[House Report 118-592]
[From the U.S. Government Publishing Office]


 118th Congress    }                                     {    Report
                         HOUSE OF REPRESENTATIVES
  2nd Session      }                                     {    118-592

======================================================================



 
                  VETERANS EXAM EXPANSION ACT OF 2023

                                _______
                                

 July 18, 2024.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

   Mr. Bost, from the Committee on Veterans' Affairs, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 5938]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Veterans' Affairs, to whom was referred 
the bill (H.R. 5938) to amend the Veterans' Benefits 
Improvements Act of 1996 and the Johnny Isakson and David P. 
Roe, M.D. Veterans Health Care and Benefits Improvement Act of 
2020 to improve the temporary licensure requirements for 
contract health care professionals who perform medical 
disability examinations for the Department of Veterans Affairs, 
and for other purposes, having considered the same, reports 
favorably thereon with an amendment and recommends that the 
bill as amended do pass.

                                CONTENTS

                                                                   Page
Amendment........................................................     2
Purpose and Summary..............................................     2
Background and Need for Legislation..............................     3
Hearings.........................................................     4
Subcommittee Consideration.......................................     5
Committee Consideration..........................................     5
Committee Votes..................................................     5
Committee Oversight Findings.....................................     5
Statement of General Performance Goals and Objectives............     5
Earmarks and Tax and Tariff Benefits.............................     5
Committee Cost Estimate..........................................     5
Budget Authority and Congressional Budget Office Estimate........     6
Federal Mandates Statement.......................................     7
Advisory Committee Statement.....................................     7
Applicability to Legislative Branch..............................     7
Statement on Duplication of Federal Programs.....................     7
Section-by-Section Analysis of the Legislation...................     7
Changes in Existing Law Made by the Bill as Reported.............     8

    The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Veterans Exam Expansion Act of 2023''.

SEC. 2. IMPROVEMENTS TO TEMPORARY LICENSURE REQUIREMENTS FOR CONTRACT 
                    HEALTH CARE PROFESSIONALS WHO PERFORM MEDICAL 
                    DISABILITY EXAMINATIONS FOR THE DEPARTMENT OF 
                    VETERANS AFFAIRS.

  (a) Expansion.--
          (1) In general.--Section 504(c)(2) of the Veterans' Benefits 
        Improvements Act of 1996 (Public Law 104-275; 38 U.S.C. 5101 
        note), as amended by paragraph (1) of subsection (a) of section 
        2002 of the Johnny Isakson and David P. Roe, M.D. Veterans 
        Health Care and Benefits Improvement Act of 2020 (Public Law 
        116-315; 38 U.S.C. 5101 note), is further amended, subject to 
        the sunset in paragraph (4) of such subsection--
                  (A) in the matter preceding subparagraph (A), by 
                striking ``or psychologist'' and inserting 
                ``psychologist, podiatrist, dentist, optometrist, or 
                other health care professional specified in regulations 
                prescribed by the Secretary''; and
                  (B) in subparagraph (A), by striking ``the physician, 
                physician assistant, nurse practitioner, audiologist, 
                or psychologist, as the case may be'' and inserting 
                ``such health care professional''.
          (2) Conforming amendment.--Section 2002(a)(2) of the Johnny 
        Isakson and David P. Roe, M.D. Veterans Health Care and 
        Benefits Improvement Act of 2020 (Public Law 116-315; 38 U.S.C. 
        5101 note) is amended by striking ``physicians assistants, 
        nurse practitioners, audiologists, and psychologists'' and 
        inserting ``health care professionals''.
  (b) Report.--Not later than 15 months after the date of the enactment 
of this Act, the Secretary of Veterans Affairs shall submit to the 
Committees on Veterans' Affairs of the Senate and House of 
Representatives a report regarding the use of the authority under 
section 504 of the Veterans' Benefits Improvements Act of 1996 (Public 
Law 104-275; 38 U.S.C. 5101 note), as temporarily amended by section 
2002(a)(1) of the Johnny Isakson and David P. Roe, M.D. Veterans Health 
Care and Benefits Improvement Act of 2020 (Public Law 116-315; 38 
U.S.C. 5101 note) and by subsection (a). Such report shall include, 
with respect to the one-year period after the date of the enactment of 
this Act, the following elements:
          (1) The number of examinations conducted pursuant to a 
        contract under such authority.
          (2) The number of such examinations conducted in each State, 
        the District of Columbia, or a Commonwealth, territory, or 
        possession of the United States.
          (3) The numbers of each kind of health care professionals who 
        conducted such examinations.
          (4) The number of examinations that were erroneously 
        conducted by a health care professional--
                  (A) without such a contract; or
                  (B) unauthorized to enter into such a contract.
          (5) The plan of the Secretary to correct errors in the use of 
        such authority.

