For the purposes of this chapter—
(1) The term "disability" means a disease, injury, or other physical or mental defect.
(2) The term "veteran of any war" includes any veteran awarded the Medal of Honor.
(3) The term "facilities of the Department" means—
(A) facilities over which the Secretary has direct jurisdiction;
(B) Government facilities for which the Secretary contracts; and
(C) public or private facilities at which the Secretary provides recreational activities for patients receiving care under section 1710 of this title.
(4) The term "non-Department facilities" means facilities other than Department facilities.
(5) The term "hospital care" includes—
(A)(i) medical services rendered in the course of the hospitalization of any veteran, and (ii) travel and incidental expenses pursuant to the provisions of section 111 of this title;
(B) such mental health services, consultation, professional counseling, marriage and family counseling, and training for the members of the immediate family or legal guardian of a veteran, or the individual in whose household such veteran certifies an intention to live, as the Secretary considers appropriate for the effective treatment and rehabilitation of a veteran or dependent or survivor of a veteran receiving care under the last sentence of section 1781(b) of this title; and
(C)(i) medical services rendered in the course of the hospitalization of a dependent or survivor of a veteran receiving care under the last sentence of section 1781(b) of this title, and (ii) travel and incidental expenses for such dependent or survivor under the terms and conditions set forth in section 111 of this title.
(6) The term "medical services" includes, in addition to medical examination, treatment, and rehabilitative services, the following:
(A) Surgical services.
(B) Dental services and appliances as described in sections 1710 and 1712 of this title.
(C) Optometric and podiatric services.
(D) Preventive health services.
(E) Noninstitutional extended care services, including alternatives to institutional extended care that the Secretary may furnish directly, by contract, or through provision of case management by another provider or payer.
(F) In the case of a person otherwise receiving care or services under this chapter—
(i) wheelchairs, artificial limbs, trusses, and similar appliances;
(ii) special clothing made necessary by the wearing of prosthetic appliances; and
(iii) such other supplies or services as the Secretary determines to be reasonable and necessary.
(G) Travel and incidental expenses pursuant to section 111 of this title.
(H) Chiropractic services.
(I) The provision of medically necessary van lifts, raised doors, raised roofs, air conditioning, and wheelchair tiedowns for passenger use.
(7) The term "domiciliary care" includes necessary medical services and travel and incidental expenses pursuant to the provisions of section 111 of this title.
(8) The term "rehabilitative services" means such professional, counseling, chiropractic, and guidance services and treatment programs as are necessary to restore, to the maximum extent possible, the physical, mental, and psychological functioning of an ill or disabled person.
(9) The term "preventive health services" means—
(A) periodic medical and dental examinations;
(B) patient health education (including nutrition education);
(C) maintenance of drug use profiles, patient drug monitoring, and drug utilization education;
(D) mental health preventive services;
(E) substance abuse prevention measures;
(F) chiropractic examinations and services;
(G) immunizations against infectious diseases, including each immunization on the recommended adult immunization schedule at the time such immunization is indicated on that schedule;
(H) prevention of musculoskeletal deformity or other gradually developing disabilities of a metabolic or degenerative nature;
(I) genetic counseling concerning inheritance of genetically determined diseases;
(J) routine vision testing and eye care services;
(K) periodic reexamination of members of likely target populations (high-risk groups) for selected diseases and for functional decline of sensory organs, together with attendant appropriate remedial intervention; and
(L) such other health-care services as the Secretary may determine to be necessary to provide effective and economical preventive health care.
(10) The term "recommended adult immunization schedule" means the schedule established (and periodically reviewed and, as appropriate, revised) by the Advisory Committee on Immunization Practices established by the Secretary of Health and Human Services and delegated to the Centers for Disease Control and Prevention.
(Pub. L. 85–857, Sept. 2, 1958, 72 Stat. 1141, §601; Pub. L. 86–598, July 7, 1960, 74 Stat. 335; Pub. L. 86–639, §2, July 12, 1960, 74 Stat. 472; Pub. L. 88–481, Aug. 22, 1964, 78 Stat. 593; Pub. L. 90–612, §2, Oct. 21, 1968, 82 Stat. 1202; Pub. L. 93–82, title I, §101, Aug. 2, 1973, 87 Stat. 179; Pub. L. 94–581, title I, §102, title II, §202(b), Oct. 21, 1976, 90 Stat. 2843, 2855; Pub. L. 95–520, §5, Oct. 26, 1978, 92 Stat. 1820; Pub. L. 96–22, title I, §102(c), title II, §201(a), June 13, 1979, 93 Stat. 48, 54; Pub. L. 96–151, title II, §§201(b), 202, Dec. 20, 1979, 93 Stat. 1093, 1094; Pub. L. 97–72, title I, §101, Nov. 3, 1981, 95 Stat. 1047; Pub. L. 97–251, §4, Sept. 8, 1982, 96 Stat. 716; Pub. L. 98–105, Sept. 30, 1983, 97 Stat. 730; Pub. L. 98–160, title I, §106(a), Nov. 21, 1983, 97 Stat. 998; Pub. L. 98–528, title I, §103(a), Oct. 19, 1984, 98 Stat. 2688; Pub. L. 99–108, §2, Sept. 30, 1985, 99 Stat. 481; Pub. L. 99–166, title I, §102(a), Dec. 3, 1985, 99 Stat. 943; Pub. L. 99–272, title XIX, §§19011(d)(2), 19012(a), Apr. 7, 1986, 100 Stat. 378, 380; Pub. L. 99–576, title II, §203, Oct. 28, 1986, 100 Stat. 3255; Pub. L. 100–322, title I, §131, May 20, 1988, 102 Stat. 506; Pub. L. 102–54, §14(b)(8), June 13, 1991, 105 Stat. 283; renumbered §1701 and amended Pub. L. 102–83, §§4(a)(2)(E), (3)–(5), (b)(1), (2)(E), 5(a), (c)(1), Aug. 6, 1991, 105 Stat. 404–406; Pub. L. 102–585, title V, §513, Nov. 4, 1992, 106 Stat. 4958; Pub. L. 103–446, title XII, §1202(b)(1), Nov. 2, 1994, 108 Stat. 4689; Pub. L. 104–262, title I, §§101(d)(1), 103(a), Oct. 9, 1996, 110 Stat. 3179, 3182; Pub. L. 106–117, title I, §101(b), Nov. 30, 1999, 113 Stat. 1548; Pub. L. 107–135, title II, §208(a)(1), (e)(2), Jan. 23, 2002, 115 Stat. 2461, 2463; Pub. L. 107–330, title III, §308(g)(3), Dec. 6, 2002, 116 Stat. 2828; Pub. L. 108–170, title I, §§104(a), 106(a), Dec. 6, 2003, 117 Stat. 2044, 2045; Pub. L. 110–387, title III, §301(a)(1), title VIII, §801, Oct. 10, 2008, 122 Stat. 4120, 4140; Pub. L. 114–315, title VI, §602(a), Dec. 16, 2016, 130 Stat. 1569; Pub. L. 115–141, div. J, title II, §245(b), Mar. 23, 2018, 132 Stat. 823; Pub. L. 117–333, §22, Jan. 5, 2023, 136 Stat. 6138.)
The text of section 1762 of this title, which was transferred to the end of this section, redesignated as par. (9), and amended by Pub. L. 102–585, was based on Pub. L. 96–22, title I, §105(a), June 13, 1979, 93 Stat. 52, §662; renumbered §1762 and amended Pub. L. 102–83, §§4(b)(1), (2)(E), 5(a), Aug. 6, 1991, 105 Stat. 404–406.
Prior sections 1700 and 1701 were renumbered sections 3500 and 3501 of this title, respectively.
2023—Par. (6)(I). Pub. L. 117–333 added subpar. (I).
2018—Par. (6)(H). Pub. L. 115–141, §245(b)(1), added subpar. (H).
Par. (8). Pub. L. 115–141, §245(b)(2), inserted "chiropractic," after "counseling,".
Par. (9)(F) to (L). Pub. L. 115–141, §245(b)(3), added subpar. (F) and redesignated former subpars. (F) to (K) as (G) to (L), respectively.
2016—Par. (9)(F). Pub. L. 114–315, §602(a)(1), amended subpar. (F) generally. Prior to amendment, subpar. (F) read as follows: "immunizations against infectious disease;".
Par. (10). Pub. L. 114–315, §602(a)(2), added par. (10).
2008—Par. (5)(B). Pub. L. 110–387, §301(a)(1), inserted "marriage and family counseling," after "professional counseling," and substituted "as the Secretary considers appropriate for" for "as may be essential to".
Par. (6)(E) to (G). Pub. L. 110–387, §801(2), added subpar. (E) and redesignated former subpars. (E) and (F) as (F) and (G), respectively.
Par. (10). Pub. L. 110–387, §801(1), struck out par. (10) which read as follows:
"(10)(A) During the period beginning on November 30, 1999, and ending on December 31, 2008, the term 'medical services' includes noninstitutional extended care services.
"(B) For the purposes of subparagraph (A), the term 'noninstitutional extended care services' means such alternatives to institutional extended care which the Secretary may furnish (i) directly, (ii) by contract, or (iii) (through provision of case management) by another provider or payor."
2003—Par. (8). Pub. L. 108–170, §104(a), struck out "(other than those types of vocational rehabilitation services provided under chapter 31 of this title)" after "programs".
Par. (10)(A). Pub. L. 108–170, §106(a), substituted "November 30, 1999, and ending on December 31, 2008," for "the date of the enactment of the Veterans Millennium Health Care and Benefits Act and ending on December 31, 2003,".
2002—Par. (5). Pub. L. 107–135, §208(e)(2), substituted "1781(b)" for "1713(b)" in subpars. (B) and (C)(i).
Par. (6). Pub. L. 107–135, §208(a)(1)(A), (B), substituted "services, the following:" for "services—" in introductory provisions and struck out concluding provisions which read as follows: "For the purposes of this paragraph, a dependent or survivor of a veteran receiving care under the last sentence of section 1713(b) of this title shall be eligible for the same medical services as a veteran."
Par. (6)(A). Pub. L. 107–135, §208(a)(1)(C), added subpar. (A) and struck out former subpar. (A) which read as follows: "(i) surgical services, dental services and appliances as described in sections 1710 and 1712 of this title, optometric and podiatric services, preventive health services, and (in the case of a person otherwise receiving care or services under this chapter) wheelchairs, artificial limbs, trusses, and similar appliances, special clothing made necessary by the wearing of prosthetic appliances, and such other supplies or services as the Secretary determines to be reasonable and necessary, except that the Secretary may not furnish sensori-neural aids other than in accordance with guidelines which the Secretary shall prescribe, and (ii) travel and incidental expenses pursuant to the provisions of section 111 of this title; and".
Par. (6)(B) to (F). Pub. L. 107–135, §208(a)(1)(A), (C), added subpars. (B) to (F) and struck out former subpar. (B) which included in the definition of "medical services" certain necessary consultation, professional counseling, training, and mental health services.
Par. (10)(A). Pub. L. 107–330, which directed the substitution of "November 30, 1999," for "the date of the enactment of the Veterans' Millennium Health Care and Benefits Act", could not be executed because the word "Veterans' " did not appear in text.
1999—Par. (10). Pub. L. 106–117 added par. (10).
1996—Par. (6)(A)(i). Pub. L. 104–262, §103(a), struck out "(in the case of a person otherwise receiving care or services under this chapter)" before "preventive health services,", substituted "(in the case of a person otherwise receiving care or services under this chapter)" for "(except under the conditions described in section 1712(a)(5)(A) of this title),", and inserted "except that the Secretary may not furnish sensori-neural aids other than in accordance with guidelines which the Secretary shall prescribe," after "reasonable and necessary,".
Par. (6)(B)(i)(I). Pub. L. 104–262, §101(d)(1)(A), substituted "paragraph (1) or (2) of section 1710(a)" for "section 1712(a)".
Par. (6)(B)(i)(II). Pub. L. 104–262, §101(d)(1)(B), substituted "paragraph (1), (2) or (3) of section 1710(a)" for "section 1712(a)(5)(B)".
1994—Par. (3). Pub. L. 103–446 made technical correction to directory language of Pub. L. 102–83, §4(a)(2)(E). See 1991 Amendment note below.
1992—Par. (6)(A)(i). Pub. L. 102–585, §513(b), substituted "preventive health services," for "preventive health-care services as defined in section 1762 of this title,".
Par. (9). Pub. L. 102–585, §513(a), transferred the text of section 1762 of this title to the end of this section and redesignated it as par. (9), substituted "The term 'preventive health service' means" for "For the purposes of this subchapter, the term 'preventive health-care services' means", and redesignated pars. (1) to (11) as subpars. (A) to (K), respectively. See Codification note above.
1991—Pub. L. 102–83, §5(a), renumbered section 601 of this title as this section.
Par. (2). Pub. L. 102–54, §14(b)(8)(A), struck out "any veteran of the Indian Wars, or" after "includes".
Par. (3). Pub. L. 102–83, §5(c)(1), substituted "1710" for "610" in subpar. (C).
Pub. L. 102–83, §4(b)(1), (2)(E), substituted "Secretary" for "Administrator" in subpars. (A) to (C).
Pub. L. 102–83, §4(a)(2)(E), as amended by Pub. L. 103–446, substituted "facilities of the Department" for "Veterans' Administration facilities".
Pub. L. 102–54, §14(b)(8)(B), (C), redesignated par. (4) as (3) and struck out former par. (3) which read as follows: "The term 'period of war' includes each of the Indian Wars."
Par. (4). Pub. L. 102–83, §4(a)(5), substituted "non-Department" for "non-Veterans' Administration".
Pub. L. 102–83, §4(a)(3), (4), substituted "Department" for "Veterans' Administration".
Pub. L. 102–54, §14(b)(8)(E), redesignated par. (9) as (4).
Par. (5). Pub. L. 102–83, §5(c)(1), substituted "1713(b)" for "613(b)" in subpars. (B) and (C)(i).
Par. (6). Pub. L. 102–83, §5(c)(1), in subpar. (A) substituted "1710 and 1712" for "610 and 612", "1762" for "662", and "1712(a)(5)(A)" for "612(a)(5)(A)", in subpar. (B) substituted "1712(a)" for "612(a)", "1712(a)(5)(B)" for "612(a)(5)(B)", and "1713(b)" for "613(b)", and in last sentence substituted "1713(b)" for "613(b)".
Pub. L. 102–83, §4(b)(1), (2)(E), substituted "Secretary" for "Administrator" wherever appearing.
Pub. L. 102–54, §14(b)(8)(D), substituted "612(a)(5)(A)" for "612(f)(1)(A)(i)" in subpar. (A)(i) and "612(a)(5)(B)" for "612(f)(1)(A)(ii)" in subpar. (B)(i)(II).
Par. (9). Pub. L. 102–54, §14(b)(8)(E), redesignated par. (9) as (4).
1988—Par. (4)(C). Pub. L. 100–322 added subpar. (C).
1986—Par. (4). Pub. L. 99–272, §19012(a)(1), struck out cl. (C) and provision following such clause, both relating to private facilities under contract as Veterans' Administration facilities.
