[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 2372 Enrolled Bill (ENR)]
S.2372
One Hundred Fifteenth Congress
of the
United States of America
AT THE SECOND SESSION
Begun and held at the City of Washington on Wednesday,
the third day of January, two thousand and eighteen
An Act
To establish a permanent community care program for veterans, to
establish a commission for the purpose of making recommendations
regarding the modernization or realignment of facilities of the Veterans
Health Administration, to improve construction of the Department of
Veterans Affairs, to make certain improvements in the laws administered
by the Secretary of Veterans Affairs relating to the home loan program
of the Department of Veterans Affairs, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,

dc8fb02aedc35ed27326891620028613e8aa2ef863b801a2e8d1dc805234bb99

(a) Short Title.--This Act may be cited as the ``John S. McCain
III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal
Systems and Strengthening Integrated Outside Networks Act of 2018'' or
the ``VA MISSION Act of 2018''.
(b) Table of Contents.--The table of contents for this Act is as
follows:

e0faa22fa0f322d298fe52d6728b08e42746441ff061433fffe67badac961474

Subtitle A--Developing an Integrated High-Performing Network
Chapter 1--Establishing Community Care Programs

7f470acbca81cce4e0121afca497ee3b6317f1d01f51c85baa8cdc411a32f2e1

TITLE I

-CARING FOR OUR VETERANS

73142e1bd90addb1ff532536a7f15a0f1d042b6fc5547bbd5d7a191c743d2863

Performing Integrated Health Care Network.

96aeb7b754a0b66b185a02d99dbc88a3f13a3a12bdb9a54bb5d7fcf3e01525cd

07fee773e742257277f37191dc6b5f0d662d41ad97e13bd0e787f0be4ada96ca

non-Department health care services to veterans.

73dbb9eb010eb3c38de4c1b55d26d9484bd36bda5c3c482660a339b1bf81d9bf

Chapter 2--Paying Providers and Improving Collections

12459c8379462edfb14d4a72263eb9ba11cff82978c8b41d01a1118f3dcf7fea

6009d04f6ef260946a417d146a55c5343426126bd5b1a911c234202b78dbc211

furnished for non-service-connected disabilities.

7969d723dd8ba919ce45b919e0842914b0ce3d8608fe9174365402768f19036d

interface.
Chapter 3--Education and Training Programs

6bcd7f83d5f5be80815e4999284caa95964d29774a70cfba7133c6bfb6eecdd9

c0c8b38fbe5b9878f49af927cf964e746fb86d5521e0fe7ee97fbf7ab6f19397

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

2564f27aa4d5793e90d9b46a5f4c236ed45c43286aaf97433ac7411cb2993fdb

practices by non-Department of Veterans Affairs health care
providers.

61ec75c02cadf618861a84daa9d7645b47b7c4384fcd02067f23cd6ba572b473

23374bfdc1b68ef4d080adb0f6cb149c8fd2dbd67cb0b3bd48683b15882b3253

network of State-based prescription drug monitoring programs.
Chapter 5--Other Non-Department Health Care Matters

212997574bcf8c020bc3d3c740866c9c99dacade439842d01a2a0634ed57f6c6

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

3d990bafdaa0cac61099aaa678b2ebef9865566bef37ad5eff12b50ce478f6f4

Veterans Affairs providing treatment via telemedicine.

69686fea63bb18dd1254f292bec136ea9f33ff4abfb749c2cf407a1a3d8342ff

193846880da57a943d1a5f0f6e823adb17923270d1f6cedc90bb6f124dca56bd

purposes of conducting transplant procedures for veterans.
Subtitle C--Family Caregivers

e0345951978f80a193932de0f488cb837fc3fd95def75d7c548ee12cc6748969

97997c008cda0bcb8bbaabfac489fc43862b2748dbc27f84db98d3594aaa840b

of Veterans Affairs to assess and improve the family caregiver
program.

f95126efe6e9712b5e4e0f3443358a9909dd5122bb5d129731b2f12e984edffa

of Department of Veterans Affairs.
Subtitle A--Asset and Infrastructure Review

032b442037ab59067b4b868ce926766d760ba31a258685bd0e261c7065b5274e

c8f19cefa3dd36f7007a90ba4afe232408fb9e3449e4e27d29e920072340c575

TITLE II

-VA ASSET AND INFRASTRUCTURE REVIEW

d3ffa4ba09baedcedbe43f2b2c36315dbfc1ef1786714f157d4540ae7b29fc2f

495531b8f99d04a80acd69e3f8140bdedaf5014361f5ae6fa4c8fee89e196745

veterans who live in the Pacific territories.

39698e211440ca68c27c58394a65fc48edecfa5f47a1a549063cc22212c01a5d

Department of Veterans Affairs Health Professional Scholarship
Program.

70d2e0082ceccb7bc8dda9056d8246dc3e542ccafb3ec096283121b31d128ded

TITLE III

-IMPROVEMENTS TO RECRUITMENT OF HEALTH CARE PROFESSIONALS

Education Debt Reduction Program of Department of Veterans
Affairs.

c8518d2d8458565ce563935aca3f5fddd50da1878757c4084115d19ff099f02a

241859c153e82d1ebb278e02eb88a7b2f5eaac00edaf4b452fdb75b085486435

5305a71592d8233ec3f5758aa8d8274dde872cb8022045d909da72a4d02161d2

Program of Department of Veterans Affairs.

a74346810c2f5f224ea1866bc50114fe268c5776305efc386e31927f9d46623d

facilities of the Department of Veterans Affairs as
underserved facilities and plan to address problem of
underserved facilities.

78f61e7d0e7332fdff2605ca2681e3118d301c48a26d55af48730b98636d5270

TITLE IV

-HEALTH CARE IN UNDERSERVED AREAS

c71938ce2d4995e3c9ba73df5beaf77fb6cf452f088ec3f6da36c3a429bf6752

certain high-level employees of the department.

823165a839f44f83cbb3cd548a504dfae3c79dd0a61c6a3eea248e2091c0ccea

TITLE V

-OTHER MATTERS

93cf30b2a44fd16ba87afa892932e8dae64a4f5553f76921f3c3e80b2cde4274

aligned care team settings within medical centers of
Department of Veterans Affairs.

f07c7b30b51f27860ae47dc3e2b376ac284b0067d6823a6a332951920399303a

guaranteed by Secretary of Veterans Affairs.

f03aedbd55d1e375bc845c5357edc4bbaeeb79ea0416e180271cf8b9e3aaa72d

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

4317b38c8f39da063673541833b70e8421bd571c45d7994842bf078c3707206c

(a) Short Title.--This title may be cited as the ``Caring for Our
Veterans Act of 2018''.
(b) References to Title 38, United States Code.--Except as
otherwise expressly provided, whenever in this title an amendment or
repeal is expressed in terms of an amendment to, or repeal of, a
section or other provision, the reference shall be considered to be
made to a section or other provision of title 38, United States Code.
Subtitle A--Developing an Integrated High-Performing Network
CHAPTER 1--ESTABLISHING COMMUNITY CARE PROGRAMS

a5fa34a98d450de7438905677c361a42db9c9b566d7effa9dad38346b4f09440

46bbd116f5c486e60c5cd3a84719f97234801c53d7a5db95233c72148f1853ff

VETERANS AFFAIRS AND NON-DEPARTMENT PROVIDERS.
(a) In General.--Subchapter I of chapter 17 is amended by inserting
after section 1703 the following new section:
``Sec. 1703A. Agreements with eligible entities or providers;
certification processes
``(a) Agreements Authorized.--(1)(A) When hospital care, a medical
service, or an extended care service required by a veteran who is
entitled to such care or service under this chapter is not feasibly
available to the veteran from a facility of the Department or through a
contract or sharing agreement entered into pursuant to another
provision of law, the Secretary may furnish such care or service to
such veteran through an agreement under this section with an eligible
entity or provider to provide such hospital care, medical service, or
extended care service.
``(B) An agreement entered into under this section to provide
hospital care, a medical service, or an extended care service shall be
known as a `Veterans Care Agreement'.
``(C) For purposes of subparagraph (A), hospital care, a medical
service, or an extended care service may be considered not feasibly
available to a veteran from a facility of the Department or through a
contract or sharing agreement described in such subparagraph when the
Secretary determines the veteran's medical condition, the travel
involved, the nature of the care or services required, or a combination
of these factors make the use of a facility of the Department or a
contract or sharing agreement described in such subparagraph
impracticable or inadvisable.
``(D) A Veterans Care Agreement may be entered into by the
Secretary or any Department official authorized by the Secretary.
``(2)(A) Subject to subparagraph (B), the Secretary shall review
each Veterans Care Agreement of material size, as determined by the
Secretary or set forth in paragraph (3), for hospital care, a medical
service, or an extended care service to determine whether it is
feasible and advisable to provide such care or service within a
facility of the Department or by contract or sharing agreement entered
into pursuant to another provision of law and, if so, take action to do
so.
``(B)(i) The Secretary shall review each Veterans Care Agreement of
material size that has been in effect for at least 6 months within the
first 2 years of its taking effect, and not less frequently than once
every 4 years thereafter.
``(ii) If a Veterans Care Agreement has not been in effect for at
least 6 months by the date of the review required by subparagraph (A),
the agreement shall be reviewed during the next cycle required by
subparagraph (A), and such review shall serve as its review within the
first 2 years of its taking effect for purposes of clause (i).
``(3)(A) In fiscal year 2019 and in each fiscal year thereafter, in
addition to such other Veterans Care Agreements as the Secretary may
determine are of material size, a Veterans Care Agreement for the
purchase of extended care services that exceeds $5,000,000 annually
shall be considered of material size.
``(B) From time to time, the Secretary may publish a notice in the
Federal Register to adjust the dollar amount specified in subparagraph
(A) to account for changes in the cost of health care based upon
recognized health care market surveys and other available data.
``(b) Eligible Entities and Providers.--For purposes of this
section, an eligible entity or provider is--
``(1) any provider of services that has enrolled and entered
into a provider agreement under section 1866(a) of the Social
Security Act (42 U.S.C. 1395cc(a)) and any physician or other
supplier who has enrolled and entered into a participation
agreement under section 1842(h) of such Act (42 U.S.C. 1395u(h));
``(2) any provider participating under a State plan under title
XIX of such Act (42 U.S.C. 1396 et seq.);
``(3) an Aging and Disability Resource Center, an area agency
on aging, or a State agency (as defined in section 102 of the Older
Americans Act of 1965 (42 U.S.C. 3002));
``(4) a center for independent living (as defined in section
702 of the Rehabilitation Act of 1973 (29 U.S.C. 796a)); or
``(5) any entity or provider not described in paragraph (1) or
(2) of this subsection that the Secretary determines to be eligible
pursuant to the certification process described in subsection (c).
``(c) Eligible Entity or Provider Certification Process.--The
Secretary shall establish by regulation a process for the certification
of eligible entities or providers or recertification of eligible
entities or providers under this section. Such a process shall, at a
minimum--
``(1) establish deadlines for actions on applications for
certification;
``(2) set forth standards for an approval or denial of
certification, duration of certification, revocation of an eligible
entity or provider's certification, and recertification of eligible
entities or providers;
``(3) require the denial of certification if the Secretary
determines the eligible entity or provider is excluded from
participation in a Federal health care program under section 1128
or section 1128A of the Social Security Act (42 U.S.C. 1320a-7 or
1320a-7a) or is currently identified as an excluded source on the
System for Award Management Exclusions list described in part 9 of
title 48, Code of Federal Regulations, and part 180 of title 2 of
such Code, or successor regulations;
``(4) establish procedures for screening eligible entities or
providers according to the risk of fraud, waste, and abuse that are
similar to the standards under section 1866(j)(2)(B) of the Social
Security Act (42 U.S.C. 1395cc(j)(2)(B)) and section 9.104 of title
48, Code of Federal Regulations, or successor regulations; and
``(5) incorporate and apply the restrictions and penalties set
forth in chapter 21 of title 41 and treat this section as a
procurement program only for purposes of applying such provisions.
``(d) Rates.--To the extent practicable, the rates paid by the
Secretary for hospital care, medical services, and extended care
services provided under a Veterans Care Agreement shall be in
accordance with the rates paid by the United States under section
1703(i) of this title.
``(e) Terms of Veterans Care Agreements.--(1) Pursuant to
regulations promulgated under subsection (k), the Secretary may define
the requirements for providers and entities entering into agreements
under this section based upon such factors as the number of patients
receiving care or services, the number of employees employed by the
entity or provider furnishing such care or services, the amount paid by
the Secretary to the provider or entity, or other factors as determined
by the Secretary.
``(2) To furnish hospital care, medical services, or extended care
services under this section, an eligible entity or provider shall
agree--
``(A) to accept payment at the rates established in regulations
prescribed under this section;
``(B) that payment by the Secretary under this section on
behalf of a veteran to a provider of services or care shall, unless
rejected and refunded by the provider within 30 days of receipt,
constitute payment in full and extinguish any liability on the part
of the veteran for the treatment or care provided, and no provision
of a contract, agreement, or assignment to the contrary shall
operate to modify, limit, or negate this requirement;
``(C) to provide only the care and services authorized by the
Department under this section and to obtain the prior written
consent of the Department to furnish care or services outside the
scope of such authorization;
``(D) to bill the Department in accordance with the methodology
outlined in regulations prescribed under this section;
``(E) to not seek to recover or collect from a health plan
contract or third party, as those terms are defined in section 1729
of this title, for any care or service that is furnished or paid
for by the Department;
``(F) to provide medical records to the Department in the time
frame and format specified by the Department; and
``(G) to meet such other terms and conditions, including
quality of care assurance standards, as the Secretary may specify
in regulation.
``(f) Discontinuation or Nonrenewal of a Veterans Care Agreement.--
(1) An eligible entity or provider may discontinue a Veterans Care
Agreement at such time and upon such notice to the Secretary as may be
provided in regulations prescribed under this section.
``(2) The Secretary may discontinue a Veterans Care Agreement with
an eligible entity or provider at such time and upon such reasonable
notice to the eligible entity or provider as may be specified in
regulations prescribed under this section, if an official designated by
the Secretary--
``(A) has determined that the eligible entity or provider
failed to comply substantially with the provisions of the Veterans
Care Agreement, or with the provisions of this section or
regulations prescribed under this section;
``(B) has determined the eligible entity or provider is
excluded from participation in a Federal health care program under
section 1128 or section 1128A of the Social Security Act (42 U.S.C.
1320a-7 or 1320a-7a) or is identified on the System for Award
Management Exclusions list as provided in part 9 of title 48, Code
of Federal Regulations, and part 180 of title 2 of such Code, or
successor regulations;
``(C) has ascertained that the eligible entity or provider has
been convicted of a felony or other serious offense under Federal
or State law and determines the eligible entity or provider's
continued participation would be detrimental to the best interests
of veterans or the Department; or
``(D) has determined that it is reasonable to terminate the
agreement based on the health care needs of a veteran.
``(g) Quality of Care.--The Secretary shall establish a system or
systems for monitoring the quality of care provided to veterans through
Veterans Care Agreements and for assessing the quality of hospital
care, medical services, and extended care services furnished by
eligible entities and providers before the renewal of Veterans Care
Agreements.
``(h) Disputes.--(1) The Secretary shall promulgate administrative
procedures for eligible entities and providers to present all disputes
arising under or related to Veterans Care Agreements.
``(2) Such procedures constitute the eligible entities' and
providers' exhaustive and exclusive administrative remedies.
``(3) Eligible entities or providers must first exhaust such
administrative procedures before seeking any judicial review under
section 1346 of title 28 (known as the `Tucker Act').
``(4) Disputes under this section must pertain to either the scope
of authorization under the Veterans Care Agreement or claims for
payment subject to the Veterans Care Agreement and are not claims for
the purposes of such laws that would otherwise require application of
sections 7101 through 7109 of title 41, United States Code.
``(i) Applicability of Other Provisions of Law.--(1) A Veterans
Care Agreement may be authorized by the Secretary or any Department
official authorized by the Secretary, and such action shall not be
treated as--
``(A) an award for the purposes of such laws that would
otherwise require the use of competitive procedures for the
furnishing of care and services; or
``(B) a Federal contract for the acquisition of goods or
services for purposes of any provision of Federal law governing
Federal contracts for the acquisition of goods or services except
section 4706(d) of title 41.
``(2)(A) Except as provided in the agreement itself, in
subparagraph (B), and unless otherwise provided in this section or
regulations prescribed pursuant to this section, an eligible entity or
provider that enters into an agreement under this section is not
subject to, in the carrying out of the agreement, any law to which
providers of services and suppliers under the Medicare program under
title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) are not
subject.
``(B) An eligible entity or provider that enters into an agreement
under this section is subject to--
``(i) all laws regarding integrity, ethics, or fraud, or that
subject a person to civil or criminal penalties; and
``(ii) all laws that protect against employment discrimination
or that otherwise ensure equal employment opportunities.
``(3) Notwithstanding paragraph (2)(B)(i), an eligible entity or
provider that enters into an agreement under this section shall not be
treated as a Federal contractor or subcontractor for purposes of
chapter 67 of title 41 (commonly known as the `McNamara-O'Hara Service
Contract Act of 1965').
``(j) Parity of Treatment.--Eligibility for hospital care, medical
services, and extended care services furnished to any veteran pursuant
to a Veterans Care Agreement shall be subject to the same terms as
though provided in a facility of the Department, and provisions of this
chapter applicable to veterans receiving such care and services in a
facility of the Department shall apply to veterans treated under this
section.
``(k) Rulemaking.--The Secretary shall promulgate regulations to
carry out this section.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item relating to section
1703 the following new item:
``1703A. Agreements with eligible entities or providers; certification
processes.''.

2ae25c83bcc912376767e655d629ed5c0d4ba88422ef95cc5f2326fc4586fc27

(a) In General.--Section 1745(a) is amended--
(1) in paragraph (1), by striking ``(or agreement under section
1720(c)(1) of this title)'' and inserting ``(or an agreement)'';
and
(2) by adding at the end the following new paragraph:
``(4)(A) An agreement under this section may be authorized by the
Secretary or any Department official authorized by the Secretary, and
any such action is not an award for purposes of such laws that would
otherwise require the use of competitive procedures for the furnishing
of hospital care, medical services, and extended care services.
``(B)(i) Except as provided in the agreement itself, in clause
(ii), and unless otherwise provided in this section or regulations
prescribed pursuant to this section, a State home that enters into an
agreement under this section is not subject to, in the carrying out of
the agreement, any provision of law to which providers of services and
suppliers under the Medicare program under title XVIII of the Social
Security Act (42 U.S.C. 1395 et seq.) are not subject.
``(ii) A State home that enters into an agreement under this
section is subject to--
``(I) all provisions of law regarding integrity, ethics, or
fraud, or that subject a person to civil or criminal penalties;
``(II) all provisions of law that protect against employment
discrimination or that otherwise ensure equal employment
opportunities; and
``(III) all provisions in subchapter V of chapter 17 of this
title.
``(iii) Notwithstanding subparagraph (B)(ii)(I), a State home that
enters into an agreement under this section may not be treated as a
Federal contractor or subcontractor for purposes of chapter 67 of title
41 (known as the `McNamara-O'Hara Service Contract Act of 1965').''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply to care provided on or after the effective date of regulations
issued by the Secretary of Veterans Affairs to carry out this section.

