    [United States Statutes at Large, Volume 132, 115th Congress, 2nd Session]
    [From the U.S. Government Publishing Office, www.gpo.gov]

    Public Law 115-182
    115th Congress

    An Act

    To establish a permanent community care program for veterans, to
    establish a commission for the purpose of making recommendations
    regarding the modernization or realignment of facilities of the Veterans
    Health Administration, to improve construction of the Department of
    Veterans Affairs, to make certain improvements in the laws administered
    by the Secretary of Veterans Affairs relating to the home loan program
    of 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 ``John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson VA
    Maintaining Internal Systems and Strengthening Integrated Outside
    Networks Act of 2018'' or the ``VA MISSION Act of 2018''.

    (b) Table of Contents.--The table of contents for this Act is as
    follows:

    Sec. 1. Short title; table of contents.

    TITLE I--CARING FOR OUR VETERANS

    Sec. 100. Short title; references to title 38, United States Code.

    Subtitle A--Developing an Integrated High-Performing Network

    Chapter 1--Establishing Community Care Programs

    Sec. 101. Establishment of Veterans Community Care Program.
    Sec. 102. Authorization of agreements between Department of Veterans
    Affairs and non-Department providers.
    Sec. 103. Conforming amendments for State veterans homes.
    Sec. 104. Access standards and standards for quality.
    Sec. 105. Access to walk-in care.
    Sec. 106. Strategy regarding the Department of Veterans Affairs High-
    Performing Integrated Health Care Network.
    Sec. 107. Applicability of Directive of Office of Federal Contract
    Compliance Programs.
    Sec. 108. Prevention of certain health care providers from providing
    non-Department health care services to veterans.
    Sec. 109. Remediation of medical service lines.

    Chapter 2--Paying Providers and Improving Collections

    Sec. 111. Prompt payment to providers.
    Sec. 112. Authority to pay for authorized care not subject to an
    agreement.
    Sec. 113. Improvement of authority to recover the cost of services
    furnished for non-service-connected disabilities.
    Sec. 114. Processing of claims for reimbursement through electronic
    interface.

    Chapter 3--Education and Training Programs

    Sec. 121. Education program on health care options.
    Sec. 122. Training program for administration of non-Department of
    Veterans Affairs health care.

    [[Page 1394]]

    Sec. 123. Continuing medical education for non-Department medical
    professionals.

    Chapter 4--Other Matters Relating to Non-Department of Veterans Affairs
    Providers

    Sec. 131. Establishment of processes to ensure safe opioid prescribing
    practices by non-Department of Veterans Affairs health care
    providers.
    Sec. 132. Improving information sharing with community providers.
    Sec. 133. Competency standards for non-Department of Veterans Affairs
    health care providers.
    Sec. 134. Department of Veterans Affairs participation in national
    network of State-based prescription drug monitoring programs.

    Chapter 5--Other Non-Department Health Care Matters

    Sec. 141. Plans for Use of Supplemental Appropriations Required.
    Sec. 142. Veterans Choice Fund flexibility.
    Sec. 143. Sunset of Veterans Choice Program.
    Sec. 144. Conforming amendments.

    Subtitle B--Improving Department of Veterans Affairs Health Care
    Delivery

    Sec. 151. Licensure of health care professionals of the Department of
    Veterans Affairs providing treatment via telemedicine.
    Sec. 152. Authority for Department of Veterans Affairs Center for
    Innovation for Care and Payment.
    Sec. 153. Authorization to provide for operations on live donors for
    purposes of conducting transplant procedures for veterans.

    Subtitle C--Family Caregivers

    Sec. 161. Expansion of family caregiver program of Department of
    Veterans Affairs.
    Sec. 162. Implementation of information technology system of Department
    of Veterans Affairs to assess and improve the family
    caregiver program.
    Sec. 163. Modifications to annual evaluation report on caregiver program
    of Department of Veterans Affairs.

    TITLE II--VA ASSET AND INFRASTRUCTURE REVIEW

    Subtitle A--Asset and Infrastructure Review

    Sec. 201. Short title.
    Sec. 202. The Commission.
    Sec. 203. Procedure for making recommendations.
    Sec. 204. Actions regarding infrastructure and facilities of the
    Veterans Health Administration.
    Sec. 205. Implementation.
    Sec. 206. Department of Veterans Affairs Asset and Infrastructure Review
    Account.
    Sec. 207. Congressional consideration of Commission report.
    Sec. 208. Other matters.
    Sec. 209. Definitions.

    Subtitle B--Other Infrastructure Matters

    Sec. 211. Improvement to training of construction personnel.
    Sec. 212. Review of enhanced use leases.
    Sec. 213. Assessment of health care furnished by the Department to
    veterans who live in the Pacific territories.

    TITLE III--IMPROVEMENTS TO RECRUITMENT OF HEALTH CARE PROFESSIONALS

    Sec. 301. Designated scholarships for physicians and dentists under
    Department of Veterans Affairs Health Professional
    Scholarship Program.
    Sec. 302. Increase in maximum amount of debt that may be reduced under
    Education Debt Reduction Program of Department of Veterans
    Affairs.
    Sec. 303. Establishing the Department of Veterans Affairs Specialty
    Education Loan Repayment Program.
    Sec. 304. Veterans healing veterans medical access and scholarship
    program.
    Sec. 305. Bonuses for recruitment, relocation, and retention.
    Sec. 306. Inclusion of Vet Center employees in Education Debt Reduction
    Program of Department of Veterans Affairs.

    TITLE IV--HEALTH CARE IN UNDERSERVED AREAS

    Sec. 401. Development of criteria for designation of certain medical
    facilities of the Department of Veterans Affairs as
    underserved facilities and plan to address problem of
    underserved facilities.

    [[Page 1395]]

    Sec. 402. Pilot program to furnish mobile deployment teams to
    underserved facilities.
    Sec. 403. Pilot program on graduate medical education and residency.

    TITLE V--OTHER MATTERS

    Sec. 501. Annual report on performance awards and bonuses awarded to
    certain high-level employees of the department.
    Sec. 502. Role of podiatrists in Department of Veterans Affairs.
    Sec. 503. Definition of major medical facility project.
    Sec. 504. Authorization of certain major medical facility projects of
    the Department of Veterans Affairs.
    Sec. 505. Department of Veterans Affairs personnel transparency.
    Sec. 506. Program on establishment of peer specialists in patient
    aligned care team settings within medical centers of
    Department of Veterans Affairs.
    Sec. 507. Department of Veterans Affairs medical scribe pilot program.
    Sec. 508. Extension of requirement to collect fees for housing loans
    guaranteed by Secretary of Veterans Affairs.
    Sec. 509. 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. 510. Appropriation of amounts.
    Sec. 511. Technical correction.
    Sec. 512. Budgetary effects.

    TITLE I-- <> CARING FOR OUR
    VETERANS
    SEC. 100. SHORT TITLE; REFERENCES TO TITLE 38, UNITED STATES CODE.

    (a) Short Title. <> --This title may be
    cited as the ``Caring for Our Veterans Act of 2018''.

    (b) References to Title 38, United States Code.--Except as otherwise
    expressly provided, whenever in this title an amendment or repeal is
    expressed in terms of an amendment to, or repeal of, a section or other
    provision, the reference shall be considered to be made to a section or
    other provision of title 38, United States Code.

    Subtitle A--Developing an Integrated High-Performing Network

    CHAPTER 1--ESTABLISHING COMMUNITY CARE PROGRAMS

    SEC. 101. ESTABLISHMENT OF VETERANS COMMUNITY CARE PROGRAM.

    (a) Establishment of Program.--
    (1) In general.--Section 1703 is amended to read as follows:
    ``Sec. 1703. Veterans Community Care Program

    ``(a) In General.--(1) There is established a program to furnish
    hospital care, medical services, and extended care services to covered
    veterans through health care providers specified in subsection (c).
    ``(2) <>  The Secretary shall coordinate the
    furnishing of hospital care, medical services, and extended care
    services under this section to covered veterans, including coordination
    of, at a minimum, the following:

    [[Page 1396]]

    ``(A) Ensuring the scheduling of medical appointments in a
    timely manner and the establishment of a mechanism to receive
    medical records from non-Department providers.
    ``(B) Ensuring continuity of care and services.
    ``(C) Ensuring coordination among regional networks if the
    covered veteran accesses care and services in a different
    network than the regional network in which the covered veteran
    resides.
    ``(D) Ensuring that covered veterans do not experience a
    lapse in care resulting from errors or delays by the Department
    or its contractors or an unusual or excessive burden in
    accessing hospital care, medical services, or extended care
    services.

    ``(3) A covered veteran may only receive care or services under this
    section upon the authorization of such care or services by the
    Secretary.
    ``(b) Covered Veterans.--For purposes of this section, a covered
    veteran is any veteran who--
    ``(1) is enrolled in the system of annual patient enrollment
    established and operated under section 1705 of this title; or
    ``(2) is not enrolled in such system but is otherwise
    entitled to hospital care, medical services, or extended care
    services under subsection (c)(2) of such section.

    ``(c) Health Care Providers Specified.--Health care providers
    specified in this subsection are the following:
    ``(1) 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 a program.
    ``(2) The Department of Defense.
    ``(3) The Indian Health Service.
    ``(4) 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))).
    ``(5) <>  Any health care provider not
    otherwise covered under any of paragraphs (1) through (4) that
    meets criteria established by the Secretary for purposes of this
    section.

    ``(d) Conditions Under Which Care Is Required To Be Furnished
    Through Non-Department Providers.--(1) The Secretary shall, subject to
    the availability of appropriations, furnish hospital care, medical
    services, and extended care services to a covered veteran through health
    care providers specified in subsection (c) if--
    ``(A) the Department does not offer the care or services the
    veteran requires;
    ``(B) the Department does not operate a full-service medical
    facility in the State in which the covered veteran resides;
    ``(C)(i) the covered veteran was an eligible veteran under
    section 101(b)(2)(B) of the Veterans Access, Choice, and
    Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 1701
    note) as of the day before the date of the enactment of the
    Caring for Our Veterans Act of 2018;
    ``(ii) continues to reside in a location that would qualify
    the veteran for eligibility under such section; and
    ``(iii) either--
    ``(I) resides in one of the five States with the
    lowest population density as determined by data from the
    2010 decennial census; or

    [[Page 1397]]

    ``(II) resides in a State not described in subclause
    (I) and--
    ``(aa) received care or services under this
    title in the year preceding the enactment of the
    Caring for Our Veterans Act of 2018; and
    ``(bb) is seeking care or services within 2
    years of the date of the enactment of the Caring
    for Our Veterans Act of 2018;
    ``(D) the covered veteran has contacted the Department to
    request care or services and the Department is not able to
    furnish such care or services in a manner that complies with
    designated access standards developed by the Secretary under
    section 1703B of this title; or
    ``(E) <>  the covered veteran and the
    covered veteran's referring clinician agree that furnishing care
    and services through a non-Department entity or provider would
    be in the best medical interest of the covered veteran based
    upon criteria developed by the Secretary.

    ``(2) The Secretary shall ensure that the criteria developed under
    paragraph (1)(E) include consideration of the following:
    ``(A) The distance between the covered veteran and the
    facility that provides the hospital care, medical services, or
    extended care services the veteran needs.
    ``(B) The nature of the hospital care, medical services, or
    extended care services required.
    ``(C) The frequency that the hospital care, medical
    services, or extended care services needs to be furnished.
    ``(D) The timeliness of available appointments for the
    hospital care, medical services, or extended care services the
    veteran needs.
    ``(E) Whether the covered veteran faces an unusual or
    excessive burden to access hospital care, medical services, or
    extended care services from the Department medical facility
    where a covered veteran seeks hospital care, medical services,
    or extended care services, which shall include consideration of
    the following:
    ``(i) Whether the covered veteran faces an excessive
    driving distance, geographical challenge, or
    environmental factor that impedes the access of the
    covered veteran.
    ``(ii) Whether the hospital care, medical services,
    or extended care services sought by the veteran is
    provided by a medical facility of the Department that is
    reasonably accessible to a covered veteran.
    ``(iii) Whether a medical condition of the covered
    veteran affects the ability of the covered veteran to
    travel.
    ``(iv) Whether there is compelling reason, as
    determined by the Secretary, that the veteran needs to
    receive hospital care, medical services, or extended
    care services from a medical facility other than a
    medical facility of the Department.
    ``(v) Such other considerations as the Secretary
    considers appropriate.

    ``(3) If the Secretary has determined that the Department does not
    offer the care or services the covered veteran requires under
    subparagraph (A) of paragraph (1), that the Department does not operate
    a full-service medical facility in the State in which the covered
    veteran resides under subparagraph (B) of such paragraph,

    [[Page 1398]]

    that the covered veteran is described under subparagraph (C) of such
    paragraph, or that the Department is not able to furnish care or
    services in a manner that complies with designated access standards
    developed by the Secretary under section 1703B of this title under
    subparagraph (D) of such paragraph, the decision to receive hospital
    care, medical services, or extended care services under such
    subparagraphs from a health care provider specified in subsection (c)
    shall be at the election of the veteran.
    ``(e) Conditions Under Which Care Is Authorized To Be Furnished
    Through Non-Department Providers.--(1)(A) The Secretary may furnish
    hospital care, medical services, or extended care services through a
    health care provider specified in subsection (c) to a covered veteran
    served by a medical service line of the Department that the Secretary
    has determined is not providing care that complies with the standards
    for quality the Secretary shall establish under section 1703C.
    ``(B) In carrying out subparagraph (A), the Secretary shall--
    ``(i) measure timeliness of the medical service line at a
    facility of the Department when compared with the same medical
    service line at different Department facilities; and
    ``(ii) measure quality at a medical service line of a
    facility of the Department by comparing it with two or more
    distinct and appropriate quality measures at non-Department
    medical service lines.

    ``(C)(i) The Secretary may not concurrently furnish hospital care,
    medical services, or extended care services under subparagraph (A) with
    respect to more than three medical service lines described in such
    subparagraph at any one health care facility of the Department.
    ``(ii) The Secretary may not concurrently furnish hospital care,
    medical services, or extended care services under subparagraph (A) with
    respect to more than 36 medical service lines nationally described in
    such subparagraph.
    ``(2) The Secretary may limit the types of hospital care, medical
    services, or extended care services covered veterans may receive under
    paragraph (1) in terms of the length of time such care and services will
    be available, the location at which such care and services will be
    available, and the clinical care and services that will be available.
    ``(3)(A) Except as provided for in subparagraph (B), the hospital
    care, medical services, and extended care services authorized under
    paragraph (1) with respect to a medical service line shall cease when
    the remediation described in section 1706A with respect to such medical
    service line is complete.
    ``(B) <>  The Secretary shall ensure continuity
    and coordination of care for any veteran who elects to receive care or
    services under paragraph (1) from a health care provider specified in
    subsection (c) through the completion of an episode of care.

    ``(4) <>  The Secretary shall publish in the Federal
    Register, and shall take all reasonable steps to provide direct notice
    to covered veterans affected under this subsection, at least once each
    year stating the time period during which such care and services will be
    available, the location or locations where such care and services will
    be available, and the clinical services available at each location under
    this subsection in accordance with regulations the Secretary shall
    prescribe.

    [[Page 1399]]

    ``(5) When the Secretary exercises the authority under paragraph
    (1), the decision to receive care or services under such paragraph from
    a health care provider specified in subsection (c) shall be at the
    election of the covered veteran.
    ``(f) Review of Decisions.--The review of any decision under
    subsection (d) or (e) shall be subject to the Department's clinical
    appeals process, and such decisions may not be appealed to the Board of
    Veterans' Appeals.
    ``(g) <>  Tiered Network.--(1) To promote the
    provision of high-quality and high-value hospital care, medical
    services, and extended care services under this section, the Secretary
    may develop a tiered provider network of eligible providers based on
    criteria established by the Secretary for purposes of this section.

    ``(2) In developing a tiered provider network of eligible providers
    under paragraph (1), the Secretary shall not prioritize providers in a
    tier over providers in any other tier in a manner that limits the choice
    of a covered veteran in selecting a health care provider specified in
    subsection (c) for receipt of hospital care, medical services, or
    extended care services under this section.
    ``(h) Contracts To Establish Networks of Health Care Providers.--(1)
    The Secretary shall enter into consolidated, competitively bid contracts
    to establish networks of health care providers specified in paragraphs
    (1) and (5) of subsection (c) for purposes of providing sufficient
    access to hospital care, medical services, or extended care services
    under this section.
    ``(2)(A) The Secretary shall, to the extent practicable, ensure that
    covered veterans are able to make their own appointments using advanced
    technology.
    ``(B) To the extent practicable, the Secretary shall be responsible
    for the scheduling of appointments for hospital care, medical services,
    and extended care services under this section.
    ``(3)(A) <>  The Secretary may terminate a
    contract with an entity entered into under paragraph (1) at such time
    and upon such notice to the entity as the Secretary may specify for
    purposes of this section, if the Secretary notifies the appropriate
    committees of Congress that, at a minimum--
    ``(i) the entity--
    ``(I) failed to comply substantially with the
    provisions of the contract or with the provisions of
    this section and the regulations prescribed under this
    section;
    ``(II) failed to comply with the access standards or
    the standards for quality established by the Secretary;
    ``(III) is excluded from participation in a Federal
    health care program (as defined in section 1128B(f) of
    the Social Security Act (42 U.S.C. 1320a-7b(f))) under
    section 1128 or 1128A of the Social Security Act (42
    U.S.C. 1320a-7 and 1320a-7a);
    ``(IV) is identified as an excluded source on the
    list maintained in the System for Award Management, or
    any successor system; or
    ``(V) has been convicted of a felony or other
    serious offense under Federal or State law and the
    continued participation of the entity would be
    detrimental to the best interests of veterans or the
    Department;
    ``(ii) it is reasonable to terminate the contract based on
    the health care needs of veterans; or

    [[Page 1400]]

    ``(iii) it is reasonable to terminate the contract based on
    coverage provided by contracts or sharing agreements entered
    into under authorities other than this section.

    ``(B) Nothing in subparagraph (A) may be construed to restrict the
    authority of the Secretary to terminate a contract entered into under
    paragraph (1) under any other provision of law.
    ``(4) <>  Whenever the Secretary provides notice to
    an entity that the entity is failing to meet contractual obligations
    entered into under paragraph (1), 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 such
    failure. Such report shall include the following:
    ``(A) An explanation of the reasons for providing such
    notice.
    ``(B) A description of the effect of such failure, including
    with respect to cost, schedule, and requirements.
    ``(C) A description of the actions taken by the Secretary to
    mitigate such failure.
    ``(D) A description of the actions taken by the contractor
    to address such failure.
    ``(E) A description of any effect on the community provider
    market for veterans in the affected area.

    ``(5)(A) <>  The Secretary shall instruct
    each entity awarded a contract under paragraph (1) to recognize and
    accept, on an interim basis, the credentials and qualifications of
    health care providers who are authorized to furnish hospital care and
    medical services to veterans under a community care program of the
    Department in effect as of the day before the date of the enactment of
    the Caring for Our Veterans Act of 2018, including under the Patient-
    Centered Community Care Program and the Veterans Choice Program under
    section 101 of the Veterans Access, Choice, and Accountability Act of
    2014 (Public Law 113-146; 38 U.S.C. 1701 note), as qualified providers
    under the program established under this section.

    ``(B) <>  The interim acceptance
    period under subparagraph (A) shall be determined by the Secretary based
    on the following criteria:
    ``(i) With respect to a health care provider, when the
    current certification agreement for the health care provider
    expires.
    ``(ii) Whether the Department has enacted certification and
    eligibility criteria and regulatory procedures by which non-
    Department providers will be authorized under this section.

    ``(6) The Secretary shall establish a system or systems for
    monitoring the quality of care provided to covered veterans through a
    network under this subsection and for assessing the quality of hospital
    care, medical services, and extended care services furnished through
    such network before the renewal of the contract for such network.
    ``(i) Payment Rates for Care and Services.--(1) Except as provided
    in paragraph (2), and to the extent practicable, the rate paid for
    hospital care, medical services, or extended care services under any
    provision in this title may not exceed the rate 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 XI or title XVIII of the Social Security Act (42
    U.S.C. 1301 et seq.), including section 1834 of such Act (42 U.S.C.
    1395m), for the same care or services.

    [[Page 1401]]

    ``(2)(A) A higher rate than the rate paid by the United States as
    described in paragraph (1) may be negotiated with respect to the
    furnishing of care or services to a covered veteran who resides in a
    highly rural area.
    ``(B) <>  In this paragraph, 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.

    ``(3) <>  With respect to furnishing care or services
    under this section in Alaska, the Alaska Fee Schedule of the Department
    of Veterans Affairs shall be followed, except for when another payment
    agreement, including a contract or provider agreement, is in effect.

    ``(4) With respect to furnishing hospital care, medical services, or
    extended care services under this section in a State with an All-Payer
    Model Agreement under section 1814(b)(3) of the Social Security Act (42
    U.S.C. 1395f(b)(3)) that became effective on or after January 1, 2014,
    the Medicare payment rates under paragraph (2)(A) shall be calculated
    based on the payment rates under such agreement.
    ``(5) Notwithstanding paragraph (1), the Secretary may incorporate,
    to the extent practicable, the use of value-based reimbursement models
    to promote the provision of high-quality care.
    ``(6) With respect to hospital care, medical services, or extended
    care services for which there is not a rate paid under the Medicare
    program as described in paragraph (1), the rate paid for such care or
    services shall be determined by the Secretary.
    ``(j) Treatment of Other Health Plan Contracts.--In any case in
    which a covered veteran is furnished hospital care, medical services, or
    extended care services under this section for a non-service-connected
    disability described in subsection (a)(2) of section 1729 of this title,
    the Secretary shall recover or collect reasonable charges for such care
    or services from a health plan contract described in section 1729 in
    accordance with such section.
    ``(k) Payment by Veteran.--A covered veteran shall not pay a greater
    amount for receiving care or services under this section than the amount
    the veteran would pay for receiving the same or comparable care or
    services at a medical facility of the Department or from a health care
    provider of the Department.
    ``(l) Transplant Authority for Improved Access.--(1) In the case of
    a covered veteran described in paragraph (2), the Secretary shall
    determine whether to authorize an organ or bone marrow transplant for
    that covered veteran at a non-Department facility.
    ``(2) A covered veteran described in this paragraph--
    ``(A) requires an organ or bone marrow transplant; and
    ``(B) has, in the opinion of the primary care provider of
    the veteran, a medically compelling reason to travel outside the
    region of the Organ Procurement and Transplantation Network,
    established under section 372 of the National Organ
    Transplantation Act (Public Law 98-507; 42 U.S.C. 274), in which
    the veteran resides, to receive such transplant.

    ``(m) <>  Monitoring of Care Provided.--
    (1)(A) Not later than 540 days after the date of the enactment of the
    Caring for Our Veterans Act of 2018, and not less frequently than
    annually thereafter, the Secretary shall submit to appropriate
    committees of Congress a review of the types and frequency of care
    sought under subsection (d).

    [[Page 1402]]

    ``(B) <>  The review submitted under subparagraph
    (A) shall include an assessment of the following:
    ``(i) The top 25 percent of types of care and services most
    frequently provided under subsection (d) due to the Department
    not offering such care and services.
    ``(ii) The frequency such care and services were sought by
    covered veterans under this section.
    ``(iii) <>  An analysis of the reasons the
    Department was unable to provide such care and services.
    ``(iv) Any steps the Department took to provide such care
    and services at a medical facility of the Department.
    ``(v) The cost of such care and services.

    ``(2) <>  In monitoring the hospital care,
    medical services, and extended care services furnished under this
    section, the Secretary shall do the following:
    ``(A) With respect to hospital care, medical services, and
    extended care services furnished through provider networks
    established under subsection (i)--
    ``(i) <>  compile data on the types of
    hospital care, medical services, and extended care
    services furnished through such networks and how many
    patients used each type of care and service;
    ``(ii) identify gaps in hospital care, medical
    services, or extended care services furnished through
    such networks;
    ``(iii) identify how such gaps may be fixed through
    new contracts within such networks or changes in the
    manner in which hospital care, medical services, or
    extended care services are furnished through such
    networks;
    ``(iv) assess the total amounts spent by the
    Department on hospital care, medical services, and
    extended care services furnished through such networks;
    ``(v) assess the timeliness of the Department in
    referring hospital care, medical services, and extended
    care services to such networks; and
    ``(vi) assess the timeliness of such networks in--
    ``(I) accepting referrals; and
    ``(II) scheduling and completing appointments.
    ``(B) <>  Report the number of medical
    service lines the Secretary has determined under subsection
    (e)(1) not to be providing hospital care, medical services, or
    extended care services that comply with the standards for
    quality established by the Secretary.
    ``(C) Assess the use of academic affiliates and centers of
    excellence of the Department to furnish hospital care, medical
    services, and extended care services to covered veterans under
    this section.
    ``(D) Assess the hospital care, medical services, and
    extended care services furnished to covered veterans under this
    section by medical facilities operated by Federal agencies other
    than the Department.

    ``(3) <>  Not later than 540 days after the date of
    the enactment of the Caring for Our Veterans Act of 2018 and not less
    frequently than once each year thereafter, 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
    information gathered under paragraph (2).

    [[Page 1403]]

    ``(n) Prohibition on Certain Limitations.--(1) The Secretary shall
    not limit the types of hospital care, medical services, or extended care
    services covered veterans may receive under this section if it is in the
    best medical interest of the veteran to receive such hospital care,
    medical services, or extended care services, as determined by the
    veteran and the veteran's health care provider.
    ``(2) No provision in this section may be construed to alter or
    modify any other provision of law establishing specific eligibility
    criteria for certain hospital care, medical services, or extended care
    services.
    ``(o) Definitions.--In this section:
    ``(1) 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.
    ``(2) The term `medical service line' means a clinic within
    a Department medical center.''.
    (2) Clerical amendment.--The table of sections at the
    beginning of chapter 17 <>  is amended
    by striking the item relating to section 1703 and inserting the
    following new item:

    ``1703. Veterans Community Care Program.''.

    (b) <>  Effective Date.--Section 1703 of
    title 38, United States Code, as amended by subsection (a), shall take
    effect on the later of--
    (1) the date that is 30 days after the date on which the
    Secretary of Veterans Affairs submits the report required under
    section 101(q)(2) of the Veterans Access, Choice, and
    Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 1701
    note); or
    (2) the date on which the Secretary promulgates regulations
    pursuant to subsection (c).

    (c) Regulations.--
    (1) In general.-- <> Not later than 1 year
    after the date of the enactment of this Act, the Secretary of
    Veterans Affairs shall promulgate regulations to carry out
    section 1703 of title 38, United States Code, as amended by
    subsection (a) of this section.
    (2) Updates.--
    (A) Periodic.--Before promulgating the regulations
    required under paragraph (1), the Secretary shall
    provide to the appropriate committees of Congress
    periodic updates to confirm the progress of the
    Secretary toward developing such regulations.
    (B) <>  First update.--The first
    update under subparagraph (A) shall occur no later than
    120 days from the date of the enactment of this Act.
    (C) Appropriate committees of congress defined.--In
    this paragraph, the term ``appropriate committees of
    Congress'' means--
    (i) the Committee on Veterans' Affairs and the
    Committee on Appropriations of the Senate; and
    (ii) the Committee on Veterans' Affairs and
    the Committee on Appropriations of the House of
    Representatives.

