    [United States Statutes at Large, Volume 128, 113th Congress, 2nd Session]
    [From the U.S. Government Publishing Office, www.gpo.gov]

    Public Law 113-146
    113th Congress

    An Act

    To improve the access of veterans to medical services from the
    Department of Veterans Affairs, and for other purposes. <>

    Be it enacted by the Senate and House of Representatives of the
    United States of America in Congress assembled, <>
    SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

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

    Sec. 1. Short title; table of contents.
    Sec. 2. Definitions.

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

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

    TITLE II--HEALTH CARE ADMINISTRATIVE MATTERS

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

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

    Sec. 301. Treatment of staffing shortage and biennial report on staffing
    of medical facilities of the Department of Veterans Affairs.

    [[Page 1755]]

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

    TITLE IV--HEALTH CARE RELATED TO SEXUAL TRAUMA

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

    TITLE V--OTHER HEALTH CARE MATTERS

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

    TITLE VI--MAJOR MEDICAL FACILITY LEASES

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

    TITLE VII--OTHER VETERANS MATTERS

    Sec. 701. Expansion of Marine Gunnery Sergeant John David Fry
    Scholarship.
    Sec. 702. Approval of courses of education provided by public
    institutions of higher learning for purposes of All-Volunteer
    Force Educational Assistance Program and Post-9/11
    Educational Assistance conditional on in-State tuition rate
    for veterans.
    Sec. 703. Extension of reduction in amount of pension furnished by
    Department of Veterans Affairs for certain veterans covered
    by Medicaid plans for services furnished by nursing
    facilities.
    Sec. 704. Extension of requirement for collection of fees for housing
    loans guaranteed by Secretary of Veterans Affairs.
    Sec. 705. Limitation on awards and bonuses paid to employees of
    Department of Veterans Affairs.
    Sec. 706. Extension of authority to use income information.
    Sec. 707. Removal of senior executives of the Department of Veterans
    Affairs for performance or misconduct.

    TITLE VIII--OTHER MATTERS

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

    SEC. 2. <>  DEFINITIONS.

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

    TITLE I--IMPROVEMENT OF <>  ACCESS TO CARE FROM
    NON-DEPARTMENT OF VETERANS AFFAIRS PROVIDERS
    SEC. 101. EXPANDED AVAILABILITY OF HOSPITAL CARE AND MEDICAL
    SERVICES FOR VETERANS THROUGH THE USE OF
    AGREEMENTS WITH NON-DEPARTMENT OF VETERANS
    AFFAIRS ENTITIES.

    (a) Expansion of Available Care and Services.--
    (1) Furnishing of care.--
    (A) In general.--Hospital care and medical services
    under chapter 17 of title 38, United States Code, shall

    [[Page 1756]]

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

    (b) Eligible Veterans.--A veteran is an eligible veteran for
    purposes of this section if--
    (1)(A) <>  as of August 1, 2014,
    the veteran is enrolled in the patient enrollment system of the
    Department of Veterans Affairs established and operated under
    section 1705 of title 38, United States Code, including any such
    veteran who has not received hospital care or medical services
    from the Department and has contacted the Department seeking an
    initial appointment from the Department for the receipt of such
    care or services; or
    (B) the veteran is eligible for hospital care and medical
    services under section 1710(e)(1)(D) of such title and is a
    veteran described in section 1710(e)(3) of such title; and
    (2) the veteran--
    (A) attempts, or has attempted, to schedule an
    appointment for the receipt of hospital care or medical
    services under chapter 17 of title 38, United States
    Code, but is unable to schedule an appointment within
    the wait-time goals of the Veterans Health
    Administration for the furnishing of such care or
    services;
    (B) resides more than 40 miles from the medical
    facility of the Department, including a community-based
    outpatient clinic, that is closest to the residence of
    the veteran;
    (C) resides--
    (i) in a State without a medical facility of
    the Department that provides--
    (I) hospital care;

    [[Page 1757]]

    (II) emergency medical services; and
    (III) surgical care rated by the
    Secretary as having a surgical
    complexity of standard; and
    (ii) more than 20 miles from a medical
    facility of the Department described in clause
    (i); or
    (D)(i) resides in a location, other than a location
    in Guam, American Samoa, or the Republic of the
    Philippines, that is 40 miles or less from a medical
    facility of the Department, including a community-based
    outpatient clinic; and
    (ii)(I) is required to travel by air, boat, or ferry
    to reach each medical facility described in clause (i)
    that is 40 miles or less from the residence of the
    veteran; or
    (II) faces an unusual or excessive burden in
    accessing each medical facility described in clause (i)
    that is 40 miles or less from the residence of the
    veteran due to geographical challenges, as determined by
    the Secretary.

    (c) Election and Authorization.--
    (1) In general.--In the case of an eligible veteran
    described in subsection (b)(2)(A), the Secretary shall, at the
    election of the eligible veteran--
    (A) place such eligible veteran on an electronic
    waiting list described in paragraph (2) for an
    appointment for hospital care or medical services the
    veteran has elected to receive under this section; or
    (B)(i) authorize that such care or services be
    furnished to the eligible veteran under this section for
    a period of time specified by the Secretary; and
    (ii) <>  notify the eligible
    veteran by the most effective means available, including
    electronic communication or notification in writing,
    describing the care or services the eligible veteran is
    eligible to receive under this section.
    (2) Electronic waiting list.--The electronic waiting list
    described in this paragraph shall be maintained by the
    Department and allow access by each eligible veteran via
    www.myhealth.va.gov or any successor website for the following
    purposes:
    (A) To determine the place of such eligible veteran
    on the waiting list.
    (B) To determine the average length of time an
    individual spends on the waiting list, disaggregated by
    medical facility of the Department and type of care or
    service needed, for purposes of allowing such eligible
    veteran to make an informed election under paragraph
    (1).

    (d) Care and Services Through Agreements.--
    (1) Agreements.--
    (A) In general.--The Secretary shall enter into
    agreements for furnishing care and services to eligible
    veterans under this section with entities specified in
    subsection (a)(1)(B).
    (B) Agreement defined.--In this paragraph, the term
    ``agreement'' includes contracts, intergovernmental
    agreements, and provider agreements, as appropriate.
    (2) Rates and reimbursement.--

    [[Page 1758]]

    (A) In general.--In entering into an agreement under
    paragraph (1) with an entity specified in subsection
    (a)(1)(B), the Secretary shall--
    (i) negotiate rates for the furnishing of care
    and services under this section; and
    (ii) reimburse the entity for such care and
    services at the rates negotiated pursuant to
    clause (i) as provided in such agreement.
    (B) Limit on rates.--
    (i) In general.--Except as provided in clause
    (ii), rates negotiated under subparagraph (A)(i)
    shall not be more than the rates paid by the
    United States to a provider of services (as
    defined in section 1861(u) of the Social Security
    Act (42 U.S.C. 1395x(u))) or a supplier (as
    defined in section 1861(d) of such Act (42 U.S.C.
    1395x(d))) under the Medicare program under title
    XVIII of the Social Security Act (42 U.S.C. 1395
    et seq.) for the same care or services.
    (ii) Exception.--
    (I) In general.--The Secretary may
    negotiate a rate that is more than the
    rate paid by the United States as
    described in clause (i) with respect to
    the furnishing of care or services under
    this section to an eligible veteran who
    resides in a highly rural area.
    (II) Highly rural area defined.--In
    this clause, the term ``highly rural
    area'' means an area located in a county
    that has fewer than seven individuals
    residing in that county per square mile.
    (C) Limit on collection.--For the furnishing of care
    or services pursuant to an agreement under paragraph
    (1), an entity specified in subsection (a)(1)(B) may not
    collect any amount that is greater than the rate
    negotiated pursuant to subparagraph (A)(i).
    (3) Certain procedures.--
    (A) In general.--In entering into an agreement under
    paragraph (1) with an entity described in subparagraph
    (B), the Secretary may use the procedures, including
    those procedures relating to reimbursement, available
    for entering into provider agreements under section
    1866(a) of the Social Security Act (42 U.S.C. 1395cc(a))
    and participation agreements under section 1842(h) of
    such Act (42 U.S.C. 1395u(h)). During the period in
    which such entity furnishes care or services pursuant to
    this section, such entity may not be treated as a
    Federal contractor or subcontractor by the Office of
    Federal Contract Compliance Programs of the Department
    of Labor by virtue of furnishing such care or services.
    (B) Entities described.--The entities described in
    this subparagraph are the following:
    (i) In the case of the Medicare program, any
    provider of services that has entered into a
    provider agreement under section 1866(a) of the
    Social Security Act (42 U.S.C. 1395cc(a)) and any
    physician or other supplier who has entered into a
    participation agreement under section 1842(h) of
    such Act (42 U.S.C. 1395u(h)); and

    [[Page 1759]]

    (ii) In the case of the Medicaid program, any
    provider participating under a State plan under
    title XIX of such Act (42 U.S.C. 1396 et seq.).
    (4) Information on policies and procedures.--The Secretary
    shall provide to any entity with which the Secretary has entered
    into an agreement under paragraph (1) the following:
    (A) Information on applicable policies and
    procedures for submitting bills or claims for authorized
    care or services furnished to eligible veterans under
    this section.
    (B) Access to a telephone hotline maintained by the
    Department that such entity may call for information on
    the following:
    (i) Procedures for furnishing care and
    services under this section.
    (ii) Procedures for submitting bills or claims
    for authorized care and services furnished to
    eligible veterans under this section and being
    reimbursed for furnishing such care and services.
    (iii) Whether particular care or services
    under this section are authorized, and the
    procedures for authorization of such care or
    services.

    (e) Other Health-Care Plan.--
    (1) Submittal of information to secretary.--Before receiving
    hospital care or medical services under this section, an
    eligible veteran shall provide to the Secretary information on
    any health-care plan described in paragraph (4) under which the
    eligible veteran is covered.
    (2) Disclosure of information to non-department entity.--
    Notwithstanding section 5701 of title 38, United States Code,
    for purposes of furnishing hospital care or medical services to
    an eligible veteran under this section, the Secretary shall
    disclose to the entity specified in paragraph (1)(B) of
    subsection (a) with which the Secretary has entered into an
    agreement described in such subsection--
    (A) whether the eligible veteran is covered under a
    health-care plan described in paragraph (4); and
    (B) whether the hospital care or medical services
    sought by the eligible veteran is for a medical
    condition that is related to a non-service-connected
    disability described in paragraph (3)(C).
    (3) Care for which the department is secondarily
    responsible.--
    (A) In general.--If an eligible veteran is covered
    under a health-care plan described in paragraph (4) and
    receives hospital care or medical services for a non-
    service-connected disability described in subparagraph
    (C), such health-care plan shall be primarily
    responsible for paying for such care or services, to the
    extent such care or services is covered by such health-
    care plan, and the Secretary shall be secondarily
    responsible for paying for such care or services in
    accordance with subparagraph (B)(ii).
    (B) Responsibility for costs of care.--In a case in
    which the Secretary is secondarily responsible for
    paying for hospital care or medical services as
    described in subparagraph (A)--

    [[Page 1760]]

    (i) the health care provider that furnishes
    such care or services pursuant to an agreement
    described in subsection (a) shall be responsible
    for seeking reimbursement for the cost of such
    care or services from the health-care plan
    described in paragraph (4) under which the
    eligible veteran is covered; and
    (ii) the Secretary shall be responsible for
    promptly paying only the amount that is not
    covered by such health-care plan, except that such
    responsibility for payment may not exceed the rate
    determined for such care or services pursuant to
    subsection (d)(2).
    (C) Non-service-connected disability described.--A
    non-service-connected disability described in this
    subsection is a non-service-connected disability (as
    defined in section 101 of title 38, United States
    Code)--
    (i) that is incurred incident to a veteran's
    employment and that is covered under a workers'
    compensation law or plan that provides for payment
    for the cost of health care and services provided
    to the veteran by reason of the disability;
    (ii) that is incurred as the result of a motor
    vehicle accident to which applies a State law that
    requires the owners or operators of motor vehicles
    registered in that State to have in force
    automobile accident reparations insurance;
    (iii) that is incurred as the result of a
    crime of personal violence that occurred in a
    State, or a political subdivision of a State, in
    which a person injured as the result of such a
    crime is entitled to receive health care and
    services at such State's or subdivision's expense
    for personal injuries suffered as the result of
    such crime;
    (iv) that is incurred by a veteran--
    (I) who does not have a service-
    connected disability; and
    (II) who is entitled to care (or
    payment of the expenses of care) under a
    health-care plan; or
    (v) for which care and services are furnished
    under this section to a veteran who--
    (I) has a service-connected
    disability; and
    (II) is entitled to care (or payment
    of the expenses of care) under a health-
    care plan.
    (4) Health-care plan.--A health-care plan described in this
    paragraph--
    (A) is an insurance policy or contract, medical or
    hospital service agreement, membership or subscription
    contract, or similar arrangement not administered by the
    Secretary of Veterans Affairs, under which health
    services for individuals are provided or the expenses of
    such services are paid; and
    (B) does not include any such policy, contract,
    agreement, or similar arrangement pursuant to title
    XVIII or XIX of the Social Security Act (42 U.S.C. 1395
    et seq.) or chapter 55 of title 10, United States Code.

    (f) Veterans Choice Card.--

    [[Page 1761]]

    (1) <>  In general.--For purposes of
    receiving care and services under this section, the Secretary
    shall, not later than 90 days after the date of the enactment of
    this Act, issue to each veteran described in subsection (b)(1) a
    card that may be presented to a health care provider to
    facilitate the receipt of care or services under this section.
    (2) Name of card.--Each card issued under paragraph (1)
    shall be known as a ``Veterans Choice Card''.
    (3) Details of card.--Each Veterans Choice Card issued to a
    veteran under paragraph (1) shall include the following:
    (A) The name of the veteran.
    (B) An identification number for the veteran that is
    not the social security number of the veteran.
    (C) The contact information of an appropriate office
    of the Department for health care providers to confirm
    that care or services under this section are authorized
    for the veteran.
    (D) Contact information and other relevant
    information for the submittal of claims or bills for the
    furnishing of care or services under this section.
    (E) The following statement: ``This card is for
    qualifying medical care outside the Department of
    Veterans Affairs. Please call the Department of Veterans
    Affairs phone number specified on this card to ensure
    that treatment has been authorized.''.
    (4) Information on use of card.--Upon issuing a Veterans
    Choice Card to a veteran, the Secretary shall provide the
    veteran with information clearly stating the circumstances under
    which the veteran may be eligible for care or services under
    this section.