7f1d84a9eee2adb4d882b5c3069c39e610fd7a84ab9757b8449e98fbf680a0d6

(a) In General.--Subchapter I of chapter 17, as amended by section
102, is further amended by inserting after section 1703A the following
new sections:
``Sec. 1703B. Access standards
``(a)(1) The Secretary shall establish access standards for
furnishing hospital care, medical services, or extended care services
to covered veterans for the purposes of section 1703(d).
``(2) The Secretary shall ensure that the access standards
established under paragraph (1) define such categories of care to cover
all care and services within the medical benefits package of the
Department of Veterans Affairs.
``(b) The Secretary shall ensure that the access standards provide
covered veterans, employees of the Department, and health care
providers in the network established under section 1703(h) with
relevant comparative information that is clear, useful, and timely, so
that covered veterans can make informed decisions regarding their
health care.
``(c) The Secretary shall consult with all pertinent Federal
entities (including the Department of Defense, the Department of Health
and Human Services, and the Centers for Medicare & Medicaid Services),
entities in the private sector, and other nongovernmental entities in
establishing access standards.
``(d)(1) Not later than 270 days after the date of the enactment of
the Caring for Our Veterans Act of 2018, the Secretary shall submit to
the appropriate committees of Congress a report detailing the access
standards.
``(2)(A) Before submitting the report required under paragraph (1),
the Secretary shall provide periodic updates to the appropriate
committees of Congress to confirm the Department's progress towards
developing the access standards required by this section.
``(B) The first update under subparagraph (A) shall occur no later
than 120 days from the date of the enactment of the Caring for Our
Veterans Act of 2018.
``(3) Not later than 540 days after the date on which the Secretary
implements the access standards established under subsection (a), the
Secretary shall submit to the appropriate committees of Congress a
report detailing the implementation of and compliance with such access
standards by Department and non-Department entities or providers.
``(e) Not later than 3 years after the date on which the Secretary
establishes access standards under subsection (a) and not less
frequently than once every 3 years thereafter, the Secretary shall--
``(1) conduct a review of such standards; and
``(2) submit to the appropriate committees of Congress a report
on the findings and any modification to the access standards with
respect to the review conducted under paragraph (1).
``(f) The Secretary shall ensure health care providers specified
under section 1703(c) are able to comply with the applicable access
standards established by the Secretary.
``(g) The Secretary shall publish in the Federal Register and on an
internet website of the Department the designated access standards
established under this section for purposes of section 1703(d)(1)(D).
``(h)(1) Consistent with paragraphs (1)(D) and (3) of section
1703(d), covered veterans may contact the Department at any time to
request a determination regarding whether they are eligible to receive
care and services from a non-Department entity or provider based on the
Department being unable to furnish such care and services in a manner
that complies with the designated access standards established under
this section.
``(2) The Secretary shall establish a process to review such
requests from covered veterans to determine whether--
``(A) the requested care is clinically necessary; and
``(B) the Department is able to provide such care in a manner
that complies with designated access standards established under
this section.
``(3) The Secretary shall promptly respond to any such request by a
covered veteran.
``(i)(1) The term `appropriate committees of Congress' means--
``(A) the Committee on Veterans' Affairs and the Committee on
Appropriations of the Senate; and
``(B) the Committee on Veterans' Affairs and the Committee on
Appropriations of the House of Representatives.
``(2) The term `covered veterans' refers to veterans described in
section 1703(b) of this title.
``Sec. 1703C. Standards for quality
``(a) In General.--(1) The Secretary shall establish standards for
quality regarding hospital care, medical services, and extended care
services furnished by the Department pursuant to this title, including
through non-Department health care providers pursuant to section 1703
of this title.
``(2) In establishing standards for quality under paragraph (1),
the Secretary shall consider existing health quality measures that are
applied to public and privately sponsored health care systems with the
purpose of providing covered veterans relevant comparative information
to make informed decisions regarding their health care.
``(3) The Secretary shall collect and consider data for purposes of
establishing the standards under paragraph (1). Such data collection
shall include--
``(A) after consultation with veterans service organizations
and other key stakeholders on survey development or modification of
an existing survey, a survey of veterans who have used hospital
care, medical services, or extended care services furnished by the
Veterans Health Administration during the most recent 2-year period
to assess the satisfaction of the veterans with service and quality
of care; and
``(B) datasets that include, at a minimum, elements relating to
the following:
``(i) Timely care.
``(ii) Effective care.
``(iii) Safety, including, at a minimum, complications,
readmissions, and deaths.
``(iv) Efficiency.
``(4) The Secretary shall consult with all pertinent Federal
entities (including the Department of Defense, the Department of Health
and Human Services, and the Centers for Medicare & Medicaid Services),
entities in the private sector, and other nongovernmental entities in
establishing standards for quality.
``(5)(A) Not later than 270 days after the date of the enactment of
the Caring for Our Veterans Act of 2018, the Secretary shall submit to
the appropriate committees of Congress a report detailing the standards
for quality.
``(B)(i) Before submitting the report required under subparagraph
(A), the Secretary shall provide periodic updates to the appropriate
committees of Congress to confirm the Department's progress towards
developing the standards for quality required by this section.
``(ii) The first update under clause (i) shall occur no later than
120 days from the date of the enactment of the Caring for Our Veterans
Act of 2018.
``(b) Publication and Consideration of Public Comments.--(1) Not
later than 1 year after the date on which the Secretary establishes
standards for quality under subsection (a), the Secretary shall publish
the quality rating of medical facilities of the Department in the
publicly available Hospital Compare website through the Centers for
Medicare & Medicaid Services for the purpose of providing veterans with
information that allows them to compare performance measure information
among Department and non-Department health care providers.
``(2) Not later than 2 years after the date on which the Secretary
establishes standards for quality under subsection (a), the Secretary
shall consider and solicit public comment on potential changes to the
measures used in such standards to ensure that they include the most
up-to-date and applicable industry measures for veterans.
``(c)(1) The term `appropriate committees of Congress' means--
``(A) the Committee on Veterans' Affairs and the Committee on
Appropriations of the Senate; and
``(B) the Committee on Veterans' Affairs and the Committee on
Appropriations of the House of Representatives.
``(2) The term `covered veterans' refers to veterans described in
section 1703(b) of this title.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 17, as amended by section 102, is further amended by inserting
after the item relating to section 1703A the following new items:
``1703B. Access standards.
``1703C. Standards for quality.''.

887dfb32788dd7d15ab2756d0917668d48cf86aa7bc1d56dedfe6bc73464fa6a

(a) In General.--Chapter 17 is amended by inserting after section
1725 the following new section:
``Sec. 1725A. Access to walk-in care
``(a) Procedures To Ensure Access to Walk-In Care.--The Secretary
shall develop procedures to ensure that eligible veterans are able to
access walk-in care from qualifying non-Department entities or
providers.
``(b) Eligible Veterans.--For purposes of this section, an eligible
veteran is any individual who--
``(1) is enrolled in the health care system established under
section 1705(a) of this title; and
``(2) has received care under this chapter within the 24-month
period preceding the furnishing of walk-in care under this section.
``(c) Qualifying Non-Department Entities or Providers.--For
purposes of this section, a qualifying non-Department entity or
provider is a non-Department entity or provider that has entered into a
contract or other agreement with the Secretary to furnish services
under this section.
``(d) Federally-Qualified Health Centers.--Whenever practicable,
the Secretary may use a Federally-qualified health center (as defined
in section 1905(l)(2)(B) of the Social Security Act (42 U.S.C.
1396d(l)(2)(B))) to carry out this section.
``(e) Continuity of Care.--The Secretary shall ensure continuity of
care for those eligible veterans who receive walk-in care services
under this section, including through the establishment of a mechanism
to receive medical records from walk-in care providers and provide
pertinent patient medical records to providers of walk-in care.
``(f) Copayments.--(1)(A) The Secretary may require an eligible
veteran to pay the United States a copayment for each episode of
hospital care or medical services provided under this section if the
eligible veteran would be required to pay a copayment under this title.
``(B) An eligible veteran not required to pay a copayment under
this title may access walk-in care without a copayment for the first
two visits in a calendar year. For any additional visits, a copayment
at an amount determined by the Secretary may be required.
``(C) An eligible veteran required to pay a copayment under this
title may be required to pay a regular copayment for the first two
walk-in care visits in a calendar year. For any additional visits, a
higher copayment at an amount determined by the Secretary may be
required.
``(2) After the first two episodes of care furnished to an eligible
veteran under this section, the Secretary may adjust the copayment
required of the veteran under this subsection based upon the priority
group of enrollment of the eligible veteran, the number of episodes of
care furnished to the eligible veteran during a year, and other factors
the Secretary considers appropriate under this section.
``(3) The amount or amounts of the copayments required under this
subsection shall be prescribed by the Secretary by rule.
``(4) Section 8153(c) of this title shall not apply to this
subsection.
``(g) Regulations.--Not later than 1 year after the date of the
enactment of the Caring for Our Veterans Act of 2018, the Secretary
shall promulgate regulations to carry out this section.
``(h) Walk-In Care Defined.--In this section, the term `walk-in
care' means non-emergent care provided by a qualifying non-Department
entity or provider that furnishes episodic care and not longitudinal
management of conditions and is otherwise defined through regulations
the Secretary shall promulgate.''.
(b) Effective Date.--Section 1725A of title 38, United States Code,
as added by subsection (a) shall take effect on the date upon which
final regulations implementing such section take effect.
(c) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item relating to section
1725 the following new item:
``1725A. Access to walk-in care.''.

0cec0b4019d1766e03bc5b6c5999be1c31fe992f9aa174f21f60a6a335b4bfca

HIGH-PERFORMING INTEGRATED HEALTH CARE NETWORK.
(a) In General.--Subchapter II of chapter 73 is amended by
inserting after section 7330B the following new section:
``Sec. 7330C. Quadrennial Veterans Health Administration review
``(a) Market Area Assessments.--(1) Not less frequently than every
4 years, the Secretary of Veterans Affairs shall perform market area
assessments regarding the health care services furnished under the laws
administered by the Secretary.
``(2) Each market area assessment established under paragraph (1)
shall include the following:
``(A) An assessment of the demand for health care from the
Department, disaggregated by geographic market areas as determined
by the Secretary, including the number of requests for health care
services under the laws administered by the Secretary.
``(B) An inventory of the health care capacity of the
Department of Veterans Affairs across the Department's system of
facilities.
``(C) An assessment of the health care capacity to be provided
through contracted community care providers and providers who
entered into a provider agreement with the Department under section
1703A of title 38, as added by section 102, including the number of
providers, the geographic location of the providers, and categories
or types of health care services provided by the providers.
``(D) An assessment obtained from other Federal direct delivery
systems of their capacity to provide health care to veterans.
``(E) An assessment of the health care capacity of non-
contracted providers where there is insufficient network supply.
``(F) An assessment of the health care capacity of academic
affiliates and other collaborations of the Department as it relates
to providing health care to veterans.
``(G) An assessment of the effects on health care capacity of
the access standards and standards for quality established under
sections 1703B and 1703C of this title.
``(H) The number of appointments for health care services under
the laws administered by the Secretary, disaggregated by--
``(i) appointments at facilities of the Department of
Veterans Affairs; and
``(ii) appointments with non-Department health care
providers.
``(3)(A) The Secretary shall submit to the appropriate committees
of Congress the market area assessments established in paragraph (1).
``(B) The Secretary also shall submit to the appropriate committees
of Congress the market area assessments completed by or being performed
on the day before the date of the enactment of the Caring for Our
Veterans Act of 2018.
``(4)(A) The Secretary shall use the market area assessments
established under paragraph (1) to--
``(i) determine the capacity of the health care provider
networks established under section 1703(h) of this title;
``(ii) inform the Department budget, in accordance with
subparagraph (B); and
``(iii) inform and assess the appropriateness of the access
standards established under section 1703B of this title and
standards for quality under section 1703C and to make
recommendations for any changes to such standards.
``(B) The Secretary shall ensure that the Department budget for any
fiscal year (as submitted with the budget of the President under
section 1105(a) of title 31) reflects the findings of the Secretary
with respect to the most recent market area assessments under paragraph
(1) and health care utilization data from the Department and non-
Department entities or providers furnishing care and services to
covered veterans as described in section 1703(b).
``(b) Strategic Plan To Meet Health Care Demand.--(1) Not later
than 1 year after the date of the enactment of the Caring for Our
Veterans Act of 2018 and not less frequently than once every 4 years
thereafter, the Secretary shall submit to the appropriate committees of
Congress a strategic plan that specifies a 4-year forecast of--
``(A) the demand for health care from the Department,
disaggregated by geographic area as determined by the Secretary;
``(B) the health care capacity to be provided at each medical
center of the Department; and
``(C) the health care capacity to be provided through community
care providers.
``(2) In preparing the strategic plan under paragraph (1), the
Secretary shall--
``(A) assess the access standards and standards for quality
established under sections 1703B and 1703C of this title;
``(B) assess the market area assessments established under
subsection (a);
``(C) assess the needs of the Department based on identified
services that provide management of conditions or disorders related
to military service for which there is limited experience or access
in the national market, the overall health of veterans throughout
their lifespan, or other services as the Secretary determines
appropriate;
``(D) consult with key stakeholders within the Department, the
heads of other Federal agencies, and other relevant governmental
and nongovernmental entities, including State, local, and tribal
government officials, members of Congress, veterans service
organizations, private sector representatives, academics, and other
policy experts;
``(E) identify emerging issues, trends, problems, and
opportunities that could affect health care services furnished
under the laws administered by the Secretary;
``(F) develop recommendations regarding both short- and long-
term priorities for health care services furnished under the laws
administered by the Secretary;
``(G) after consultation with veterans service organizations
and other key stakeholders on survey development or modification of
an existing survey, consider a survey of veterans who have used
hospital care, medical services, or extended care services
furnished by the Veterans Health Administration during the most
recent 2-year period to assess the satisfaction of the veterans
with service and quality of care;
``(H) conduct a comprehensive examination of programs and
policies of the Department regarding the delivery of health care
services and the demand of health care services for veterans in
future years;
``(I) assess the remediation of medical service lines of the
Department as described in section 1706A in conjunction with the
utilization of non-Department entities or providers to offset
remediation; and
``(J) consider such other matters as the Secretary considers
appropriate.
``(c) Responsibilities.--The Secretary shall be responsible for--
``(1) overseeing the transformation and organizational change
across the Department to achieve such high performing integrated
health care network;
``(2) developing the capital infrastructure planning and
procurement processes, whether minor or major construction projects
or leases; and
``(3) developing a multi-year budget process that is capable of
forecasting future year budget requirements and projecting the cost
of delivering health care services under a high-performing
integrated health care network.
``(d) Appropriate Committees of Congress Defined.--In this section,
the term `appropriate committees of Congress' means--
``(1) the Committee on Veterans' Affairs and the Committee on
Appropriations of the Senate; and
``(2) the Committee on Veterans' Affairs and the Committee on
Appropriations of the House of Representatives.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item relating to section
7330B the following new item:
``7330C. Quadrennial Veterans Health Administration review.''.

a0d0011edf153ca5b7806139896d754f63a8903088a45a4deb1b9b2d93e965da

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

c691450c75a4ef22812b2c3240b87640100e18440d7ec1e4ffd1c6a87a96e4ee

PROVIDING NON-DEPARTMENT HEALTH CARE SERVICES TO VETERANS.
(a) In General.--On and after the date that is 1 year after the
date of the enactment of this Act, the Secretary of Veterans Affairs
shall deny or revoke the eligibility of a health care provider to
provide non-Department health care services to veterans if the
Secretary determines that the health care provider--
(1) was removed from employment with the Department of Veterans
Affairs due to conduct that violated a policy of the Department
relating to the delivery of safe and appropriate health care; or
(2) violated the requirements of a medical license of the
health care provider that resulted in the loss of such medical
license.
(b) Permissive Action.--On and after the date that is 1 year after
the date of the enactment of this Act, the Secretary may deny, revoke,
or suspend the eligibility of a health care provider to provide non-
Department health care services if the Secretary determines such action
is necessary to immediately protect the health, safety, or welfare of
veterans and the health care provider is under investigation by the
medical licensing board of a State in which the health care provider is
licensed or practices.
(c) Suspension.--The Secretary shall suspend the eligibility of a
health care provider to provide non-Department health care services to
veterans if the health care provider is suspended from serving as a
health care provider of the Department.
(d) Comptroller General Report.--Not later than 2 years after the
date of the enactment of this Act, the Comptroller General of the
United States shall submit to Congress a report on the implementation
by the Secretary of this section, including the following:
(1) The aggregate number of health care providers denied or
suspended under this section from participation in providing non-
Department health care services.
(2) An evaluation of any impact on access to health care for
patients or staffing shortages in programs of the Department
providing non-Department health care services.
(3) An explanation of the coordination of the Department with
the medical licensing boards of States in implementing this
section, the amount of involvement of such boards in such
implementation, and efforts by the Department to address any
concerns raised by such boards with respect to such implementation.
(4) Such recommendations as the Comptroller General considers
appropriate regarding harmonizing eligibility criteria between
health care providers of the Department and health care providers
eligible to provide non-Department health care services.
(e) Non-Department Health Care Services Defined.--In this section,
the term ``non-Department health care services'' means services--
(1) provided under subchapter I of chapter 17 of title 38,
United States Code, at non-Department facilities (as defined in
section 1701 of such title);
(2) provided under section 101 of the Veterans Access, Choice,
and Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 1701
note);
(3) purchased through the Medical Community Care account of the
Department; or
(4) purchased with amounts deposited in the Veterans Choice
Fund under section 802 of the Veterans Access, Choice, and
Accountability Act of 2014.

3091324b86fc9fb41e8950a1c21c6170a2d0f05969200be052a9b18741e557a5

(a) In General.--Subchapter I of chapter 17 is amended by inserting
after section 1706 the following new section:
``Sec. 1706A. Remediation of medical service lines
``(a) In General.--Not later than 30 days after determining under
section 1703(e)(1) that a medical service line of the Department is
providing hospital care, medical services, or extended care services
that does not comply with the standards for quality established by the
Secretary, the Secretary shall submit to Congress an assessment of the
factors that led the Secretary to make such determination and a plan
with specific actions, and the time to complete them, to be taken to
comply with such standards for quality, including the following:
``(1) Increasing personnel or temporary personnel assistance,
including mobile deployment teams.
``(2) Special hiring incentives, including the Education Debt
Reduction Program under subchapter VII of chapter 76 of this title
and recruitment, relocation, and retention incentives.
``(3) Utilizing direct hiring authority.
``(4) Providing improved training opportunities for staff.
``(5) Acquiring improved equipment.
``(6) Making structural modifications to the facility used by
the medical service line.
``(7) Such other actions as the Secretary considers
appropriate.
``(b) Responsible Parties.--In each assessment submitted under
subsection (a) with respect to a medical service line, the Secretary
shall identify the individuals at the Central Office of the Veterans
Health Administration, the facility used by the medical service line,
and the central office of the relevant Veterans Integrated Service
Network who are responsible for overseeing the progress of that medical
service line in complying with the standards for quality established by
the Secretary.
``(c) Interim Reports.--Not later than 180 days after submitting an
assessment under subsection (a) with respect to a medical service line,
the Secretary shall submit to Congress a report on the progress of that
medical service line in complying with the standards for quality
established by the Secretary and any other measures the Secretary will
take to assist the medical service line in complying with such
standards for quality.
``(d) Annual Reports.--Not less frequently than once each year, the
Secretary shall--
``(1) submit to Congress an analysis of the remediation actions
and costs of such actions taken with respect to each medical
service line with respect to which the Secretary submitted an
assessment and plan under paragraph (1) in the preceding year,
including an update on the progress of each such medical service
line in complying with the standards for quality and timeliness
established by the Secretary and any other actions the Secretary is
undertaking to assist the medical service line in complying with
standards for quality as established by the Secretary; and
``(2) publish such analysis on the internet website of the
Department.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item relating to section
1706 the following new item:
``1706A. Remediation of medical service lines.''.
CHAPTER 2--PAYING PROVIDERS AND IMPROVING COLLECTIONS

b4a2dcdac26cf9dfc4d5f3ac7550bd2b5e8f7924676629c0ac18990e01e5e030

(a) In General.--Subchapter I of chapter 17 is amended by inserting
after section 1703C, as added by section 104 of this title, the
following new section:
``Sec. 1703D. Prompt payment standard
``(a) In General.--(1) Notwithstanding any other provision of this
title or of any other provision of law, the Secretary shall pay for
hospital care, medical services, or extended care services furnished by
health care entities or providers under this chapter within 45 calendar
days upon receipt of a clean paper claim or 30 calendar days upon
receipt of a clean electronic claim.
``(2) If a claim is denied, the Secretary shall, within 45 calendar
days of denial for a paper claim and 30 calendar days of denial for an
electronic claim, notify the health care entity or provider of the
reason for denying the claim and what, if any, additional information
is required to process the claim.
``(3) Upon the receipt of the additional information, the Secretary
shall ensure that the claim is paid, denied, or otherwise adjudicated
within 30 calendar days from the receipt of the requested information.
``(4) This section shall only apply to payments made on an invoice
basis and shall not apply to capitation or other forms of periodic
payment to entities or providers.
``(b) Submittal of Claims by Health Care Entities and Providers.--A
health care entity or provider that furnishes hospital care, a medical
service, or an extended care service under this chapter shall submit to
the Secretary a claim for payment for furnishing the hospital care,
medical service, or extended care service not later than 180 days after
the date on which the entity or provider furnished the hospital care,
medical service, or extended care service.
``(c) Fraudulent Claims.--(1) Sections 3729 through 3733 of title
31 shall apply to fraudulent claims for payment submitted to the
Secretary by a health care entity or provider under this chapter.
``(2) Pursuant to regulations prescribed by the Secretary, the
Secretary shall bar a health care entity or provider from furnishing
hospital care, medical services, and extended care services under this
chapter when the Secretary determines the entity or provider has
submitted to the Secretary fraudulent health care claims for payment by
the Secretary.
``(d) Overdue Claims.--(1) Any claim that has not been denied with
notice, made pending with notice, or paid to the health care entity or
provider by the Secretary shall be overdue if the notice or payment is
not received by the entity provider within the time periods specified
in subsection (a).
``(2)(A) If a claim is overdue under this subsection, the Secretary
may, under the requirements established by subsection (a) and
consistent with the provisions of chapter 39 of title 31 (commonly
referred to as the `Prompt Payment Act'), require that interest be paid
on clean claims.
``(B) Interest paid under subparagraph (A) shall be computed at the
rate of interest established by the Secretary of the Treasury under
section 3902 of title 31 and published in the Federal Register.
``(3) Not less frequently than annually, the Secretary shall submit
to Congress a report on payment of overdue claims under this
subsection, disaggregated by paper and electronic claims, that includes
the following:
``(A) The amount paid in overdue claims described in this
subsection, disaggregated by the amount of the overdue claim and
the amount of interest paid on such overdue claim.
``(B) The number of such overdue claims and the average number
of days late each claim was paid, disaggregated by facility of the
Department and Veterans Integrated Service Network region.
``(e) Overpayment.--(1) The Secretary shall deduct the amount of
any overpayment from payments due a health care entity or provider
under this chapter.
``(2) Deductions may not be made under this subsection unless the
Secretary has made reasonable efforts to notify a health care entity or
provider of the right to dispute the existence or amount of such
indebtedness and the right to request a compromise of such
indebtedness.
``(3) The Secretary shall make a determination with respect to any
such dispute or request prior to deducting any overpayment unless the
time required to make such a determination before making any deductions
would jeopardize the Secretary's ability to recover the full amount of
such indebtedness.
``(f) Information and Documentation Required.--(1) The Secretary
shall provide to all health care entities and providers participating
in a program to furnish hospital care, medical services, or extended
care services under this chapter a list of information and
documentation that is required to establish a clean claim under this
section.
``(2) The Secretary shall consult with entities in the health care
industry, in the public and private sector, to determine the
information and documentation to include in the list under paragraph
(1).
``(3) If the Secretary modifies the information and documentation
included in the list under paragraph (1), the Secretary shall notify
all health care entities and providers described in paragraph (1) not
later than 30 days before such modifications take effect.
``(g) Processing of Claims.--(1) In processing a claim for
compensation for hospital care, medical services, or extended care
services furnished by a non-Department health care entity or provider
under this chapter, the Secretary may act through--
``(A) a non-Department entity that is under contract or
agreement for the program established under section 1703(a) of this
title; or
``(B) a non-Department entity that specializes in such
processing for other Federal agency health care systems.
``(2) The Secretary shall seek to contract with a third party to
conduct a review of claims described in paragraph (3) that includes--
``(A) a feasibility assessment to determine the capacity of the
Department to process such claims in a timely manner; and
``(B) a cost benefit analysis comparing the capacity of the
Department to a third party entity capable of processing such
claims.
``(3) The review required under paragraph (2) shall apply to claims
for hospital care, medical services, or extended care services
furnished under section 1703 of this Act, as amended by the Caring for
Our Veterans Act of 2018, that are processed by the Department.
``(h) Report on Encounter Data System.--(1) Not later than 90 days
after the date of the enactment of the Caring for Our Veterans Act of
2018, the Secretary shall submit to the appropriate committees of
Congress a report on the feasibility and advisability of adopting a
funding mechanism similar to what is utilized by other Federal agencies
to allow a contracted entity to act as a fiscal intermediary for the
Federal Government to distribute, or pass through, Federal Government
funds for certain non-underwritten hospital care, medical services, or
extended care services.
``(2) The Secretary may coordinate with the Department of Defense,
the Department of Health and Human Services, and the Department of the
Treasury in developing the report required by paragraph (1).
``(i) Definitions.--In this section:
``(1) The term `appropriate committees of Congress' means--
``(A) the Committee on Veterans' Affairs and the Committee
on Appropriations of the Senate; and
``(B) the Committee on Veterans' Affairs and the Committee
on Appropriations of the House of Representatives.
``(2) The term `clean electronic claim' means the transmission
of data for purposes of payment of covered health care expenses
that is submitted to the Secretary which contains substantially all
of the required data elements necessary for accurate adjudication,
without obtaining additional information from the entity or
provider that furnished the care or service, submitted in such
format as prescribed by the Secretary in regulations for the
purpose of paying claims for care or services.
``(3) The term `clean paper claim' means a paper claim for
payment of covered health care expenses that is submitted to the
Secretary which contains substantially all of the required data
elements necessary for accurate adjudication, without obtaining
additional information from the entity or provider that furnished
the care or service, submitted in such format as prescribed by the
Secretary in regulations for the purpose of paying claims for care
or services.
``(4) The term `fraudulent claims' means the knowing
misrepresentation of a material fact or facts by a health care
entity or provider made to induce the Secretary to pay a claim that
was not legally payable to that provider.
``(5) The term `health care entity or provider' includes any
non-Department health care entity or provider, but does not include
any Federal health care entity or provider.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item relating to section
1703C, as added by section 104 of this title, the following new item:
``1703D. Prompt payment standard.''.

