[Congressional Record (Bound Edition), Volume 160 (2014), Part 7]
[House]
[Pages 10337-10349]
[From the U.S. Government Publishing Office, www.gpo.gov]




                     PAY OUR GUARD AND RESERVE ACT

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

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Veterans' 
     Access to Care through Choice, Accountability, and 
     Transparency Act of 2014''.
       (b) Table of Contents.--The table of contents for this Act 
     is as follows:

Sec. 1. Short title; table of contents.

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

Sec. 101. Independent assessment of the scheduling of appointments and 
              other health care management processes of the Department 
              of Veterans Affairs.
Sec. 102. Technology task force on review of scheduling system and 
              software of the Department of Veterans Affairs.

           TITLE II--TRAINING AND HIRING OF HEALTH CARE STAFF

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

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

Sec. 301. Expanded availability of hospital care and medical services 
              for veterans through the use of contracts.
Sec. 302. Transfer of authority for payments for hospital care, medical 
              services, and other health care from non-Department 
              providers to the Chief Business Office of the Veterans 
              Health Administration of the Department.
Sec. 303. Enhancement of collaboration between Department of Veterans 
              Affairs and Indian Health Service.
Sec. 304. Enhancement of collaboration between Department of Veterans 
              Affairs and Native Hawaiian health care systems.
Sec. 305. Sense of Congress on prompt payment by Department of Veterans 
              Affairs.

              TITLE IV--HEALTH CARE ADMINISTRATIVE MATTERS

Sec. 401. Improvement of access of veterans to mobile vet centers of 
              the Department of Veterans Affairs.
Sec. 402. Commission on construction projects of the Department of 
              Veterans Affairs.
Sec. 403. Commission on Access to Care.
Sec. 404. Improved performance metrics for health care provided by 
              Department of Veterans Affairs.
Sec. 405. Improved transparency concerning health care provided by 
              Department of Veterans Affairs.
Sec. 406. Information for veterans on the credentials of Department of 
              Veterans Affairs physicians.
Sec. 407. Information in annual budget of the President on hospital 
              care and medical services furnished through expanded use 
              of contracts for such care.
Sec. 408. Prohibition on falsification of data concerning wait times 
              and quality measures at Department of Veterans Affairs.
Sec. 409. Removal of Senior Executive Service employees of the 
              Department of Veterans Affairs for performance.

             TITLE V--HEALTH CARE RELATED TO SEXUAL TRAUMA

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

                TITLE VI--MAJOR MEDICAL FACILITY LEASES

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

                  TITLE VII--VETERANS BENEFITS MATTERS

Sec. 701. Expansion of Marine Gunnery Sergeant John David Fry 
              Scholarship.

[[Page 10338]]

Sec. 702. Approval of courses of education provided by public 
              institutions of higher learning for purposes of All-
              Volunteer Force Educational Assistance Program and Post-
              9/11 Educational Assistance conditional on in-State 
              tuition rate for veterans.

          TITLE VIII--APPROPRIATION AND EMERGENCY DESIGNATIONS

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

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

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

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

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

       (C) The organization, processes, and tools used by the 
     Department to support clinical documentation and the 
     subsequent coding of inpatient services.
       (D) The purchasing, distribution, and use of 
     pharmaceuticals, medical and surgical supplies, and medical 
     devices by the Department, including the following:
       (i) The prices paid for, standardization of, and use by the 
     Department of the following:

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

       (ii) The use by the Department of group purchasing 
     arrangements to purchase pharmaceuticals, medical and 
     surgical supplies, medical devices, and health care related 
     services.
       (iii) The strategy used by the Department to distribute 
     pharmaceuticals, medical and surgical supplies, and medical 
     devices to Veterans Integrated Service Networks and medical 
     facilities of the Department.
       (E) The performance of the Department in paying amounts 
     owed to third parties and collecting amounts owed to the 
     Department with respect to hospital care, medical services, 
     and other health care, including any recommendations of the 
     independent third party as follows:
       (i) To avoid the payment of penalties to vendors.
       (ii) To increase the collection of amounts owed to the 
     Department for hospital care, medical services, or other 
     health care provided by the Department for which 
     reimbursement from a third party is authorized.
       (iii) To increase the collection of any other amounts owed 
     to the Department.
       (2) Elements of scheduling assessment.--In carrying out the 
     assessment required by paragraph (1)(A), the independent 
     third party shall do the following:
       (A) Review all training materials pertaining to scheduling 
     of appointments at each medical facility of the Department.
       (B) Assess whether all employees of the Department 
     conducting tasks related to scheduling are properly trained 
     for conducting such tasks.
       (C) Assess whether changes in the technology or system used 
     in scheduling appointments are necessary to limit access to 
     the system to only those employees that have been properly 
     trained in conducting such tasks.
       (D) Assess whether health care providers of the Department 
     are making changes to their schedules that hinder the ability 
     of employees conducting such tasks to perform such tasks.
       (E) Assess whether the establishment of a centralized call 
     center throughout the Department for scheduling appointments 
     at medical facilities of the Department would improve the 
     process of scheduling such appointments.
       (F) Assess whether booking templates for each medical 
     facility or clinic of the Department would improve the 
     process of scheduling such appointments.
       (G) Recommend any actions to be taken by the Department to 
     improve the process for scheduling such appointments, 
     including the following:
       (i) Changes in training materials provided to employees of 
     the Department with respect to conducting tasks related to 
     scheduling such appointments.
       (ii) Changes in monitoring and assessment conducted by the 
     Department of wait times of veterans for such appointments.
       (iii) Changes in the system used to schedule such 
     appointments, including changes to improve how the 
     Department--

       (I) measures wait times of veterans for such appointments;
       (II) monitors the availability of health care providers of 
     the Department; and
       (III) provides veterans the ability to schedule such 
     appointments.

       (iv) Such other actions as the independent third party 
     considers appropriate.
       (3) Timing.--The independent third party carrying out the 
     assessment required by paragraph (1) shall complete such 
     assessment not later than 180 days after entering into the 
     contract described in such paragraph.
       (b) Report.--
       (1) In general.--Not later than 90 days after the date on 
     which the independent third party completes the assessment 
     under this section, the Secretary shall submit to the 
     Committee on Veterans' Affairs of the Senate and the 
     Committee on Veterans' Affairs of the House of 
     Representatives a report on the results of such assessment.
       (2) Publication.--Not later than 30 days after submitting 
     the report under paragraph (1), the Secretary shall publish 
     such report in the Federal Register and on an Internet 
     website of the Department accessible to the public.

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

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

           TITLE II--TRAINING AND HIRING OF HEALTH CARE STAFF

     SEC. 201. TREATMENT OF STAFFING SHORTAGE AND BIANNUAL REPORT 
                   ON STAFFING OF MEDICAL FACILITIES OF THE 
                   DEPARTMENT OF VETERANS AFFAIRS.

       (a) Staffing Shortage.--
       (1) In general.--Not later than 180 days after the date of 
     the enactment of this Act, and not later than September 30 
     each year thereafter, the Inspector General of the Department 
     of Veterans Affairs shall determine, and the Secretary of 
     Veterans Affairs shall publish in the Federal Register, the 
     five occupations of health care providers of the Department 
     of Veterans Affairs for which there is the largest staffing 
     shortage throughout the Department.
       (2) Recruitment and appointment.--Notwithstanding sections 
     3304 and 3309 through 3318 of title 5, United States Code, 
     the Secretary may, upon a determination by the Inspector 
     General under paragraph (1) that there is a staffing shortage 
     throughout the Department with respect to a particular 
     occupation of health care provider, recruit and directly 
     appoint highly qualified health care providers to serve as 
     health care providers in that particular occupation for the 
     Department.
       (3) Priority in health professionals educational assistance 
     program to certain providers.--Section 7612(b)(5) of title 
     38, United States Code, is amended--
       (A) in subparagraph (A), by striking ``and'' at the end;
       (B) by redesignating subparagraph (B) as subparagraph (C); 
     and
       (C) by inserting after subparagraph (A) the following new 
     subparagraph (B):

[[Page 10339]]

