lactation space' means a hygienic place, other than a
bathroom, that--
``(1) is shielded from view;
``(2) is free from intrusion;
``(3) is accessible to disabled individuals (including such
individuals who use wheelchairs);
``(4) contains a chair and a working surface;
``(5) is easy to locate;
``(6) is clearly identified with signage; and
``(7) is available for use by women veterans and members of
the public to express breast milk.''.
(b) Clerical Amendment.--The table of sections at the
beginning of such chapter is
[[Page H4576]]
amended by inserting after the item related to section 1720L
the following new item:
``1720M. Lactation spaces in medical centers of the Department.''.
(c) Implementation.--The Secretary of Veterans Affairs
shall ensure that--
(1) not later than two years after the date of the
enactment of this Act, not fewer than 80 percent of medical
centers of the Department of Veterans Affairs are in
compliance with section 1720M of title 38, United States
Code, as added by subsection (a); and
(2) not later than three years after such date of
enactment, all medical centers of the Department are in
compliance with such section.
(d) Report.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, and annually thereafter, the
Secretary of Veterans Affairs shall submit to the Committee
on Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives a report on
the progress of the Secretary in meeting the requirements
under section 1720M of title 38, United States Code, as added
by subsection (a), including--
(A) a list of which medical centers of the Department of
Veterans Affairs currently have a lactation space;
(B) a list of which medical centers of the Department do
not have a lactation space; and
(C) for each medical center listed under subparagraph (B),
a description of actions the Department has taken to design
and plan a lactation space and a timeline for such lactation
space to be fully functional and open for use within the time
periods specified under subsection (c).
(2) Termination.--The Secretary is not required to submit a
report under paragraph (1) on or after the date on which the
Secretary confirms in a report submitted under such paragraph
that each medical center of the Department contains a
lactation space.
SEC. 323. RESEARCH RELATED TO MENOPAUSE, PERIMENOPAUSE, AND
MID-LIFE WOMEN'S HEALTH: REPORT; PLAN.
(a) Definitions.--In this section:
(1) Covered provider.--The term ``covered provider'' means
a health care provider employed by the Department of Veterans
Affairs.
(2) Menopause.--The term ``menopause'' means the stage of a
woman's life--
(A) when menstrual periods stop permanently and she can no
longer get pregnant; and
(B) that is not a disease state, but a normal part of aging
for women.
(3) Mid-life.--The term ``mid-life'' means a life stage
that--
(A) coincides with the menopausal transition in women,
which may be physical or emotional;
(B) encompasses the late reproductive age, which can begin
at approximately 35 years of age, to the late postmenopausal
stages of reproductive aging, which can extend to
approximately 65 years of age; and
(C) often marks the onset of many chronic diseases.
(4) Perimenopause.--The term ``perimenopause'' means the
time during a woman's life when levels of the hormone
estrogen fall unevenly in a woman's body and is also called
the menopausal transition.
(5) Postmenopausal.--The term ``postmenopausal'' means the
stage of a woman's life after a woman has been without a
menstrual period for 12 months that lasts for the rest of a
woman's life and reflects a time when women are at increased
risk for osteoporosis and heart disease.
(b) Evaluation of Certain Research Related to Menopause,
Perimenopause, or Mid-life Women's Health.--
(1) In general.--The Secretary of Veterans Affairs shall
evaluate--
(A) the results of completed research related to menopause,
perimenopause, or mid-life women's health among women who are
members of the uniformed services or veterans;
(B) the status of such research that is ongoing;
(C) any gaps in knowledge and research on--
(i) treatments for menopause-related symptoms, including
hormone and non-hormone treatments;
(ii) the safety and effectiveness of treatments for
menopause-related symptoms;
(iii) the impact of perimenopause and menopause on the
mental health of women who are members of the uniformed
services or veterans;
(D) the availability of and uptake of professional training
resources for covered providers relating to mid-life women's
health with respect to the care, treatment, and management of
perimenopause and menopausal symptoms, and related support
services; and
(E) the availability of and uptake of treatments for women
who are members of the uniformed services or veterans who are
experiencing perimenopause or menopause.
(2) Report; strategic plan.--Not later than 180 days after
the date of the enactment of this Act, the Secretary of
Veterans Affairs shall submit to Congress a report
containing--
(A) the findings of the evaluation conducted under
paragraph (1);
(B) recommendations for improving professional training
resources described in paragraph (1)(D) for covered
providers; and
(C) a strategic plan that--
(i) resolves the gaps in knowledge and research identified
in the report; and
(ii) identifies topics in need of further research relating
to potential treatments for menopause-related symptoms of
women who are members of the uniformed services or veterans.
(3) Nonduplication and supplementation of efforts.--In
carrying out activities under this section, the Secretary of
Veterans Affairs shall ensure that such activities minimize
duplication and supplement, not supplant, existing
information-sharing efforts of the Department of Health and
Human Services.
(c) Sense of Congress on Additional Research Related to
Menopause, Perimenopause, or Mid-life Women's Health.--It is
the sense of Congress that the Secretary of Defense and the
Secretary of Veterans Affairs should each conduct research
related to menopause, perimenopause, or mid-life health
regarding women who are members of the uniformed services or
veterans.
SEC. 324. PILOT PROGRAM ON PROVISION OF OPIOID RESCUE
MEDICATIONS TO VETERANS.
(a) In General.--Commencing not later than 120 days after
the date of the enactment of this Act, the Secretary of
Veterans Affairs shall carry out a one-year pilot program
under which the Secretary shall make covered medications
available to any veteran at no charge (in this section
referred to as the ``pilot program'').
(b) Provision of Medication Prior to Confirmation of
Status.--The Secretary may provide covered medication to an
individual under the pilot program prior to confirming the
status of the individual as a veteran if the individual
provides contact information for the individual and a written
self-attestation of veteran status.
(c) Site Selection.--The Secretary shall prioritize
carrying out the pilot program in geographical areas where
data indicates a disproportionately high risk of overdose
among the veteran population.
(d) Limitation on Use of Information.--
(1) In general.--In carrying out this section, the
Secretary may only collect the personally identifiable
information needed for prescribing covered medication under
the pilot program, and any personally identifiable
information collected under this section may be used solely
for the purpose of delivering, evaluating, and enhancing the
quality of health care.
(2) Exclusion.--The Secretary may not use any personally
identifiable information collected under this section--
(A) for the purpose of preventing a veteran from
employment;
(B) as evidence of a history of drug use; or
(C) as evidence that an individual is an unlawful user of
or addicted to any controlled substance.
(e) Provision of Information.--The Secretary shall ensure
that any individual who receives covered medication under the
pilot program also receives--
(1) information about addiction services, suicide
prevention services, mental health services, and other
related services provided by the Department of Veterans
Affairs; and
(2) information on the use and application of covered
medications.
(f) Report.--
(1) In general.--Not later than 30 days before the
completion of the pilot program under this section, the
Secretary shall submit to Congress a report on the pilot
program.
(2) Elements.--The report required by paragraph (1) shall
include the following:
(A) The number of veterans who received a covered
medication under the pilot program, disaggregated by those
enrolled in the system of annual patient enrollment of the
Department of Veterans Affairs under section 1705(a) of title
38, United States Code, and those not enrolled in such
system.
(B) An assessment of the feasibility of expanding the pilot
program to provide covered medications to immediate family
members of veterans.
(C) Any considerations associated with continuing,
expanding, or making permanent the pilot program.
(D) Any other recommendations of the Secretary with respect
to modifying or continuing the pilot program.
(g) Definitions.--In this section:
(1) Covered medication.--The term ``covered medication''
means any opioid overdose rescue medication, such as
naloxone.
(2) Veteran.--The term ``veteran'' has the meaning given
that term in section 101 of title 38, United States Code.
SEC. 325. ESTABLISHMENT OF VETERANS HEALTH ADMINISTRATION
POLICY ADVISORY COMMISSION.
(a) In General.--Chapter 1 of title 38, United States Code,
is amended by adding at the end the following new section:
``Sec. 120. Veterans Health Administration Policy Advisory
Commission
``(a) Establishment.--There is established the Veterans
Health Administration Policy Advisory Commission (in this
section referred to as the `Commission').
``(b) Membership.--
``(1) Composition.--The Commission shall be composed of 17
members appointed by the Comptroller General of the United
States, of which not fewer than 2 shall be veterans.
``(2) Qualifications.--
``(A) In general.--An individual is eligible for
appointment to the Commission under paragraph (1) if the
individual has significant expertise in operating or advising
large
[[Page H4577]]
medical systems, including expertise in quality of care,
staffing issues, health information technology, artificial
intelligence in health care, medical research, and managed
care plans and networks.
``(B) Experience of members.--In appointing members under
paragraph (1), the Comptroller General shall select
individuals from backgrounds that reflect the broad diversity
of health care received by veterans, including nonprofit
health systems, public and private health systems, care
furnished by the Veterans Health Administration, and care
furnished by the Department of Defense.
``(3) Ethical disclosure.--A member of the Commission shall
be considered an employee of Congress whose compensation is
disbursed by the Secretary of the Senate for purposes of
applying subchapter I of chapter 131 of title 5, United
States Code, except that a member of the Commission is
required to file public financial disclosure reports without
regard to their number of days of service or rate of pay.
``(c) Period of Appointment; Vacancies.--
``(1) Vacancies.--
``(A) In general.--A vacancy on the Commission shall be
filled in the manner in which the original appointment was
made and shall be subject to any conditions that applied with
respect to the original appointment.
``(B) Filling unexpired term.--An individual chosen to fill
a vacancy shall be appointed for the unexpired term of the
member replaced.
``(2) Expiration of terms.--The term of any member shall
not expire before the date on which the member's successor
takes office.
``(d) Meetings.--
``(1) Frequency.--The Commission shall meet at the call of
the Chairman, but not less frequently than once per year.
``(2) Quorum.--A majority of the members of the Commission
shall constitute a quorum, but a lesser number of members may
hold meetings.
``(e) Chairman and Vice Chairman.--The Comptroller General
shall designate one member of the Commission as Chairman and
one member of the Commission as Vice Chairman, at the time of
appointment of such member and for the term of appointment of
such member, except that in the case of vacancy of the
Chairmanship or Vice Chairmanship, the Comptroller General
may designate another member for the remainder of that
member's term.
``(f) Duties of the Commission.--
``(1) Review.--The Commission shall--
``(A) review operations at the Veterans Health
Administration; and
``(B) prepare reports for Congress based on such review,
including recommendations to Congress.
``(2) Topics to be reviewed.--In conducting a review under
paragraph (1)(A), the Commission shall include periodic
reviews of the following, taking into consideration other
independent assessments in selecting topics to limit
duplicative efforts:
``(A) Information technology infrastructure at medical
facilities of the Department, including with respect to
electronic health record systems.
``(B) Referrals to care at facilities of the Department and
under the Veterans Community Care Program under section 1703
of this title, and factors impacting those referrals.
``(C) Access and wait times at medical facilities of the
Department and under the Veterans Community Care Program,
including both primary and specialty care, and factors
impacting those wait times.
``(D) The quality of health care furnished by the
Department and through the Veterans Community Care Program.
``(E) Workforce issues, including workforce performance,
recruitment, and retention factors.
``(F) Patient satisfaction and customer service at medical
facilities of the Department and through the Veterans
Community Care Program.
``(G) The training of health care providers and the
standards of care at facilities of the Department and in the
Veterans Community Care Program.
``(H) The long-term budgetary outlook of the Veterans
Health Administration, as well as key components driving
budgetary changes over time.
``(I) The research program of the Department, including
both internal and external research.
``(J) The interaction of care under the Medicare program
under title XVIII of the Social Security Act (42 U.S.C. 1395
et seq.), the Medicaid program under title XIX of such Act
(42 U.S.C. 1396 et seq.), the TRICARE program under chapter
55 of title 10, and commercial health care plans with care
furnished by the Veterans Health Administration.
``(3) Use of existing data.--In carrying out the
requirements of this subsection, the Commission, to the
extent practicable, shall use existing data that has been
compiled by the Department, compiled for the Department, or
purchased by the Department, including--
``(A) data described in subsection (c)(1) of section 1704A
of this title; and
``(B) the results of the independent assessments conducted
under such section.
``(4) Issues regarding veteran health care delivery
generally.--In carrying out the requirements of this
subsection, the Commission shall review the effect of
policies under this title on the delivery of health care
services to veterans and assess the implications of changes
in health care delivery for veterans under the laws
administered by the Secretary.
``(5) Transmittal of certain reports.--If the Secretary or
the Inspector General of the Department of Veterans Affairs
submits to Congress (or a committee of Congress) a report
that is required by law and that relates to policies for
health care furnished under the laws administered by the
Secretary, the Secretary shall transmit a copy of that report
to the Commission.
``(6) Consultation and additional reviews and studies.--
``(A) Consultation.--In carrying out the requirements of
this subsection, the Commission shall consult periodically
with the chairmen and ranking members of the Committee on
Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives regarding
the agenda of the Commission and progress towards achieving
that agenda.
``(B) Additional reviews and reports.--The Commission may
conduct additional reviews, and may submit additional reports
to the Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of
Representatives, from time to time on such topics relating to
the activities of the Commission as may be requested by the
Chairman and members and as the Commission determines
appropriate.
``(C) Special studies.--The Commission may conduct special
studies requested by the chairman or ranking member of the
Committee on Veterans' Affairs of the Senate or the Committee
on Veterans' Affairs of the House of Representatives and as
the Commission determines appropriate.
``(7) Coordination.--In carrying out reviews, preparing
reports, and conducting studies under this section, the
Commission shall, to the extent practicable, coordinate with
the Inspector General of the Department to ensure the work of
the Commission does not interfere with investigations or
remediations underway by the Inspector General.
``(8) Budgetary considerations.--Before making any
recommendations to Congress, the Commission shall examine the
budget consequences of such recommendations, directly or
through consultation with appropriate expert entities.
``(9) Report.--
``(A) In general.--By not later than March 15 of each year,
the Commission shall submit to Congress a report containing
the results and recommendations from the review conducted
under paragraph (1).
``(B) Inclusion of recommendations.--A recommendation may
be included in a report under subparagraph (A) if a simple
majority of the members of the Commission vote to include the
recommendation in the report.
``(10) Limitation.--Nothing in this section shall be
construed to authorize the Commission to direct, control,
approve, suspend, delay, or administer any program, policy,
contract, personnel action, budgetary decision, clinical
decision, or operational activity of the Department. The
Commission shall serve solely in an advisory capacity to
Congress and to the Department on matters expressly
authorized under laws administered by the Secretary.
``(g) Powers of Commission.--
``(1) In general.--The Commission may--
``(A) employ and fix the compensation:
``(i) of an Executive Director (at a rate of pay not
greater than that provided for level III of the Executive
Schedule under section 5314 of title 5) who is confirmed by
two-thirds vote by members of the Commission; and
``(ii) other such personnel as may be necessary to carry
out the duties of the Commission, without regard to the
provisions of title 5 governing appointments in the
competitive service;
``(B) seek such assistance and support as may be required
in the performance of its duties from appropriate departments
and agencies of the United States or departments or agencies
of a State;
``(C) enter into a contract or conduct original research
only upon a written determination by the Chair and Vice Chair
that comparable information is unavailable, insufficient, or
outdated;
``(D) make advance, progress, and other payments that
relate to the work of the Commission;
``(E) provide transportation and subsistence for
individuals serving the Commission without compensation; and
``(F) prescribe such rules and regulations as the
Commission determines necessary with respect to the internal
organization and operation of the Commission.
``(2) Data collection.--In order to carry out its
functions, the Commission shall--
``(A) utilize existing information, both published and
unpublished, if possible, collected and assessed either by
its own staff or under other arrangements made in accordance
with this section;
``(B) to the maximum extent practicable, rely on existing
data, reports, audits, evaluations, and assessments prepared
by the Department, the Inspector General of the Department,
the Government Accountability Office, the Congressional
Research Service, the Congressional Budget Office, and other
relevant Federal entities before entering into any contract
or conducting original research; and
``(C) adopt procedures allowing any interested party to
submit information for use by the Commission in making
reports and recommendations.
[[Page H4578]]
``(3) Information from federal agencies.--
``(A) In general.--The Commission may secure directly from
any relevant department or agency of the United States health
care information the Chairman determines would be helpful to
enable the Commission to carry out this section.
``(B) Timing.--Upon request of the Chairman, the head of a
department or agency of the United States shall furnish
information requested under subparagraph (A) to the
Commission on an agreed upon schedule or not later than 180
days after the date of the request.
``(h) Compensation.--
``(1) Members.--
``(A) In general.--While conducting the business of the
Commission (including travel time), a member of the
Commission shall be entitled to compensation at the per diem
equivalent of the rate provided for level IV of the Executive
Schedule under section 5315 of title 5.
``(B) Travel expenses.--While conducting the business of
the Commission away from home and the regular place of
business of the member, a member may be allowed travel
expenses, as authorized by the Chairman.
``(2) Physician comparability allowance for personnel.--The
Commission may provide a physician comparability allowance to
physicians serving as personnel of the Commission in the same
manner as physicians of the Federal Government may be
provided such an allowance by an agency under section 5948 of
title 5, and for such purpose, subsection (i) of such section
shall apply to the Commission in the same manner as it
applies to the Tennessee Valley Authority.
``(3) Treatment of personnel.--For purposes of pay (other
than pay of members of the Commission) and employment
benefits, rights, and privileges, all personnel of the
Commission shall be treated as if they were employees of the
United States Senate.
``(i) Detail of Federal Employees.--An employee of the
Federal Government may be detailed to the Commission without
reimbursement and without interruption or loss of civil
service status or privileges.
``(j) Access of Congressional Support Agencies to
Information.--The Commission shall provide to the Comptroller
General, the Congressional Research Service, and the
Congressional Budget Office unrestricted access to all
deliberations, records, and nonproprietary data of the
Commission not later than 30 days after such access is
requested.
``(k) Authorization of Appropriations.--The Commission
shall submit requests for appropriations in the same manner
as the Comptroller General submits requests for
appropriations, but amounts appropriated for the Commission
shall be separate from amounts appropriated for the
Comptroller General.
``(l) Termination.--
``(1) The Commission shall terminate on September 30, 2032.
``(2) Not later than 1 year before the date of termination
under paragraph (1), the Commission shall submit to the
Committees on Veterans' Affairs of the House of
Representatives and the Senate a final assessment on whether
the Commission should be continued, modified, or allowed to
terminate.
``(3) A member of the Commission shall be appointed under
subsection (b)(1) for a term of 5 years, except that the
Comptroller General shall designate staggered terms for the
members first appointed.
``(4) No funds may be obligated by the Commission after the
date of termination under paragraph (1), except for
activities necessary to close out the operations of the
Commission.''.
(b) Clerical Amendment.--The table of sections at the
beginning of such chapter is amended by inserting after the
item relating to section 119 the following new item:
``120. Veterans Health Administration Policy Advisory Commission.''.
(c) Initial Appointment.--Not later than 280 days after the
date on which amounts are first appropriated to the Veterans
Health Administration Policy Advisory Commission established
under section 120 of title 38, United States Code, as added
by subsection (a), the Comptroller General of the United
States shall make initial appointments of members to the
Commission under subsection (b)(1) of such section.
SEC. 326. ACCESS TO HEALTH CARE.
(a) Connection to Veterans Health Administration When a
Disability Claim Related to Military Sexual Trauma Is
Submitted to Veterans Benefits Administration.--Section 2 of
the MST Claims Coordination Act (Public Law 117-303; 38
U.S.C. 1166 note) is amended--
(1) in subsection (a)(1)--
(A) in subparagraph (C), by striking ``; and'' and
inserting a semicolon; and
(B) by striking subparagraph (D) and inserting the
following:
``(D) the contact information for the nearest military
sexual trauma coordinator for the veteran at the Veterans
Benefits Administration and a description of the assistance
such coordinator can provide;
``(E) the contact information for the nearest military
sexual trauma coordinator for the veteran at the Veterans
Health Administration and a description of the assistance
such coordinator can provide;
``(F) the types of services that individuals who have
experienced military sexual trauma are eligible to receive
from the Department of Veterans Affairs, such as mental
health counseling from providers trained in military sexual
trauma issues and peer support services, including the
nearest locations where such services are furnished,
including the nearest Readjustment Counseling Service
location, and the contact information for the providers of
such services; and
``(G) such other information on services, care, or
resources for military sexual trauma as the Secretary
determines appropriate.''; and
(2) in subsection (d)--
(A) in paragraph (3)--
(i) in subparagraph (B), by striking ``; and'' and
inserting a semicolon;
(ii) in subparagraph (C), by striking the period and
inserting ``; and''; and
(iii) by adding at the end the following:
``(D) submitting a claim for disability compensation to the
Veterans Benefits Administration for a disability relating to
military sexual trauma.''; and
(B) by amending paragraph (5) to read as follows:
``(5) The term `military sexual trauma' with respect to
eligibility for health care, has the meaning given such term
in section 1166(d)(2) of title 38, United States Code.''.
(b) Care Relating to Military Sexual Trauma for Individuals
Who Withdraw From or Otherwise Do Not Complete Service at
Service Academies.--
(1) In general.--The Secretary of Veterans Affairs, in
coordination with the Secretary of Defense, the Secretary of
Homeland Security, and the Secretary of Transportation, shall
ensure that each individual who withdraws from, or otherwise
does not complete service at, a service academy is provided--
(A) information on the potential eligibility of such
individual for care and counseling relating to military
sexual trauma provided through the Department of Veterans
Affairs; and
(B) the option to receive copies of--
(i) the individual's service treatment records or military
personnel records that document military sexual trauma;
(ii) reporting forms of the Department of Defense, the
Department of Homeland Security, or the Department of
Transportation on sexual assault or sexual harassment for
which the individual was the victim; and
(iii) any investigative reports into military sexual trauma
that occurred during the individual's service in the Armed
Forces and for which the individual was the victim, which are
in the possession of the Department of Defense, the
Department of Homeland Security, or the Department of
Transportation.
(2) Definitions.--In this subsection:
(A) Military sexual trauma.--The term ``military sexual
trauma'' has the meaning given such term in section
1166(d)(2) of title 38, United States Code.
(B) Service academy.--The term ``service academy'' means
any of the following:
(i) The United States Military Academy.
(ii) The United States Naval Academy.
(iii) The United States Air Force Academy.
(iv) The United States Coast Guard Academy.
(v) The United States Merchant Marine Academy.
SEC. 327. RESEARCH ON HEALTH CONDITIONS OF DESCENDANTS OF
TOXIC-EXPOSED VETERANS.
(a) Research on Diagnosis and Treatment of Health
Conditions of Descendants of Individuals Exposed to Toxic
Substances While Serving in Armed Forces.--
(1) Contract or agreement.--The Secretary of Veterans
Affairs shall enter into a contract or interagency agreement
with the Agency for Toxic Substances and Disease Registry (in
this section referred to as the ``Agency'') to perform the
services covered by this section.
(2) Services.--Under a contract or agreement between the
Secretary and the Agency under this section, the Agency
shall--
(A) conduct a literature review on the health effects on
descendants of toxic-exposed veterans and toxic-exposed
members of the Armed Forces from their toxic exposure and
identify any gaps in knowledge or research on such topic;
(B) not later than 180 days after completing the literature
review under subparagraph (A) establish and maintain a
publicly available report with information on--
(i) the findings of the Agency with respect to such
literature review; and
(ii) the ongoing research and activities directed by the
Agency, including a review of all relevant data to determine
the strength of evidence for a positive association between a
health condition researched and a toxic exposure based on the
categories set forth under section 1173(c)(2) of title 38,
United States Code; and
(C) not later than 30 days after the date on which the
first review is published under subparagraph (B) and not less
frequently than once every year thereafter, publish a new
report containing the information made available under clause
(ii) of such subparagraph.
(3) Sunset.--On the date that is 7 years after the date of
enactment of this Act.
(4) Literature review.--
(A) In general.--In carrying out the literature review
under paragraph (2)(A), the Agency shall review available
literature to determine the association between military
toxic exposures and the incidence or prevalence of birth
defects among the descendants of toxic-exposed veterans and
toxic-exposed members of the Armed Forces.
(B) Report.--Not later than one year after the date of the
enactment of this Act, the Agency shall submit to the
Secretary, the
[[Page H4579]]
Committee on Veterans' Affairs of the Senate, and the
Committee on Veterans' Affairs of the House of
Representatives a report containing the findings of the
Agency with respect to the activities of the Agency under
paragraph (2)(A).
(C) Plan.--
(i) In general.--Not later than 180 days after the date of
the enactment of this Act, the Agency shall submit to the
Secretary and to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a plan describing the Agency's proposed
approach to carrying out the literature review under
paragraph (2)(A).
(ii) Contents.--The plan submitted pursuant to clause (i)
shall include--
(I) the scope and key research questions to be addressed;
and
(II) the methodology to be used in identifying, evaluating,
and synthesizing relevant scientific and medical literature.
(5) Consultation.--The Agency shall carry out the services
covered by this subsection in consultation with such Federal,
State, and research partners as the Agency and the Secretary
jointly consider appropriate.
(6) Prohibition on expansion of services.--Nothing in this
section shall be construed to authorize the expansion of
compensation or healthcare benefits furnished by the
Department to the descendants of members of the Armed Forces.
(b) Program for Monitoring Health of Descendants of
Veterans and Members of the Armed Forces Subjected to Toxic
Exposure in the Armed Forces.--
(1) In general.--The Secretary of Veterans Affairs shall
use the results of the literature review conducted under
subsection (a)(2)(A) to establish a health monitoring or
screening program for descendants of toxic-exposed veterans
and toxic-exposed members of the Armed Forces, to assist in
identifying potential patterns or signals, supporting public
health surveillance, and facilitating epidemiologic and
clinical research related to birth defects.
(2) Requirements.--In carrying out the program required by
paragraph (1), the Secretary shall--
(A) leverage Government data sets to improve the program;
(B) recruit additional descendants;
(C) consult with relevant stakeholders to develop a
strategy to coordinate collection of information under the
program; and
(D) ensure data from the program is used to inform basic
research, translational research, and epidemiological studies
to help address data and knowledge gaps identified in the
literature review conducted under subsection (a)(2)(A).
(3) Mechanisms for administration.--The Secretary may
administer the program required by paragraph (1) either
directly or through such mechanisms as the Secretary
considers appropriate, such as through the award of a grant
or cooperative agreement.
(4) Collection of information.--In administering the health
monitoring program required by paragraph (1), the Secretary
may collect, process, maintain, and consolidate information
on birth defects among descendants of toxic-exposed veterans
and toxic-exposed members of the Armed Forces, including
biological samples, environmental factors, and personal and
social factors.
(5) Consultation.--The Secretary shall carry out the
services covered by this section in consultation with such
Federal, State, and research partners as the Department
considers appropriate.
(6) Sunset.--This section shall terminate on the date that
is 7 years after the date of enactment of this Act.
(7) Prohibition on expansion of services.--No information
collected by this program shall be used to inform the
expansion of compensation or healthcare benefits furnished by
the Department to the descendants of members of the Armed
Forces, unless otherwise authorized by another Act of
Congress on a date after the passage of this legislation.
(c) Definitions.--In this subsection:
(1) Active military, naval, air, or space service.--The
term ``active military, naval, air, or space service'' has
the meaning given such term in section 101 of title 38,
United States Code.
(2) Relevant stakeholders.--The term ``relevant
stakeholders'' means--
(A) public health experts with experience in developing and
maintaining registries;
(B) epidemiologists with experience in studying health
effects of toxic exposure on the descendants of toxic-exposed
veterans;
(C) descendants of toxic-exposed veterans; and
(D) veterans service organizations.
(3) Toxic-exposed member of the armed forces.--The term
``toxic-exposed member of the Armed Forces'' means a member
of the Armed Forces who was subject to a toxic exposure in
line of duty in the active military, naval, air, or space
service.
(4) Toxic-exposed veteran.--The term ``toxic-exposed
veteran'' means a veteran who was subject to a toxic exposure
in line of duty in the active military, naval, air, or space
service.
(5) Toxic exposure.--The terms ``toxic exposure'' and
``toxic-exposed veteran'' have the meanings given such terms
in section 101 of title 38, United States Code.
SEC. 328. VETERANS SPINAL TRAUMA ACCESS TO NEW DEVICES ACT.
Section 1706 of title 38, United States Code, is amended by
adding at the end the following new subsection:
``(d)(1) In managing the provision of hospital care and
medical services under section 1710(a) of this title, the
Secretary shall furnish (through direct provision of service,
referral, or a telehealth program operated by the Department)
a preventative health evaluation annually to any veteran with
a spinal cord injury or disorder who elects to undergo the
evaluation.
``(2) The evaluation described in paragraph (1) shall
include the following:
``(A) An assessment of any circumstance or condition the
veteran is experiencing that indicates a risk for any health
complication related to the spinal cord injury or disorder,
including a risk of comorbidities.
``(B) An assessment regarding chronic pain and, if
applicable, the management of chronic pain.
``(C) An assessment regarding dietary management and weight
management.
``(D) An assessment regarding prosthetic equipment,
including which prosthetic equipment the veteran needs, how
well any existing prosthetic equipment is functioning
considering the needs of the veteran, and any safety concerns
regarding the prosthetic equipment in use by or recommended
to the veteran.
``(E) An assessment with respect to the provision of
assistive technology, including spinal cord neuromodulation
technology (such as non-invasive transcutaneous spinal
stimulation), that could help maximize the veteran's
voluntary motor or autonomic function, independence, or
mobility, including suitability for home use and need for
training, programming, and remote follow-up.
``(3)(A) In maintaining, prescribing, or amending any
guidance, rules, or regulations issued by the Department
regarding the requirements set out in this subsection, the
Secretary shall consult with--
``(i) the spinal cord injury and disorder program managers
of the Department;
``(ii) clinicians employed by the Department as specialists
in spinal cord injuries and disorders;
``(iii) clinicians and technologists with demonstrated
expertise in spinal cord neuromodulation therapies, including
non-invasive transcutaneous approaches; and
``(iv) representatives of organizations recognized under
section 5902 of this title.
``(B) Before issuing any guidance, rules, or regulations
regarding the requirements set out in this subsection, the
Secretary shall consult with manufacturers of assistive
technologies and other entities relevant to the provision of
assistive technologies if the guidance, rules, or regulations
would directly affect such manufacturers or entities.
``(C) The Secretary shall ensure, to the extent possible,
that any veteran known by the Secretary to have a spinal cord
injury or disorder receives information annually about the
evaluation available under this subsection and the benefits
to the veteran of choosing to undergo the evaluation.
``(4) As the Secretary determines clinically appropriate,
the Secretary may provide training, programming, remote
monitoring, and follow-up for assistive technologies through
telehealth.
``(5) Not later than one year after the date of the
enactment of the Take Care of America's Veterans Act, and
every two years thereafter, 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) For the period covered by the report--
``(i) the number of veterans who--
``(I) received medical care or hospital services from the
Department and used an assistive technology;
``(II) received medical care or hospital services from the
Department and were assessed for the provision of an
assistive technology; and
``(III) received medical care or hospital services from the
Department and were prescribed an assistive technology.
``(ii) for any assistive technology prescribed, an
identification of the category of such technology, including
spinal cord neuromodulation, and a summary of functional
outcomes associated with the prescription of such technology,
if available.
``(B) The year-to-year change (for the period covered by
the report, including the two years immediately prior to the
year the report is submitted) in the percent of veterans with
a spinal cord injury or disorder who received an evaluation
under this subsection.
``(6) In reviewing the performance metrics of a Veterans
Integrated Service Network for any year beginning after the
date that is one year after the date of the enactment of the
Take Care of America's Veterans Act, the Secretary shall
consider the provision of evaluations under paragraph (1).
``(7) In this subsection, the term `assistive technology'
means a powered medical device or electronic tool used to
treat or alleviate symptoms or conditions caused by a spinal
cord injury or disorder, including the following:
``(A) A personal mobility device, including a powered
exoskeleton device.
``(B) A speech generating device.
``(C) A spinal cord neuromodulation technology, including
non-invasive transcutaneous spinal stimulation using sensory
(afferent) pathways, intended to improve voluntary motor
function, autonomic function, independence, or quality of
life.
``(D) Where clinically appropriate, and consistent with the
prosthetic and sensory aids
[[Page H4580]]
policies of the Department, an implantable spinal cord
stimulation system that is approved by the Food and Drug
Administration.''.
SEC. 329. DEPARTMENT OF VETERANS AFFAIRS PILOT PROGRAM TO
AWARD GRANTS FOR THE PROVISION OF SERVICE DOGS
TO VETERANS.
(a) In General.--
(1) Pilot program required.--Not later than 24 months after
the date of the enactment of this Act, the Secretary of
Veterans Affairs shall establish a pilot program under which
the Secretary shall award grants, on a competitive basis
based on the application elements listed in subsection
(b)(2), to nonprofit entities to provide service dogs to
eligible veterans.
(2) Duration.--The Secretary shall carry out the pilot
program during the three-year period beginning on the date on
which the first grant is awarded under this section.
(b) Applications.--
(1) In general.--To be eligible to receive a grant under
this section, a nonprofit entity shall submit an application
to the Secretary at such time and in such manner as the
Secretary may require.
(2) Elements.--An application submitted by a nonprofit
entity under paragraph (1) shall include the following:
(A) A proposal for the provision of service dogs to
eligible veterans, including how the nonprofit entity will
communicate with the Secretary to ensure an increasing number
of service dogs are provided to veterans.
(B) A description of the following services or commitments
to be provided by the nonprofit entity:
(i) The training that will be provided to eligible
veterans.
(ii) The training of dogs that will serve as service dogs.
(iii) Any additional support or services that will be
provided for such dogs and eligible veterans.
(iv) The plan for publicizing the availability of such
service dogs through a marketing campaign that targets
eligible veterans.
(v) The commitment to have humane standards for animals.
(vi) The demonstrated experience of the nonprofit entity in
training service dogs in compliance with the requirements of
the Americans with Disabilities Act of 1990 (42 U.S.C. 12101
et seq.).
(c) Award of Grants.--
(1) In general.--The Secretary shall award a grant to each
nonprofit entity for which the Secretary has approved an
application submitted under subsection (b)(1).
(2) Agreement required.--Before the provision of any grant
amounts to a nonprofit entity selected to receive a grant
under this section, the Secretary shall enter into an
agreement, containing such terms, conditions, and limitations
as the Secretary determines appropriate, with such entity.
(3) Maximum grant amount.--A grant awarded to a nonprofit
entity under this section may not exceed $2,000,000 in a
fiscal year.
(4) Payments.--The Secretary shall establish intervals of
payment for the administration of each grant awarded under
this section.
(d) Use of Funds.--
(1) In general.--
(A) Requirement.--A recipient of a grant under this section
shall use the grant amounts to plan, develop, implement, and
manage one or more covered programs.
(B) Covered program defined.--In this paragraph, the term
``covered program'' means a program under which--
(i) service dogs are provided to participants in the
program; and
(ii) only eligible veterans are allowed to participate in
the program.
(2) Administrative expenses.--The Secretary may establish a
maximum amount for each grant awarded under this section that
may be used by the recipient of the grant to cover
administrative expenses.
(3) Other conditions and limitations.--The Secretary may
establish other conditions or limitations on the use of grant
amounts under this section.
(e) Requirements for Grant Recipients.--
(1) Notifications and information.--A recipient of a grant
under this section shall--
(A) notify each veteran who receives a service dog through
such grant that the service dog is being paid for, in whole
or in part, by the Department of Veterans Affairs; and
(B) inform each such veteran of the benefits and services
available from the Secretary for the veteran and the service
dog.
(2) Prohibition on certain fees.--A recipient of a grant
under this section may not charge a fee to a veteran
receiving a service dog through such grant.
(f) Veterinary Insurance.--
(1) In general.--The Secretary shall provide to each
veteran who receives a service dog through a grant under this
section a commercially available veterinary insurance policy
for the service dog.
(2) Continuation.--If the Secretary provides a veterinary
insurance policy to a veteran under paragraph (1), the
Secretary shall continue to provide the policy to the veteran
without regard to the continuation or termination of the
pilot program.
(g) Training and Technical Assistance.--The Secretary may
provide training and technical assistance regarding grant
application and administration to recipients of grants under
this section.
(h) Oversight and Monitoring.--The Secretary--
(1) may require each recipient of a grant under this
section to provide, in such form as may be prescribed by the
Secretary, such reports or answers in writing to specific
questions, surveys, or questionnaires as the Secretary
determines necessary to carry out the pilot program;
(2) shall establish such oversight and monitoring
requirement as the Secretary determines appropriate to ensure
that grant amounts awarded under this section are used
appropriately; and
(3) may take such actions as the Secretary determines
necessary and according to the terms of the grant agreement
to address any issues identified through the enforcement of
such requirements.
