[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3230 Enrolled Bill (ENR)]
H.R.3230
One Hundred Thirteenth Congress
of the
United States of America
AT THE SECOND SESSION
Begun and held at the City of Washington on Friday,
the third day of January, two thousand and fourteen
An Act
To improve the access of veterans to medical services from the
Department of Veterans Affairs, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,

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

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for veterans through the use of agreements with non-Department
of Veterans Affairs entities.

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TITLE I

-IMPROVEMENT OF ACCESS TO CARE FROM NON-DEPARTMENT OF VETERANS

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Affairs and Native Hawaiian health care systems.

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contract care authority for health care needs of veterans.

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services, and other health care from non-Department of
Veterans Affairs providers to the chief business office of the
Veterans Health Administration.

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management processes of the Department of Veterans Affairs.

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TITLE II

-HEALTH CARE ADMINISTRATIVE MATTERS

software of the Department of Veterans Affairs.

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mobile medical centers of the Department of Veterans Affairs.

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and medical services furnished through expanded use of
contracts for such care.

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quality measures at Department of Veterans Affairs.

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of medical facilities of the Department of Veterans Affairs.

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TITLE III

-HEALTH CARE STAFFING, RECRUITMENT, AND TRAINING MATTERS

Department of Veterans Affairs Health Professionals
Educational Assistance Program.

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treatment to veterans on inactive duty training.

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TITLE IV

-HEALTH CARE RELATED TO SEXUAL TRAUMA

Department of Veterans Affairs to members of the Armed Forces.

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TITLE V

-OTHER HEALTH CARE MATTERS

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TITLE VI

-MAJOR MEDICAL FACILITY LEASES

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TITLE VII

-OTHER VETERANS MATTERS

institutions of higher learning for purposes of All-Volunteer
Force Educational Assistance Program and Post-9/11 Educational
Assistance conditional on in-State tuition rate for veterans.

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Department of Veterans Affairs for certain veterans covered by
Medicaid plans for services furnished by nursing facilities.

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loans guaranteed by Secretary of Veterans Affairs.

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

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TITLE VIII

-OTHER MATTERS

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VETERANS AFFAIRS AND INDIAN HEALTH SERVICE.
(a) Outreach to Tribal-Run Medical Facilities.--The Secretary of
Veterans Affairs shall, in consultation with the Director of the Indian
Health Service, conduct outreach to each medical facility operated by
an Indian tribe or tribal organization through a contract or compact
with the Indian Health Service under the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450 et seq.) to raise awareness of
the ability of such facilities, Indian tribes, and tribal organizations
to enter into agreements with the Department of Veterans Affairs under
which the Secretary reimburses such facilities, Indian tribes, or
tribal organizations, as the case may be, for health care provided to
veterans who are--
(1) eligible for health care at such facilities; and
(2)(A) enrolled in the patient enrollment system of the
Department established and operated under section 1705 of title 38,
United States Code; or
(B) eligible for hospital care and medical services pursuant to
subsection (c)(2) of such section.
(b) Performance Metrics for Memorandum of Understanding.--The
Secretary of Veterans Affairs shall establish performance metrics for
assessing the performance by the Department of Veterans Affairs and the
Indian Health Service under the memorandum of understanding entitled
``Memorandum of Understanding between the Department of Veterans
Affairs (VA) and the Indian Health Service (IHS)'' in increasing access
to health care, improving quality and coordination of health care,
promoting effective patient-centered collaboration and partnerships
between the Department and the Service, and ensuring health-promotion
and disease-prevention services are appropriately funded and available
for beneficiaries under both health care systems.
(c) Report.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs and the
Director of the Indian Health Service shall jointly submit to Congress
a report on the feasibility and advisability of the following:
(1) Entering into agreements for the reimbursement by the
Secretary of the costs of direct care services provided through
organizations receiving amounts pursuant to grants made or
contracts entered into under section 503 of the Indian Health Care
Improvement Act (25 U.S.C. 1653) to veterans who are otherwise
eligible to receive health care from such organizations.
(2) Including the reimbursement of the costs of direct care
services provided to veterans who are not Indians in agreements
between the Department and the following:
(A) The Indian Health Service.
(B) An Indian tribe or tribal organization operating a
medical facility through a contract or compact with the Indian
Health Service under the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450 et seq.).
(C) A medical facility of the Indian Health Service.
(d) Definitions.--In this section:
(1) Indian.--The terms ``Indian'' and ``Indian tribe'' have the
meanings given those terms in section 4 of the Indian Health Care
Improvement Act (25 U.S.C. 1603).
(2) Medical facility of the indian health service.--The term
``medical facility of the Indian Health Service'' includes a
facility operated by an Indian tribe or tribal organization through
a contract or compact with the Indian Health Service under the
Indian Self-Determination and Education Assistance Act (25 U.S.C.
450 et seq.).
(3) Tribal organization.--The term ``tribal organization'' has
the meaning given the term in section 4 of the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450b).

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VETERANS AFFAIRS AND NATIVE HAWAIIAN HEALTH CARE SYSTEMS.
(a) In General.--The Secretary of Veterans Affairs shall, in
consultation with Papa Ola Lokahi and such other organizations involved
in the delivery of health care to Native Hawaiians as the Secretary
considers appropriate, enter into contracts or agreements with Native
Hawaiian health care systems that are in receipt of funds from the
Secretary of Health and Human Services pursuant to grants awarded or
contracts entered into under section 6(a) of the Native Hawaiian Health
Care Improvement Act (42 U.S.C. 11705(a)) for the reimbursement of
direct care services provided to eligible veterans as specified in such
contracts or agreements.
(b) Definitions.--In this section, the terms ``Native Hawaiian'',
``Native Hawaiian health care system'', and ``Papa Ola Lokahi'' have
the meanings given those terms in section 12 of the Native Hawaiian
Health Care Improvement Act (42 U.S.C. 11711).

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ENHANCED CONTRACT CARE AUTHORITY FOR HEALTH CARE NEEDS OF
VETERANS.
Section 403 of the Veterans' Mental Health and Other Care
Improvements Act of 2008 (Public Law 110-387; 38 U.S.C. 1703 note) is
amended--
(1) in subsection (a)--
(A) in paragraph (3), by striking ``only during the'' and
all that follows through the period at the end and inserting
``only during the period beginning on the date of the
commencement of the pilot program under paragraph (2) and
ending on the date that is two years after the date of the
enactment of the Veterans Access, Choice, and Accountability
Act of 2014.''; and
(B) by amending paragraph (4) to read as follows:
``(4) Program locations.--The Secretary shall carry out the
pilot program at locations in the following Veterans Integrated
Service Networks (and such other locations as the Secretary
considers appropriate):
``(A) Veterans Integrated Service Network 1.
``(B) Veterans Integrated Service Network 6.
``(C) Veterans Integrated Service Network 15.
``(D) Veterans Integrated Service Network 18.
``(E) Veterans Integrated Service Network 19.'';
(2) in subsection (b)(1)(A), by striking ``as of the date of
the commencement of the pilot program under subsection (a)(2)'' and
inserting ``as of August 1, 2014'';
(3) by redesignating subsection (h) as subsection (k);
(4) by inserting after subsection (g) the following new
subsections:
``(h) Appointments.--In carrying out the pilot program under this
section, the Secretary shall ensure that medical appointments for
covered veterans--
``(1) are scheduled not later than 5 days after the date on
which the appointment is requested; and
``(2) occur not later than 30 days after such date.
``(i) Outreach.--The Secretary shall ensure that covered veterans
are informed about the pilot program under this section.
``(j) Use of Existing Contracts.--In carrying out the pilot program
under this section after the date of the enactment of the Veterans
Access, Choice, and Accountability Act of 2014, the Secretary shall
make use of contracts entered into before such date or may enter into
new contracts.''; and
(5) in paragraph (2)(B) of subsection (k), as redesignated by
paragraph (3) of this section, by striking the semicolon at the end
and inserting ``; and''.

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(a) Sense of Congress on Prompt Payment by Department.--It is the
sense of Congress that the Secretary of Veterans Affairs shall comply
with section 1315 of title 5, Code of Federal Regulations (commonly
known as the ``prompt payment rule''), or any corresponding similar
regulation or ruling, in paying for health care pursuant to contracts
entered into with non-Department of Veterans Affairs providers to
provide health care under the laws administered by the Secretary.
(b) Establishment of Claims Processing System.--
(1) Claims processing system.--The Secretary of Veterans
Affairs shall establish and implement a system to process and pay
claims for payment for hospital care, medical services, and other
health care furnished by non-Department of Veterans Affairs health
care providers under the laws administered by the Secretary.
(2) Compliance with prompt payment act.--The system established
and implemented under paragraph (1) shall comply with all
requirements of chapter 39, United States Code (commonly referred
to as the ``Prompt Payment Act'').
(c) Report.--Not later than 1 year after the date of the enactment
of this Act, the Comptroller General of the United States shall submit
to Congress a report on the timeliness of payments by the Secretary for
hospital care, medical services, and other health care furnished by
non-Department of Veterans Affairs health care providers under the laws
administered by the Secretary.
(d) Elements.--The report required by subsection (b) shall include
the following:
(1) The results of a survey of non-Department health care
providers who have submitted claims to the Department for hospital
care, medical services, or other health care furnished to veterans
for which payment is authorized under the laws administered by the
Secretary during the one-year period preceding the submittal of the
report, which survey shall include the following:
(A) The amount of time it took for such health care
providers, after submitting such claims, to receive payment
from the Department for such care or services.
(B) A comparison of the amount of time under subparagraph
(A) and the amount of time it takes such health care providers
to receive payments from the United States for similar care or
services provided to the following, if applicable:
(i) Beneficiaries under the Medicare program under
title XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.).
(ii) Covered beneficiaries under the TRICARE program
under chapter 55 of title 10, United States Code.
(2) Such recommendations for legislative or administrative
action as the Comptroller General considers appropriate.
(e) Survey Elements.--In carrying out the survey, the Comptroller
General shall seek responses from non-Department health care providers
in a manner that ensures that the survey reflects the responses of such
providers that--
(1) are located in different geographic areas;
(2) furnish a variety of different hospital care, medical
services, and other health care; and
(3) furnish such care and services in a variety of different
types of medical facilities.