       ``(B) shall give priority to applicants pursuing a course 
     of education or training towards a career in an occupation 
     for which the Secretary has, in the most current 
     determination published in the Federal Register pursuant to 
     section 201(a)(1) of the Veterans' Access to Care through 
     Choice, Accountability, and Transparency Act of 2014, 
     determined that there is one of the largest staffing 
     shortages throughout the Department with respect to such 
     occupation; and''.
       (b) Reports.--
       (1) In general.--Not later than 180 days after the date of 
     the enactment of this Act, and not later than December 31 of 
     each even numbered year thereafter until 2024, the Secretary 
     of Veterans Affairs shall submit to the Committee on 
     Veterans' Affairs of the Senate and the Committee on 
     Veterans' Affairs of the House of Representatives a report 
     assessing the staffing of each medical facility of the 
     Department of Veterans Affairs.
       (2) Elements.--Each report submitted under paragraph (1) 
     shall include the following:
       (A) The results of a system-wide assessment of all medical 
     facilities of the Department to ensure the following:
       (i) Appropriate staffing levels for health care providers 
     to meet the goals of the Secretary for timely access to care 
     for veterans.
       (ii) Appropriate staffing levels for support personnel, 
     including clerks.
       (iii) Appropriate sizes for clinical panels.
       (iv) Appropriate numbers of full-time staff, or full-time 
     equivalents, dedicated to direct care of patients.
       (v) Appropriate physical plant space to meet the capacity 
     needs of the Department in that area.
       (vi) Such other factors as the Secretary considers 
     necessary.
       (B) A plan for addressing any issues identified in the 
     assessment described in subparagraph (A), including a 
     timeline for addressing such issues.
       (C) A list of the current wait times and workload levels 
     for the following clinics in each medical facility:
       (i) Mental health.
       (ii) Primary care.
       (iii) Gastroenterology.
       (iv) Women's health.
       (v) Such other clinics as the Secretary considers 
     appropriate.
       (D) A description of the results of the most current 
     determination of the Inspector General under paragraph (1) of 
     subsection (a) and a plan to use direct appointment authority 
     under paragraph (2) of such subsection to fill staffing 
     shortages, including recommendations for improving the speed 
     at which the credentialing and privileging process can be 
     conducted.
       (E) The current staffing models of the Department for the 
     following clinics, including recommendations for changes to 
     such models:
       (i) Mental health.
       (ii) Primary care.
       (iii) Gastroenterology.
       (iv) Women's health.
       (v) Such other clinics as the Secretary considers 
     appropriate.
       (F) A detailed analysis of succession planning at medical 
     facilities of the Department, including the following:
       (i) The number of positions in medical facilities 
     throughout the Department that are not filled by a permanent 
     employee.
       (ii) The length of time each position described in clause 
     (i) remained vacant or filled by a temporary or acting 
     employee.
       (iii) A description of any barriers to filling the 
     positions described in clause (i).
       (iv) A plan for filling any positions that are vacant or 
     filled by a temporary or acting employee for more than 180 
     days.
       (v) A plan for handling emergency circumstances, such as 
     administrative leave or sudden medical leave for senior 
     officials.
       (G) The number of health care providers of the Department 
     who have been removed from their positions, have retired, or 
     have left their positions for another reason, disaggregated 
     by provider type, during the two-year period preceding the 
     submittal of the report.
       (H) Of the health care providers specified in subparagraph 
     (G) who have been removed from their positions, the 
     following:
       (i) The number of such health care providers who were 
     reassigned to other positions in the Department.
       (ii) The number of such health care providers who left the 
     Department.
       (iii) The number of such health care providers who left the 
     Department and were subsequently rehired by the Department.

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

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

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

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

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

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

       (a) Expansion of Available Care and Services.--
       (1) Furnishing of care.--
       (A) In general.--Hospital care and medical services under 
     chapter 17 of title 38, United States Code, shall be 
     furnished to an eligible veteran described in subsection (b), 
     at the election of such veteran, through contracts authorized 
     under subsection (d), or any other law administered by the 
     Secretary of Veterans Affairs, with entities specified in 
     subparagraph (B) for the furnishing of such care and services 
     to veterans.
       (B) Entities specified.--The entities specified in this 
     subparagraph are the following:
       (i) Any health care provider that is participating in the 
     Medicare program under title XVIII of the Social Security Act 
     (42 U.S.C. 1395 et seq.).
       (ii) Any Federally-qualified health center (as defined in 
     section 1905(l)(2)(B) of the Social Security Act (42 U.S.C. 
     1396d(l)(2)(B))).
       (iii) The Department of Defense.
       (iv) The Indian Health Service.
       (2) Choice of provider.--An eligible veteran who elects to 
     receive care and services under this section may select the 
     provider of such care and services from among any source of 
     provider of such care and services through an entity 
     specified in paragraph (1)(B) that is accessible to the 
     veteran.
       (3) Coordination of care and services.--The Secretary shall 
     coordinate, through the Non-VA Care Coordination Program of 
     the Department of Veterans Affairs, the furnishing of care 
     and services under this section to eligible veterans, 
     including by ensuring that an eligible veteran receives an 
     appointment for such care and services within the current 
     wait-time goals of the Veterans Health Administration for the 
     furnishing of hospital care and medical services.

[[Page 10340]]

       (b) Eligible Veterans.--A veteran is an eligible veteran 
     for purposes of this section if--
       (1)(A) the veteran is enrolled in the patient enrollment 
     system of the Department of Veterans Affairs established and 
     operated under section 1705 of title 38, United States Code; 
     or
       (B) the veteran is enrolled in such system, has not 
     received hospital care or medical services from the 
     Department, and has contacted the Department seeking an 
     initial appointment from the Department for the receipt of 
     such care or services; and
       (2) the veteran--
       (A)(i) attempts, or has attempted under paragraph (1)(B), 
     to schedule an appointment for the receipt of hospital care 
     or medical services under chapter 17 of title 38, United 
     States Code, but is unable to schedule an appointment within 
     the current wait-time goals of the Veterans Health 
     Administration for the furnishing of such care or services; 
     and
       (ii) elects, and is authorized, to be furnished such care 
     or services pursuant to subsection (c)(2);
       (B) resides more than 40 miles from the nearest medical 
     facility of the Department, including a community-based 
     outpatient clinic, that is closest to the residence of the 
     veteran; or
       (C) resides--
       (i) in a State without a medical facility of the Department 
     that provides--

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

       (ii) more than 20 miles from a medical facility of the 
     Department described in clause (i).
       (c) Election and Authorization.--
       (1) In general.--If the Secretary confirms that an 
     appointment for an eligible veteran described in subsection 
     (b)(2)(A) for the receipt of hospital care or medical 
     services under chapter 17 of title 38, United States Code, is 
     unavailable within the current wait-time goals of the 
     Department for the furnishing of such care or services, the 
     Secretary shall, at the election of the eligible veteran--
       (A) place such eligible veteran on an electronic waiting 
     list described in paragraph (2) for such an appointment; or
       (B)(i) authorize that such care and services be furnished 
     to the eligible veteran under this section for a period of 
     time specified by the Secretary; and
       (ii) send a letter to the eligible veteran describing the 
     care and services the eligible veteran is eligible to receive 
     under this section.
       (2) Electronic waiting list.--The electronic waiting list 
     described in this paragraph shall be maintained by the 
     Department and allow access by each eligible veteran via 
     www.myhealth.va.gov or any successor website for the 
     following purposes:
       (A) To determine the place of such eligible veteran on the 
     waiting list.
       (B) To determine the average length of time an individual 
     spends on the waiting list, disaggregated by medical facility 
     of the Department and type of care or service needed, for 
     purposes of allowing such eligible veteran to make an 
     informed election under paragraph (1).
       (d) Care and Services Through Contracts.--
       (1) In general.--The Secretary shall enter into contracts 
     with health care providers that are participating in the 
     Medicare program under title XVIII of the Social Security Act 
     (42 U.S.C. 1395 et seq.) to furnish care and services to 
     eligible veterans under this section.
       (2) Rates and reimbursement.--
       (A) In general.--In entering into a contract under this 
     subsection, the Secretary shall--
       (i) negotiate rates for the furnishing of care and services 
     under this section; and
       (ii) reimburse the health care provider for such care and 
     services at the rates negotiated pursuant to clause (i) as 
     provided in such contract.
       (B) Limit on rates.--
       (i) In general.--Except as provided in clause (ii), rates 
     negotiated under subparagraph (A)(i) shall not be more than 
     the rates paid by the United States to a provider of services 
     (as defined in section 1861(u) of the Social Security Act (42 
     U.S.C. 1395x(u))) or a supplier (as defined in section 
     1861(d) of such Act (42 U.S.C. 1395x(d))) under the Medicare 
     program under title XVIII of the Social Security Act (42 
     U.S.C. 1395 et seq.) for the same care and services.
       (ii) Exception.--The Secretary may negotiate a rate that is 
     more than the rate paid by the United States as described in 
     clause (i) with respect to the furnishing of care or services 
     under this section to an eligible veteran if the Secretary 
     determines that there is no health care provider that will 
     provide such care or services to such eligible veteran at the 
     rate required under such clause--

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

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

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

[[Page 10341]]

