    [United States Senate Manual, 117th Congress]
    [S. Doc. 117-1]
    [Cleaves Manual of Conferences and Conference Reports]
    [Pages 437-444]
    [From the U.S. Government Publishing Office, www.gpo.gov]

    [[Page 437]]

                                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 438]]

                    (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 439]]

                                (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 440]]

                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 441]]

                    (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 442]]

                    ``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 443]]

                                    ``(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 444]]

                                ``(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