(i) Definitions.--In this section:
(1) Eligible veteran.--The term ``eligible veteran'' means
a veteran (as defined in section 101 of title 38, United
States Code) who--
(A) as determined by a physician, has one or more
disabilities, conditions, or diagnoses described in paragraph
(2); and
(B) is 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, or is otherwise entitled to receive such care and
services under subsection (c)(2) of such section.
(2) Disability, condition, diagnosis described.--A
disability, condition, or diagnosis described in this
subparagraph is any of the following:
(A) Blindness or visual impairment.
(B) Loss of use of a limb, paralysis, or other significant
mobility issue.
(C) Loss of hearing.
(D) Post-traumatic stress disorder.
(E) Traumatic brain injury.
(F) Any other disability, condition, or diagnosis for which
the Secretary determines, based on medical judgment, that it
is optimal for the veteran to manage the disability,
condition, or diagnosis and live independently through the
assistance of a service dog.
(3) Pilot program.--The term ``pilot program'' means the
pilot program required by subsection (a)(1).
(4) Service dog.--The term ``service dog'' means any dog
that is individually trained to do work or perform tasks that
are--
(A) for the benefit of a veteran with a disability,
condition, or diagnosis described in paragraph (2); and
(B) directly related to the disability, condition, or
diagnosis of the veteran.
(j) Authorization of Appropriations.--There is authorized
to be appropriated to carry out this section $10,000,000 for
each of the three consecutive fiscal years beginning the
fiscal year in which the pilot program is established under
subsection (a).
(k) Termination.--
(1) The authority to carry out a pilot program under this
section shall terminate on September 30, 2029.
(2) No funds may be obligated by the Secretary to carry out
a pilot program under this section after the date of
termination in paragraph (1), except for activities necessary
to close operations of such pilot program.
SEC. 330. AUTHORIZATION OF MAJOR MEDICAL FACILITY PROJECT OF
DEPARTMENT OF VETERANS AFFAIRS FOR FISCAL YEAR
2027 IN MANCHESTER, NEW HAMPSHIRE.
(a) Authorization of Major Medical Facility Project of
Department of Veterans Affairs for Fiscal Year 2027 in
Manchester, New Hampshire.--
(1) In general.--The Secretary of Veterans Affairs shall
carry out a major medical facility project for the
replacement of a medical center, a new central utility plant,
a community living center, a residential rehabilitation
treatment facility, associated parking, and demolition of
existing buildings in Manchester, New Hampshire.
(2) Non-department federal entity waiver.--In order to
reduce cost and expedite timelines, the Secretary may waive
the requirements under section 8103(e) of title 38, United
States Code, and section 1096 of the National Defense
Authorization Act for Fiscal Year 2016 (Public Law 114-92; 38
U.S.C. 8103 note) for a non-Department Federal entity to be
engaged in project management and other activities for the
project under paragraph (1).
(3) Notification.--Not later than 60 days after making a
waiver, modification, or substitution relating to the project
under subsection (a), including a waiver under paragraph (2),
the Secretary shall submit to the appropriate committees of
Congress a notification describing the waiver, modification,
or substitution and the reason for such waiver, modification,
or substitution.
(4) Authorization of appropriations.--There is authorized
to be appropriated to the Secretary of Veterans Affairs for
the Construction, Major Projects account $1,180,000,000 for
the project under paragraph (1), to remain available until
expended.
(5) Appropriate committees of congress defined.--In this
section the term ``appropriate committees of Congress''
means--
(A) the Committee on Veterans' Affairs and the Committee on
Appropriations of the Senate; and
(B) the Committee on Veterans' Affairs and the Committee on
Appropriations of the House of Representatives.
(b) Access to Information for Medical Facility Construction
Projects and Leases.--
(1) In general.--Subchapter I of chapter 81 of title 38,
United States Code, is amended by inserting after section
8106 the following:
[[Page H4581]]
``Sec. 8107. Access to information for medical facility
construction projects and leases
``(a) In General.--For any major construction project,
lease, or enhanced-use lease for a medical facility of the
Department, the Secretary shall ensure that the Committee on
Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives are
provided timely access to all information, records,
documents, data, analyses, communications, contracts,
agreements, project schedules, cost estimates, memoranda,
briefings, reports, and other materials relating to the
project or lease.
``(b) Prohibition on Withholding Information.--The
Secretary may not withhold information under subsection (a)
from the Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of
Representatives solely on the basis that the information is
predecisional, deliberative, advisory, procurement-sensitive,
or subject to an internal policy or directive of the
Department.''.
(2) Clerical amendment.--The table of sections at the
beginning of such chapter is amended by inserting after the
item relating to section 8106 the following new item:
``8107. Access to information for medical facility construction
projects and leases.''.
SEC. 331. AUTHORIZATION OF MAJOR MEDICAL FACILITY PROJECT OF
DEPARTMENT OF VETERANS AFFAIRS FOR FISCAL YEAR
2027 IN SAN ANTONIO, TEXAS.
(a) In General.--The Secretary of Veterans Affairs shall
carry out a major medical facility project for the
acquisition of land for a new Department of Veterans Affairs
health care facility in San Antonio, Texas.
(b) Non-Department Federal Entity Waiver.--In order to
reduce cost and expedite timelines, the Secretary may waive
the requirements under section 8103(e) of title 38, United
States Code, and section 1096 of the National Defense
Authorization Act for Fiscal Year 2016 (Public Law 114-92; 38
U.S.C. 8103 note) for a non-Department Federal entity to be
engaged in project management and other activities for the
project under subsection (a).
(c) Notification.--Not later than 60 days after making a
waiver, modification, or substitution relating to the project
under subsection (a), including a waiver under subsection
(b), the Secretary shall submit to the appropriate committees
of Congress a notification describing the waiver,
modification, or substitution and the reason for such waiver,
modification, or substitution.
(d) Authorization of Appropriations.--There is authorized
to be appropriated to the Secretary of Veterans Affairs for
the Construction, Major Projects account $30,000,000 for the
project under subsection (a) to remain available until
expended.
SEC. 332. AUTHORIZATION OF MAJOR MEDICAL FACILITY PROJECT OF
DEPARTMENT OF VETERANS AFFAIRS FOR FISCAL YEAR
2027 IN INDIANAPOLIS, INDIANA.
(a) In General.--The Secretary of Veterans Affairs shall
carry out a major medical facility project for the
replacement of a medical center, a new central utility plant,
a replacement multi-specialty outpatient clinic, and
associated parking in Indianapolis, Indiana.
(b) Non-Department Federal Entity Waiver.--In order to
reduce cost and expedite timelines, the Secretary may waive
the requirements under section 8103(e) of title 38, United
States Code, and section 1096 of the National Defense
Authorization Act for Fiscal Year 2016 (Public Law 114-92; 38
U.S.C. 8103 note) for a non-Department Federal entity to be
engaged in project management and other activities for the
project under subsection (a).
(c) Notification.--Not later than 60 days after making a
waiver, modification, or substitution relating to the project
under subsection (a), including a waiver under subsection
(b), the Secretary shall submit to the appropriate committees
of Congress a notification describing the waiver,
modification, or substitution and the reason for such waiver,
modification, or substitution.
(d) Authorization of Appropriations.--There is authorized
to be appropriated to the Secretary of Veterans Affairs for
the Construction, Major Projects account $1,641,570,000 for
the project under subsection (a), to remain available until
expended.
SEC. 333. BOWEL AND BLADDER CARE PROGRAM OF DEPARTMENT OF
VETERANS AFFAIRS.
(a) Findings; Sense of Congress.--
(1) Findings.--Congress finds the following:
(A) Bowel care and bladder care are supportive and
necessary medical services for veterans with spinal cord
injuries and disorders when they are unable to manage their
bowel and bladder functions independently.
(B) Inadequate care will lead to complications and problems
such as autonomic dysreflexia that can be potentially life-
threatening and result in illness and hospitalization.
(C) Bowel care and bladder care are essential to support
veterans with spinal cord injuries and disorders in non-
institutional settings, improve quality of life, optimize
health, and prevent complications from neurogenic bowel and
bladder.
(D) Family caregivers and individually employed caregivers
provide life-sustaining care for the bowel and bladder care
needs of veterans that allow them to live in their
communities.
(2) Sense of congress.--It is the sense of Congress that--
(A) family caregivers and individually employed caregivers
should not be subjected to self-employment taxes and treated
as vendors or contractors for the veterans to whom they
provide care;
(B) veterans should not be forced to finish their bowel and
bladder care needs in a set period of time that does not
consider their individual needs; and
(C) veterans should not be subjected to ongoing clinical
determinations regarding their bowel and bladder care needs
absent a decision by their medical care provider that such
care is no longer needed.
(b) In General.--The Secretary of Veterans Affairs shall
establish a program to address the bowel and bladder care
needs of covered veterans (in this section referred to as the
``program'').
(c) Provision of Care.--
(1) Clinical need.--The Secretary shall provide bowel and
bladder care under the program to covered veterans based on
clinical need, which may include covered veterans receiving
aid and attendance benefits from the Department of Veterans
Affairs.
(2) Caregiver or agency.--A covered veteran may receive
bowel and bladder care under the program through a qualified
family member, an individually employed caregiver, or a
contracted home health agency.
(3) Individualized assessment.--The Secretary shall conduct
an individualized assessment with respect to a covered
veteran to determine the number of hours of bowel and bladder
care needed by such veteran under the program.
(4) Denial of care.--Before denying bowel and bladder care
for any covered veteran under the program, the Secretary
shall first obtain review of and concurrence with respect to
such denial from a designated Spinal Cord Injuries and
Disorders Center of the Department.
(d) Coordination of Care and Benefits.--The Secretary shall
ensure the program is coordinated with other programs and
benefits of the Department for which the covered veteran is
eligible to ensure that covered veterans and caregivers
receive appropriate support without duplicating benefits or
services.
(e) Supportive Medical Training and Qualifications.--
(1) In general.--The Secretary shall provide to each family
member or individually employed caregiver providing care to a
covered veteran under the program necessary supportive
medical training to participate in and receive payment by the
Secretary for the provision of such care.
(2) Qualifications.--The Secretary shall establish such
requirements, conditions, and qualifications for providers of
care under the program as necessary to provide clinically
appropriate bowel and bladder care to covered veterans and to
ensure the financial and administrative integrity of the
program.
(f) Payment.--
(1) In general.--The Secretary shall provide a monthly
stipend to family members and individually employed
caregivers and payment to contracted home health agencies for
care provided to covered veterans under the program.
(2) Limitation.--
(A) Family members and individually employed caregivers.--
The stipend for a family member or individually employed
caregiver for care provided to a covered veteran under the
program--
(i) shall be determined by the Secretary;
(ii) shall be based on the amount and degree of assistance
provided; and
(iii) may not exceed the fifth step of the applicable grade
of the General Schedule hourly rate paid to nursing
assistants who provide such care at the medical facility of
the Department that is nearest to the residence of such
veteran.
(B) Home health agencies.--Payment to a home health agency
for care provided to a covered veteran under the program may
not exceed the payment rates of the Department under section
17.4035 of title 38, Code of Federal Regulations (relating to
payment rates and methodologies), or successor regulations.
(g) Submission of Documentation.--Family members and
individually employed caregivers providing care to covered
veterans under the program shall provide such documentation
and information in such format and under such terms as the
Secretary may require as a condition of receiving payment
under the program.
(h) Continued Participation in Program.--If a covered
veteran has been medically determined to require care under
the program for a continuous period of three years or more,
the veteran is deemed to require such care for life or until
such time as the medical provider for such veteran determines
the service is no longer needed.
(i) Not Vendors or Contractors.--Family members and
individually employed caregivers providing care to covered
veterans under the program shall not be considered vendors or
contractors for purposes of the program.
(j) Limitation.--Care may not be provided under the program
to a veteran who can perform the bowel and bladder functions
of the veteran without assistance.
(k) Covered Veteran Defined.--In this section, the term
``covered veteran'' means a veteran who--
(1) is enrolled in the system of annual patient enrollment
of the Department of Veterans Affairs established and
operated under
[[Page H4582]]
section 1705(a) of title 38, United States Code;
(2) has a spinal cord injury or disorder; and
(3) is dependent upon others for bowel and bladder care
while residing in non-institutional settings.
TITLE IV--ORGANIZATION
SEC. 401. AUTHORIZATION OF APPROPRIATIONS TO THE OFFICE OF
INFORMATION AND TECHNOLOGY OF THE DEPARTMENT OF
VETERANS AFFAIRS FOR CERTAIN PURPOSES.
(a) Authorization of Appropriations.--There is authorized
to be appropriated, and there is appropriated, to the
Secretary of Veterans Affairs $500,000,000 for fiscal year
2026, to remain available until September 30, 2031, for
deposit into the accounts of the Office of Information and
Technology of the Department of Veterans Affairs for the
purposes described in subsection (b).
(b) Use of Funds.--Funds shall be allocated and expended
only as follows:
(1) $150,000,000 for Enterprise Logistics and Supply Chain
Visibility -- To develop and deploy integrated, real-time
enterprise-wide logistics systems, inventory visibility,
pharmaceutical tracking, and medical supply chain resiliency
capabilities. These systems shall support both routine
veteran care operations and 4th Mission medical surge,
patient movement, and emergency distribution requirements in
consultation with the Secretary of Defense, the Administrator
of the Federal Emergency Management Agency, and the heads of
other Federal agencies.
(2) $200,000,000 for Cybersecurity and Operational
Resiliency -- For zero trust architecture implementation,
threat detection, secure cloud hardening, endpoint
protection, continuity of operations (COOP) platforms, and
protection of mission-essential systems against cyber and
physical disruptions. Funds shall prioritize high-risk legacy
systems and medical device security.
(3) $150,000,000 for Resilient Communications and Digital
Records Modernization -- For interoperable, survivable
communications infrastructure, and targeted digitization/
automation of high-volume paper-based workflows (claims,
correspondence, administrative records) to reduce fraud risk
and improve continuity during degraded or emergency
environments. Funds shall not be used for broad Electronic
Health Record Modernization expansion.
(c) Oversight and Protection of Sensitive Information.--
(1) The Secretary may obligate and expend amounts under
this section in classified, controlled, or protected
environments consistent with applicable law.
(2) Not later than 90 days after the date of enactment of
this Act, and annually thereafter until September 30, 2031,
the Secretary shall provide to the Committees on Veterans'
Affairs of the House of Representatives and the Senate a
briefing and report on--
(A) activities carried out using funds made available under
this section;
(B) progress on improving cybersecurity, resiliency,
continuity, logistics, communications, digitization, and
mission assurance capabilities; and
(C) coordination with other Federal agencies, as
appropriate. Such reports may include a classified annex.
(3) Detailed implementation plan and quarterly briefings.--
(A) Not later than 90 days after the date of enactment of
this Act, the Secretary, acting through the Office of
Information and Technology, shall submit to the Committees on
Veterans' Affairs of the House of Representatives and the
Senate a comprehensive implementation plan. The plan shall
include--
(i) specific milestones, deliverables, and performance
metrics for each category of activities in subsection (b);
(ii) a zero trust architecture strategy with timelines and
technical requirements;
(iii) a detailed expenditure plan by fiscal quarter and by
activity category; and
(iv) any proposed interagency or private-sector
partnerships.
(B) Not later than 30 days after the end of each fiscal
quarter through September 30, 2031, the Secretary shall
provide the Committees a briefing and written report on--
(i) obligations and expenditures to date, by category;
(ii) progress against the implementation plan;
(iii) any deviations from the plan and corrective actions;
and
(iv) updated projections for remaining funds.
(C) The initial briefing under subparagraph (B) shall be in
person and subsequent briefings may be virtual unless
otherwise requested by the Committees. Reports under such
subparagraph may include a classified annex.
(d) Limitation.--Funds made available under this section
may not be used for any purpose unrelated to information
technology modernization, cybersecurity, operational
resilience, logistics modernization, communications
modernization, digitization, or fraud prevention activities
of the Department.
(e) Supplement, Not Supplant.--Amounts made available under
this section shall supplement and not supplant other amounts
otherwise authorized to be appropriated for the Office of
Information and Technology of the Department of Veterans
Affairs.
(f) Rule of Construction.--Nothing in this section shall be
construed to require the public disclosure of classified
information, controlled unclassified information, operational
details, cybersecurity architecture, contingency planning
information, mission-essential system design, or information
otherwise protected from disclosure under Federal law or
Executive Order.
(g) Reauthorization and Sunset.--
(1) Reauthorization required.--The authority provided under
this section to obligate or expend amounts appropriated
pursuant to subsection (a) shall terminate on September 30,
2031, unless subsequently reauthorized by law.
(2) Limitation on new obligations after sunset.--Beginning
on October 1, 2031, the Secretary may not initiate, award,
enter into, renew, extend, or otherwise obligate funds for
any new program, project, activity, contract, task order, or
operational capability carried out pursuant to this section
unless expressly authorized by a subsequent Act of Congress.
(3) Continuation of existing activities.--Nothing in
paragraph (2) shall be construed to prohibit the Secretary
from--
(A) maintaining, sustaining, securing, operating,
completing, or supporting any program, project, activity,
contract, system, platform, infrastructure capability, or
operational activity lawfully initiated using amounts
obligated before September 30, 2031; or
(B) carrying out similar information technology
modernization, cybersecurity, continuity of operations,
logistics modernization, communications modernization,
operational resiliency, or mission assurance activities using
amounts otherwise authorized and appropriated under any other
provision of law.
(h) Use of Existing Contracting Authorities.--The Secretary
shall carry out the activities authorized under this section,
to the maximum extent practicable, through contracts, task
orders, delivery orders, interagency agreements, cooperative
agreements, or other agreements entered into under existing
authorities of title 38, United States Code, as applicable.
Amounts made available under this section shall not be used
to establish a new full-time equivalent position, hire
additional employees of the Department, or otherwise increase
the number of full-time equivalent employees of the
Department, except to the extent the Secretary determines
that such personnel are necessary for the oversight,
management, cybersecurity supervision, acquisition
administration, or operational integration of activities
carried out under this section.
SEC. 402. ESTABLISHMENT OF UNDER SECRETARY FOR MANAGEMENT AND
CHIEF FINANCIAL OFFICER.
(a) Chief Financial Officer; Office of Budget.--Section 309
of title 38, United States Code, is amended to read as
follows:
``Sec. 309. Under Secretary for Management and Chief
Financial Officer
``(a) Under Secretary for Management and Chief Financial
Officer.--
``(1) The Under Secretary for Management and Chief
Financial Officer shall be the principal management and
financial officer of the Department.
``(2) The Under Secretary shall report directly to the
Secretary.
``(3) The Under Secretary shall serve as the Chief
Financial Officer of the Department for purposes of chapter 9
of title 31.
``(4) The Under Secretary shall exercise authority,
direction, and control over the Office of Budget and such
other offices as may be assigned by law or by the Secretary.
``(b) Duties.--The duties of the Under Secretary include
the following:
``(1) To advise the Secretary on financial management of
the Department.
``(2) To formulate, justify, execute, oversee, and certify
the budget of the Department.
``(3) To control, account for, audit, and report on the
finances of the Department.
``(4) To coordinate and assist the Chief Acquisition
Officer with the life cycle of major acquisition programs of
the Department.
``(5) To exercise the authority and carry out the functions
specified in section 902 of title 31.
``(6) To ensure compliance with sections 1341, 1342, 1349,
1350, and 1511 through 1519 of title 31.
``(7) To provide to Congress, or a congressional committee
upon request, information regarding the budget, finances, and
fiscal condition of the Department.
``(8) To serve as the head of the Office of Budget of the
Department.
``(9) To establish and oversee Department-wide financial
management policies, accounting systems, internal controls,
enterprise risk management programs, strategic planning
processes, and capital planning activities.
``(10) To oversee infrastructure investment planning,
financial systems modernization, and business transformation
initiatives of the Department.
``(c) Deputy Assistant Secretary.--(1) There is in the
Department a Deputy Assistant Secretary for Infrastructure
and Construction.
``(2) Such Deputy Assistant Secretary shall be a career
appointee (as that term is defined in section 3132(a) of
title 5) within the Senior Executive Service of the
Department.
``(d) Office of Infrastructure and Construction.--There is
an Office of Infrastructure and Construction in the
Department.
``(e) Budget and Appropriations Affairs Office.--(1) There
is within the Office of Management a Budget and
Appropriations
[[Page H4583]]
Affairs Office (in this subsection referred to as the `BAA
Office'). The Under Secretary shall appoint a head of the BAA
Office who shall report exclusively to the Under Secretary.
``(2) The sole function of the BAA Office is to provide to
Congress (or a congressional committee), accurate, timely,
and certified information regarding the finances and budget
of the Department.
``(3) Congress or a congressional committee may submit a
request for information described in paragraph (2) directly
to the BAA Office.
``(4) Paragraphs (2) and (3) notwithstanding, the Assistant
Secretary for Congressional and Legislative Affairs may
facilitate and transmit responses to requests described in
paragraph (3) that are submitted to the BAA Office. Any
response containing information described in paragraph (2)
shall be prepared and certified by the BAA Office and may not
be altered, delayed, withheld, edited, or modified by any
other officer or employee of the Department prior to
transmission to Congress or a congressional committee.
``(5) Not more than six full-time equivalent employees,
including supervisors, may be assigned to the BAA Office.
``(f) Limitation on Authority to Appoint.--The Secretary
may not establish an employee position--
``(1) that performs a function substantially similar to the
function of the Budget and Appropriations Affairs Office
established under section 309(e); and
``(2) that is not within the Office of Management.
``(g) Transfer of Functions.--(1) All functions, powers,
duties, authorities, responsibilities, personnel, property,
records, contracts, delegations, directives, regulations,
administrative actions, and unobligated balances of
appropriations relating to the Chief Financial Officer of the
Department immediately before the effective date of this Act
are transferred to the Under Secretary for Management and
Chief Financial Officer.
``(2) Any delegation, determination, rule, regulation,
order, permit, contract, agreement, certification, or other
administrative action in effect immediately before the
effective date of this Act shall continue in effect according
to its terms until modified, superseded, terminated, or
revoked.
``(h) References.--Any reference in any law, regulation,
rule, directive, delegation, contract, agreement,
determination, record, or other official document of the
United States to the Chief Financial Officer of the
Department shall be deemed to refer to the Under Secretary
for Management and Chief Financial Officer.''.
(b) Technical and Conforming Amendments.--
(1) The table of sections for chapter 3 of title 38, United
States Code, is amended accordingly.
(2) The Secretary shall make such additional technical and
conforming amendments to regulations, directives,
delegations, organizational charters, manuals, and internal
guidance as may be necessary to carry out this Act.
(c) Financial Employees.--Subchapter I of chapter 7 of such
title is amended by inserting after section 715 the following
new section (and the table of sections at the beginning of
such chapter is amended accordingly):
``Sec. 716 Employees with certain financial authority:
management; limitation on duties
``(a) In General.--An employee described in subsection
(b)--
``(1) shall report exclusively to the Chief Financial
Officer of the Department designated under section 309 of
this title; and
``(2) may not perform a programmatic or operational
function in the Department.
``(b) Employee Described.--An employee described in this
subsection is an employee of the Department--
``(1) whose position is that of chief financial officer of
an Administration of the Department or a Veterans Integrated
Service Network; or
``(2) whose duties are substantially similar to a position
described in paragraph (1).''.
SEC. 403. DEPARTMENT OF VETERANS AFFAIRS ACQUISITION REFORM
AND COST ASSESSMENT.
(a) Department of Veterans Affairs Acquisition
Organization.--
(1) Definitions.--Chapter 81 of title 38, United States
Code, is amended by inserting after subchapter VI the
following new subchapter:
``SUBCHAPTER VII--ACQUISITION ORGANIZATION, COST ASSESSMENT, AND
PROGRAM EVALUATION
``Sec. 8181. Definition of major acquisition program
``In this subchapter, the term `major acquisition program'
means a program of the Department to acquire services,
supplies, technology, systems, or a combination thereof, with
an estimated total program cost, estimated by the Secretary,
that exceeds--
``(1) $1,000,000,000 (adjusted pursuant to section 1908 of
title 41) for the total life cycle cost of the program; or
``(2) $200,000,000 (adjusted pursuant to section 1908 of
title 41) annually.''.
(2) Assistant secretary for acquisition.--Section 308 of
such title is amended--
(A) in subsection (a)(1), by striking ``seven'' and
inserting ``eight'';
(B) in subsection (b)(10), by striking ``Procurement
functions'' and inserting ``Acquisition functions''; and
(C) in subsection (d)(1), strike ``19'' and insert ``22''.
(3) Acquisition organization.--Subchapter VII of chapter 81
of such title, as added by paragraph (1), is amended by
adding at the end the following new section:
``Sec. 8182. Acquisition organization
``(a) Assistant Secretary for Acquisition; Chief
Acquisition Officer.--(1) The Secretary shall designate one
of the Assistant Secretaries specified in subsection (a)(1)
of section 308 of this title as the Assistant Secretary of
Veterans Affairs for Acquisition, who shall focus solely on
the administration of functions specified in subsection
(b)(10) of such section.
``(2) Pursuant to section 1702(a) of title 41, the
Secretary shall designate the Assistant Secretary of Veterans
Affairs for Acquisition as the Chief Acquisition Officer of
the Department.
``(b) Office of Acquisition.--(1) There is in the
Department an Office of Acquisition.
``(2) The head of the Office of Acquisition shall be the
Assistant Secretary of Veterans Affairs for Acquisition
designated pursuant to subsection (a).
``(3) The Secretary shall take such actions as may be
necessary to ensure that major acquisition program offices of
the Department align under the Office of Acquisition and
report directly to the Assistant Secretary of Veterans
Affairs for Acquisition.
``(4) The budget of the Office of Acquisition, including
budgets for major acquisition programs, shall be established
in the budget justification materials submitted to Congress
in support of the budget of the Department (as submitted with
the budget of the President under section 1105(a) of title
31).
``(c) Deputy Assistant Secretary for Logistics.--(1)
Pursuant to section 308(d) of this title, the Secretary shall
appoint a Deputy Assistant Secretary of Veterans Affairs for
Logistics, who shall report to the Assistant Secretary for
Acquisition.
``(2) The Deputy Assistant Secretary of Veterans Affairs
for Logistics shall be responsible for administration of
logistics and supply chain operations of the Department.
``(d) Deputy Assistant Secretary for Procurement.--(1)
Pursuant to section 308(d) of this title, the Secretary shall
appoint a Deputy Assistant Secretary of Veterans Affairs for
Procurement, who shall report to the Assistant Secretary for
Acquisition.
``(2) The Deputy Assistant Secretary of Veterans Affairs
for Procurement shall be responsible for all procurement and
contracting organizations of the Department.
``(e) Deputy Assistant Secretary for Acquisition, Program
Management, and Performance.--(1) Pursuant to section 308(d)
of this title, the Secretary shall appoint a Deputy Assistant
Secretary of Veterans Affairs for Acquisition, Program
Management, and Performance, who shall report to the
Assistant Secretary for Acquisition.
``(2) The Deputy Assistant Secretary for Acquisition,
Program Management, and Performance shall be responsible for
the following:
``(A) Lifecycle management.
``(B) Requirements planning.
``(C) Programming and budgeting.
``(D) Policy.
``(E) Performance standards.
``(F) Governance.
``(G) Enhancing the capabilities of the acquisition
workforce.
``(f) Program Executive Officers.--(1) The Assistant
Secretary for Acquisition shall appoint no fewer than four
Program Executive Officers, each responsible for overseeing
major acquisition programs in one of the following areas:
``(A) Medical.
``(B) Information technology.
``(C) Professional services.
``(D) Other areas not included in subparagraphs (A) through
(C).
``(2) Each Program Executive Officer shall report directly
to the Assistant Secretary for Acquisition and shall
supervise the managers of major acquisition programs within
their respective area, as appointed under section 8183 of
this title.
``(3) Each Program Executive Officer shall be--
``(A) certified in project management at level three by--
``(i) the Department;
``(ii) the Federal Acquisition Institute pursuant to
section 1201 of title 41; or
``(iii) the Department of Defense pursuant to section 1701a
of title 10; or
``(B) hold an equivalent certification by a private sector
project management certification organization, as determined
appropriate by the Secretary.''.
(b) Department of Veterans Affairs Major Acquisition
Program Managers.--Subchapter VII of chapter 81 of title 38,
United States Code, as added by subsection (a), is amended by
adding at the end the following new section:
``Sec. 8183. Major acquisition program managers
``(a) Appointments.--Not later than 30 days after any date
on which the Secretary approves a major acquisition program
to commence, the applicable Program Executive Officer shall
appoint a manager to be responsible for administering such
program.
``(b) Qualifications.--Each manager appointed pursuant to
subsection (a) shall be--
``(1) certified in project management at level three by--
``(A) the Department;
``(B) the Federal Acquisition Institute pursuant to section
1201 of title 41; or
[[Page H4584]]
``(C) the Department of Defense pursuant to section 1701a
of title 10; or
``(2) hold an equivalent certification by a private sector
project management certification organization, as determined
appropriate by the Secretary.
``(c) Duties.--Each manager appointed pursuant to
subsection (a) for a major acquisition program shall--
``(1) report to the Assistant Secretary for Acquisition
through the Program Executive Officer responsible for the
major acquisition program; and
``(2) be responsible for, with respect to the major
acquisition program--
``(A) developing, in coordination with the Program
Executive Officer, a plan to administer the major acquisition
program, which shall be known as the `program baseline' for
the major acquisition program, that includes--
``(i) a description of each acquisition phase of the major
acquisition program;
``(ii) for each such acquisition phase, requirements for
advancing the major acquisition program to a subsequent
acquisition phase; and
``(iii) estimates of the cost, schedule, and performance of
the major acquisition program that account for the entire
life cycle of the major acquisition program;
``(B) ensuring the major acquisition program is in
compliance with such requirements and providing all program
documentation, including program baseline documentation,
cost, schedule, performance and risk assessments, and other
relevant materials, to designated officials and relevant
governance boards;
``(C) developing resource requests and justifications
necessary to satisfy such requirements; and
``(D) on a continuous basis, assessing and managing risks
to satisfying the requirements of such program baseline
relating to cost and schedule.
``(d) Program Decision Authority.--(1) The Assistant
Secretary for Acquisition is the program decision authority
regarding a major acquisition program.
``(2) Program management offices for major acquisition
programs shall--
``(A) report directly to the Assistant Secretary for
Acquisition; and
``(B) operate independently of the Veterans Benefits
Administration, the Veterans Health Administration, the
National Cemetery Administration, and staff offices of the
Department.
``(e) Notification Required.--Not later than 30 days after
any date on which a major acquisition program concludes an
acquisition phase, the manager of such program appointed
pursuant to subsection (a) shall notify the Assistant
Secretary for Acquisition.''.
(c) Department of Veterans Affairs Acquisition and
Procurement Reorganization Matters.--
(1) Organizational consolidation.--Not later than one year
after the date of the enactment of this Act, the Secretary of
Veterans Affairs shall organizationally consolidate under the
Assistant Secretary of Veterans Affairs for Acquisition every
activity of the Department of Veterans Affairs, including the
Veterans Benefits Administration, the Veterans Health
Administration, and the National Cemetery Administration,
that relates to--
(A) acquisition;
(B) procurement and contracting; or
(C) logistics and supply chain.
(2) Relocation.--Paragraph (1) shall not be construed to
require the physical relocation of employees of the
Department.
(3) Plan and briefing.--
(A) In general.--Not later than 90 days after commencing
organizational consolidation under paragraph (1), the
Secretary shall--
(i) submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a written plan to carry out such
organizational consolidation; and
(ii) provide such committees a briefing on such plan.
(B) Contents.--The plan submitted pursuant to subparagraph
(A)(i) shall include the following:
(i) A timeline.
(ii) A plan for communication and training activities for
relevant Department personnel.
(iii) A plan for modification of relevant Department policy
and guidance.
(iv) Such other matters as the Secretary considers relevant
and appropriate.
(d) Independent Verification and Validation of Major
Acquisition Programs of Department of Veterans Affairs.--
(1) Contracting authority.--Not later than 120 days after
the date of the enactment of this Act, the Secretary of
Veterans Affairs shall seek to enter into one or more
contracts using competitive procedures with one or more
entities to carry out the functions described in paragraph
(3).
(2) Eligibility.--
(A) In general.--An entity is not eligible to be awarded a
contract under this section unless the Chief Acquisition
Officer of the Department of Veterans Affairs determines, at
the time of evaluation of offers submitted under paragraph
(1), that the entity is currently performing or has
performed, during the preceding three-year period, not fewer
than three prime contracts from either governmental or
commercial health care organizations for--
(i) the independent verification and validation services or
equivalent services, including systems engineering and
technical advisory (SETA) support of major acquisition
programs; or
(ii) the independent verification and validation or systems
engineering and technical advisory (SETA) support of the
development or acquisition of major acquisition programs or
defense systems, in accordance with guidance of the
Department of Defense relating to such acquisition programs
or such business systems.
(B) Past performance.--For any contract used to demonstrate
eligibility under subparagraph (A), an entity must have
performed the work at a satisfactory or better level as
indicated by the past performance information in the
Contractor Performance Assessment Reporting System, or
successor system.
(C) Demonstration of lack of conflict of interest.--The
Secretary shall revoke the eligibility of an entity under
this subsection if an entity does not demonstrate clear and
unmitigable evidence that the entity does not have a conflict
of interest with respect to the effective performance of
functions under paragraph (3).
(D) No mitigation plans acceptable.--The Secretary may not
accept from an entity a plan to mitigate a conflict of
interest in order to ameliorate any limitation or prohibition
under this subsection.
(3) Functions.--The functions specified in this subsection
are the following:
(A) The independent verification and validation of each
major acquisition program project--
(i) when such major acquisition program is initiated, with
respect to its design and the development of its requirements
and acquisition;
(ii) at the conclusion of such program; and
(iii) at any other intervals during such program selected
by the Chief Acquisition Officer of the Department.
(B) The independent verification and validation of other
programs or projects of the Department selected by the Chief
Acquisition Officer of the Department, at intervals selected
by the Chief Acquisition Officer.
(4) Funding.--The Chief Financial Officer of the Department
shall ensure that each organizational subdivision of the
Department that enters into a contract under paragraph (1)
proportionally contributes amounts to fund each such
contract.
(5) Definitions.--In this section:
(A) Covered contract.--The term ``covered contract'' means
any prime or subcontract with the Department, including--
(i) information technology support or software or system
design, development, sustainment, or maintenance services;
(ii) professional or management consulting services; or
(iii) advisory and assistance services.
(B) Independent verification validation.--The term
``independent verification and validation'' means a
comprehensive inspection, a review, analysis, and testing, or
an assessment of systems, software, or hardware, as
applicable, performed by an entity awarded a contract under
paragraph (1)--
(i) to verify that the requirements of a program, project
or system, or a development phase of such a program or
project, are correctly defined; and
(ii) to validate cost, schedule, and performance baselines
of current programs and measure program effectiveness.
(e) Department of Veterans Affairs Cost Assessment and
Program Evaluation.--
(1) In general.--Subchapter VII of chapter 81 of title 38,
United States Code, as added by subsection (a) and amended by
subsection (b), is further amended by adding at the end the
following new section:
``Sec. 8184. Cost assessment and program evaluation
``(a) Director of Cost Assessment and Program Evaluation.--
There is in the Department a Director of Cost Assessment and
Program Evaluation, who shall report directly to the
Secretary.
``(b) Responsibilities.--The responsibilities of the
Director are as follows:
``(1) To develop policies and procedures for cost
estimation and analysis of major acquisition programs of the
Department.
``(2) To conduct independent cost estimates and analyses
for major acquisition programs to support acquisition
decisions, or any other acquisitions as directed by the
Secretary.
``(3) To provide an independent cost estimate to the
Assistant Secretary for Acquisition in advance of a decision
to proceed with full-scale acquisition for a major
acquisition program or any other program as directed by the
Director.
``(4) To evaluate the effectiveness of major acquisition
programs in meeting Department objectives.
``(5) Not less frequently than once each year, to submit to
the Secretary and the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives an annual report on cost estimation and
program evaluation activities, including recommendations to
improve acquisition efficiency. Such report shall include a
list of all acquisitions where the independent cost estimate
for a major acquisition program exceeded the budget request
for the program by more than 5 percent.