       (j) Medical Records.--The Secretary shall ensure that any 
     health care provider that furnishes care and services under 
     this section to an eligible veteran submits to the Department 
     any medical record related to the care and services provided 
     to such eligible veteran by such health care provider for 
     inclusion in the electronic medical record of such eligible 
     veteran maintained by the Department upon the completion of 
     the provision of such care and services to such eligible 
     veteran.
       (k) Tracking of Missed Appointments.--The Secretary shall 
     implement a mechanism to track any missed appointments for 
     care and services under this section by eligible veterans to 
     ensure that the Department does not pay for such care and 
     services that were not furnished to an eligible veteran.
       (l) Implementation.--Not later than 90 days after the date 
     of the enactment of this Act, the Secretary shall prescribe 
     interim final regulations on the implementation of this 
     section and publish such regulations in the Federal Register.
       (m) Inspector General Report.--Not later than 540 days 
     after the publication of the interim final regulations under 
     subsection (l), the Inspector General of the Department shall 
     submit to the Secretary a report on the results of an audit 
     of the care and services furnished under this section to 
     ensure the accuracy and timeliness of payments by the 
     Department for the cost of such care and services, including 
     any findings and recommendations of the Inspector General.
       (n) Termination.--The requirement of the Secretary to 
     furnish care and services under this section terminates on 
     the date that is two years after the date on which the 
     Secretary publishes the interim final regulations under 
     subsection (l).
       (o) Reports.--
       (1) Initial report.--Not later than 90 days after the 
     publication of the interim final regulations under subsection 
     (l), the Secretary shall submit to the Committee on Veterans' 
     Affairs of the Senate and the Committee on Veterans' Affairs 
     of the House of Representatives a report on the furnishing of 
     care and services under this section that includes the 
     following:
       (A) The number of eligible veterans who have received care 
     and services under this section.
       (B) A description of the type of care and services 
     furnished to eligible veterans under this section.
       (2) Final report.--Not later than 540 days after the 
     publication of the interim final regulations under subsection 
     (l), the Secretary shall submit to the Committee on Veterans' 
     Affairs of the Senate and the Committee on Veterans' Affairs 
     of the House of Representatives a report on the furnishing of 
     care and services under this section that includes the 
     following:
       (A) The total number of eligible veterans who have received 
     care and services under this section, disaggregated by--
       (i) eligible veterans described in subsection (b)(2)(A); 
     and
       (ii) eligible veterans described in subsection (b)(2)(B).
       (B) A description of the type of care and services 
     furnished to eligible veterans under this section.
       (C) An accounting of the total cost of furnishing care and 
     services to eligible veterans under this section.
       (D) The results of a survey of eligible veterans who have 
     received care or services under this section on the 
     satisfaction of such eligible veterans with the care or 
     services received by such eligible veterans under this 
     section.
       (E) An assessment of the effect of furnishing care and 
     services under this section on wait times for an appointment 
     for the receipt of hospital care and medical services from 
     the Department.
       (F) An assessment of the feasibility and advisability of 
     continuing furnishing care and services under this section 
     after the termination date specified in subsection (n).
       (p) Rules of Construction.--
       (1) No modification of contracts.--Nothing in this section 
     shall be construed to require the Secretary to renegotiate 
     contracts for the furnishing of hospital care or medical 
     services to veterans entered into by the Department before 
     the date of the enactment of this Act.
       (2) Filling and paying for prescription medications.--
     Nothing in this section shall be construed to alter the 
     process of the Department for filling and paying for 
     prescription medications.

     SEC. 302. TRANSFER OF AUTHORITY FOR PAYMENTS FOR HOSPITAL 
                   CARE, MEDICAL SERVICES, AND OTHER HEALTH CARE 
                   FROM NON-DEPARTMENT PROVIDERS TO THE CHIEF 
                   BUSINESS OFFICE OF THE VETERANS HEALTH 
                   ADMINISTRATION OF THE DEPARTMENT.

       (a) Transfer of Authority.--
       (1) In general.--Effective on October 1, 2014, the 
     Secretary of Veterans Affairs shall transfer the authority to 
     pay for hospital care, medical services, and other health 
     care through non-Department providers to the Chief Business 
     Office of the Veterans Health Administration of the 
     Department of Veterans Affairs from the Veterans Integrated 
     Service Networks and medical centers of the Department of 
     Veterans Affairs.
       (2) Manner of care.--The Chief Business Office shall work 
     in consultation with the Office of Clinical Operations and 
     Management of the Department of Veterans Affairs to ensure 
     that care and services described in paragraph (1) are 
     provided in a manner that is clinically appropriate and 
     effective.
       (3) No delay in payment.--The transfer of authority under 
     paragraph (1) shall be carried out in a manner that does not 
     delay or impede any payment by the Department for hospital 
     care, medical services, or other health care provided through 
     a non-Department provider under the laws administered by the 
     Secretary.
       (b) Budgetary Effect.--The Secretary shall, for each fiscal 
     year that begins after the date of the enactment of this 
     Act--
       (1) include in the budget for the Chief Business Office of 
     the Veterans Health Administration amounts to pay for 
     hospital care, medical services, and other health care 
     provided through non-Department providers, including any 
     amounts necessary to carry out the transfer of authority to 
     pay for such care and services under subsection (a), 
     including any increase in staff; and
       (2) not include in the budget of each Veterans Integrated 
     Service Network and medical center of the Department amounts 
     to pay for such care and services.

     SEC. 303. ENHANCEMENT OF COLLABORATION BETWEEN DEPARTMENT OF 
                   VETERANS AFFAIRS AND INDIAN HEALTH SERVICE.

       (a) Outreach to Tribal-Run Medical Facilities.--The 
     Secretary of Veterans Affairs shall, in consultation with the 
     Director of the Indian Health Service, conduct outreach to 
     each medical facility operated by an Indian tribe or tribal 
     organization through a contract or compact with the Indian 
     Health Service under the Indian Self-Determination and 
     Education Assistance Act (25 U.S.C. 450 et seq.) to raise 
     awareness of the ability of such facilities, Indian tribes, 
     and tribal organizations to enter into agreements with the 
     Department of Veterans Affairs under which the Secretary 
     reimburses such facilities, Indian tribes, or tribal 
     organizations, as the case may be, for health care provided 
     to veterans eligible for health care at such facilities.
       (b) Metrics for Memorandum of Understanding Performance.--
     The Secretary of Veterans Affairs shall implement performance 
     metrics for assessing the performance by the Department of 
     Veterans Affairs and the Indian Health Service under the 
     memorandum of understanding entitled ``Memorandum of 
     Understanding between the Department of Veterans Affairs (VA) 
     and the Indian Health Service (IHS)'' in increasing access to 
     health care, improving quality and coordination of health 
     care, promoting effective patient-centered collaboration and 
     partnerships between the Department and the Service, and 
     ensuring health-promotion and disease-prevention services are 
     appropriately funded and available for beneficiaries under 
     both health care systems.
       (c) Report.--Not later than 180 days after the date of the 
     enactment of this Act, the Secretary of Veterans Affairs and 
     the Director of the Indian Health Service shall jointly 
     submit to Congress a report on the feasibility and 
     advisability of the following:
       (1) Entering into agreements for the reimbursement by the 
     Secretary of the costs of direct care services provided 
     through organizations receiving amounts pursuant to grants 
     made or contracts entered into under section 503 of the 
     Indian Health Care Improvement Act (25 U.S.C. 1653) to 
     veterans who are otherwise eligible to receive health care 
     from such organizations.
       (2) Including the reimbursement of the costs of direct care 
     services provided to veterans who are not Indians in 
     agreements between the Department and the following:
       (A) The Indian Health Service.
       (B) An Indian tribe or tribal organization operating a 
     medical facility through a contract or compact with the 
     Indian Health Service under the Indian Self-Determination and 
     Education Assistance Act (25 U.S.C. 450 et seq.).
       (C) A medical facility of the Indian Health Service.
       (d) Definitions.--In this section:
       (1) Indian.--The terms ``Indian'' and ``Indian tribe'' have 
     the meanings given those terms in section 4 of the Indian 
     Health Care Improvement Act (25 U.S.C. 1603).
       (2) Medical facility of the indian health service.--The 
     term ``medical facility of the Indian Health Service'' 
     includes a facility operated by an Indian tribe or tribal 
     organization through a contract or compact with the Indian 
     Health Service under the Indian Self-Determination and 
     Education Assistance Act (25 U.S.C. 450 et seq.).
       (3) Tribal organization.--The term ``tribal organization'' 
     has the meaning given the term in section 4 of the Indian 
     Self-Determination and Education Assistance Act (25 U.S.C. 
     450b).

     SEC. 304. ENHANCEMENT OF COLLABORATION BETWEEN DEPARTMENT OF 
                   VETERANS AFFAIRS AND NATIVE HAWAIIAN HEALTH 
                   CARE SYSTEMS.

       (a) In General.--The Secretary of Veterans Affairs shall, 
     in consultation with Papa Ola Lokahi and such other 
     organizations involved in the delivery of health care to 
     Native Hawaiians as the Secretary considers appropriate, 
     enter into contracts or agreements with Native Hawaiian 
     health care systems that are in receipt of funds from the 
     Secretary of Health and Human Services pursuant to grants 
     awarded or contracts entered into under section 6(a) of the 
     Native Hawaiian Health Care Improvement Act (42 U.S.C. 
     11705(a)) for the reimbursement of direct care services 
     provided to eligible veterans as specified in such contracts 
     or agreements.
       (b) Definitions.--In this section, the terms ``Native 
     Hawaiian'', ``Native Hawaiian health care system'', and 
     ``Papa Ola Lokahi'' have the meanings given those terms in 
     section 12 of the Native Hawaiian Health Care Improvement Act 
     (42 U.S.C. 11711).

