[113th Congress Public Law 146]
[From the U.S. Government Publishing Office]
[[Page 1753]]
VETERANS ACCESS, CHOICE, AND ACCOUNTABILITY ACT OF 2014
[[Page 128 STAT. 1754]]
Public Law 113-146
113th Congress
An Act
To improve the access of veterans to medical services from the
Department of Veterans Affairs, and for other purposes. <<NOTE: Aug. 7,
2014 - [H.R. 3230]>>
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled, <<NOTE: Veterans Access,
Choice, and Accountability Act of 2014. 38 USC 101 note.>>
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Veterans Access,
Choice, and Accountability Act of 2014''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Definitions.
TITLE I--IMPROVEMENT OF ACCESS TO CARE FROM NON-DEPARTMENT OF VETERANS
AFFAIRS PROVIDERS
Sec. 101. Expanded availability of hospital care and medical services
for veterans through the use of agreements with non-
Department of Veterans Affairs entities.
Sec. 102. Enhancement of collaboration between Department of Veterans
Affairs and Indian Health Service.
Sec. 103. Enhancement of collaboration between Department of Veterans
Affairs and Native Hawaiian health care systems.
Sec. 104. Reauthorization and modification of pilot program of enhanced
contract care authority for health care needs of veterans.
Sec. 105. Prompt payment by Department of Veterans Affairs.
Sec. 106. Transfer of authority for payments for hospital care, medical
services, and other health care from non-Department of
Veterans Affairs providers to the chief business office of
the Veterans Health Administration.
TITLE II--HEALTH CARE ADMINISTRATIVE MATTERS
Sec. 201. Independent assessment of the health care delivery systems and
management processes of the Department of Veterans Affairs.
Sec. 202. Commission on Care.
Sec. 203. Technology task force on review of scheduling system and
software of the Department of Veterans Affairs.
Sec. 204. Improvement of access of veterans to mobile vet centers and
mobile medical centers of the Department of Veterans Affairs.
Sec. 205. Improved performance metrics for health care provided by
Department of Veterans Affairs.
Sec. 206. Improved transparency concerning health care provided by
Department of Veterans Affairs.
Sec. 207. Information for veterans on the credentials of Department of
Veterans Affairs physicians.
Sec. 208. Information in annual budget of the President on hospital care
and medical services furnished through expanded use of
contracts for such care.
Sec. 209. Prohibition on falsification of data concerning wait times and
quality measures at Department of Veterans Affairs.
TITLE III--HEALTH CARE STAFFING, RECRUITMENT, AND TRAINING MATTERS
Sec. 301. Treatment of staffing shortage and biennial report on staffing
of medical facilities of the Department of Veterans Affairs.
[[Page 128 STAT. 1755]]
Sec. 302. Extension and modification of certain programs within the
Department of Veterans Affairs Health Professionals
Educational Assistance Program.
Sec. 303. Clinic management training for employees at medical facilities
of the Department of Veterans Affairs.
TITLE IV--HEALTH CARE RELATED TO SEXUAL TRAUMA
Sec. 401. Expansion of eligibility for sexual trauma counseling and
treatment to veterans on inactive duty training.
Sec. 402. Provision of counseling and treatment for sexual trauma by the
Department of Veterans Affairs to members of the Armed
Forces.
Sec. 403. Reports on military sexual trauma.
TITLE V--OTHER HEALTH CARE MATTERS
Sec. 501. Extension of pilot program on assisted living services for
veterans with traumatic brain injury.
TITLE VI--MAJOR MEDICAL FACILITY LEASES
Sec. 601. Authorization of major medical facility leases.
Sec. 602. Budgetary treatment of Department of Veterans Affairs major
medical facilities leases.
TITLE VII--OTHER VETERANS MATTERS
Sec. 701. Expansion of Marine Gunnery Sergeant John David Fry
Scholarship.
Sec. 702. Approval of courses of education provided by public
institutions of higher learning for purposes of All-Volunteer
Force Educational Assistance Program and Post-9/11
Educational Assistance conditional on in-State tuition rate
for veterans.
Sec. 703. Extension of reduction in amount of pension furnished by
Department of Veterans Affairs for certain veterans covered
by Medicaid plans for services furnished by nursing
facilities.
Sec. 704. Extension of requirement for collection of fees for housing
loans guaranteed by Secretary of Veterans Affairs.
Sec. 705. Limitation on awards and bonuses paid to employees of
Department of Veterans Affairs.
Sec. 706. Extension of authority to use income information.
Sec. 707. Removal of senior executives of the Department of Veterans
Affairs for performance or misconduct.
TITLE VIII--OTHER MATTERS
Sec. 801. Appropriation of amounts.
Sec. 802. Veterans Choice Fund.
Sec. 803. Emergency designations.
SEC. 2. <<NOTE: 38 USC 1701 note.>> DEFINITIONS.
In this Act:
(1) The term ``facility of the Department'' has the meaning
given the term ``facilities of the Department'' in section 1701
of title 38, United States Code.
(2) The terms ``hospital care'' and ``medical services''
have the meanings given such terms in section 1701 of title 38,
United States Code.
TITLE I--IMPROVEMENT OF <<NOTE: 38 USC 1701 note.>> ACCESS TO CARE FROM
NON-DEPARTMENT OF VETERANS AFFAIRS PROVIDERS
SEC. 101. EXPANDED AVAILABILITY OF HOSPITAL CARE AND MEDICAL
SERVICES FOR VETERANS THROUGH THE USE OF
AGREEMENTS WITH NON-DEPARTMENT OF VETERANS
AFFAIRS ENTITIES.
(a) Expansion of Available Care and Services.--
(1) Furnishing of care.--
(A) In general.--Hospital care and medical services
under chapter 17 of title 38, United States Code, shall
[[Page 128 STAT. 1756]]
be furnished to an eligible veteran described in
subsection (b), at the election of such veteran, through
agreements authorized under subsection (d), or any other
law administered by the Secretary of Veterans Affairs,
with entities specified in subparagraph (B) for the
furnishing of such care and services to veterans.
(B) Entities specified.--The entities specified in
this subparagraph are the following:
(i) Any health care provider that is
participating in the Medicare program under title
XVIII of the Social Security Act (42 U.S.C. 1395
et seq.), including any physician furnishing
services under such program.
(ii) Any Federally-qualified health center (as
defined in section 1905(l)(2)(B) of the Social
Security Act (42 U.S.C. 1396d(l)(2)(B))).
(iii) The Department of Defense.
(iv) The Indian Health Service.
(2) Choice of provider.--An eligible veteran who makes an
election under subsection (c) to receive hospital care or
medical services under this section may select a provider of
such care or services from among the entities specified in
paragraph (1)(B) that are accessible to the veteran.
(3) Coordination of care and services.--The Secretary shall
coordinate, through the Non-VA Care Coordination Program of the
Department of Veterans Affairs, the furnishing of care and
services under this section to eligible veterans, including by
ensuring that an eligible veteran receives an appointment for
such care and services within the wait-time goals of the
Veterans Health Administration for the furnishing of hospital
care and medical services.
(b) Eligible Veterans.--A veteran is an eligible veteran for
purposes of this section if--
(1)(A) <<NOTE: Eligibility date.>> as of August 1, 2014,
the veteran is enrolled in the patient enrollment system of the
Department of Veterans Affairs established and operated under
section 1705 of title 38, United States Code, including any such
veteran who has not received hospital care or medical services
from the Department and has contacted the Department seeking an
initial appointment from the Department for the receipt of such
care or services; or
(B) the veteran is eligible for hospital care and medical
services under section 1710(e)(1)(D) of such title and is a
veteran described in section 1710(e)(3) of such title; and
(2) the veteran--
(A) attempts, or has attempted, to schedule an
appointment for the receipt of hospital care or medical
services under chapter 17 of title 38, United States
Code, but is unable to schedule an appointment within
the wait-time goals of the Veterans Health
Administration for the furnishing of such care or
services;
(B) resides more than 40 miles from the medical
facility of the Department, including a community-based
outpatient clinic, that is closest to the residence of
the veteran;
(C) resides--
(i) in a State without a medical facility of
the Department that provides--
(I) hospital care;
[[Page 128 STAT. 1757]]
(II) emergency medical services; and
(III) surgical care rated by the
Secretary as having a surgical
complexity of standard; and
(ii) more than 20 miles from a medical
facility of the Department described in clause
(i); or
(D)(i) resides in a location, other than a location
in Guam, American Samoa, or the Republic of the
Philippines, that is 40 miles or less from a medical
facility of the Department, including a community-based
outpatient clinic; and
(ii)(I) is required to travel by air, boat, or ferry
to reach each medical facility described in clause (i)
that is 40 miles or less from the residence of the
veteran; or
(II) faces an unusual or excessive burden in
accessing each medical facility described in clause (i)
that is 40 miles or less from the residence of the
veteran due to geographical challenges, as determined by
the Secretary.
(c) Election and Authorization.--
(1) In general.--In the case of an eligible veteran
described in subsection (b)(2)(A), the Secretary shall, at the
election of the eligible veteran--
(A) place such eligible veteran on an electronic
waiting list described in paragraph (2) for an
appointment for hospital care or medical services the
veteran has elected to receive under this section; or
(B)(i) authorize that such care or services be
furnished to the eligible veteran under this section for
a period of time specified by the Secretary; and
(ii) <<NOTE: Notification.>> notify the eligible
veteran by the most effective means available, including
electronic communication or notification in writing,
describing the care or services the eligible veteran is
eligible to receive under this section.
(2) Electronic waiting list.--The electronic waiting list
described in this paragraph shall be maintained by the
Department and allow access by each eligible veteran via
www.myhealth.va.gov or any successor website for the following
purposes:
(A) To determine the place of such eligible veteran
on the waiting list.
(B) To determine the average length of time an
individual spends on the waiting list, disaggregated by
medical facility of the Department and type of care or
service needed, for purposes of allowing such eligible
veteran to make an informed election under paragraph
(1).
(d) Care and Services Through Agreements.--
(1) Agreements.--
(A) In general.--The Secretary shall enter into
agreements for furnishing care and services to eligible
veterans under this section with entities specified in
subsection (a)(1)(B).
(B) Agreement defined.--In this paragraph, the term
``agreement'' includes contracts, intergovernmental
agreements, and provider agreements, as appropriate.
(2) Rates and reimbursement.--
[[Page 128 STAT. 1758]]
(A) In general.--In entering into an agreement under
paragraph (1) with an entity specified in subsection
(a)(1)(B), the Secretary shall--
(i) negotiate rates for the furnishing of care
and services under this section; and
(ii) reimburse the entity for such care and
services at the rates negotiated pursuant to
clause (i) as provided in such agreement.
(B) Limit on rates.--
(i) In general.--Except as provided in clause
(ii), rates negotiated under subparagraph (A)(i)
shall not be more than the rates paid by the
United States to a provider of services (as
defined in section 1861(u) of the Social Security
Act (42 U.S.C. 1395x(u))) or a supplier (as
defined in section 1861(d) of such Act (42 U.S.C.
1395x(d))) under the Medicare program under title
XVIII of the Social Security Act (42 U.S.C. 1395
et seq.) for the same care or services.
(ii) Exception.--
(I) In general.--The Secretary may
negotiate a rate that is more than the
rate paid by the United States as
described in clause (i) with respect to
the furnishing of care or services under
this section to an eligible veteran who
resides in a highly rural area.
(II) Highly rural area defined.--In
this clause, the term ``highly rural
area'' means an area located in a county
that has fewer than seven individuals
residing in that county per square mile.
(C) Limit on collection.--For the furnishing of care
or services pursuant to an agreement under paragraph
(1), an entity specified in subsection (a)(1)(B) may not
collect any amount that is greater than the rate
negotiated pursuant to subparagraph (A)(i).