    (g) Information on Availability of Care.--The Secretary shall
    provide information to a veteran about the availability of care and
    services under this section in the following circumstances:
    (1) In the case of a veteran described in subsection
    (b)(1)(B), when the veteran enrolls in the patient enrollment
    system of the Department under section 1705 of title 38, United
    States Code.
    (2) When the veteran attempts to schedule an appointment for
    the receipt of hospital care or medical services from the
    Department but is unable to schedule an appointment within the
    wait-time goals of the Veterans Health Administration for the
    furnishing of such care or services.
    (3) When the veteran becomes eligible for hospital care or
    medical services under this section under subparagraph (B), (C),
    or (D) of subsection (b)(2).

    (h) <>  Follow-Up Care.--In carrying out this
    section, the Secretary shall ensure that, at the election of an eligible
    veteran who receives hospital care or medical services from a health
    care provider in an episode of care under this section, the veteran
    receives such hospital care and medical services from such health care
    provider through the completion of the episode of care (but for a period
    not exceeding 60 days), including all specialty and ancillary services
    deemed necessary as part of the treatment recommended in the course of
    such hospital care or medical services.

    (i) Providers.--To be eligible to furnish care or services under
    this section, a health care provider must--

    [[Page 1762]]

    (1) maintain at least the same or similar credentials and
    licenses as those credentials and licenses that are required of
    health care providers of the Department, as determined by the
    Secretary for purposes of this section; and
    (2) submit, not less frequently than once each year during
    the period in which the Secretary is authorized to carry out
    this section pursuant to subsection (p), verification of such
    licenses and credentials maintained by such health care
    provider.

    (j) Cost-Sharing.--
    (1) <>  In general.--The Secretary shall
    require an eligible veteran to pay a copayment for the receipt
    of care or services under this section only if such eligible
    veteran would be required to pay a copayment for the receipt of
    such care or services at a medical facility of the Department or
    from a health care provider of the Department pursuant to
    chapter 17 of title 38, United States Code.
    (2) Limitation.--The amount of a copayment charged under
    paragraph (1) may not exceed the amount of the copayment that
    would be payable by such eligible veteran for the receipt of
    such care or services at a medical facility of the Department or
    from a health care provider of the Department pursuant to
    chapter 17 of title 38, United States Code.
    (3) Collection of copayment.--A health care provider that
    furnishes care or services to an eligible veteran under this
    section shall collect the copayment required under paragraph (1)
    from such eligible veteran at the time of furnishing such care
    or services.

    (k) Claims Processing System.--
    (1) In general.--The Secretary shall provide for an
    efficient nationwide system for processing and paying bills or
    claims for authorized care and services furnished to eligible
    veterans under this section.
    (2) <>  Regulations.--Not later than 90
    days after the date of the enactment of this Act, the Secretary
    of Veterans Affairs shall prescribe regulations for the
    implementation of such system.
    (3) Oversight.--The Chief Business Office of the Veterans
    Health Administration shall oversee the implementation and
    maintenance of such system.
    (4) Accuracy of payment.--
    (A) In general.--The Secretary shall ensure that
    such system meets such goals for accuracy of payment as
    the Secretary shall specify for purposes of this
    section.
    (B) Quarterly report.--
    (i) In general.--The Secretary shall submit to
    the Committee on Veterans' Affairs of the Senate
    and the Committee on Veterans' Affairs of the
    House of Representatives a quarterly report on the
    accuracy of such system.
    (ii) Elements.--Each report required by clause
    (i) shall include the following:
    (I) A description of the goals for
    accuracy for such system specified by
    the Secretary under subparagraph (A).

    [[Page 1763]]

    (II) An assessment of the success of
    the Department in meeting such goals
    during the quarter covered by the
    report.
    (iii) Deadline.--The Secretary shall submit
    each report required by clause (i) not later than
    20 days after the end of the quarter covered by
    the report.

    (l) Medical Records.--
    (1) In general.--The Secretary shall ensure that any health
    care provider that furnishes care or services under this section
    to an eligible veteran submits to the Department any medical
    record related to the care or services provided to such eligible
    veteran by such health care provider for inclusion in the
    electronic medical record of such eligible veteran maintained by
    the Department upon the completion of the provision of such care
    or services to such eligible veteran.
    (2) Electronic format.--Any medical record submitted to the
    Department under paragraph (1) shall, to the extent possible, be
    in an electronic format.

    (m) Tracking of Missed Appointments.--The Secretary shall implement
    a mechanism to track any missed appointments for care or services under
    this section by eligible veterans to ensure that the Department does not
    pay for such care or services that were not furnished to an eligible
    veteran.
    (n) <>
    Implementation.--Not later than 90 days after the date of the enactment
    of this Act, the Secretary shall prescribe interim final regulations on
    the implementation of this section and publish such regulations in the
    Federal Register.

    (o) <>  Inspector General
    Report.--Not later than 30 days after the date on which the Secretary
    determines that 75 percent of the amounts deposited in the Veterans
    Choice Fund established by section 802 have been exhausted, the
    Inspector General of the Department shall submit to the Secretary a
    report on the results of an audit of the care and services furnished
    under this section to ensure the accuracy and timeliness of payments by
    the Department for the cost of such care and services, including any
    findings and recommendations of the Inspector General.

    (p) Authority To Furnish Care and Services.--
    (1) In general.--The Secretary may not use the authority
    under this section to furnish care and services after the date
    specified in paragraph (2).
    (2) Date specified.--The date specified in this paragraph is
    the date on which the Secretary has exhausted all amounts
    deposited in the Veterans Choice Fund established by section
    802, or the date that is 3 years after the date of the enactment
    of this Act, whichever occurs first.
    (3) <>  Publication.--The
    Secretary shall publish such date in the Federal Register and on
    an Internet website of the Department available to the public
    not later than 30 days before such date.

    (q) Reports.--
    (1) Initial report.--Not later than 90 days after the
    publication of the interim final regulations under subsection
    (n), the Secretary shall submit to the Committee on Veterans'
    Affairs of the Senate and the Committee on Veterans' Affairs of
    the House of Representatives a report on the furnishing of care
    and services under this section that includes the following:

    [[Page 1764]]

    (A) The number of eligible veterans who have
    received care or services under this section.
    (B) A description of the types of care and services
    furnished to eligible veterans under this section.
    (2) <>  Final report.--Not later than
    30 days after the date on which the Secretary determines that 75
    percent of the amounts deposited in the Veterans Choice Fund
    established by section 802 have been exhausted, the Secretary
    shall submit to the Committee on Veterans' Affairs of the Senate
    and the Committee on Veterans' Affairs of the House of
    Representatives a report on the furnishing of care and services
    under this section that includes the following:
    (A) The total number of eligible veterans who have
    received care or services under this section,
    disaggregated by--
    (i) eligible veterans described in subsection
    (b)(2)(A);
    (ii) eligible veterans described in subsection
    (b)(2)(B);
    (iii) eligible veterans described in
    subsection (b)(2)(C); and
    (iv) eligible veterans described in subsection
    (b)(2)(D).
    (B) A description of the types of care and services
    furnished to eligible veterans under this section.
    (C) An accounting of the total cost of furnishing
    care and services to eligible veterans under this
    section.
    (D) The results of a survey of eligible veterans who
    have received care or services under this section on the
    satisfaction of such eligible veterans with the care or
    services received by such eligible veterans under this
    section.
    (E) An assessment of the effect of furnishing care
    and services under this section on wait times for
    appointments for the receipt of hospital care and
    medical services from the Department.
    (F) An assessment of the feasibility and
    advisability of continuing furnishing care and services
    under this section after the termination date specified
    in subsection (p).

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

    [[Page 1765]]

    (B) <>  the Secretary shall
    publish such wait-time goals in the Federal Register and
    on an Internet website of the Department available to
    the public.
    SEC. 102. ENHANCEMENT OF COLLABORATION BETWEEN DEPARTMENT OF
    VETERANS AFFAIRS AND INDIAN HEALTH
    SERVICE.

    (a) <>  Outreach to Tribal-Run Medical
    Facilities.--The Secretary of Veterans Affairs shall, in consultation
    with the Director of the Indian Health Service, conduct outreach to each
    medical facility operated by an Indian tribe or tribal organization
    through a contract or compact with the Indian Health Service under the
    Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et
    seq.) to raise awareness of the ability of such facilities, Indian
    tribes, and tribal organizations to enter into agreements with the
    Department of Veterans Affairs under which the Secretary reimburses such
    facilities, Indian tribes, or tribal organizations, as the case may be,
    for health care provided to veterans who are--
    (1) eligible for health care at such facilities; and
    (2)(A) enrolled in the patient enrollment system of the
    Department established and operated under section 1705 of title
    38, United States Code; or
    (B) eligible for hospital care and medical services pursuant
    to subsection (c)(2) of such section.

    (b) Performance Metrics for Memorandum of Understanding.--The
    Secretary of Veterans Affairs shall establish performance metrics for
    assessing the performance by the Department of Veterans Affairs and the
    Indian Health Service under the memorandum of understanding entitled
    ``Memorandum of Understanding between the Department of Veterans Affairs
    (VA) and the Indian Health Service (IHS)'' in increasing access to
    health care, improving quality and coordination of health care,
    promoting effective patient-centered collaboration and partnerships
    between the Department and the Service, and ensuring health-promotion
    and disease-prevention services are appropriately funded and available
    for beneficiaries under both health care systems.
    (c) Report.--Not later than 180 days after the date of the enactment
    of this Act, the Secretary of Veterans Affairs and the Director of the
    Indian Health Service shall jointly submit to Congress a report on the
    feasibility and advisability of the following:
    (1) Entering into agreements for the reimbursement by the
    Secretary of the costs of direct care services provided through
    organizations receiving amounts pursuant to grants made or
    contracts entered into under section 503 of the Indian Health
    Care Improvement Act (25 U.S.C. 1653) to veterans who are
    otherwise eligible to receive health care from such
    organizations.
    (2) Including the reimbursement of the costs of direct care
    services provided to veterans who are not Indians in agreements
    between the Department and the following:
    (A) The Indian Health Service.
    (B) An Indian tribe or tribal organization operating
    a medical facility through a contract or compact with
    the Indian Health Service under the Indian Self-
    Determination and Education Assistance Act (25 U.S.C.
    450 et seq.).
    (C) A medical facility of the Indian Health Service.

    [[Page 1766]]

    (d) Definitions.--In this section:
    (1) Indian.--The terms ``Indian'' and ``Indian tribe'' have
    the meanings given those terms in section 4 of the Indian Health
    Care Improvement Act (25 U.S.C. 1603).
    (2) Medical facility of the indian health service.--The term
    ``medical facility of the Indian Health Service'' includes a
    facility operated by an Indian tribe or tribal organization
    through a contract or compact with the Indian Health Service
    under the Indian Self-Determination and Education Assistance Act
    (25 U.S.C. 450 et seq.).
    (3) Tribal organization.--The term ``tribal organization''
    has the meaning given the term in section 4 of the Indian Self-
    Determination and Education Assistance Act (25 U.S.C. 450b).
    SEC. 103. ENHANCEMENT OF COLLABORATION BETWEEN DEPARTMENT OF
    VETERANS AFFAIRS AND NATIVE HAWAIIAN
    HEALTH CARE SYSTEMS.

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

    (b) Definitions.--In this section, the terms ``Native Hawaiian'',
    ``Native Hawaiian health care system'', and ``Papa Ola Lokahi'' have the
    meanings given those terms in section 12 of the Native Hawaiian Health
    Care Improvement Act (42 U.S.C. 11711).
    SEC. 104. REAUTHORIZATION AND MODIFICATION OF PILOT PROGRAM OF
    ENHANCED CONTRACT CARE AUTHORITY FOR
    HEALTH CARE NEEDS OF VETERANS.

    Section 403 of the Veterans' Mental Health and Other Care
    Improvements Act of 2008 (Public Law 110-387; 38 U.S.C. 1703 note) is
    amended--
    (1) in subsection (a)--
    (A) in paragraph (3), by striking ``only during
    the'' and all that follows through the period at the end
    and inserting ``only during the period beginning on the
    date of the commencement of the pilot program under
    paragraph (2) and ending on the date that is two years
    after the date of the enactment of the Veterans Access,
    Choice, and Accountability Act of 2014.''; and
    (B) by amending paragraph (4) to read as follows:
    ``(4) Program locations.--The Secretary shall carry out the
    pilot program at locations in the following Veterans Integrated
    Service Networks (and such other locations as the Secretary
    considers appropriate):
    ``(A) Veterans Integrated Service Network 1.
    ``(B) Veterans Integrated Service Network 6.
    ``(C) Veterans Integrated Service Network 15.
    ``(D) Veterans Integrated Service Network 18.
    ``(E) Veterans Integrated Service Network 19.'';

    [[Page 1767]]

    (2) in subsection (b)(1)(A), by striking ``as of the date of
    the commencement of the pilot program under subsection (a)(2)''
    and inserting ``as of August 1, 2014'';
    (3) by redesignating subsection (h) as subsection (k);
    (4) by inserting after subsection (g) the following new
    subsections:

    ``(h) Appointments.--In carrying out the pilot program under this
    section, the Secretary shall ensure that medical appointments for
    covered veterans--
    ``(1) are scheduled not later than 5 days after the date on
    which the appointment is requested; and
    ``(2) occur not later than 30 days after such date.