                          Purpose and Summary

    H.R. 5938, as amended, the ``Veterans Exam Expansion Act of 
2023,'' was introduced by Rep. Juan Ciscomani of Arizona on 
October 12, 2023. This bill, as amended, would expand the 
categories of specialty healthcare professionals who perform 
disability compensation examinations pursuant to a contract 
with the Department of Veterans Affairs (VA), and are also 
authorized to perform such examinations in states other than 
the state in which they are licensed to practice medicine. 
Specifically, the bill, as amended, would expand those 
categories to include dentists, podiatrists, and optometrists. 
It would also authorize the Secretary of the Department of 
Veterans Affairs to add additional categories of healthcare 
professionals to the list of those authorized to perform 
examinations in states other than the state in which they are 
licensed. The bill, as amended, would also require the 
Secretary to report information concerning the examinations 
conducted under this license portability authority.

                  Background and Need for Legislation


Section 1: Short Title

    This Act may be cited as the ``Veterans Exam Expansion Act 
of 2023.''

Section 2: Improvements to Temporary Licensure Requirements for 
        Contract Health Care Professionals Who Perform Medical 
        Disability Examinations for the Department of Veterans Affairs

    When a veteran files a claim for VA disability benefits, it 
may trigger VA's duty to provide them with a VA disability 
compensation exam. Whether VA grants or denies a claim often 
hinges on the results of these exams. The vast majority of such 
exams--92% of all exams conducted in fiscal year 2023--are 
performed by medical professionals who have been contracted by 
VA. Under the Veterans Benefits Improvement Act of 1996, and 
the Johnny Isakson and David P. Roe, M.D. Veterans Health Care 
and Benefits Improvement Act of 2020, certain categories of 
contracted healthcare professionals are authorized to conduct 
exams in states other than those in which they hold a medical 
license.
    At a July 27, 2023, Subcommittee on Disability Assistance 
and Memorial Affairs oversight hearing,\1\ the Committee 
learned that though the license portability authority helps 
veterans who have difficulty traveling to a VA facility for 
their exam, including veterans who live in rural areas with a 
scarcity of local specialty care providers, VA's oversight of 
its contract exam program is ineffective. As a result, contract 
exams were improperly conducted by certain healthcare 
professionals who are not covered under the license portability 
authority.
---------------------------------------------------------------------------
    \1\VA Disability Exams: Are Veterans Receiving Quality Services? | 
Committee Repository | U.S. House of Representatives.
---------------------------------------------------------------------------
    In her written testimony for the July 27, 2023, oversight 
hearing, Ms. Elizabeth Curda, Director, Education, Workforce, 
and Income Security, U.S. Government Accountability Office 
(GAO), stated, ``VBA and vendor officials reported that the 
temporary expansion of license portability helped expand their 
exam reach to rural and high-need areas and increase veterans' 
access to specialists and experienced examiners.'' The GAO, 
however, found that VBA's instructions to vendors for 
conducting contracted disability exams ``inaccurately listed 
dentists as eligible for license portability and included the 
term `etc.' following the list of examiner types eligible for 
license portability.'' Because these instructions were 
inaccurate and confusing, GAO found that vendors were 
improperly using dentists and optometrists to conduct exams 
under license portability. GAO also found that ``VBA did not 
adequately monitor vendors' use of license portability. VBA was 
unaware that some vendors were using dentists and optometrists 
to conduct exams in states other than where they were 
licensed.''\2\
---------------------------------------------------------------------------
    \2\Elizabeth Curda, Testimony of GAO (July 27, 2023), https://
docs.house.gov/meetings/VR/VR09/20230727/116269/HHRG-118-VR09-Wstate-
CurdaE-20230727.pdf.
---------------------------------------------------------------------------
    To address this issue, this bill, as amended, would require 
the Secretary to submit a report to Congress on how often the 
license portability authority is used by contractors, the type 
of healthcare professionals using this authority, and the 
number of exams improperly conducted without this authority. 
This bill, as amended, would also require the Secretary to 
submit to Congress a plan to correct errors in the use of this 
authority. This bill, as amended, would also expand the license 
portability authority to podiatrists, dentists, and 
optometrists, as well as authorize the Secretary to add 
additional categories of healthcare professionals to the list 
of those covered by the license portability authority.
    The Committee believes that this legislation is crucial to 
ensure that veterans, particularly those in rural areas, have 
easier access to disability compensation exams, including the 
specialty exams that are necessary to substantiate claims for 
disabilities of the feet, teeth, and eyes. The Committee also 
believes that this legislation is crucial to ensure proper 
oversight of VA's contract exam program, and to ensure that VA 
obtains the data necessary to determine the effectiveness of 
the temporary license portability authority going forward.