bfbc85e26e7b1b4468f890c94f27d0085582d04bbdcdb37f64b253e9b6ffee07

AGREEMENT.
(a) In General.--Subchapter IV of chapter 81 is amended by adding
at the end the following new section:
``Sec. 8159. Authority to pay for services authorized but not subject
to an agreement
``(a) In General.--If, in the course of furnishing hospital care, a
medical service, or an extended care service authorized by the
Secretary and pursuant to a contract, agreement, or other arrangement
with the Secretary, a provider who is not a party to the contract,
agreement, or other arrangement furnishes hospital care, a medical
service, or an extended care service that the Secretary considers
necessary, the Secretary may compensate the provider for the cost of
such care or service.
``(b) New Contracts and Agreements.--The Secretary shall take
reasonable efforts to enter into a contract, agreement, or other
arrangement with a provider described in subsection (a) to ensure that
future care and services authorized by the Secretary and furnished by
the provider are subject to such a contract, agreement, or other
arrangement.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item relating to section
8158 the following new item:
``8159. Authority to pay for services authorized but not subject to an
agreement.''.

3d2661228e48e291cd9bb9113af099e82e99b6f328b7fdf932adef66460867d0

FURNISHED FOR NON-SERVICE-CONNECTED DISABILITIES.
(a) Broadening Scope of Applicability.--Section 1729 is amended--
(1) in subsection (a)--
(A) in paragraph (2)(A)--
(i) by striking ``the veteran's'' and inserting ``the
individual's''; and
(ii) by striking ``the veteran'' and inserting ``the
individual''; and
(B) in paragraph (3)--
(i) in the matter preceding subparagraph (A), by
striking ``the veteran'' and inserting ``the individual'';
and
(ii) in subparagraph (A), by striking ``the veteran's''
and inserting ``the individual's'';
(2) in subsection (b)--
(A) in paragraph (1)--
(i) by striking ``the veteran'' and inserting ``the
individual''; and
(ii) by striking ``the veteran's'' and inserting ``the
individual's''; and
(B) in paragraph (2)--
(i) in subparagraph (A)--
(I) by striking ``the veteran'' and inserting ``the
individual''; and
(II) by striking ``the veteran's'' and inserting
``the individual's''; and
(ii) in subparagraph (B)--
(I) in clause (i), by striking ``the veteran'' and
inserting ``the individual''; and
(II) in clause (ii)--
(aa) by striking ``the veteran'' and inserting
``the individual''; and
(bb) by striking ``the veteran's'' each place
it appears and inserting ``the individual's'';
(3) in subsection (e), by striking ``A veteran'' and inserting
``An individual''; and
(4) in subsection (h)--
(A) in paragraph (1)--
(i) in the matter preceding subparagraph (A), by
striking ``a veteran'' and inserting ``an individual'';
(ii) in subparagraph (A), by striking ``the veteran''
and inserting ``the individual''; and
(iii) in subparagraph (B), by striking ``the veteran''
and inserting ``the individual''; and
(B) in paragraph (2)--
(i) by striking ``A veteran'' and inserting ``An
individual'';
(ii) by striking ``a veteran'' and inserting ``an
individual''; and
(iii) by striking ``the veteran'' and inserting ``the
individual''.
(b) Modification of Authority.--Subsection (a)(1) of such section
is amended by striking ``(1) Subject'' and all that follows through the
period and inserting the following: ``(1) Subject to the provisions of
this section, in any case in which the United States is required by law
to furnish or pay for care or services under this chapter for a non-
service-connected disability described in paragraph (2) of this
subsection, the United States has the right to recover or collect from
a third party the reasonable charges of care or services so furnished
or paid for to the extent that the recipient or provider of the care or
services would be eligible to receive payment for such care or services
from such third party if the care or services had not been furnished or
paid for by a department or agency of the United States.''.
(c) Modification of Eligible Individuals.--Subparagraph (D) of
subsection (a)(2) of such section is amended to read as follows:
``(D) that is incurred by an individual who is entitled to care
(or payment of the expenses of care) under a health-plan
contract.''.

f879c027ca6c19112e998e99be675283f0a14ecd388b2d458a8bb2e7aeb74601

INTERFACE.
The Secretary of Veterans Affairs may enter into an agreement with
a third-party entity to process, through the use of an electronic
interface, claims for reimbursement for health care provided under the
laws administered by the Secretary.
CHAPTER 3--EDUCATION AND TRAINING PROGRAMS

bfb7ef82bac190a3d1557a51be2f19d3d1ee074a3b6d9c786b755944c0d8068e

(a) In General.--The Secretary of Veterans Affairs shall develop
and administer an education program that teaches veterans about their
health care options through the Department of Veterans Affairs.
(b) Elements.--The program under subsection (a) shall--
(1) teach veterans about--
(A) eligibility criteria for care from the Department set
forth under sections 1703, as amended by section 101 of this
title, and 1710 of title 38, United States Code;
(B) priority groups for enrollment in the system of annual
patient enrollment under section 1705(a) of such title;
(C) the copayments and other financial obligations, if any,
required of certain individuals for certain services; and
(D) how to utilize the access standards and standards for
quality established under sections 1703B and 1703C of such
title;
(2) teach veterans about the interaction between health
insurance (including private insurance, Medicare, Medicaid, the
TRICARE program, the Indian Health Service, tribal health programs,
and other forms of insurance) and health care from the Department;
and
(3) provide veterans with information on what to do when they
have a complaint about health care received from the Department
(whether about the provider, the Department, or any other type of
complaint).
(c) Accessibility.--In developing the education program under this
section, the Secretary shall ensure that materials under such program
are accessible--
(1) to veterans who may not have access to the internet; and
(2) to veterans in a manner that complies with the Americans
with Disabilities Act of 1990 (42 U.S.C. 12101 et seq.).
(d) Annual Evaluation and Report.--
(1) Evaluation.--The Secretary shall develop a method to
evaluate the effectiveness of the education program under this
section and evaluate the program using the method not less
frequently than once each year.
(2) Report.--Not less frequently than once each year, the
Secretary shall submit to Congress a report on the findings of the
Secretary with respect to the most recent evaluation conducted by
the Secretary under paragraph (1).
(e) Definitions.--In this section:
(1) Medicaid.--The term ``Medicaid'' means the Medicaid program
under title XIX of the Social Security Act (42 U.S.C. 1396 et
seq.).
(2) Medicare.--The term ``Medicare'' means the Medicare program
under title XVIII of such Act (42 U.S.C. 1395 et seq.).
(3) Tricare program.--The term ``TRICARE program'' has the
meaning given that term in section 1072 of title 10, United States
Code.

e36b8921aa2e22ceb25f907869efd45bd59c0f69969c47084f6a0f1112350eeb

VETERANS AFFAIRS HEALTH CARE.
(a) Establishment of Program.--The Secretary of Veterans Affairs
shall develop and implement a training program to train employees and
contractors of the Department of Veterans Affairs on how to administer
non-Department health care programs, including the following:
(1) Reimbursement for non-Department emergency room care.
(2) The Veterans Community Care Program under section 1703 of
such title, as amended by section 101.
(3) Management of prescriptions pursuant to improvements under
section 131.
(b) Annual Evaluation and Report.--The Secretary shall--
(1) develop a method to evaluate the effectiveness of the
training program developed and implemented under subsection (a);
(2) evaluate such program not less frequently than once each
year; and
(3) not less frequently than once each year, submit to Congress
the findings of the Secretary with respect to the most recent
evaluation carried out under paragraph (2).

c004298b7ed4b084fe291819564d2e9e2c82216dad94c6513bd48b0b5f588fc9

PROFESSIONALS.
(a) Establishment of Program.--
(1) In general.--The Secretary of Veterans Affairs shall
establish a program to provide continuing medical education
material to non-Department medical professionals.
(2) Education provided.--The program established under
paragraph (1) shall include education on the following:
(A) Identifying and treating common mental and physical
conditions of veterans and family members of veterans.
(B) The health care system of the Department of Veterans
Affairs.
(C) Such other matters as the Secretary considers
appropriate.
(b) Material Provided.--The continuing medical education material
provided to non-Department medical professionals under the program
established under subsection (a) shall be the same material provided to
medical professionals of the Department to ensure that all medical
professionals treating veterans have access to the same materials,
which supports core competencies throughout the community.
(c) Administration of Program.--
(1) In general.--The Secretary shall administer the program
established under subsection (a) to participating non-Department
medical professionals through an internet website of the Department
of Veterans Affairs.
(2) Curriculum and credit provided.--The Secretary shall
determine the curriculum of the program and the number of hours of
credit to provide to participating non-Department medical
professionals for continuing medical education.
(3) Accreditation.--The Secretary shall ensure that the program
is accredited in as many States as practicable.
(4) Consistency with existing rules.--The Secretary shall
ensure that the program is consistent with the rules and
regulations of the following:
(A) The medical licensing agency of each State in which the
program is accredited.
(B) Such medical credentialing organizations as the
Secretary considers appropriate.
(5) User cost.--The Secretary shall carry out the program at no
cost to participating non-Department medical professionals.
(6) Monitoring, evaluation, and report.--The Secretary shall
monitor the utilization of the program established under subsection
(a), evaluate its effectiveness, and report to Congress on
utilization and effectiveness not less frequently than once each
year.
(d) Non-Department Medical Professional Defined.--In this section,
the term ``non-Department medical professional'' means any individual
who is licensed by an appropriate medical authority in the United
States and is in good standing, is not an employee of the Department of
Veterans Affairs, and provides care to veterans or family members of
veterans under the laws administered by the Secretary of Veterans
Affairs.
CHAPTER 4--OTHER MATTERS RELATING TO NON-DEPARTMENT OF VETERANS AFFAIRS
PROVIDERS

a24438dd97e4bc89b321ee93e9eb5fdfc637a23f706e5b5f7721494631eb623d

PRESCRIBING PRACTICES BY NON-DEPARTMENT OF VETERANS AFFAIRS
HEALTH CARE PROVIDERS.
(a) Receipt and Review of Guidelines.--The Secretary of Veterans
Affairs shall ensure that all covered health care providers are
provided a copy of and certify that they have reviewed the evidence-
based guidelines for prescribing opioids set forth by the Opioid Safety
Initiative of the Department of Veterans Affairs.
(b) Inclusion of Medical History and Current Medications.--The
Secretary shall implement a process to ensure that, if care of a
veteran by a covered health care provider is authorized under the laws
administered by the Secretary, the document authorizing such care
includes the available and relevant medical history of the veteran and
a list of all medications prescribed to the veteran as known by the
Department.
(c) Submittal of Medical Records and Prescriptions.--
(1) In general.--The Secretary shall, consistent with section
1703(a)(2)(A), as amended by section 101 of this title, and section
1703A(e)(2)(F), as added by section 102 of this title, require each
covered health care provider to submit medical records of any care
or services furnished, including records of any prescriptions for
opioids, to the Department in the timeframe and format specified by
the Secretary.
(2) Responsibility of department for recording and
monitoring.--In carrying out paragraph (1) and upon the receipt by
the Department of the medical records described in paragraph (1),
the Secretary shall--
(A) ensure the Department is responsible for the recording
of the prescription in the electronic health record of the
veteran; and
(B) enable other monitoring of the prescription as outlined
in the Opioid Safety Initiative of the Department.
(3) Report.--Not less frequently than annually, the Secretary
shall submit to the Committee on Veterans' Affairs of the Senate
and the Committee on Veterans' Affairs of the House of
Representatives a report evaluating the compliance of covered
health care providers with the requirements under this section.
(d) Use of Opioid Safety Initiative Guidelines.--
(1) In general.--If the Secretary determines that the opioid
prescribing practices of a covered health care provider, when
treating covered veterans, satisfy a condition described in
paragraph (3), the Secretary shall take such action as the
Secretary considers appropriate to ensure the safety of all
veterans receiving care from that health care provider, including
removing or directing the removal of any such health care provider
from provider networks or otherwise refusing to authorize care of
veterans by such health care provider in any program authorized
under the laws administered by the Secretary.
(2) Inclusion in contracts.--The Secretary shall ensure that
any contracts, agreements, or other arrangements entered into by
the Secretary with third parties involved in administering programs
that provide care in the community to veterans under the laws
administered by the Secretary specifically grant the authority set
forth in paragraph (1) to such third parties and to the Secretary,
as the case may be.
(3) Conditions for exclusion or limitation.--The Secretary
shall take such action as is considered appropriate under paragraph
(1) when the opioid prescribing practices of a covered health care
provider when treating covered veterans--
(A) conflict with or are otherwise inconsistent with the
standards of appropriate and safe care;
(B) violate the requirements of a medical license of the
health care provider; or
(C) may place at risk the veterans receiving health care
from the provider.
(e) Covered Health Care Provider Defined.--In this section, the
term ``covered health care provider'' means a non-Department of
Veterans Affairs health care provider who provides health care to
veterans under the laws administered by the Secretary of Veterans
Affairs, but does not include a health care provider employed by
another agency of the Federal Government.

80407e391c68d34fb9f7423e8377dcebe555cb18803d9cc81239232c6d866706

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

a613918c40b388d6e02a68fda2cfcbf0201d1c9a3dab1b38a851969cde3f5853

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

9cd9198a4e2f7f6466876ee0cddc153415dc1f8d7492f737bc71e32b644f9e5d

NETWORK OF STATE-BASED PRESCRIPTION DRUG MONITORING PROGRAMS.
(a) In General.--Chapter 17 is amended by inserting after section
1730A the following new section:
``Sec. 1730B. Access to State prescription drug monitoring programs
``(a) Access to Programs.--(1) Any licensed health care provider or
delegate of such a provider shall be considered an authorized recipient
or user for the purpose of querying and receiving data from the
national network of State-based prescription drug monitoring programs
to support the safe and effective prescribing of controlled substances
to covered patients.
``(2) Under the authority granted by paragraph (1)--
``(A) licensed health care providers or delegates of such
providers shall query such network in accordance with applicable
regulations and policies of the Veterans Health Administration; and
``(B) notwithstanding any general or specific provision of law,
rule, or regulation of a State, no State may restrict the access of
licensed health care providers or delegates of such providers from
accessing that State's prescription drug monitoring programs.
``(3) No State shall deny or revoke the license, registration, or
certification of a licensed health care provider or delegate who
otherwise meets that State's qualifications for holding the license,
registration, or certification on the basis that the licensed health
care provider or delegate queried or received data, or attempted to
query or receive data, from the national network of State-based
prescription drug monitoring programs under this section.
``(b) Covered Patients.--For purposes of this section, a covered
patient is a patient who--
``(1) receives a prescription for a controlled substance; and
``(2) is not receiving palliative care or enrolled in hospice
care.
``(c) Definitions.--In this section:
``(1) The term `controlled substance' has the meaning given
such term in section 102(6) of the Controlled Substances Act (21
U.S.C. 802(6)).
``(2) The term `delegate' means a person or automated system
accessing the national network of State-based prescription
monitoring programs at the direction or under the supervision of a
licensed health care provider.
``(3) The term `licensed health care provider' means a health
care provider employed by the Department who is licensed,
certified, or registered within any State to fill or prescribe
medications within the scope of his or her practice as a Department
employee.
``(4) The term `national network of State-based prescription
monitoring programs' means an interconnected nation-wide system
that facilitates the transfer to State prescription drug monitoring
program data across State lines.
``(5) The term `State' means a State, as defined in section
101(20) of this title, or a political subdivision of a State.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 17 of such title is amended by inserting after the item
relating to section 1730A the following new item:
``1730B. Access to State prescription drug monitoring programs.''.
CHAPTER 5--OTHER NON-DEPARTMENT HEALTH CARE MATTERS

b6406efb01ce729774401b0831574546f79bc4be854d81501b46d1ba9c5d7c82

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

ff5da315676bb7fde552c34ff799870ffc7e1002a41520f3eb69e61801586f00

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

46e5663c8b6454718024fc5855e2e5d051c20750d54d27b7a5d2608480e9ba44

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

14da093884c73b350060070adfe937590236884584791ccd50df4962e22b326a

(a) In General.--
(1) Title 38.--Title 38, United States Code, is amended--
(A) in section 1712(a)--
(i) in paragraph (3), by striking ``under clause (1),
(2), or (5) of section 1703(a) of this title'' and
inserting ``or entered an agreement''; and
(ii) in paragraph (4)(A), by striking ``under the
provisions of this subsection and section 1703 of this
title'';
(B) in section 1712A(e)(1)--
(i) by inserting ``or agreements'' after ``contracts'';
and
(ii) by striking ``(under sections 1703(a)(2) and
1710(a)(1)(B) of this title)''; and
(C) in section 2303(a)(2)(B)(i), by striking ``with section
1703'' and inserting ``with sections 1703A, 8111, and 8153''.
(2) Social security act.--Section 1866(a)(1)(L) of the Social
Security Act (42 U.S.C. 1395cc(a)(1)(L)) is amended by striking
``under section 603'' and inserting ``under chapter 17''.
(3) Veterans' benefits improvements act of 1994.--Section
104(a)(4)(A) of the Veterans' Benefits Improvements Act of 1994
(Public Law 103-446; 38 U.S.C. 1117 note) is amended by striking
``in section 1703'' and inserting ``in sections 1703A, 8111, and
8153''.
(b) Effective Date.--The amendments made by subsection (a) shall
take effect on the date described in section 101(b).
Subtitle B--Improving Department of Veterans Affairs Health Care
Delivery