    ``(i) Outreach.--The Secretary shall ensure that covered veterans
    are informed about the pilot program under this section.
    ``(j) Use of Existing Contracts.--In carrying out the pilot program
    under this section after the date of the enactment of the Veterans
    Access, Choice, and Accountability Act of 2014, the Secretary shall make
    use of contracts entered into before such date or may enter into new
    contracts.''; and
    (5) in paragraph (2)(B) of subsection (k), as redesignated
    by paragraph (3) of this section, by striking the semicolon at
    the end and inserting ``; and''.
    SEC. 105. PROMPT PAYMENT BY DEPARTMENT OF VETERANS AFFAIRS.

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

    (b) Establishment of Claims Processing System.--
    (1) Claims processing system.--The Secretary of Veterans
    Affairs shall establish and implement a system to process and
    pay claims for payment for hospital care, medical services, and
    other health care furnished by non-Department of Veterans
    Affairs health care providers under the laws administered by the
    Secretary.
    (2) Compliance with prompt payment act.--The system
    established and implemented under paragraph (1) shall comply
    with all requirements of chapter 39, United States Code
    (commonly referred to as the ``Prompt Payment Act'').

    (c) Report.--Not later than 1 year after the date of the enactment
    of this Act, the Comptroller General of the United States shall submit
    to Congress a report on the timeliness of payments by the Secretary for
    hospital care, medical services, and other health care furnished by non-
    Department of Veterans Affairs health care providers under the laws
    administered by the Secretary.
    (d) Elements.--The report required by subsection (b) shall include
    the following:
    (1) The results of a survey of non-Department health care
    providers who have submitted claims to the Department for
    hospital care, medical services, or other health care furnished
    to veterans for which payment is authorized under the laws

    [[Page 1768]]

    administered by the Secretary during the one-year period
    preceding the submittal of the report, which survey shall
    include the following:
    (A) The amount of time it took for such health care
    providers, after submitting such claims, to receive
    payment from the Department for such care or services.
    (B) A comparison of the amount of time under
    subparagraph (A) and the amount of time it takes such
    health care providers to receive payments from the
    United States for similar care or services provided to
    the following, if applicable:
    (i) Beneficiaries under the Medicare program
    under title XVIII of the Social Security Act (42
    U.S.C. 1395 et seq.).
    (ii) Covered beneficiaries under the TRICARE
    program under chapter 55 of title 10, United
    States Code.
    (2) <>  Such recommendations for
    legislative or administrative action as the Comptroller General
    considers appropriate.

    (e) Survey Elements.--In carrying out the survey, the Comptroller
    General shall seek responses from non-Department health care providers
    in a manner that ensures that the survey reflects the responses of such
    providers that--
    (1) are located in different geographic areas;
    (2) furnish a variety of different hospital care, medical
    services, and other health care; and
    (3) furnish such care and services in a variety of different
    types of medical facilities.
    SEC. 106. TRANSFER OF AUTHORITY FOR PAYMENTS FOR HOSPITAL CARE,
    MEDICAL SERVICES, AND OTHER HEALTH CARE
    FROM NON-DEPARTMENT OF VETERANS AFFAIRS
    PROVIDERS TO THE CHIEF BUSINESS OFFICE OF
    THE VETERANS HEALTH ADMINISTRATION.

    (a) Transfer of Authority.--
    (1) <>  In general.--Effective as of
    October 1, 2014, the Secretary of Veterans Affairs shall
    transfer the authority to pay for hospital care, medical
    services, and other health care furnished through non-Department
    of Veterans Affairs providers from--
    (A) the Veterans Integrated Service Networks and
    medical centers of the Department of Veterans Affairs,
    to
    (B) the Chief Business Office of the Veterans Health
    Administration of the Department of Veterans Affairs.
    (2) <>  Manner of care.--The Chief
    Business Office shall work in consultation with the Office of
    Clinical Operations and Management of the Department to ensure
    that care and services described in paragraph (1) are provided
    in a manner that is clinically appropriate and in the best
    interest of the veterans receiving such care and services.
    (3) No delay in payment.--The transfer of authority under
    paragraph (1) shall be carried out in a manner that does not
    delay or impede any payment by the Department for hospital care,
    medical services, or other health care furnished through a non-
    Department provider under the laws administered by the
    Secretary.

    (b) Budget Matters.--The budget of the Department of Veterans
    Affairs for any fiscal year beginning after the date of the

    [[Page 1769]]

    enactment of this Act (as submitted to Congress pursuant to section
    1105(a) of title 31, United States Code) shall specify funds for the
    payment for hospital care, medical services, and other health care
    furnished through non-Department of Veterans Affairs providers,
    including any administrative costs associated with such payment, as
    funds for the Chief Business Office of the Veterans Health
    Administration rather than as funds for the Veterans Integrated Service
    Networks or medical centers of the Department.

    TITLE <>  II--HEALTH CARE ADMINISTRATIVE
    MATTERS
    SEC. 201. INDEPENDENT ASSESSMENT OF THE HEALTH CARE DELIVERY
    SYSTEMS AND MANAGEMENT PROCESSES OF THE
    DEPARTMENT OF VETERANS AFFAIRS.

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

    [[Page 1770]]

    industry performance metrics, which may include an
    assessment of any of the following:
    (i) The case load of, and number of patients
    treated by, each health care provider at such
    medical facility during an average week.
    (ii) The time spent by such health care
    provider on matters other than the case load of
    such health care provider, including time spent by
    such health care provider as follows:
    (I) At a medical facility that is
    affiliated with the Department.
    (II) Conducting research.
    (III) Training or supervising other
    health care professionals of the
    Department.
    (H) The information technology strategies of the
    Department with respect to furnishing and managing
    health care, including an identification of any
    weaknesses and opportunities with respect to the
    technology used by the Department, especially those
    strategies with respect to clinical documentation of
    episodes of hospital care, medical services, and other
    health care, including any clinical images and
    associated textual reports, furnished by the Department
    in Department or non-Department facilities.
    (I) Business processes of the Veterans Health
    Administration, including processes relating to
    furnishing non-Department health care, insurance
    identification, third-party revenue collection, and
    vendor reimbursement, including an identification of
    mechanisms as follows:
    (i) To avoid the payment of penalties to
    vendors.
    (ii) To increase the collection of amounts
    owed to the Department for hospital care, medical
    services, or other health care provided by the
    Department for which reimbursement from a third
    party is authorized and to ensure that such
    amounts collected are accurate.
    (iii) To increase the collection of any other
    amounts owed to the Department with respect to
    hospital care, medical services, and other health
    care and to ensure that such amounts collected are
    accurate.
    (iv) To increase the accuracy and timeliness
    of Department payments to vendors and providers.
    (J) The purchasing, distribution, and use of
    pharmaceuticals, medical and surgical supplies, medical
    devices, and health care related services by the
    Department, including the following:
    (i) The prices paid for, standardization of,
    and use by the Department of the following:
    (I) Pharmaceuticals.
    (II) Medical and surgical supplies.
    (III) Medical devices.
    (ii) The use by the Department of group
    purchasing arrangements to purchase
    pharmaceuticals, medical and surgical supplies,
    medical devices, and health care related services.
    (iii) The strategy and systems used by the
    Department to distribute pharmaceuticals, medical
    and surgical supplies, medical devices, and health
    care related

    [[Page 1771]]

    services to Veterans Integrated Service Networks
    and medical facilities of the Department.
    (K) The process of the Department for carrying out
    construction and maintenance projects at medical
    facilities of the Department and the medical facility
    leasing program of the Department.
    (L) The competency of leadership with respect to
    culture, accountability, reform readiness, leadership
    development, physician alignment, employee engagement,
    succession planning, and performance management.
    (2) Particular elements of certain assessments.--
    (A) Scheduling assessment.--In carrying out the
    assessment required by paragraph (1)(E), the private
    sector entity or entities shall do the following:
    (i) Review all training materials pertaining
    to scheduling of appointments at each medical
    facility of the Department.
    (ii) Assess whether all employees of the
    Department conducting tasks related to scheduling
    are properly trained for conducting such tasks.
    (iii) Assess whether changes in the technology
    or system used in scheduling appointments are
    necessary to limit access to the system to only
    those employees that have been properly trained in
    conducting such tasks.
    (iv) Assess whether health care providers of
    the Department are making changes to their
    schedules that hinder the ability of employees
    conducting such tasks to perform such tasks.
    (v) Assess whether the establishment of a
    centralized call center throughout the Department
    for scheduling appointments at medical facilities
    of the Department would improve the process of
    scheduling such appointments.
    (vi) Assess whether booking templates for each
    medical facility or clinic of the Department would
    improve the process of scheduling such
    appointments.
    (vii) Assess any interim technology changes or
    attempts by Department to internally develop a
    long-term scheduling solutions with respect to the
    feasibility and cost effectiveness of such
    internally developed solutions compared to
    commercially available solutions.
    (viii) Recommend actions, if any, to be taken
    by the Department to improve the process for
    scheduling such appointments, including the
    following:
    (I) Changes in training materials
    provided to employees of the Department
    with respect to conducting tasks related
    to scheduling such appointments.
    (II) Changes in monitoring and
    assessment conducted by the Department
    of wait times of veterans for such
    appointments.
    (III) Changes in the system used to
    schedule such appointments, including
    changes to improve how the Department--
    (aa) measures wait times of
    veterans for such appointments;

    [[Page 1772]]

    (bb) monitors the
    availability of health care
    providers of the Department; and
    (cc) provides veterans the
    ability to schedule such
    appointments.
    (IV) Such other actions as the
    private sector entity or entities
    considers appropriate.
    (B) Medical construction and maintenance project and
    leasing program assessment.--In carrying out the
    assessment required by paragraph (1)(K), the private
    sector entity or entities shall do the following:
    (i) Review the process of the Department for
    identifying and designing proposals for
    construction and maintenance projects at medical
    facilities of the Department and leases for
    medical facilities of the Department.
    (ii) Assess the process through which the
    Department determines the following:
    (I) That a construction or
    maintenance project or lease is
    necessary with respect to a medical
    facility or proposed medical facility of
    the Department.
    (II) The proper size of such medical
    facility or proposed medical facility
    with respect to treating veterans in the
    catchment area of such medical facility
    or proposed medical facility.
    (iii) Assess the management processes of the
    Department with respect to the capital management
    programs of the Department, including processes
    relating to the methodology for construction and
    design of medical facilities of the Department,
    the management of projects relating to the
    construction and design of such facilities, and
    the activation of such facilities.
    (iv) Assess the medical facility leasing
    program of the Department.
    (3) <>  Timing.--The private sector entity
    or entities carrying out the assessment required by paragraph
    (1) shall complete such assessment not later than 240 days after
    entering into the contract described in such paragraph.

    (b) Private Sector Entities Described.--A private entity described
    in this subsection is a private entity that--
    (1) has experience and proven outcomes in optimizing the
    performance of the health care delivery systems of the Veterans
    Health Administration and the private sector and in health care
    management; and
    (2) specializes in implementing large-scale organizational
    and cultural transformations, especially with respect to health
    care delivery systems.

    (c) Program Integrator.--
    (1) In general.--If the Secretary enters into contracts with
    more than one private sector entity under subsection (a), the
    Secretary shall designate one such entity that is predominately
    a health care organization as the program integrator.
    (2) Responsibilities.--The program integrator designated
    pursuant to paragraph (1) shall be responsible for coordinating
    the outcomes of the assessments conducted by the private
    entities pursuant to such contracts.

    [[Page 1773]]

    (d) Report on Assessment.--
    (1) In general.--Not later than 60 days after completing the
    assessment required by subsection (a), the private sector entity
    or entities carrying out such assessment shall submit to the
    Secretary of Veterans Affairs, the Committee on Veterans'
    Affairs of the Senate, the Committee on Veterans' Affairs of the
    House of Representatives, and the Commission on Care established
    under section 202 a report on the findings and recommendations
    of the private sector entity or entities with respect to such
    assessment.
    (2) <>  Publication.--Not later than 30
    days after receiving the report under paragraph (1), the
    Secretary shall publish such report in the Federal Register and
    on an Internet website of the Department of Veterans Affairs
    that is accessible to the public.

    (e) Non-Department Facilities Defined.--In this section, the term
    ``non-Department facilities'' has the meaning given that term in section
    1701 of title 38, United States Code.
    SEC. 202. COMMISSION ON CARE.

    (a) Establishment of Commission.--
    (1) In general.--There is established a commission, to be
    known as the ``Commission on Care'' (in this section referred to
    as the ``Commission''), to examine the access of veterans to
    health care from the Department of Veterans Affairs and
    strategically examine how best to organize the Veterans Health
    Administration, locate health care resources, and deliver health
    care to veterans during the 20-year period beginning on the date
    of the enactment of this Act.
    (2) Membership.--
    (A) Voting members.--The Commission shall be
    composed of 15 voting members who are appointed as
    follows:
    (i) Three members appointed by the Speaker of
    the House of Representatives, at least one of whom
    shall be a veteran.
    (ii) Three members appointed by the Minority
    Leader of the House of Representatives, at least
    one of whom shall be a veteran.
    (iii) Three members appointed by the Majority
    Leader of the Senate, at least one of whom shall
    be a veteran.
    (iv) Three members appointed by the Minority
    Leader of the Senate, at least one of whom shall
    be a veteran.
    (v) Three members appointed by the President,
    at least two of whom shall be veterans.
    (B) Qualifications.--Of the members appointed under
    subparagraph (A)--
    (i) at least one member shall represent an
    organization recognized by the Secretary of
    Veterans Affairs for the representation of
    veterans under section 5902 of title 38, United
    States Code;
    (ii) at least one member shall have experience
    as senior management for a private integrated
    health care system with an annual gross revenue of
    more than $50,000,000;

    [[Page 1774]]

    (iii) at least one member shall be familiar
    with government health care systems, including
    those systems of the Department of Defense, the
    Indian Health Service, and Federally-qualified
    health centers (as defined in section
    1905(l)(2)(B) of the Social Security Act (42
    U.S.C. 1396d(l)(2)(B)));
    (iv) at least one member shall be familiar
    with the Veterans Health Administration but shall
    not be currently employed by the Veterans Health
    Administration; and
    (v) at least one member shall be familiar with
    medical facility construction and leasing projects
    carried out by government entities and have
    experience in the building trades, including
    construction, engineering, and architecture.
    (C) <>  Date.--The appointments of
    members of the Commission shall be made not later than 1
    year after the date of the enactment of this Act.
    (3) Period of appointment.--
    (A) In general.--Members shall be appointed for the
    life of the Commission.
    (B) Vacancies.--Any vacancy in the Commission shall
    not affect its powers, but shall be filled in the same
    manner as the original appointment.
    (4) <>  Initial meeting.--Not later than 15
    days after the date on which eight voting members of the
    Commission have been appointed, the Commission shall hold its
    first meeting.
    (5) Meetings.--The Commission shall meet at the call of the
    Chairperson.
    (6) Quorum.--A majority of the members of the Commission
    shall constitute a quorum, but a lesser number of members may
    hold hearings.
    (7) <>  Chairperson and vice
    chairperson.--The President shall designate a member of the
    commission to serve as Chairperson of the Commission. The
    Commission shall select a Vice Chairperson from among its
    members.