(3) Certain procedures.--
(A) In general.--In entering into an agreement under
paragraph (1) with an entity described in subparagraph
(B), the Secretary may use the procedures, including
those procedures relating to reimbursement, available
for entering into provider agreements under section
1866(a) of the Social Security Act (42 U.S.C. 1395cc(a))
and participation agreements under section 1842(h) of
such Act (42 U.S.C. 1395u(h)). During the period in
which such entity furnishes care or services pursuant to
this section, such entity may not be treated as a
Federal contractor or subcontractor by the Office of
Federal Contract Compliance Programs of the Department
of Labor by virtue of furnishing such care or services.
(B) Entities described.--The entities described in
this subparagraph are the following:
(i) In the case of the Medicare program, any
provider of services that has entered into a
provider agreement under section 1866(a) of the
Social Security Act (42 U.S.C. 1395cc(a)) and any
physician or other supplier who has entered into a
participation agreement under section 1842(h) of
such Act (42 U.S.C. 1395u(h)); and
[[Page 128 STAT. 1759]]
(ii) In the case of the Medicaid program, any
provider participating under a State plan under
title XIX of such Act (42 U.S.C. 1396 et seq.).
(4) Information on policies and procedures.--The Secretary
shall provide to any entity with which the Secretary has entered
into an agreement under paragraph (1) the following:
(A) Information on applicable policies and
procedures for submitting bills or claims for authorized
care or services furnished to eligible veterans under
this section.
(B) Access to a telephone hotline maintained by the
Department that such entity may call for information on
the following:
(i) Procedures for furnishing care and
services under this section.
(ii) Procedures for submitting bills or claims
for authorized care and services furnished to
eligible veterans under this section and being
reimbursed for furnishing such care and services.
(iii) Whether particular care or services
under this section are authorized, and the
procedures for authorization of such care or
services.
(e) Other Health-Care Plan.--
(1) Submittal of information to secretary.--Before receiving
hospital care or medical services under this section, an
eligible veteran shall provide to the Secretary information on
any health-care plan described in paragraph (4) under which the
eligible veteran is covered.
(2) Disclosure of information to non-department entity.--
Notwithstanding section 5701 of title 38, United States Code,
for purposes of furnishing hospital care or medical services to
an eligible veteran under this section, the Secretary shall
disclose to the entity specified in paragraph (1)(B) of
subsection (a) with which the Secretary has entered into an
agreement described in such subsection--
(A) whether the eligible veteran is covered under a
health-care plan described in paragraph (4); and
(B) whether the hospital care or medical services
sought by the eligible veteran is for a medical
condition that is related to a non-service-connected
disability described in paragraph (3)(C).
(3) Care for which the department is secondarily
responsible.--
(A) In general.--If an eligible veteran is covered
under a health-care plan described in paragraph (4) and
receives hospital care or medical services for a non-
service-connected disability described in subparagraph
(C), such health-care plan shall be primarily
responsible for paying for such care or services, to the
extent such care or services is covered by such health-
care plan, and the Secretary shall be secondarily
responsible for paying for such care or services in
accordance with subparagraph (B)(ii).
(B) Responsibility for costs of care.--In a case in
which the Secretary is secondarily responsible for
paying for hospital care or medical services as
described in subparagraph (A)--
[[Page 128 STAT. 1760]]
(i) the health care provider that furnishes
such care or services pursuant to an agreement
described in subsection (a) shall be responsible
for seeking reimbursement for the cost of such
care or services from the health-care plan
described in paragraph (4) under which the
eligible veteran is covered; and
(ii) the Secretary shall be responsible for
promptly paying only the amount that is not
covered by such health-care plan, except that such
responsibility for payment may not exceed the rate
determined for such care or services pursuant to
subsection (d)(2).
(C) Non-service-connected disability described.--A
non-service-connected disability described in this
subsection is a non-service-connected disability (as
defined in section 101 of title 38, United States
Code)--
(i) that is incurred incident to a veteran's
employment and that is covered under a workers'
compensation law or plan that provides for payment
for the cost of health care and services provided
to the veteran by reason of the disability;
(ii) that is incurred as the result of a motor
vehicle accident to which applies a State law that
requires the owners or operators of motor vehicles
registered in that State to have in force
automobile accident reparations insurance;
(iii) that is incurred as the result of a
crime of personal violence that occurred in a
State, or a political subdivision of a State, in
which a person injured as the result of such a
crime is entitled to receive health care and
services at such State's or subdivision's expense
for personal injuries suffered as the result of
such crime;
(iv) that is incurred by a veteran--
(I) who does not have a service-
connected disability; and
(II) who is entitled to care (or
payment of the expenses of care) under a
health-care plan; or
(v) for which care and services are furnished
under this section to a veteran who--
(I) has a service-connected
disability; and
(II) is entitled to care (or payment
of the expenses of care) under a health-
care plan.
(4) Health-care plan.--A health-care plan described in this
paragraph--
(A) is an insurance policy or contract, medical or
hospital service agreement, membership or subscription
contract, or similar arrangement not administered by the
Secretary of Veterans Affairs, under which health
services for individuals are provided or the expenses of
such services are paid; and
(B) does not include any such policy, contract,
agreement, or similar arrangement pursuant to title
XVIII or XIX of the Social Security Act (42 U.S.C. 1395
et seq.) or chapter 55 of title 10, United States Code.
(f) Veterans Choice Card.--
[[Page 128 STAT. 1761]]
(1) <<NOTE: Deadline.>> In general.--For purposes of
receiving care and services under this section, the Secretary
shall, not later than 90 days after the date of the enactment of
this Act, issue to each veteran described in subsection (b)(1) a
card that may be presented to a health care provider to
facilitate the receipt of care or services under this section.
(2) Name of card.--Each card issued under paragraph (1)
shall be known as a ``Veterans Choice Card''.
(3) Details of card.--Each Veterans Choice Card issued to a
veteran under paragraph (1) shall include the following:
(A) The name of the veteran.
(B) An identification number for the veteran that is
not the social security number of the veteran.
(C) The contact information of an appropriate office
of the Department for health care providers to confirm
that care or services under this section are authorized
for the veteran.
(D) Contact information and other relevant
information for the submittal of claims or bills for the
furnishing of care or services under this section.
(E) The following statement: ``This card is for
qualifying medical care outside the Department of
Veterans Affairs. Please call the Department of Veterans
Affairs phone number specified on this card to ensure
that treatment has been authorized.''.
(4) Information on use of card.--Upon issuing a Veterans
Choice Card to a veteran, the Secretary shall provide the
veteran with information clearly stating the circumstances under
which the veteran may be eligible for care or services under
this section.
(g) Information on Availability of Care.--The Secretary shall
provide information to a veteran about the availability of care and
services under this section in the following circumstances:
(1) In the case of a veteran described in subsection
(b)(1)(B), when the veteran enrolls in the patient enrollment
system of the Department under section 1705 of title 38, United
States Code.
(2) When the veteran attempts to schedule an appointment for
the receipt of hospital care or medical services from the
Department but is unable to schedule an appointment within the
wait-time goals of the Veterans Health Administration for the
furnishing of such care or services.
(3) When the veteran becomes eligible for hospital care or
medical services under this section under subparagraph (B), (C),
or (D) of subsection (b)(2).
(h) <<NOTE: Time period.>> Follow-Up Care.--In carrying out this
section, the Secretary shall ensure that, at the election of an eligible
veteran who receives hospital care or medical services from a health
care provider in an episode of care under this section, the veteran
receives such hospital care and medical services from such health care
provider through the completion of the episode of care (but for a period
not exceeding 60 days), including all specialty and ancillary services
deemed necessary as part of the treatment recommended in the course of
such hospital care or medical services.
(i) Providers.--To be eligible to furnish care or services under
this section, a health care provider must--
[[Page 128 STAT. 1762]]
(1) maintain at least the same or similar credentials and
licenses as those credentials and licenses that are required of
health care providers of the Department, as determined by the
Secretary for purposes of this section; and
(2) submit, not less frequently than once each year during
the period in which the Secretary is authorized to carry out
this section pursuant to subsection (p), verification of such
licenses and credentials maintained by such health care
provider.
(j) Cost-Sharing.--
(1) <<NOTE: Requirement.>> In general.--The Secretary shall
require an eligible veteran to pay a copayment for the receipt
of care or services under this section only if such eligible
veteran would be required to pay a copayment for the receipt of
such care or services at a medical facility of the Department or
from a health care provider of the Department pursuant to
chapter 17 of title 38, United States Code.
(2) Limitation.--The amount of a copayment charged under
paragraph (1) may not exceed the amount of the copayment that
would be payable by such eligible veteran for the receipt of
such care or services at a medical facility of the Department or
from a health care provider of the Department pursuant to
chapter 17 of title 38, United States Code.
(3) Collection of copayment.--A health care provider that
furnishes care or services to an eligible veteran under this
section shall collect the copayment required under paragraph (1)
from such eligible veteran at the time of furnishing such care
or services.
(k) Claims Processing System.--
(1) In general.--The Secretary shall provide for an
efficient nationwide system for processing and paying bills or
claims for authorized care and services furnished to eligible
veterans under this section.
(2) <<NOTE: Deadline.>> Regulations.--Not later than 90
days after the date of the enactment of this Act, the Secretary
of Veterans Affairs shall prescribe regulations for the
implementation of such system.
(3) Oversight.--The Chief Business Office of the Veterans
Health Administration shall oversee the implementation and
maintenance of such system.
(4) Accuracy of payment.--
(A) In general.--The Secretary shall ensure that
such system meets such goals for accuracy of payment as
the Secretary shall specify for purposes of this
section.
(B) Quarterly report.--
(i) In general.--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 quarterly report on the
accuracy of such system.
(ii) Elements.--Each report required by clause
(i) shall include the following:
(I) A description of the goals for
accuracy for such system specified by
the Secretary under subparagraph (A).
[[Page 128 STAT. 1763]]
(II) An assessment of the success of
the Department in meeting such goals
during the quarter covered by the
report.
(iii) Deadline.--The Secretary shall submit
each report required by clause (i) not later than
20 days after the end of the quarter covered by
the report.
(l) Medical Records.--
(1) In general.--The Secretary shall ensure that any health
care provider that furnishes care or services under this section
to an eligible veteran submits to the Department any medical
record related to the care or services provided to such eligible
veteran by such health care provider for inclusion in the
electronic medical record of such eligible veteran maintained by
the Department upon the completion of the provision of such care
or services to such eligible veteran.
(2) Electronic format.--Any medical record submitted to the
Department under paragraph (1) shall, to the extent possible, be
in an electronic format.
(m) Tracking of Missed Appointments.--The Secretary shall implement
a mechanism to track any missed appointments for care or services under
this section by eligible veterans to ensure that the Department does not
pay for such care or services that were not furnished to an eligible
veteran.
(n) <<NOTE: Deadline. Regulations. Federal Register, publication.>>
Implementation.--Not later than 90 days after the date of the enactment
of this Act, the Secretary shall prescribe interim final regulations on
the implementation of this section and publish such regulations in the
Federal Register.
(o) <<NOTE: Determination.>> Inspector General Report.--Not later
than 30 days after the date on which the Secretary determines that 75
percent of the amounts deposited in the Veterans Choice Fund established
by section 802 have been exhausted, the Inspector General of the
Department shall submit to the Secretary a report on the results of an
audit of the care and services furnished under this section to ensure
the accuracy and timeliness of payments by the Department for the cost
of such care and services, including any findings and recommendations of
the Inspector General.
(p) Authority To Furnish Care and Services.--
(1) In general.--The Secretary may not use the authority
under this section to furnish care and services after the date
specified in paragraph (2).
(2) Date specified.--The date specified in this paragraph is
the date on which the Secretary has exhausted all amounts
deposited in the Veterans Choice Fund established by section
802, or the date that is 3 years after the date of the enactment
of this Act, whichever occurs first.