    (d) Continuity of Existing Agreements.--

    [[Page 1404]]

    (1) In general.--Notwithstanding section 1703 of title 38,
    United States Code, as amended by subsection (a), the Secretary
    of Veterans Affairs shall continue all contracts, memorandums of
    understanding, memorandums of agreements, and other arrangements
    that were in effect on the day before the date of the enactment
    of this Act between the Department of Veterans Affairs and the
    American Indian and Alaska Native health care systems as
    established under the terms of the Department of Veterans
    Affairs and Indian Health Service Memorandum of Understanding,
    signed October 1, 2010, the National Reimbursement Agreement,
    signed December 5, 2012, arrangements under section 405 of the
    Indian Health Care Improvement Act (25 U.S.C. 1645), and
    agreements entered into under sections 102 and 103 of the
    Veterans Access, Choice, and Accountability Act of 2014 (Public
    Law 113-146).
    (2) Modifications.--Paragraph (1) shall not be construed to
    prohibit the Secretary and the parties to the contracts,
    memorandums of understanding, memorandums of agreements, and
    other arrangements described in such paragraph from making such
    changes to such contracts, memorandums of understanding,
    memorandums of agreements, and other arrangements as may be
    otherwise authorized pursuant to other provisions of law or the
    terms of the contracts, memorandums of understanding,
    memorandums of agreements, and other arrangements.
    SEC. 102. AUTHORIZATION OF AGREEMENTS BETWEEN DEPARTMENT OF
    VETERANS AFFAIRS AND NON-DEPARTMENT
    PROVIDERS.

    (a) In General.--Subchapter I of chapter 17 is amended by inserting
    after section 1703 the following new section:
    ``Sec. 1703A. <>  Agreements with eligible
    entities or providers; certification processes

    ``(a) Agreements Authorized.--(1)(A) When hospital care, a medical
    service, or an extended care service required by a veteran who is
    entitled to such care or service under this chapter is not feasibly
    available to the veteran from a facility of the Department or through a
    contract or sharing agreement entered into pursuant to another provision
    of law, the Secretary may furnish such care or service to such veteran
    through an agreement under this section with an eligible entity or
    provider to provide such hospital care, medical service, or extended
    care service.
    ``(B) An agreement entered into under this section to provide
    hospital care, a medical service, or an extended care service shall be
    known as a `Veterans Care Agreement'.
    ``(C) For purposes of subparagraph (A), hospital care, a medical
    service, or an extended care service may be considered not feasibly
    available to a veteran from a facility of the Department or through a
    contract or sharing agreement described in such subparagraph when the
    Secretary determines the veteran's medical condition, the travel
    involved, the nature of the care or services required, or a combination
    of these factors make the use of a facility of the Department or a
    contract or sharing agreement described in such subparagraph
    impracticable or inadvisable.
    ``(D) A Veterans Care Agreement may be entered into by the Secretary
    or any Department official authorized by the Secretary.

    [[Page 1405]]

    ``(2)(A) <>  Subject to subparagraph
    (B), the Secretary shall review each Veterans Care Agreement of material
    size, as determined by the Secretary or set forth in paragraph (3), for
    hospital care, a medical service, or an extended care service to
    determine whether it is feasible and advisable to provide such care or
    service within a facility of the Department or by contract or sharing
    agreement entered into pursuant to another provision of law and, if so,
    take action to do so.

    ``(B)(i) <>  The Secretary shall review each
    Veterans Care Agreement of material size that has been in effect for at
    least 6 months within the first 2 years of its taking effect, and not
    less frequently than once every 4 years thereafter.

    ``(ii) If a Veterans Care Agreement has not been in effect for at
    least 6 months by the date of the review required by subparagraph (A),
    the agreement shall be reviewed during the next cycle required by
    subparagraph (A), and such review shall serve as its review within the
    first 2 years of its taking effect for purposes of clause (i).
    ``(3)(A) <>  In fiscal year 2019 and in each
    fiscal year thereafter, in addition to such other Veterans Care
    Agreements as the Secretary may determine are of material size, a
    Veterans Care Agreement for the purchase of extended care services that
    exceeds $5,000,000 annually shall be considered of material size.

    ``(B) From time to time, the Secretary may publish a notice in the
    Federal Register to adjust the dollar amount specified in subparagraph
    (A) to account for changes in the cost of health care based upon
    recognized health care market surveys and other available data.
    ``(b) Eligible Entities and Providers.--For purposes of this
    section, an eligible entity or provider is--
    ``(1) any provider of services that has enrolled and 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 enrolled and entered into a participation
    agreement under section 1842(h) of such Act (42 U.S.C.
    1395u(h));
    ``(2) any provider participating under a State plan under
    title XIX of such Act (42 U.S.C. 1396 et seq.);
    ``(3) an Aging and Disability Resource Center, an area
    agency on aging, or a State agency (as defined in section 102 of
    the Older Americans Act of 1965 (42 U.S.C. 3002));
    ``(4) a center for independent living (as defined in section
    702 of the Rehabilitation Act of 1973 (29 U.S.C. 796a)); or
    ``(5) any entity or provider not described in paragraph (1)
    or (2) of this subsection that the Secretary determines to be
    eligible pursuant to the certification process described in
    subsection (c).

    ``(c) Eligible Entity or Provider Certification Process.--
    The <>  Secretary shall establish by regulation a
    process for the certification of eligible entities or providers or
    recertification of eligible entities or providers under this section.
    Such a process shall, at a minimum--
    ``(1) establish deadlines for actions on applications for
    certification;
    ``(2) set forth standards for an approval or denial of
    certification, duration of certification, revocation of an
    eligible entity

    [[Page 1406]]

    or provider's certification, and recertification of eligible
    entities or providers;
    ``(3) <>  require the denial of
    certification if the Secretary determines the eligible entity or
    provider is excluded from participation in a Federal health care
    program under section 1128 or section 1128A of the Social
    Security Act (42 U.S.C. 1320a-7 or 1320a-7a) or is currently
    identified as an excluded source on the System for Award
    Management Exclusions list described in part 9 of title 48, Code
    of Federal Regulations, and part 180 of title 2 of such Code, or
    successor regulations;
    ``(4) <>  establish procedures for
    screening eligible entities or providers according to the risk
    of fraud, waste, and abuse that are similar to the standards
    under section 1866(j)(2)(B) of the Social Security Act (42
    U.S.C. 1395cc(j)(2)(B)) and section 9.104 of title 48, Code of
    Federal Regulations, or successor regulations; and
    ``(5) incorporate and apply the restrictions and penalties
    set forth in chapter 21 of title 41 and treat this section as a
    procurement program only for purposes of applying such
    provisions.

    ``(d) Rates.--To the extent practicable, the rates paid by the
    Secretary for hospital care, medical services, and extended care
    services provided under a Veterans Care Agreement shall be in accordance
    with the rates paid by the United States under section 1703(i) of this
    title.
    ``(e) Terms of Veterans Care Agreements.--(1) Pursuant to
    regulations promulgated under subsection (k), the Secretary may define
    the requirements for providers and entities entering into agreements
    under this section based upon such factors as the number of patients
    receiving care or services, the number of employees employed by the
    entity or provider furnishing such care or services, the amount paid by
    the Secretary to the provider or entity, or other factors as determined
    by the Secretary.
    ``(2) To furnish hospital care, medical services, or extended care
    services under this section, an eligible entity or provider shall
    agree--
    ``(A) to accept payment at the rates established in
    regulations prescribed under this section;
    ``(B) <>  that payment by the Secretary
    under this section on behalf of a veteran to a provider of
    services or care shall, unless rejected and refunded by the
    provider within 30 days of receipt, constitute payment in full
    and extinguish any liability on the part of the veteran for the
    treatment or care provided, and no provision of a contract,
    agreement, or assignment to the contrary shall operate to
    modify, limit, or negate this requirement;
    ``(C) to provide only the care and services authorized by
    the Department under this section and to obtain the prior
    written consent of the Department to furnish care or services
    outside the scope of such authorization;
    ``(D) to bill the Department in accordance with the
    methodology outlined in regulations prescribed under this
    section;
    ``(E) to not seek to recover or collect from a health plan
    contract or third party, as those terms are defined in section
    1729 of this title, for any care or service that is furnished or
    paid for by the Department;

    [[Page 1407]]

    ``(F) to provide medical records to the Department in the
    time frame and format specified by the Department; and
    ``(G) to meet such other terms and conditions, including
    quality of care assurance standards, as the Secretary may
    specify in regulation.

    ``(f) <> Discontinuation or Nonrenewal of a Veterans
    Care Agreement.--(1) An eligible entity or provider may discontinue a
    Veterans Care Agreement at such time and upon such notice to the
    Secretary as may be provided in regulations prescribed under this
    section.

    ``(2) <>  The Secretary may discontinue a
    Veterans Care Agreement with an eligible entity or provider at such time
    and upon such reasonable notice to the eligible entity or provider as
    may be specified in regulations prescribed under this section, if an
    official designated by the Secretary--
    ``(A) has determined that the eligible entity or provider
    failed to comply substantially with the provisions of the
    Veterans Care Agreement, or with the provisions of this section
    or regulations prescribed under this section;
    ``(B) has determined the eligible entity or provider is
    excluded from participation in a Federal health care program
    under section 1128 or section 1128A of the Social Security Act
    (42 U.S.C. 1320a-7 or 1320a-7a) or is identified on the System
    for Award Management Exclusions list as provided in part 9 of
    title 48, Code of Federal Regulations, and part 180 of title 2
    of such Code, or successor regulations;
    ``(C) has ascertained that the eligible entity or provider
    has been convicted of a felony or other serious offense under
    Federal or State law and determines the eligible entity or
    provider's continued participation would be detrimental to the
    best interests of veterans or the Department; or
    ``(D) has determined that it is reasonable to terminate the
    agreement based on the health care needs of a veteran.

    ``(g) <>  Quality of Care.--The Secretary shall
    establish a system or systems for monitoring the quality of care
    provided to veterans through Veterans Care Agreements and for assessing
    the quality of hospital care, medical services, and extended care
    services furnished by eligible entities and providers before the renewal
    of Veterans Care Agreements.

    ``(h) <>  Disputes.--(1) The Secretary shall
    promulgate administrative procedures for eligible entities and providers
    to present all disputes arising under or related to Veterans Care
    Agreements.

    ``(2) Such procedures constitute the eligible entities' and
    providers' exhaustive and exclusive administrative remedies.
    ``(3) Eligible entities or providers must first exhaust such
    administrative procedures before seeking any judicial review under
    section 1346 of title 28 (known as the `Tucker Act').
    ``(4) Disputes under this section must pertain to either the scope
    of authorization under the Veterans Care Agreement or claims for payment
    subject to the Veterans Care Agreement and are not claims for the
    purposes of such laws that would otherwise require application of
    sections 7101 through 7109 of title 41, United States Code.
    ``(i) Applicability of Other Provisions of Law.--(1) A Veterans Care
    Agreement may be authorized by the Secretary or any Department official
    authorized by the Secretary, and such action shall not be treated as--

    [[Page 1408]]

    ``(A) an award for the purposes of such laws that would
    otherwise require the use of competitive procedures for the
    furnishing of care and services; or
    ``(B) a Federal contract for the acquisition of goods or
    services for purposes of any provision of Federal law governing
    Federal contracts for the acquisition of goods or services
    except section 4706(d) of title 41.

    ``(2)(A) Except as provided in the agreement itself, in subparagraph
    (B), and unless otherwise provided in this section or regulations
    prescribed pursuant to this section, an eligible entity or provider that
    enters into an agreement under this section is not subject to, in the
    carrying out of the agreement, any law to which providers of services
    and suppliers under the Medicare program under title XVIII of the Social
    Security Act (42 U.S.C. 1395 et seq.) are not subject.
    ``(B) An eligible entity or provider that enters into an agreement
    under this section is subject to--
    ``(i) all laws regarding integrity, ethics, or fraud, or
    that subject a person to civil or criminal penalties; and
    ``(ii) all laws that protect against employment
    discrimination or that otherwise ensure equal employment
    opportunities.

    ``(3) Notwithstanding paragraph (2)(B)(i), an eligible entity or
    provider that enters into an agreement under this section shall not be
    treated as a Federal contractor or subcontractor for purposes of chapter
    67 of title 41 (commonly known as the `McNamara-O'Hara Service Contract
    Act of 1965').
    ``(j) Parity of Treatment.--Eligibility for hospital care, medical
    services, and extended care services furnished to any veteran pursuant
    to a Veterans Care Agreement shall be subject to the same terms as
    though provided in a facility of the Department, and provisions of this
    chapter applicable to veterans receiving such care and services in a
    facility of the Department shall apply to veterans treated under this
    section.
    ``(k) Rulemaking.--The Secretary shall promulgate regulations to
    carry out this section.''.
    (b) Clerical Amendment.--The table of sections at the beginning of
    such chapter <>  is amended by inserting after
    the item relating to section 1703 the following new item:

    ``1703A. Agreements with eligible entities or providers; certification
    processes.''.

    SEC. 103. CONFORMING AMENDMENTS FOR STATE VETERANS HOMES.

    (a) In General.--Section 1745(a) is amended--
    (1) in paragraph (1), by striking ``(or agreement under
    section 1720(c)(1) of this title)'' and inserting ``(or an
    agreement)''; and
    (2) by adding at the end the following new paragraph:

    ``(4)(A) An agreement under this section may be authorized by the
    Secretary or any Department official authorized by the Secretary, and
    any such action is not an award for purposes of such laws that would
    otherwise require the use of competitive procedures for the furnishing
    of hospital care, medical services, and extended care services.
    ``(B)(i) Except as provided in the agreement itself, in clause (ii),
    and unless otherwise provided in this section or regulations prescribed
    pursuant to this section, a State home that enters into an agreement
    under this section is not subject to, in the carrying out of the
    agreement, any provision of law to which providers

    [[Page 1409]]

    of services and suppliers under the Medicare program under title XVIII
    of the Social Security Act (42 U.S.C. 1395 et seq.) are not subject.
    ``(ii) A State home that enters into an agreement under this section
    is subject to--
    ``(I) all provisions of law regarding integrity, ethics, or
    fraud, or that subject a person to civil or criminal penalties;
    ``(II) all provisions of law that protect against employment
    discrimination or that otherwise ensure equal employment
    opportunities; and
    ``(III) all provisions in subchapter V of chapter 17 of this
    title.

    ``(iii) Notwithstanding subparagraph (B)(ii)(I), a State home that
    enters into an agreement under this section may not be treated as a
    Federal contractor or subcontractor for purposes of chapter 67 of title
    41 (known as the `McNamara-O'Hara Service Contract Act of 1965').''.
    (b) <>  Effective Date.--The amendment made
    by subsection (a) shall apply to care provided on or after the effective
    date of regulations issued by the Secretary of Veterans Affairs to carry
    out this section.
    SEC. 104. ACCESS STANDARDS AND STANDARDS FOR QUALITY.

    (a) In General.--Subchapter I of chapter 17, as amended by section
    102, is further amended by inserting after section 1703A the following
    new sections:
    ``Sec. 1703B. <>  Access standards

    ``(a)(1) The Secretary shall establish access standards for
    furnishing hospital care, medical services, or extended care services to
    covered veterans for the purposes of section 1703(d).
    ``(2) The Secretary shall ensure that the access standards
    established under paragraph (1) define such categories of care to cover
    all care and services within the medical benefits package of the
    Department of Veterans Affairs.
    ``(b) The Secretary shall ensure that the access standards provide
    covered veterans, employees of the Department, and health care providers
    in the network established under section 1703(h) with relevant
    comparative information that is clear, useful, and timely, so that
    covered veterans can make informed decisions regarding their health
    care.
    ``(c) <>  The Secretary shall consult with all
    pertinent Federal entities (including the Department of Defense, the
    Department of Health and Human Services, and the Centers for Medicare &
    Medicaid Services), entities in the private sector, and other
    nongovernmental entities in establishing access standards.

    ``(d)(1) <>  Not later than 270 days after the date
    of the enactment of the Caring for Our Veterans Act of 2018, the
    Secretary shall submit to the appropriate committees of Congress a
    report detailing the access standards.

    ``(2)(A) Before submitting the report required under paragraph (1),
    the Secretary shall provide periodic updates to the appropriate
    committees of Congress to confirm the Department's progress towards
    developing the access standards required by this section.
    ``(B) The first update under subparagraph (A) shall occur no later
    than 120 days from the date of the enactment of the Caring for Our
    Veterans Act of 2018.

    [[Page 1410]]

    ``(3) Not later than 540 days after the date on which the Secretary
    implements the access standards established under subsection (a), the
    Secretary shall submit to the appropriate committees of Congress a
    report detailing the implementation of and compliance with such access
    standards by Department and non-Department entities or providers.
    ``(e) <>  Not later than 3 years after
    the date on which the Secretary establishes access standards under
    subsection (a) and not less frequently than once every 3 years
    thereafter, the Secretary shall--
    ``(1) <>  conduct a review of such standards;
    and
    ``(2) <>  submit to the appropriate
    committees of Congress a report on the findings and any
    modification to the access standards with respect to the review
    conducted under paragraph (1).

    ``(f) <>  The Secretary shall ensure health care
    providers specified under section 1703(c) are able to comply with the
    applicable access standards established by the Secretary.

    ``(g) <>  The
    Secretary shall publish in the Federal Register and on an internet
    website of the Department the designated access standards established
    under this section for purposes of section 1703(d)(1)(D).

    ``(h)(1) <>  Consistent with paragraphs (1)(D)
    and (3) of section 1703(d), covered veterans may contact the Department
    at any time to request a determination regarding whether they are
    eligible to receive care and services from a non-Department entity or
    provider based on the Department being unable to furnish such care and
    services in a manner that complies with the designated access standards
    established under this section.

    ``(2) <>  The Secretary shall establish a
    process to review such requests from covered veterans to determine
    whether--
    ``(A) the requested care is clinically necessary; and
    ``(B) <>  the Department is able to
    provide such care in a manner that complies with designated
    access standards established under this section.

    ``(3) The Secretary shall promptly respond to any such request by a
    covered veteran.
    ``(i)(1) <>  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.

    ``(2) The term `covered veterans' refers to veterans described in
    section 1703(b) of this title.
    ``Sec. 1703C. <>  Standards for quality

    ``(a) In General.--(1) The Secretary shall establish standards for
    quality regarding hospital care, medical services, and extended care
    services furnished by the Department pursuant to this title, including
    through non-Department health care providers pursuant to section 1703 of
    this title.
    ``(2) In establishing standards for quality under paragraph (1), the
    Secretary shall consider existing health quality measures that are
    applied to public and privately sponsored health care systems with the
    purpose of providing covered veterans relevant comparative information
    to make informed decisions regarding their health care.

    [[Page 1411]]

    ``(3) <>  The Secretary shall collect and consider data
    for purposes of establishing the standards under paragraph (1). Such
    data collection shall include--
    ``(A) <>  after
    consultation with veterans service organizations and other key
    stakeholders on survey development or modification of an
    existing survey, a survey of veterans who have used hospital
    care, medical services, or extended care services furnished by
    the Veterans Health Administration during the most recent 2-year
    period to assess the satisfaction of the veterans with service
    and quality of care; and
    ``(B) datasets that include, at a minimum, elements relating
    to the following:
    ``(i) Timely care.
    ``(ii) Effective care.
    ``(iii) Safety, including, at a minimum,
    complications, readmissions, and deaths.
    ``(iv) Efficiency.

    ``(4) <>  The Secretary shall consult with all
    pertinent Federal entities (including the Department of Defense, the
    Department of Health and Human Services, and the Centers for Medicare &
    Medicaid Services), entities in the private sector, and other
    nongovernmental entities in establishing standards for quality.

    ``(5)(A) <>  Not later than 270 days after the date
    of the enactment of the Caring for Our Veterans Act of 2018, the
    Secretary shall submit to the appropriate committees of Congress a
    report detailing the standards for quality.

    ``(B)(i) Before submitting the report required under subparagraph
    (A), the Secretary shall provide periodic updates to the appropriate
    committees of Congress to confirm the Department's progress towards
    developing the standards for quality required by this section.
    ``(ii) The first update under clause (i) shall occur no later than
    120 days from the date of the enactment of the Caring for Our Veterans
    Act of 2018.
    ``(b) <>  Publication and Consideration of Public
    Comments.--(1) <>  Not later than 1 year after the
    date on which the Secretary establishes standards for quality under
    subsection (a), the Secretary shall publish the quality rating of
    medical facilities of the Department in the publicly available Hospital
    Compare website through the Centers for Medicare & Medicaid Services for
    the purpose of providing veterans with information that allows them to
    compare performance measure information among Department and non-
    Department health care providers.

    ``(2) Not later than 2 years after the date on which the Secretary
    establishes standards for quality under subsection (a), the Secretary
    shall consider and solicit public comment on potential changes to the
    measures used in such standards to ensure that they include the most up-
    to-date and applicable industry measures for veterans.
    ``(c)(1) <>  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.

    ``(2) The term `covered veterans' refers to veterans described in
    section 1703(b) of this title.''.
    (b) Clerical Amendment.--The table of sections at the beginning of
    chapter 17, as amended by section 102, <> is
    further amended

    [[Page 1412]]

    by inserting after the item relating to section 1703A the following new
    items:

    ``1703B. Access standards.
    ``1703C. Standards for quality.''.

    SEC. 105. ACCESS TO WALK-IN CARE.

    (a) In General.--Chapter 17 is amended by inserting after section
    1725 the following new section:
    ``Sec. 1725A. <>  Access to walk-in care

    ``(a) Procedures To Ensure Access to Walk-In Care.--The Secretary
    shall develop procedures to ensure that eligible veterans are able to
    access walk-in care from qualifying non-Department entities or
    providers.
    ``(b) Eligible Veterans.--For purposes of this section, an eligible
    veteran is any individual who--
    ``(1) is enrolled in the health care system established
    under section 1705(a) of this title; and
    ``(2) has received care under this chapter within the 24-
    month period preceding the furnishing of walk-in care under this
    section.

    ``(c) Qualifying Non-Department Entities or Providers.--For purposes
    of this section, a qualifying non-Department entity or provider is a
    non-Department entity or provider that has entered into a contract or
    other agreement with the Secretary to furnish services under this
    section.
    ``(d) Federally-Qualified Health Centers.--Whenever practicable, the
    Secretary may use a 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))) to carry out this section.
    ``(e) Continuity of Care.--The Secretary shall ensure continuity of
    care for those eligible veterans who receive walk-in care services under
    this section, including through the establishment of a mechanism to
    receive medical records from walk-in care providers and provide
    pertinent patient medical records to providers of walk-in care.
    ``(f) Copayments.--(1)(A) The Secretary may require an eligible
    veteran to pay the United States a copayment for each episode of
    hospital care or medical services provided under this section if the
    eligible veteran would be required to pay a copayment under this title.
    ``(B) An eligible veteran not required to pay a copayment under this
    title may access walk-in care without a copayment for the first two
    visits in a calendar year. For any additional visits, a copayment at an
    amount determined by the Secretary may be required.
    ``(C) An eligible veteran required to pay a copayment under this
    title may be required to pay a regular copayment for the first two walk-
    in care visits in a calendar year. For any additional visits, a higher
    copayment at an amount determined by the Secretary may be required.
    ``(2) After the first two episodes of care furnished to an eligible
    veteran under this section, the Secretary may adjust the copayment
    required of the veteran under this subsection based upon the priority
    group of enrollment of the eligible veteran, the number of episodes of
    care furnished to the eligible veteran during a year,

    [[Page 1413]]

    and other factors the Secretary considers appropriate under this
    section.
    ``(3) <>  The amount or amounts of the
    copayments required under this subsection shall be prescribed by the
    Secretary by rule.

    ``(4) Section 8153(c) of this title shall not apply to this
    subsection.
    ``(g) <>  Regulations.--Not later than 1 year after
    the date of the enactment of the Caring for Our Veterans Act of 2018,
    the Secretary shall promulgate regulations to carry out this section.

    ``(h) Walk-In Care Defined.--In this section, the term `walk-in
    care' means non-emergent care provided by a qualifying non-Department
    entity or provider that furnishes episodic care and not longitudinal
    management of conditions and is otherwise defined through regulations
    the Secretary shall promulgate.''.
    (b) <>  Effective Date.--Section 1725A of
    title 38, United States Code, as added by subsection (a) shall take
    effect on the date upon which final regulations implementing such
    section take effect.

    (c) Clerical Amendment.--The table of sections at the beginning of
    such chapter <> is amended by inserting after
    the item relating to section 1725 the following new item:

    ``1725A. Access to walk-in care.''.

    SEC. 106. STRATEGY REGARDING THE DEPARTMENT OF VETERANS AFFAIRS
    HIGH-PERFORMING INTEGRATED HEALTH CARE
    NETWORK.

    (a) In General.--Subchapter II of chapter 73 is amended by inserting
    after section 7330B the following new section:
    ``Sec. 7330C. <> Quadrennial Veterans Health
    Administration review

    ``(a) Market Area Assessments.--(1) <>  Not less
    frequently than every 4 years, the Secretary of Veterans Affairs shall
    perform market area assessments regarding the health care services
    furnished under the laws administered by the Secretary.

    ``(2) Each market area assessment established under paragraph (1)
    shall include the following:
    ``(A) An assessment of the demand for health care from the
    Department, disaggregated by geographic market areas as
    determined by the Secretary, including the number of requests
    for health care services under the laws administered by the
    Secretary.
    ``(B) <>  An inventory of the health care
    capacity of the Department of Veterans Affairs across the
    Department's system of facilities.
    ``(C) An assessment of the health care capacity to be
    provided through contracted community care providers and
    providers who entered into a provider agreement with the
    Department under section 1703A of title 38, as added by section
    102, including the number of providers, the geographic location
    of the providers, and categories or types of health care
    services provided by the providers.
    ``(D) An assessment obtained from other Federal direct
    delivery systems of their capacity to provide health care to
    veterans.
    ``(E) An assessment of the health care capacity of non-
    contracted providers where there is insufficient network supply.

    [[Page 1414]]

    ``(F) An assessment of the health care capacity of academic
    affiliates and other collaborations of the Department as it
    relates to providing health care to veterans.
    ``(G) An assessment of the effects on health care capacity
    of the access standards and standards for quality established
    under sections 1703B and 1703C of this title.
    ``(H) The number of appointments for health care services
    under the laws administered by the Secretary, disaggregated by--
    ``(i) appointments at facilities of the Department
    of Veterans Affairs; and
    ``(ii) appointments with non-Department health care
    providers.

    ``(3)(A) The Secretary shall submit to the appropriate committees of
    Congress the market area assessments established in paragraph (1).
    ``(B) <>  The Secretary also shall submit to
    the appropriate committees of Congress the market area assessments
    completed by or being performed on the day before the date of the
    enactment of the Caring for Our Veterans Act of 2018.

    ``(4)(A) The Secretary shall use the market area assessments
    established under paragraph (1) to--
    ``(i) determine the capacity of the health care provider
    networks established under section 1703(h) of this title;
    ``(ii) inform the Department budget, in accordance with
    subparagraph (B); and
    ``(iii) <>  inform and assess the
    appropriateness of the access standards established under
    section 1703B of this title and standards for quality under
    section 1703C and to make recommendations for any changes to
    such standards.

    ``(B) The Secretary shall ensure that the Department budget for any
    fiscal year (as submitted with the budget of the President under section
    1105(a) of title 31) reflects the findings of the Secretary with respect
    to the most recent market area assessments under paragraph (1) and
    health care utilization data from the Department and non-Department
    entities or providers furnishing care and services to covered veterans
    as described in section 1703(b).
    ``(b) <>  Strategic Plan To Meet
    Health Care Demand.--(1) Not later than 1 year after the date of the
    enactment of the Caring for Our Veterans Act of 2018 and not less
    frequently than once every 4 years thereafter, the Secretary shall
    submit to the appropriate committees of Congress a strategic plan that
    specifies a 4-year forecast of--
    ``(A) the demand for health care from the Department,
    disaggregated by geographic area as determined by the Secretary;
    ``(B) the health care capacity to be provided at each
    medical center of the Department; and
    ``(C) the health care capacity to be provided through
    community care providers.