``(c) Support and Resources.--The Chief Financial Officer
of the Department shall
[[Page H4585]]
provide to the Secretary such support and resources as may be
necessary for the Secretary to ensure the effective
establishment and functioning of the Director of Cost
Assessment and Program Evaluation.''.
(2) Report on monitoring of operating and support costs for
major acquisition programs.--
(A) Report to secretary of veterans affairs.--Not later
than one year after the date of the enactment of this Act,
and not less frequently than once each year thereafter until
December 31, 2028, the Director of Cost Assessment and
Program Evaluation of the Department of Veterans Affairs
shall submit to the Secretary of Veterans Affairs a report on
systems and methods for tracking and assessing operating and
support costs of major acquisition programs (as defined in
section 8181 of title 38, United States Code, as added by
subsection (a)), including recommendations for establishing
cost baselines.
(B) Transmittal to congress.--Not later than 30 days after
receiving a report pursuant to 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 the report received by the
Secretary.
(f) Improvements to Hiring of Entry-level Acquisition
Positions in Department of Veterans Affairs.--
(1) Priority use of internship programs for hiring into
entry-level positions in acquisitions.--The Secretary of
Veterans Affairs shall prioritize the use of acquisition
internship programs to hire employees to entry-level
positions relating to acquisition in the Department of
Veterans Affairs.
(2) Annual number of participants in acquisition internship
programs.--
(A) In general.--Not later than September 30 of the first
fiscal year beginning after the date of the enactment of this
Act, the Secretary shall take such actions as may be
necessary to ensure that the annual number of participants in
acquisition internship programs of the Department is--
(i) not fewer than twice the number of participants in such
programs during fiscal year 2025; and
(ii) not more than 4 times the number of participants in
such programs during such fiscal year.
(B) Termination.--The requirements of subparagraph (A)
shall terminate on the date on which the Secretary certifies
to the appropriate committees of Congress that the projected
number of graduates of acquisition internship programs is
sufficient to satisfy the human capital needs of the
Department with respect to acquisition, taking into account
the rate of attrition and projected retirements of personnel.
(C) Appropriate committees of congress defined.--In this
subsection, the term ``appropriate committees of Congress''
means the Committee on Veterans' Affairs of the Senate and
the Committee on Veterans' Affairs of the House of
Representatives.
(g) Independent Analysis of Acquisition Process of
Department of Veterans Affairs.--
(1) Systems engineering analysis.--Not later than one year
after the date of the enactment of this Act, the Secretary of
Veterans Affairs shall enter into a memorandum of
understanding with the Executive Director of the Acquisition
Research Center of the Department of Defense to conduct a
systems engineering analysis of the acquisition process of
the Department of Veterans Affairs.
(2) Report.--Not later than one year after the date in
which the Secretary enters into the memorandum of
understanding required by paragraph (1), the Secretary shall
submit to the Committee on Veterans' Affairs of the Senate
and the Committee on Veterans' Affairs of the House of
Representatives a report on the findings of the Executive
Director with respect to the analysis conducted under such
subsection.
(h) Requirements Development Process.--
(1) In general.--Subchapter VII of chapter 81 of title 38,
United States Code, as added by subsection (a) and amended by
subsections (b) and (e), is further amended by adding at the
end the following new section:
``Sec. 8185. Requirements development process
``(a) Establishment of Process.--(1) The Secretary shall
establish a standardized requirements development process for
major acquisition programs.
``(2) The process established pursuant to paragraph (1)
shall--
``(A) define and validate mission-driven requirements for
major acquisition programs exceeding $200,000,000 annually or
$1,000,000,000 in lifecycle costs, in coordination with the
Assistant Secretary for Acquisition;
``(B) incorporate data-driven needs assessments,
stakeholder input from relevant administrations, staff
offices, and other elements of the Department, and alignment
with statutory mandates, such as section 8121 of this title;
and
``(C) ensure iterative validation of requirements through
independent verification and validation, as described in
section 8183 of this title, to confirm cost, schedule, and
performance baselines.
``(b) Limitation on Personnel.--The Secretary shall
implement the process established pursuant to subsection (a)
using staff within the Office of Acquisition and other
relevant offices of the Department, as established under
section 8182 of this title, without creating new positions,
unless a subsequent cost-benefit analysis, validated by the
Director of Cost Assessment and Program Evaluation, justifies
additional resources.''.
(2) Report.--Not later than 180 days after the enactment of
this Act, the Secretary shall submit to the Committee on
Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives a report
detailing the requirements process established pursuant to
section 8183 of such title, as added by paragraph (1) and a
plan for implementation of such process, including timelines
for integration with major acquisition program baselines.
(i) Conforming Amendments.--Subchapter VI of chapter 81 of
title 38, United States Code, is amended--
(1) in section 8171, by striking paragraphs (5) and (6);
and
(2) by striking section 8172.
(j) Clerical Amendments.--The table of sections at the
beginning of chapter 81 of title 38, United States Code, is
amended--
(1) by striking the item relating to section 8172; and
(2) by adding at the end the following:
``subchapter vii--acquisition review, cost assessment, and program
evaluation
``8181. Definition of major acquisition program.
``8182. Acquisition reorganization.
``8183. Major acquisition program managers.
``8184. Cost assessment and program evaluation.
``8185. Requirements development process.''.
SEC. 404. IMPROVEMENT OF TELEPHONE COMMUNICATION BY
DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--Chapter 63 of title 38, United States
Code, is amended by adding at the end the following new
section:
``Sec. 6321. Telephone communication
``(a) Calls Associated With Department.--Not later than one
year after the date of the enactment of the Take Care of
America's Veterans Act, the Secretary shall ensure, to the
extent practicable and feasible, that any call made to a
veteran, beneficiary, claimant, or other relevant individual
by an employee or contractor of the Department regarding
services or benefits furnished by the Department--
``(1) is made from a single, well-known telephone number;
and
``(2) uses caller identification branding that indicates to
the individual that the call is from or on behalf of the
Department.
``(b) Call Centers for Health Care Appointments and
Referrals.--
``(1) In general.--Not later than one year after the date
of the enactment of the Take Care of America's Veterans Act,
the Secretary shall ensure that the Veterans Health
Administration has at least one call center in each of the
time zones specified in paragraph (3) to address concerns
regarding appointments and referrals for health care under
the laws administered by the Secretary.
``(2) Existing efforts and call centers.--In carrying out
paragraph (1), the Secretary--
``(A) shall ensure coordination with existing efforts of
the Department to improve call center operations; and
``(B) may use existing call centers to meet the
requirements of such paragraph.
``(3) Time zones specified.--The time zones specified in
this paragraph are the following:
``(A) Eastern time.
``(B) Central time.
``(C) Mountain time.
``(D) Pacific time.
``(E) Alaska time.
``(F) Hawaii time.
``(4) Clarification.--The Secretary is not required to
ensure that the Veterans Health Administration has a call
center in any location generally within a time zone specified
in paragraph (3) that does not follow daylight saving
time.''.
(b) Clerical Amendment.--The table of sections at the
beginning of chapter 63 of such title is amended by adding at
the end the following new item:
``6321. Telephone communication.''.
(c) Report.--Not later than 180 days after enactment, and
annually for three years thereafter, the Secretary shall
submit to the Committees on Veterans' Affairs of the Senate
and House of Representatives a report on implementation,
including call-answer rates, abandoned-call rates, average
wait times, veteran complaints, spoofing or fraud-prevention
measures, and any exceptions granted.
SEC. 405. ADVANCING DEPARTMENT OF VETERANS AFFAIRS EMERGENCY
RESPONSE TO CRISIS.
(a) Report on Emergency Management Roles for Department of
Veterans Affairs.--
(1) In general.--Not later than 180 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a report outlining the roles and
responsibilities of all offices of the Department of Veterans
Affairs involved with emergency management.
(2) Consultation.--In preparing the report required by
paragraph (1), the Secretary of Veterans Affairs shall
consult with the Comptroller General of the United States,
the Inspector General of the Department of Veterans Affairs,
the Secretary of Homeland Security, the Secretary of Defense,
and such other Federal agencies as the Secretary of Veterans
Affairs considers relevant, to obtain insights from their
experience and
[[Page H4586]]
trends that they have found, and such recommendations as they
may have with respect to the management by the Department of
Veterans Affairs of emergency management functions.
(3) Contents.--The report submitted pursuant to paragraph
(1) shall include the following:
(A) A description of the organizational structure of each
office, both during normal operations and during emergency or
disaster operations.
(B) The roles and responsibilities of each office.
(C) A detailed description of roles and responsibilities
that are shared by both the Office of Emergency Management of
the Department and the Office of Operations, Security, and
Preparedness of the Department, including an analysis of how
each office plays a part in emergency management functions.
(D) Recommendations for improving the structure and
alignment of relevant offices to better prepare the
Department for emergencies, remove redundancies, and improve
accountability.
(E) An analysis of the feasibility and advisability of
consolidating relevant offices into one centralized emergency
management office to improve communication and streamline
emergency preparedness and response efforts of the
Department.
(b) Plan to Allow Fuel Sharing and Increased Coordination
Between the Federal Emergency Management Agency and the
Department of Veterans Affairs.--Not later than 90 days after
the date of the enactment of this Act, the Secretary of
Veterans Affairs shall, after consulting with the
Administrator of the Federal Emergency Management Agency,
submit to the Committee on Veterans' Affairs of the Senate,
the Committee on Veterans' Affairs of the House of
Representatives, the Committee on Homeland Security and
Government Affairs of the Senate, and the Committee on
Homeland Security of the House of Representatives a report
regarding--
(1) the current limitations preventing the Federal
Emergency Management Agency from providing fuel or other
resources to the Department of Veterans Affairs during
emergencies;
(2) whether the Department requires action by Congress to
allow such resource provision to occur;
(3) whether the Secretary has been unable to coordinate
with the Administrator during prior emergencies or Fourth
Mission activations due to a lack of authority for such
coordination;
(4) whether the Secretary requires action by Congress to
address any of the issues mentioned under paragraph (3); and
(5) whether the Secretary requires action by Congress to
address the issue of Department employees or responders being
unable to use Department-purchased fuel.
SEC. 406. MEMBERSHIP OF DEPARTMENT OF VETERANS AFFAIRS
GERIATRICS AND GERONTOLOGY ADVISORY COMMITTEE.
Section 7315 of title 38, United States Code, is amended,
in subsection (a)--
(1) in the second sentence, by striking ``and at least one
representative of a national veterans service organization''
and inserting ``, at least one individual who represents a
national veterans service organization, at least one
individual who has served veterans or families of veterans in
a State home, and at least one individual who holds a
professional license in nursing home administration''; and
(2) by designating the first, second, and third sentences
as paragraphs (1) through (3), respectively (and adjusting
the margins accordingly).
SEC. 407. SCHEDULING OF APPOINTMENTS UNDER THE VETERANS
COMMUNITY CARE PROGRAM.
(a) Electronic Process.--Subsection (d) of section 3101 of
the Johnny Isakson and David P. Roe, M.D. Veterans Health
Care and Benefits Improvement Act of 2020 (Public Law 116-
315; 38 U.S.C. 1701 note) is amended to read as follows:
``(d) Electronic Process.--(1) The Secretary shall
implement an electronic process through which a scheduler of
the Department, using an information technology system, may
schedule an appointment for health care furnished by the
Department or through the Veterans Community Care Program,
under section 1703 of this title, by a non-Department health
care provider.
``(2) The electronic process under this subsection shall
allow a scheduler, with regards to appointments described
in--
``(A) either clause of subparagraph (A) of subsection
(a)(1), to view, search, and sort such appointments by type
of care, location, and date; and
``(B) clause (ii) of such subparagraph--
``(i) to schedule such an appointment;
``(ii) to provide referral and authorization documents
directly to a non-Department provider; and
``(iii) to perform any other function the Secretary
determines necessary.
``(3) The Secretary shall ensure that the electronic
process allows a scheduler to schedule an appointment for
health care furnished by the Secretary through a health care
provider of the Department.
``(4) The Secretary shall implement the electronic process
through an existing agreement if practicable.
``(5) The Secretary shall submit to the Committees on
Veterans' Affairs of the Senate and House of Representatives
the following regarding the electronic process:
``(A) Not later than 90 days after the Secretary makes a
determination under subparagraph (B)(iii) of paragraph (2), a
briefing regarding the functions the Secretary has determined
necessary.
``(B) Not later than six months after the date of the
enactment of Take Care of America's Veterans Act, and
semiannually thereafter during the following three years, a
report regarding operation of the electronic process during
both the semiannual period preceding the date of the report
and the cumulative period since the date of the enactment of
such Act. Such a report shall include the following for each
such period:
``(i) The number of non-Department health care providers
that participated in such electronic process, disaggregated
by--
``(I) category of hospital care or medical services
provided; and
``(II) medical center of the Department;
``(ii) The number of appointments scheduled pursuant to the
electronic process, disaggregated by--
``(I) category of hospital care or medical services
provided;
``(II) medical center of the Department; and
``(III) month.
``(iii) A comparison of the average wait time for
appointments scheduled through the electronic process and
through non-electronic methods, disaggregated by medical
center of the Department.
``(iv) The rates at which veterans cancelled appointments
scheduled through the electronic process.
``(v) The rates at which veterans did not appear for
appointments scheduled through the electronic process.''.
(b) Implementation.--
(1) Date.--The Secretary of Veterans Affairs shall
implement the electronic process under subsection (d) of
section 1703H of such title, as added by this section, not
later than two years after the date of the enactment of this
Act.
(2) Guidelines.--Not later than 90 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall establish guidelines. Such guidelines shall include the
following:
(A) Procedures for schedulers and other employees of the
Department involved in the scheduling of appointments
described in such section.
(B) A directive that employees described in subparagraph
(A) use the electronic process to the extent practicable.
(C) A directive that employees described in subparagraph
(A), when scheduling an appointment for a covered veteran (as
such term is used in section 1703 of such title) for health
care furnished by the Secretary, inform such covered veteran
of available appointments through providers of the Department
and through providers under the Veterans Community Care
Program when eligible.
(D) Procedures for engaging with non-Department health care
providers in specialized cases.
(E) Standards regarding timeliness and accuracy.
(F) Escalation protocols for scheduling failures or delays.
(3) Training.--Not later than 180 days after the date of
the enactment of this Act, the Secretary shall implement a
mandatory training program for employees described in
subparagraph (B) regarding the guidelines under subparagraph
(B).
(4) Evaluation.--Not later than 60 days after the date of
the enactment of this Act, the Secretary shall prescribe
performance benchmarks and outcome-based metrics for the
electronic process under such section, including--
(A) time between a referral and a scheduled appointment;
(B) patient satisfaction; and
(C) the percentage of appointments scheduled exclusively
through the electronic process.
(5) Outreach.--Not later than 90 days after the date of the
enactment of this Act, the Secretary shall plan and carry out
an outreach strategy to encourage non-Department of Veterans
Affairs health care providers that participate in the
Veterans Community Care Program to participate in the
electronic process under such subsection. Such outreach
shall--
(A) include contacting each such provider during such 90
days;
(B) include seeking to enter into an agreement with each
such provider under which the provider shall participate in
the electronic process;
(C) include collaborating with State hospital associations
and rural health associations to promote such participation;
(D) focus on providers in specialties or underserved areas,
as determined by the Secretary; and
(E) include the publication, on a publicly accessible
website of the Department, of information regarding--
(i) details of the electronic process;
(ii) how a provider may elect to participate in the
electronic process; and
(iii) a point of contact in the Department regarding the
electronic process.
(6) Oversight.--The Secretary shall submit to the
Committees on Veterans' Affairs of the Senate and House of
Representatives, with regards to the electronic process under
such subsection, the following:
[[Page H4587]]
(A) Not later than 30 days after the Secretary establishes
guidelines under paragraph (2) of this subsection, a copy of
such guidelines.
(B) Not later than 30 days after the Secretary formulates
the plan under paragraph (5) of this subsection, a briefing
on the outreach strategy under such paragraph.
(C) Not later than 180 days after the date of the enactment
of this Act, the benchmarks and metrics prescribed under
paragraph (4).
(c) Expansion.--Not later than 90 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 integrate the scheduling of
appointments for health care furnished through health care
providers of the Department of Veterans Affairs into the
electronic process under subsection (d) of section 1703H of
such title, as added by this section. Such plan shall include
the following elements:
(1) A timeline to implement such plan.
(2) Estimated costs to carry out such plan.
(3) Changes to policies and procedures of the Department
the Secretary determines necessary to implement such plan.
(d) Codification.--
(1) In general.--Section 3101 of such Act, as amended by
subsection (a), is transferred to subchapter I of chapter 17
of title 38, United States Code, inserted after section
1703G, and redesignated as section 1703H.
(2) Conforming amendments.--Section 1703H of such title, as
transferred and redesignated by this subsection, is amended--
(A) by striking any heading that is not a section heading
or subsection heading and conforming the margins accordingly;
(B) by striking ``of title 38, United States Code'' both
places it appears and inserting ``of this title'';
(C) in subsection (b)(1), by striking ``Not later than one
year after the date of the enactment of this Act, the
Secretary'' and inserting ``The Secretary'';
(D) in subsection (c)--
(i) in paragraph (1), in the matter preceding subparagraph
(A), by striking ``Not later than 180 days after the date of
the enactment of this Act, the Secretary'' and inserting
``The Secretary''; and
(ii) in paragraph (2), by striking subparagraphs (A) and
(B) and inserting ``The Secretary shall require each medical
facility of the Department to use the method or tool
described in paragraph (1).'';
(E) in the section enumerator, by striking ``sec.'' and
inserting ``Sec. ''; and
(F) in the section heading--
(i) by striking ``process and requirements for scheduling
appointments for health care from department of veterans
affairs and non-department health care.'' and inserting
``scheduling of appointments''; and
(ii) by conforming the typeface and typestyle, including
capitalization, to the typeface and typestyle used in the
section heading of section 1703G of such title.
(3) Table of sections.--The table of sections at the
beginning of such chapter is amended by inserting, after the
item relating to section 1703G, the following new item:
``1703H. Scheduling of appointments.''.
TITLE V--MEMORIAL AFFAIRS
SEC. 501. EXPANSION OF ELIGIBILITY FOR DEPARTMENT OF VETERANS
AFFAIRS MEMORIAL HEADSTONE OR MARKER FOR
CERTAIN INDIVIDUALS.
Section 2306(b)(2) of title 38, United States Code, is
amended in subparagraphs (B) and (C) by striking ``who dies
on or after November 11, 1998,'' each place it appears.
SEC. 502. DEPARTMENT OF VETERANS AFFAIRS PROVISION OF
ADDITIONAL BURIAL BENEFITS WHEN AN URN OR
COMMEMORATIVE PLAQUE IS FURNISHED.
(a) In General.--Paragraph (2) of section 2306(h) of title
38, United States Code, is amended to read as follows:
``(2) If the Secretary furnishes an urn or commemorative
plaque for an individual under paragraph (1), the Secretary
may not provide for such individual a headstone or marker
under this section, or any interment benefit under section
2402 of this title, unless--
``(A) in the case of a request for a headstone or marker
under this section--
``(i) such request is made at the same time as a request
for placement of a headstone or marker for another individual
who is eligible to have such a headstone or marker placed in
a national cemetery, a veterans' cemetery in receipt of a
grant made under section 2408 of this title, or a post
cemetery; and
``(ii) the Secretary furnishes one headstone or marker
inscribed for both individuals; or
``(B) in the case of a request for interment, the
individual is interred at the same time and in the same
gravesite as the interment of another individual eligible for
interment in a national cemetery under section 2402(a) of
this title.''.
(b) Applicability.--The amendment made by subsection (a)
shall apply with respect to an individual who dies on or
after January 5, 2021.
SEC. 503. FALLEN SERVICEMEMBERS RELIGIOUS HERITAGE
RESTORATION PROGRAM.
(a) Findings.--Congress finds the following:
(1) An estimated 900 American-Jewish servicemembers of the
Armed Forces, killed in World War I and World War II and
buried overseas in United States military cemeteries, were,
for various reasons, mistakenly buried under Latin Crosses.
In most instances, those mistakes were made inadvertently.
(2) In 2022, more than 2,000,000 people visited the United
States World War I and World War II cemeteries in foreign
countries.
(3) American-Jewish servicemembers played a vital role in
the Allied victories in World War I and World War II.
(4) American-Jewish servicemembers who fought and died for
the United States must have their heritage properly
recognized and honored.
(5) The United States Government has a solemn
responsibility to ensure that every American servicemember
killed in action and buried overseas is properly honored.
(6) The work of properly identifying American-Jewish
servicemembers buried overseas is vital and integral to the
responsibility of the American Battle Monuments Commission to
ensure that past mistakes in honoring those servicemembers
who died in the line of duty are corrected.
(b) Fallen Servicemembers Religious Heritage Restoration
Program.--
(1) Establishment.--The American Battle Monuments
Commission shall establish a program to identify covered
members and to contact survivors and descendants of such
covered members. Such program shall be known as the ``Fallen
Servicemembers Religious Heritage Restoration Program''.
(2) Duration.--The Commission shall carry out the Fallen
Servicemembers Religious Heritage Restoration Program during
the first five fiscal years that begin after the date of the
enactment of this Act.
(3) Contracts.--
(A) Authority.--During each fiscal year described in
subsection (b), the Commission shall seek to enter into a
contract with a nonprofit organization under which such
nonprofit organization shall carry out the purpose described
in subsection (b)(1).
(B) Term; amount.--Each contract under this subsection
shall be for one year and in the amount of $500,000 to the
nonprofit organization.
(C) Priority.--In awarding a contract under this
subsection, the Commission shall give priority to a nonprofit
organization that has demonstrated capability and expertise
in carrying out the purpose described in subsection (b)(1).
(4) Definitions.--In this section:
(A) The term ``covered member'' means a deceased member of
the Armed Forces who was Jewish and buried--
(i) in a United States military cemetery located outside
the United States; and
(ii) under a marker that indicates such member was not
Jewish.
(B) The term ``nonprofit organization'' means an
organization described in section 501(c)(3) of the Internal
Revenue Code of 1986 and exempt from taxation under section
501(a) of such Code.
TITLE VI--VETERANS' ASSURING CRITICAL CARE EXPANSIONS TO SUPPORT
SERVICEMEMBERS
Subtitle A--Improvement of Veterans Community Care Program
SEC. 601. CODIFICATION OF REQUIREMENTS FOR ELIGIBILITY
STANDARDS FOR ACCESS TO COMMUNITY CARE FROM
DEPARTMENT OF VETERANS AFFAIRS.
(a) Eligibility Access Standards.--Section 1703B of title
38, United States Code, is amended--
(1) by striking subsections (a) through (e) and inserting
the following:
``(a) Access Standards for Community Care.--(1) For
purposes of section 1703(d)(1)(D) of this title, the
eligibility access standards for hospital care, medical
services, or non-institutional extended care services, are as
follows:
``(A) With respect to primary care, mental health care, or
non-institutional extended care services, the Secretary must
schedule an appointment for the covered veteran with a health
care provider of the Department who can provide the needed
service--
``(i) within 30 minutes average driving time from the
residence of the veteran unless a longer average driving time
has been agreed to by the veteran in consultation with a
health care provider of the veteran; and
``(ii) within 20 days of either the date of request for
such an appointment or a later date agreed to by the veteran
in consultation with a health care provider of the veteran.
``(B) With respect to specialty care, the Secretary must
schedule an appointment for the covered veteran with a health
care provider of the Department who can provide the needed
service--
``(i) within 60 minutes average driving time from the
residence of the veteran unless a longer average driving time
has been agreed to by the veteran in consultation with a
health care provider of the veteran; and
``(ii) within 28 days of either the date of request for
such an appointment or a later date agreed to by the veteran
in consultation with a health care provider of the veteran.
``(C) With respect to a covered treatment program, the
Secretary must--
``(i) provide to a covered veteran a screening not later
than 48 hours after the date on which the veteran, or a
relevant health care provider, makes a documented request for
the veteran to be admitted to a covered treatment program;
and
``(ii) if the veteran is determined eligible for priority
admission to a covered treatment program--
[[Page H4588]]
``(I) admit the veteran to a covered treatment program not
later than 48 hours after the date of such determination; or
``(II) give the veteran the option of seeking care at a
non-Department facility pursuant to section 1792(e) of this
title.
``(2) For the purposes of determining the ability of the
Secretary to schedule an appointment for a covered veteran
with a health care provider of the Department under paragraph
(1), the Secretary shall not take into consideration the
availability of telehealth appointments from the Department.
``(3) In the case of a covered veteran who has had an
appointment with a health care provider of the Department
canceled by the Department for a reason other than either the
request of the veteran or the failure of the veteran to
appear as scheduled, in calculating a wait time for a
subsequent appointment under the eligibility access standards
established under paragraph (1), the Secretary shall
calculate such wait time from the date of the request for the
original, canceled appointment.
``(4) If a veteran agrees to a longer average drive time or
a later date under paragraph (1), the Secretary shall
document the agreement to such longer average drive time or
later date in the electronic health record of the veteran and
provide the veteran a copy of such documentation. Such copy
may be provided electronically.
``(5) Paragraph (1)(C) shall not be construed to affect a
covered veteran in a covered treatment program pursuant to a
determination made on or before the date of the enactment of
the Take Care of America's Veterans Act.
``(6)(A) Subject to the provisions of this paragraph,
subparagraphs (A) and (B) of paragraph (1) shall terminate on
the date that is eight years after the date of the enactment
of the Take Care of America's Veterans Act.
``(B) Not later than seven years after the date of the
enactment of the Take Care of America's Veterans Act, the
Secretary shall submit to the Committee on Veterans' Affairs
of the Senate and the Committee on Veterans' Affairs of the
House of Representatives a report containing--
``(i) an assessment of the effects of the codification of
eligibility access standards for primary care, mental health
care, non-institutional extended care services, and specialty
care under this subsection on the management and oversight of
the Veterans Community Care Program under section 1703 of
this title; and
``(ii) the recommendation of the Secretary for continued
codification of such standards along with a justification for
such recommendation.
``(C) On and after the date that is eight years after the
date of the enactment of the Take Care of America's Veterans
Act, the Secretary may not establish access standards for
care and services described in subparagraph (A) or (B) of
paragraph (1) that are different from the standards set forth
in those subparagraphs unless, not later than 180 days before
establishing such different standards--
``(i) the Secretary submits to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans' Affairs
of the House of Representatives notification of the intent of
the Secretary to establish such different standards,
including a description of the changes the Secretary intends
to make and the justification for such changes; and
``(ii) a joint resolution of approval is enacted that
approves such different standards.
``(D) For purposes of this subsection, the term `joint
resolution of approval' means only a joint resolution the
matter after the resolving clause of which is as follows:
`That Congress approves the access standards established by
the Secretary submitted on __ relating to __.', with the
first blank space filled by the appropriate date and the
second blank space filled with a description of the access
standards.
``(E) A joint resolution of approval shall be considered
under the expedited procedures outlined in section 802 of
title 5 to the same extent as a joint resolution described in
subsection (a) of that section is considered.
``(b) Application.--The Secretary shall ensure that the
eligibility access standards established under subsection (a)
apply--
``(1) to all care and services within the medical benefits
package of the Department to which a covered veteran is
eligible under section 1703 of this title; and
``(2) to all covered veterans, regardless of whether a
veteran is a new or established patient.
``(c) Periodic Review of Access Standards.--(1) Not later
than three years after the date of the enactment of the Take
Care of America's Veterans Act, and not less frequently than
once every three years thereafter, the Secretary shall--
``(A) conduct a review of the eligibility access standards
under subsection (a) in consultation with--
``(i) such Federal entities as the Secretary considers
appropriate, including the Department of Defense, the
Department of Health and Human Services, and the Centers for
Medicare & Medicaid Services;
``(ii) entities and individuals in the private sector,
including--
``(I) veteran patients;
``(II) representatives of veterans, including individual
veterans and participants from veteran stakeholder
organizations selected through an open and transparent
process; and
``(III) health care providers participating in the Veterans
Community Care Program under section 1703 of this title; and
``(iii) other entities that are not part of the Federal
Government; and
``(B) submit to the appropriate committees of Congress a
report on--
``(i) the findings of the Secretary with respect to the
review conducted under paragraph (1); and
``(ii) such recommendations as the Secretary may have with
respect to the eligibility access standards under subsection
(a).
``(2) Chapter 10 of title 5 shall not apply to the
consultation required by paragraph (1)(A).'';
(2) by striking subsection (g);
(3) by redesignating subsections (f), (h), and (i) as
subsections (d), (e), and (f), respectively;
(4) in subsection (d), as redesignated by paragraph (3)--
(A) by striking ``established'' each place it appears; and
(B) in paragraph (1), by striking ``(1) Subject to'' and
inserting ``Compliance by Community Care Providers With
Access Standards.--(1) Subject to'';
(5) in subsection (e), as so redesignated--
(A) in paragraph (1)--
(i) by striking ``(1) Consistent with'' and inserting
``Determination Regarding Eligibility.--(1) Consistent
with''; and
(ii) by striking ``designated access standards established
under this section'' and inserting ``eligibility access
standards under subsection (a)''; and
(B) in paragraph (2)(B), by striking ``designated access
standards established under this section'' and inserting
``eligibility access standards under subsection (a)''; and
(6) in subsection (f), as redesignated by paragraph (2)--
(A) in the matter preceding paragraph (1), by striking ``In
this section'' and inserting ``Definitions.--In this
section''; and
(B) in paragraph (2)--
(i) by striking ``covered veterans'' and inserting
``covered veteran'';
(ii) by striking ``veterans described'' and inserting ``a
veteran described'';
(iii) by redesignating paragraphs (3) and (4) as paragraphs
(4) and (5), respectively; and
(iv) by inserting after paragraph (2) the following new
paragraph (3):
``(3) The term `covered treatment program' has the meaning
given such term in section 1791 of this title.''.
(b) Conforming Amendments.--Section 1703(d) of such title
is amended--
(1) in paragraph (1)(D), by striking ``designated access
standards developed by the Secretary under section 1703B of
this title'' and inserting ``eligibility access standards
under section 1703B(a) of this title'';
(2) in paragraph (3), by striking ``designated access
standards developed by the Secretary under section 1703B of
this title'' and inserting ``eligibility access standards
under section 1703B(a) of this title''; and
(3) in paragraph (4), by striking ``designated access
standards developed by the Secretary under section 1703B of
this title'' and inserting ``eligibility access standards
under section 1703B(a) of this title''.
SEC. 602. REQUIREMENT THAT SECRETARY NOTIFY VETERANS OF
ELIGIBILITY FOR CARE OR DENIAL OF REQUEST FOR
CARE UNDER VETERANS COMMUNITY CARE PROGRAM.
(a) In General.--Section 1703(a) of title 38, United States
Code, is amended by adding at the end the following new
paragraph:
``(5)(A)(i) Except as provided in clause (iii), the
Secretary shall notify each covered veteran in writing of the
eligibility of such veteran for care or services under this
section as soon as possible but not later than five days
after the date on which the Secretary is aware that the
veteran is seeking care or services and is eligible for such
care or services under this section.
``(ii) The Secretary is required to notify a covered
veteran under clause (i) only at the start of an episode of
care for such veteran.
``(iii) The Secretary shall allow a covered veteran to opt
out of receiving notification under clause (i).
``(B) With respect to each covered veteran eligible for
care or services under subsection (d), and consistent with
subparagraph (A), the Secretary shall provide such veteran
periodic reminders, as applicable and as the Secretary
determines appropriate, of their ongoing eligibility under
such subsection.
``(C) Any notification or reminder under this paragraph may
be provided electronically.
``(6)(A) If a request by a veteran for the Secretary to
authorize care or services under this section is denied,
except as provided in subparagraph (C), the Secretary shall
notify the veteran in writing as soon as possible but not
later than five days after the denial is made--
``(i) of the reason for the denial; and
``(ii) with instructions on how to appeal such denial using
the clinical appeals process of the Veterans Health
Administration.
``(B) If a denial under subparagraph (A) is due to the
Secretary meeting the eligibility access standards under
section 1703B(a) of this title, notice under such
subparagraph shall include an explanation of how the
Secretary met such standards.
``(C) The Secretary shall allow a covered veteran to opt
out of receiving notification under subparagraph (A).
``(D) Any notification under this paragraph may be provided
electronically.''.
(b) Reports to Congress.-- Not later than one year after
the date of the enactment of
[[Page H4589]]
this Act, and not less frequently than annually thereafter
for a period of five years, the Secretary of Veterans Affairs
shall submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a report on the implementation of the
amendments made by subsection (a), including--
(1) an assessment of the timeliness of the notifications
required by those amendments;
(2) a description of barriers to increasing the timeliness
of those notifications; and
(3) the number of veterans who opt out of receiving those
notifications.
SEC. 603. CONSIDERATION UNDER VETERANS COMMUNITY CARE PROGRAM
OF CONTINUITY OF CARE AND NEED FOR CAREGIVER OR
ATTENDANT.
Section 1703(d) of title 38, United States Code, is
amended--
(1) in paragraph (2), by adding at the end the following
new subparagraphs:
``(F) The potential for improved continuity of care,
including if a veteran has an established relationship with a
non-Department provider and the likelihood of the covered
veteran to seek and complete recommended care, including if
the veteran would abstain from seeking such care if required
to seek such care at a facility of the Department.
``(G) Whether the covered veteran needs an attendant to
provide required aid or assistance to the veteran, including
for the veteran to travel to a facility of the Department.'';
and
(2) by adding at the end the following new paragraph:
``(5) The Secretary shall ensure that consideration of the
factors specified in paragraph (2) includes consideration of
all relevant factors, is driven by clinical need, and that no
single factor is required to be determinative when
considering the best medical interest of a covered
veteran.''.
SEC. 604. DISCUSSION OF TELEHEALTH OPTIONS UNDER VETERANS
COMMUNITY CARE PROGRAM.
Section 1703 of title 38, United States Code, is amended--
(1) by redesignating subsection (q) as subsection (r); and
(2) by inserting after subsection (p) the following new
subsection (q):
``(q) Discussion of Options for Telehealth.--(1) When
discussing options for care or services for a covered veteran
under this section, the Secretary shall ensure that the
veteran is informed of the ability of the veteran to seek
care or services via telehealth, either through a medical
facility of the Department or through a non-Department
provider, if--
``(A) telehealth is--
``(i) available to the veteran;
``(ii) appropriate for the type of care or services the
veteran is seeking, as determined by the Secretary; and
``(iii) is acceptable to the veteran; or
``(B) the care or services the veteran is seeking is only
or primarily available through telehealth.
``(2) Nothing in paragraph (1) shall be construed to
prohibit a health care provider specified in subsection (c)
from furnishing hospital care, medical services, or extended
care services under this section via telehealth.''.
SEC. 605. EXTENSION OF DEADLINE FOR SUBMITTAL OF CLAIMS BY
HEALTH CARE ENTITIES AND PROVIDERS UNDER PROMPT
PAYMENT STANDARD.
Section 1703D of title 38, United States Code, is amended--
(1) in subsection (a)(2), by striking ``the reason for
denying the claim and what, if any, additional information is
required to process the claim'' and inserting ``the reason
for denying the claim and request additional missing
information, if any, that is required to process the claim'';
(2) by amending subsection (b) to read as follows:
``(b) Submittal of Claims by Health Care Entities and
Providers.--(1) A health care entity or provider that
furnishes hospital care, a medical service, or an extended
care service under this chapter pursuant to a contract,
agreement, or other arrangement shall submit to the Secretary
a claim for payment for furnishing the hospital care, medical
service, or extended care service not later than one year
after the date on which the entity or provider furnished the
hospital care, medical service, or extended care service.
``(2) No health care entity or provider may seek payment
from a patient if the health care entity or provider failed
to comply with the timely filing requirement set forth in
paragraph (1).''; and
(3) in subsection (c), by adding at the end the following
new paragraph:
``(3)(A) If the Secretary determines, based on reliable
evidence, that a health care entity or provider has submitted
or caused to be submitted a fraudulent claim for payment
under this chapter, the Secretary may suspend such entity or
provider from furnishing hospital care, medical services, or
extended care services under this chapter.
``(B) Before imposing a suspension under subparagraph (A)
with respect to an entity or provider, the Secretary shall--
``(i) provide written notice to the entity or provider
identifying the basis for the proposed suspension;
``(ii) afford the entity or provider an opportunity to
respond within a period of 30 days; and
``(iii) consider any evidence or explanation submitted by
the entity or provider.