(3) <<NOTE: Federal Register, publication. Web
posting. Public information. Deadline.>> Publication.--The
Secretary shall publish such date in the Federal Register and on
an Internet website of the Department available to the public
not later than 30 days before such date.
(q) Reports.--
(1) Initial report.--Not later than 90 days after the
publication of the interim final regulations under subsection
(n), 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 furnishing of care
and services under this section that includes the following:
[[Page 128 STAT. 1764]]
(A) The number of eligible veterans who have
received care or services under this section.
(B) A description of the types of care and services
furnished to eligible veterans under this section.
(2) <<NOTE: Determination.>> Final report.--Not later than
30 days after the date on which the Secretary determines that 75
percent of the amounts deposited in the Veterans Choice Fund
established by section 802 have been exhausted, 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 furnishing of care and services
under this section that includes the following:
(A) The total number of eligible veterans who have
received care or services under this section,
disaggregated by--
(i) eligible veterans described in subsection
(b)(2)(A);
(ii) eligible veterans described in subsection
(b)(2)(B);
(iii) eligible veterans described in
subsection (b)(2)(C); and
(iv) eligible veterans described in subsection
(b)(2)(D).
(B) A description of the types of care and services
furnished to eligible veterans under this section.
(C) An accounting of the total cost of furnishing
care and services to eligible veterans under this
section.
(D) The results of a survey of eligible veterans who
have received care or services under this section on the
satisfaction of such eligible veterans with the care or
services received by such eligible veterans under this
section.
(E) An assessment of the effect of furnishing care
and services under this section on wait times for
appointments for the receipt of hospital care and
medical services from the Department.
(F) An assessment of the feasibility and
advisability of continuing furnishing care and services
under this section after the termination date specified
in subsection (p).
(r) Rule of Construction.--Nothing in this section shall be
construed to alter the process of the Department for filling and paying
for prescription medications.
(s) Wait-Time Goals of the Veterans Health Administration.--
(1) <<NOTE: Definition.>> In general.--Except as provided
in paragraph (2), in this section, the term ``wait-time goals of
the Veterans Health Administration'' means not more than 30 days
from the date on which a veteran requests an appointment for
hospital care or medical services from the Department.
(2) <<NOTE: Deadline. Reports.>> Alternate goals.--If the
Secretary submits to Congress, not later than 60 days after the
date of the enactment of this Act, a report stating that the
actual wait-time goals of the Veterans Health Administration are
different from the wait-time goals specified in paragraph (1)--
(A) for purposes of this section, the wait-time
goals of the Veterans Health Administration shall be the
wait-time goals submitted by the Secretary under this
paragraph; and
[[Page 128 STAT. 1765]]
(B) <<NOTE: Federal Register, publication. Web
posting. Public information.>> the Secretary shall
publish such wait-time goals in the Federal Register and
on an Internet website of the Department available to
the public.
SEC. 102. ENHANCEMENT OF COLLABORATION BETWEEN DEPARTMENT OF
VETERANS AFFAIRS AND INDIAN HEALTH
SERVICE.
(a) <<NOTE: Consultation.>> Outreach to Tribal-Run Medical
Facilities.--The Secretary of Veterans Affairs shall, in consultation
with the Director of the Indian Health Service, conduct outreach to each
medical facility operated by an Indian tribe or tribal organization
through a contract or compact with the Indian Health Service under the
Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et
seq.) to raise awareness of the ability of such facilities, Indian
tribes, and tribal organizations to enter into agreements with the
Department of Veterans Affairs under which the Secretary reimburses such
facilities, Indian tribes, or tribal organizations, as the case may be,
for health care provided to veterans who are--
(1) eligible for health care at such facilities; and
(2)(A) enrolled in the patient enrollment system of the
Department established and operated under section 1705 of title
38, United States Code; or
(B) eligible for hospital care and medical services pursuant
to subsection (c)(2) of such section.
(b) Performance Metrics for Memorandum of Understanding.--The
Secretary of Veterans Affairs shall establish performance metrics for
assessing the performance by the Department of Veterans Affairs and the
Indian Health Service under the memorandum of understanding entitled
``Memorandum of Understanding between the Department of Veterans Affairs
(VA) and the Indian Health Service (IHS)'' in increasing access to
health care, improving quality and coordination of health care,
promoting effective patient-centered collaboration and partnerships
between the Department and the Service, and ensuring health-promotion
and disease-prevention services are appropriately funded and available
for beneficiaries under both health care systems.
(c) Report.--Not later than 180 days after the date of the enactment
of this Act, the Secretary of Veterans Affairs and the Director of the
Indian Health Service shall jointly submit to Congress a report on the
feasibility and advisability of the following:
(1) Entering into agreements for the reimbursement by the
Secretary of the costs of direct care services provided through
organizations receiving amounts pursuant to grants made or
contracts entered into under section 503 of the Indian Health
Care Improvement Act (25 U.S.C. 1653) to veterans who are
otherwise eligible to receive health care from such
organizations.
(2) Including the reimbursement of the costs of direct care
services provided to veterans who are not Indians in agreements
between the Department and the following:
(A) The Indian Health Service.
(B) An Indian tribe or tribal organization operating
a medical facility through a contract or compact with
the Indian Health Service under the Indian Self-
Determination and Education Assistance Act (25 U.S.C.
450 et seq.).
(C) A medical facility of the Indian Health Service.
[[Page 128 STAT. 1766]]
(d) Definitions.--In this section:
(1) Indian.--The terms ``Indian'' and ``Indian tribe'' have
the meanings given those terms in section 4 of the Indian Health
Care Improvement Act (25 U.S.C. 1603).
(2) Medical facility of the indian health service.--The term
``medical facility of the Indian Health Service'' includes a
facility operated by an Indian tribe or tribal organization
through a contract or compact with the Indian Health Service
under the Indian Self-Determination and Education Assistance Act
(25 U.S.C. 450 et seq.).
(3) Tribal organization.--The term ``tribal organization''
has the meaning given the term in section 4 of the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450b).
SEC. 103. ENHANCEMENT OF COLLABORATION BETWEEN DEPARTMENT OF
VETERANS AFFAIRS AND NATIVE HAWAIIAN
HEALTH CARE SYSTEMS.
(a) <<NOTE: Consultation. Contracts.>> In General.--The Secretary
of Veterans Affairs shall, in consultation with Papa Ola Lokahi and such
other organizations involved in the delivery of health care to Native
Hawaiians as the Secretary considers appropriate, enter into contracts
or agreements with Native Hawaiian health care systems that are in
receipt of funds from the Secretary of Health and Human Services
pursuant to grants awarded or contracts entered into under section 6(a)
of the Native Hawaiian Health Care Improvement Act (42 U.S.C. 11705(a))
for the reimbursement of direct care services provided to eligible
veterans as specified in such contracts or agreements.
(b) Definitions.--In this section, the terms ``Native Hawaiian'',
``Native Hawaiian health care system'', and ``Papa Ola Lokahi'' have the
meanings given those terms in section 12 of the Native Hawaiian Health
Care Improvement Act (42 U.S.C. 11711).
SEC. 104. REAUTHORIZATION AND MODIFICATION OF PILOT PROGRAM OF
ENHANCED CONTRACT CARE AUTHORITY FOR
HEALTH CARE NEEDS OF VETERANS.
Section 403 of the Veterans' Mental Health and Other Care
Improvements Act of 2008 (Public Law 110-387; 38 U.S.C. 1703 note) is
amended--
(1) in subsection (a)--
(A) in paragraph (3), by striking ``only during
the'' and all that follows through the period at the end
and inserting ``only during the period beginning on the
date of the commencement of the pilot program under
paragraph (2) and ending on the date that is two years
after the date of the enactment of the Veterans Access,
Choice, and Accountability Act of 2014.''; and
(B) by amending paragraph (4) to read as follows:
``(4) Program locations.--The Secretary shall carry out the
pilot program at locations in the following Veterans Integrated
Service Networks (and such other locations as the Secretary
considers appropriate):
``(A) Veterans Integrated Service Network 1.
``(B) Veterans Integrated Service Network 6.
``(C) Veterans Integrated Service Network 15.
``(D) Veterans Integrated Service Network 18.
``(E) Veterans Integrated Service Network 19.'';
[[Page 128 STAT. 1767]]
(2) in subsection (b)(1)(A), by striking ``as of the date of
the commencement of the pilot program under subsection (a)(2)''
and inserting ``as of August 1, 2014'';
(3) by redesignating subsection (h) as subsection (k);
(4) by inserting after subsection (g) the following new
subsections:
``(h) Appointments.--In carrying out the pilot program under this
section, the Secretary shall ensure that medical appointments for
covered veterans--
``(1) are scheduled not later than 5 days after the date on
which the appointment is requested; and
``(2) occur not later than 30 days after such date.
``(i) Outreach.--The Secretary shall ensure that covered veterans
are informed about the pilot program under this section.
``(j) Use of Existing Contracts.--In carrying out the pilot program
under this section after the date of the enactment of the Veterans
Access, Choice, and Accountability Act of 2014, the Secretary shall make
use of contracts entered into before such date or may enter into new
contracts.''; and
(5) in paragraph (2)(B) of subsection (k), as redesignated
by paragraph (3) of this section, by striking the semicolon at
the end and inserting ``; and''.
SEC. 105. PROMPT PAYMENT BY DEPARTMENT OF VETERANS AFFAIRS.
(a) Sense of Congress on Prompt Payment by Department.--It is the
sense <<NOTE: Compliance.>> of Congress that the Secretary of Veterans
Affairs shall comply with section 1315 of title 5, Code of Federal
Regulations (commonly known as the ``prompt payment rule''), or any
corresponding similar regulation or ruling, in paying for health care
pursuant to contracts entered into with non-Department of Veterans
Affairs providers to provide health care under the laws administered by
the Secretary.
(b) Establishment of Claims Processing System.--
(1) Claims processing system.--The Secretary of Veterans
Affairs shall establish and implement a system to process and
pay claims for payment for hospital care, medical services, and
other health care furnished by non-Department of Veterans
Affairs health care providers under the laws administered by the
Secretary.
(2) Compliance with prompt payment act.--The system
established and implemented under paragraph (1) shall comply
with all requirements of chapter 39, United States Code
(commonly referred to as the ``Prompt Payment Act'').
(c) Report.--Not later than 1 year after the date of the enactment
of this Act, the Comptroller General of the United States shall submit
to Congress a report on the timeliness of payments by the Secretary for
hospital care, medical services, and other health care furnished by non-
Department of Veterans Affairs health care providers under the laws
administered by the Secretary.
(d) Elements.--The report required by subsection (b) shall include
the following:
(1) The results of a survey of non-Department health care
providers who have submitted claims to the Department for
hospital care, medical services, or other health care furnished
to veterans for which payment is authorized under the laws
[[Page 128 STAT. 1768]]
administered by the Secretary during the one-year period
preceding the submittal of the report, which survey shall
include the following:
(A) The amount of time it took for such health care
providers, after submitting such claims, to receive
payment from the Department for such care or services.
(B) A comparison of the amount of time under
subparagraph (A) and the amount of time it takes such
health care providers to receive payments from the
United States for similar care or services provided to
the following, if applicable:
(i) Beneficiaries under the Medicare program
under title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.).
(ii) Covered beneficiaries under the TRICARE
program under chapter 55 of title 10, United
States Code.
(2) Such recommendations for legislative or administrative
action as the Comptroller General considers appropriate.
(e) Survey Elements.--In carrying out the survey, the Comptroller
General shall seek responses from non-Department health care providers
in a manner that ensures that the survey reflects the responses of such
providers that--
(1) are located in different geographic areas;
(2) furnish a variety of different hospital care, medical
services, and other health care; and
(3) furnish such care and services in a variety of different
types of medical facilities.