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MEDICAL SERVICES, AND OTHER HEALTH CARE FROM NON-DEPARTMENT OF
VETERANS AFFAIRS PROVIDERS TO THE CHIEF BUSINESS OFFICE OF THE
VETERANS HEALTH ADMINISTRATION.
(a) Transfer of Authority.--
(1) In general.--Effective as of October 1, 2014, the Secretary
of Veterans Affairs shall transfer the authority to pay for
hospital care, medical services, and other health care furnished
through non-Department of Veterans Affairs providers from--
(A) the Veterans Integrated Service Networks and medical
centers of the Department of Veterans Affairs, to
(B) the Chief Business Office of the Veterans Health
Administration of the Department of Veterans Affairs.
(2) Manner of care.--The Chief Business Office shall work in
consultation with the Office of Clinical Operations and Management
of the Department to ensure that care and services described in
paragraph (1) are provided in a manner that is clinically
appropriate and in the best interest of the veterans receiving such
care and services.
(3) No delay in payment.--The transfer of authority under
paragraph (1) shall be carried out in a manner that does not delay
or impede any payment by the Department for hospital care, medical
services, or other health care furnished through a non-Department
provider under the laws administered by the Secretary.
(b) Budget Matters.--The budget of the Department of Veterans
Affairs for any fiscal year beginning after the date of the enactment
of this Act (as submitted to Congress pursuant to section 1105(a) of
title 31, United States Code) shall specify funds for the payment for
hospital care, medical services, and other health care furnished
through non-Department of Veterans Affairs providers, including any
administrative costs associated with such payment, as funds for the
Chief Business Office of the Veterans Health Administration rather than
as funds for the Veterans Integrated Service Networks or medical
centers of the Department.

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SYSTEMS AND MANAGEMENT PROCESSES OF THE DEPARTMENT OF VETERANS
AFFAIRS.
(a) Independent Assessment.--
(1) Assessment.--Not later than 90 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall
enter into one or more contracts with a private sector entity or
entities described in subsection (b) to conduct an independent
assessment of the hospital care, medical services, and other health
care furnished in medical facilities of the Department. Such
assessment shall address each of the following:
(A) Current and projected demographics and unique health
care needs of the patient population served by the Department.
(B) Current and projected health care capabilities and
resources of the Department, including hospital care, medical
services, and other health care furnished by non-Department
facilities under contract with the Department, to provide
timely and accessible care to veterans.
(C) The authorities and mechanisms under which the
Secretary may furnish hospital care, medical services, and
other health care at non-Department facilities, including
whether the Secretary should have the authority to furnish such
care and services at such facilities through the completion of
episodes of care.
(D) The appropriate system-wide access standard applicable
to hospital care, medical services, and other health care
furnished by and through the Department, including an
identification of appropriate access standards for each
individual specialty and post-care rehabilitation.
(E) The workflow process at each medical facility of the
Department for scheduling appointments for veterans to receive
hospital care, medical services, or other health care from the
Department.
(F) The organization, workflow processes, and tools used by
the Department to support clinical staffing, access to care,
effective length-of-stay management and care transitions,
positive patient experience, accurate documentation, and
subsequent coding of inpatient services.
(G) The staffing level at each medical facility of the
Department and the productivity of each health care provider at
such medical facility, compared with health care 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) Particular elements of certain assessments.--
(A) Scheduling assessment.--In carrying out the assessment
required by paragraph (1)(E), the private sector entity or
entities shall do the following:
(i) Review all training materials pertaining to
scheduling of appointments at each medical facility of the
Department.
(ii) Assess whether all employees of the Department
conducting tasks related to scheduling are properly trained
for conducting such tasks.
(iii) Assess whether changes in the technology or
system used in scheduling appointments are necessary to
limit access to the system to only those employees that
have been properly trained in conducting such tasks.
(iv) Assess whether health care providers of the
Department are making changes to their schedules that
hinder the ability of employees conducting such tasks to
perform such tasks.
(v) Assess whether the establishment of a centralized
call center throughout the Department for scheduling
appointments at medical facilities of the Department would
improve the process of scheduling such appointments.
(vi) Assess whether booking templates for each medical
facility or clinic of the Department would improve the
process of scheduling such appointments.
(vii) Assess any interim technology changes or attempts
by Department to internally develop a long-term scheduling
solutions with respect to the feasibility and cost
effectiveness of such internally developed solutions
compared to commercially available solutions.
(viii) Recommend actions, if any, to be taken by the
Department to improve the process for scheduling such
appointments, including the following:
(I) Changes in training materials provided to
employees of the Department with respect to conducting
tasks related to scheduling such appointments.
(II) Changes in monitoring and assessment conducted
by the Department of wait times of veterans for such
appointments.
(III) Changes in the system used to schedule such
appointments, including changes to improve how the
Department--
(aa) measures wait times of veterans for such
appointments;
(bb) monitors the availability of health care
providers of the Department; and
(cc) provides veterans the ability to schedule
such appointments.
(IV) Such other actions as the private sector
entity or entities considers appropriate.
(B) Medical construction and maintenance project and
leasing program assessment.--In carrying out the assessment
required by paragraph (1)(K), the private sector entity or
entities shall do the following:
(i) Review the process of the Department for
identifying and designing proposals for construction and
maintenance projects at medical facilities of the
Department and leases for medical facilities of the
Department.
(ii) Assess the process through which the Department
determines the following:
(I) That a construction or maintenance project or
lease is necessary with respect to a medical facility
or proposed medical facility of the Department.
(II) The proper size of such medical facility or
proposed medical facility with respect to treating
veterans in the catchment area of such medical facility
or proposed medical facility.
(iii) Assess the management processes of the Department
with respect to the capital management programs of the
Department, including processes relating to the methodology
for construction and design of medical facilities of the
Department, the management of projects relating to the
construction and design of such facilities, and the
activation of such facilities.
(iv) Assess the medical facility leasing program of the
Department.
(3) Timing.--The private sector entity or entities carrying out
the assessment required by paragraph (1) shall complete such
assessment not later than 240 days after entering into the contract
described in such paragraph.
(b) Private Sector Entities Described.--A private entity described
in this subsection is a private entity that--
(1) has experience and proven outcomes in optimizing the
performance of the health care delivery systems of the Veterans
Health Administration and the private sector and in health care
management; and
(2) specializes in implementing large-scale organizational and
cultural transformations, especially with respect to health care
delivery systems.
(c) Program Integrator.--
(1) In general.--If the Secretary enters into contracts with
more than one private sector entity under subsection (a), the
Secretary shall designate one such entity that is predominately a
health care organization as the program integrator.
(2) Responsibilities.--The program integrator designated
pursuant to paragraph (1) shall be responsible for coordinating the
outcomes of the assessments conducted by the private entities
pursuant to such contracts.
(d) Report on Assessment.--
(1) In general.--Not later than 60 days after completing the
assessment required by subsection (a), the private sector entity or
entities carrying out such assessment shall submit to the Secretary
of Veterans Affairs, the Committee on Veterans' Affairs of the
Senate, the Committee on Veterans' Affairs of the House of
Representatives, and the Commission on Care established under
section 202 a report on the findings and recommendations of the
private sector entity or entities with respect to such assessment.
(2) Publication.--Not later than 30 days after receiving the
report under paragraph (1), the Secretary shall publish such report
in the Federal Register and on an Internet website of the
Department of Veterans Affairs that is accessible to the public.
(e) Non-Department Facilities Defined.--In this section, the term
``non-Department facilities'' has the meaning given that term in
section 1701 of title 38, United States Code.