    (b) Duties of Commission.--
    (1) Evaluation and assessment.--The Commission shall
    undertake a comprehensive evaluation and assessment of access to
    health care at the Department of Veterans Affairs.
    (2) Matters evaluated and assessed.--In undertaking the
    comprehensive evaluation and assessment required by paragraph
    (1), the Commission shall evaluate and assess the results of the
    assessment conducted by the private sector entity or entities
    under section 201, including any findings, data, or
    recommendations included in such assessment.
    (3) Reports.--The Commission shall submit to the President,
    through the Secretary of Veterans Affairs, reports as follows:
    (A) Not later than 90 days after the date of the
    initial meeting of the Commission, an interim report
    on--
    (i) the findings of the Commission with
    respect to the evaluation and assessment required
    by this subsection; and
    (ii) such recommendations as the Commission
    may have for legislative or administrative action
    to improve

    [[Page 1775]]

    access to health care through the Veterans Health
    Administration.
    (B) Not later than 180 days after the date of the
    initial meeting of the Commission, a final report on--
    (i) the findings of the Commission with
    respect to the evaluation and assessment required
    by this subsection; and
    (ii) such recommendations as the Commission
    may have for legislative or administrative action
    to improve access to health care through the
    Veterans Health Administration.

    (c) Powers of the Commission.--
    (1) Hearings.--The Commission may hold such hearings, sit
    and act at such times and places, take such testimony, and
    receive such evidence as the Commission considers advisable to
    carry out this section.
    (2) Information from federal agencies.--The Commission may
    secure directly from any Federal agency such information as the
    Commission considers necessary to carry out this section. Upon
    request of the Chairperson of the Commission, the head of such
    agency shall furnish such information to the Commission.

    (d) Commission Personnel Matters.--
    (1) Compensation of members.--
    (A) In general.--Each member of the Commission who
    is not an officer or employee of the Federal Government
    shall be compensated at a rate equal to the daily
    equivalent of the annual rate of basic pay prescribed
    for level IV of the Executive Schedule under section
    5315 of title 5, United States Code, for each day
    (including travel time) during which such member is
    engaged in the performance of the duties of the
    Commission.
    (B) Officers or employees of the united states.--All
    members of the Commission who are officers or employees
    of the United States shall serve without compensation in
    addition to that received for their services as officers
    or employees of the United States.
    (2) Travel expenses.--The members of the Commission shall be
    allowed travel expenses, including per diem in lieu of
    subsistence, at rates authorized for employees of agencies under
    subchapter I of chapter 57 of title 5, United States Code, while
    away from their homes or regular places of business in the
    performance of services for the Commission.
    (3) Staff.--
    (A) In general.--The Chairperson of the Commission
    may, without regard to the civil service laws and
    regulations, appoint and terminate an executive director
    and such other additional personnel as may be necessary
    to enable the Commission to perform its duties. The
    employment of an executive director shall be subject to
    confirmation by the Commission.
    (B) Compensation.--The Chairperson of the Commission
    may fix the compensation of the executive director and
    other personnel without regard to chapter 51 and
    subchapter III of chapter 53 of title 5, United States
    Code, relating to classification of positions and
    General Schedule pay rates, except that the rate of pay
    for the executive

    [[Page 1776]]

    director and other personnel may not exceed the rate
    payable for level V of the Executive Schedule under
    section 5316 of such title.
    (4) Detail of government employees.--Any Federal Government
    employee may be detailed to the Commission without
    reimbursement, and such detail shall be without interruption or
    loss of civil service status or privilege.
    (5) Procurement of temporary and intermittent services.--The
    Chairperson of the Commission may procure temporary and
    intermittent services under section 3109(b) of title 5, United
    States Code, at rates for individuals that do not exceed the
    daily equivalent of the annual rate of basic pay prescribed for
    level V of the Executive Schedule under section 5316 of such
    title.

    (e) Termination of the Commission.--The Commission shall terminate
    30 days after the date on which the Commission submits the report under
    subsection (b)(3)(B).
    (f) Funding.--The Secretary of Veterans Affairs shall make available
    to the Commission from amounts appropriated or otherwise made available
    to the Secretary such amounts as the Secretary and the Chairperson of
    the Commission jointly consider appropriate for the Commission to
    perform its duties under this section.
    (g) <>  Executive Action.--
    (1) Action on recommendations.--The President shall require
    the Secretary of Veterans Affairs and such other heads of
    relevant Federal departments and agencies to implement each
    recommendation set forth in a report submitted under subsection
    (b)(3) that the President--
    (A) considers feasible and advisable; and
    (B) determines can be implemented without further
    legislative action.
    (2) Reports.--Not later than 60 days after the date on which
    the President receives a report under subsection (b)(3), the
    President shall submit to the Committee on Veterans' Affairs of
    the Senate and the Committee on Veterans' Affairs of the House
    of Representatives and such other committees of Congress as the
    President considers appropriate a report setting forth the
    following:
    (A) An assessment of the feasibility and
    advisability of each recommendation contained in the
    report received by the President.
    (B) For each recommendation assessed as feasible and
    advisable under subparagraph (A) the following:
    (i) Whether such recommendation requires
    legislative action.
    (ii) If such recommendation requires
    legislative action, a recommendation concerning
    such legislative action.
    (iii) A description of any administrative
    action already taken to carry out such
    recommendation.
    (iv) A description of any administrative
    action the President intends to be taken to carry
    out such recommendation and by whom.

    [[Page 1777]]

    SEC. 203. TECHNOLOGY TASK FORCE ON REVIEW OF SCHEDULING SYSTEM AND
    SOFTWARE OF THE DEPARTMENT OF VETERANS
    AFFAIRS.

    (a) Task Force Review.--
    (1) <>  In general.--The Secretary of
    Veterans Affairs shall, through the use of a technology task
    force, conduct a review of the needs of the Department of
    Veterans Affairs with respect to the scheduling system and
    scheduling software of the Department of Veterans Affairs that
    is used by the Department to schedule appointments for veterans
    for hospital care, medical services, and other health care from
    the Department.
    (2) Agreement.--
    (A) In general.--The Secretary shall seek to enter
    into an agreement with a technology organization or
    technology organizations to carry out the review
    required by paragraph (1).
    (B) Prohibition on use of funds.--Notwithstanding
    any other provision of law, no Federal funds may be used
    to assist the technology organization or technology
    organizations under subparagraph (A) in carrying out the
    review required by paragraph (1).

    (b) Report.--
    (1) In general.--Not later than 45 days after the date of
    the enactment of this Act, the technology task force required
    under subsection (a)(1) shall submit to the Secretary, the
    Committee on Veterans' Affairs of the Senate, and the Committee
    on Veterans' Affairs of the House of Representatives a report
    setting forth the findings and recommendations of the technology
    task force regarding the needs of the Department with respect to
    the scheduling system and scheduling software of the Department
    described in such subsection.
    (2) Elements.--The report required by paragraph (1) shall
    include the following:
    (A) Proposals for specific actions to be taken by
    the Department to improve the scheduling system and
    scheduling software of the Department described in
    subsection (a)(1).
    (B) A determination as to whether one or more
    existing off-the-shelf systems would--
    (i) meet the needs of the Department to
    schedule appointments for veterans for hospital
    care, medical services, and other health care from
    the Department; and
    (ii) improve the access of veterans to such
    care and services.
    (3) <>  Publication.--Not
    later than 30 days after the receipt of the report required by
    paragraph (1), the Secretary shall publish such report in the
    Federal Register and on an Internet website of the Department
    accessible to the public.

    (c) Implementation of Task Force Recommendations.--Not later than 1
    year after the receipt of the report required by subsection (b)(1), the
    Secretary shall implement the recommendations set forth in such report
    that the Secretary considers are feasible, advisable, and cost
    effective.

    [[Page 1778]]

    SEC. 204. IMPROVEMENT OF ACCESS OF VETERANS TO MOBILE VET CENTERS
    AND MOBILE MEDICAL CENTERS OF THE
    DEPARTMENT OF VETERANS AFFAIRS.

    (a) Improvement of Access.--
    (1) In general.--The Secretary of Veterans Affairs shall
    improve the access of veterans to telemedicine and other health
    care through the use of mobile vet centers and mobile medical
    centers of the Department of Veterans Affairs by providing
    standardized requirements for the operation of such centers.
    (2) Requirements.--The standardized requirements required by
    paragraph (1) shall include the following:
    (A) The number of days each mobile vet center and
    mobile medical center of the Department is expected to
    travel per year.
    (B) The number of locations each center is expected
    to visit per year.
    (C) The number of appointments each center is
    expected to conduct per year.
    (D) The method and timing of notifications given by
    each center to individuals in the area to which the
    center is traveling, including notifications informing
    veterans of the availability to schedule appointments at
    the center.
    (3) Use of telemedicine.--The Secretary shall ensure that
    each mobile vet center and mobile medical center of the
    Department has the capability to provide telemedicine services.

    (b) Reports.--
    (1) In general.--Not later than 1 year after the date of the
    enactment of this Act, and not later than September 30 each year
    thereafter, the Secretary of Veterans Affairs shall submit to
    the Committee on Veterans' Affairs of the Senate and the
    Committee on Veterans' Affairs of the House of Representatives a
    report on access to health care through the use of mobile vet
    centers and mobile medical centers of the Department that
    includes statistics on each of the requirements set forth in
    subsection (a)(2) for the year covered by the report.
    (2) Elements.--Each report required by paragraph (1) shall
    include the following:
    (A) A description of the use of mobile vet centers
    and mobile medical centers to provide telemedicine
    services to veterans during the year preceding the
    submittal of the report, including the following:
    (i) The number of days each mobile vet center
    and mobile medical center was open to provide such
    services.
    (ii) The number of days each center traveled
    to a location other than the headquarters of the
    center to provide such services.
    (iii) The number of appointments each center
    conducted to provide such services on average per
    month and in total during such year.
    (B) An analysis of the effectiveness of using mobile
    vet centers and mobile medical centers to provide health
    care services to veterans through the use of
    telemedicine.
    (C) Any recommendations for an increase in the
    number of mobile vet centers and mobile medical centers
    of the Department.

    [[Page 1779]]

    (D) Any recommendations for an increase in the
    telemedicine capabilities of each mobile vet center and
    mobile medical center.
    (E) The feasibility and advisability of using
    temporary health care providers, including locum tenens,
    to provide direct health care services to veterans at
    mobile vet centers and mobile medical centers.
    (F) Such other recommendations on improvement of the
    use of mobile vet centers and mobile medical centers by
    the Department as the Secretary considers appropriate.
    SEC. 205. IMPROVED PERFORMANCE METRICS FOR HEALTH CARE PROVIDED BY
    DEPARTMENT OF VETERANS AFFAIRS.

    (a) Prohibition on Use of Scheduling and Wait-Time Metrics in
    Determination of Performance Awards.--The Secretary of Veterans Affairs
    shall ensure that scheduling and wait-time metrics or goals are not used
    as factors in determining the performance of the following employees for
    purposes of determining whether to pay performance awards to such
    employees:
    (1) Directors, associate directors, assistant directors,
    deputy directors, chiefs of staff, and clinical leads of medical
    centers of the Department of Veterans Affairs.
    (2) Directors, assistant directors, and quality management
    officers of Veterans Integrated Service Networks of the
    Department of Veterans Affairs.

    (b) Modification of Performance Plans.--
    (1) <>  In general.--Not later than 30 days
    after the date of the enactment of this Act, the Secretary shall
    modify the performance plans of the directors of the medical
    centers of the Department and the directors of the Veterans
    Integrated Service Networks to ensure that such plans are based
    on the quality of care received by veterans at the health care
    facilities under the jurisdictions of such directors.
    (2) Factors.--In modifying performance plans under paragraph
    (1), the Secretary shall ensure that assessment of the quality
    of care provided at health care facilities under the
    jurisdiction of a director described in paragraph (1) includes
    consideration of the following:
    (A) Recent reviews by the Joint Commission (formerly
    known as the ``Joint Commission on Accreditation of
    Healthcare Organizations'') of such facilities.
    (B) The number and nature of recommendations
    concerning such facilities by the Inspector General of
    the Department in reviews conducted through the Combined
    Assessment Program, in the reviews by the Inspector
    General of community-based outpatient clinics and
    primary care clinics, and in reviews conducted through
    the Office of Healthcare Inspections during the two most
    recently completed fiscal years.
    (C) The number of recommendations described in
    subparagraph (B) that the Inspector General of the
    Department determines have not been carried out
    satisfactorily with respect to such facilities.
    (D) Reviews of such facilities by the Commission on
    Accreditation of Rehabilitation Facilities.

