[Congressional Record (Bound Edition), Volume 160 (2014), Part 9]
[House]
[Pages 13342-13365]
[From the U.S. Government Publishing Office, www.gpo.gov]




     CONFERENCE REPORT ON H.R. 3230, PAY OUR GUARD AND RESERVE ACT

  Mr. MILLER of Florida submitted the following conference report and 
statement on 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:

                           Conference Report

                            H. Rept. 113-564

       The committee of conference on the disagreeing votes of the 
     two Houses on the amendment of the House to the amendment of 
     the Senate to the bill (H.R. 3230), making continuing 
     appropriations during a Government shutdown to provide pay 
     and allowances to members of the reserve components

[[Page 13343]]

     of the Armed Forces who perform inactive-duty training during 
     such period, having met, after full and free conference, have 
     agreed to recommend and do recommend to their respective 
     Houses as follows:
       That the Senate recede from its disagreement to the 
     amendment of the House and agree to the same with an 
     amendment as follows:
       In lieu of the matter proposed to be inserted by the House 
     amendment, insert the following:

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Veterans 
     Access, Choice, and Accountability Act of 2014''.
       (b) Table of Contents.--The table of contents for this Act 
     is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Definitions.

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

Sec. 101. Expanded availability of hospital care and medical services 
              for veterans through the use of agreements with non-
              Department of Veterans Affairs entities.
Sec. 102. Enhancement of collaboration between Department of Veterans 
              Affairs and Indian Health Service.
Sec. 103. Enhancement of collaboration between Department of Veterans 
              Affairs and Native Hawaiian health care systems.
Sec. 104. Reauthorization and modification of pilot program of enhanced 
              contract care authority for health care needs of 
              veterans.
Sec. 105. Prompt payment by Department of Veterans Affairs.
Sec. 106. Transfer of authority for payments for hospital care, medical 
              services, and other health care from non-Department of 
              Veterans Affairs providers to the chief business office 
              of the Veterans Health Administration.

              TITLE II--HEALTH CARE ADMINISTRATIVE MATTERS

Sec. 201. Independent assessment of the health care delivery systems 
              and management processes of the Department of Veterans 
              Affairs.
Sec. 202. Commission on Care.
Sec. 203. Technology task force on review of scheduling system and 
              software of the Department of Veterans Affairs.
Sec. 204. Improvement of access of veterans to mobile vet centers and 
              mobile medical centers of the Department of Veterans 
              Affairs.
Sec. 205. Improved performance metrics for health care provided by 
              Department of Veterans Affairs.
Sec. 206. Improved transparency concerning health care provided by 
              Department of Veterans Affairs.
Sec. 207. Information for veterans on the credentials of Department of 
              Veterans Affairs physicians.
Sec. 208. Information in annual budget of the President on hospital 
              care and medical services furnished through expanded use 
              of contracts for such care.
Sec. 209. Prohibition on falsification of data concerning wait times 
              and quality measures at Department of Veterans Affairs.

   TITLE III--HEALTH CARE STAFFING, RECRUITMENT, AND TRAINING MATTERS

Sec. 301. Treatment of staffing shortage and biennial report on 
              staffing of medical facilities of the Department of 
              Veterans Affairs.
Sec. 302. Extension and modification of certain programs within the 
              Department of Veterans Affairs Health Professionals 
              Educational Assistance Program.
Sec. 303. Clinic management training for employees at medical 
              facilities of the Department of Veterans Affairs.

             TITLE IV--HEALTH CARE RELATED TO SEXUAL TRAUMA

Sec. 401. Expansion of eligibility for sexual trauma counseling and 
              treatment to veterans on inactive duty training.
Sec. 402. Provision of counseling and treatment for sexual trauma by 
              the Department of Veterans Affairs to members of the 
              Armed Forces.
Sec. 403. Reports on military sexual trauma.

                   TITLE V--OTHER HEALTH CARE MATTERS

Sec. 501. Extension of pilot program on assisted living services for 
              veterans with traumatic brain injury.

                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--OTHER VETERANS MATTERS

Sec. 701. Expansion of Marine Gunnery Sergeant John David Fry 
              Scholarship.
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.
Sec. 703. Extension of reduction in amount of pension furnished by 
              Department of Veterans Affairs for certain veterans 
              covered by Medicaid plans for services furnished by 
              nursing facilities.
Sec. 704. Extension of requirement for collection of fees for housing 
              loans guaranteed by Secretary of Veterans Affairs.
Sec. 705. Limitation on awards and bonuses paid to employees of 
              Department of Veterans Affairs.
Sec. 706. Extension of authority to use income information.
Sec. 707. Removal of senior executives of the Department of Veterans 
              Affairs for performance or misconduct.

                       TITLE VIII--OTHER MATTERS

Sec. 801. Appropriation of amounts.
Sec. 802. Veterans Choice Fund.
Sec. 803. Emergency designations.

     SEC. 2. DEFINITIONS.

       In this Act:
       (1) The term ``facility of the Department'' has the meaning 
     given the term ``facilities of the Department'' in section 
     1701 of title 38, United States Code.
       (2) The terms ``hospital care'' and ``medical services'' 
     have the meanings given such terms in section 1701 of title 
     38, United States Code.

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

     SEC. 101. EXPANDED AVAILABILITY OF HOSPITAL CARE AND MEDICAL 
                   SERVICES FOR VETERANS THROUGH THE USE OF 
                   AGREEMENTS WITH NON-DEPARTMENT OF VETERANS 
                   AFFAIRS ENTITIES.

       (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 agreements 
     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 makes an 
     election under subsection (c) to receive hospital care or 
     medical services under this section may select a provider of 
     such care or services from among the entities specified in 
     paragraph (1)(B) that are 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 wait-time 
     goals of the Veterans Health Administration for the 
     furnishing of hospital care and medical services.
       (b) Eligible Veterans.--A veteran is an eligible veteran 
     for purposes of this section if--
       (1)(A) as of August 1, 2014, 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, including any such veteran who 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; or
       (B) the veteran is eligible for hospital care and medical 
     services under section 1710(e)(1)(D) of such title and is a 
     veteran described in section 1710(e)(3) of such title; and
       (2) the veteran--
       (A) attempts, or has attempted, 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 wait-time goals of the 
     Veterans Health Administration for the furnishing of such 
     care or services;
       (B) resides more than 40 miles from the medical facility of 
     the Department, including a community-based outpatient 
     clinic, that is closest to the residence of the veteran;
       (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

[[Page 13344]]

       (ii) more than 20 miles from a medical facility of the 
     Department described in clause (i); or
       (D)(i) resides in a location, other than a location in 
     Guam, American Samoa, or the Republic of the Philippines, 
     that is 40 miles or less from a medical facility of the 
     Department, including a community-based outpatient clinic; 
     and
       (ii)(I) is required to travel by air, boat, or ferry to 
     reach each medical facility described in clause (i) that is 
     40 miles or less from the residence of the veteran; or
       (II) faces an unusual or excessive burden in accessing each 
     medical facility described in clause (i) that is 40 miles or 
     less from the residence of the veteran due to geographical 
     challenges, as determined by the Secretary.
       (c) Election and Authorization.--
       (1) In general.--In the case of an eligible veteran 
     described in subsection (b)(2)(A), 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 an appointment for 
     hospital care or medical services the veteran has elected to 
     receive under this section; or
       (B)(i) authorize that such care or services be furnished to 
     the eligible veteran under this section for a period of time 
     specified by the Secretary; and
       (ii) notify the eligible veteran by the most effective 
     means available, including electronic communication or 
     notification in writing, describing the care or 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 Agreements.--
       (1) Agreements.--
       (A) In general.--The Secretary shall enter into agreements 
     for furnishing care and services to eligible veterans under 
     this section with entities specified in subsection (a)(1)(B).
       (B) Agreement defined.--In this paragraph, the term 
     ``agreement'' includes contracts, intergovernmental 
     agreements, and provider agreements, as appropriate.
       (2) Rates and reimbursement.--
       (A) In general.--In entering into an agreement under 
     paragraph (1) with an entity specified in subsection 
     (a)(1)(B), the Secretary shall--
       (i) negotiate rates for the furnishing of care and services 
     under this section; and
       (ii) reimburse the entity for such care and services at the 
     rates negotiated pursuant to clause (i) as provided in such 
     agreement.
       (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 or services.
       (ii) Exception.--

       (I) In general.--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 who resides in a 
     highly rural area.
       (II) Highly rural area defined.--In this clause, the term 
     ``highly rural area'' means an area located in a county that 
     has fewer than seven individuals residing in that county per 
     square mile.

       (C) Limit on collection.--For the furnishing of care or 
     services pursuant to an agreement under paragraph (1), an 
     entity specified in subsection (a)(1)(B) may not collect any 
     amount that is greater than the rate negotiated pursuant to 
     subparagraph (A)(i).
       (3) Certain procedures.--
       (A) In general.--In entering into an agreement under 
     paragraph (1) with an entity described in subparagraph (B), 
     the Secretary may use the procedures, including those 
     procedures relating to reimbursement, available for entering 
     into provider agreements under section 1866(a) of the Social 
     Security Act (42 U.S.C. 1395cc(a)). During the period in 
     which such entity furnishes care or services pursuant to this 
     section, such entity may not be treated as a Federal 
     contractor or subcontractor by the Office of Federal Contract 
     Compliance Programs of the Department of Labor by virtue of 
     furnishing such care or services.
       (B) Entities described.--The entities described in this 
     subparagraph are the following:
       (i) In the case of the Medicare program, any provider of 
     service that has entered into a provider agreement under 
     section 1866(a) of the Social Security Act (42 U.S.C. 
     1395cc(a)); and
       (ii) In the case of the Medicaid program, any provider 
     participating under a State plan under title XIX of such Act 
     (42 U.S.C. 1396 et seq.).
       (4) Information on policies and procedures.--The Secretary 
     shall provide to any entity with which the Secretary has 
     entered into an agreement under paragraph (1) the following:
       (A) Information on applicable policies and procedures for 
     submitting bills or claims for authorized care or services 
     furnished to eligible veterans under this section.
       (B) Access to a telephone hotline maintained by the 
     Department that such entity 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) Other Health-care Plan.--
       (1) Submittal of information to secretary.--Before 
     receiving hospital care or medical services under this 
     section, an eligible veteran shall provide to the Secretary 
     information on any health-care plan described in paragraph 
     (4) under which the eligible veteran is covered.
       (2) Disclosure of information to non-department entity.--
     Notwithstanding section 5701 of title 38, United States Code, 
     for purposes of furnishing hospital care or medical services 
     to an eligible veteran under this section, the Secretary 
     shall disclose to the entity specified in paragraph (1)(B) of 
     subsection (a) with which the Secretary has entered into an 
     agreement described in such subsection--
       (A) whether the eligible veteran is covered under a health-
     care plan described in paragraph (4); and
       (B) whether the hospital care or medical services sought by 
     the eligible veteran is for a medical condition that is 
     related to a non-service-connected disability described in 
     paragraph (3)(C).
       (3) Care for which the department is secondarily 
     responsible.--
       (A) In general.--If an eligible veteran is covered under a 
     health-care plan described in paragraph (4) and receives 
     hospital care or medical services for a non-service-connected 
     disability described in subparagraph (C), such health-care 
     plan shall be primarily responsible for paying for such care 
     or services, to the extent such care or services is covered 
     by such health-care plan, and the Secretary shall be 
     secondarily responsible for paying for such care or services 
     in accordance with subparagraph (B)(ii).
       (B) Responsibility for costs of care.--In a case in which 
     the Secretary is secondarily responsible for paying for 
     hospital care or medical services as described in 
     subparagraph (A)--
       (i) the health care provider that furnishes such care or 
     services pursuant to an agreement described in subsection (a) 
     shall be responsible for seeking reimbursement for the cost 
     of such care or services from the health-care plan described 
     in paragraph (4) under which the eligible veteran is covered; 
     and
       (ii) the Secretary shall be responsible for promptly paying 
     only the amount that is not covered by such health-care plan, 
     except that such responsibility for payment may not exceed 
     the rate determined for such care or services pursuant to 
     subsection (d)(2).
       (C) Non-service-connected disability described.--A non-
     service-connected disability described in this subsection is 
     a non-service-connected disability (as defined in section 101 
     of title 38, United States Code)--
       (i) that is incurred incident to a veteran's employment and 
     that is covered under a workers' compensation law or plan 
     that provides for payment for the cost of health care and 
     services provided to the veteran by reason of the disability;
       (ii) that is incurred as the result of a motor vehicle 
     accident to which applies a State law that requires the 
     owners or operators of motor vehicles registered in that 
     State to have in force automobile accident reparations 
     insurance;
       (iii) that is incurred as the result of a crime of personal 
     violence that occurred in a State, or a political subdivision 
     of a State, in which a person injured as the result of such a 
     crime is entitled to receive health care and services at such 
     State's or subdivision's expense for personal injuries 
     suffered as the result of such crime;
       (iv) that is incurred by a veteran--

       (I) who does not have a service-connected disability; and
       (II) who is entitled to care (or payment of the expenses of 
     care) under a health-care plan; or

       (v) for which care and services are furnished under this 
     section to a veteran who--

       (I) has a service-connected disability; and
       (II) is entitled to care (or payment of the expenses of 
     care) under a health-care plan.

       (4) Health-care plan.--A health-care plan described in this 
     paragraph--
       (A) is an insurance policy or contract, medical or hospital 
     service agreement, membership or subscription contract, or 
     similar arrangement not administered by the Secretary of 
     Veterans Affairs, under which health services for individuals 
     are provided or the expenses of such services are paid; and
       (B) does not include any such policy, contract, agreement, 
     or similar arrangement pursuant to title XVIII or XIX of the 
     Social Security Act (42 U.S.C. 1395 et seq.) or chapter 55 of 
     title 10, United States Code.
       (f) Veterans Choice Card.--
       (1) In general.--For purposes of receiving care and 
     services under this section, the Secretary shall, not later 
     than 90 days after the date of the enactment of this Act, 
     issue to each veteran described in subsection (b)(1) a card 
     that may be presented to a health care provider

[[Page 13345]]

     to facilitate the receipt of care or services under this 
     section.
       (2) Name of card.--Each card issued under paragraph (1) 
     shall be known as a ``Veterans Choice Card''.
       (3) Details of card.--Each Veterans Choice Card issued to a 
     veteran under paragraph (1) shall include the following:
       (A) The name of the veteran.
       (B) An identification number for the veteran that is not 
     the social security number of the veteran.
       (C) The contact information of an appropriate office of the 
     Department for health care providers to confirm that care or 
     services under this section are authorized for the veteran.
       (D) Contact information and other relevant information for 
     the submittal of claims or bills for the furnishing of care 
     or 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 Veterans 
     Choice Card to a veteran, the Secretary shall provide the 
     veteran with information clearly stating the circumstances 
     under which the veteran may be eligible for care or services 
     under this section.
       (g) 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) In the case of a veteran described in subsection 
     (b)(1)(B), 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 wait-time goals of the Veterans Health Administration for 
     the furnishing of such care or services.
       (3) When the veteran becomes eligible for hospital care or 
     medical services under this section under subparagraph (B), 
     (C), or (D) of subsection (b)(2).
       (h) Follow-Up Care.--In carrying out this section, the 
     Secretary shall ensure that, at the election of an eligible 
     veteran who receives hospital care or medical services from a 
     health care provider in an episode of care under this 
     section, the veteran receives such hospital care and medical 
     services from such health care provider 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.
       (i) Providers.--To be eligible to furnish care or 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 during 
     the period in which the Secretary is authorized to carry out 
     this section pursuant to subsection (p), verification of such 
     licenses and credentials maintained by such health care 
     provider.
       (j) Cost-sharing.--
       (1) In general.--The Secretary shall require an eligible 
     veteran to pay a copayment for the receipt of care or 
     services under this section only if such eligible veteran 
     would be required to pay a copayment for the receipt of such 
     care or services at a medical facility of the Department or 
     from a health care provider of the Department pursuant to 
     chapter 17 of title 38, United States Code.
       (2) Limitation.--The amount of a copayment charged under 
     paragraph (1) may not exceed the amount of the copayment that 
     would be payable by such eligible veteran for the receipt of 
     such care or services at a medical facility of the Department 
     or from a health care provider of the Department pursuant to 
     chapter 17 of title 38, United States Code.
       (3) Collection of copayment.--A health care provider that 
     furnishes care or services to an eligible veteran under this 
     section shall collect the copayment required under paragraph 
     (1) from such eligible veteran at the time of furnishing such 
     care or services.
       (k) 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) Quarterly report.--
       (i) In general.--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 quarterly report on the 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 quarter covered by the report.