[[Page 10342]]



     SEC. 305. SENSE OF CONGRESS ON PROMPT PAYMENT BY DEPARTMENT 
                   OF VETERANS AFFAIRS.

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

              TITLE IV--HEALTH CARE ADMINISTRATIVE MATTERS

     SEC. 401. IMPROVEMENT OF ACCESS OF VETERANS TO MOBILE VET 
                   CENTERS OF THE DEPARTMENT OF VETERANS AFFAIRS.

       (a) Improvement of Access.--
       (1) In general.--The Secretary of Veterans Affairs shall 
     improve the access of veterans to telemedicine and other 
     health care through the use of mobile vet centers of the 
     Department of Veterans Affairs by providing standardized 
     requirements for the operation of such centers.
       (2) Requirements.--The standardized requirements required 
     by paragraph (1) shall include the following:
       (A) The number of days each mobile vet center of the 
     Department is expected to travel per year.
       (B) The number of locations each center is expected to 
     visit per year.
       (C) The number of appointments each center is expected to 
     conduct per year.
       (D) The method and timing of notifications given by each 
     center to individuals in the area to which such center is 
     traveling, including notifications informing veterans of the 
     availability to schedule appointments at the center.
       (3) Use of telemedicine.--The Secretary shall ensure that 
     each mobile vet center of the Department has the capability 
     to provide telemedicine services.
       (b) Reports.--Not later than one year after the date of the 
     enactment of this Act, and not later than September 30 each 
     year thereafter, the Secretary of Veterans Affairs shall 
     submit to the Committee on Veterans' Affairs of the Senate 
     and the Committee on Veterans' Affairs of the House of 
     Representatives a report on the following:
       (1) The use of mobile vet centers to provide telemedicine 
     services to veterans during the year preceding the submittal 
     of the report, including the following:
       (A) The number of days each mobile vet center was open to 
     provide such services.
       (B) The number of days each mobile vet center traveled to a 
     location other than the headquarters of the mobile vet center 
     to provide such services.
       (C) The number of appointments each center conducted to 
     provide such services on average per month and in total 
     during such year.
       (2) An analysis of the effectiveness of using mobile vet 
     centers to provide health care services to veterans through 
     the use of telemedicine.
       (3) Any recommendations for an increase in the number of 
     mobile vet centers of the Department.
       (4) Any recommendations for an increase in the telemedicine 
     capabilities of each mobile vet center.
       (5) The feasibility and advisability of using temporary 
     health care providers, including locum tenens, to provide 
     direct health care services to veterans at mobile vet 
     centers.
       (6) Such other recommendations on improvement of the use of 
     mobile vet centers by the Department as the Secretary 
     considers appropriate.

     SEC. 402. COMMISSION ON CONSTRUCTION PROJECTS OF THE 
                   DEPARTMENT OF VETERANS AFFAIRS.

       (a) Establishment of Commission.--
       (1) Establishment.--There is established an Independent 
     Commission on Department of Veterans Affairs Construction 
     Projects (in this section referred to as the ``Commission'').
       (2) Membership.--
       (A) Voting members.--The Commission shall be composed of 10 
     voting members as follows:
       (i) Three members to be appointed by the President from 
     among members of the National Academy of Engineering who are 
     nominated under subparagraph (B).
       (ii) Three members to be appointed by the President from 
     among members of the National Institute of Building Sciences 
     who are nominated under subparagraph (B).
       (iii) Four members to be appointed by the President from 
     among veterans enrolled in the patient enrollment system of 
     the Department of Veterans Affairs under section 1705 of 
     title 38, United States Code, who are nominated under 
     subparagraph (B).
       (B) Nomination of voting members.--The majority leader of 
     the Senate, the minority leader of the Senate, the speaker of 
     the House of Representatives, and the minority leader of the 
     House of Representatives shall jointly nominate not less than 
     24 individuals to be considered by the President for 
     appointment under subparagraph (A).
       (C) Nonvoting members.--The Commission shall be composed of 
     the following nonvoting members:
       (i) The Comptroller General of the United States, or 
     designee.
       (ii) The Secretary of Veterans Affairs, or designee.
       (iii) The Inspector General of the Department of Veterans 
     Affairs, or designee.
       (D) Date of appointment of members.--The appointments of 
     the members of the Commission under subparagraph (A) shall be 
     made not later than 14 days after the date of the enactment 
     of this Act.
       (3) Period of appointment; vacancies.--Members shall be 
     appointed for the life of the Commission. Any vacancy in the 
     Commission shall not affect its powers, but shall be filled 
     in the same manner as the original appointment.
       (4) Initial meeting.--Not later than five days after the 
     date on which all members of the Commission have been 
     appointed, the Commission shall hold its first meeting.
       (5) Meetings.--The Commission shall meet at the call of the 
     Chairperson.
       (6) Quorum.--A majority of the members of the Commission 
     shall constitute a quorum, but a lesser number of members may 
     hold hearings.
       (7) Chairperson and vice chairperson.--The Commission shall 
     select a Chairperson and Vice Chairperson from among its 
     members.
       (b) Duties of Commission.--
       (1) Review.--The Commission shall review current 
     construction and maintenance projects and the medical 
     facility leasing program of the Department of Veterans 
     Affairs to identify any problems experienced by the 
     Department in carrying out such projects and program.
       (2) Reports.--
       (A) Commission report.--Not later than 120 days after the 
     date of the enactment of this Act, the Commission shall 
     submit to the Secretary of Veterans Affairs, the Committee on 
     Veterans' Affairs of the Senate, and the Committee on 
     Veterans' Affairs of the House of Representatives a report 
     setting forth recommendations, if any, for improving the 
     manner in which the Secretary carries out the projects and 
     program specified in paragraph (1).
       (B) Department report.--Not later than 60 days after the 
     submittal of the report under subparagraph (A), the Secretary 
     of Veterans Affairs shall submit to the Committee on 
     Veterans' Affairs of the Senate and the Committee on 
     Veterans' Affairs of the House of Representatives a report on 
     the feasibility and advisability of implementing the 
     recommendations of the Commission, if any, included in the 
     report submitted under such subparagraph, including a 
     timeline for the implementation of such recommendations.
       (c) Powers of Commission.--
       (1) Hearings.--The Commission may hold such hearings, sit 
     and act at such times and places, take such testimony, and 
     receive such evidence as the Commission considers advisable 
     to carry out this section.
       (2) Information from federal agencies.--The Commission may 
     secure directly from any Federal agency such information as 
     the Commission considers necessary to carry out this section. 
     Upon request of the Chairperson of the Commission, the head 
     of such agency shall furnish such information to the 
     Commission.
       (d) Commission Personnel Matters.--
       (1) Compensation of members.--Each member of the Commission 
     who is not an officer or employee of the Federal Government 
     shall be compensated at a rate equal to the daily equivalent 
     of the annual rate of basic pay prescribed for level IV of 
     the Executive Schedule under section 5315 of title 5, United 
     States Code, for each day (including travel time) during 
     which such member is engaged in the performance of the duties 
     of the Commission. All members of the Commission who are 
     officers or employees of the United States shall serve 
     without compensation in addition to that received for their 
     services as officers or employees of the United States.
       (2) Travel expenses.--The members of the Commission shall 
     be allowed travel expenses, including per diem in lieu of 
     subsistence, at rates authorized for employees of agencies 
     under subchapter I of chapter 57 of title 5, United States 
     Code, while away from their homes or regular places of 
     business in the performance of services for the Commission.
       (3) Staff.--
       (A) In general.--The Chairperson of the Commission may, 
     without regard to the civil service laws and regulations, 
     appoint and terminate an executive director and such other 
     additional personnel as may be necessary to enable the 
     Commission to perform its duties. The employment of an 
     executive director shall be subject to confirmation by the 
     Commission.
       (B) Compensation.--The Chairperson of the Commission may 
     fix the compensation of the executive director and other 
     personnel without regard to chapter 51 and subchapter III of 
     chapter 53 of title 5, United States Code, relating to 
     classification of positions and General Schedule pay rates, 
     except that the rate of pay for the executive director and 
     other personnel may not exceed the rate payable for level V 
     of the Executive Schedule under section 5316 of such title.
       (4) Detail of government employees.--Any Federal Government 
     employee may be detailed to the Commission without 
     reimbursement, and such detail shall be without interruption 
     or loss of civil service status or privilege.
       (5) Procurement of temporary and intermittent services.--
     The Chairperson of the Commission may procure temporary and 
     intermittent services under section 3109(b) of title 5, 
     United States Code, at rates for individuals that do not 
     exceed the daily equivalent of the annual rate of basic pay 
     prescribed for level V of the Executive Schedule under 
     section 5316 of such title.
       (e) Termination of Commission.--The Commission shall 
     terminate 30 days after the date on which the Commission 
     submits its report under subsection (b)(2)(A).

     SEC. 403. COMMISSION ON ACCESS TO CARE.