``(C)(i) The Secretary shall take all necessary actions to
resolve a suspension under subparagraph (A) as soon as
possible and not later than one year after the date of such
suspension unless the Secretary determines and provides a
written determination that an extension beyond one year is
strictly necessary to protect the interests of veterans and
taxpayers and to preserve the integrity of the health care
delivery system of the Department.
``(ii) Any extension under clause (i) of a suspension
shall--
``(I) be for an additional period of not longer than one
year; and
``(II) shall be reported to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans' Affairs
of the House of Representatives.
``(D) The Secretary shall establish procedures for
reinstatement of an entity or provider suspended under
subparagraph (A) following the resolution of any fraud-
related investigation or proceeding.
``(E) The Secretary shall coordinate actions under this
paragraph with the Office of Inspector General of the
Department.
``(F) The Secretary shall prescribe regulations to carry
out this paragraph, including standards of evidence, notice,
and appeal procedures.
``(G)(i) Not less frequently than quarterly, 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 written notification of the suspensions
entered into, if any, during the preceding quarter that
includes--
``(I) the identity of the suspended entity or provider;
``(II) the statutory or regulatory basis for the
suspension;
``(III) a summary of the factual findings or evidence
supporting the action; and
``(IV) the status of any related investigation of or
referral to the Office of Inspector General of the Department
or any other appropriate Federal agency.
``(ii) The Secretary shall provide to the Committee on
Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives, upon
request, all records, memoranda, and communications relevant
to any suspension or reinstatement action taken under this
paragraph, in accordance with applicable laws related to
privacy, ongoing investigations, or sensitive law enforcement
information.
``(iii) Failure by the Secretary to provide notice under
clause (i) shall be treated as a failure to comply with a
statutory reporting requirement.''.
SEC. 606. AUDIT OF REPRESENTATIVE SAMPLE OF VETERANS
RECEIVING CARE AND SERVICES UNDER VETERANS
COMMUNITY CARE PROGRAM.
Not later than one year after the date of the enactment of
this Act, and not less frequently than annually thereafter
for the following five years, the Secretary of Veterans
Affairs shall--
(1) conduct an audit, for the one-year period preceding the
audit, of--
(A) the number of veterans eligible for care or services
under section 1703 of title 38, United States Code, and the
reasons for such eligibility, including multiple such reasons
for veterans eligible under more than one eligibility
criteria;
(B) with respect to veterans eligible for care or services
under section 1703 of title 38, United States Code, the
number of veterans who are informed of such eligibility;
(C) the number of veterans who opt to seek care or services
under such section;
(D) the number of veterans who do not opt to seek care or
services under such section;
(E) the timeliness of referrals for care or services under
such section and the timeliness of receipt of such care or
services, including whether care or services received by the
veteran through a non-Department of Veterans Affairs provider
had a shorter wait time than the average wait time for such
care or services at a facility of the Department;
(F) the number of requests for an appeal of a denial of
care or services under such section using the clinical
appeals process of the Veterans Health Administration;
(G) the timeliness of each such appeal; and
(H) the outcome of each such appeal; and
(2) 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 audit conducted under
paragraph (1).
SEC. 607. INFORMATION ON WAIT TIME AND DRIVE TIME OPTIONS FOR
RECEIPT OF CARE BY VETERANS.
(a) In General.--To the greatest extent practicable, the
Secretary of Veterans Affairs shall ensure that veterans are
informed in writing, for each episode of care provided under
the laws administered by the Secretary, of current wait time
and average drive time options for such episode of care
disaggregated by care provided--
(1) in person at a facility of the Department of Veterans
Affairs;
(2) via telehealth through a provider of the Department;
(3) in person through the nearest suitable non-Department
facility with which the Department has a provider agreement
or other arrangement for non-Department care pursuant to
section 1703 of title 38, United States Code; and
(4) via telehealth through a non-Department provider with
which the Department has a provider agreement or other
arrangement for non-Department care pursuant to such section
with the shortest wait time.
(b) Form of Information.--Information provided under
subsection (a)--
[[Page H4590]]
(1) may be provided electronically; and
(2) shall be documented in the health record of the
veteran.
(c) Opt Out.--The Secretary shall permit a veteran to opt
out of receiving information under subsection (a).
SEC. 608. ESTABLISHMENT OF PERIOD DURING WHICH A REFERRAL
UNDER VETERANS COMMUNITY CARE PROGRAM REMAINS
VALID.
Section 1703(a) of title 38, United States Code, as amended
by section 602(a), is further amended by adding at the end
the following new paragraph:
``(7) When authorizing care or services under this section,
the Secretary shall ensure that the period during which such
care or services may be performed by a health care provider
specified in subsection (c) begins on the date that the
covered veteran has the first appointment with such
provider.''.
SEC. 609. UPDATES TO CONTRACTING REQUIREMENTS UNDER VETERANS
COMMUNITY CARE PROGRAM.
Section 1703(h) of title 38, United States Code, is
amended--
(1) in paragraph (3)--
(A) by amending subparagraph (A) to read as follows:
``(A) The Secretary may terminate a contract with an entity
entered into under paragraph (1) at such time and upon such
notice to the entity as the Secretary may specify for
purposes of this section, if the Secretary notifies the
appropriate committees of Congress that, at a minimum--
``(i) the entity failed to comply substantially with the
provisions of the contract or with the provisions of this
section and the regulations prescribed under this section,
including with respect to access, quality, training, and
medical documentation;
``(ii) it is reasonable to terminate the contract based on
the health care needs of veterans; or
``(iii) it is reasonable to terminate the contract based on
coverage provided by contracts or sharing agreements entered
into under authorities other than this section.'';
(B) by redesignating subparagraph (B) as subparagraph (D);
(C) by inserting after subparagraph (A) the following new
subparagraphs:
``(B)(i) The Secretary shall terminate a contract with an
entity entered into under paragraph (1) at such a time and
upon such notice to the entity as the Secretary may specify
for the purposes of this section, if the entity--
``(I) is excluded from participation in a Federal health
care program (as defined in section 1128B(f) of the Social
Security Act (42 U.S.C. 1320a-7b(f))) under section 1128 or
1128A of the Social Security Act (42 U.S.C. 1320a-7 and
1320a-7a);
``(II) has been convicted of a felony or other serious
offense under Federal or State law and the continued
participation of the entity would be detrimental to the best
interests of veterans or the Department; or
``(III) is identified as an excluded source on the list
maintained in the System for Award Management, or any
successor system.
``(ii) The Secretary may issue a waiver for entities
subject to clause (i) for a one-year period, and such a
waiver shall be reported to Congress not later than 30 days
after such waiver is issued.
``(C) Any entities ineligible to enter into contracts with
the Department due to one or more reasons specified in this
paragraph may be listed on a publicly available website of
the Department or appropriate third party administrator.'';
(D) in subparagraph (D), as redesignated by subparagraph
(B) of this paragraph, by striking ``in subparagraph (A)''
and inserting ``in this paragraph''; and
(2) by adding at the end the following new paragraph:
``(7) Any contract or agreement between the Department and
a third party administrator or between a third party
administrator and a health care provider specified in
subsection (c) that is made with respect to care or services
provided under this section shall include--
``(A) notice of obligations to comply with Federal laws and
the consequences for failure to comply with those laws,
including specific information regarding claims for payment
and consequences for any false claims, statements, or
documents, or concealment of a material fact;
``(B) confirmation by the health care provider that they
are accredited to provide any specialized services subject to
the contract or agreement and that they will only use
qualified staff to provide those services; and
``(C) confirmation that the health care provider will
identify any individuals providing specialized services or
treatments included in the contract or agreement and provide
proof of the licensure of those individuals to the
Department.''.
SEC. 610. PUBLICATION OF COMMUNITY CARE NETWORK SUFFICIENCY
AND PAYMENT WAIVER REQUESTS AND APPROVALS.
Not later than one year after the date of the enactment of
this Act, and not less frequently than annually thereafter,
the Secretary of Veterans Affairs shall publish on a publicly
available and user-friendly website--
(1) the information contained in the most recent report
required by section 1703(p) of title 38, United States Code;
and
(2) an overview, disaggregated by region, of the waivers
requested, approved, and denied under section 1703B(f)(3) of
such title.
SEC. 611. REQUIREMENTS RELATING TO QUALITY OF COMMUNITY CARE
PROVIDERS.
(a) Monthly Checks Against List of Excluded Individuals or
Entities.--The Secretary of Veterans Affairs shall ensure
that third party administrators under the Veterans Community
Care Program perform automated monthly checks for all
community care providers against the list of excluded
individuals or entities set forth by the Office of Inspector
General of the Department of Health and Human Services using
national provider identifier records or other unique
identifiers.
(b) Revision of Provider Exclusion Standard Operating
Procedures.--Not later than 90 days after the date of the
enactment of this Act, the Secretary shall ensure that the
Office of Integrated Veteran Care or successor office revises
its provider exclusion standard operating procedures to
require automated matching of community care providers in the
provider profile management system of the Department of
Veterans Affairs to the system for award management
exclusions of the General Services Administration using both
taxpayer identification number and national provider
identifier as identifiers.
(c) Process to Identify Department Providers Terminated or
Resigning From Employment.--Not later than 90 days after the
date of the enactment of this Act, the Secretary shall ensure
that the Under Secretary for Health of the Department of
Veterans Affairs develops a process to identify health care
providers that are terminated, retire, or resign from
employment with the Department for quality of care concerns
or while under investigation for quality of care concerns so
those health care providers can be prevented from
participating in the Veterans Community Care Program.
(d) Update of Information on Providers.--Not later than one
year after the date of the enactment of this Act, the
Secretary, through the Office of Integrated Veteran Care or
successor office, shall develop a process to ensure that
third party administrators regularly, not less frequently
than quarterly--
(1) update their lists of community care providers to
reflect accurate provider contact information;
(2) annotate providers that are not currently accepting
patients under the Veterans Community Care Program; and
(3) remove providers from the provider profile management
system that--
(A) are on the list of excluded individuals or entities set
forth by the Office of Inspector General of the Department of
Health and Human Services;
(B) are in the system for award management exclusions of
the General Services Administration; or
(C) have been terminated from employment with the
Department of Veterans Affairs due to quality of care
concerns or left such employment voluntarily, through
resignation, or through retirement, while under investigation
for quality of care concerns.
(e) Definitions.--In this section:
(1) Community care provider.--The term ``community care
provider'' means a health care provider specified under
section 1703(c) of title 38, United States Code.
(2) Veterans community care program.--The term ``Veterans
Community Care Program'' means the Veterans Community Care
Program under section 1703 of title 38, United States Code.
SEC. 612. PROVIDER TRAINING.
(a) Development of Plan.--Not later than 180 days after the
date of the enactment of this Act, the Secretary of Veterans
Affairs shall develop a comprehensive plan to better align
training and incentive requirements applicable to community
care providers participating in the Veterans Community Care
Program and health care providers, residents, and trainees of
the Department of Veterans Affairs.
(b) Elements.--The plan required under subsection (a)
shall--
(1) identify existing training requirements or incentives
applicable to health care providers of the Department;
(2) identify existing training requirements or incentives
applicable to health care trainees or residents of the
Department;
(3) identify existing training requirements or incentives
applicable to community care providers;
(4) assess gaps between training requirements and
incentives for health care providers of the Department,
trainees or residents of the Department, and community care
providers;
(5) establish standardized baseline training requirements
to ensure consistency in the quality of care furnished
through the Department from health care providers of the
Department, trainees or residents of the Department, and
community care providers; and
(6) provide a strategy, assessment of barriers, and
timeline for implementing such baseline training
requirements, including--
(A) through online modules and continuing medical education
programs; and
(B) within such strategy--
(i) metrics to measure the effectiveness of baseline
training requirements in improving clinical quality,
satisfaction of veterans, and health outcomes for veterans;
(ii) a mechanism to account for non-Department training
that is equivalent or substantially similar to the Department
training in length, scope, and content, as determined by the
Secretary;
(iii) a mechanism to regularly communicate, including
through direct outreach
[[Page H4591]]
and publication online and in provider handbooks of third
party administrators under the Veterans Community Care
Program, requirements and expectations with respect to
training;
(iv) a mechanism to track, report, and address non-
compliance, to include corrective actions, which may include
suspending or barring providers who are routinely non-
compliant; and
(v) a mechanism to designate community care providers who
routinely meet or exceed baseline training requirements as
preferred providers or part of the high performing provider
program of the Department, as the Secretary considers
appropriate.
(c) Implementation.--Not later than one year after
submission of the report required under subsection (d), the
Secretary shall begin implementing the plan required under
subsection (a).
(d) Report to Congress.--Not later than 180 days after the
date of the enactment of this Act, the Secretary shall submit
to the Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of
Representatives a report containing--
(1) the plan required under subsection (a);
(2) a description of identified gaps between training or
incentives for providers of the Department, trainees or
residents of the Department, and community care providers;
(3) the estimated costs associated with implementation of
the plan; and
(4) a description of any legislative or regulatory changes
necessary to carry out the plan.
(e) Annual Updates.--Not later than one year after the
submission of the report required by subsection (d), and
annually thereafter for the following two years, 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--
(1) describing progress in implementing the plan required
under subsection (a);
(2) assessing any measurable impacts of such implementation
on quality of care; and
(3) assessing any improvements in rates of compliance with
training requirements among health care providers, trainees,
and residents of the Department and community care providers.
(f) Definitions.--In this section:
(1) Community care provider.--The term ``community care
provider'' means a health care provider specified under
section 1703(c) of title 38, United States Code.
(2) Training.--The term ``training'' includes training
relating to--
(A) veteran-specific cultural competency;
(B) health conditions related to military service,
including toxic exposures, post-traumatic stress disorder,
traumatic brain injury, and military sexual trauma;
(C) suicide prevention;
(D) pain management and opioid safety; and
(E) any other matter the Secretary determines appropriate.
(3) Veterans community care program.--The term ``Veterans
Community Care Program'' means the Veterans Community Care
Program under section 1703 of title 38, United States Code.
SEC. 613. OVERSIGHT AUTHORITY OVER COMMUNITY CARE.
(a) In General.--The Secretary of Veterans Affairs shall
include in each contract or agreement used to provide care or
services through the Veterans Community Care Program
provisions requiring the contractor and any subcontractor or
participating provider to provide government officials,
including the Office of the Inspector General of the
Department of Veterans Affairs, access, within a reasonable
time and manner, to records, materials, documents, data, and
personnel necessary to conduct audits, inspections,
evaluations, or investigations related to such care or
services.
(b) Third Party Administrators.--
(1) Requirement.--The Secretary shall require third party
administrators under the Veterans Community Care Program to
include provisions in agreements with participating providers
that are equivalent to the provisions required under
subsection (a).
(2) Notification.--Notification of the requirements under
this section and any other related information as the
Secretary determines appropriate shall be included in the
provider handbooks of third party administrators under the
Veterans Community Care Program.
(c) Standard Contract Language.--The Secretary shall
establish standard contract language under this section in
consultation with the Inspector General of the Department of
Veterans Affairs.
(d) Veterans Community Care Program Defined.--In this
section, the term ``Veterans Community Care Program'' means
the Veterans Community Care Program under section 1703 of
title 38, United States Code.
Subtitle B--Mental Health Treatment Programs
SEC. 621. VETERAN PARTICIPATION IN CERTAIN MENTAL HEALTH
PROGRAMS.
(a) Establishment.--Chapter 17 of title 38, United States
Code, is amended by adding at the end the following new
subchapter:
``SUBCHAPTER IX--PARTICIPATION BY VETERANS IN CERTAIN MENTAL HEALTH
TREATMENT PROGRAMS
``Sec. 1791. Definitions
``In this subchapter:
``(1) Activities of daily living.--The term `activities of
daily living' means specific personal care activities that
are required for basic daily maintenance and sustenance, to
include eating, toileting, bathing, grooming, dressing and
undressing, and mobility.
``(2) Covered treatment program.--
``(A) In general.--The term `covered treatment program'--
``(i) means--
``(I) a mental health residential rehabilitation treatment
program of the Department; or
``(II) a program of the Department for residential care for
mental health and substance use disorders;
``(ii) includes--
``(I) the programs designated as of the date of the
enactment of the Take Care of America's Veterans Act as
domiciliary residential rehabilitation treatment programs;
and
``(II) any programs designated as domiciliary residential
rehabilitation treatment programs on or after such date of
enactment; and
``(iii) does not include--
``(I) Compensated Work Therapy Transition Residence
programs of the Department; or
``(II) Department or non-Department programs in which more
than 20 percent of the care provided is provided through
telehealth.
``(B) Accreditation.--A program described in subparagraph
(A) must maintain accreditation by the Commission on
Accreditation of Rehabilitation Facilities and the Joint
Commission.
``(3) Covered veteran.--The term `covered veteran' means a
veteran described in section 1703(b) of this title.
``(4) Evidence-based treatment.--The term `evidence-based
treatment' means treatment provided in accordance with the
Department of Veterans Affairs/Department of Defense Clinical
Practice Guidelines for Mental Health and Substance Use
Disorder, or any successor similar guidelines.
``(5) Social support systems.--The term `social support
systems', with respect to a covered veteran--
``(A) means--
``(i) a member of the family of the covered veteran,
including a parent, spouse, child, step-family member, or
extended family member; or
``(ii) an individual who lives with the veteran but is not
a member of the family of the veteran; and
``(B) does not include a facility-organized peer support
program.
``Sec. 1792. Standardized process to determine eligibility of
covered veterans for participation in certain mental health
treatment programs
``(a) Standardized Screening Process.--Not later than one
year after the date of the enactment of the Take Care of
America's Veterans Act, the Secretary shall establish a
standardized screening process to determine, based on
clinical need, whether a covered veteran satisfies criteria
for priority or routine admission to a covered treatment
program.
``(b) Eligibility Criteria for Priority Admission.--
``(1) In general.--Under the standardized screening process
required by subsection (a), a covered veteran shall be
eligible for priority admission to a covered treatment
program if the covered veteran meets criteria established by
the Secretary that shall include the following:
``(A) A clinical assessment of the symptoms of the veteran,
including symptoms that--
``(i) significantly affect activities of daily life; and
``(ii) increase the risk of adverse outcomes, such as
overdose, suicide, self-harm, or an unsafe living situation.
``(B) The lack of availability and applicability of other
treatment options.
``(C) Whether the veteran has a recent suicide or overdose
attempt.
``(D) Whether the veteran is determined to be a high risk
for suicide or overdose.
``(E) Whether the veteran has a demonstrated history of
non-responsiveness, relapse, or inability to find recovery
from two other completed courses of treatment, such as
outpatient or intensive outpatient treatment, through a
program that--
``(i) is licensed by a State;
``(ii) is accredited by the Commission on Accreditation of
Rehabilitation Facilities or the Joint Commission; and
``(iii) provides evidence-based treatment.
``(F) Such other criteria as the Secretary determines
appropriate, in consultation with Congress.
``(2) Consideration.--In making a determination that a
covered veteran meets criteria established by the Secretary
under paragraph (1) for priority admission to a covered
treatment program, the Secretary shall--
``(A) consider any referral of a health care provider of a
covered veteran; and
``(B) ensure that consideration of such criteria includes
consideration of all relevant factors, is driven by clinical
need, and that no single factor is required to be
determinative when considering the best medical interest of a
covered veteran.
``(3) Provision of higher-level care.--The Secretary shall
provide immediate and clinically necessary care under other
authorities available to the Secretary to any covered veteran
who is not clinically recommended for admission to a covered
treatment program based on the need for a higher level of
care, such as being at a high acute risk for suicide.
[[Page H4592]]
``(c) Screening for Traumatic Brain Injury.--Under the
standardized screening process required by subsection (a),
the Secretary shall ensure a covered veteran is screened at
an appropriate time for potential mild, moderate, or severe
traumatic brain injury.
``(d) Considerations.--In making placement decisions in a
covered treatment program for veterans who meet criteria for
priority or routine admission, the Secretary shall--
``(1) consider the input of the covered veteran with
respect to the--
``(A) program specialty, subtype, and treatment track
offered to the covered veteran; and
``(B) geographic placement of the covered veteran,
including proximity to the current residence, time zone, or
geographic region of the covered veteran;
``(2) maximize the proximity of the covered veteran to
social support systems; and
``(3) to the greatest extent practicable, place the veteran
in a covered treatment program located within the same time
zone and geographic region as the residence of the veteran at
the time of admission.
``(e) Conditions Under Which Care Shall Be Furnished
Through Non-Department Providers.--
``(1) Priority admission.--If the Secretary determines a
covered veteran is eligible for priority admission to a
covered treatment program pursuant to the standardized
screening process required by subsection (a) and the
Secretary is unable to admit such covered veteran to a
covered treatment program at a facility of the Department in
a manner that complies with the requirements under subsection
(d) and section 1703B(a)(1)(C) of this title, the Secretary
shall offer the covered veteran the option to receive care at
a non-Department facility that--
``(A) can admit the covered veteran within the period
required by section 1703B(a)(1)(C)(ii)(I) of this title;
``(B) is party to a contract or agreement with the
Department or enters into such a contract or agreement under
which the Department furnishes a program that is equivalent
to a covered treatment program to a veteran through such non-
Department facility;
``(C) is licensed by a State;
``(D) is accredited by the Commission on Accreditation of
Rehabilitation Facilities or the Joint Commission; and
``(E) provides evidence-based treatment.
``(2) Routine admission.--If the Secretary determines a
covered veteran is eligible for routine admission to a
covered treatment program pursuant to the standardized
screening process required by subsection (a) and the
Secretary is unable to admit such covered veteran to a
covered treatment program at a facility of the Department in
a manner that complies with the requirements under section
1703B(a)(1)(C) of this title with respect to routine
admission, the Secretary shall offer the covered veteran the
option to receive care at a non-Department facility that--
``(A) is party to a contract or agreement with the
Department or enters into such a contract or agreement under
which the Department furnishes a program that is equivalent
to a covered treatment program to a veteran through such non-
Department facility;
``(B) is licensed by a State;
``(C) is accredited by the Commission on Accreditation of
Rehabilitation Facilities or the Joint Commission; and
``(D) provides evidence-based treatment.
``(3) Rule of construction.--This subsection shall not be
construed to affect a covered veteran in a covered treatment
program pursuant to a determination made on or before the
date of the Take Care of America's Veterans Act.
``Sec. 1793. Improvements to Department of Veterans Affairs
mental health residential rehabilitation treatment program
``(a) Performance Metrics.--
``(1) In general.--The Secretary shall develop metrics to
track, and shall subsequently track, the performance of
medical facilities of the Department, Veterans Integrated
Service Networks, and non-Department facilities in meeting
the requirements for--
``(A) screening, under section 1792 of this title, for a
covered treatment program;
``(B) timely admission, under section 1792 of this title,
to a covered treatment program pursuant to such screening;
and
``(C) adherence to evidence-based treatment standards
developed by the Secretary in consultation with appropriate
governmental and non-governmental professional organizations
with a demonstrated history of providing or accrediting
programs that are substantially similar to covered treatment
programs, or made of professionals who provide for such
programs, including by--
``(i) using placement criteria established by the American
Society of Addiction Medicine; and
``(ii) maintaining standards to meet accreditation by the
Commission on Accreditation of Rehabilitation Facilities or
the Joint Commission.
``(2) Elements.--The metrics developed under paragraph (1)
shall include metrics for tracking the performance of medical
facilities of the Department, Veterans Integrated Service
Networks, and non-Department facilities with respect to
routine and priority admission under a covered treatment
program as well as adherence to evidence-based treatment
standards.
``(3) Consultation.--In developing metrics under paragraph
(1), the Secretary shall consult with mental health and
substance use disorder providers, including providers
employed by the Department and those employed by non-
Department entities, and ensure adherence to industry
standards.
``(4) Report.--Not later than one year after the date of
the enactment of the Take Care of America's Veterans Act, the
Secretary shall submit to the Committee on Veterans' Affairs
of the Senate and the Committee on Veterans' Affairs of the
House a report describing the consultation and performance
metrics required under this subsection.
``(b) Oversight.--
``(1) In general.--The Secretary shall develop a process
for systematically assessing at the facility, network, and
regional level, as the Secretary considers appropriate, the
quality of care delivered by facilities of the Department and
non-Department facilities treating covered veterans under
this section as well as a process for rectifying any
identified concerns.
``(2) Elements.--The processes required under paragraph (1)
shall include assessments of--
``(A) the extent to which providers at the facility deliver
evidence-based treatments to covered veterans;
``(B) clinical outcomes for covered veterans, including
those outcomes assessed pursuant to a subsequent clinical
screening under subsection (g)(3)(F);
``(C) the ratio of licensed independent practitioners per
resident;
``(D) the rate of completion of training under section 1795
of this title by licensed independent practitioners;
``(E) whether non-Department facilities and providers
generally meet the criteria outlined in section 1792(e) of
this title;
``(F) the timeliness, completeness, and rate of
transmission, if applicable, of medical records during and
following treatment of covered veterans; and
``(G) potentially wasteful, fraudulent, or inappropriate
referral or billing practices.
``(3) Consultation.--In developing the processes required
under paragraph (1), the Secretary shall consult with
relevant stakeholders, including mental health and substance
use disorder providers employed by the Department and those
employed by non-Department entities, and ensure adherence to
industry standards.
``(4) Report.--Not later than one year after the date of
the enactment of the Take Care of America's Veterans Act, the
Secretary shall submit to the Committee on Veterans' Affairs
of the Senate and the Committee on Veterans' Affairs of the
House of Representatives a report describing the consultation
and oversight processes required by this subsection.
``(c) Placement; Transportation.--
``(1) Locations.--If the Secretary determines that a
covered veteran is in need of residential care under a
covered treatment program, the Secretary shall provide to the
covered veteran a list of locations at which such covered
veteran can receive such residential care that meets--
``(A) the standards for screening under section 1792 of
this title; and
``(B) the care needs of the covered veteran, including
applicable treatment tracks.
``(2) Transportation coverage.--
``(A) In general.--Notwithstanding any other provision of
law regarding the transportation of individuals under this
title, or any other law administered by the Secretary, and
except as provided in subparagraph (B), the Secretary shall
provide transportation, pay for, or reimburse the costs of
transportation for any covered veteran who is admitted into a
covered treatment program and needs transportation
assistance--
``(i) from the residence of the covered veteran or a
facility of the Department or authorized non-Department
facility that does not provide such care to another
Department or non-Department facility that provides
residential care covered under a covered treatment program;
and
``(ii) back to the residence of the covered veteran or to a
facility of the Department or an authorized non-Department
facility after the conclusion of a covered treatment program,
if applicable.
``(B) Limitations.--
``(i) Costs incurred by veterans.--The Secretary shall
provide reimbursement under subparagraph (A) directly to a
covered veteran only for costs directly incurred by the
covered veteran and pre-approved by the Department.
``(ii) No coverage of transportation provided by covered
treatment program.--The Secretary shall not reimburse a
covered veteran for transportation provided to the covered
veteran by a covered treatment program, unless for a purpose
and amount approved by the Secretary.
``(d) Appeals.--
``(1) In general.--The Secretary shall develop a national
policy and associated procedures, in accordance with the
existing clinical appeals process of the Veterans Health
Administration, under which a covered veteran, a
representative of a covered veteran, or a provider who
requests a covered veteran be admitted to a covered treatment
program, including a provider of the Department or a non-
Department provider, may file a clinical appeal pursuant to
this subsection if the covered veteran is--
``(A) denied admission into a covered treatment program; or
[[Page H4593]]
``(B) accepted into a covered treatment program but is not
offered bed placement in a timely manner.
``(2) Timeliness standards for review.--
``(A) In general.--The national policy and procedures
developed under paragraph (1) for appeals described in such
paragraph shall include timeliness standards for the
Department to review and make a decision on such an appeal.
``(B) Decision.--The Secretary shall review and respond to
any appeal under paragraph (1) not later than 72 hours after
the Secretary receives such appeal.
``(3) Public guidance.--The Secretary shall develop, and
make available to the public, guidance on how a covered
veteran, a representative of the covered veteran, or a
provider of the covered veteran can file a clinical appeal
pursuant to this subsection--
``(A) if the covered veteran is denied admission into a
covered treatment program;
``(B) if the first date on which the covered veteran may
enter a covered treatment program does not comply with the
eligibility access standards under section 1703B(a) of this
title for care at a covered treatment program; or
``(C) with respect to such other factors as the Secretary
may specify.
``(4) Rule of construction.--Nothing in this subsection may
be construed as granting a covered veteran, a representative
of a covered veteran, or a provider who requests a covered
veteran be admitted to a covered treatment program, including
a provider of the Department or a non-Department provider,
the right to appeal a decision of the Secretary with respect
to admission to a covered treatment program to the Board of
Veterans' Appeals under chapter 71 of this title.
``(e) Tracking of Availability and Wait Times.--
``(1) In general.--The Secretary, to the extent
practicable, shall create a method for tracking availability
and wait times under a covered treatment program across all
facilities of the Department, Veterans Integrated Service
Networks, and non-Department providers throughout the United
States.
``(2) Availability of information.--The Secretary shall
make the information tracked under paragraph (1) available,
in real time to--
``(A) the mental health treatment coordinators at each
facility of the Department;
``(B) the leadership of each medical center of the
Department;
``(C) the leadership of each Veterans Integrated Service
Network; and
``(D) the Office of the Under Secretary for Health of the
Department.
``(3) Publication of information.--Not less frequently than
monthly, the Secretary shall publish the information tracked
under paragraph (1) on a publicly accessible website of the
Department.
``(f) Staffing Matters.--
``(1) Training.--
``(A) In general.--The Secretary shall update and implement
training for staff of the Department directly involved in a
covered treatment program regarding referrals, screening,
admission, placement decisions, and appeals for such program,
including all changes to processes and guidance under such
program required by this section and section 1792.
``(B) Covered veterans awaiting admission.--The training
under subparagraph (A) shall include procedures for the care
of covered veterans awaiting admission into a covered
treatment program and communication with such covered
veterans and the providers of such covered veterans.
``(C) Timing of training.--
``(i) In general.--The Secretary shall require the training
under subparagraph (A) to be completed by staff required to
complete such training--
``(I) not later than 60 days after beginning employment at
the Department in a position that includes work directly
involving a covered treatment program; and
``(II) not less frequently than annually.
``(ii) Tracking.--The Secretary shall track completion of
training required under clause (i) by staff required to
complete such training.
``(2) Oversight standards.--The Secretary shall review and
revise oversight standards for the leadership of the Veterans
Integrated Service Networks and the Veterans Health
Administration to ensure that facilities and staff of the
Department are adhering to the policy on access to care of
each covered treatment program.
``(3) Staff coverage.--The Secretary shall not require
staff of a covered treatment program to act as coverage for
any other team, service, or project unrelated to the covered
treatment program for a period of greater than three days per
month unless such coverage is for purposes of the fourth
mission of the Department or under an emergency declaration.
``(g) Care Coordination and Follow-up Care.--
``(1) Continuity of care.--The Secretary shall ensure each
covered veteran who is screened for admission to a covered
treatment program is offered, and provided if agreed upon,
care options during the period between screening of the
covered veteran and admission of the covered veteran to such
program to ensure the covered veteran does not experience any
lapse in care.
``(2) Care coordination for substance use disorder.--For a
covered veteran being treated for substance use disorder, the
Secretary shall--
``(A) ensure there is a care plan in place during the
period between any detoxification services or inpatient care
received by the covered veteran and admission of the covered
veteran to a covered treatment program; and
``(B) communicate that care plan to the covered veteran,
the primary care provider of the covered veteran, and the
facility where the covered veteran is or will be residing
under such program.
``(3) Care planning and clinical screening.--
``(A) In general.--A covered treatment program, in
consultation with the covered veteran and the treating
providers of the covered veteran in the covered treatment
program, shall ensure the completion of a care plan and a
clinical screening upon admittance to the covered treatment
program and prior to discharge from the covered treatment
program, which shall include an assessment of, with respect
to the covered veteran--
``(i) overall mental health;
``(ii) risk for suicide;
``(iii) risk for overdose;
``(iv) housing insecurity;
``(v) food insecurity;
``(vi) employment;
``(vii) complex medical needs and diagnoses; and
``(viii) any other factors the Secretary determines
necessary.
``(B) Matters to be included.--The care plan required under
subparagraph (A) for a covered veteran shall include details
on the course of treatment for the covered veteran following
completion of treatment under the covered treatment program,
including recommended length of stay and any necessary
follow-up care and the results of any screening conducted
under such subparagraph.
``(C) Length of stay.--
``(i) In general.--Covered treatment programs at non-
Department facilities shall submit the care plan under
subparagraph (A) for a covered veteran, including the
requested or recommended length of stay for the covered
veteran, to the Department not later than 72 hours after the
veteran is admitted to the covered treatment program.
``(ii) Approval required.--Any length of stay of a covered
veteran at a covered treatment program longer than 30 days or
extensions of length of stay greater than a total of 30 days
shall require approval by the Secretary. The Secretary shall
respond to any such requests for approval within 72 hours.
Any such requests that have not received a response within 72
hours shall be automatically approved on a daily basis until
the Secretary responds.
``(D) Sharing of care plan.--The care plan required under
subparagraph (A) shall be shared with the covered veteran,
the primary care provider of the covered veteran, and any
other providers with which the covered veteran consents to
sharing the plan.
``(E) Discharge from non-department facility.--Upon
discharge of a covered veteran under a covered treatment
program from a non-Department facility, and not later than 30
days after discharge, the facility shall share with the
Department all care records maintained by the facility with
respect to the covered veteran and shall work in consultation
with the Department on the care plan of the covered veteran
required under subparagraph (A).
``(F) Subsequent clinical screening.--Not later than 180
days after the end of treatment of a covered veteran in a
covered treatment program, the covered treatment program or a
Department or non-Department provider shall conduct a
subsequent clinical screening, which shall include an
assessment of the factors specified in clauses (i) through
(viii) of subparagraph (A) and recommendations for follow-up
care as the Secretary considers appropriate.
``(G) Complex medical needs.--Before, during, and after
treatment in a covered treatment program, the Secretary shall
provide greater engagement, coordination, and monitoring of
care for covered veterans with--
``(i) complex medical diagnoses, including diagnoses of
dementia, spinal cord injury or disorder, epilepsy,
Parkinson's, anemia, severe mental illness, multiple
sclerosis, incontinence of the bladder or bowel, mobility
limitations, or impaired vision; or
``(ii) complex medical needs, including chemotherapy or
other oncology care, dialysis, recurring blood transfusions,
or physical or occupational therapy.
``(h) Data Collection.--The Secretary shall consult with
the Office of Research and Development of the Department, or
any successor office, regarding any data the Department
should consider requesting or requiring from non-Department
facilities to assist with research studies and projects in
which the Department is participating relating to mental
health residential rehabilitation treatment programs.
``(i) Reports to Congress.--
``(1) Report on modifications to programs.--
``(A) In general.--Not later than two years after the date
of the enactment of the Take Care of America's Veterans Act,
the Secretary shall submit to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans' Affairs
of the House of Representatives a report on modifications
made to the guidance, operation, and oversight of covered
treatment programs to fulfill the requirements of this
section.
``(B) Elements.--The report required by subparagraph (A)
shall include--
[[Page H4594]]
``(i) an assessment of whether costs of covered treatment
programs, including for residential care provided through
facilities of the Department and non-Department facilities,
serve as a disincentive to placement in such a program;
``(ii) a description of actions taken by the Department to
address the findings and recommendations by the Secretary
contained in the report under section 503(c) of the STRONG
Veterans Act of 2022 (division V of Public Law 117-328; 136
Stat. 5515), including--
``(I) such actions with respect to--
``(aa) any new locations added for covered treatment
programs;
``(bb) any beds added at existing facilities of such
programs; and
``(cc) any additional treatment tracks or sex-specific
programs created or added at facilities of the Department;
and
``(II) a breakdown of the number and percentage of covered
veterans who are determined eligible for priority placement
into a covered treatment program and the number and
percentage of covered veterans who are determined eligible
for routine placement into a covered treatment program; and
``(iii) such recommendations as the Secretary may have for
legislative or administrative action to address any funding
constraints or disincentives for use of a covered treatment
program.
``(2) Annual report on operation of programs.--
``(A) In general.--Not later than one year after the
submission of the report under paragraph (1), and not less
frequently than annually thereafter for the following five
years, 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 operation of covered treatment programs.