4c5a05005b4e58c9942e5bbcfd4482ee4b3f005a971a66dd91a62b47e328527a

OF VETERANS AFFAIRS PROVIDING TREATMENT VIA TELEMEDICINE.
(a) In General.--Chapter 17 is amended by inserting after section
1730B, as added by section 134, the following new section:
``Sec. 1730C. Licensure of health care professionals providing
treatment via telemedicine
``(a) In General.--Notwithstanding any provision of law regarding
the licensure of health care professionals, a covered health care
professional may practice the health care profession of the health care
professional at any location in any State, regardless of where the
covered health care professional or the patient is located, if the
covered health care professional is using telemedicine to provide
treatment to an individual under this chapter.
``(b) Covered Health Care Professionals.--For purposes of this
section, a covered health care professional is any health care
professional who--
``(1) is an employee of the Department appointed under the
authority under section 7306, 7401, 7405, 7406, or 7408 of this
title or title 5;
``(2) is authorized by the Secretary to provide health care
under this chapter;
``(3) is required to adhere to all standards for quality
relating to the provision of medicine in accordance with applicable
policies of the Department; and
``(4) has an active, current, full, and unrestricted license,
registration, or certification in a State to practice the health
care profession of the health care professional.
``(c) Property of Federal Government.--Subsection (a) shall apply
to a covered health care professional providing treatment to a patient
regardless of whether the covered health care professional or patient
is located in a facility owned by the Federal Government during such
treatment.
``(d) Relation to State Law.--(1) The provisions of this section
shall supersede any provisions of the law of any State to the extent
that such provision of State law are inconsistent with this section.
``(2) No State shall deny or revoke the license, registration, or
certification of a covered health care professional who otherwise meets
the qualifications of the State for holding the license, registration,
or certification on the basis that the covered health care professional
has engaged or intends to engage in activity covered by subsection (a).
``(e) Rule of Construction.--Nothing in this section may be
construed to remove, limit, or otherwise affect any obligation of a
covered health care professional under the Controlled Substances Act
(21 U.S.C. 801 et seq.).
``(f) State Defined.--In this section, the term `State' means a
State, as defined in section 101(20) of this title, or a political
subdivision of a State.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 17 of such title is amended by inserting after the item
relating to section 1730B, as added by section 134, the following new
item:
``1730C. Licensure of health care professionals providing treatment via
telemedicine.''.
(c) Report on Telemedicine.--
(1) In general.--Not later than 1 year after the earlier of the
date on which services provided under section 1730B of title 38,
United States Code, as added by subsection (a), first occur or
regulations are promulgated to carry out such section, the
Secretary of Veterans Affairs shall submit to the Committee on
Veterans' Affairs of the Senate and the Committee on Veterans'
Affairs of the House of Representatives a report on the
effectiveness of the use of telemedicine by the Department of
Veterans Affairs.
(2) Elements.--The report required by paragraph (1) shall
include an assessment of the following:
(A) The satisfaction of veterans with telemedicine
furnished by the Department.
(B) The satisfaction of health care providers in providing
telemedicine furnished by the Department.
(C) The effect of telemedicine furnished by the Department
on the following:
(i) The ability of veterans to access health care,
whether from the Department or from non-Department health
care providers.
(ii) The frequency of use by veterans of telemedicine.
(iii) The productivity of health care providers.
(iv) Wait times for an appointment for the receipt of
health care from the Department.
(v) The use by veterans of in-person services at
Department facilities and non-Department facilities.
(D) The types of appointments for the receipt of
telemedicine furnished by the Department that were provided
during the 1-year period preceding the submittal of the report.
(E) The number of appointments for the receipt of
telemedicine furnished by the Department that were requested
during such period, disaggregated by medical facility.
(F) Savings by the Department, if any, including travel
costs, from furnishing health care through the use of
telemedicine during such period.

fc3795b1fefccd31382c7d0f6659ff0d23c95c9a400152181b20b52bbbf7f5cf

INNOVATION FOR CARE AND PAYMENT.
(a) In General.--Subchapter I of chapter 17, as amended by this
title, is further amended by inserting after section 1703D, as added by
section 111, the following new section:
``Sec. 1703E. Center for Innovation for Care and Payment
``(a) In General.--(1) There is established within the Department a
Center for Innovation for Care and Payment (in this section referred to
as the `Center').
``(2) The Secretary, acting through the Center, may carry out such
pilot programs the Secretary determines to be appropriate to develop
innovative approaches to testing payment and service delivery models in
order to reduce expenditures while preserving or enhancing the quality
of care furnished by the Department.
``(3) The Secretary, acting through the Center, shall test payment
and service delivery models to determine whether such models--
``(A) improve access to, and quality, timeliness, and patient
satisfaction of care and services; and
``(B) create cost savings for the Department.
``(4)(A) The Secretary shall test a model in a location where the
Secretary determines that the model will addresses deficits in care
(including poor clinical outcomes or potentially avoidable
expenditures) for a defined population.
``(B) The Secretary shall focus on models the Secretary expects to
reduce program costs while preserving or enhancing the quality of care
received by individuals receiving benefits under this chapter.
``(C) The models selected may include those described in section
1115A(b)(2)(B) of the Social Security Act (42 U.S.C. 1315a(b)(2)(B)).
``(5) In selecting a model for testing, the Secretary may consider,
in addition to other factors identified in this subsection, the
following factors:
``(A) Whether the model includes a regular process for
monitoring and updating patient care plans in a manner that is
consistent with the needs and preferences of individuals receiving
benefits under this chapter.
``(B) Whether the model places the individual receiving
benefits under this chapter (including family members and other
caregivers of such individual) at the center of the care team of
such individual.
``(C) Whether the model uses technology or new systems to
coordinate care over time and across settings.
``(D) Whether the model demonstrates effective linkage with
other public sector payers, private sector payers, or statewide
payment models.
``(6)(A) Models tested under this section may not be designed in
such a way that would allow the United States to recover or collect
reasonable charges from a Federal health care program for care or
services furnished by the Secretary to a veteran under pilot programs
carried out under this section.
``(B) In this paragraph, the term `Federal health care program'
means--
``(i) an insurance program described in section 1811 of the
Social Security Act (42 U.S.C. 1395c) or established by section
1831 of such Act (42 U.S.C. 1395j);
``(ii) a State plan for medical assistance approved under title
XIX of such Act (42 U.S.C. 1396 et seq.); or
``(iii) a TRICARE program operated under sections 1075, 1075a,
1076, 1076a, 1076c, 1076d, 1076e, or 1076f of title 10.
``(b) Duration.--Each pilot program carried out by the Secretary
under this section shall terminate no later than 5 years after the date
of the commencement of the pilot program.
``(c) Location.--The Secretary shall ensure that each pilot program
carried out under this section occurs in an area or areas appropriate
for the intended purposes of the pilot program. To the extent
practicable, the Secretary shall ensure that the pilot programs are
located in geographically diverse areas of the United States.
``(d) Budget.--Funding for each pilot program carried out by the
Secretary under this section shall come from appropriations--
``(1) provided in advance in appropriations acts for the
Veterans Health Administration; and
``(2) provided for information technology systems.
``(e) Notice.--The Secretary shall--
``(1) publish information about each pilot program under this
section in the Federal Register; and
``(2) take reasonable actions to provide direct notice to
veterans eligible to participate in such pilot programs.
``(f) Waiver of Authorities.--(1) Subject to reporting under
paragraph (2) and approval under paragraph (3), in implementing a pilot
program under this section, the Secretary may waive such requirements
in subchapters I, II, and III of this chapter as the Secretary
determines necessary solely for the purposes of carrying out this
section with respect to testing models described in subsection (a).
``(2) Before waiving any authority under paragraph (1), the
Secretary shall submit to the Speaker of the House of Representatives,
the minority leader of the House of Representatives, the majority
leader of the Senate, the minority leader of the Senate, and each
standing committee with jurisdiction under the rules of the Senate and
of the House of Representatives to report a bill to amend the provision
or provisions of law that would be waived by the Department, a report
on a request for waiver that describes in detail the following:
``(A) The specific authorities to be waived under the pilot
program.
``(B) The standard or standards to be used in the pilot program
in lieu of the waived authorities.
``(C) The reasons for such waiver or waivers.
``(D) A description of the metric or metrics the Secretary will
use to determine the effect of the waiver or waivers upon the
access to and quality, timeliness, or patient satisfaction of care
and services furnished through the pilot program.
``(E) The anticipated cost savings, if any, of the pilot
program.
``(F) The schedule for interim reports on the pilot program
describing the results of the pilot program so far and the
feasibility and advisability of continuing the pilot program.
``(G) The schedule for the termination of the pilot program and
the submission of a final report on the pilot program describing
the result of the pilot program and the feasibility and
advisability of making the pilot program permanent.
``(H) The estimated budget of the pilot program.
``(3)(A) Upon receipt of a report submitted under paragraph (2),
each House of Congress shall provide copies of the report to the
chairman and ranking member of each standing committee with
jurisdiction under the rules of the House of Representatives or the
Senate to report a bill to amend the provision or provisions of law
that would be waived by the Department under this subsection.
``(B) The waiver requested by the Secretary under paragraph (2)
shall be considered approved under this paragraph if there is enacted
into law a joint resolution approving such request in its entirety.
``(C) For purposes of this paragraph, the term `joint resolution'
means only a joint resolution which is introduced within the period of
five legislative days beginning on the date on which the Secretary
transmits the report to the Congress under such paragraph (2), and--
``(i) which does not have a preamble; and
``(ii) the matter after the resolving clause of which is as
follows: `that Congress approves the request for a waiver under
section 1703E(f) of title 38, United States Code, as submitted by
the Secretary on ___', the blank space being filled with the
appropriate date.
``(D)(i) Any committee of the House of Representatives to which a
joint resolution is referred shall report it to the House without
amendment not later than 15 legislative days after the date of
introduction thereof. If a committee fails to report the joint
resolution within that period, the committee shall be discharged from
further consideration of the joint resolution.
``(ii) It shall be in order at any time after the third legislative
day after each committee authorized to consider a joint resolution has
reported or has been discharged from consideration of a joint
resolution, to move to proceed to consider the joint resolution in the
House. All points of order against the motion are waived. Such a motion
shall not be in order after the House has disposed of a motion to
proceed on a joint resolution addressing a particular submission. The
previous question shall be considered as ordered on the motion to its
adoption without intervening motion. The motion shall not be debatable.
A motion to reconsider the vote by which the motion is disposed of
shall not be in order.
``(iii) The joint resolution shall be considered as read. All
points of order against the joint resolution and against its
consideration are waived. The previous question shall be considered as
ordered on the joint resolution to its passage without intervening
motion except two hours of debate equally divided and controlled by the
proponent and an opponent. A motion to reconsider the vote on passage
of the joint resolution shall not be in order.
``(E)(i) A joint resolution introduced in the Senate shall be
referred to the Committee on Veterans' Affairs.
``(ii) Any committee of the Senate to which a joint resolution is
referred shall report it to the Senate without amendment not later than
15 session days after the date of introduction of a joint resolution
described in paragraph (C). If a committee fails to report the joint
resolution within that period, the committee shall be discharged from
further consideration of the joint resolution and the joint resolution
shall be placed on the calendar.
``(iii)(I) Notwithstanding Rule XXII of the Standing Rules of the
Senate, it is in order at any time after the third session day on which
the Committee on Veterans' Affairs has reported or has been discharged
from consideration of a joint resolution described in paragraph (C)
(even though a previous motion to the same effect has been disagreed
to) to move to proceed to the consideration of the joint resolution,
and all points of order against the joint resolution (and against
consideration of the joint resolution) are waived. The motion to
proceed is not debatable. The motion is not subject to a motion to
postpone. A motion to reconsider the vote by which the motion is agreed
to or disagreed to shall not be in order. If a motion to proceed to the
consideration of the resolution is agreed to, the joint resolution
shall remain the unfinished business until disposed of.
``(II) Consideration of the joint resolution, and on all debatable
motions and appeals in connection therewith, shall be limited to not
more than two hours, which shall be divided equally between the
majority and minority leaders or their designees. A motion further to
limit debate is in order and not debatable. An amendment to, or a
motion to postpone, or a motion to proceed to the consideration of
other business, or a motion to recommit the joint resolution is not in
order.
``(III) If the Senate has voted to proceed to a joint resolution,
the vote on passage of the joint resolution shall occur immediately
following the conclusion of consideration of the joint resolution, and
a single quorum call at the conclusion of the debate if requested in
accordance with the rules of the Senate.
``(IV) Appeals from the decisions of the Chair relating to the
application of the rules of the Senate, as the case may be, to the
procedure relating to a joint resolution shall be decided without
debate.
``(F) A joint resolution considered pursuant to this paragraph
shall not be subject to amendment in either the House of
Representatives or the Senate.
``(G)(i) If, before the passage by one House of the joint
resolution of that House, that House receives the joint resolution from
the other House, then the following procedures shall apply:
``(I) The joint resolution of the other House shall not be
referred to a committee.
``(II) With respect to the joint resolution of the House
receiving the joint resolution--
``(aa) the procedure in that House shall be the same as
if no joint resolution had been received from the other
House; but
``(bb) the vote on passage shall be on the joint
resolution of the other House.
``(ii) If the Senate fails to introduce or consider a joint
resolution under this paragraph, the joint resolution of the House
shall be entitled to expedited floor procedures under this
subparagraph.
``(iii) If, following passage of the joint resolution in the
Senate, the Senate then receives the companion measure from the
House of Representatives, the companion measure shall not be
debatable.
``(H) This subparagraph is enacted by Congress--
``(i) as an exercise of the rulemaking power of the Senate and
House of Representatives, respectively, and as such it is deemed a
part of the rules of each House, respectively, but applicable only
with respect to the procedure to be followed in that House in the
case of a joint resolution, and it supersedes other rules only to
the extent that it is inconsistent with such rules; and
``(ii) with full recognition of the constitutional right of
either House to change the rules (so far as relating to the
procedure of that House) at any time, in the same manner, and to
the same extent as in the case of any other rule of that House.
``(g) Limitations.--(1) The Secretary may not carry out more than
10 pilot programs concurrently.
``(2)(A) Subject to subparagraph (B), the Secretary may not expend
more than $50,000,000 in any fiscal year from amounts under subsection
(d).
``(B) The Secretary may expend more than the amount in subparagraph
(A) if--
``(i) the Secretary determines that the additional expenditure
is necessary to carry out pilot programs under this section;
``(ii) the Secretary submits to the Committees on Veterans'
Affairs of the Senate and the House of Representatives a report
setting forth the amount of the additional expenditure and a
justification for the additional expenditure; and
``(iii) the Chairmen of the Committees on Veterans' Affairs of
the Senate and the House of Representatives transmit to the
Secretary a letter approving of the additional expenditure.
``(3) The waiver provisions in subsection (f) shall not apply
unless the Secretary, in accordance with the requirements in subsection
(f), submits the first proposal for a pilot program not later than 18
months after the date of the enactment of the Caring for Our Veterans
Act of 2018.
``(4) Notwithstanding section 502 of this title, decisions by the
Secretary under this section shall, consistent with section 511 of this
title, be final and conclusive and may not be reviewed by any other
official or by any court, whether by an action in the nature of
mandamus or otherwise.
``(5)(A) If the Secretary determines that a pilot program is not
improving the quality of care or producing cost savings, the Secretary
shall--
``(i) propose a modification to the pilot program in the
interim report that shall also be considered a report under
subsection (f)(2) and shall be subject to the terms and conditions
of subsection (f)(2); or
``(ii) terminate such pilot program not later than 30 days
after submitting the interim report to Congress.
``(B) If the Secretary terminates a pilot program under
subparagraph (A)(ii), for purposes of subparagraphs (F) and (G) of
subsection (f)(2), such interim report will also serve as the final
report for that pilot program.
``(h) Evaluation and Reporting Requirements.--(1) The Secretary
shall conduct an evaluation of each model tested, which shall include,
at a minimum, an analysis of--
``(A) the quality of care furnished under the model, including
the measurement of patient-level outcomes and patient-centeredness
criteria determined appropriate by the Secretary; and
``(B) the changes in spending by reason of that model.
``(2) The Secretary shall make the results of each evaluation under
this subsection available to the public in a timely fashion and may
establish requirements for other entities participating in the testing
of models under this section to collect and report information that the
Secretary determines is necessary to monitor and evaluate such models.
``(i) Coordination and Advice.--(1) The Secretary shall obtain
advice from the Under Secretary for Health and the Special Medical
Advisory Group established pursuant to section 7312 of this title in
the development and implementation of any pilot program operated under
this section.
``(2) In carrying out the duties under this section, the Secretary
shall consult representatives of relevant Federal agencies, and
clinical and analytical experts with expertise in medicine and health
care management. The Secretary shall use appropriate mechanisms to seek
input from interested parties.
``(j) Expansion of Successful Pilot Programs.--Taking into account
the evaluation under subsection (f), the Secretary may, through
rulemaking, expand (including implementation on a nationwide basis) the
duration and the scope of a model that is being tested under subsection
(a) to the extent determined appropriate by the Secretary, if--
``(1) the Secretary determines that such expansion is expected
to--
``(A) reduce spending without reducing the quality of care;
or
``(B) improve the quality of patient care without
increasing spending; and
``(2) the Secretary determines that such expansion would not
deny or limit the coverage or provision of benefits for individuals
receiving benefits under this chapter.''.
(b) Conforming Amendment.--The table of sections at the beginning
of such chapter, as amended by this title, is further amended by
inserting after the item relating to section 1703D the following new
item:
``1703E. Center for Innovation for Care and Payment.''.

0ac367f6f470d461c15e15713e2d3ced2ecb68670d353f3ef7aec0e5dae54934

FOR PURPOSES OF CONDUCTING TRANSPLANT PROCEDURES FOR VETERANS.
(a) In General.--Subchapter VIII of chapter 17 is amended by adding
at the end the following new section:
``Sec. 1788. Transplant procedures with live donors and related
services
``(a) In General.--Subject to subsections (b) and (c), in a case in
which a veteran is eligible for a transplant procedure from the
Department, the Secretary may provide for an operation on a live donor
to carry out such procedure for such veteran, notwithstanding that the
live donor may not be eligible for health care from the Department.
``(b) Other Services.--Subject to the availability of
appropriations for such purpose, the Secretary shall furnish to a live
donor any care or services before and after conducting the transplant
procedure under subsection (a) that may be required in connection with
such procedure.
``(c) Use of Non-Department Facilities.--In carrying out this
section, the Secretary may provide for the operation described in
subsection (a) on a live donor and furnish to the live donor the care
and services described in subsection (b) at a non-Department facility
pursuant to an agreement entered into by the Secretary under this
chapter. The live donor shall be deemed to be an individual eligible
for hospital care and medical services at a non-Department facility
pursuant to such an agreement solely for the purposes of receiving such
operation, care, and services at the non-Department facility.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 17 is amended by inserting after the item relating to section
1787 the following new item:
``1788. Transplant procedures with live donors and related services.''.
Subtitle C--Family Caregivers

52134955636fd000ef8d90cb1aa3934453f53e0c3416f460ac2c10fc3c86f869

VETERANS AFFAIRS.
(a) Family Caregiver Program.--
(1) Expansion of eligibility.--
(A) In general.--Subparagraph (B) of subsection (a)(2) of
section 1720G is amended to read as follows:
``(B) for assistance provided under this subsection--
``(i) before the date on which the Secretary submits to
Congress a certification that the Department has fully
implemented the information technology system required by
section 162(a) of the Caring for Our Veterans Act of 2018, has
a serious injury (including traumatic brain injury,
psychological trauma, or other mental disorder) incurred or
aggravated in the line of duty in the active military, naval,
or air service on or after September 11, 2001;
``(ii) during the 2-year period beginning on the date on
which the Secretary submitted to Congress the certification
described in clause (i), has a serious injury (including
traumatic brain injury, psychological trauma, or other mental
disorder) incurred or aggravated in the line of duty in the
active military, naval, or air service--
``(I) on or before May 7, 1975; or
``(II) on or after September 11, 2001; or
``(iii) after the date that is 2 years after the date on
which the Secretary submits to Congress the certification
described in clause (i), has a serious injury (including
traumatic brain injury, psychological trauma, or other mental
disorder) incurred or aggravated in the line of duty in the
active military, naval, or air service; and''.
(B) Publication in federal register.--Not later than 30
days after the date on which the Secretary of Veterans Affairs
submits to Congress the certification described in subsection
(a)(2)(B)(i) of section 1720G of such title, as amended by
subparagraph (A) of this paragraph, the Secretary shall publish
the date specified in such subsection in the Federal Register.
(2) Expansion of needed services in eligibility criteria.--
Subsection (a)(2)(C) of such section is amended--
(A) in clause (ii), by striking ``; or'' and inserting a
semicolon;
(B) by redesignating clause (iii) as clause (iv); and
(C) by inserting after clause (ii) the following new clause
(iii):
``(iii) a need for regular or extensive instruction or
supervision without which the ability of the veteran to
function in daily life would be seriously impaired; or''.
(3) Expansion of services provided.--Subsection (a)(3)(A)(ii)
of such section is amended--
(A) in subclause (IV), by striking ``; and'' and inserting
a semicolon;
(B) in subclause (V), by striking the period at the end and
inserting ``; and''; and
(C) by adding at the end the following new subclause:
``(VI) through the use of contracts with, or the provision
of grants to, public or private entities--
``(aa) financial planning services relating to the
needs of injured veterans and their caregivers; and
``(bb) legal services, including legal advice and
consultation, relating to the needs of injured veterans and
their caregivers.''.
(4) Modification of stipend calculation.--Subsection (a)(3)(C)
of such section is amended--
(A) by redesignating clause (iii) as clause (iv); and
(B) by inserting after clause (ii) the following new clause
(iii):
``(iii) In determining the amount and degree of personal care
services provided under clause (i) with respect to an eligible veteran
whose need for personal care services is based in whole or in part on a
need for supervision or protection under paragraph (2)(C)(ii) or
regular instruction or supervision under paragraph (2)(C)(iii), the
Secretary shall take into account the following:
``(I) The assessment by the family caregiver of the needs and
limitations of the veteran.
``(II) The extent to which the veteran can function safely and
independently in the absence of such supervision, protection, or
instruction.
``(III) The amount of time required for the family caregiver to
provide such supervision, protection, or instruction to the
veteran.''.
(5) Periodic evaluation of need for certain services.--
Subsection (a)(3) of such section is amended by adding at the end
the following new subparagraph:
``(D) In providing instruction, preparation, and training under
subparagraph (A)(i)(I) and technical support under subparagraph
(A)(i)(II) to each family caregiver who is approved as a provider of
personal care services for an eligible veteran under paragraph (6), the
Secretary shall periodically evaluate the needs of the eligible veteran
and the skills of the family caregiver of such veteran to determine if
additional instruction, preparation, training, or technical support
under those subparagraphs is necessary.''.
(6) Use of primary care teams.--Subsection (a)(5) of such
section is amended, in the matter preceding subparagraph (A), by
inserting ``(in collaboration with the primary care team for the
eligible veteran to the maximum extent practicable)'' after
``evaluate''.
(7) Assistance for family caregivers.--Subsection (a) of such
section is amended by adding at the end the following new
paragraph:
``(11)(A) In providing assistance under this subsection to family
caregivers of eligible veterans, the Secretary may enter into
contracts, provider agreements, and memoranda of understanding with
Federal agencies, States, and private, nonprofit, and other entities to
provide such assistance to such family caregivers.
``(B) The Secretary may provide assistance under this paragraph
only if such assistance is reasonably accessible to the family
caregiver and is substantially equivalent or better in quality to
similar services provided by the Department.
``(C) The Secretary may provide fair compensation to Federal
agencies, States, and other entities that provide assistance under this
paragraph.''.
(b) Modification of Definition of Personal Care Services.--
Subsection (d)(4) of such section is amended--
(1) in subparagraph (A), by striking ``independent'';
(2) by redesignating subparagraph (B) as subparagraph (D); and
(3) by inserting after subparagraph (A) the following new
subparagraphs:
``(B) Supervision or protection based on symptoms or
residuals of neurological or other impairment or injury.
``(C) Regular or extensive instruction or supervision
without which the ability of the veteran to function in daily
life would be seriously impaired.''.