    ``(2) In preparing the strategic plan under paragraph (1), the
    Secretary shall--
    ``(A) <>  assess the access standards and
    standards for quality established under sections 1703B and 1703C
    of this title;
    ``(B) <>  assess the market area
    assessments established under subsection (a);

    [[Page 1415]]

    ``(C) <>  assess the needs of the
    Department based on identified services that provide management
    of conditions or disorders related to military service for which
    there is limited experience or access in the national market,
    the overall health of veterans throughout their lifespan, or
    other services as the Secretary determines appropriate;
    ``(D) <>  consult with key stakeholders
    within the Department, the heads of other Federal agencies, and
    other relevant governmental and nongovernmental entities,
    including State, local, and tribal government officials, members
    of Congress, veterans service organizations, private sector
    representatives, academics, and other policy experts;
    ``(E) identify emerging issues, trends, problems, and
    opportunities that could affect health care services furnished
    under the laws administered by the Secretary;
    ``(F) <>  develop recommendations
    regarding both short- and long-term priorities for health care
    services furnished under the laws administered by the Secretary;
    ``(G) <>  after consultation
    with veterans service organizations and other key stakeholders
    on survey development or modification of an existing survey,
    consider a survey of veterans who have used hospital care,
    medical services, or extended care services furnished by the
    Veterans Health Administration during the most recent 2-year
    period to assess the satisfaction of the veterans with service
    and quality of care;
    ``(H) <>  conduct a comprehensive
    examination of programs and policies of the Department regarding
    the delivery of health care services and the demand of health
    care services for veterans in future years;
    ``(I) <>  assess the remediation of
    medical service lines of the Department as described in section
    1706A in conjunction with the utilization of non-Department
    entities or providers to offset remediation; and
    ``(J) consider such other matters as the Secretary considers
    appropriate.

    ``(c) Responsibilities.--The Secretary shall be responsible for--
    ``(1) overseeing the transformation and organizational
    change across the Department to achieve such high performing
    integrated health care network;
    ``(2) developing the capital infrastructure planning and
    procurement processes, whether minor or major construction
    projects or leases; and
    ``(3) developing a multi-year budget process that is capable
    of forecasting future year budget requirements and projecting
    the cost of delivering health care services under a high-
    performing integrated health care network.

    ``(d) Appropriate Committees of Congress Defined.--In this section,
    the term `appropriate committees of Congress' means--
    ``(1) the Committee on Veterans' Affairs and the Committee
    on Appropriations of the Senate; and
    ``(2) the Committee on Veterans' Affairs and the Committee
    on Appropriations of the House of Representatives.''.

    (b) Clerical Amendment.--The table of sections at the beginning of
    such chapter <>  is amended by inserting after
    the item relating to section 7330B the following new item:

    ``7330C. Quadrennial Veterans Health Administration review.''.

    [[Page 1416]]

    SEC. 107. <>  APPLICABILITY OF DIRECTIVE
    OF OFFICE OF FEDERAL CONTRACT COMPLIANCE
    PROGRAMS.

    (a) In General.--Notwithstanding the treatment of certain laws under
    subsection (i) of section 1703A of title 38, United States Code, as
    added by section 102 of this title, Directive 2014-01 of the Office of
    Federal Contract Compliance Programs of the Department of Labor
    (effective as of May 7, 2014) shall apply to any entity entering into an
    agreement under such section 1703A or section 1745 of such title, as
    amended by section 103, in the same manner as such directive applies to
    subcontractors under the TRICARE program for the duration of the
    moratorium provided under such directive.
    (b) Applicability Period.--The directive described in subsection
    (a), and the moratorium provided under such directive, shall not be
    altered or rescinded before May 7, 2019.
    (c) TRICARE Program Defined.--In this section, the term ``TRICARE
    program'' has the meaning given that term in section 1072 of title 10,
    United States Code.
    SEC. 108. <>  PREVENTION OF CERTAIN
    HEALTH CARE PROVIDERS FROM PROVIDING NON-
    DEPARTMENT HEALTH CARE SERVICES TO
    VETERANS.

    (a) In General. <> --On and
    after the date that is 1 year after the date of the enactment of this
    Act, the Secretary of Veterans Affairs shall deny or revoke the
    eligibility of a health care provider to provide non-Department health
    care services to veterans if the Secretary determines that the health
    care provider--
    (1) was removed from employment with the Department of
    Veterans Affairs due to conduct that violated a policy of the
    Department relating to the delivery of safe and appropriate
    health care; or
    (2) violated the requirements of a medical license of the
    health care provider that resulted in the loss of such medical
    license.

    (b) Permissive Action. <> --On and after the
    date that is 1 year after the date of the enactment of this Act, the
    Secretary may deny, revoke, or suspend the eligibility of a health care
    provider to provide non-Department health care services if the Secretary
    determines such action is necessary to immediately protect the health,
    safety, or welfare of veterans and the health care provider is under
    investigation by the medical licensing board of a State in which the
    health care provider is licensed or practices.

    (c) Suspension.--The Secretary shall suspend the eligibility of a
    health care provider to provide non-Department health care services to
    veterans if the health care provider is suspended from serving as a
    health care provider of the Department.
    (d) Comptroller General 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 Congress a report on the implementation by the
    Secretary of this section, including the following:
    (1) The aggregate number of health care providers denied or
    suspended under this section from participation in providing
    non-Department health care services.
    (2) <>  An evaluation of any impact on
    access to health care for patients or staffing shortages in
    programs of the Department providing non-Department health care
    services.

    [[Page 1417]]

    (3) An explanation of the coordination of the Department
    with the medical licensing boards of States in implementing this
    section, the amount of involvement of such boards in such
    implementation, and efforts by the Department to address any
    concerns raised by such boards with respect to such
    implementation.
    (4) <>  Such recommendations as
    the Comptroller General considers appropriate regarding
    harmonizing eligibility criteria between health care providers
    of the Department and health care providers eligible to provide
    non-Department health care services.

    (e) Non-Department Health Care Services Defined.--In this section,
    the term ``non-Department health care services'' means services--
    (1) provided under subchapter I of chapter 17 of title 38,
    United States Code, at non-Department facilities (as defined in
    section 1701 of such title);
    (2) provided under section 101 of the Veterans Access,
    Choice, and Accountability Act of 2014 (Public Law 113-146; 38
    U.S.C. 1701 note);
    (3) purchased through the Medical Community Care account of
    the Department; or
    (4) purchased with amounts deposited in the Veterans Choice
    Fund under section 802 of the Veterans Access, Choice, and
    Accountability Act of 2014.
    SEC. 109. REMEDIATION OF MEDICAL SERVICE LINES.

    (a) In General.--Subchapter I of chapter 17 is amended by inserting
    after section 1706 the following new section:
    ``Sec. 1706A. <>  Remediation of medical
    service lines

    ``(a) In
    General <> .--Not
    later than 30 days after determining under section 1703(e)(1) that a
    medical service line of the Department is providing hospital care,
    medical services, or extended care services that does not comply with
    the standards for quality established by the Secretary, the Secretary
    shall submit to Congress an assessment of the factors that led the
    Secretary to make such determination and a plan with specific actions,
    and the time to complete them, to be taken to comply with such standards
    for quality, including the following:
    ``(1) Increasing personnel or temporary personnel
    assistance, including mobile deployment teams.
    ``(2) Special hiring incentives, including the Education
    Debt Reduction Program under subchapter VII of chapter 76 of
    this title and recruitment, relocation, and retention
    incentives.
    ``(3) Utilizing direct hiring authority.
    ``(4) Providing improved training opportunities for staff.
    ``(5) Acquiring improved equipment.
    ``(6) Making structural modifications to the facility used
    by the medical service line.
    ``(7) Such other actions as the Secretary considers
    appropriate.

    ``(b) Responsible Parties.--In each assessment submitted under
    subsection (a) with respect to a medical service line, the Secretary
    shall identify the individuals at the Central Office of the Veterans
    Health Administration, the facility used by the medical service line,
    and the central office of the relevant Veterans

    [[Page 1418]]

    Integrated Service Network who are responsible for overseeing the
    progress of that medical service line in complying with the standards
    for quality established by the Secretary.
    ``(c) <> Interim Reports.--Not later than 180
    days after submitting an assessment under subsection (a) with respect to
    a medical service line, the Secretary shall submit to Congress a report
    on the progress of that medical service line in complying with the
    standards for quality established by the Secretary and any other
    measures the Secretary will take to assist the medical service line in
    complying with such standards for quality.

    ``(d) Annual Reports.--Not less frequently than once each year, the
    Secretary shall--
    ``(1) <>  submit to Congress an
    analysis of the remediation actions and costs of such actions
    taken with respect to each medical service line with respect to
    which the Secretary submitted an assessment and plan under
    paragraph (1) in the preceding year, including an update on the
    progress of each such medical service line in complying with the
    standards for quality and timeliness established by the
    Secretary and any other actions the Secretary is undertaking to
    assist the medical service line in complying with standards for
    quality as established by the Secretary; and
    ``(2) <>  publish such analysis on the
    internet website of the Department.''.

    (b) Clerical Amendment.--The table of sections at the beginning of
    such chapter <> is amended by inserting after
    the item relating to section 1706 the following new item:

    ``1706A. Remediation of medical service lines.''.

    CHAPTER 2--PAYING PROVIDERS AND IMPROVING COLLECTIONS

    SEC. 111. PROMPT PAYMENT TO PROVIDERS.

    (a) In General.--Subchapter I of chapter 17 is amended by inserting
    after section 1703C, as added by section 104 of this title, the
    following new section:
    ``Sec. 1703D. <>  Prompt payment standard

    ``(a) <>  In General.--(1) Notwithstanding any
    other provision of this title or of any other provision of law, the
    Secretary shall pay for hospital care, medical services, or extended
    care services furnished by health care entities or providers under this
    chapter within 45 calendar days upon receipt of a clean paper claim or
    30 calendar days upon receipt of a clean electronic claim.

    ``(2) <>  If a claim is denied, the Secretary
    shall, within 45 calendar days of denial for a paper claim and 30
    calendar days of denial for an electronic claim, notify the health care
    entity or provider of the reason for denying the claim and what, if any,
    additional information is required to process the claim.

    ``(3) Upon the receipt of the additional information, the Secretary
    shall ensure that the claim is paid, denied, or otherwise adjudicated
    within 30 calendar days from the receipt of the requested information.
    ``(4) This section shall only apply to payments made on an invoice
    basis and shall not apply to capitation or other forms of periodic
    payment to entities or providers.

    [[Page 1419]]

    ``(b) <>  Submittal of Claims by Health Care
    Entities and Providers.--A health care entity or provider that furnishes
    hospital care, a medical service, or an extended care service under this
    chapter shall submit to the Secretary a claim for payment for furnishing
    the hospital care, medical service, or extended care service not later
    than 180 days after the date on which the entity or provider furnished
    the hospital care, medical service, or extended care service.

    ``(c) <>  Fraudulent Claims.--(1) Sections
    3729 through 3733 of title 31 shall apply to fraudulent claims for
    payment submitted to the Secretary by a health care entity or provider
    under this chapter.

    ``(2) <>  Pursuant to regulations prescribed by
    the Secretary, the Secretary shall bar a health care entity or provider
    from furnishing hospital care, medical services, and extended care
    services under this chapter when the Secretary determines the entity or
    provider has submitted to the Secretary fraudulent health care claims
    for payment by the Secretary.

    ``(d) Overdue Claims.--(1) Any claim that has not been denied with
    notice, made pending with notice, or paid to the health care entity or
    provider by the Secretary shall be overdue if the notice or payment is
    not received by the entity provider within the time periods specified in
    subsection (a).
    ``(2)(A) If a claim is overdue under this subsection, the Secretary
    may, under the requirements established by subsection (a) and consistent
    with the provisions of chapter 39 of title 31 (commonly referred to as
    the `Prompt Payment Act'), require that interest be paid on clean
    claims.
    ``(B) <>  Interest paid under
    subparagraph (A) shall be computed at the rate of interest established
    by the Secretary of the Treasury under section 3902 of title 31 and
    published in the Federal Register.

    ``(3) <>  Not less frequently than
    annually, the Secretary shall submit to Congress a report on payment of
    overdue claims under this subsection, disaggregated by paper and
    electronic claims, that includes the following:
    ``(A) The amount paid in overdue claims described in this
    subsection, disaggregated by the amount of the overdue claim and
    the amount of interest paid on such overdue claim.
    ``(B) The number of such overdue claims and the average
    number of days late each claim was paid, disaggregated by
    facility of the Department and Veterans Integrated Service
    Network region.

    ``(e) Overpayment.--(1) The Secretary shall deduct the amount of any
    overpayment from payments due a health care entity or provider under
    this chapter.
    ``(2) <>  Deductions may not be made under this
    subsection unless the Secretary has made reasonable efforts to notify a
    health care entity or provider of the right to dispute the existence or
    amount of such indebtedness and the right to request a compromise of
    such indebtedness.

    ``(3) <>  The Secretary shall make a
    determination with respect to any such dispute or request prior to
    deducting any overpayment unless the time required to make such a
    determination before making any deductions would jeopardize the
    Secretary's ability to recover the full amount of such indebtedness.

    ``(f) Information and Documentation Required.--(1) The Secretary
    shall provide to all health care entities and providers

    [[Page 1420]]

    participating in a program to furnish hospital care, medical services,
    or extended care services under this chapter a list of information and
    documentation that is required to establish a clean claim under this
    section.
    ``(2) <>  The Secretary shall consult with
    entities in the health care industry, in the public and private sector,
    to determine the information and documentation to include in the list
    under paragraph (1).

    ``(3) <>  If the Secretary modifies
    the information and documentation included in the list under paragraph
    (1), the Secretary shall notify all health care entities and providers
    described in paragraph (1) not later than 30 days before such
    modifications take effect.

    ``(g) Processing of Claims.--(1) In processing a claim for
    compensation for hospital care, medical services, or extended care
    services furnished by a non-Department health care entity or provider
    under this chapter, the Secretary may act through--
    ``(A) a non-Department entity that is under contract or
    agreement for the program established under section 1703(a) of
    this title; or
    ``(B) a non-Department entity that specializes in such
    processing for other Federal agency health care systems.

    ``(2) <>  The Secretary shall seek to
    contract with a third party to conduct a review of claims described in
    paragraph (3) that includes--
    ``(A) <>  a feasibility assessment to
    determine the capacity of the Department to process such claims
    in a timely manner; and
    ``(B) <>  a cost benefit analysis comparing
    the capacity of the Department to a third party entity capable
    of processing such claims.

    ``(3) <>  The review required under paragraph
    (2) shall apply to claims for hospital care, medical services, or
    extended care services furnished under section 1703 of this Act, as
    amended by the Caring for Our Veterans Act of 2018, that are processed
    by the Department.

    ``(h) Report on Encounter Data System.--(1) Not later than 90 days
    after the date of the enactment of the Caring for Our Veterans Act of
    2018, the Secretary shall submit to the appropriate committees of
    Congress a report on the feasibility and advisability of adopting a
    funding mechanism similar to what is utilized by other Federal agencies
    to allow a contracted entity to act as a fiscal intermediary for the
    Federal Government to distribute, or pass through, Federal Government
    funds for certain non-underwritten hospital care, medical services, or
    extended care services.
    ``(2) The Secretary may coordinate with the Department of Defense,
    the Department of Health and Human Services, and the Department of the
    Treasury in developing the report required by paragraph (1).
    ``(i) Definitions.--In this section:
    ``(1) 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.
    ``(2) The term `clean electronic claim' means the
    transmission of data for purposes of payment of covered health
    care expenses that is submitted to the Secretary which contains
    substantially all of the required data elements necessary for

    [[Page 1421]]

    accurate adjudication, without obtaining additional information
    from the entity or provider that furnished the care or service,
    submitted in such format as prescribed by the Secretary in
    regulations for the purpose of paying claims for care or
    services.
    ``(3) The term `clean paper claim' means a paper claim for
    payment of covered health care expenses that is submitted to the
    Secretary which contains substantially all of the required data
    elements necessary for accurate adjudication, without obtaining
    additional information from the entity or provider that
    furnished the care or service, submitted in such format as
    prescribed by the Secretary in regulations for the purpose of
    paying claims for care or services.
    ``(4) The term `fraudulent claims' means the knowing
    misrepresentation of a material fact or facts by a health care
    entity or provider made to induce the Secretary to pay a claim
    that was not legally payable to that provider.
    ``(5) The term `health care entity or provider' includes any
    non-Department health care entity or provider, but does not
    include any Federal health care entity or provider.''.

    (b) Clerical Amendment.--The table of sections at the beginning of
    such chapter <>  is amended by inserting after
    the item relating to section 1703C, as added by section 104 of this
    title, the following new item:

    ``1703D. Prompt payment standard.''.

    SEC. 112. AUTHORITY TO PAY FOR AUTHORIZED CARE NOT SUBJECT TO AN
    AGREEMENT.

    (a) In General.--Subchapter IV of chapter 81 is amended by adding at
    the end the following new section:
    ``Sec. 8159. <>  Authority to pay for services
    authorized but not subject to an agreement

    ``(a) In General.--If, in the course of furnishing hospital care, a
    medical service, or an extended care service authorized by the Secretary
    and pursuant to a contract, agreement, or other arrangement with the
    Secretary, a provider who is not a party to the contract, agreement, or
    other arrangement furnishes hospital care, a medical service, or an
    extended care service that the Secretary considers necessary, the
    Secretary may compensate the provider for the cost of such care or
    service.
    ``(b) New Contracts and Agreements.--The Secretary shall take
    reasonable efforts to enter into a contract, agreement, or other
    arrangement with a provider described in subsection (a) to ensure that
    future care and services authorized by the Secretary and furnished by
    the provider are subject to such a contract, agreement, or other
    arrangement.''.
    (b) Clerical Amendment.--The table of sections at the beginning of
    such chapter <>  is amended by inserting after
    the item relating to section 8158 the following new item:

    ``8159. Authority to pay for services authorized but not subject to an
    agreement.''.

    SEC. 113. IMPROVEMENT OF AUTHORITY TO RECOVER THE COST OF SERVICES
    FURNISHED FOR NON-SERVICE-CONNECTED
    DISABILITIES.

    (a) Broadening Scope of Applicability.--Section 1729 is amended--
    (1) in subsection (a)--

    [[Page 1422]]

    (A) in paragraph (2)(A)--
    (i) by striking ``the veteran's'' and
    inserting ``the individual's''; and
    (ii) by striking ``the veteran'' and inserting
    ``the individual''; and
    (B) in paragraph (3)--
    (i) in the matter preceding subparagraph (A),
    by striking ``the veteran'' and inserting ``the
    individual''; and
    (ii) in subparagraph (A), by striking ``the
    veteran's'' and inserting ``the individual's'';
    (2) in subsection (b)--
    (A) in paragraph (1)--
    (i) by striking ``the veteran'' and inserting
    ``the individual''; and
    (ii) by striking ``the veteran's'' and
    inserting ``the individual's''; and
    (B) in paragraph (2)--
    (i) in subparagraph (A)--
    (I) by striking ``the veteran'' and
    inserting ``the individual''; and
    (II) by striking ``the veteran's''
    and inserting ``the individual's''; and
    (ii) in subparagraph (B)--
    (I) in clause (i), by striking ``the
    veteran'' and inserting ``the
    individual''; and
    (II) in clause (ii)--
    (aa) by striking ``the
    veteran'' and inserting ``the
    individual''; and
    (bb) by striking ``the
    veteran's'' each place it
    appears and inserting ``the
    individual's'';
    (3) in subsection (e), by striking ``A veteran'' and
    inserting ``An individual''; and
    (4) in subsection (h)--
    (A) in paragraph (1)--
    (i) in the matter preceding subparagraph (A),
    by striking ``a veteran'' and inserting ``an
    individual'';
    (ii) in subparagraph (A), by striking ``the
    veteran'' and inserting ``the individual''; and
    (iii) in subparagraph (B), by striking ``the
    veteran'' and inserting ``the individual''; and
    (B) in paragraph (2)--
    (i) by striking ``A veteran'' and inserting
    ``An individual'';
    (ii) by striking ``a veteran'' and inserting
    ``an individual''; and
    (iii) by striking ``the veteran'' and
    inserting ``the individual''.

    (b) Modification of Authority.--Subsection (a)(1) of such section is
    amended by striking ``(1) Subject'' and all that follows through the
    period and inserting the following: ``(1) Subject to the provisions of
    this section, in any case in which the United States is required by law
    to furnish or pay for care or services under this chapter for a non-
    service-connected disability described in paragraph (2) of this
    subsection, the United States has the right to recover or collect from a
    third party the reasonable charges of care or services so furnished or
    paid for to the extent that

    [[Page 1423]]

    the recipient or provider of the care or services would be eligible to
    receive payment for such care or services from such third party if the
    care or services had not been furnished or paid for by a department or
    agency of the United States.''.
    (c) Modification of Eligible Individuals.--Subparagraph (D) of
    subsection (a)(2) of such section is amended to read as follows:
    ``(D) that is incurred by an individual who is entitled to
    care (or payment of the expenses of care) under a health-plan
    contract.''.
    SEC. 114. <>  PROCESSING OF CLAIMS FOR
    REIMBURSEMENT THROUGH ELECTRONIC
    INTERFACE.

    The Secretary of Veterans Affairs may enter into an agreement with a
    third-party entity to process, through the use of an electronic
    interface, claims for reimbursement for health care provided under the
    laws administered by the Secretary.

    CHAPTER 3--EDUCATION AND TRAINING PROGRAMS

    SEC. 121. <>  EDUCATION PROGRAM ON HEALTH
    CARE OPTIONS.

    (a) In General.--The Secretary of Veterans Affairs shall develop and
    administer an education program that teaches veterans about their health
    care options through the Department of Veterans Affairs.
    (b) Elements.--The program under subsection (a) shall--
    (1) teach veterans about--
    (A) eligibility criteria for care from the
    Department set forth under sections 1703, as amended by
    section 101 of this title, and 1710 of title 38, United
    States Code;
    (B) priority groups for enrollment in the system of
    annual patient enrollment under section 1705(a) of such
    title;
    (C) the copayments and other financial obligations,
    if any, required of certain individuals for certain
    services; and
    (D) how to utilize the access standards and
    standards for quality established under sections 1703B
    and 1703C of such title;
    (2) teach veterans about the interaction between health
    insurance (including private insurance, Medicare, Medicaid, the
    TRICARE program, the Indian Health Service, tribal health
    programs, and other forms of insurance) and health care from the
    Department; and
    (3) provide veterans with information on what to do when
    they have a complaint about health care received from the
    Department (whether about the provider, the Department, or any
    other type of complaint).

    (c) Accessibility.--In developing the education program under this
    section, the Secretary shall ensure that materials under such program
    are accessible--
    (1) to veterans who may not have access to the internet; and
    (2) <>  to veterans in a manner that
    complies with the Americans with Disabilities Act of 1990 (42
    U.S.C. 12101 et seq.).

    (d) Annual Evaluation and Report.--
    (1) Evaluation.--The Secretary shall develop a method to
    evaluate the effectiveness of the education program under

    [[Page 1424]]

    this section and evaluate the program using the method not less
    frequently than once each year.
    (2) Report.--Not less frequently than once each year, the
    Secretary shall submit to Congress a report on the findings of
    the Secretary with respect to the most recent evaluation
    conducted by the Secretary under paragraph (1).

    (e) Definitions.--In this section:
    (1) Medicaid.--The term ``Medicaid'' means the Medicaid
    program under title XIX of the Social Security Act (42 U.S.C.
    1396 et seq.).
    (2) Medicare.--The term ``Medicare'' means the Medicare
    program under title XVIII of such Act (42 U.S.C. 1395 et seq.).
    (3) Tricare program.--The term ``TRICARE program'' has the
    meaning given that term in section 1072 of title 10, United
    States Code.
    SEC. 122. <>  TRAINING PROGRAM FOR
    ADMINISTRATION OF NON-DEPARTMENT OF
    VETERANS AFFAIRS HEALTH CARE.

    (a) Establishment of Program.--The Secretary of Veterans Affairs
    shall develop and implement a training program to train employees and
    contractors of the Department of Veterans Affairs on how to administer
    non-Department health care programs, including the following:
    (1) Reimbursement for non-Department emergency room care.
    (2) The Veterans Community Care Program under section 1703
    of such title, as amended by section 101.
    (3) Management of prescriptions pursuant to improvements
    under section 131.

    (b) Annual Evaluation and Report.--The Secretary shall--
    (1) develop a method to evaluate the effectiveness of the
    training program developed and implemented under subsection (a);
    (2) evaluate such program not less frequently than once each
    year; and
    (3) not less frequently than once each year, submit to
    Congress the findings of the Secretary with respect to the most
    recent evaluation carried out under paragraph (2).
    SEC. 123. <>  CONTINUING MEDICAL
    EDUCATION FOR NON-DEPARTMENT MEDICAL
    PROFESSIONALS.

    (a) Establishment of Program.--
    (1) In general.--The Secretary of Veterans Affairs shall
    establish a program to provide continuing medical education
    material to non-Department medical professionals.
    (2) Education provided.--The program established under
    paragraph (1) shall include education on the following:
    (A) Identifying and treating common mental and
    physical conditions of veterans and family members of
    veterans.
    (B) The health care system of the Department of
    Veterans Affairs.
    (C) Such other matters as the Secretary considers
    appropriate.

    (b) Material Provided.--The continuing medical education material
    provided to non-Department medical professionals under the program
    established under subsection (a) shall be the same material provided to
    medical professionals of the Department to

    [[Page 1425]]

    ensure that all medical professionals treating veterans have access to
    the same materials, which supports core competencies throughout the
    community.
    (c) Administration of Program.--
    (1) <>  In general.--The Secretary shall
    administer the program established under subsection (a) to
    participating non-Department medical professionals through an
    internet website of the Department of Veterans Affairs.
    (2) Curriculum and credit provided.--The Secretary shall
    determine the curriculum of the program and the number of hours
    of credit to provide to participating non-Department medical
    professionals for continuing medical education.
    (3) Accreditation.--The Secretary shall ensure that the
    program is accredited in as many States as practicable.
    (4) Consistency with existing rules.--The Secretary shall
    ensure that the program is consistent with the rules and
    regulations of the following:
    (A) The medical licensing agency of each State in
    which the program is accredited.
    (B) Such medical credentialing organizations as the
    Secretary considers appropriate.
    (5) User cost.--The Secretary shall carry out the program at
    no cost to participating non-Department medical professionals.
    (6) Monitoring, evaluation, and report.--The Secretary shall
    monitor the utilization of the program established under
    subsection (a), evaluate its effectiveness, and report to
    Congress on utilization and effectiveness not less frequently
    than once each year.

    (d) Non-Department Medical Professional Defined.--In this section,
    the term ``non-Department medical professional'' means any individual
    who is licensed by an appropriate medical authority in the United States
    and is in good standing, is not an employee of the Department of
    Veterans Affairs, and provides care to veterans or family members of
    veterans under the laws administered by the Secretary of Veterans
    Affairs.