    [[Page 1780]]

    (E) The number and outcomes of administrative
    investigation boards, root cause analyses, and peer
    reviews conducted at such facilities during the fiscal
    year for which the assessment is being conducted.
    (F) The effectiveness of any remedial actions or
    plans resulting from any Inspector General
    recommendations in the reviews and analyses described in
    subparagraphs (A) through (E).
    (3) <>  Additional leadership
    positions.--To the degree practicable, the Secretary shall
    assess the performance of other employees of the Department in
    leadership positions at Department medical centers, including
    associate directors, assistant directors, deputy directors,
    chiefs of staff, and clinical leads, and in Veterans Integrated
    Service Networks, including assistant directors and quality
    management officers, using factors and criteria similar to those
    used in the performance plans modified under paragraph (1).

    (c) Removal of Certain Performance Goals.--For each fiscal year that
    begins after the date of the enactment of this Act, the Secretary shall
    not include in the performance goals of any employee of a Veterans
    Integrated Service Network or medical center of the Department any
    performance goal that might disincentivize the payment of Department
    amounts to provide hospital care, medical services, or other health care
    through a non-Department provider.
    SEC. 206. IMPROVED TRANSPARENCY CONCERNING HEALTH CARE PROVIDED BY
    DEPARTMENT OF VETERANS AFFAIRS.

    (a) <>  Publication of Wait Times.--Not later
    than 90 days after the date of the enactment of this Act, the Secretary
    of Veterans Affairs shall publish in the Federal Register, and on a
    publicly accessible Internet website of each medical center of the
    Department of Veterans Affairs, the wait-times for the scheduling of an
    appointment in each Department facility by a veteran for the receipt of
    primary care, specialty care, and hospital care and medical services
    based on the general severity of the condition of the veteran. Whenever
    the wait-times for the scheduling of such an appointment changes, the
    Secretary shall publish the revised wait-times--
    (1) on a publicly accessible Internet website of each
    medical center of the Department by not later than 30 days after
    such change; and
    (2) in the Federal Register by not later than 90 days after
    such change.

    (b) Publicly Available Database of Patient Safety, Quality of Care,
    and Outcome Measures.--
    (1) <>  In general.--Not later than 180
    days after the date of the enactment of this Act, the Secretary
    shall develop and make available to the public a comprehensive
    database containing all applicable patient safety, quality of
    care, and outcome measures for health care provided by the
    Department that are tracked by the Secretary.
    (2) Update frequency.--The Secretary shall update the
    database required by paragraph (1) not less frequently than once
    each year.
    (3) <>  Unavailable measures.--For all
    measures that the Secretary would otherwise publish in the
    database required

    [[Page 1781]]

    by paragraph (1) but has not done so because such measures are
    not available, the Secretary shall publish notice in the
    database of the reason for such unavailability and a timeline
    for making such measures available in the database.
    (4) Accessibility.--The Secretary shall ensure that the
    database required by paragraph (1) is accessible to the public
    through the primary Internet website of the Department and
    through each primary Internet website of a Department medical
    center.

    (c) Hospital Compare Website of Department of Health and Human
    Services.--
    (1) <>  Agreement
    required.--Not later than 180 days after the date of the
    enactment of this Act, the Secretary of Veterans Affairs shall
    enter into an agreement with the Secretary of Health and Human
    Services for the provision by the Secretary of Veterans Affairs
    of such information as the Secretary of Health and Human
    Services may require to report and make publicly available
    patient quality and outcome information concerning Department of
    Veterans Affairs medical centers through the Hospital Compare
    Internet website of the Department of Health and Human Services
    or any successor Internet website.
    (2) Information provided.--The information provided by the
    Secretary of Veterans Affairs to the Secretary of Health and
    Human Services under paragraph (1) shall include the following:
    (A) Measures of timely and effective health care.
    (B) Measures of readmissions, complications of
    death, including with respect to 30-day mortality rates
    and 30-day readmission rates, surgical complication
    measures, and health care related infection measures.
    (C) Survey data of patient experiences, including
    the Hospital Consumer Assessment of Healthcare Providers
    and Systems or any similar successor survey developed by
    the Department of Health and Human Services.
    (D) Any other measures required of or reported with
    respect to hospitals participating in the Medicare
    program under title XVIII of the Social Security Act (42
    U.S.C. 1395 et seq.).
    (3) <>  Unavailable information.--For any
    applicable metric collected by the Department of Veterans
    Affairs or required to be provided under paragraph (2) and
    withheld from or unavailable in the Hospital Compare Internet
    website or any successor Internet website, the Secretary of
    Veterans Affairs shall publish a notice on such Internet website
    stating the reason why such metric was withheld from public
    disclosure and a timeline for making such metric available, if
    applicable.

    (d) Comptroller General Review of Publicly Available Safety and
    Quality Metrics.--Not later <>  than 3 years after the
    date of the enactment of this Act, the Comptroller General of the United
    States shall conduct a review of the safety and quality metrics made
    publicly available by the Secretary of Veterans Affairs under this
    section to assess the degree to which the Secretary is complying with
    the provisions of this section.

    [[Page 1782]]

    SEC. 207. INFORMATION FOR VETERANS ON THE CREDENTIALS OF
    DEPARTMENT OF VETERANS AFFAIRS PHYSICIANS.

    (a) Improvement of ``Our Doctors'' Internet Website Links.--
    (1) Availability through department of veterans affairs
    homepage.--A link to the ``Our Doctors'' health care providers
    database of the Department of Veterans Affairs, or any successor
    database, shall be available on and through the homepage of the
    Internet website of the Department that is accessible to the
    public.
    (2) Information on location of residency training.--The
    Internet website of the Department that is accessible to the
    public shall include under the link to the ``Our Doctors''
    health care providers database of the Department, or any
    successor database, the name of the facility at which each
    licensed physician of the Department underwent residency
    training.
    (3) Information on physicians at particular facilities.--The
    ``Our Doctors'' health care providers database of the
    Department, or any successor database, shall identify whether
    each licensed physician of the Department is a physician in
    residency.

    (b) Information on Credentials of Physicians for Veterans Undergoing
    Surgical Procedures.--
    (1) In general.--Each veteran who is undergoing a surgical
    procedure by or through the Department shall be provided
    information described in paragraph (2) with respect to the
    surgeon to be performing such procedure at such time in advance
    of the procedure as is appropriate to permit such veteran to
    evaluate such information.
    (2) Information described.--The information described in
    this paragraph with respect to a surgeon described in paragraph
    (1) is as follows:
    (A) The education and training of the surgeon.
    (B) The licensure, registration, and certification
    of the surgeon by the State or national entity
    responsible for such licensure, registration, or
    certification.
    (3) Other individuals.--If a veteran is unable to evaluate
    the information provided under paragraph (1) due to the health
    or mental competence of the veteran, such information shall be
    provided to an individual acting on behalf of the veteran.

    (c) Comptroller General Report and Plan.--
    (1) Report.--Not later than 2 years after the date of the
    enactment of this Act, the Comptroller General of the United
    States shall submit to the Committee on Veterans' Affairs of the
    Senate and the Committee on Veterans' Affairs of the House of
    Representatives a report setting forth an assessment by the
    Comptroller General of the following:
    (A) The manner in which contractors under the
    Patient-Centered Community Care initiative of the
    Department perform oversight of the credentials of
    physicians within the networks of such contractors under
    the initiative.
    (B) The oversight by the Department of the contracts
    under the Patient-Centered Community Care initiative.
    (C) The verification by the Department of the
    credentials and licenses of health care providers
    furnishing hospital care and medical services under
    section 101.

    [[Page 1783]]

    (2) <>  Plan.--
    (A) In general.--Not later than 30 days after the
    submittal of the report under paragraph (1), the
    Secretary shall submit to the Comptroller General, the
    Committee on Veterans' Affairs of the Senate, and the
    Committee on Veterans' Affairs of the House of
    Representatives a plan to address any findings and
    recommendations of the Comptroller General included in
    such report.
    (B) Implementation.--Not later than 90 days after
    the submittal of the report under paragraph (1), the
    Secretary shall carry out such plan.
    SEC. 208. INFORMATION IN ANNUAL BUDGET OF THE PRESIDENT ON
    HOSPITAL CARE AND MEDICAL SERVICES
    FURNISHED THROUGH EXPANDED USE OF
    CONTRACTS FOR SUCH CARE.

    The materials on the Department of Veterans Affairs in the budget of
    the President for a fiscal year, as submitted to Congress pursuant to
    section 1105(a) of title 31, United States Code, shall set forth the
    following:
    (1) The number of veterans who received hospital care and
    medical services under section 101 during the fiscal year
    preceding the fiscal year in which such budget is submitted.
    (2) The amount expended by the Department on furnishing care
    and services under such section during the fiscal year preceding
    the fiscal year in which such budget is submitted.
    (3) The amount requested in such budget for the costs of
    furnishing care and services under such section during the
    fiscal year covered by such budget, set forth in aggregate and
    by amounts for each account for which amounts are so requested.
    (4) The number of veterans that the Department estimates
    will receive hospital care and medical services under such
    section during the fiscal years covered by the budget
    submission.
    (5) The number of employees of the Department on paid
    administrative leave at any point during the fiscal year
    preceding the fiscal year in which such budget is submitted.
    SEC. 209. PROHIBITION ON FALSIFICATION OF DATA CONCERNING WAIT
    TIMES AND QUALITY MEASURES AT DEPARTMENT
    OF VETERANS AFFAIRS.

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

    [[Page 1784]]

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

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

    (a) Staffing Shortages.--
    (1) In general.--Subchapter I of chapter 74 of title 38,
    United States Code, is amended by adding at the end the
    following new section:
    ``Sec. 7412. <>  Annual determination of
    staffing shortages; recruitment and appointment
    for needed occupations

    ``(a) <>  In General.--Not later than September 30 of each year, the
    Inspector General of the Department shall determine, and the Secretary
    shall publish in the Federal Register, the five occupations of personnel
    of this title of the Department covered under section 7401 of this title
    for which there are the largest staffing shortages throughout the
    Department as calculated over the five-year period preceding the
    determination.

    ``(b) Recruitment and Appointment.--Notwithstanding sections 3304
    and 3309 through 3318 of title 5, the Secretary may, upon a
    determination by the Inspector General under paragraph (1) that there is
    a staffing shortage throughout the Department with respect to a
    particular occupation, recruit and directly appoint, during the fiscal
    year after the fiscal year during which such determination is made,
    qualified personnel to serve in that particular occupation for the
    Department.''.
    (2) Clerical amendment.--The table of sections at the
    beginning of such chapter is amended by inserting after the item
    relating to section 7411 the following new item:

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

    (3) <>  Deadline for first determination.--Notwithstanding the
    deadline under section 7412 of title 38, United States Code, as
    added by paragraph (1), for the annual determination of staffing
    shortages in the Veterans Health Administration, the Inspector
    General of the Department of Veterans Affairs shall make the
    first determination required under such section, and the
    Secretary of Veterans Affairs shall publish in the Federal
    Register such determination, by not later than the date that is
    180 days after the date of the enactment of this Act.

    (b) Increase of Graduate Medical Education Residency Positions.--
    (1) In general.--Section 7302 of title 38, United States
    Code, is amended by adding at the end the following new
    subsection:

    ``(e)(1) In carrying out this section, the Secretary shall establish
    medical residency programs, or ensure that already established medical
    residency programs have a sufficient number of residency positions, at
    any medical facility of the Department that the Secretary determines--

    [[Page 1785]]

    ``(A) is experiencing a shortage of physicians; and
    ``(B) is located in a community that is designated as a
    health professional shortage area (as defined in section 332 of
    the Public Health Service Act (42 U.S.C. 254e)).

    ``(2) In carrying out paragraph (1), the Secretary shall--
    ``(A) allocate the residency positions under such paragraph
    among occupations included in the most current determination
    published in the Federal Register pursuant to section 7412(a) of
    this title; and
    ``(B) give priority to residency positions and programs in
    primary care, mental health, and any other specialty the
    Secretary determines appropriate.''.
    (2) Five-year increase.--
    (A) <>  In general.--In carrying out section 7302(e) of
    title 38, United States Code, as added by paragraph (1),
    during the 5-year period beginning on the day that is 1
    year after the date of the enactment of this Act, the
    Secretary of Veterans Affairs shall increase the number
    of graduate medical education residency positions at
    medical facilities of the Department by up to 1,500
    positions.
    (B) Priority.--In increasing the number of graduate
    medical education residency positions at medical
    facilities of the Department under subparagraph (A), the
    Secretary shall give priority to medical facilities
    that--
    (i) as of the date of the enactment of this
    Act, do not have a medical residency program; and
    (ii) are located in a community that has a
    high concentration of veterans.
    (3) Report.--
    (A) In general.--Not later than 60 days after the
    date of the enactment of this Act, and not later than
    October 1 each year thereafter until 2019, the Secretary
    shall submit to the Committee on Veterans' Affairs of
    the Senate and the Committee on Veterans' Affairs of the
    House of Representatives a report on graduate medical
    education residency positions at medical facilities of
    the Department.
    (B) Elements.--Each report required by subparagraph
    (A) shall include the following:
    (i) For the year preceding the submittal of
    the report, the number of graduate medical
    education residency positions at medical
    facilities of the Department as follows:
    (I) That were filled.
    (II) That were not filled.
    (III) That the Department
    anticipated filling.
    (ii) With respect to each graduate medical
    education residency position specified in clause
    (i)--
    (I) the geographic location of each
    such position; and
    (II) if such position was filled,
    the academic affiliation of the medical
    resident that filled such position.
    (iii) The policy at each medical facility of
    the Department with respect to the ratio of
    medical residents to staff supervising medical
    residents.