993df91e78fdbaf8806cb49a3e893e91a615c0149aa546190d8b8f5096385420

DEPARTMENT OF VETERANS AFFAIRS TO ASSESS AND IMPROVE THE FAMILY
CAREGIVER PROGRAM.
(a) Implementation of New System.--
(1) In general.--Not later than October 1, 2018, the Secretary
of Veterans Affairs shall implement an information technology
system that fully supports the Program and allows for data
assessment and comprehensive monitoring of the Program.
(2) Elements of system.--The information technology system
required to be implemented under paragraph (1) shall include the
following:
(A) The ability to easily retrieve data that will allow all
aspects of the Program (at the medical center and aggregate
levels) and the workload trends for the Program to be assessed
and comprehensively monitored.
(B) The ability to manage data with respect to a number of
caregivers that is more than the number of caregivers that the
Secretary expects to apply for the Program.
(C) The ability to integrate the system with other relevant
information technology systems of the Veterans Health
Administration.
(b) Assessment of Program.--Not later than 180 days after
implementing the system described in subsection (a), the Secretary
shall, through the Under Secretary for Health, use data from the system
and other relevant data to conduct an assessment of how key aspects of
the Program are structured and carried out.
(c) Ongoing Monitoring of and Modifications to Program.--
(1) Monitoring.--The Secretary shall use the system implemented
under subsection (a) to monitor and assess the workload of the
Program, including monitoring and assessment of data on--
(A) the status of applications, appeals, and home visits in
connection with the Program; and
(B) the use by caregivers participating in the Program of
other support services under the Program such as respite care.
(2) Modifications.--Based on the monitoring and assessment
conducted under paragraph (1), the Secretary shall identify and
implement such modifications to the Program as the Secretary
considers necessary to ensure the Program is functioning as
intended and providing veterans and caregivers participating in the
Program with services in a timely manner.
(d) Reports.--
(1) Initial report.--
(A) In general.--Not later than 90 days after the date of
the enactment of this Act, the Secretary shall submit to the
Committee on Veterans' Affairs of the Senate, the Committee on
Veterans' Affairs of the House of Representatives, and the
Comptroller General of the United States a report that
includes--
(i) the status of the planning, development, and
deployment of the system required to be implemented under
subsection (a), including any changes in the timeline for
the implementation of the system; and
(ii) an assessment of the needs of family caregivers of
veterans described in subparagraph (B), the resources
needed for the inclusion of such family caregivers in the
Program, and such changes to the Program as the Secretary
considers necessary to ensure the successful expansion of
the Program to include such family caregivers.
(B) Veterans described.--Veterans described in this
subparagraph are veterans who are eligible for the Program
under clause (ii) or (iii) of section 1720G(a)(2)(B) of title
38, United States Code, as amended by section 161(a)(1) of this
title, solely due to a serious injury (including traumatic
brain injury, psychological trauma, or other mental disorder)
incurred or aggravated in the line of duty in the active
military, naval, or air service before September 11, 2001.
(2) Notification by comptroller general.--The Comptroller
General shall review the report submitted under paragraph (1) and
notify the Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of Representatives with
respect to the progress of the Secretary in--
(A) fully implementing the system required under subsection
(a); and
(B) implementing a process for using such system to monitor
and assess the Program under subsection (c)(1) and modify the
Program as considered necessary under subsection (c)(2).
(3) Final report.--
(A) In general.--Not later than October 1, 2019, the
Secretary shall submit to the Committee on Veterans' Affairs of
the Senate, the Committee on Veterans' Affairs of the House of
Representatives, and the Comptroller General a report on the
implementation of subsections (a) through (c).
(B) Elements.--The report required by subparagraph (A)
shall include the following:
(i) A certification by the Secretary that the
information technology system described in subsection (a)
has been implemented.
(ii) A description of how the Secretary has implemented
such system.
(iii) A description of the modifications to the
Program, if any, that were identified and implemented under
subsection (c)(2).
(iv) A description of how the Secretary is using such
system to monitor the workload of the Program.
(e) Definitions.--In this section:
(1) Active military, naval, or air service.--The term ``active
military, naval, or air service'' has the meaning given that term
in section 101 of title 38, United States Code.
(2) Program.--The term ``Program'' means the program of
comprehensive assistance for family caregivers under section
1720G(a) of title 38, United States Code, as amended by section 161
of this title.

e29ebd53cf2811cb93625a958fa8889afb2b1a4f94b92f9a379d39bd6f79b0cf

PROGRAM OF DEPARTMENT OF VETERANS AFFAIRS.
(a) Barriers to Care and Services.--Subparagraph (A)(iv) of section
101(c)(2) of the Caregivers and Veterans Omnibus Health Services Act of
2010 (Public Law 111-163; 38 U.S.C. 1720G note) is amended by inserting
``, including a description of any barriers to accessing and receiving
care and services under such programs'' before the semicolon.
(b) Sufficiency of Training for Family Caregiver Program.--
Subparagraph (B) of such section is amended--
(1) in clause (i), by striking ``; and'' and inserting a
semicolon;
(2) in clause (ii), by striking the period at the end and
inserting ``; and''; and
(3) by adding at the end the following new clause:
``(iii) an evaluation of the sufficiency and
consistency of the training provided to family caregivers
under such program in preparing family caregivers to
provide care to veterans under such program.''.
Subtitle A--Asset and Infrastructure Review

59fff6fa6f5a75cf968dcbacc80d49da0d43f12ed44a1c2809a304c29271bd72

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

c9f18ff02b239f6cac1c0ff55f475987ed4fe09a75cff532d991066ff5b43659

(a) Establishment.--There is established an independent commission
to be known as the ``Asset and Infrastructure Review Commission'' (in
this subtitle referred to as the ``Commission'').
(b) Duties.--The Commission shall carry out the duties specified
for it in this subtitle.
(c) Appointment.--
(1) In general.--
(A) Appointment.--The Commission shall be composed of nine
members appointed by the President, by and with the advice and
consent of the Senate.
(B) Transmission of nominations.--The President shall
transmit to the Senate the nominations for appointment to the
Commission not later than May 31, 2021.
(2) Consultation in selection process.--In selecting
individuals for nominations for appointments to the Commission, the
President shall consult with--
(A) the Speaker of the House of Representatives;
(B) the majority leader of the Senate;
(C) the minority leader of the House of Representatives;
(D) the minority leader of the Senate; and
(E) congressionally chartered, membership based veterans
service organizations concerning the appointment of three
members.
(3) Designation of chair.--At the time the President nominates
individuals for appointment to the Commission under paragraph
(1)(B), the President shall designate one such individual who shall
serve as Chair of the Commission and one such individual who shall
serve as Vice Chair of the Commission.
(4) Member representation.--In nominating individuals under
this subsection, the President shall ensure that--
(A) veterans, reflecting current demographics of veterans
enrolled in the system of annual patient enrollment under
section 1705 of title 38, United States Code, are adequately
represented in the membership of the Commission;
(B) at least one member of the Commission has experience
working for a private integrated health care system that has
annual gross revenues of more than $50,000,000;
(C) at least one member has experience as a senior manager
for an entity specified in clause (ii), (iii), or (iv) of
section 101(a)(1)(B) of the Veterans Access, Choice, and
Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 1701
note);
(D) at least one member--
(i) has experience with capital asset management for
the Federal Government; and
(ii) is familiar with trades related to building and
real property, including construction, engineering,
architecture, leasing, and strategic partnerships; and
(E) at least three members represent congressionally
chartered, membership-based, veterans service organizations.
(d) Meetings.--
(1) In general.--The Commission shall meet only during calendar
years 2022 and 2023.
(2) Public nature of meetings and proceedings.--
(A) Public meetings.--Each meeting of the Commission shall
be open to the public.
(B) Open participation.--All the proceedings, information,
and deliberations of the Commission shall be available for
review by the public.
(e) Vacancies.--A vacancy in the Commission shall be filled in the
same manner as the original appointment, but the individual appointed
to fill the vacancy shall serve only for the unexpired portion of the
term for which the individual's predecessor was appointed.
(f) Pay.--
(1) In general.--Members of the Commission shall serve without
pay.
(2) Officers or employees of the united states.--Each member of
the Commission who is an officer or employee of the United States
shall serve without compensation in addition to that received for
service as an officer or employee of the United States.
(3) Travel expenses.--Members shall receive travel expenses,
including per diem in lieu of subsistence, in accordance with
sections 5702 and 5703 of title 5, United States Code.
(g) Director of Staff.--
(1) Appointment.--The Commission shall appoint a Director who--
(A) has not served as an employee of the Department of
Veterans Affairs during the 1-year period preceding the date of
such appointment; and
(B) is not otherwise barred or prohibited from serving as
Director under Federal ethics laws and regulations, by reason
of post-employment conflict of interest.
(2) Rate of pay.--The Director shall be paid at the rate of
basic pay payable for level IV of the Executive Schedule under
section 5315 of title 5, United States Code.
(h) Staff.--
(1) Pay of personnel.--Subject to paragraphs (2) and (3), the
Director, with the approval of the Commission, may appoint and fix
the pay of additional personnel.
(2) Exemption from certain requirements.--The Director may make
such appointments without regard to the provisions of title 5,
United States Code, governing appointments in the competitive
service, and any personnel so appointed may be paid without regard
to the provisions of chapter 51 and subchapter III of chapter 53 of
that title relating to classification and General Schedule pay
rates, except that an individual so appointed may not receive pay
in excess of the annual rate of basic pay payable for GS-15 of the
General Schedule.
(3) Detailees.--
(A) Limitation on number.--Not more than two-thirds of the
personnel employed by or detailed to the Commission may be on
detail from the Department of Veterans Affairs.
(B) Professional analysts.--Not more than half of the
professional analysts of the Commission staff may be persons
detailed from the Department of Veterans Affairs to the
Commission.
(C) Prohibition on detail of certain personnel.--A person
may not be detailed from the Department of Veterans Affairs to
the Commission if, within 6 months before the detail is to
begin, that person participated personally and substantially in
any matter within the Department of Veterans Affairs concerning
the preparation of recommendations regarding facilities of the
Veterans Health Administration.
(4) Authority to request detailed personnel.--Subject to
paragraph (3), the head of any Federal department or agency, upon
the request of the Director, may detail any of the personnel of
that department or agency to the Commission to assist the
Commission in carrying out its duties under this subtitle.
(5) Information from federal agencies.--The Commission may
secure directly from any Federal agency such information the
Commission considers necessary to carry out this subtitle. Upon
request of the Chair, the head of such agency shall furnish such
information to the Commission.
(i) Other Authority.--
(1) Temporary and intermittent services.--The Commission may
procure by contract, to the extent funds are available, the
temporary or intermittent services of experts or consultants
pursuant to section 3109 of title 5, United States Code.
(2) Leasing and acquisition of property.--To the extent funds
are available, the Commission may lease real property and acquire
personal property either of its own accord or in consultation with
the General Services Administration.
(j) Termination.--The Commission shall terminate on December 31,
2023.
(k) Prohibition Against Restricting Communications.--
(1) In general.--Except as provided in paragraph (2), no person
may restrict an employee of the Department of Veterans Affairs in
communicating with the Commission.
(2) Unlawful communications.--Paragraph (1) does not apply to a
communication that is unlawful.

9bcb7b2313477c207a151fac5a988334751ef25ec20462b571fb696185329abf

(a) Selection Criteria.--
(1) Publication.--The Secretary shall, not later than February
1, 2021, and after consulting with veterans service organizations,
publish in the Federal Register and transmit to the Committees on
Veterans' Affairs of the Senate and the House of Representatives
the criteria proposed to be used by the Department of Veterans
Affairs in assessing and making recommendations regarding the
modernization or realignment of facilities of the Veterans Health
Administration under this subtitle. Such criteria shall include the
preferences of veterans regarding health care furnished by the
Department.
(2) Public comment.--The Secretary shall provide an opportunity
for public comment on the proposed criteria under paragraph (1) for
a period of at least 90 days and shall include notice of that
opportunity in the publication required under such paragraph.
(3) Publication of final criteria.--The Secretary shall, not
later than May 31, 2021, publish in the Federal Register and
transmit to the Committees on Veterans' Affairs of the Senate and
the House of Representatives the final criteria to be used in
making recommendations regarding the closure, modernization, or
realignment of facilities of the Veterans Health Administration
under this subtitle.
(b) Recommendations of the Secretary.--
(1) Publication in federal register.--The Secretary shall, not
later than January 31, 2022, and after consulting with veterans
service organizations, publish in the Federal Register and transmit
to the Committees on Veterans' Affairs of the Senate and the House
of Representatives and to the Commission a report detailing the
recommendations regarding the modernization or realignment of
facilities of the Veterans Health Administration on the basis of
the final criteria referred to in subsection (a)(2) that are
applicable.
(2) Factors for consideration.--In making recommendations under
this subsection, the Secretary shall consider each of the following
factors:
(A) The degree to which any health care delivery or other
site for providing services to veterans reflect the metrics of
the Department of Veterans Affairs regarding market area health
system planning.
(B) The provision of effective and efficient access to
high-quality health care and services for veterans.
(C) The extent to which the real property that no longer
meets the needs of the Federal Government could be
reconfigured, repurposed, consolidated, realigned, exchanged,
outleased, replaced, sold, or disposed.
(D) The need of the Veterans Health Administration to
acquire infrastructure or facilities that will be used for the
provision of health care and services to veterans.
(E) The extent to which the operating and maintenance costs
are reduced through consolidating, colocating, and
reconfiguring space, and through realizing other operational
efficiencies.
(F) The extent and timing of potential costs and savings,
including the number of years such costs or savings will be
incurred, beginning with the date of completion of the proposed
recommendation.
(G) The extent to which the real property aligns with the
mission of the Department of Veterans Affairs.
(H) The extent to which any action would impact other
missions of the Department (including education, research, or
emergency preparedness).
(I) Local stakeholder inputs and any factors identified
through public field hearings.
(J) The assessments under paragraph (3).
(K) The extent to which the Veterans Health Administration
has appropriately staffed the medical facility, including
determinations whether there has been insufficient resource
allocation or deliberate understaffing.
(L) Any other such factors the Secretary determines
appropriate.
(3) Capacity and commercial market assessments.--
(A) Assessments.--The Secretary shall assess the capacity
of each Veterans Integrated Service Network and medical
facility of the Department to furnish hospital care or medical
services to veterans under chapter 17 of title 38, United
States Code. Each such assessment shall--
(i) identify gaps in furnishing such care or services
at such Veterans Integrated Service Network or medical
facility;
(ii) identify how such gaps can be filled by--
(I) entering into contracts or agreements with
network providers under this section or with entities
under other provisions of law;
(II) making changes in the way such care and
services are furnished at such Veterans Integrated
Service Network or medical facility, including--
(aa) extending hours of operation;
(bb) adding personnel; or
(cc) expanding space through the construction,
leasing, or sharing of health care facilities; and
(III) the building or realignment of Department
resources or personnel;
(iii) forecast, based on future projections and
historical trends, both the short- and long-term demand in
furnishing care or services at such Veterans Integrated
Service Network or medical facility and assess how such
demand affects the needs to use such network providers;
(iv) include a commercial health care market assessment
of designated catchment areas in the United States
conducted by a non-governmental entity; and
(v) consider the unique ability of the Federal
Government to retain a presence in an area otherwise devoid
of commercial health care providers or from which such
providers are at risk of leaving.
(B) Consultation.--In carrying out the assessments under
subparagraph (A), the Secretary shall consult with veterans
service organizations and veterans served by each such Veterans
Integrated Service Network and medical facility.
(C) Submittal.--The Secretary shall submit such assessments
to the Committees on Veterans' Affairs of the House of
Representatives and the Senate with the recommendations of the
Secretary under this subsection and make the assessments
publicly available.
(4) Summary of selection process.--The Secretary shall include,
with the list of recommendations published and transmitted pursuant
to paragraph (1), a summary of the selection process that resulted
in the recommendation for each facility of the Veterans Health
Administration, including a justification for each recommendation.
The Secretary shall transmit the matters referred to in the
preceding sentence not later than 7 days after the date of the
transmittal to the Committees on Veterans' Affairs of the Senate
and the House of Representatives and the Commission of the report
referred to in paragraph (1).
(5) Treatment of facilities.--In assessing facilities of the
Veterans Health Administration, the Secretary shall consider all
such facilities equally without regard to whether the facility has
been previously considered or proposed for reuse, closure,
modernization, or realignment by the Department of Veterans
Affairs.
(6) Availability of information to congress.--In addition to
making all information used by the Secretary to prepare the
recommendations under this subsection available to Congress
(including any committee or Member of Congress), the Secretary
shall also make such information available to the Commission and
the Comptroller General of the United States.
(7) Certification of accuracy.--
(A) In general.--Each person referred to in subparagraph
(B), when submitting information to the Secretary or the
Commission concerning the modernization or realignment of a
facility of the Veterans Health Administration, shall certify
that such information is accurate and complete to the best of
that person's knowledge and belief.
(B) Covered persons.--Subparagraph (A) applies to the
following persons:
(i) Each Under Secretary of the Department of Veterans
Affairs.
(ii) Each director of a Veterans Integrated Service
Network.
(iii) Each director of a medical center of the
Department of Veterans Affairs.
(iv) Each director of a program office of the
Department of Veterans Affairs.
(v) Each person who is in a position the duties of
which include personal and substantial involvement in the
preparation and submission of information and
recommendations concerning the modernization or realignment
of facilities of the Veterans Health Administration.
(c) Review and Recommendations by the Commission.--
(1) Public hearings.--
(A) In general.--After receiving the recommendations from
the Secretary pursuant to subsection (b), the Commission shall
conduct public hearings on the recommendations.
(B) Locations.--The Commission shall conduct public
hearings in regions affected by a recommendation of the
Secretary to close a facility of the Veterans Health
Administration. To the greatest extent practicable, the
Commission shall conduct public hearings in regions affected by
a recommendation of the Secretary to modernize or realign such
a facility.
(C) Required witnesses.--Witnesses at each public hearing
shall include at a minimum--
(i) a veteran--
(I) enrolled under section 1705 of title 38, United
States Code; and
(II) identified by a local veterans service
organization; and
(ii) a local elected official.
(2) Transmittal to president.--
(A) In general.--The Commission shall, not later than
January 31, 2023, transmit to the President a report containing
the Commission's findings and conclusions based on a review and
analysis of the recommendations made by the Secretary, together
with the Commission's recommendations, for modernizations and
realignments of facilities of the Veterans Health
Administration.
(B) Authority to make changes to recommendations.--Subject
to subparagraph (C), in making its recommendations, the
Commission may change any recommendation made by the Secretary
if the Commission--
(i) determines that the Secretary deviated
substantially from the final criteria referred to in
subsection (a)(2) in making such recommendation;
(ii) determines that the change is consistent with the
final criteria referred to in subsection (a)(2);
(iii) publishes a notice of the proposed change in the
Federal Register not less than 45 days before transmitting
its recommendations to the President pursuant to
subparagraph (A); and
(iv) conducts public hearings on the proposed change.
(3) Justification for changes.--The Commission shall explain
and justify in its report submitted to the President pursuant to
paragraph (2) any recommendation made by the Commission that is
different from the recommendations made by the Secretary pursuant
to subsection (b). The Commission shall transmit a copy of such
report to the Committees on Veterans' Affairs of the Senate and the
House of Representatives on the same date on which it transmits its
recommendations to the President under paragraph (2).
(4) Provision of information to congress.--After the Commission
transmits its report to the President, the Commission shall
promptly provide, upon request, to any Member of Congress,
information used by the Commission in making its recommendations.
(d) Review by the President.--
(1) Report.--The President shall, not later than February 15,
2023, transmit to the Commission and to the Congress a report
containing the President's approval or disapproval of the
Commission's recommendations.
(2) Presidential approval.--If the President approves all the
recommendations of the Commission, the President shall transmit a
copy of such recommendations to the Congress, together with a
certification of such approval.
(3) Presidential disapproval.--If the President disapproves the
recommendations of the Commission, in whole or in part, the
President shall transmit to the Commission and the Congress, not
later than March 1, 2023, the reasons for that disapproval. The
Commission, after consideration of the President's reasons for
disapproval, shall then transmit to the President, not later than
March 15, 2023, a report containing--
(A) the Commission's findings and conclusions based on a
review and analysis of those reasons for disapproval provided
by the President; and
(B) recommendations that the Commission determines are
appropriate for modernizations and realignments of facilities
of the Veterans Health Administration.
(4) Transmittal of recommendations to congress.--If the
President approves all recommendations of the Commission
transmitted to the President under paragraph (3), the President
shall transmit a copy of such recommendations to the Congress,
together with a certification of such approval.
(5) Failure to transmit.--If the President does not transmit to
the Congress an approval and certification described in paragraph
(2) or (4) by March 30, 2023, the process by which facilities of
the Veterans Health Administration may be selected for
modernization or realignment under this subtitle shall be
terminated.