       (a) Establishment of Commission.--
       (1) In general.--There is established the Commission on 
     Access to Care (in this section referred to as the 
     ``Commission'') to examine the

[[Page 10343]]

     access of veterans to health care from the Department of 
     Veterans Affairs and strategically examine how best to 
     organize the Veterans Health Administration, locate health 
     care resources, and deliver health care to veterans during 
     the 10- to 20-year period beginning on the date of the 
     enactment of this Act.
       (2) Membership.--
       (A) Voting members.--The Commission shall be composed of 10 
     voting members who are appointed by the President as follows:
       (i) At least two members who represent an organization 
     recognized by the Secretary of Veterans Affairs for the 
     representation of veterans under section 5902 of title 38, 
     United States Code.
       (ii) At least one member from among persons who have 
     experience as senior management for a private integrated 
     health care system with an annual gross revenue of more than 
     $50,000,000.
       (iii) At least one member from among persons who are 
     familiar with government health care systems, including those 
     systems of the Department of Defense, the Indian Health 
     Service, and Federally-qualified health centers (as defined 
     in section 1905(l)(2)(B) of the Social Security Act (42 
     U.S.C. 1396d(l)(2)(B))).
       (iv) At least two members from among persons who are 
     familiar with the Veterans Health Administration but are not 
     current employees of the Veterans Health Administration.
       (v) At least two members from among persons who are 
     veterans or eligible for hospital care, medical services, or 
     other health care under the laws administered by the 
     Secretary of Veterans Affairs.
       (B) Nonvoting members.--
       (i) In general.--In addition to members appointed under 
     subparagraph (A), the Commission shall be composed of 10 
     nonvoting members who are appointed by the President as 
     follows:

       (I) At least two members who represent an organization 
     recognized by the Secretary of Veterans Affairs for the 
     representation of veterans under section 5902 of title 38, 
     United States Code.
       (II) At least one member from among persons who have 
     experience as senior management for a private integrated 
     health care system with an annual gross revenue of more than 
     $50,000,000.
       (III) At least one member from among persons who are 
     familiar with government health care systems, including those 
     systems of the Department of Defense, the Indian Health 
     Service, and Federally-qualified health centers (as defined 
     in section 1905(l)(2)(B) of the Social Security Act (42 
     U.S.C. 1396d(l)(2)(B))).
       (IV) At least two members from among persons who are 
     familiar with the Veterans Health Administration but are not 
     current employees of the Veterans Health Administration.
       (V) At least two members from among persons who are 
     veterans or eligible for hospital care, medical services, or 
     other health care under the laws administered by the 
     Secretary of Veterans Affairs.

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

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

       (C) Date.--The appointments of members of the Commission 
     shall be made not later than 60 days after the date of the 
     enactment of this Act.
       (3) Period of appointment; vacancies.--Members shall be 
     appointed for the life of the Commission. Any vacancy in the 
     Commission shall not affect its powers, but shall be filled 
     in the same manner as the original appointment.
       (4) Initial meeting.--Not later than 15 days after the date 
     on which seven voting members of the Commission have been 
     appointed, the Commission shall hold its first meeting.
       (5) Meetings.--The Commission shall meet at the call of the 
     Chairperson.
       (6) Quorum.--A majority of the members of the Commission 
     shall constitute a quorum, but a lesser number of members may 
     hold hearings.
       (7) Chairperson and vice chairperson.--The Commission shall 
     select a Chairperson and Vice Chairperson from among its 
     members.
       (b) Duties of Commission.--
       (1) Evaluation and assessment.--The Commission shall 
     undertake a comprehensive evaluation and assessment of access 
     to health care at the Department of Veterans Affairs.
       (2) Matters evaluated and assessed.--The matters evaluated 
     and assessed by the Commission shall include the following:
       (A) The appropriateness of current standards of the 
     Department of Veterans Affairs concerning access to health 
     care.
       (B) The measurement of such standards.
       (C) The appropriateness of performance standards and 
     incentives in relation to standards described in subparagraph 
     (A).
       (D) Staffing levels throughout the Veterans Health 
     Administration and whether they are sufficient to meet 
     current demand for health care from the Administration.
       (E) The results of the assessment conducted by an 
     independent third party under section 101(a), including any 
     data or recommendations included in such assessment.
       (3) Reports.--The Commission shall submit to the President, 
     through the Secretary of Veterans Affairs, reports as 
     follows:
       (A) Not later than 90 days after the date of the initial 
     meeting of the Commission, an interim report on--
       (i) the findings of the Commission with respect to the 
     evaluation and assessment required by this subsection; and
       (ii) such recommendations as the Commission may have for 
     legislative or administrative action to improve access to 
     health care through the Veterans Health Administration.
       (B) Not later than 180 days after the date of the initial 
     meeting of the Commission, a final report on--
       (i) the findings of the Commission with respect to the 
     evaluation and assessment required by this subsection; and
       (ii) such recommendations as the Commission may have for 
     legislative or administrative action to improve access to 
     health care through the Veterans Health Administration.
       (c) Powers of the Commission.--
       (1) Hearings.--The Commission may hold such hearings, sit 
     and act at such times and places, take such testimony, and 
     receive such evidence as the Commission considers advisable 
     to carry out this section.
       (2) Information from federal agencies.--The Commission may 
     secure directly from any Federal department or agency such 
     information as the Commission considers necessary to carry 
     out this section. Upon request of the Chairperson of the 
     Commission, the head of such department or agency shall 
     furnish such information to the Commission.
       (d) Commission Personnel Matters.--
       (1) Compensation of members.--Each member of the Commission 
     who is not an officer or employee of the Federal Government 
     shall be compensated at a rate equal to the daily equivalent 
     of the annual rate of basic pay prescribed for level IV of 
     the Executive Schedule under section 5315 of title 5, United 
     States Code, for each day (including travel time) during 
     which such member is engaged in the performance of the duties 
     of the Commission. All members of the Commission who are 
     officers or employees of the United States shall serve 
     without compensation in addition to that received for their 
     services as officers or employees of the United States.
       (2) Travel expenses.--The members of the Commission shall 
     be allowed travel expenses, including per diem in lieu of 
     subsistence, at rates authorized for employees of agencies 
     under subchapter I of chapter 57 of title 5, United States 
     Code, while away from their homes or regular places of 
     business in the performance of services for the Commission.
       (3) Staff.--
       (A) In general.--The Chairperson of the Commission may, 
     without regard to the civil service laws and regulations, 
     appoint and terminate an executive director and such other 
     additional personnel as may be necessary to enable the 
     Commission to perform its duties. The employment of an 
     executive director shall be subject to confirmation by the 
     Commission.
       (B) Compensation.--The Chairperson of the Commission may 
     fix the compensation of the executive director and other 
     personnel without regard to chapter 51 and subchapter III of 
     chapter 53 of title 5, United States Code, relating to 
     classification of positions and General Schedule pay rates, 
     except that the rate of pay for the executive director and 
     other personnel may not exceed the rate payable for level V 
     of the Executive Schedule under section 5316 of such title.
       (4) Detail of government employees.--Any Federal Government 
     employee may be detailed to the Commission without 
     reimbursement, and such detail shall be without interruption 
     or loss of civil service status or privilege.
       (5) Procurement of temporary and intermittent services.--
     The Chairperson of the Commission may procure temporary and 
     intermittent services under section 3109(b) of title 5, 
     United States Code, at rates for individuals that do not 
     exceed the daily equivalent of the annual rate of basic pay 
     prescribed for level V of the Executive Schedule under 
     section 5316 of such title.
       (e) Termination of the Commission.--The Commission shall 
     terminate 30 days after the date on which the Commission 
     submits its report under subsection (b)(3)(B).
       (f) Funding.--The Secretary of Veterans Affairs shall make 
     available to the Commission from amounts appropriated or 
     otherwise made available to the Secretary such amounts as the 
     Secretary and the Chairperson of the Commission jointly 
     consider appropriate for the Commission to perform its duties 
     under this section.
       (g) Executive Action.--
       (1) Action on recommendations.--The President shall require 
     the Secretary of Veterans Affairs and such other heads of 
     relevant Federal departments and agencies to implement each 
     recommendation set forth in a report submitted under 
     subsection (b)(3) that the President--
       (A) considers feasible and advisable; and
       (B) determines can be implemented without further 
     legislative action.
       (2) Reports.--Not later than 60 days after the date on 
     which the President receives a report under subsection 
     (b)(3), the President shall submit to the Committee on 
     Veterans' Affairs of the Senate and the Committee on 
     Veterans' Affairs of the House of Representatives and such 
     other committees of Congress as the President considers 
     appropriate a report setting forth the following:
       (A) An assessment of the feasibility and advisability of 
     each recommendation contained in the report received by the 
     President.
       (B) For each recommendation assessed as feasible and 
     advisable under subparagraph (A) the following:
       (i) Whether such recommendation requires legislative 
     action.
       (ii) If such recommendation requires legislative action, a 
     recommendation concerning such legislative action.
       (iii) A description of any administrative action already 
     taken to carry out such recommendation.

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       (iv) A description of any administrative action the 
     President intends to be taken to carry out such 
     recommendation and by whom.

     SEC. 404. IMPROVED PERFORMANCE METRICS FOR HEALTH CARE 
                   PROVIDED BY DEPARTMENT OF VETERANS AFFAIRS.