Par. (6)(A)(i). Pub. L. 99–272, §19011(d)(2)(A), substituted "section 612(f)(1)(A)(i)" for "section 612(f)(1)(A)".
Par. (6)(B). Pub. L. 99–576 amended subpar. (B) generally. Prior to amendment, subpar. (B) read as follows: "such consultation, professional counseling, training, and mental health services as are necessary in connection with the treatment—
"(i) of the service-connected disability of a veteran pursuant to section 612(a) of this title, and
"(ii) in the discretion of the Administrator, of the non-service-connected disability of a veteran eligible for treatment under section 612(f)(1)(A)(ii) of this title where such services were initiated during the veteran's hospitalization and the provision of such services on an outpatient basis is essential to permit the discharge of the veteran from the hospital,
for the members of the immediate family or legal guardian of a veteran, or the individual in whose household such veteran certifies an intention to live, as may be essential to the effective treatment and rehabilitation of the veteran (including, under the terms and conditions set forth in section 111 of this title, travel and incidental expenses of such family member or individual in the case of a veteran who is receiving care for a service-connected disability, or in the case of dependent or survivor of a veteran receiving care under the last sentence of section 613(b) of this title). For the purposes of this paragraph, a dependent or survivor of a veteran receiving care under the last sentence of section 613(b) of this title shall be eligible for the same medical services as a veteran."
Par. (6)(B)(ii). Pub. L. 99–272, §19011(d)(2)(B), substituted "section 612(f)(1)(A)(ii)" for "section 612(f)(1)(B)".
Par. (9). Pub. L. 99–272, §19012(a)(2), added par. (9).
1985—Par. (4)(C)(v). Pub. L. 99–166, §102(a), substituted "with respect to the Commonwealth of Puerto Rico shall expire on September 30, 1988" for "(except with respect to Alaska and Hawaii) shall expire on October 31, 1985" and struck out "and to the Virgin Islands" before "of the restrictions in this subclause".
Pub. L. 99–108 substituted "October 31, 1985" for "September 30, 1985".
1984—Par. (4)(C)(v). Pub. L. 98–528 substituted "September 30, 1985" for "September 30, 1984".
1983—Par. (4)(C)(v). Pub. L. 98–105 substituted "September 30, 1984" for "September 30, 1983".
Par. (6)(a)(i). Pub. L. 98–160 inserted "(in the case of a person otherwise receiving care or services under this chapter) preventive health-care services as defined in section 662 of this title,".
1982—Par. (4)(C)(v). Pub. L. 97–251 substituted "September 30, 1983" for "September 30, 1982".
1981—Par. (4)(C)(v). Pub. L. 97–72 substituted "September 30, 1982" for "December 31, 1981".
1979—Par. (4). Pub. L. 96–22, §§102(c)(1), 201(a), substituted "medical services for the treatment of any disability of a veteran described in clause (1)(B) or (2) of the first sentence, or the third sentence, of section 612(f) of this title or of a veteran described in section 612(g) of this title if the Administrator has determined, based on an examination by a physician employed by the Veterans' Administration (or, in areas where no such physician is available, by a physician carrying out such function under a contract or fee arrangement), that the medical condition of such veteran precludes appropriate treatment in facilities described in clauses (A) and (B) of this paragraph" for "medical services for the treatment of any disability of a veteran described in clause (1)(B) or (2) of section 612(f) of this title" in subcl. (ii) of cl. (C), and added subcl. (vi) of cl. (C) and the provisions following cl. (C) relating to the periodic review of the necessity for continuing contractual arrangements in the case of veterans receiving contract care.
Par. (4)(C)(iii). Pub. L. 96–151, §202, inserted provisions respecting safe transfer of the veteran, and substituted "medical services in" for "hospital care in".
Par. (5)(A). Pub. L. 96–151, §201(b)(1), substituted "travel" for "transportation".
Par. (5)(C). Pub. L. 96–151, §201(b)(2), substituted provisions relating to travel and incidental expenses for provisions relating to transportation and incidental expenses.
Par. (6)(A)(i). Pub. L. 96–22, §102(c)(2), substituted "described in sections 610 and 612 of this title" for "authorized in sections 612 (b), (c), (d), and (e) of this title".
Par. (6)(B). Pub. L. 96–151, §201(b)(3), substituted "travel and incidental expenses" for "necessary expenses of travel and subsistence".
1978—Par. (4)(C)(v). Pub. L. 95–520 defined "Veterans' Administration facilities" to include certain private facilities to provide medical services to obviate the need for hospital admission, deleted reference to hospital care for veterans in a territory, Commonwealth, or possession of the United States not contiguous to the forty-eight contiguous States, substituted provision requiring the annually determined hospital patient load and incidence of the provision of medical services to veterans hospitalized or treated at expense of Veterans' Administration in Government and private facilities in each noncontiguous State to be consistent with patient load or incidence of the provision of medical services for veterans hospitalized or treated by the Veterans' Administration within the forty-eight contiguous States for prior requirement that the annually determined average hospital patient load per thousand veteran population hospitalized at Veterans' Administration expense in Government and private facilities in each noncontiguous State not exceed the average patient load per thousand veteran population hospitalized by the Veterans' Administration within the forty-eight contiguous States; extended termination date for exercise of subcl. (v) authority to Dec. 31, 1981, from Dec. 31, 1978, except as to Alaska and Hawaii, and authorized waiver by the Administrator, to prevent hardship, of applicability to Puerto Rico and Virgin Islands of subcl. (v) restrictions with respect to hospital patient loads and incidence of provision of medical services.
1976—Par. (4)(A). Pub. L. 94–581, §202(b)(1), substituted "direct jurisdiction" for "direct and exclusive jurisdiction".
Par. (4)(C). Pub. L. 94–581, §202(b)(2), inserted "when facilities described in clause (A) or (B) of this paragraph are not capable of furnishing economical care because of geographical inaccessibility or of furnishing the care or services required" after "contracts" in provisions preceding subcl. (i), substituted "to a veteran for the treatment of a service-connected disability or a disability for which a veteran was discharged" for "for persons suffering from service-connected disabilities or from disabilities for which such persons were discharged" in subcl. (i), added subcls. (ii) and (iii), redesignated former subcls. (ii) and (iii) as (iv) and (v), respectively, and in subcl. (v) as so redesignated, substituted "subclause (v)" for "clause (iii)".
Par. (5)(A)(ii). Pub. L. 94–581, §202(b)(3), substituted "pursuant to the provisions of section 111 of this title" for "for any veteran who is in need of treatment for a service-connected disability or who is unable to defray the expense of transportation".
Par. (5)(B). Pub. L. 94–581, §102(1), substituted "for the members of the immediate family or legal guardian of a veteran, or the individual in whose household such veteran certifies an intention to live, as may be essential to the effective treatment and rehabilitation of a veteran or dependent or survivor of a veteran receiving care under the last sentence of section 613(b) of this title; and" for "(including (i) necessary expenses for transportation if unable to defray such expenses; or (ii) necessary expenses of transportation and subsistence in the case of a veteran who is receiving care for a service-connected disability, or in the case of a dependent or survivor of a veteran receiving care under the last sentence of section 613(b) of this title, under the terms and conditions set forth in section 111 of this title) of the members of the immediate family (including legal guardians) of a veteran or such a dependent or survivor of a veteran, or in the case of a veteran or such dependent or survivor of a veteran who has no immediate family members (or legal guardian), the person in whose household such veteran, or such a dependent or survivor certifies his intention to live, as may be necessary or appropriate to the effective treatment and rehabilitation of a veteran or such a dependent or a survivor of a veteran; and".
Par. (6). Pub. L. 94–581, §102(2), expanded definition of "medical services" to include rehabilitation services, podiatric services, and travel and incidental expenses pursuant to the provisions of section 111 of this title, and, for the members of the immediate family or legal guardian of a veteran, or the individual in whose household such veteran certifies an intention to live, as may be essential to the effective treatment and rehabilitation of the veteran, such consultation, professional counseling, training, and mental health services as are necessary in connection with the treatment of the service-connected disability of a veteran pursuant to section 612(a) of this title, and, in the discretion of the Administrator, of the non-service-connected disability of a veteran eligible for treatment under section 612(f)(1)(B) of this title where such services were initiated during the veteran's hospitalization and the provision of such services on an outpatient basis is essential to permit the discharge of the veteran from the hospital.
Par. (7). Pub. L. 94–581, §102(3), substituted "necessary medical services and travel and incidental expenses pursuant to the provisions of section 111 of this title" for "transportation and incidental expenses for veterans who are unable to defray the expenses of transportation".
Par. (8). Pub. L. 94–581, §102(4), added par. (8).
1973—Par. (4)(C). Pub. L. 93–82, §101(a), extended the Administrator's contract authority for providing hospital care and medical services to persons suffering from service-connected disabilities or from disabilities for which such persons were discharged or released from the active military, naval, or air service and removed the limitation on such authority that such care be rendered in emergency cases only.
Par. (5). Pub. L. 93–82, §101(b), incorporated existing provisions in subpar. (A) and added subpars. (B) and (C).
Par. (6). Pub. L. 93–82, §101(c), expanded definition of "medical services" to include home health services determined by the Secretary to be necessary or appropriate for the effective and economical treatment of a disability of a veteran or a dependent or survivor of a veteran receiving care under section 613(b) of this title.
1968—Par. (4)(C)(iii). Pub. L. 90–612 expanded category of veterans of wars in the Territories, Commonwealths, or possessions of the United States to include, until December 31, 1978, veterans of such wars in States not contiguous to the forty-eight contiguous States, with the annually determined average hospital patient load per thousand of hospitalized veteran population in each such noncontiguous States not to exceed the average within the forty-eight contiguous States.
1964—Par. (2). Pub. L. 88–481 included any veteran awarded the Medal of Honor.
1960—Par. (6). Pub. L. 86–639 inserted "(except under the conditions described in section 612(f)(1))".
Pub. L. 86–598 inserted "optometrists' services" after "medical examination and treatment".
Pub. L. 103–446, title XII, §1202(b), Nov. 2, 1994, 108 Stat. 4689, provided that the amendment made by that section is effective Aug. 6, 1991, and as if included in the enactment of Pub. L. 102–83.
Amendment by section 19011(d)(2) of Pub. L. 99–272 applicable to hospital care, nursing home care, and medical services furnished on or after July 1, 1986, see section 19011(f) of Pub. L. 99–272, set out as a note under section 1710 of this title.
Amendment by Pub. L. 96–151 effective Jan. 1, 1980, see section 206 of Pub. L. 96–151, set out as a note under section 111 of this title.
Pub. L. 96–22, title I, §107, June 13, 1979, 93 Stat. 53, provided that: "The amendments made to title 38, United States Code, by sections 102, 103, 104, 105, and 106 of this Act [see Tables for classification] shall be effective on October 1, 1979."
Amendment by Pub. L. 94–581 effective Oct. 21, 1976, see section 211 of Pub. L. 94–581, set out as a note under section 111 of this title.
Pub. L. 93–82, title V, §501, Aug. 2, 1973, 87 Stat. 196, provided that: "The provisions of this Act [see Tables for classification] shall become effective the first day of the first calendar month following the date of enactment [Aug. 2, 1973], except that sections 105 and 106 [amending section 626 [now 1726] of this title and enacting section 628 [now 1728] of this title] shall be effective on January 1, 1971; section 107 [enacting sections 631 and 632 [now 1731 and 1732] of this title and provisions set out as note under section 1732 of this title] shall be effective July 1, 1973; and section 203 [amending former section 4107 of this title] shall become effective beginning the first pay period following thirty days after the date of enactment of this Act [Aug. 2, 1973]."
Pub. L. 114–315, title VI, §602(d), Dec. 16, 2016, 130 Stat. 1570, provided that: "Nothing in this section [amending this section and section 1704 of this title] or the amendments made by this section may be construed to require a veteran to receive an immunization that the veteran does not want to receive."
Pub. L. 117–328, div. U, title I, §102, Dec. 29, 2022, 136 Stat. 5408, provided that:
"(a)
"(1) Prostate cancer is the number one cancer diagnosed in the Veterans Health Administration.
"(2) A 1996 report published by the National Academy of Sciences, Engineering, and Medicine established a link between prostate cancer and exposure to herbicides, such as Agent Orange.
"(3) It is essential to acknowledge that due to these circumstances, certain veterans are made aware that they are high-risk individuals when it comes to the potential to develop prostate cancer.
"(4) In being designated as 'high risk', it is essential that veterans are proactive in seeking earlier preventative clinical services for the early detection and successful treatment of prostate cancer, whether that be through the Veterans Health Administration or through a community provider.
"(5) Clinical preventative services and initial detection are some of the most important components in the early detection of prostate cancer for veterans at high risk of prostate cancer.
"(6) For veterans with prostate cancer, including prostate cancer that has metastasized, precision oncology, including biomarker-driven clinical trials and innovations underway through the Prostate Cancer Foundation and Department of Veterans Affairs partnership, represents one of the most promising areas of interventions, treatments, and cures for such veterans and their families.
"(b)
"(1)
"(2)
"(A) A diagnosis pathway for prostate cancer that includes early screening and diagnosis protocol, including screening recommendations for veterans with evidence-based risk factors.
"(B) A treatment pathway that details the respective roles of each office of the Department that will interact with veterans receiving prostate cancer care, including treatment protocol recommendations for veterans with evidence-based risk factors.
"(C) Treatment recommendations for all stages of prostate cancer that reflect nationally recognized standards for oncology, including National Comprehensive Cancer Network guidelines.
"(D) A suggested protocol timeframe for each point of care, from early screening to treatment and end-of-life care, based on severity and stage of cancer.
"(E) A plan that includes, as appropriate, both Department medical facilities and community-based partners and providers and research centers specializing in prostate cancer, especially such centers that have entered into partnerships with the Department.
"(3)
"(A) the National Institutes of Health;
"(B) the National Cancer Institute;
"(C) the National Institute on Minority Health and Health Disparities;
"(D) the Centers for Disease Control and Prevention;
"(E) the Centers for Medicare and Medicaid Services;
"(F) the Patient-Centered Outcomes Research Institute;
"(G) the Food and Drug Administration;
"(H) the Department of Defense; and
"(I) other Institutes and Centers as the Secretary determines necessary.
"(4)
"(5)
"(A) publish the clinical pathway established under this subsection on a publicly available Department website; and
"(B) update the clinical pathway as needed by review of the medical literature and available evidence-based guidelines at least annually, in accordance with the criteria under paragraph (2).
"(c)
"(1)
"(2)
"(A) receive direct oversight from the Deputy Undersecretary for Health of the Department of Veterans Affairs;
"(B) include a yearly program implementation evaluation to facilitate replication for other disease states or in other healthcare institutions;
"(C) be metric driven and include the development of biannual reports on the quality of prostate cancer care, which shall be provided to the leadership of the Department, medical centers, and providers and made publicly available in an electronic form; and
"(D) include an education plan for patients and providers.
"(3)
"(4)
"(A) include details regarding the funding of and coordination between the National Precision Oncology Program of the Department and the PCF–VA Precision Oncology Centers of Excellence as related to the requirements of this Act [div. U of Pub. L. 117–328, see Tables for classification]; and
"(B) affirm that no funding included in such funding plan is duplicative in nature.