ec543cc3adda3aefdbbd3ad22b33640f5c12ffeb9209c6a269aed4d9ae4aecd0

VETERANS HEALTH ADMINISTRATION.
(a) In General.--Subject to subsection (b), the Secretary shall
begin to implement the recommended modernizations and realignments in
the report under section 203(d) not later than 3 years after the date
on which the President transmits such report to Congress. In any fiscal
year, such implementation includes--
(1) the planning of modernizations and realignments of
facilities of the Veterans Health Administration as recommended in
such report; and
(2) providing detailed information on the budget for such
modernizations or realignments in documents submitted to Congress
by the Secretary in support of the President's budget for that
fiscal year.
(b) Congressional Disapproval.--
(1) In general.--The Secretary may not carry out any
modernization or realignment recommended by the Commission in a
report transmitted from the President pursuant to section 203(d) if
a joint resolution is enacted, in accordance with the provisions of
section 207, disapproving such recommendations of the Commission
before the earlier of--
(A) the end of the 45-day period beginning on the date on
which the President transmits such report; or
(B) the adjournment of Congress sine die for the session
during which such report is transmitted.
(2) Computation of period.--For purposes of paragraph (1) and
subsections (a) and (c) of section 207, the days on which either
House of Congress is not in session because of an adjournment of
more than three days to a day certain shall be excluded in the
computation of a period.

a433dc16bfb38ec6eab4fb98fd70fcf4ec9eb8da090a9b4655fe7adcfb7d75ab

(a) In General.--
(1) Modernizing and realigning facilities.--In modernizing or
realigning any facility of the Veterans Health Administration under
this subtitle, the Secretary may--
(A) take such actions as may be necessary to modernize or
realign any such facility, including the alteration of such
facilities, the acquisition of such land, the leasing or
construction of such replacement facilities, the disposition of
such land or facilities, the performance of such activities,
and the conduct of such advance planning and design as may be
required to transfer functions from a facility of the Veterans
Health Administration to another such facility, and may use for
such purpose funds in the Account or funds appropriated to the
Department of Veterans Affairs for such purposes;
(B) carry out activities for the purposes of environmental
mitigation, abatement, or restoration at any such facility, and
shall use for such purposes funds in the Account;
(C) reimburse other Federal agencies for actions performed
at the request of the Secretary with respect to any such
closure or realignment, and may use for such purpose funds in
the Account or funds appropriated to the Department of Veterans
Affairs and available for such purpose; and
(D) exercise the authority of the Secretary under
subchapter V of chapter 81 of title 38, United States Code.
(2) Environmental restoration; historic preservation.--In
carrying out any closure or realignment under this subtitle, the
Secretary, with regards to any property made excess to the needs of
the Department of Veterans Affairs as a result of such closure or
realignment, shall carry out, as soon as possible with funds
available for such purpose, any of the following for which the
Secretary is responsible:
(A) Environmental mitigation.
(B) Environmental abatement.
(C) Environmental restoration.
(D) Compliance with historic preservation requirements.
(b) Management and Disposal of Property.--
(1) Existing disposal authorities.--To transfer or dispose of
surplus real property or infrastructure located at any facility of
the Veterans Health Administration that is modernized or realigned
under this title, the Secretary may exercise the authorities of the
Secretary under subchapters I and II of chapter 81 of title 38,
United States Code, or the authorities delegated to the Secretary
by the Administrator of General Services under subchapter III of
chapter 5 of title 40, United States Code.
(2) Effects on local communities.--
(A) Consultation with state and local government.--Before
any action may be taken with respect to the disposal of any
surplus real property or infrastructure located at any facility
of the Veterans Health Administration to be closed or realigned
under this subtitle, the Secretary of Veterans Affairs shall
consult with the Governor of the State and the heads of the
local governments concerned for the purpose of considering any
plan for the use of such property by the local community
concerned.
(B) Treatment of roads.--If infrastructure or a facility of
the Veterans Health Administration to be closed or realigned
under this subtitle includes a road used for public access
through, into, or around the facility, the Secretary--
(i) shall consult with the Government of the State and
the heads of the local governments concerned for the
purpose of considering the continued availability of the
road for public use after the recommended action is
complete; and
(ii) may exercise the authority of the Secretary under
section 8108 of title 38, United States Code.
(3) Leases; cercla.--
(A) Lease authority.--
(i) Transfer to redevelopment authority for lease.--The
Secretary may transfer title to a facility of the Veterans
Health Administration approved for closure or realignment
under this subtitle (including property at a facility of
the Veterans Health Administration approved for realignment
which will be retained by the Department of Veterans
Affairs or another Federal agency after realignment) to the
redevelopment authority for the facility if the
redevelopment authority agrees to lease, directly upon
transfer, one or more portions of the property transferred
under this subparagraph to the Secretary or to the head of
another department or agency of the Federal Government.
(ii) Term of lease.--A lease under clause (i) shall be
for a term of not to exceed 50 years, but may provide for
options for renewal or extension of the term by the
department or agency concerned.
(iii) Limitation.--A lease under clause (i) may not
require rental payments by the United States.
(iv) Treatment of remaindered lease terms.--A lease
under clause (i) shall include a provision specifying that
if the department or agency concerned ceases requiring the
use of the leased property before the expiration of the
term of the lease, the remainder of the lease term may be
satisfied by the same or another department or agency of
the Federal Government using the property for a use similar
to the use under the lease. Exercise of the authority
provided by this clause shall be made in consultation with
the redevelopment authority concerned.
(v) Facility services.--Notwithstanding clause (iii),
if a lease under clause (i) involves a substantial portion
of the facility, the department or agency concerned may
obtain facility services for the leased property and common
area maintenance from the redevelopment authority or the
redevelopment authority's assignee as a provision of the
lease. The facility services and common area maintenance
shall be provided at a rate no higher than the rate charged
to non-Federal tenants of the transferred property.
Facility services and common area maintenance covered by
the lease shall not include--
(I) municipal services that a State or local
government is required by law to provide to all
landowners in its jurisdiction without direct charge;
or
(II) firefighting or security-guard functions.
(B) Application of cercla.--The provisions of section
120(h) of the Comprehensive Environmental Response,
Compensation, and Liability Act of 1980 (42 U.S.C. 9620(h))
shall apply to any transfer of real property under this
paragraph.
(C) Additional terms and conditions.--The Secretary may
require any additional terms and conditions in connection with
a transfer under this paragraph as such Secretary considers
appropriate to protect the interests of the United States.
(4) Application of mckinney-vento homeless assistance act.--
Nothing in this subtitle shall limit or otherwise affect the
application of the provisions of the McKinney-Vento Homeless
Assistance Act (42 U.S.C. 11301 et seq.) to facilities of the
Veterans Health Administration closed under this subtitle.
(c) Applicability of National Environmental Policy Act of 1969.--
(1) In general.--The provisions of the National Environmental
Policy Act of 1969 (42 U.S.C. 4321 et seq.) shall not apply to the
actions of the President, the Commission, and, except as provided
in paragraph (2), the Department of Veterans Affairs in carrying
out this subtitle.
(2) Department of veterans affairs.--
(A) Covered activities.--The provisions of the National
Environmental Policy Act of 1969 shall apply to actions of the
Department of Veterans Affairs under this subtitle--
(i) during the process of property disposal; and
(ii) during the process of relocating functions from a
facility of the Veterans Health Administration being closed
or realigned to another facility after the receiving
facility has been selected but before the functions are
relocated.
(B) Other activities.--In applying the provisions of the
National Environmental Policy Act of 1969 to the processes
referred to in subparagraph (A), the Secretary shall not have
to consider--
(i) the need for closing or realigning the facility of
the Veterans Health Administration as recommended by the
Commission;
(ii) the need for transferring functions to any
facility of the Veterans Health Administration which has
been selected as the receiving facility; or
(iii) facilities of the Veterans Health Administration
alternative to those recommended or selected.
(d) Waiver.--
(1) Restrictions on use of funds.--The Secretary may close or
realign facilities of the Veterans Health Administration under this
subtitle without regard to any provision of law restricting the use
of funds for closing or realigning facilities of the Veterans
Health Administration included in any appropriation or
authorization Act.
(2) Restrictions on authorities.--The Secretary may close or
realign facilities of the Veterans Health Administration under this
subtitle without regard to the restrictions of section 8110 of
title 38, United States Code.
(e) Transfer Authority in Connection With Payment of Environmental
Remediation Costs.--
(1) In general.--
(A) Transfer by deed.--Subject to paragraph (2) of this
subsection and section 120(h) of the Comprehensive
Environmental Response, Compensation, and Liability Act of 1980
(42 U.S.C. 9620(h)), the Secretary may enter into an agreement
to transfer by deed a facility of the Veterans Health
Administration with any person who agrees to perform all
environmental restoration, waste management, and environmental
compliance activities that are required for the property or
facilities under Federal and State laws, administrative
decisions, agreements (including schedules and milestones), and
concurrences.
(B) Additional terms or conditions.--The Secretary may
require any additional terms and conditions in connection with
an agreement authorized by subparagraph (A) as the Secretary
considers appropriate to protect the interests of the United
States.
(2) Limitation.--A transfer of a facility of the Veterans
Health Administration may be made under paragraph (1) only if the
Secretary certifies to Congress that--
(A) the costs of all environmental restoration, waste
management, and environmental compliance activities otherwise
to be paid by the Secretary with respect to the facility of the
Veterans Health Administration are equal to or greater than the
fair market value of the property or facilities to be
transferred, as determined by the Secretary; or
(B) if such costs are lower than the fair market value of
the facility of the Veterans Health Administration, the
recipient of such transfer agrees to pay the difference between
the fair market value and such costs.
(3) Payment by the secretary for certain transfers.--In the
case of a facility of the Veterans Health Administration covered by
a certification under paragraph (2)(A), the Secretary may pay the
recipient of such facility an amount equal to the lesser of--
(A) the amount by which the costs incurred by the recipient
of the facility of the Veterans Health Administration for all
environmental restoration, waste, management, and environmental
compliance activities with respect to such facility exceed the
fair market value of such property as specified in such
certification; or
(B) the amount by which the costs (as determined by the
Secretary) that would otherwise have been incurred by the
Secretary for such restoration, management, and activities with
respect to such facility of the Veterans Health Administration
exceed the fair market value of property as so specified.
(4) Disclosure.--As part of an agreement under paragraph (1),
the Secretary shall disclose to the person to whom the facility of
the Veterans Health Administration will be transferred any
information of the Secretary regarding the environmental
restoration, waste management, and environmental compliance
activities described in paragraph (1) that relate to the facility
of the Veterans Health Administration. The Secretary shall provide
such information before entering into the agreement.
(5) Applicability of certain environmental laws.--Nothing in
this subsection shall be construed to modify, alter, or amend the
Comprehensive Environmental Response, Compensation, and Liability
Act of 1980 (42 U.S.C. 9601 et seq.) or the Solid Waste Disposal
Act (42 U.S.C. 6901 et seq.).

b12a64a0344f78965058b393e5327512fead9f4465182ecee9ded176edb9bb7a

REVIEW ACCOUNT.
(a) Establishment.--There is hereby established in the ledgers of
the Treasury an account to be known as the ``Department of Veterans
Affairs Asset and Infrastructure Review Account'' which shall be
administered by the Secretary as a single account.
(b) Credits to Account.--There shall be credited to the Account the
following:
(1) Funds authorized for and appropriated to the Account.
(2) Proceeds received from the lease, transfer, or disposal of
any property at a facility of the Veterans Health Administration
closed or realigned under this subtitle.
(c) Use of Account.--The Secretary may use the funds in the Account
only for the following purposes:
(1) To carry out this subtitle.
(2) To cover property management and disposal costs incurred at
facilities of the Veterans Health Administration closed,
modernized, or realigned under this subtitle.
(3) To cover costs associated with supervision, inspection,
overhead, engineering, and design of construction projects
undertaken under this subtitle, and subsequent claims, if any,
related to such activities.
(4) Other purposes that the Secretary determines support the
mission and operations of the Department of Veterans Affairs.
(d) Consolidated Budget Justification Display for Account.--
(1) Consolidated budget information required.--The Secretary
shall establish a consolidated budget justification display in
support of the Account that for each fiscal year--
(A) details the amount and nature of credits to, and
expenditures from, the Account during the preceding fiscal
year;
(B) separately details the environmental remediation costs
associated with facility of the Veterans Health Administration
for which a budget request is made;
(C) specifies the transfers into the Account and the
purposes for which these transferred funds will be further
obligated, to include caretaker and environment remediation
costs associated with each facility of the Veterans Health
Administration; and
(D) details any intra-budget activity transfers within the
Account that exceeded $1,000,000 during the preceding fiscal
year or that are proposed for the next fiscal year and will
exceed $1,000,000.
(2) Submission.--The Secretary shall include the information
required by paragraph (1) in the materials that the Secretary
submits to Congress in support of the budget for a fiscal year
submitted by the President pursuant to section 1105 of title 31,
United States Code.
(e) Closure of Account; Treatment of Remaining Funds.--
(1) Closure.--The Account shall be closed at the time and in
the manner provided for appropriation accounts under section 1555
of title 31, United States Code, except that unobligated funds
which remain in the Account upon closure shall be held by the
Secretary of the Treasury until transferred to the Secretary of
Veterans Affairs by law after the Committees on Veterans' Affairs
of the Senate and the House of Representatives receive the final
report transmitted under paragraph (2).
(2) Final report.--No later than 60 days after the closure of
the Account under paragraph (1), the Secretary shall transmit to
the Committees on Veterans' Affairs of the Senate and the House of
Representatives and the Committees on Appropriations of the House
of Representatives and the Senate a report containing an accounting
of--
(A) all the funds credited to and expended from the Account
or otherwise expended under this subtitle; and
(B) any funds remaining in the Account.

af82c3b2849771e10c897e24e1505b685c66409e795aed34afe32c9d94eb239e

(a) Disapproval Resolution.--For purposes of this subtitle, the
term ``joint resolution'' means only a joint resolution which is
introduced within the 5-day period beginning on the date on which the
President transmits the report to the Congress under section 203(d),
and--
(1) which does not have a preamble;
(2) the matter after the resolving clause of which is as
follows: ``that Congress disapproves the recommendations of the VHA
Asset and Infrastructure Review Commission as submitted by the
President on ___'', the blank space being filled with the
appropriate date; and
(3) the title of which is as follows: ``Joint resolution
disapproving the recommendations of the VHA Asset and
Infrastructure Review Commission.''.
(b) Consideration in the House of Representatives.--
(1) Reporting and discharge.--Any committee of the House of
Representatives to which a joint resolution is referred shall
report it to the House without amendment not later than 15
legislative days after the date of introduction thereof. If a
committee fails to report the joint resolution within that period,
the committee shall be discharged from further consideration of the
joint resolution.
(2) Proceeding to consideration.--It shall be in order at any
time after the third legislative day after each committee
authorized to consider a joint resolution has reported or has been
discharged from consideration of a joint resolution, to move to
proceed to consider the joint resolution in the House. All points
of order against the motion are waived. Such a motion shall not be
in order after the House has disposed of a motion to proceed on a
joint resolution addressing a particular submission. The previous
question shall be considered as ordered on the motion to its
adoption without intervening motion. The motion shall not be
debatable. A motion to reconsider the vote by which the motion is
disposed of shall not be in order.
(3) Consideration.--The joint resolution shall be considered as
read. All points of order against the joint resolution and against
its consideration are waived. The previous question shall be
considered as ordered on the joint resolution to its passage
without intervening motion except 2 hours of debate equally divided
and controlled by the proponent and an opponent. A motion to
reconsider the vote on passage of the joint resolution shall not be
in order.
(c) Consideration in the Senate.--
(1) Referral.--A joint resolution introduced in the Senate
shall be referred to the Committee on Veterans' Affairs.
(2) Reporting and discharge.--Any committee of the Senate to
which a joint resolution is referred shall report it to the Senate
without amendment not later than 15 session days after the date of
introduction of a joint resolution described in subsection (a). If
a committee fails to report the joint resolution within that
period, the committee shall be discharged from further
consideration of the joint resolution and the joint resolution
shall be placed on the calendar.
(3) Floor consideration.--
(A) In general.--Notwithstanding Rule XXII of the Standing
Rules of the Senate, it is in order at any time after the third
session day on which the Committee on Veterans' Affairs has
reported or has been discharged from consideration of a joint
resolution described in subsection (a) (even though a previous
motion to the same effect has been disagreed to) to move to
proceed to the consideration of the joint resolution, and all
points of order against the joint resolution (and against
consideration of the joint resolution) are waived. The motion
to proceed is not debatable. The motion is not subject to a
motion to postpone. A motion to reconsider the vote by which
the motion is agreed to or disagreed to shall not be in order.
If a motion to proceed to the consideration of the resolution
is agreed to, the joint resolution shall remain the unfinished
business until disposed of.
(B) Consideration.--Consideration of the joint resolution,
and on all debatable motions and appeals in connection
therewith, shall be limited to not more than 2 hours, which
shall be divided equally between the majority and minority
leaders or their designees. A motion further to limit debate is
in order and not debatable. An amendment to, or a motion to
postpone, or a motion to proceed to the consideration of other
business, or a motion to recommit the joint resolution is not
in order.
(C) Vote on passage.--If the Senate has voted to proceed to
a joint resolution, the vote on passage of the joint resolution
shall occur immediately following the conclusion of
consideration of the joint resolution, and a single quorum call
at the conclusion of the debate if requested in accordance with
the rules of the Senate.
(D) Rulings of the chair on procedure.--Appeals from the
decisions of the Chair relating to the application of the rules
of the Senate, as the case may be, to the procedure relating to
a joint resolution shall be decided without debate.
(d) Amendment Not in Order.--A joint resolution of disapproval
considered pursuant to this section shall not be subject to amendment
in either the House of Representatives or the Senate.
(e) Coordination With Action by Other House.--
(1) In general.--If, before the passage by one House of the
joint resolution of that House, that House receives the joint
resolution from the other House, then the following procedures
shall apply:
(A) The joint resolution of the other House shall not be
referred to a committee.
(B) With respect to the joint resolution of the House
receiving the joint resolution--
(i) the procedure in that House shall be the same as if
no joint resolution had been received from the other House;
but
(ii) the vote on passage shall be on the joint
resolution of the other House.
(2) Treatment of joint resolution of other house.--If the
Senate fails to introduce or consider a joint resolution under this
section, the joint resolution of the House shall be entitled to
expedited floor procedures under this section.
(3) Treatment of companion measures.--If, following passage of
the joint resolution in the Senate, the Senate then receives the
companion measure from the House of Representatives, the companion
measure shall not be debatable.
(f) Rules of the House of Representatives and Senate.--This section
is enacted by Congress--
(1) as an exercise of the rulemaking power of the Senate and
House of Representatives, respectively, and as such it is deemed a
part of the rules of each House, respectively, but applicable only
with respect to the procedure to be followed in that House in the
case of a joint resolution, and it supersedes other rules only to
the extent that it is inconsistent with such rules; and
(2) with full recognition of the constitutional right of either
House to change the rules (so far as relating to the procedure of
that House) at any time, in the same manner, and to the same extent
as in the case of any other rule of that House.

a82b7fb451e37c97fbf357327c510457ebb79ba5f2aba7ae715ed35e71b03bb4

(a) Online Publication of Communications.--
(1) In general.--Not later than 24 hours after the transmission
or receipt of any communication under this subtitle that is
transmitted or received by a party specified in paragraph (2), the
Secretary of Veterans Affairs shall publish such communication
online.
(2) Parties specified.--The parties specified under this
paragraph are the following:
(A) The Secretary of Veterans Affairs.
(B) The Commission.
(C) The President.
(b) Continuation of Existing Construction Projects and Planning.--
During activities that the Commission, President, or Congress carry out
under this subtitle, the Secretary of Veterans Affairs may not stop,
solely because of such activities--
(1) a construction or leasing project of the Veterans Health
Administration;
(2) long term planning regarding infrastructure and assets of
the Veterans Health Administration; or
(3) budgetary processes for the Veterans Health Administration.
(c) Recommendations for Future Asset Reviews.--The Secretary of
Veterans Affairs may, after consulting with veterans service
organizations, include in budget submissions the Secretary submits
after the termination of the Commission recommendations for future such
commissions or other capital asset realignment and management
processes.

