[United States Senate Manual, 116th Congress]
[S. Doc. 116-1]
[Cleaves Manual of Conferences and Conference Reports]
[Pages 430-437]
[From the U.S. Government Publishing Office, www.gpo.gov]
[[Page 430]]
TITLE 38--VETERANS' BENEFITS
Chapter 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL
CARE
383 Sec. 1703E. Center for Innovation for Care and Payment
(a) In General.--(1) There is established within the
Department a Center for Innovation for Care and Payment (in
this section referred to as the ``Center'').
(2) The Secretary, acting through the Center, may carry
out such pilot programs the Secretary determines to be
appropriate to develop innovative approaches to testing
payment and service delivery models in order to reduce
expenditures while preserving or enhancing the quality of
care furnished by the Department.
(3) The Secretary, acting through the Center, shall test
payment and service delivery models to determine whether
such models--
(A) improve access to, and quality,
timeliness, and patient satisfaction of care and
services; and
(B) create cost savings for the Department.
(4)(A) The Secretary shall test a model in a location
where the Secretary determines that the model will addresses
deficits in care (including poor clinical outcomes or
potentially avoidable expenditures) for a defined
population.
(B) The Secretary shall focus on models the Secretary
expects to reduce program costs while preserving or
enhancing the quality of care received by individuals
receiving benefits under this chapter.
(C) The models selected may include those described in
section 1115A(b)(2)(B) of the Social Security Act (42 U.S.C.
1315a(b)(2)(B)).
(5) In selecting a model for testing, the Secretary may
consider, in addition to other factors identified in this
subsection, the following factors:
(A) Whether the model includes a regular
process for monitoring and updating patient care
plans in a manner that is consistent with the
needs and preferences of individuals receiving
benefits under this chapter.
(B) Whether the model places the individual
receiving benefits under this chapter (including
family members and other caregivers of such
individual) at the center of the care team of
such individual.
(C) Whether the model uses technology or new
systems to coordinate care over time and across
settings.
(D) Whether the model demonstrates effective
linkage with other public sector payers, private
sector payers, or statewide payment models.
(6)(A) Models tested under this section may not be
designed in such a way that would allow the United States to
recover or collect reasonable charges from a Federal health
care program for care or services furnished by the Secretary
to a veteran under pilot programs carried out under this
section.
[[Page 431]]
(B) In this paragraph, the term ``Federal health care
program'' means--
(i) an insurance program described in
section 1811 of the Social Security Act (42
U.S.C. 1395c) or established by section 1831
of such Act (42 U.S.C. 1395j);
(ii) a State plan for medical assistance
approved under title XIX of such Act (42
U.S.C. 1396 et seq.); or
(iii) a TRICARE program operated under
sections 1075, 1075a, 1076, 1076a, 1076c,
1076d, 1076e, or 1076f of title 10.
(b) Duration.--Each pilot program carried out by the
Secretary under this section shall terminate no later than 5
years after the date of the commencement of the pilot
program.
(c) Location.--The Secretary shall ensure that each
pilot program carried out under this section occurs in an
area or areas appropriate for the intended purposes of the
pilot program. To the extent practicable, the Secretary
shall ensure that the pilot programs are located in
geographically diverse areas of the United States.
(d) Budget.--Funding for each pilot program carried out
by the Secretary under this section shall come from
appropriations--
(1) provided in advance in appropriations
acts for the Veterans Health Administration; and
(2) provided for information technology
systems.
(e) Notice.--The Secretary shall--
(1) publish information about each pilot
program under this section in the Federal
Register; and
(2) take reasonable actions to provide
direct notice to veterans eligible to
participate in such pilot programs.
(f) Waiver of Authorities.--(1) Subject to reporting
under paragraph (2) and approval under paragraph (3), in
implementing a pilot program under this section, the
Secretary may waive such requirements in subchapters I, II,
and III of this chapter as the Secretary determines
necessary solely for the purposes of carrying out this
section with respect to testing models described in
subsection (a).
(2) Before waiving any authority under paragraph (1),
the Secretary shall submit to the Speaker of the House of
Representatives, the minority leader of the House of
Representatives, the majority leader of the Senate, the
minority leader of the Senate, and each standing committee
with jurisdiction under the rules of the Senate and of the
House of Representatives to report a bill to amend the
provision or provisions of law that would be waived by the
Department, a report on a request for waiver that describes
in detail the following:
(A) The specific authorities to be waived
under the pilot program.
(B) The standard or standards to be used in
the pilot program in lieu of the waived
authorities.
(C) The reasons for such waiver or waivers.