SEC. 106. TRANSFER OF AUTHORITY FOR PAYMENTS FOR HOSPITAL CARE,
MEDICAL SERVICES, AND OTHER HEALTH CARE
FROM NON-DEPARTMENT OF VETERANS AFFAIRS
PROVIDERS TO THE CHIEF BUSINESS OFFICE OF
THE VETERANS HEALTH ADMINISTRATION.
(a) Transfer of Authority.--
(1) <<NOTE: Effective date.>> In general.--Effective as of
October 1, 2014, the Secretary of Veterans Affairs shall
transfer the authority to pay for hospital care, medical
services, and other health care furnished through non-Department
of Veterans Affairs providers from--
(A) the Veterans Integrated Service Networks and
medical centers of the Department of Veterans Affairs,
to
(B) the Chief Business Office of the Veterans Health
Administration of the Department of Veterans Affairs.
(2) <<NOTE: Consultation.>> Manner of care.--The Chief
Business Office shall work in consultation with the Office of
Clinical Operations and Management of the Department to ensure
that care and services described in paragraph (1) are provided
in a manner that is clinically appropriate and in the best
interest of the veterans receiving such care and services.
(3) No delay in payment.--The transfer of authority under
paragraph (1) shall be carried out in a manner that does not
delay or impede any payment by the Department for hospital care,
medical services, or other health care furnished through a non-
Department provider under the laws administered by the
Secretary.
(b) Budget Matters.--The budget of the Department of Veterans
Affairs for any fiscal year beginning after the date of the
[[Page 128 STAT. 1769]]
enactment of this Act (as submitted to Congress pursuant to section
1105(a) of title 31, United States Code) shall specify funds for the
payment for hospital care, medical services, and other health care
furnished through non-Department of Veterans Affairs providers,
including any administrative costs associated with such payment, as
funds for the Chief Business Office of the Veterans Health
Administration rather than as funds for the Veterans Integrated Service
Networks or medical centers of the Department.
TITLE <<NOTE: 38 USC 1701 note.>> II--HEALTH CARE ADMINISTRATIVE
MATTERS
SEC. 201. INDEPENDENT ASSESSMENT OF THE HEALTH CARE DELIVERY
SYSTEMS AND MANAGEMENT PROCESSES OF THE
DEPARTMENT OF VETERANS AFFAIRS.
(a) Independent Assessment.--
(1) <<NOTE: Deadline. Contracts.>> Assessment.--Not later
than 90 days after the date of the enactment of this Act, the
Secretary of Veterans Affairs shall enter into one or more
contracts with a private sector entity or entities described in
subsection (b) to conduct an independent assessment of the
hospital care, medical services, and other health care furnished
in medical facilities of the Department. Such assessment shall
address each of the following:
(A) Current and projected demographics and unique
health care needs of the patient population served by
the Department.
(B) Current and projected health care capabilities
and resources of the Department, including hospital
care, medical services, and other health care furnished
by non-Department facilities under contract with the
Department, to provide timely and accessible care to
veterans.
(C) The authorities and mechanisms under which the
Secretary may furnish hospital care, medical services,
and other health care at non-Department facilities,
including whether the Secretary should have the
authority to furnish such care and services at such
facilities through the completion of episodes of care.
(D) The appropriate system-wide access standard
applicable to hospital care, medical services, and other
health care furnished by and through the Department,
including an identification of appropriate access
standards for each individual specialty and post-care
rehabilitation.
(E) The workflow process at each medical facility of
the Department for scheduling appointments for veterans
to receive hospital care, medical services, or other
health care from the Department.
(F) The organization, workflow processes, and tools
used by the Department to support clinical staffing,
access to care, effective length-of-stay management and
care transitions, positive patient experience, accurate
documentation, and subsequent coding of inpatient
services.
(G) The staffing level at each medical facility of
the Department and the productivity of each health care
provider at such medical facility, compared with health
care
[[Page 128 STAT. 1770]]
industry performance metrics, which may include an
assessment of any of the following:
(i) The case load of, and number of patients
treated by, each health care provider at such
medical facility during an average week.
(ii) The time spent by such health care
provider on matters other than the case load of
such health care provider, including time spent by
such health care provider as follows:
(I) At a medical facility that is
affiliated with the Department.
(II) Conducting research.
(III) Training or supervising other
health care professionals of the
Department.
(H) The information technology strategies of the
Department with respect to furnishing and managing
health care, including an identification of any
weaknesses and opportunities with respect to the
technology used by the Department, especially those
strategies with respect to clinical documentation of
episodes of hospital care, medical services, and other
health care, including any clinical images and
associated textual reports, furnished by the Department
in Department or non-Department facilities.
(I) Business processes of the Veterans Health
Administration, including processes relating to
furnishing non-Department health care, insurance
identification, third-party revenue collection, and
vendor reimbursement, including an identification of
mechanisms as follows:
(i) To avoid the payment of penalties to
vendors.
(ii) To increase the collection of amounts
owed to the Department for hospital care, medical
services, or other health care provided by the
Department for which reimbursement from a third
party is authorized and to ensure that such
amounts collected are accurate.
(iii) To increase the collection of any other
amounts owed to the Department with respect to
hospital care, medical services, and other health
care and to ensure that such amounts collected are
accurate.
(iv) To increase the accuracy and timeliness
of Department payments to vendors and providers.
(J) The purchasing, distribution, and use of
pharmaceuticals, medical and surgical supplies, medical
devices, and health care related services by the
Department, including the following:
(i) The prices paid for, standardization of,
and use by the Department of the following:
(I) Pharmaceuticals.
(II) Medical and surgical supplies.
(III) Medical devices.
(ii) The use by the Department of group
purchasing arrangements to purchase
pharmaceuticals, medical and surgical supplies,
medical devices, and health care related services.
(iii) The strategy and systems used by the
Department to distribute pharmaceuticals, medical
and surgical supplies, medical devices, and health
care related
[[Page 128 STAT. 1771]]
services to Veterans Integrated Service Networks
and medical facilities of the Department.
(K) The process of the Department for carrying out
construction and maintenance projects at medical
facilities of the Department and the medical facility
leasing program of the Department.
(L) The competency of leadership with respect to
culture, accountability, reform readiness, leadership
development, physician alignment, employee engagement,
succession planning, and performance management.
(2) Particular elements of certain assessments.--
(A) Scheduling assessment.--In carrying out the
assessment required by paragraph (1)(E), the private
sector entity or entities shall do the following:
(i) Review all training materials pertaining
to scheduling of appointments at each medical
facility of the Department.
(ii) Assess whether all employees of the
Department conducting tasks related to scheduling
are properly trained for conducting such tasks.
(iii) Assess whether changes in the technology
or system used in scheduling appointments are
necessary to limit access to the system to only
those employees that have been properly trained in
conducting such tasks.
(iv) Assess whether health care providers of
the Department are making changes to their
schedules that hinder the ability of employees
conducting such tasks to perform such tasks.
(v) Assess whether the establishment of a
centralized call center throughout the Department
for scheduling appointments at medical facilities
of the Department would improve the process of
scheduling such appointments.
(vi) Assess whether booking templates for each
medical facility or clinic of the Department would
improve the process of scheduling such
appointments.
(vii) Assess any interim technology changes or
attempts by Department to internally develop a
long-term scheduling solutions with respect to the
feasibility and cost effectiveness of such
internally developed solutions compared to
commercially available solutions.
(viii) Recommend actions, if any, to be taken
by the Department to improve the process for
scheduling such appointments, including the
following:
(I) Changes in training materials
provided to employees of the Department
with respect to conducting tasks related
to scheduling such appointments.
(II) Changes in monitoring and
assessment conducted by the Department
of wait times of veterans for such
appointments.
(III) Changes in the system used to
schedule such appointments, including
changes to improve how the Department--
(aa) measures wait times of
veterans for such appointments;
[[Page 128 STAT. 1772]]
(bb) monitors the
availability of health care
providers of the Department; and
(cc) provides veterans the
ability to schedule such
appointments.
(IV) Such other actions as the
private sector entity or entities
considers appropriate.
(B) Medical construction and maintenance project and
leasing program assessment.--In carrying out the
assessment required by paragraph (1)(K), the private
sector entity or entities shall do the following:
(i) Review the process of the Department for
identifying and designing proposals for
construction and maintenance projects at medical
facilities of the Department and leases for
medical facilities of the Department.
(ii) Assess the process through which the
Department determines the following:
(I) That a construction or
maintenance project or lease is
necessary with respect to a medical
facility or proposed medical facility of
the Department.
(II) The proper size of such medical
facility or proposed medical facility
with respect to treating veterans in the
catchment area of such medical facility
or proposed medical facility.
(iii) Assess the management processes of the
Department with respect to the capital management
programs of the Department, including processes
relating to the methodology for construction and
design of medical facilities of the Department,
the management of projects relating to the
construction and design of such facilities, and
the activation of such facilities.
(iv) Assess the medical facility leasing
program of the Department.
(3) <<NOTE: Deadline.>> Timing.--The private sector entity
or entities carrying out the assessment required by paragraph
(1) shall complete such assessment not later than 240 days after
entering into the contract described in such paragraph.
(b) Private Sector Entities Described.--A private entity described
in this subsection is a private entity that--
(1) has experience and proven outcomes in optimizing the
performance of the health care delivery systems of the Veterans
Health Administration and the private sector and in health care
management; and
(2) specializes in implementing large-scale organizational
and cultural transformations, especially with respect to health
care delivery systems.
(c) Program Integrator.--
(1) In general.--If the Secretary enters into contracts with
more than one private sector entity under subsection (a), the
Secretary shall designate one such entity that is predominately
a health care organization as the program integrator.
(2) Responsibilities.--The program integrator designated
pursuant to paragraph (1) shall be responsible for coordinating
the outcomes of the assessments conducted by the private
entities pursuant to such contracts.
[[Page 128 STAT. 1773]]
(d) Report on Assessment.--
(1) In general.--Not later than 60 days after completing the
assessment required by subsection (a), the private sector entity
or entities carrying out such assessment shall submit to the
Secretary of Veterans Affairs, the Committee on Veterans'
Affairs of the Senate, the Committee on Veterans' Affairs of the
House of Representatives, and the Commission on Care established
under section 202 a report on the findings and recommendations
of the private sector entity or entities with respect to such
assessment.
(2) <<NOTE: Deadline. Federal Register, publication. Web
posting. Public information.>> Publication.--Not later than 30
days after receiving the report under paragraph (1), the
Secretary shall publish such report in the Federal Register and
on an Internet website of the Department of Veterans Affairs
that is accessible to the public.
(e) Non-Department Facilities Defined.--In this section, the term
``non-Department facilities'' has the meaning given that term in section
1701 of title 38, United States Code.
SEC. 202. COMMISSION ON CARE.
(a) Establishment of Commission.--
(1) In general.--There is established a commission, to be
known as the ``Commission on Care'' (in this section referred to
as the ``Commission''), to examine the access of veterans to
health care from the Department of Veterans Affairs and
strategically examine how best to organize the Veterans Health
Administration, locate health care resources, and deliver health
care to veterans during the 20-year period beginning on the date
of the enactment of this Act.
(2) Membership.--
(A) Voting members.--The Commission shall be
composed of 15 voting members who are appointed as
follows:
(i) Three members appointed by the Speaker of
the House of Representatives, at least one of whom
shall be a veteran.
(ii) Three members appointed by the Minority
Leader of the House of Representatives, at least
one of whom shall be a veteran.
(iii) Three members appointed by the Majority
Leader of the Senate, at least one of whom shall
be a veteran.
(iv) Three members appointed by the Minority
Leader of the Senate, at least one of whom shall
be a veteran.
(v) Three members appointed by the President,
at least two of whom shall be veterans.