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(a) Establishment of Commission.--
(1) In general.--There is established a commission, to be known
as the ``Commission on Care'' (in this section referred to as the
``Commission''), to examine the access of veterans to health care
from the Department of Veterans Affairs and strategically examine
how best to organize the Veterans Health Administration, locate
health care resources, and deliver health care to veterans during
the 20-year period beginning on the date of the enactment of this
Act.
(2) Membership.--
(A) Voting members.--The Commission shall be composed of 15
voting members who are appointed as follows:
(i) Three members appointed by the Speaker of the House
of Representatives, at least one of whom shall be a
veteran.
(ii) Three members appointed by the Minority Leader of
the House of Representatives, at least one of whom shall be
a veteran.
(iii) Three members appointed by the Majority Leader of
the Senate, at least one of whom shall be a veteran.
(iv) Three members appointed by the Minority Leader of
the Senate, at least one of whom shall be a veteran.
(v) Three members appointed by the President, at least
two of whom shall be veterans.
(B) Qualifications.--Of the members appointed under
subparagraph (A)--
(i) at least one member shall represent an organization
recognized by the Secretary of Veterans Affairs for the
representation of veterans under section 5902 of title 38,
United States Code;
(ii) at least one member shall have experience as
senior management for a private integrated health care
system with an annual gross revenue of more than
$50,000,000;
(iii) at least one member shall be familiar with
government health care systems, including those systems of
the Department of Defense, the Indian Health Service, and
Federally-qualified health centers (as defined in section
1905(l)(2)(B) of the Social Security Act (42 U.S.C.
1396d(l)(2)(B)));
(iv) at least one member shall be familiar with the
Veterans Health Administration but shall not be currently
employed by the Veterans Health Administration; and
(v) at least one member shall be familiar with medical
facility construction and leasing projects carried out by
government entities and have experience in the building
trades, including construction, engineering, and
architecture.
(C) Date.--The appointments of members of the Commission
shall be made not later than 1 year after the date of the
enactment of this Act.
(3) Period of appointment.--
(A) In general.--Members shall be appointed for the life of
the Commission.
(B) Vacancies.--Any vacancy in the Commission shall not
affect its powers, but shall be filled in the same manner as
the original appointment.
(4) Initial meeting.--Not later than 15 days after the date on
which eight voting members of the Commission have been appointed,
the Commission shall hold its first meeting.
(5) Meetings.--The Commission shall meet at the call of the
Chairperson.
(6) Quorum.--A majority of the members of the Commission shall
constitute a quorum, but a lesser number of members may hold
hearings.
(7) Chairperson and vice chairperson.--The President shall
designate a member of the commission to serve as Chairperson of the
Commission. The Commission shall select a Vice Chairperson from
among its members.
(b) Duties of Commission.--
(1) Evaluation and assessment.--The Commission shall undertake
a comprehensive evaluation and assessment of access to health care
at the Department of Veterans Affairs.
(2) Matters evaluated and assessed.--In undertaking the
comprehensive evaluation and assessment required by paragraph (1),
the Commission shall evaluate and assess the results of the
assessment conducted by the private sector entity or entities under
section 201, including any findings, data, or recommendations
included in such assessment.
(3) Reports.--The Commission shall submit to the President,
through the Secretary of Veterans Affairs, reports as follows:
(A) Not later than 90 days after the date of the initial
meeting of the Commission, an interim report on--
(i) the findings of the Commission with respect to the
evaluation and assessment required by this subsection; and
(ii) such recommendations as the Commission may have
for legislative or administrative action to improve access
to health care through the Veterans Health Administration.
(B) Not later than 180 days after the date of the initial
meeting of the Commission, a final report on--
(i) the findings of the Commission with respect to the
evaluation and assessment required by this subsection; and
(ii) such recommendations as the Commission may have
for legislative or administrative action to improve access
to health care through the Veterans Health Administration.
(c) Powers of the Commission.--
(1) Hearings.--The Commission may hold such hearings, sit and
act at such times and places, take such testimony, and receive such
evidence as the Commission considers advisable to carry out this
section.
(2) Information from federal agencies.--The Commission may
secure directly from any Federal agency such information as the
Commission considers necessary to carry out this section. Upon
request of the Chairperson of the Commission, the head of such
agency shall furnish such information to the Commission.
(d) Commission Personnel Matters.--
(1) Compensation of members.--
(A) In general.--Each member of the Commission who is not
an officer or employee of the Federal Government shall be
compensated at a rate equal to the daily equivalent of the
annual rate of basic pay prescribed for level IV of the
Executive Schedule under section 5315 of title 5, United States
Code, for each day (including travel time) during which such
member is engaged in the performance of the duties of the
Commission.
(B) Officers or employees of the united states.--All
members of the Commission who are officers or employees of the
United States shall serve without compensation in addition to
that received for their services as officers or employees of
the United States.
(2) Travel expenses.--The members of the Commission shall be
allowed travel expenses, including per diem in lieu of subsistence,
at rates authorized for employees of agencies under subchapter I of
chapter 57 of title 5, United States Code, while away from their
homes or regular places of business in the performance of services
for the Commission.
(3) Staff.--
(A) In general.--The Chairperson of the Commission may,
without regard to the civil service laws and regulations,
appoint and terminate an executive director and such other
additional personnel as may be necessary to enable the
Commission to perform its duties. The employment of an
executive director shall be subject to confirmation by the
Commission.
(B) Compensation.--The Chairperson of the Commission may
fix the compensation of the executive director and other
personnel without regard to chapter 51 and subchapter III of
chapter 53 of title 5, United States Code, relating to
classification of positions and General Schedule pay rates,
except that the rate of pay for the executive director and
other personnel may not exceed the rate payable for level V of
the Executive Schedule under section 5316 of such title.
(4) Detail of government employees.--Any Federal Government
employee may be detailed to the Commission without reimbursement,
and such detail shall be without interruption or loss of civil
service status or privilege.
(5) Procurement of temporary and intermittent services.--The
Chairperson of the Commission may procure temporary and
intermittent services under section 3109(b) of title 5, United
States Code, at rates for individuals that do not exceed the daily
equivalent of the annual rate of basic pay prescribed for level V
of the Executive Schedule under section 5316 of such title.
(e) Termination of the Commission.--The Commission shall terminate
30 days after the date on which the Commission submits the report under
subsection (b)(3)(B).
(f) Funding.--The Secretary of Veterans Affairs shall make
available to the Commission from amounts appropriated or otherwise made
available to the Secretary such amounts as the Secretary and the
Chairperson of the Commission jointly consider appropriate for the
Commission to perform its duties under this section.
(g) Executive Action.--
(1) Action on recommendations.--The President shall require the
Secretary of Veterans Affairs and such other heads of relevant
Federal departments and agencies to implement each recommendation
set forth in a report submitted under subsection (b)(3) that the
President--
(A) considers feasible and advisable; and
(B) determines can be implemented without further
legislative action.
(2) Reports.--Not later than 60 days after the date on which
the President receives a report under subsection (b)(3), the
President shall submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives and such other committees of Congress as the
President considers appropriate a report setting forth the
following:
(A) An assessment of the feasibility and advisability of
each recommendation contained in the report received by the
President.
(B) For each recommendation assessed as feasible and
advisable under subparagraph (A) the following:
(i) Whether such recommendation requires legislative
action.
(ii) If such recommendation requires legislative
action, a recommendation concerning such legislative
action.
(iii) A description of any administrative action
already taken to carry out such recommendation.
(iv) A description of any administrative action the
President intends to be taken to carry out such
recommendation and by whom.

9a7cdd0ac7e37797ccb0ba5cc6bdd8ae0502256df0ba500ae4b0f6d3ebb644bc

SOFTWARE OF THE DEPARTMENT OF VETERANS AFFAIRS.
(a) Task Force Review.--
(1) In general.--The Secretary of Veterans Affairs shall,
through the use of a technology task force, conduct a review of the
needs of the Department of Veterans Affairs with respect to the
scheduling system and scheduling software of the Department of
Veterans Affairs that is used by the Department to schedule
appointments for veterans for hospital care, medical services, and
other health care from the Department.
(2) Agreement.--
(A) In general.--The Secretary shall seek to enter into an
agreement with a technology organization or technology
organizations to carry out the review required by paragraph
(1).
(B) Prohibition on use of funds.--Notwithstanding any other
provision of law, no Federal funds may be used to assist the
technology organization or technology organizations under
subparagraph (A) in carrying out the review required by
paragraph (1).
(b) Report.--
(1) In general.--Not later than 45 days after the date of the
enactment of this Act, the technology task force required under
subsection (a)(1) shall submit to the Secretary, the Committee on
Veterans' Affairs of the Senate, and the Committee on Veterans'
Affairs of the House of Representatives a report setting forth the
findings and recommendations of the technology task force regarding
the needs of the Department with respect to the scheduling system
and scheduling software of the Department described in such
subsection.
(2) Elements.--The report required by paragraph (1) shall
include the following:
(A) Proposals for specific actions to be taken by the
Department to improve the scheduling system and scheduling
software of the Department described in subsection (a)(1).
(B) A determination as to whether one or more existing off-
the-shelf systems would--
(i) meet the needs of the Department to schedule
appointments for veterans for hospital care, medical
services, and other health care from the Department; and
(ii) improve the access of veterans to such care and
services.
(3) Publication.--Not later than 30 days after the receipt of
the report required by paragraph (1), the Secretary shall publish
such report in the Federal Register and on an Internet website of
the Department accessible to the public.
(c) Implementation of Task Force Recommendations.--Not later than 1
year after the receipt of the report required by subsection (b)(1), the
Secretary shall implement the recommendations set forth in such report
that the Secretary considers are feasible, advisable, and cost
effective.

c90e486618fe60ac5491530d3435c13fb3331719a3dd9d93e9e7e1677528fd72

AND MOBILE MEDICAL CENTERS OF THE DEPARTMENT OF VETERANS AFFAIRS.
(a) Improvement of Access.--
(1) In general.--The Secretary of Veterans Affairs shall
improve the access of veterans to telemedicine and other health
care through the use of mobile vet centers and mobile medical
centers of the Department of Veterans Affairs by providing
standardized requirements for the operation of such centers.
(2) Requirements.--The standardized requirements required by
paragraph (1) shall include the following:
(A) The number of days each mobile vet center and mobile
medical center of the Department is expected to travel per
year.
(B) The number of locations each center is expected to
visit per year.
(C) The number of appointments each center is expected to
conduct per year.
(D) The method and timing of notifications given by each
center to individuals in the area to which the center is
traveling, including notifications informing veterans of the
availability to schedule appointments at the center.
(3) Use of telemedicine.--The Secretary shall ensure that each
mobile vet center and mobile medical center of the Department has
the capability to provide telemedicine services.
(b) Reports.--
(1) In general.--Not later than 1 year after the date of the
enactment of this Act, and not later than September 30 each year
thereafter, the Secretary of Veterans Affairs shall submit to the
Committee on Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives a report on
access to health care through the use of mobile vet centers and
mobile medical centers of the Department that includes statistics
on each of the requirements set forth in subsection (a)(2) for the
year covered by the report.
(2) Elements.--Each report required by paragraph (1) shall
include the following:
(A) A description of the use of mobile vet centers and
mobile medical centers to provide telemedicine services to
veterans during the year preceding the submittal of the report,
including the following:
(i) The number of days each mobile vet center and
mobile medical center was open to provide such services.
(ii) The number of days each center traveled to a
location other than the headquarters of the center to
provide such services.
(iii) The number of appointments each center conducted
to provide such services on average per month and in total
during such year.
(B) An analysis of the effectiveness of using mobile vet
centers and mobile medical centers to provide health care
services to veterans through the use of telemedicine.
(C) Any recommendations for an increase in the number of
mobile vet centers and mobile medical centers of the
Department.
(D) Any recommendations for an increase in the telemedicine
capabilities of each mobile vet center and mobile medical
center.
(E) The feasibility and advisability of using temporary
health care providers, including locum tenens, to provide
direct health care services to veterans at mobile vet centers
and mobile medical centers.
(F) Such other recommendations on improvement of the use of
mobile vet centers and mobile medical centers by the Department
as the Secretary considers appropriate.