(D) A description of the metric or metrics
the Secretary will use to determine the effect
of the waiver or waivers upon the access to and
quality, timeliness, or patient satisfaction of
care and services furnished through the pilot
program.
(E) The anticipated cost savings, if any, of
the pilot program.
(F) The schedule for interim reports on the
pilot program describing the results of the
pilot program so far and the feasibility and
advisability of continuing the pilot program.
[[Page 432]]
(G) The schedule for the termination of the
pilot program and the submission of a final
report on the pilot program describing the
result of the pilot program and the feasibility
and advisability of making the pilot program
permanent.
(H) The estimated budget of the pilot
program.
(3)(A) Upon receipt of a report submitted under
paragraph (2), each House of Congress shall provide copies
of the report to the chairman and ranking member of each
standing committee with jurisdiction under the rules of the
House of Representatives or the Senate to report a bill to
amend the provision or provisions of law that would be
waived by the Department under this subsection.
(B) The waiver requested by the Secretary under
paragraph (2) shall be considered approved under this
paragraph if there is enacted into law a joint resolution
approving such request in its entirety.
(C) For purposes of this paragraph, the term ``joint
resolution'' means only a joint resolution which is
introduced within the period of five legislative days
beginning on the date on which the Secretary transmits the
report to the Congress under such paragraph (2), and--
(i) which does not have a preamble; and
(ii) the matter after the resolving
clause of which is as follows: ``that
Congress approves the request for a waiver
under section 1703E(f) of title 38, United
States Code, as submitted by the Secretary
on_____'', the blank space being filled with
the appropriate date.
(D)(i) Any committee of the House of Representatives to
which a joint resolution is referred shall report it to the
House without amendment not later than 15 legislative days
after the date of introduction thereof. If a committee fails
to report the joint resolution within that period, the
committee shall be discharged from further consideration of
the joint resolution.
(ii) It shall be in order at any time after the third
legislative day after each committee authorized to consider
a joint resolution has reported or has been discharged from
consideration of a joint resolution, to move to proceed to
consider the joint resolution in the House. All points of
order against the motion are waived. Such a motion shall not
be in order after the House has disposed of a motion to
proceed on a joint resolution addressing a particular
submission. The previous question shall be considered as
ordered on the motion to its adoption without intervening
motion. The motion shall not be debatable. A motion to
reconsider the vote by which the motion is disposed of shall
not be in order.
(iii) The joint resolution shall be considered as read.
All points of order against the joint resolution and against
its consideration are waived. The previous question shall be
considered as ordered on the joint resolution to its passage
without intervening motion except two hours of debate
equally divided and controlled by the proponent and an
opponent. A motion to reconsider the vote on passage of the
joint resolution shall not be in order.
(E)(i) A joint resolution introduced in the Senate shall
be referred to the Committee on Veterans' Affairs.
(ii) Any committee of the Senate to which a joint
resolution is referred shall report it to the Senate without
amendment not later than 15 session days after the date of
introduction of a joint resolution described
[[Page 433]]
in paragraph (C). If a committee fails to report the joint
resolution within that period, the committee shall be
discharged from further consideration of the joint
resolution and the joint resolution shall be placed on the
calendar.
(iii)(I) Notwithstanding Rule XXII of the Standing Rules
of the Senate, it is in order at any time after the third
session day on which the Committee on Veterans' Affairs has
reported or has been discharged from consideration of a
joint resolution described in paragraph (C) (even though a
previous motion to the same effect has been disagreed to) to
move to proceed to the consideration of the joint
resolution, and all points of order against the joint
resolution (and against consideration of the joint
resolution) are waived. The motion to proceed is not
debatable. The motion is not subject to a motion to
postpone. A motion to reconsider the vote by which the
motion is agreed to or disagreed to shall not be in order.
If a motion to proceed to the consideration of the
resolution is agreed to, the joint resolution shall remain
the unfinished business until disposed of.
(II) Consideration of the joint resolution, and on all
debatable motions and appeals in connection therewith, shall
be limited to not more than two hours, which shall be
divided equally between the majority and minority leaders or
their designees. A motion further to limit debate is in
order and not debatable. An amendment to, or a motion to
postpone, or a motion to proceed to the consideration of
other business, or a motion to recommit the joint resolution
is not in order.
(III) If the Senate has voted to proceed to a joint
resolution, the vote on passage of the joint resolution
shall occur immediately following the conclusion of
consideration of the joint resolution, and a single quorum
call at the conclusion of the debate if requested in
accordance with the rules of the Senate.
(IV) Appeals from the decisions of the Chair relating to
the application of the rules of the Senate, as the case may
be, to the procedure relating to a joint resolution shall be
decided without debate.