``(B) Elements.--Subject to subparagraph (C), each report
required by subparagraph (A) shall include the following:
``(i) The number of covered veterans served by a covered
treatment program, disaggregated by--
``(I) Veterans Integrated Service Network in which the
covered veteran receives care;
``(II) facility, including facilities of the Department and
non-Department facilities, at which the covered veteran
receives care;
``(III) type of residential rehabilitation treatment care
received by the covered veteran under such program;
``(IV) sex of the covered veteran; and
``(V) race or ethnicity of the covered veteran.
``(ii) Wait times under a covered treatment program for the
most recent year data is available, disaggregated by--
``(I) treatment track or specificity of residential
rehabilitation treatment care sought by the covered veteran;
``(II) sex of the covered veteran;
``(III) State or territory in which the covered veteran is
located;
``(IV) Veterans Integrated Service Network in which the
covered veteran is located; and
``(V) facility of the Department at which the covered
veteran seeks care.
``(iii) A list of all locations of a covered treatment
program and number of bed spaces at each such location,
disaggregated by residential rehabilitation treatment care or
treatment track provided under such program at such location.
``(iv) A list of any new locations of covered treatment
programs added or removed and any bed spaces added or removed
during the one-year period preceding the date of the report.
``(v) Average cost of a stay under a covered treatment
program, including total stay average and daily average, at
facilities of the Department compared to non-Department
facilities.
``(vi) A review of staffing needs and gaps with respect to
covered treatment programs that is data-driven and aligned
with industry benchmarks and standards, including--
``(I) a list of facilities that had unstaffed beds or
closed beds due to lack of staffing at any point in the
previous year;
``(II) the number of additional staff needed to staff those
beds;
``(III) the number of beds at each facility;
``(IV) the average wait-times for the covered treatment
program, disaggregated by month, during the periods of bed
closures; and
``(V) a list of facilities that required staff of covered
treatment programs to perform duties unrelated to covered
treatment programs for a period of greater than three days.
``(vii) An overview of data collected pursuant to a
subsequent clinical screening under subsection (g)(3)(F).
``(viii) A list of health care systems without a covered
treatment program and an assessment of the feasibility and
advisability of opening a covered treatment program at such
health care system that is aligned and justified by patient
demand and market factors.
``(ix) A list of health care systems that offer a covered
treatment program aligned with patient demand and market
factors and that have an average wait time of more than 20
days and an assessment of the feasibility and advisability of
expanding such covered treatment program to lower such
average wait time.
``(x) Any recommendations for changes to the operation of
covered treatment programs, including any policy changes,
guidance changes, training changes, or other changes.
``(C) Anonymity.--To ensure that the data provided under
this paragraph, or some portion of that data, will not
undermine the anonymity of a veteran, the Secretary shall
provide such data pursuant to applicable Federal law and in a
manner that is wholly consistent with applicable Federal
privacy and confidentiality laws, including--
``(i) section 552a of title 5 (commonly known as the
`Privacy Act of 1974');
``(ii) the Health Insurance Portability and Accountability
Act of 1996 (Public Law 104-191);
``(iii) parts 160 and 164 of title 45, Code of Federal
Regulations, or successor regulations; and
``(iv) sections 5701, 5705, and 7332 of this title.
``(3) Notification to congress of beds not available due to
lack of staffing.--The Secretary shall notify Congress of any
covered treatment programs of the Department with more than
five beds or more than ten percent of beds unavailable,
closed, or reassigned due to lack of staffing, including--
``(A) information on the staff needed to reopen beds that
are closed;
``(B) plans to recruit and retain staff;
``(C) the total number of beds closed or expected to be
closed;
``(D) the estimated length of time until those closed beds
are made available; and
``(E) the current wait time for access to those beds.
``(j) Third-party Assessment.--
``(1) In general.--Not later than two years after the date
of the enactment of the Take Care of America's Veterans Act,
the Secretary shall seek to enter into a contract with an
appropriate entity to conduct a study of the care provided
under covered treatment programs through facilities of the
Department and non-Department facilities.
``(2) Elements.--The study required under paragraph (1)
shall include a review of--
``(A) whether facilities are meeting requirements of the
Department pursuant to law, regulation, or policy;
``(B) staffing models used by facilities and level of
adherence to those models;
``(C) success rates of covered treatment programs in
preventing readmittance to a covered treatment program or
death by suicide or overdose within a year of discharge from
the program;
``(D) adherence of non-Department facilities to timelines
for claim submission and record returns to the Department;
and
``(E) any other factors the Secretary or the appropriate
entity determines relevant or appropriate to include.
``(3) Completion of study.--The contract sought under
paragraph (1) shall include a requirement that the
appropriate entity, not later than four years after the date
of the enactment of the Take Care of America's Veterans Act,
complete the study required under such paragraph and submit
to the Secretary a report on the study.
``(4) Action plan and commentary.--Not later than five
years after the date of the enactment of the Take Care of
America's Veterans Act, the Secretary shall submit to the
Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of
Representatives, and publish on a publicly accessible website
of the Department, a report containing--
``(A) the results of the study required under paragraph
(1);
``(B) action plans for improvement based on the results of
the study; and
``(C) general commentary and feedback on the results of the
study.
``(5) Appropriate entity defined.--In this subsection, the
term `appropriate entity' means--
``(A) a nongovernmental entity with experience in assessing
programs that deliver services provided under covered
treatment programs on a large scale; or
``(B) a federally funded research and development center.
``(k) Revision of Guidance.--The Secretary shall update the
guidance of the Department on the operation of covered
treatment programs to reflect each of the requirements under
this section.
``(l) Deadline.--Unless otherwise specified, the Secretary
shall carry out each requirement under this section by not
later than one year after the date of the enactment of the
Take Care of America's Veterans Act.
``(m) Comptroller General Review.--
``(1) In general.--Not later than two years after the date
of the enactment of the Take Care of America's Veterans Act,
the Comptroller General of the United States shall review
access to care under a covered treatment program for covered
veterans in need of residential mental health care and
substance use disorder care.
``(2) Elements.--The review required by paragraph (1) shall
include the following:
``(A) A review of wait times for covered veterans under a
covered treatment program, disaggregated by--
``(i) treatment track or specificity of residential
rehabilitation treatment care needed;
``(ii) sex of the covered veteran;
``(iii) home State of the covered veteran;
``(iv) home Veterans Integrated Service Network of the
covered veteran; and
``(v) wait times for--
``(I) facilities of the Department; and
``(II) non-Department facilities.
``(B) A review of policy and training of the Department on
screening, admission, and placement under a covered treatment
program.
[[Page H4595]]
``(C) A review of the rights of covered veterans and
providers to appeal admission decisions under a covered
treatment program and how the Department adjudicates appeals.
``(D) When determining the facility at which a covered
veteran admitted to a covered treatment program will be
placed in such program, a review of how the input of the
covered veteran is taken into consideration with respect to--
``(i) program specialty, subtype, or treatment track
offered to the covered veteran; and
``(ii) the geographic placement of the covered veteran,
including family- or occupation-related preferences or
circumstances.
``(E) A review of staffing and staffing needs and gaps of
covered treatment programs, including with respect to--
``(i) mental health providers and coordinators at the
facility level;
``(ii) staff of facilities of such programs;
``(iii) staff of Veterans Integrated Service Networks; and
``(iv) overall administration of such programs at the
national level.
``(F) A review of outcomes from Department and non-
Department covered treatment programs based at least in part
on the subsequent clinical screenings required under
subsection (g)(3)(F).
``(G) Recommendations for improvement of access by covered
veterans to care under a covered treatment program, including
with respect to--
``(i) any new sites or types of programs needed or in
development;
``(ii) changes in training or policy;
``(iii) changes in communications with covered veterans;
and
``(iv) oversight of covered treatment programs by the
Department.
``Sec. 1794. Fee schedule
``(a) In General.--Not later than 180 days after the date
of the enactment of the Take Care of America's Veterans Act,
the Secretary shall make publicly available on an appropriate
website of the Department a fee schedule for each covered
treatment program provided by a non-Department provider
through which the Secretary furnishes care and services under
section 1710 of this title.
``(b) Elements.--The fee schedule required under subsection
(a) for a covered treatment program shall--
``(1) reflect reasonable charges for the services provided;
``(2) be based on the amounts customarily paid for similar
services under the Medicaid program under title XIX of the
Social Security Act (42 U.S.C. 1396 et seq.) and by
commercial health insurance providers;
``(3) to the greatest extent practicable, be consistent
with payment rates under section 1703(i) of this title;
``(4) be comprehensive to include a variety of possible
types of care, services, and charges; and
``(5) be sufficient to ensure a robust network of qualified
community providers able to provide services under a covered
treatment program to covered veterans.
``(c) Coordination of Payment Rates.--After the date of the
initial publication of the fee schedule under subsection (a),
the rate paid by the Department for residential substance use
disorder treatment shall be the rate provided in the fee
schedule required under such subsection.
``(d) Recoupment of Amounts.--
``(1) In general.--The Secretary shall recoup from a non-
Department entity, including a third party administrator, any
amount paid to such entity that exceeds the amount specified
under the fee schedule under subsection (a) for the care or
services provided.
``(2) Limitation.--A non-Department entity shall not bill a
veteran for any charges recouped under paragraph (1).
``Sec. 1795. Training
``(a) In General.--Not later than one year after the date
of the enactment of the Take Care of America's Veterans Act,
the Secretary shall--
``(1) develop and implement a plan to ensure that health
care providers caring for veterans under covered treatment
programs receive and complete relevant training aligned with
industry standards and practices; and
``(2) submit that plan to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans' Affairs
of the House of Representatives.
``(b) Elements of Training.--Training required under
subsection (a) shall--
``(1) be easily accessible, no-cost, and offered in such a
manner as to qualify for or fulfill continuing education
requirements for health care professionals;
``(2) include course modules related to military culture,
post-traumatic stress disorder, the evaluation and management
of suicide, traumatic brain injury, and opioid safety, or
comparable course modules, as determined by the Secretary;
and
``(3) be offered through Department and non-Department
entities or organizations.
``(c) Elements of Plan.--The plan required under subsection
(a) shall--
``(1) allow for Department or non-Department providers to
receive credit for non-Department training that is equivalent
or substantially similar to training required under
subsection (a); and
``(2) include details regarding consequences for non-
compliance with training required under such plan, which may
include removal from a network of providers under the
Veterans Community Care Program under section 1703 of this
title for a specified period of time.
``(d) Consultation.--The Secretary shall consult with
relevant professional organizations with respect to the
content of relevant training required under subsection
(a).''.
(b) Clerical Amendment.--The table of sections at the
beginning of such chapter is amended by adding at the end the
following new items:
``subchapter ix--participation by veterans in certain mental health
treatment programs
``1791. Definitions.
``1792. Standardized process to determine eligibility of covered
veterans for participation in certain mental health
treatment programs.
``1793. Improvements to Department of Veterans Affairs mental health
residential rehabilitation treatment program.
``1794. Fee schedule.
``1795. Training.''.
SEC. 622. ACCESS TO MENTAL HEALTH RESIDENTIAL REHABILITATION
TREATMENT PROGRAMS FOR VETERANS WITH SPINAL
CORD INJURY OR DISORDER.
(a) Plan.--
(1) In general.--Not later than 90 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a plan to ensure access to mental health
residential treatment programs for veterans with a spinal
cord injury or disorder.
(2) Elements.--The plan required under paragraph (1) shall
include--
(A) a staffing plan, which shall include a plan for how the
Department will--
(i) incorporate staff from other facilities to support the
pilot program required under subsection (b); and
(ii) ensure adequate staffing to support the needs of
veterans with a spinal cord injury or disorder;
(B) an assessment of medical equipment needs; and
(C) an assessment of the best location to deliver treatment
and health care under mental health residential treatment
programs, including through the use of spinal cord injury or
disorder centers, spinal cord injury or disorder spokes, and
community care providers.
(b) Pilot Program.--
(1) In general.--Commencing not later than 120 days after
the date of the enactment of this Act, the Secretary shall
carry out a pilot program to provide improved access to
mental health residential treatment programs of the
Department of Veterans Affairs for veterans with a spinal
cord injury or disorder at not fewer than three medical
facilities of the Department.
(2) Selection of locations.--In selecting sites for the
pilot program under paragraph (1), the Secretary shall
prioritize sites in the following areas:
(A) Areas with geographic diversity, including areas that
serve veterans residing in rural or highly rural areas.
(B) Areas with a significant number of veterans with spinal
cord injury or disorder.
(c) Report.--Not later than one year after the date of the
enactment of this Act, the Secretary shall submit to the
Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of
Representatives a report on--
(1) the implementation of the plan required under
subsection (a);
(2) the initial results from the pilot program under
subsection (b), including the number of unique veterans who
participated in the pilot program, the cost of the pilot
program, and an assessment of the effectiveness of the pilot
program in increasing access to, and improving outcomes for,
participants in the pilot program;
(3) plans, if any, to expand or extend the pilot program to
address demand for the highly specialized treatment provided
under the mental health residential treatment programs of the
Department for veterans with a spinal cord injury or
disorder; and
(4) such other matters as the Secretary considers
appropriate.
Subtitle C--Staffing Matters
SEC. 631. TREATMENT OF PSYCHOLOGISTS.
(a) Treatment as Title 38 Employees.--Section 7401 of title
38, United States Code, is amended--
(1) in paragraph (1), by inserting ``psychologists,'' after
``chiropractors,''; and
(2) in paragraph (3), by striking ``psychologists,''.
(b) Inclusion in Contracts for Scarce Medical Specialist
Services.--Section 7409(a) of title 38, United States Code,
is amended by inserting ``psychologists,'' after
``chiropractors,''.
SEC. 632. MENTORSHIP PROGRAM FOR EXECUTIVE LEADERSHIP TEAMS
AT MEDICAL CENTERS OF THE DEPARTMENT OF
VETERANS AFFAIRS.
(a) In General.--The Secretary of Veterans Affairs may
establish a program to connect covered individuals (in this
section referred to as ``mentees'') with peer mentors to
facilitate sharing of best practices and leadership
experiences and to foster opportunities to develop knowledge
and skills required to lead successfully at medical
facilities of the Department (in this section referred to as
the ``mentorship program'').
[[Page H4596]]
(b) Covered Individual Defined.--In this section, the term
``covered individual'' means--
(1) an individual in the position of Facility Director,
Chief of Staff, Associate Director of Patient Care Services,
Associate Director, Assistant Director, or Deputy Director at
a medical center of the Department; or
(2) any other employee of the Department who is determined
by the Secretary to be an executive leader at a medical
center of the Department.
(c) Eligibility.--The following employees of the Department
are eligible for participation as mentees in the mentorship
program:
(1) An employee appointed to a position as a covered
individual who has been in that position for less than one
year.
(2) A covered individual employed at a medical center of
the Department (regardless of appointment commencement date)
that meets one or more of the following criteria:
(A) Reports poor performance, as defined by the Secretary,
on the Strategic Analytics for Improvement and Learning Value
Model of the Department, or successor similar model.
(B) Reports data under section 1703C(a)(3) of title 38,
United States Code, as published on the Access to Care
website of the Department, or successor similar website,
that--
(i) does not consistently meet the level reported in the
community surrounding such medical center, as determined by
the Secretary; or
(ii) does not meet a threshold level determined by the
Secretary.
(C) Has one or more recommendations from a report by the
Office of Inspector General of the Department of Veterans
Affairs that is still open more than one year after the
report was published.
(3) A covered individual employed at a medical center of
the Department (regardless of appointment commencement date)
who is recommended by the regional leadership overseeing such
medical center.
(d) Criteria for Peer Mentors.--Each peer mentor to be
paired with a mentee under subsection (a) shall meet each of
the following criteria:
(1) Previous or current employment in the same position
title as the mentee.
(2) Employment in that position for not less than two
years.
(3) Employment at a medical center of the Department that
reports--
(A) above average performance, as defined by the Secretary,
on the Strategic Analytics for Improvement and Learning Value
Model of the Department, or successor similar model; and
(B) data under section 1703C(a)(3) of title 38, United
States Code, as published on the Access to Care website of
the Department, or successor similar website, that exceeds
the level reported in the community surrounding such medical
center, as determined by the Secretary.
(e) Report.--Not later than one year after the date of the
enactment of this Act, and annually thereafter for an
additional three years, 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 mentorship program,
including--
(1) the number of mentees and peer mentors participating in
the mentorship program, disaggregated by medical center of
the Department;
(2) the number of mentor-mentee pairings initiated under
each of the eligibility criteria outlined in paragraphs (1),
(2), and (3) of subsection (c), including information on any
circumstances in which multiple criteria under such
paragraphs were met;
(3) a description of the actions taken by the Department to
encourage communication between mentees and peer mentors;
(4) aggregated feedback from participants in the mentorship
program; and
(5) the turnover rate for mentee participants in the
mentorship program.
(f) Termination.--The authority under this section shall
terminate on September 30, 2030.
SEC. 633. REQUIREMENT FOR EQUIVALENT ROLE POSTINGS FOR VACANT
POSITIONS AT DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--Whenever possible and practicable, if the
Secretary of Veterans Affairs is issuing a posting for vacant
positions at the Department of Veterans Affairs that may be
filled by more than one type of professional or clinician,
the Secretary shall issue postings for all possible
clinicians or professionals who could fill the position.
(b) Application to Certain Positions.--The Secretary shall
consider the requirement under subsection (a) in particular
with respect to hard-to-recruit, hard-to-retain, primary
care, and mental health care positions.
SEC. 634. IMPROVEMENTS TO DEPARTMENT OF VETERANS AFFAIRS
HIRING PROCESSES.
(a) In General.--Subchapter I of chapter 7 of title 38,
United States Code, is amended by inserting after section 701
the following new section:
``Sec. 702. Hiring processes
``(a) Standardized Approval Process for Filling Vacant
Positions.--
``(1) Process required.--
``(A) In general.--The Secretary shall establish a
standardized, nationwide approval process for filling vacant
employment positions within the Department.
``(B) Variability.--The process required by subparagraph
(A) may be different for each type of employment position in
the Department.
``(C) Approval windows.--The process required by
subparagraph (A) shall include a standardized approval window
for each approval step.
``(2) Delegation.--If the approval authority for a step in
the hiring process established under paragraph (1) is vacant,
on leave, or otherwise unable to respond to requests for
approval in an appropriate timeframe, such authority for
approval shall be delegated to the extent practicable to the
supervisor of such approval authority or such other designee
as may be specified in the chain of command.
``(3) Time to fill goal.--Each window of time allotted for
each approval step under paragraph (1)(C) when added together
shall not exceed the time-to-fill goal of the Department for
such employment position.
``(b) Process for Tentative Offers of Employment.--The
Secretary shall develop a standardized process for issuing
tentative offers of employment with the Department and such
process shall require that each such offer includes a
specified rate of basic pay when possible and practicable.
``(c) Third-party Contracts.--The Secretary may conduct
laboratory testing, background clearances, and other
candidate approval and vetting procedures through a contract
with a third party if the Secretary determines that the
contract would ensure equal or better quality or timeliness.
``(d) Electronic Signatures.--
``(1) Authority.--The Secretary shall allow electronic
signatures on any hiring, recruitment, retention, or other
employment documents once a standardized process for such
signatures is developed and implemented under paragraph (2).
``(2) Standardized process.--The Secretary shall develop a
standardized process for use of electronic signatures as
described in paragraph (1), which shall include exceptions
and limitations as the Secretary considers appropriate and
that allows for use of electronic signatures for employment
documents, including SF 1152 and related successor forms, SF
2823 and related successor forms, and SF 3102-FERS and
related successor forms.
``(e) Employee Community Building Program.--The Secretary
shall, to the extent practicable, establish an employee
community building program that connects employees in similar
positions, offices, and programs to connect with each other
nationwide.''.
(b) Clerical Amendment.--The table of sections at the
beginning of chapter 7 of such title is amended by inserting
after the item relating to section 701 the following new
item:
``702. Hiring processes.''.
SEC. 635. DEPARTMENT OF VETERANS AFFAIRS TELEWORK POLICY.
(a) Policy Required.--Not later than 180 days after the
date of the enactment of this Act, the Secretary of Veterans
Affairs shall, in accordance with the requirements of this
section and the requirements of section 6502 of title 5,
United States Code, establish a policy for the use of
telework within the Department of Veterans Affairs.
(b) Locations.--The policy established under subsection (a)
may be different for different locations, specialties, and
categories of employees, as determined appropriate by the
Secretary.
(c) Assessment.--In developing the policy required by
subsection (a), the Secretary shall assess the following for
each category of employees at the Department--
(1) staffing levels and trends over the last 5 years;
(2) exit survey data related to telework;
(3) the availability of dedicated work space at facilities
of the Department to enable onsite work at a duty station;
(4) a comparison of productivity levels when duties are
performed on site or through telework;
(5) telework flexibilities for comparable categories of
employees in the private sector and in other Federal
agencies; and
(6) particular duties that necessitate on site work.
(d) Notice and Reporting.--
(1) In general.--For any change made to the policy
established pursuant to subsection (a), the Secretary shall--
(A) notify all affected employees of the Department of the
changes; and
(B) submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a report on the changes.
(2) Report contents.--For each report submitted to Congress
under paragraph (1)(B), the Secretary shall include the
analyses for each category conducted in subsection (c) and
the role of those analyses in the telework policy for each
category.
(3) Deadline.--A report submitted under paragraph (1)(B)
regarding a change to the policy established under subsection
(a) shall be made not fewer than 90 days before the change
goes into effect.
(e) Report on Budgetary Impact.--Not later than 1 year
after the date on which the policy established pursuant to
subsection (a) goes into effect, the Secretary shall submit
to the Committee on Veterans' Affairs and the Committee on
Appropriations of the Senate and the Committee on Veterans'
Affairs and the Committee on Appropriations of the House of
Representatives a report on the annual budgetary impact of
such policy.
[[Page H4597]]
(f) Effective Date and Changes.--
(1) Effective date of initial policy.--The initial policy
established pursuant to subsection (a) shall go into effect
not later than 180 days after the date on which the policy is
established.
(2) Effective date of subsequent changes.--Any change made
to the policy established pursuant to subsection (a) after
the effective date set forth in paragraph (1) shall take
effect not less than 90 days after the date on which the
change is made.
(3) Notice.--For any change made to the policy established
pursuant to subsection (a) after the effective date set forth
in paragraph (1), the Secretary shall--
(A) notify all affected employees of the Department of the
changes; and
(B) submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a report on the changes.
SEC. 636. EXPANSION OF REIMBURSEMENT OF CONTINUING
PROFESSIONAL EDUCATION EXPENSES.
(a) In General.--Section 7411 of title 38, United States
Code, is amended to read as follows:
``Sec. 7411. Reimbursement of continuing professional
education expenses
``(a) Required Reimbursement.--The Secretary shall
reimburse any full-time physician, dentist, podiatrist,
chiropractor, optometrist, psychologist, registered nurse
(including any advanced practice registered nurse), or
physician assistant appointed under section 7401(1) of this
title not more than $1,000 per year for each such individual
for expenses incurred for continuing professional education
directly related to the duties and responsibilities of the
position of the employee or related to the duties and
responsibilities of the position or positions of the
employees overseen by the employee.
``(b) Authorized Reimbursement.--The Secretary may
reimburse any full-time licensed practical or vocational
nurse (including any nurse practitioner), medical
technologist, pharmacist, pharmacy technician, diagnostic
radiologic technologist, or social worker appointed under
section 7401(3) of this title, not more than $1,000 per year
for each such individual for expenses incurred for continuing
professional education directly related to the duties and
responsibilities of the position of the employee or related
to the duties and responsibilities of the position or
positions of the employees overseen by the employee.
``(c) Maximum Number of Individuals Reimbursed.--The total
number of individuals who may be reimbursed under this
section may not exceed 50,000 per year.
``(d) Priority Reimbursements.--In providing reimbursement
under subsection (a), the Secretary shall prioritize
reimbursement for individuals providing direct patient care
or individuals who are decision-makers for direct patient
care.
``(e) Report Required.--
``(1) In general.--Not less frequently than annually after
the end of the first fiscal year following the date of the
enactment of the Take Care of America's Veterans Act, the
Secretary shall submit to the Committee on Veterans' Affairs
of the Senate and the Committee on Veterans' Affairs of the
House of Representatives information on utilization of
reimbursement under this section, including--
``(A) locations at which reimbursement is claimed;
``(B) position title and specialty of the individual
claiming reimbursement;
``(C) average amount claimed per position and specialty;
and
``(D) percent utilization by each position and specialty
overall.
``(2) Authority to include in existing report.--The
information required under paragraph (1) may be submitted
independently or included in another annual report to
Congress.''.
(b) Clerical Amendment.--The table of sections at the
beginning of subchapter I of chapter 74 of title 38, United
States Code, is amended by striking the item relating to
section 7411 and inserting the following new item:
``7411. Reimbursement of continuing professional education expenses.''.
SEC. 637. DEPARTMENT OF VETERANS AFFAIRS PERSONNEL
TRANSPARENCY.
(a) In General.--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; 38 U.S.C. 301 note)
is amended--
(1) in subsection (a)--
(A) in paragraph (1)--
(i) in the matter before subparagraph (A), by striking
``information,'' and all that follows through ``facility:''
and inserting ``information:'';
(ii) in subparagraph (B)--
(I) by inserting ``(i)'' before ``The number''; and
(II) by adding at the end the following new clause:
``(ii) Information made available under this subparagraph
shall be updated not less frequently than once each quarter
to account for delays in data processing and shall reflect
the most recently available data.'';
(iii) in subparagraph (C), by striking ``vacancies, by
occupation.'' and inserting ``positions currently undergoing
a recruitment action, disaggregated by occupation and by
stage of recruitment.'';
(iv) in subparagraph (E)(iii), by striking ``potential
hires or''; and
(v) by adding at the end the following new subparagraph:
``(F) The number of positions vacated during the quarter
for which the Department has not initiated a recruitment
action or is not planning to initiate a recruitment
action.'';
(B) by redesignating paragraph (5) as paragraph (6);
(C) by inserting after paragraph (4) the following new
paragraph (5):
``(5) Display of information.--The display of information
made publicly available on a website of the Department
pursuant to paragraph (1) shall be disaggregated--
``(A) by departmental component;
``(B) in the case of information relating to Veterans
Health Administration positions, by medical facility; and
``(C) in the case of information relating to Veterans
Benefits Administration positions, by regional office.''; and
(D) in paragraph (6), as redesignated by subparagraph (B),
by striking ``shall'' and all that follows and inserting the
following: ``shall--
``(A) review the administration of the website required
under paragraph (1);
``(B) develop recommendations relating to the improvement
of such administration; and
``(C) submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a report containing--
``(i) the findings of the Inspector General with respect to
the most recent review conducted under subparagraph (A); and
``(ii) the recommendations most recently developed under
subparagraph (B).''; and
(2) by amending subsection (b) to read as follows:
``(b) Annual Report.--Each year, the Secretary shall submit
to Congress an annual report that includes the following:
``(1) A description of the steps the Department is taking
to achieve full staffing capacity.
``(2) A description of the actions the Department is taking
to improve the onboard timeline for facilities of the
Department, including--
``(A) in the case of facilities of the Veterans Health
Administration, for facilities for which the duration of the
onboarding process exceeds the metrics laid out in the Time
to Hire Model of the Veterans Health Administration, or
successor model; and
``(B) in the case of the Veterans Benefits Administration,
for regional offices that exceed the time-to-hire target of
the Office of Personnel Management.
``(3) The amount of additional funds necessary to enable
the Department to reach full staffing capacity.
``(4) Such recommendations for legislative or
administrative action as the Secretary may have in order to
achieve full staffing capacity at the Department.''.
(b) Effective Date.--The amendments made by subsection (a)
shall take effect on the date of the enactment of this Act
and shall apply with respect to the second update under
section 505(a)(3) of such Act beginning after the date of the
enactment of this Act and each update thereafter.
SEC. 638. MODIFICATION OF AUTHORITY OF LICENSURE OF HEALTH
CARE PROFESSIONALS PROVIDING TREATMENT VIA
TELEMEDICINE.
Section 1730C of title 38, United States Code, is amended--
(1) by amending subsection (a) to read as follows:
``(a) In General.--Notwithstanding any provision of law
regarding the licensure of health care professionals or the
prescribing of controlled substances, a covered health care
professional may practice the health care profession of the
health care professional and prescribe controlled substances
at any location in any State or any of the Freely Associated
States (as defined in section 1724(f) of this title),
regardless of where the covered health care professional or
the patient is located, if the covered health care
professional is using telemedicine to provide treatment or
prescribe controlled substances to an individual under this
chapter.'';
(2) in subsection (b), by adding at the end the following
new paragraph:
``(4) A health care professional who is a contractor of the
Department acting in the scope of a contract with the
Department to furnish care in a facility or clinic of the
Department and who has an active, current, full, and
unrestricted license, registration, or certification in a
State to practice the health care profession of the health
care professional, excluding the following:
``(A) A health care professional located outside a facility
or clinic of the Department providing care through the
Veterans Community Care Program under section 1703 of this
title or a similar authority under the laws administered by
the Secretary.
``(B) A health care professional conducting disability
compensation evaluations pursuant to a contract with the
Department.'';
(3) in subsection (d)--
(A) by redesignating paragraph (2) as paragraph (3); and
(B) by inserting after paragraph (1) the following new
paragraph (2):
``(2) State laws that may be inconsistent under paragraph
(1) include--
``(A) the laws of--
``(i) the State of licensure, certification, or
registration of the covered health care professional;
[[Page H4598]]
``(ii) the State of practice of the covered health care
professional;
``(iii) the State in which the patient is located; or
``(iv) the State of residence of the patient; and
``(B) such laws specified under subparagraph (A) as
incorporated by the Controlled Substances Act (21 U.S.C. 801
et seq.).''; and
(4) in subsection (e), striking ``Nothing'' and inserting
``Except as provided in subsections (a) and (d), nothing''.
SEC. 639. PROVISION OF DATA ON EDUCATIONAL ASSISTANCE
PROGRAMS OF VETERANS HEALTH ADMINISTRATION.
(a) In General.--Beginning not later than 180 days after
the date of the enactment of this Act, the Secretary of
Veterans Affairs shall provide to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans' Affairs
of the House of Representatives data on graduate medical
education programs, health profession scholarship programs,
and any other educational assistance programs within the
Veterans Health Administration.
(b) Elements.--The data required to be provided under
subsection (a) shall include, for each program, the
following:
(1) The number of active participants, broken down by
position or expected future position or licensure.
(2) The amount of funds spent each fiscal year.
(3) The number of participants who have completed their
education and are currently completing their service
requirements at the Department of Veterans Affairs.
(4) The number of participants who were previously active
in the program but left the program before completing their
education or service requirement during the year preceding
the date on which the data is provided.
(5) An overview of outreach by the Department to
prospective participants in the program.
(6) Such other information as the Secretary considers
appropriate.
(c) Update and Submittal of Data.--The data required to be
provided under subsection (a)--
(1) shall be updated not less frequently than annually; and
(2) may be submitted to the Committee on Veterans' Affairs
of the Senate and the Committee on Veterans' Affairs of the
House of Representatives as part of another report required
by law.
(d) Initial Data.--With the first iteration of data
provided under subsection (a), the Secretary shall provide to
the Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of
Representatives a report on the implementation of the pilot
program under section 246 of the Military Construction,
Veterans Affairs, and Related Agencies Appropriations Act,
2018 (division J of Public Law 115-141; 38 U.S.C. 7601 note),
including the current status of the pilot program and a
timeline of the status of the pilot program since its initial
implementation.
Subtitle D--Optimization of Workforce
SEC. 641. DEPARTMENT OF VETERANS AFFAIRS STRATEGIC HUMAN
CAPITAL PLAN.
(a) In General.--Subchapter I of chapter 7 of title 38,
United States Code, is amended by adding at the end the
following new section:
``Sec. 729. Strategic human capital plan
``(a) Plan Development.--(1) Not later than September 30,
2027, the Secretary shall develop and submit to the
appropriate committees of Congress a five-year strategic
human capital plan to support the mission and
responsibilities of the Department, disaggregated by the
Veterans Health Administration, the Veterans Benefits
Administration, the National Cemetery Administration, and
such other administrative components of the Department as the
Secretary considers necessary to carry out the mission of the
Department.
``(2) Not later than September 30, 2028, and each September
30 thereafter, the Secretary shall update the plan developed
pursuant to paragraph (1) and extend the plan so that it
covers the next period of five fiscal years commencing
immediately after the date of the update.
``(b) Requirements.--(1) In developing the plan required by
subsection (a), the Secretary shall take into account and
document current and future projected demand for benefits and
services administered by the Department, disaggregated for
each component by facility location, facility type, region,
administration, program office, the type of benefit or
service, and such other categories as the Secretary
determines appropriate.
``(2) The Secretary shall develop and update the plan under
subsection (a) in consultation with veterans service
organizations and such other stakeholders as the Secretary
considers appropriate.
``(c) Contents.--The strategic human capital plan required
by subsection (a) shall incorporate leading practices,
including the following:
``(1) A workforce gap analysis, including an assessment
of--
``(A) the staffing levels of each employee position needed
to deliver high quality, accessible, and timely health care,
benefits, and other services the Secretary considers
appropriate, disaggregated by employee position, facility
location, facility type, region, administration, program
office, the type of benefit or service, and such other
categories as the Secretary determines appropriate;
``(B) how the staffing levels described in subparagraph (A)
align with industry best practices in each employee position
for the anticipated demand for health care, benefits, and
other services described in subsection (b); and
``(C) core competencies, as defined by the Secretary, and
the staffing levels needed in each of these core
competencies, disaggregated by employee position, facility
location, facility type, region, administration, program
office, the type of benefit or service and such other
categories as the Secretary considers appropriate.
``(2) An implementation plan that includes the following:
``(A) Specific recruitment and retention goals to fulfill
the staffing needs identified in the strategic human capital
plan and the strategy of the Department to achieve such
goals.
``(B) Specific strategies--
``(i) to improve workforce productivity using
technological, organizational, behavioral, and such other
approaches as the Secretary determines appropriate and
productivity measures that are specific to employee positions
and the benefits or services they provide; and
``(ii) that are informed by applicable industry best
practices.
``(C) Specific strategies for recruiting and retaining
veterans, spouses of veterans and members of the Armed
Forces, family members of veterans and members of the Armed
Forces, caregivers of veterans, and survivors of members of
the Armed Forces as employees of the Department.
``(D) Specific goals to reduce the time to hire and onboard
employees of the Department and a strategy to achieve such
goals, including draft legislative language for any
legislative action necessary to achieve such goals, without
degradation of--
``(i) necessary background checks; and
``(ii) measures to protect Department customer and employee
safety.
``(d) Annual Updates.--Not later than September 30, 2028,
and on September 30 of each of year thereafter, the Secretary
shall submit to the appropriate committees of Congress an
update on the implementation of the strategic human capital
plan developed pursuant to subsection (a), including an
assessment by the Secretary of--
``(1) the progress of the Department in implementing the
strategic human capital plan;
``(2) the progress of the Department in improving outcomes
for veterans and their spouses, dependents, and caregivers
through the delivery of high quality, accessible, and timely
health care, benefits, and other services the Secretary
considers appropriate using results based performance
measures;
``(3) changes to projected demand for benefits and services
based on new legislative action or other factors,
disaggregated for each component by facility location,
facility type, region, administration, program office and the
type of benefit or service;
``(4) changes to the staffing levels included in the
strategic human capital plan, including justifications for
such changes, disaggregated by employee position, facility
location, facility type, region, administration, program
office, the type of benefit or service and such other
categories as the Secretary determines appropriate;
``(5) any differentiation between the staffing levels
included in the strategic human capital plan and those
included in the budget justification materials most recently
submitted to Congress in support of the budget of the
Department (as submitted with the budget of the President
under section 1105(a) of title 31); and
``(6) any differentiation from the Quadrennial Veterans
Health Administration review required by section 7330C of
this title.
``(e) Comptroller General of the United States Biennial
Reviews.--Not later than 180 days after the date on which the
human capital plan is submitted to the appropriate committees
of Congress pursuant to subsection (a), and not less
frequently than once every 2 years thereafter, the
Comptroller General of the United States shall--
``(1) review the strategic human capital plan developed
pursuant to subsection (a) and updated pursuant to subsection
(d), as the case may be, particularly with respect to the
adequacy of the plan to fulfill the mission and
responsibilities of the Department; and
``(2) submit to Congress the findings of the Comptroller
General with respect to the review conducted pursuant to
paragraph (1).
``(f) Definitions.--In this section:
``(1) The term `appropriate committees of Congress' means--
``(A) the Committee on Veterans' Affairs and the Committee
on Appropriations of the Senate; and
``(B) the Committee on Veterans' Affairs and the Committee
on Appropriations of the House of Representatives.