                                Hearings

    On November 8, 2023, the Subcommittee on Disability 
Assistance and Memorial Affairs held a legislative hearing on 
H.R. 5938 and other bills that were pending before the 
subcommittee.
    The following witnesses testified:
          The Honorable Morgan Luttrell, U.S. House of 
        Representatives; The Honorable Mike Bost, U.S. House of 
        Representatives; The Honorable Elissa Slotkin, U.S. 
        House of Representatives; The Honorable Juan Ciscomani, 
        U.S. House of Representatives; The Honorable Abigail 
        Davis Spanberger, U.S. House of Representatives; The 
        Honorable Keith Self, U.S. House of Representatives; 
        The Honorable David J. Trone, U.S. House of 
        Representatives; The Honorable Darrell Issa, U.S. House 
        of Representatives; Ms. Beth Murphy, Executive 
        Director, Compensation Service, Veterans Benefits 
        Administration, U.S. Department of Veterans Affairs; 
        Mr. Kevin Friel, Deputy Director, Pension & Fiduciary 
        Service, Veterans Benefits Administration, U.S. 
        Department of Veterans Affairs; Mr. Kenneth Arnold, 
        Vice Chairman, Board of Veterans' Appeals, U.S. 
        Department of Veterans Affairs; Mr. Shane Liermann, 
        Deputy National Legislative Director, Disabled American 
        Veterans; Ms. Quandrea N. Patterson, Associate 
        Director, Veterans of Foreign Wars of the United 
        States; and Mr. Zachary M. Stolz, Partner, Chisholm, 
        Chisholm, & Kilpatrick LTD.
    The following individuals and organizations submitted 
statements for the record:
          The Honorable Gerald E. Connolly, U.S. House of 
        Representatives; The ALS Association; American Veterans 
        (AMVETS); National Organization of Veterans' Advocates; 
        Paralyzed Veterans of America; Quality. Timeliness. 
        Customer Service (QTC); Special Operations Association 
        of America; Service Women's Action Network, and 
        Military Veterans Advocacy.

                       Subcommittee Consideration

    On November 29, 2023, the Subcommittee on Disability 
Assistance and Memorial Affairs held a markup on proposed 
legislation, including H.R. 5938. An amendment in the nature of 
a substitute offered by Mr. Ciscomani was adopted by voice 
vote, and the bill was ordered favorably forwarded for 
consideration by the full Committee on Veterans' Affairs. The 
amendment in the nature of a substitute removed the extension 
of the temporary license portability authority and authorized 
the Secretary to add, through a rulemaking process, additional 
categories of healthcare professionals to the list of those who 
may use the license portability authority.