(F) A joint resolution considered pursuant to this
paragraph shall not be subject to amendment in either the
House of Representatives or the Senate.
(G)(i) If, before the passage by one House of the joint
resolution of that House, that House receives the joint
resolution from the other House, then the following
procedures shall apply:
(I) The joint resolution of the other House
shall not be referred to a committee.
(II) With respect to the joint resolution of
the House receiving the joint resolution--
(aa) the procedure in that House
shall be the same as if no joint
resolution had been received from
the other House; but
(bb) the vote on passage shall
be on the joint resolution of the
other House.
(ii) If the Senate fails to introduce or consider a
joint resolution under this paragraph, the joint resolution
of the House shall be entitled to expedited floor procedures
under this subparagraph.
(iii) If, following passage of the joint resolution in
the Senate, the Senate then receives the companion measure
from the House of Representatives, the companion measure
shall not be debatable.
[[Page 434]]
(H) This subparagraph is enacted by Congress--
(i) as an exercise of the rulemaking power
of the Senate and House of Representatives,
respectively, and as such it is deemed a part of
the rules of each House, respectively, but
applicable only with respect to the procedure to
be followed in that House in the case of a joint
resolution, and it supersedes other rules only
to the extent that it is inconsistent with such
rules; and
(ii) with full recognition of the
constitutional right of either House to change
the rules (so far as relating to the procedure
of that House) at any time, in the same manner,
and to the same extent as in the case of any
other rule of that House. (Pub. L. 115-182,
Title I, Sec. 152(a), June 6, 2018, 132 Stat.
1432.)
* * * * * * *
Chapter 81--ACQUISITION AND OPERATION OF HOSPITAL AND
DOMICILIARY FACILITIES; PROCUREMENT AND SUPPLY; ENHANCED-USE
LEASES OF REAL PROPERTY
384 38 U.S.C. 8122 note. VA asset and infrastructure review
* * * * * * *
``SEC. 204. ACTIONS REGARDING INFRASTRUCTURE AND
FACILITIES OF THE VETERANS HEALTH ADMINISTRATION.
``(a) In General.--Subject to subsection (b), the
Secretary shall begin to implement the recommended
modernizations and realignments in the report under section
203(d) not later than 3 years after the date on which the
President transmits such report to Congress. In any fiscal
year, such implementation includes--
``(1) the planning of modernizations and
realignments of facilities of the Veterans
Health Administration as recommended in such
report; and
``(2) providing detailed information on the
budget for such modernizations or realignments
in documents submitted to Congress by the
Secretary in support of the President's budget
for that fiscal year.
``(b) Congressional Disapproval.--
``(1) In general.--The Secretary may not
carry out any modernization or realignment
recommended by the Commission in a report
transmitted from the President pursuant to
section 203(d) if a joint resolution is enacted,
in accordance with the provisions of section
207, disapproving such recommendations of the
Commission before the earlier of--
``(A) the end of the 45-day period
beginning on the date on which the President
transmits such report; or
``(B) the adjournment of Congress sine
die for the session during which such report
is transmitted.
``(2) Computation of period.--For purposes
of paragraph (1) and subsections (a) and (c) of
section 207, the days on which either House of
Congress is not in session because of an
adjournment of more than three days to a day
certain shall be excluded in the computation of
a period.
* * * * * * *
[[Page 435]]
``SEC. 207. CONGRESSIONAL CONSIDERATION OF COMMISSION
REPORT.
``(a) Disapproval Resolution.--For purposes of this
subtitle, the term `joint resolution' means only a joint
resolution which is introduced within the 5-day period
beginning on the date on which the President transmits the
report to the Congress under section 203(d), and--
``(1) which does not have a preamble;
``(2) the matter after the resolving clause
of which is as follows: `that Congress
disapproves the recommendations of the VHA Asset
and Infrastructure Review Commission as
submitted by the President on_____', the blank
space being filled with the appropriate date;
and
``(3) the title of which is as follows:
`Joint resolution disapproving the
recommendations of the VHA Asset and
Infrastructure Review Commission.'.
``(b) Consideration in the House of Representatives.--
``(1) Reporting and discharge.--Any
committee of the House of Representatives to
which a joint resolution is referred shall
report it to the House without amendment not
later than 15 legislative days after the date of
introduction thereof. If a committee fails to
report the joint resolution within that period,
the committee shall be discharged from further
consideration of the joint resolution.
``(2) Proceeding to consideration.--It shall
be in order at any time after the third
legislative day after each committee authorized
to consider a joint resolution has reported or
has been discharged from consideration of a
joint resolution, to move to proceed to consider
the joint resolution in the House.