    [[Page 1786]]

    (iv) <>  During the 1-year
    period preceding the submittal of the report, the
    number of individuals who declined an offer from
    the Department to serve as a medical resident at a
    medical facility of the Department and the reason
    why each such individual declined such offer.
    (v) <>  During the 1-year
    period preceding the submittal of the report, a
    description of--
    (I) challenges, if any, faced by the
    Department in filling graduate medical
    education residency positions at medical
    facilities of the Department; and
    (II) actions, if any, taken by the
    Department to address such challenges.
    (vi) A description of efforts of the
    Department, as of the date of the submittal of the
    report, to recruit and retain medical residents to
    work for the Veterans Health Administration as
    full-time employees.

    (c) Priority in Scholarship Program of Health Professionals
    Educational Assistance Program to Certain Providers.--Section 7612(b)(5)
    of title 38, United States Code, is amended--
    (1) in subparagraph (A), by striking ``and'' at the end;
    (2) by redesignating subparagraph (B) as subparagraph (C);
    and
    (3) by inserting after subparagraph (A) the following new
    subparagraph (B):
    ``(B) shall give priority to applicants pursuing a course of
    education or training toward a career in an occupation for which
    the Inspector General of the Department has, in the most current
    determination published in the Federal Register pursuant to
    section 7412(a) of this title, determined that there is one of
    the largest staffing shortages throughout the Department with
    respect to such occupation; and''.

    (d) Reports.--
    (1) In general.--Not later than 180 days after the date of
    the enactment of this Act, and not later than December 31 of
    each even-numbered year thereafter until 2024, the Secretary of
    Veterans Affairs shall submit to the Committees on Veterans'
    Affairs of the Senate and House of Representatives a report
    assessing the staffing of each medical facility of the
    Department.
    (2) Elements.--Each report submitted under paragraph (1)
    shall include the following:
    (A) The results of a system-wide assessment of all
    medical facilities of the Department to ensure the
    following:
    (i) Appropriate staffing levels for health
    care professionals to meet the goals of the
    Secretary for timely access to care for veterans.
    (ii) Appropriate staffing levels for support
    personnel, including clerks.
    (iii) Appropriate sizes for clinical panels.
    (iv) Appropriate numbers of full-time staff,
    or full-time equivalents, dedicated to direct care
    of patients.
    (v) Appropriate physical plant space to meet
    the capacity needs of the Department in that area.

    [[Page 1787]]

    (vi) Such other factors as the Secretary
    considers necessary.
    (B) A plan for addressing any issues identified in
    the assessment described in subparagraph (A), including
    a timeline for addressing such issues.
    (C) A list of the current wait times and workload
    levels for the following clinics in each medical
    facility:
    (i) Mental health.
    (ii) Primary care.
    (iii) Gastroenterology.
    (iv) Women's health.
    (v) Such other clinics as the Secretary
    considers appropriate.
    (D) A description of the results of the most current
    determination of the Inspector General under subsection
    (a) of section 7412 of title 38, United States Code, as
    added by subsection (a)(1) of this section, and a plan
    to use direct appointment authority under subsection (b)
    of such section 7412 to fill staffing shortages,
    including recommendations for improving the speed at
    which the credentialing and privileging process can be
    conducted.
    (E) The current staffing models of the Department
    for the following clinics, including recommendations for
    changes to such models:
    (i) Mental health.
    (ii) Primary care.
    (iii) Gastroenterology.
    (iv) Women's health.
    (v) Such other clinics as the Secretary
    considers appropriate.
    (F) A detailed analysis of succession planning at
    medical facilities of the Department, including the
    following:
    (i) The number of positions in medical
    facilities throughout the Department that are not
    filled by a permanent employee.
    (ii) The length of time each position
    described in clause (i) remained vacant or filled
    by a temporary or acting employee.
    (iii) A description of any barriers to filling
    the positions described in clause (i).
    (iv) A plan for filling any positions that are
    vacant or filled by a temporary or acting employee
    for more than 180 days.
    (v) A plan for handling emergency
    circumstances, such as administrative leave or
    sudden medical leave for senior officials.
    (G) <>  The number of health
    care providers of the Department who have been removed
    from their positions, have retired, or have left their
    positions for another reason, disaggregated by provider
    type, during the 2-year period preceding the submittal
    of the report.
    (H) Of the health care providers specified in
    subparagraph (G) who have been removed from their
    positions, the following:
    (i) The number of such health care providers
    who were reassigned to other positions in the
    Department.

    [[Page 1788]]

    (ii) The number of such health care providers
    who left the Department.
    (iii) The number of such health care providers
    who left the Department and were subsequently
    rehired by the Department.
    SEC. 302. EXTENSION AND MODIFICATION OF CERTAIN PROGRAMS WITHIN
    THE DEPARTMENT OF VETERANS AFFAIRS HEALTH
    PROFESSIONALS EDUCATIONAL ASSISTANCE
    PROGRAM.

    (a) Extension of Scholarship Program.--Section 7619 of title 38,
    United States Code, is amended by striking ``December 31, 2014'' and
    inserting ``December 31, 2019''.
    (b) Modification of Education Debt Reduction Program.--
    (1) Modification of amount and duration of eligibility.--
    Paragraph (1) of section 7683(d) of such title is amended--
    (A) by striking ``$60,000'' and inserting
    ``$120,000''; and
    (B) by striking ``$12,000 of such payments'' and all
    that follows through the period at the end and inserting
    ``$24,000 of such payments may be made in each year of
    participation in the Program''.
    (2) Elimination of limitation.--
    (A) In general.--Such section is further amended--
    (i) by striking paragraph (2);
    (ii) by redesignating paragraph (3) as
    paragraph (2); and
    (iii) in paragraph (2), as redesignated by
    clause (ii), by striking ``paragraphs (1) and
    (2)'' and inserting ``paragraph (1)''.
    (B) Conforming amendment.--Paragraph (1) of such
    section, as amended by paragraph (1), is further amended
    by striking ``Subject to paragraph (2), the amount'' and
    inserting ``The amount''.
    SEC. 303. <>  CLINIC MANAGEMENT TRAINING
    FOR EMPLOYEES AT MEDICAL FACILITIES OF THE
    DEPARTMENT OF VETERANS AFFAIRS.

    (a) Clinic Management Training Program.--
    (1) <>  In general.--Not later than 180
    days after the date of the enactment of this Act, the Secretary
    of Veterans Affairs shall commence a role-specific clinic
    management training program to provide in-person, standardized
    education on systems and processes for health care practice
    management and scheduling to all appropriate employees, as
    determined by the Secretary, at medical facilities of the
    Department.
    (2) Elements.--
    (A) In general.--The clinic management training
    program required by paragraph (1) shall include the
    following:
    (i) Training on how to manage the schedules of
    health care providers of the Department, including
    the following:
    (I) Maintaining such schedules in a
    manner that allows appointments to be
    booked at least eight weeks in advance.
    (II) Proper planning procedures for
    vacation, leave, and graduate medical
    education training schedules.

    [[Page 1789]]

    (ii) Training on the appropriate number of
    appointments that a health care provider should
    conduct on a daily basis, based on specialty.
    (iii) Training on how to determine whether
    there are enough available appointment slots to
    manage demand for different appointment types and
    mechanisms for alerting management of insufficient
    slots.
    (iv) Training on how to properly use the
    appointment scheduling system of the Department,
    including any new scheduling system implemented by
    the Department.
    (v) Training on how to optimize the use of
    technology, including the following:
    (I) Telemedicine.
    (II) Electronic mail.
    (III) Text messaging.
    (IV) Such other technologies as
    specified by the Secretary.
    (vi) Training on how to properly use physical
    plant space at medical facilities of the
    Department to ensure efficient flow and privacy
    for patients and staff.
    (B) Role-specific.--The Secretary shall ensure that
    each employee of the Department included in the clinic
    management training program required by paragraph (1)
    receives education under such program that is relevant
    to the responsibilities of such employee.
    (3) Sunset.--The clinic management training program required
    by paragraph (1) shall terminate on the date that is 2 years
    after the date on which the Secretary commences such program.

    (b) Training Materials.--
    (1) In general.--After the termination of the clinic
    management training program required by subsection (a), the
    Secretary shall provide training materials on health care
    management to each of the following employees of the Department
    that are relevant to the position and responsibilities of such
    employee upon the commencement of employment of such employee:
    (A) Any manager of a medical facility of the
    Department.
    (B) Any health care provider at a medical facility
    of the Department.
    (C) Such other employees of the Department as the
    Secretary considers appropriate.
    (2) Update.--The Secretary shall regularly update the
    training materials required under paragraph (1).

    TITLE IV--HEALTH CARE RELATED TO SEXUAL TRAUMA

    SEC. 401. EXPANSION OF ELIGIBILITY FOR SEXUAL TRAUMA COUNSELING
    AND TREATMENT TO VETERANS ON INACTIVE DUTY
    TRAINING.

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

    [[Page 1790]]

    SEC. 402. PROVISION OF COUNSELING AND TREATMENT FOR SEXUAL TRAUMA
    BY THE DEPARTMENT OF VETERANS AFFAIRS TO
    MEMBERS OF THE ARMED FORCES.

    (a) Expansion of Coverage to Members of the Armed Forces.--
    Subsection (a) of section 1720D of title 38, United States Code, is
    amended--
    (1) by redesignating paragraph (2) as paragraph (3);
    (2) by inserting after paragraph (1) the following new
    paragraph (2):

    ``(2)(A) <>  In operating the program required
    by paragraph (1), the Secretary may, in consultation with the Secretary
    of Defense, provide counseling and care and services to members of the
    Armed Forces (including members of the National Guard and Reserves) on
    active duty to overcome psychological trauma described in that
    paragraph.

    ``(B) A member described in subparagraph (A) shall not be required
    to obtain a referral before receiving counseling and care and services
    under this paragraph.''; and
    (3) in paragraph (3), as redesignated by paragraph (1)--
    (A) by striking ``a veteran'' and inserting ``an
    individual''; and
    (B) by striking ``that veteran'' each place it
    appears and inserting ``that individual''.

    (b) Information to Members on Availability of Counseling and
    Services.--Subsection (c) of such section is amended--
    (1) by striking ``to veterans'' each place it appears; and
    (2) in paragraph (3), by inserting ``members of the Armed
    Forces and'' before ``individuals''.

    (c) Inclusion of Members in Reports on Counseling and Services.--
    Subsection (e) of such section is amended--
    (1) in the matter preceding paragraph (1), by striking ``to
    veterans'';
    (2) in paragraph (2)--
    (A) by striking ``women veterans'' and inserting
    ``individuals''; and
    (B) by striking ``training under subsection (d).''
    and inserting ``training under subsection (d),
    disaggregated by--
    ``(A) veterans;
    ``(B) members of the Armed Forces (including members
    of the National Guard and Reserves) on active duty; and
    ``(C) for each of subparagraphs (A) and (B)--
    ``(i) men; and
    ``(ii) women.'';
    (3) in paragraph (4), by striking ``veterans'' and inserting
    ``individuals''; and
    (4) in paragraph (5)--
    (A) by striking ``women veterans'' and inserting
    ``individuals''; and
    (B) by inserting ``, including specific
    recommendations for individuals specified in
    subparagraphs (A), (B), and (C) of paragraph (2)''
    before the period at the end.

    (d) <>  Effective Date.--The amendments made by
    this section shall take effect on the date that is 1 year after the date
    of the enactment of this Act.

    [[Page 1791]]

    SEC. 403. REPORTS ON MILITARY SEXUAL TRAUMA.

    (a) Report on Services Available for Military Sexual Trauma in the
    Department of Veterans Affairs.--Not later than 630 days after the date
    of the enactment of this Act, the Secretary of Veterans Affairs shall
    submit to the Committee on Veterans' Affairs of the Senate and the
    Committee on Veterans' Affairs of the House of Representatives a report
    on the treatment and services available from the Department of Veterans
    Affairs for male veterans who experience military sexual trauma compared
    to such treatment and services available to female veterans who
    experience military sexual trauma.
    (b) Reports on Transition of Military Sexual Trauma Treatment From
    Department of Defense to Department of Veterans Affairs.--Not later than
    630 days after the date of the enactment of this Act, and annually
    thereafter for 5 years, the Department of Veterans Affairs-Department of
    Defense Joint Executive Committee established by section 320(a) of title
    38, United States Code, shall submit to the appropriate committees of
    Congress a report on military sexual trauma that includes the following:
    (1) The processes and procedures utilized by the Department
    of Veterans Affairs and the Department of Defense to facilitate
    transition of treatment of individuals who have experienced
    military sexual trauma from treatment provided by the Department
    of Defense to treatment provided by the Department of Veterans
    Affairs.
    (2) A description and assessment of the collaboration
    between the Department of Veterans Affairs and the Department of
    Defense in assisting veterans in filing claims for disabilities
    related to military sexual trauma, including permitting veterans
    access to information and evidence necessary to develop or
    support such claims.

    (c) Definitions.--In this section:
    (1) Appropriate committees of congress.--The term
    ``appropriate committees of Congress'' means--
    (A) the Committee on Veterans' Affairs and the
    Committee on Armed Services of the Senate; and
    (B) the Committee on Veterans' Affairs and the
    Committee on Armed Services of the House of
    Representatives.
    (2) Military sexual trauma.--The term ``military sexual
    trauma'' means psychological trauma, which in the judgment of a
    mental health professional employed by the Department, resulted
    from a physical assault of a sexual nature, battery of a sexual
    nature, or sexual harassment which occurred while the veteran
    was serving on active duty, active duty for training, or
    inactive duty training.
    (3) Sexual harassment.--The term ``sexual harassment'' means
    repeated, unsolicited verbal or physical contact of a sexual
    nature which is threatening in character.
    (4) Sexual trauma.--The term ``sexual trauma'' shall have
    the meaning given that term by the Secretary of Veterans Affairs
    for purposes of this section.

    (d) Effective Date.--This section shall take effect on the date that
    is 270 days after the date of the enactment of this Act.

    [[Page 1792]]

    TITLE V--OTHER HEALTH CARE MATTERS

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

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

    TITLE VI--MAJOR MEDICAL FACILITY LEASES

    SEC. 601. AUTHORIZATION OF MAJOR MEDICAL FACILITY LEASES.