       (iii) Deadline.--The Secretary shall submit each report 
     required by clause (i) not later than 20 days after the end 
     of the quarter covered by the report.
       (l) Medical Records.--
       (1) In general.--The Secretary shall ensure that any health 
     care provider that furnishes care or services under this 
     section to an eligible veteran submits to the Department any 
     medical record related to the care or 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 or services to such eligible 
     veteran.
       (2) Electronic format.--Any medical record submitted to the 
     Department under paragraph (1) shall, to the extent possible, 
     be in an electronic format.
       (m) Tracking of Missed Appointments.--The Secretary shall 
     implement a mechanism to track any missed appointments for 
     care or services under this section by eligible veterans to 
     ensure that the Department does not pay for such care or 
     services that were not furnished to an eligible veteran.
       (n) 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.
       (o) Inspector General Report.--Not later than 30 days after 
     the date on which the Secretary determines that 75 percent of 
     the amounts deposited in the Veterans Choice Fund established 
     by section 802 have been exhausted, 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.
       (p) Authority to Furnish Care and Services.--
       (1) In general.--The Secretary may not use the authority 
     under this section to furnish care and services after the 
     date specified in paragraph (2).
       (2) Date specified.--The date specified in this paragraph 
     is the date on which the Secretary has exhausted all amounts 
     deposited in the Veterans Choice Fund established by section 
     802, or the date that is three years after the date of the 
     enactment of this Act, whichever occurs first.
       (3) Publication.--The Secretary shall publish such date in 
     the Federal Register and on an Internet website of the 
     Department available to the public not later than 30 days 
     before such date.
       (q) Reports.--
       (1) Initial report.--Not later than 90 days after the 
     publication of the interim final regulations under 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 furnishing of 
     care and services under this section that includes the 
     following:
       (A) The number of eligible veterans who have received care 
     or services under this section.
       (B) A description of the types of care and services 
     furnished to eligible veterans under this section.
       (2) Final report.--Not later than 30 days after the date on 
     which the Secretary determines that 75 percent of the amounts 
     deposited in the Veterans Choice Fund established by section 
     802 have been exhausted, 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 or services under this section, disaggregated by--
       (i) eligible veterans described in subsection (b)(2)(A);
       (ii) eligible veterans described in subsection (b)(2)(B);
       (iii) eligible veterans described in subsection (b)(2)(C); 
     and
       (iv) eligible veterans described in subsection (b)(2)(D).
       (B) A description of the types 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 appointments 
     for the receipt of hospital care and medical services from 
     the Department.

[[Page 13346]]

       (F) An assessment of the feasibility and advisability of 
     continuing furnishing care and services under this section 
     after the termination date specified in subsection (p).
       (r) Rule of Construction.--Nothing in this section shall be 
     construed to alter the process of the Department for filling 
     and paying for prescription medications.
       (s) Wait-time Goals of the Veterans Health 
     Administration.--
       (1) In general.--Except as provided in paragraph (2), in 
     this section, the term ``wait-time goals of the Veterans 
     Health Administration'' means not more than 30 days from the 
     date on which a veteran requests an appointment for hospital 
     care or medical services from the Department.
       (2) Alternate goals.--If the Secretary submits to Congress, 
     not later than 60 days after the date of the enactment of 
     this Act, a report stating that the actual wait-time goals of 
     the Veterans Health Administration are different from the 
     wait-time goals specified in paragraph (1)--
       (A) for purposes of this section, the wait-time goals of 
     the Veterans Health Administration shall be the wait-time 
     goals submitted by the Secretary under this paragraph; and
       (B) the Secretary shall publish such wait-time goals in the 
     Federal Register and on an Internet website of the Department 
     available to the public.

     SEC. 102. 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 who are--
       (1) eligible for health care at such facilities; and
       (2)(A) enrolled in the patient enrollment system of the 
     Department established and operated under section 1705 of 
     title 38, United States Code; or
       (B) eligible for hospital care and medical services 
     pursuant to subsection (c)(2) of such section.
       (b) Performance Metrics for Memorandum of Understanding.--
     The Secretary of Veterans Affairs shall establish 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. 103. 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).

     SEC. 104. REAUTHORIZATION AND MODIFICATION OF PILOT PROGRAM 
                   OF ENHANCED CONTRACT CARE AUTHORITY FOR HEALTH 
                   CARE NEEDS OF VETERANS.

       Section 403 of the Veterans' Mental Health and Other Care 
     Improvements Act of 2008 (Public Law 110-387; 38 U.S.C. 1703 
     note) is amended--
       (1) in subsection (a)--
       (A) in paragraph (3), by striking ``only during the'' and 
     all that follows through the period at the end and inserting 
     ``only during the period beginning on the date of the 
     commencement of the pilot program under paragraph (2) and 
     ending on the date that is two years after the date of the 
     enactment of the Veterans Access, Choice, and Accountability 
     Act of 2014.''; and
       (B) by amending paragraph (4) to read as follows:
       ``(4) Program locations.--The Secretary shall carry out the 
     pilot program at locations in the following Veterans 
     Integrated Service Networks (and such other locations as the 
     Secretary considers appropriate):
       ``(A) Veterans Integrated Service Network 1.
       ``(B) Veterans Integrated Service Network 6.
       ``(C) Veterans Integrated Service Network 15.
       ``(D) Veterans Integrated Service Network 18.
       ``(E) Veterans Integrated Service Network 19.'';
       (2) in subsection (b)(1)(A), by striking ``as of the date 
     of the commencement of the pilot program under subsection 
     (a)(2)'' and inserting ``as of August 1, 2014'';
       (3) by redesignating subsection (h) as subsection (k);
       (4) by inserting after subsection (g) the following new 
     subsections:
       ``(h) Appointments.--In carrying out the pilot program 
     under this section, the Secretary shall ensure that medical 
     appointments for covered veterans--
       ``(1) are scheduled not later than 5 days after the date on 
     which the appointment is requested; and
       ``(2) occur not later than 30 days after such date.
       ``(i) Outreach.--The Secretary shall ensure that covered 
     veterans are informed about the pilot program under this 
     section.
       ``(j) Use of Existing Contracts.--In carrying out the pilot 
     program under this section after the date of the enactment of 
     the Veterans Access, Choice, and Accountability Act of 2014, 
     the Secretary shall make use of contracts entered into before 
     such date or may enter into new contracts.''; and
       (5) in paragraph (2)(B) of subsection (k), as redesignated 
     by paragraph (3) of this section, by striking the semicolon 
     at the end and inserting ``; and''.

     SEC. 105. PROMPT PAYMENT BY DEPARTMENT OF VETERANS AFFAIRS.

       (a) Sense of Congress on Prompt Payment by Department.--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.
       (b) Establishment of Claims Processing System.--
       (1) Claims processing system.--The Secretary of Veterans 
     Affairs shall establish and implement a system to process and 
     pay claims for payment for hospital care, medical services, 
     and other health care furnished by non-Department of Veterans 
     Affairs health care providers under the laws administered by 
     the Secretary.
       (2) Compliance with prompt payment act.--The system 
     established and implemented under paragraph (1) shall comply 
     with all requirements of chapter 39, United States Code 
     (commonly referred to as the ``Prompt Payment Act'').
       (c) Report.--Not later than one year after the date of the 
     enactment of this Act, the Comptroller General of the United 
     States shall submit to Congress a report on the timeliness of 
     payments by the Secretary for hospital care, medical 
     services, and other health care furnished by non-Department 
     of Veterans Affairs health care providers under the laws 
     administered by the Secretary.
       (d) Elements.--The report required by subsection (b) shall 
     include the following:
       (1) The results of a survey of non-Department health care 
     providers who have submitted claims to the Department for 
     hospital care, medical services, or other health care 
     furnished to veterans for which payment is authorized under 
     the laws administered by the Secretary during the one-year 
     period preceding the submittal of the report, which survey 
     shall include the following:
       (A) The amount of time it took for such health care 
     providers, after submitting such claims, to

[[Page 13347]]

     receive payment from the Department for such care or 
     services.
       (B) A comparison of the amount of time under subparagraph 
     (A) and the amount of time it takes such health care 
     providers to receive payments from the United States for 
     similar care or services provided to the following, if 
     applicable:
       (i) Beneficiaries under the Medicare program under title 
     XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).
       (ii) Covered beneficiaries under the TRICARE program under 
     chapter 55 of title 10, United States Code.
       (2) Such recommendations for legislative or administrative 
     action as the Comptroller General considers appropriate.
       (e) Survey Elements.--In carrying out the survey, the 
     Comptroller General shall seek responses from non-Department 
     health care providers in a manner that ensures that the 
     survey reflects the responses of such providers that--
       (1) are located in different geographic areas;
       (2) furnish a variety of different hospital care, medical 
     services, and other health care; and
       (3) furnish such care and services in a variety of 
     different types of medical facilities.

     SEC. 106. TRANSFER OF AUTHORITY FOR PAYMENTS FOR HOSPITAL 
                   CARE, MEDICAL SERVICES, AND OTHER HEALTH CARE 
                   FROM NON-DEPARTMENT OF VETERANS AFFAIRS 
                   PROVIDERS TO THE CHIEF BUSINESS OFFICE OF THE 
                   VETERANS HEALTH ADMINISTRATION.

       (a) Transfer of Authority.--
       (1) In general.--Effective as of October 1, 2014, the 
     Secretary of Veterans Affairs shall transfer the authority to 
     pay for hospital care, medical services, and other health 
     care furnished through non-Department of Veterans Affairs 
     providers from--
       (A) the Veterans Integrated Service Networks and medical 
     centers of the Department of Veterans Affairs, to
       (B) the Chief Business Office of the Veterans Health 
     Administration 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 to ensure that care and services 
     described in paragraph (1) are provided in a manner that is 
     clinically appropriate and in the best interest of the 
     veterans receiving such care and services.
       (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 furnished 
     through a non-Department provider under the laws administered 
     by the Secretary.
       (b) Budget Matters.--The budget of the Department of 
     Veterans Affairs for any fiscal year beginning after the date 
     of the enactment of this Act (as submitted to Congress 
     pursuant to section 1105(a) of title 31, United States Code) 
     shall specify funds for the payment for hospital care, 
     medical services, and other health care furnished through 
     non-Department of Veterans Affairs providers, including any 
     administrative costs associated with such payment, as funds 
     for the Chief Business Office of the Veterans Health 
     Administration rather than as funds for the Veterans 
     Integrated Service Networks or medical centers of the 
     Department.

              TITLE II--HEALTH CARE ADMINISTRATIVE MATTERS

     SEC. 201. INDEPENDENT ASSESSMENT OF THE HEALTH CARE DELIVERY 
                   SYSTEMS AND MANAGEMENT PROCESSES OF THE 
                   DEPARTMENT OF VETERANS AFFAIRS.

       (a) Independent Assessment.--
       (1) Assessment.--Not later than 90 days after the date of 
     the enactment of this Act, the Secretary of Veterans Affairs 
     shall enter into one or more contracts with a private sector 
     entity or entities described in subsection (b) to conduct an 
     independent assessment of the hospital care, medical 
     services, and other health care furnished in medical 
     facilities of the Department. Such assessment shall address 
     each of the following:
       (A) Current and projected demographics and unique health 
     care needs of the patient population served by the 
     Department.
       (B) Current and projected health care capabilities and 
     resources of the Department, including hospital care, medical 
     services, and other health care furnished by non-Department 
     facilities under contract with the Department, to provide 
     timely and accessible care to veterans.
       (C) The authorities and mechanisms under which the 
     Secretary may furnish hospital care, medical services, and 
     other health care at non-Department facilities, including 
     whether the Secretary should have the authority to furnish 
     such care and services at such facilities through the 
     completion of episodes of care.
       (D) The appropriate system-wide access standard applicable 
     to hospital care, medical services, and other health care 
     furnished by and through the Department, including an 
     identification of appropriate access standards for each 
     individual specialty and post-care rehabilitation.
       (E) The workflow process at each medical facility of the 
     Department for scheduling appointments for veterans to 
     receive hospital care, medical services, or other health care 
     from the Department.
       (F) The organization, workflow processes, and tools used by 
     the Department to support clinical staffing, access to care, 
     effective length-of-stay management and care transitions, 
     positive patient experience, accurate documentation, and 
     subsequent coding of inpatient services.
       (G) The staffing level at each medical facility of the 
     Department and the productivity of each health care provider 
     at such medical facility, compared with health care industry 
     performance metrics, which may include an assessment of any 
     of the following:
       (i) The case load of, and number of patients treated by, 
     each health care provider at such medical facility during an 
     average week.
       (ii) The time spent by such health care provider 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 supervising other health care 
     professionals of the Department.

       (H) The information technology strategies of the Department 
     with respect to furnishing and managing health care, 
     including an identification of any weaknesses and 
     opportunities with respect to the technology used by the 
     Department, especially those strategies with respect to 
     clinical documentation of episodes of hospital care, medical 
     services, and other health care, including any clinical 
     images and associated textual reports, furnished by the 
     Department in Department or non-Department facilities.
       (I) Business processes of the Veterans Health 
     Administration, including processes relating to furnishing 
     non-Department health care, insurance identification, third-
     party revenue collection, and vendor reimbursement, including 
     an identification of mechanisms 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 and to ensure 
     that such amounts collected are accurate.
       (iii) To increase the collection of any other amounts owed 
     to the Department with respect to hospital care, medical 
     services, and other health care and to ensure that such 
     amounts collected are accurate.
       (iv) To increase the accuracy and timeliness of Department 
     payments to vendors and providers.
       (J) The purchasing, distribution, and use of 
     pharmaceuticals, medical and surgical supplies, medical 
     devices, and health care related services by the Department, 
     including the following:
       (i) The prices paid for, standardization of, and use by the 
     Department of the following:

       (I) 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 and systems used by the Department to 
     distribute pharmaceuticals, medical and surgical supplies, 
     medical devices, and health care related services to Veterans 
     Integrated Service Networks and medical facilities of the 
     Department.
       (K) The process of the Department for carrying out 
     construction and maintenance projects at medical facilities 
     of the Department and the medical facility leasing program of 
     the Department.
       (L) The competency of leadership with respect to culture, 
     accountability, reform readiness, leadership development, 
     physician alignment, employee engagement, succession 
     planning, and performance management.
       (2) Particular elements of certain assessments.--
       (A) Scheduling assessment.--In carrying out the assessment 
     required by paragraph (1)(E), the private sector entity or 
     entities shall do the following:
       (i) Review all training materials pertaining to scheduling 
     of appointments at each medical facility of the Department.
       (ii) Assess whether all employees of the Department 
     conducting tasks related to scheduling are properly trained 
     for conducting such tasks.
       (iii) 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.
       (iv) 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.
       (v) 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.
       (vi) Assess whether booking templates for each medical 
     facility or clinic of the Department would improve the 
     process of scheduling such appointments.
       (vii) Assess any interim technology changes or attempts by 
     Department to internally develop a long-term scheduling 
     solutions with respect to the feasibility and cost 
     effectiveness of such internally developed solutions compared 
     to commercially available solutions.
       (viii) Recommend actions, if any, 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--

[[Page 13348]]

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

       (IV) Such other actions as the private sector entity or 
     entities considers appropriate.

       (B) Medical construction and maintenance project and 
     leasing program assessment.--In carrying out the assessment 
     required by paragraph (1)(K), the private sector entity or 
     entities shall do the following:
       (i) Review the process of the Department for identifying 
     and designing proposals for construction and maintenance 
     projects at medical facilities of the Department and leases 
     for medical facilities of the Department.
       (ii) Assess the process through which the Department 
     determines the following:

       (I) That a construction or maintenance project or lease is 
     necessary with respect to a medical facility or proposed 
     medical facility of the Department.
       (II) The proper size of such medical facility or proposed 
     medical facility with respect to treating veterans in the 
     catchment area of such medical facility or proposed medical 
     facility.

       (iii) Assess the management processes of the Department 
     with respect to the capital management programs of the 
     Department, including processes relating to the methodology 
     for construction and design of medical facilities of the 
     Department, the management of projects relating to the 
     construction and design of such facilities, and the 
     activation of such facilities.
       (iv) Assess the medical facility leasing program of the 
     Department.
       (3) Timing.--The private sector entity or entities carrying 
     out the assessment required by paragraph (1) shall complete 
     such assessment not later than 240 days after entering into 
     the contract described in such paragraph.
       (b) Private Sector Entities Described.--A private entity 
     described in this subsection is a private entity that--
       (1) has experience and proven outcomes in optimizing the 
     performance of the health care delivery systems of the 
     Veterans Health Administration and the private sector and in 
     health care management; and
       (2) specializes in implementing large-scale organizational 
     and cultural transformations, especially with respect to 
     health care delivery systems.
       (c) Program Integrator.--
       (1) In general.--If the Secretary enters into contracts 
     with more than one private sector entity under subsection 
     (a), the Secretary shall designate one such entity that is 
     predominately a health care organization as the program 
     integrator.
       (2) Responsibilities.--The program integrator designated 
     pursuant to paragraph (1) shall be responsible for 
     coordinating the outcomes of the assessments conducted by the 
     private entities pursuant to such contracts.
       (d) Report on Assessment.--
       (1) In general.--Not later than 60 days after completing 
     the assessment required by subsection (a), the private sector 
     entity or entities carrying out such assessment shall submit 
     to the Secretary of Veterans Affairs, the Committee on 
     Veterans' Affairs of the Senate, the Committee on Veterans' 
     Affairs of the House of Representatives, and the Commission 
     on Care established under section 202 a report on the 
     findings and recommendations of the private sector entity or 
     entities with respect to such assessment.
       (2) Publication.--Not later than 30 days after receiving 
     the report under paragraph (1), the Secretary shall publish 
     such report in the Federal Register and on an Internet 
     website of the Department of Veterans Affairs that is 
     accessible to the public.
       (e) Non-department Facilities Defined.--In this section, 
     the term ``non-Department facilities'' has the meaning given 
     that term in section 1701 of title 38, United States Code.