                        Committee Consideration

    On December 5, 2023, the Full Committee met in open markup 
session, a quorum being present, and ordered H.R. 5938, as 
amended, be reported favorably to the House of Representatives 
by voice vote.
    A motion by Ranking Member Takano to report H.R. 5938, as 
amended, favorably to the House of Representatives was agreed 
to by voice vote.

                            Committee Votes

    In compliance with clause 3(b) of rule XIII of the Rules of 
the House of Representatives, no recorded votes were taken on 
amendments or in connection with ordering H.R. 5938, as 
amended, reported to the House.

                      Committee Oversight Findings

    In compliance with clause 3(c)(1) of rule XIII and clause 
(2)(b)(1) of rule X of the Rules of the House of 
Representatives, the Committee's oversight findings and 
recommendations are reflected in the descriptive portions of 
this report.

         Statement of General Performance Goals and Objectives

    In accordance with clause 3(c)(4) of rule XIII of the Rules 
of the House of Representatives, the Committee's performance 
goals and objectives of H.R. 5938, as amended, are to ensure 
that all veterans, including those in rural and underserved 
areas, have access to VA disability compensation examinations 
such that they may receive the VA benefits they have earned.

                  Earmarks and Tax and Tariff Benefits

    H.R. 5938, as amended, does not contain any Congressional 
earmarks, limited tax benefits, or limited tariff benefits as 
defined in clause 9 of rule XXI of the Rules of the House of 
Representatives.

                        Committee Cost Estimate

    The Committee adopts as its own the Congressional Budget 
Office cost estimate on this measure.

     Budget Authority and Congressional Budget Office Cost Estimate

[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]


    H.R. 5938 would expand the Department of Veterans Affairs' 
(VA) authority to contract with health care providers for 
medical examinations of veterans in any location in the United 
States, regardless of whether the providers are licensed to 
practice in that jurisdiction. Under current law, the 
department contracts with health care providers to perform 
medical examinations to determine whether veterans are eligible 
for disability compensation and pension benefits from VA. 
Health care providers who have valid licenses to practice as 
physicians, physician assistants, nurse practitioners, 
audiologists, or psychologists may conduct those examinations 
under VA contracts in any U.S. jurisdiction regardless of 
whether they are licensed to practice there. The bill would 
permit health care providers of any profession deemed necessary 
by VA to conduct disability examinations in any jurisdiction if 
the exam is performed under a contract with VA. Expanding the 
list of eligible health care providers who may provide 
disability examinations in a jurisdiction could change which 
providers perform exams but would not affect the number of 
veterans eligible to receive VA benefits. As a result, CBO 
estimates that enacting the provision would not affect direct 
spending for disability compensation benefits.
    The bill also would require VA to report to the Congress on 
the number and type of examinations provided by contracted 
health care providers during the 1-year period following 
enactment. The report would be due within 15 months of 
enactment. Under current law, VA may use mandatory 
appropriations to pay for administrative expenses associated 
with contract medical exams, including reports. Based on the 
cost of similar reports, CBO estimates that providing the 
report would increase direct spending by less than $500,000.
    The bill would impose an intergovernmental mandate as 
defined in the Unfunded Mandates Reform Act (UMRA) by expanding 
a preemption of state laws. Under current law, medical 
professionals performing exams on behalf of the department may 
do so in any state, commonwealth, territory, or the District of 
Columbia so long as they hold a valid medical license. The bill 
would expand the scope of the preemption to include more 
medical professions. As a result, states would be unable to 
collect fees for issuing medical licenses to those 
professionals contracted with the department and licensed by 
another jurisdiction. CBO estimates the loss in revenue would 
not exceed the threshold for intergovernmental mandates 
established in UMRA ($99 million in 2023, adjusted annually for 
inflation).
    The bill would not impose a private-sector mandate as 
defined in UMRA.
    The CBO staff contacts for this estimate are Logan Smith 
(for VA) and Brandon Lever (for mandates). The estimate was 
reviewed by Christina Hawley Anthony, Deputy Director of Budget 
Analysis.