    CHAPTER 4--OTHER MATTERS RELATING TO NON-DEPARTMENT OF VETERANS AFFAIRS
    PROVIDERS

    SEC. 131. <>  ESTABLISHMENT OF PROCESSES
    TO ENSURE SAFE OPIOID PRESCRIBING
    PRACTICES BY NON-DEPARTMENT OF VETERANS
    AFFAIRS HEALTH CARE PROVIDERS.

    (a) <> Receipt and Review of Guidelines.--The
    Secretary of Veterans Affairs shall ensure that all covered health care
    providers are provided a copy of and certify that they have reviewed the
    evidence-based guidelines for prescribing opioids set forth by the
    Opioid Safety Initiative of the Department of Veterans Affairs.

    (b) Inclusion of Medical History and Current Medications.--The
    Secretary shall implement a process to ensure that, if care of a veteran
    by a covered health care provider is authorized under the laws
    administered by the Secretary, the document authorizing such care
    includes the available and relevant medical history of the veteran and a
    list of all medications prescribed to the veteran as known by the
    Department.
    (c) Submittal of Medical Records and Prescriptions.--

    [[Page 1426]]

    (1) In general.--The Secretary shall, consistent with
    section 1703(a)(2)(A), as amended by section 101 of this title,
    and section 1703A(e)(2)(F), as added by section 102 of this
    title, require each covered health care provider to submit
    medical records of any care or services furnished, including
    records of any prescriptions for opioids, to the Department in
    the timeframe and format specified by the Secretary.
    (2) Responsibility of department for recording and
    monitoring.--In carrying out paragraph (1) and upon the receipt
    by the Department of the medical records described in paragraph
    (1), the Secretary shall--
    (A) ensure the Department is responsible for the
    recording of the prescription in the electronic health
    record of the veteran; and
    (B) enable other monitoring of the prescription as
    outlined in the Opioid Safety Initiative of the
    Department.
    (3) Report.--Not less frequently than annually, 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 evaluating the compliance of covered
    health care providers with the requirements under this section.

    (d) Use of Opioid Safety Initiative Guidelines.--
    (1) <>  In general.--If the Secretary
    determines that the opioid prescribing practices of a covered
    health care provider, when treating covered veterans, satisfy a
    condition described in paragraph (3), the Secretary shall take
    such action as the Secretary considers appropriate to ensure the
    safety of all veterans receiving care from that health care
    provider, including removing or directing the removal of any
    such health care provider from provider networks or otherwise
    refusing to authorize care of veterans by such health care
    provider in any program authorized under the laws administered
    by the Secretary.
    (2) Inclusion in contracts.--The Secretary shall ensure that
    any contracts, agreements, or other arrangements entered into by
    the Secretary with third parties involved in administering
    programs that provide care in the community to veterans under
    the laws administered by the Secretary specifically grant the
    authority set forth in paragraph (1) to such third parties and
    to the Secretary, as the case may be.
    (3) Conditions for exclusion or limitation.--The Secretary
    shall take such action as is considered appropriate under
    paragraph (1) when the opioid prescribing practices of a covered
    health care provider when treating covered veterans--
    (A) conflict with or are otherwise inconsistent with
    the standards of appropriate and safe care;
    (B) violate the requirements of a medical license of
    the health care provider; or
    (C) may place at risk the veterans receiving health
    care from the provider.

    (e) Covered Health Care Provider Defined.--In this section, the term
    ``covered health care provider'' means a non-Department of Veterans
    Affairs health care provider who provides health care to veterans under
    the laws administered by the Secretary of Veterans Affairs, but does not
    include a health care provider employed by another agency of the Federal
    Government.

    [[Page 1427]]

    SEC. 132. IMPROVING INFORMATION SHARING WITH COMMUNITY PROVIDERS.

    Section 7332(b)(2) is amended by striking subparagraph (H) and
    inserting the following new subparagraphs:
    ``(H)(i) To a non-Department entity (including private
    entities and other Federal agencies) for purposes of providing
    health care, including hospital care, medical services, and
    extended care services, to patients or performing other health
    care-related activities or functions.
    ``(ii) An entity to which a record is disclosed under this
    subparagraph may not disclose or use such record for a purpose
    other than that for which the disclosure was made or as
    permitted by law.
    ``(I) To a third party in order to recover or collect
    reasonable charges for care furnished to, or paid on behalf of,
    a patient in connection with a non-service connected disability
    as permitted by section 1729 of this title or for a condition
    for which recovery is authorized or with respect to which the
    United States is deemed to be a third party beneficiary under
    the Act entitled `An Act to provide for the recovery from
    tortiously liable third persons of the cost of hospital and
    medical care and treatment furnished by the United States'
    (Public Law 87-693; 42 U.S.C. 2651 et seq.; commonly known as
    the `Federal Medical Care Recovery Act').''.
    SEC. 133. <>  COMPETENCY STANDARDS FOR
    NON-DEPARTMENT OF VETERANS AFFAIRS HEALTH
    CARE PROVIDERS.

    (a) Establishment of Standards and Requirements.--The Secretary of
    Veterans Affairs shall establish standards and requirements for the
    provision of care by non-Department of Veterans Affairs health care
    providers in clinical areas for which the Department of Veterans Affairs
    has special expertise, including post-traumatic stress disorder,
    military sexual trauma-related conditions, and traumatic brain injuries.
    (b) Condition for Eligibility To Furnish Care.--(1) Each non-
    Department of Veterans Affairs health care provider shall, to the extent
    practicable as determined by the Secretary or otherwise provided for in
    paragraph (2), meet the standards and requirements established pursuant
    to subsection (a) before furnishing care pursuant to a contract,
    agreement, or other arrangement with the Department of Veterans Affairs.
    Non-Department of Veterans Affairs health care providers furnishing care
    pursuant to a contract, agreement, or other arrangement shall, to the
    extent practicable as determined by the Secretary, fulfill training
    requirements established by the Secretary on how to deliver evidence-
    based treatments in the clinical areas for which the Department of
    Veterans Affairs has special expertise.
    (2) <>  Each non-Department of Veterans
    Affairs health care provider who enters into a contract, agreement, or
    other arrangement after the effective date identified in subsection (c)
    shall, to the extent practicable, meet the standards and requirements
    established pursuant to subsection (a) within 6 months of the contract,
    agreement, or other arrangement taking effect.

    (c) Effective Date.--This section shall take effect on the day that
    is 1 year after the date of the enactment of this Act.

    [[Page 1428]]

    SEC. 134. DEPARTMENT OF VETERANS AFFAIRS PARTICIPATION IN NATIONAL
    NETWORK OF STATE-BASED PRESCRIPTION DRUG
    MONITORING PROGRAMS.

    (a) In General.--Chapter 17 is amended by inserting after section
    1730A the following new section:
    ``Sec. 1730B. <>  Access to State
    prescription drug monitoring programs

    ``(a) Access to Programs.--(1) Any licensed health care provider or
    delegate of such a provider shall be considered an authorized recipient
    or user for the purpose of querying and receiving data from the national
    network of State-based prescription drug monitoring programs to support
    the safe and effective prescribing of controlled substances to covered
    patients.
    ``(2) Under the authority granted by paragraph (1)--
    ``(A) licensed health care providers or delegates of such
    providers shall query such network in accordance with applicable
    regulations and policies of the Veterans Health Administration;
    and
    ``(B) notwithstanding any general or specific provision of
    law, rule, or regulation of a State, no State may restrict the
    access of licensed health care providers or delegates of such
    providers from accessing that State's prescription drug
    monitoring programs.

    ``(3) No State shall deny or revoke the license, registration, or
    certification of a licensed health care provider or delegate who
    otherwise meets that State's qualifications for holding the license,
    registration, or certification on the basis that the licensed health
    care provider or delegate queried or received data, or attempted to
    query or receive data, from the national network of State-based
    prescription drug monitoring programs under this section.
    ``(b) Covered Patients.--For purposes of this section, a covered
    patient is a patient who--
    ``(1) receives a prescription for a controlled substance;
    and
    ``(2) is not receiving palliative care or enrolled in
    hospice care.

    ``(c) Definitions.--In this section:
    ``(1) The term `controlled substance' has the meaning given
    such term in section 102(6) of the Controlled Substances Act (21
    U.S.C. 802(6)).
    ``(2) The term `delegate' means a person or automated system
    accessing the national network of State-based prescription
    monitoring programs at the direction or under the supervision of
    a licensed health care provider.
    ``(3) The term `licensed health care provider' means a
    health care provider employed by the Department who is licensed,
    certified, or registered within any State to fill or prescribe
    medications within the scope of his or her practice as a
    Department employee.
    ``(4) The term `national network of State-based prescription
    monitoring programs' means an interconnected nation-wide system
    that facilitates the transfer to State prescription drug
    monitoring program data across State lines.
    ``(5) The term `State' means a State, as defined in section
    101(20) of this title, or a political subdivision of a State.''.

    [[Page 1429]]

    (b) Clerical Amendment.--The table of sections at the beginning of
    chapter 17 of such title <> is amended by
    inserting after the item relating to section 1730A the following new
    item:

    ``1730B. Access to State prescription drug monitoring programs.''.

    CHAPTER 5--OTHER NON-DEPARTMENT HEALTH CARE MATTERS

    SEC. 141. <>
    PLANS FOR USE OF SUPPLEMENTAL
    APPROPRIATIONS REQUIRED.

    Whenever the Secretary submits to Congress a request for
    supplemental appropriations or any other appropriation outside the
    standard budget process to address a budgetary issue affecting the
    Department of Veterans Affairs, the Secretary shall, not later than 45
    days before the date on which such budgetary issue would start affecting
    a program or service, submit to Congress a justification for the
    request, including a plan that details how the Secretary intends to use
    the requested appropriation and how long the requested appropriation is
    expected to meet the needs of the Department and certification that the
    request was made using an updated and sound actuarial analysis.
    SEC. 142. <>  VETERANS CHOICE FUND
    FLEXIBILITY.

    Section 802 of the Veterans Access, Choice, and Accountability Act
    of 2014 (Public Law 113-146; 38 U.S.C. 1701 note) is amended--
    (1) in subsection (c)--
    (A) in paragraph (1), by striking ``by paragraph
    (3)'' and inserting ``in paragraphs (3) and (4)''; and
    (B) by adding at the end the following new
    paragraph:
    ``(4) <>  Permanent authority for
    other uses.--Beginning on March 1, 2019, amounts remaining in
    the Veterans Choice Fund may be used to furnish hospital care,
    medical services, and extended care services to individuals
    pursuant to chapter 17 of title 38, United States Code, at non-
    Department facilities, including pursuant to non-Department
    provider programs other than the program established by section
    101. Such amounts shall be available in addition to amounts
    available in other appropriations accounts for such purposes.'';
    and
    (2) in subsection (d)(1), by striking ``to subsection
    (c)(3)'' and inserting ``to paragraphs (3) and (4) of subsection
    (c)''.
    SEC. 143. <>  SUNSET OF VETERANS CHOICE
    PROGRAM.

    Subsection (p) of section 101 of the Veterans Access, Choice, and
    Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 1701 note) is
    amended to read as follows:
    ``(p) Authority To Furnish Care and Services.--The Secretary may not
    use the authority under this section to furnish care and services after
    the date that is 1 year after the date of the enactment of the Caring
    for Our Veterans Act of 2018.''.
    SEC. 144. CONFORMING AMENDMENTS.

    (a) In General.--
    (1) Title 38.--Title 38, United States Code, is amended--
    (A) in section 1712(a)--
    (i) in paragraph (3), by striking ``under
    clause (1), (2), or (5) of section 1703(a) of this
    title'' and inserting ``or entered an agreement'';
    and

    [[Page 1430]]

    (ii) in paragraph (4)(A), by striking ``under
    the provisions of this subsection and section 1703
    of this title'';
    (B) in section 1712A(e)(1)--
    (i) by inserting ``or agreements'' after
    ``contracts''; and
    (ii) by striking ``(under sections 1703(a)(2)
    and 1710(a)(1)(B) of this title)''; and
    (C) in section 2303(a)(2)(B)(i), by striking ``with
    section 1703'' and inserting ``with sections 1703A,
    8111, and 8153''.
    (2) Social security act.--Section 1866(a)(1)(L) of the
    Social Security Act (42 U.S.C. 1395cc(a)(1)(L)) is amended by
    striking ``under section 603'' and inserting ``under chapter
    17''.
    (3) Veterans' benefits improvements act of 1994.--Section
    104(a)(4)(A) of the Veterans' Benefits Improvements Act of 1994
    (Public Law 103-446; 38 U.S.C. 1117 note) is amended by striking
    ``in section 1703'' and inserting ``in sections 1703A, 8111, and
    8153''.

    (b) <>  Effective Date.--The amendments
    made by subsection (a) shall take effect on the date described in
    section 101(b).

    Subtitle B--Improving Department of Veterans Affairs Health Care
    Delivery

    SEC. 151. LICENSURE OF HEALTH CARE PROFESSIONALS OF THE DEPARTMENT
    OF VETERANS AFFAIRS PROVIDING TREATMENT
    VIA TELEMEDICINE.

    (a) In General.--Chapter 17 is amended by inserting after section
    1730B, as added by section 134, the following new section:
    ``Sec. 1730C. <>  Licensure of health care
    professionals providing treatment via
    telemedicine

    ``(a) In General.--Notwithstanding any provision of law regarding
    the licensure of health care professionals, a covered health care
    professional may practice the health care profession of the health care
    professional at any location in any State, regardless of where the
    covered health care professional or the patient is located, if the
    covered health care professional is using telemedicine to provide
    treatment to an individual under this chapter.
    ``(b) <>  Covered Health Care Professionals.--For
    purposes of this section, a covered health care professional is any
    health care professional who--
    ``(1) is an employee of the Department appointed under the
    authority under section 7306, 7401, 7405, 7406, or 7408 of this
    title or title 5;
    ``(2) is authorized by the Secretary to provide health care
    under this chapter;
    ``(3) is required to adhere to all standards for quality
    relating to the provision of medicine in accordance with
    applicable policies of the Department; and
    ``(4) has an active, current, full, and unrestricted
    license, registration, or certification in a State to practice
    the health care profession of the health care professional.

    ``(c) Property of Federal Government.--Subsection (a) shall apply to
    a covered health care professional providing treatment

    [[Page 1431]]

    to a patient regardless of whether the covered health care professional
    or patient is located in a facility owned by the Federal Government
    during such treatment.
    ``(d) Relation to State Law.--(1) The provisions of this section
    shall supersede any provisions of the law of any State to the extent
    that such provision of State law are inconsistent with this section.
    ``(2) No State shall deny or revoke the license, registration, or
    certification of a covered health care professional who otherwise meets
    the qualifications of the State for holding the license, registration,
    or certification on the basis that the covered health care professional
    has engaged or intends to engage in activity covered by subsection (a).
    ``(e) Rule of Construction.--Nothing in this section may be
    construed to remove, limit, or otherwise affect any obligation of a
    covered health care professional under the Controlled Substances Act (21
    U.S.C. 801 et seq.).
    ``(f) State Defined.--In this section, the term `State' means a
    State, as defined in section 101(20) of this title, or a political
    subdivision of a State.''.
    (b) Clerical Amendment.--The table of sections at the beginning of
    chapter 17 of such title <> is amended by
    inserting after the item relating to section 1730B, as added by section
    134, the following new item:

    ``1730C. Licensure of health care professionals providing treatment via
    telemedicine.''.

    (c) Report on Telemedicine.--
    (1) <>  In general.--Not later than 1
    year after the earlier of the date on which services provided
    under section 1730B of title 38, United States Code, as added by
    subsection (a), first occur or regulations are promulgated to
    carry out such section, 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 effectiveness of the use of
    telemedicine by the Department of Veterans Affairs.
    (2) <>  Elements.--The report required by
    paragraph (1) shall include an assessment of the following:
    (A) The satisfaction of veterans with telemedicine
    furnished by the Department.
    (B) The satisfaction of health care providers in
    providing telemedicine furnished by the Department.
    (C) The effect of telemedicine furnished by the
    Department on the following:
    (i) The ability of veterans to access health
    care, whether from the Department or from non-
    Department health care providers.
    (ii) The frequency of use by veterans of
    telemedicine.
    (iii) The productivity of health care
    providers.
    (iv) Wait times for an appointment for the
    receipt of health care from the Department.
    (v) The use by veterans of in-person services
    at Department facilities and non-Department
    facilities.
    (D) <>  The types of
    appointments for the receipt of telemedicine furnished
    by the Department that were provided

    [[Page 1432]]

    during the 1-year period preceding the submittal of the
    report.
    (E) The number of appointments for the receipt of
    telemedicine furnished by the Department that were
    requested during such period, disaggregated by medical
    facility.
    (F) Savings by the Department, if any, including
    travel costs, from furnishing health care through the
    use of telemedicine during such period.
    SEC. 152. AUTHORITY FOR DEPARTMENT OF VETERANS AFFAIRS CENTER FOR
    INNOVATION FOR CARE AND PAYMENT.

    (a) In General.--Subchapter I of chapter 17, as amended by this
    title, is further amended by inserting after section 1703D, as added by
    section 111, the following new section:
    ``Sec. 1703E. <>  Center for Innovation for
    Care and Payment

    ``(a) In General.--(1) There is established within the Department a
    Center for Innovation for Care and Payment (in this section referred to
    as the `Center').
    ``(2) The Secretary, acting through the Center, may carry out such
    pilot programs the Secretary determines to be appropriate to develop
    innovative approaches to testing payment and service delivery models in
    order to reduce expenditures while preserving or enhancing the quality
    of care furnished by the Department.
    ``(3) The Secretary, acting through the Center, shall test payment
    and service delivery models to determine whether such models--
    ``(A) improve access to, and quality, timeliness, and
    patient satisfaction of care and services; and
    ``(B) create cost savings for the Department.

    ``(4)(A) The Secretary shall test a model in a location where the
    Secretary determines that the model will addresses deficits in care
    (including poor clinical outcomes or potentially avoidable expenditures)
    for a defined population.
    ``(B) The Secretary shall focus on models the Secretary expects to
    reduce program costs while preserving or enhancing the quality of care
    received by individuals receiving benefits under this chapter.
    ``(C) The models selected may include those described in section
    1115A(b)(2)(B) of the Social Security Act (42 U.S.C. 1315a(b)(2)(B)).
    ``(5) In selecting a model for testing, the Secretary may consider,
    in addition to other factors identified in this subsection, the
    following factors:
    ``(A) Whether the model includes a regular process for
    monitoring and updating patient care plans in a manner that is
    consistent with the needs and preferences of individuals
    receiving benefits under this chapter.
    ``(B) Whether the model places the individual receiving
    benefits under this chapter (including family members and other
    caregivers of such individual) at the center of the care team of
    such individual.
    ``(C) Whether the model uses technology or new systems to
    coordinate care over time and across settings.
    ``(D) Whether the model demonstrates effective linkage with
    other public sector payers, private sector payers, or statewide
    payment models.

    [[Page 1433]]

    ``(6)(A) Models tested under this section may not be designed in
    such a way that would allow the United States to recover or collect
    reasonable charges from a Federal health care program for care or
    services furnished by the Secretary to a veteran under pilot programs
    carried out under this section.
    ``(B) <>  In this paragraph, the term `Federal
    health care program' means--
    ``(i) an insurance program described in section 1811 of the
    Social Security Act (42 U.S.C. 1395c) or established by section
    1831 of such Act (42 U.S.C. 1395j);
    ``(ii) a State plan for medical assistance approved under
    title XIX of such Act (42 U.S.C. 1396 et seq.); or
    ``(iii) a TRICARE program operated under sections 1075,
    1075a, 1076, 1076a, 1076c, 1076d, 1076e, or 1076f of title 10.

    ``(b) Duration.--Each pilot program carried out by the Secretary
    under this section shall terminate no later than 5 years after the date
    of the commencement of the pilot program.
    ``(c) Location.--The Secretary shall ensure that each pilot program
    carried out under this section occurs in an area or areas appropriate
    for the intended purposes of the pilot program. To the extent
    practicable, the Secretary shall ensure that the pilot programs are
    located in geographically diverse areas of the United States.
    ``(d) Budget.--Funding for each pilot program carried out by the
    Secretary under this section shall come from appropriations--
    ``(1) provided in advance in appropriations acts for the
    Veterans Health Administration; and
    ``(2) provided for information technology systems.

    ``(e) Notice.--The Secretary shall--
    ``(1) <>  publish
    information about each pilot program under this section in the
    Federal Register; and
    ``(2) take reasonable actions to provide direct notice to
    veterans eligible to participate in such pilot programs.

    ``(f) Waiver of Authorities.--(1) Subject to reporting under
    paragraph (2) and approval under paragraph (3), in implementing a pilot
    program under this section, the Secretary may waive such requirements in
    subchapters I, II, and III of this chapter as the Secretary determines
    necessary solely for the purposes of carrying out this section with
    respect to testing models described in subsection (a).
    ``(2) <>  Before waiving any authority under
    paragraph (1), the Secretary shall submit to the Speaker of the House of
    Representatives, the minority leader of the House of Representatives,
    the majority leader of the Senate, the minority leader of the Senate,
    and each standing committee with jurisdiction under the rules of the
    Senate and of the House of Representatives to report a bill to amend the
    provision or provisions of law that would be waived by the Department, a
    report on a request for waiver that describes in detail the following:
    ``(A) The specific authorities to be waived under the pilot
    program.
    ``(B) The standard or standards to be used in the pilot
    program in lieu of the waived authorities.
    ``(C) The reasons for such waiver or waivers.
    ``(D) A description of the metric or metrics the Secretary
    will use to determine the effect of the waiver or waivers upon

    [[Page 1434]]

    the access to and quality, timeliness, or patient satisfaction
    of care and services furnished through the pilot program.
    ``(E) The anticipated cost savings, if any, of the pilot
    program.
    ``(F) The schedule for interim reports on the pilot program
    describing the results of the pilot program so far and the
    feasibility and advisability of continuing the pilot program.
    ``(G) The schedule for the termination of the pilot program
    and the submission of a final report on the pilot program
    describing the result of the pilot program and the feasibility
    and advisability of making the pilot program permanent.
    ``(H) <>  The estimated budget of
    the pilot program.

    ``(3)(A) <>  Upon receipt of a report submitted
    under paragraph (2), each House of Congress shall provide copies of the
    report to the chairman and ranking member of each standing committee
    with jurisdiction under the rules of the House of Representatives or the
    Senate to report a bill to amend the provision or provisions of law that
    would be waived by the Department under this subsection.

    ``(B) The waiver requested by the Secretary under paragraph (2)
    shall be considered approved under this paragraph if there is enacted
    into law a joint resolution approving such request in its entirety.
    ``(C) <>  For purposes of this paragraph, the
    term `joint resolution' means only a joint resolution which is
    introduced within the period of five legislative days beginning on the
    date on which the Secretary transmits the report to the Congress under
    such paragraph (2), and--
    ``(i) which does not have a preamble; and
    ``(ii) the matter after the resolving clause of which is as
    follows: `that Congress approves the request for a waiver under
    section 1703E(f) of title 38, United States Code, as submitted
    by the Secretary on ___', the blank space being filled with the
    appropriate date.

    ``(D)(i) <>  Any committee of the House of
    Representatives to which a joint resolution is referred shall report it
    to the House without amendment not later than 15 legislative days after
    the date of introduction thereof. If a committee fails to report the
    joint resolution within that period, the committee shall be discharged
    from further consideration of the joint resolution.

    ``(ii) It shall be in order at any time after the third legislative
    day after each committee authorized to consider a joint resolution has
    reported or has been discharged from consideration of a joint
    resolution, to move to proceed to consider the joint resolution in the
    House. All points of order against the motion are waived. Such a motion
    shall not be in order after the House has disposed of a motion to
    proceed on a joint resolution addressing a particular submission. The
    previous question shall be considered as ordered on the motion to its
    adoption without intervening motion. The motion shall not be debatable.
    A motion to reconsider the vote by which the motion is disposed of shall
    not be in order.
    ``(iii) The joint resolution shall be considered as read. All points
    of order against the joint resolution and against its consideration are
    waived. The previous question shall be considered as ordered on the
    joint resolution to its passage without intervening motion except two
    hours of debate equally divided and controlled by the

    [[Page 1435]]

    proponent and an opponent. A motion to reconsider the vote on passage of
    the joint resolution shall not be in order.
    ``(E)(i) A joint resolution introduced in the Senate shall be
    referred to the Committee on Veterans' Affairs.
    ``(ii) <>  Any committee of the Senate to which a
    joint resolution is referred shall report it to the Senate without
    amendment not later than 15 session days after the date of introduction
    of a joint resolution described in paragraph (C). If a committee fails
    to report the joint resolution within that period, the committee shall
    be discharged from further consideration of the joint resolution and the
    joint resolution shall be placed on the calendar.

    ``(iii)(I) Notwithstanding Rule XXII of the Standing Rules of the
    Senate, it is in order at any time after the third session day on which
    the Committee on Veterans' Affairs has reported or has been discharged
    from consideration of a joint resolution described in paragraph (C)
    (even though a previous motion to the same effect has been disagreed to)
    to move to proceed to the consideration of the joint resolution, and all
    points of order against the joint resolution (and against consideration
    of the joint resolution) are waived. The motion to proceed is not
    debatable. The motion is not subject to a motion to postpone. A motion
    to reconsider the vote by which the motion is agreed to or disagreed to
    shall not be in order. If a motion to proceed to the consideration of
    the resolution is agreed to, the joint resolution shall remain the
    unfinished business until disposed of.
    ``(II) Consideration of the joint resolution, and on all debatable
    motions and appeals in connection therewith, shall be limited to not
    more than two hours, which shall be divided equally between the majority
    and minority leaders or their designees. A motion further to limit
    debate is in order and not debatable. An amendment to, or a motion to
    postpone, or a motion to proceed to the consideration of other business,
    or a motion to recommit the joint resolution is not in order.
    ``(III) If the Senate has voted to proceed to a joint resolution,
    the vote on passage of the joint resolution shall occur immediately
    following the conclusion of consideration of the joint resolution, and a
    single quorum call at the conclusion of the debate if requested in
    accordance with the rules of the Senate.
    ``(IV) Appeals from the decisions of the Chair relating to the
    application of the rules of the Senate, as the case may be, to the
    procedure relating to a joint resolution shall be decided without
    debate.
    ``(F) A joint resolution considered pursuant to this paragraph shall
    not be subject to amendment in either the House of Representatives or
    the Senate.
    ``(G)(i) <>  If, before the
    passage by one House of the joint resolution of that House, that House
    receives the joint resolution from the other House, then the following
    procedures shall apply:
    ``(I) The joint resolution of the other House shall not be
    referred to a committee.
    ``(II) With respect to the joint resolution of the House
    receiving the joint resolution--
    ``(aa) the procedure in that House shall be
    the same as if no joint resolution had been
    received from the other House; but
    ``(bb) the vote on passage shall be on the
    joint resolution of the other House.

    [[Page 1436]]

    ``(ii) If the Senate fails to introduce or consider a joint
    resolution under this paragraph, the joint resolution of the
    House shall be entitled to expedited floor procedures under this
    subparagraph.
    ``(iii) If, following passage of the joint resolution in the
    Senate, the Senate then receives the companion measure from the
    House of Representatives, the companion measure shall not be
    debatable.

    ``(H) This subparagraph is enacted by Congress--
    ``(i) as an exercise of the rulemaking power of the Senate
    and House of Representatives, respectively, and as such it is
    deemed a part of the rules of each House, respectively, but
    applicable only with respect to the procedure to be followed in
    that House in the case of a joint resolution, and it supersedes
    other rules only to the extent that it is inconsistent with such
    rules; and
    ``(ii) with full recognition of the constitutional right of
    either House to change the rules (so far as relating to the
    procedure of that House) at any time, in the same manner, and to
    the same extent as in the case of any other rule of that House.