052081a09df97324d7ac82e23e1593e05b06b6270b76dfe5abaad834fb8c4618

DEPARTMENT OF VETERANS AFFAIRS.
(a) Prohibition on Use of Scheduling and Wait-Time Metrics in
Determination of Performance Awards.--The Secretary of Veterans Affairs
shall ensure that scheduling and wait-time metrics or goals are not
used as factors in determining the performance of the following
employees for purposes of determining whether to pay performance awards
to such employees:
(1) Directors, associate directors, assistant directors, deputy
directors, chiefs of staff, and clinical leads of medical centers
of the Department of Veterans Affairs.
(2) Directors, assistant directors, and quality management
officers of Veterans Integrated Service Networks of the Department
of Veterans Affairs.
(b) Modification of Performance Plans.--
(1) In general.--Not later than 30 days after the date of the
enactment of this Act, the Secretary shall modify the performance
plans of the directors of the medical centers of the Department and
the directors of the Veterans Integrated Service Networks to ensure
that such plans are based on the quality of care received by
veterans at the health care facilities under the jurisdictions of
such directors.
(2) Factors.--In modifying performance plans under paragraph
(1), the Secretary shall ensure that assessment of the quality of
care provided at health care facilities under the jurisdiction of a
director described in paragraph (1) includes consideration of the
following:
(A) Recent reviews by the Joint Commission (formerly known
as the ``Joint Commission on Accreditation of Healthcare
Organizations'') of such facilities.
(B) The number and nature of recommendations concerning
such facilities by the Inspector General of the Department in
reviews conducted through the Combined Assessment Program, in
the reviews by the Inspector General of community-based
outpatient clinics and primary care clinics, and in reviews
conducted through the Office of Healthcare Inspections during
the two most recently completed fiscal years.
(C) The number of recommendations described in subparagraph
(B) that the Inspector General of the Department determines
have not been carried out satisfactorily with respect to such
facilities.
(D) Reviews of such facilities by the Commission on
Accreditation of Rehabilitation Facilities.
(E) The number and outcomes of administrative investigation
boards, root cause analyses, and peer reviews conducted at such
facilities during the fiscal year for which the assessment is
being conducted.
(F) The effectiveness of any remedial actions or plans
resulting from any Inspector General recommendations in the
reviews and analyses described in subparagraphs (A) through
(E).
(3) Additional leadership positions.--To the degree
practicable, the Secretary shall assess the performance of other
employees of the Department in leadership positions at Department
medical centers, including associate directors, assistant
directors, deputy directors, chiefs of staff, and clinical leads,
and in Veterans Integrated Service Networks, including assistant
directors and quality management officers, using factors and
criteria similar to those used in the performance plans modified
under paragraph (1).
(c) Removal of Certain Performance Goals.--For each fiscal year
that begins after the date of the enactment of this Act, the Secretary
shall not include in the performance goals of any employee of a
Veterans Integrated Service Network or medical center of the Department
any performance goal that might disincentivize the payment of
Department amounts to provide hospital care, medical services, or other
health care through a non-Department provider.

e993adc0a7ef2b20a3851310377ce33ee226ce219a44113b79bbca80696b2271

DEPARTMENT OF VETERANS AFFAIRS.
(a) Publication of Wait Times.--Not later than 90 days after the
date of the enactment of this Act, the Secretary of Veterans Affairs
shall publish in the Federal Register, and on a publicly accessible
Internet website of each medical center of the Department of Veterans
Affairs, the wait-times for the scheduling of an appointment in each
Department facility by a veteran for the receipt of primary care,
specialty care, and hospital care and medical services based on the
general severity of the condition of the veteran. Whenever the wait-
times for the scheduling of such an appointment changes, the Secretary
shall publish the revised wait-times--
(1) on a publicly accessible Internet website of each medical
center of the Department by not later than 30 days after such
change; and
(2) in the Federal Register by not later than 90 days after
such change.
(b) Publicly Available Database of Patient Safety, Quality of Care,
and Outcome Measures.--
(1) In general.--Not later than 180 days after the date of the
enactment of this Act, the Secretary shall develop and make
available to the public a comprehensive database containing all
applicable patient safety, quality of care, and outcome measures
for health care provided by the Department that are tracked by the
Secretary.
(2) Update frequency.--The Secretary shall update the database
required by paragraph (1) not less frequently than once each year.
(3) Unavailable measures.--For all measures that the Secretary
would otherwise publish in the database required by paragraph (1)
but has not done so because such measures are not available, the
Secretary shall publish notice in the database of the reason for
such unavailability and a timeline for making such measures
available in the database.
(4) Accessibility.--The Secretary shall ensure that the
database required by paragraph (1) is accessible to the public
through the primary Internet website of the Department and through
each primary Internet website of a Department medical center.
(c) Hospital Compare Website of Department of Health and Human
Services.--
(1) Agreement required.--Not later than 180 days after the date
of the enactment of this Act, the Secretary of Veterans Affairs
shall enter into an agreement with the Secretary of Health and
Human Services for the provision by the Secretary of Veterans
Affairs of such information as the Secretary of Health and Human
Services may require to report and make publicly available patient
quality and outcome information concerning Department of Veterans
Affairs medical centers through the Hospital Compare Internet
website of the Department of Health and Human Services or any
successor Internet website.
(2) Information provided.--The information provided by the
Secretary of Veterans Affairs to the Secretary of Health and Human
Services under paragraph (1) shall include the following:
(A) Measures of timely and effective health care.
(B) Measures of readmissions, complications of death,
including with respect to 30-day mortality rates and 30-day
readmission rates, surgical complication measures, and health
care related infection measures.
(C) Survey data of patient experiences, including the
Hospital Consumer Assessment of Healthcare Providers and
Systems or any similar successor survey developed by the
Department of Health and Human Services.
(D) Any other measures required of or reported with respect
to hospitals participating in the Medicare program under title
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).
(3) Unavailable information.--For any applicable metric
collected by the Department of Veterans Affairs or required to be
provided under paragraph (2) and withheld from or unavailable in
the Hospital Compare Internet website or any successor Internet
website, the Secretary of Veterans Affairs shall publish a notice
on such Internet website stating the reason why such metric was
withheld from public disclosure and a timeline for making such
metric available, if applicable.
(d) Comptroller General Review of Publicly Available Safety and
Quality Metrics.--Not later than 3 years after the date of the
enactment of this Act, the Comptroller General of the United States
shall conduct a review of the safety and quality metrics made publicly
available by the Secretary of Veterans Affairs under this section to
assess the degree to which the Secretary is complying with the
provisions of this section.

724f53f24992fa6b81c76e1d506f66be42bf3f9ba6d9c0a36864718ed69bafca

OF VETERANS AFFAIRS PHYSICIANS.
(a) Improvement of ``Our Doctors'' Internet Website Links.--
(1) Availability through department of veterans affairs
homepage.--A link to the ``Our Doctors'' health care providers
database of the Department of Veterans Affairs, or any successor
database, shall be available on and through the homepage of the
Internet website of the Department that is accessible to the
public.
(2) Information on location of residency training.--The
Internet website of the Department that is accessible to the public
shall include under the link to the ``Our Doctors'' health care
providers database of the Department, or any successor database,
the name of the facility at which each licensed physician of the
Department underwent residency training.
(3) Information on physicians at particular facilities.--The
``Our Doctors'' health care providers database of the Department,
or any successor database, shall identify whether each licensed
physician of the Department is a physician in residency.
(b) Information on Credentials of Physicians for Veterans
Undergoing Surgical Procedures.--
(1) In general.--Each veteran who is undergoing a surgical
procedure by or through the Department shall be provided
information described in paragraph (2) with respect to the surgeon
to be performing such procedure at such time in advance of the
procedure as is appropriate to permit such veteran to evaluate such
information.
(2) Information described.--The information described in this
paragraph with respect to a surgeon described in paragraph (1) is
as follows:
(A) The education and training of the surgeon.
(B) The licensure, registration, and certification of the
surgeon by the State or national entity responsible for such
licensure, registration, or certification.
(3) Other individuals.--If a veteran is unable to evaluate the
information provided under paragraph (1) due to the health or
mental competence of the veteran, such information shall be
provided to an individual acting on behalf of the veteran.
(c) Comptroller General Report and Plan.--
(1) Report.--Not later than 2 years after the date of the
enactment of this Act, the Comptroller General of the United States
shall submit to the Committee on Veterans' Affairs of the Senate
and the Committee on Veterans' Affairs of the House of
Representatives a report setting forth an assessment by the
Comptroller General of the following:
(A) The manner in which contractors under the Patient-
Centered Community Care initiative of the Department perform
oversight of the credentials of physicians within the networks
of such contractors under the initiative.
(B) The oversight by the Department of the contracts under
the Patient-Centered Community Care initiative.
(C) The verification by the Department of the credentials
and licenses of health care providers furnishing hospital care
and medical services under section 101.
(2) Plan.--
(A) In general.--Not later than 30 days after the submittal
of the report under paragraph (1), the Secretary shall submit
to the Comptroller General, the Committee on Veterans' Affairs
of the Senate, and the Committee on Veterans' Affairs of the
House of Representatives a plan to address any findings and
recommendations of the Comptroller General included in such
report.
(B) Implementation.--Not later than 90 days after the
submittal of the report under paragraph (1), the Secretary
shall carry out such plan.

837b6f6a2b7fba90ab2d49a9bb581f10f06daeccefc1ca7c4718e273b6cc59fc

CARE AND MEDICAL SERVICES FURNISHED THROUGH EXPANDED USE OF
CONTRACTS FOR SUCH CARE.
The materials on the Department of Veterans Affairs in the budget
of the President for a fiscal year, as submitted to Congress pursuant
to section 1105(a) of title 31, United States Code, shall set forth the
following:
(1) The number of veterans who received hospital care and
medical services under section 101 during the fiscal year preceding
the fiscal year in which such budget is submitted.
(2) The amount expended by the Department on furnishing care
and services under such section during the fiscal year preceding
the fiscal year in which such budget is submitted.
(3) The amount requested in such budget for the costs of
furnishing care and services under such section during the fiscal
year covered by such budget, set forth in aggregate and by amounts
for each account for which amounts are so requested.
(4) The number of veterans that the Department estimates will
receive hospital care and medical services under such section
during the fiscal years covered by the budget submission.
(5) The number of employees of the Department on paid
administrative leave at any point during the fiscal year preceding
the fiscal year in which such budget is submitted.