     SEC. 202. COMMISSION ON CARE.

       (a) Establishment of Commission.--
       (1) In general.--There is established a commission, to be 
     known as the ``Commission on Care'' (in this section referred 
     to as the ``Commission''), to examine the 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 20-year period 
     beginning on the date of the enactment of this Act.
       (2) Membership.--
       (A) Voting members.--The Commission shall be composed of 15 
     voting members who are appointed as follows:
       (i) Three members appointed by the Speaker of the House of 
     Representatives, at least one of whom shall be a veteran.
       (ii) Three members appointed by the Minority Leader of the 
     House of Representatives, at least one of whom shall be a 
     veteran.
       (iii) Three members appointed by the Majority Leader of the 
     Senate, at least one of whom shall be a veteran.
       (iv) Three members appointed by the Minority Leader of the 
     Senate, at least one of whom shall be a veteran.
       (v) Three members appointed by the President, at least two 
     of whom shall be veterans.
       (B) Qualifications.--Of the members appointed under 
     subparagraph (A)--
       (i) at least one member shall 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 shall 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 shall be 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 one member shall be familiar with the 
     Veterans Health Administration but shall not be currently 
     employed by the Veterans Health Administration; and
       (v) at least one member shall be familiar with medical 
     facility construction and leasing projects carried out by 
     government entities and have experience in the building 
     trades, including construction, engineering, and 
     architecture.
       (C) Date.--The appointments of members of the Commission 
     shall be made not later than one year after the date of the 
     enactment of this Act.
       (3) Period of appointment.--
       (A) In general.--Members shall be appointed for the life of 
     the Commission.
       (B) Vacancies.--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 eight 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 President shall 
     designate a member of the commission to serve as Chairperson 
     of the Commission. The Commission shall select a 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.--In undertaking the 
     comprehensive evaluation and assessment required by paragraph 
     (1), the Commission shall evaluate and assess the results of 
     the assessment conducted by the private sector entity or 
     entities under section 201, including any findings, 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 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.--
       (A) In general.--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.
       (B) Officers or employees of the united states.--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.

[[Page 13349]]

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

     SEC. 203. 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.--Notwithstanding any other 
     provision of law, 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 one or more existing off-
     the-shelf systems 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.

     SEC. 204. IMPROVEMENT OF ACCESS OF VETERANS TO MOBILE VET 
                   CENTERS AND MOBILE MEDICAL 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 and mobile 
     medical 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 and mobile 
     medical 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 the 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 and mobile medical center of the 
     Department has the capability to provide telemedicine 
     services.
       (b) Reports.--
       (1) In general.--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 access to health care through the 
     use of mobile vet centers and mobile medical centers of the 
     Department that includes statistics on each of the 
     requirements set forth in subsection (a)(2) for the year 
     covered by the report.
       (2) Elements.--Each report required by paragraph (1) shall 
     include the following:
       (A) A description of the use of mobile vet centers and 
     mobile medical centers to provide telemedicine services to 
     veterans during the year preceding the submittal of the 
     report, including the following:
       (i) The number of days each mobile vet center and mobile 
     medical center was open to provide such services.
       (ii) The number of days each center traveled to a location 
     other than the headquarters of the center to provide such 
     services.
       (iii) The number of appointments each center conducted to 
     provide such services on average per month and in total 
     during such year.
       (B) An analysis of the effectiveness of using mobile vet 
     centers and mobile medical centers to provide health care 
     services to veterans through the use of telemedicine.
       (C) Any recommendations for an increase in the number of 
     mobile vet centers and mobile medical centers of the 
     Department.
       (D) Any recommendations for an increase in the telemedicine 
     capabilities of each mobile vet center and mobile medical 
     center.
       (E) 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 
     and mobile medical centers.
       (F) Such other recommendations on improvement of the use of 
     mobile vet centers and mobile medical centers by the 
     Department as the Secretary considers appropriate.

     SEC. 205. 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.

[[Page 13350]]

       (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, 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 analyses, 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. 206. IMPROVED TRANSPARENCY CONCERNING HEALTH CARE 
                   PROVIDED BY DEPARTMENT OF VETERANS AFFAIRS.

       (a) Publication of Wait Times.--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 a publicly accessible Internet website of each medical 
     center of the Department of Veterans Affairs, the wait-times 
     for the scheduling of an appointment in each Department 
     facility by a veteran for the receipt of primary care, 
     specialty care, and hospital care and medical services based 
     on the general severity of the condition of the veteran. 
     Whenever the wait-times for the scheduling of such an 
     appointment changes, the Secretary shall publish the revised 
     wait-times--
       (1) on a publicly accessible Internet website of each 
     medical center of the Department by not later than 30 days 
     after such change; and
       (2) in the Federal Register by not later than 90 days after 
     such change.
       (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 or any 
     successor Internet website, the Secretary of Veterans Affairs 
     shall publish a notice on such Internet website 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. 207. INFORMATION FOR VETERANS ON THE CREDENTIALS OF 
                   DEPARTMENT OF VETERANS AFFAIRS PHYSICIANS.

       (a) Improvement of ``Our Doctors'' Internet Website 
     Links.--
       (1) Availability through department of veterans affairs 
     homepage.--A link to the ``Our Doctors'' 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 Doctors'' 
     health care providers database of the Department, or any 
     successor database, the name of the facility at which each 
     licensed physician of the Department underwent residency 
     training.
       (3) Information on physicians at particular facilities.--
     The ``Our Doctors'' 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 described in paragraph (2) with respect to 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.
       (2) Information described.--The information described in 
     this paragraph with respect to a surgeon described in 
     paragraph (1) is as follows:
       (A) The education and training of the surgeon.
       (B) The licensure, registration, and certification of the 
     surgeon by the State or national entity responsible for such 
     licensure, registration, or certification.
       (3) 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 101.
       (2) Plan.--
       (A) In general.--Not later than 30 days after the submittal 
     of the report under paragraph (1), the Secretary shall 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.
       (B) Implementation.--Not later than 90 days after the 
     submittal of the report under paragraph (1), the Secretary 
     shall carry out such plan.

     SEC. 208. 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 101

[[Page 13351]]

     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. 209. 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.

   TITLE III--HEALTH CARE STAFFING, RECRUITMENT, AND TRAINING MATTERS

     SEC. 301. TREATMENT OF STAFFING SHORTAGE AND BIENNIAL REPORT 
                   ON STAFFING OF MEDICAL FACILITIES OF THE 
                   DEPARTMENT OF VETERANS AFFAIRS.

       (a) Staffing Shortages.--
       (1) In general.--Subchapter I of chapter 74 of title 38, 
     United States Code, is amended by adding at the end the 
     following new section:

     ``Sec. 7412. Annual determination of staffing shortages; 
       recruitment and appointment for needed occupations

       ``(a) In General.--Not later than September 30 of each 
     year, the Inspector General of the Department shall 
     determine, and the Secretary shall publish in the Federal 
     Register, the five occupations of personnel of this title of 
     the Department covered under section 7401 of this title for 
     which there are the largest staffing shortages throughout the 
     Department as calculated over the five-year period preceding 
     the determination.
       ``(b) Recruitment and Appointment.--Notwithstanding 
     sections 3304 and 3309 through 3318 of title 5, 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, 
     recruit and directly appoint, during the fiscal year after 
     the fiscal year during which such determination is made, 
     qualified personnel to serve in that particular occupation 
     for the Department.''.
       (2) Clerical amendment.--The table of sections at the 
     beginning of such chapter is amended by inserting after the 
     item relating to section 7411 the following new item:

``7412. Annual determination of staffing shortages; recruitment and 
              appointment for needed occupations.''.

       (3) Deadline for first determination.--Notwithstanding the 
     deadline under section 7412 of title 38, United States Code, 
     as added by paragraph (1), for the annual determination of 
     staffing shortages in the Veterans Health Administration, the 
     Inspector General of the Department of Veterans Affairs shall 
     make the first determination required under such section, and 
     the Secretary of Veterans Affairs shall publish in the 
     Federal Register such determination, by not later than the 
     date that is 180 days after the date of the enactment of this 
     Act.
       (b) Increase of Graduate Medical Education Residency 
     Positions.--
       (1) In general.--Section 7302 of title 38, United States 
     Code, is amended by adding at the end the following new 
     subsection:
       ``(e)(1) In carrying out this section, the Secretary shall 
     establish medical residency programs, or ensure that already 
     established medical residency programs have a sufficient 
     number of residency positions, at any medical facility of the 
     Department that the Secretary determines--
       ``(A) is experiencing a shortage of physicians; and
       ``(B) is located in a community that is designated as a 
     health professional shortage area (as defined in section 332 
     of the Public Health Service Act (42 U.S.C. 254e)).
       ``(2) In carrying out paragraph (1), the Secretary shall--
       ``(A) allocate the residency positions under such paragraph 
     among occupations included in the most current determination 
     published in the Federal Register pursuant to section 7412(a) 
     of this title; and
       ``(B) give priority to residency positions and programs in 
     primary care, mental health, and any other specialty the 
     Secretary determines appropriate.''.
       (2) Five-year increase.--
       (A) In general.--In carrying out section 7302(e) of title 
     38, United States Code, as added by paragraph (1), during the 
     five-year period beginning on the day that is one year after 
     the date of the enactment of this Act, the Secretary of 
     Veterans Affairs shall increase the number of graduate 
     medical education residency positions at medical facilities 
     of the Department by up to 1,500 positions.
       (B) Priority.--In increasing the number of graduate medical 
     education residency positions at medical facilities of the 
     Department under subparagraph (A), the Secretary shall give 
     priority to medical facilities that--
       (i) as of the date of the enactment of this Act, do not 
     have a medical residency program; and
       (ii) are located in a community that has a high 
     concentration of veterans.
       (3) Report.--
       (A) In general.--Not later than 60 days after the date of 
     the enactment of this Act, and not later than October 1 each 
     year thereafter until 2019, 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 graduate medical education 
     residency positions at medical facilities of the Department.
       (B) Elements.--Each report required by subparagraph (A) 
     shall include the following:
       (i) For the year preceding the submittal of the report, the 
     number of graduate medical education residency positions at 
     medical facilities of the Department as follows:

       (I) That were filled.
       (II) That were not filled.
       (III) That the Department anticipated filling.

       (ii) With respect to each graduate medical education 
     residency position specified in clause (i)--

       (I) the geographic location of each such position; and
       (II) if such position was filled, the academic affiliation 
     of the medical resident that filled such position.

       (iii) The policy at each medical facility of the Department 
     with respect to the ratio of medical residents to staff 
     supervising medical residents.
       (iv) During the one-year period preceding the submittal of 
     the report, the number of individuals who declined an offer 
     from the Department to serve as a medical resident at a 
     medical facility of the Department and the reason why each 
     such individual declined such offer.
       (v) During the one-year period preceding the submittal of 
     the report, a description of--

       (I) challenges, if any, faced by the Department in filling 
     graduate medical education residency positions at medical 
     facilities of the Department; and
       (II) actions, if any, taken by the Department to address 
     such challenges.

       (vi) A description of efforts of the Department, as of the 
     date of the submittal of the report, to recruit and retain 
     medical residents to work for the Veterans Health 
     Administration as full-time employees.
       (c) Priority in Scholarship Program of Health Professionals 
     Educational Assistance Program to Certain Providers.--Section 
     7612(b)(5) of title 38, United States Code, is amended--
       (1) in subparagraph (A), by striking ``and'' at the end;
       (2) by redesignating subparagraph (B) as subparagraph (C); 
     and
       (3) by inserting after subparagraph (A) the following new 
     subparagraph (B):
       ``(B) shall give priority to applicants pursuing a course 
     of education or training toward a career in an occupation for 
     which the Inspector General of the Department has, in the 
     most current determination published in the Federal Register 
     pursuant to section 7412(a) of this title, determined that 
     there is one of the largest staffing shortages throughout the 
     Department with respect to such occupation; and''.
       (d) 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 Committees on 
     Veterans' Affairs of the Senate and House of Representatives 
     a report assessing the staffing of each medical facility of 
     the Department.
       (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 
     professionals 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

[[Page 13352]]

     under subsection (a) of section 7412 of title 38, United 
     States Code, as added by subsection (a)(1) of this section, 
     and a plan to use direct appointment authority under 
     subsection (b) of such section 7412 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. 302. EXTENSION AND MODIFICATION OF CERTAIN PROGRAMS 
                   WITHIN THE DEPARTMENT OF VETERANS AFFAIRS 
                   HEALTH PROFESSIONALS EDUCATIONAL ASSISTANCE 
                   PROGRAM.

       (a) Extension of Scholarship Program.--Section 7619 of 
     title 38, United States Code, is amended by striking 
     ``December 31, 2014'' and inserting ``December 31, 2019''.
       (b) Modification of Education Debt Reduction Program.--
       (1) Modification of amount and duration of eligibility.--
     Paragraph (1) of section 7683(d) of such title is amended--
       (A) by striking ``$60,000'' and inserting ``$120,000''; and
       (B) by striking ``$12,000 of such payments'' and all that 
     follows through the period at the end and inserting ``$24,000 
     of such payments may be made in each year of participation in 
     the Program''.
       (2) Elimination of limitation.--
       (A) In general.--Such section is further amended--
       (i) by striking paragraph (2);
       (ii) by redesignating paragraph (3) as paragraph (2); and
       (iii) in paragraph (2), as redesignated by clause (ii), by 
     striking ``paragraphs (1) and (2)'' and inserting ``paragraph 
     (1)''.
       (B) Conforming amendment.--Paragraph (1) of such section, 
     as amended by paragraph (1), is further amended by striking 
     ``Subject to paragraph (2), the amount'' and inserting ``The 
     amount''.

     SEC. 303. CLINIC MANAGEMENT TRAINING FOR EMPLOYEES AT MEDICAL 
                   FACILITIES 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 role-specific clinic management training 
     program to provide in-person, standardized education on 
     systems and processes for health care practice management and 
     scheduling to all appropriate employees, as determined by the 
     Secretary, at medical facilities of the Department.
       (2) Elements.--
       (A) In general.--The clinic management training program 
     required by paragraph (1) shall include the following:
       (i) 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.

       (ii) Training on the appropriate number of appointments 
     that a health care provider should conduct on a daily basis, 
     based on specialty.
       (iii) 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.
       (iv) Training on how to properly use the appointment 
     scheduling system of the Department, including any new 
     scheduling system implemented by the Department.
       (v) 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.

       (vi) 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.
       (B) Role-specific.--The Secretary shall ensure that each 
     employee of the Department included in the clinic management 
     training program required by paragraph (1) receives education 
     under such program that is relevant to the responsibilities 
     of such employee.
       (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 that are relevant to the position and 
     responsibilities of such employee 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).

             TITLE IV--HEALTH CARE RELATED TO SEXUAL TRAUMA

     SEC. 401. 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. 402. 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 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 redesignated 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), disaggregated 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. 403. 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

[[Page 13353]]

     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, active duty for 
     training, or inactive duty 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 V--OTHER HEALTH CARE MATTERS

     SEC. 501. EXTENSION OF PILOT PROGRAM ON ASSISTED LIVING 
                   SERVICES FOR VETERANS WITH TRAUMATIC BRAIN 
                   INJURY.

       (a) In General.--Section 1705 of the National Defense 
     Authorization Act for Fiscal Year 2008 (Public Law 110-181; 
     38 U.S.C. 1710C note) is amended by adding at the end the 
     following:
       ``(g) Termination.--The pilot program shall terminate on 
     October 6, 2017.''.
       (b) Conforming Amendment.--Subsection (a) of such section 
     is amended by striking ``five-year''.

                TITLE VI--MAJOR MEDICAL FACILITY LEASES

     SEC. 601. AUTHORIZATION OF MAJOR MEDICAL FACILITY LEASES.