"(d)
"(e)
"(1)
"(2)
Pub. L. 117–328, div. U, title I, §126, Dec. 29, 2022, 136 Stat. 5418, provided that:
"(a)
"(b)
"(1)
"(2)
"(A) An assessment of the progress of the Department in identifying impending realignments of medical facilities of the Department and the impact of such realignments on access of veterans to care, including any impact on the network of health care providers under the Community Care Program.
"(B) The progress of the Department in establishing operated sites of care and related activities to address the impact of such a realignment.
"(C) An outline of collaborative actions and processes the Department can take to address potential gaps in health care created by such a realignment, including actions and processes to be taken by the Office of Integrated Veteran Care, the Chief Strategy Office, and the Office of Asset Enterprise Management of the Department.
"(D) A description of how the Department can identify to Third Party Administrators changes in the catchment areas of medical facilities to be realigned and develop a process with Third Party Administrators to strengthen provider coverage in advance of such realignments.
"(3)
"(c)
"(1)
"(2)
"(A) any action that changes the number of facilities or relocates services, functions, or personnel positions; and
"(B) strategic collaborations between the Department and non-Federal Government entities, including tribal organizations and Urban Indian Organizations.
"(3)
"(4)
"(5)
Pub. L. 117–328, div. U, title I, §151, Dec. 29, 2022, 136 Stat. 5425, provided that:
"(a)
"(1) The COVID–19 pandemic caused the Department of Veterans Affairs to exponentially increase telehealth and virtual care modalities, including VA Video Connect, to deliver health care services to veteran patients.
"(2) Between January 2020 and January 2021, the number of telehealth appointments offered by the Department increased by 1,831 percent.
"(3) The Department maintains strategic partnerships, such as the Digital Divide Consult, with a goal of ensuring veterans who reside in rural, highly rural, or medically underserved areas have access to high-quality telehealth services offered by the Department.
"(4) As of 2019, veterans who reside in rural and highly rural areas make up approximately 1/3 of veteran enrollees in the patient enrollment system, and are on average, older than their veteran peers in urban areas, experience higher degrees of financial instability, and live with a greater number of complex health needs and comorbidities.
"(5) The Federal Communications Commission estimated in 2020 that 15 percent of veteran households do not have an internet connection.
"(6) Under the Coronavirus Aid, Relief, and Economic Security Act (Public Law 116–136) [see Tables for classification], Congress granted the Department additional authority to enter into short-term agreements or contracts with private sector telecommunications companies to provide certain broadband services for the purposes of providing expanded mental health services to isolated veterans through telehealth or VA Video Connect during a public health emergency.
"(7) The authority described in paragraph (6) was not utilized to the fullest extent by the Department.
"(8) Though the Department has made significant progress in expanding telehealth services offered to veterans who are enrolled in the patient enrollment system, significant gaps still exist to ensure all veterans receive equal and high-quality access to virtual care.
"(9) Questions regarding the efficacy of using telehealth for certain health care services and specialties remain, and should be further studied.
"(10) The Department continues to expand telehealth and virtual care offerings for primary care, mental health care, specialty care, urgent care, and even remote intensive care units.
"(b)
"(c)
"(1)
"(2)
"(A)
"(B)
"(i) The Chief Officer of the Office of Connected Care of the Department.
"(ii) The Executive Director of Telehealth Services of the Office of Connected Care.
"(iii) The Executive Director of Connected Health of the Office of Connected Care.
"(iv) The Executive Director of the Office of Rural Health of the Department.
"(v) The Executive Director of Solution Delivery, IT Operations and Services of the Office of Information and Technology of the Department.
"(3)
"(A) A comprehensive list of all health care specialties the Department is currently delivering by telehealth or virtual care.
"(B) An assessment of the effectiveness and patient outcomes for each type of health care specialty delivered by telehealth or virtual care by the Department.
"(C) An assessment of satisfaction of veterans in receiving care through telehealth or virtual care disaggregated by age group and by Veterans Integrated Service Network.
"(D) An assessment of the percentage of virtual visits delivered by the Department through each modality including standard telephone telehealth, VA Video Connect, and the Accessing Telehealth through Local Area Stations program of the Department.
"(E) An outline of all current partnerships maintained by the Department to bolster telehealth or virtual care services for veterans.
"(F) An assessment of the barriers faced by the Department in delivering telehealth or virtual care services to veterans residing in rural and highly rural areas, and the strategies the Department is deploying beyond purchasing hardware for veterans who are enrolled in the patient enrollment system.
"(G) A detailed plan illustrating how the Department is working with other Federal agencies, including the Department of Health and Human Services, the Department of Agriculture, the Federal Communications Commission, and the National Telecommunications and Information Administration, to enhance connectivity in rural, highly rural, and medically underserved areas to better reach all veterans.
"(H) The feasibility and advisability of partnering with Federally qualified health centers, rural health clinics, and critical access hospitals to fill the gap for health care services that exists for veterans who reside in rural and highly rural areas.
"(I) An evaluation of the number of veterans who are enrolled in the patient enrollment system who have previously received care under the Veterans Community Care Program under section 1703 of title 38, United States Code.
"(d)
"(1) The completed strategic plan or update, as the case may be.
"(2) An identification of areas of improvement by the Department in the delivery of telehealth and virtual care services to veterans who are enrolled in the patient enrollment system, with a timeline for improvements to be implemented.
"(e)
"(1)
"(2)
"(3)
Pub. L. 117–328, div. U, title I, §195(b), (c), Dec. 29, 2022, 136 Stat. 5445, provided that:
"(b)
"(1)
"(A) The Website is directly accessible from—
"(i) the main homepage of the publicly accessible internet website of the Department; and
"(ii) the main homepage of the publicly accessible internet website of each medical center of the Department.
"(B) Where practicable, the Website is organized and searchable by each medical center of the Department.
"(C) The Website is easily understandable and usable by the general public.
"(2)
"(A) shall consult with—
"(i) veterans service organizations; and
"(ii) veterans and caregivers of veterans from geographically diverse areas and representing different eras of service in the Armed Forces; and
"(B) may enter into a contract to design the Website with a company, non-profit entity, or other entity specializing in website design that has substantial experience in presenting health care data and information in a easily understandable and usable manner to patients and consumers.
"(c)
"(1)
"(2)
"(A) determines the extent that the medical record information, clinical information, data, and documentation provided by each medical facility of the Department that is used to calculate the information on the Website is accurate and complete;
"(B) identifies any deficiencies in the recording of medical record information, clinical information, or data by medical facilities of the Department that affects the accuracy and completeness of the information on the Website; and
"(C) provides recommendations to medical facilities of the Department on how to—
"(i) improve the accuracy and completeness of the medical record information, clinical information, data, and documentation that is used to calculate the information on the Website; and
"(ii) ensure that each medical facility of the Department provides such information in a uniform manner.
"(3)
Pub. L. 117–328, div. V, title V, §502, Dec. 29, 2022, 136 Stat. 5514, provided that:
"(a)
"(b)
"(1) assessment and treatment options for such disorders;
"(2) barriers to care for such disorders, such as wait time, travel time, and lack of staffing;
"(3) the efficacy of the clinical practice guidelines of the Department of Veterans Affairs and the Department of Defense for such disorders; and
"(4) the availability of and efficacy of the use by the Department of Veterans Affairs of cognitive behavioral therapy for insomnia.
"(c)
"(1) the findings from the analysis conducted under subsection (b); and
"(2) any actions taken under subsection (a) to improve the assessment and treatment of veterans with sleep disorders.
"(d)
Pub. L. 117–4, Mar. 24, 2021, 135 Stat. 247, provided that:
"This Act may be cited as the 'Strengthening and Amplifying Vaccination Efforts to Locally Immunize All Veterans and Every Spouse Act' or the 'SAVE LIVES Act'.
"(a)
"(b)
"(1) prioritize the vaccination of veterans who are enrolled in the patient enrollment system, veterans who receive hospital care and medical services pursuant to subsection (c)(2) of section 1705 of title 38, United States Code, and accompanying caregivers of such veterans before the vaccination of covered individuals not otherwise described in this paragraph; and
"(2) only furnish vaccines for COVID–19 to covered individuals under this section to the extent that such vaccines are available.
"(c)
"(d)
"(e)
"(1)
"(2)
"(A) A veteran who is not eligible to enroll in the patient enrollment system.
"(B) A veteran who is eligible for care under section 1724 of title 38, United States Code.
"(C) A beneficiary under section 1781 of such title.
"(D) A family caregiver of a veteran participating in the program of comprehensive assistance for family caregivers under section 1720G(a) of such title.
"(E) A caregiver of a veteran participating in the program of general caregiver support services under section 1720G(b) of such title.
"(F) A caregiver of a veteran participating in the Medical Foster Home Program, Bowel and Bladder Program, Home Based Primary Care Program, or Veteran Directed Care Program of the Department of Veterans Affairs.
"(G) A spouse of a veteran.
"(3)
"(4)
"(5)
"(6)
Pub. L. 117–2, title VIII, §8007, Mar. 11, 2021, 135 Stat. 116, provided that:
"(a)
"(1) shall provide for any copayment or other cost sharing with respect to health care under the laws administered by the Secretary received by a veteran during the period specified in subsection (b); and
"(2) shall reimburse any veteran who paid a copayment or other cost sharing for health care under the laws administered by the Secretary received by a veteran during such period the amount paid by the veteran.
"(b)
"(c)
Pub. L. 116–315, title III, §3003, Jan. 5, 2021, 134 Stat. 4991, provided that:
"(a)
"(1)
"(2)
"(A) The number of suspected and confirmed COVID–19 infections among residents and staff, including residents previously treated for COVID–19, disaggregated by—
"(i) veteran, spouse of a veteran, staff, and other;
"(ii) race and ethnicity;
"(iii) gender; and
"(iv) age.
"(B) The number of total deaths and COVID–19 deaths among residents and staff, disaggregated by—
"(i) veteran, spouse of a veteran, staff, and other;
"(ii) race and ethnicity;
"(iii) gender; and
"(iv) age.
"(C) An assessment of the supply of personal protective equipment and hand hygiene supplies.
"(D) An assessment of ventilator capacity and supplies.
"(E) The number of resident beds and the occupancy rate, disaggregated by veteran, spouse of a veteran, and other.
"(F) An assessment of the access of residents to testing for COVID–19.
"(G) An assessment of staffing shortages, if any.
"(H) Such other information as the Secretary may specify.
"(b)
"(1)
"(A) the total number of residents and staff of State homes who are infected with COVID–19; and
"(B) the total number of such residents and staff who have died from COVID–19.
"(2)
"(c)
"(1)
"(2)
Pub. L. 116–315, title III, §3101, Jan. 5, 2021, 134 Stat. 4999, provided that:
"(a)
"(1)
"(A) establish a process and requirements for scheduling appointments for—
"(i) health care from the Department of Veterans Affairs; and
"(ii) health care furnished through the Veterans Community Care Program under section 1703 of title 38, United States Code, by a non-Department health care provider; and
"(B) submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a description of such process and requirements.
"(2)
"(A) information on how such process and requirements take into account the access standards established under section 1703B of title 38, United States Code; and
"(B) the maximum number of days allowed to complete each step of such process.
"(3)
"(A)
"(B)
"(b)
"(1)
"(2)
"(A) to undergo training on the process and requirements established under subsection (a) as part of training for the position for which the employee has been hired; and
"(B) to make the certification to the Secretary required under paragraph (1).
"(c)
"(1)
"(A) to enable monitoring of the compliance of the Department with the process and requirements established under subsection (a), including compliance with policies of the Department relating to the maximum number of days allowed to complete each step of such process; and
"(B) to ensure that each medical facility of the Department complies with such process and requirements.
"(2)
"(A)
"(B)
"(d)
Pub. L. 116–315, title III, §3102, Jan. 5, 2021, 134 Stat. 5001, provided that:
"(a)
"(b)
"(1)
"(2)
"(c)
"(1) With respect to each medical center of the Department covered by the audit, an assessment of any scheduling or consultation management issues at that medical center, including the following:
"(A) An assessment of noncompliance with policies of the Veterans Health Administration relating to scheduling appointments and managing consultations.
"(B) An assessment of the extent to which appointments or consultations are not timely processed.
"(C) A description of any backlogs in appointments or consultations that are awaiting action.
"(D) An assessment of whether consultations are appropriately processed.
"(E) Data with respect to consultations as follows:
"(i) Consultations that were scheduled within the request window.
"(ii) Duplicate consultation requests.
"(iii) Consultations that were discontinued.
"(iv) Delays in consultations.
"(v) Consultations that were not properly closed or discontinued, including a description of remediation attempts.
"(F) A review for accuracy with respect to consultation management as follows:
"(i) A review of the accuracy of the type of service, either administrative or clinical, that is inputted in the electronic health record.
"(ii) A review of the accuracy of the type of consultation setting, either impatient [sic] or outpatient, that is inputted in the electronic health record.
"(iii) A review of the appropriateness of the level of urgency of the consultation that is inputted in the electronic health record.
"(iv) A review of any delayed or unresolved consultations.
"(2) An identification of such recommendations for corrective action as the Secretary considers necessary, including additional training, increased personnel, and other resources.
"(3) A certification that the director of each medical center of the Department covered by the audit is in compliance with the process and requirements established under section 3101(a) [set out as a note above] and such other requirements relating to the scheduling of appointments and management of consultations as the Secretary considers appropriate.
"(4) With respect to referrals for health care between health care providers or facilities of the Department, a measurement of, for each medical facility of the Department covered by the audit—
"(A) the period of time between—
"(i) the date that a clinician of the Department determines that a veteran requires care from another health care provider or facility and the date that the referral for care is sent to the other health care provider or facility;
"(ii) the date that the referral for care is sent to the other health care provider or facility and the date that the other health care provider or facility accepts the referral;
"(iii) the date that the other health care provider or facility accepts the referral and the date that the appointment with the other health care provider or at the other facility is made; and
"(iv) the date that the appointment with the other health care provider or at the other facility is made and the date of the appointment with the other health care provider or at the other facility; and
"(B) any other period of time that the Secretary determines necessary to measure.
"(5) With respect to referrals for non-Department health care originating from medical facilities of the Department, a measurement of, for each such facility covered by the audit—
"(A) the period of time between—
"(i) the date that a clinician of the Department determines that a veteran requires care, or a veteran presents to the Department requesting care, and the date that the referral for care is sent to a non-Department health care provider;
"(ii) the date that the referral for care is sent to a non-Department health care provider and the date that a non-Department health care provider accepts the referral;
"(iii) the date that a non-Department health care provider accepts the referral and the date that the referral to a non-Department health care provider is completed;
"(iv) the date that the referral to a non-Department health care provider is completed and the date that an appointment with a non-Department health care provider is made; and
"(v) the date that an appointment with a non-Department health care provider is made and the date that an appointment with a non-Department health care provider occurs; and
"(B) any other period of time that the Secretary determines necessary to measure.
"(d)
"(e)
"(1) strengthen oversight of the scheduling of appointments and management of consultations throughout the Department;
"(2) monitor national policy on such scheduling and management; and
"(3) develop a remediation plan to address issues uncovered by those audits.