c2dce3451d8f37419437a1fbd39573c93d796e9764e6a8947bfee5fbd01b6c2b

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

303604458eee2b767f4db6e7f7b2b72c0aefa0242a9e4115cd207c9ad6cf85fb

STAFFING OF MEDICAL FACILITIES OF THE DEPARTMENT OF VETERANS
AFFAIRS.
(a) Staffing Shortages.--
(1) In general.--Subchapter I of chapter 74 of title 38, United
States Code, is amended by adding at the end the following new
section:
``Sec. 7412. Annual determination of staffing shortages; recruitment
and appointment for needed occupations
``(a) In General.--Not later than September 30 of each year, the
Inspector General of the Department shall determine, and the Secretary
shall publish in the Federal Register, the five occupations of
personnel of this title of the Department covered under section 7401 of
this title for which there are the largest staffing shortages
throughout the Department as calculated over the five-year period
preceding the determination.
``(b) Recruitment and Appointment.--Notwithstanding sections 3304
and 3309 through 3318 of title 5, the Secretary may, upon a
determination by the Inspector General under paragraph (1) that there
is a staffing shortage throughout the Department with respect to a
particular occupation, recruit and directly appoint, during the fiscal
year after the fiscal year during which such determination is made,
qualified personnel to serve in that particular occupation for the
Department.''.
(2) Clerical amendment.--The table of sections at the beginning
of such chapter is amended by inserting after the item relating to
section 7411 the following new item:
``7412. Annual determination of staffing shortages; recruitment and
appointment for needed occupations.''.
(3) Deadline for first determination.--Notwithstanding the
deadline under section 7412 of title 38, United States Code, as
added by paragraph (1), for the annual determination of staffing
shortages in the Veterans Health Administration, the Inspector
General of the Department of Veterans Affairs shall make the first
determination required under such section, and the Secretary of
Veterans Affairs shall publish in the Federal Register such
determination, by not later than the date that is 180 days after
the date of the enactment of this Act.
(b) Increase of Graduate Medical Education Residency Positions.--
(1) In general.--Section 7302 of title 38, United States Code,
is amended by adding at the end the following new subsection:
``(e)(1) In carrying out this section, the Secretary shall
establish medical residency programs, or ensure that already
established medical residency programs have a sufficient number of
residency positions, at any medical facility of the Department that the
Secretary determines--
``(A) is experiencing a shortage of physicians; and
``(B) is located in a community that is designated as a health
professional shortage area (as defined in section 332 of the Public
Health Service Act (42 U.S.C. 254e)).
``(2) In carrying out paragraph (1), the Secretary shall--
``(A) allocate the residency positions under such paragraph
among occupations included in the most current determination
published in the Federal Register pursuant to section 7412(a) of
this title; and
``(B) give priority to residency positions and programs in
primary care, mental health, and any other specialty the Secretary
determines appropriate.''.
(2) Five-year increase.--
(A) In general.--In carrying out section 7302(e) of title
38, United States Code, as added by paragraph (1), during the
5-year period beginning on the day that is 1 year after the
date of the enactment of this Act, the Secretary of Veterans
Affairs shall increase the number of graduate medical education
residency positions at medical facilities of the Department by
up to 1,500 positions.
(B) Priority.--In increasing the number of graduate medical
education residency positions at medical facilities of the
Department under subparagraph (A), the Secretary shall give
priority to medical facilities that--
(i) as of the date of the enactment of this Act, do not
have a medical residency program; and
(ii) are located in a community that has a high
concentration of veterans.
(3) Report.--
(A) In general.--Not later than 60 days after the date of
the enactment of this Act, and not later than October 1 each
year thereafter until 2019, the Secretary shall submit to the
Committee on Veterans' Affairs of the Senate and the Committee
on Veterans' Affairs of the House of Representatives a report
on graduate medical education residency positions at medical
facilities of the Department.
(B) Elements.--Each report required by subparagraph (A)
shall include the following:
(i) For the year preceding the submittal of the report,
the number of graduate medical education residency
positions at medical facilities of the Department as
follows:
(I) That were filled.
(II) That were not filled.
(III) That the Department anticipated filling.
(ii) With respect to each graduate medical education
residency position specified in clause (i)--
(I) the geographic location of each such position;
and
(II) if such position was filled, the academic
affiliation of the medical resident that filled such
position.
(iii) The policy at each medical facility of the
Department with respect to the ratio of medical residents
to staff supervising medical residents.
(iv) During the 1-year period preceding the submittal
of the report, the number of individuals who declined an
offer from the Department to serve as a medical resident at
a medical facility of the Department and the reason why
each such individual declined such offer.
(v) During the 1-year period preceding the submittal of
the report, a description of--
(I) challenges, if any, faced by the Department in
filling graduate medical education residency positions
at medical facilities of the Department; and
(II) actions, if any, taken by the Department to
address such challenges.
(vi) A description of efforts of the Department, as of
the date of the submittal of the report, to recruit and
retain medical residents to work for the Veterans Health
Administration as full-time employees.
(c) Priority in Scholarship Program of Health Professionals
Educational Assistance Program to Certain Providers.--Section
7612(b)(5) of title 38, United States Code, is amended--
(1) in subparagraph (A), by striking ``and'' at the end;
(2) by redesignating subparagraph (B) as subparagraph (C); and
(3) by inserting after subparagraph (A) the following new
subparagraph (B):
``(B) shall give priority to applicants pursuing a course of
education or training toward a career in an occupation for which
the Inspector General of the Department has, in the most current
determination published in the Federal Register pursuant to section
7412(a) of this title, determined that there is one of the largest
staffing shortages throughout the Department with respect to such
occupation; and''.
(d) Reports.--
(1) In general.--Not later than 180 days after the date of the
enactment of this Act, and not later than December 31 of each even-
numbered year thereafter until 2024, the Secretary of Veterans
Affairs shall submit to the Committees on Veterans' Affairs of the
Senate and House of Representatives a report assessing the staffing
of each medical facility of the Department.
(2) Elements.--Each report submitted under paragraph (1) shall
include the following:
(A) The results of a system-wide assessment of all medical
facilities of the Department to ensure the following:
(i) Appropriate staffing levels for health care
professionals to meet the goals of the Secretary for timely
access to care for veterans.
(ii) Appropriate staffing levels for support personnel,
including clerks.
(iii) Appropriate sizes for clinical panels.
(iv) Appropriate numbers of full-time staff, or full-
time equivalents, dedicated to direct care of patients.
(v) Appropriate physical plant space to meet the
capacity needs of the Department in that area.
(vi) Such other factors as the Secretary considers
necessary.
(B) A plan for addressing any issues identified in the
assessment described in subparagraph (A), including a timeline
for addressing such issues.
(C) A list of the current wait times and workload levels
for the following clinics in each medical facility:
(i) Mental health.
(ii) Primary care.
(iii) Gastroenterology.
(iv) Women's health.
(v) Such other clinics as the Secretary considers
appropriate.
(D) A description of the results of the most current
determination of the Inspector General under subsection (a) of
section 7412 of title 38, United States Code, as added by
subsection (a)(1) of this section, and a plan to use direct
appointment authority under subsection (b) of such section 7412
to fill staffing shortages, including recommendations for
improving the speed at which the credentialing and privileging
process can be conducted.
(E) The current staffing models of the Department for the
following clinics, including recommendations for changes to
such models:
(i) Mental health.
(ii) Primary care.
(iii) Gastroenterology.
(iv) Women's health.
(v) Such other clinics as the Secretary considers
appropriate.
(F) A detailed analysis of succession planning at medical
facilities of the Department, including the following:
(i) The number of positions in medical facilities
throughout the Department that are not filled by a
permanent employee.
(ii) The length of time each position described in
clause (i) remained vacant or filled by a temporary or
acting employee.
(iii) A description of any barriers to filling the
positions described in clause (i).
(iv) A plan for filling any positions that are vacant
or filled by a temporary or acting employee for more than
180 days.
(v) A plan for handling emergency circumstances, such
as administrative leave or sudden medical leave for senior
officials.
(G) The number of health care providers of the Department
who have been removed from their positions, have retired, or
have left their positions for another reason, disaggregated by
provider type, during the 2-year period preceding the submittal
of the report.
(H) Of the health care providers specified in subparagraph
(G) who have been removed from their positions, the following:
(i) The number of such health care providers who were
reassigned to other positions in the Department.
(ii) The number of such health care providers who left
the Department.
(iii) The number of such health care providers who left
the Department and were subsequently rehired by the
Department.

165b93ad723ca8f839369e3afdda3c62f3209b0a874a1c0c74ed0381a9c9a784

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

298dc4da3b19d0393bff365f388f399f16b7e1ca4fcc945846ee0f2e2681b4ce

FACILITIES OF THE DEPARTMENT OF VETERANS AFFAIRS.
(a) Clinic Management Training Program.--
(1) In general.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall
commence a role-specific clinic management training program to
provide in-person, standardized education on systems and processes
for health care practice management and scheduling to all
appropriate employees, as determined by the Secretary, at medical
facilities of the Department.
(2) Elements.--
(A) In general.--The clinic management training program
required by paragraph (1) shall include the following:
(i) Training on how to manage the schedules of health
care providers of the Department, including the following:
(I) Maintaining such schedules in a manner that
allows appointments to be booked at least eight weeks
in advance.
(II) Proper planning procedures for vacation,
leave, and graduate medical education training
schedules.
(ii) Training on the appropriate number of appointments
that a health care provider should conduct on a daily
basis, based on specialty.
(iii) Training on how to determine whether there are
enough available appointment slots to manage demand for
different appointment types and mechanisms for alerting
management of insufficient slots.
(iv) Training on how to properly use the appointment
scheduling system of the Department, including any new
scheduling system implemented by the Department.
(v) Training on how to optimize the use of technology,
including the following:
(I) Telemedicine.
(II) Electronic mail.
(III) Text messaging.
(IV) Such other technologies as specified by the
Secretary.
(vi) Training on how to properly use physical plant
space at medical facilities of the Department to ensure
efficient flow and privacy for patients and staff.
(B) Role-specific.--The Secretary shall ensure that each
employee of the Department included in the clinic management
training program required by paragraph (1) receives education
under such program that is relevant to the responsibilities of
such employee.
(3) Sunset.--The clinic management training program required by
paragraph (1) shall terminate on the date that is 2 years after the
date on which the Secretary commences such program.
(b) Training Materials.--
(1) In general.--After the termination of the clinic management
training program required by subsection (a), the Secretary shall
provide training materials on health care management to each of the
following employees of the Department that are relevant to the
position and responsibilities of such employee upon the
commencement of employment of such employee:
(A) Any manager of a medical facility of the Department.
(B) Any health care provider at a medical facility of the
Department.
(C) Such other employees of the Department as the Secretary
considers appropriate.
(2) Update.--The Secretary shall regularly update the training
materials required under paragraph (1).