       (a) In General.--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 a 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 Kapolei 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 Richey, 
     Florida, an amount not to exceed $11,927,000.
       (10) For an outpatient clinic, Ponce, 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 Errera 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 multispecialty 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, Hines, 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.
       (27) For the expansion of a community-based outpatient 
     clinic, Tulsa, Oklahoma, an amount not to exceed $13,269,200.
       (b) Requirements for Clinic in Tulsa.--
       (1) In general.--In carrying out the expansion of the 
     community-based outpatient clinic in Tulsa, Oklahoma, 
     authorized by subsection (a)(27), the Secretary of Veterans 
     Affairs shall ensure that such clinic satisfies the following 
     requirements:
       (A) Consist of not more than 140,000 gross square feet.
       (B) Have an annual cost per square foot of not more than 
     the average market rate in Tulsa, Oklahoma, for an equivalent 
     medical facility plus 20 percent.
       (C) Satisfy the mandate of the Department of Veterans 
     Affairs to provide veterans in Oklahoma with access to 
     quality and efficient care.
       (D) Expand clinical capacity in the region in which the 
     clinic is located in a cost efficient manner based upon 
     regional cost comparisons, taking into account the needs of 
     current veterans and the potential demand by veterans for 
     care in the future.
       (E) Be the most cost effective option for the Department as 
     predicted over a 30-year life cycle for such clinic.
       (2) Cost effective determination.--
       (A) In general.--If the Secretary determines that the most 
     cost effective option over a 30-year life cycle would be to 
     purchase or construct a facility in Tulsa, Oklahoma, instead 
     of entering into a major medical facility lease in such 
     location as authorized by subsection (a)(27), the Secretary 
     shall not enter into such lease.
       (B) Major medical facility project.--If the Secretary makes 
     the determination described in subparagraph (A), the 
     Secretary may request authority for a major medical facility 
     project in Tulsa, Oklahoma, from Congress pursuant to section 
     8104(b) of title 38, United States Code.
       (C) Cost-benefit analysis.--If the Secretary requests 
     authority for the major medical facility project described in 
     subparagraph (B), not later than 90 days after making the 
     determination described in subparagraph (A), the Secretary 
     shall submit to Congress a detailed cost-benefit analysis of 
     such major medical facility project.

     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

[[Page 13354]]

       (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 the self-insuring 
     authority identified in title 40, United States Code, 
     consistent with Office of Management and Budget Circular A-
     11.
       (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--OTHER VETERANS 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; or
       ``(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''.
       (d) Effective Date.--The amendments made by this section 
     shall apply with respect to a quarter, semester, or term, as 
     applicable, commencing on or after January 1, 2015.

     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 a program of education 
     during a quarter, semester, or term, as applicable, that 
     begins after July 1, 2015.

     SEC. 703. EXTENSION OF REDUCTION IN AMOUNT OF PENSION 
                   FURNISHED BY DEPARTMENT OF VETERANS AFFAIRS FOR 
                   CERTAIN VETERANS COVERED BY MEDICAID PLANS FOR 
                   SERVICES FURNISHED BY NURSING FACILITIES.

       Section 5503(d)(7) of title 38, United States Code, is 
     amended by striking ``November 30, 2016'' and inserting 
     ``September 30, 2024''.

     SEC. 704. EXTENSION OF REQUIREMENT FOR COLLECTION OF FEES FOR 
                   HOUSING LOANS GUARANTEED BY SECRETARY OF 
                   VETERANS AFFAIRS.

       Section 3729(b)(2) of title 38, United States Code, is 
     amended--
       (1) in subparagraph (A)--
       (A) in clause (iii), by striking ``October 1, 2017'' and 
     inserting ``September 30, 2024''; and
       (B) in clause (iv), by striking ``October 1, 2017'' and 
     inserting ``September 30, 2024'';
       (2) in subparagraph (B)--
       (A) in clause (i), by striking ``October 1, 2017'' and 
     inserting ``September 30, 2024''; and
       (B) in clause (ii), by striking ``October 1, 2017'' and 
     inserting ``September 30, 2024'';
       (3) in subparagraph (C)--
       (A) in clause (i), by striking ``October 1, 2017'' and 
     inserting ``September 30, 2024''; and
       (B) in clause (ii), by striking ``October 1, 2017'' and 
     inserting ``September 30, 2024''; and
       (4) in subparagraph (D)--
       (A) in clause (i), by striking ``October 1, 2017'' and 
     inserting ``September 30, 2024''; and
       (B) in clause (ii), by striking ``October 1, 2017'' and 
     inserting ``September 30, 2024''.

     SEC. 705. LIMITATION ON AWARDS AND BONUSES PAID TO EMPLOYEES 
                   OF DEPARTMENT OF VETERANS AFFAIRS.

       In each of fiscal years 2015 through 2024, the Secretary of 
     Veterans Affairs shall ensure that the aggregate amount of 
     awards and bonuses paid by the Secretary in a fiscal year 
     under chapter 45 or 53 of title 5, United States Code, or any 
     other awards or bonuses authorized under such title does not 
     exceed $360,000,000.

     SEC. 706. EXTENSION OF AUTHORITY TO USE INCOME INFORMATION.

       Section 5317(g) of title 38, United States Code, is amended 
     by striking ``September 30, 2016'' and inserting ``September 
     30, 2024''.

     SEC. 707. REMOVAL OF SENIOR EXECUTIVES OF THE DEPARTMENT OF 
                   VETERANS AFFAIRS FOR PERFORMANCE OR MISCONDUCT.

       (a) Removal or Transfer.--

[[Page 13355]]

       (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 executives: removal based on performance 
       or misconduct

       ``(a) In General.--(1) The Secretary may remove an 
     individual employed in a senior executive position at the 
     Department of Veterans Affairs from the senior executive 
     position if the Secretary determines the performance or 
     misconduct of the individual warrants such removal. If the 
     Secretary so removes such an individual, the Secretary may--
       ``(A) remove the individual from the civil service (as 
     defined in section 2101 of title 5); or
       ``(B) in the case of an individual described in paragraph 
     (2), transfer the individual from the senior executive 
     position 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.
       ``(2) An individual described in this paragraph is an 
     individual who--
       ``(A) previously occupied a permanent position within the 
     competitive service (as that term is defined in section 2102 
     of title 5);
       ``(B) previously occupied a permanent position within the 
     excepted service (as that term is defined in section 2103 of 
     title 5); or
       ``(C) prior to employment in a senior executive position at 
     the Department of Veterans Affairs, did not occupy any 
     position within the Federal Government.
       ``(b) Pay of Transferred Individual.--(1) Notwithstanding 
     any other provision of law, including the requirements of 
     section 3594 of title 5, any individual transferred to a 
     General Schedule position under subsection (a)(2) shall, 
     beginning on the date of such transfer, receive the annual 
     rate of pay applicable to such position.
       ``(2) An individual so transferred may not be placed on 
     administrative leave or any other category of paid leave 
     during the period during which an appeal (if any) under this 
     section is ongoing, and may only receive pay if the 
     individual reports for duty. If an individual so transferred 
     does not report for duty, such individual shall not receive 
     pay or other benefits pursuant to subsection (e)(5).
       ``(c) Notice to Congress.--Not later than 30 days after 
     removing or transferring an individual from a senior 
     executive position 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.
       ``(d) Procedure.--(1) The procedures under section 7543(b) 
     of title 5 shall not apply to a removal or transfer under 
     this section.
       ``(2)(A) Subject to subparagraph (B) and subsection (e), 
     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 seven days after the date of such removal or transfer.
       ``(e) Expedited Review by Administrative Judge.--(1) Upon 
     receipt of an appeal under subsection (d)(2)(A), the Merit 
     Systems Protection Board shall refer such appeal to an 
     administrative judge pursuant to section 7701(b)(1) of title 
     5. The administrative judge shall expedite any such appeal 
     under such section and, in any such case, shall issue a 
     decision not later than 21 days after the date of the appeal.
       ``(2) Notwithstanding any other provision of law, including 
     section 7703 of title 5, the decision of an administrative 
     judge under paragraph (1) shall be final and shall not be 
     subject to any further appeal.
       ``(3) In any case in which the administrative judge cannot 
     issue a decision in accordance with the 21-day requirement 
     under paragraph (1), the removal or transfer is final. In 
     such a case, the Merit Systems Protection Board shall, within 
     14 days after the date that such removal or transfer is 
     final, submit to Congress and the Committees on Veterans' 
     Affairs of the Senate and House of Representatives a report 
     that explains the reasons why a decision was not issued in 
     accordance with such requirement.
       ``(4) The Merit Systems Protection Board or administrative 
     judge may not stay any removal or transfer under this 
     section.
       ``(5) During the period beginning on the date on which an 
     individual appeals a removal from the civil service under 
     subsection (d) and ending on the date that the administrative 
     judge issues a final decision on such appeal, such individual 
     may not receive any pay, awards, bonuses, incentives, 
     allowances, differentials, student loan repayments, special 
     payments, or benefits.
       ``(6) To the maximum extent practicable, the Secretary 
     shall provide to the Merit Systems Protection Board, and to 
     any administrative judge to whom an appeal under this section 
     is referred, such information and assistance as may be 
     necessary to ensure an appeal under this subsection is 
     expedited.
       ``(f) Relation to Title 5.--(1) The authority provided by 
     this section is in addition to the authority provided by 
     section 3592 or subchapter V of chapter 75 of title 5.
       ``(2) Section 3592(b)(1) of title 5 does not apply to an 
     action to remove or transfer an individual under this 
     section.
       ``(g) Definitions.--In this section:
       ``(1) The term `individual' means--
       ``(A) a career appointee (as that term is defined in 
     section 3132(a)(4) of title 5); or
       ``(B) any individual who occupies an administrative or 
     executive position and who was appointed under section 
     7306(a) or section 7401(1) of this title.
       ``(2) The term `misconduct' includes neglect of duty, 
     malfeasance, or failure to accept a directed reassignment or 
     to accompany a position in a transfer of function.
       ``(3) The term `senior executive position' means--
       ``(A) with respect to a career appointee (as that term is 
     defined in section 3132(a)(4) of title 5), a Senior Executive 
     Service position (as such term is defined in section 
     3132(a)(2) of title 5); and
       ``(B) with respect to an individual appointed under section 
     7306(a) or section 7401(1) of this title, an administrative 
     or executive position.''.
       (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 executives: removal based on performance or 
              misconduct.''.
       (b) Establishment of Expedited Review Process.--
       (1) In general.--Not later than 14 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) Waiver.--The Merit Systems Protection Board may waive 
     any other regulation in order to provide for the expedited 
     review required under section 713(d) of title 38, United 
     States Code.
       (4) Report by merit systems protection board.--Not later 
     than 14 days after the date of the enactment of this Act, the 
     Merit Systems Protection Board shall submit to the Committees 
     on Veterans' Affairs of the Senate and House of 
     Representatives 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 7543 of title 5, United States Code, may 
     be initiated, notwithstanding section 3592(b) of such title, 
     or any other provision of law.
       (d) Construction.--
       (1) In general.--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.
       (2) Relation to title 5.--With respect to the removal or 
     transfer of an individual (as that term is defined in such 
     section 713) employed at the Department of Veterans Affairs, 
     the authority provided by such section 713 is in addition to 
     the authority provided by section 3592 or subchapter V of 
     chapter 75 of title 5, United States Code.

                       TITLE VIII--OTHER MATTERS

     SEC. 801. APPROPRIATION OF AMOUNTS.

       (a) In General.--There is authorized to be appropriated, 
     and is appropriated, to the Secretary of Veterans Affairs, 
     out of any funds in the Treasury not otherwise appropriated 
     $5,000,000,000 to carry out subsection (b). Such funds shall 
     be available for obligation or expenditure without fiscal 
     year limitation.
       (b) Use of Amounts.--The amount appropriated under 
     subsection (a) shall be used by the Secretary as follows:
       (1) To increase the access of veterans to care as follows:
       (A) To hire primary care and specialty care physicians for 
     employment in the Department of Veterans Affairs.
       (B) To hire other medical staff, including the following:
       (i) Physicians.
       (ii) Nurses.
       (iii) Social workers.
       (iv) Mental health professionals.
       (v) Other health care professionals as the Secretary 
     considers appropriate.
       (C) To carry out sections 301 and 302, including the 
     amendments made by such sections.
       (D) To pay for expenses, equipment, and other costs 
     associated with the hiring of primary care, specialty care 
     physicians, and other medical staff under subparagraphs (A), 
     (B), and (C).
       (2) To improve the physical infrastructure of the 
     Department as follows:
       (A) To maintain and operate hospitals, nursing homes, 
     domiciliary facilities, and other facilities of the Veterans 
     Health Administration.
       (B) To enter into contracts or hire temporary employees to 
     repair, alter, or improve facilities under the jurisdiction 
     of the Department that are not otherwise provided for under 
     this paragraph.
       (C) To carry out leases for facilities of the Department.
       (D) To carry out minor construction projects of the 
     Department.

[[Page 13356]]

       (c) Availability.--The amount appropriated under subsection 
     (a) shall remain available until expended.
       (d) Report.--
       (1) In general.--Not later than one year after the date of 
     the enactment of this Act, the Secretary of Veterans Affairs 
     shall submit to the appropriate committees of Congress a 
     report on how the Secretary has obligated the amounts 
     appropriated under subsection (a) as of the date of the 
     submittal of the report.
       (2) Appropriate committees of congress defined.--In this 
     subsection, the term ``appropriate committees of Congress'' 
     means--
       (A) the Committee on Veterans' Affairs and the Committee on 
     Appropriations of the Senate; and
       (B) the Committee on Veterans' Affairs and the Committee on 
     Appropriations of the House of Representatives.
       (e) Funding Plan.--The Secretary shall submit to Congress a 
     funding plan describing how the Secretary intends to use the 
     amounts provided under subsection (a).

     SEC. 802. VETERANS CHOICE FUND.

       (a) In General.--There is established in the Treasury of 
     the United States a fund to be known as the Veterans Choice 
     Fund.
       (b) Administration of Fund.--The Secretary of Veterans 
     Affairs shall administer the Veterans Choice Fund established 
     by subsection (a).
       (c) Use of Amounts.--
       (1) In general.--Any amounts deposited in the Veteran 
     Choice Fund shall be used by the Secretary of Veterans 
     Affairs to carry out section 101, including, subject to 
     paragraph (2), any administrative requirements of such 
     section.
       (2) Amount for administrative requirements.--
       (A) Limitation.--Except as provided by subparagraph (B), of 
     the amounts deposited in the Veterans Choice Fund, not more 
     than $300,000,000 may be used for administrative requirements 
     to carry out section 101.
       (B) Increase.--The Secretary may increase the amount set 
     forth in subparagraph (A) with respect to the amounts used 
     for administrative requirements if--
       (i) the Secretary determines that the amount of such 
     increase is necessary to carry out section 101;
       (ii) the Secretary submits to the Committees on Veterans' 
     Affairs and Appropriations of the House of Representatives 
     and the Committees on Veterans' Affairs and Appropriations of 
     the Senate a report described in subparagraph (C); and
       (iii) a period of 60 days has elapsed following the date on 
     which the Secretary submits the report under clause (ii).
       (C) Report.--A report described in this subparagraph is a 
     report that contains the following:
       (i) A notification of the amount of the increase that the 
     Secretary determines necessary under subparagraph (B)(i).
       (ii) The justifications for such increased amount.
       (iii) The administrative requirements that the Secretary 
     will carry out using such increased amount.
       (d) Appropriation and Deposit of Amounts.--
       (1) In general.--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 
     $10,000,000,000 to be deposited in the Veterans Choice Fund 
     established by subsection (a). Such funds shall be available 
     for obligation or expenditure without fiscal year limitation, 
     and only for the program created under section 101.
       (2) Availability.--The amount appropriated under paragraph 
     (1) shall remain available until expended.
       (e) Sense of Congress.--It is the sense of Congress that 
     the Veterans Choice Fund is a supplement to but distinct from 
     the Department of Veterans Affairs' current and expected 
     level of non-Department care currently part of Department's 
     medical care budget. Congress expects that the Department 
     will maintain at least its existing obligations of non-
     Department care programs in addition to but distinct from the 
     Veterans Choice Fund for each of fiscal years 2015 through 
     2017.

     SEC. 803. 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.
         And the House agree to the same.

     For consideration of the House amendment and the Senate 
     amendment, and modifications committed to conference:
     Jeff Miller of Florida,
     Doug Lamborn,
     David P. Roe of Tennessee,
     Bill Flores,
     Dan Benishek,
     Mike Coffman,
     Brad R. Wenstrup,
     Jackie Walorski,
     Michael H. Michaud,
     Corrine Brown of Florida,
     Mark Takano,
     Julia Brownley of California,
     Ann Kirkpatrick,
     Timothy J. Walz,
                                Managers on the part of the House.

     Bernard Sanders,
     John D. Rockefeller IV,
     Patty Murray,
     Sherrod Brown,
     Jon Tester,
     Mark Begich,
     Richard Blumenthal,
     Mazie K. Hirono,
     Richard Burr,
     Johnny Isakson,
     Mike Johanns,
                               Managers on the part of the Senate.