(B) Qualifications.--Of the members appointed under
subparagraph (A)--
(i) at least one member shall represent an
organization recognized by the Secretary of
Veterans Affairs for the representation of
veterans under section 5902 of title 38, United
States Code;
(ii) at least one member shall have experience
as senior management for a private integrated
health care system with an annual gross revenue of
more than $50,000,000;
[[Page 128 STAT. 1774]]
(iii) at least one member shall be familiar
with government health care systems, including
those systems of the Department of Defense, the
Indian Health Service, and Federally-qualified
health centers (as defined in section
1905(l)(2)(B) of the Social Security Act (42
U.S.C. 1396d(l)(2)(B)));
(iv) at least one member shall be familiar
with the Veterans Health Administration but shall
not be currently employed by the Veterans Health
Administration; and
(v) at least one member shall be familiar with
medical facility construction and leasing projects
carried out by government entities and have
experience in the building trades, including
construction, engineering, and architecture.
(C) <<NOTE: Deadline.>> Date.--The appointments of
members of the Commission shall be made not later than 1
year after the date of the enactment of this Act.
(3) Period of appointment.--
(A) In general.--Members shall be appointed for the
life of the Commission.
(B) Vacancies.--Any vacancy in the Commission shall
not affect its powers, but shall be filled in the same
manner as the original appointment.
(4) <<NOTE: Deadline.>> Initial meeting.--Not later than 15
days after the date on which eight voting members of the
Commission have been appointed, the Commission shall hold its
first meeting.
(5) Meetings.--The Commission shall meet at the call of the
Chairperson.
(6) Quorum.--A majority of the members of the Commission
shall constitute a quorum, but a lesser number of members may
hold hearings.
(7) <<NOTE: President.>> Chairperson and vice
chairperson.--The President shall designate a member of the
commission to serve as Chairperson of the Commission. The
Commission shall select a Vice Chairperson from among its
members.
(b) Duties of Commission.--
(1) Evaluation and assessment.--The Commission shall
undertake a comprehensive evaluation and assessment of access to
health care at the Department of Veterans Affairs.
(2) Matters evaluated and assessed.--In undertaking the
comprehensive evaluation and assessment required by paragraph
(1), the Commission shall evaluate and assess the results of the
assessment conducted by the private sector entity or entities
under section 201, including any findings, data, or
recommendations included in such assessment.
(3) Reports.--The Commission shall submit to the President,
through the Secretary of Veterans Affairs, reports as follows:
(A) Not later than 90 days after the date of the
initial meeting of the Commission, an interim report
on--
(i) the findings of the Commission with
respect to the evaluation and assessment required
by this subsection; and
(ii) such recommendations as the Commission
may have for legislative or administrative action
to improve
[[Page 128 STAT. 1775]]
access to health care through the Veterans Health
Administration.
(B) Not later than 180 days after the date of the
initial meeting of the Commission, a final report on--
(i) the findings of the Commission with
respect to the evaluation and assessment required
by this subsection; and
(ii) such recommendations as the Commission
may have for legislative or administrative action
to improve access to health care through the
Veterans Health Administration.
(c) Powers of the Commission.--
(1) Hearings.--The Commission may hold such hearings, sit
and act at such times and places, take such testimony, and
receive such evidence as the Commission considers advisable to
carry out this section.
(2) Information from federal agencies.--The Commission may
secure directly from any Federal agency such information as the
Commission considers necessary to carry out this section. Upon
request of the Chairperson of the Commission, the head of such
agency shall furnish such information to the Commission.
(d) Commission Personnel Matters.--
(1) Compensation of members.--
(A) In general.--Each member of the Commission who
is not an officer or employee of the Federal Government
shall be compensated at a rate equal to the daily
equivalent of the annual rate of basic pay prescribed
for level IV of the Executive Schedule under section
5315 of title 5, United States Code, for each day
(including travel time) during which such member is
engaged in the performance of the duties of the
Commission.
(B) Officers or employees of the united states.--All
members of the Commission who are officers or employees
of the United States shall serve without compensation in
addition to that received for their services as officers
or employees of the United States.
(2) Travel expenses.--The members of the Commission shall be
allowed travel expenses, including per diem in lieu of
subsistence, at rates authorized for employees of agencies under
subchapter I of chapter 57 of title 5, United States Code, while
away from their homes or regular places of business in the
performance of services for the Commission.
(3) Staff.--
(A) In general.--The Chairperson of the Commission
may, without regard to the civil service laws and
regulations, appoint and terminate an executive director
and such other additional personnel as may be necessary
to enable the Commission to perform its duties. The
employment of an executive director shall be subject to
confirmation by the Commission.
(B) Compensation.--The Chairperson of the Commission
may fix the compensation of the executive director and
other personnel without regard to chapter 51 and
subchapter III of chapter 53 of title 5, United States
Code, relating to classification of positions and
General Schedule pay rates, except that the rate of pay
for the executive
[[Page 128 STAT. 1776]]
director and other personnel may not exceed the rate
payable for level V of the Executive Schedule under
section 5316 of such title.
(4) Detail of government employees.--Any Federal Government
employee may be detailed to the Commission without
reimbursement, and such detail shall be without interruption or
loss of civil service status or privilege.
(5) Procurement of temporary and intermittent services.--The
Chairperson of the Commission may procure temporary and
intermittent services under section 3109(b) of title 5, United
States Code, at rates for individuals that do not exceed the
daily equivalent of the annual rate of basic pay prescribed for
level V of the Executive Schedule under section 5316 of such
title.
(e) Termination of the Commission.--The Commission shall terminate
30 days after the date on which the Commission submits the report under
subsection (b)(3)(B).
(f) Funding.--The Secretary of Veterans Affairs shall make available
to the Commission from amounts appropriated or otherwise made available
to the Secretary such amounts as the Secretary and the Chairperson of
the Commission jointly consider appropriate for the Commission to
perform its duties under this section.
(g) <<NOTE: President.>> Executive Action.--
(1) Action on recommendations.--The President shall require
the Secretary of Veterans Affairs and such other heads of
relevant Federal departments and agencies to implement each
recommendation set forth in a report submitted under subsection
(b)(3) that the President--
(A) considers feasible and advisable; and
(B) determines can be implemented without further
legislative action.
(2) Reports.--Not later than 60 days after the date on which
the President receives a report under subsection (b)(3), the
President shall submit to the Committee on Veterans' Affairs of
the Senate and the Committee on Veterans' Affairs of the House
of Representatives and such other committees of Congress as the
President considers appropriate a report setting forth the
following:
(A) An assessment of the feasibility and
advisability of each recommendation contained in the
report received by the President.
(B) For each recommendation assessed as feasible and
advisable under subparagraph (A) the following:
(i) Whether such recommendation requires
legislative action.
(ii) If such recommendation requires
legislative action, a recommendation concerning
such legislative action.
(iii) A description of any administrative
action already taken to carry out such
recommendation.
(iv) A description of any administrative
action the President intends to be taken to carry
out such recommendation and by whom.
[[Page 128 STAT. 1777]]
SEC. 203. TECHNOLOGY TASK FORCE ON REVIEW OF SCHEDULING SYSTEM AND
SOFTWARE OF THE DEPARTMENT OF VETERANS
AFFAIRS.
(a) Task Force Review.--
(1) <<NOTE: Establishment.>> In general.--The Secretary of
Veterans Affairs shall, through the use of a technology task
force, conduct a review of the needs of the Department of
Veterans Affairs with respect to the scheduling system and
scheduling software of the Department of Veterans Affairs that
is used by the Department to schedule appointments for veterans
for hospital care, medical services, and other health care from
the Department.
(2) Agreement.--
(A) In general.--The Secretary shall seek to enter
into an agreement with a technology organization or
technology organizations to carry out the review
required by paragraph (1).
(B) Prohibition on use of funds.--Notwithstanding
any other provision of law, no Federal funds may be used
to assist the technology organization or technology
organizations under subparagraph (A) in carrying out the
review required by paragraph (1).
(b) Report.--
(1) In general.--Not later than 45 days after the date of
the enactment of this Act, the technology task force required
under subsection (a)(1) shall submit to the Secretary, the
Committee on Veterans' Affairs of the Senate, and the Committee
on Veterans' Affairs of the House of Representatives a report
setting forth the findings and recommendations of the technology
task force regarding the needs of the Department with respect to
the scheduling system and scheduling software of the Department
described in such subsection.
(2) Elements.--The report required by paragraph (1) shall
include the following:
(A) Proposals for specific actions to be taken by
the Department to improve the scheduling system and
scheduling software of the Department described in
subsection (a)(1).
(B) A determination as to whether one or more
existing off-the-shelf systems would--
(i) meet the needs of the Department to
schedule appointments for veterans for hospital
care, medical services, and other health care from
the Department; and
(ii) improve the access of veterans to such
care and services.
(3) <<NOTE: Deadline. Federal Register, publication. Web
posting. Public information. Deadline.>> Publication.--Not
later than 30 days after the receipt of the report required by
paragraph (1), the Secretary shall publish such report in the
Federal Register and on an Internet website of the Department
accessible to the public.
(c) Implementation of Task Force Recommendations.--Not later than 1
year after the receipt of the report required by subsection (b)(1), the
Secretary shall implement the recommendations set forth in such report
that the Secretary considers are feasible, advisable, and cost
effective.
[[Page 128 STAT. 1778]]
SEC. 204. IMPROVEMENT OF ACCESS OF VETERANS TO MOBILE VET CENTERS
AND MOBILE MEDICAL CENTERS OF THE
DEPARTMENT OF VETERANS AFFAIRS.
(a) Improvement of Access.--
(1) In general.--The Secretary of Veterans Affairs shall
improve the access of veterans to telemedicine and other health
care through the use of mobile vet centers and mobile medical
centers of the Department of Veterans Affairs by providing
standardized requirements for the operation of such centers.
(2) Requirements.--The standardized requirements required by
paragraph (1) shall include the following:
(A) The number of days each mobile vet center and
mobile medical center of the Department is expected to
travel per year.
(B) The number of locations each center is expected
to visit per year.
(C) The number of appointments each center is
expected to conduct per year.
(D) The method and timing of notifications given by
each center to individuals in the area to which the
center is traveling, including notifications informing
veterans of the availability to schedule appointments at
the center.
(3) Use of telemedicine.--The Secretary shall ensure that
each mobile vet center and mobile medical center of the
Department has the capability to provide telemedicine services.
(b) Reports.--
(1) In general.--Not later than 1 year after the date of the
enactment of this Act, and not later than September 30 each year
thereafter, the Secretary of Veterans Affairs shall submit to
the Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of Representatives a
report on access to health care through the use of mobile vet
centers and mobile medical centers of the Department that
includes statistics on each of the requirements set forth in
subsection (a)(2) for the year covered by the report.
(2) Elements.--Each report required by paragraph (1) shall
include the following:
(A) A description of the use of mobile vet centers
and mobile medical centers to provide telemedicine
services to veterans during the year preceding the
submittal of the report, including the following:
(i) The number of days each mobile vet center
and mobile medical center was open to provide such
services.
(ii) The number of days each center traveled
to a location other than the headquarters of the
center to provide such services.
(iii) The number of appointments each center
conducted to provide such services on average per
month and in total during such year.
(B) An analysis of the effectiveness of using mobile
vet centers and mobile medical centers to provide health
care services to veterans through the use of
telemedicine.
(C) Any recommendations for an increase in the
number of mobile vet centers and mobile medical centers
of the Department.
[[Page 128 STAT. 1779]]
(D) Any recommendations for an increase in the
telemedicine capabilities of each mobile vet center and
mobile medical center.
(E) The feasibility and advisability of using
temporary health care providers, including locum tenens,
to provide direct health care services to veterans at
mobile vet centers and mobile medical centers.
(F) Such other recommendations on improvement of the
use of mobile vet centers and mobile medical centers by
the Department as the Secretary considers appropriate.
SEC. 205. IMPROVED PERFORMANCE METRICS FOR HEALTH CARE PROVIDED BY
DEPARTMENT OF VETERANS AFFAIRS.