abb58dbbf01781dfa5e08128d4ca1379e2e20e01e6e4e0ed13085e94e8aa743b

In this subtitle:
(1) The term ``Account'' means the Department of Veterans
Affairs Asset and Infrastructure Review Account established by
section 206(a).
(2) The term ``Commission'' means the Commission established by
section 202.
(3) The term ``date of approval'', with respect to a
modernization or realignment of a facility of the Veterans Health
Administration, means the date on which the authority of Congress
to disapprove a recommendation of modernization or realignment, as
the case may be, of such facility under this subtitle expires.
(4) The term ``facility of the Veterans Health
Administration''--
(A) means any land, building, structure, or infrastructure
(including any medical center, nursing home, domiciliary
facility, outpatient clinic, center that provides readjustment
counseling, or leased facility) that is--
(i) under the jurisdiction of the Department of
Veterans Affairs;
(ii) under the control of the Veterans Health
Administration; and
(iii) not under the control of the General Services
Administration; or
(B) with respect to a colocated facility of the Department
of Veterans Affairs, includes any land, building, or
structure--
(i) under the jurisdiction of the Department of
Veterans Affairs;
(ii) under the control of another administration of the
Department of Veterans Affairs; and
(iii) not under the control of the General Services
Administration.
(5) The term ``infrastructure'' means improvements to land
other than buildings or structures.
(6) The term ``modernization'' includes--
(A) any action, including closure, required to align the
form and function of a facility of the Veterans Health
Administration to the provision of modern day health care,
including utilities and environmental control systems;
(B) the construction, purchase, lease, or sharing of a
facility of the Veterans Health Administration; and
(C) realignments, disposals, exchanges, collaborations
between the Department of Veterans Affairs and other Federal
entities, and strategic collaborations between the Department
and non-Federal entities, including tribal organizations.
(7) The term ``realignment'', with respect to a facility of the
Veterans Health Administration, includes--
(A) any action that changes the numbers of or relocates
services, functions, and personnel positions;
(B) disposals or exchanges between the Department of
Veterans Affairs and other Federal entities, including the
Department of Defense; and
(C) strategic collaborations between the Department of
Veterans Affairs and non-Federal entities, including tribal
organizations.
(8) The term ``redevelopment authority'', in the case of a
facility of the Veterans Health Administration closed or modernized
under this subtitle, means any entity (including an entity
established by a State or local government) recognized by the
Secretary of Veterans Affairs as the entity responsible for
developing the redevelopment plan with respect to the facility or
for directing the implementation of such plan.
(9) The term ``redevelopment plan'' in the case of a facility
of the Veterans Health Administration to be closed or realigned
under this subtitle, means a plan that--
(A) is agreed to by the local redevelopment authority with
respect to the facility; and
(B) provides for the reuse or redevelopment of the real
property and personal property of the facility that is
available for such reuse and redevelopment as a result of the
closure or realignment of the facility.
(10) The term ``Secretary'' means the Secretary of Veterans
Affairs.
(11) The term ``tribal organization'' has the meaning given
such term in section 3765 of title 38, United States Code.
Subtitle B--Other Infrastructure Matters

aaf7bd075c26d9080aa10f2a727fdaaa639e472f7323450282677ce52dd6a12d

Subsection (g) of section 8103 of title 38, United States Code, is
amended to read as follows:
``(g)(1)(A) Not later than September 30 of the fiscal year
following the fiscal year during which the VA Asset and Infrastructure
Review Act of 2018 is enacted, the Secretary shall implement the
covered training curriculum and the covered certification program.
``(B) In designing and implementing the covered training curriculum
and the covered certification program under paragraph (1), the
Secretary shall use as models existing training curricula and
certification programs that have been established under chapter 87 of
title 10, United States Code, as determined relevant by the Secretary.
``(2) The Secretary may develop the training curriculum under
paragraph (1)(A) in a manner that provides such training in any
combination of--
``(A) training provided in person;
``(B) training provided over an internet website; or
``(C) training provided by another department or agency of the
Federal Government.
``(3) The Secretary may develop the certification program under
paragraph (1)(A) in a manner that uses--
``(A) one level of certification; or
``(B) more than one level of certification, as determined
appropriate by the Secretary with respect to the level of
certification for different grades of the General Schedule.
``(4) The Secretary may enter into a contract with an appropriate
entity to provide the covered training curriculum and the covered
certification program under paragraph (1)(A).
``(5)(A) Not later than September 30 of the second fiscal year
following the fiscal year during which the VA Asset and Infrastructure
Review Act of 2018 is enacted, the Secretary shall ensure that the
majority of employees subject to the covered certification program
achieve the certification or the appropriate level of certification
pursuant to paragraph (3), as the case may be.
``(B) After carrying out subparagraph (A), the Secretary shall
ensure that each employee subject to the covered certification program
achieves the certification or the appropriate level of certification
pursuant to paragraph (3), as the case may be, as quickly as
practicable.
``(6) In this subsection:
``(A) The term `covered certification program' means, with
respect to employees of the Department of Veterans Affairs who are
members of occupational series relating to construction or
facilities management, or employees of the Department who award or
administer contracts for major construction, minor construction, or
nonrecurring maintenance, including as contract specialists or
contracting officers' representatives, a program to certify
knowledge and skills relating to construction or facilities
management and to ensure that such employees maintain adequate
expertise relating to industry standards and best practices for the
acquisition of design and construction services.
``(B) The term `covered training curriculum' means, with
respect to employees specified in subparagraph (A), a training
curriculum relating to construction or facilities management.''.

413e585fafa578352969880eabb14e48be4c8fcb26cf602e69c07ba6c924574c

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

f03018eb8c1521e6abc1a6215b7f220b9059d52678173655a7373f9db34011c4

VETERANS WHO LIVE IN THE PACIFIC TERRITORIES.
(a) In General.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall submit
to the Committees on Veterans' Affairs of the Senate and the House of
Representatives a report regarding health care furnished by the
Department of Veterans Affairs to veterans who live in the Pacific
territories.
(b) Elements.--The report under subsection (a) shall include
assessments of the following:
(1) The ability of the Department to furnish to veterans who
live in the Pacific territories the following:
(A) Hospital care.
(B) Medical services.
(C) Mental health services.
(D) Geriatric services.
(2) The feasibility of establishing a community-based
outpatient clinic of the Department in any Pacific territory that
does not contain such a facility.
(c) Definition.--In this section, the term ``Pacific territories''
means American Samoa, Guam, and the Northern Mariana Islands.

47d3ba20e249c6790a908466f4085187aaf91dc07216b4242315fd731d335634

DEPARTMENT OF VETERANS AFFAIRS HEALTH PROFESSIONAL SCHOLARSHIP
PROGRAM.
(a) Scholarships for Physicians and Dentists.--Section 7612(b) of
title 38, United States Code, is amended by adding at the end the
following new paragraph:
``(6)(A) Of the scholarships awarded under this subchapter, the
Secretary shall ensure that not less than 50 scholarships are awarded
each year to individuals who are accepted for enrollment or enrolled
(as described in section 7602 of this title) in a program of education
or training leading to employment as a physician or dentist until such
date as the Secretary determines that the staffing shortage of
physicians and dentists in the Department is less than 500.
``(B) After such date, the Secretary shall ensure that of the
scholarships awarded under this subchapter, a number of scholarships is
awarded each year to individuals referred to in subparagraph (A) in an
amount equal to not less than ten percent of the staffing shortage of
physicians and dentists in the Department, as determined by the
Secretary.
``(C) Notwithstanding subsection (c)(1), the agreement between the
Secretary and a participant in the Scholarship Program who receives a
scholarship pursuant to this paragraph shall provide the following:
``(i) The Secretary's agreement to provide the participant with
a scholarship under this subchapter for a specified number (from
two to four) of school years during which the participant is
pursuing a course of education or training leading to employment as
a physician or dentist.
``(ii) The participant's agreement to serve as a full-time
employee in the Veterans Health Administration for a period of time
(hereinafter in this subchapter referred to as the `period of
obligated service') of 18 months for each school year or part
thereof for which the participant was provided a scholarship under
the Scholarship Program.
``(D) In providing scholarships pursuant to this paragraph, the
Secretary may provide a preference for applicants who are veterans.
``(E) On an annual basis, the Secretary shall provide to
appropriate educational institutions informational material about the
availability of scholarships under this paragraph.''.
(b) Breach of Agreement.--Section 7617 of such title is amended--
(1) by redesignating paragraphs (4) and (5) as paragraphs (5)
and (6), respectively; and
(2) by inserting after paragraph (3) the following new
paragraph (4):
``(4) In the case of a participant who is enrolled in a program
or education or training leading to employment as a physician, the
participant fails to successfully complete post-graduate training
leading to eligibility for board certification in a specialty.''.
(c) Extension of Program.--Section 7619 of such title is amended by
striking ``December 31, 2019'' and inserting ``December 31, 2033''.

dbfe86e8467ccffe04ce57c5b2b5eab1008c8d9bc0bda1d332a0a052eaf74dec

UNDER EDUCATION DEBT REDUCTION PROGRAM OF DEPARTMENT OF VETERANS
AFFAIRS.
(a) Increase in Amount.--Section 7683(d)(1) is amended--
(1) by striking ``$120,000'' and inserting ``$200,000''; and
(2) by striking ``$24,000'' and inserting ``$40,000''.
(b) Study.--
(1) In general.--Not later than 1 year after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall--
(A) conduct a study on the demand for education debt
reduction under subchapter VII of chapter 76 of title 38,
United States Code; and
(B) submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a report on the findings of the Secretary with
respect to the study carried out under subparagraph (A).
(2) Considerations.--In carrying out the study required by
paragraph (1)(A), the Secretary shall consider the following:
(A) The total number of vacancies within the Veterans
Health Administration whose applicants are eligible to
participate in the Education Debt Reduction Program pursuant to
section 7682(a) of such title.
(B) The types of medical professionals in greatest demand
in the United States.
(C) Projections by the Secretary of the numbers and types
of medical professions that meet the needs of veterans.

2341ed25082b9f588978809910c4a98c1320b0ed3b09a39e3bc9cfeda6e02fae

EDUCATION LOAN REPAYMENT PROGRAM.
(a) In General.--Chapter 76 of title 38, United States Code, is
amended by inserting after subchapter VII the following new subchapter:
``SUBCHAPTER VIII--SPECIALTY EDUCATION LOAN REPAYMENT PROGRAM
``Sec. 7691. Establishment
``As part of the Educational Assistance Program, the Secretary may
carry out a student loan repayment program under section 5379 of title
5. The program shall be known as the Department of Veterans Affairs
Specialty Education Loan Repayment Program (in this chapter referred to
as the `Specialty Education Loan Repayment Program').
``Sec. 7692. Purpose
``The purpose of the Specialty Education Loan Repayment Program is
to assist, through the establishment of an incentive program for
certain individuals employed in the Veterans Health Administration, in
meeting the staffing needs of the Veterans Health Administration for
physicians in medical specialties for which the Secretary determines
recruitment or retention of qualified personnel is difficult.
``Sec. 7693. Eligibility; preferences; covered costs
``(a) Eligibility.--An individual is eligible to participate in the
Specialty Education Loan Repayment Program if the individual--
``(1) is hired under section 7401 of this title to work in an
occupation described in section 7692 of this title;
``(2) owes any amount of principal or interest under a loan,
the proceeds of which were used by or on behalf of that individual
to pay costs relating to a course of education or training which
led to a degree that qualified the individual for the position
referred to in paragraph (1); and
``(3) is--
``(A) recently graduated from an accredited medical or
osteopathic school and matched to an accredited residency
program in a medical specialty described in section 7692 of
this title; or
``(B) a physician in training in a medical specialty
described in section 7692 of this title with more than 2 years
remaining in such training.
``(b) Preferences.--In selecting individuals for participation in
the Specialty Education Loan Repayment Program under this subchapter,
the Secretary may give preference to the following:
``(1) Individuals who are, or will be, participating in
residency programs in health care facilities--
``(A) located in rural areas;
``(B) operated by Indian tribes, tribal organizations, or
the Indian Health Service; or
``(C) affiliated with underserved health care facilities of
the Department.
``(2) Veterans.
``(c) Covered Costs.--For purposes of subsection (a)(2), costs
relating to a course of education or training include--
``(1) tuition expenses;
``(2) all other reasonable educational expenses, including
expenses for fees, books, equipment, and laboratory expenses; and
``(3) reasonable living expenses.
``Sec. 7694. Specialty education loan repayment
``(a) In General.--Payments under the Specialty Education Loan
Repayment Program shall consist of payments for the principal and
interest on loans described in section 7682(a)(2) of this title for
individuals selected to participate in the Program to the holders of
such loans.
``(b) Frequency of Payment.--The Secretary shall make payments for
any given participant in the Specialty Education Loan Repayment Program
on a schedule determined appropriate by the Secretary.
``(c) Maximum Amount; Waiver.--(1) The amount of payments made for
a participant under the Specialty Education Loan Repayment Program may
not exceed $160,000 over a total of 4 years of participation in the
Program, of which not more than $40,000 of such payments may be made in
each year of participation in the Program.
``(2)(A) The Secretary may waive the limitations under paragraph
(1) in the case of a participant described in subparagraph (B). In the
case of such a waiver, the total amount of payments payable to or for
that participant is the total amount of the principal and the interest
on the participant's loans referred to in subsection (a).
``(B) A participant described in this subparagraph is a participant
in the Program who the Secretary determines serves in a position for
which there is a shortage of qualified employees by reason of either
the location or the requirements of the position.
``Sec. 7695. Choice of location
``Each participant in the Specialty Education Loan Repayment
Program who completes residency may select, from a list of medical
facilities of the Veterans Health Administration provided by the
Secretary, at which such facility the participant will work in a
medical specialty described in section 7692 of this title.
``Sec. 7696. Term of obligated service
``(a) In General.--In addition to any requirements under section
5379(c) of title 5, a participant in the Specialty Education Loan
Repayment Program must agree, in writing and before the Secretary may
make any payment to or for the participant, to--
``(1) obtain a license to practice medicine in a State;
``(2) successfully complete post-graduate training leading to
eligibility for board certification in a specialty;
``(3) serve as a full-time clinical practice employee of the
Veterans Health Administration for 12 months for every $40,000 in
such benefits that the employee receives, but in no case for fewer
than 24 months; and
``(4) except as provided in subsection (b), to begin such
service as a full-time practice employee by not later than 60 days
after completing a residency.
``(b) Fellowship.--In the case of a participant who receives an
accredited fellowship in a medical specialty other than a medical
specialty described in section 7692 of this title, the Secretary, on
written request of the participant, may delay the term of obligated
service under subsection (a) for the participant until after the
participant completes the fellowship, but in no case later than 60 days
after completion of such fellowship.
``(c) Penalty.--(1) An employee who does not complete a period of
obligated service under this section shall owe the Federal Government
an amount determined in accordance with the following formula: A = B
<greek-e> ((T - S) <divide> T)).
``(2) In the formula in paragraph (1):
``(A) `A' is the amount the employee owes the Federal
Government.
``(B) `B' is the sum of all payments to or for the participant
under the Specialty Education Loan Repayment Program.
``(C) `T' is the number of months in the period of obligated
service of the employee.
``(D) `S' is the number of whole months of such period of
obligated service served by the employee.
``Sec. 7697. Relationship to Educational Assistance Program
``Assistance under the Specialty Education Loan Repayment Program
may be in addition to other assistance available to individuals under
the Educational Assistance Program.''.
(b) Conforming and Technical Amendments.--
(1) Conforming amendments.--
(A) Section 7601(a) of title 38, United States Code, is
amended--
(i) in paragraph (4), by striking ``and'';
(ii) in paragraph (5), by striking the period and
inserting ``; and''; and
(iii) by adding at the end the following new paragraph:
``(6) the specialty education loan repayment program provided
for in subchapter VIII of this chapter.''.
(B) Section 7603(a)(1) of title 38, United States Code, is
amended by striking ``or VI'' and inserting ``VI, or VIII''.
(C) Section 7604 of title 38, United States Code, is
amended by striking ``or VI'' each place it appears and
inserting ``VI, or VIII''.
(D) Section 7631 of title 38, United States Code, is
amended--
(i) in subsection (a)(1)--
(I) by striking ``and'' after ``scholarship
amount,''; and
(II) by inserting ``, and the maximum specialty
education loan repayment amount'' after ``reduction
payments amount''; and
(ii) in subsection (b) by adding at the end the
following new paragraph:
``(7) The term `specialty education loan repayment amount' means
the maximum amount of specialty education loan repayment payments
payable to or for a participant in the Department of Veterans Affairs
Specialty Education Loan Repayment Program under subchapter VIII of
this chapter, as specified in section 7694(c)(1) of this title and as
previously adjusted (if at all) in accordance with this section.''.
(E) Section 7632 of title 38, United States Code, is
amended--
(i) in paragraph (1), by striking ``and the Education
Debt Reduction Program'' and inserting ``the Education Debt
Reduction Program, and the Specialty Education Loan
Repayment Program''; and
(ii) in paragraph (4), by striking ``and per
participant in the Education Debt Reduction Program'' and
inserting ``per participant in the Education Debt Reduction
Program, and per participant in the Specialty Education
Loan Repayment Program''.
(2) Table of sections.--The table of sections at the beginning
of chapter 76 of such title is amended by inserting after the items
relating to subchapter VII the following:
``subchapter viii--specialty education loan repayment program
``7691. Establishment.
``7692. Purpose.
``7693.  Eligibility; preferences; covered costs.
``7694. Specialty education loan repayment.
``7695. Choice of location.
``7696. Term of obligated service.
``7697. Relationship to Educational Assistance Program.''.
(c) Needs of the VHA.--In making determinations each year under
section 7692 of title 38, United States Code, as enacted by subsection
(a), the Secretary of Veterans Affairs shall consider the anticipated
needs of the Veterans Health Administration during the period 2 to 6
years in the future.
(d) Preference.--In granting preference under section 7693 of title
38, United States Code, as enacted by subsection (a), the Secretary of
Veterans Affairs shall determine whether a facility of the Department
is underserved based on the criteria developed under section 401 of
this Act.
(e) Offer Deadline.--In the case of an applicant who applies before
receiving a residency match and whom the Secretary of Veterans Affairs
selects for participation in the Specialty Education Loan Repayment
Program established by subsection (a), the Secretary shall offer
participation to the applicant not later than 28 days after--
(1) the applicant matches with a residency in a medical
specialty described in section 7692 of title 38, United States
Code, as enacted by subsection (a); and
(2) such match is published.
(f) Publicity.--The Secretary of Veterans Affairs shall take such
steps as the Secretary determines are appropriate to publicize the
Specialty Education Loan Repayment Program established under subchapter
VIII of chapter 76 of title 38, United States Code, as enacted by
subsection (a).

689159789f437713af850e0864d145c973291b129b7242d5448a8609a19e030a

PROGRAM.
(a) Establishment.--The Secretary of Veterans Affairs, acting
through the Office of Academic Affiliations of the Department of
Veterans Affairs, shall carry out a pilot program under which the
Secretary shall provide funding for the medical education of a total of
18 eligible veterans. Such funding shall be provided for two veterans
enrolled in each covered medical schools in accordance with this
section.
(b) Eligible Veterans.--To be eligible to receive funding for
medical education under this section, a veteran shall--
(1) have been discharged from the Armed Forces not more than 10
years before the date of application for admission to a covered
medical school;
(2) not be entitled to educational assistance under chapter 30,
31, 32, 33, 34, or 35 of title 38, United States Code, or chapter
1606 or 1607 of title 10, United States Code;
(3) apply for admission to a covered medical school for the
entering class of 2019;
(4) indicate on such application for admission that the veteran
would like to be considered for an award of funding under this
section;
(5) meet the minimum admissions criteria for the covered
medical school to which the veteran applies; and
(6) enter into an agreement described in subsection (e).
(c) Award of Funding.--
(1) In general.--Each covered medical school that opts to
participate in the program under this section shall reserve two
seats in the entering class of 2019 for eligible veterans who
receive funding under such program. Such funding shall be awarded
to the two eligible veterans with the highest admissions rankings
for such class at such school.
(2) Amount of funding.--Each eligible veteran who receives
funding under this section shall receive an amount equal to the
actual cost of--
(A) tuition at the covered medical school at which the
veteran enrolls for 4 years;
(B) books, fees, and technical equipment;
(C) fees associated with the National Residency Match
Program;
(D) two away rotations performed during the fourth year at
a Department of Veterans Affairs medical facility; and
(E) a monthly stipend for the 4-year period during which
the veteran is enrolled in medical school in an amount to be
determined by the Secretary.
(3) Distribution of funding.--In the event that two or more
eligible veterans do not apply for admission at one of the covered
medical schools for the entering class of 2019, the Secretary shall
distribute the available funding to eligible veterans who applied
for admission at other covered medical schools.
(d) Agreement.--
(1) Terms of agreement.--Each eligible veteran who accepts
funding for medical education under this section shall enter into
an agreement with the Secretary that provides that the veteran
agrees--
(A) to maintain enrollment and attendance in the medical
school;
(B) while enrolled in such medical school, to maintain an
acceptable level of academic standing (as determined by the
medical school under regulations prescribed by the Secretary);
(C) to complete post-graduate training leading to
eligibility for board certification in a speciality applicable
to the Department of Veterans Affairs, as determined by the
Secretary;
(D) after completion of medical school, to obtain a license
to practice medicine in a State; and
(E) after completion of medical school and post-graduate
training, to serve as a full-time clinical practice employee in
the Veterans Health Administration for a period of 4 years.
(2) Breach of agreement.--If an eligible veteran who accepts
funding under this section breaches the terms of the agreement
described in paragraph (1), the United States shall be entitled to
recover damages in an amount equal to the total amount of such
funding received by the veteran.
(e) Rule of Construction.--Nothing in this section shall be
construed to prevent any covered medical school from accepting more
than two eligible veterans for the entering class of 2019.
(f) Report to Congress.--Not later than December 31, 2020, and
annually thereafter for the subsequent 3 years, the Secretary shall
submit to Congress a report on the pilot program under this section.
Such report shall include the evaluation of the Secretary of the
success of the pilot program, including the number of veterans who
received funding under the program who matriculated and an evaluation
of the academic progress of such veterans.
(g) Covered Medical Schools.--In this section, the term ``covered
medical school'' means any of the following:
(1) The Teague-Cranston medical schools, consisting of--
(A) Texas A&M College of Medicine;
(B) Quillen College of Medicine at East Tennessee State
University;
(C) Boonshoft School of Medicine at Wright State
University;
(D) Joan C. Edwards School of Medicine at Marshall
University; and
(E) University of South Carolina School of Medicine.
(2) Charles R Drew University of Medicine and Science.
(3) Howard University College of Medicine.
(4) Meharry Medical College.
(5) Morehouse School of Medicine.

f08dfb9464304f0ea9a12a6f7fd86072688b31538c552e9b623291fd2d24989b

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

0f97b16842c78a82651ccafa5b34c0f12eacd2fa89c3fd905791392d0979527f

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

5a1c7a121caa1ce8c5c078c81284330dc38fecc14e081e6f7dcdc5601b51788c

MEDICAL FACILITIES OF THE DEPARTMENT OF VETERANS AFFAIRS AS
UNDERSERVED FACILITIES AND PLAN TO ADDRESS PROBLEM OF UNDERSERVED
FACILITIES.
(a) In General.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall develop
criteria to designate medical centers, ambulatory care facilities, and
community based outpatient clinics of the Department of Veterans
Affairs as underserved facilities.
(b) Consideration.--Criteria developed under subsection (a) shall
include consideration of the following with respect to a facility:
(1) The ratio of veterans to health care providers of the
Department of Veterans Affairs for a standardized geographic area
surrounding the facility, including a separate ratio for general
practitioners and specialists.
(2) The range of clinical specialties covered by such providers
in such area.
(3) Whether the local community is medically underserved.
(4) The type, number, and age of open consults.
(5) Whether the facility is meeting the wait-time goals of the
Department.
(6) Such other criteria as the Secretary considers important in
determining which facilities are not adequately serving area
veterans.
(c) Analysis of Facilities.--Not less frequently than annually,
directors of Veterans Integrated Service Networks of the Department
shall perform an analysis to determine which facilities within that
Veterans Integrated Service Network qualify as underserved facilities
pursuant to criteria developed under subsection (a).
(d) Annual Plan To Address Underserved Facilities.--
(1) Plan required.--Not later than 1 year after the date of the
enactment of this Act and not less frequently than once each year,
the Secretary shall submit to Congress a plan to address the
problem of underserved facilities of the Department, as designated
pursuant to criteria developed under subsection (a).
(2) Contents.--Each plan submitted under paragraph (1) shall
address the following:
(A) Increasing personnel or temporary personnel assistance,
including mobile deployment teams furnished under section 407
of this Act.
(B) Providing special hiring incentives, including under
the Education Debt Reduction Program under subchapter VII of
chapter 76 of title 38, United States Code, and recruitment,
relocation, and retention incentives.
(C) Using direct hiring authority.
(D) Improving training opportunities for staff.
(E) Such other actions as the Secretary considers
appropriate.