       JOINT EXPLANATORY STATEMENT OF THE COMMITTEE OF CONFERENCE

       The managers on the part of the House and the Senate at the 
     conference on the disagreeing votes of the two Houses on the 
     amendment of the House to the amendment of the Senate to 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, submit the 
     following joint statement to the House and the Senate in 
     explanation of the effect of the action agreed upon by the 
     managers and recommended in the accompanying conference 
     report:
       The House amendment to the Senate amendment struck all of 
     the House bill after the enacting clause and inserted a 
     substitute text.
       The Senate recedes from its disagreement to the amendment 
     of the House with an amendment that is a substitute for the 
     House bill and the House amendment to the Senate amendment. 
     The differences between the House amendment, the Senate 
     amendment, and the substitute agreed to in conference are 
     noted below, except for clerical corrections, conforming 
     changes made necessary by agreements reached by the 
     conferees, and minor drafting and clarifying changes.

                                OVERVIEW

       The House amendment to the Senate amendment to the 
     Conference bill consists of provisions from the following 
     House bills: H.R. 4810, the Veteran Access to Care Act of 
     2014, which passed the House on June 10, 2014, and H.R. 4031, 
     the Department of Veterans Affairs Management Accountability 
     Act of 2014, which passed the House on May 21, 2014.
       The Senate amendment consists of provisions from the 
     following Senate bill: S. 2450, the Veterans' Access to Care 
     through Choice, Accountability, and Transparency Act of 2014, 
     which was incorporated as a substitute amendment to H.R. 3230 
     and passed the Senate on June 11, 2014.

Title I--Improvement of Access to Care From Non-Department of Veterans 
                           Affairs Providers


    Expanded availability of hospital care and medical services for 
veterans through the use of agreements with non-Department of Veterans 
                            Affairs entities

     Current Law
       Section 1710 of title 38, United States Code (hereinafter, 
     ``U.S.C.''), requires the Department of Veterans Affairs 
     (hereinafter, ``VA'') to provide hospital care and medical 
     services to eligible veterans. Section 1703 of title 38, 
     U.S.C., authorizes VA to contract with non-Department 
     facilities and providers to furnish hospital or medical 
     services to eligible veterans when VA is not capable of 
     providing economical care because of geographical 
     inaccessibility or due to an inability to furnish such care 
     or services required. Sections 1725 and 1728 of title 38, 
     U.S.C., authorize VA to reimburse for certain types of care, 
     such as emergency treatment, at non-Department facilities. 
     Section 1786 of title 38, U.S.C., authorizes VA to provide 
     needed post-delivery care and services. Section 8111 of title 
     38, U.S.C., authorizes VA to enter into sharing agreements at 
     other government facilities. Section 8153 of title 38, 
     U.S.C., authorizes a VA facility to enter into a contract or 
     agreement with non-VA health care entities to secure 
     healthcare services that are either unavailable or not cost-
     effective to provide at a VA facility.
     Senate Amendment
       The Senate amendment would require VA to provide hospital 
     and medical services to an eligible veteran, at the election 
     of such veteran, through non-VA health care providers, who 
     participate in the Medicare program, or at Federally 
     Qualified Health Centers (hereinafter, ``FQHCs''), facilities 
     funded by the Indian Health Service (hereinafter, ``IHS''), 
     or Department of Defense (hereinafter, ``DOD''). It would 
     also require the Secretary of Veterans Affairs (hereinafter, 
     ``the Secretary'') to coordinate the delivery of such non-VA 
     care and services through the Non-VA Care Coordination 
     Program.
       For purposes of receiving non-VA care and services as a 
     veteran enrolled in the VA health care system, the Senate 
     amendment would define an eligible veteran as someone who is 
     unable to schedule an appointment at a VA medical facility 
     within VA's stated wait-time goals; resides more than 40 
     miles from the nearest VA medical facility; or, in the case 
     of a veteran who resides in a State without a VA medical 
     facility that provides hospital care, emergency medical 
     services, and surgical care, resides 20 miles from such VA 
     medical facility.
       It would also authorize VA to enter into negotiated 
     contracts with eligible non-VA

[[Page 13357]]

     providers for the provision of care and services to an 
     eligible veteran. Furthermore, it would authorize VA to 
     establish contracts with non-VA providers at the Medicare 
     rate or to negotiate a rate that is higher than the Medicare 
     rate, only if VA is unable to find a health care provider 
     that is able to provide such care and services at the 
     Medicare rate.
     House Amendment
       The House amendment would require VA, for two years after 
     enactment, to offer non-VA care at the Department's expense 
     to any enrolled veteran who resides more than 40 miles from a 
     VA medical facility or has waited longer than the VA's wait-
     time goals--as of June 1, 2014--for a medical appointment or 
     has been notified by VA that an appointment is not available 
     within VA's wait-time goals--as of June 1, 2014--and who 
     elects to receive care at a non-VA facility. In furnishing 
     such care, the House amendment would require VA to utilize 
     existing contracts to the greatest extent possible; to 
     reimburse any non-VA care providers with which VA has not 
     entered into an existing contract, at the greater of the rate 
     set by VA, TRICARE, or Medicare, for care received by an 
     eligible veteran; and, ensure that a non-VA care 
     authorization encompasses the complete episode of care but 
     does not exceed sixty days.
       It would also require VA to submit to Congress a quarterly 
     report, which includes how many eligible veterans have 
     received non-VA care or services.
     Conference Agreement
       The Conference agreement adopts the Senate provision with 
     amendments to eligibility, payment rates and VA's obligation 
     for payments for non-service-connected care or services. The 
     conference substitute defines an eligible veteran as a 
     veteran who is enrolled in the patient enrollment system as 
     of August 1, 2014, or any veteran who enrolls after such date 
     and who, at any time during the five-year period preceding 
     such enrollment, served on active duty in a theater of combat 
     operation. It also includes those veterans who live within 40 
     miles of a medical facility and are required to travel by 
     air, boat, or ferry to access a VA medical facility or who 
     face geographical challenges in accessing that medical 
     facility. In calculating the distance from a nearest VA 
     medical facility, it is the Conferees' expectation that VA 
     will use geodesic distance, or the shortest distance between 
     two points. The Conferees do not intend the 40-mile 
     eligibility criteria included in this section to preclude 
     veterans who reside closer than 40-miles from a VA facility 
     from accessing care through non-VA providers, particularly if 
     the VA facility the veteran resides near provides limited 
     services.
       Should an appointment not be available for a veteran within 
     the established wait time goals and the veteran chooses to be 
     seen by non-VA entities, the veteran will be informed by 
     electronic means, or by a letter if the veteran so chooses, 
     as to the care or services they are authorized to receive.
       The rates for contracts established under this section 
     shall be no more than the rates paid to a provider of 
     services under Medicare with the exception VA may negotiate a 
     higher rate for care provided to veterans residing in highly 
     rural areas.
       A ``Veterans Choice Card'' will be issued to each enrolled 
     veteran for presentation to health care providers for the 
     delivery of authorized medical care and services. This card 
     will contain identifying information as well as contact and 
     relevant information for authorization and claims procedures. 
     The Secretary will provide information to veterans about the 
     availability of care and services through the use of this 
     card. The Conferees do not intend for any delays that may 
     occur in the production of the ``Veterans Choice Card'' to 
     delay the implementation of the choice program.
       This election to receive care through a health care 
     provider also includes what would be considered an episode of 
     care up to a period of 60 days. The Conferees recognize that 
     chronic conditions or illnesses may require episodes of care 
     that extend beyond the 60 day limit. In such cases, the 
     Conferees expect the Secretary to authorize additional 
     episodes of care sufficient to complete the needed treatment 
     or in the case of treatment needed to maintain a quality of 
     life during a terminal illness.
       For those veterans receiving hospital care or medical 
     services for non-service-connected conditions, the Department 
     is secondarily responsible. The health care provider that 
     furnishes care or services shall be responsible for seeking 
     reimbursement from the health care plan contract under which 
     the eligible veteran is covered. Eligible veterans will pay a 
     copayment for the receipt of hospital care or medical 
     services under this section only if such eligible veteran 
     would be required to pay a copayment for the receipt of care 
     and services at a VA medical facility. Nothing in this 
     section amends health plans not administered by the 
     Department, including with respect to the terms and 
     conditions of such coverage, reimbursement, and cost-sharing.
       Numerous reports are required to document program 
     implementation, establishment and success in meeting goals, 
     utilization of and satisfaction in care and services 
     delivered under this section, and Department expenditures.
       The Conferees expect VA will provide care and services 
     under this section at the choice of an eligible veteran if 
     the veteran experiences the time or distance delays described 
     in this section. When coordinating care for eligible veterans 
     through the Non-VA Care Coordination program, the Department 
     should attempt to ensure when an appointment is authorized, 
     the eligible veteran receives care within an appropriate time 
     period, as defined by medical necessity as determined by the 
     referring physician, or a mandatory time period established 
     by the Secretary when the request for care is not initiated 
     by a physician, that all medical fees are appropriately paid 
     and health care records are returned to the Department within 
     the prescribed time. The Conferees also expect that VA will 
     utilize providers who have demonstrated success providing a 
     variety of care, to veterans under an integrated model of 
     care and a proven ability to partner with the Federal 
     government.
       Congress has authorized a new program to provide care and 
     choice to veterans, the funds made available for this program 
     through section 802(d)(1) are available only to carry out 
     this new program.


Enhancement of collaboration between Department of Veterans Affairs and 
                         Indian Health Service

     Current Law
       Subsection 1645(c) of title 25, U.S.C., requires VA and DOD 
     to reimburse IHS, an Indian tribe, or a tribal organization 
     for providing eligible beneficiaries with health care 
     services. In 2010, VA and IHS signed an updated Memorandum of 
     Understanding (hereinafter, ``MOU'') in order to establish 
     ``mutual goals and objectives for ongoing collaboration 
     between VA and IHS in support of their respective missions 
     and to establish a common mission of serving our nation's 
     American Indian and Alaska Native Veteran.'' This MOU set 
     forth five goals, to be achieved through 12 areas of 
     collaboration between VA and IHS. One of the areas of 
     collaboration focused on increasing the availability of 
     health care services through development of payment and 
     reimbursement policies to support interagency care delivery.
       As a result, in December 2012, VA and IHS signed a national 
     reimbursement agreement to create a mechanism by which VA can 
     reimburse IHS for health services provided to eligible 
     veterans. This MOU only covers direct care services provided 
     by IHS. In addition to providing direct care, IHS also 
     contracts with Urban Indian Health Centers and Tribal Health 
     Programs (hereinafter, ``THP'') to provide additional points 
     of care to eligible Native Americans. VA has worked with 
     individual THPs to negotiate separate reimbursement 
     agreements to care for veterans. While VA's agreement with 
     IHS only covers dual eligible veterans, the Department's 
     agreements with health providers through the Alaska Native 
     Tribal Health Consortium include coverage for all veterans. 
     VA has not yet entered into reimbursement agreements with any 
     Urban IHS Centers to treat veterans.
       In April 2013 and June 2014, the Government Accountability 
     Office (hereinafter, ``GAO'') issued two reports on the VA-
     IHS MOU. GAO's recommendations indicated that better 
     definition of metrics and improved oversight and guidance 
     would improve implementation of the MOU and its impact on 
     access to care for veterans.
     Senate Amendment
       The Senate amendment would require VA, in consultation with 
     IHS, to conduct more outreach to IHS tribal health programs 
     to ensure they are aware of the opportunity to negotiate a 
     reimbursement agreement.
       It would require VA, in collaboration with IHS, to define 
     metrics for implementing and overseeing existing partnership 
     efforts under the current VA-IHS MOU.
       Finally, it would require VA and IHS to jointly report to 
     Congress, within 180 days of enactment, on the feasibility 
     and advisability of entering into reimbursement agreements 
     with Urban IHS Centers and including treatment of non-Native 
     veterans as a reimbursable expense under existing 
     reimbursement structures.
     House Amendment
       The House amendment contained no similar provision.
     Conference Agreement
       The Conference substitute adopts the Senate provision.


Enhancement of collaboration between Department of Veterans Affairs and 
                  Native Hawaiian Health Care Systems

     Current Law
       In October 2013, the VA Pacific Islands Health Care System 
     (hereinafter, ``VAPIHCS'') entered into an MOU with Papa Ola 
     Lokahi, the statutorily designated statewide coordinating 
     body for the five Native Hawaiian Health Care Systems, in 
     order to improve communication, collaboration, and 
     cooperation regarding health care for Native Hawaiian 
     veterans. The purpose statement of the MOU notes that both 
     parties, ``hope to seek and develop greater means of 
     achieving efficiency of care provided and to create future 
     processes for VAPIHCS reimbursement for services provided to 
     Native Hawaiian veterans referred to Papa Ola Lokahi by

[[Page 13358]]

     VAPIHCS.'' VA estimated the average waiting time for a new 
     patient requesting a primary care appointment at VAPIHCS was 
     nearly 130 days, the highest in the nation. Due to the rural 
     nature of the state, VAPIHCS has received funding above and 
     beyond its Veterans Equitable Resource Allocation in Fiscal 
     Year (hereinafter, ``FY'') 2012 and FY 2013, in order to 
     account for the costs of beneficiary travel for eligible 
     veterans to receive services on other islands. These numbers 
     were $4.94 million and $4.65 million, respectively.
     Senate Amendment
       The Senate amendment would require VA to enter into 
     contracts or agreements with the Native Hawaiian health care 
     systems for reimbursement of direct care services provided to 
     eligible veterans.
     House Amendment
       The House amendment contained no similar provision.
     Conference Agreement
       The Conference substitute adopts the Senate provision.


Reauthorization and modification of pilot program of enhanced contract 
            care authority for health care needs of veterans

     Current Law
       Section 403 of the Veterans' Mental Health and Other Care 
     Improvements Act of 2008, Public Law 110-387, provided VA 
     with authority to conduct a pilot program commonly known as 
     Project ARCH (Access Received Closer to Home) in five 
     Veterans Integrated Service Networks (hereinafter, 
     ``VISNs''). The pilot program was to be carried out in at 
     least five VISNs, restricted by various geographic and 
     demographic factors. Locations included: Northern Maine; 
     Farmville, Virginia; Pratt, Kansas; Flagstaff, Arizona; and, 
     Billings, Montana. The aim of the pilot was to provide health 
     care access to eligible veterans closer to home through a 
     non-Department health care provider.
     Senate Amendment
       The Senate amendment contained no similar provision.
     House Amendment
       The House amendment contained no similar provision.
     Conference Agreement
       The Committee substitute would extend Project ARCH within 
     specified VISNs for veterans in highly rural areas who are 
     enrolled in VA health care for an additional 2 years. It 
     would also require appointments to be scheduled within 5 days 
     from the date the provider accepts a referral from VA and 
     requires these veterans receive care within 30 days from the 
     date the appointment was made.


          Prompt Payment by the Department of Veterans Affairs

     Current Law
       In general, the Prompt Payment Act, as amended, requires 
     executive branch agencies, including VA, to pay late-payment 
     penalties when the Department does not pay commercial 
     payments on time.
       In March 2014, GAO reported that billing officials at one 
     non-VA provider experienced ``lengthy delays'' in the 
     processing of their claims, which in some cases took years. 
     Additionally, GAO testified at a House Committee on Veterans' 
     Affairs hearing on June 18, 2014, on claim processing 
     discrepancies that delayed or denied payments for healthcare 
     provided by non-VA providers.
       According to GAO, these delays or denials create an 
     environment where non-VA entities are hesitant to provide 
     care due to fears they will not be paid for services 
     provided. This hinders access to care for veterans who need 
     non-VA services.
     Senate Amendment
       The Senate amendment would provide a Sense of Congress that 
     VA comply with section 1315 of title 5, Code of Federal 
     Regulations (hereinafter, ``CFR''), (commonly known as the 
     ``prompt payment rule'') in paying for health care pursuant 
     to contracts with non-VA providers.
     House Amendment
       The House amendment contained no similar provision.
     Conference Agreement
       The Conference substitute adopts the Senate provision with 
     an amendment that adds a GAO report on the timeliness of 
     payments by VA for non-VA care and services. The Committee is 
     concerned that the Department is not paying claims for 
     services provided to veterans by non-Department providers in 
     a timely manner. The Committee urges the Secretary to 
     establish and implement a system for the processing and 
     paying of those claims.