                                         Phillip L. Swagel,
                             Director, Congressional Budget Office.

                       Federal Mandates Statement

    Section 423 of the Congressional Budget and Impoundment 
Control Act (as amended by Section 101(a)(2) of the Unfunded 
Mandate Reform Act, P.L. 104-4 is inapplicable to H.R. 5938, as 
amended.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act would be created by H.R. 
5938, as amended.

                  Applicability to Legislative Branch

    The Committee finds that H.R. 5938, as amended, does not 
relate to the terms and conditions of employment or access to 
public services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

              Statement on Duplication of Federal Programs

    Pursuant to clause 3(c)(5) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that no provision 
of H.R. 5938, as amended, would establish or reauthorize a 
program of the Federal Government known to be duplicative of 
another Federal program, a program that was included in any 
report from the Government Accountability Office to Congress 
pursuant to section 21 of Public Law 111-139, or a program 
related to a program identified in the most recent Catalog of 
Federal Domestic Assistance.

             Section-by-Section Analysis of the Legislation


Section 1. Short title

    Section 1 would establish the short title of the bill as 
the ``Veterans Exam Expansion Act of 2023.''

Section 2. Improvements to temporary licensure requirements for 
        contract health care professionals who perform medical 
        disability examinations for the Department of Veterans Affairs

    Section 2 would expand the temporary license portability 
authority to podiatrists, dentists, and optometrists. This 
section would also allow the Secretary to add, through a 
rulemaking process, additional practitioners to the list of 
medical professionals covered under this authority. This 
section would also require the Secretary to submit a report to 
Congress on the number of examinations conducted pursuant to a 
contract under the license portability authority in each State 
or territory, the numbers of each kind of health care 
professionals who conducted such examinations, the number of 
examinations that were erroneously conducted by a health care 
professional without license portability authority, and a plan 
to correct errors in the use of such authority.

         Changes in Existing Law Made by the Bill, as Reported

    In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italics, existing law in which no change 
is proposed is shown in roman):

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italics, and existing law in which no 
change is proposed is shown in roman):

              VETERANS' BENEFITS IMPROVEMENTS ACT OF 1996



           *       *       *       *       *       *       *
TITLE V--DEPARTMENT OF VETERANS AFFAIRS ADMINISTRATIVE MATTERS

           *       *       *       *       *       *       *


SEC. 504. PILOT PROGRAM FOR USE OF CONTRACT PHYSICIANS FOR DISABILITY 
                    EXAMINATIONS.