(a) Prohibition on Use of Scheduling and Wait-Time Metrics in
Determination of Performance Awards.--The Secretary of Veterans Affairs
shall ensure that scheduling and wait-time metrics or goals are not used
as factors in determining the performance of the following employees for
purposes of determining whether to pay performance awards to such
employees:
(1) Directors, associate directors, assistant directors,
deputy directors, chiefs of staff, and clinical leads of medical
centers of the Department of Veterans Affairs.
(2) Directors, assistant directors, and quality management
officers of Veterans Integrated Service Networks of the
Department of Veterans Affairs.
(b) Modification of Performance Plans.--
(1) <<NOTE: Deadline.>> In general.--Not later than 30 days
after the date of the enactment of this Act, the Secretary shall
modify the performance plans of the directors of the medical
centers of the Department and the directors of the Veterans
Integrated Service Networks to ensure that such plans are based
on the quality of care received by veterans at the health care
facilities under the jurisdictions of such directors.
(2) Factors.--In modifying performance plans under paragraph
(1), the Secretary shall ensure that assessment of the quality
of care provided at health care facilities under the
jurisdiction of a director described in paragraph (1) includes
consideration of the following:
(A) Recent reviews by the Joint Commission (formerly
known as the ``Joint Commission on Accreditation of
Healthcare Organizations'') of such facilities.
(B) The number and nature of recommendations
concerning such facilities by the Inspector General of
the Department in reviews conducted through the Combined
Assessment Program, in the reviews by the Inspector
General of community-based outpatient clinics and
primary care clinics, and in reviews conducted through
the Office of Healthcare Inspections during the two most
recently completed fiscal years.
(C) The number of recommendations described in
subparagraph (B) that the Inspector General of the
Department determines have not been carried out
satisfactorily with respect to such facilities.
(D) Reviews of such facilities by the Commission on
Accreditation of Rehabilitation Facilities.
[[Page 128 STAT. 1780]]
(E) The number and outcomes of administrative
investigation boards, root cause analyses, and peer
reviews conducted at such facilities during the fiscal
year for which the assessment is being conducted.
(F) The effectiveness of any remedial actions or
plans resulting from any Inspector General
recommendations in the reviews and analyses described in
subparagraphs (A) through (E).
(3) <<NOTE: Assessment.>> Additional leadership
positions.--To the degree practicable, the Secretary shall
assess the performance of other employees of the Department in
leadership positions at Department medical centers, including
associate directors, assistant directors, deputy directors,
chiefs of staff, and clinical leads, and in Veterans Integrated
Service Networks, including assistant directors and quality
management officers, using factors and criteria similar to those
used in the performance plans modified under paragraph (1).
(c) Removal of Certain Performance Goals.--For each fiscal year that
begins after the date of the enactment of this Act, the Secretary shall
not include in the performance goals of any employee of a Veterans
Integrated Service Network or medical center of the Department any
performance goal that might disincentivize the payment of Department
amounts to provide hospital care, medical services, or other health care
through a non-Department provider.
SEC. 206. IMPROVED TRANSPARENCY CONCERNING HEALTH CARE PROVIDED BY
DEPARTMENT OF VETERANS AFFAIRS.
(a) <<NOTE: Deadline. Federal Register, publication. Web
posting. Public information.>> Publication of Wait Times.--Not later
than 90 days after the date of the enactment of this Act, the Secretary
of Veterans Affairs shall publish in the Federal Register, and on a
publicly accessible Internet website of each medical center of the
Department of Veterans Affairs, the wait-times for the scheduling of an
appointment in each Department facility by a veteran for the receipt of
primary care, specialty care, and hospital care and medical services
based on the general severity of the condition of the veteran. Whenever
the wait-times for the scheduling of such an appointment changes, the
Secretary shall publish the revised wait-times--
(1) on a publicly accessible Internet website of each
medical center of the Department by not later than 30 days after
such change; and
(2) in the Federal Register by not later than 90 days after
such change.
(b) Publicly Available Database of Patient Safety, Quality of Care,
and Outcome Measures.--
(1) <<NOTE: Deadline.>> In general.--Not later than 180
days after the date of the enactment of this Act, the Secretary
shall develop and make available to the public a comprehensive
database containing all applicable patient safety, quality of
care, and outcome measures for health care provided by the
Department that are tracked by the Secretary.
(2) Update frequency.--The Secretary shall update the
database required by paragraph (1) not less frequently than once
each year.
(3) <<NOTE: Notice.>> Unavailable measures.--For all
measures that the Secretary would otherwise publish in the
database required
[[Page 128 STAT. 1781]]
by paragraph (1) but has not done so because such measures are
not available, the Secretary shall publish notice in the
database of the reason for such unavailability and a timeline
for making such measures available in the database.
(4) Accessibility.--The Secretary shall ensure that the
database required by paragraph (1) is accessible to the public
through the primary Internet website of the Department and
through each primary Internet website of a Department medical
center.
(c) Hospital Compare Website of Department of Health and Human
Services.--
(1) <<NOTE: Deadline. Public information.>> Agreement
required.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall
enter into an agreement with the Secretary of Health and Human
Services for the provision by the Secretary of Veterans Affairs
of such information as the Secretary of Health and Human
Services may require to report and make publicly available
patient quality and outcome information concerning Department of
Veterans Affairs medical centers through the Hospital Compare
Internet website of the Department of Health and Human Services
or any successor Internet website.
(2) Information provided.--The information provided by the
Secretary of Veterans Affairs to the Secretary of Health and
Human Services under paragraph (1) shall include the following:
(A) Measures of timely and effective health care.
(B) Measures of readmissions, complications of
death, including with respect to 30-day mortality rates
and 30-day readmission rates, surgical complication
measures, and health care related infection measures.
(C) Survey data of patient experiences, including
the Hospital Consumer Assessment of Healthcare Providers
and Systems or any similar successor survey developed by
the Department of Health and Human Services.
(D) Any other measures required of or reported with
respect to hospitals participating in the Medicare
program under title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.).
(3) <<NOTE: Notice.>> Unavailable information.--For any
applicable metric collected by the Department of Veterans
Affairs or required to be provided under paragraph (2) and
withheld from or unavailable in the Hospital Compare Internet
website or any successor Internet website, the Secretary of
Veterans Affairs shall publish a notice on such Internet website
stating the reason why such metric was withheld from public
disclosure and a timeline for making such metric available, if
applicable.
(d) Comptroller General Review of Publicly Available Safety and
Quality Metrics.--Not later <<NOTE: Deadline.>> than 3 years after the
date of the enactment of this Act, the Comptroller General of the United
States shall conduct a review of the safety and quality metrics made
publicly available by the Secretary of Veterans Affairs under this
section to assess the degree to which the Secretary is complying with
the provisions of this section.
[[Page 128 STAT. 1782]]
SEC. 207. INFORMATION FOR VETERANS ON THE CREDENTIALS OF
DEPARTMENT OF VETERANS AFFAIRS PHYSICIANS.
(a) Improvement of ``Our Doctors'' Internet Website Links.--
(1) Availability through department of veterans affairs
homepage.--A link to the ``Our Doctors'' health care providers
database of the Department of Veterans Affairs, or any successor
database, shall be available on and through the homepage of the
Internet website of the Department that is accessible to the
public.
(2) Information on location of residency training.--The
Internet website of the Department that is accessible to the
public shall include under the link to the ``Our Doctors''
health care providers database of the Department, or any
successor database, the name of the facility at which each
licensed physician of the Department underwent residency
training.
(3) Information on physicians at particular facilities.--The
``Our Doctors'' health care providers database of the
Department, or any successor database, shall identify whether
each licensed physician of the Department is a physician in
residency.
(b) Information on Credentials of Physicians for Veterans Undergoing
Surgical Procedures.--
(1) In general.--Each veteran who is undergoing a surgical
procedure by or through the Department shall be provided
information described in paragraph (2) with respect to the
surgeon to be performing such procedure at such time in advance
of the procedure as is appropriate to permit such veteran to
evaluate such information.
(2) Information described.--The information described in
this paragraph with respect to a surgeon described in paragraph
(1) is as follows:
(A) The education and training of the surgeon.
(B) The licensure, registration, and certification
of the surgeon by the State or national entity
responsible for such licensure, registration, or
certification.
(3) Other individuals.--If a veteran is unable to evaluate
the information provided under paragraph (1) due to the health
or mental competence of the veteran, such information shall be
provided to an individual acting on behalf of the veteran.
(c) Comptroller General Report and Plan.--
(1) Report.--Not later than 2 years after the date of the
enactment of this Act, the Comptroller General of the United
States shall submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a report setting forth an assessment by the
Comptroller General of the following:
(A) The manner in which contractors under the
Patient-Centered Community Care initiative of the
Department perform oversight of the credentials of
physicians within the networks of such contractors under
the initiative.
(B) The oversight by the Department of the contracts
under the Patient-Centered Community Care initiative.
(C) The verification by the Department of the
credentials and licenses of health care providers
furnishing hospital care and medical services under
section 101.
[[Page 128 STAT. 1783]]
(2) <<NOTE: Deadlines.>> Plan.--
(A) In general.--Not later than 30 days after the
submittal of the report under paragraph (1), the
Secretary shall submit to the Comptroller General, the
Committee on Veterans' Affairs of the Senate, and the
Committee on Veterans' Affairs of the House of
Representatives a plan to address any findings and
recommendations of the Comptroller General included in
such report.
(B) Implementation.--Not later than 90 days after
the submittal of the report under paragraph (1), the
Secretary shall carry out such plan.
SEC. 208. INFORMATION IN ANNUAL BUDGET OF THE PRESIDENT ON
HOSPITAL CARE AND MEDICAL SERVICES
FURNISHED THROUGH EXPANDED USE OF
CONTRACTS FOR SUCH CARE.
The materials on the Department of Veterans Affairs in the budget of
the President for a fiscal year, as submitted to Congress pursuant to
section 1105(a) of title 31, United States Code, shall set forth the
following:
(1) The number of veterans who received hospital care and
medical services under section 101 during the fiscal year
preceding the fiscal year in which such budget is submitted.
(2) The amount expended by the Department on furnishing care
and services under such section during the fiscal year preceding
the fiscal year in which such budget is submitted.
(3) The amount requested in such budget for the costs of
furnishing care and services under such section during the
fiscal year covered by such budget, set forth in aggregate and
by amounts for each account for which amounts are so requested.
(4) The number of veterans that the Department estimates
will receive hospital care and medical services under such
section during the fiscal years covered by the budget
submission.
(5) The number of employees of the Department on paid
administrative leave at any point during the fiscal year
preceding the fiscal year in which such budget is submitted.
SEC. 209. PROHIBITION ON FALSIFICATION OF DATA CONCERNING WAIT
TIMES AND QUALITY MEASURES AT DEPARTMENT
OF VETERANS AFFAIRS.
Not <<NOTE: Deadline.>> later than 60 days after the date of the
enactment of this Act, and in accordance with title 5, United States
Code, the Secretary of Veterans Affairs shall establish policies whereby
any employee of the Department of Veterans Affairs who knowingly submits
false data concerning wait times for health care or quality measures
with respect to health care to another employee of the Department or
knowingly requires another employee of the Department to submit false
data concerning such wait times or quality measures to another employee
of the Department is subject to a penalty the Secretary considers
appropriate after notice and an opportunity for a hearing, including
civil penalties, unpaid suspensions, or termination.
[[Page 128 STAT. 1784]]
TITLE III--HEALTH CARE STAFFING, RECRUITMENT, AND TRAINING MATTERS
SEC. 301. TREATMENT OF STAFFING SHORTAGE AND BIENNIAL REPORT ON
STAFFING OF MEDICAL FACILITIES OF THE
DEPARTMENT OF VETERANS AFFAIRS.