Transfer of authority for payments for hospital care, medical services, 
and other health care from non-Department of Veterans Affairs providers 
   to the chief business office of the Veterans Health Administration

     Current Law
       Under current law, section 1703 of title 38, U.S.C., VA may 
     contract with non-Department facilities and providers to 
     furnish hospital care or medical services to eligible 
     veterans when VA is not capable of furnishing the care or 
     services required or VA is not capable of providing 
     economical care because of geographical inaccessibility. 
     Further, VA has authority, under sections 1725 and 1728 of 
     title 38, U.S.C., to reimburse for certain types of care, 
     such as emergency treatment, at non-Department facilities.
       The criteria for determining whether a veteran is eligible 
     for non-VA care is established by each VISN or VA medical 
     center. Committee oversight has determined that a 
     decentralized eligibility determination process ensures 
     eligibility is appropriate for each medical center's capacity 
     and the needs of the veterans it serves. However, such 
     decentralization has caused disparity in eligibility criteria 
     throughout the VA health care system and in some cases has 
     led to the determination of eligibility as subject to 
     facility budget considerations rather than to the 
     determination of what is best for the veteran.
       The use of non-VA care has increased. In fact, non-VA care 
     has been the subject of two recent reports by the GAO. Both 
     reports highlighted vulnerabilities in VA's ability to manage 
     and oversee utilization of and spending on non-VA care. In 
     its May 2013 report, GAO noted VA's fee basis care spending 
     had increased nearly $1.5 billion from FY 2008 through FY 
     2012 and had witnessed an increase in utilization of 19% 
     during that same time period.
       Without central oversight of non-VA care, VA has limited 
     ability to collect and analyze data that could help to 
     improve the program's management.
     Senate Amendment
       The Senate amendment would require the Secretary to 
     transfer the authority to pay for hospital care, medical 
     services, and other health care through non-VA providers to 
     the Chief Business Office from VA's VISNs and medical centers 
     by October 1, 2014. It would also require the Chief Business 
     Office to work with the Office of Clinical Operations and 
     Management to ensure care and services are provided in a 
     manner that is clinically appropriate and in the best 
     interest of the veterans receiving such care and services.
       Finally, in each FY after the date of enactment, the 
     Secretary would be required to include in the Chief Business 
     Office budget funds to pay for hospital care, medical 
     services, and other health care provided through non-VA 
     providers.
     House Amendment
       The House amendment contained no similar provision.
     Conference Agreement
       The Conference substitute adopts the Senate provision.

              Title II--Health Care Administrative Matters


    Independent assessment of the health care delivery systems and 
       management processes of the Department of Veterans Affairs

     Current Law
       VA operates the largest integrated health care system in 
     the nation, comprised of 150 VA medical centers (hereinafter, 
     ``VAMCs''), 820 community-based outpatient clinics, 135 
     community-living centers, 300 Vet Centers, 140 domiciliary 
     treatment programs, and 70 mobile Vet Centers. These sites of 
     care are divided amongst 21 VISNs. The VA health care system 
     is overseen by the Veterans Health Administration 
     (hereinafter, ``VHA''), which operates under the leadership 
     of the VA Under Secretary for Health. VHA employs a staff of 
     approximately 288,000 employees and oversees a medical care 
     budget of approximately $55 billion. In addition to providing 
     direct health care services to eligible veterans, caregivers, 
     and dependents, VHA also conducts education and training 
     programs for health care professionals and medical residents; 
     operates an extensive medical research program; and, serves 
     as the contingency back-up to the Department of Defense 
     during national emergencies.
       VHA directive 2010-027, ``VHA Outpatient Scheduling 
     Processes and Procedures'' (hereinafter, ``the directive''), 
     established on June 9, 2010, outlines the policy for 
     implementing processes and procedures for scheduling 
     outpatient appointments using the Veterans Health Information 
     Systems and Technology Architecture (hereinafter, ``VistA''). 
     The directive also provides detail regarding how to ensure 
     staff is competent in the scheduling process. This directive 
     is set to expire on June 30, 2015.
       VA's Office of Inspector General (hereinafter, ``VAOIG''), 
     GAO and a recent VA audit have identified significant 
     problems with VA's ability to provide timely access to health 
     care.
     Senate Amendment
       The Senate amendment would require VA to enter into a 
     contract with an independent third party for a 180-day 
     assessment of: the process for scheduling appointments at 
     each VA medical facility; the staffing level at and 
     productivity of each VA medical facility; the organization, 
     processes, and tools used to support clinical documentation 
     and coding of inpatient services; the purchasing, 
     distribution, and use of pharmaceuticals; and the performance 
     of the Department in paying amounts owed to third parties and 
     collecting amounts owed to the Department. The independent 
     third party conducting the

[[Page 13359]]

     assessment would be required to conduct a comprehensive 
     review of the Department's scheduling process and recommend 
     any actions to be taken by the Department to improve its 
     process for scheduling medical appointments.
       The Senate amendment would also require VA to submit a 
     report to the Committees on Veterans' Affairs of the Senate 
     and the House of Representatives (hereinafter, ``the 
     Committees''), no later than 90 days after the date on which 
     the independent third party completes the assessment, on the 
     results of such assessment.
     House Amendment
       The House amendment would require an independent assessment 
     of hospital care and medical services furnished in VA medical 
     facilities. The independent assessment would address: the 
     current and projected demographics and unique needs of the 
     patient population served by VA; the Department's current and 
     projected health care capabilities and resources; the 
     authorities and mechanisms under which the Secretary may 
     furnish hospital care and medical services at non-VA 
     facilities; the appropriate system-wide access standard 
     applicable to hospital care and medical services furnished by 
     VA; the current organization, processes, and tools used to 
     support clinical staffing; VA's staffing levels and 
     productivity standards; information technology strategies; 
     and, VHA' s business processes. Further, the independent 
     assessment would include: an identification of improvement 
     areas; recommendations for how to address such improvement 
     areas; the business case associated with making such 
     improvements; and findings and supporting analysis on how 
     credible conclusions were established.
       It would also require the Secretary to designate a program 
     integrator if VA enters into contracts with more than one 
     private sector entity to conduct the independent assessment. 
     The program integrator would be required to be responsible 
     for coordinating the outcomes of the assessments conducted by 
     the private entities.
       Finally, the House amendment would require VA to submit to 
     the Committees a report, no later than 10 months after 
     entering into a contract with a private entity, on the 
     findings of the independent assessment and a subsequent 
     report, no later than 120 days after the date of the 
     submission of the first report, which would be required to 
     include VA's action plan for fully implementing the 
     recommendations of the independent assessment.
     Conference Agreement
       The Conference substitute adopts the House provision with 
     amendments to broaden the breadth of the assessment to 
     include: VA leadership; access to care; length of stay 
     management; patient experience; workflow; care transitions; 
     mechanisms by which VA ensures timely payments to nonVA care 
     providers; pharmaceutical; supply and device purchasing; 
     distribution and use; scheduling; and medical construction, 
     maintenance and leasing.
       The Conferees expect that the assessment will produce 
     outcomes that identify improvement areas outlined both 
     qualitatively and quantitatively, taking into consideration 
     Department of Veterans Affairs' directives and industry 
     benchmarks from outside the Federal Government. The 
     assessment is also expected to provide supporting analysis on 
     how credible conclusions were established. The business cases 
     associated with and the recommendations for how to address 
     these identified improvement areas relating to structure, 
     accountability, process changes, technology, capabilities and 
     usage, staff compliance, training effectiveness, and other 
     relevant drivers of performance are expected to better inform 
     the Commission on Care in its work.


                           Commission on Care

     Current Law
       Precedent exists for establishing an independent commission 
     in response to concerns regarding the care provided to our 
     nation's servicemembers and veterans. In 2007, ``the 
     President's Commission on Care for America's Returning 
     Wounded Warriors,'' known as the Dole-Shalala Commission, was 
     established in response to reports of substandard conditions 
     and mismanagement at Walter Reed Army Hospital. The 
     subsequent report and recommendations issued by the Dole-
     Shalala Commission have been critical to improving the health 
     care, benefits, and services available to our nation's 
     veterans in recent years.
       Another independent, high-level commission, the Capital 
     Asset Realignment for Enhanced Services (``CARES'') 
     Commission has been utilized in recent history to examine and 
     recommend improvements for addressing a host of challenges 
     facing VHA, such as how best to align VA's health care system 
     to deliver care to veterans.
       Physical infrastructure plays a significant role in VA's 
     ability to provide high quality care to veterans. With more 
     than 2 million new veterans enrolling into the VA health care 
     system since 2009, and veterans experiencing extended wait 
     times for appointments, it is essential that VA facility 
     leasing programs and maintenance projects are completed on 
     time and within budget.
     Senate Amendment
       The Senate amendment would establish a Commission on Access 
     to Care to examine the access of veterans to health care and 
     strategically examine how best to organize VHA, locate health 
     care resources, and deliver health care to veterans. The 
     Commission would be required to report initial findings and 
     recommendations within 90 days of its first meeting, and 
     would be required to provide a final report within 180 days 
     of such meeting.
       The Senate amendment would also establish an Independent 
     Commission on Department of Veterans Affairs Construction 
     Projects to review current construction and maintenance 
     projects and the medical facility leasing program in order to 
     identify any issues the Department may be experiencing as it 
     carries out these projects. The Commission would be required 
     to report to the Secretary and Congress not later than 120 
     days after enactment any recommendations for improving how VA 
     carries out its construction and maintenance projects. 
     Following submission of the Commission's report, the 
     Secretary would have 60 days to submit to Congress a report 
     on the feasibility and advisability of implementing the 
     recommendations of the Commission, including a timeline for 
     the implementation of such recommendations.
     House Amendment
       The House amendment contained no similar provision.
     Conference Agreement
       The Conference substitute adopts the Senate provision on 
     the Commission on Care with an amendment to include a 
     representative with familiarity with medical facility 
     construction and leasing projects. This amendment would allow 
     the Commission on Care to examine how VA's physical 
     infrastructure impacts VA's ability to provide high quality 
     care to veterans and eliminate the need for a separate 
     Independent Commission on Department of Veterans Affairs 
     Construction Projects. Further, the Conference substitute 
     increases the number of voting members to 15, eliminates non-
     voting members, and allows for appointment by the Speaker and 
     Minority Leader of the House of Representatives and Majority 
     and Minority Leaders of the Senate. It is the expectation of 
     the Conferees that the membership of the Commission on Care 
     will represent and reflect a bipartisan, cross-section of VHA 
     users.
       The Commission on Care may also consider looking at the 
     relationship and communication structure between the VHA and 
     the Veterans Benefits Administration. The Conferees are 
     concerned the two administrations do not communicate and lack 
     synergy to ensure that veterans' benefits and services are 
     rendered in a timely, safe, and veteran focused manner.


 Technology task force on review of scheduling system and software of 
                   the Department of Veterans Affairs

     Current Law
       VHA presently relies on an outpatient scheduling system 
     that is more than 25 years-old. In October 2001, due to an 
     aging system with various limitations that hindered its 
     effectiveness, VHA launched a scheduling replacement 
     initiative. This process was wrought with setbacks, including 
     failed information technology (hereinafter, ``IT'') 
     management and acquisition practices. After expending $127 
     million on that effort, VA was only able to obtain defective 
     software that could not be fixed and did not achieve the 
     intended goal. Further, reports by GAO and VAOIG have 
     repeatedly highlighted challenges with the use of the 
     Electronic Wait List (hereinafter, ``EWL''), an inability to 
     connect with the consult management system, and other change 
     management challenges regarding training for medical 
     appointment schedulers.
       Utilizing the America Competes Reauthorization Act of 2011, 
     VA started the 21st Century Medical Scheduling contest in 
     order to encourage commercial vendors to develop solutions VA 
     can use and to mitigate risks VA identified in previous 
     attempts to replace the existing Medical Scheduling Package. 
     The contest ended on September 30, 2013, and three winners 
     were identified and awarded slightly over $3 million for 
     their efforts. VA is currently pursuing modernization of 
     VistA; thus, there has been renewed focus within the 
     Department on how to improve its functionality and user 
     experiences across the board. VA recently held Industry Days 
     and one-on-one demonstrations with potential vendors in order 
     to choose an off-the-shelf product as part of a long-term 
     scheduling package replacement strategy.
     Senate Amendment
       The Senate amendment would require VA to review, through 
     the use of a technology task force, the needs of the 
     Department with respect to the scheduling system and 
     scheduling software. The task force would be required to 
     issue a report to propose specific actions that VA can take 
     to improve its scheduling software and determine whether an 
     existing off-the-shelf system would meet the Department's 
     needs within 45 days of enactment. VA would be required to 
     publish the report in the Federal Register and on a publicly 
     accessible website. VA would also be

[[Page 13360]]

     required to implement any feasible, advisable, and cost-
     effective recommendations set forth in the report within one 
     year of its receipt.
     House Amendment
       The House amendment contained no similar provision.
     Conference Agreement
       The Conference substitute adopts the Senate provision. The 
     Conferees expect VA to utilize the Northern Virginia 
     Technology Task Force to implement this section. The Task 
     Force previously provided a pro-bono review for Arlington 
     National Cemetery.


  Improvement of access of veterans to mobile vet centers and mobile 
         medical centers of the Department of Veterans Affairs

     Current Law
       In May 2014, VHA's Office of Rural Health published a fact 
     sheet reporting that, of the Nation's 22 million veterans, 
     5.3 million live in rural areas. Currently, there are 70 
     mobile vet centers operating around the country providing 
     readjustment counseling and information resources to veterans 
     in rural areas. Mobile vet centers in some areas also provide 
     limited telemedicine services. VA, however, has not issued 
     any standard procedures for the operation of mobile vet 
     centers. Currently, regional managers determine how a mobile 
     vet center is employed and utilized. As a result, mobile vet 
     centers are vulnerable to inconsistencies.
       In addition to mobile vet centers, VA uses mobile medical 
     units (hereinafter, ``MMUs'') to increase access to care for 
     rural veterans. As of March 2013, VA operated eight MMUs. In 
     May 2014, VAOIG issued an audit of VA MMUs, which found that 
     VA lacked critical information regarding the number, 
     locations, purpose, patient workloads, operation costs, and 
     operations of MMUs. VAOIG recommended that VA improve 
     oversight of MMUs.
     Senate Amendment
       The Senate amendment would require VA to improve access to 
     health care services, including telemedicine, by 
     standardizing requirements for the operation of mobile vet 
     centers. It would also require the Secretary to submit an 
     annual report to Congress on the use of mobile vet centers as 
     well as recommended improvements for access to telemedicine 
     and health care via mobile vet centers.
     House Amendment
       The House amendment contained no similar provision.
     Conference Agreement
       The Conference substitute adopts the Senate provision with 
     an amendment to require VA to use MMUs as well as mobile vet 
     centers to improve access to care for veterans, particularly 
     those residing in rural areas.


Improved performance metrics for health care provided by Department of 
                            Veterans Affairs

     Current Law
       Under current law, chapter 45, chapter 53, and other 
     provisions of title 5, U.S.C., VA has the authority to 
     provide awards to certain employees. For example, chapter 45 
     of title 5, U.S.C., provides VA with authority to grant cash 
     awards to employees in recognition of performance.
     Senate Amendment
       The Senate amendment would require the Secretary to ensure 
     that scheduling and wait-time metrics are not used as factors 
     in determining the performance of certain employees for 
     purposes of determining whether to pay performance awards to 
     such employees. It would also require the Secretary to remove 
     from the performance goals of any VISN or VA medical center 
     employee, any performance goal that might disincentivize the 
     payment of Department amounts to provide health care through 
     non-VA providers.
       The Senate amendment would also require the Secretary to 
     modify the performance plans of the directors of VISNs and VA 
     medical centers to ensure that such plans are based on the 
     quality of care received by veterans at VA medical 
     facilities, including reviews and recommendations concerning 
     such facilities by the VAOIG and the Joint Commission.
     House Amendment
       The House amendment contained no similar provision.
     Conference Agreement
       The Conference substitute adopts the Senate provision.


Improved transparency concerning health care provided by Department of 
                            Veterans Affairs

     Current Law
       VHA operates the largest integrated health care system in 
     the nation, providing care to nearly 6.5 million veterans, 
     survivors, and their dependents every year. According to GAO, 
     between FY 2005 and FY 2012, the number of outpatient medical 
     appointments at VA has increased by roughly 45 percent. VA' s 
     own data on wait times for FY 2010 suggested it was seeing 
     virtually all its primary and specialty care appointments 
     within the 30 days of desired date requirement that had been 
     established in 1995. As a result, in FY 2011, VHA shortened 
     its goal of scheduling both primary and specialty care 
     appointments to 14 days. While VA did not publicly publish 
     data related to wait times, it did attempt to encourage 
     accountability by incorporating the wait-time goal metric 
     into the performance contracts of VISN and VAMC directors.
     Senate Amendment
       The Senate amendment would require the Secretary to publish 
     wait-times for scheduling an appointment at VA facilities in 
     the Federal Register and on a public website of each medical 
     center within 90 days of the date of enactment of this Act. 
     It would also require VA to publish, on the Internet, current 
     wait times for appointments in primary and specialty care at 
     each VA medical center.
     House Amendment
       The House amendment contained no similar provision.
     Conference Agreement
       The Conference substitute adopts the Senate provision.