  (a) Authority.--The Secretary of Veterans Affairs, acting 
through the Under Secretary for Benefits, may conduct a pilot 
program under this section under which examinations with 
respect to medical disability of applicants for benefits under 
laws administered by the Secretary that are carried out through 
the Under Secretary for Benefits may be made by persons other 
than employees of the Department of Veterans Affairs. Any such 
examination shall be performed pursuant to contracts entered 
into by the Under Secretary for Benefits with those persons.
  (b) Limitation.--The Secretary may carry out the pilot 
program under this section as follows:
          (1) In fiscal years before fiscal year 2015, through 
        not more than 10 regional offices of the Department of 
        Veterans Affairs.
          (2) In fiscal year 2015, through not more than 12 
        regional offices of the Department.
          (3) In fiscal year 2016, through not more than 15 
        regional offices of the Department.
          (4) In fiscal year 2017 and each fiscal year 
        thereafter, through such regional offices of the 
        Department as the Secretary considers appropriate.
  (c) Licensure of Contract Health Care Professionals.--
          (1) In general.--Notwithstanding any law regarding 
        the licensure of health care professionals, a health 
        care professional described in paragraph (2) may 
        conduct an examination pursuant to a contract entered 
        into under subsection (a) at any location in any State, 
        the District of Columbia, or a Commonwealth, territory, 
        or possession of the United States, so long as the 
        examination is within the scope of the authorized 
        duties under such contract.
          (2) Health care professional described.--A health 
        care professional described in this paragraph is a 
        physician, physician assistant, nurse practitioner, 
        audiologist, [or psychologist] psychologist, 
        podiatrist, dentist, optometrist, or other health care 
        professional specified in regulations prescribed by the 
        Secretary, who--
                  (A) has a current unrestricted license to 
                practice the health care profession of [the 
                physician, physician assistant, nurse 
                practitioner, audiologist, or psychologist, as 
                the case may be] health care professionals;
                  (B) is not barred from practicing such health 
                care profession in any State, the District of 
                Columbia, or a Commonwealth, territory, or 
                possession of the United States; and
                  (C) is performing authorized duties for the 
                Department of Veterans Affairs pursuant to a 
                contract entered into under subsection (a).
  (d) Source of Funds.--Expenses of carrying out the pilot 
program under this section, including payments for pilot 
program examination travel and incidental expenses under the 
terms and conditions set forth by 38 U.S.C. 111, shall be 
reimbursed to the accounts available for the general operating 
expenses of the Veterans Benefits Administration and 
information technology systems from amounts available to the 
Secretary of Veterans Affairs for payment of compensation and 
pensions.
  (e) Report to Congress.--Not later than three years after the 
date of the enactment of this Act, the Secretary shall submit 
to the Congress a report on the effect of the use of the 
authority provided by subsection (a) on the cost, timeliness, 
and thoroughness of medical disability examinations.

           *       *       *       *       *       *       *

                              ----------                              


  SECTION 2002 OF THE JOHNNY ISAKSON AND DAVID P. ROE, M.D. VETERANS 
            HEALTH CARE AND BENEFITS IMPROVEMENT ACT OF 2020

SEC. 2002. MATTERS RELATING TO DEPARTMENT OF VETERANS AFFAIRS MEDICAL 
                    DISABILITY EXAMINATIONS.