"(f)
"(1)
"(2)
"(A) the nationwide results of the audit conducted under subsection (a);
"(B) the results of such audit with respect to each medical facility of the Department covered by such audit;
"(C) an assessment of how the Department strengthened oversight of the scheduling of appointments and management of consultations at each such facility as a result of the audit;
"(D) an assessment of how the audit informed the national policy of the Department with respect to the scheduling of appointments and management of consultations; and
"(E) a description of any remediation plans to address issues raised by the audit that was completed."
Pub. L. 116–315, title V, §5103, Jan. 5, 2021, 134 Stat. 5027, provided that:
"(a)
"(1) an alignment of the requirements for such standards and inspections with the women's health handbook of the Veterans Health Administration;
"(2) a requirement for the frequency of such inspections;
"(3) delineation of the roles and responsibilities of staff at each medical center who are responsible for compliance;
"(4) the requirement that each medical center submit to the Secretary and make publicly available a report on the compliance of the medical center with the standards; and
"(5) a remediation plan.
"(b)
Pub. L. 116–315, title V, §5204, Jan. 5, 2021, 134 Stat. 5035, provided that:
"(a)
"(1) if the program is appropriately staffed at each medical center of the Department;
"(2) whether each medical center of the Department is staffed with a Women Veteran Program Manager; and
"(3) whether it would be feasible and advisable to have a Women Veteran Program Ombudsman at each medical center of the Department.
"(b)
"(c)
Pub. L. 116–260, div. FF, title XVI, §1601, Dec. 27, 2020, 134 Stat. 3290, provided that: "Hereafter, subject to the availability of appropriations, the Secretary of Veterans Affairs shall record as an obligation of the United States Government amounts owed for hospital care or medical services furnished at non-Department facilities under title 38, United States Code, or Acts making appropriations for the Department of Veterans Affairs, on the date on which the Secretary approves: (i) a claim by a health care provider for payment or (ii) a voucher, invoice, or request for payment from a vendor for services rendered under a contract: Provided, That for any fiscal year in which an appropriation for the payment of hospital care or medical services furnished at non-Department facilities has been exhausted or has yet to be enacted, this title shall not provide the Secretary of Veterans Affairs with the authority to issue any new authorizations or orders for such care or such services in advance of such appropriation: Provided further, That this title shall take effect as if enacted on October 1, 2018: Provided further, That not later than 30 days after the date of enactment of this Act [Dec. 27, 2020], the Department of Veterans Affairs, in consultation with the Office of Management and Budget, shall submit a report to the President and the Congress, similar to the report required pursuant to 31 U.S.C. 1351, detailing how, in the absence of the enactment of this title, the expenditures or obligations would have exceeded the amount available in fiscal year 2019 and fiscal year 2020 in the Medical Community Care appropriation: Provided further, That the report required in the preceding proviso shall also include an explanation as to how the Department plans to avoid incurring obligations for the Medical Community Care appropriation in excess of its available budgetary resources in fiscal year 2021 and future fiscal years pursuant to the recording of obligations required by this title."
Pub. L. 116–171, title VII, §701, Oct. 17, 2020, 134 Stat. 825, provided that:
"(a)
"(b)
"(1)
"(2)
"(3)
"(A)
"(i) Purchasing, replacing or upgrading hardware or software necessary for the provision of secure and private telehealth services.
"(ii) Upgrading security protocols for consistency with the security requirements of the Department of Veterans Affairs.
"(iii) Training of site attendants, including payment of those attendants for completing that training, with respect to—
"(I) military and veteran cultural competence, if the entity is not an organization that represents veterans;
"(II) equipment required to provide telehealth services;
"(III) privacy, including the Health Insurance Portability and Accountability Act of 1996 [Pub. L. 104–191] privacy rule under part 160 and subparts A and E of part 164 of title 45, Code of Federal Regulations, or successor regulations, as it relates to health care for veterans;
"(IV) scheduling for telehealth services for veterans; or
"(V) any other unique training needs for the provision of telehealth services to veterans.
"(iv) Upgrading existing infrastructure owned or leased by the entity to make rooms more conducive to telehealth care, including—
"(I) additions or modifications to windows or walls in an existing room, or other alterations as needed to create a new, private room, including permits or inspections required in association with space modifications;
"(II) soundproofing of an existing room;
"(III) new electrical, telephone, or internet outlets in an existing room; or
"(IV) aesthetic enhancements to establish a more suitable therapeutic environment.
"(v) Upgrading existing infrastructure to comply with the Americans with Disabilities Act of 1990 (42 U.S.C. 12101 et seq.).
"(vi) Upgrading internet infrastructure and sustainment of internet services.
"(vii) Sustainment of telephone services.
"(B)
"(c)
"(1)
"(2)
"(d)
"(1)
"(2)
"(A) A description of the barriers veterans face in using telehealth while not on property of the Department.
"(B) A description of how the Department plans to address the barriers described in subparagraph (A).
"(C) Such other matters related to access by veterans to telehealth while not on property of the Department as the Secretary considers relevant.
"(3)
Pub. L. 116–171, title VII, §702(a), Oct. 17, 2020, 134 Stat. 827, provided that:
"(1)
"(2)
"(A) Partnerships to conduct research on hyperbaric oxygen therapy.
"(B) Partnerships to review research on hyperbaric oxygen therapy provided to nonveterans.
"(C) Partnerships to create industry working groups to determine standards for research on hyperbaric oxygen therapy.
"(D) Partnerships to provide to veterans hyperbaric oxygen therapy for the purposes of conducting research on the effectiveness of such therapy.
"(3)
Pub. L. 116–171, title VII, §702(b), Oct. 17, 2020, 134 Stat. 827, provided that: "Not later than 90 days after the date of the enactment of this Act [Oct. 17, 2020], the Secretary [of Veterans Affairs], in consultation with the Center for Compassionate Innovation, shall begin using an objective and quantifiable method to review the effectiveness and applicability of hyperbaric oxygen therapy, such as through the use of a device approved or cleared by the Food and Drug Administration that assesses traumatic brain injury by tracking eye movement."
Pub. L. 116–127, div. F, §6006(b), Mar. 18, 2020, 134 Stat. 207, provided that: "The Secretary of Veterans Affairs may not require any copayment or other cost sharing under chapter 17 of title 38, United States Code, for in vitro diagnostic products described in paragraph (1) of section 6001(a) [of Pub. L. 116–127, 42 U.S.C. 1320b–5 note] (or the administration of such products) or visits described in paragraph (2) of such section furnished during any portion of the emergency period defined in paragraph (1)(B) of section 1135(g) of the Social Security Act (42 U.S.C. 1320b–5(g)) beginning on or after the date of the enactment of this Act [Mar. 18, 2020]."
Pub. L. 115–407, title VI, §602, Dec. 31, 2018, 132 Stat. 5380, provided that:
"(a)
"(1)
"(2)
"(b)
"(c)
Pub. L. 115–182, title I, §108, June 6, 2018, 132 Stat. 1416, as amended by Pub. L. 117–328, div. U, title I, §144, Dec. 29, 2022, 136 Stat. 5425, provided that:
"(a)
"(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)
"(c)
"(d)
"(e)
"(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.
"(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.
"(f)
"(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 [38 U.S.C. 1701 note]."
Pub. L. 115–182, title I, §121–123, June 6, 2018, 132 Stat. 1423, 1424, as amended by Pub. L. 115–251, title II, §211(b)(1), Sept. 29, 2018, 132 Stat. 3176, provided that:
"(a)
"(b)
"(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 [38 U.S.C. 1705(a)];
"(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)
"(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)
"(1)
"(2)
"(e)
"(1)
"(2)
"(3)
"(a)
"(1) Reimbursement for non-Department emergency room care.
"(2) The Veterans Community Care Program under section 1703 of title 38, United States Code, as amended by section 101.
"(3) Management of prescriptions pursuant to improvements under section 131.
"(b)
"(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).
"(a)
"(1)
"(2)
"(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)
"(c)
"(1)
"(2)
"(3)
"(4)
"(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)
"(6)
"(d)
Pub. L. 115–182, title I, §131, June 6, 2018, 132 Stat. 1425, as amended by Pub. L. 115–251, title II, §211(b)(2), Sept. 29, 2018, 132 Stat. 3176, provided that:
"(a)
"(b)
"(c)
"(1)
"(2)
"(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)
"(d)
"(1)
"(2)
"(3)
"(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)
Pub. L. 115–182, title I, §133, June 6, 2018, 132 Stat. 1427, provided that:
"(a)
"(b)
"(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)
Pub. L. 115–182, title V, §506, June 6, 2018, 132 Stat. 1477, as amended by Pub. L. 117–328, div. V, title IV, §401(a), Dec. 29, 2022, 136 Stat. 5509, provided that:
"(a)
"(b)
"(1) Not later than May 31, 2019, at not fewer than 15 medical centers of the Department.
"(2) Not later than May 31, 2020, at not fewer than 30 medical centers of the Department.
"(c)
"(1)
"(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)
"(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)
"(1)
"(A) As of the date of the enactment of the STRONG Veterans Act of 2022 [Dec. 29, 2022], the Secretary shall make such program permanent at each medical center participating in the program on the day before such date of enactment.
"(B) During the seven-year period following such date of enactment, the Secretary shall expand the program to an additional 25 medical centers per year until the program is carried out at each medical center of the Department.
"(2)
"(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.
"(e)
"(1) the needs of female veterans are specifically considered and addressed;
"(2) female peer specialists are hired and made available to support female veterans who are treated at each medical center.
"(f)
"(g)
"(1)
"(A)
"(B)
"(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 (f) with health care providers in the community and veterans served by such providers.
"(iv) The name and location of each medical center where new peer specialists were hired.
"(v) The number of new peer specialists hired at each medical center pursuant to this section and the total number of peer specialists within the Department hired pursuant to this section.
"(vi) An assessment of any barriers confronting the recruitment, training, or retention of peer specialists.
"(2)
Pub. L. 115–182, title V, §507, June 6, 2018, 132 Stat. 1479, as amended by Pub. L. 115–251, title II, §211(b)(10), Sept. 29, 2018, 132 Stat. 3177, provided that:
"(a)
"(b)
"(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 determined by the Secretary.
"(c)
"(1)
"(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)
"(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 specialty care in specialties with the longest patient wait times or lowest efficiency ratings, as determined by the Secretary.
"(d)
"(1)
"(A) A separate analysis of each [of] 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.
"(B) Metrics and data for analyzing the effects of the pilot program, including an evaluation of the each of the [sic] 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)
"(e)
"(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)
Pub. L. 115–141, div. J, title II, §252, Mar. 23, 2018, 132 Stat. 825, as amended by Pub. L. 116–94, div. F, title II, §254, Dec. 20, 2019, 133 Stat. 2808, provided that: "During the period preceding October 1, 2022, the Secretary of Veterans Affairs may carry out a 2-year pilot program making grants to nonprofit veterans services organizations recognized by the Secretary in accordance with section 5902 of title 38, United States Code, to upgrade, through construction and repair, VSO community facilities into health and wellness centers and to promote and expand complementary and integrative wellness programs: Provided, That no single grant may exceed a total of $500,000: Provided further, That the Secretary may not provide more than 20 grants during the 2-year pilot program: Provided further, That the recipient of a grant under this section may not use the grant to purchase real estate or to carry out repair of facilities leased by the recipient or to construct facilities on property leased by the recipient: Provided further, That the Secretary ensures that the grant recipients use grant funds to construct or repair facilities located in at least 10 different geographic locations in economically depressed areas or areas designated as highly rural that are not in close proximity to Department of Veterans Affairs medical centers: Provided further, That the Secretary shall report to the Committees on Appropriations of both Houses of Congress no later than 180 days after enactment of this Act [Mar. 23, 2018], on the grant program established under this section."
Pub. L. 115–95, §2, Dec. 20, 2017, 131 Stat. 2042, provided that:
"(a)
"(b)
"(1)
"(2)
"(c)
"(1) to prevent the Office of the Inspector General of the Department of Veterans Affairs from conducting any review, audit, evaluation, or inspection regarding a topic for which an investigation is conducted under this section; or
"(2) to modify the requirement that employees of the Department assist with any review, audit, evaluation, or inspection conducted by the Office of the Inspector General of the Department."
Pub. L. 114–286, Dec. 16, 2016, 130 Stat. 1459, provided that:
"This Act may be cited as the 'Faster Care for Veterans Act of 2016'.
"(a)
"(b)
"(c)
"(1)
"(2)
"(3)
"(d)
"(1)
"(2)
"(e)
"(a)
"(1) Capability to schedule, modify, and cancel appointments for primary care, specialty care, and mental health.
"(2) Capability to support appointments for the provision of health care regardless of whether such care is provided in person or through telehealth services.
"(3) Capability to view appointment availability in real time.
"(4) Capability to make available, in real time, appointments that were previously filled but later cancelled by other patients.
"(5) Capability to provide prompts or reminders to veterans to schedule follow-up appointments.
"(6) Capability to be used 24 hours per day, 7 days per week.
"(7) Capability to integrate with the Veterans Health Information Systems and Technology Architecture of the Department, or such successor information technology system.
"(b)
"(1)
"(A) The Secretary shall seek to enter into an agreement with an appropriate non-governmental, not-for-profit entity with expertise in health information technology to independently validate and verify that the patient self-scheduling appointment system used in the pilot program under section 2, and any other patient self-scheduling appointment system developed or used by the Department of Veterans Affairs, includes the capabilities specified in subsection (a).
"(B) Each independent validation and verification conducted under subparagraph (A) shall be completed as follows:
"(i) With respect to the validation and verification of the patient self-scheduling appointment system used in the pilot program under section 2, by not later than 60 days after the date on which such pilot program commences.
"(ii) With respect to any other patient self-scheduling appointment system developed or used by the Department of Veterans Affairs, by not later than 60 days after the date on which such system is deployed, regardless of whether such deployment is on a limited basis, but not including any deployments for testing purposes.
"(2)
"(A) The Comptroller General of the United States shall evaluate each validation and verification conducted under paragraph (1).
"(B) Not later than 30 days after the date on which the Comptroller General completes an evaluation under paragraph (1), the Comptroller General shall submit to the appropriate congressional committees a report on such evaluation.
"(C) In this paragraph, the term 'appropriate congressional committees' means—
"(i) the Committees on Veterans' Affairs of the House of Representatives and the Senate; and
"(ii) the Committees on Appropriations of the House of Representatives and the Senate.
"(c)
"(1)
"(2)
"(3)
"No additional funds are authorized to carry out the requirements of this Act. Such requirements shall be carried out using amounts otherwise authorized."
Pub. L. 114–223, div. A, title II, §251, Sept. 29, 2016, 130 Stat. 893, provided that:
"(a)
"(b)
"(1)
"(2)
"(A) is not part of the Federal Government;
"(B) operates as a not-for-profit entity; and
"(C) has expertise and objectivity comparable to that of the Joint Commission on Accreditation of Hospital Organizations.
"(c)
"(1)
"(A) implement a remediation plan for that medical facility within 72 hours; and
"(B) Conduct [sic] a second inspection under subsection (a) at that medical facility within 14 days of the failed inspection.