 Information for veterans on the credentials of Department of Veterans 
                           Affairs physicians

     Current Law
       In FY 2013, 18,342 physicians; 991 dentists; 50,862 
     registered nurses; 23,729 licensed practical nurses, licensed 
     vocational nurses, and nurse assistants; and 12,102 non-
     physician providers delivered care to nearly 6.5 million 
     veterans, survivors, and their dependents. VA makes 
     information regarding its health care providers available to 
     its patients and the public through the ``Our Doctors'' 
     section on the website for each of VA's medical centers. 
     Congressional oversight has determined that these websites 
     contain limited information regarding the credentials for 
     VA's physicians.
     Senate Amendment
       The Senate amendment would require VA to improve the 
     information available to veterans regarding residency 
     training in the ``Our Doctors'' database located on each VA 
     medical facility's website. It would also require VA to 
     provide information regarding a physician's credentials to a 
     veteran, or an individual acting on behalf of a veteran, 
     prior to undergoing a surgical procedure by or through VA.
     House Amendment
       The House amendment contained no similar provision.
     Conference Agreement
       The Conference substitute adopts the Senate provision.


  Information in annual budget of the President on hospital care and 
 medical services furnished through expanded use of contracts for such 
                                  care

     Current Law
       Under current law, section 1105 of title 31, U.S.C., the 
     President submits a budget for the U.S. Government that 
     includes a message, summary and supporting information.
     Senate Amendment
       The Senate amendment would require the Secretary to include 
     information in the Department's budget submission regarding 
     hospital care and medical services furnished through expanded 
     use of contracts.
     House Amendment
       The House amendment contained no similar provision.
     Conference Agreement
       The Conference substitute adopts the Senate provision.


Prohibition on falsification of data concerning wait times and quality 
               measures at Department of Veterans Affairs

     Current Law
       In May 2014, concerns about VA's scheduling practices, 
     including excessive wait times, were identified in the 
     VAOIG's interim report regarding the alleged patient deaths 
     at the Phoenix Health Care System. The results indicated that 
     1,700 veterans were waiting for a primary care appointment 
     but had not been placed on the EWL. In its report, the VAOIG 
     noted that, as a direct result of not properly placing 
     veterans on the EWL, the leadership at the Phoenix Health 
     Care System had radically understated the amount of time new 
     patients waited for their primary care appointments.
     Senate Amendment
       The Senate amendment would require VA to establish 
     disciplinary procedures within 60 days of enactment of this 
     Act for employees who knowingly submit false data pertaining 
     to wait times and quality measures or knowingly require 
     another employee of the Department to submit false data 
     concerning such wait times or quality measures to another 
     employee of the Department.
     House Amendment
       The House amendment contained no similar provision.
     Conference Agreement
       The Conference substitute adopts the Senate provision.

[[Page 13361]]



   Title III--Health Care Staffing, Recruitment, and Training Matters


   Treatment of staffing shortage and biennial report on staffing of 
        medical facilities of the Department of Veterans Affairs

     Current Law
       Subsection 3304(a) of title 5, U.S.C., authorizes federal 
     agencies to appoint, without regard to certain hiring 
     preferences and competitive service selection requirements, 
     candidates directly to positions for which a severe shortage 
     of candidates or a critical hiring need has been identified.
       VA's own nation-wide access audit determined that VA faces 
     staffing challenges and needs additional health care 
     professionals, such as primary care physicians, specialty 
     care physicians, and administrative and support staff, to 
     improve access to high quality health care for veterans. 
     These reviews and Congressional oversight have identified the 
     federal government's long hiring process as a barrier to 
     recruiting qualified health care professionals to the VA 
     health care system.
       Furthermore, GAO and VAOIG have reported that inadequate 
     staffing and gaps in hiring health care professionals at VA 
     medical facilities throughout the country have adverse 
     effects on patient care. These adverse effects include 
     increased wait times and delays in scheduling appointments. 
     Current law, however, is silent on requiring periodic 
     assessments of VA's staffing and succession planning process.
     Senate Amendment
       The Senate amendment would require VAOIG to annually 
     identify the five occupations of health care providers with 
     the largest staffing shortages and would authorize VA to 
     utilize direct appointment authority to fill such openings in 
     an expedited manner. It would also give priority for VA' s 
     Health Professionals Educational Assistance Program to 
     individuals pursuing a medical degree with the intent to 
     specialize in occupations identified by the VAOIG.
       It would also require VA to submit a report to the 
     Committees, not later than 180 days after the date of 
     enactment of and not later than December 31, biennially, 
     thereafter through 2024, on staffing at each VA medical 
     facility. Such report would be required to include: the 
     results of a system-wide assessment of all VA medical 
     facilities, including a plan for addressing any issues 
     identified in such assessment; a list of the current wait 
     times, workload levels, and staffing models for certain 
     clinics; the results of the most current VAOIG findings 
     regarding staffing shortages and VA's plan to use direct 
     appointment authority to fill such staffing shortages; an 
     analysis of succession planning at VA medical facilities; and 
     the number of VA health care providers who have been removed, 
     retired, or left their positions for other reasons.
     House Amendment
       The House amendment contained no similar provision.
     Conference Agreement
       The Conference substitute adopts the Senate provision with 
     an amendment that would require the Secretary to establish 
     medical residency programs or ensure sufficient numbers of 
     medical residency positions at facilities with existing 
     programs in areas experiencing a shortage of physicians or 
     located in a community that is designated as a health 
     professional shortage area. It would also increase the number 
     of graduate medical education residency positions by up to 
     1,500 over five years with a priority for primary care, 
     mental health, and other specialties as VA determines 
     appropriate. Finally, it would require an annual report to 
     Congress.
       The Conference encourages VA to explore options of 
     partnering with private sector and affiliate hospitals who 
     could potentially provide vacant space to VA for care.


Extension and modification of certain programs within the Department of 
  Veterans Affairs Health Professionals Educational Assistance Program

     Current Law
       Section 7601, et seq. of title 38, U.S.C., provides VA with 
     authority to carry out the VA Health Professionals Education 
     Assistance Program (hereinafter, ``HPEAP'') to provide 
     scholarships, tuition assistance, debt reduction assistance, 
     and other educational programs to VA health care 
     professionals. HPEAP serves as a recruitment and retention 
     tool for the Department. For example, the Education Debt 
     Reduction Program (hereinafter, ``EDRP''), which provides 
     educational assistance to VHA employees in an effort to 
     maintain staffing levels, has assisted 10,055 individuals 
     from FY 2002 through FY 2013. However, VA has acknowledged 
     EDRP has experienced lower than expected utilization rates 
     because it requires participants to pay student loan expenses 
     upfront which are reimbursed later by the Department. As a 
     result, the number of participants defaulting on their loans 
     and subsequently being removed from the program is higher 
     than anticipated.
     Senate Amendment
       The Senate amendment contained no similar provision.
     House Amendment
       The House amendment contained no similar provision.
     Conference Agreement
       The Conference substitute would extend VA's authority to 
     operate HPEAP through December 31, 2019. It would also 
     increase the cap on debt reduction payments to an individual 
     participant from $60,000 to $120,000. These amendments would 
     bring VA's Health Professionals Educational Assistance 
     Program in line with other similar federal programs and 
     ensure VA has the authority to provide appropriate incentives 
     to attract health care professionals.


 Clinic management training for employees at medical facilities of the 
                     Department of Veterans Affairs

     Current Law
       Timely access to health care requires efficient clinic 
     management. As early as 2005, GAO noted that VHA lacked 
     standardized training programs for scheduling. Further, VHA 
     has no leadership or management training in access to care 
     management. GAO, VAOIG and VA's Office of Medical Inspector 
     have identified standardization of clinic management training 
     regarding availability of providers' schedules as a VA 
     management challenge. Specific VA medical centers that have 
     experienced difficulty with standardized scheduling processes 
     are the VA San Diego Health Care System, the Cheyenne, 
     Wyoming, VA Medical Center, and the Phoenix VA Healthcare 
     System. Moreover, the tone of VHA's directive entitled 
     Outpatient Scheduling Processes and Procedures is written in 
     a manner that offers guidance rather than specific policy, 
     seemingly allowing for discretion regarding its 
     implementation.
     Senate Amendment
       The Senate amendment would require VA to implement a clinic 
     management training program to provide in-person, 
     standardized education on health care management to all VA 
     managers and health care providers. Such training program 
     would be required to include training on: managing the 
     schedules of VA health care providers; the appropriate number 
     of appointments that a VA health care provider should conduct 
     on a daily basis; managing appointments; the proper use of 
     VA' s appointment scheduling system; optimizing the use of 
     technology; and the proper use of physical plant space at VA 
     medical facilities.
       It would also require VA to carry out the clinic management 
     training program for two years and would require VA to update 
     training materials on an ongoing basis and provide such 
     training materials to relevant officials, as appropriate. 
     Updating of training materials will need to account for new 
     IT such as a new scheduling system or electronic access to 
     care dash board.
     House Amendment
       The House amendment contained no similar provision.
     Conference Agreement
       The Conference substitute adopts the Senate provision.

             Title IV--Health Care Related to Sexual Trauma


expansion of eligibility for sexual trauma counseling and treatment to 
                   veterans on inactive duty training

     Current Law
       Section 1720D of title 38, U.S.C., requires VA to provide 
     counseling and appropriate care and services to veterans to 
     overcome psychological trauma, which in the judgment of a VA 
     mental health professional, 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 (otherwise known as 
     military sexual trauma) (hereinafter, ``MST''). Veterans who 
     experienced MST while serving on active duty or active duty 
     for training are included under this authority. However, 
     veterans who experienced MST while on inactive duty for 
     training--for example, those who were assaulted during 
     weekend drill training for the National Guard and Reserve--
     are not included.
     Senate Amendment
       The Senate amendment would amend section 1720D of title 38, 
     U.S.C., to provide VA with the authority to provide 
     counseling, care and services to veterans, and certain other 
     servicemembers who may not have veteran status, who 
     experienced sexual trauma while serving on inactive duty for 
     training.
     House Amendment
       The House amendment contained no similar provision.
     Conference Agreement
       The Conference substitute adopts the Senate provision.


    provision of counseling and treatment for sexual trauma by the 
     Department of Veterans Affairs to members of the Armed Forces

     Current Law
       Under current law, section 1720D of title 38, U.S.C., VA 
     has the authority to provide counseling, care and services to 
     veterans who experienced sexual trauma while serving on 
     active duty or active duty for training.
     Senate Amendment
       The Senate amendment would expand eligibility for care and 
     services for MST at a

[[Page 13362]]

     VA facility to active duty servicemembers. Active duty 
     servicemembers would not be required to initially be seen by 
     DOD and receive a referral before seeking treatment at a VA 
     facility for MST. It would take effect on the date that is 
     one year after the date of enactment.
     House Amendment
       The House amendment contains no similar provision.
     Conference Agreement
       The Conference substitute adopts the Senate position.


                   reports on military sexual trauma

     Current Law
       Section 1720D of title 38, U.S.C., states that ``each year, 
     the Secretary shall submit to Congress an annual report on 
     the counseling, care, and services provided to veterans 
     pursuant to this section.'' However, there is no language 
     requiring an assessment.
     Senate Amendment
       The Senate amendment would require the VA-DOD Joint 
     Executive Committee to conduct an annual assessment for the 
     next five years of the processes and procedures regarding the 
     transition and continuum of care from the DOD to VA for 
     individuals who have experienced MST. The assessment would 
     also include the processes and collaboration by the agencies 
     to assist individuals filing a claim for MST related 
     disability. Additionally, VA would be required to submit a 
     report to Congress no later than 630 days from the date of 
     enactment of the Act on the treatment and services available 
     for male veterans who experience MST compared to such 
     treatment and services available to female veterans. It would 
     take effect on the date that is 270 days after the date of 
     enactment of the Act.
     House Amendment
       The House amendment contained no similar provision.
     Conference Agreement
       The Conference substitute adopts the Senate provision.

                   Title V--Other Health Care Matters


  extension of pilot program on assisted living services for veterans 
                      with traumatic brain injury

     Current Law
       Section 1705 of Public Law 110-181, the ``National Defense 
     Authorization Act for Fiscal Year 2008,'' requires: (1) VA, 
     in collaboration with the Defense and Veterans Brain Injury 
     Center, to carry out a five-year pilot program to assess the 
     effectiveness of providing assisted living services to 
     veterans with traumatic brain injury (hereinafter, ``TBI'') 
     to enhance their rehabilitation, quality of life, and 
     community integration; (2) at least one part of the pilot 
     program to be carried out in a VISN that contains a VA 
     polytrauma center; (3) special consideration to be given to 
     veterans in rural areas; and, (4) VA to report to the 
     Committees on the pilot program. To comply with this 
     requirement, VA awarded a national contract to 20 contractors 
     at more than 150 sites of care across the U.S. However, 
     statutory authority for this pilot program expires on 
     September 30, 2014.
     Senate Amendment
       The Senate amendment contains no similar provision.
     House Amendment
       The House amendment contains no similar provision.
     Conference Agreement
       The Conference agreement extends the statutory authority 
     for VA to operate the pilot program from September 30, 2014, 
     to October 6, 2017.

                Title VI--Major Medical Facility Leases


             authorization of major medical facility leases

     Current Law
       Under current law, section 8104 of title 38, U.S.C., 
     Congressional authorization is required prior to entering 
     into any VA major medical facility lease that has an average 
     annual rent of $1,000,000 or above.
     Senate Amendment
       The Senate amendment would authorize VA to enter into 26 
     major medical facility leases in 17 states and Puerto Rico.
     House Amendment
       The House amendment contained no similar provision.
     Conference Agreement
       The Conference substitute adopts the Senate provision with 
     an amendment to include a lease authorization for a VA 
     community-based outpatient clinic in Tulsa, Oklahoma, in an 
     amount not to exceed $13.27 million. In enacting such leases, 
     the Conferees would like the Secretary to consider any 
     potential cost, energy and schedule savings that might be 
     offered by standardized design elements and off-site 
     construction methods, including prefabricated components and 
     panelized structures.


  Budgetary treatment of Department of Veterans Affairs major medical 
                           facilities leases

     Current Law
       Section 8104 of title 38, U.S.C., requires authorization of 
     any major medical facility construction project or lease. 
     Subsections (a)(l)(A) and (a)(l)(B) of section 1341 of title 
     31, U.S.C., prohibit any government employee from entering 
     into contracts, or making or authorizing expenditures and 
     obligations that exceed the amount of appropriated funds for 
     such expenditures.
       Appendix B of the Office of Management and Budget's 
     (hereinafter, ``OMB'') Circular A-11 (hereinafter, 
     ``Circular'') describes the processes through which budgetary 
     treatment of leasepurchase and leases of capital assets will 
     be consistent with scorekeeping rules originally promulgated 
     in connection with the Budget Enforcement Act of 1990 and the 
     Anti-Deficiency Act. According to the Circular, at the time 
     an Agency enters into a binding commitment, the Agency must 
     obligate sufficient budget authority to cover associated 
     legal obligations to the government, consistent with the 
     requirements of the Anti-Deficiency Act. For lease-purchases 
     or capital leases, this consists of the net present value of 
     the total estimated legal obligations over the entire life of 
     the contract. For operating leases, this can consist of 
     either an amount sufficient to cover the lease payments for 
     the first year plus a sufficient amount to cover any costs 
     associated with cancellation of the contract, if the contract 
     includes a cancellation clause, or an amount sufficient to 
     cover the annual lease payment, if the lease is funded 
     through a self-insuring fund such as the General Services 
     Administration's Federal Building Fund.
       After receiving information about how VA has exercised the 
     authority provided in prior VA major medical facilities 
     leasing authorizations, the Congressional Budget Office 
     (hereinafter, ``CBO'') concluded in 2012 that VA has been 
     entering into binding obligations for the full period of the 
     lease, without regard to the scorekeeping rules contained in 
     the Circular.
     Senate Amendment
       The Senate amendment would require the funding prospectus 
     of a proposed lease to include a detailed analysis of how the 
     lease is expected to comply with OMB's Circular and the 
     AntiDeficiency Act. It also directs VA, at least 30 days 
     before entering into a lease, to submit to the Committees: 
     (1) notice of the intention to enter into, and a detailed 
     summary of, such lease; (2) a description and analysis of any 
     differences between the lease prospectus submitted and the 
     proposed lease; and (3) a scoring analysis demonstrating that 
     the proposed lease fully complies with OMB's Circular. VA 
     must also report any material differences between the 
     proposed lease and the lease entered, no later than 30 days 
     after entering into a lease.
     House Amendment
       The House amendment contains no similar provision.
     Conference Agreement
       The Conference substitute adopts the Senate provision.