``(2) The term `veterans service organization' means any
organization recognized by the Secretary under section 5902
of this title.''.
(b) Clerical Amendment.--The table of sections at the
beginning of chapter 7 of such title is amended by inserting
after the item relating to section 728 the following new
item:
``729. Strategic human capital plan.''.
SEC. 642. DEPARTMENT OF VETERANS AFFAIRS REDUCTION IN FORCE
NOTICE REQUIREMENT.
(a) In General.--Subchapter I of chapter 7 of title 38,
United States Code, as amended
[[Page H4599]]
by section 641, is further amended by inserting after section
729 the following new section:
``Sec. 729A. Reductions in force
``(a) Notice Required.--In any case in which the Secretary
plans to carry out a reduction in force, the Secretary shall,
not later than the date that is 60 days before the date on
which the Secretary commences carrying out such reduction in
force, submit to the appropriate committees of Congress and
the employees of the Department who will be affected by the
reduction in force notice of the intention of the Secretary
to carry out such reduction in force.
``(b) Limitation.--Notwithstanding any other provision of
law, the Secretary may not carry out any reduction in force
with respect to any employee who has not received the notice
required under subsection (a) in the manner and within the
time required by such subsection.
``(c) Contents.--Notice regarding plans to carry out a
reduction in force submitted pursuant to subsection (a) shall
include the following:
``(1) The total number of employees of the Department who
will be affected by the reduction.
``(2) The offices of the Department that will be affected
by the reduction, including, for each such office, the
following:
``(A) The location of the office.
``(B) The program of the Department carried out by the
office.
``(C) The total number of employees of the office before
and after the reduction in force.
``(D) The services provided by the office.
``(3) A justification for the reduction in force, including
how--
``(A) the new staffing levels resulting from the reduction
in force align with the current and future projected demand
for benefits and services administered by the Department,
disaggregated for each component by facility location,
facility type, region, administration, program office, the
type of benefit or service, and such other categories as the
Secretary determines appropriate; and
``(B) the reduction in force aligns with the strategic
human capital plan required by section 729 of this title.
``(4) Budgetary effects of the reduction in force.
``(5) An assessment of the anticipated impact of the
reduction in force on the delivery of benefits and services
furnished by the Department and the actions the Secretary
plans to take to mitigate any adverse impacts.
``(d) Equal Content.--A notice regarding a reduction in
force sent to an employee pursuant to subsection (a) shall be
the same as the notice submitted under such subsection to
Congress for the same reduction in force.
``(e) Administrative Remedy.--A reduction in force carried
out with respect to an employee in violation of subsection
(b) shall have no force or effect with respect to such
employee until the Secretary complies with subsection (a).
``(f) Definitions.--In this section:
``(1) The term `appropriate committees of Congress' means--
``(A) the Committee on Veterans' Affairs and the Committee
on Appropriations of the Senate; and
``(B) the Committee on Veterans' Affairs and the Committee
on Appropriations of the House of Representatives.
``(2) The term `reduction in force' means any action that
would have required notice under part 351 of title 5, Code of
Federal Regulations, as in effect on January 1, 2026.''.
(b) Clerical Amendment.--The table of sections at the
beginning of chapter 7 of such title is amended by inserting
after the item relating to section 729 the following new
item:
``729A. Reductions in force.''.
SEC. 643. DETAILED PLANS AND JUSTIFICATIONS FOR
REORGANIZATION OF OFFICES.
Section 510 of title 38, United States Code, is amended--
(1) in subsection (f)(2)--
(A) in subparagraph (D), by inserting ``in improving
outcomes for veterans and their spouses, dependents, and
caregivers through the delivery of high quality, accessible,
and timely health care, benefits, and other services the
Secretary considers appropriate'' before the period at the
end; and
(B) by adding at the end the following new subparagraphs:
``(G) A description of how the Secretary will analyze
success of the reorganization using results based performance
metrics that are derived from the justification for the
reorganization.
``(H) A risk mitigation plan identifying significant
operational, workforce, financial, information technology,
patient care, and service-delivery risks reasonably
anticipated by the Secretary and the actions planned to
mitigate such risks.'';
(2) by redesignating subsections (e) and (f) as subsections
(f) and (g), respectively; and
(3) by inserting after subsection (d) the following new
subsection (e):
``(e) Not later than 180 days after the date on which the
Secretary completes an administrative reorganization for
which the Secretary submitted under subsection (b) a report
containing a detailed plan and justification for the
administrative reorganization, and not less frequently than
once every 180 days thereafter until the date that is two
years after the date of the completion of such administrative
reorganization, 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
assessing the administrative reorganization using the
performance metrics described in the detailed plan and
justification pursuant to subsection (g)(2)(G).''.
SEC. 644. RULE OF CONSTRUCTION.
Nothing in this subtitle or an amendment made by this
subtitle shall be construed to have any effect on any
provision of law in effect before the date of the enactment
of this Act.
Subtitle E--Veterans Infrastructure and Transformation
SEC. 651. SHORT TITLE.
This subtitle may be cited as the ``Veterans Infrastructure
and Transformation Act of 2026'' or the ``VITAL Act of
2026''.
SEC. 652. MODIFICATION OF AUTHORITY FOR SHARING OF HEALTH-
CARE RESOURCES OF DEPARTMENT OF VETERANS
AFFAIRS TO INCLUDE FLEXIBLE SPACE UTILIZATION
AND STREAMLINED SERVICE AGREEMENTS.
Section 8153 of title 38, United States Code, is amended--
(1) in subsection (a)(3)--
(A) in subparagraph (A), by inserting ``physical'' before
``space'';
(B) in subparagraph (B)(i), by inserting ``physical''
before ``space'';
(C) by striking subparagraph (E);
(D) by redesignating subparagraphs (C) and (D) as
subparagraphs (D) and (E), respectively;
(E) by inserting after subparagraph (B) the following new
subparagraph (C):
``(C) If the health-care resource required is physical
space or common services with respect to existing buildings
and is to be acquired from an institution affiliated with the
Department in accordance with section 7302 of this title or
another entity, the Secretary may enter into contracts or
agreements for the acquisition of the space or service--
``(i) without regard to any law or regulation (including
any Executive order, circular, or other administrative
policy) that would otherwise require the use of competitive
procedures for acquiring the resource; and
``(ii) if all obligations are funded through available
appropriations or borne by the institution or entity, without
regard to any limitations applicable to leases of the
Department, if, in the case of a multi-year space-sharing
agreement, the agreement--
``(I) requires that payments for each fiscal year be made
only from appropriated funds and available that year; and
``(II) includes a provision that the Government's
obligations for future years is contingent upon availability
of appropriations.'';
(F) in subparagraph (D), as redesignated by subparagraph
(D) of this paragraph, by striking ``subparagraph (A) or
(B)'' and inserting ``subparagraph (A), (B), or (C)'';
(2) by adding at the end the following:
``(h) In this section:
``(1) The term `commercial service' means a service that is
offered and sold competitively in the commercial marketplace,
is performed under standard commercial terms and conditions,
and is procured using firm-fixed price contracts.
``(2) The term `common service' means a commercial service
necessary to maintain or operate existing physical space,
including maintenance, heating, ventilation, air
conditioning, electricity, energy, water, wastewater,
landscaping, security, laundry, or any other service as
determined by the Secretary.
``(3) The term `physical space' means a portion of a
building or parking facilities.''.
SEC. 653. USE OF COMMERCIAL CONSTRUCTION AND FACILITIES CODE
AND STANDARDS.
(a) In General.--The Secretary of Veterans Affairs may use
commercial codes and standards instead of or in addition to
Federal codes and standards in the construction or alteration
of facilities of the Department of Veterans Affairs, where
such commercial codes and standards do not conflict with
statutory and regulatory requirements.
(b) Pilot Projects.--The Secretary shall carry out not
fewer than three pilot projects during each of fiscal years
2027, 2028, 2029, 2030, and 2031 utilizing commercial codes
and standards instead of Federal codes and standards to lease
or construct facilities of the Department for major
construction, minor construction, or major lease projects.
(c) Reports.--The Secretary shall submit to the Committee
on Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives not later
than 90 days after the end of each of fiscal years 2027,
2028, 2029, 2030, and 2031, a report detailing the use by the
Secretary of the authority provided by subsection (a) and
conduct of each pilot project required by subsection (b) that
was initiated, ongoing, or completed during the fiscal year.
(d) Definitions.--In this section:
(1) Commercial codes and standards.--The term ``commercial
codes and standards'' means building codes or standards of
the following:
(A) The National Fire Protection Association.
(B) The International Code Council.
(C) The American Society for Testing and Materials.
(D) The American Society of Civil Engineers.
(E) Any other building code or standard, other than those
described in paragraph (2), determined by the Secretary.
[[Page H4600]]
(2) Federal codes and standards.--The term ``Federal codes
and standards'' means the following:
(A) Building codes or standards specific to one or more
Federal agencies.
(B) Building codes or standards specific to the Department,
including the Technical Information Library.
(C) Standards of the Federal Guidelines Institute.
SEC. 654. FEASIBILITY STUDY FOR FULL-SERVICE HOSPITAL OF
DEPARTMENT OF VETERANS AFFAIRS IN CERTAIN
STATES.
(a) In General.--The Secretary of Veterans Affairs shall
conduct a study on the feasibility of establishing a full-
service hospital of the Department of Veterans Affairs in
Alaska and Hawaii.
(b) Publication.--Not later than one year after the date of
the enactment of this title, the Secretary shall publish on a
publicly available website of the Department the findings of
the Secretary with respect to the study conducted under
subsection (a).
SEC. 655. REPORT ON STRATEGIC PLAN FOR INFRASTRUCTURE AND
CAPITAL ASSETS OF DEPARTMENT OF VETERANS
AFFAIRS.
(a) Report.--Not later than one year after the date of the
enactment of this Act, the Secretary of Veterans Affairs
shall submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a report on the strategic plan for
infrastructure and capital assets of the Department of
Veterans Affairs, which summarizes a facility lifecycle
strategy targeting modernization of owned and leased
facilities and infrastructure required to mitigate increasing
systemic failures, veteran and staff safety, benefits
delivery interruptions, and funding associated to address
emergency repairs.
(b) Elements.--The report required by subsection (a) shall
cover known and projected requirements over a period of not
less than 10 years for the following:
(1) Land acquisition.
(2) Operations and maintenance of facilities of the
existing capital asset portfolio of the Department.
(3) Operations and maintenance of the planned future
capital asset portfolio of the Department.
(4) New construction, disaggregated by type of new
construction, including the following types of construction:
(A) Major construction.
(B) Minor construction.
(C) Nonrecurring maintenance.
(5) Leasing.
(6) Alternative acquisition methods, such as partnerships
and donations.
(7) Activation of space.
(8) Disposal, reuse, and remediation.
(9) Facility lifecycle strategy process supporting the
planning, programming delivery, management, and maintenance
of the current and future capital asset portfolio of the
Department.
(10) A discussion of the negative effect of the lack of
stable and predictable capital asset funding on the ability
of the Department to plan, staff, and execute effective
capital asset management.
(11) Overview of the strategy being utilized in the
approach of the Secretary to capital investment, across all
the capital and leasing programs, including the approach of
repair versus recapitalization, use of leasing, and other
relevant strategies as deemed appropriate by the Secretary.
(12) Such other matters as the Secretary considers
appropriate, including with respect to legislative or
administrative action, if such actions are subject to the
availability of appropriated funds.
(c) Rule of Construction.--Nothing in this section or a
report submitted under this section shall be construed to
create or imply any financial or operational obligation
beyond the availability of appropriated funds.
SEC. 656. PILOT PROGRAM ON ACCEPTANCE BY THE DEPARTMENT OF
VETERANS AFFAIRS OF DONATED FACILITIES AND
RELATED IMPROVEMENTS: EXTENSION; MODIFICATION.
(a) Extension.--Section 2 of the Communities Helping Invest
through Property and Improvements Needed for Veterans Act of
2016 (Public Law 114-294; 38 U.S.C. 8103 note) is amended, in
subsection (i), by striking ``December 16, 2026'' and
inserting ``the day that is five years after the date of the
enactment of the Take Care of America's Veterans Act''.
(b) Modification of Acceptance of Property.--Paragraph (1)
of subsection (b) of such section is amended to read as
follows:
``(1) the donation aligns with--
``(A) a need identified in a Strategic Capital Investment
Planning process priority list, a five-year development plan,
a facility master plan, or an annual capital needs inventory
of the Department; or
``(B) any component or phase of a need described in
paragraph (1); and''.
SEC. 657. AUTHORITY TO ACCEPT DONATIONS OF CONSTRUCTION
SERVICES, MINOR CONSTRUCTION OR NONRECURRING
MAINTENANCE PROJECTS, AND TARGETED
CONTRIBUTIONS.
(a) Authority.--Notwithstanding any other provision of law,
the Secretary of Veterans Affairs may accept donations
comprising the total cost or a portion of the cost of--
(1) minor construction projects;
(2) nonrecurring maintenance projects; or
(3) construction services relating--
(A) to minor construction projects;
(B) to nonrecurring maintenance projects;
(C) to an existing facility of the Department; or
(D) to a new facility or portion thereof of the Department.
(b) Alignment to Needs.--The Secretary may accept a
donation under this section only if--
(1) the donation aligns with--
(A) a need identified in a Strategic Capital Investment
Planning process priority list, a five-year development plan,
a facility master plan, or an annual capital needs inventory
of the Department; or
(B) any component or phase of a need described in
subparagraph (A);
(2) the donation is from an entity described in section
2(a)(2) of the Communities Helping Invest through Property
and Improvements Needed for Veterans Act of 2016 (Public Law
114-294; 38 U.S.C. 8103 note);
(3) the Secretary determines such donation would--
(A) accelerate project completion;
(B) reduce the expense to the Department;
(C) improve facility condition; or
(D) otherwise benefit veterans;
(4) the donor enters into a formal agreement with the
Secretary that includes--
(A) provisions for the Department's oversight during
performance;
(B) compliance with applicable construction codes and
standards, and applicable laws and regulations;
(C) donor-provided insurance, warranties, and liability
protections;
(D) the amount of the donation and the amount of the
Department's funding contribution, if any;
(E) that the donation shall not increase the cost to the
Federal Government of completing such project described in
subsection (a) (excluding activation and sustainment of such
facility); and
(F) such other terms as the Secretary determines necessary.
(c) Streamlined Requirements.--For donations under this
section that do not involve transfer of real property title--
(1) the donor shall enter into an agreement with the
Department that determines who is responsible to ensure
environmental or historic preservation due diligence is
completed;
(2) the donor shall obtain all federally required
construction and facility related permits; and
(3) agreements may be simplified relative to those under
section 2 of the Communities Helping Invest through Property
and Improvements Needed for Veterans Act of 2016 (Public Law
114-294; 38 U.S.C. 8103 note) to reflect the nature of
services or targeted contributions.
(d) Reporting.--The Secretary shall include information on
donations accepted under this section in the reports required
under section 2(g) of the Communities Helping Invest through
Property and Improvements Needed for Veterans Act of 2016
(Public Law 114-294; 38 U.S.C. 8103 note), with separate
tracking for donations under this section.
SEC. 658. REPORT ON USE OF ADDITIONAL AUTHORITIES RELATING TO
RECRUITMENT AND RETENTION OF PERSONNEL.
(a) Report Required.--Not later than 90 days after the date
of the enactment of this Act, the Secretary of Veterans
Affairs shall submit to the appropriate committees of
Congress a report detailing how the Secretary will use the
authorities of section 706 of title 38, United States Code,
to increase the size and performance of the acquisition
workforce of the Department of Veterans Affairs.
(b) Definitions.--In this section:
(1) Acquisition workforce of the department.--The term
``acquisition workforce of the Department of Veterans
Affairs'' means personnel of the Department of Veterans
Affairs occupying positions within occupational series, as
defined by the Director of the Office of Personnel
Management, responsible for acquisition functions, as
determined by the Secretary.
(2) Appropriate committees of congress.--The term
``appropriate committees of Congress'' means the Committee on
Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives.
SEC. 659. REPORTS ON KEY CAPITAL ASSET INVESTMENTS,
ACTIVITIES, AND PERFORMANCE OF DEPARTMENT OF
VETERANS AFFAIRS.
(a) In General.--Section 8120 of title 38, United States
Code, is amended to read as follows:
``Sec. 8120. Reports on key capital asset investments,
activities, and performance
``(a) Capital Asset Investment, Activities, and
Performance.--
``(1) In general.--Not later than 30 days after the end of
each fiscal year, and every 60 days thereafter until the end
of the subsequent fiscal year, the Secretary shall submit to
the appropriate committees of Congress a report on key
capital asset investments, activities, and performance of the
Department.
``(2) Elements.--
``(A) First report in each fiscal year.--The first report
under paragraph (1) in each fiscal year shall include the
following:
``(i) A brief summary of work that was completed on each
capital asset project that was completed in the previous
fiscal year.
``(ii) A brief summary of the accomplishments, impediments,
and challenges experienced by the Department with respect to
capital asset projects in the previous fiscal year and a
description of efforts made to address any such impediments
and challenges.
[[Page H4601]]
``(iii) With respect to each capital asset project
completed in such year, the following:
``(I) The type of project (major construction, minor
construction, nonrecurring maintenance, leases, or other
category, including disposals).
``(II) The estimated total cost and the actual total cost
of the project.
``(III) A description of the project.
``(IV) The location and facility with respect to which the
project was carried out.
``(V) The fiscal quarter the project was expected to begin,
the fiscal quarter the project began, the month and year the
project was completed, and the fiscal quarter the facility in
connection to such project was in use by veterans, employees
of the Department, or other relevant users, as the case may
be.
``(iv) In the case of any capital asset project completed
during the previous fiscal year with respect to which the
final cost of the project (or any increment of the project)
was more than 10 percent greater than the estimated cost of
the project (or increment) or the completion of such project
(or increment) was more than 180 days later than the planned
schedule for such project (or increment)--
``(I) the reason for any such overage or delay; and
``(II) actions being taken to prevent any such overage or
delay in future projects.
``(v) A list of any capital asset projects cancelled during
the previous fiscal year, including any projects in the
design phase and including the reason for the cancellation.
``(vi) A summary of total actual obligations for capital
asset projects for the previous fiscal year, broken out by
major construction, minor construction, nonrecurring
maintenance, and leases from the medical facilities
appropriation account of the Department.
``(vii) A projected list of capital asset projects, broken
out by type of project under subclause (I), that are expected
to be initiated during the current fiscal year and those that
are expected to be completed during the current fiscal year,
which shall include the following:
``(I) The type of project (major construction, minor
construction, nonrecurring maintenance, leases, or other
category, including disposals).
``(II) The estimated total cost of the project.
``(III) A description of the project.
``(IV) The location and facility with respect to which the
project was carried out or is expected to be carried out.
``(V) The fiscal quarter the project is expected to begin,
the fiscal quarter the project is expected to be completed,
and the fiscal quarter the facility in connection to such
project is expected to be in use by veterans, employees of
the Department, or other relevant users, as the case may be.
``(viii) Projected total obligations for capital asset
projects for the current fiscal year, broken out by major
construction, minor construction, nonrecurring maintenance,
and leases, from the medical facilities appropriation account
of the Department.
``(ix) Such observations of best practices, impediments,
and accomplishments related to the capital asset management
and performance of the Department, including any legislative
or administrative action, as the Secretary considers
appropriate with respect to such practices, impediments, and
accomplishments.
``(x) Meaningful metrics that show the progress of the
Department toward meeting relevant goals of the Department
relating to capital asset management.
``(xi) Such other matters as the Secretary considers
appropriate.
``(B) Subsequent reports.--Each report in a fiscal year
after the first report shall include, at a minimum, relevant
updates on any capital asset projects that are ongoing during
that fiscal year, including any updates to information
provided with respect to such projects under subparagraph
(A).
``(3) Matters relating to reporting costs.--In each report
under paragraph (1), when reporting on costs for capital
asset projects, the Secretary may include information
regarding Federal requirements, including those specific to
the Department, that may not exist in the non-Federal
construction sector that may increase costs for capital asset
projects.
``(b) Super Construction Projects.--
``(1) In general.--Not later than 30 days after the end of
each fiscal year, and every 60 days thereafter until the end
of that fiscal year, the Secretary shall submit to the
appropriate committees of Congress a report on the super
construction projects carried out by the appropriate non-
Department Federal entity described in section 8103(e)(1) of
this title during such year.
``(2) Elements.--Each report required under paragraph (1)
shall include, for each project described in such paragraph--
``(A) the budgetary and scheduling status of the project,
as of the last day of the most recent fiscal quarter ending
before the date on which the report is required to be
submitted; and
``(B) the actual cost and schedule variances of the
project, as of such day, compared to the planned cost and
schedules for the project.
``(c) Definitions.--In this section:
``(1) Appropriate committees of congress.--The term
`appropriate committees of Congress' means--
``(A) the Committee on Appropriations and the Committee on
Veterans' Affairs of the Senate; and
``(B) the Committee on Appropriations and the Committee on
Veterans' Affairs of the House of Representatives.
``(2) Capital asset project.--The term `capital asset
project' means a capital asset investment or activity of the
Department.
``(3) Super construction project.--The term `super
construction project' has the meaning given such term in
section 8103(e)(3) of this title.''.
(b) Clerical Amendment.--The table of sections at the
beginning of chapter 81 of title 38, United States Code, is
amended by striking the item relating to section 8120 and
inserting the following new item:
``8120. Reports on key capital asset investments, activities, and
performance.''.
SEC. 660. DEVELOPMENT OF STREAMLINED PROCUREMENT MODEL;
REPORT.
Not later than 180 days after the date of enactment of this
Act, the Secretary of Veterans Affairs, in consultation with
the Comptroller General of the United States, the Director of
the Office of Management and Budget, and private sector
stakeholders, shall develop a revised process for the
procurement of major medical facility leases under chapter 81
of title 38, United States Code, and submit to the Committees
on Veterans' Affairs of the House of Representatives and the
Senate a report that includes a description of such revised
process.
SEC. 661. SUBMISSION AND NOTIFICATION OF COST ESTIMATES FOR
MEDICAL FACILITY LEASES.
(a) Submission of Cost Estimates for Major Medical Facility
Leases With Presidential Budget Request.--Subchapter I of
chapter 81 of title 38, United States Code, is amended by
inserting after section 8104 the following new section:
``Sec. 8104A. Submission of cost estimates for major medical
facility leases with president's budget request
``(a) In General.--For each major medical facility lease or
prospectus-level lease for which the Secretary seeks
authorization, appropriations, or prospectus approval, the
Secretary shall include in the budget justification materials
submitted to Congress in connection with the budget of the
Department for the applicable fiscal year (as submitted with
the budget of the President under section 1105(a) of title
31) a market-based cost estimate and full life-cycle cost
estimate for such lease.
``(b) Market-based Cost Estimate.--Each market-based cost
estimate required under subsection (a) shall include an
evaluation of--
``(1) local land values;
``(2) applicable construction costs; and
``(3) other cost factors the Secretary determines relevant
to build-to-suit facilities.
``(c) Standardized Methodology.--
``(1) In general.--The Secretary shall adopt and apply a
standardized methodology for estimating under subsection (a)
the full life-cycle cost of major medical facility leases and
prospectus-level leases.
``(2) Required elements.--The methodology required under
paragraph (1) shall include, at a minimum--
``(A) base rent projections over the full lease term;
``(B) tenant improvement and buildout costs based on
current medical facility standards;
``(C) estimated operating expenses, including utilities,
maintenance, and security;
``(D) annual escalation factors tied to construction cost
indices, labor rates, and market trends;
``(E) cost assumptions for option periods or potential
renewal terms; and
``(F) geographic adjustments using current regional market
data to reflect location-specific construction and leasing
conditions.
``(d) Annual Adjustment.--
``(1) In general.--To reflect inflation and market
escalation, the Secretary shall annually adjust each cost
estimate for a lease submitted to Congress for authorization,
appropriations, or prospectus approval during the period
beginning on the date on which the Secretary first includes
such cost estimate in the budget justification materials
described in subsection (a) and ending on the projected award
date for the lease.
``(2) Indices.--In adjusting a cost estimate under
paragraph (1), the Secretary shall use such medical
construction or real estate indices as the Secretary
determines appropriate.
``(e) Rules of Construction.--
``(1) Budgetary treatment.--Nothing in this section shall
be construed to alter, supersede, waive, or otherwise affect
the application of the scorekeeping guidelines, including the
budgetary treatment of leases under Office of Management and
Budget Circular A-11 or any successor guidance.
``(2) Preservation of existing budget authority
requirements.--Nothing in this section shall be construed to
authorize the Secretary to enter into a lease, incur an
obligation, or make an expenditure except to the extent and
in the amount provided in advance in appropriations Acts.
``(f) Definitions.--In this section, the term `major
medical facility lease' has the meaning given that term in
section 8104(a)(3)(B) of this title.''.
(b) Congressional Notification and Plan Required for Cost
Estimates Exceeding Approved Prospectus Amounts.--Subchapter
I of such chapter is further amended
[[Page H4602]]
by inserting after section 8104A the following new section:
``Sec. 8104B. Congressional notification and plan required
for cost estimates exceeding approved prospectus amounts
``(a) Price Estimates Required During Solicitation Phase.--
As part of the request for lease proposals (or equivalent
formal solicitation) for a major medical facility lease, the
Secretary shall require offerors to provide detailed price
proposals, including the cost of land (if applicable), to
enable evaluation against the authorized prospectus amount.
``(b) Notification Required.--If the lowest responsive
offer for a major medical facility lease exceeds the
unserviced shell rent authorized in the approved prospectus
by more than 10 percent, the Secretary shall notify the
Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of
Representatives not later than 45 days after the date on
which the Secretary determines that such offer exceeds such
authorized amount.
``(c) Plan Required.--
``(1) In general.--Not later than 60 days after
notification under subsection (b) with respect to a major
medical facility lease, the Secretary shall submit to the
Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of
Representatives a plan to address the cost discrepancy for
such lease, which may include scope adjustment, value
engineering, requesting additional authority, or other
appropriate measures.
``(2) Limitation on award.--The Secretary shall not award a
major medical facility lease until the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans' Affairs
of the House of Representatives have received the plan
required under paragraph (1) with respect to such lease.
``(d) Limitation on Further Action.--If the Secretary is
required to submit a notification under subsection (b), the
Secretary may not issue a request for lease proposals for the
applicable major medical facility lease until the date on
which the Secretary submits the plan required under
subsection (c).
``(e) Rule of Construction.--Nothing in this section shall
be construed to authorize the Secretary to exceed any amount
authorized in an approved prospectus or any amount provided
in advance in an appropriations Act.''.
(c) Clerical Amendment.--The table of sections at the
beginning of such chapter is amended by inserting after the
item relating to section 8104 the following new items:
``8104A. Submission of cost estimates for major medical facility leases
with President's budget request
``8104B. Congressional notification and plan required for cost
estimates exceeding approved prospectus amounts''.
SEC. 662. REPORT ON CAPITAL ASSET AND INFORMATION TECHNOLOGY
NEEDS OF THE RESEARCH AND DEVELOPMENT PROGRAM
OF DEPARTMENT OF VETERANS AFFAIRS.
(a) Report Required.--Not later than two years after the
date of the enactment of this Act, the Secretary of Veterans
Affairs shall submit to Congress a report on the capital
asset and information technology needs of the research and
development program of the Department of Veterans Affairs.
(b) Contents.--
(1) In general.--The report required by subsection (a)
shall include the following:
(A) A comprehensive summary of new facilities, renovations
of existing facilities, leasing of facilities, and any other
such facilities or physical infrastructure the Department
requires to effectively perform its research and development
functions, including projected functions.
(B) Detailed information on the information technology
resources, projects, equipment, and related information
technology needs, disaggregated by type of information
technology funding categories, such as development or
operations and maintenance, the Department requires in order
to make the research and development program and activities
of the Department functional and high-performing in the
short-, medium-, and long-term, and those needed to enable
employees of the Department to perform their research and
development activities in an effective and efficient manner.
(C) Such matters as the Secretary determines relevant to
maintain and further improve and advance the research and
development functions of the Department through improved
capital asset and information technology support.
(2) Requirements.--
(A) Facilities.--
(i) Summaries by project.--In providing information under
paragraph (1)(A), the Secretary shall provide estimated
summaries for each project with cost data as well as a
realistic multi-year plan to design and deliver the capital
asset projects, assuming required funding is provided.
(ii) Identification of projects.--The Secretary shall
identify each project under paragraph (1)(A) by its project
type, such as major construction, minor construction,
nonrecurring maintenance, major lease, minor lease, or such
other category as the Secretary determines may be
appropriate.
(B) Information technology.--In providing information under
paragraph (1)(B), the Secretary shall provide estimated
summaries for each project or investment with individual and
total cost data as well as a realistic multi-year plan to
develop relevant requirements and acquire and deploy the
relevant information technology services, projects,
equipment, and related matters.
(C) Scope.--The scope of the report submitted under
subsection (a) is on the capital asset, information
technology, and other related critical support functions,
excluding human capital related needs, needed for the
Department to perform research and development in an
effective and efficient manner.
(c) Considerations.--In preparing the report required by
subsection (a), the Secretary may consider the following:
(1) The findings of the 2012 final report of the Research
Infrastructure Program of the Department.
(2) Current and updated data providing the most accurate
and holistic presentation of the physical infrastructure,
information technology, and other relevant support function
needs of the research and development program of the
Department.
(3) Such other matters as the Secretary considers
appropriate.
SEC. 663. IMPROVING PREVENTION, DETECTION, AND REPORTING OF
WASTE, FRAUD, AND ABUSE IN DEPARTMENT OF
VETERANS AFFAIRS CAPITAL ASSET PROJECTS AND
ACTIVITIES.
(a) Report Required.--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 actions the Department of Veterans
Affairs is taking or plans to take to enhance the ability of
the Department to prevent, detect, and report waste, fraud,
and abuse occurring in capital asset projects of the
Department, whether by employees, contractors, or other
relevant persons or entities involved with the Department.
(b) Elements.--The report required by subsection (a) shall
include the following:
(1) An assessment of whether new training or enhancements
to existing training should be undertaken to improve the
prevention, detection, and reporting of waste, fraud, and
abuse.
(2) Recommendations for such legislative and administrative
action as the Secretary determines appropriate to improve the
prevention, detection, and reporting of waste, fraud, and
abuse.
(3) Such other matters as the Secretary considers
appropriate.
(c) Consultation.--In carrying out subsection (a), the
Secretary--
(1) shall consult with the Inspector General of the
Department of Veterans Affairs and the Comptroller General of
the United States on matters relating to best practices and
strategies to improve detection and prevention by the
Department of waste, fraud, and abuse in capital asset
projects and management; and
(2) may consult with such other persons and entities on
such matters as the Secretary considers appropriate.
SEC. 664. REPORT ON LONG-TERM CARE PHYSICAL INFRASTRUCTURE
NEEDS OF DEPARTMENT 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 submit to the appropriate committees of Congress a
report, disaggregated by medical center or other relevant
health care facility of the Department of Veterans Affairs,
identifying the physical infrastructure needs of the
Department to support current and future anticipated long-
term care needs and models of care for veterans, including--
(1) infrastructure needed to support the delivery of long-
term care for women veterans, veterans with spinal cord
injuries and diseases, veterans with traumatic brain injury,
veterans with unique behavioral health needs, veterans with
memory loss, and other population groups with unique needs or
projected future needs;
(2) information regarding the plans of the Department to
provide such care as the Department builds internal capacity
but space is not yet available to meet the demand for such
care; and
(3) with respect to any projects needed to provide the
infrastructure specified under paragraph (1)--
(A) the estimated individual project cost and total cost to
accomplish those projects; and
(B) the estimated individual project timeline to accomplish
each such project upon receipt of appropriate funding.
(b) Inclusion of Information Regarding Prioritization of
Certain Projects.--The Secretary shall include in the report
required under subsection (a) information regarding how the
infrastructure prioritization processes of the Department,
such as the Strategic Capital Investment Planning process, or
successor process, could be modified to include higher
prioritization of projects that support the provision of a
health care service that is not widely available, or is not
available in compliance with appropriate quality or access
standards, from non-Department providers.
(c) Development of Report.--In developing the report
required under subsection (a), the Secretary shall consult
with relevant regional and national program offices of the
Veterans Health Administration with responsibility for
managing the various health care services covered by the
report, including long-term care and care relating to spinal
cord injuries and diseases, to ensure that the report
contains a holistic, comprehensive, and integrated plan to
address the capital asset and other space needs for the
population of veterans who require those services.
[[Page H4603]]
(d) Indication of Types of Projects.--In the report
required under subsection (a), the Secretary shall indicate
the projects that can be most efficiently and effectively
accomplished through smaller individual infrastructure
projects or through a larger medical facility replacement or
new site of care, as determined by the Secretary.
Subtitle F--Other Health Care Matters
SEC. 671. PRESCRIPTION, DELIVERY, DISTRIBUTION, AND
DISPENSATION OF CONTROLLED SUBSTANCE
MEDICATIONS BY COVERED HEALTH CARE
PROFESSIONALS OF DEPARTMENT OF VETERANS AFFAIRS
VIA TELEMEDICINE.
(a) In General.--Subchapter III of chapter 17 of title 38,
United States Code, is amended by adding at the end the
following new section:
``Sec. 1730D. Prescription, delivery, distribution, and
dispensation of controlled substance medications via
telemedicine
``(a) In General.--Notwithstanding sections 102(54) and
309(e) of the Controlled Substances Act (21 U.S.C. 802(54)
and 829(e)), a covered health care professional may
prescribe, deliver, distribute, and dispense a controlled
substance if the covered health care professional is using
telemedicine through the use of an interactive
telecommunications system, including an audio-only
telecommunications system when necessary, to prescribe,
deliver, distribute, or dispense to a patient eligible to
receive hospital care or medical services under this chapter
a controlled substance that is a prescription drug as
determined under the Federal Food, Drug, and Cosmetic Act (21
U.S.C. 301 et seq.), regardless of whether such covered
health care professional has conducted an in-person medical
examination of such patient, if--
``(1) such covered health care professional--
``(A) is acting in the usual course of professional
practice;
``(B) is registered pursuant to section 303(g) of the
Controlled Substances Act (21 U.S.C. 823(g)) in any State or
is utilizing the registration of a facility of the Department
registered pursuant to section 303(f) of such Act (21 U.S.C.
823(f));
``(C) has access to medical documentation from an in-person
medical evaluation of such patient in the past two years by--
``(i) a covered health care professional;
``(ii) a health care professional who furnished care and
services under the Veterans Community Care Program under
section 1703 of this title; or
``(iii) a health care professional of the Department of
Defense; and
``(D) at the time of the telemedicine visit of the
patient--
``(i) has reviewed the prescription data of the individual
from the electronic health record database of the Department
and data from the prescription drug monitoring program for
the State in which the patient is located at the time of the
telemedicine encounter (if such a program exists) for at
least the one-year period preceding the date of the visit or,
if less than one year of data is available, for the entire
period available; and
``(ii) provides documentation of--
``(I) such review;
``(II) all successful attempts to access such databases and
program; and
``(III) all unsuccessful attempts to access such databases
and program that resulted in the prescription of a limited
supply under subsection (b); and
``(2) such substance is delivered, distributed, or
dispensed for a legitimate medical purpose.
``(b) Authority for Limited Supply.--
``(1) In general.--If the databases and program described
in subsection (a)(1)(D) are unavailable or inaccessible at
the time of a telemedicine encounter conducted by a covered
health care professional, the covered health care
professional may not prescribe, deliver, distribute, or
dispense more than a seven-day supply of a controlled
substance until the covered health care professional is able
to review such databases and program.
``(2) Databases unavailable or inaccessible.--If a database
or program required to be reviewed under subsection (a)(1)(D)
is unavailable or inaccessible for an extended period, as
determined by the Secretary, a covered health care
professional may provide additional seven-day supplies of a
controlled substance until such database or program is
accessible.
``(c) Maximum Supply.--The authority under this section may
be used to supply a controlled substance for not more than a
six-month period.
``(d) Use of Authority.--The Secretary shall ensure that
the authority under this section is used to prevent
interruptions to patient care and not as a replacement for
routine in-person patient care.
``(e) Regulations.--
``(1) In general.--The Secretary shall establish in
regulations guidelines and a process for the prescription,
delivery, distribution, and dispensation of a controlled
substance pursuant to subsection (a).