    ``(g) Limitations.--(1) The Secretary may not carry out more than 10
    pilot programs concurrently.
    ``(2)(A) Subject to subparagraph (B), the Secretary may not expend
    more than $50,000,000 in any fiscal year from amounts under subsection
    (d).
    ``(B) The Secretary may expend more than the amount in subparagraph
    (A) if--
    ``(i) <>  the Secretary determines
    that the additional expenditure is necessary to carry out pilot
    programs under this section;
    ``(ii) <>  the Secretary submits to the
    Committees on Veterans' Affairs of the Senate and the House of
    Representatives a report setting forth the amount of the
    additional expenditure and a justification for the additional
    expenditure; and
    ``(iii) the Chairmen of the Committees on Veterans' Affairs
    of the Senate and the House of Representatives transmit to the
    Secretary a letter approving of the additional expenditure.

    ``(3) <>  The waiver provisions in subsection (f)
    shall not apply unless the Secretary, in accordance with the
    requirements in subsection (f), submits the first proposal for a pilot
    program not later than 18 months after the date of the enactment of the
    Caring for Our Veterans Act of 2018.

    ``(4) Notwithstanding section 502 of this title, decisions by the
    Secretary under this section shall, consistent with section 511 of this
    title, be final and conclusive and may not be reviewed by any other
    official or by any court, whether by an action in the nature of mandamus
    or otherwise.
    ``(5)(A) <>  If the Secretary determines that
    a pilot program is not improving the quality of care or producing cost
    savings, the Secretary shall--
    ``(i) <>  propose a modification to the
    pilot program in the interim report that shall also be
    considered a report under subsection (f)(2) and shall be subject
    to the terms and conditions of subsection (f)(2); or
    ``(ii) <>  terminate such pilot program not
    later than 30 days after submitting the interim report to
    Congress.

    [[Page 1437]]

    ``(B) If the Secretary terminates a pilot program under subparagraph
    (A)(ii), for purposes of subparagraphs (F) and (G) of subsection (f)(2),
    such interim report will also serve as the final report for that pilot
    program.
    ``(h) <>  Evaluation and Reporting Requirements.--
    (1) The Secretary shall conduct an evaluation of each model tested,
    which shall include, at a minimum, an analysis of--
    ``(A) the quality of care furnished under the model,
    including the measurement of patient-level outcomes and patient-
    centeredness criteria determined appropriate by the Secretary;
    and
    ``(B) the changes in spending by reason of that model.

    ``(2) <>  The Secretary shall make the
    results of each evaluation under this subsection available to the public
    in a timely fashion and may establish requirements for other entities
    participating in the testing of models under this section to collect and
    report information that the Secretary determines is necessary to monitor
    and evaluate such models.

    ``(i) Coordination and Advice.--(1) The Secretary shall obtain
    advice from the Under Secretary for Health and the Special Medical
    Advisory Group established pursuant to section 7312 of this title in the
    development and implementation of any pilot program operated under this
    section.
    ``(2) <>  In carrying out the duties under this
    section, the Secretary shall consult representatives of relevant Federal
    agencies, and clinical and analytical experts with expertise in medicine
    and health care management. The Secretary shall use appropriate
    mechanisms to seek input from interested parties.

    ``(j) <>  Expansion of Successful
    Pilot Programs.--Taking into account the evaluation under subsection
    (f), the Secretary may, through rulemaking, expand (including
    implementation on a nationwide basis) the duration and the scope of a
    model that is being tested under subsection (a) to the extent determined
    appropriate by the Secretary, if--
    ``(1) the Secretary determines that such expansion is
    expected to--
    ``(A) reduce spending without reducing the quality
    of care; or
    ``(B) improve the quality of patient care without
    increasing spending; and
    ``(2) the Secretary determines that such expansion would not
    deny or limit the coverage or provision of benefits for
    individuals receiving benefits under this chapter.''.

    (b) Conforming Amendment.--The table of sections at the beginning of
    such chapter, as amended by this title, is <> further amended by inserting after the item relating to section
    1703D the following new item:

    ``1703E. Center for Innovation for Care and Payment.''.

    SEC. 153. AUTHORIZATION TO PROVIDE FOR OPERATIONS ON LIVE DONORS
    FOR PURPOSES OF CONDUCTING TRANSPLANT
    PROCEDURES FOR VETERANS.

    (a) In General.--Subchapter VIII of chapter 17 is amended by adding
    at the end the following new section:

    [[Page 1438]]

    ``Sec. 1788. <>  Transplant procedures with
    live donors and related services

    ``(a) In General.--Subject to subsections (b) and (c), in a case in
    which a veteran is eligible for a transplant procedure from the
    Department, the Secretary may provide for an operation on a live donor
    to carry out such procedure for such veteran, notwithstanding that the
    live donor may not be eligible for health care from the Department.
    ``(b) Other Services.--Subject to the availability of appropriations
    for such purpose, the Secretary shall furnish to a live donor any care
    or services before and after conducting the transplant procedure under
    subsection (a) that may be required in connection with such procedure.
    ``(c) Use of Non-Department Facilities.--In carrying out this
    section, the Secretary may provide for the operation described in
    subsection (a) on a live donor and furnish to the live donor the care
    and services described in subsection (b) at a non-Department facility
    pursuant to an agreement entered into by the Secretary under this
    chapter. The live donor shall be deemed to be an individual eligible for
    hospital care and medical services at a non-Department facility pursuant
    to such an agreement solely for the purposes of receiving such
    operation, care, and services at the non-Department facility.''.
    (b) Clerical Amendment.--The table of sections at the beginning of
    chapter 17 <>  is amended by inserting after
    the item relating to section 1787 the following new item:

    ``1788. Transplant procedures with live donors and related services.''.

    Subtitle C--Family Caregivers

    SEC. 161. EXPANSION OF FAMILY CAREGIVER PROGRAM OF DEPARTMENT OF
    VETERANS AFFAIRS.

    (a) Family Caregiver Program.--
    (1) Expansion of eligibility.--
    (A) In general.--Subparagraph (B) of subsection
    (a)(2) of section 1720G is amended to read as follows:
    ``(B) <>  for assistance
    provided under this subsection--
    ``(i) before the date on which the Secretary submits
    to Congress a certification that the Department has
    fully implemented the information technology system
    required by section 162(a) of the Caring for Our
    Veterans Act of 2018, has a serious injury (including
    traumatic brain injury, psychological trauma, or other
    mental disorder) incurred or aggravated in the line of
    duty in the active military, naval, or air service on or
    after September 11, 2001;
    ``(ii) during the 2-year period beginning on the
    date on which the Secretary submitted to Congress the
    certification described in clause (i), has a serious
    injury (including traumatic brain injury, psychological
    trauma, or other mental disorder) incurred or aggravated
    in the line of duty in the active military, naval, or
    air service--
    ``(I) on or before May 7, 1975; or
    ``(II) on or after September 11, 2001; or

    [[Page 1439]]

    ``(iii) after the date that is 2 years after the
    date on which the Secretary submits to Congress the
    certification described in clause (i), has a serious
    injury (including traumatic brain injury, psychological
    trauma, or other mental disorder) incurred or aggravated
    in the line of duty in the active military, naval, or
    air service; and''.
    (B) Publication in federal
    register <> .--Not
    later than 30 days after the date on which the Secretary
    of Veterans Affairs submits to Congress the
    certification described in subsection (a)(2)(B)(i) of
    section 1720G of such title, as amended by subparagraph
    (A) of this paragraph, the Secretary shall publish the
    date specified in such subsection in the Federal
    Register.
    (2) Expansion of needed services in eligibility criteria.--
    Subsection (a)(2)(C) of such section is amended--
    (A) in clause (ii), by striking ``; or'' and
    inserting a semicolon;
    (B) by redesignating clause (iii) as clause (iv);
    and
    (C) by inserting after clause (ii) the following new
    clause (iii):
    ``(iii) a need for regular or extensive instruction
    or supervision without which the ability of the veteran
    to function in daily life would be seriously impaired;
    or''.
    (3) Expansion of services provided.--Subsection
    (a)(3)(A)(ii) of such section is amended--
    (A) in subclause (IV), by striking ``; and'' and
    inserting a semicolon;
    (B) in subclause (V), by striking the period at the
    end and inserting ``; and''; and
    (C) by adding at the end the following new
    subclause:
    ``(VI) through the use of contracts with, or the
    provision of grants to, public or private entities--
    ``(aa) financial planning services relating to
    the needs of injured veterans and their
    caregivers; and
    ``(bb) legal services, including legal advice
    and consultation, relating to the needs of injured
    veterans and their caregivers.''.
    (4) Modification of stipend calculation.--Subsection
    (a)(3)(C) of such section is amended--
    (A) by redesignating clause (iii) as clause (iv);
    and
    (B) by inserting after clause (ii) the following new
    clause (iii):

    ``(iii) In determining the amount and degree of personal care
    services provided under clause (i) with respect to an eligible veteran
    whose need for personal care services is based in whole or in part on a
    need for supervision or protection under paragraph (2)(C)(ii) or regular
    instruction or supervision under paragraph (2)(C)(iii), the Secretary
    shall take into account the following:
    ``(I) The assessment by the family caregiver of the needs
    and limitations of the veteran.
    ``(II) The extent to which the veteran can function safely
    and independently in the absence of such supervision,
    protection, or instruction.
    ``(III) The amount of time required for the family caregiver
    to provide such supervision, protection, or instruction to the
    veteran.''.

    [[Page 1440]]

    (5) Periodic evaluation of need for certain services.--
    Subsection (a)(3) of such section is amended by adding at the
    end the following new subparagraph:

    ``(D) In providing instruction, preparation, and training under
    subparagraph (A)(i)(I) and technical support under subparagraph
    (A)(i)(II) to each family caregiver who is approved as a provider of
    personal care services for an eligible veteran under paragraph (6), the
    Secretary shall periodically evaluate the needs of the eligible veteran
    and the skills of the family caregiver of such veteran to determine if
    additional instruction, preparation, training, or technical support
    under those subparagraphs is necessary.''.
    (6) Use of primary care teams.--Subsection (a)(5) of such
    section is amended, in the matter preceding subparagraph (A), by
    inserting ``(in collaboration with the primary care team for the
    eligible veteran to the maximum extent practicable)'' after
    ``evaluate''.
    (7) Assistance for family caregivers.--Subsection (a) of
    such section is amended by adding at the end the following new
    paragraph:

    ``(11)(A) In providing assistance under this subsection to family
    caregivers of eligible veterans, the Secretary may enter into contracts,
    provider agreements, and memoranda of understanding with Federal
    agencies, States, and private, nonprofit, and other entities to provide
    such assistance to such family caregivers.
    ``(B) The Secretary may provide assistance under this paragraph only
    if such assistance is reasonably accessible to the family caregiver and
    is substantially equivalent or better in quality to similar services
    provided by the Department.
    ``(C) The Secretary may provide fair compensation to Federal
    agencies, States, and other entities that provide assistance under this
    paragraph.''.
    (b) Modification of Definition of Personal Care Services.--
    Subsection (d)(4) of such section is amended--
    (1) in subparagraph (A), by striking ``independent'';
    (2) by redesignating subparagraph (B) as subparagraph (D);
    and
    (3) by inserting after subparagraph (A) the following new
    subparagraphs:
    ``(B) Supervision or protection based on symptoms or
    residuals of neurological or other impairment or injury.
    ``(C) Regular or extensive instruction or
    supervision without which the ability of the veteran to
    function in daily life would be seriously impaired.''.
    SEC. 162. <>  IMPLEMENTATION OF
    INFORMATION TECHNOLOGY SYSTEM OF
    DEPARTMENT OF VETERANS AFFAIRS TO ASSESS
    AND IMPROVE THE FAMILY CAREGIVER PROGRAM.

    (a) Implementation of New System.--
    (1) <>  In general.--Not later than October
    1, 2018, the Secretary of Veterans Affairs shall implement an
    information technology system that fully supports the Program
    and allows for data assessment and comprehensive monitoring of
    the Program.
    (2) Elements of system.--The information technology system
    required to be implemented under paragraph (1) shall include the
    following:
    (A) The ability to easily retrieve data that will
    allow all aspects of the Program (at the medical center
    and

    [[Page 1441]]

    aggregate levels) and the workload trends for the
    Program to be assessed and comprehensively monitored.
    (B) The ability to manage data with respect to a
    number of caregivers that is more than the number of
    caregivers that the Secretary expects to apply for the
    Program.
    (C) The ability to integrate the system with other
    relevant information technology systems of the Veterans
    Health Administration.

    (b) <>  Assessment of Program.--Not later than 180
    days after implementing the system described in subsection (a), the
    Secretary shall, through the Under Secretary for Health, use data from
    the system and other relevant data to conduct an assessment of how key
    aspects of the Program are structured and carried out.

    (c) Ongoing Monitoring of and Modifications to Program.--
    (1) Monitoring.--The Secretary shall use the system
    implemented under subsection (a) to monitor and assess the
    workload of the Program, including monitoring and assessment of
    data on--
    (A) the status of applications, appeals, and home
    visits in connection with the Program; and
    (B) the use by caregivers participating in the
    Program of other support services under the Program such
    as respite care.
    (2) Modifications.--Based on the monitoring and assessment
    conducted under paragraph (1), the Secretary shall identify and
    implement such modifications to the Program as the Secretary
    considers necessary to ensure the Program is functioning as
    intended and providing veterans and caregivers participating in
    the Program with services in a timely manner.

    (d) Reports.--
    (1) Initial report.--
    (A) In general.--Not later than 90 days after the
    date of the enactment of this Act, the Secretary shall
    submit to the Committee on Veterans' Affairs of the
    Senate, the Committee on Veterans' Affairs of the House
    of Representatives, and the Comptroller General of the
    United States a report that includes--
    (i) the status of the planning, development,
    and deployment of the system required to be
    implemented under subsection (a), including any
    changes in the timeline for the implementation of
    the system; and
    (ii) an assessment of the needs of family
    caregivers of veterans described in subparagraph
    (B), the resources needed for the inclusion of
    such family caregivers in the Program, and such
    changes to the Program as the Secretary considers
    necessary to ensure the successful expansion of
    the Program to include such family caregivers.
    (B) Veterans described.--Veterans described in this
    subparagraph are veterans who are eligible for the
    Program under clause (ii) or (iii) of section
    1720G(a)(2)(B) of title 38, United States Code, as
    amended by section 161(a)(1) of this title, solely due
    to a serious injury (including traumatic brain injury,
    psychological trauma, or other mental disorder) incurred
    or aggravated in the line of duty in

    [[Page 1442]]

    the active military, naval, or air service before
    September 11, 2001.
    (2) <>  Notification by comptroller
    general.--The Comptroller General shall review the report
    submitted under paragraph (1) and notify the Committee on
    Veterans' Affairs of the Senate and the Committee on Veterans'
    Affairs of the House of Representatives with respect to the
    progress of the Secretary in--
    (A) fully implementing the system required under
    subsection (a); and
    (B) implementing a process for using such system to
    monitor and assess the Program under subsection (c)(1)
    and modify the Program as considered necessary under
    subsection (c)(2).
    (3) Final report.--
    (A) In general.--Not later than October 1, 2019, the
    Secretary shall submit to the Committee on Veterans'
    Affairs of the Senate, the Committee on Veterans'
    Affairs of the House of Representatives, and the
    Comptroller General a report on the implementation of
    subsections (a) through (c).
    (B) Elements.--The report required by subparagraph
    (A) shall include the following:
    (i) <>  A certification
    by the Secretary that the information technology
    system described in subsection (a) has been
    implemented.
    (ii) A description of how the Secretary has
    implemented such system.
    (iii) A description of the modifications to
    the Program, if any, that were identified and
    implemented under subsection (c)(2).
    (iv) A description of how the Secretary is
    using such system to monitor the workload of the
    Program.

    (e) Definitions.--In this section:
    (1) Active military, naval, or air service.--The term
    ``active military, naval, or air service'' has the meaning given
    that term in section 101 of title 38, United States Code.
    (2) Program.--The term ``Program'' means the program of
    comprehensive assistance for family caregivers under section
    1720G(a) of title 38, United States Code, as amended by section
    161 of this title.
    SEC. 163. <>  MODIFICATIONS TO ANNUAL
    EVALUATION REPORT ON CAREGIVER PROGRAM OF
    DEPARTMENT OF VETERANS AFFAIRS.

    (a) Barriers to Care and Services.--Subparagraph (A)(iv) of section
    101(c)(2) of the Caregivers and Veterans Omnibus Health Services Act of
    2010 (Public Law 111-163; 38 U.S.C. 1720G note) is amended by inserting
    ``, including a description of any barriers to accessing and receiving
    care and services under such programs'' before the semicolon.
    (b) Sufficiency of Training for Family Caregiver Program.--
    Subparagraph (B) of such section is amended--
    (1) in clause (i), by striking ``; and'' and inserting a
    semicolon;
    (2) in clause (ii), by striking the period at the end and
    inserting ``; and''; and

    [[Page 1443]]

    (3) by adding at the end the following new clause:
    ``(iii) an evaluation of the sufficiency and
    consistency of the training provided to family
    caregivers under such program in preparing family
    caregivers to provide care to veterans under such
    program.''.

    TITLE II--VA ASSET AND INFRASTRUCTURE REVIEW

    Subtitle A <> --Asset and Infrastructure Review
    SEC. 201. SHORT TITLE.

    This subtitle may be cited as the ``VA Asset and Infrastructure
    Review Act of 2018''.
    SEC. 202. THE COMMISSION.

    (a) Establishment.--There is established an independent commission
    to be known as the ``Asset and Infrastructure Review Commission'' (in
    this subtitle referred to as the ``Commission'').
    (b) Duties.--The Commission shall carry out the duties specified for
    it in this subtitle.
    (c) <>  Appointment.--
    (1) In general.--
    (A) Appointment.--The Commission shall be composed
    of nine members appointed by the President, by and with
    the advice and consent of the Senate.
    (B) <>  Transmission of
    nominations.--The President shall transmit to the Senate
    the nominations for appointment to the Commission not
    later than May 31, 2021.
    (2) Consultation in selection process.--In selecting
    individuals for nominations for appointments to the Commission,
    the President shall consult with--
    (A) the Speaker of the House of Representatives;
    (B) the majority leader of the Senate;
    (C) the minority leader of the House of
    Representatives;
    (D) the minority leader of the Senate; and
    (E) congressionally chartered, membership based
    veterans service organizations concerning the
    appointment of three members.
    (3) Designation of chair.--At the time the President
    nominates individuals for appointment to the Commission under
    paragraph (1)(B), the President shall designate one such
    individual who shall serve as Chair of the Commission and one
    such individual who shall serve as Vice Chair of the Commission.
    (4) Member representation.--In nominating individuals under
    this subsection, the President shall ensure that--
    (A) veterans, reflecting current demographics of
    veterans enrolled in the system of annual patient
    enrollment under section 1705 of title 38, United States
    Code, are adequately represented in the membership of
    the Commission;

    [[Page 1444]]

    (B) at least one member of the Commission has
    experience working for a private integrated health care
    system that has annual gross revenues of more than
    $50,000,000;
    (C) at least one member has experience as a senior
    manager for an entity specified in clause (ii), (iii),
    or (iv) of section 101(a)(1)(B) of the Veterans Access,
    Choice, and Accountability Act of 2014 (Public Law 113-
    146; 38 U.S.C. 1701 note);
    (D) at least one member--
    (i) has experience with capital asset
    management for the Federal Government; and
    (ii) is familiar with trades related to
    building and real property, including
    construction, engineering, architecture, leasing,
    and strategic partnerships; and
    (E) at least three members represent congressionally
    chartered, membership-based, veterans service
    organizations.

    (d)Meetings.--
    (1) In general. <> --The Commission
    shall meet only during calendar years 2022 and 2023.
    (2) Public nature of meetings and proceedings.--
    (A) Public meetings.--Each meeting of the Commission
    shall be open to the public.
    (B) Open participation.--All the proceedings,
    information, and deliberations of the Commission shall
    be available for review by the public.

    (e) Vacancies.--A vacancy in the Commission shall be filled in the
    same manner as the original appointment, but the individual appointed to
    fill the vacancy shall serve only for the unexpired portion of the term
    for which the individual's predecessor was appointed.
    (f) Pay.--
    (1) In general.--Members of the Commission shall serve
    without pay.
    (2) Officers or employees of the united states.--Each member
    of the Commission who is an officer or employee of the United
    States shall serve without compensation in addition to that
    received for service as an officer or employee of the United
    States.
    (3) Travel expenses.--Members shall receive travel expenses,
    including per diem in lieu of subsistence, in accordance with
    sections 5702 and 5703 of title 5, United States Code.

    (g) Director of Staff.--
    (1) Appointment.--The Commission shall appoint a Director
    who--
    (A) <>  has not served as an
    employee of the Department of Veterans Affairs during
    the 1-year period preceding the date of such
    appointment; and
    (B) is not otherwise barred or prohibited from
    serving as Director under Federal ethics laws and
    regulations, by reason of post-employment conflict of
    interest.
    (2) Rate of pay.--The Director shall be paid at the rate of
    basic pay payable for level IV of the Executive Schedule under
    section 5315 of title 5, United States Code.

    (h) Staff.--

    [[Page 1445]]

    (1) Pay of personnel.--Subject to paragraphs (2) and (3),
    the Director, with the approval of the Commission, may appoint
    and fix the pay of additional personnel.
    (2) Exemption from certain requirements.--The Director may
    make such appointments without regard to the provisions of title
    5, United States Code, governing appointments in the competitive
    service, and any personnel so appointed may be paid without
    regard to the provisions of chapter 51 and subchapter III of
    chapter 53 of that title relating to classification and General
    Schedule pay rates, except that an individual so appointed may
    not receive pay in excess of the annual rate of basic pay
    payable for GS-15 of the General Schedule.
    (3) Detailees.--
    (A) Limitation on number.--Not more than two-thirds
    of the personnel employed by or detailed to the
    Commission may be on detail from the Department of
    Veterans Affairs.
    (B) Professional analysts.--Not more than half of
    the professional analysts of the Commission staff may be
    persons detailed from the Department of Veterans Affairs
    to the Commission.
    (C) Prohibition on detail of certain
    personnel. <> --A person may not be
    detailed from the Department of Veterans Affairs to the
    Commission if, within 6 months before the detail is to
    begin, that person participated personally and
    substantially in any matter within the Department of
    Veterans Affairs concerning the preparation of
    recommendations regarding facilities of the Veterans
    Health Administration.
    (4) Authority to request detailed personnel.--Subject to
    paragraph (3), the head of any Federal department or agency,
    upon the request of the Director, may detail any of the
    personnel of that department or agency to the Commission to
    assist the Commission in carrying out its duties under this
    subtitle.
    (5) Information from federal agencies.--The Commission may
    secure directly from any Federal agency such information the
    Commission considers necessary to carry out this subtitle. Upon
    request of the Chair, the head of such agency shall furnish such
    information to the Commission.

    (i) Other Authority.--
    (1) Temporary and intermittent services.--The Commission may
    procure by contract, to the extent funds are available, the
    temporary or intermittent services of experts or consultants
    pursuant to section 3109 of title 5, United States Code.
    (2) Leasing and acquisition of property.--
    <> To the extent funds are available, the
    Commission may lease real property and acquire personal property
    either of its own accord or in consultation with the General
    Services Administration.

    (j) Termination.--The Commission shall terminate on December 31,
    2023.
    (k) Prohibition Against Restricting Communications.--
    (1) In general.--Except as provided in paragraph (2), no
    person may restrict an employee of the Department of Veterans
    Affairs in communicating with the Commission.

    [[Page 1446]]

    (2) Unlawful communications.--Paragraph (1) does not apply
    to a communication that is unlawful.
    SEC. 203. PROCEDURE FOR MAKING RECOMMENDATIONS.

    (a) Selection Criteria.--
    (1) Publication.--The Secretary shall, not
    later <>  than February 1, 2021, and after consulting with
    veterans service organizations, publish in the Federal Register
    and transmit to the Committees on Veterans' Affairs of the
    Senate and the House of Representatives the criteria proposed to
    be used by the Department of Veterans Affairs in assessing and
    making recommendations regarding the modernization or
    realignment of facilities of the Veterans Health Administration
    under this subtitle. Such criteria shall include the preferences
    of veterans regarding health care furnished by the Department.
    (2) <>  Public comment.--The
    Secretary shall provide an opportunity for public comment on the
    proposed criteria under paragraph (1) for a period of at least
    90 days and shall include notice of that opportunity in the
    publication required under such paragraph.
    (3) <>
    Publication of final criteria.--The Secretary shall, not later
    than May 31, 2021, publish in the Federal Register and transmit
    to the Committees on Veterans' Affairs of the Senate and the
    House of Representatives the final criteria to be used in making
    recommendations regarding the closure, modernization, or
    realignment of facilities of the Veterans Health Administration
    under this subtitle.

    (b) Recommendations of the Secretary.--
    (1) <>  Publication in federal
    register.--The Secretary shall, not later than January 31, 2022,
    and after consulting with veterans service organizations,
    publish in the Federal Register and transmit to the Committees
    on Veterans' Affairs of the Senate and the House of
    Representatives and to the Commission a report detailing the
    recommendations regarding the modernization or realignment of
    facilities of the Veterans Health Administration on the basis of
    the final criteria referred to in subsection (a)(2) that are
    applicable.
    (2) Factors for consideration.--In making recommendations
    under this subsection, the Secretary shall consider each of the
    following factors:
    (A) The degree to which any health care delivery or
    other site for providing services to veterans reflect
    the metrics of the Department of Veterans Affairs
    regarding market area health system planning.
    (B) The provision of effective and efficient access
    to high-quality health care and services for veterans.
    (C) The extent to which the real property that no
    longer meets the needs of the Federal Government could
    be reconfigured, repurposed, consolidated, realigned,
    exchanged, outleased, replaced, sold, or disposed.
    (D) The need of the Veterans Health Administration
    to acquire infrastructure or facilities that will be
    used for the provision of health care and services to
    veterans.
    (E) The extent to which the operating and
    maintenance costs are reduced through consolidating,
    colocating, and reconfiguring space, and through
    realizing other operational efficiencies.