"(2)
"(3)
"(d)
Pub. L. 114–223, div. A, title II, §252, Sept. 29, 2016, 130 Stat. 894, provided that:
"(a)
"(b)
"(1)
"(2)
"(A) is not part of the Federal Government;
"(B) operates as a not-for-profit entity; and
"(C) has expertise and objectivity comparable to that of the Joint Commission on Accreditation of Hospital Organizations.
"(c)
"(1) implement a remediation plan for that medical facility within 7 days; and
"(2) Conduct [sic] a second inspection under subsection (a) at that medical facility within 90 days of the initial inspection.
"(d)
Pub. L. 114–198, title IX, July 22, 2016, 130 Stat. 755, as amended by Pub. L. 115–251, title II, §208, Sept. 29, 2018, 132 Stat. 3173, provided that:
"This title may be cited as the 'Jason Simcakoski Memorial and Promise Act'.
"In this title:
"(1) The term 'controlled substance' has the meaning given that term in section 102 of the Controlled Substances Act (21 U.S.C. 802).
"(2) The term 'State' means each of the several States, territories, and possessions of the United States, the District of Columbia, and the Commonwealth of Puerto Rico.
"(3) The term 'complementary and integrative health' has the meaning given that term, or any successor term, by the National Institutes of Health.
"(4) The term 'opioid receptor antagonist' means a drug or device approved or cleared under the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 301 et seq.) for emergency treatment of known or suspected opioid overdose.
"(a)
"(1)
"(2)
"(3)
"(A) that such tests occur not less frequently than once each year or as otherwise determined according to treatment protocols; and
"(B) that health care providers appropriately order, interpret and respond to the results from such tests to tailor pain therapy, safeguards, and risk management strategies to each patient.
"(b)
"(1)
"(2)
"(A) The implementation of and full compliance with the VA/DOD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain, including any update to such guideline.
"(B) The use of evidence-based pain management therapies and complementary and integrative health services, including cognitive-behavioral therapy, non-opioid alternatives, and non-drug methods and procedures to managing pain and related health conditions including, to the extent practicable, medical devices approved or cleared by the Food and Drug Administration for the treatment of patients with chronic pain and related health conditions.
"(C) Screening and identification of patients with substance use disorder, including drug-seeking behavior, before prescribing opioids, assessment of risk potential for patients developing an addiction, and referral of patients to appropriate addiction treatment professionals if addiction is identified or strongly suspected.
"(D) Communication with patients on the potential harm associated with the use of opioids and other controlled substances, including the need to safely store and dispose of supplies relating to the use of opioids and other controlled substances.
"(E) Such other education and training as the Secretary considers appropriate to ensure that veterans receive safe and high-quality pain management care from the Department.
"(3)
"(c)
"(1)
"(2)
"(A)
"(B)
"(i) consults with a health care provider with pain management expertise or who is on the pain management team of the medical facility; and
"(ii) refers the patient to the pain management team for any subsequent prescriptions and related therapy.
"(3)
"(A)
"(B)
"(i) a certification as to whether all members of the pain management team at the medical facility have completed the education and training required under subsection (b);
"(ii) a plan for the management and referral of patients to such pain management team if health care providers without expertise in prescribing analgesics prescribe opioid medications to treat acute and chronic pain that is non-cancer related; and
"(iii) a certification as to whether the medical facility—
"(I) fully complies with the stepped-care model, or successor models, of pain management and other pain management policies of the Department; or
"(II) does not fully comply with such stepped-care model, or successor models, of pain management and other pain management policies but is carrying out a corrective plan of action to ensure such full compliance.
"(d)
"(1)
"(A) ensure access by health care providers of the Department to information on controlled substances, including opioids and benzodiazepines, prescribed to veterans who receive care outside the Department through the prescription drug monitoring program of each State with such a program, including by seeking to enter into memoranda of understanding with States to allow shared access of such information between States and the Department;
"(B) include such information in the Opioid Therapy Risk Report tool; and
"(C) require health care providers of the Department to submit to the prescription drug monitoring program of each State with such a program information on prescriptions of controlled substances received by veterans in that State under the laws administered by the Secretary.
"(2)
"(A) the key clinical indicators with respect to the totality of opioid use by veterans;
"(B) concurrent prescribing by health care providers of the Department of opioids in different health care settings, including data on concurrent prescribing of opioids to treat mental health disorders other than opioid use disorder; and
"(C) mail-order prescriptions of opioids prescribed to veterans under the laws administered by the Secretary.
"(e)
"(1)
"(A)
"(B)
"(i) equip each pharmacy of the Department with opioid receptor antagonists to be dispensed to outpatients as needed; and
"(ii) expand the Overdose Education and Naloxone Distribution program of the Department to ensure that all veterans in receipt of health care under laws administered by the Secretary who are at risk of opioid overdose may access such opioid receptor antagonists and training on the proper administration of such opioid receptor antagonists.
"(C)
"(i) veterans receiving long-term opioid therapy;
"(ii) veterans receiving opioid therapy who have a history of substance use disorder or prior instances of overdose; and
"(iii) veterans who are at risk as determined by a health care provider who is treating the veteran.
"(2)
"(f)
"(1)
"(A) information on the most recent time the tool was accessed by a health care provider of the Department with respect to each veteran; and
"(B) information on the results of the most recent urine drug test for each veteran.
"(2)
"(g)
"(1) is receiving opioid therapy and has a history of substance use disorder or prior instances of overdose;
"(2) has a history of opioid abuse; or
"(3) is at risk of developing an opioid use disorder, as determined by a health care provider who is treating the veteran.
"(a)
"(1) The opioid prescribing practices of health care providers of each Department.
"(2) The ability of each Department to manage acute and chronic pain among individuals receiving health care from the Department, including training health care providers with respect to pain management.
"(3) The use by each Department of complementary and integrative health in treating such individuals.
"(4) The concurrent use and practice by health care providers of each Department of opioids and prescription drugs to treat mental health disorders, including benzodiazepines.
"(5) The use of care transition plans by health care providers of each Department to address case management issues for patients receiving opioid therapy who transition between inpatient and outpatient care.
"(6) The coordination in coverage of and consistent access to medications prescribed for patients transitioning from receiving health care from the Department of Defense to receiving health care from the Department of Veterans Affairs.
"(7) The ability of each Department to properly screen, identify, refer, and treat patients with substance use disorders who are seeking treatment for acute and chronic pain management conditions.
"(b)
"(1) coordinates the activities of the working group with other relevant working groups established under section 320 of title 38, United States Code;
"(2) consults with other relevant Federal agencies, including the Centers for Disease Control and Prevention, with respect to the activities of the working group; and
"(3) consults with the Department of Veterans Affairs and the Department of Defense with respect to the VA/DOD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain, or any successor guideline, and reviews and provides comments before any update to the guideline is released.
"(c)
"(1)
"(2)
"(A) Enhanced guidance with respect to—
"(i) the co-administration of an opioid and other drugs, including benzodiazepines, that may result in life-limiting drug interactions;
"(ii) the treatment of patients with current acute psychiatric instability or substance use disorder or patients at risk of suicide; and
"(iii) the use of opioid therapy to treat mental health disorders other than opioid use disorder.
"(B) Enhanced guidance with respect to the treatment of patients with behaviors or comorbidities, such as post-traumatic stress disorder or other psychiatric disorders, or a history of substance abuse or addiction, that requires a consultation or co-management of opioid therapy with one or more specialists in pain management, mental health, or addictions.
"(C) Enhanced guidance with respect to health care providers—
"(i) conducting an effective assessment for patients beginning or continuing opioid therapy, including understanding and setting realistic goals with respect to achieving and maintaining an expected level of pain relief, improved function, or a clinically appropriate combination of both; and
"(ii) effectively assessing whether opioid therapy is achieving or maintaining the established treatment goals of the patient or whether the patient and health care provider should discuss adjusting, augmenting, or discontinuing the opioid therapy.
"(D) Guidelines to inform the methodologies used by health care providers of the Department of Veterans Affairs and the Department of Defense to safely taper opioid therapy when adjusting or discontinuing the use of opioid therapy, including—
"(i) prescription of the lowest effective dose based on patient need;
"(ii) use of opioids only for a limited time; and
"(iii) augmentation of opioid therapy with other pain management therapies and modalities.
"(E) Guidelines with respect to appropriate case management for patients receiving opioid therapy who transition between inpatient and outpatient health care settings, which may include the use of care transition plans.
"(F) Guidelines with respect to appropriate case management for patients receiving opioid therapy who transition from receiving care during active duty to post-military health care networks.
"(G) Guidelines with respect to providing options, before initiating opioid therapy, for pain management therapies without the use of opioids and options to augment opioid therapy with other clinical and complementary and integrative health services to minimize opioid dependence.
"(H) Guidelines with respect to the provision of evidence-based non-opioid treatments within the Department of Veterans Affairs and the Department of Defense, including medical devices and other therapies approved or cleared by the Food and Drug Administration for the treatment of chronic pain as an alternative to or to augment opioid therapy.
"(I) Guidelines developed by the Centers for Disease Control and Prevention for safely prescribing opioids for the treatment of chronic, non-cancer related pain in outpatient settings.
"(3)
"(a)
"(1)
"(2)
"(A) An assessment of the implementation and monitoring by the Veterans Health Administration of the Opioid Safety Initiative of the Department, including examining, as appropriate, the following:
"(i) How the Department monitors the key clinical outcomes of such safety initiative (for example, the percentage of unique veterans visiting each medical center of the Department that are prescribed an opioid or an opioid and benzodiazepine concurrently) and how the Department uses that information—
"(I) to improve prescribing practices; and
"(II) to identify high prescribing or otherwise inappropriate prescribing practices by health care providers.
"(ii) How the Department monitors the use of the Opioid Therapy Risk Report tool of the Department (as developed through such safety initiative) and compliance with such tool by medical facilities and health care providers of the Department, including any findings by the Department of prescription rates or prescription practices by medical facilities or health care providers that are inappropriate.
"(iii) The implementation of academic detailing programs within the Veterans Integrated Service Networks of the Department and how such programs are being used to improve opioid prescribing practices.
"(iv) Recommendations on such improvements to the Opioid Safety Initiative of the Department as the Comptroller General considers appropriate.
"(B) Information made available under the Opioid Therapy Risk Report tool with respect to—
"(i) deaths resulting from sentinel events involving veterans prescribed opioids by a health care provider;
"(ii) overall prescription rates and, if applicable, indications used by health care providers for prescribing chronic opioid therapy to treat non-cancer, non-palliative, and non-hospice care patients;
"(iii) the prescription rates and indications used by health care providers for prescribing benzodiazepines and opioids concomitantly;
"(iv) the practice by health care providers of prescribing opioids to treat patients without any pain, including to treat patients with mental health disorders other than opioid use disorder; and
"(v) the effectiveness of opioid therapy for patients receiving such therapy, including the effectiveness of long-term opioid therapy.
"(C) An evaluation of processes of the Department in place to oversee opioid use among veterans, including procedures to identify and remedy potential over-prescribing of opioids by health care providers of the Department.
"(D) An assessment of the implementation by the Secretary of Veterans Affairs of the VA/DOD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain, including any figures or approaches used by the Department to assess compliance with such guidelines by medical centers of the Department and identify any medical centers of the Department operating action plans to improve compliance with such guidelines.
"(E) An assessment of the data that the Department has developed to review the opioid prescribing practices of health care providers of the Department, as required by this subtitle, including a review of how the Department identifies the practices of individual health care providers that warrant further review based on prescribing levels, health conditions for which the health care provider is prescribing opioids or opioids and benzodiazepines concurrently, or other practices of the health care provider.
"(b)
"(c)
"(1) The number of patients and the percentage of the patient population of the Department who were prescribed benzodiazepines and opioids concurrently by a health care provider of the Department.
"(2) The number of patients and the percentage of the patient population of the Department without any pain who were prescribed opioids by a health care provider of the Department, including those who were prescribed benzodiazepines and opioids concurrently.
"(3) The number of non-cancer, non-palliative, and non-hospice care patients and the percentage of such patients who were treated with opioids by a health care provider of the Department on an inpatient-basis and who also received prescription opioids by mail from the Department while being treated on an inpatient-basis.
"(4) The number of non-cancer, non-palliative, and non-hospice care patients and the percentage of such patients who were prescribed opioids concurrently by a health care provider of the Department and a health care provider that is not a health care provider of the Department.
"(5) With respect to each medical facility of the Department, the collected and reviewed information on opioids prescribed by health care providers at the facility to treat non-cancer, non-palliative, and non-hospice care patients, including—
"(A) the prescription rate at which each health care provider at the facility prescribed benzodiazepines and opioids concurrently to such patients and the aggregate of such prescription rate for all health care providers at the facility;
"(B) the prescription rate at which each health care provider at the facility prescribed benzodiazepines or opioids to such patients to treat conditions for which benzodiazepines or opioids are not approved treatment and the aggregate of such prescription rate for all health care providers at the facility;
"(C) the prescription rate at which each health care provider at the facility prescribed or dispensed mail-order prescriptions of opioids to such patients while such patients were being treated with opioids on an inpatient-basis and the aggregate of such prescription rate for all health care providers at the facility; and
"(D) the prescription rate at which each health care provider at the facility prescribed opioids to such patients who were also concurrently prescribed opioids by a health care provider that is not a health care provider of the Department and the aggregate of such prescription rates for all health care providers at the facility.
"(6) With respect to each medical facility of the Department, the number of times a pharmacist at the facility overrode a critical drug interaction warning with respect to an interaction between opioids and another medication before dispensing such medication to a veteran.
"(d)
"(1) immediately notify the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives of such determination, including information relating to such determination, prescription rate, and health care provider or medical facility, as the case may be; and
"(2) through the Office of the Medical Inspector of the Veterans Health Administration, conduct a full investigation of the health care provider or medical facility, as the case may be.
"(e)
"(1) The number of patients treated with opioids by the health care provider or at the medical facility, as the case may be, divided by the total number of pharmacy users of that health care provider or medical facility.
"(2) The average number of morphine equivalents per day prescribed by the health care provider or at the medical facility, as the case may be, to patients being treated with opioids.
"(3) Of the patients being treated with opioids by the health care provider or at the medical facility, as the case may be, the average number of prescriptions of opioids per patient.
[Amended section 5701 of this title.]
"(a)
"(b)
"(a)
"(1)
"(2)
"(b)
"(1)
"(2)
"(c)
"Not later than 90 days after the date of the enactment of this Act [July 22, 2016], the Secretary of Veterans Affairs shall, in as many prominent locations as the Secretary determines appropriate to be seen by the largest percentage of patients and family members of patients at each medical facility of the Department of Veterans Affairs—
"(1) display the purposes of the Patient Advocacy Program of the Department and the contact information for the patient advocate at such medical facility; and
"(2) display the rights and responsibilities of—
"(A) patients and family members of patients at such medical facility; and
"(B) with respect to community living centers and other residential facilities of the Department, residents and family members of residents at such medical facility.
"(a)
"(b)
"(1) A description of the Program, including—
"(A) the purpose of the Program;
"(B) the activities carried out under the Program; and
"(C) the sufficiency of the Program in achieving the purpose of the Program.
"(2) An assessment of the sufficiency of staffing of employees of the Department responsible for carrying out the Program.
"(3) An assessment of the sufficiency of the training of such employees.