``(2) Elements.--The Secretary shall ensure the guidelines
and process described in paragraph (1)--
``(A) do not restrict access of a patient to in-person
care; and
``(B) provide for the collection and analysis of data to
determine if an individual has evidence of a prior in-person
medical evaluation by a health care professional described in
subsection (a)(1)(C) who would reasonably be expected to have
prescribing authority based on their credential or
organizational role.
``(3) Initiating treatment.--
``(A) In general.--The guidelines established by paragraph
(1) shall prohibit a covered health care professional from
initiating treatment with an opioid medication listed in
schedule II or III under section 202 of the Controlled
Substances Act (21 U.S.C. 812) unless the covered health care
professional is providing treatment--
``(i) for opioid use disorder;
``(ii) for a patient receiving palliative care or enrolled
in hospice care; or
``(iii) for a patient who is physically located in a
medical facility where the patient is receiving in-person
care.
``(B) Exception.--The prohibition under subparagraph (A)
shall not apply to renewal or maintenance of a previously
prescribed medication described in such subparagraph.
``(f) Reporting.--
``(1) In general.--Not later than one year after the date
of the enactment of the Take Care of America's Veterans Act,
and not less frequently than annually thereafter until the
termination date under subsection (g), the Secretary shall
submit to the Committee on Veterans' Affairs of the Senate
and the Committee on Veterans' Affairs of the House of
Representatives a report that addresses the use of the
authority under this section during the fiscal year preceding
the date of submission of the report in each Veterans
Integrated Service Network.
``(2) Elements.--Each report under paragraph (1) shall
indicate, at a minimum--
``(A) how many patients received prescriptions for
controlled substance medications through telemedicine under
this section;
``(B) which controlled substances are being prescribed
under this section and how many prescriptions were written
for each such substance;
``(C) the number of individuals who received a controlled
substance medication that was prescribed, delivered,
distributed, or dispensed under this section without evidence
of an in-person medical evaluation within the previous two
years by a health care professional described in subsection
(a)(1)(C); and
``(D) the barriers that exist to reviewing prescription
drug monitoring programs of States and how often those
barriers occur.
``(g) Duration.--The authority under this section shall
terminate on September 30, 2031.
``(h) Definitions.-- In this section:
``(1) The terms `controlled substance', `deliver',
`dispense', and `distribute' have the meanings given those
terms in section 102 of the Controlled Substances Act (21
U.S.C. 802).
``(2) The term `covered health care professional' means--
``(A) a health care professional who--
``(i) is--
``(I) an employee of the Department appointed under section
7306, 7401, 7405, 7406, or 7408 of this title or under title
5; or
``(II) operating from a facility of the Department,
including a clinic of the Department;
``(ii) is authorized by the Secretary to provide health
care under this chapter;
``(iii) is required to adhere to all standards for quality
relating to the provision of health care in accordance with
applicable policies of the Department;
``(iv) has an active, current, full, and unrestricted
license, registration, or certification or meets
qualification standards set forth by the Secretary within a
specified time frame; and
``(v) with respect to a health care profession listed under
section 7402(b) of this title, has the qualifications for
such profession as set forth by the Secretary; and
``(B) a health professions trainee who--
``(i) is appointed under section 7405 of this title; and
``(ii) is under the clinical supervision of a health care
professional described in subparagraph (A).''.
(b) Clerical Amendment.--The table of sections at the
beginning of such chapter is amended by inserting after the
item relating to section 1730C the following new item:
``1730D. Prescription, delivery, distribution, and dispensation of
controlled substance medications via telemedicine.''.
SEC. 672. COPAYMENTS FOR LIMITED SUPPLIES OF MEDICATIONS.
Paragraph (4) of section 1722A(a) of title 38, United
States Code, is amended to read as follows:
``(4) Paragraph (1) does not apply--
``(A) to opioid antagonists furnished under this chapter to
a veteran who is at high risk for overdose of a specific
medication or substance in order to reverse the effect of
such an overdose; and
``(B) to any limited supply prescription for medication, up
to a 30-day supply of such medication, under section 1730D(b)
of this title if the covered health care professional would
have prescribed, delivered, distributed, or dispensed a
supply for more than seven days if not for the restrictions
under such section.''.
SEC. 673. PLAN ON ESTABLISHMENT OF INTERACTIVE, ONLINE SELF-
SERVICE MODULE FOR CARE.
(a) In General.--The Secretary of Veterans Affairs shall
develop and implement a plan to establish, to the greatest
extent practicable, an interactive, online self-service
module--
[[Page H4604]]
(1) to allow 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--
(A) to request appointments, track referrals for health
care under the laws administered by the Secretary, whether at
a facility of the Department of Veterans Affairs or through a
non-Department provider, and receive appointment reminders;
(B) to appeal and track decisions relating to--
(i) denials of requests for authorization for care or
services under section 1703 of title 38, United States Code;
or
(ii) denials of requests for care or services at facilities
of the Department, including under section 1710 of such
title;
(C) to compare the average wait times for appointments for
the type of care sought by the veteran at facilities of the
Department and with non-Department facilities and providers
through which the Secretary furnishes care and services under
section 1703 of such title;
(D) to compare average driving times between their
residence and the nearest facility of the Department that
provides the care they are seeking and between their
residence and the closest non-Department provider that
provides the care they are seeking and through which the
Secretary furnishes care and services under section 1703 of
such title; and
(E) to view a provider directory, information regarding
pending medical claims, and explanations of benefits; and
(2) to implement such other matters as determined
appropriate by the Secretary.
(b) Submittal of Plan.--
(1) Initial plan.--Not later than 180 days after the date
of the enactment of this Act, the Secretary shall submit to
the Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of
Representatives the plan developed under subsection (a).
(2) Biannual update.--Not less frequently than once every
180 days during the two-year period beginning on the
submittal of the plan under paragraph (1), the Secretary
shall brief the Committee on Veterans' Affairs of the Senate
and the Committee on Veterans' Affairs of the House of
Representatives on any updates on the implementation of such
plan.
SEC. 674. MODIFICATION OF REQUIREMENTS FOR CENTER FOR
INNOVATION FOR CARE AND PAYMENT OF THE
DEPARTMENT OF VETERANS AFFAIRS AND TRANSFER OF
AUTHORITY.
(a) In General.--Chapter 3 of title 38, United States Code,
is amended by adding at the end the following new section:
``Sec. 326. Center for Innovation
``(a) Establishment.--There is established in the
Department, within the Office of the Secretary, a Center for
Innovation (in this section referred to as the `Center').
``(b) Purpose.--The purpose of the Center is to test
innovative payment and service delivery models to reduce
program expenditures of the Department under chapter 17 of
this title while preserving or enhancing the quality of care
furnished to veterans and other eligible individuals.
``(c) Identification and Testing of Models.--
``(1) In general.--The Center shall--
``(A) identify and test health care payment and service
delivery models under this title, including care from non-
Department providers under subchapter I of chapter 17 of this
title, that have the potential to--
``(i) reduce program expenditures; and
``(ii) preserve or enhance the quality of care furnished to
veterans;
``(B) give preference to models that improve the
coordination, quality, and efficiency of health care services
furnished under this title; and
``(C) evaluate the effect of applying such models on
program expenditures and quality outcomes under this title.
``(2) Included models.--The models identified and tested
under paragraph (1) may include the following:
``(A) Bundled payment arrangements.
``(B) Preventive care initiatives.
``(C) Chronic care coordination models.
``(d) Selection of Models.--
``(1) In general.--The Secretary, acting through the
Center, shall select models to be tested under subsection (c)
from among those that--
``(A) address a defined population for which there are
demonstrated deficits in care leading to poor clinical
outcomes or potentially avoidable expenditures; and
``(B) are expected to reduce program costs while preserving
or enhancing the quality of care furnished to veterans.
``(2) Criteria.--In selecting models under paragraph (1),
the Secretary shall apply criteria consistent with the model
selection framework used in evidence-based criteria that the
Secretary determines appropriate.
``(e) Testing and Evaluation.--
``(1) In general.--The Secretary shall design and test each
model under this section in a manner that allows for the
evaluation of--
``(A) changes in program expenditures;
``(B) changes in quality and outcomes of care for veterans;
and
``(C) other factors the Secretary determines relevant to
care coordination, access, and equity.
``(2) Evaluation.--The Secretary shall evaluate each model
under this section using scientifically valid methodologies,
including control or comparison groups if practicable.
``(f) Reporting.--
``(1) Annual report.--Not less frequently than annually,
the Secretary shall submit to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans' Affairs
of the House of Representatives a report on models being
tested under this section and their preliminary results,
including--
``(A) a brief narrative description of the model explaining
its intent and the proposed manner in which it is supposed to
reduce expenditures and increase quality of or access to care
for veterans;
``(B) the number of veterans and providers participating in
the model, broken down by demographics such as age, race or
ethnicity, geographic location, and other characteristics as
chosen by the Secretary;
``(C) gross and net savings or increases to the medical
services account of the Department, including in comparison
to baseline budgetary assumptions in the absence of the
model;
``(D) an assessment of the utilization of the model,
including the proportion of providers choosing to participate
in the model and the proportion of veterans choosing to
participate in the model, as the case may be;
``(E) an assessment of quality of care and patient outcomes
as measured by discrete objective metrics, including changes
to morbidity and mortality, changes to admission rates,
changes to readmission rates, changes to population health
metrics such as average blood pressure, A1C levels, body mass
index, or other relevant health metrics, or other relevant
clinical outcome metrics;
``(F) a description of provider, stakeholder, and veteran
experiences; and
``(G) such other matters as the Secretary may consider
relevant.
``(2) Final report on models.--Not later than 180 days
after completing each model under this section, the Secretary
shall submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a final report on such model, including--
``(A) findings from the evaluation of such model;
``(B) updated findings under paragraph (1) with respect to
such model;
``(C) an assessment of the fiscal impact of such model; and
``(D) recommendations for expansion or termination of the
use of such model.
``(g) Expansion of Successful Models.--
``(1) In general.--Except as provided in paragraph (2), the
Secretary may, through rulemaking, expand the duration and
scope of a model tested under this section to the extent
that--
``(A) the Secretary determines such expansion is expected
to--
``(i) reduce program expenditures without reducing quality
of care; or
``(ii) improve quality of care without increasing program
expenditures; and
``(B) the Chief Financial Officer of the Department
certifies that such expansion will maintain budget
neutrality.
``(2) Limitation.--The Secretary shall not expand a model
unless the results of the evaluation of the model under
subsection (e) demonstrate that the requirements of paragraph
(1) are satisfied.
``(h) Cost Neutrality and Funding.--
``(1) In general.--Implementation or expansion of any model
under this section shall be conducted in a manner that is
cost-neutral to the Department over the duration of the use
of the model, including administrative costs.
``(2) Use of available amounts.--The Secretary shall ensure
that expenditures under this section are made from amounts
otherwise available to the Department for medical services,
community care, or medical support and compliance.
``(i) Rule of Construction.--Nothing in this section shall
be construed to authorize the Secretary to reduce the scope
or amount of benefits under this title, or to impose
additional eligibility requirements, except as may be
necessary to carry out an approved model under this
section.''.
(b) Conforming and Clerical Amendments.--
(1) Conforming repeal.--Section 1703E of title 38, United
States Code, is repealed.
(2) Conforming amendments.--
(A) Pilot program to improve administration of care under
veterans community care program.--Section 105(a) of the
Senator Elizabeth Dole 21st Century Veterans Healthcare and
Benefits Improvement Act (Public Law 118-210; 38 U.S.C. 1703
note) is amended, in the matter preceding paragraph (1), by
striking ``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'' and
inserting ``Pursuant to section 326 of title 38, United
States Code, the Secretary of Veterans Affairs, acting
through the Center for Innovation''.
(B) Pilot program on consolidating approval process of
department of veterans affairs for covered dental care.--
Section 106(a) of the Senator Elizabeth Dole 21st Century
Veterans Healthcare and Benefits Improvement Act (Public Law
118-210; 38 U.S.C. 1703 note) is amended, in the matter
preceding paragraph (1), by striking ``the Center for
Innovation for Care and Payment established under section
1703E of title 38, United States Code'' and inserting ``the
Center for Innovation established under section 326 of title
38, United States Code''.
[[Page H4605]]
(C) Strategic plan on value-based health care system for
veterans health administration; pilot program.--Section 107
of the Senator Elizabeth Dole 21st Century Veterans
Healthcare and Benefits Improvement Act (Public Law 118-210;
38 U.S.C. 1701 note) is amended--
(i) in subsection (a)(2)(A)(viii), by striking ``the Center
for Innovation for Care and Payment of the Department under
section 1703E of title 38, United States Code'' and inserting
``the Center for Innovation under section 326 of title 38,
United States Code''; and
(ii) in subsection (c)(1), by striking ``the Center for
Innovation for Care and Payment established under section
1703E of title 38, United States Code'' and inserting ``the
Center for Innovation under section 326 of title 38, United
States Code''.
(3) Clerical amendments.--
(A) Chapter 17.--The table of sections at the beginning of
chapter 17 of title 38, United States Code, is amended by
striking the item relating to section 1703E.
(B) Chapter 3.--The table of sections at the beginning of
chapter 3 of such title is amended by adding at the end the
following new item:
``326. Center for Innovation.''.
(c) Comptroller General Report.--Not later than 18 months
after the date of the enactment of this Act, the Comptroller
General of the United States shall submit to Congress a
report--
(1) on the efforts of the Center for Innovation of the
Department of Veterans Affairs in fulfilling the objectives
and requirements under section 326 of title 38, United States
Code, as added by subsection (a); and
(2) containing such recommendations as the Comptroller
General considers appropriate.
(d) Review of Veterans Community Care Program.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, the Secretary of Veterans Affairs,
acting through the Office of Management of the Department of
Veterans Affairs, shall conduct a review of all aspects of
the Veterans Community Care Program.
(2) Elements.--The review required by paragraph (1) shall--
(A) identify proven management and payment best practices
of the Federal Government used under the Medicare program
under title XVIII of the Social Security Act (42 U.S.C. 1395
et seq.), the Medicaid program under title XIX of such Act
(42 U.S.C. 1396 et seq.), and the TRICARE program (as defined
in section 1072 of title 10, United States Code);
(B) determine what best practices, if any, identified under
subparagraph (A) should be adopted and implemented by the
Secretary, including those practices that would require
legislative action before adoption and implementation;
(C) determine how the Secretary can improve access to care
through the Veterans Community Care Program for veterans
eligible for such care;
(D) identify solutions to ease administrative, legislative,
and regulatory burdens and improve efficiency in the Veterans
Community Care Program;
(E) identify improvements to the Veterans Community Care
Program that can enhance the experience of veterans and
participating entities and providers furnishing hospital
care, medical services, and extended care services under the
Veterans Community Care Program;
(F) review how the Secretary--
(i) identifies eligibility for and reviews, processes, and
approves referrals for care under the Veterans Community Care
Program;
(ii) authorizes the furnishing of services under the
Veterans Community Care Program; and
(iii) receives, reviews, processes, and approves requests
for payment from participating entities and providers
furnishing services under the Veterans Community Care
Program.
(G) assess such other factors as determined appropriate by
the Secretary in consultation with Congress.
(3) Briefing and report.--
(A) Briefing.--Periodically throughout the duration of the
review required under paragraph (1), but not less frequently
than quarterly, the Secretary shall brief the Committee on
Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives on the
status and preliminary findings of such review.
(B) Report.--Not later than 30 days after the conclusion of
the review required under paragraph (1), the Secretary shall
submit to the Committee on Veterans' Affairs of the Senate
and the Committee on Veterans' Affairs of the House of
Representatives a written report containing--
(i) a complete and unredacted list of all findings and
recommendations from the review; and
(ii) any legislative, administrative, regulatory, policy,
or other changes sought by the Secretary as a result of such
findings.
(4) Veterans community care program defined.--In this
subsection, the term ``Veterans Community Care Program''
means the Veterans Community Care Program under section 1703
of title 38, United States Code.
(e) Pilot Programs.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall commence carrying out the pilot programs described in
paragraph (2) through the Center for Innovation established
by section 326 of title 38, United States Code, as added by
subsection (a), and the Office of Management of the
Department of Veterans Affairs.
(2) Pilot programs described.--The Secretary shall carry
out the following pilot programs:
(A) A pilot program to test innovative payment models for
the furnishing of preventive health services, as such term is
defined in section 1701 of title 38, United States Code.
(B) A pilot program to test innovative payment models
involving payment bundling for integrated care during an
episode of care authorized under the Veterans Community Care
Program under section 1703 of title 38, United States Code,
to improve the coordination, quality, and efficiency of
health care delivery under such program.
(f) Modification of Independent Assessments of Health Care
Delivery Systems and Management Processes.--Section 1704A of
title 38, United States Code, is amended--
(1) in subsection (a)(2)(I), by adding at the end the
following new clause:
``(vi) To identify proven management and payment best
practices of the Federal Government used under the Medicare
program under title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.), the Medicaid program under title XIX of
such Act (42 U.S.C. 1396 et seq.), and the TRICARE program
(as defined in section 1072 of title 10).''; and
(2) in subsection (d), by inserting ``or federally funded
research and development center'' after ``private entity''.
SEC. 675. REPORT ON IMPROVEMENTS TO CLINICAL APPEALS PROCESS.
(a) In General.--Not later than two years after the date of
the enactment of this Act, the Secretary of Veterans Affairs,
in consultation with veterans service organizations,
veterans, caregivers of veterans, employees of the Department
of Veterans Affairs, and other stakeholders as determined by
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 containing
recommendations for legislative or administrative action to
improve the clinical appeals process of the Department with
respect to timeliness, transparency, objectivity,
consistency, and fairness.
(b) Inapplicability of Requirements Relating to Federal
Advisory Committees.--Chapter 10 of title 5, United States
Code, shall not apply to the consultation required by
subsection (a).
(c) Veterans Service Organization Defined.--In this
section, the term ``veterans service organization'' means any
organization recognized by the Secretary under section 5902
of title 38, United States Code.
SEC. 676. PLAN ON INCREASING ACCESSIBILITY OF CARE FOR
VETERANS WITH SPINAL CORD INJURY OR DISORDER.
(a) In General.--Not later than one year after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a plan on improving disability-related access
to care from facilities of the Department and from non-
Department facilities and providers through which the
Secretary furnishes care and services under section 1703 of
title 38, United States Code, for veterans with spinal cord
injury or disorder.
(b) Consultation.--In developing the plan required under
subsection (a), the Secretary shall consult with relevant
stakeholders, including veterans service organizations who
serve veterans with spinal cord injury or disorder.
(c) Elements.--The plan required under subsection (a) shall
include an assessment of disability-related barriers to care
at medical facilities of the Department of Veterans Affairs
and through community care networks of non-Department
providers for veterans with spinal cord injury or disorder
and a description of the actions needed to overcome such
barriers, including cost estimates, timelines for corrective
action, and requests for legislative action, if any.
(d) Veterans Service Organization Defined.--In this
section, the term ``veterans service organization'' means any
organization recognized by the Secretary under section 5902
of title 38, United States Code.
The SPEAKER pro tempore. The bill, as amended, shall be debatable for
1 hour, equally divided and controlled by the chair and ranking
minority member of the Committee on Veterans' Affairs, or their
respective designees.
The gentleman from Illinois (Mr. Bost) and the gentleman from
California (Mr. Takano) each will control 30 minutes.
The Chair recognizes the gentleman from Illinois.
General Leave
Mr. BOST. Mr. Speaker, I ask unanimous consent that all Members have
5 legislative days in which to revise and extend their remarks and
insert extraneous material into the Record on H.R. 9237.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Illinois?
There was no objection.
Mr. BOST. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I rise today in strong support of my bill, H.R. 9237,
the Take Care of America's Veterans Act.
[[Page H4606]]
As a veteran of the United States Marine Corps, for me, this bill is
personal. When a young man or woman raises their right hand and agrees
to serve this country, America makes a promise. That promise does not
end when a servicemember is wounded. It is my goal--and the goal of my
friend, Senator Jerry Moran--to deliver on that promise.
This bill would be one of the most comprehensive veteran packages
considered by Congress in a decade. This bill includes more than 60
bipartisan provisions that would improve healthcare, benefits,
operations, and accountability across the VA.
Mr. Speaker, I would like to tell you more about some of those
important provisions. One is the Major Richard Star Act. For decades,
medically retired, combat-injured veterans have had their military
retirement offset dollar-for-dollar by their VA disability. While some
disabled veterans who served 20 years receive both, there are tens of
thousands of combat-injured veterans who currently do not. Many combat-
injured veterans would have served longer if their injuries had not
taken that opportunity from them.
H.R. 9237 would help end that injustice. It would end that offset for
combat-injured veterans, allowing them to receive both benefits up to
what a 20-year retiree with the same disabilities would receive.
Members on both sides of the aisle and veterans service organizations
support this and have for years. A press release, a handshake, or a
discharge petition does not end the wounded warrior tax. This bill
will.
The Love Lives On Act is another important provision included in this
bill. Currently, surviving spouses lose their benefits if they remarry
before age 55, but those benefits were earned by their spouse's
sacrifice for this country. The Love Lives On Act would allow surviving
spouses to remarry at any age.
Another important provision in this bill is the Sharri Briley and
Eric Edmundson Veterans Benefits Expansion Act. This bill would provide
long-awaited increases to catastrophically disabled veterans and
surviving spouses.
Eric was 25 years old when an IED left him with a fractured spine and
a traumatic brain injury. H.R. 9237 would increase benefits for
catastrophically disabled veterans like Eric by $10,000 a year.
It would also increase benefits for surviving spouses. These American
families have not seen a meaningful increase in decades.
Mr. Speaker, this bill also includes the Veterans' ACCESS Act.
Veterans should be able to access healthcare in their own communities.
Too many veterans still face delays, confusion, and barriers when
trying to use VA community care.
This bill would also improve mental health care and community-based
suicide prevention. A veteran's healthcare should be driven by the
veteran's needs, not by government control.
H.R. 9237 would improve education benefits and vocational training to
help veterans transition into civilian life. It would modernize the
VA's claims and appeals process so veterans have a system that works
for them. It would streamline the way VA handles construction, leasing,
contracting, IT, and finances.
The Take Care of America's Veterans Act would expand benefits and
push VA to do better.
Mr. Speaker, I also want to address how this bill is funded, as I
have heard a lot of misinformation about this point. H.R. 9237 would
codify VA's own pending regulation on how to evaluate sleep apnea and
tinnitus' effect on a veteran's workplace earnings. This regulation was
proposed by the Biden-era VA in 2022, created by VA's team of doctors
and researchers. It was part of VA's efforts to modernize its
disability rating schedule created in the 1940s.
President Biden's Under Secretary for Benefits, Josh Jacobs,
testified in favor of these changes at his confirmation hearing.
Earlier this year, VA's executive director of compensation confirmed
plans to finalize these changes this year. These are not new ideas, and
there is nothing unprecedented about this. This bill would not
eliminate disability ratings for sleep apnea or tinnitus. It would not
automatically reduce any veteran's current disability rating. Future
veterans with sleep apnea will still get treatment through VA
healthcare, but if a CPAP eliminates your symptoms, VA would compensate
you less.
Currently, the amount of compensation for sleep apnea is often more
than the amount that a veteran receives if they lose a limb.
This change is just common sense. It is why VA has worked hard to
propose changes like these, which reflect modern medicine. For
tinnitus, VA has found it is best understood as a symptom of another
condition such as hearing loss or TBI.
Under the proposed change, tinnitus would still be rated as part of
another underlying condition. This is not about denying these
conditions exist. Let's be clear. This is not cutting benefits. No one
will lose their benefits who are receiving them.
{time} 0920
It is about making sure the VA rating schedule follows modern science
and using those savings to fund the expansion of benefits and other VA
programs.
Mr. Speaker, if we don't pass H.R. 9237 today, VA can make these
rating changes as planned but the savings would go back to one place:
Big Government. I want those savings to go instead into the pockets and
the benefits for millions of veterans and their families.
Mr. Speaker, as a United States Marine Corps veteran, you can bet
your bottom dollar that I believe that this bill would not harm a
single veteran, and I would not bring it forward to this floor if I
thought it would. Veterans do not need a bill that makes Members feel
good for a day and then dies in the Senate. They need legislation that
can pass.
Mr. Speaker, veterans groups agree. I include in the Record a letter
from 20 different veterans organizations in support of this
legislation.
Richard Star Act would be funded through the defense
authorizing committees and fu11y end the unjust wounded
veteran tax on combat-injured warriors. Pay-as-you-go rules
would be waived for these earned benefits. There would be
complete clarity from the Administration and VA about whether
long-anticipated VASRD changes will proceed independently of
this bill. Unfortunately, the current environment is far from
ideal, and veterans, families, survivors, and caregivers have
already waited years across multiple Congresses and
administrations for action on provisions that maintain strong
bipartisan support.
The Administration must also provide immediate clarity on
whether these rating-schedule changes are intended to proceed
independently of the Take Care of America's Veterans Act
through VA regulation, White House direction, or other
administrative action. That clarity is essential because the
bill's financing rests on assumptions that remain unresolved.
If similar VASRD changes are implemented outside this
legislation, the resulting savings could revert to the
Treasury rather than be reinvested in veterans, families,
survivors, and caregivers.
Given that reality, we believe the practical question
before Congress is whether this process should continue so
these resources can be reinvested in veterans, caregivers,
families, and survivors, or whether the opportunity to enact
this package is lost while unresolved funding questions
remain. We support advancing the Take Care of America's
Veterans Act because the bill represents a net expansion of
benefits and support for the veteran community and contains
protections intended to prevent reductions for current
beneficiaries. The goodness and positive impact of this
package should not be lost in the debate over its financing.
As Congress continues its consideration of this
legislation, we urge Members to preserve and strengthen key
protections: no retroactive harm to veterans currently
receiving compensation; prospective application only to
future claims or future requests for increased ratings; full
transparency from VA, the White House, and the Administration
regarding any independent regulatory or policy action; and a
final package that ensures expanded benefits are delivered
responsibly and effectively. We are committed to working with
Congress, VA, the Administration, coalition partners, and the
broader veteran community to improve the pay-for, identify
any credible alternative path forward, and secure the
strongest possible outcome.
This moment presents a clear test of whether Congress can
translate long-standing bipartisan agreement into meaningful
action. We support the Take Care of America's Veterans Act so
the process can continue and so Congress can deliver lasting
results for veterans, their families, caregivers, and
survivors. We urge swift action to advance this legislation
and stand ready to work with lawmakers in both chambers to
honor our commitments to all who have served.
Sincerely,
The American Legion, Military Officers Association of
America (MOAA), Wounded
[[Page H4607]]
Warrior Project, Elizabeth Dole Foundation, Tragedy
Assistance Program for Survivors (TAPS), American Veterans
(AMVETS), Air Force Sergeants Association, American
Optometric Association, Avalon Action Alliance, Commissioned
Officers Association of the USPHS (COA).
Gold Star Spouses of America, K9s For Warriors, Korean War
Veterans Association, Military Chaplains Association,
Military Order of the Purple Heart (MOPH), Mission Roll Call,
National Defense Committee, National Military Family
Association (NMFA), USCG Chief Petty Officers Association
(CPOA), Vietnam Veterans of America.
Mr. BOST. Mr. Speaker, veterans groups from The American Legion to
the Wounded Warrior Project support this bill. Survivor groups like the
Tragedy Assistance Program for Survivors support this bill. Caregiver
organizations, like the Elizabeth Dole Foundation, support this bill.
They all want this bill to pass.
Chairman Moran and I have worked for months to try to enact a law
that will help the greatest number of veterans. I believe we have
offered that kind of package today.
I want to take a moment to share what we have heard directly from
veterans. Mission Roll Call, a national nonpartisan organization
dedicated to serving veterans and their families, recently conducted a
survey on my bill. They found 71 percent of veterans support the bill.
I think that is a clear choice.
Mr. Speaker, as our Nation observes its 250th birthday, H.R. 9237
asks a simple question: Do we have veterans' backs? Do we have the
backs of fellow Americans who raise their right hand to serve in
defense of this great country, the Gold Star families who carry the
cost of their loved one's sacrifice, or caregivers who every single day
care for a disabled veteran family member? For me, the answer will
always be ``yes,'' both during service and after.
Mr. Speaker, I urge all my colleagues to support the Take Care of
America's Veterans Act, and I reserve the balance of my time.
Mr. TAKANO. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I rise today in strong opposition to H.R. 9237. It is a
beautiful day here in Washington, D.C., but Republicans are casting a
dark cloud over all of us and especially over America's veterans.
We have before us today a bill that, despite its name, does the exact
opposite of taking care of veterans. It enshrines into law the largest
cut to veterans' benefits ever in the history of this Nation.
The premise of this bill is that some veterans must be made worse off
in order to make others better off. Mr. Speaker, I reject that premise,
I reject this bill, and I encourage others to do the same.
Here is the core issue: The majority treats veterans as a zero-sum
game: cut disability pay for some to find benefits for others. That is
not governing. That is rationing suffering among our Nation's heroes.
With this bill, the majority would, for the first time ever, have
Congress interfere in the scientific process that the determines
veterans' disability ratings, overriding the expertise of medical
professionals at the Department of Veterans Affairs. I respect that
Chairman Bost is a military veteran, but he is not a medical
professional.
The majority, for the first time ever, would have us cut tens of
billions of dollars from veteran disability compensation to pay for the
Department of Defense obligations. This is absolutely unconscionable.
Consider the math. Republicans are discussing nearly $70 billion in
new Pentagon spending without offsets. They vote enthusiastically for
$1.5 trillion in annual defense budgets. Yet, they insist on paying for
veterans' priorities by cutting benefits with the two most common
service-connected conditions. Apparently, there is no problem sending
veterans the bill for the wars that Congress funds.
This is a massive 600-page bill--crafted behind closed doors and
brought to the floor without careful consideration--packed with harmful
provisions designed to boost a few vulnerable Members' electoral
prospects.
Mr. Speaker, for those reasons and many, many more, I cannot in good
conscience support this legislation.
More important than my opposition is the opposition of the very
people whom the majority claims to help, the veterans themselves. Over
30 Veteran Service Organizations and advocates oppose this legislation,
including many of the largest, like the Veterans of Foreign Wars,
Disabled American Veterans, Iraq and Afghanistan Veterans of America,
and numerous others. They know that reaching into the pockets of one
set of veterans to provide for another is morally wrong. Creating tiers
of veterans based on their period of service and treating tomorrow's
veterans worse than today's is morally wrong. They will not stand for
it, and neither should we.
In addition to the numerous VSOs and over two dozen labor unions
opposed to this bill, including the Union of Veterans Council, American
Federation of Government Employees, and AFL-CIO, so do professional
associations like the American Psychological Association and the Nurses
Organization of VA. They all recognize the devastating effect this
legislation will have on VA's workforce and their ability to deliver
high-quality care.
Even the Mortgage Bankers Association has expressed opposition to
this bill. The majority has decided that, during a housing
affordability crisis, it makes sense to raise costs on struggling
veteran homeowners who are desperately trying to avoid foreclosure.
This package contains multiple harmful provisions. It would
accelerate the privatization of veteran healthcare--creating new grant
programs for private providers that divert resources from VA mental
health and PTSD programs--and steer veterans into more expensive
community-based care, even where VA services remain available, and
strip VA psychologists of their collective bargaining rights.
This bill also contains numerous sections opposed by key
stakeholders, like Student Veterans of America, Veterans Education
Success, and the American Federation of Teachers, that would direct GI
Bill funding toward low-quality, for-profit, unaccredited online
programs.
This bill contains provisions that would allow GI benefits to be used
for online welding courses. Can you believe it? Explain to me how you
can teach someone online how to weld.
Inexplicably, H.R. 9237 even includes a $500 million IT slush fund
that VA will use to enrich contractors and reward the President's
cronies. The list goes on and on.
We are going to hear arguments from the majority today about all the
good things this bill attempts to do. If we exist in a vacuum, I would
say that I agree. There are parts of this bill with broad bipartisan
support: long overdue increases to dependency and indemnity
compensation and a special monthly compensation, for example.
We do not exist in isolation here, and we must take the bill as the
total sum of its parts, especially since the majority has blocked
amendments to this bill, as they have done so often in this Congress.
{time} 0930
Regrettably, we will also hear the chairman say that cutting
veterans' benefits is the only way that we can get them done. This is
patently false, and the chairman knows it. Everyone in this Chamber
knows it, and everyone in America knows it, as well. There are any
number of other places we can find money for these priorities.
We don't lack money around here. What is in short supply, at least on
the other side of the aisle, is the political will to use some of it on
behalf of America's veterans. There is $1.5 trillion for the Department
of Defense, $70 billion for the Department of Homeland Security, and
hundreds of millions of dollars for permanent tax cuts for the wealthy,
none of it offset, and all of which the chairman voted for
enthusiastically.
Just 10 days of President Trump's folly in Iran would pay for 10
years of benefits under the Major Richard Star Act.
Let me say that again. Just 10 days of President Trump's folly in
Iran would pay for 10 years of benefits under the Major Richard Star
Act.
The question we have before us today is this: Why do you insist on
offsets now? Why only now when we are trying to do work on behalf of
our Nation's veterans do you care about the deficit? Why are
Republicans holding veterans' priorities hostage, including the
overwhelming top priority of veterans, the Major Richard Star Act, in
exchange
[[Page H4608]]
for multibillion-dollar cuts to veterans' benefits?
That is a mystery to me, and it is a question that Chairman Bost and
Republicans will struggle to answer, as well.
I will point to this chart here.
Mr. Speaker, let me finish with a quote from just one veteran in
opposition to this legislation: ``I am a disabled Michigan veteran and
lifelong conservative. Please pass the Major Richard Star Act as a
stand-alone bill. We do not support the Take Care of America's Veterans
Act, H.R. 9237, and we will never elect Representatives who want to cut
veterans' benefits. How could Republicans propose this.''
I couldn't have said it any better, and there are thousands more
comments just like this as you can see here.
Mr. Speaker, I reserve the balance of my time.
The SPEAKER pro tempore. Members are reminded to direct their remarks
to the Chair.
Mr. BOST. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, the ranking member knows VA has an obligation to update
disability conditions based on the latest science and medicine. In his
opening, he said that I am not a doctor. He is right. I am a marine. I
am a truck driver, and somehow I have been blessed to serve our
veterans as the chairman of the committee. He is not a doctor either.
Likewise, he has been blessed by his community to be here, but what I
do want to say is, for the record, the proposed changes for sleep apnea
and tinnitus aren't developed by Congress.
They were developed by VA physicians. They are doctors--medical
experts, doctors--and researchers under the Biden administration as
part of the ongoing disability rating modernization efforts.
In testimony before the House Veterans' Affairs Committee in January
2026, VA officials stated that the Department intended to continue
moving forward with respiratory ear-body system, rulemaking, and
anticipated completing those efforts by the end of year 2026. That
testimony was not given by career staff acting alone.
In fact, just this morning, VA officials confirmed that they are
planning to move forward with the proposed rule on sleep apnea and
tinnitus.
The testimony represents the official position of the Department at
the time it was delivered to Congress. The question before us is not
whether Congress created these proposed changes. We did not. VA's
announcement makes their intention clear. This is moving forward
regardless, but Ranking Member Takano would rather play politics.
The question is whether the savings associated with the proposed
deployment and changes by the VA should remain in their control and the
bureaucrats' control, or do we make it through our Article I power to
reinvest into our veterans and their families. H.R. 9237 chooses
veterans.
Mr. Speaker, I ask you to look at the testimony of Josh Jacobs, Biden
Under Secretary for Benefits, and Nina Tann, President Trump's
Executive Director of the Compensation Service at the Department of
Veterans Affairs.
Mr. Speaker, I yield 3 minutes to the gentleman from Ohio (Mr.
Taylor), a good friend.
Mr. TAYLOR. Mr. Speaker, I thank Chairman Bost for yielding me the
time.
Mr. Speaker, I rise today in support of the Take Care of America's
Veterans Act. America's veterans represent the best our country has to
offer, and it is time for Congress to deliver meaningful reforms to our
veterans' benefit programs that improve the quality of life for
America's warfighters.
That is why I am proud to be an original cosponsor of the Take Care
of America's Veterans Act, which will modernize and enhance the
delivery of VA benefits for veterans across our country.
As we continue to celebrate America's 250th anniversary, it is
important that we realize that freedom is not free, and we wouldn't
have this amazing country without the sacrifices of countless
servicemembers and their families.
Now is the time to reaffirm Congress' support of our veteran
community and put veterans first by passing this legislation.