All points of order against the motion are
waived. Such a motion shall not be in order
after the House has disposed of a motion to
proceed on a joint resolution addressing a
particular submission. The previous question
shall be considered as ordered on the motion to
its adoption without intervening motion. The
motion shall not be debatable. A motion to
reconsider the vote by which the motion is
disposed of shall not be in order.
``(3) Consideration.--The joint resolution
shall be considered as read. All points of order
against the joint resolution and against its
consideration are waived. The previous question
shall be considered as ordered on the joint
resolution to its passage without intervening
motion except 2 hours of debate equally divided
and controlled by the proponent and an opponent.
A motion to reconsider the vote on passage of
the joint resolution shall not be in order.
``(c) Consideration in the Senate.--
``(1) Referral.--A joint resolution
introduced in the Senate shall be referred to
the Committee on Veterans' Affairs.
``(2) Reporting and discharge.--Any
committee of the Senate to which a joint
resolution is referred shall report it to the
Senate without amendment not later than 15
session days after the date of introduction of a
joint resolution described in subsection (a). If
a committee fails to report the joint resolution
within that period, the committee shall be
discharged from further consideration of the
joint resolution and the joint resolution shall
be placed on the calendar.
``(3) Floor consideration.--
[[Page 436]]
``(A) In general.--Notwithstanding Rule
XXII of the Standing Rules of the Senate, it
is in order at any time after the third
session day on which the Committee on
Veterans' Affairs has reported or has been
discharged from consideration of a joint
resolution described in subsection (a) (even
though a previous motion to the same effect
has been disagreed to) to move to proceed to
the consideration of the joint resolution,
and all points of order against the joint
resolution (and against consideration of the
joint resolution) are waived. The motion to
proceed is not debatable. The motion is not
subject to a motion to postpone. A motion to
reconsider the vote by which the motion is
agreed to or disagreed to shall not be in
order. If a motion to proceed to the
consideration of the resolution is agreed
to, the joint resolution shall remain the
unfinished business until disposed of.
``(B) Consideration.--Consideration of
the joint resolution, and on all debatable
motions and appeals in connection therewith,
shall be limited to not more than 2 hours,
which shall be divided equally between the
majority and minority leaders or their
designees. A motion further to limit debate
is in order and not debatable. An amendment
to, or a motion to postpone, or a motion to
proceed to the consideration of other
business, or a motion to recommit the joint
resolution is not in order.
``(C) Vote on passage.--If the Senate
has voted to proceed to a joint resolution,
the vote on passage of the joint resolution
shall occur immediately following the
conclusion of consideration of the joint
resolution, and a single quorum call at the
conclusion of the debate if requested in
accordance with the rules of the Senate.
``(D) Rulings of the chair on
procedure.--Appeals from the decisions of
the Chair relating to the application of the
rules of the Senate, as the case may be, to
the procedure relating to a joint resolution
shall be decided without debate.
``(d) Amendment Not in Order.--A joint resolution of
disapproval considered pursuant to this section shall not be
subject to amendment in either the House of Representatives
or the Senate.
``(e) Coordination With Action by Other House.--
``(1) In general.--If, before the passage by
one House of the joint resolution of that House,
that House receives the joint resolution from
the other House, then the following procedures
shall apply:
``(A) The joint resolution of the other
House shall not be referred to a committee.
``(B) With respect to the joint
resolution of the House receiving the joint
resolution--
``(i) the procedure in that
House shall be the same as if no
joint resolution had been received
from the other House; but
``(ii) the vote on passage shall
be on the joint resolution of the
other House.
``(2) Treatment of joint resolution of other
house.--If the Senate fails to introduce or
consider a joint resolution under this section,
the joint resolution of the House shall be
entitled to expedited floor procedures under
this section.
[[Page 437]]
``(3) Treatment of companion measures.--If,
following passage of the joint resolution in the
Senate, the Senate then receives the companion
measure from the House of Representatives, the
companion measure shall not be debatable.
``(f) Rules of the House of Representatives and
Senate.--This section is enacted by Congress--
``(1) as an exercise of the rulemaking power
of the Senate and House of Representatives,
respectively, and as such it is deemed a part of
the rules of each House, respectively, but
applicable only with respect to the procedure to
be followed in that House in the case of a joint
resolution, and it supersedes other rules only
to the extent that it is inconsistent with such
rules; and
``(2) with full recognition of the
constitutional right of either House to change
the rules (so far as relating to the procedure
of that House) at any time, in the same manner,
and to the same extent as in the case of any
other rule of that House. (Pub. L. 115-182,
Title II, Subtitle A, June 6, 2018, 132 Stat.
1443.)
42 u.s.c.--the public health and welfare
united states senate procedures enacted in law