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

     SEC. 405. IMPROVED TRANSPARENCY CONCERNING HEALTH CARE 
                   PROVIDED BY DEPARTMENT OF VETERANS AFFAIRS.

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

       (I) on an Internet website accessible to the public of each 
     medical center of the Department not later than 30 days after 
     such modification; and
       (II) in the Federal Register not later than 90 days after 
     such modification.

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

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

       (a) Improvement of ``Our Providers'' Internet Website 
     Links.--
       (1) Availability through department of veterans affairs 
     homepage.--A link to the ``Our Providers'' health care 
     providers database of the Department of Veterans Affairs, or 
     any successor database, shall be available on and through the 
     homepage of the Internet website of the Department that is 
     accessible to the public.
       (2) Information on location of residency training.--The 
     Internet website of the Department that is accessible to the 
     public shall include under the link to the ``Our Providers'' 
     health care providers database of the Department, or any 
     successor database, the location of residency training of 
     each licensed physician of the Department.
       (3) Information on physicians at particular facilities.--
     The ``Our Providers'' health care providers database of the 
     Department, or any successor database, shall identify whether 
     each licensed physician of the Department is a physician in 
     residency.
       (b) Information on Credentials of Physicians for Veterans 
     Undergoing Surgical Procedures.--
       (1) In general.--Each veteran who is undergoing a surgical 
     procedure by or through the Department shall be provided 
     information on the credentials of the surgeon to be 
     performing such procedure at such time in advance of the 
     procedure as is appropriate to permit such veteran to 
     evaluate such information.

[[Page 10345]]

       (2) Other individuals.--If a veteran is unable to evaluate 
     the information provided under paragraph (1) due to the 
     health or mental competence of the veteran, such information 
     shall be provided to an individual acting on behalf of the 
     veteran.
       (c) Comptroller General Report and Plan.--
       (1) Report.--Not later than two years after the date of the 
     enactment of this Act, the Comptroller General of the United 
     States shall submit to the Committee on Veterans' Affairs of 
     the Senate and the Committee on Veterans' Affairs of the 
     House of Representatives a report setting forth an assessment 
     by the Comptroller General of the following:
       (A) The manner in which contractors under the Patient-
     Centered Community Care initiative of the Department perform 
     oversight of the credentials of physicians within the 
     networks of such contractors under the initiative.
       (B) The oversight by the Department of the contracts under 
     the Patient-Centered Community Care initiative.
       (C) The verification by the Department of the credentials 
     and licenses of health care providers furnishing hospital 
     care and medical services under section 301.
       (2) Plan.--
       (A) In general.--Not later than 30 days after the submittal 
     of the report under paragraph (1), the Secretary shall--
       (i) submit to the Comptroller General, the Committee on 
     Veterans' Affairs of the Senate, and the Committee on 
     Veterans' Affairs of the House of Representatives a plan to 
     address any findings and recommendations of the Comptroller 
     General included in such report; and
       (ii) submit to the Committee on Veterans' Affairs of the 
     Senate and the Committee on Veterans' Affairs of the House of 
     Representatives a request for additional amounts, if any, 
     that may be necessary to carry out such plan.
       (B) Implementation.--Not later than 90 days after the 
     submittal of the report under paragraph (1), the Secretary 
     shall carry out such plan.

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

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

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

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

     SEC. 409. REMOVAL OF SENIOR EXECUTIVE SERVICE EMPLOYEES OF 
                   THE DEPARTMENT OF VETERANS AFFAIRS FOR 
                   PERFORMANCE.

       (a) Removal or Transfer.--
       (1) In general.--Chapter 7 of title 38, United States Code, 
     is amended by adding at the end the following new section:

     ``Sec. 713. Senior Executive Service: removal based on 
       performance

       ``(a) In General.--The Secretary may remove any individual 
     from the Senior Executive Service if the Secretary determines 
     the performance of the individual warrants such removal. If 
     the Secretary so removes such an individual, the Secretary 
     may--
       ``(1) remove the individual from the civil service (as 
     defined in section 2101 of title 5); or
       ``(2) transfer the individual to a General Schedule 
     position at any grade of the General Schedule for which the 
     individual is qualified and that the Secretary determines is 
     appropriate.
       ``(b) Notice to Congress.--Not later than 30 days after 
     removing or transferring an individual from the Senior 
     Executive Service under subsection (a), the Secretary shall 
     submit to the Committees on Veterans' Affairs of the Senate 
     and House of Representatives notice in writing of such 
     removal or transfer and the reason for such removal or 
     transfer.
       ``(c) Procedure.--(1) The procedures under section 7543 of 
     title 5 shall not apply to a removal or transfer under this 
     section.
       ``(2)(A) Subject to subparagraph (B), any removal or 
     transfer under subsection (a) may be appealed to the Merit 
     Systems Protection Board under section 7701 of title 5.
       ``(B) An appeal under subparagraph (A) of a removal or 
     transfer may only be made if such appeal is made not later 
     than 7 days after the date of such removal or transfer.
       ``(d) Expedited Review by Merit Systems Protection Board.--
     (1) The Merit Systems Protection Board shall expedite any 
     appeal under section 7701 of title 5 of a removal or transfer 
     under subsection (a) and, in any such case, shall issue a 
     decision not later than 21 days after the date of the appeal.
       ``(2) In any case in which the Merit Systems Protection 
     Board determines that it cannot issue a decision in 
     accordance with the 21-day requirement under paragraph (1), 
     the Merit Systems Protection Board shall submit to Congress a 
     report that explains the reason why the Merit Systems 
     Protection Board is unable to issue a decision in accordance 
     with such requirement in such case.
       ``(3) There is authorized to be appropriated such sums as 
     may be necessary for the Merit Systems Protection Board to 
     expedite appeals under paragraph (1).
       ``(4) The Merit Systems Protection Board may not stay any 
     personnel action taken under this section.
       ``(5) A person who appeals under section 7701 of title 5 a 
     removal under subsection (a)(1) may not receive any pay, 
     awards, bonuses, incentives, allowances, differentials, 
     student loan repayments, special payments, or benefits from 
     the Secretary until the Merit Systems Protection Board has 
     made a final decision on such appeal.
       ``(6) A decision made by the Merit Systems Protection Board 
     with respect to a removal or transfer under subsection (a) 
     shall not be subject to any further appeal.''.
       (2) Clerical amendment.--The table of sections at the 
     beginning of such chapter is amended by adding at the end the 
     following new item:

``713. Senior Executive Service: removal based on performance.''.
       (b) Establishment of Expedited Review Process.--
       (1) In general.--Not later than 30 days after the date of 
     the enactment of this Act, the Merit Systems Protection Board 
     shall establish and put into effect a process to conduct 
     expedited reviews in accordance with section 713(d) of title 
     38, United States Code.
       (2) Inapplicability of certain regulations.--Section 
     1201.22 of title 5, Code of Federal Regulations, as in effect 
     on the day before the date of the enactment of this Act, 
     shall not apply to expedited reviews carried out under 
     section 713(d) of title 38, United States Code.
       (3) Report by merit systems protection board.--Not later 
     than 30 days after the date of the enactment of this Act, the 
     Merit Systems Protection Board shall submit to Congress a 
     report on the actions the Board plans to take to conduct 
     expedited reviews under section 713(d) of title 38, United 
     States Code, as added by subsection (a). Such report shall 
     include a description of the resources the Board determines 
     will be necessary to conduct such reviews and a description 
     of whether any resources will be necessary to conduct such 
     reviews that were not available to the Board on the day 
     before the date of the enactment of this Act.
       (c) Temporary Exemption From Certain Limitation on 
     Initiation of Removal From Senior Executive Service.--During 
     the 120-day period beginning on the date of the enactment of 
     this Act, an action to remove an individual from the Senior 
     Executive Service at the Department of Veterans Affairs 
     pursuant to section 713 of title 38, United States Code, as 
     added by subsection (a), or section 7543 of title 5, United 
     States Code, may be initiated, notwithstanding section 
     3592(b) of title 5, United States Code, or any other 
     provision of law.
       (d) Construction.--Nothing in this section or section 713 
     of title 38, United States Code, as added by subsection (a), 
     shall be construed to apply to an appeal of a removal, 
     transfer, or other personnel action that was pending before 
     the date of the enactment of this Act.

             TITLE V--HEALTH CARE RELATED TO SEXUAL TRAUMA

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

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

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

       (a) Expansion of Coverage to Members of the Armed Forces.--
     Subsection (a) of section 1720D of title 38, United States 
     Code, is amended--
       (1) by redesignating paragraph (2) as paragraph (3);
       (2) by inserting after paragraph (1) the following new 
     paragraph (2):
       ``(2)(A) In operating the program required by paragraph 
     (1), the Secretary may, in consultation with the Secretary of 
     Defense, provide counseling and care and services to members 
     of

[[Page 10346]]

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

     SEC. 503. REPORTS ON MILITARY SEXUAL TRAUMA.

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

                TITLE VI--MAJOR MEDICAL FACILITY LEASES

     SEC. 601. AUTHORIZATION OF MAJOR MEDICAL FACILITY LEASES.