    [[Page 1447]]

    (F) The extent and timing of potential costs and
    savings, including the number of years such costs or
    savings will be incurred, beginning with the date of
    completion of the proposed recommendation.
    (G) The extent to which the real property aligns
    with the mission of the Department of Veterans Affairs.
    (H) The extent to which any action would impact
    other missions of the Department (including education,
    research, or emergency preparedness).
    (I) Local stakeholder inputs and any factors
    identified through public field hearings.
    (J) The assessments under paragraph (3).
    (K) <>  The extent to which
    the Veterans Health Administration has appropriately
    staffed the medical facility, including determinations
    whether there has been insufficient resource allocation
    or deliberate understaffing.
    (L) Any other such factors the Secretary determines
    appropriate.
    (3) Capacity and commercial market assessments.--
    (A) Assessments.--The Secretary shall assess the
    capacity of each Veterans Integrated Service Network and
    medical facility of the Department to furnish hospital
    care or medical services to veterans under chapter 17 of
    title 38, United States Code. Each such assessment
    shall--
    (i) identify gaps in furnishing such care or
    services at such Veterans Integrated Service
    Network or medical facility;
    (ii) identify how such gaps can be filled by--
    (I) <>  entering
    into contracts or agreements with
    network providers under this section or
    with entities under other provisions of
    law;
    (II) making changes in the way such
    care and services are furnished at such
    Veterans Integrated Service Network or
    medical facility, including--
    (aa) extending hours of
    operation;
    (bb) adding personnel; or
    (cc) expanding space through
    the construction, leasing, or
    sharing of health care
    facilities; and
    (III) the building or realignment of
    Department resources or personnel;
    (iii) forecast, based on future projections
    and historical trends, both the short- and long-
    term demand in furnishing care or services at such
    Veterans Integrated Service Network or medical
    facility and assess how such demand affects the
    needs to use such network providers;
    (iv) include a commercial health care market
    assessment of designated catchment areas in the
    United States conducted by a non-governmental
    entity; and
    (v) consider the unique ability of the Federal
    Government to retain a presence in an area
    otherwise devoid of commercial health care
    providers or from which such providers are at risk
    of leaving.
    (B) Consultation.--In carrying out the assessments
    under subparagraph (A), the Secretary shall consult with

    [[Page 1448]]

    veterans service organizations and veterans served by
    each such Veterans Integrated Service Network and
    medical facility.
    (C) <>  Submittal.--The
    Secretary shall submit such assessments to the
    Committees on Veterans' Affairs of the House of
    Representatives and the Senate with the recommendations
    of the Secretary under this subsection and make the
    assessments publicly available.
    (4) Summary of selection process.--The Secretary shall
    include, with the list of recommendations published and
    transmitted pursuant to paragraph (1), a summary of the
    selection process that resulted in the recommendation for each
    facility of the Veterans Health Administration, including a
    justification for each recommendation. <> The
    Secretary shall transmit the matters referred to in the
    preceding sentence not later than 7 days after the date of the
    transmittal to the Committees on Veterans' Affairs of the Senate
    and the House of Representatives and the Commission of the
    report referred to in paragraph (1).
    (5) Treatment of facilities.--In assessing facilities of the
    Veterans Health Administration, the Secretary shall consider all
    such facilities equally without regard to whether the facility
    has been previously considered or proposed for reuse, closure,
    modernization, or realignment by the Department of Veterans
    Affairs.
    (6) Availability of information to congress.--In addition to
    making all information used by the Secretary to prepare the
    recommendations under this subsection available to Congress
    (including any committee or Member of Congress), the Secretary
    shall also make such information available to the Commission and
    the Comptroller General of the United States.
    (7) Certification of accuracy.--
    (A) In general.--Each person referred to in
    subparagraph (B), when submitting information to the
    Secretary or the Commission concerning the modernization
    or realignment of a facility of the Veterans Health
    Administration, shall certify that such information is
    accurate and complete to the best of that person's
    knowledge and belief.
    (B) Covered persons.--Subparagraph (A) applies to
    the following persons:
    (i) Each Under Secretary of the Department of
    Veterans Affairs.
    (ii) Each director of a Veterans Integrated
    Service Network.
    (iii) Each director of a medical center of the
    Department of Veterans Affairs.
    (iv) Each director of a program office of the
    Department of Veterans Affairs.
    (v) Each person who is in a position the
    duties of which include personal and substantial
    involvement in the preparation and submission of
    information and recommendations concerning the
    modernization or realignment of facilities of the
    Veterans Health Administration.

    (c) Review and Recommendations by the Commission.--
    (1) Public hearings.--

    [[Page 1449]]

    (A) In general.--After receiving the recommendations
    from the Secretary pursuant to subsection (b), the
    Commission shall conduct public hearings on the
    recommendations.
    (B) Locations.--The Commission shall conduct public
    hearings in regions affected by a recommendation of the
    Secretary to close a facility of the Veterans Health
    Administration. To the greatest extent practicable, the
    Commission shall conduct public hearings in regions
    affected by a recommendation of the Secretary to
    modernize or realign such a facility.
    (C) Required witnesses.--Witnesses at each public
    hearing shall include at a minimum--
    (i) a veteran--
    (I) enrolled under section 1705 of
    title 38, United States Code; and
    (II) identified by a local veterans
    service organization; and
    (ii) a local elected official.
    (2) Transmittal to president.--
    (A) In general.--The
    Commission <> shall, not later
    than January 31, 2023, transmit to the President a
    report containing the Commission's findings and
    conclusions based on a review and analysis of the
    recommendations made by the Secretary, together with the
    Commission's recommendations, for modernizations and
    realignments of facilities of the Veterans Health
    Administration.
    (B) <>  Authority to make
    changes to recommendations.--Subject to subparagraph
    (C), in making its recommendations, the Commission may
    change any recommendation made by the Secretary if the
    Commission--
    (i) determines that the Secretary deviated
    substantially from the final criteria referred to
    in subsection (a)(2) in making such
    recommendation;
    (ii) determines that the change is consistent
    with the final criteria referred to in subsection
    (a)(2);
    (iii) <>  publishes a notice of
    the proposed change in the Federal Register not
    less than 45 days before transmitting its
    recommendations to the President pursuant to
    subparagraph (A); and
    (iv) conducts public hearings on the proposed
    change.
    (3) Justification for changes. <> --The
    Commission shall explain and justify in its report submitted to
    the President pursuant to paragraph (2) any recommendation made
    by the Commission that is different from the recommendations
    made by the Secretary pursuant to subsection (b). The Commission
    shall transmit a copy of such report to the Committees on
    Veterans' Affairs of the Senate and the House of Representatives
    on the same date on which it transmits its recommendations to
    the President under paragraph (2).
    (4) Provision of information to congress.--After the
    Commission transmits its report to the President, the Commission
    shall promptly provide, upon request, to any Member of Congress,
    information used by the Commission in making its
    recommendations.

    (d) Review by the President.--

    [[Page 1450]]

    (1) Report.--The President shall, not later than February
    15, 2023, transmit to the Commission and to the Congress a
    report containing the President's approval or disapproval of the
    Commission's recommendations.
    (2) <>  Presidential approval.--If the
    President approves all the recommendations of the Commission,
    the President shall transmit a copy of such recommendations to
    the Congress, together with a certification of such approval.
    (3) <>  Presidential disapproval.--If the
    President disapproves the recommendations of the Commission, in
    whole or in part, the President shall transmit to the Commission
    and the Congress, not later than March 1, 2023, the reasons for
    that disapproval. <> The Commission, after
    consideration of the President's reasons for disapproval, shall
    then transmit to the President, not later than March 15, 2023, a
    report containing--
    (A) the Commission's findings and conclusions based
    on a review and analysis of those reasons for
    disapproval provided by the President; and
    (B) recommendations that the Commission determines
    are appropriate for modernizations and realignments of
    facilities of the Veterans Health Administration.
    (4) <>  Transmittal of recommendations
    to congress.--If the President approves all recommendations of
    the Commission transmitted to the President under paragraph (3),
    the President shall transmit a copy of such recommendations to
    the Congress, together with a certification of such approval.
    (5) <>  Failure to transmit.--If the
    President does not transmit to the Congress an approval and
    certification described in paragraph (2) or (4) by March 30,
    2023, the process by which facilities of the Veterans Health
    Administration may be selected for modernization or realignment
    under this subtitle shall be terminated.
    SEC. 204. ACTIONS REGARDING INFRASTRUCTURE AND FACILITIES OF THE
    VETERANS HEALTH ADMINISTRATION.

    (a) <>  In General.--Subject to subsection (b), the
    Secretary shall begin to implement the recommended modernizations and
    realignments in the report under section 203(d) not later than 3 years
    after the date on which the President transmits such report to Congress.
    In any fiscal year, such implementation includes--
    (1) the planning of modernizations and realignments of
    facilities of the Veterans Health Administration as recommended
    in such report; and
    (2) providing detailed information on the budget for such
    modernizations or realignments in documents submitted to
    Congress by the Secretary in support of the President's budget
    for that fiscal year.

    (b) Congressional Disapproval.--
    (1) In general.--The Secretary may not carry out any
    modernization or realignment recommended by the Commission in a
    report transmitted from the President pursuant to section 203(d)
    if a joint resolution is enacted, in accordance with the
    provisions of section 207, disapproving such recommendations of
    the Commission before the earlier of--
    (A) <>  the end of the 45-day
    period beginning on the date on which the President
    transmits such report; or

    [[Page 1451]]

    (B) the adjournment of Congress sine die for the
    session during which such report is transmitted.
    (2) Computation of period.--For purposes of paragraph (1)
    and subsections (a) and (c) of section 207, the days on which
    either House of Congress is not in session because of an
    adjournment of more than three days to a day certain shall be
    excluded in the computation of a period.
    SEC. 205. IMPLEMENTATION.

    (a) In General.--
    (1) Modernizing and realigning facilities.--In modernizing
    or realigning any facility of the Veterans Health Administration
    under this subtitle, the Secretary may--
    (A) take such actions as may be necessary to
    modernize or realign any such facility, including the
    alteration of such facilities, the acquisition of such
    land, the leasing or construction of such replacement
    facilities, the disposition of such land or facilities,
    the performance of such activities, and the conduct of
    such advance planning and design as may be required to
    transfer functions from a facility of the Veterans
    Health Administration to another such facility, and may
    use for such purpose funds in the Account or funds
    appropriated to the Department of Veterans Affairs for
    such purposes;
    (B) carry out activities for the purposes of
    environmental mitigation, abatement, or restoration at
    any such facility, and shall use for such purposes funds
    in the Account;
    (C) <>  reimburse other
    Federal agencies for actions performed at the request of
    the Secretary with respect to any such closure or
    realignment, and may use for such purpose funds in the
    Account or funds appropriated to the Department of
    Veterans Affairs and available for such purpose; and
    (D) exercise the authority of the Secretary under
    subchapter V of chapter 81 of title 38, United States
    Code.
    (2) Environmental restoration; historic preservation.--In
    carrying out any closure or realignment under this subtitle, the
    Secretary, with regards to any property made excess to the needs
    of the Department of Veterans Affairs as a result of such
    closure or realignment, shall carry out, as soon as possible
    with funds available for such purpose, any of the following for
    which the Secretary is responsible:
    (A) Environmental mitigation.
    (B) Environmental abatement.
    (C) Environmental restoration.
    (D) Compliance with historic preservation
    requirements.

    (b) Management and Disposal of Property.--
    (1) Existing disposal authorities.--To transfer or dispose
    of surplus real property or infrastructure located at any
    facility of the Veterans Health Administration that is
    modernized or realigned under this title, the Secretary may
    exercise the authorities of the Secretary under subchapters I
    and II of chapter 81 of title 38, United States Code, or the
    authorities delegated to the Secretary by the Administrator of
    General

    [[Page 1452]]

    Services under subchapter III of chapter 5 of title 40, United
    States Code.
    (2) Effects on local communities.--
    (A) Consultation with state and local government.--
    Before any action may be taken with respect to the
    disposal of any surplus real property or infrastructure
    located at any facility of the Veterans Health
    Administration to be closed or realigned under this
    subtitle, the Secretary of Veterans Affairs shall
    consult with the Governor of the State and the heads of
    the local governments concerned for the purpose of
    considering any plan for the use of such property by the
    local community concerned.
    (B) Treatment of roads.--If infrastructure or a
    facility of the Veterans Health Administration to be
    closed or realigned under this subtitle includes a road
    used for public access through, into, or around the
    facility, the Secretary--
    (i) <>  shall consult
    with the Government of the State and the heads of
    the local governments concerned for the purpose of
    considering the continued availability of the road
    for public use after the recommended action is
    complete; and
    (ii) may exercise the authority of the
    Secretary under section 8108 of title 38, United
    States Code.
    (3) Leases; cercla.--
    (A) Lease authority.--
    (i) Transfer to redevelopment authority for
    lease.--The Secretary may transfer title to a
    facility of the Veterans Health Administration
    approved for closure or realignment under this
    subtitle (including property at a facility of the
    Veterans Health Administration approved for
    realignment which will be retained by the
    Department of Veterans Affairs or another Federal
    agency after realignment) to the redevelopment
    authority for the facility if the redevelopment
    authority agrees to lease, directly upon transfer,
    one or more portions of the property transferred
    under this subparagraph to the Secretary or to the
    head of another department or agency of the
    Federal Government.
    (ii) Term of lease.--A lease under clause (i)
    shall be for a term of not to exceed 50 years, but
    may provide for options for renewal or extension
    of the term by the department or agency concerned.
    (iii) Limitation.--A lease under clause (i)
    may not require rental payments by the United
    States.
    (iv) Treatment of remaindered lease terms.--A
    lease under clause (i) shall include a provision
    specifying that if the department or agency
    concerned ceases requiring the use of the leased
    property before the expiration of the term of the
    lease, the remainder of the lease term may be
    satisfied by the same or another department or
    agency of the Federal Government using the
    property for a use similar to the use under the
    lease. <> Exercise of the
    authority provided by this clause shall be made in
    consultation with the redevelopment authority
    concerned.

    [[Page 1453]]

    (v) Facility services.--Notwithstanding clause
    (iii), if a lease under clause (i) involves a
    substantial portion of the facility, the
    department or agency concerned may obtain facility
    services for the leased property and common area
    maintenance from the redevelopment authority or
    the redevelopment authority's assignee as a
    provision of the lease. The facility services and
    common area maintenance shall be provided at a
    rate no higher than the rate charged to non-
    Federal tenants of the transferred property.
    Facility services and common area maintenance
    covered by the lease shall not include--
    (I) municipal services that a State
    or local government is required by law
    to provide to all landowners in its
    jurisdiction without direct charge; or
    (II) firefighting or security-guard
    functions.
    (B) Application of cercla.--The provisions of
    section 120(h) of the Comprehensive Environmental
    Response, Compensation, and Liability Act of 1980 (42
    U.S.C. 9620(h)) shall apply to any transfer of real
    property under this paragraph.
    (C) Additional terms and conditions.--The Secretary
    may require any additional terms and conditions in
    connection with a transfer under this paragraph as such
    Secretary considers appropriate to protect the interests
    of the United States.
    (4) Application of mckinney-vento homeless assistance act.--
    Nothing in this subtitle shall limit or otherwise affect the
    application of the provisions of the McKinney-Vento Homeless
    Assistance Act (42 U.S.C. 11301 et seq.) to facilities of the
    Veterans Health Administration closed under this subtitle.

    (c) Applicability of National Environmental Policy Act of 1969.--
    (1) In general.--The provisions of the National
    Environmental Policy Act of 1969 (42 U.S.C. 4321 et seq.) shall
    not apply to the actions of the President, the Commission, and,
    except as provided in paragraph (2), the Department of Veterans
    Affairs in carrying out this subtitle.
    (2) Department of veterans affairs.--
    (A) Covered activities.--The provisions of the
    National Environmental Policy Act of 1969 shall apply to
    actions of the Department of Veterans Affairs under this
    subtitle--
    (i) during the process of property disposal;
    and
    (ii) during the process of relocating
    functions from a facility of the Veterans Health
    Administration being closed or realigned to
    another facility after the receiving facility has
    been selected but before the functions are
    relocated.
    (B) Other activities.--In applying the provisions of
    the National Environmental Policy Act of 1969 to the
    processes referred to in subparagraph (A), the Secretary
    shall not have to consider--
    (i) the need for closing or realigning the
    facility of the Veterans Health Administration as
    recommended by the Commission;

    [[Page 1454]]

    (ii) the need for transferring functions to
    any facility of the Veterans Health Administration
    which has been selected as the receiving facility;
    or
    (iii) facilities of the Veterans Health
    Administration alternative to those recommended or
    selected.

    (d) Waiver.--
    (1) Restrictions on use of funds.--The Secretary may close
    or realign facilities of the Veterans Health Administration
    under this subtitle without regard to any provision of law
    restricting the use of funds for closing or realigning
    facilities of the Veterans Health Administration included in any
    appropriation or authorization Act.
    (2) Restrictions on authorities.--The Secretary may close or
    realign facilities of the Veterans Health Administration under
    this subtitle without regard to the restrictions of section 8110
    of title 38, United States Code.

    (e) Transfer Authority in Connection With Payment of Environmental
    Remediation Costs.--
    (1) In general.--
    (A) Transfer by deed.--Subject to paragraph (2) of
    this subsection and section 120(h) of the Comprehensive
    Environmental Response, Compensation, and Liability Act
    of 1980 (42 U.S.C. 9620(h)), the Secretary may enter
    into an agreement to transfer by deed a facility of the
    Veterans Health Administration with any person who
    agrees to perform all environmental restoration, waste
    management, and environmental compliance activities that
    are required for the property or facilities under
    Federal and State laws, administrative decisions,
    agreements (including schedules and milestones), and
    concurrences.
    (B) Additional terms or conditions.--The Secretary
    may require any additional terms and conditions in
    connection with an agreement authorized by subparagraph
    (A) as the Secretary considers appropriate to protect
    the interests of the United States.
    (2) <>  Limitation.--A transfer of a
    facility of the Veterans Health Administration may be made under
    paragraph (1) only if the Secretary certifies to Congress that--
    (A) the costs of all environmental restoration,
    waste management, and environmental compliance
    activities otherwise to be paid by the Secretary with
    respect to the facility of the Veterans Health
    Administration are equal to or greater than the fair
    market value of the property or facilities to be
    transferred, as determined by the Secretary; or
    (B) if such costs are lower than the fair market
    value of the facility of the Veterans Health
    Administration, the recipient of such transfer agrees to
    pay the difference between the fair market value and
    such costs.
    (3) Payment by the secretary for certain transfers.--In the
    case of a facility of the Veterans Health Administration covered
    by a certification under paragraph (2)(A), the Secretary may pay
    the recipient of such facility an amount equal to the lesser
    of--
    (A) the amount by which the costs incurred by the
    recipient of the facility of the Veterans Health
    Administration for all environmental restoration, waste,
    management,

    [[Page 1455]]

    and environmental compliance activities with respect to
    such facility exceed the fair market value of such
    property as specified in such certification; or
    (B) the amount by which the costs (as determined by
    the Secretary) that would otherwise have been incurred
    by the Secretary for such restoration, management, and
    activities with respect to such facility of the Veterans
    Health Administration exceed the fair market value of
    property as so specified.
    (4) Disclosure.--As part of an agreement under paragraph
    (1), the Secretary shall disclose to the person to whom the
    facility of the Veterans Health Administration will be
    transferred any information of the Secretary regarding the
    environmental restoration, waste management, and environmental
    compliance activities described in paragraph (1) that relate to
    the facility of the Veterans Health Administration. The
    Secretary shall provide such information before entering into
    the agreement.
    (5) Applicability of certain environmental laws.--Nothing in
    this subsection shall be construed to modify, alter, or amend
    the Comprehensive Environmental Response, Compensation, and
    Liability Act of 1980 (42 U.S.C. 9601 et seq.) or the Solid
    Waste Disposal Act (42 U.S.C. 6901 et seq.).
    SEC. 206. DEPARTMENT OF VETERANS AFFAIRS ASSET AND INFRASTRUCTURE
    REVIEW ACCOUNT.

    (a) Establishment.--There is hereby established in the ledgers of
    the Treasury an account to be known as the ``Department of Veterans
    Affairs Asset and Infrastructure Review Account'' which shall be
    administered by the Secretary as a single account.
    (b) Credits to Account.--There shall be credited to the Account the
    following:
    (1) Funds authorized for and appropriated to the Account.
    (2) Proceeds received from the lease, transfer, or disposal
    of any property at a facility of the Veterans Health
    Administration closed or realigned under this subtitle.

    (c) Use of Account.--The Secretary may use the funds in the Account
    only for the following purposes:
    (1) To carry out this subtitle.
    (2) To cover property management and disposal costs incurred
    at facilities of the Veterans Health Administration closed,
    modernized, or realigned under this subtitle.
    (3) To cover costs associated with supervision, inspection,
    overhead, engineering, and design of construction projects
    undertaken under this subtitle, and subsequent claims, if any,
    related to such activities.
    (4) Other purposes that the Secretary determines support the
    mission and operations of the Department of Veterans Affairs.

    (d) Consolidated Budget Justification Display for Account.--
    (1) Consolidated budget information required.--The Secretary
    shall establish a consolidated budget justification display in
    support of the Account that for each fiscal year--
    (A) details the amount and nature of credits to, and
    expenditures from, the Account during the preceding
    fiscal year;

    [[Page 1456]]

    (B) separately details the environmental remediation
    costs associated with facility of the Veterans Health
    Administration for which a budget request is made;
    (C) specifies the transfers into the Account and the
    purposes for which these transferred funds will be
    further obligated, to include caretaker and environment
    remediation costs associated with each facility of the
    Veterans Health Administration; and
    (D) details any intra-budget activity transfers
    within the Account that exceeded $1,000,000 during the
    preceding fiscal year or that are proposed for the next
    fiscal year and will exceed $1,000,000.
    (2) Submission.--The Secretary shall include the information
    required by paragraph (1) in the materials that the Secretary
    submits to Congress in support of the budget for a fiscal year
    submitted by the President pursuant to section 1105 of title 31,
    United States Code.

    (e) Closure of Account; Treatment of Remaining Funds.--
    (1) Closure.--The Account shall be closed at the time and in
    the manner provided for appropriation accounts under section
    1555 of title 31, United States Code, except that unobligated
    funds which remain in the Account upon closure shall be held by
    the Secretary of the Treasury until transferred to the Secretary
    of Veterans Affairs by law after the Committees on Veterans'
    Affairs of the Senate and the House of Representatives receive
    the final report transmitted under paragraph (2).
    (2) Final report.--No later than 60 days after the closure
    of the Account under paragraph (1), the Secretary shall transmit
    to the Committees on Veterans' Affairs of the Senate and the
    House of Representatives and the Committees on Appropriations of
    the House of Representatives and the Senate a report containing
    an accounting of--
    (A) all the funds credited to and expended from the
    Account or otherwise expended under this subtitle; and
    (B) any funds remaining in the Account.
    SEC. 207. CONGRESSIONAL CONSIDERATION OF COMMISSION REPORT.

    (a) <>  Disapproval Resolution.--For
    purposes of this subtitle, the term ``joint resolution'' means only a
    joint resolution which is introduced within the 5-day period beginning
    on the date on which the President transmits the report to the Congress
    under section 203(d), and--
    (1) which does not have a preamble;
    (2) the matter after the resolving clause of which is as
    follows: ``that Congress disapproves the recommendations of the
    VHA Asset and Infrastructure Review Commission as submitted by
    the President on ___'', the blank space being filled with the
    appropriate date; and
    (3) the title of which is as follows: ``Joint resolution
    disapproving the recommendations of the VHA Asset and
    Infrastructure Review Commission.''.

    (b) Consideration in the House of Representatives.--
    (1) Reporting and discharge.--Any committee of the House of
    Representatives to which a joint resolution is referred shall
    report it to the House without amendment not later than 15
    legislative days after the date of introduction thereof. If a
    committee fails to report the joint resolution within that

    [[Page 1457]]

    period, the committee shall be discharged from further
    consideration of the joint resolution.
    (2) Proceeding to consideration.--It shall be in order at
    any time after the third legislative day after each committee
    authorized to consider a joint resolution has reported or has
    been discharged from consideration of a joint resolution, to
    move to proceed to consider the joint resolution in the House.
    All points of order against the motion are waived. Such a motion
    shall not be in order after the House has disposed of a motion
    to proceed on a joint resolution addressing a particular
    submission. The previous question shall be considered as ordered
    on the motion to its adoption without intervening motion. The
    motion shall not be debatable. A motion to reconsider the vote
    by which the motion is disposed of shall not be in order.
    (3) Consideration.--The joint resolution shall be considered
    as read. All points of order against the joint resolution and
    against its consideration are waived. The previous question
    shall be considered as ordered on the joint resolution to its
    passage without intervening motion except 2 hours of debate
    equally divided and controlled by the proponent and an opponent.
    A motion to reconsider the vote on passage of the joint
    resolution shall not be in order.

    (c) Consideration in the Senate.--
    (1) Referral.--A joint resolution introduced in the Senate
    shall be referred to the Committee on Veterans' Affairs.
    (2) Reporting and discharge.--Any committee of the Senate to
    which a joint resolution is referred shall report it to the
    Senate without amendment not later than 15 session days after
    the date of introduction of a joint resolution described in
    subsection (a). If a committee fails to report the joint
    resolution within that period, the committee shall be discharged
    from further consideration of the joint resolution and the joint
    resolution shall be placed on the calendar.
    (3) Floor consideration.--
    (A) In general.--Notwithstanding Rule XXII of the
    Standing Rules of the Senate, it is in order at any time
    after the third session day on which the Committee on
    Veterans' Affairs has reported or has been discharged
    from consideration of a joint resolution described in
    subsection (a) (even though a previous motion to the
    same effect has been disagreed to) to move to proceed to
    the consideration of the joint resolution, and all
    points of order against the joint resolution (and
    against consideration of the joint resolution) are
    waived. The motion to proceed is not debatable. The
    motion is not subject to a motion to postpone. A motion
    to reconsider the vote by which the motion is agreed to
    or disagreed to shall not be in order. If a motion to
    proceed to the consideration of the resolution is agreed
    to, the joint resolution shall remain the unfinished
    business until disposed of.
    (B) Consideration.--Consideration of the joint
    resolution, and on all debatable motions and appeals in
    connection therewith, shall be limited to not more than
    2 hours, which shall be divided equally between the
    majority and minority leaders or their designees. A
    motion further to limit debate is in order and not
    debatable. An amendment

    [[Page 1458]]

    to, or a motion to postpone, or a motion to proceed to
    the consideration of other business, or a motion to
    recommit the joint resolution is not in order.
    (C) Vote on passage.--If the Senate has voted to
    proceed to a joint resolution, the vote on passage of
    the joint resolution shall occur immediately following
    the conclusion of consideration of the joint resolution,
    and a single quorum call at the conclusion of the debate
    if requested in accordance with the rules of the Senate.
    (D) Rulings of the chair on procedure.--Appeals from
    the decisions of the Chair relating to the application
    of the rules of the Senate, as the case may be, to the
    procedure relating to a joint resolution shall be
    decided without debate.

    (d) Amendment Not in Order.--A joint resolution of disapproval
    considered pursuant to this section shall not be subject to amendment in
    either the House of Representatives or the Senate.
    (e) Coordination With Action by Other House.--
    (1) In general. <> --If,
    before the passage by one House of the joint resolution of that
    House, that House receives the joint resolution from the other
    House, then the following procedures shall apply:
    (A) The joint resolution of the other House shall
    not be referred to a committee.
    (B) With respect to the joint resolution of the
    House receiving the joint resolution--
    (i) the procedure in that House shall be the
    same as if no joint resolution had been received
    from the other House; but
    (ii) the vote on passage shall be on the joint
    resolution of the other House.
    (2) Treatment of joint resolution of other house.--If the
    Senate fails to introduce or consider a joint resolution under
    this section, the joint resolution of the House shall be
    entitled to expedited floor procedures under this section.
    (3) Treatment of companion measures.--If, following passage
    of the joint resolution in the Senate, the Senate then receives
    the companion measure from the House of Representatives, the
    companion measure shall not be debatable.

    (f) Rules of the House of Representatives and Senate.--This section
    is enacted by Congress--
    (1) as an exercise of the rulemaking power of the Senate and
    House of Representatives, respectively, and as such it is deemed
    a part of the rules of each House, respectively, but applicable
    only with respect to the procedure to be followed in that House
    in the case of a joint resolution, and it supersedes other rules
    only to the extent that it is inconsistent with such rules; and
    (2) with full recognition of the constitutional right of
    either House to change the rules (so far as relating to the
    procedure of that House) at any time, in the same manner, and to
    the same extent as in the case of any other rule of that House.
    SEC. 208. OTHER MATTERS.