"(4) An assessment of—
"(A) the awareness of the Program among veterans and family members of veterans; and
"(B) the use of the Program by veterans and family members of veterans.
"(5) Such recommendations and proposals for improving or modifying the Program as the Comptroller General considers appropriate.
"(6) Such other information with respect to the Program as the Comptroller General considers appropriate.
"(a)
"(b)
"(c)
"(a)
"(b)
"(1) Examine the efficacy of the evidence-based therapy model used by the Secretary for treating mental health illnesses of veterans and identify areas to improve wellness-based outcomes.
"(2) Conduct a patient-centered survey within each of the Veterans Integrated Service Networks to examine—
"(A) the experience of veterans with the Department of Veterans Affairs when seeking medical assistance for mental health issues through the health care system of the Department;
"(B) the experience of veterans with non-Department facilities and health professionals for treating mental health issues;
"(C) the preference of veterans regarding available treatment for mental health issues and which methods the veterans believe to be most effective;
"(D) the experience, if any, of veterans with respect to the complementary and integrative health treatment therapies described in paragraph (3);
"(E) the prevalence of prescribing prescription medication among veterans seeking treatment through the health care system of the Department as remedies for addressing mental health issues; and
"(F) the outreach efforts of the Secretary regarding the availability of benefits and treatments for veterans for addressing mental health issues, including by identifying ways to reduce barriers to gaps in such benefits and treatments.
"(3) Examine available research on complementary and integrative health treatment therapies for mental health issues and identify what benefits could be made with the inclusion of such treatments for veterans, including with respect to—
"(A) music therapy;
"(B) equine therapy;
"(C) training and caring for service dogs;
"(D) yoga therapy;
"(E) acupuncture therapy;
"(F) meditation therapy;
"(G) outdoor sports therapy;
"(H) hyperbaric oxygen therapy;
"(I) accelerated resolution therapy;
"(J) art therapy;
"(K) magnetic resonance therapy; and
"(L) other therapies the Commission determines appropriate.
"(4) Study the sufficiency of the resources of the Department to ensure the delivery of quality health care for mental health issues among veterans seeking treatment within the Department.
"(5) Study the current treatments and resources available within the Department and assess—
"(A) the effectiveness of such treatments and resources in decreasing the number of suicides per day by veterans;
"(B) the number of veterans who have been diagnosed with mental health issues;
"(C) the percentage of veterans using the resources of the Department who have been diagnosed with mental health issues;
"(D) the percentage of veterans who have completed counseling sessions offered by the Department; and
"(E) the efforts of the Department to expand complementary and integrative health treatments viable to the recovery of veterans with mental health issues as determined by the Secretary to improve the effectiveness of treatments offered by the Department.
"(c)
"(1)
"(A) Two members appointed by the Speaker of the House of Representatives, at least one of whom shall be a veteran.
"(B) Two members appointed by the minority leader of the House of Representatives, at least one of whom shall be a veteran.
"(C) Two members appointed by the majority leader of the Senate, at least one of whom shall be a veteran.
"(D) Two members appointed by the minority leader of the Senate, at least one of whom shall be a veteran.
"(E) Two members appointed by the President, at least one of whom shall be a veteran.
"(2)
"(A) are of recognized standing and distinction within the medical community with a background in treating mental health;
"(B) have experience working with the military and veteran population; and
"(C) do not have a financial interest in any of the complementary and integrative health treatments reviewed by the Commission.
"(3)
"(4)
"(5)
"(6)
"(d)
"(1)
"(A)
"(B)
"(2)
"(3)
"(4)
"(5)
"(6)
"(7)
"(8)
"(9)
"(A)
"(B)
"(10)
"(11)
"(12)
"(13)
"(e)
"(1)
"(A)
"(B)
"(2)
"(A) Recommendations to implement in a feasible, timely, and cost-efficient manner the solutions and remedies identified within the findings of the Commission pursuant to subsection (b).
"(B) An analysis of the evidence-based therapy model used by the Secretary of Veterans Affairs for treating veterans with mental health care issues, and an examination of the prevalence and efficacy of prescription drugs as a means for treatment.
"(C) The findings of the patient-centered survey conducted within each of the Veterans Integrated Service Networks pursuant to subsection (b)(2).
"(D) An examination of complementary and integrative health treatments described in subsection (b)(3) and the potential benefits of incorporating such treatments in the therapy models used by the Secretary for treating veterans with mental health issues.
"(3)
"(A) An action plan for implementing the recommendations established by the Commission on such solutions and remedies for improving wellness-based outcomes for veterans with mental health care issues.
"(B) A feasible timeframe on when the complementary and integrative health treatments described in subsection (b)(3) can be implemented Department-wide.
"(C) With respect to each recommendation established by the Commission, including any complementary and integrative health treatment, that the Secretary determines is not appropriate or feasible to implement, a justification for such determination and an alternative solution to improve the efficacy of the therapy models used by the Secretary for treating veterans with mental health issues.
"(f)
"(a)
"(b)
"(1) Research on the following:
"(A) The effectiveness of various complementary and integrative health services, including the effectiveness of such services integrated with clinical services.
"(B) Approaches to integrating complementary and integrative health services into other health care services provided by the Department of Veterans Affairs.
"(2) Education and training for health care professionals of the Department on the following:
"(A) Complementary and integrative health services selected by the Secretary for purposes of the plan.
"(B) Appropriate uses of such services.
"(C) Integration of such services into the delivery of health care to veterans.
"(3) Research, education, and clinical activities on complementary and integrative health at centers of innovation at medical centers of the Department.
"(4) Identification or development of metrics and outcome measures to evaluate the effectiveness of the provision and integration of complementary and integrative health services into the delivery of health care to veterans.
"(5) Integration and delivery of complementary and integrative health services with other health care services provided by the Department.
"(c)
"(1)
"(A) The Director of the National Center for Complementary and Integrative Health of the National Institutes of Health.
"(B) The Commissioner of Food and Drugs.
"(C) Institutions of higher education, private research institutes, and individual researchers with extensive experience in complementary and integrative health and the integration of complementary and integrative health practices into the delivery of health care.
"(D) Nationally recognized providers of complementary and integrative health.
"(E) Such other officials, entities, and individuals with expertise on complementary and integrative health as the Secretary considers appropriate.
"(2)
"(A) To develop the plan.
"(B) To identify specific complementary and integrative health practices that, on the basis of research findings or promising clinical interventions, are appropriate to include as services to veterans.
"(C) To identify barriers to the effective provision and integration of complementary and integrative health services into the delivery of health care to veterans, and to identify mechanisms for overcoming such barriers.
"(a)
"(1)
"(2)
"(A) Means of improving coordination between Federal, State, local, and community providers of health care in the provision of pain management and related health care services to veterans.
"(B) Means of enhancing outreach, and coordination of outreach, by and among providers of health care referred to in subparagraph (A) on the pain management and related health care services available to veterans.
"(C) Means of using complementary and integrative health and wellness-based programs of providers of health care referred to in subparagraph (A) as complements to the provision by the Department of Veterans Affairs of pain management and related health care services to veterans.
"(D) Whether complementary and integrative health and wellness-based programs described in subparagraph (C)—
"(i) are effective in enhancing the quality of life and well-being of veterans;
"(ii) are effective in increasing the adherence of veterans to the primary pain management and related health care services provided such veterans by the Department;
"(iii) have an effect on the sense of well-being of veterans who receive primary pain management and related health care services from the Department; and
"(iv) are effective in encouraging veterans receiving health care from the Department to adopt a more healthy lifestyle.
"(b)
"(c)
"(1)
"(2)
"(d)
"(e)
"(1) has a mental health condition diagnosed by a clinician of the Department;
"(2) experiences chronic pain;
"(3) has a chronic condition being treated by a clinician of the Department; or
"(4) is not described in paragraph (1), (2), or (3) and requests to participate in the pilot program or is referred by a clinician of the Department who is treating the veteran.
"(f)
"(1)
"(2)
"(A) Covered services shall be administered by professionals or other instructors with appropriate training and expertise in complementary and integrative health services who are employees of the Department or with whom the Department enters into an agreement to provide such services.
"(B) Covered services shall be included as part of the Patient Aligned Care Teams initiative of the Office of Patient Care Services, Primary Care Program Office, in coordination with the Office of Patient Centered Care and Cultural Transformation.
"(C) Covered services shall be made available to—
"(i) covered veterans who have received conventional treatments from the Department for the conditions for which the covered veteran seeks complementary and integrative health services under the pilot program; and
"(ii) covered veterans who have not received conventional treatments from the Department for such conditions.
"(g)
"(1)
"(2)
"(A) The findings and conclusions of the Secretary with respect to the pilot program under subsection (a)(1), including with respect to—
"(i) the use and efficacy of the complementary and integrative health services established under the pilot program;
"(ii) the outreach conducted by the Secretary to inform veterans and community organizations about the pilot program; and
"(iii) an assessment of the benefit of the pilot program to covered veterans in mental health diagnoses, pain management, and treatment of chronic illness.
"(B) Identification of any unresolved barriers that impede the ability of the Secretary to incorporate complementary and integrative health services with other health care services provided by the Department.
"(C) Such recommendations for the continuation or expansion of the pilot program as the Secretary considers appropriate.
"As part of the hiring process for each health care provider considered for a position at the Department of Veterans Affairs after the date of the enactment of the [this] Act [July 22, 2016], the Secretary of Veterans Affairs shall require from the medical board of each State in which the health care provider has or had a medical license—
"(1) information on any violation of the requirements of the medical license of the health care provider during the 20-year period preceding the consideration of the health care provider by the Department; and
"(2) information on whether the health care provider has entered into any settlement agreement for a disciplinary charge relating to the practice of medicine by the health care provider.
"Notwithstanding section 552a of title 5, United States Code, with respect to each health care provider of the Department of Veterans Affairs who has violated a requirement of the medical license of the health care provider, the Secretary of Veterans Affairs shall provide to the medical board of each State in which the health care provider is licensed detailed information with respect to such violation, regardless of whether such board has formally requested such information.
"Not later than 180 days after the date of the enactment of this Act [July 22, 2016], 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 compliance by the Department of Veterans Affairs with the policy of the Department—
"(1) to conduct a review of each health care provider of the Department who transfers to another medical facility of the Department, resigns, retires, or is terminated to determine whether there are any concerns, complaints, or allegations of violations relating to the medical practice of the health care provider; and
"(2) to take appropriate action with respect to any such concern, complaint, or allegation.
[Amended section 705 of Pub. L. 113–146, set out as a note under section 703 of this title.]
Pub. L. 114–41, title IV, §4003, July 31, 2015, 129 Stat. 462, provided that: "Each budget of the President submitted to Congress under section 1105 of title 31, United States Code, for fiscal year 2017 and each fiscal year thereafter shall include an appropriations account for non-Department provider programs (as defined in section 2(d) [probably means section 4002(d) of Pub. L. 114–41, 129 Stat. 462]) to be comprised of—
"(1) discretionary medical services funding that is designated for hospital care and medical services furnished at non-Department facilities; and
"(2) any funds transferred for such purpose from the Veterans Choice Fund established by section 802 of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113–146; 128 Stat. 1802) [set out below]."
Pub. L. 114–41, title IV, §4006, July 31, 2015, 129 Stat. 465, provided that:
"(a)
"(1) an independent analysis of the dialysis pilot program is conducted for each such initial facility;
"(2) the Secretary submits to the appropriate congressional committees the report under subsection (b); and
"(3) a period of 180 days has elapsed following the date on which the Secretary submits such report.
"(b)
"(1) The independent analysis described in subsection (a)(1).
"(2) A five-year dialysis investment plan explaining all of the options of the Secretary for delivering dialysis care to veterans, including how and where such care will be delivered.
"(c)
"(1) The term 'appropriate congressional committees' means—
"(A) the Committee on Veterans' Affairs and the Committee on Appropriations of the House of Representatives; and
"(B) the Committee on Veterans' Affairs and the Committee on Appropriations of the Senate.
"(2) The term 'dialysis pilot program' means the pilot demonstration program approved by the Under Secretary of Veterans Affairs for Health in August 2010 and by the Secretary of Veterans Affairs in September 2010 to provide dialysis care to patients at certain outpatient facilities operated by the Department of Veterans Affairs.
"(3) The term 'initial facility' means one of the four outpatient facilities identified by the Secretary to participate in the dialysis pilot program prior to the date of the enactment of this Act [July 31, 2015]."
Pub. L. 113–146, §2, titles I, II, VIII, Aug. 7, 2014, 128 Stat. 1755, 1769, 1801, as amended by Pub. L. 113–175, title IV, §409(a)–(f), Sept. 26, 2014, 128 Stat. 1906, 1907; Pub. L. 113–235, div. I, title II, §242, Dec. 16, 2014, 128 Stat. 2568; Pub. L. 114–19, §3(a), May 22, 2015, 129 Stat. 215; Pub. L. 114–41, title IV, §§4004, 4005, July 31, 2015, 129 Stat. 463, 464; Pub. L. 114–131, §1, Feb. 29, 2016, 130 Stat. 292; Pub. L. 115–26, §§1, 2, Apr. 19, 2017, 131 Stat. 129; Pub. L. 115–182, title I, §§142, 143, June 6, 2018, 132 Stat. 1429, provided that:
"In this Act [see Tables for classification]:
"(1) The term 'facility of the Department' has the meaning given the term 'facilities of the Department' in section 1701 of title 38, United States Code.
"(2) The terms 'hospital care' and 'medical services' have the meanings given such terms in section 1701 of title 38, United States Code.
"(a)
"(1)
"(A)
"(B)
"(i) Any health care provider that is participating in the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), including any physician furnishing services under such program.
"(ii) Any Federally-qualified health center (as defined in section 1905(l)(2)(B) of the Social Security Act (42 U.S.C. 1396d(l)(2)(B))).
"(iii) The Department of Defense.
"(iv) The Indian Health Service.
"(v) Subject to subsection (d)(5), a health care provider not otherwise covered under any of clauses (i) through (iv).
"(2)
"(3)
"(b)
"(1) the veteran is enrolled in the patient enrollment system of the Department of Veterans Affairs established and operated under section 1705 of title 38, United States Code, including any such veteran who has not received hospital care or medical services from the Department and has contacted the Department seeking an initial appointment from the Department for the receipt of such care or services; and
"(2) the veteran—
"(A) attempts, or has attempted, to schedule an appointment for the receipt of hospital care or medical services under chapter 17 of title 38, United States Code, but is unable to schedule an appointment within—
"(i) the wait-time goals of the Veterans Health Administration for the furnishing of such care or services; or
"(ii) with respect to such care or services that are clinically necessary, the period determined necessary for such care or services if such period is shorter than such wait-time goals;
"(B) resides more than 40 miles (as calculated based on distance traveled) from—
"(i) with respect to a veteran who is seeking primary care, a medical facility of the Department, including a community-based outpatient clinic, that is able to provide such primary care by a full-time primary care physician; or
"(ii) with respect to a veteran not covered under clause (i), the medical facility of the Department, including a community-based outpatient clinic, that is closest to the residence of the veteran;
"(C) resides—
"(i) in a State without a medical facility of the Department that provides—
"(I) hospital care;
"(II) emergency medical services; and
"(III) surgical care rated by the Secretary as having a surgical complexity of standard; and
"(ii) more than 20 miles from a medical facility of the Department described in clause (i); or
"(D)(i) resides in a location, other than a location in Guam, American Samoa, or the Republic of the Philippines, that is 40 miles or less from a medical facility of the Department, including a community-based outpatient clinic; and
"(ii)(I) is required to travel by air, boat, or ferry to reach each medical facility described in clause (i) that is 40 miles or less from the residence of the veteran; or
"(II) faces an unusual or excessive burden in traveling to such a medical facility of the Department based on—
"(aa) geographical challenges;
"(bb) environmental factors, such as roads that are not accessible to the general public, traffic, or hazardous weather;
"(cc) a medical condition that impacts the ability to travel; or
"(dd) other factors, as determined by the Secretary.