(a) Staffing Shortages.--
(1) In general.--Subchapter I of chapter 74 of title 38,
United States Code, is amended by adding at the end the
following new section:
``Sec. 7412. <<NOTE: 38 USC 7412.>> Annual determination of
staffing shortages; recruitment and appointment
for needed occupations
``(a) <<NOTE: Deadline. Federal Register, publication. Time
period.>> In General.--Not later than September 30 of each year, the
Inspector General of the Department shall determine, and the Secretary
shall publish in the Federal Register, the five occupations of personnel
of this title of the Department covered under section 7401 of this title
for which there are the largest staffing shortages throughout the
Department as calculated over the five-year period preceding the
determination.
``(b) Recruitment and Appointment.--Notwithstanding sections 3304
and 3309 through 3318 of title 5, the Secretary may, upon a
determination by the Inspector General under paragraph (1) that there is
a staffing shortage throughout the Department with respect to a
particular occupation, recruit and directly appoint, during the fiscal
year after the fiscal year during which such determination is made,
qualified personnel to serve in that particular occupation for the
Department.''.
(2) Clerical amendment.--The table of sections at the
beginning of such chapter is amended by inserting after the item
relating to section 7411 the following new item:
``7412. Annual determination of staffing shortages; recruitment and
appointment for needed occupations.''.
(3) <<NOTE: Federal Register, publication. 38 USC 7412
note.>> Deadline for first determination.--Notwithstanding the
deadline under section 7412 of title 38, United States Code, as
added by paragraph (1), for the annual determination of staffing
shortages in the Veterans Health Administration, the Inspector
General of the Department of Veterans Affairs shall make the
first determination required under such section, and the
Secretary of Veterans Affairs shall publish in the Federal
Register such determination, by not later than the date that is
180 days after the date of the enactment of this Act.
(b) Increase of Graduate Medical Education Residency Positions.--
(1) In general.--Section 7302 of title 38, United States
Code, is amended by adding at the end the following new
subsection:
``(e)(1) In carrying out this section, the Secretary shall establish
medical residency programs, or ensure that already established medical
residency programs have a sufficient number of residency positions, at
any medical facility of the Department that the Secretary determines--
[[Page 128 STAT. 1785]]
``(A) is experiencing a shortage of physicians; and
``(B) is located in a community that is designated as a
health professional shortage area (as defined in section 332 of
the Public Health Service Act (42 U.S.C. 254e)).
``(2) In carrying out paragraph (1), the Secretary shall--
``(A) allocate the residency positions under such paragraph
among occupations included in the most current determination
published in the Federal Register pursuant to section 7412(a) of
this title; and
``(B) give priority to residency positions and programs in
primary care, mental health, and any other specialty the
Secretary determines appropriate.''.
(2) Five-year increase.--
(A) <<NOTE: Time period. Effective date. 38 USC 7302
note.>> In general.--In carrying out section 7302(e) of
title 38, United States Code, as added by paragraph (1),
during the 5-year period beginning on the day that is 1
year after the date of the enactment of this Act, the
Secretary of Veterans Affairs shall increase the number
of graduate medical education residency positions at
medical facilities of the Department by up to 1,500
positions.
(B) Priority.--In increasing the number of graduate
medical education residency positions at medical
facilities of the Department under subparagraph (A), the
Secretary shall give priority to medical facilities
that--
(i) as of the date of the enactment of this
Act, do not have a medical residency program; and
(ii) are located in a community that has a
high concentration of veterans.
(3) Report.--
(A) In general.--Not later than 60 days after the
date of the enactment of this Act, and not later than
October 1 each year thereafter until 2019, the Secretary
shall submit to the Committee on Veterans' Affairs of
the Senate and the Committee on Veterans' Affairs of the
House of Representatives a report on graduate medical
education residency positions at medical facilities of
the Department.
(B) Elements.--Each report required by subparagraph
(A) shall include the following:
(i) For the year preceding the submittal of
the report, the number of graduate medical
education residency positions at medical
facilities of the Department as follows:
(I) That were filled.
(II) That were not filled.
(III) That the Department
anticipated filling.
(ii) With respect to each graduate medical
education residency position specified in clause
(i)--
(I) the geographic location of each
such position; and
(II) if such position was filled,
the academic affiliation of the medical
resident that filled such position.
(iii) The policy at each medical facility of
the Department with respect to the ratio of
medical residents to staff supervising medical
residents.
[[Page 128 STAT. 1786]]
(iv) <<NOTE: Time period.>> During the 1-year
period preceding the submittal of the report, the
number of individuals who declined an offer from
the Department to serve as a medical resident at a
medical facility of the Department and the reason
why each such individual declined such offer.
(v) <<NOTE: Time period.>> During the 1-year
period preceding the submittal of the report, a
description of--
(I) challenges, if any, faced by the
Department in filling graduate medical
education residency positions at medical
facilities of the Department; and
(II) actions, if any, taken by the
Department to address such challenges.
(vi) A description of efforts of the
Department, as of the date of the submittal of the
report, to recruit and retain medical residents to
work for the Veterans Health Administration as
full-time employees.
(c) Priority in Scholarship Program of Health Professionals
Educational Assistance Program to Certain Providers.--Section 7612(b)(5)
of title 38, United States Code, is amended--
(1) in subparagraph (A), by striking ``and'' at the end;
(2) by redesignating subparagraph (B) as subparagraph (C);
and
(3) by inserting after subparagraph (A) the following new
subparagraph (B):
``(B) shall give priority to applicants pursuing a course of
education or training toward a career in an occupation for which
the Inspector General of the Department has, in the most current
determination published in the Federal Register pursuant to
section 7412(a) of this title, determined that there is one of
the largest staffing shortages throughout the Department with
respect to such occupation; and''.
(d) Reports.--
(1) In general.--Not later than 180 days after the date of
the enactment of this Act, and not later than December 31 of
each even-numbered year thereafter until 2024, the Secretary of
Veterans Affairs shall submit to the Committees on Veterans'
Affairs of the Senate and House of Representatives a report
assessing the staffing of each medical facility of the
Department.
(2) Elements.--Each report submitted under paragraph (1)
shall include the following:
(A) The results of a system-wide assessment of all
medical facilities of the Department to ensure the
following:
(i) Appropriate staffing levels for health
care professionals to meet the goals of the
Secretary for timely access to care for veterans.
(ii) Appropriate staffing levels for support
personnel, including clerks.
(iii) Appropriate sizes for clinical panels.
(iv) Appropriate numbers of full-time staff,
or full-time equivalents, dedicated to direct care
of patients.
(v) Appropriate physical plant space to meet
the capacity needs of the Department in that area.
[[Page 128 STAT. 1787]]
(vi) Such other factors as the Secretary
considers necessary.
(B) A plan for addressing any issues identified in
the assessment described in subparagraph (A), including
a timeline for addressing such issues.
(C) A list of the current wait times and workload
levels for the following clinics in each medical
facility:
(i) Mental health.
(ii) Primary care.
(iii) Gastroenterology.
(iv) Women's health.
(v) Such other clinics as the Secretary
considers appropriate.
(D) A description of the results of the most current
determination of the Inspector General under subsection
(a) of section 7412 of title 38, United States Code, as
added by subsection (a)(1) of this section, and a plan
to use direct appointment authority under subsection (b)
of such section 7412 to fill staffing shortages,
including recommendations for improving the speed at
which the credentialing and privileging process can be
conducted.
(E) The current staffing models of the Department
for the following clinics, including recommendations for
changes to such models:
(i) Mental health.
(ii) Primary care.
(iii) Gastroenterology.
(iv) Women's health.
(v) Such other clinics as the Secretary
considers appropriate.
(F) A detailed analysis of succession planning at
medical facilities of the Department, including the
following:
(i) The number of positions in medical
facilities throughout the Department that are not
filled by a permanent employee.
(ii) The length of time each position
described in clause (i) remained vacant or filled
by a temporary or acting employee.
(iii) A description of any barriers to filling
the positions described in clause (i).
(iv) A plan for filling any positions that are
vacant or filled by a temporary or acting employee
for more than 180 days.
(v) A plan for handling emergency
circumstances, such as administrative leave or
sudden medical leave for senior officials.
(G) <<NOTE: Time period.>> The number of health
care providers of the Department who have been removed
from their positions, have retired, or have left their
positions for another reason, disaggregated by provider
type, during the 2-year period preceding the submittal
of the report.
(H) Of the health care providers specified in
subparagraph (G) who have been removed from their
positions, the following:
(i) The number of such health care providers
who were reassigned to other positions in the
Department.
[[Page 128 STAT. 1788]]
(ii) The number of such health care providers
who left the Department.
(iii) The number of such health care providers
who left the Department and were subsequently
rehired by the Department.
SEC. 302. EXTENSION AND MODIFICATION OF CERTAIN PROGRAMS WITHIN
THE DEPARTMENT OF VETERANS AFFAIRS HEALTH
PROFESSIONALS EDUCATIONAL ASSISTANCE
PROGRAM.
(a) Extension of Scholarship Program.--Section 7619 of title 38,
United States Code, is amended by striking ``December 31, 2014'' and
inserting ``December 31, 2019''.
(b) Modification of Education Debt Reduction Program.--
(1) Modification of amount and duration of eligibility.--
Paragraph (1) of section 7683(d) of such title is amended--
(A) by striking ``$60,000'' and inserting
``$120,000''; and
(B) by striking ``$12,000 of such payments'' and all
that follows through the period at the end and inserting
``$24,000 of such payments may be made in each year of
participation in the Program''.
(2) Elimination of limitation.--
(A) In general.--Such section is further amended--
(i) by striking paragraph (2);
(ii) by redesignating paragraph (3) as
paragraph (2); and
(iii) in paragraph (2), as redesignated by
clause (ii), by striking ``paragraphs (1) and
(2)'' and inserting ``paragraph (1)''.
(B) Conforming amendment.--Paragraph (1) of such
section, as amended by paragraph (1), is further amended
by striking ``Subject to paragraph (2), the amount'' and
inserting ``The amount''.
SEC. 303. <<NOTE: 38 USC 703 note.>> CLINIC MANAGEMENT TRAINING
FOR EMPLOYEES AT MEDICAL FACILITIES OF THE
DEPARTMENT OF VETERANS AFFAIRS.
(a) Clinic Management Training Program.--
(1) <<NOTE: Deadline.>> In general.--Not later than 180
days after the date of the enactment of this Act, the Secretary
of Veterans Affairs shall commence a role-specific clinic
management training program to provide in-person, standardized
education on systems and processes for health care practice
management and scheduling to all appropriate employees, as
determined by the Secretary, at medical facilities of the
Department.
(2) Elements.--
(A) In general.--The clinic management training
program required by paragraph (1) shall include the
following:
(i) Training on how to manage the schedules of
health care providers of the Department, including
the following:
(I) Maintaining such schedules in a
manner that allows appointments to be
booked at least eight weeks in advance.
(II) Proper planning procedures for
vacation, leave, and graduate medical
education training schedules.
[[Page 128 STAT. 1789]]
(ii) Training on the appropriate number of
appointments that a health care provider should
conduct on a daily basis, based on specialty.
(iii) Training on how to determine whether
there are enough available appointment slots to
manage demand for different appointment types and
mechanisms for alerting management of insufficient
slots.
(iv) Training on how to properly use the
appointment scheduling system of the Department,
including any new scheduling system implemented by
the Department.
(v) Training on how to optimize the use of
technology, including the following:
(I) Telemedicine.
(II) Electronic mail.
(III) Text messaging.
(IV) Such other technologies as
specified by the Secretary.
(vi) Training on how to properly use physical
plant space at medical facilities of the
Department to ensure efficient flow and privacy
for patients and staff.
(B) Role-specific.--The Secretary shall ensure that
each employee of the Department included in the clinic
management training program required by paragraph (1)
receives education under such program that is relevant
to the responsibilities of such employee.
(3) Sunset.--The clinic management training program required
by paragraph (1) shall terminate on the date that is 2 years
after the date on which the Secretary commences such program.