505342abbd52c29670a1aab141741c7ffc8014ed7ab778b49fe742de4982e0d1

UNDERSERVED FACILITIES.
(a) In General.--The Secretary of Veterans Affairs shall carry out
a pilot program to furnish mobile deployment teams of medical personnel
to underserved facilities.
(b) Elements.--In furnishing mobile deployment teams under
subsection (a), the Secretary shall consider the following elements:
(1) The medical positions of greatest need at underserved
facilities.
(2) The size and composition of teams to be deployed.
(3) Such other elements as the Secretary considers necessary
for effective oversight of the program established under subsection
(a).
(c) Use of Annual Analysis.--The Secretary shall use the results of
the annual analysis conducted under section 401(c) of this Act to form
mobile deployment teams under subsection (a) that are composed of the
most needed medical personnel for underserved facilities.
(d) Reporting.--
(1) Progress report.--Not later than 1 year after the date of
the enactment of this Act, the Secretary shall submit a report to
Congress on the implementation of the pilot program under this
section.
(2) Final report.--Not later than the termination of the pilot
program under this section, the Secretary shall submit a final
report to Congress that contains the recommendations of the
Secretary regarding the feasibility and advisability of--
(A) extending or expanding the pilot program; and
(B) making the pilot program (or any aspect thereof)
permanent.
(e) Duration.--The pilot program under this section shall terminate
3 years after the date of the enactment of this Act.
(f) Underserved Facility Defined.--In this section, the term
``underserved facility'' means a medical center, ambulatory care
facility, or community based outpatient clinic of the Department of
Veterans Affairs designated by the Secretary of Veterans Affairs as
underserved pursuant to criteria developed under section 401 of this
Act.

8da0a71b368c7ceade357f5883bd89120a25e9dcfbb8ede12acf5c7371f5e12b

RESIDENCY.
(a) Establishment.--
(1) In general.--Subject to paragraph (5), the Secretary of
Veterans Affairs shall establish a pilot program to establish
medical residency positions authorized under section 301(b)(2) of
the Veterans Access, Choice, and Accountability Act of 2014 (Public
Law 113-146; 38 U.S.C. 7302 note) at covered facilities.
(2) Covered facilities.--For purposes of this section, a
covered facility is any of the following:
(A) A health care facility of the Department of Veterans
Affairs.
(B) A health care facility operated by an Indian tribe or a
tribal organization, as those terms are defined in section 4 of
the Indian Self-Determination and Education Assistance Act (25
U.S.C. 5304).
(C) A health care facility operated by the Indian Health
Service.
(D) A Federally-qualified health center, as defined in
section 1905(l)(2)(B) of the Social Security Act (42 U.S.C.
1396d(l)(2)(B)).
(E) A health care facility operated by the Department of
Defense.
(F) Such other health care facility as the Secretary
considers appropriate for purposes of this section.
(3) Agreements.--To carry out the pilot program under this
section, the Secretary may enter into agreements with entities that
operate covered facilities in which the Secretary places residents
under paragraph (1).
(4) Parameters for location, affiliate sponsor, and duration.--
When determining in which covered facilities to place residents
under paragraph (1), the Secretary shall consider the extent to
which there is a clinical need for providers in an area, as
determined by the following:
(A) The ratio of veterans to health care providers of the
Department for a standardized geographic area surrounding a
facility, including a separate ratio for general practitioners
and specialists.
(B) The range of clinical specialties of providers in
standardized geographic areas surrounding a facility.
(C) Whether the specialty of a provider is included in the
most recent staffing shortage determination of the Department
under section 7412 of title 38, United States Code.
(D) Whether the local community is designated by the
Secretary of Veterans Affairs as underserved pursuant to
criteria developed under section 401 of this Act.
(E) Whether the facility is located in a community that is
designated by the Secretary of Health and Human Services as a
health professional shortage area under section 332 of the
Public Health Service Act (42 U.S.C. 254e).
(F) Whether the facility is located in a rural or remote
area.
(G) Such other criteria as the Secretary considers
important in determining which facilities are not adequately
serving area veterans.
(5) Priority in placements.--During the pilot program under
this section, the Secretary shall place no fewer than 100 residents
in covered facilities--
(A) operated by the Indian Health Service;
(B) operated by an Indian tribe;
(C) operated by a tribal organization; or
(D) located in communities designated by the Secretary as
underserved pursuant to criteria developed under section 401 of
this Act.
(6) Stipends and benefits.--The Secretary may pay stipends and
provide benefits for residents in positions under paragraph (1),
regardless of whether they have been assigned in a Department
facility.
(b) Reimbursement.--If a covered facility establishes a new
residency program in which the Secretary places a resident under the
pilot program, the Secretary shall reimburse that covered facility for
costs of the following:
(1) Curriculum development.
(2) Recruitment and retention of faculty.
(3) Accreditation of the program by the Accreditation Council
for Graduate Medical Education.
(4) The portion of faculty salaries attributable to duties
under an agreement subsection (a)(3).
(5) Expenses relating to educating a resident under the pilot
program.
(c) Reporting.--
(1) In general.--Not later than 1 year after the date of the
enactment of this Act and not less frequently than once each year
thereafter until the termination of the pilot program, the
Secretary shall submit to Congress a report on the implementation
of the pilot program.
(2) Elements.--Each report submitted under paragraph (1) shall
include the following with regard to the immediately preceding
year, and in comparison to the year immediately preceding that
year:
(A) The number of veterans who received care from residents
under the pilot program.
(B) The number of veterans who received care from each
resident per position described in subsection (a)(1) under the
pilot program.
(C) The number of veterans who received care from residents
under the pilot program expressed as a percentage of all
individuals who received care from such residents.
(D) The number of clinical appointments for veterans
conducted by each resident under the pilot program.
(E) The number of clinical appointments for veterans
conducted by residents per position described in subsection
(a)(1) under the pilot program.
(F) The number of clinical appointments for veterans
expressed as a percentage of all clinical appointments
conducted by residents under the pilot program.
(G) The number of positions described in subsection (a)(1)
at each covered facility under the pilot program.
(H) For each position described in subsection (a)(1) in a
residency program affiliated with a health care facility of the
Department, the time a resident under the pilot program spent
training at that facility of the Department, expressed as a
percentage of the total training time for that resident
position.
(I) For each residency program affiliated with a health
care facility of the Department, the time all residents under
the pilot program spent training at that facility of the
Department, expressed as a percentage of the total training
time for those residents.
(J) The time that all residents under the pilot program who
are assigned to programs affiliated with health care facilities
of the Department spent training at facilities of the
Department, expressed as a percentage of the total training
time for those residents.
(K) The cost to the Department of Veterans Affairs under
the pilot program in the year immediately preceding the report
and since the beginning of the pilot program.
(L) The cost to the Department of Veterans Affairs per
resident placed under the pilot program at each covered
facility.
(M) The number of residents under the pilot program hired
by the Secretary to work in the Veterans Health Administration
after completion of residency in the year immediately preceding
the report and since the beginning of the pilot program.
(N) The medical specialties pursued by residents under the
pilot program.
(d) Duration.--The pilot program under this section shall terminate
on August 7, 2024.

04ab2bdf4d75bb159b4b358ae66a8ace1c63f60bcd595aa4e2382bd040c26b13

TO CERTAIN HIGH-LEVEL EMPLOYEES OF THE DEPARTMENT.
(a) In General.--Chapter 7 of title 38, United States Code, is
amended by adding at the end the following new section:
``Sec. 726. Annual report on performance awards and bonuses awarded to
certain high-level employees
``(a) In General.--Not later than 100 days after the end of each
fiscal year, the Secretary shall submit to the appropriate committees
of Congress a report that contains, for the most recent fiscal year
ending before the submittal of the report, a description of all
performance awards or bonuses awarded to each of the following:
``(1) Regional Office Director of the Department.
``(2) Director of a Medical Center of the Department.
``(3) Director of a Veterans Integrated Service Network.
``(4) Senior executive of the Department.
``(b) Elements.--Each report submitted under subsection (a) shall
include the following with respect to each performance award or bonus
awarded to an individual described in such subsection:
``(1) The amount of each award or bonus.
``(2) The job title of the individual awarded the award or
bonus.
``(3) The location where the individual awarded the award or
bonus works.
``(c) Definitions.--In this section:
``(1) The term `appropriate committees of Congress' means the
Committees on Veterans' Affairs and Appropriations of the Senate
and House of Representatives.
``(2) The term `senior executive' means--
``(A) a career appointee; or
``(B) an individual--
``(i) in an administrative or executive position; and
``(ii) appointed under section 7306(a) or section
7401(1) of this title.
``(3) The term `career appointee' has the meaning given that
term in section 3132(a) of title 5, United States Code.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item relating to section
725 the following new item:
``726. Annual report on performance awards and bonuses awarded to
certain high-level employees.''.

8fdb43f2b92f52153ca69bbeacfe7a1a43503cebcd5ac2f53f980217a0736521

(a) Inclusion as Physician.--
(1) In general.--Subchapter I of chapter 74 is amended by
adding at the end the following new section:
``Sec. 7413. Treatment of podiatrists; clinical oversight standards
``(a) Podiatrists.--Except as provided by subsection (b), a doctor
of podiatric medicine who is appointed as a podiatrist under section
7401(1) of this title is eligible for any supervisory position in the
Veterans Health Administration to the same degree that a physician
appointed under such section is eligible for the position.
``(b) Establishment of Clinical Oversight Standards.--The
Secretary, in consultation with appropriate stakeholders, shall
establish standards to ensure that specialists appointed in the
Veterans Health Administration to supervisory positions do not provide
direct clinical oversight for purposes of peer review or practice
evaluation for providers of other clinical specialties.''.
(2) Clerical amendment.--The table of sections at the beginning
of chapter 74 is amended by inserting after the item relating to
section 7412 the following new item:
``7413. Treatment of podiatrists; clinical oversight standards.''.
(b) Modification and Clarification of Pay Grade.--
(1) Grade.--The list in section 7404(b) of such title is
amended--
(A) by striking ``PHYSICIAN AND DENTIST SCHEDULE'' and
inserting ``PHYSICIAN AND SURGEON (MD/DO), PODIATRIC SURGEON
(DPM), AND DENTIST AND ORAL SURGEON (DDS, DMD) SCHEDULE'';
(B) by striking ``Physician grade'' and inserting
``Physician and surgeon grade''; and
(C) by striking ``PODIATRIST, CHIROPRACTOR, AND'' and
inserting ``CHIROPRACTOR AND''.
(2) Application.--The amendments made by paragraph (1) shall
apply with respect to a pay period of the Department of Veterans
Affairs beginning on or after the date that is 30 days after the
date of the enactment of this Act.

4672afceb185f23c3975f52390046c8cbc83f68fc0a12d83d87723f52591ce6d

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

5e79f168abf20a32876b2355158aacc4da5d72aea180b360756c7ac16f5f80b0

OF THE DEPARTMENT OF VETERANS AFFAIRS.
(a) Authorization.--The Secretary of Veterans Affairs may carry out
the following major medical facility project, to be carried out in an
amount not to exceed the amount specified for that project:
Construction of the new East Bay Community Based Outpatient Clinic and
all associated site work, utilities, parking, and landscaping,
construction of the Central Valley Engineering and Logistics support
facility, and enhanced flood plain mitigation at the Central Valley and
East Bay Community Based Outpatient Clinics as part of the realignment
of medical facilities in Livermore, California, in an amount not to
exceed $117,300,000.
(b) Authorization of Appropriations for Construction.--There is
authorized to be appropriated to the Secretary of Veterans Affairs for
fiscal year 2018 or the year in which funds are appropriated for the
Construction, Major Projects account, $117,300,000 for the project
authorized in subsection (a).
(c) Submittal of Information.--Not later than 90 days after the
date of the enactment of this Act, for the project authorized in
subsection (a), the Secretary of Veterans Affairs shall submit to the
Committee on Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives the following
information:
(1) A line item accounting of expenditures relating to
construction management carried out by the Department of Veterans
Affairs for such project.
(2) The future amounts that are budgeted to be obligated for
construction management carried out by the Department for such
project.
(3) A justification for the expenditures described in paragraph
(1) and the future amounts described in paragraph (2).
(4) Any agreement entered into by the Secretary regarding a
non-Department of Veterans Affairs Federal entity providing
management services relating to such project, including
reimbursement agreements and the costs to the Department for such
services.

640a08225c2686dd0494901e24d832d67b5fd71c147cc5fc60eee5f4b0d96ec7

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

b0674d4b681e9e088e7b3ac36b5a242d5f1e6181f97a00e99da4e15589134493

ALIGNED CARE TEAM SETTINGS WITHIN MEDICAL CENTERS OF DEPARTMENT
OF VETERANS AFFAIRS.
(a) Program Required.--The Secretary of Veterans Affairs shall
carry out a program to establish not fewer than two peer specialists in
patient aligned care teams at medical centers of the Department of
Veterans Affairs to promote the use and integration of services for
mental health, substance use disorder, and behavioral health in a
primary care setting.
(b) Timeframe for Establishment of Program.--The Secretary shall
carry out the program at medical centers of the Department as follows:
(1) Not later than May 31, 2019, at not fewer than 15 medical
centers of the Department.
(2) Not later than May 31, 2020, at not fewer than 30 medical
centers of the Department.
(c) Selection of Locations.--
(1) In general.--The Secretary shall select medical centers for
the program as follows:
(A) Not fewer than five shall be medical centers of the
Department that are designated by the Secretary as polytrauma
centers.
(B) Not fewer than 10 shall be medical centers of the
Department that are not designated by the Secretary as
polytrauma centers.
(2) Considerations.--In selecting medical centers for the
program under paragraph (1), the Secretary shall consider the
feasibility and advisability of selecting medical centers in the
following areas:
(A) Rural areas and other areas that are underserved by the
Department.
(B) Areas that are not in close proximity to an active duty
military installation.
(C) Areas representing different geographic locations, such
as census tracts established by the Bureau of the Census.
(d) Gender-Specific Services.--In carrying out the program at each
location selected under subsection (c), the Secretary shall ensure
that--
(1) the needs of female veterans are specifically considered
and addressed; and
(2) female peer specialists are made available to female
veterans who are treated at each location.
(e) Engagement With Community Providers.--At each location selected
under subsection (c), the Secretary shall consider ways in which peer
specialists can conduct outreach to health care providers in the
community who are known to be serving veterans to engage with those
providers and veterans served by those providers.
(f) Reports.--
(1) Periodic reports.--
(A) In general.--Not later than 180 days after the date of
the enactment of this Act, and not less frequently than once
every 180 days thereafter until the Secretary determines that
the program is being carried out at the last location to be
selected under subsection (c), the Secretary shall submit to
Congress a report on the program.
(B) Elements.--Each report required by subparagraph (A)
shall, with respect to the 180-day period preceding the
submittal of the report, include the following:
(i) The findings and conclusions of the Secretary with
respect to the program.
(ii) An assessment of the benefits of the program to
veterans and family members of veterans.
(iii) An assessment of the effectiveness of peer
specialists in engaging under subsection (e) with health
care providers in the community and veterans served by
those providers.
(2) Final report.--Not later than 180 days after the Secretary
determines that the program is being carried out at the last
location to be selected under subsection (c), the Secretary shall
submit to Congress a report detailing the recommendations of the
Secretary as to the feasibility and advisability of expanding the
program to additional locations.

7f95dfdfdd0032685ad476c63e5ed96f375ae6217c3712fee9bfd85b7b87e79b

PROGRAM.
(a) In General.--The Secretary of Veterans Affairs shall carry out
a 2-year pilot program under which the Secretary shall increase the use
of medical scribes at Department of Veterans Affairs medical centers.
(b) Locations.--The Secretary shall carry out the pilot program at
the 10 medical centers of the Department as follows:
(1) At least four such medical centers located in rural areas.
(2) At least four such medical centers located in urban areas.
(3) Two such medical centers located in areas with need for
increased access or increased efficiency, as determine by the
Secretary.
(c) Medical Scribes.--
(1) Hiring.--Under the pilot program the Secretary shall--
(A) hire 20 new Department of Veterans Affairs term
employees as medical scribes; and
(B) seek to enter into contracts with appropriate entities
for the employment of 20 additional medical scribes.
(2) Distribution.--The Secretary shall assign four medical
scribes to each of the 10 medical centers of the Department where
the Secretary carries out the pilot program as follows:
(A) Two scribes shall be assigned to each of two
physicians.
(B) Thirty percent of the scribes shall be employed in the
provision of emergency care.
(C) Seventy percent of the scribes shall be employed in the
provision of speciality care in specialties with the longest
patient wait times or lowest efficiency ratings, as determined
by the Secretary.
(d) Reports.--
(1) Reports to congress.--Not later than 180 days after the
commencement of the pilot program required under this section, and
every 180 days thereafter for the duration of the pilot program,
the Secretary of Veterans Affairs shall submit to Congress a report
on the pilot program. Each such report shall include each of the
following:
(A) A separate analysis of each the following with respect
to medical scribes employed by the Department of Veterans
Affairs and medical scribes performing Department of Veterans
Affairs functions under a contract:
(i) Provider efficiency.
(ii) Patient satisfaction.
(iii) Average wait time.
(iv) The number of patients seen per day by each
physician or practitioner.
(v) The amount of time required to hire and train an
employee to perform medical scribe functions under the
pilot program.
(B) Metrics and data for analyzing the effects of the pilot
program, including an evaluation of the each of the elements
under clauses (i) through (iv) of subparagraph (A) at medical
centers who employed scribes under the pilot program for an
appropriate period preceding the hiring of such scribes.
(2) Comptroller general report.--Not later than 90 days after
the termination of the pilot program under this section, the
Comptroller General of the United States shall submit to Congress a
report on the pilot program. Such report shall include a comparison
of the pilot program with similar programs carried out in the
private sector.
(e) Definitions.--In this section:
(1) The term ``medical scribe'' means an unlicensed individual
hired to enter information into the electronic health record or
chart at the direction of a physician or licensed independent
practitioner whose responsibilities include the following:
(A) Assisting the physician or practitioner in navigating
the electronic health record.
(B) Responding to various messages as directed by the
physician or practitioner.
(C) Entering information into the electronic health record,
as directed by the physician or practitioner.
(2) The terms ``urban'' and ``rural'' have the meanings given
such terms under the rural-urban commuting codes developed by the
Secretary of Agriculture and the Secretary of Health and Human
Services.
(f) Funding.--The pilot program under this section shall be carried
out using amounts otherwise authorized to be appropriated for the
Department of Veterans Affairs. No additional amounts are authorized to
be appropriated to carry out such program.

66ea978560f8f2a34625d78c77edac18959d67afa849bc04521e95f571f960b6

LOANS GUARANTEED BY SECRETARY OF VETERANS AFFAIRS.
Section 3729(b)(2) of title 38, United States Code, is amended by
striking ``2027'' each place it appears and inserting ``2028''.

ade7c208eb3239e68b57fcc178866d28abfab1dd954f2c517a0d26be2df9b5bf

DEPARTMENT OF VETERANS AFFAIRS FOR CERTAIN VETERANS COVERED BY
MEDICAID PLANS FOR SERVICES FURNISHED BY NURSING FACILITIES.
Section 5503(d)(7) of title 38, United States Code, is amended by
striking ``September 30, 2027'' and inserting ``September 30, 2028''.

eb5486ba3a2454794698d3035686b78e8bd0e198cc8660019368e7fbfec3c684

John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018 — S. 2372

Other Sections

TITLE I

TITLE II

TITLE III

TITLE IV

TITLE V

Want the full experience?