"(c)
"(1)
"(A) provide the veteran an appointment that exceeds the wait-time goals described in such subsection or place such eligible veteran on an electronic waiting list described in paragraph (2) for an appointment for hospital care or medical services the veteran has elected to receive under this section; or
"(B)(i) authorize that such care or services be furnished to the eligible veteran under this section for a period of time specified by the Secretary; and
"(ii) notify the eligible veteran by the most effective means available, including electronic communication or notification in writing, describing the care or services the eligible veteran is eligible to receive under this section.
"(2)
"(A) To determine the place of such eligible veteran on the waiting list.
"(B) To determine the average length of time an individual spends on the waiting list, disaggregated by medical facility of the Department and type of care or service needed, for purposes of allowing such eligible veteran to make an informed election under paragraph (1).
"(d)
"(1)
"(A)
"(B)
"(2)
"(A)
"(i) negotiate rates for the furnishing of care and services under this section; and
"(ii) reimburse the entity for such care and services at the rates negotiated pursuant to clause (i) as provided in such agreement.
"(B)
"(i)
"(ii)
"(I)
"(II)
"(III)
"(C)
"(3)
"(A)
"(B)
"(i) In the case of the Medicare program, any provider of services that has entered into a provider agreement under section 1866(a) of the Social Security Act (42 U.S.C. 1395cc(a)) and any physician or other supplier who has entered into a participation agreement under section 1842(h) of such Act (42 U.S.C. 1395u(h)); and
"(ii) In the case of the Medicaid program, any provider participating under a State plan under title XIX of such Act (42 U.S.C. 1396 et seq.).
"(4)
"(A) Information on applicable policies and procedures for submitting bills or claims for authorized care or services furnished to eligible veterans under this section.
"(B) Access to a telephone hotline maintained by the Department that such entity may call for information on the following:
"(i) Procedures for furnishing care and services under this section.
"(ii) Procedures for submitting bills or claims for authorized care and services furnished to eligible veterans under this section and being reimbursed for furnishing such care and services.
"(iii) Whether particular care or services under this section are authorized, and the procedures for authorization of such care or services.
"(5)
"(e)
"(1)
"(2)
"(A) is an insurance policy or contract, medical or hospital service agreement, membership or subscription contract, or similar arrangement not administered by the Secretary of Veterans Affairs, under which health services for individuals are provided or the expenses of such services are paid; and
"(B) does not include any such policy, contract, agreement, or similar arrangement pursuant to title XVIII or XIX of the Social Security Act (42 U.S.C. 1395 et seq.[, 1396 et seq.]) or chapter 55 of title 10, United States Code.
"(3)
"(A)
"(B)
"(f)
"(1)
"(2)
"(3)
"(A) The name of the veteran.
"(B) An identification number for the veteran that is not the social security number of the veteran.
"(C) The contact information of an appropriate office of the Department for health care providers to confirm that care or services under this section are authorized for the veteran.
"(D) Contact information and other relevant information for the submittal of claims or bills for the furnishing of care or services under this section.
"(E) The following statement: 'This card is for qualifying medical care outside the Department of Veterans Affairs. Please call the Department of Veterans Affairs phone number specified on this card to ensure that treatment has been authorized.'.
"(4)
"(g)
"(1) When the veteran enrolls in the patient enrollment system of the Department under section 1705 of title 38, United States Code.
"(2) When the veteran attempts to schedule an appointment for the receipt of hospital care or medical services from the Department but is unable to schedule an appointment within the wait-time goals of the Veterans Health Administration for the furnishing of such care or services.
"(3) When the veteran becomes eligible for hospital care or medical services under this section under subparagraph (B), (C), or (D) of subsection (b)(2).
"(h)
"(i)
"(1) maintain at least the same or similar credentials and licenses as those credentials and licenses that are required of health care providers of the Department, as determined by the Secretary for purposes of this section; and
"(2) submit, not less frequently than once each year during the period in which the Secretary is authorized to carry out this section pursuant to subsection (p), verification of such licenses and credentials maintained by such health care provider.
"(j)
"(1)
"(2)
"(3)
"(k)
"(1)
"(2)
"(3)
"(4)
"(A)
"(B)
"(i)
"(ii)
"(I) A description of the goals for accuracy for such system specified by the Secretary under subparagraph (A).
"(II) An assessment of the success of the Department in meeting such goals during the quarter covered by the report.
"(iii)
"(l)
"(1)
"(2)
"(m)
"(n)
"(o)
"(p)
"(q)
"(1)
"(A) The number of eligible veterans who have received care or services under this section.
"(B) A description of the types of care and services furnished to eligible veterans under this section.
"(2)
"(A) The total number of eligible veterans who have received care or services under this section, disaggregated by—
"(i) eligible veterans described in subsection (b)(2)(A);
"(ii) eligible veterans described in subsection (b)(2)(B);
"(iii) eligible veterans described in subsection (b)(2)(C); and
"(iv) eligible veterans described in subsection (b)(2)(D).
"(B) A description of the types of care and services furnished to eligible veterans under this section.
"(C) An accounting of the total cost of furnishing care and services to eligible veterans under this section.
"(D) The results of a survey of eligible veterans who have received care or services under this section on the satisfaction of such eligible veterans with the care or services received by such eligible veterans under this section.
"(E) An assessment of the effect of furnishing care and services under this section on wait times for appointments for the receipt of hospital care and medical services from the Department.
"(F) An assessment of the feasibility and advisability of continuing furnishing care and services under this section after the termination date specified in subsection (p).
"(r)
"(s)
"(1)
"(2)
"(A) for purposes of this section, the wait-time goals of the Veterans Health Administration shall be the wait-time goals submitted by the Secretary under this paragraph; and
"(B) the Secretary shall publish such wait-time goals in the Federal Register and on an Internet website of the Department available to the public.
"(t)
"(a)
"(1) eligible for health care at such facilities; and
"(2)(A) enrolled in the patient enrollment system of the Department established and operated under section 1705 of title 38, United States Code; or
"(B) eligible for hospital care and medical services pursuant to subsection (c)(2) of such section.
"(b)
"(c)
"(1) Entering into agreements for the reimbursement by the Secretary of the costs of direct care services provided through organizations receiving amounts pursuant to grants made or contracts entered into under section 503 of the Indian Health Care Improvement Act (25 U.S.C. 1653) to veterans who are otherwise eligible to receive health care from such organizations.
"(2) Including the reimbursement of the costs of direct care services provided to veterans who are not Indians in agreements between the Department and the following:
"(A) The Indian Health Service.
"(B) An Indian tribe or tribal organization operating a medical facility through a contract or compact with the Indian Health Service under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) [now 25 U.S.C. 5301 et seq.].
"(C) A medical facility of the Indian Health Service.
"(3) Entering into an agreement between the Department and the Indian Health Service described in paragraph (2)(A) with respect to the effect of such agreement on the priority access of any Indian to health care services provided through the Indian Health Service, the eligibility of any Indian to receive health services through the Indian Health Service, and the quality of health care services provided to any Indian through the Indian Health Service.
"(a)
"(b)
[Amended section 403 of Pub. L. 110—387, set out as a note under section 1703 of this title.]
"(a)
"(b)
"(1)
"(2)
"(c)
"(d)
"(1) The results of a survey of non-Department health care providers who have submitted claims to the Department for hospital care, medical services, or other health care furnished to veterans for which payment is authorized under the laws administered by the Secretary during the one-year period preceding the submittal of the report, which survey shall include the following:
"(A) The amount of time it took for such health care providers, after submitting such claims, to receive payment from the Department for such care or services.
"(B) A comparison of the amount of time under subparagraph (A) and the amount of time it takes such health care providers to receive payments from the United States for similar care or services provided to the following, if applicable:
"(i) Beneficiaries under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).
"(ii) Covered beneficiaries under the TRICARE program under chapter 55 of title 10, United States Code.
"(2) Such recommendations for legislative or administrative action as the Comptroller General considers appropriate.
"(e)
"(1) are located in different geographic areas;
"(2) furnish a variety of different hospital care, medical services, and other health care; and
"(3) furnish such care and services in a variety of different types of medical facilities.
"(a)
"(1)
"(A) the Veterans Integrated Service Networks and medical centers of the Department of Veterans Affairs, to
"(B) the Chief Business Office of the Veterans Health Administration of the Department of Veterans Affairs.
"(2)
"(3)
"(b)
"(a)
"(1)
"(A) Current and projected demographics and unique health care needs of the patient population served by the Department.
"(B) Current and projected health care capabilities and resources of the Department, including hospital care, medical services, and other health care furnished by non-Department facilities under contract with the Department, to provide timely and accessible care to veterans.
"(C) The authorities and mechanisms under which the Secretary may furnish hospital care, medical services, and other health care at non-Department facilities, including whether the Secretary should have the authority to furnish such care and services at such facilities through the completion of episodes of care.
"(D) The appropriate system-wide access standard applicable to hospital care, medical services, and other health care furnished by and through the Department, including an identification of appropriate access standards for each individual specialty and post-care rehabilitation.
"(E) The workflow process at each medical facility of the Department for scheduling appointments for veterans to receive hospital care, medical services, or other health care from the Department.
"(F) The organization, workflow processes, and tools used by the Department to support clinical staffing, access to care, effective length-of-stay management and care transitions, positive patient experience, accurate documentation, and subsequent coding of inpatient services.
"(G) The staffing level at each medical facility of the Department and the productivity of each health care provider at such medical facility, compared with health care industry performance metrics, which may include an assessment of any of the following:
"(i) The case load of, and number of patients treated by, each health care provider at such medical facility during an average week.
"(ii) The time spent by such health care provider on matters other than the case load of such health care provider, including time spent by such health care provider as follows:
"(I) At a medical facility that is affiliated with the Department.
"(II) Conducting research.
"(III) Training or supervising other health care professionals of the Department.
"(H) The information technology strategies of the Department with respect to furnishing and managing health care, including an identification of any weaknesses and opportunities with respect to the technology used by the Department, especially those strategies with respect to clinical documentation of episodes of hospital care, medical services, and other health care, including any clinical images and associated textual reports, furnished by the Department in Department or non-Department facilities.
"(I) Business processes of the Veterans Health Administration, including processes relating to furnishing non-Department health care, insurance identification, third-party revenue collection, and vendor reimbursement, including an identification of mechanisms as follows:
"(i) To avoid the payment of penalties to vendors.
"(ii) To increase the collection of amounts owed to the Department for hospital care, medical services, or other health care provided by the Department for which reimbursement from a third party is authorized and to ensure that such amounts collected are accurate.
"(iii) To increase the collection of any other amounts owed to the Department with respect to hospital care, medical services, and other health care and to ensure that such amounts collected are accurate.
"(iv) To increase the accuracy and timeliness of Department payments to vendors and providers.
"(J) The purchasing, distribution, and use of pharmaceuticals, medical and surgical supplies, medical devices, and health care related services by the Department, including the following:
"(i) The prices paid for, standardization of, and use by the Department of the following:
"(I) Pharmaceuticals.
"(II) Medical and surgical supplies.
"(III) Medical devices.
"(ii) The use by the Department of group purchasing arrangements to purchase pharmaceuticals, medical and surgical supplies, medical devices, and health care related services.
"(iii) The strategy and systems used by the Department to distribute pharmaceuticals, medical and surgical supplies, medical devices, and health care related services to Veterans Integrated Service Networks and medical facilities of the Department.
"(K) The process of the Department for carrying out construction and maintenance projects at medical facilities of the Department and the medical facility leasing program of the Department.
"(L) The competency of leadership with respect to culture, accountability, reform readiness, leadership development, physician alignment, employee engagement, succession planning, and performance management.
"(2)
"(A)
"(i) Review all training materials pertaining to scheduling of appointments at each medical facility of the Department.
"(ii) Assess whether all employees of the Department conducting tasks related to scheduling are properly trained for conducting such tasks.
"(iii) Assess whether changes in the technology or system used in scheduling appointments are necessary to limit access to the system to only those employees that have been properly trained in conducting such tasks.
"(iv) Assess whether health care providers of the Department are making changes to their schedules that hinder the ability of employees conducting such tasks to perform such tasks.
"(v) Assess whether the establishment of a centralized call center throughout the Department for scheduling appointments at medical facilities of the Department would improve the process of scheduling such appointments.
"(vi) Assess whether booking templates for each medical facility or clinic of the Department would improve the process of scheduling such appointments.
"(vii) Assess any interim technology changes or attempts by Department to internally develop a long-term scheduling solutions with respect to the feasibility and cost effectiveness of such internally developed solutions compared to commercially available solutions.
"(viii) Recommend actions, if any, to be taken by the Department to improve the process for scheduling such appointments, including the following:
"(I) Changes in training materials provided to employees of the Department with respect to conducting tasks related to scheduling such appointments.
"(II) Changes in monitoring and assessment conducted by the Department of wait times of veterans for such appointments.
"(III) Changes in the system used to schedule such appointments, including changes to improve how the Department—
"(aa) measures wait times of veterans for such appointments;
"(bb) monitors the availability of health care providers of the Department; and
"(cc) provides veterans the ability to schedule such appointments.
"(IV) Such other actions as the private sector entity or entities considers appropriate.
"(B)
"(i) Review the process of the Department for identifying and designing proposals for construction and maintenance projects at medical facilities of the Department and leases for medical facilities of the Department.
"(ii) Assess the process through which the Department determines the following:
"(I) That a construction or maintenance project or lease is necessary with respect to a medical facility or proposed medical facility of the Department.
"(II) The proper size of such medical facility or proposed medical facility with respect to treating veterans in the catchment area of such medical facility or proposed medical facility.
"(iii) Assess the management processes of the Department with respect to the capital management programs of the Department, including processes relating to the methodology for construction and design of medical facilities of the Department, the management of projects relating to the construction and design of such facilities, and the activation of such facilities.
"(iv) Assess the medical facility leasing program of the Department.
"(3)
"(b)
"(1) has experience and proven outcomes in optimizing the performance of the health care delivery systems of the Veterans Health Administration and the private sector and in health care management; and
"(2) specializes in implementing large-scale organizational and cultural transformations, especially with respect to health care delivery systems.
"(c)
"(1)
"(2)
"(d)
"(1)
"(2)
"(e)
"(a)
"(1)
"(2)
"(A)
"(i) Three members appointed by the Speaker of the House of Representatives, at least one of whom shall be a veteran.
"(ii) Three members appointed by the Minority Leader of the House of Representatives, at least one of whom shall be a veteran.