d1fe3af9c285167743aa8f88f7aa9d0c7cdf2146079e481258a290a1f08258da

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

1433a66f86ac24a5afdcb0f90637fefdb3f030430b04f45d23ce8af2296a28bf

BY THE DEPARTMENT OF VETERANS AFFAIRS TO MEMBERS OF THE ARMED
FORCES.
(a) Expansion of Coverage to Members of the Armed Forces.--
Subsection (a) of section 1720D of title 38, United States Code, is
amended--
(1) by redesignating paragraph (2) as paragraph (3);
(2) by inserting after paragraph (1) the following new
paragraph (2):
``(2)(A) In operating the program required by paragraph (1), the
Secretary may, in consultation with the Secretary of Defense, provide
counseling and care and services to members of the Armed Forces
(including members of the National Guard and Reserves) on active duty
to overcome psychological trauma described in that paragraph.
``(B) A member described in subparagraph (A) shall not be required
to obtain a referral before receiving counseling and care and services
under this paragraph.''; and
(3) in paragraph (3), as redesignated by paragraph (1)--
(A) by striking ``a veteran'' and inserting ``an
individual''; and
(B) by striking ``that veteran'' each place it appears and
inserting ``that individual''.
(b) Information to Members on Availability of Counseling and
Services.--Subsection (c) of such section is amended--
(1) by striking ``to veterans'' each place it appears; and
(2) in paragraph (3), by inserting ``members of the Armed
Forces and'' before ``individuals''.
(c) Inclusion of Members in Reports on Counseling and Services.--
Subsection (e) of such section is amended--
(1) in the matter preceding paragraph (1), by striking ``to
veterans'';
(2) in paragraph (2)--
(A) by striking ``women veterans'' and inserting
``individuals''; and
(B) by striking ``training under subsection (d).'' and
inserting ``training under subsection (d), disaggregated by--
``(A) veterans;
``(B) members of the Armed Forces (including members of the
National Guard and Reserves) on active duty; and
``(C) for each of subparagraphs (A) and (B)--
``(i) men; and
``(ii) women.'';
(3) in paragraph (4), by striking ``veterans'' and inserting
``individuals''; and
(4) in paragraph (5)--
(A) by striking ``women veterans'' and inserting
``individuals''; and
(B) by inserting ``, including specific recommendations for
individuals specified in subparagraphs (A), (B), and (C) of
paragraph (2)'' before the period at the end.
(d) Effective Date.--The amendments made by this section shall take
effect on the date that is 1 year after the date of the enactment of
this Act.

9c78137eea491fb2165b3961e222618699e647cbd2852ead0081ef6531b83f42

(a) Report on Services Available for Military Sexual Trauma in the
Department of Veterans Affairs.--Not later than 630 days after the date
of the enactment of this Act, the Secretary of Veterans Affairs shall
submit to the Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of Representatives a report
on the treatment and services available from the Department of Veterans
Affairs for male veterans who experience military sexual trauma
compared to such treatment and services available to female veterans
who experience military sexual trauma.
(b) Reports on Transition of Military Sexual Trauma Treatment From
Department of Defense to Department of Veterans Affairs.--Not later
than 630 days after the date of the enactment of this Act, and annually
thereafter for 5 years, the Department of Veterans Affairs-Department
of Defense Joint Executive Committee established by section 320(a) of
title 38, United States Code, shall submit to the appropriate
committees of Congress a report on military sexual trauma that includes
the following:
(1) The processes and procedures utilized by the Department of
Veterans Affairs and the Department of Defense to facilitate
transition of treatment of individuals who have experienced
military sexual trauma from treatment provided by the Department of
Defense to treatment provided by the Department of Veterans
Affairs.
(2) A description and assessment of the collaboration between
the Department of Veterans Affairs and the Department of Defense in
assisting veterans in filing claims for disabilities related to
military sexual trauma, including permitting veterans access to
information and evidence necessary to develop or support such
claims.
(c) Definitions.--In this section:
(1) Appropriate committees of congress.--The term ``appropriate
committees of Congress'' means--
(A) the Committee on Veterans' Affairs and the Committee on
Armed Services of the Senate; and
(B) the Committee on Veterans' Affairs and the Committee on
Armed Services of the House of Representatives.
(2) Military sexual trauma.--The term ``military sexual
trauma'' means psychological trauma, which in the judgment of a
mental health professional employed by the Department, resulted
from a physical assault of a sexual nature, battery of a sexual
nature, or sexual harassment which occurred while the veteran was
serving on active duty, active duty for training, or inactive duty
training.
(3) Sexual harassment.--The term ``sexual harassment'' means
repeated, unsolicited verbal or physical contact of a sexual nature
which is threatening in character.
(4) Sexual trauma.--The term ``sexual trauma'' shall have the
meaning given that term by the Secretary of Veterans Affairs for
purposes of this section.
(d) Effective Date.--This section shall take effect on the date
that is 270 days after the date of the enactment of this Act.

5c50d7a2ea1f8e896de80f9eee7bfda9a2168e810d0815a272633d29fa6f4b88

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

ac1c1aac6a8045e19107f6590efc509f89f1eb49887bda343ce7a3f79401e19c

(a) In General.--The Secretary of Veterans Affairs may carry out
the following major medical facility leases at the locations specified,
and in an amount for each lease not to exceed the amount shown for such
location (not including any estimated cancellation costs):
(1) For a clinical research and pharmacy coordinating center,
Albuquerque, New Mexico, an amount not to exceed $9,560,000.
(2) For a community-based outpatient clinic, Brick, New Jersey,
an amount not to exceed $7,280,000.
(3) For a new primary care and dental clinic annex, Charleston,
South Carolina, an amount not to exceed $7,070,250.
(4) For a community-based outpatient clinic, Cobb County,
Georgia, an amount not to exceed $6,409,000.
(5) For the Leeward Outpatient Healthcare Access Center,
Honolulu, Hawaii, including a co-located clinic with the Department
of Defense and the co-location of the Honolulu Regional Office of
the Veterans Benefits Administration and the Kapolei Vet Center of
the Department of Veterans Affairs, an amount not to exceed
$15,887,370.
(6) For a community-based outpatient clinic, Johnson County,
Kansas, an amount not to exceed $2,263,000.
(7) For a replacement community-based outpatient clinic,
Lafayette, Louisiana, an amount not to exceed $2,996,000.
(8) For a community-based outpatient clinic, Lake Charles,
Louisiana, an amount not to exceed $2,626,000.
(9) For outpatient clinic consolidation, New Port Richey,
Florida, an amount not to exceed $11,927,000.
(10) For an outpatient clinic, Ponce, Puerto Rico, an amount
not to exceed $11,535,000.
(11) For lease consolidation, San Antonio, Texas, an amount not
to exceed $19,426,000.
(12) For a community-based outpatient clinic, San Diego,
California, an amount not to exceed $11,946,100.
(13) For an outpatient clinic, Tyler, Texas, an amount not to
exceed $4,327,000.
(14) For the Errera Community Care Center, West Haven,
Connecticut, an amount not to exceed $4,883,000.
(15) For the Worcester Community-Based Outpatient Clinic,
Worcester, Massachusetts, an amount not to exceed $4,855,000.
(16) For the expansion of a community-based outpatient clinic,
Cape Girardeau, Missouri, an amount not to exceed $4,232,060.
(17) For a multispecialty clinic, Chattanooga, Tennessee, an
amount not to exceed $7,069,000.
(18) For the expansion of a community-based outpatient clinic,
Chico, California, an amount not to exceed $4,534,000.
(19) For a community-based outpatient clinic, Chula Vista,
California, an amount not to exceed $3,714,000.
(20) For a new research lease, Hines, Illinois, an amount not
to exceed $22,032,000.
(21) For a replacement research lease, Houston, Texas, an
amount not to exceed $6,142,000.
(22) For a community-based outpatient clinic, Lincoln,
Nebraska, an amount not to exceed $7,178,400.
(23) For a community-based outpatient clinic, Lubbock, Texas,
an amount not to exceed $8,554,000.
(24) For a community-based outpatient clinic consolidation,
Myrtle Beach, South Carolina, an amount not to exceed $8,022,000.
(25) For a community-based outpatient clinic, Phoenix, Arizona,
an amount not to exceed $20,757,000.
(26) For the expansion of a community-based outpatient clinic,
Redding, California, an amount not to exceed $8,154,000.
(27) For the expansion of a community-based outpatient clinic,
Tulsa, Oklahoma, an amount not to exceed $13,269,200.
(b) Requirements for Clinic in Tulsa.--
(1) In general.--In carrying out the expansion of the
community-based outpatient clinic in Tulsa, Oklahoma, authorized by
subsection (a)(27), the Secretary of Veterans Affairs shall ensure
that such clinic satisfies the following requirements:
(A) Consist of not more than 140,000 gross square feet.
(B) Have an annual cost per square foot of not more than
the average market rate in Tulsa, Oklahoma, for an equivalent
medical facility plus 20 percent.
(C) Satisfy the mandate of the Department of Veterans
Affairs to provide veterans in Oklahoma with access to quality
and efficient care.
(D) Expand clinical capacity in the region in which the
clinic is located in a cost efficient manner based upon
regional cost comparisons, taking into account the needs of
current veterans and the potential demand by veterans for care
in the future.
(E) Be the most cost effective option for the Department as
predicted over a 30-year life cycle for such clinic.
(2) Cost effective determination.--
(A) In general.--If the Secretary determines that the most
cost effective option over a 30-year life cycle would be to
purchase or construct a facility in Tulsa, Oklahoma, instead of
entering into a major medical facility lease in such location
as authorized by subsection (a)(27), the Secretary shall not
enter into such lease.
(B) Major medical facility project.--If the Secretary makes
the determination described in subparagraph (A), the Secretary
may request authority for a major medical facility project in
Tulsa, Oklahoma, from Congress pursuant to section 8104(b) of
title 38, United States Code.
(C) Cost-benefit analysis.--If the Secretary requests
authority for the major medical facility project described in
subparagraph (B), not later than 90 days after making the
determination described in subparagraph (A), the Secretary
shall submit to Congress a detailed cost-benefit analysis of
such major medical facility project.