    (a) In General.--The Secretary of Veterans Affairs may carry out the
    following major medical facility leases at the locations specified, and
    in an amount for each lease not to exceed the amount shown for such
    location (not including any estimated cancellation costs):
    (1) For a clinical research and pharmacy coordinating
    center, Albuquerque, New Mexico, an amount not to exceed
    $9,560,000.
    (2) For a community-based outpatient clinic, Brick, New
    Jersey, an amount not to exceed $7,280,000.
    (3) For a new primary care and dental clinic annex,
    Charleston, South Carolina, an amount not to exceed $7,070,250.
    (4) For a community-based outpatient clinic, Cobb County,
    Georgia, an amount not to exceed $6,409,000.
    (5) For the Leeward Outpatient Healthcare Access Center,
    Honolulu, Hawaii, including a co-located clinic with the
    Department of Defense and the co-location of the Honolulu
    Regional Office of the Veterans Benefits Administration and the
    Kapolei Vet Center of the Department of Veterans Affairs, an
    amount not to exceed $15,887,370.
    (6) For a community-based outpatient clinic, Johnson County,
    Kansas, an amount not to exceed $2,263,000.
    (7) For a replacement community-based outpatient clinic,
    Lafayette, Louisiana, an amount not to exceed $2,996,000.
    (8) For a community-based outpatient clinic, Lake Charles,
    Louisiana, an amount not to exceed $2,626,000.
    (9) For outpatient clinic consolidation, New Port Richey,
    Florida, an amount not to exceed $11,927,000.
    (10) For an outpatient clinic, Ponce, Puerto Rico, an amount
    not to exceed $11,535,000.
    (11) For lease consolidation, San Antonio, Texas, an amount
    not to exceed $19,426,000.
    (12) For a community-based outpatient clinic, San Diego,
    California, an amount not to exceed $11,946,100.
    (13) For an outpatient clinic, Tyler, Texas, an amount not
    to exceed $4,327,000.

    [[Page 1793]]

    (14) For the Errera Community Care Center, West Haven,
    Connecticut, an amount not to exceed $4,883,000.
    (15) For the Worcester Community-Based Outpatient Clinic,
    Worcester, Massachusetts, an amount not to exceed $4,855,000.
    (16) For the expansion of a community-based outpatient
    clinic, Cape Girardeau, Missouri, an amount not to exceed
    $4,232,060.
    (17) For a multispecialty clinic, Chattanooga, Tennessee, an
    amount not to exceed $7,069,000.
    (18) For the expansion of a community-based outpatient
    clinic, Chico, California, an amount not to exceed $4,534,000.
    (19) For a community-based outpatient clinic, Chula Vista,
    California, an amount not to exceed $3,714,000.
    (20) For a new research lease, Hines, Illinois, an amount
    not to exceed $22,032,000.
    (21) For a replacement research lease, Houston, Texas, an
    amount not to exceed $6,142,000.
    (22) For a community-based outpatient clinic, Lincoln,
    Nebraska, an amount not to exceed $7,178,400.
    (23) For a community-based outpatient clinic, Lubbock,
    Texas, an amount not to exceed $8,554,000.
    (24) For a community-based outpatient clinic consolidation,
    Myrtle Beach, South Carolina, an amount not to exceed
    $8,022,000.
    (25) For a community-based outpatient clinic, Phoenix,
    Arizona, an amount not to exceed $20,757,000.
    (26) For the expansion of a community-based outpatient
    clinic, Redding, California, an amount not to exceed $8,154,000.
    (27) For the expansion of a community-based outpatient
    clinic, Tulsa, Oklahoma, an amount not to exceed $13,269,200.

    (b) <>  Requirements for Clinic in Tulsa.--
    (1) In general.--In carrying out the expansion of the
    community-based outpatient clinic in Tulsa, Oklahoma, authorized
    by subsection (a)(27), the Secretary of Veterans Affairs shall
    ensure that such clinic satisfies the following requirements:
    (A) Consist of not more than 140,000 gross square
    feet.
    (B) Have an annual cost per square foot of not more
    than the average market rate in Tulsa, Oklahoma, for an
    equivalent medical facility plus 20 percent.
    (C) Satisfy the mandate of the Department of
    Veterans Affairs to provide veterans in Oklahoma with
    access to quality and efficient care.
    (D) Expand clinical capacity in the region in which
    the clinic is located in a cost efficient manner based
    upon regional cost comparisons, taking into account the
    needs of current veterans and the potential demand by
    veterans for care in the future.
    (E) Be the most cost effective option for the
    Department as predicted over a 30-year life cycle for
    such clinic.
    (2) Cost effective determination.--
    (A) In general.--If the Secretary determines that
    the most cost effective option over a 30-year life cycle
    would be to purchase or construct a facility in Tulsa,
    Oklahoma, instead of entering into a major medical
    facility lease in

    [[Page 1794]]

    such location as authorized by subsection (a)(27), the
    Secretary shall not enter into such lease.
    (B) Major medical facility project.--If the
    Secretary makes the determination described in
    subparagraph (A), the Secretary may request authority
    for a major medical facility project in Tulsa, Oklahoma,
    from Congress pursuant to section 8104(b) of title 38,
    United States Code.
    (C) <>  Cost-benefit analysis.--If
    the Secretary requests authority for the major medical
    facility project described in subparagraph (B), not
    later than 90 days after making the determination
    described in subparagraph (A), the Secretary shall
    submit to Congress a detailed cost-benefit analysis of
    such major medical facility project.
    SEC. 602. <>  BUDGETARY TREATMENT OF
    DEPARTMENT OF VETERANS AFFAIRS MAJOR
    MEDICAL FACILITIES LEASES.

    (a) Findings.--Congress finds the following:
    (1) Title 31, United States Code, requires the Department of
    Veterans Affairs to record the full cost of its contractual
    obligation against funds available at the time a contract is
    executed.
    (2) Office of Management and Budget Circular A-11 provides
    guidance to agencies in meeting the statutory requirements under
    title 31, United States Code, with respect to leases.
    (3) For operating leases, Office of Management and Budget
    Circular A-11 requires the Department of Veterans Affairs to
    record up-front budget authority in an ``amount equal to total
    payments under the full term of the lease or [an] amount
    sufficient to cover first year lease payments plus cancellation
    costs''.

    (b) Requirement for Obligation of Full Cost.--
    (1) <>  In general.--Subject to the
    availability of appropriations provided in advance, in
    exercising the authority of the Secretary of Veterans Affairs to
    enter into leases provided in this Act, the Secretary shall
    record, pursuant to section 1501 of title 31, United States
    Code, as the full cost of the contractual obligation at the time
    a contract is executed either--
    (A) an amount equal to total payments under the full
    term of the lease; or
    (B) if the lease specifies payments to be made in
    the event the lease is terminated before its full term,
    an amount sufficient to cover the first year lease
    payments plus the specified cancellation costs.
    (2) Self-insuring authority.--The requirements of paragraph
    (1) may be satisfied through the use of the self-insuring
    authority identified in title 40, United States Code, consistent
    with Office of Management and Budget Circular A-11.

    (c) Transparency.--
    (1) Compliance.--Subsection (b) of section 8104 of title 38,
    United States Code, is amended by adding at the end the
    following new paragraph:
    ``(7) In the case of a prospectus proposing funding for a
    major medical facility lease, a detailed analysis of how the
    lease is expected to comply with Office of Management and Budget
    Circular A-11 and section 1341 of title 31 (commonly

    [[Page 1795]]

    referred to as the `Anti-Deficiency Act'). Any such analysis
    shall include--
    ``(A) an analysis of the classification of the lease
    as a `lease-purchase', `capital lease', or `operating
    lease' as those terms are defined in Office of
    Management and Budget Circular A-11;
    ``(B) an analysis of the obligation of budgetary
    resources associated with the lease; and
    ``(C) an analysis of the methodology used in
    determining the asset cost, fair market value, and
    cancellation costs of the lease.''.
    (2) Submittal to congress.--Such section 8104 is further
    amended by adding at the end the following new subsection:

    ``(h)(1) <>  Not less than 30 days before entering
    into a major medical facility lease, the Secretary shall submit to the
    Committees on Veterans' Affairs of the Senate and the House of
    Representatives--
    ``(A) <>  notice of the Secretary's intention
    to enter into the lease;
    ``(B) a detailed summary of the proposed lease;
    ``(C) a description and analysis of any differences between
    the prospectus submitted pursuant to subsection (b) and the
    proposed lease; and
    ``(D) a scoring analysis demonstrating that the proposed
    lease fully complies with Office of Management and Budget
    Circular A-11.

    ``(2) <>  Each committee described in
    paragraph (1) shall ensure that any information submitted to the
    committee under such paragraph is treated by the committee with the same
    level of confidentiality as is required by law of the Secretary and
    subject to the same statutory penalties for unauthorized disclosure or
    use as the Secretary.

    ``(3) <>  Not more than 30 days after
    entering into a major medical facility lease, the Secretary shall submit
    to each committee described in paragraph (1) a report on any material
    differences between the lease that was entered into and the proposed
    lease described under such paragraph, including how the lease that was
    entered into changes the previously submitted scoring analysis described
    in subparagraph (D) of such paragraph.''.

    (d) Rule of Construction.--Nothing in this section, or the
    amendments made by this section, shall be construed to in any way
    relieve the Department of Veterans Affairs from any statutory or
    regulatory obligations or requirements existing prior to the enactment
    of this section and such amendments.

    TITLE VII--OTHER VETERANS MATTERS

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

    (a) Expansion of Entitlement.--Subsection (b)(9) of section 3311 of
    title 38, United States Code, is amended by inserting ``or spouse''
    after ``child''.
    (b) Limitation and Election on Certain Benefits.--Subsection (f) of
    such section is amended--
    (1) by redesignating paragraph (2) as paragraph (4); and

    [[Page 1796]]

    (2) by inserting after paragraph (1) the following new
    paragraphs:
    ``(2) <>  Limitation.--The
    entitlement of an individual to assistance under subsection (a)
    pursuant to paragraph (9) of subsection (b) because the
    individual was a spouse of a person described in such paragraph
    shall expire on the earlier of--
    ``(A) the date that is 15 years after the date on
    which the person died; or
    ``(B) the date on which the individual remarries.
    ``(3) Election on receipt of certain benefits.--A surviving
    spouse entitled to assistance under subsection (a) pursuant to
    paragraph (9) of subsection (b) who is also entitled to
    educational assistance under chapter 35 of this title may not
    receive assistance under both this section and such chapter, but
    shall make an irrevocable election (in such form and manner as
    the Secretary may prescribe) under which section or chapter to
    receive educational assistance.''.

    (c) Conforming Amendment.--Section 3321(b)(4) of such title is
    amended--
    (1) by striking ``an individual'' and inserting ``a child'';
    and
    (2) by striking ``such individual's'' each time it appears
    and inserting ``such child's''.

    (d) <>  Effective Date.--The
    amendments made by this section shall apply with respect to a quarter,
    semester, or term, as applicable, commencing on or after January 1,
    2015.
    SEC. 702. APPROVAL OF COURSES OF EDUCATION PROVIDED BY PUBLIC
    INSTITUTIONS OF HIGHER LEARNING FOR
    PURPOSES OF ALL-VOLUNTEER FORCE
    EDUCATIONAL ASSISTANCE PROGRAM AND POST-9/
    11 EDUCATIONAL ASSISTANCE CONDITIONAL ON
    IN-STATE TUITION RATE FOR VETERANS.

    (a) In General.--Section 3679 of title 38, United States Code, is
    amended by adding at the end the following new subsection:
    ``(c)(1) Notwithstanding any other provision of this chapter and
    subject to paragraphs (3) through (6), the Secretary shall disapprove a
    course of education provided by a public institution of higher learning
    to a covered individual pursuing a course of education with educational
    assistance under chapter 30 or 33 of this title while living in the
    State in which the public institution of higher learning is located if
    the institution charges tuition and fees for that course for the covered
    individual at a rate that is higher than the rate the institution
    charges for tuition and fees for that course for residents of the State
    in which the institution is located, regardless of the covered
    individual's State of residence.
    ``(2) <>  For purposes of this subsection, a
    covered individual is any individual as follows:
    ``(A) <>  A veteran who was discharged
    or released from a period of not fewer than 90 days of service
    in the active military, naval, or air service less than three
    years before the date of enrollment in the course concerned.
    ``(B) An individual who is entitled to assistance under
    section 3311(b)(9) or 3319 of this title by virtue of such
    individual's relationship to a veteran described in subparagraph
    (A).

    ``(3) If after enrollment in a course of education that is subject
    to disapproval under paragraph (1) by reason of paragraph (2)(A)

    [[Page 1797]]

    or (2)(B) a covered individual pursues one or more courses of education
    at the same public institution of higher learning while remaining
    continuously enrolled (other than during regularly scheduled breaks
    between courses, semesters or terms) at that institution of higher
    learning, any course so pursued by the covered individual at that
    institution of higher learning while so continuously enrolled shall also
    be subject to disapproval under paragraph (1).
    ``(4) It shall not be grounds to disapprove a course of education
    under paragraph (1) if a public institution of higher learning requires
    a covered individual pursuing a course of education at the institution
    to demonstrate an intent, by means other than satisfying a physical
    presence requirement, to establish residency in the State in which the
    institution is located, or to satisfy other requirements not relating to
    the establishment of residency, in order to be charged tuition and fees
    for that course at a rate that is equal to or less than the rate the
    institution charges for tuition and fees for that course for residents
    of the State.
    ``(5) <>  The Secretary may waive such
    requirements of paragraph (1) as the Secretary considers appropriate.

    ``(6) <>  Disapproval under paragraph (1)
    shall apply only with respect to educational assistance under chapters
    30 and 33 of this title.''.