"(iii) Three members appointed by the Majority Leader of the Senate, at least one of whom shall be a veteran.
"(iv) Three members appointed by the Minority Leader of the Senate, at least one of whom shall be a veteran.
"(v) Three members appointed by the President, at least two of whom shall be veterans.
"(B)
"(i) at least one member shall represent an organization recognized by the Secretary of Veterans Affairs for the representation of veterans under section 5902 of title 38, United States Code;
"(ii) at least one member shall have experience as senior management for a private integrated health care system with an annual gross revenue of more than $50,000,000;
"(iii) at least one member shall be familiar with government health care systems, including those systems of the Department of Defense, the Indian Health Service, and Federally-qualified health centers (as defined in section 1905(l)(2)(B) of the Social Security Act (42 U.S.C. 1396d(l)(2)(B)));
"(iv) at least one member shall be familiar with the Veterans Health Administration but shall not be currently employed by the Veterans Health Administration; and
"(v) at least one member shall be familiar with medical facility construction and leasing projects carried out by government entities and have experience in the building trades, including construction, engineering, and architecture.
"(C)
"(3)
"(A) In
"(B)
"(4)
"(5)
"(6)
"(7)
"(b)
"(1)
"(2)
"(3)
"(A) Not later than 90 days after the date of the initial meeting of the Commission, an interim report on—
"(i) the findings of the Commission with respect to the evaluation and assessment required by this subsection; and
"(ii) such recommendations as the Commission may have for legislative or administrative action to improve access to health care through the Veterans Health Administration.
"(B) Not later than June 30, 2016, a final report on—
"(i) the findings of the Commission with respect to the evaluation and assessment required by this subsection; and
"(ii) such recommendations as the Commission may have for legislative or administrative action to improve access to health care through the Veterans Health Administration.
"(c)
"(1)
"(2)
"(d)
"(1)
"(A)
"(B)
"(2)
"(3)
"(A)
"(B)
"(4)
"(5)
"(e)
"(f)
"(g)
"(1)
"(A) considers feasible and advisable; and
"(B) determines can be implemented without further legislative action.
"(2)
"(A) An assessment of the feasibility and advisability of each recommendation contained in the report received by the President.
"(B) For each recommendation assessed as feasible and advisable under subparagraph (A) the following:
"(i) Whether such recommendation requires legislative action.
"(ii) If such recommendation requires legislative action, a recommendation concerning such legislative action.
"(iii) A description of any administrative action already taken to carry out such recommendation.
"(iv) A description of any administrative action the President intends to be taken to carry out such recommendation and by whom.
"(a)
"(1)
"(2)
"(A)
"(B)
"(b)
"(1)
"(2)
"(A) Proposals for specific actions to be taken by the Department to improve the scheduling system and scheduling software of the Department described in subsection (a)(1).
"(B) A determination as to whether one or more existing off-the-shelf systems would—
"(i) meet the needs of the Department to schedule appointments for veterans for hospital care, medical services, and other health care from the Department; and
"(ii) improve the access of veterans to such care and services.
"(3)
"(c)
"(a)
"(1)
"(2)
"(A) The number of days each mobile vet center and mobile medical center of the Department is expected to travel per year.
"(B) The number of locations and events each center is expected to visit per year.
"(C) The number of appointments and outreach contacts each center is expected to conduct per year.
"(D) The method and timing of notifications given by each center to individuals in the area to which the center is traveling, including notifications informing veterans of the availability to schedule appointments at the center.
"(3)
"(b)
"(1)
"(2)
"(A) A description of the use of mobile vet centers and mobile medical centers to provide telemedicine services and readjustment counseling to veterans during the year preceding the submittal of the report, including the following:
"(i) The number of days each mobile vet center and mobile medical center was open to provide such services.
"(ii) The number of days each center traveled to a location other than the headquarters of the center to provide such services.
"(iii) The number of appointments and outreach contacts each center conducted to provide such services on average per month and in total during such year.
"(B) An analysis of the effectiveness of using mobile vet centers and mobile medical centers to provide health care services and readjustment counseling to veterans through the use of telemedicine.
"(C) Any recommendations for an increase in the number of mobile vet centers and mobile medical centers of the Department.
"(D) Any recommendations for an increase in the telemedicine capabilities of each mobile vet center and mobile medical center.
"(E) The feasibility and advisability of using temporary health care providers, including locum tenens, to provide direct health care services to veterans at mobile medical centers.
"(F) Such other recommendations on improvement of the use of mobile vet centers and mobile medical centers by the Department as the Secretary considers appropriate.
"(a)
"(1) Directors, associate directors, assistant directors, deputy directors, chiefs of staff, and clinical leads of medical centers of the Department of Veterans Affairs.
"(2) Directors, assistant directors, and quality management officers of Veterans Integrated Service Networks of the Department of Veterans Affairs.
"(b)
"(1)
"(2)
"(A) Recent reviews by the Joint Commission (formerly known as the 'Joint Commission on Accreditation of Healthcare Organizations') of such facilities.
"(B) The number and nature of recommendations concerning such facilities by the Inspector General of the Department in reviews conducted through the Combined Assessment Program, in the reviews by the Inspector General of community-based outpatient clinics and primary care clinics, and in reviews conducted through the Office of Healthcare Inspections during the two most recently completed fiscal years.
"(C) The number of recommendations described in subparagraph (B) that the Inspector General of the Department determines have not been carried out satisfactorily with respect to such facilities.
"(D) Reviews of such facilities by the Commission on Accreditation of Rehabilitation Facilities.
"(E) The number and outcomes of administrative investigation boards, root cause analyses, and peer reviews conducted at such facilities during the fiscal year for which the assessment is being conducted.
"(F) The effectiveness of any remedial actions or plans resulting from any Inspector General recommendations in the reviews and analyses described in subparagraphs (A) through (E).
"(3)
"(c)
"(a)
"(1) on a publicly accessible Internet website of each medical center of the Department by not later than 30 days after such change; and
"(2) in the Federal Register by not later than 90 days after such change.
"(b)
"(1)
"(2)
"(3)
"(4)
"(c)
"(1)
"(2)
"(A) Measures of timely and effective health care.
"(B) Measures of readmissions, complications of death, including with respect to 30-day mortality rates and 30-day readmission rates, surgical complication measures, and health care related infection measures.
"(C) Survey data of patient experiences, including the Hospital Consumer Assessment of Healthcare Providers and Systems or any similar successor survey developed by the Department of Health and Human Services.
"(D) Any other measures required of or reported with respect to hospitals participating in the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).
"(3)
"(d)
"(a)
"(1)
"(2)
"(3)
"(b)
"(1)
"(2)
"(A) The education and training of the surgeon.
"(B) The licensure, registration, and certification of the surgeon by the State or national entity responsible for such licensure, registration, or certification.
"(3)
"(c)
"(1)
"(A) The manner in which contractors under the Patient-Centered Community Care initiative of the Department perform oversight of the credentials of physicians within the networks of such contractors under the initiative.
"(B) The oversight by the Department of the contracts under the Patient-Centered Community Care initiative.
"(C) The verification by the Department of the credentials and licenses of health care providers furnishing hospital care and medical services under section 101.
"(2)
"(A)
"(B)
"The materials on the Department of Veterans Affairs in the budget of the President for a fiscal year, as submitted to Congress pursuant to section 1105(a) of title 31, United States Code, shall set forth the following:
"(1) The number of veterans who received hospital care and medical services under section 101 during the fiscal year preceding the fiscal year in which such budget is submitted.
"(2) The amount expended by the Department on furnishing care and services under such section during the fiscal year preceding the fiscal year in which such budget is submitted.
"(3) The amount requested in such budget for the costs of furnishing care and services under such section during the fiscal year covered by such budget, set forth in aggregate and by amounts for each account for which amounts are so requested.
"(4) The number of veterans that the Department estimates will receive hospital care and medical services under such section during the fiscal years covered by the budget submission.
"(5) The number of employees of the Department on paid administrative leave at any point during the fiscal year preceding the fiscal year in which such budget is submitted.
"Not later than 60 days after the date of the enactment of this Act [Aug. 7, 2014], and in accordance with title 5, United States Code, the Secretary of Veterans Affairs shall establish policies whereby any employee of the Department of Veterans Affairs who knowingly submits false data concerning wait times for health care or quality measures with respect to health care to another employee of the Department or knowingly requires another employee of the Department to submit false data concerning such wait times or quality measures to another employee of the Department is subject to a penalty the Secretary considers appropriate after notice and an opportunity for a hearing, including civil penalties, unpaid suspensions, or termination.
"(a)
"(b)
"(1) To increase the access of veterans to care as follows:
"(A) To hire primary care and specialty care physicians for employment in the Department of Veterans Affairs.
"(B) To hire other medical staff, including the following:
"(i) Physicians.
"(ii) Nurses.
"(iii) Social workers.
"(iv) Mental health professionals.
"(v) Other health care professionals as the Secretary considers appropriate.
"(C) To carry out sections 301 [enacting section 7412 of this title, amending sections 7302 and 7612 of this title, and enacting provisions set out as notes under sections 7302 and 7412 of this title] and 302 [amending sections 7619 and 7683 of this title], including the amendments made by such sections.
"(D) To pay for expenses, equipment, and other costs associated with the hiring of primary care, specialty care physicians, and other medical staff under subparagraphs (A), (B), and (C).
"(2) To improve the physical infrastructure of the Department as follows:
"(A) To maintain and operate hospitals, nursing homes, domiciliary facilities, and other facilities of the Veterans Health Administration.
"(B) To enter into contracts or hire temporary employees to repair, alter, or improve facilities under the jurisdiction of the Department that are not otherwise provided for under this paragraph.
"(C) To carry out leases for facilities of the Department.
"(D) To carry out minor construction projects of the Department.
"(c)
"(d)
"(1)
"(2)
"(A) the Committee on Veterans' Affairs and the Committee on Appropriations of the Senate; and
"(B) the Committee on Veterans' Affairs and the Committee on Appropriations of the House of Representatives.
"(e)
"(a)
"(b)
"(c)
"(1)
"(2)
"(A)
"(B)
"(i) the Secretary determines that the amount of such increase is necessary to carry out section 101;
"(ii) the Secretary submits to the Committees on Veterans' Affairs and Appropriations of the House of Representatives and the Committees on Veterans' Affairs and Appropriations of the Senate a report described in subparagraph (C); and
"(iii) a period of 60 days has elapsed following the date on which the Secretary submits the report under clause (ii).
"(C)
"(i) A notification of the amount of the increase that the Secretary determines necessary under subparagraph (B)(i).
"(ii) The justifications for such increased amount.
"(iii) The administrative requirements that the Secretary will carry out using such increased amount.
"(3)
"(A)
"(B)
"(C)
"(D)
"(i) the amounts used by the Secretary pursuant to subparagraphs (A) and (B); and
"(ii) an identification of such amounts listed by the non-Department provider program for which the amounts were used.
"(E)
"(i) The term 'appropriate congressional committees' means—
"(I) the Committee on Veterans' Affairs and the Committee on Appropriations of the House of Representatives; and
"(II) the Committee on Veterans' Affairs and the Committee on Appropriations of the Senate.
"(ii) The term 'non-Department facilities' has the meaning given that term in section 1701 of title 38, United States Code.
"(iii) The term 'non-Department provider program' has the meaning given that term in section 4002(d) of the VA Budget and Choice Improvement Act [Pub. L. 114–41, 129 Stat. 462].
"(4)
"(d)
"(1)
"(2)
"(e)
"(a)
"(b)
[Pub. L. 114–19, §3(b), May 22, 2015, 129 Stat. 216, provided that: "The amendments made by subsection (a) [amending section 101(b)(2) of Pub. L. 113–146, set out above] shall take effect on the date of the enactment of this Act [May 22, 2015] and apply with respect to care or services provided on or after such date."]
Pub. L. 110–387, title III, §301(b), Oct. 10, 2008, 122 Stat. 4120, provided that: "Paragraph (5) of section 1701 of title 38, United States Code, shall not be construed to prevent the Secretary of Veterans Affairs from providing services described in subparagraph (B) of such paragraph to individuals described in such subparagraph in centers under section 1712A of such title (commonly referred to as 'Vet Centers'), Department of Veterans Affairs medical centers, community-based outpatient clinics, or in such other facilities of the Department of Veterans Affairs as the Secretary considers necessary."
Pub. L. 104–262, title I, §103(b), Oct. 9, 1996, 110 Stat. 3182, provided that: "Not later than 30 days after the date of the enactment of this Act [Oct. 9, 1996], the Secretary of Veterans Affairs shall prescribe the guidelines required by the amendments made by subsection (a) [amending this section] and shall furnish a copy of those guidelines to the Committees on Veterans' Affairs of the Senate and House of Representatives."
Pub. L. 103–446, title XI, §1104, Nov. 2, 1994, 108 Stat. 4682, directed Secretary of Veterans Affairs to submit to Congress, not later than one year after Nov. 2, 1994, report and study on feasibility and advisability of alternative organizational structures, such as the establishment of a wholly-owned Government corporation or a Government-sponsored enterprise, for the effective provision of health care services to veterans.
Pub. L. 98–528, title I, §103(b), Oct. 19, 1984, 98 Stat. 2688, ratified actions by Administrator of Veterans' Affairs in entering into contracts applicable to the period beginning Oct. 1, 1984, and ending Oct. 19, 1984, for care described in par. (4)(C)(v) of this section and in making waivers described in that provision.
Pub. L. 98–160, title III, §302, Nov. 21, 1983, 97 Stat. 1004, as amended by Pub. L. 102–40, title IV, §402(d)(2), May 7, 1991, 105 Stat. 239; Pub. L. 102–83, §§5(c)(2), 6(f), Aug. 6, 1991, 105 Stat. 406, 407, provided that: "The Secretary of Veterans Affairs shall ensure that each health-care facility under the direct jurisdiction of the Secretary is able, through services made available either by individuals appointed to positions in the Veterans Health Administration or under contracts or other agreements made under section 4117 [see 7409], 8111, or 8153 of title 38, United States Code, to provide appropriate care, in a timely fashion, for any gender-specific disability (as defined in section 1701(1) of such title) of a woman veteran eligible for such care under chapter 17 or chapter 31 of such title."
Pub. L. 96–22, title II, §201(b), June 13, 1979, 93 Stat. 54, which directed Chief Medical Director of the Veterans' Administration to report to appropriate committees of Congress, not later than Feb. 1, 1980, and annually thereafter, on implementation of former par. (4)(C)(v) of this section and amendments made to this section by section 201 of Pub. L. 96–22, and on numbers of veterans provided contract treatment (and average cost and duration thereof) in each State in certain enumerated categories, was repealed by Pub. L. 100–322, title I, §112(b), May 20, 1988, 102 Stat. 499.
Pub. L. 95–520, §8, Oct. 26, 1978, 92 Stat. 1822, as amended by Pub. L. 96–330, title IV, §407, Aug. 26, 1980, 94 Stat. 1053, directed Administrator of Veterans' Affairs, not later than Feb. 1, 1981, to submit a report to President and Congress on furnishing by Administration of hospital care and medical services in Puerto Rico and Virgin Islands, and set forth applicable criteria and considerations for the report.