[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.