    (b) <>  Effective Date.--
    Subsection (c) of section 3679 of title 38, United States Code (as added
    by subsection (a) of this section), shall apply with respect to
    educational assistance provided for pursuit of a program of education
    during a quarter, semester, or term, as applicable, that begins after
    July 1, 2015.
    SEC. 703. EXTENSION OF REDUCTION IN AMOUNT OF PENSION FURNISHED BY
    DEPARTMENT OF VETERANS AFFAIRS FOR CERTAIN
    VETERANS COVERED BY MEDICAID PLANS FOR
    SERVICES FURNISHED BY NURSING FACILITIES.

    Section 5503(d)(7) of title 38, United States Code, is amended by
    striking ``November 30, 2016'' and inserting ``September 30, 2024''.
    SEC. 704. EXTENSION OF REQUIREMENT FOR COLLECTION OF FEES FOR
    HOUSING LOANS GUARANTEED BY SECRETARY OF
    VETERANS AFFAIRS.

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

    [[Page 1798]]

    (B) in clause (ii), by striking ``October 1, 2017''
    and inserting ``September 30, 2024''.
    SEC. 705. <>  LIMITATION ON AWARDS AND
    BONUSES PAID TO EMPLOYEES OF DEPARTMENT OF
    VETERANS AFFAIRS.

    In each of fiscal years 2015 through 2024, the Secretary of Veterans
    Affairs shall ensure that the aggregate amount of awards and bonuses
    paid by the Secretary in a fiscal year under chapter 45 or 53 of title
    5, United States Code, or any other awards or bonuses authorized under
    such title does not exceed $360,000,000.
    SEC. 706. EXTENSION OF AUTHORITY TO USE INCOME INFORMATION.

    Section 5317(g) of title 38, United States Code, is amended by
    striking ``September 30, 2016'' and inserting ``September 30, 2024''.
    SEC. 707. REMOVAL OF SENIOR EXECUTIVES OF THE DEPARTMENT OF
    VETERANS AFFAIRS FOR PERFORMANCE OR
    MISCONDUCT.

    (a) Removal or Transfer.--
    (1) In general.--Chapter 7 of title 38, United States Code,
    is amended by adding at the end the following new section:
    ``Sec. 713. <>  Senior executives: removal
    based on performance or misconduct

    ``(a) In General.--(1) The Secretary may remove an individual
    employed in a senior executive position at the Department of Veterans
    Affairs from the senior executive position if the Secretary determines
    the performance or misconduct of the individual warrants such removal.
    If the Secretary so removes such an individual, the Secretary may--
    ``(A) remove the individual from the civil service (as
    defined in section 2101 of title 5); or
    ``(B) in the case of an individual described in paragraph
    (2), transfer the individual from the senior executive position
    to a General Schedule position at any grade of the General
    Schedule for which the individual is qualified and that the
    Secretary determines is appropriate.

    ``(2) An individual described in this paragraph is an individual
    who--
    ``(A) previously occupied a permanent position within the
    competitive service (as that term is defined in section 2102 of
    title 5);
    ``(B) previously occupied a permanent position within the
    excepted service (as that term is defined in section 2103 of
    title 5); or
    ``(C) prior to employment in a senior executive position at
    the Department of Veterans Affairs, did not occupy any position
    within the Federal Government.

    ``(b) Pay of Transferred Individual.--(1) Notwithstanding any other
    provision of law, including the requirements of section 3594 of title 5,
    any individual transferred to a General Schedule position under
    subsection (a)(2) shall, beginning on the date of such transfer, receive
    the annual rate of pay applicable to such position.
    ``(2) An individual so transferred may not be placed on
    administrative leave or any other category of paid leave during the
    period

    [[Page 1799]]

    during which an appeal (if any) under this section is ongoing, and may
    only receive pay if the individual reports for duty. If an individual so
    transferred does not report for duty, such individual shall not receive
    pay or other benefits pursuant to subsection (e)(5).
    ``(c) <>  Notice to Congress.--Not later than 30
    days after removing or transferring an individual from a senior
    executive position under subsection (a), the Secretary shall submit to
    the Committees on Veterans' Affairs of the Senate and House of
    Representatives notice in writing of such removal or transfer and the
    reason for such removal or transfer.

    ``(d) Procedure.--(1) The procedures under section 7543(b) of title
    5 shall not apply to a removal or transfer under this section.
    ``(2)(A) Subject to subparagraph (B) and subsection (e), any removal
    or transfer under subsection (a) may be appealed to the Merit Systems
    Protection Board under section 7701 of title 5.
    ``(B) <>  An appeal under subparagraph (A) of a
    removal or transfer may only be made if such appeal is made not later
    than seven days after the date of such removal or transfer.

    ``(e) Expedited Review by Administrative Judge.--(1) Upon receipt of
    an appeal under subsection (d)(2)(A), the Merit Systems Protection Board
    shall refer such appeal to an administrative judge pursuant to section
    7701(b)(1) of title 5. <>  The administrative judge
    shall expedite any such appeal under such section and, in any such case,
    shall issue a decision not later than 21 days after the date of the
    appeal.

    ``(2) Notwithstanding any other provision of law, including section
    7703 of title 5, the decision of an administrative judge under paragraph
    (1) shall be final and shall not be subject to any further appeal.
    ``(3) In any case in which the administrative judge cannot issue a
    decision in accordance with the 21-day requirement under paragraph (1),
    the removal or transfer is final. <>  In such
    a case, the Merit Systems Protection Board shall, within 14 days after
    the date that such removal or transfer is final, submit to Congress and
    the Committees on Veterans' Affairs of the Senate and House of
    Representatives a report that explains the reasons why a decision was
    not issued in accordance with such requirement.

    ``(4) The Merit Systems Protection Board or administrative judge may
    not stay any removal or transfer under this section.
    ``(5) <>  During the period beginning on the
    date on which an individual appeals a removal from the civil service
    under subsection (d) and ending on the date that the administrative
    judge issues a final decision on such appeal, such individual may not
    receive any pay, awards, bonuses, incentives, allowances, differentials,
    student loan repayments, special payments, or benefits.

    ``(6) To the maximum extent practicable, the Secretary shall provide
    to the Merit Systems Protection Board, and to any administrative judge
    to whom an appeal under this section is referred, such information and
    assistance as may be necessary to ensure an appeal under this subsection
    is expedited.
    ``(f) Relation to Title 5.--(1) The authority provided by this
    section is in addition to the authority provided by section 3592 or
    subchapter V of chapter 75 of title 5.
    ``(2) Section 3592(b)(1) of title 5 does not apply to an action to
    remove or transfer an individual under this section.
    ``(g) Definitions.--In this section:

    [[Page 1800]]

    ``(1) The term `individual' means--
    ``(A) a career appointee (as that term is defined in
    section 3132(a)(4) of title 5); or
    ``(B) any individual who occupies an administrative
    or executive position and who was appointed under
    section 7306(a) or section 7401(1) of this title.
    ``(2) The term `misconduct' includes neglect of duty,
    malfeasance, or failure to accept a directed reassignment or to
    accompany a position in a transfer of function.
    ``(3) The term `senior executive position' means--
    ``(A) with respect to a career appointee (as that
    term is defined in section 3132(a)(4) of title 5), a
    Senior Executive Service position (as such term is
    defined in section 3132(a)(2) of title 5); and
    ``(B) with respect to an individual appointed under
    section 7306(a) or section 7401(1) of this title, an
    administrative or executive position.''.
    (2) Clerical amendment.--The table of sections at the
    beginning of such chapter is amended by adding at the end the
    following new item:

    ``713. Senior executives: removal based on performance or misconduct.''.

    (b) <>  Establishment of Expedited Review
    Process.--
    (1) <>  In general.--Not later than 14 days
    after the date of the enactment of this Act, the Merit Systems
    Protection Board shall establish and put into effect a process
    to conduct expedited reviews in accordance with section 713(d)
    of title 38, United States Code.
    (2) Inapplicability of certain regulations.--Section 1201.22
    of title 5, Code of Federal Regulations, as in effect on the day
    before the date of the enactment of this Act, shall not apply to
    expedited reviews carried out under section 713(d) of title 38,
    United States Code.
    (3) Waiver.--The Merit Systems Protection Board may waive
    any other regulation in order to provide for the expedited
    review required under section 713(d) of title 38, United States
    Code.
    (4) Report by merit systems protection board.--Not later
    than 14 days after the date of the enactment of this Act, the
    Merit Systems Protection Board shall submit to the Committees on
    Veterans' Affairs of the Senate and House of Representatives a
    report on the actions the Board plans to take to conduct
    expedited reviews under section 713(d) of title 38, United
    States Code, as added by subsection (a). Such report shall
    include a description of the resources the Board determines will
    be necessary to conduct such reviews and a description of
    whether any resources will be necessary to conduct such reviews
    that were not available to the Board on the day before the date
    of the enactment of this Act.

    (c) <>
    Temporary Exemption From Certain Limitation on Initiation of Removal
    From Senior Executive Service.--During the 120-day period beginning on
    the date of the enactment of this Act, an action to remove an individual
    from the Senior Executive Service at the Department of Veterans Affairs
    pursuant to section 7543 of title 5, United States Code, may be
    initiated, notwithstanding section 3592(b) of such title, or any other
    provision of law.

    [[Page 1801]]

    (d) <>  Construction.--
    (1) <>  In general.--Nothing in this
    section or section 713 of title 38, United States Code, as added
    by subsection (a), shall be construed to apply to an appeal of a
    removal, transfer, or other personnel action that was pending
    before the date of the enactment of this Act.
    (2) Relation to title 5.--With respect to the removal or
    transfer of an individual (as that term is defined in such
    section 713) employed at the Department of Veterans Affairs, the
    authority provided by such section 713 is in addition to the
    authority provided by section 3592 or subchapter V of chapter 75
    of title 5, United States Code.

    TITLE <>  VIII--OTHER MATTERS
    SEC. 801. APPROPRIATION OF AMOUNTS.

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

    (c) Availability.--The amount appropriated under subsection (a)
    shall remain available until expended.
    (d) Report.--
    (1) In general.--Not later than 1 year after the date of the
    enactment of this Act, the Secretary of Veterans Affairs

    [[Page 1802]]

    shall submit to the appropriate committees of Congress a report
    on how the Secretary has obligated the amounts appropriated
    under subsection (a) as of the date of the submittal of the
    report.
    (2) Appropriate committees of congress defined.--In this
    subsection, the term ``appropriate committees of Congress''
    means--
    (A) the Committee on Veterans' Affairs and the
    Committee on Appropriations of the Senate; and
    (B) the Committee on Veterans' Affairs and the
    Committee on Appropriations of the House of
    Representatives.

    (e) Funding Plan.--The Secretary shall submit to Congress a funding
    plan describing how the Secretary intends to use the amounts provided
    under subsection (a).
    SEC. 802. VETERANS CHOICE FUND.

    (a) In General.--There is established in the Treasury of the United
    States a fund to be known as the Veterans Choice Fund.
    (b) Administration of Fund.--The Secretary of Veterans Affairs shall
    administer the Veterans Choice Fund established by subsection (a).
    (c) Use of Amounts.--
    (1) In general.--Any amounts deposited in the Veteran Choice
    Fund shall be used by the Secretary of Veterans Affairs to carry
    out section 101, including, subject to paragraph (2), any
    administrative requirements of such section.
    (2) Amount for administrative requirements.--
    (A) Limitation.--Except as provided by subparagraph
    (B), of the amounts deposited in the Veterans Choice
    Fund, not more than $300,000,000 may be used for
    administrative requirements to carry out section 101.
    (B) Increase.--The Secretary may increase the amount
    set forth in subparagraph (A) with respect to the
    amounts used for administrative requirements if--
    (i) <>  the Secretary
    determines that the amount of such increase is
    necessary to carry out section 101;
    (ii) <>  the
    Secretary submits to the Committees on Veterans'
    Affairs and Appropriations of the House of
    Representatives and the Committees on Veterans'
    Affairs and Appropriations of the Senate a report
    described in subparagraph (C); and
    (iii) a period of 60 days has elapsed
    following the date on which the Secretary submits
    the report under clause (ii).
    (C) Report.--A report described in this subparagraph
    is a report that contains the following:
    (i) A notification of the amount of the
    increase that the Secretary determines necessary
    under subparagraph (B)(i).
    (ii) The justifications for such increased
    amount.
    (iii) The administrative requirements that the
    Secretary will carry out using such increased
    amount.

    (d) Appropriation and Deposit of Amounts.--
    (1) In general.--There is authorized to be appropriated, and
    is appropriated, to the Secretary of Veterans Affairs, out of
    any funds in the Treasury not otherwise appropriated
    $10,000,000,000 to be deposited in the Veterans Choice Fund

    [[Page 1803]]

    established by subsection (a). Such funds shall be available for
    obligation or expenditure without fiscal year limitation, and
    only for the program created under section 101.
    (2) Availability.--The amount appropriated under paragraph
    (1) shall remain available until expended.

    (e) Sense of Congress.--It is the sense of Congress that the
    Veterans Choice Fund is a supplement to but distinct from the Department
    of Veterans Affairs' current and expected level of non-Department care
    currently part of Department's medical care budget. Congress expects
    that the Department will maintain at least its existing obligations of
    non-Department care programs in addition to but distinct from the
    Veterans Choice Fund for each of fiscal years 2015 through 2017.
    SEC. 803. EMERGENCY DESIGNATIONS.

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

    Approved August 7, 2014.

    LEGISLATIVE HISTORY--H.R. 3230 (S. 2450):
    ---------------------------------------------------------------------------

    HOUSE REPORTS: No. 113-564 (Comm. of Conference).
    CONGRESSIONAL RECORD:
    Vol. 159 (2013):
    Oct. 3, considered and passed House.
    Vol. 160 (2014):
    June 11, considered and passed
    Senate, amended, in lieu of S.
    2450.
    June 18, House concurred in Senate
    amendments with an amendment.
    July 30, House agreed to conference
    report.
    July 31, Senate agreed to conference
    report.
    DAILY COMPILATION OF PRESIDENTIAL DOCUMENTS (2014):
    Aug. 7, Presidential remarks.