       The Secretary of Veterans Affairs may carry out the 
     following major medical facility leases at the locations 
     specified, and in an amount for each lease not to exceed the 
     amount shown for such location (not including any estimated 
     cancellation costs):
       (1) For a clinical research and pharmacy coordinating 
     center, Albuquerque, New Mexico, an amount not to exceed 
     $9,560,000.
       (2) For a community-based outpatient clinic, Brick, New 
     Jersey, an amount not to exceed $7,280,000.
       (3) For a new primary care and dental clinic annex, 
     Charleston, South Carolina, an amount not to exceed 
     $7,070,250.
       (4) For the Cobb County community-based Outpatient Clinic, 
     Cobb County, Georgia, an amount not to exceed $6,409,000.
       (5) For the Leeward Outpatient Healthcare Access Center, 
     Honolulu, Hawaii, including a co-located clinic with the 
     Department of Defense and the co-location of the Honolulu 
     Regional Office of the Veterans Benefits Administration and 
     the Capel Vet Center of the Department of Veterans Affairs, 
     an amount not to exceed $15,887,370.
       (6) For a community-based outpatient clinic, Johnson 
     County, Kansas, an amount not to exceed $2,263,000.
       (7) For a replacement community-based outpatient clinic, 
     Lafayette, Louisiana, an amount not to exceed $2,996,000.
       (8) For a community-based outpatient clinic, Lake Charles, 
     Louisiana, an amount not to exceed $2,626,000.
       (9) For outpatient clinic consolidation, New Port Riche, 
     Florida, an amount not to exceed $11,927,000.
       (10) For an outpatient clinic, Pence, Puerto Rico, an 
     amount not to exceed $11,535,000.
       (11) For lease consolidation, San Antonio, Texas, an amount 
     not to exceed $19,426,000.
       (12) For a community-based outpatient clinic, San Diego, 
     California, an amount not to exceed $11,946,100.
       (13) For an outpatient clinic, Tyler, Texas, an amount not 
     to exceed $4,327,000.
       (14) For the Arere Community Care Center, West Haven, 
     Connecticut, an amount not to exceed $4,883,000.
       (15) For the Worcester community-based Outpatient Clinic, 
     Worcester, Massachusetts, an amount not to exceed $4,855,000.
       (16) For the expansion of a community-based outpatient 
     clinic, Cape Girardeau, Missouri, an amount not to exceed 
     $4,232,060.
       (17) For a multi specialty clinic, Chattanooga, Tennessee, 
     an amount not to exceed $7,069,000.
       (18) For the expansion of a community-based outpatient 
     clinic, Chico, California, an amount not to exceed 
     $4,534,000.
       (19) For a community-based outpatient clinic, Chula Vista, 
     California, an amount not to exceed $3,714,000.
       (20) For a new research lease, Haines, Illinois, an amount 
     not to exceed $22,032,000.
       (21) For a replacement research lease, Houston, Texas, an 
     amount not to exceed $6,142,000.
       (22) For a community-based outpatient clinic, Lincoln, 
     Nebraska, an amount not to exceed $7,178,400.
       (23) For a community-based outpatient clinic, Lubbock, 
     Texas, an amount not to exceed $8,554,000.
       (24) For a community-based outpatient clinic consolidation, 
     Myrtle Beach, South Carolina, an amount not to exceed 
     $8,022,000.
       (25) For a community-based outpatient clinic, Phoenix, 
     Arizona, an amount not to exceed $20,757,000.
       (26) For the expansion of a community-based outpatient 
     clinic, Redding, California, an amount not to exceed 
     $8,154,000.

     SEC. 602. BUDGETARY TREATMENT OF DEPARTMENT OF VETERANS 
                   AFFAIRS MAJOR MEDICAL FACILITIES LEASES.

       (a) Findings.--Congress finds the following:
       (1) Title 31, United States Code, requires the Department 
     of Veterans Affairs to record the full cost of its 
     contractual obligation against funds available at the time a 
     contract is executed.
       (2) Office of Management and Budget Circular A-11 provides 
     guidance to agencies in meeting the statutory requirements 
     under title 31, United States Code, with respect to leases.
       (3) For operating leases, Office of Management and Budget 
     Circular A-11 requires the Department of Veterans Affairs to 
     record up-front budget authority in an ``amount equal to 
     total payments under the full term of the lease or [an] 
     amount sufficient to cover first year lease payments plus 
     cancellation costs''.
       (b) Requirement for Obligation of Full Cost.--
       (1) In general.--Subject to the availability of 
     appropriations provided in advance, in exercising the 
     authority of the Secretary of Veterans Affairs to enter into 
     leases provided in this Act, the Secretary shall record, 
     pursuant to section 1501 of title 31, United States Code, as 
     the full cost of the contractual obligation at the time a 
     contract is executed either--
       (A) an amount equal to total payments under the full term 
     of the lease; or
       (B) if the lease specifies payments to be made in the event 
     the lease is terminated before its full term, an amount 
     sufficient to cover the first year lease payments plus the 
     specified cancellation costs.
       (2) Self-insuring authority.--The requirements of paragraph 
     (1) may be satisfied through the use of a self-insuring 
     authority consistent with Office of Management and Budget 
     Circular A-11.

[[Page 10347]]

       (c) Transparency.--
       (1) Compliance.--Subsection (b) of section 8104 of title 
     38, United States Code, is amended by adding at the end the 
     following new paragraph:
       ``(7) In the case of a prospectus proposing funding for a 
     major medical facility lease, a detailed analysis of how the 
     lease is expected to comply with Office of Management and 
     Budget Circular A-11 and section 1341 of title 31 (commonly 
     referred to as the `Anti-Deficiency Act'). Any such analysis 
     shall include--
       ``(A) an analysis of the classification of the lease as a 
     `lease-purchase', `capital lease', or `operating lease' as 
     those terms are defined in Office of Management and Budget 
     Circular A-11;
       ``(B) an analysis of the obligation of budgetary resources 
     associated with the lease; and
       ``(C) an analysis of the methodology used in determining 
     the asset cost, fair market value, and cancellation costs of 
     the lease.''.
       (2) Submittal to congress.--Such section 8104 is further 
     amended by adding at the end the following new subsection:
       ``(h)(1) Not less than 30 days before entering into a major 
     medical facility lease, the Secretary shall submit to the 
     Committees on Veterans' Affairs of the Senate and the House 
     of Representatives--
       ``(A) notice of the Secretary's intention to enter into the 
     lease;
       ``(B) a detailed summary of the proposed lease;
       ``(C) a description and analysis of any differences between 
     the prospectus submitted pursuant to subsection (b) and the 
     proposed lease; and
       ``(D) a scoring analysis demonstrating that the proposed 
     lease fully complies with Office of Management and Budget 
     Circular A-11.
       ``(2) Each committee described in paragraph (1) shall 
     ensure that any information submitted to the committee under 
     such paragraph is treated by the committee with the same 
     level of confidentiality as is required by law of the 
     Secretary and subject to the same statutory penalties for 
     unauthorized disclosure or use as the Secretary.
       ``(3) Not more than 30 days after entering into a major 
     medical facility lease, the Secretary shall submit to each 
     committee described in paragraph (1) a report on any material 
     differences between the lease that was entered into and the 
     proposed lease described under such paragraph, including how 
     the lease that was entered into changes the previously 
     submitted scoring analysis described in subparagraph (D) of 
     such paragraph.''.
       (d) Rule of Construction.--Nothing in this section, or the 
     amendments made by this section, shall be construed to in any 
     way relieve the Department of Veterans Affairs from any 
     statutory or regulatory obligations or requirements existing 
     prior to the enactment of this section and such amendments.