I am particularly proud that this legislation includes the expansion
of GI Bill benefits, increases benefits for severely disabled veterans
and their families, and ends the wounded veterans tax, thanks to the
inclusion of the Major Richard Star Act.
These reforms are long overdue, and I applaud Chairman Bost and the
work of the House Veterans' Affairs Committee for their role in
crafting this legislation.
This bill upholds the promise we made to our Nation's veterans that
upon completion of their service, we would take care of them and their
families.
It is our duty as temporary caretakers of our Republic to fight for
those who keep us safe, and veterans are at the top of that list.
Mr. Speaker, on behalf of southern Ohio, I thank all our veterans and
their families for the countless sacrifices they have made to keep our
Nation safe. This vote is for them.
Mr. Speaker, I urge all my colleagues to support this bill.
Mr. TAKANO. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, the chairman has said several times that the disability
changes this bill makes are coming anyway. That is simply not true. He
is counting on a golden egg that the VA has simply not laid yet.
The first Trump administration floated changes to conditions like
sleep apnea and tinnitus beginning in 2019. Then 4 years ago, when VA
sought public comment on a notice of proposed rulemaking, the 2022
changes during the Biden administration, VSOs and many Members of this
body spoke loudly and clearly and unanimously in opposition to them,
and what he doesn't mention is that the Biden administration walked
away from those proposed rule changes.
The VA listened to those voices in 2022, and as a result, the
proposed rule has been on a shelf since then. Just a few short weeks
ago, VA clarified that it is not planning to take any action on this
proposed rule. That was from a VA spokesperson in public. There is
nothing inevitable about these rule changes, which are going to bring
about the golden egg of savings, the $57 billion that the chairman is
counting on in order to pay for this bill. The savings will come from
cuts to veterans disability benefits. Their tweet that he is referring
to this morning quoting an unnamed source is not the same as
rulemaking.
This is simply the majority trying to find any excuse possible to cut
benefits they view as overly generous, which has long been their goal.
That is why Americans for Prosperity has endorsed this bill.
The architects of Project 2025 have been desperate to cut benefits
for years, and they have been trying to find a way to touch veterans
benefits. I am not going to let them do that. They even showed up at
the majority's press conference to cheer on their efforts just a few
short days ago, and now they finally have a majority who is willing to
bow to their demands to harm veterans.
{time} 0940
My majority counterparts have picked an interesting time to care
about science again. Their remarks today attempt to demonstrate that
they are working to align themselves with the best science to update
and modernize the disability ratings schedule.
Yet, my majority colleagues fail to see the irony in legislating away
veteran benefits before VA completes a thorough review of the best
science. They are substituting their own judgment for that of VA
clinicians and researchers who actually understand the medical evidence
related to these disabilities.
If this bill is passed, the expertise of VA and the years of work
that go into clinical determinations become moot.
If you don't believe me, just listen to what one of VA's top doctors,
former VA Secretary and Under Secretary for Health David Shulkin,
stated regarding this bill's proposed changes to disability ratings:
``Any modernization of the VA Schedule for Rating Disabilities should
be instead conducted through an independent, evidence-based medical
review led by the Department of Veterans Affairs, with opportunities
for public comment and
[[Page H4609]]
congressional oversight. Any savings resulting from that process should
be reinvested in improving disability evaluations, rehabilitation
services, and veterans' healthcare--not used to finance unrelated
provisions of the legislation.''
If my colleagues are suddenly interested in following that science,
they should let the experts continue their work independently without
the political pressure that passage of this bill will inevitably
create.
Mr. Speaker, I yield 2 minutes to the gentlewoman from Illinois (Ms.
Underwood), my good friend. She is a former member of this committee
who currently serves on the House Committee on Appropriations.
Ms. UNDERWOOD. Mr. Speaker, I rise today in support of my bill, the
Lactation Spaces for Veteran Moms Act.
Serving veterans is one of the greatest privileges we have as Members
of Congress, and we must do everything that we can to ensure not only
that they receive the benefits that they have earned through their
service and sacrifice, but also that they can access those benefits
with the dignity that they deserve.
That is why I am so proud to lead the bipartisan Lactation Spaces for
Veteran Moms Act with Congresswoman Ashley Hinson.
As a nurse, I have seen firsthand the benefits of breastfeeding for
moms and babies. My bill will ensure that every VA medical center
contains a clean, private space specifically designed for nursing and
pumping.
Our veterans and their families have given so much in service to our
country, and they deserve the same level of support and respect when
they seek care.
For VA medical centers to meet the needs of young families,
caregivers, and our hardworking VA employees, they need to be equipped
with proper facilities.
In the VA medical centers that lack a dedicated lactation space, moms
are forced to use unsanitary places like bathrooms or struggle to find
a private corner. That is unacceptable. Our veterans deserve better.
That is why we must pass the Lactation Spaces for Veteran Moms Act
now.
Mr. BOST. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I don't think that the ranking member is caught up on
current events. Just recently, just to confirm what we already knew,
the VA officials confirmed that they are moving ahead with the changes
on tinnitus, sleep apnea, and disability benefits.
VA has made no move to withdraw the sleep apnea and/or those from the
changes that will then save the money that then the bureaucrats will
control.
So as we are moving forward--I mean, the ranking member can keep
saying things that aren't true, or he can admit this is an issue, and
that is where we are coming up with the revenue.
That being said, let me tell you the next person I want to yield time
to has worked on the Major Richard Star Act for years, as did his
father before him.
With that, Mr. Speaker, I yield 2 minutes to the gentleman from
Florida (Mr. Bilirakis), the Representative from Florida's 12th
District.
Mr. BILIRAKIS. Mr. Speaker, I thank the chairman for his leadership
and thank him for this great package that will support our veterans.
Mr. Speaker, I rise today in strong support of the Take Care of
America's Veterans Act.
First and foremost, this legislation delivers long-overdue justice by
including key provisions of my Major Richard Star Act. I promised
Richard Star that we would get this done, and we are in the process of
doing it, again, on behalf of our true American heroes, which I remain
committed to achieving full concurrent receipt. Anything that is not
included in this bill, we are going to pursue for the benefit of our
veterans.
This package takes a major step forward by providing immediate relief
to nearly 60,000 combat-injured veterans, Mr. Speaker. For far too
long, medically retired servicemembers wounded in combat have been
forced to forfeit a portion of the retirement pay they earned simply
because they also receive VA disability compensation, and that is
wrong. That is the so-called wounded veteran tax, and it is
fundamentally unjust.
These men and women sacrificed their health in defense of our Nation.
They earned both benefits, and they deserve to receive both.
This legislation also strengthens veterans' access to healthcare by
expanding choice, improves the VA claims and appeals process, and
increases support for catastrophically disabled veterans, caregivers,
and surviving spouses.
Republicans have been working on these issues for many years, Mr.
Speaker, and it looks like it is going to come to fruition. I
appreciate it so very much, and I thank the chairman for his
leadership.
It enhances mental health services, expands care in rural
communities, improves transition assistance for servicemembers entering
civilian life, and modernizes VA facilities to better serve future
generations.
The SPEAKER pro tempore. The time of the gentleman has expired.
Mr. BOST. Mr. Speaker, I yield an additional 1 minute to the
gentleman from Florida.
Mr. BILIRAKIS. Most importantly, this bill honors the legacy of Major
Richard Star, who fought tirelessly to correct this injustice before
his passing. His determination has brought us to this moment, and
today, we have the opportunity to continue that fight on behalf of
thousands of deserving veterans.
Mr. TAKANO. Mr. Speaker, I include in the Record a coalition letter
from 10 veterans service organizations; a resolution from The American
Legion Department of Texas; a statement from The American Legion,
Trujillo-Sheets Post 28, in Durango, Colorado; and emails from
Minnesota Blue Earth Post 89 of The American Legion and American Legion
Post 58 in Belleville, Illinois, all in opposition to this bill.
June 24, 2026.
Hon. Jerry Moran,
Chairman, Committee on Veterans' Affairs,
U.S. Senate, Washington, DC.
Hon. Richard Blumenthal,
Ranking Member, Committee on Veterans' Affairs, U.S. Senate,
Washington, DC.
Hon. Mike Bost,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
Hon. Mark Takano,
Ranking Member, Committee on Veterans' Affairs, House of
Representatives, Washington, DC.
Dear Chairmen Moran and Bost, and Ranking Members
Blumenthal and Takano: As organizations representing millions
of veterans, service members, survivors, caregivers, and
military families of all generations, we have long worked
with Congress to protect and strengthen the benefits and
services earned through military service. For that reason, we
do not support the funding mechanism within the Take Care of
America's Veterans Act (H.R. 9237/S. 4744) that would
significantly reduce future benefits for more than a million
disabled veterans.
The Veterans Affairs Schedule for Rating Disabilities is
intended to reflect medical evidence, functional impairment,
and scientific expertise, not serve as a budgetary offset. If
Congress establishes the precedent that disability ratings
may be rewritten through statute to generate ``savings'',
future Congresses will have a ready-made roadmap for reducing
earned benefits whenever fiscal pressures arise. Disability
compensation is not a government program to be trimmed when
convenient. It is earned compensation for injuries and
illnesses incurred in service to our nation.
Some supporters argue that Congress is simply implementing
changes previously proposed by the Department of Veterans
Affairs. However, VA never finalized those proposals, largely
due to receiving more than 2,600 comments raising concerns
about the medical justification for the changes and their
impact on future veterans. In fact, VA spokesman Quinn Slaven
recently stated, ``No changes are planned or imminent,'' and
noted that the agency is still reviewing the proposed rule,
which ``would need to undergo significant changes [emphasis
added] prior to being finalized'' before any implementation
could occur (Slaven, quoted in GovExec, June 16, 2026).
We are also troubled that reductions to future VA
disability compensation are being used to finance provisions
such as the Major Richard Star Act, which addresses a
military retirement inequity rooted in Department of Defense
policy. Correcting a Title 10 obligation should not come at
the expense of Title 38 benefits. We continue to support
enactment of a clean and complete Major Richard Star Act that
delivers full concurrent receipt to combat-injured retirees
without reducing earned benefits for future veterans.
Congress can and should address these priorities without
reducing compensation for future disabled veterans, bypassing
the regulatory process, or undermining confidence in the
disability compensation system.
We respectfully urge Congress to find a different path
forward for these important benefit increases, including a
clean and complete Major Richard Star Act, that does not
[[Page H4610]]
force one generation of veterans to bear the cost for
another.
Sincerely,
DAV (Disabled American Veterans), Iraq and Afghanistan
Veterans of America, Jewish War Veterans, Marine Corps
League, National Organization of Veterans' Advocates,
National Veterans Legal Services Program, Reserve
Organization of America, Veterans of Foreign Wars,
54kVeterans.
____
The American Legion
DEPARTMENT OF TEXAS
Resolution No: 8-26
Title: Equal Advocacy for all Veterans and Equitable Funding
of earned Veterans' Benefits
Origin: American Legion Post 300
Assigned To: Legislative Convention Committee
Whereas, William J Bordelon Post 300 believes that future
changes to disability compensation policies governing sleep
apnea and tinnitus would result in similarly situated
veterans receiving different compensation based solely upon
when they entered military service or became eligible to file
their claims; and
Whereas, William J Bordelon Post 300 further believes that
every veteran who honorably serves the United States deserves
equal advocacy from The American Legion regardless of
generation, era of service, or date of military service, and
that Congress should fully fund veterans' benefits without
relying upon offsets affecting future veterans; now,
therefore, be it
Resolved, By the American Legion Department of Texas in
Annual Convention assembled in Austin, Texas, July 10-12,
2026; That The American Legion reaffirms its unwavering
support for passage of the Major Richard Star Act and
restoration of full concurrent receipt for eligible combat-
disabled military retirees; and, be it further
Resolved, That The American Legion, Department of Texas
respectfully petition the National Convention of The American
Legion to establish as national policy that The American
Legion continue supporting legislation benefiting veterans
while opposing any legislative funding mechanism that
finances earned veterans' benefits through future reductions,
limitations, or policy changes affecting Department of
Veterans Affairs disability compensation; and, be it further
Resolved, That The American Legion reaffirm its commitment
that benefits earned through honorable military service are
obligations of the Nation and should be fully funded by
Congress without creating disparities in compensation policy
between current and future veterans; and, be it finally
Resolved, That copies of this resolution be forwarded to
the National Convention of The American Legion for
consideration and appropriate action.
____
American Legion Trujillo-Sheets Post 28 Durango, CO's Post
Last night all members at the post meeting voted
unanimously that the post is NOT SUPPORTING the TCAVA.
At the 2022 American Legion convention resolution 33 was
approved which clearly describes the feeling of the
membership of the legion. This is the guidance that the
leadership should be using to determine our support for bills
that affect our VA benefits. You can read it here from the
National Archives. https://archive.legion.org/node/8419
____
From: Paul Kafka
Sent: Tuesday, July 14, 2026 11:30:06 AM
To: Shane Junkert
Subject: TCAVA opposition
Tonight 07/13/2026 at the Blue Earth Post 89 American
Legion Department of Minnesota meeting, a motion was made to
disapprove of National's position on the TCAVA. After
discussion, a vote was held, and it was unanimous. Blue Earth
Post 89 is in disagreement with Department and National on
this issue. We fully support the original MAJ Richard Star
act, but can not abide by taking from one group of veterans
to pay another.
Paul J. Kafka,
Past Commander, American Legion Post 89.
____
Bill Enyart.
Here is the email American Legion Post 58, Belleville, IL,
sent Mike Bost tonight:
Re TCAVA HR 9237 Section 108
Congressman Bost: American Legion Post 58 voted unanimously
at tonight's meeting to indicate our disagreement with TCAVA
Section 108 in its entirety. And further to voice our
disagreement with the position taken by the American Legion
National Commander in support of this legislation as
currently written. He does not speak for us.
Located in Belleville, about half of our members reside in
your district, most of the balance in Congresswoman
Budzinski's. We will be watching your vote on this carefully.
We urge you to change your position on this. Do not strip
benefits from future and current veterans.
Respectfully,
Bill Enyart, Post Commander; Rodney Buhr, Senior Vice-
commander; Marvin Hammel, Junior Vice-commander; April
Tarbill, Finance Pio Officer.
We sent similar letters to Congresswoman Budzinski, and
Senators Durbin and Duckworth.
Mr. TAKANO. Mr. Speaker, the chairman has made the claim that VA is
going to move forward with taking away sleep apnea and tinnitus as
conditions that veterans may claim disability ratings for. I would like
to ask the chairman who at VA has made that commitment. He has tweeted
out this morning that this is the case.
Mr. Speaker, I yield 15 seconds to the gentleman from Illinois (Mr.
Bost) for the purpose of a colloquy to tell me the name of the person
at VA who has confirmed that the VA is moving forward with these
changes to disability ratings.
Mr. BOST. We have heard from the opening statement that came out of
the VA, from the leadership at VA--
Mr. TAKANO. The Secretary?
Mr. BOST.--and that was sent out this morning under the approval of
the Secretary.
Mr. TAKANO. So the gentleman is saying that a Secretary who backed
away from changes to disability ratings in terms of medication--the
intent was to say that if veterans take medication or get some sort of
treatment, that if their conditions improve, that their disability
ratings could then be lowered. He backed away from that after immense
protest and opposition from veterans and veterans organizations.
{time} 0950
You are telling me that this very same Secretary is telling you that
he is moving forward with a $57 billion cut to disability ratings?
Mr. Speaker, I yield to the gentleman for the purposes of a colloquy.
Mr. BOST. That is exactly the position of the VA and their
administration. That was said this morning. It was sent out this
morning. It is now being reported in the news.
Mr. TAKANO. Mr. Speaker, I reclaim my time.
Mr. BOST. You can reclaim your time, but you asked the question.
Mr. TAKANO. The time is mine. I am reclaiming my time.
Mr. Speaker, there has been no public statement by the Secretary.
There has been no named official from VA today. I defy the chairman to
produce such a name. He is making a claim, but, again, I will contend
that they are counting on a golden egg in disability cuts, savings on
the backs of veterans, that has not been laid yet and that I contend
will not be.
Mr. Speaker, I yield 2 minutes to the gentleman from Pennsylvania
(Mr. Deluzio), a veteran of the U.S. Navy, a former member of this
committee and who now serves on the House Armed Services Committee and
the House Transportation Committee.
Mr. DELUZIO. Mr. Speaker, I thank the gentleman from California for
yielding.
Mr. Speaker, I rise in opposition to this bill. I rise in opposition
to any effort to cut veterans' benefits.
Let's be clear. This bill raises the cost of the VA Home Loan Program
during a housing crisis, and this program and this bill cuts VA
benefits for current veterans who don't have them and for troops
downrange right now for two of the most common conditions they may
experience: sleep apnea and tinnitus.
This bill sells off more VA and veterans' care to the private sector.
It continues the privatization push of the Trump administration and so
many congressional Republicans. I am not going to take a lecture on
fiscal responsibility or accept this argument from the Republicans and
the Trump administration that you have to fund veterans' programs by
cutting care or benefits for other veterans.
The same people who have funded an Iran war at the tune of billions
and billions of dollars, the same people who added nearly $5 trillion
to the debt through their One Big Beautiful Bill Act, which, by the
way, has a new name now, I guess. We have lost track of that. That new
bill, by the way, would also add $19 trillion over 30 years.
Mr. Speaker, there is no problem on the Republican side with adding
to the debt when it comes time to give tax breaks and tax giveaways to
the ultrarich and to corporations, but when it comes time to care of
veterans, now they are counting pennies.
Let's be crystal clear about what this bill does. It says to troops
downrange right now who are in harm's way that they have to have worse
benefits than veterans have today to pay for benefits and care that
other veterans have earned.
[[Page H4611]]
That is ridiculous. It is why groups like the VFW, the IAVA, and
others oppose this bill. It is why I think Democrats and Republicans
should oppose this bill on the floor today.
For this reason and many others, at the appropriate time, I will
offer a motion to recommit this bill back to committee. If the House
Rules permitted, I would have offered the motion with an amendment to
this bill.
The amendment would change the offsets used in the bill. Instead of
reducing the VA home loan benefit and cutting disability benefits for
sleep apnea and tinnitus, it takes unobligated, appropriated but not
committed, funding given to the DOD in the One Big Beautiful Bill Act
and uses it as a pay-for.
The SPEAKER pro tempore. The time of the gentleman has expired.
Mr. TAKANO. Mr. Speaker, I yield an additional 15 seconds to the
gentleman from Pennsylvania.
Mr. DELUZIO. Mr. Speaker, I ask unanimous consent to insert the text
of my amendment into the Record immediately prior to the vote on the
motion to recommit.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Pennsylvania?
There was no objection.
Mr. DELUZIO. Mr. Speaker, I hope my colleagues will join me in voting
for the motion to recommit.
Mr. BOST. Mr. Speaker, I yield 2 minutes to the gentleman from
Michigan (Mr. Barrett), my good friend from the Seventh District.
Mr. BARRETT. Mr. Speaker, I rise today in support of the Take Care of
America's Veterans Act.
This package includes more than 60 bipartisan bills that modernize,
enhance, and reform the delivery of healthcare and benefits for the
entire veteran community.
It also delivers numerous bills that veterans and VSOs across America
have been vocal about, like the Major Richard Star Act, the Love Lives
On Act, the ACCESS Act, the TAP Promotion and Expansion Act, and more.
It also includes eight of my own specific bill priorities, including:
The ASSIST Act and CRUISE Act, which will help disabled veterans and
businesses make necessary and timely modifications to vehicles,
ensuring that veterans have accessibility to move about.
The Sharri Briley & Eric Edmundson Veterans Benefits Expansion Act
will finally deliver the first notable increase in over 30 years to our
most severely disabled veterans and our Gold Star families who have
sacrificed so much.
My Clear Communication for Veterans Claims Act and my Delivering
Digitally to Our Veterans Act, which will ensure that every veteran can
understand the messages and communications they receive from the VA in
a simplified manner and even opt in to get them electronically.
My Veterans Community Care Scheduling Improvement Act, which will
make it easier for veterans to schedule medical appointments closer to
home and easier to access.
The Acquisition Reform and Cost Assessment Act to strengthen
oversight of VA acquisitions with the ginormous contracts that they
often enter into.
And, finally, my Home Affordability for Guard and Reserve Act to
empower more of our National Guard and reservists to take advantage of
the VA Home Loan Program. Today, they would wait 6 years to qualify for
the VA Home Loan Program. Under this bill, they will qualify once they
return home from their training and are in good standing with their
unit.
Mr. Speaker, I worked hard on these bills for nearly 2 years, and
they and more than 50 other bipartisan bills just like them are all
major wins that will improve the lives of our Nation's heroes.
I thank Chairman Bost for his work on this legislation, and I look
forward to the passage of this bill. I urge my colleagues to vote
``yes.''
Mr. TAKANO. Mr. Speaker, there is overwhelming opposition to cutting
veterans' disability benefits to offset the cost of this bill.
Major VSOs, like the Veterans of Foreign Wars, Disabled American
Veterans, Iraq and Afghanistan Veterans of America, along with numerous
others, all oppose this bill due to the offset.
More importantly, veterans themselves are overwhelmingly opposed, as
well. Check out any online veteran forum, and you will find thousands
of comments from both veterans and Active-Duty servicemembers decrying
these proposed cuts.
Veterans of all eras agree that their receipt of benefits should not
be predicated on cuts to benefits for another generation of veterans.
It is our job to listen to them. There are other ways to fund this
bill's provisions. We just need to have the political courage to stand
up and do what is right for our veterans.
Mr. Speaker, I yield 2 minutes to the gentleman from Texas (Mr.
Menefee), my good friend who serves on the House Committee on Science,
Space, and Technology and the House Committee on Oversight and
Government Reform.
Mr. MENEFEE. Mr. Speaker, I rise today to oppose H.R. 9237, which, if
we are being clear, cuts veterans' benefits.
The President and my colleagues on the Republican side in Congress
have no problem sending our men and women off to war, but the real
measure of a nation is not just how it treats their servicemembers when
they are on Active Duty. It is how it treats them when they are no
longer dodging the bombs, the bullets, and the storms at sea and when
they are no longer serving in war.
As a Congress, we have to do right by our veterans, and this bill
simply does not do it with $57 billion in cuts for disability benefits
for veterans. It raises home loan refinancing fees $4 billion on
veteran borrowers.
Mr. Speaker, I am the son of two veterans, and we would have never
purchased our first home when I was in high school were it not for a VA
home assistance loan. That is to say not just for me but for so many
folks across the 18th Congressional District of Texas.
I keep hearing my colleagues on the other side of the aisle saying
that we have to find money to offset to be able to pay for some of the
other benefits in this bill. Yet, if we are pinching pennies, let's
tell the President to end his war in Iran, which has cost taxpayers
billions and billions of dollars. It is time for this Congress to do
right by our veterans.
Mr. Speaker, I urge my colleagues on both sides of the aisle to vote
against H.R. 9237.
Mr. BOST. Mr. Speaker, I yield 2 minutes to the gentleman from
Pennsylvania (Mr. Meuser), from the Ninth District.
{time} 1000
Mr. MEUSER. Mr. Speaker, I thank Chairman Bost for his leadership.
Mr. Speaker, I rise today in support of the Take Care of America's
Veterans Act. Our veterans answered the call to serve, sacrificed on
behalf of this country, and defended the freedoms every American
enjoys.
They have earned a Department of Veterans Affairs that delivers the
care, benefits, and support that they were promised without unnecessary
delays or bureaucratic obstacles, and that includes community care, Mr.
Speaker. That is one of the aversions and obstacles and reasons for
opposition because Democrats are pretty much against community care
initiatives.
This bipartisan package brings together more than 60 commonsense
proposals that truly make this happen. And by the way, it is supported
by The American Legion, Military Officers Association of America,
Wounded Warrior Project, Elizabeth Dole Foundation, Korean War Veterans
Association, Vietnam Veterans of America, AMVETS, Gold Star Spouses of
America, and the list goes on.
Very importantly, it includes the Major Richard Star Act. Voting
against this bill is voting against the Major Richard Star Act, which
ends the unfair wounded veterans tax for eligible combat-injured
retirees. These veterans were medically retired because their service
was cut short by injuries sustained defending our country. They should
not be forced to give up a portion of their military retirement pay
simply because they also receive VA disability compensation. This bill
corrects that injustice.
It also strengthens access to community care, as mentioned, and
mental health treatment. It allows military widows to remarry and
maintain their benefits. It cuts through the VA red
[[Page H4612]]
tape and strengthens the claims appeals processes. This is not about a
cutting of benefits. It is about advancing services with some
modernization initiatives, as well.
We owe our veterans more than the words of gratitude. We owe them
this action. We owe them the Take Care of America's Veterans Act.
Mr. TAKANO. Mr. Speaker, I yield myself such time as I may consume.
I will point out that yesterday, House Republicans released a $95
billion supplemental for the reconciliation bill they want to bring
forward next week for Pentagon spending, farm assistance, and
intelligence operations all without offsets. We are talking about $95
billion--none of them with an offset. Yet, we are asking our veterans
to pay for this bill. Only in the case of veterans is the chairman
looking for an offset.
I defy the chairman to tell me whether he will ask for an offset for
the $95 billion supplemental that goes to Pentagon spending, farm
assistance, and intelligence operations. I eagerly await to hear his
answer.
Mr. Speaker, I reserve the balance of my time.
Mr. BOST. Mr. Speaker, I yield 2 minutes to the gentlewoman from the
Northern Mariana Islands (Ms. King-Hinds), my good friend.
Ms. KING-HINDS. Mr. Speaker, I rise before you today to lend my voice
in strong support of H.R. 9237, the Take Care of America's Veterans
Act.
This comprehensive package is designed to address the critical needs
of our Nation's veterans.
The legislation represents a meaningful step forward closing resource
gaps that have persisted for far too long. Among its provisions are
vital improvements for veterans affected by traumatic brain injuries,
expanded survivor benefits, and increased access to medical care in the
U.S. territories and the Freely Associated States.
I am proud to note that two bills I authored are included in this
package. First is the Territorial Response and Access to Veterans'
Essential Lifecare, or TRAVEL Act. This provision, which already passed
in the House, establishes a VA program enabling physicians to travel to
the U.S. territories and deliver essential medical care directly to
veterans.
The second bill, the U.S. Vets of the Freely Associated States Act,
empowers the VA to provide telehealth services and mail prescriptions
to veterans residing in the Republic of the Marshall Islands, the
Federated States of Micronesia, and Palau. These Pacific Island
countries are among our closest allies whose citizens serve in our
military at exceptionally high rates, yet they lack access to basic
care and benefits. This legislation will help remedy that inequity.
The Take Care of America's Veterans Act is not just important. It is
urgent. Our veterans deserve the best we can offer, and this package
delivers on that promise.
I thank Chairman Bost for his leadership and dedication to veterans
everywhere. I urge my colleagues to join me in supporting the passage
of H.R. 9237.
Mr. TAKANO. Mr. Speaker, I yield myself such time as I may consume.
I continue to ask the chairman in advance of a $95 billion
supplemental for Pentagon spending, farm assistance, and intelligence
operation, on none of this are the Republicans seeking an offset? Only
the chairman in this particular case when it comes to our veterans is
demanding that veterans pay for veterans.
We could pass this bill without having to ask veterans to pay for
veterans--actually, for disabled veterans to pay for veterans.
Mr. Speaker, I would ask the chairman again: Does he plan to seek an
offset or demand an offset for the $95 billion supplemental for
Pentagon spending, farm assistance, and intelligence operations, none
of which Republicans are intending to pay for? Their rules and their
policy is to make veterans pay for veterans.
Mr. Speaker, I reserve the balance of my time.
Mr. BOST. Mr. Speaker, I have no further speakers, and I am ready to
close.
I reserve the balance of my time.
Mr. TAKANO. I yield myself such time as I may consume.
In listening to the chairman today and at the Rules Committee several
weeks ago, it is clear to me that he has been picking his words very
carefully. He has been very specific that this bill, the so-called Take
Care of America's Veterans Act, would not impair current veterans.
I am not sure if the chairman fully understands how the disability
benefits system works or if he truly believes what he is saying, but
what he is saying isn't even remotely the full truth.
The bill can and will lead to cuts for those who already have
service-connected disability ratings for sleep apnea and tinnitus. This
is because anytime a veteran applies for a rating increase or applies
for a new rating for some other condition, VA can and does review
previous ratings, sometimes even lowering them.
It is foolish to think that VA won't apply the new rules for sleep
apnea and tinnitus when veterans have their ratings reviewed.
Further, his remarks fail to take into consideration two other
critically important populations here. First, these cuts would make
servicemembers currently serving who may be incurring these injuries
right now ineligible to receive compensation for service-connected
tinnitus or sleep apnea. Those servicemembers President Trump keeps
sending into harm's way in this foolish war with Iran would be
ineligible for these benefits. That should give us all pause.
Let me just say a ``yes'' vote on this bill is a message that we are
sending to the servicemembers currently serving in and around the
waters of Iran and the Strait of Hormuz and our servicemembers that are
stationed at bases who have already faced incoming missile fire and
have been subjected to the blasts that have surely affected their
eardrums, we are saying to them that they will not be able to apply to
make claims based on tinnitus, much less sleep apnea. That is the
message a ``yes'' vote will send to them. That is why I say vote
``no.''
In addition, the chairman and his colleagues fail to acknowledge that
the existing veterans who have yet to file a claim for tinnitus or
sleep apnea--I am talking about a group of people not the current
servicemembers, but veterans who have yet to apply for a rating--these
two groups of veterans, that is, current servicemembers and veterans
who have yet to file, will be treated worse than those that came before
them.
This contract will unilaterally be changed on them and for the worse.
How my Republican colleagues are okay with treating two veterans with
the same exact condition differently is beyond me.
Mr. Speaker, this is the largest cut to veterans' disability benefits
in history being used to pay for this bill when Republicans are not
demanding offsets for $95 billion next week. I don't know how you all
can live with yourselves.
Mr. Speaker, I reserve the balance of my time.
Mr. BOST. Mr. Speaker, I am prepared to close, and I reserve the
balance of my time.
{time} 1010
Mr. TAKANO. Mr. Speaker, I yield myself the balance of my time to
close.
Throughout this process, I have tried to stay up to date on what
veterans are saying online about the so-called Take Care of America's
Veterans Act. I found the discussions to be enlightening.
Before my colleagues say I have cherry-picked those comments, I urge
them to pull out their phones and take a look at the comment sections
on any social media post discussing this bill. It will become clear to
you that opposition to this legislation is coming from veterans on both
sides of the aisle. Let's take a look. I am quoting from the comments:
``This creates two tiers of veterans.''
``Veterans should not have to take a reduced amount to provide
savings to pay for fellow veterans. The U.S. Government should honor
their commitment to us.''
``This is a false choice. Find the funds without making veterans
literally pay the cost.''
``If they truly cared, they wouldn't rob all veterans to pay for this
as there are plenty of other ways to fund this act.''
``Pitting veterans against veterans.''
``You taught us to take care of each other; this bill contradicts
that.''
[[Page H4613]]
There are thousands more just like this from veterans in each of our
districts telling us to vote ``no'' on this bad bill. If my colleagues
won't listen to my concerns here, I urge them to listen to the
veterans, dependents, caregivers, survivors, and advocates in their
districts.
We cannot today, tomorrow, or ever balance budgets on the backs of
veterans who have already sacrificed so much for their country.
Instead, we must honor the contract we made with our Nation's veterans
and reject the false choice Chairman Bost has foisted upon us.
I join the millions of veterans across the country who vehemently
oppose H.R. 9237, the Take Care of America's Veterans Act, and urge
everyone to do the same.
Mr. Speaker, I yield back the balance of my time.
Mr. BOST. Mr. Speaker, I yield myself the balance of my time to
close.
I will respond to a few claims that the veterans do not want this
package. It is just not true. The ranking member can disagree on the
bill. He can disagree on the offset. He can argue that they would have
written the package differently, but I do not think it is accurate to
suggest the veterans' community, as a whole, is somehow united against
this legislative package.
The package has support from a wide range of organizations, including
The American Legion, Vietnam Veterans of America, Mission Roll Call,
Wounded Warrior Project, Military Officers Association of America,
AMVETS, Concerned Veterans for America, Tragedy Assistance Programs for
Survivors, Gold Star Spouses of America, the Veterans Survivor
Coalition, the Military Order of the Purple Heart, Veterans Justice
Alliance, the National Association of State Approving Agencies, the ALS
Association, Elizabeth Dole Foundation, Air Force Sergeants
Association, American Optometric Association, Avalon Action Alliance,
Career Education Colleges and Universities, Commissioned Officers
Association of the USPHS, K9s for Warriors, Korean War Veterans
Association, Military Chaplains Association, National Defense
Committee, National Military Family Association, USCG Chief Petty
Officers Association, Americans for Prosperity, National Federal
Development Association, National Taxpayers Union, and the Association
of Mature American Citizens.
Those organizations represent veterans, survivors, Gold Star
families, wounded veterans, military families, advocates, and
professionals who work directly with the people this bill would help.
When the ranking member claims that veterans do not want this
package, that ignores millions of voices in the veterans' community who
are asking Congress to act.
This bill includes longstanding priorities for veterans and,
importantly, it does so in a way that is paid for and capable of
actually moving from here to the Senate and to the President's desk.
At some point, we have to decide whether we are going to keep talking
about these promises or actually move a package that can become law. I
believe that this package is a serious, responsible step forward, and I
reject the idea that veterans do not want this Congress to act on this
bill.
Also, whether they want to admit it or not, the problem with most of
these organizations that were in opposition is because they didn't want
the offset. That offset, as I have told you this morning, as the VA has
said exactly what we said, they are going to implement it.
The question for my colleagues is very simple: Do they want to use
their Article I power to make decisions, as we should in Congress, to
direct that money to our veterans and where they need it? We have sat
and looked at these over and over again. We have also passed some of
these bills and sent them over to the Senate to die because they don't
have an offset.
This isn't an easy game, and it is not a game. If you don't believe
this marine is serious about helping veterans--and I am telling you I
took a lot of crap this week--I can tell you this: I will stand and
always stand for my veterans.
I am the son of a veteran. I am the grandson of a veteran. I am the
nephew of a veteran. I am the father of a veteran, and I am the
grandfather of two of them.
Mr. Speaker, I have heard a lot this week. I am going to tell you, we
have worked hard and did the best we can to put the best bill forward.
It is the best bill that has been around in decades.
Do we want the bureaucrats to make the decision and not support those
areas where we are trying to help our veterans? You can love it. You
can hate it, but I am telling you, this is the best thing we can do for
veterans right now. I would encourage all of my colleagues to support
this legislation, and I yield back the balance of my time.
The SPEAKER pro tempore (Mr. Hurd). All time for debate has now
expired.
Pursuant to House Resolution 1423, the previous question is ordered
on the bill, as amended.
The question is on the engrossment and third reading of the bill.
The bill was ordered to be engrossed and read a third time, and was
read the third time.
Motion to Recommit
Mr. DELUZIO. Mr. Speaker, I have a motion to recommit at the desk.
The SPEAKER pro tempore. The Clerk will report the motion to
recommit.
The Clerk read as follows:
Mr. Deluzio of Pennsylvania moves to recommit the bill H.R.
9237 to the Committee on Veterans' Affairs.
The material previously referred to by Mr. Deluzio is as follows:
Mr. Deluzio moves to recommit the bill H.R. 9237 to the
Committee on Veterans' Affairs with instructions to report
the same back to the House forthwith, with the following
amendments:
Page 17, strike lines 9 through 17.
Page 17, line 18, redesignate subsection (c) as subsection
(b).
Strike section 108 and insert the following new section:
SEC. 108. RESCISSION OF ONE BIG BEAUTIFUL BILL ACT FUNDS FOR
DEPARTMENT OF DEFENSE.
Notwithstanding any other provision of law, of the
unobligated balances of amounts made available under title II
of the Act entitled ``An Act to provide for reconciliation
pursuant to title II of H. Con. Res. 14'', approved July 4,
2025 (Public Law 119-21; 139 Stat. 112) (commonly known as
the ``One Big Beautiful Bill Act''), an amount sufficient to
offset the costs of carrying out the amendments made by this
Act is hereby rescinded.
The SPEAKER pro tempore. Pursuant to clause 2(b) of rule XIX, the
previous question is ordered on the motion to recommit.
The question is on the motion to recommit.
The question was taken; and the Speaker pro tempore announced that
the noes appeared to have it.
Mr. DELUZIO. Mr. 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 question are postponed.
____________________