fc3f2fd97a46726384e3d221ff2b339cd338fa1f207f8be979ce8c49b529fc29

MAJOR MEDICAL FACILITIES LEASES.
(a) Findings.--Congress finds the following:
(1) Title 31, United States Code, requires the Department of
Veterans Affairs to record the full cost of its contractual
obligation against funds available at the time a contract is
executed.
(2) Office of Management and Budget Circular A-11 provides
guidance to agencies in meeting the statutory requirements under
title 31, United States Code, with respect to leases.
(3) For operating leases, Office of Management and Budget
Circular A-11 requires the Department of Veterans Affairs to record
up-front budget authority in an ``amount equal to total payments
under the full term of the lease or [an] amount sufficient to cover
first year lease payments plus cancellation costs''.
(b) Requirement for Obligation of Full Cost.--
(1) In general.--Subject to the availability of appropriations
provided in advance, in exercising the authority of the Secretary
of Veterans Affairs to enter into leases provided in this Act, the
Secretary shall record, pursuant to section 1501 of title 31,
United States Code, as the full cost of the contractual obligation
at the time a contract is executed either--
(A) an amount equal to total payments under the full term
of the lease; or
(B) if the lease specifies payments to be made in the event
the lease is terminated before its full term, an amount
sufficient to cover the first year lease payments plus the
specified cancellation costs.
(2) Self-insuring authority.--The requirements of paragraph (1)
may be satisfied through the use of the self-insuring authority
identified in title 40, United States Code, consistent with Office
of Management and Budget Circular A-11.
(c) Transparency.--
(1) Compliance.--Subsection (b) of section 8104 of title 38,
United States Code, is amended by adding at the end the following
new paragraph:
``(7) In the case of a prospectus proposing funding for a major
medical facility lease, a detailed analysis of how the lease is
expected to comply with Office of Management and Budget Circular A-
11 and section 1341 of title 31 (commonly referred to as the `Anti-
Deficiency Act'). Any such analysis shall include--
``(A) an analysis of the classification of the lease as a
`lease-purchase', `capital lease', or `operating lease' as
those terms are defined in Office of Management and Budget
Circular A-11;
``(B) an analysis of the obligation of budgetary resources
associated with the lease; and
``(C) an analysis of the methodology used in determining
the asset cost, fair market value, and cancellation costs of
the lease.''.
(2) Submittal to congress.--Such section 8104 is further
amended by adding at the end the following new subsection:
``(h)(1) Not less than 30 days before entering into a major medical
facility lease, the Secretary shall submit to the Committees on
Veterans' Affairs of the Senate and the House of Representatives--
``(A) notice of the Secretary's intention to enter into the
lease;
``(B) a detailed summary of the proposed lease;
``(C) a description and analysis of any differences between the
prospectus submitted pursuant to subsection (b) and the proposed
lease; and
``(D) a scoring analysis demonstrating that the proposed lease
fully complies with Office of Management and Budget Circular A-11.
``(2) Each committee described in paragraph (1) shall ensure that
any information submitted to the committee under such paragraph is
treated by the committee with the same level of confidentiality as is
required by law of the Secretary and subject to the same statutory
penalties for unauthorized disclosure or use as the Secretary.
``(3) Not more than 30 days after entering into a major medical
facility lease, the Secretary shall submit to each committee described
in paragraph (1) a report on any material differences between the lease
that was entered into and the proposed lease described under such
paragraph, including how the lease that was entered into changes the
previously submitted scoring analysis described in subparagraph (D) of
such paragraph.''.
(d) Rule of Construction.--Nothing in this section, or the
amendments made by this section, shall be construed to in any way
relieve the Department of Veterans Affairs from any statutory or
regulatory obligations or requirements existing prior to the enactment
of this section and such amendments.

a1e88d0604276007494a39ccc4d286872a6e23978490643ebd5a49da73138270

SCHOLARSHIP.
(a) Expansion of Entitlement.--Subsection (b)(9) of section 3311 of
title 38, United States Code, is amended by inserting ``or spouse''
after ``child''.
(b) Limitation and Election on Certain Benefits.--Subsection (f) of
such section is amended--
(1) by redesignating paragraph (2) as paragraph (4); and
(2) by inserting after paragraph (1) the following new
paragraphs:
``(2) Limitation.--The entitlement of an individual to
assistance under subsection (a) pursuant to paragraph (9) of
subsection (b) because the individual was a spouse of a person
described in such paragraph shall expire on the earlier of--
``(A) the date that is 15 years after the date on which the
person died; or
``(B) the date on which the individual remarries.
``(3) Election on receipt of certain benefits.--A surviving
spouse entitled to assistance under subsection (a) pursuant to
paragraph (9) of subsection (b) who is also entitled to educational
assistance under chapter 35 of this title may not receive
assistance under both this section and such chapter, but shall make
an irrevocable election (in such form and manner as the Secretary
may prescribe) under which section or chapter to receive
educational assistance.''.
(c) Conforming Amendment.--Section 3321(b)(4) of such title is
amended--
(1) by striking ``an individual'' and inserting ``a child'';
and
(2) by striking ``such individual's'' each time it appears and
inserting ``such child's''.
(d) Effective Date.--The amendments made by this section shall
apply with respect to a quarter, semester, or term, as applicable,
commencing on or after January 1, 2015.

ce0c3ff14ef93ee59cd0fd08858f5352deb23ccbdff6d01f91c8208060141562

INSTITUTIONS OF HIGHER LEARNING FOR PURPOSES OF ALL-VOLUNTEER
FORCE EDUCATIONAL ASSISTANCE PROGRAM AND POST-9/11 EDUCATIONAL
ASSISTANCE CONDITIONAL ON IN-STATE TUITION RATE FOR VETERANS.
(a) In General.--Section 3679 of title 38, United States Code, is
amended by adding at the end the following new subsection:
``(c)(1) Notwithstanding any other provision of this chapter and
subject to paragraphs (3) through (6), the Secretary shall disapprove a
course of education provided by a public institution of higher learning
to a covered individual pursuing a course of education with educational
assistance under chapter 30 or 33 of this title while living in the
State in which the public institution of higher learning is located if
the institution charges tuition and fees for that course for the
covered individual at a rate that is higher than the rate the
institution charges for tuition and fees for that course for residents
of the State in which the institution is located, regardless of the
covered individual's State of residence.
``(2) For purposes of this subsection, a covered individual is any
individual as follows:
``(A) A veteran who was discharged or released from a period of
not fewer than 90 days of service in the active military, naval, or
air service less than three years before the date of enrollment in
the course concerned.
``(B) An individual who is entitled to assistance under section
3311(b)(9) or 3319 of this title by virtue of such individual's
relationship to a veteran described in subparagraph (A).
``(3) If after enrollment in a course of education that is subject
to disapproval under paragraph (1) by reason of paragraph (2)(A) or
(2)(B) a covered individual pursues one or more courses of education at
the same public institution of higher learning while remaining
continuously enrolled (other than during regularly scheduled breaks
between courses, semesters or terms) at that institution of higher
learning, any course so pursued by the covered individual at that
institution of higher learning while so continuously enrolled shall
also be subject to disapproval under paragraph (1).
``(4) It shall not be grounds to disapprove a course of education
under paragraph (1) if a public institution of higher learning requires
a covered individual pursuing a course of education at the institution
to demonstrate an intent, by means other than satisfying a physical
presence requirement, to establish residency in the State in which the
institution is located, or to satisfy other requirements not relating
to the establishment of residency, in order to be charged tuition and
fees for that course at a rate that is equal to or less than the rate
the institution charges for tuition and fees for that course for
residents of the State.
``(5) The Secretary may waive such requirements of paragraph (1) as
the Secretary considers appropriate.
``(6) Disapproval under paragraph (1) shall apply only with respect
to educational assistance under chapters 30 and 33 of this title.''.
(b) Effective Date.--Subsection (c) of section 3679 of title 38,
United States Code (as added by subsection (a) of this section), shall
apply with respect to educational assistance provided for pursuit of a
program of education during a quarter, semester, or term, as
applicable, that begins after July 1, 2015.

59c01f7258a28504d1462ea0cfd5c73c85aadbe32b4af4b901db78f27d0b3262

DEPARTMENT OF VETERANS AFFAIRS FOR CERTAIN VETERANS COVERED BY
MEDICAID PLANS FOR SERVICES FURNISHED BY NURSING FACILITIES.
Section 5503(d)(7) of title 38, United States Code, is amended by
striking ``November 30, 2016'' and inserting ``September 30, 2024''.

23028348b3ac865ae64759ef9344ff5d62e41dfb0ae6352f52a4df1dfdb2afe6

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

13c0f6d67f1ca3ecf47e2eba9b9a04df4596f57dd959a8e3ef662c5b4dba397c

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

ee7caef15787e700d37de19e4cbece4e31152d5edf6795d4a441dceed40b07df

Section 5317(g) of title 38, United States Code, is amended by
striking ``September 30, 2016'' and inserting ``September 30, 2024''.