                  TITLE VII--VETERANS BENEFITS MATTERS

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

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

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

       (a) In General.--Section 3679 of title 38, United States 
     Code, is amended by adding at the end the following new 
     subsection:
       ``(c)(1) Notwithstanding any other provision of this 
     chapter and subject to paragraphs (3) through (6), the 
     Secretary shall disapprove a course of education provided by 
     a public institution of higher learning to a covered 
     individual pursuing a course of education with educational 
     assistance under chapter 30 or 33 of this title while living 
     in the State in which the public institution of higher 
     learning is located if the institution charges tuition and 
     fees for that course for the covered individual at a rate 
     that is higher than the rate the institution charges for 
     tuition and fees for that course for residents of the State 
     in which the institution is located, regardless of the 
     covered individual's State of residence.
       ``(2) For purposes of this subsection, a covered individual 
     is any individual as follows:
       ``(A) A veteran who was discharged or released from a 
     period of not fewer than 90 days of service in the active 
     military, naval, or air service less than three years before 
     the date of enrollment in the course concerned.
       ``(B) An individual who is entitled to assistance under 
     section 3311(b)(9) or 3319 of this title by virtue of such 
     individual's relationship to a veteran described in 
     subparagraph (A).
       ``(3) If after enrollment in a course of education that is 
     subject to disapproval under paragraph (1) by reason of 
     paragraph (2)(A) or (2)(B) a covered individual pursues one 
     or more courses of education at the same public institution 
     of higher learning while remaining continuously enrolled 
     (other than during regularly scheduled breaks between 
     courses, semesters or terms) at that institution of higher 
     learning, any course so pursued by the covered individual at 
     that institution of higher learning while so continuously 
     enrolled shall also be subject to disapproval under paragraph 
     (1).
       ``(4) It shall not be grounds to disapprove a course of 
     education under paragraph (1) if a public institution of 
     higher learning requires a covered individual pursuing a 
     course of education at the institution to demonstrate an 
     intent, by means other than satisfying a physical presence 
     requirement, to establish residency in the State in which the 
     institution is located, or to satisfy other requirements not 
     relating to the establishment of residency, in order to be 
     charged tuition and fees for that course at a rate that is 
     equal to or less than the rate the institution charges for 
     tuition and fees for that course for residents of the State.
       ``(5) The Secretary may waive such requirements of 
     paragraph (1) as the Secretary considers appropriate.
       ``(6) Disapproval under paragraph (1) shall apply only with 
     respect to educational assistance under chapters 30 and 33 of 
     this title.''.
       (b) Effective Date.--Subsection (c) of section 3679 of 
     title 38, United States Code (as added by subsection (a) of 
     this section), shall apply with respect to educational 
     assistance provided for pursuit of programs of education 
     during academic terms that begin after July 1, 2015, through 
     courses of education that commence on or after that date.

          TITLE VIII--APPROPRIATION AND EMERGENCY DESIGNATIONS

     SEC. 801. APPROPRIATION OF EMERGENCY AMOUNTS.

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

     SEC. 802. EMERGENCY DESIGNATIONS.

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

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


                Motion Offered by Mr. Miller of Florida

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

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

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

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

     SECTION 1. SHORT TITLE.

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

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

       (a) In General.--As authorized by section 1710 of title 38, 
     United States Code, the Secretary of Veterans Affairs (in 
     this Act referred to as the ``Secretary'') shall enter into 
     contracts with such non-Department facilities as may be 
     necessary in order to furnish hospital care and medical 
     services to covered veterans who are eligible for such care 
     and services under chapter 17 of title 38, United States 
     Code. To the greatest extent possible, the Secretary shall 
     carry out this section using contracts entered into before 
     the date of the enactment of this Act.

[[Page 10348]]

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

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

       (a) In General.--To the extent that appropriations are 
     available for the Veterans Health Administration of the 
     Department of Veterans Affairs for medical services, to the 
     extent that the Secretary of Veterans Affairs is unable to 
     provide access, within the wait-time goals of the Veterans 
     Health Administration (as of June 1, 2014), to hospital care 
     or medical services to a covered veteran who is eligible for 
     such care or services under chapter 17 of title 38, United 
     States Code, under contracts described in section 2, the 
     Secretary shall reimburse any non-Department facility with 
     which the Secretary has not entered into a contract to 
     furnish hospital care or medical services for furnishing such 
     hospital care or medical services to such veteran, if the 
     veteran elects to receive such care or services from the non-
     Department facility. The Secretary shall reimburse the 
     facility for the care or services furnished to the veteran at 
     the greatest of the following rates:
       (1) VA payment rate.--The rate of reimbursement for such 
     care or services established by the Secretary of Veterans 
     Affairs.
       (2) Medicare payment rate.--The payment rate for such care 
     or services or comparable care or services under the Medicare 
     program under title XVIII of the Social Security Act.
       (3) TRICARE payment rate.--The reimbursement rate for such 
     care or services furnished to a member of the Armed Forces 
     under chapter 55 of title 10, United States Code.
       (b) Covered Veterans.--For purposes of this section, the 
     term ``covered veteran'' means a veteran--
       (1) who is enrolled in the patient enrollment system under 
     section 1705 of title 38, United States Code; and
       (2) who--
       (A) has waited longer than the wait-time goals of the 
     Veterans Health Administration (as of June 1, 2014) for an 
     appointment for hospital care or medical services in a 
     facility of the Department;
       (B) has been notified by a facility of the Department that 
     an appointment for hospital care or medical services is not 
     available within such wait-time goals after the date for 
     which the veteran requests the appointment; or
       (C) who resides more than 40 miles from the medical 
     facility of the Department of Veterans Affairs, including a 
     community-based outpatient clinic, that is closest to the 
     residence of the veteran.
       (c) Definitions.--For purposes of this section, the terms 
     ``facilities of the Department'', ``non-Department 
     facilities'', ``hospital care'', and ``medical services'' 
     have the meanings given such terms in section 1701 of title 
     38, United States Code.
       (d) Implementation.--The Secretary shall begin implementing 
     this section on the date of the enactment of this Act.
       (e) Construction.--Nothing in this section shall be 
     construed to authorize payment for care or services not 
     otherwise covered under chapter 17 of title 38, United States 
     Code.
       (f) Termination.--The authority of the Secretary under this 
     section shall terminate with respect to care or services 
     furnished after the date that is 2 years after the date of 
     the enactment of this Act.

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

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

[[Page 10349]]

       (1) Report on independent assessment.--Not later than 10 
     months after entering into the contract under subsection (a), 
     the Secretary shall submit to the Committees on Veterans' 
     Affairs of the Senate and House of Representatives the 
     findings and recommendations of the independent assessment 
     required by such subsection.
       (2) Report on va action plan to implement recommendations 
     in assessment.--Not later than 120 days after the date of 
     submission of the report under paragraph (1), the Secretary 
     shall submit to such Committees on the Secretary's response 
     to the findings of the assessment and shall include an action 
     plan, including a timeline, for fully implementing the 
     recommendations of the assessment.

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

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

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

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

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

       (a) In General.--Chapter 7 of title 38, United States Code, 
     is amended by adding at the end the following new section:

     ``Sec. 713. Senior Executive Service: removal based on 
       performance

       ``(a) In General.--Notwithstanding any other provision of 
     law, the Secretary may remove any individual from the Senior 
     Executive Service if the Secretary determines the performance 
     of the individual warrants such removal. If the Secretary so 
     removes such an individual, the Secretary may--
       ``(1) remove the individual from Federal service; or
       ``(2) transfer the individual to a General Schedule 
     position at any grade of the General Schedule the Secretary 
     determines appropriate.
       ``(b) Notice to Congress.--Not later than 30 days after 
     removing an individual from the Senior Executive Service 
     under paragraph (1), the Secretary shall submit to the 
     Committees on Veterans' Affairs of the Senate and House of 
     Representatives notice in writing of such removal and the 
     reason for such removal.
       ``(c) Manner of Removal.--A removal under this section 
     shall be done in the same manner as the removal of a 
     professional staff member employed by a Member of 
     Congress.''.
       (b) Clerical Amendment.--The table of sections at the 
     beginning of such chapter is amended by adding at the end the 
     following new item:

``713. Senior Executive Service: removal based on performance.''.

     SEC. 8. BUDGETARY EFFECTS OF ACT.

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

  The SPEAKER pro tempore. Pursuant to House Resolution 628, the motion 
shall be debatable for 1 hour equally divided and controlled by the 
chair and ranking minority member of the Committee on Veterans' 
Affairs.
  The gentleman from Florida (Mr. Miller) and the gentleman from Maine 
(Mr. Michaud) each will control 30 minutes.
  The Chair recognizes the gentleman from Florida.
  Mr. MILLER of Florida. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, this motion is to help us go to conference and to 
quickly work out the differences between the House and Senate bills 
that would provide meaningful reform to the Department of Veterans 
Affairs.
  This motion also ensures that the House has a position from which to 
begin negotiations with the Senate in a conference.
  Mr. Speaker, I reserve the balance of my time.
  Mr. MICHAUD. Mr. Speaker, I support the motion to concur in the 
Senate amendments, and a further amendment, and I support the motion to 
go to conference.
  The crisis within the VA is of national interest and must be a 
congressional priority. America's veterans deserve timely access to the 
care and benefits they have earned. They fought for us. Now is the time 
that we fight for them.
  But our fight should not be just about the failures in Phoenix and 
other facilities. The House has worked hard to develop important and 
much-needed legislation to address other failures within the VA. 
Enhanced programs ensure the VA is working on behalf of the veterans.
  I am disappointed that we have not included in this amendment all 
relevant bills that have passed the House to ensure that these 
important matters are included. I am disappointed that we are not 
moving forward with a more comprehensive package of reforms.
  I am also disappointed that the House amendment is limited to two 
measures we have recently passed, H.R. 4031 and H.R. 4810. Limiting 
ourselves to just Republican-sponsored legislation, no matter how 
widely supported, runs counter to the bipartisan spirit of the 
committee and fails to recognize the great work of all committee 
Members. Republicans and Democrats have worked together to improve 
programs for the VA.
  Finally, I am disappointed that H.R. 4399 was not included in the 
House amendment to H.R. 3230. Without it, we are falling short of our 
responsibility to hold all VA executives--I want to emphasize all VA 
executives--accountable for the grave failures lately.

                              {time}  1330

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

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