    (a) Online Publication of Communications.--
    (1) In general.--Not <>  later than 24
    hours after the transmission or receipt of any communication
    under this subtitle

    [[Page 1459]]

    that is transmitted or received by a party specified in
    paragraph (2), the Secretary of Veterans Affairs shall publish
    such communication online.
    (2) Parties specified.--The parties specified under this
    paragraph are the following:
    (A) The Secretary of Veterans Affairs.
    (B) The Commission.
    (C) The President.

    (b) Continuation of Existing Construction Projects and Planning.--
    During activities that the Commission, President, or Congress carry out
    under this subtitle, the Secretary of Veterans Affairs may not stop,
    solely because of such activities--
    (1) a construction or leasing project of the Veterans Health
    Administration;
    (2) long term planning regarding infrastructure and assets
    of the Veterans Health Administration; or
    (3) budgetary processes for the Veterans Health
    Administration.

    (c) Recommendations for Future Asset Reviews.--
    <> The Secretary of Veterans Affairs may, after
    consulting with veterans service organizations, include in budget
    submissions the Secretary submits after the termination of the
    Commission recommendations for future such commissions or other capital
    asset realignment and management processes.
    SEC. 209. DEFINITIONS.

    In this subtitle:
    (1) The term ``Account'' means the Department of Veterans
    Affairs Asset and Infrastructure Review Account established by
    section 206(a).
    (2) The term ``Commission'' means the Commission established
    by section 202.
    (3) The term ``date of approval'', with respect to a
    modernization or realignment of a facility of the Veterans
    Health Administration, means the date on which the authority of
    Congress to disapprove a recommendation of modernization or
    realignment, as the case may be, of such facility under this
    subtitle expires.
    (4) The term ``facility of the Veterans Health
    Administration''--
    (A) means any land, building, structure, or
    infrastructure (including any medical center, nursing
    home, domiciliary facility, outpatient clinic, center
    that provides readjustment counseling, or leased
    facility) that is--
    (i) under the jurisdiction of the Department
    of Veterans Affairs;
    (ii) under the control of the Veterans Health
    Administration; and
    (iii) not under the control of the General
    Services Administration; or
    (B) with respect to a colocated facility of the
    Department of Veterans Affairs, includes any land,
    building, or structure--
    (i) under the jurisdiction of the Department
    of Veterans Affairs;
    (ii) under the control of another
    administration of the Department of Veterans
    Affairs; and

    [[Page 1460]]

    (iii) not under the control of the General
    Services Administration.
    (5) The term ``infrastructure'' means improvements to land
    other than buildings or structures.
    (6) The term ``modernization'' includes--
    (A) any action, including closure, required to align
    the form and function of a facility of the Veterans
    Health Administration to the provision of modern day
    health care, including utilities and environmental
    control systems;
    (B) the construction, purchase, lease, or sharing of
    a facility of the Veterans Health Administration; and
    (C) realignments, disposals, exchanges,
    collaborations between the Department of Veterans
    Affairs and other Federal entities, and strategic
    collaborations between the Department and non-Federal
    entities, including tribal organizations.
    (7) The term ``realignment'', with respect to a facility of
    the Veterans Health Administration, includes--
    (A) any action that changes the numbers of or
    relocates services, functions, and personnel positions;
    (B) disposals or exchanges between the Department of
    Veterans Affairs and other Federal entities, including
    the Department of Defense; and
    (C) strategic collaborations between the Department
    of Veterans Affairs and non-Federal entities, including
    tribal organizations.
    (8) The term ``redevelopment authority'', in the case of a
    facility of the Veterans Health Administration closed or
    modernized under this subtitle, means any entity (including an
    entity established by a State or local government) recognized by
    the Secretary of Veterans Affairs as the entity responsible for
    developing the redevelopment plan with respect to the facility
    or for directing the implementation of such plan.
    (9) The term ``redevelopment plan'' in the case of a
    facility of the Veterans Health Administration to be closed or
    realigned under this subtitle, means a plan that--
    (A) is agreed to by the local redevelopment
    authority with respect to the facility; and
    (B) provides for the reuse or redevelopment of the
    real property and personal property of the facility that
    is available for such reuse and redevelopment as a
    result of the closure or realignment of the facility.
    (10) The term ``Secretary'' means the Secretary of Veterans
    Affairs.
    (11) The term ``tribal organization'' has the meaning given
    such term in section 3765 of title 38, United States Code.

    Subtitle B--Other Infrastructure Matters

    SEC. 211. IMPROVEMENT TO TRAINING OF CONSTRUCTION PERSONNEL.

    Subsection (g) of section 8103 of title 38, United States Code, is
    amended to read as follows:
    ``(g)(1)(A) Not later <>  than September 30 of the
    fiscal year following the fiscal year during which the VA Asset and
    Infrastructure

    [[Page 1461]]

    Review Act of 2018 is enacted, the Secretary shall implement the covered
    training curriculum and the covered certification program.

    ``(B) In designing and implementing the covered training curriculum
    and the covered certification program under paragraph (1), the Secretary
    shall use as models existing training curricula and certification
    programs that have been established under chapter 87 of title 10, United
    States Code, as determined relevant by the Secretary.
    ``(2) The Secretary may develop the training curriculum under
    paragraph (1)(A) in a manner that provides such training in any
    combination of--
    ``(A) training provided in person;
    ``(B) training provided over an internet website; or
    ``(C) training provided by another department or agency of
    the Federal Government.

    ``(3) The Secretary may develop the certification program under
    paragraph (1)(A) in a manner that uses--
    ``(A) one level of certification; or
    ``(B) more than one level of certification, as determined
    appropriate by the Secretary with respect to the level of
    certification for different grades of the General Schedule.

    ``(4) <>  The Secretary may enter into a contract
    with an appropriate entity to provide the covered training curriculum
    and the covered certification program under paragraph (1)(A).

    ``(5)(A) Not later than <>  September 30 of the
    second fiscal year following the fiscal year during which the VA Asset
    and Infrastructure Review Act of 2018 is enacted, the Secretary shall
    ensure that the majority of employees subject to the covered
    certification program achieve the certification or the appropriate level
    of certification pursuant to paragraph (3), as the case may be.

    ``(B) After carrying out subparagraph (A), the Secretary shall
    ensure that each employee subject to the covered certification program
    achieves the certification or the appropriate level of certification
    pursuant to paragraph (3), as the case may be, as quickly as
    practicable.
    ``(6) <>  In this subsection:
    ``(A) The term `covered certification program' means, with
    respect to employees of the Department of Veterans Affairs who
    are members of occupational series relating to construction or
    facilities management, or employees of the Department who award
    or administer contracts for major construction, minor
    construction, or nonrecurring maintenance, including as contract
    specialists or contracting officers' representatives, a program
    to certify knowledge and skills relating to construction or
    facilities management and to ensure that such employees maintain
    adequate expertise relating to industry standards and best
    practices for the acquisition of design and construction
    services.
    ``(B) The term `covered training curriculum' means, with
    respect to employees specified in subparagraph (A), a training
    curriculum relating to construction or facilities management.''.
    SEC. 212. REVIEW OF ENHANCED USE LEASES.

    Section 8162(b)(6) is amended to read as follows:
    ``(6) The Office of Management and Budget shall review each
    enhanced-use lease before the lease goes into effect to determine
    whether the lease is in compliance with paragraph (5).''.

    [[Page 1462]]

    SEC. 213. ASSESSMENT OF HEALTH CARE FURNISHED BY THE DEPARTMENT TO
    VETERANS WHO LIVE IN THE PACIFIC
    TERRITORIES.

    (a) In General.--Not <>  later than 180 days after
    the date of the enactment of this Act, the Secretary of Veterans Affairs
    shall submit to the Committees on Veterans' Affairs of the Senate and
    the House of Representatives a report regarding health care furnished by
    the Department of Veterans Affairs to veterans who live in the Pacific
    territories.

    (b) Elements.--The report under subsection (a) shall include
    assessments of the following:
    (1) The ability of the Department to furnish to veterans who
    live in the Pacific territories the following:
    (A) Hospital care.
    (B) Medical services.
    (C) Mental health services.
    (D) Geriatric services.
    (2) The feasibility of establishing a community-based
    outpatient clinic of the Department in any Pacific territory
    that does not contain such a facility.

    (c) Definition.--In this section, the term ``Pacific territories''
    means American Samoa, Guam, and the Northern Mariana Islands.

    TITLE III--IMPROVEMENTS TO RECRUITMENT OF HEALTH CARE PROFESSIONALS

    SEC. 301. DESIGNATED SCHOLARSHIPS FOR PHYSICIANS AND DENTISTS
    UNDER DEPARTMENT OF VETERANS AFFAIRS
    HEALTH PROFESSIONAL SCHOLARSHIP PROGRAM.

    (a) Scholarships for Physicians and Dentists.--Section 7612(b) of
    title 38, United States Code, is amended by adding at the end the
    following new paragraph:
    ``(6)(A) Of the scholarships awarded under this subchapter, the
    Secretary shall ensure that not less than 50 scholarships are awarded
    each year to individuals who are accepted for enrollment or enrolled (as
    described in section 7602 of this title) in a program of education or
    training leading to employment as a physician or dentist until such date
    as the Secretary determines that the staffing shortage of physicians and
    dentists in the Department is less than 500.
    ``(B) After such date, the Secretary shall ensure that of the
    scholarships awarded under this subchapter, a number of scholarships is
    awarded each year to individuals referred to in subparagraph (A) in an
    amount equal to not less than ten percent of the staffing shortage of
    physicians and dentists in the Department, as determined by the
    Secretary.
    ``(C) Notwithstanding subsection (c)(1), the agreement between the
    Secretary and a participant in the Scholarship Program who receives a
    scholarship pursuant to this paragraph shall provide the following:
    ``(i) The Secretary's agreement to provide the participant
    with a scholarship under this subchapter for a specified number
    (from two to four) of school years during which the participant

    [[Page 1463]]

    is pursuing a course of education or training leading to
    employment as a physician or dentist.
    ``(ii) <>  The participant's agreement
    to serve as a full-time employee in the Veterans Health
    Administration for a period of time (hereinafter in this
    subchapter referred to as the `period of obligated service') of
    18 months for each school year or part thereof for which the
    participant was provided a scholarship under the Scholarship
    Program.

    ``(D) In providing scholarships pursuant to this paragraph, the
    Secretary may provide a preference for applicants who are veterans.
    ``(E) <>  On an annual basis, the Secretary
    shall provide to appropriate educational institutions informational
    material about the availability of scholarships under this paragraph.''.

    (b) Breach of Agreement.--Section 7617 of such title is amended--
    (1) by redesignating paragraphs (4) and (5) as paragraphs
    (5) and (6), respectively; and
    (2) by inserting after paragraph (3) the following new
    paragraph (4):
    ``(4) In the case of a participant who is enrolled in a
    program or education or training leading to employment as a
    physician, the participant fails to successfully complete post-
    graduate training leading to eligibility for board certification
    in a specialty.''.

    (c) Extension of Program.--Section 7619 of such title is amended by
    striking ``December 31, 2019'' and inserting ``December 31, 2033''.
    SEC. 302. INCREASE IN MAXIMUM AMOUNT OF DEBT THAT MAY BE REDUCED
    UNDER EDUCATION DEBT REDUCTION PROGRAM OF
    DEPARTMENT OF VETERANS AFFAIRS.

    (a) Increase in Amount.--Section 7683(d)(1) is amended--
    (1) by striking ``$120,000'' and inserting ``$200,000''; and
    (2) by striking ``$24,000'' and inserting ``$40,000''.

    (b) Study.--
    (1) <>  In general.--Not later than 1 year
    after the date of the enactment of this Act, the Secretary of
    Veterans Affairs shall--
    (A) conduct a study on the demand for education debt
    reduction under subchapter VII of chapter 76 of title
    38, United States Code; and
    (B) <>  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 findings of the Secretary with respect to
    the study carried out under subparagraph (A).
    (2) Considerations.--In carrying out the study required by
    paragraph (1)(A), the Secretary shall consider the following:
    (A) The total number of vacancies within the
    Veterans Health Administration whose applicants are
    eligible to participate in the Education Debt Reduction
    Program pursuant to section 7682(a) of such title.
    (B) The types of medical professionals in greatest
    demand in the United States.
    (C) Projections by the Secretary of the numbers and
    types of medical professions that meet the needs of
    veterans.

    [[Page 1464]]

    SEC. 303. ESTABLISHING THE DEPARTMENT OF VETERANS AFFAIRS
    SPECIALTY EDUCATION LOAN REPAYMENT
    PROGRAM.

    (a) In General.--Chapter 76 of title 38, United States Code, is
    amended by inserting <> after subchapter VII
    the following new subchapter:

    ``SUBCHAPTER VIII--SPECIALTY EDUCATION LOAN REPAYMENT PROGRAM

    ``Sec. 7691. <>  Establishment

    ``As part of the Educational Assistance Program, the Secretary may
    carry out a student loan repayment program under section 5379 of title
    5. The program shall be known as the Department of Veterans Affairs
    Specialty Education Loan Repayment Program (in this chapter referred to
    as the `Specialty Education Loan Repayment Program').
    ``Sec. 7692. <>  Purpose

    ``The purpose of the Specialty Education Loan Repayment Program is
    to assist, through the establishment of an incentive program for certain
    individuals employed in the Veterans Health Administration, in meeting
    the staffing needs of the Veterans Health Administration for physicians
    in medical specialties for which the Secretary determines recruitment or
    retention of qualified personnel is difficult.
    ``Sec. 7693. <>  Eligibility; preferences;
    covered costs

    ``(a) Eligibility.--An individual is eligible to participate in the
    Specialty Education Loan Repayment Program if the individual--
    ``(1) is hired under section 7401 of this title to work in
    an occupation described in section 7692 of this title;
    ``(2) owes any amount of principal or interest under a loan,
    the proceeds of which were used by or on behalf of that
    individual to pay costs relating to a course of education or
    training which led to a degree that qualified the individual for
    the position referred to in paragraph (1); and
    ``(3) is--
    ``(A) recently graduated from an accredited medical
    or osteopathic school and matched to an accredited
    residency program in a medical specialty described in
    section 7692 of this title; or
    ``(B) a physician in training in a medical specialty
    described in section 7692 of this title with more than 2
    years remaining in such training.

    ``(b) Preferences.--In selecting individuals for participation in
    the Specialty Education Loan Repayment Program under this subchapter,
    the Secretary may give preference to the following:
    ``(1) Individuals who are, or will be, participating in
    residency programs in health care facilities--
    ``(A) located in rural areas;
    ``(B) operated by Indian tribes, tribal
    organizations, or the Indian Health Service; or
    ``(C) affiliated with underserved health care
    facilities of the Department.
    ``(2) Veterans.

    [[Page 1465]]

    ``(c) Covered Costs.--For purposes of subsection (a)(2), costs
    relating to a course of education or training include--
    ``(1) tuition expenses;
    ``(2) all other reasonable educational expenses, including
    expenses for fees, books, equipment, and laboratory expenses;
    and
    ``(3) reasonable living expenses.
    ``Sec. 7694. <>  Specialty education loan
    repayment

    ``(a) In General.--Payments under the Specialty Education Loan
    Repayment Program shall consist of payments for the principal and
    interest on loans described in section 7682(a)(2) of this title for
    individuals selected to participate in the Program to the holders of
    such loans.
    ``(b) Frequency of Payment.--The Secretary shall make payments for
    any given participant in the Specialty Education Loan Repayment Program
    on a schedule determined appropriate by the Secretary.
    ``(c) <>  Maximum Amount; Waiver.--(1) The
    amount of payments made for a participant under the Specialty Education
    Loan Repayment Program may not exceed $160,000 over a total of 4 years
    of participation in the Program, of which not more than $40,000 of such
    payments may be made in each year of participation in the Program.

    ``(2)(A) <>  The Secretary may waive the
    limitations under paragraph (1) in the case of a participant described
    in subparagraph (B). In the case of such a waiver, the total amount of
    payments payable to or for that participant is the total amount of the
    principal and the interest on the participant's loans referred to in
    subsection (a).

    ``(B) A participant described in this subparagraph is a participant
    in the Program who the Secretary determines serves in a position for
    which there is a shortage of qualified employees by reason of either the
    location or the requirements of the position.
    ``Sec. 7695. <>  Choice of location

    ``Each participant in the Specialty Education Loan Repayment Program
    who completes residency may select, from a list of medical facilities of
    the Veterans Health Administration provided by the Secretary, at which
    such facility the participant will work in a medical specialty described
    in section 7692 of this title.
    ``Sec. 7696. <>  Term of obligated service

    ``(a) In General.--In addition to any requirements under section
    5379(c) of title 5, a participant in the Specialty Education Loan
    Repayment Program must agree, in writing and before the Secretary may
    make any payment to or for the participant, to--
    ``(1) obtain a license to practice medicine in a State;
    ``(2) successfully complete post-graduate training leading
    to eligibility for board certification in a specialty;
    ``(3) <>  serve as a full-time clinical
    practice employee of the Veterans Health Administration for 12
    months for every $40,000 in such benefits that the employee
    receives, but in no case for fewer than 24 months; and
    ``(4) except as provided in subsection (b), to begin such
    service as a full-time practice employee
    by <> not later than 60 days after completing a
    residency.

    [[Page 1466]]

    ``(b) <> Fellowship.--In the case of a participant
    who receives an accredited fellowship in a medical specialty other than
    a medical specialty described in section 7692 of this title, the
    Secretary, on written request of the participant, may delay the term of
    obligated service under subsection (a) for the participant until after
    the participant completes the fellowship, but in no case later than 60
    days after completion of such fellowship.

    ``(c) Penalty.--(1) An employee who does not complete a period of
    obligated service under this section shall owe the Federal Government an
    amount determined in accordance with the following formula: A = B
     ((T - S)  T)).
    ``(2) In the formula in paragraph (1):
    ``(A) `A' is the amount the employee owes the Federal
    Government.
    ``(B) `B' is the sum of all payments to or for the
    participant under the Specialty Education Loan Repayment
    Program.
    ``(C) `T' is the number of months in the period of obligated
    service of the employee.
    ``(D) `S' is the number of whole months of such period of
    obligated service served by the employee.
    ``Sec. 7697. <>  Relationship to Educational
    Assistance Program

    ``Assistance under the Specialty Education Loan Repayment Program
    may be in addition to other assistance available to individuals under
    the Educational Assistance Program.''.
    (b) Conforming and Technical Amendments.--
    (1) Conforming amendments.--
    (A) Section 7601(a) of title 38, United States Code,
    is amended--
    (i) in paragraph (4), by striking ``and'';
    (ii) in paragraph (5), by striking the period
    and inserting ``; and''; and
    (iii) by adding at the end the following new
    paragraph:
    ``(6) the specialty education loan repayment program
    provided for in subchapter VIII of this chapter.''.
    (B) Section 7603(a)(1) of title 38, United States
    Code, is amended by striking ``or VI'' and inserting
    ``VI, or VIII''.
    (C) Section 7604 of title 38, United States Code, is
    amended by striking ``or VI'' each place it appears and
    inserting ``VI, or VIII''.
    (D) Section 7631 of title 38, United States Code, is
    amended--
    (i) in subsection (a)(1)--
    (I) by striking ``and'' after
    ``scholarship amount,''; and
    (II) by inserting ``, and the
    maximum specialty education loan
    repayment amount'' after ``reduction
    payments amount''; and
    (ii) in subsection (b) by adding at the end
    the following new paragraph:

    ``(7) <>  The term `specialty education loan
    repayment amount' means the maximum amount of specialty education loan
    repayment payments payable to or for a participant in the Department of
    Veterans Affairs Specialty Education Loan Repayment Program under
    subchapter VIII of this chapter, as specified in section

    [[Page 1467]]

    7694(c)(1) of this title and as previously adjusted (if at all) in
    accordance with this section.''.
    (E) Section 7632 of title 38, United States Code, is
    amended--
    (i) in paragraph (1), by striking ``and the
    Education Debt Reduction Program'' and inserting
    ``the Education Debt Reduction Program, and the
    Specialty Education Loan Repayment Program''; and
    (ii) in paragraph (4), by striking ``and per
    participant in the Education Debt Reduction
    Program'' and inserting ``per participant in the
    Education Debt Reduction Program, and per
    participant in the Specialty Education Loan
    Repayment Program''.
    (2) Table of sections.--The table of sections at the
    beginning of chapter 76 of such title is <>  amended by inserting after the items relating to
    subchapter VII the following:

    ``subchapter viii--specialty education loan repayment program

    ``7691. Establishment.
    ``7692. Purpose.
    ``7693.  Eligibility; preferences; covered costs.
    ``7694. Specialty education loan repayment.
    ``7695. Choice of location.
    ``7696. Term of obligated service.
    ``7697. Relationship to Educational Assistance Program.''.

    (c) <> Needs of the VHA.--In making
    determinations each year under section 7692 of title 38, United States
    Code, as enacted by subsection (a), the Secretary of Veterans Affairs
    shall consider the anticipated needs of the Veterans Health
    Administration during the period 2 to 6 years in the future.

    (d) <> Preference.--In granting preference
    under section 7693 of title 38, United States Code, as enacted by
    subsection (a), the Secretary of Veterans Affairs shall determine
    whether a facility of the Department is underserved based on the
    criteria developed under section 401 of this Act.

    (e) <>  Offer Deadline.--In the case of an
    applicant who applies before receiving a residency match and whom the
    Secretary of Veterans Affairs selects for participation in the Specialty
    Education Loan Repayment Program established by subsection (a), the
    Secretary shall offer participation to the applicant not later than 28
    days after--
    (1) the applicant matches with a residency in a medical
    specialty described in section 7692 of title 38, United States
    Code, as enacted by subsection (a); and
    (2) such match is published.

    (f) <>  Publicity.--The Secretary of
    Veterans Affairs shall take such steps as the Secretary determines are
    appropriate to publicize the Specialty Education Loan Repayment Program
    established under subchapter VIII of chapter 76 of title 38, United
    States Code, as enacted by subsection (a).
    SEC. 304. <>  VETERANS HEALING VETERANS
    MEDICAL ACCESS AND SCHOLARSHIP PROGRAM.

    (a) Establishment.--The Secretary of Veterans Affairs, acting
    through the Office of Academic Affiliations of the Department of
    Veterans Affairs, shall carry out a pilot program under which the
    Secretary shall provide funding for the medical education of a total of
    18 eligible veterans. Such funding shall be provided

    [[Page 1468]]

    for two veterans enrolled in each covered medical schools in accordance
    with this section.
    (b) Eligible Veterans.--To be eligible to receive funding for
    medical education under this section, a veteran shall--
    (1) <> have been discharged from the
    Armed Forces not more than 10 years before the date of
    application for admission to a covered medical school;
    (2) not be entitled to educational assistance under chapter
    30, 31, 32, 33, 34, or 35 of title 38, United States Code, or
    chapter 1606 or 1607 of title 10, United States Code;
    (3) apply for admission to a covered medical school for the
    entering class of 2019;
    (4) indicate on such application for admission that the
    veteran would like to be considered for an award of funding
    under this section;
    (5) meet the minimum admissions criteria for the covered
    medical school to which the veteran applies; and
    (6) enter into an agreement described in subsection (e).

    (c) Award of Funding.--
    (1) In general.--Each covered medical school that opts to
    participate in the program under this section shall reserve two
    seats in the entering class of 2019 for eligible veterans who
    receive funding under such program. Such funding shall be
    awarded to the two eligible veterans with the highest admissions
    rankings for such class at such school.
    (2) Amount of funding.--Each eligible veteran who receives
    funding under this section shall receive an amount equal to the
    actual cost of--
    (A) tuition at the covered medical school at which
    the veteran enrolls for 4 years;
    (B) books, fees, and technical equipment;
    (C) fees associated with the National Residency
    Match Program;
    (D) two away rotations performed during the fourth
    year at a Department of Veterans Affairs medical
    facility; and
    (E) a monthly stipend for the 4-year period during
    which the veteran is enrolled in medical school in an
    amount to be determined by the Secretary.
    (3) Distribution of funding.--In the event that two or more
    eligible veterans do not apply for admission at one of the
    covered medical schools for the entering class of 2019, the
    Secretary shall distribute the available funding to eligible
    veterans who applied for admission at other covered medical
    schools.

    (d) Agreement.--
    (1) Terms of agreement.--Each eligible veteran who accepts
    funding for medical education under this section shall enter
    into an agreement with the Secretary that provides that the
    veteran agrees--
    (A) to maintain enrollment and attendance in the
    medical school;
    (B) while enrolled in such medical school, to
    maintain an acceptable level of academic standing (as
    determined by the medical school under regulations
    prescribed by the Secretary);

    [[Page 1469]]

    (C) to complete post-graduate training leading to
    eligibility for board certification in a speciality
    applicable to the Department of Veterans Affairs, as
    determined by the Secretary;
    (D) after completion of medical school, to obtain a
    license to practice medicine in a State; and
    (E) <>  after completion of
    medical school and post-graduate training, to serve as a
    full-time clinical practice employee in the Veterans
    Health Administration for a period of 4 years.
    (2) <>  Breach of agreement.--If an
    eligible veteran who accepts funding under this section breaches
    the terms of the agreement described in paragraph (1), the
    United States shall be entitled to recover damages in an amount
    equal to the total amount of such funding received by the
    veteran.

    (e) Rule of Construction.--Nothing in this section shall be
    construed to prevent any covered medical school from accepting more than
    two eligible veterans for the entering class of 2019.
    (f) Report to Congress.--Not later than December 31, 2020, and
    annually thereafter for the subsequent 3 years, the Secretary shall
    submit to Congress a report on the pilot program under this
    section. <> Such report shall include the evaluation
    of the Secretary of the success of the pilot program, including the
    number of veterans who received funding under the program who
    matriculated and an evaluation of the academic progress of such
    veterans.

    (g) <>  Covered Medical Schools.--In this
    section, the term ``covered medical school'' means any of the following:
    (1) The Teague-Cranston medical schools, consisting of--
    (A) Texas A&M College of Medicine;
    (B) Quillen College of Medicine at East Tennessee
    State University;
    (C) Boonshoft School of Medicine at Wright State
    University;
    (D) Joan C. Edwards School of Medicine at Marshall
    University; and
    (E) University of South Carolina School of Medicine.
    (2) Charles R Drew University of Medicine and Science.
    (3) Howard University College of Medicine.
    (4) Meharry Medical College.
    (5) Morehouse School of Medicine.
    SEC. 305. BONUSES FOR RECRUITMENT, RELOCATION, AND RETENTION.

    Section 705(a) of the Veterans Access, Choice, and Accountability
    Act of 2014 (Public Law 113-146; 38 U.S.C. 703 note) is amended--
    (1) in paragraph (1), by striking ``$230,000,000'' and
    inserting ``$250,000,000, of which not less than $20,000,000
    shall be for recruitment, relocation, and retention bonuses'';
    and
    (2) in paragraph (2), by striking ``$225,000,000'' and
    inserting ``$290,000,000, of which not less than $20,000,000
    shall be for recruitment, relocation, and retention bonuses''.

    [[Page 1470]]

    SEC. 306. <>  INCLUSION OF VET CENTER
    EMPLOYEES IN EDUCATION DEBT REDUCTION
    PROGRAM OF DEPARTMENT OF VETERANS AFFAIRS.