                   Title VII--Other Veterans Matters


    expansion of marine gunnery sergeant john david fry scholarship

     Current Law
       Public Law 111-32, the ``Supplemental Appropriations Act of 
     2009,'' amended the Post-9/11 GI Bill to establish the Marine 
     Gunnery Sergeant John David Fry Scholarship for the children 
     of servicemembers who died in the line of duty after 
     September 10, 2001. Eligible children are entitled to 36 
     months of benefits at the 100 percent level and may use the 
     benefit until their 33rd birthday.
       Currently, surviving spouses of servicemembers who died in 
     the line of duty are only eligible to receive survivors' and 
     dependents' educational assistance (hereinafter, ``Chapter 
     35''). Chapter 35 benefits provide a spouse up to $1,003 per 
     month as a full-time college student, which may require the 
     spouse to find other sources of income or funding to offset 
     the high cost of education. Additionally, recipients of 
     Chapter 35 do not receive a separate living allowance.
     Senate Amendment
       The Senate amendment would expand the Marine Gunnery 
     Sergeant John David Fry Scholarship to include surviving 
     spouses of members of the Armed Forces who died or die in the 
     line of duty after September 10, 2001. It would amend 
     subsection (b)(9) of section 3311 of title 38, U.S.C., to 
     expand the ability to receive the Marine Gunnery Sergeant 
     John David Fry Scholarship to surviving spouses. It would 
     limit the entitlement of the surviving spouse to the date 
     that is 15 years after the date of the servicemember's death 
     or the date the surviving spouse remarries, whichever is 
     earlier. Further, a surviving spouse, who is entitled both 
     under amended section 3311 and under Chapter 35, would be 
     required to make an irrevocable election to receive 
     educational assistance under either amended section 3311 or 
     Chapter 35. Finally, this provision would make a necessary 
     conforming amendment to subsection (b)(4) of section 3321 of 
     title 38, U.S.C.
     House Amendment
       The House amendment contained no similar provision.
     Conference Agreement
       The Conference substitute adopts the Senate position with 
     an effective date of January 1, 2015.

[[Page 13363]]




  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

     Current Law
       Section 3313 of title 38, U.S.C., authorizes VA to pay in-
     state tuition and fees for veterans attending a public 
     educational institution using their Post-9/11 GI Bill 
     educational benefits. However, a veteran may not always 
     qualify for in-state tuition rates.
       Several states currently assist all or certain veterans by 
     recognizing them as in-state students for purposes of 
     attending a public educational institution, regardless of 
     length of residency in the state where the veteran is 
     attending college. Yet, many states require transitioning 
     veterans to meet stringent residency requirements before they 
     can be considered in-state residents. Federal law is silent 
     on this matter.
       Recently-separated veterans may not be able to meet state 
     residency requirements where they choose to attend school 
     because they were stationed elsewhere during their military 
     service, and once enrolled, they may not be able to legally 
     establish residency because of their status as full-time 
     students. The federal educational assistance provided to 
     veterans by VA was designed, in part, to help them develop 
     the skills and background necessary to make a successful 
     transition from military service to a civilian life and 
     career.
     Senate Amendment
       The Senate amendment would amend section 3679 of title 38, 
     U.S.C., by adding a new subsection (c) to require VA to 
     disapprove courses of education provided by public 
     institutions of higher learning that charge tuition and fees 
     at more than the in-state resident rate for veterans within 
     three years from discharge from a period of at least 90 days 
     service in the military, irrespective of the veteran's 
     current state of residence, if the veteran is living in the 
     state in which the institution is located while pursuing that 
     course of education. Pursuant to subsection (c), this 
     provision would apply to veterans using the educational 
     assistance programs administered by VA under chapters 30 and 
     33 of title 38, U.S.C., and to dependent beneficiaries using 
     Post-9/11 GI Bill benefits during the three years after the 
     veteran's discharge. If the veteran or dependent enrolls 
     within three years after the veteran's discharge, the 
     requirement to charge no more than the in-state tuition rate 
     would apply for the duration the individual remains 
     continuously enrolled at the institution.
       Subsection (c)(4) would permit a public educational 
     institution to require a covered individual to demonstrate an 
     intent, by means other than satisfying a physical presence 
     requirement, to eventually establish residency in that state 
     or to meet requirements unrelated to residency in order to be 
     eligible for the in-state tuition rate. This section would 
     also provide VA discretion to waive the established 
     requirements in a circumstance where it is deemed appropriate 
     in regards to approval of a specific course of education. Any 
     disapproval of courses pursuant to these new requirements 
     would apply only with respect to benefits provided under 
     chapters 30 and 33 of title 38. This provision would apply to 
     programs of education that begin during academic terms after 
     July 1, 2015.
     House Amendment
       The House amendment contained no similar provision.
     Conference Agreement
       The Conference substitute adopts the Senate provision.


Extension of reduction in amount of pension furnished by Department of 
  Veterans Affairs for certain veterans covered by Medicaid plans for 
                services furnished by nursing facilities

     Current Law
       Section 5503 of title 38, U.S.C., sets forth the criteria 
     under which eligibility for income-based pension payments and 
     aid and attendance allowances are affected by domiciliary or 
     nursing home residence. In instances where a veteran, or 
     surviving spouse, has neither a spouse nor a child, and is 
     receiving Medicaid-covered nursing home care, the veteran or 
     surviving spouse is eligible to receive no more than $90 per 
     month in VA pension or death pension payments. Under current 
     law, this authority shall expire on November 30, 2016. This 
     authority has been extended several times, most recently 
     pursuant to Public Law 112-260, the ``Dignified Burial and 
     Other Veterans' Benefits Improvement Act of 2012.''
     Senate Amendment
       The Senate amendment contains no similar provision.
     House Amendment
       The House amendment contains no similar provision.
     Conference Agreement
       The Committee substitute would amend section 5503( d)(7) to 
     extend, through September 30, 2024, current eligibility 
     restrictions for recipients of a VA pension who receive 
     Medicaid-covered nursing home care. The VA pension program 
     should not be used to subsidize other federal benefit 
     programs. Further, pension recipients should have available 
     funds for incidentals and personal expenses.


   Extension of requirement for collection of fees for housing loans 
              guaranteed by Secretary of Veterans Affairs

     Current Law
       Under VA's home loan guaranty program, VA may guarantee a 
     loan made to eligible servicemembers, veterans, reservists, 
     and certain un-remarried surviving spouses for the purchase 
     (or refinancing) of houses, condominiums, and manufactured 
     homes. Section 3729(b)(2) of title 38, U.S.C., sets forth a 
     loan fee table that lists funding fees, expressed as a 
     percentage of the loan amount, for different types of loans.
     Senate Amendment
       The Senate amendment contains no similar provision.
     House Amendment
       The House amendment contains no similar provision.
     Conference Agreement
       The Committee substitute would extend VA's authority to 
     collect certain funding fees through September 30, 2024, by 
     amending the fee schedule set forth in section 3729(b)(2) of 
     title 38, U.S.C.


  Limitation on awards and bonuses paid to employees of Department of 
                            Veterans Affairs

     Current Law
       Under current law, chapter 45, chapter 53, and other 
     provisions of title 5, U.S.C., VA has the authority to 
     provide awards to certain employees. For example, chapter 45 
     of title 5 provides VA with authority to grant cash awards to 
     employees in recognition of performance.
     Senate Amendment
       The Senate amendment contained no similar provision.
     House Amendment
       The House amendment would, for each of FYs 2014 through 
     2016, prohibit the Secretary from paying awards or bonuses 
     under chapters 45 or 53 of title 5, U.S.C., or any other 
     awards or bonuses authorized under such title.
     Conference Agreement
       The Conference substitute adopts the House provision with 
     an amendment that would, for each of FYs 2014 through 2024, 
     cap the amount of awards or bonuses payable under chapter 45 
     or 53 of title 5, U.S.C., or any other awards or bonuses 
     authorized under such title, at $360 million. It is the 
     Conferees' expectation that this cap not disproportionately 
     impact lower-wage employees.


            Extension of authority to use income information

     Current Law
       Certain benefit programs administered by VA, including 
     pension for wartime veterans and compensation for Individual 
     Unemployability are available only to beneficiaries whose 
     annual income is below a certain level. VA must have access 
     to verifiable income information in order to ensure that 
     those receiving benefits under its income-based programs are 
     not earning a greater annual income than the law permits.
       Section 6103(1)(7)(D) of title 26, U.S.C., authorizes the 
     release of certain income information by the Internal Revenue 
     Service (hereinafter, ``IRS'') or the Social Security 
     Administration (hereinafter, ``SSA'') to VA for the purposes 
     of verifying income of applicants for VA needs-based 
     benefits. Section 5317(g) of title 38, U.S.C., provides VA 
     with temporary authority to obtain and use this information. 
     Under current law, this authority expires on September 30, 
     2016.
     Senate Amendment
       The Senate amendment contains no similar provision.
     House Amendment
       The House amendment contains no similar provision.
     Conference Agreement
       The Committee substitute would extend for eight years, 
     until September 30, 2024, VA's authority to obtain 
     information from the IRS or the SSA for income verification 
     purposes for needs-based benefits.


 Removal of senior executive of the Department of Veterans Affairs for 
                       performance or misconduct

     Current Law
       Under current law, section 7543 of title 5, U.S.C., career 
     appointees in the Senior Executive Service (hereinafter, 
     ``SES'') may be removed from government service for 
     misconduct, neglect of duty, malfeasance, or failure to 
     accept a directed reassignment or to accompany a position in 
     a transfer of function. Senior executives removed as a result 
     of these conduct-related issues are entitled to certain 
     rights, including at least 30 days advance written notice; a 
     reasonable time but not less than seven days to reply; 
     representation by an attorney or other representative; a 
     written decision from the

[[Page 13364]]

     agency involved; and appeal rights to the Merit Systems 
     Protection Board (hereinafter, ``MSPB'').
       Under current law, section 3592 of title 5, U.S.C., career 
     appointees in the SES may be removed from the SES and placed 
     into a non-SES position for performance-related issues. This 
     removal may occur at any time during a one-year probationary 
     period or at any time for less than fully successful 
     executive performance. Generally, senior executives removed 
     from the SES and placed into a civil service position are 
     entitled to an informal hearing before the MSPB.
       Also under current law, section 3592(b) of title 5, U.S.C., 
     there is a 120-day moratorium from removing a career 
     appointee in the SES following the appointment of the head of 
     the agency or the SES employee's immediate supervisor.
     Senate Amendment
       The Senate amendment would provide the Secretary with the 
     authority to remove or demote any individual from the SES if 
     the Secretary determines the performance of the individual 
     warrants such removal and requires the Secretary to notify 
     Congress within 30 days of removing or demoting a senior 
     executive under this authority. The senior executive would be 
     allowed an opportunity for an expedited review by the MSPB. 
     Under such expedited appeal, the senior executive would have 
     seven days to appeal a removal or demotion and the MSPB would 
     be required to adjudicate the appeal within 21 days.
       The MSPB would be required to establish and implement a 
     process to conduct expedited reviews and submit to Congress a 
     report on their established process within 30 days of 
     enactment.
       The Senate amendment would also provide authority for the 
     Secretary to immediately remove senior executives 
     notwithstanding the 120-day moratorium in current law.
     House Amendment
       The House amendment would provide the Secretary with the 
     authority to remove or demote any individual from the SES if 
     the Secretary determines the performance of the individual 
     warrants such removal and requires the Secretary to notify 
     Congress within 30 days of removing or demoting a senior 
     executive under this authority.
     Conference Agreement
       The Conference substitute generally adopts the Senate 
     provision with an amendment to change the level of review at 
     the MSPB. The substitute requires that the expedited review 
     by the MSPB be conducted by an Administrative Judge at the 
     MSBP, and if the MSPB Administrative Judge does not conclude 
     their review within 21 days then the removal or demotion is 
     final. The substitute does not allow for any further appeal 
     beyond the Administrative Judge, and does not allow for a 
     second level review by the three-person board at the MSPB. 
     The substitute also requires that if the senior executive is 
     removed, and then appeals VA's decision, the senior executive 
     is not entitled to any type of pay, bonus, or benefit while 
     appealing the decision of removal. Furthermore, the 
     substitute requires that if a senior executive is demoted, 
     and then appeals VA's decision, the employee may only receive 
     any type of pay, bonus, or benefit at the rate appropriate 
     for the position they were demoted to, and only if the 
     individual shows up for duty, while appealing the decision of 
     demotion. The substitute requires that the MSPB submit to 
     Congress a plan within 14 days of enactment of how the 
     expedited review would be implemented. The substitute also 
     adds language to include title 38 SES equivalents under this 
     new authority and includes ``misconduct'' along with ``poor 
     performance'' as a reason to remove or demote a senior 
     executive.

                       Title VIII--Other Matters


                        Appropriation of amounts

     Current Law
       Congress uses an appropriation to provide funding for 
     discretionary spending programs of the Federal government.
     Senate Amendment
       The Senate amendment would authorize and appropriate for 
     FYs 2014, 2015, and 2016, the emergency funds necessary to 
     carry out this Act.
       In addition, the Senate amendment would make available, at 
     the end of FYs 2014 and 2015, unobligated balances in VA's 
     medical care accounts (medical services, medical support and 
     compliance, and medical facilities) for the hiring of 
     additional health care professionals.
     House Amendment
       The House amendment contained no similar provision.
     Conference Agreement
       The Conference substitute authorizes and appropriates $5 
     billion to increase veterans access to care through the 
     hiring of physicians and other medical staff and by improving 
     VA's physical infrastructure.


                          Veterans Choice Fund

     Current Law
       There is no provision of law establishing a Veterans Choice 
     Fund.
     Senate Amendment
       The Senate amendment contained no similar provision.
     House Amendment
       The House amendment contained no similar provision.
     Conference Agreement
       The Conference substitute establishes in the Treasury a 
     fund to be known as the Veterans Choice Fund to carry out the 
     expanded availability of hospital care and medical services 
     for veterans created by section 101 of the Conference 
     substitute. The Conference substitute also authorizes and 
     appropriates $10 billion for deposit in the Veterans Choice 
     Fund.


                         Emergency designations

     Current Law
       Congress may exempt the budgetary effects of a provision 
     from certain enforcement procedures by designating it as an 
     emergency requirement. An emergency designation causes the 
     spending and revenue effects estimated to result from such 
     bills as exempt for purposes of enforcing budget procedures.
     Senate Amendment
       The Senate amendment would designate this Act as an 
     emergency requirement under the Statutory Pay-As-You-Go Act 
     of 2010 and the Concurrent Resolution on the budget for FY 
     2010.
     House Amendment
       The House amendment contained no similar provision.
     Conference Agreement
       The Conference substitute adopts the Senate provision.
     Jeff Miller,
     Doug Lamborn,
     David P. Roe of Tennessee,
     Bill Flores,
     Dan Benishek,
     Mike Coffman,
     Brad R. Wenstrup,
     Jackie Walorski,
     Michael H. Michaud,
     Corrine Brown,
     Mark Takano,
     Julia Brownley of California,
     Ann Kirkpatrick,
     Timothy J. Walz,
                                Managers on the part of the House.

     Bernard Sanders,
     John D. Rockefeller IV,
     Patty Murray,
     Sherrod Brown,
     Jon Tester,
     Mark Begich,
     Richard Blumenthal,
     Mazie K. Hirono,
     Richard Burr,
     Johnny Isakson,
     Mike Johanns,
     John McCain,
     Tom Coburn,
     Marco Rubio,
                               Managers on the part of the Senate.

   COMPLIANCE WITH RULES OF THE HOUSE OF REPRESENTATIVES AND SENATE 
     REGARDING EARMARKS AND CONGRESSIONALLY DIRECTED SPENDING ITEMS

       Pursuant to clause 9 of rule XXI of the Rules of the House 
     of Representatives and rule XLIV of the Standing Rules of the 
     Senate, neither this Conference report nor the accompanying 
     joint statement of Conferees contains any congressional 
     earmarks, congressionally directed spending items, limited 
     tax benefits, or limited tariff benefits, as defined in such 
     rules.

     For consideration of the House amendment and the Senate 
     amendment, and modifications committed to conference:
     Jeff Miller of Florida,
     Doug Lamborn,
     David P. Roe of Tennessee,
     Bill Flores,
     Dan Benishek,
     Mike Coffman,
     Brad R. Wenstrup,
     Jackie Walorski,
     Michael H. Michaud,
     Corrine Brown of Florida,
     Mark Takano,
     Julia Brownley of California,
     Ann Kirkpatrick,
     Timothy J. Walz,
                                Managers on the part of the House.

     Bernard Sanders,
     John D. Rockefeller IV,
     Patty Murray,
     Sherrod Brown,
     Jon Tester,
     Mark Begich,
     Richard Blumenthal,
     Mazie K. Hirono,
     Richard Burr,
     Johnny Isakson,
     Mike Johanns,
                               Managers on the part of the Senate.

  The SPEAKER pro tempore. Under clause 8 of rule XXII, the filing of 
the conference report on H.R. 3230 has vitiated the motion to instruct 
offered by the gentleman from West Virginia (Mr. Rahall), which was 
debated on July 25, 2014, and on which further proceedings were 
postponed.

[[Page 13365]]



                          ____________________