8cbe5d9a183fb2fbf07adf03f37aa6219cd9d0a7bf3c80b3b74b1ed08c3a3317

VETERANS AFFAIRS FOR PERFORMANCE OR MISCONDUCT.
(a) Removal or Transfer.--
(1) In general.--Chapter 7 of title 38, United States Code, is
amended by adding at the end the following new section:
``Sec. 713. Senior executives: removal based on performance or
misconduct
``(a) In General.--(1) The Secretary may remove an individual
employed in a senior executive position at the Department of Veterans
Affairs from the senior executive position if the Secretary determines
the performance or misconduct of the individual warrants such removal.
If the Secretary so removes such an individual, the Secretary may--
``(A) remove the individual from the civil service (as defined
in section 2101 of title 5); or
``(B) in the case of an individual described in paragraph (2),
transfer the individual from the senior executive position to a
General Schedule position at any grade of the General Schedule for
which the individual is qualified and that the Secretary determines
is appropriate.
``(2) An individual described in this paragraph is an individual
who--
``(A) previously occupied a permanent position within the
competitive service (as that term is defined in section 2102 of
title 5);
``(B) previously occupied a permanent position within the
excepted service (as that term is defined in section 2103 of title
5); or
``(C) prior to employment in a senior executive position at the
Department of Veterans Affairs, did not occupy any position within
the Federal Government.
``(b) Pay of Transferred Individual.--(1) Notwithstanding any other
provision of law, including the requirements of section 3594 of title
5, any individual transferred to a General Schedule position under
subsection (a)(2) shall, beginning on the date of such transfer,
receive the annual rate of pay applicable to such position.
``(2) An individual so transferred may not be placed on
administrative leave or any other category of paid leave during the
period during which an appeal (if any) under this section is ongoing,
and may only receive pay if the individual reports for duty. If an
individual so transferred does not report for duty, such individual
shall not receive pay or other benefits pursuant to subsection (e)(5).
``(c) Notice to Congress.--Not later than 30 days after removing or
transferring an individual from a senior executive position under
subsection (a), the Secretary shall submit to the Committees on
Veterans' Affairs of the Senate and House of Representatives notice in
writing of such removal or transfer and the reason for such removal or
transfer.
``(d) Procedure.--(1) The procedures under section 7543(b) of title
5 shall not apply to a removal or transfer under this section.
``(2)(A) Subject to subparagraph (B) and subsection (e), any
removal or transfer under subsection (a) may be appealed to the Merit
Systems Protection Board under section 7701 of title 5.
``(B) An appeal under subparagraph (A) of a removal or transfer may
only be made if such appeal is made not later than seven days after the
date of such removal or transfer.
``(e) Expedited Review by Administrative Judge.--(1) Upon receipt
of an appeal under subsection (d)(2)(A), the Merit Systems Protection
Board shall refer such appeal to an administrative judge pursuant to
section 7701(b)(1) of title 5. The administrative judge shall expedite
any such appeal under such section and, in any such case, shall issue a
decision not later than 21 days after the date of the appeal.
``(2) Notwithstanding any other provision of law, including section
7703 of title 5, the decision of an administrative judge under
paragraph (1) shall be final and shall not be subject to any further
appeal.
``(3) In any case in which the administrative judge cannot issue a
decision in accordance with the 21-day requirement under paragraph (1),
the removal or transfer is final. In such a case, the Merit Systems
Protection Board shall, within 14 days after the date that such removal
or transfer is final, submit to Congress and the Committees on
Veterans' Affairs of the Senate and House of Representatives a report
that explains the reasons why a decision was not issued in accordance
with such requirement.
``(4) The Merit Systems Protection Board or administrative judge
may not stay any removal or transfer under this section.
``(5) During the period beginning on the date on which an
individual appeals a removal from the civil service under subsection
(d) and ending on the date that the administrative judge issues a final
decision on such appeal, such individual may not receive any pay,
awards, bonuses, incentives, allowances, differentials, student loan
repayments, special payments, or benefits.
``(6) To the maximum extent practicable, the Secretary shall
provide to the Merit Systems Protection Board, and to any
administrative judge to whom an appeal under this section is referred,
such information and assistance as may be necessary to ensure an appeal
under this subsection is expedited.
``(f) Relation to Title 5.--(1) The authority provided by this
section is in addition to the authority provided by section 3592 or
subchapter V of chapter 75 of title 5.
``(2) Section 3592(b)(1) of title 5 does not apply to an action to
remove or transfer an individual under this section.
``(g) Definitions.--In this section:
``(1) The term `individual' means--
``(A) a career appointee (as that term is defined in
section 3132(a)(4) of title 5); or
``(B) any individual who occupies an administrative or
executive position and who was appointed under section 7306(a)
or section 7401(1) of this title.
``(2) The term `misconduct' includes neglect of duty,
malfeasance, or failure to accept a directed reassignment or to
accompany a position in a transfer of function.
``(3) The term `senior executive position' means--
``(A) with respect to a career appointee (as that term is
defined in section 3132(a)(4) of title 5), a Senior Executive
Service position (as such term is defined in section 3132(a)(2)
of title 5); and
``(B) with respect to an individual appointed under section
7306(a) or section 7401(1) of this title, an administrative or
executive position.''.
(2) Clerical amendment.--The table of sections at the beginning
of such chapter is amended by adding at the end the following new
item:
``713. Senior executives: removal based on performance or misconduct.''.
(b) Establishment of Expedited Review Process.--
(1) In general.--Not later than 14 days after the date of the
enactment of this Act, the Merit Systems Protection Board shall
establish and put into effect a process to conduct expedited
reviews in accordance with section 713(d) of title 38, United
States Code.
(2) Inapplicability of certain regulations.--Section 1201.22 of
title 5, Code of Federal Regulations, as in effect on the day
before the date of the enactment of this Act, shall not apply to
expedited reviews carried out under section 713(d) of title 38,
United States Code.
(3) Waiver.--The Merit Systems Protection Board may waive any
other regulation in order to provide for the expedited review
required under section 713(d) of title 38, United States Code.
(4) Report by merit systems protection board.--Not later than
14 days after the date of the enactment of this Act, the Merit
Systems Protection Board shall submit to the Committees on
Veterans' Affairs of the Senate and House of Representatives a
report on the actions the Board plans to take to conduct expedited
reviews under section 713(d) of title 38, United States Code, as
added by subsection (a). Such report shall include a description of
the resources the Board determines will be necessary to conduct
such reviews and a description of whether any resources will be
necessary to conduct such reviews that were not available to the
Board on the day before the date of the enactment of this Act.
(c) Temporary Exemption From Certain Limitation on Initiation of
Removal From Senior Executive Service.--During the 120-day period
beginning on the date of the enactment of this Act, an action to remove
an individual from the Senior Executive Service at the Department of
Veterans Affairs pursuant to section 7543 of title 5, United States
Code, may be initiated, notwithstanding section 3592(b) of such title,
or any other provision of law.
(d) Construction.--
(1) In general.--Nothing in this section or section 713 of
title 38, United States Code, as added by subsection (a), shall be
construed to apply to an appeal of a removal, transfer, or other
personnel action that was pending before the date of the enactment
of this Act.
(2) Relation to title 5.--With respect to the removal or
transfer of an individual (as that term is defined in such section
713) employed at the Department of Veterans Affairs, the authority
provided by such section 713 is in addition to the authority
provided by section 3592 or subchapter V of chapter 75 of title 5,
United States Code.

d7c100514585902c3c48abd0d137ebecb6277f9af627934db0a7e5cba430f0b4

(a) In General.--There is authorized to be appropriated, and is
appropriated, to the Secretary of Veterans Affairs, out of any funds in
the Treasury not otherwise appropriated $5,000,000,000 to carry out
subsection (b). Such funds shall be available for obligation or
expenditure without fiscal year limitation.
(b) Use of Amounts.--The amount appropriated under subsection (a)
shall be used by the Secretary as follows:
(1) To increase the access of veterans to care as follows:
(A) To hire primary care and specialty care physicians for
employment in the Department of Veterans Affairs.
(B) To hire other medical staff, including the following:
(i) Physicians.
(ii) Nurses.
(iii) Social workers.
(iv) Mental health professionals.
(v) Other health care professionals as the Secretary
considers appropriate.
(C) To carry out sections 301 and 302, including the
amendments made by such sections.
(D) To pay for expenses, equipment, and other costs
associated with the hiring of primary care, specialty care
physicians, and other medical staff under subparagraphs (A),
(B), and (C).
(2) To improve the physical infrastructure of the Department as
follows:
(A) To maintain and operate hospitals, nursing homes,
domiciliary facilities, and other facilities of the Veterans
Health Administration.
(B) To enter into contracts or hire temporary employees to
repair, alter, or improve facilities under the jurisdiction of
the Department that are not otherwise provided for under this
paragraph.
(C) To carry out leases for facilities of the Department.
(D) To carry out minor construction projects of the
Department.
(c) Availability.--The amount appropriated under subsection (a)
shall remain available until expended.
(d) Report.--
(1) In general.--Not later than 1 year after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall
submit to the appropriate committees of Congress a report on how
the Secretary has obligated the amounts appropriated under
subsection (a) as of the date of the submittal of the report.
(2) Appropriate committees of congress defined.--In this
subsection, the term ``appropriate committees of Congress'' means--
(A) the Committee on Veterans' Affairs and the Committee on
Appropriations of the Senate; and
(B) the Committee on Veterans' Affairs and the Committee on
Appropriations of the House of Representatives.
(e) Funding Plan.--The Secretary shall submit to Congress a funding
plan describing how the Secretary intends to use the amounts provided
under subsection (a).

ef4efe2e4c0ebd0018db094d9efaee36153d69babd322f70fcbc3cf6931b06ed

(a) In General.--There is established in the Treasury of the United
States a fund to be known as the Veterans Choice Fund.
(b) Administration of Fund.--The Secretary of Veterans Affairs
shall administer the Veterans Choice Fund established by subsection
(a).
(c) Use of Amounts.--
(1) In general.--Any amounts deposited in the Veteran Choice
Fund shall be used by the Secretary of Veterans Affairs to carry
out section 101, including, subject to paragraph (2), any
administrative requirements of such section.
(2) Amount for administrative requirements.--
(A) Limitation.--Except as provided by subparagraph (B), of
the amounts deposited in the Veterans Choice Fund, not more
than $300,000,000 may be used for administrative requirements
to carry out section 101.
(B) Increase.--The Secretary may increase the amount set
forth in subparagraph (A) with respect to the amounts used for
administrative requirements if--
(i) the Secretary determines that the amount of such
increase is necessary to carry out section 101;
(ii) the Secretary submits to the Committees on
Veterans' Affairs and Appropriations of the House of
Representatives and the Committees on Veterans' Affairs and
Appropriations of the Senate a report described in
subparagraph (C); and
(iii) a period of 60 days has elapsed following the
date on which the Secretary submits the report under clause
(ii).
(C) Report.--A report described in this subparagraph is a
report that contains the following:
(i) A notification of the amount of the increase that
the Secretary determines necessary under subparagraph
(B)(i).
(ii) The justifications for such increased amount.
(iii) The administrative requirements that the
Secretary will carry out using such increased amount.
(d) Appropriation and Deposit of Amounts.--
(1) In general.--There is authorized to be appropriated, and is
appropriated, to the Secretary of Veterans Affairs, out of any
funds in the Treasury not otherwise appropriated $10,000,000,000 to
be deposited in the Veterans Choice Fund established by subsection
(a). Such funds shall be available for obligation or expenditure
without fiscal year limitation, and only for the program created
under section 101.
(2) Availability.--The amount appropriated under paragraph (1)
shall remain available until expended.
(e) Sense of Congress.--It is the sense of Congress that the
Veterans Choice Fund is a supplement to but distinct from the
Department of Veterans Affairs' current and expected level of non-
Department care currently part of Department's medical care budget.
Congress expects that the Department will maintain at least its
existing obligations of non-Department care programs in addition to but
distinct from the Veterans Choice Fund for each of fiscal years 2015
through 2017.

0c07dcb556c44f47b558ab6c7ab528f2e815864a9c494158f8950748a74f18d4

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

f9231068084aeb0d6a245cf1665376cac8745fb9efb64439325cb1e5faaaf06f

Veterans' Access to Care through Choice, Accountability, and Transparency Act of 2014 — HR. 3230

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