    (a) In General.--The Secretary of Veterans Affairs shall ensure that
    clinical staff working at Vet Centers are eligible to participate in the
    Education Debt Reduction Program of the Department of Veterans Affairs
    under subchapter VII of chapter 76 of title 38, United States Code.
    (b) Report.--Not later than 1 year after the date of the enactment
    of this Act, 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 number of participants in the
    Education Debt Reduction Program of the Department under such subchapter
    who work at Vet Centers.
    (c) Vet Center Defined.--In this section, the term ``Vet Center''
    has the meaning given that term in section 1712A(h) of title 38, United
    States Code.

    TITLE IV--HEALTH CARE IN UNDERSERVED AREAS

    SEC. 401. <> DEVELOPMENT OF CRITERIA FOR
    DESIGNATION OF CERTAIN MEDICAL FACILITIES
    OF THE DEPARTMENT OF VETERANS AFFAIRS AS
    UNDERSERVED FACILITIES AND PLAN TO ADDRESS
    PROBLEM OF UNDERSERVED FACILITIES.

    (a) <>  In General.--Not later than 180 days after
    the date of the enactment of this Act, the Secretary of Veterans Affairs
    shall develop criteria to designate medical centers, ambulatory care
    facilities, and community based outpatient clinics of the Department of
    Veterans Affairs as underserved facilities.

    (b) Consideration.--Criteria developed under subsection (a) shall
    include consideration of the following with respect to a facility:
    (1) The ratio of veterans to health care providers of the
    Department of Veterans Affairs for a standardized geographic
    area surrounding the facility, including a separate ratio for
    general practitioners and specialists.
    (2) The range of clinical specialties covered by such
    providers in such area.
    (3) Whether the local community is medically underserved.
    (4) The type, number, and age of open consults.
    (5) Whether the facility is meeting the wait-time goals of
    the Department.
    (6) Such other criteria as the Secretary considers important
    in determining which facilities are not adequately serving area
    veterans.

    (c) Analysis of Facilities <> .--Not less
    frequently than annually, directors of Veterans Integrated Service
    Networks of the Department shall perform an analysis to determine which
    facilities within that Veterans Integrated Service Network qualify as
    underserved facilities pursuant to criteria developed under subsection
    (a).

    (d) Annual Plan To Address Underserved Facilities.--
    (1) Plan required <> .--Not later than 1
    year after the date of the enactment of this Act and not less
    frequently than once each year, the Secretary shall submit to
    Congress a plan

    [[Page 1471]]

    to address the problem of underserved facilities of the
    Department, as designated pursuant to criteria developed under
    subsection (a).
    (2) Contents.--Each plan submitted under paragraph (1) shall
    address the following:
    (A) Increasing personnel or temporary personnel
    assistance, including mobile deployment teams furnished
    under section 407 of this Act.
    (B) Providing special hiring incentives, including
    under the Education Debt Reduction Program under
    subchapter VII of chapter 76 of title 38, United States
    Code, and recruitment, relocation, and retention
    incentives.
    (C) Using direct hiring authority.
    (D) Improving training opportunities for staff.
    (E) Such other actions as the Secretary considers
    appropriate.
    SEC. 402. <>  PILOT PROGRAM TO FURNISH
    MOBILE DEPLOYMENT TEAMS TO UNDERSERVED
    FACILITIES.

    (a) In General.--The Secretary of Veterans Affairs shall carry out a
    pilot program to furnish mobile deployment teams of medical personnel to
    underserved facilities.
    (b) Elements.--In furnishing mobile deployment teams under
    subsection (a), the Secretary shall consider the following elements:
    (1) The medical positions of greatest need at underserved
    facilities.
    (2) The size and composition of teams to be deployed.
    (3) Such other elements as the Secretary considers necessary
    for effective oversight of the program established under
    subsection (a).

    (c) Use of Annual Analysis.--The Secretary shall use the results of
    the annual analysis conducted under section 401(c) of this Act to form
    mobile deployment teams under subsection (a) that are composed of the
    most needed medical personnel for underserved facilities.
    (d) Reporting.--
    (1) Progress report.--Not later than 1 year after the date
    of the enactment of this Act, the Secretary shall submit a
    report to Congress on the implementation of the pilot program
    under this section.
    (2) <>  Final report.--Not later
    than the termination of the pilot program under this section,
    the Secretary shall submit a final report to Congress that
    contains the recommendations of the Secretary regarding the
    feasibility and advisability of--
    (A) extending or expanding the pilot program; and
    (B) making the pilot program (or any aspect thereof)
    permanent.

    (e) Duration.--The pilot program under this section shall terminate
    3 years after the date of the enactment of this Act.
    (f) Underserved Facility Defined.--In this section, the term
    ``underserved facility'' means a medical center, ambulatory care
    facility, or community based outpatient clinic of the Department of
    Veterans Affairs designated by the Secretary of Veterans Affairs as
    underserved pursuant to criteria developed under section 401 of this
    Act.

    [[Page 1472]]

    SEC. 403. <>  PILOT PROGRAM ON GRADUATE
    MEDICAL EDUCATION AND RESIDENCY.

    (a) Establishment.--
    (1) In general.--Subject to paragraph (5), the Secretary of
    Veterans Affairs shall establish a pilot program to establish
    medical residency positions authorized under section 301(b)(2)
    of the Veterans Access, Choice, and Accountability Act of 2014
    (Public Law 113-146; 38 U.S.C. 7302 note) at covered facilities.
    (2) Covered facilities.--For purposes of this section, a
    covered facility is any of the following:
    (A) A health care facility of the Department of
    Veterans Affairs.
    (B) A health care facility operated by an Indian
    tribe or a tribal organization, as those terms are
    defined in section 4 of the Indian Self-Determination
    and Education Assistance Act (25 U.S.C. 5304).
    (C) A health care facility operated by the Indian
    Health Service.
    (D) A 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)).
    (E) A health care facility operated by the
    Department of Defense.
    (F) Such other health care facility as the Secretary
    considers appropriate for purposes of this section.
    (3) Agreements.--To carry out the pilot program under this
    section, the Secretary may enter into agreements with entities
    that operate covered facilities in which the Secretary places
    residents under paragraph (1).
    (4) Parameters for location, affiliate sponsor, and
    duration.--When determining in which covered facilities to place
    residents under paragraph (1), the Secretary shall consider the
    extent to which there is a clinical need for providers in an
    area, as determined by the following:
    (A) The ratio of veterans to health care providers
    of the Department for a standardized geographic area
    surrounding a facility, including a separate ratio for
    general practitioners and specialists.
    (B) The range of clinical specialties of providers
    in standardized geographic areas surrounding a facility.
    (C) Whether the specialty of a provider is included
    in the most recent staffing shortage determination of
    the Department under section 7412 of title 38, United
    States Code.
    (D) Whether the local community is designated by the
    Secretary of Veterans Affairs as underserved pursuant to
    criteria developed under section 401 of this Act.
    (E) Whether the facility is located in a community
    that is designated by the Secretary of Health and Human
    Services as a health professional shortage area under
    section 332 of the Public Health Service Act (42 U.S.C.
    254e).
    (F) Whether the facility is located in a rural or
    remote area.
    (G) Such other criteria as the Secretary considers
    important in determining which facilities are not
    adequately serving area veterans.

    [[Page 1473]]

    (5) Priority in placements.--During the pilot program under
    this section, the Secretary shall place no fewer than 100
    residents in covered facilities--
    (A) operated by the Indian Health Service;
    (B) operated by an Indian tribe;
    (C) operated by a tribal organization; or
    (D) located in communities designated by the
    Secretary as underserved pursuant to criteria developed
    under section 401 of this Act.
    (6) Stipends and benefits.--The Secretary may pay stipends
    and provide benefits for residents in positions under paragraph
    (1), regardless of whether they have been assigned in a
    Department facility.

    (b) Reimbursement.--If a covered facility establishes a new
    residency program in which the Secretary places a resident under the
    pilot program, the Secretary shall reimburse that covered facility for
    costs of the following:
    (1) Curriculum development.
    (2) Recruitment and retention of faculty.
    (3) Accreditation of the program by the Accreditation
    Council for Graduate Medical Education.
    (4) The portion of faculty salaries attributable to duties
    under an agreement subsection (a)(3).
    (5) Expenses relating to educating a resident under the
    pilot program.

    (c) Reporting.--
    (1) In general.--Not later than 1 year after the date of the
    enactment of this Act and not less frequently than once each
    year thereafter until the termination of the pilot program, the
    Secretary shall submit to Congress a report on the
    implementation of the pilot program.
    (2) Elements.--Each report submitted under paragraph (1)
    shall include the following with regard to the immediately
    preceding year, and in comparison to the year immediately
    preceding that year:
    (A) The number of veterans who received care from
    residents under the pilot program.
    (B) The number of veterans who received care from
    each resident per position described in subsection
    (a)(1) under the pilot program.
    (C) The number of veterans who received care from
    residents under the pilot program expressed as a
    percentage of all individuals who received care from
    such residents.
    (D) The number of clinical appointments for veterans
    conducted by each resident under the pilot program.
    (E) The number of clinical appointments for veterans
    conducted by residents per position described in
    subsection (a)(1) under the pilot program.
    (F) The number of clinical appointments for veterans
    expressed as a percentage of all clinical appointments
    conducted by residents under the pilot program.
    (G) The number of positions described in subsection
    (a)(1) at each covered facility under the pilot program.
    (H) For each position described in subsection (a)(1)
    in a residency program affiliated with a health care
    facility of the Department, the time a resident under
    the pilot program spent training at that facility of the
    Department,

    [[Page 1474]]

    expressed as a percentage of the total training time for
    that resident position.
    (I) For each residency program affiliated with a
    health care facility of the Department, the time all
    residents under the pilot program spent training at that
    facility of the Department, expressed as a percentage of
    the total training time for those residents.
    (J) The time that all residents under the pilot
    program who are assigned to programs affiliated with
    health care facilities of the Department spent training
    at facilities of the Department, expressed as a
    percentage of the total training time for those
    residents.
    (K) The cost to the Department of Veterans Affairs
    under the pilot program in the year immediately
    preceding the report and since the beginning of the
    pilot program.
    (L) The cost to the Department of Veterans Affairs
    per resident placed under the pilot program at each
    covered facility.
    (M) The number of residents under the pilot program
    hired by the Secretary to work in the Veterans Health
    Administration after completion of residency in the year
    immediately preceding the report and since the beginning
    of the pilot program.
    (N) The medical specialties pursued by residents
    under the pilot program.

    (d) Duration.--The pilot program under this section shall terminate
    on August 7, 2024.

    TITLE V--OTHER MATTERS

    SEC. 501. ANNUAL REPORT ON PERFORMANCE AWARDS AND BONUSES AWARDED
    TO CERTAIN HIGH-LEVEL EMPLOYEES OF THE
    DEPARTMENT.

    (a) In General.--Chapter 7 of title 38, United States Code, is
    amended by adding at the end the following new section:
    ``Sec. 726. <>  Annual report on performance
    awards and bonuses awarded to certain high-level
    employees

    ``(a) In General.--Not later than 100 days after the end of each
    fiscal year, the Secretary shall submit to the appropriate committees of
    Congress a report that contains, for the most recent fiscal year ending
    before the submittal of the report, a description of all performance
    awards or bonuses awarded to each of the following:
    ``(1) Regional Office Director of the Department.
    ``(2) Director of a Medical Center of the Department.
    ``(3) Director of a Veterans Integrated Service Network.
    ``(4) Senior executive of the Department.

    ``(b) Elements.--Each report submitted under subsection (a) shall
    include the following with respect to each performance award or bonus
    awarded to an individual described in such subsection:
    ``(1) The amount of each award or bonus.
    ``(2) The job title of the individual awarded the award or
    bonus.
    ``(3) The location where the individual awarded the award or
    bonus works.

    [[Page 1475]]

    ``(c) Definitions.--In this section:
    ``(1) The term `appropriate committees of Congress' means
    the Committees on Veterans' Affairs and Appropriations of the
    Senate and House of Representatives.
    ``(2) The term `senior executive' means--
    ``(A) a career appointee; or
    ``(B) an individual--
    ``(i) in an administrative or executive
    position; and
    ``(ii) appointed under section 7306(a) or
    section 7401(1) of this title.
    ``(3) The term `career appointee' has the meaning given that
    term in section 3132(a) of title 5, United States Code.''.

    (b) Clerical Amendment.--The table of sections at the beginning of
    such chapter is <>  amended by inserting after
    the item relating to section 725 the following new item:

    ``726. Annual report on performance awards and bonuses awarded to
    certain high-level employees.''.

    SEC. 502. ROLE OF PODIATRISTS IN DEPARTMENT OF VETERANS AFFAIRS.

    (a) Inclusion as Physician.--
    (1) In general.--Subchapter I of chapter 74 is amended by
    adding at the end the following new section:
    ``Sec. 7413. <>  Treatment of podiatrists;
    clinical oversight standards

    ``(a) Podiatrists.--Except as provided by subsection (b), a doctor
    of podiatric medicine who is appointed as a podiatrist under section
    7401(1) of this title is eligible for any supervisory position in the
    Veterans Health Administration to the same degree that a physician
    appointed under such section is eligible for the position.
    ``(b) Establishment of Clinical Oversight
    Standards. <> --The Secretary, in consultation with
    appropriate stakeholders, shall establish standards to ensure that
    specialists appointed in the Veterans Health Administration to
    supervisory positions do not provide direct clinical oversight for
    purposes of peer review or practice evaluation for providers of other
    clinical specialties.''.
    (2) Clerical amendment.--The table of sections at the
    beginning of chapter 74 is <>  amended
    by inserting after the item relating to section 7412 the
    following new item:

    ``7413. Treatment of podiatrists; clinical oversight standards.''.

    (b) Modification and Clarification of Pay Grade.--
    (1) Grade.--The list in section 7404(b) of such title is
    amended--
    (A) by striking ``PHYSICIAN AND DENTIST SCHEDULE''
    and inserting ``PHYSICIAN AND SURGEON (MD/DO), PODIATRIC
    SURGEON (DPM), AND DENTIST AND ORAL SURGEON (DDS, DMD)
    SCHEDULE'';
    (B) by striking ``Physician grade'' and inserting
    ``Physician and surgeon grade''; and
    (C) by striking ``PODIATRIST, CHIROPRACTOR, AND''
    and inserting ``CHIROPRACTOR AND''.
    (2) <>  Application.--
    The amendments made by paragraph (1) shall apply with respect to
    a pay period of the Department of Veterans Affairs beginning on
    or after the date that is 30 days after the date of the
    enactment of this Act.

    [[Page 1476]]

    SEC. 503. DEFINITION OF MAJOR MEDICAL FACILITY PROJECT.

    (a) Modification of Definition of Medical Facility.--Section 8101(3)
    is amended by striking ``Secretary'' and all that follows through
    ``nursing home,'' and inserting ``Secretary, or as otherwise authorized
    by law, for the provision of health-care services (including hospital,
    outpatient clinic, nursing home,''.
    (b) Modification of Definition of Major Medical Facility Project.--
    Paragraph (3) of section 8104(a) is amended to read as follows:
    ``(3) For purposes of this subsection, the term `major medical
    facility project' means a project for the construction, alteration, or
    acquisition of a medical facility involving a total expenditure of more
    than $20,000,000, but such term does not include an acquisition by
    exchange, nonrecurring maintenance projects of the Department, or the
    construction, alteration, or acquisition of a shared Federal medical
    facility for which the Department's estimated share of the project costs
    does not exceed $20,000,000.''.
    SEC. 504. AUTHORIZATION OF CERTAIN MAJOR MEDICAL FACILITY PROJECTS
    OF THE DEPARTMENT OF VETERANS AFFAIRS.

    (a) Authorization.-- <> The Secretary of Veterans
    Affairs may carry out the following major medical facility project, to
    be carried out in an amount not to exceed the amount specified for that
    project: Construction of the new East Bay Community Based Outpatient
    Clinic and all associated site work, utilities, parking, and
    landscaping, construction of the Central Valley Engineering and
    Logistics support facility, and enhanced flood plain mitigation at the
    Central Valley and East Bay Community Based Outpatient Clinics as part
    of the realignment of medical facilities in Livermore, California, in an
    amount not to exceed $117,300,000.

    (b) Authorization of Appropriations for Construction.--There is
    authorized to be appropriated to the Secretary of Veterans Affairs for
    fiscal year 2018 or the year in which funds are appropriated for the
    Construction, Major Projects account, $117,300,000 for the project
    authorized in subsection (a).
    (c) <> Submittal of Information.--Not later than 90
    days after the date of the enactment of this Act, for the project
    authorized in subsection (a), 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 the
    following information:
    (1) A line item accounting of expenditures relating to
    construction management carried out by the Department of
    Veterans Affairs for such project.
    (2) The future amounts that are budgeted to be obligated for
    construction management carried out by the Department for such
    project.
    (3) A justification for the expenditures described in
    paragraph (1) and the future amounts described in paragraph (2).
    (4) Any agreement entered into by the Secretary regarding a
    non-Department of Veterans Affairs Federal entity providing
    management services relating to such project, including
    reimbursement agreements and the costs to the Department for
    such services.

    [[Page 1477]]

    SEC. 505. <>  DEPARTMENT OF VETERANS
    AFFAIRS PERSONNEL TRANSPARENCY.

    (a) Publication of Staffing and Vacancies.--
    (1) <>  Website required.--Subject to
    paragraph (2) and not later than 90 days after the date of the
    enactment of this Act, the Secretary of Veterans Affairs shall
    make publicly available on an Internet website of the Department
    of Veterans Affairs the following information, which shall,
    subject to subparagraph (D), be displayed by departmental
    component or, in the case of information relating to Veterans
    Health Administration positions, by medical facility:
    (A) The number of personnel encumbering positions.
    (B) The number of accessions and separation actions
    processed during the quarter preceding the date of the
    publication of the information.
    (C) The number of vacancies, by occupation.
    (D) The percentage of new hires for the Department
    who were hired within the time-to-hire target of the
    Office of Personnel Management, disaggregated by
    administration.
    (2) Exceptions.--The Secretary may withhold from publication
    under paragraph (1) information relating to law enforcement,
    information security, or such positions in the Department that
    the Secretary determines to be sensitive.
    (3) Update of information.--The Secretary shall update the
    information on the website required under paragraph (1) on a
    quarterly basis.
    (4) Treatment of contractor positions.--Any Department of
    Veterans Affairs position that is filled with a contractor may
    not be treated as a Department position for purposes of the
    information required to be published under paragraph (1).
    (5) <> Inspector general review.--On a
    semi-annual basis, the Inspector General of the Department shall
    review the administration of the website required under
    paragraph (1) and make recommendations relating to the
    improvement of such administration.

    (b) Report to Congress.--The Secretary of Veterans Affairs shall
    submit to Congress an annual report on the steps the Department is
    taking to achieve full staffing capacity. Each such report shall include
    the amount of additional funds necessary to enable the Department to
    reach full staffing capacity.
    SEC. 506. <>  PROGRAM ON ESTABLISHMENT OF
    PEER SPECIALISTS IN PATIENT ALIGNED CARE
    TEAM SETTINGS WITHIN MEDICAL CENTERS OF
    DEPARTMENT OF VETERANS AFFAIRS.

    (a) Program Required.--The Secretary of Veterans Affairs shall carry
    out a program to establish not fewer than two peer specialists in
    patient aligned care teams at medical centers of the Department of
    Veterans Affairs to promote the use and integration of services for
    mental health, substance use disorder, and behavioral health in a
    primary care setting.
    (b) <>  Timeframe for Establishment of Program.--
    The Secretary shall carry out the program at medical centers of the
    Department as follows:
    (1) Not later than May 31, 2019, at not fewer than 15
    medical centers of the Department.

    [[Page 1478]]

    (2) Not later than May 31, 2020, at not fewer than 30
    medical centers of the Department.

    (c) Selection of Locations.--
    (1) In general.--The Secretary shall select medical centers
    for the program as follows:
    (A) Not fewer than five shall be medical centers of
    the Department that are designated by the Secretary as
    polytrauma centers.
    (B) Not fewer than 10 shall be medical centers of
    the Department that are not designated by the Secretary
    as polytrauma centers.
    (2) Considerations.--In selecting medical centers for the
    program under paragraph (1), the Secretary shall consider the
    feasibility and advisability of selecting medical centers in the
    following areas:
    (A) Rural areas and other areas that are underserved
    by the Department.
    (B) Areas that are not in close proximity to an
    active duty military installation.
    (C) Areas representing different geographic
    locations, such as census tracts established by the
    Bureau of the Census.

    (d) Gender-Specific Services.--In carrying out the program at each
    location selected under subsection (c), the Secretary shall ensure
    that--
    (1) the needs of female veterans are specifically considered
    and addressed; and
    (2) female peer specialists are made available to female
    veterans who are treated at each location.

    (e) Engagement With Community Providers.--At each location selected
    under subsection (c), the Secretary shall consider ways in which peer
    specialists can conduct outreach to health care providers in the
    community who are known to be serving veterans to engage with those
    providers and veterans served by those providers.
    (f) Reports.--
    (1) Periodic reports.--
    (A) In general.--Not later than 180 days after the
    date of the enactment of this Act, and not less
    frequently than once every 180 days thereafter until the
    Secretary determines that the program is being carried
    out at the last location to be selected under subsection
    (c), the Secretary shall submit to Congress a report on
    the program.
    (B) <>  Elements.--Each report
    required by subparagraph (A) shall, with respect to the
    180-day period preceding the submittal of the report,
    include the following:
    (i) The findings and conclusions of the
    Secretary with respect to the program.
    (ii) An assessment of the benefits of the
    program to veterans and family members of
    veterans.
    (iii) An assessment of the effectiveness of
    peer specialists in engaging under subsection (e)
    with health care providers in the community and
    veterans served by those providers.
    (2) <>  Final report.--Not later
    than 180 days after the Secretary determines that the program is
    being carried out at

    [[Page 1479]]

    the last location to be selected under subsection (c), the
    Secretary shall submit to Congress a report detailing the
    recommendations of the Secretary as to the feasibility and
    advisability of expanding the program to additional locations.
    SEC. 507. <>  DEPARTMENT OF VETERANS
    AFFAIRS MEDICAL SCRIBE PILOT PROGRAM.

    (a) <> In General.--The Secretary of Veterans
    Affairs shall carry out a 2-year pilot program under which the Secretary
    shall increase the use of medical scribes at Department of Veterans
    Affairs medical centers.

    (b) Locations.--The Secretary shall carry out the pilot program at
    the 10 medical centers of the Department as follows:
    (1) At least four such medical centers located in rural
    areas.
    (2) At least four such medical centers located in urban
    areas.
    (3) Two such medical centers located in areas with need for
    increased access or increased efficiency, as determine by the
    Secretary.

    (c) Medical Scribes.--
    (1) Hiring.--Under the pilot program the Secretary shall--
    (A) hire 20 new Department of Veterans Affairs term
    employees as medical scribes; and
    (B) seek to enter into contracts with appropriate
    entities for the employment of 20 additional medical
    scribes.
    (2) Distribution.--The Secretary shall assign four medical
    scribes to each of the 10 medical centers of the Department
    where the Secretary carries out the pilot program as follows:
    (A) Two scribes shall be assigned to each of two
    physicians.
    (B) Thirty percent of the scribes shall be employed
    in the provision of emergency care.
    (C) Seventy percent of the scribes shall be employed
    in the provision of speciality care in specialties with
    the longest patient wait times or lowest efficiency
    ratings, as determined by the Secretary.

    (d) Reports.--
    (1) Reports to congress.--Not later than 180 days after the
    commencement of the pilot program required under this section,
    and every 180 days thereafter for the duration of the pilot
    program, the Secretary of Veterans Affairs shall submit to
    Congress a report on the pilot program. Each such report shall
    include each of the following:
    (A) <>  A separate analysis of each
    the following with respect to medical scribes employed
    by the Department of Veterans Affairs and medical
    scribes performing Department of Veterans Affairs
    functions under a contract:
    (i) Provider efficiency.
    (ii) Patient satisfaction.
    (iii) Average wait time.
    (iv) The number of patients seen per day by
    each physician or practitioner.
    (v) The amount of time required to hire and
    train an employee to perform medical scribe
    functions under the pilot program.

    [[Page 1480]]

    (B) <>  Metrics and data
    for analyzing the effects of the pilot program,
    including an evaluation of the each of the elements
    under clauses (i) through (iv) of subparagraph (A) at
    medical centers who employed scribes under the pilot
    program for an appropriate period preceding the hiring
    of such scribes.
    (2) Comptroller general report.--Not later than 90 days
    after the termination of the pilot program under this section,
    the Comptroller General of the United States shall submit to
    Congress a report on the pilot program. Such report shall
    include a comparison of the pilot program with similar programs
    carried out in the private sector.

    (e) Definitions.--In this section:
    (1) The term ``medical scribe'' means an unlicensed
    individual hired to enter information into the electronic health
    record or chart at the direction of a physician or licensed
    independent practitioner whose responsibilities include the
    following:
    (A) Assisting the physician or practitioner in
    navigating the electronic health record.
    (B) Responding to various messages as directed by
    the physician or practitioner.
    (C) Entering information into the electronic health
    record, as directed by the physician or practitioner.
    (2) The terms ``urban'' and ``rural'' have the meanings
    given such terms under the rural-urban commuting codes developed
    by the Secretary of Agriculture and the Secretary of Health and
    Human Services.

    (f) Funding.--The pilot program under this section shall be carried
    out using amounts otherwise authorized to be appropriated for the
    Department of Veterans Affairs. No additional amounts are authorized to
    be appropriated to carry out such program.
    SEC. 508. EXTENSION OF REQUIREMENT TO COLLECT FEES FOR HOUSING
    LOANS GUARANTEED BY SECRETARY OF VETERANS
    AFFAIRS.

    Section 3729(b)(2) of title 38, United States Code, is amended by
    striking ``2027'' each place it appears and inserting ``2028''.
    SEC. 509. 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 ``September 30, 2027'' and inserting ``September 30, 2028''.
    SEC. 510. APPROPRIATION OF AMOUNTS.

    (a) Veterans Choice Program.--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,
    $5,200,000,000 to be deposited in the Veterans Choice Fund under section
    802 of the Veterans Access, Choice, and Accountability Act of 2014
    (Public Law 113-146; 38 U.S.C. 1701 note).
    (b) Availability of Amounts.--The amounts appropriated under
    subsection (a) shall be available for obligation or expenditure without
    fiscal year limitation.

    [[Page 1481]]

    SEC. 511. TECHNICAL CORRECTION.

    Section 1712I of title 38, United States Code, is redesignated as
    section 1720I of such title.
    SEC. 512. BUDGETARY EFFECTS.

    (a) Statutory Pay-As-You-Go Scorecards.--The budgetary effects of
    this Act shall not be entered on either PAYGO scorecard maintained
    pursuant to section 4(d) of the Statutory Pay-As-You-Go Act of 2010.
    (b) Senate PAYGO Scorecards.--The budgetary effects of this Act
    shall not be entered on any PAYGO scorecard maintained for purposes of
    section 4106 of H. Con. Res. 71 (115th Congress).

    Approved June 6, 2018.

    LEGISLATIVE HISTORY--S. 2372 (H.R. 4910) (H.R. 5674):
    ---------------------------------------------------------------------------

    HOUSE REPORTS: No. 115-671, Pt. 1 (Comm. on Veterans' Affairs)
    accompanying H.R. 5674.
    CONGRESSIONAL RECORD, Vol. 164 (2018):
    Mar. 1, considered and passed Senate.
    May 16, considered and passed House, amended.
    May 17, 22, 23, Senate considered and concurred in House
    amendment.
    DAILY COMPILATION OF PRESIDENTIAL DOCUMENTS (2018):
    June 6, Presidential remarks and statement.