  (a) Temporary Clarification of Licensure Requirements for 
Contractor Medical Professionals to Perform Medical Disability 
Examinations for the Department of Veterans Affairs Under Pilot 
Program for Use of Contract Physicians for Disability 
Examinations.--
          (1) In general.--Subsection (c) of section 504 of the 
        Veterans' Benefits Improvements Act of 1996 (Public Law 
        104-275; 38 U.S.C. 5101 note) is amended to read as 
        follows:
  ``(c) Licensure of Contract Health Care Professionals.--
          ``(1) In general.--Notwithstanding any law regarding 
        the licensure of health care professionals, a health 
        care professional described in paragraph (2) may 
        conduct an examination pursuant to a contract entered 
        into under subsection (a) at any location in any State, 
        the District of Columbia, or a Commonwealth, territory, 
        or possession of the United States, so long as the 
        examination is within the scope of the authorized 
        duties under such contract.
          ``(2) Health care professional described.--A health 
        care professional described in this paragraph is a 
        physician, physician assistant, nurse practitioner, 
        audiologist, or psychologist, who--
                  ``(A) has a current unrestricted license to 
                practice the health care profession of the 
                physician, physician assistant, nurse 
                practitioner, audiologist, or psychologist, as 
                the case may be;
                  ``(B) is not barred from practicing such 
                health care profession in any State, the 
                District of Columbia, or a Commonwealth, 
                territory, or possession of the United States; 
                and
                  ``(C) is performing authorized duties for the 
                Department of Veterans Affairs pursuant to a 
                contract entered into under subsection (a).''.
          (2) Purpose.--The purpose of the amendment made by 
        paragraph (1) is to expand the license portability for 
        [physicians assistants, nurse practitioners, 
        audiologists, and psychologists] health care 
        professionals to supplement the capacity of employees 
        of the Department to provide medical examinations 
        described in subsection (b).
          (3) Rule of construction.--The amendment made by 
        paragraph (1) shall not be construed to affect the 
        license portability for physicians in effect under 
        section 504(c) of such Act as in effect on the day 
        before the date of the enactment of this Act.
          (4) Sunset.--On the date that is five years after the 
        date of the enactment of this Act, subsection (c) of 
        such section shall read as it read on the day before 
        the date of the enactment of this Act.
  (b) Temporary Halt on Elimination of Medical Examiner 
Positions in Department of Veterans Affairs.--The Secretary of 
Veterans Affairs shall temporarily suspend the efforts of the 
Secretary in effect on the day before the date of the enactment 
of this Act to eliminate medical examiner positions in the 
Department of Veterans Affairs until the number of individuals 
awaiting a medical examination with respect to medical 
disability of the individuals for benefits under laws 
administered by the Secretary that are carried out through the 
Under Secretary for Benefits is equal to or less than the 
number of such individuals who were awaiting such a medical 
examination with respect to such purposes on March 1, 2020.
  (c) Report on Provision of Medical Examinations.--
          (1) In general.--Not later than 180 days after the 
        date of the enactment of this Act, the Secretary shall 
        submit to the appropriate committees of Congress a 
        report on the provision of medical examinations 
        described in subsection (b) by the Department.
          (2) Contents.--The report submitted under paragraph 
        (1) shall cover the following:
                  (A) How the Secretary will increase the 
                capacity, efficiency, and timeliness of 
                physician assistants, nurse practitioners, 
                audiologists, and psychologists of the Veterans 
                Health Administration with respect to 
                completing medical examinations described in 
                subsection (b).
                  (B) The total number of full-time equivalent 
                employees among all physician assistants, nurse 
                practitioners, audiologists, and psychologists 
                needed for the increases described in 
                subparagraph (A).
                  (C) An assessment regarding the importance of 
                retaining a critical knowledge base within the 
                Department for performing medical examinations 
                for veterans filing claims for compensation 
                under chapters 11 and 13 of title 38, United 
                States Code, including with respect to military 
                sexual trauma, post-traumatic stress disorder, 
                traumatic brain injury, and toxic exposure.
          (3) Collaboration.--The Secretary shall collaborate 
        with the veterans community and stakeholders in the 
        preparation of the report required by paragraph (1).
          (4) 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.
  (d) Comptroller General of the United States Review.--
          (1) Review required.--Not later than 360 days after 
        the date of the enactment of this Act, the Comptroller 
        General of the United States shall commence a review of 
        the implementation of the pilot program authorized 
        under subsection (a) of section 504 of the Veterans' 
        Benefits Improvements Act of 1996 (Public Law 104-275; 
        38 U.S.C. 5101 note).
          (2) Elements.--The review conducted under paragraph 
        (1) shall include the following:
                  (A) An assessment of the use of subsection 
                (c) of section 504 of such Act, as amended by 
                subsection (a)(1) of this section.
                  (B) Efforts to retain and recruit medical 
                examiners as employees of the Department.
                  (C) Use of telehealth for medical 
                examinations described in subsection (b) that 
                are administered by the Department.
  (e) Briefing on Recommendations of Comptroller General of the 
United States.--Not later than 60 days after the date of the 
enactment of this Act, the Secretary shall provide to the 
Committee on Veterans' Affairs of the Senate and the Committee 
on Veterans' Affairs of the House of Representatives a briefing 
on how the Secretary will implement the recommendations of the 
Comptroller General of the United States regarding--
          (1) the monitoring of the training of providers of 
        examinations pursuant to contracts under section 504 of 
        the Veterans' Benefits Improvements Act of 1996 (Public 
        Law 104-275; 38 U.S.C. 5101 note); and
          (2) ensuring such providers receive such training.
  (f) Holding Underperforming Contract Medical Examiners 
Accountable.--The Secretary shall take such actions as may be 
necessary to hold accountable the providers of medical 
examinations pursuant to contracts under section 504 of the 
Veterans' Benefits Improvements Act of 1996 (Public Law 104-
275; 38 U.S.C. 5101 note) who are underperforming in the 
meeting of the needs of veterans through the performance of 
medical examinations pursuant to such contracts.

                             [all]