(b) Training Materials.--
(1) In general.--After the termination of the clinic
management training program required by subsection (a), the
Secretary shall provide training materials on health care
management to each of the following employees of the Department
that are relevant to the position and responsibilities of such
employee upon the commencement of employment of such employee:
(A) Any manager of a medical facility of the
Department.
(B) Any health care provider at a medical facility
of the Department.
(C) Such other employees of the Department as the
Secretary considers appropriate.
(2) Update.--The Secretary shall regularly update the
training materials required under paragraph (1).
TITLE IV--HEALTH CARE RELATED TO SEXUAL TRAUMA
SEC. 401. EXPANSION OF ELIGIBILITY FOR SEXUAL TRAUMA COUNSELING
AND TREATMENT TO VETERANS ON INACTIVE DUTY
TRAINING.
Section 1720D(a)(1) of title 38, United States Code, is amended by
striking ``or active duty for training'' and inserting ``, active duty
for training, or inactive duty training''.
[[Page 128 STAT. 1790]]
SEC. 402. PROVISION OF COUNSELING AND TREATMENT FOR SEXUAL TRAUMA
BY THE DEPARTMENT OF VETERANS AFFAIRS TO
MEMBERS OF THE ARMED FORCES.
(a) Expansion of Coverage to Members of the Armed Forces.--
Subsection (a) of section 1720D of title 38, United States Code, is
amended--
(1) by redesignating paragraph (2) as paragraph (3);
(2) by inserting after paragraph (1) the following new
paragraph (2):
``(2)(A) <<NOTE: Consultation.>> In operating the program required
by paragraph (1), the Secretary may, in consultation with the Secretary
of Defense, provide counseling and care and services to members of the
Armed Forces (including members of the National Guard and Reserves) on
active duty to overcome psychological trauma described in that
paragraph.
``(B) A member described in subparagraph (A) shall not be required
to obtain a referral before receiving counseling and care and services
under this paragraph.''; and
(3) in paragraph (3), as redesignated by paragraph (1)--
(A) by striking ``a veteran'' and inserting ``an
individual''; and
(B) by striking ``that veteran'' each place it
appears and inserting ``that individual''.
(b) Information to Members on Availability of Counseling and
Services.--Subsection (c) of such section is amended--
(1) by striking ``to veterans'' each place it appears; and
(2) in paragraph (3), by inserting ``members of the Armed
Forces and'' before ``individuals''.
(c) Inclusion of Members in Reports on Counseling and Services.--
Subsection (e) of such section is amended--
(1) in the matter preceding paragraph (1), by striking ``to
veterans'';
(2) in paragraph (2)--
(A) by striking ``women veterans'' and inserting
``individuals''; and
(B) by striking ``training under subsection (d).''
and inserting ``training under subsection (d),
disaggregated by--
``(A) veterans;
``(B) members of the Armed Forces (including members
of the National Guard and Reserves) on active duty; and
``(C) for each of subparagraphs (A) and (B)--
``(i) men; and
``(ii) women.'';
(3) in paragraph (4), by striking ``veterans'' and inserting
``individuals''; and
(4) in paragraph (5)--
(A) by striking ``women veterans'' and inserting
``individuals''; and
(B) by inserting ``, including specific
recommendations for individuals specified in
subparagraphs (A), (B), and (C) of paragraph (2)''
before the period at the end.
(d) <<NOTE: 38 USC 1720D.>> Effective Date.--The amendments made by
this section shall take effect on the date that is 1 year after the date
of the enactment of this Act.
[[Page 128 STAT. 1791]]
SEC. 403. REPORTS ON MILITARY SEXUAL TRAUMA.
(a) Report on Services Available for Military Sexual Trauma in the
Department of Veterans Affairs.--Not later than 630 days after the date
of the enactment of this Act, the Secretary of Veterans Affairs shall
submit to the Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of Representatives a report
on the treatment and services available from the Department of Veterans
Affairs for male veterans who experience military sexual trauma compared
to such treatment and services available to female veterans who
experience military sexual trauma.
(b) Reports on Transition of Military Sexual Trauma Treatment From
Department of Defense to Department of Veterans Affairs.--Not later than
630 days after the date of the enactment of this Act, and annually
thereafter for 5 years, the Department of Veterans Affairs-Department of
Defense Joint Executive Committee established by section 320(a) of title
38, United States Code, shall submit to the appropriate committees of
Congress a report on military sexual trauma that includes the following:
(1) The processes and procedures utilized by the Department
of Veterans Affairs and the Department of Defense to facilitate
transition of treatment of individuals who have experienced
military sexual trauma from treatment provided by the Department
of Defense to treatment provided by the Department of Veterans
Affairs.
(2) A description and assessment of the collaboration
between the Department of Veterans Affairs and the Department of
Defense in assisting veterans in filing claims for disabilities
related to military sexual trauma, including permitting veterans
access to information and evidence necessary to develop or
support such claims.
(c) Definitions.--In this section:
(1) Appropriate committees of congress.--The term
``appropriate committees of Congress'' means--
(A) the Committee on Veterans' Affairs and the
Committee on Armed Services of the Senate; and
(B) the Committee on Veterans' Affairs and the
Committee on Armed Services of the House of
Representatives.
(2) Military sexual trauma.--The term ``military sexual
trauma'' means psychological trauma, which in the judgment of a
mental health professional employed by the Department, resulted
from a physical assault of a sexual nature, battery of a sexual
nature, or sexual harassment which occurred while the veteran
was serving on active duty, active duty for training, or
inactive duty training.
(3) Sexual harassment.--The term ``sexual harassment'' means
repeated, unsolicited verbal or physical contact of a sexual
nature which is threatening in character.
(4) Sexual trauma.--The term ``sexual trauma'' shall have
the meaning given that term by the Secretary of Veterans Affairs
for purposes of this section.
(d) Effective Date.--This section shall take effect on the date that
is 270 days after the date of the enactment of this Act.
[[Page 128 STAT. 1792]]
TITLE V--OTHER HEALTH CARE MATTERS
SEC. 501. EXTENSION OF PILOT PROGRAM ON ASSISTED LIVING SERVICES
FOR VETERANS WITH TRAUMATIC BRAIN INJURY.
(a) In General.--Section 1705 of the National Defense Authorization
Act for Fiscal Year 2008 (Public Law 110-181; 38 U.S.C. 1710C note) is
amended by adding at the end the following:
``(g) Termination.--The pilot program shall terminate on October 6,
2017.''.
(b) Conforming Amendment.--Subsection (a) of such section is amended
by striking ``five-year''.
TITLE VI--MAJOR MEDICAL FACILITY LEASES
SEC. 601. AUTHORIZATION OF MAJOR MEDICAL FACILITY LEASES.
(a) In General.--The Secretary of Veterans Affairs may carry out the
following major medical facility leases at the locations specified, and
in an amount for each lease not to exceed the amount shown for such
location (not including any estimated cancellation costs):
(1) For a clinical research and pharmacy coordinating
center, Albuquerque, New Mexico, an amount not to exceed
$9,560,000.
(2) For a community-based outpatient clinic, Brick, New
Jersey, an amount not to exceed $7,280,000.
(3) For a new primary care and dental clinic annex,
Charleston, South Carolina, an amount not to exceed $7,070,250.
(4) For a community-based outpatient clinic, Cobb County,
Georgia, an amount not to exceed $6,409,000.
(5) For the Leeward Outpatient Healthcare Access Center,
Honolulu, Hawaii, including a co-located clinic with the
Department of Defense and the co-location of the Honolulu
Regional Office of the Veterans Benefits Administration and the
Kapolei Vet Center of the Department of Veterans Affairs, an
amount not to exceed $15,887,370.
(6) For a community-based outpatient clinic, Johnson County,
Kansas, an amount not to exceed $2,263,000.
(7) For a replacement community-based outpatient clinic,
Lafayette, Louisiana, an amount not to exceed $2,996,000.
(8) For a community-based outpatient clinic, Lake Charles,
Louisiana, an amount not to exceed $2,626,000.
(9) For outpatient clinic consolidation, New Port Richey,
Florida, an amount not to exceed $11,927,000.
(10) For an outpatient clinic, Ponce, Puerto Rico, an amount
not to exceed $11,535,000.
(11) For lease consolidation, San Antonio, Texas, an amount
not to exceed $19,426,000.
(12) For a community-based outpatient clinic, San Diego,
California, an amount not to exceed $11,946,100.
(13) For an outpatient clinic, Tyler, Texas, an amount not
to exceed $4,327,000.
[[Page 128 STAT. 1793]]
(14) For the Errera Community Care Center, West Haven,
Connecticut, an amount not to exceed $4,883,000.
(15) For the Worcester Community-Based Outpatient Clinic,
Worcester, Massachusetts, an amount not to exceed $4,855,000.
(16) For the expansion of a community-based outpatient
clinic, Cape Girardeau, Missouri, an amount not to exceed
$4,232,060.
(17) For a multispecialty clinic, Chattanooga, Tennessee, an
amount not to exceed $7,069,000.
(18) For the expansion of a community-based outpatient
clinic, Chico, California, an amount not to exceed $4,534,000.
(19) For a community-based outpatient clinic, Chula Vista,
California, an amount not to exceed $3,714,000.
(20) For a new research lease, Hines, Illinois, an amount
not to exceed $22,032,000.
(21) For a replacement research lease, Houston, Texas, an
amount not to exceed $6,142,000.
(22) For a community-based outpatient clinic, Lincoln,
Nebraska, an amount not to exceed $7,178,400.
(23) For a community-based outpatient clinic, Lubbock,
Texas, an amount not to exceed $8,554,000.
(24) For a community-based outpatient clinic consolidation,
Myrtle Beach, South Carolina, an amount not to exceed
$8,022,000.
(25) For a community-based outpatient clinic, Phoenix,
Arizona, an amount not to exceed $20,757,000.
(26) For the expansion of a community-based outpatient
clinic, Redding, California, an amount not to exceed $8,154,000.
(27) For the expansion of a community-based outpatient
clinic, Tulsa, Oklahoma, an amount not to exceed $13,269,200.
(b) <<NOTE: Oklahoma.>> Requirements for Clinic in Tulsa.--
(1) In general.--In carrying out the expansion of the
community-based outpatient clinic in Tulsa, Oklahoma, authorized
by subsection (a)(27), the Secretary of Veterans Affairs shall
ensure that such clinic satisfies the following requirements:
(A) Consist of not more than 140,000 gross square
feet.
(B) Have an annual cost per square foot of not more
than the average market rate in Tulsa, Oklahoma, for an
equivalent medical facility plus 20 percent.
(C) Satisfy the mandate of the Department of
Veterans Affairs to provide veterans in Oklahoma with
access to quality and efficient care.
(D) Expand clinical capacity in the region in which
the clinic is located in a cost efficient manner based
upon regional cost comparisons, taking into account the
needs of current veterans and the potential demand by
veterans for care in the future.
(E) Be the most cost effective option for the
Department as predicted over a 30-year life cycle for
such clinic.
(2) Cost effective determination.--
(A) In general.--If the Secretary determines that
the most cost effective option over a 30-year life cycle
would be to purchase or construct a facility in Tulsa,
Oklahoma, instead of entering into a major medical
facility lease in
[[Page 128 STAT. 1794]]
such location as authorized by subsection (a)(27), the
Secretary shall not enter into such lease.
(B) Major medical facility project.--If the
Secretary makes the determination described in
subparagraph (A), the Secretary may request authority
for a major medical facility project in Tulsa, Oklahoma,
from Congress pursuant to section 8104(b) of title 38,
United States Code.
(C) <<NOTE: Deadline.>> Cost-benefit analysis.--If
the Secretary requests authority for the major medical
facility project described in subparagraph (B), not
later than 90 days after making the determination
described in subparagraph (A), the Secretary shall
submit to Congress a detailed cost-benefit analysis of
such major medical facility project.
SEC. 602. <<NOTE: 38 USC 8104 note.>> BUDGETARY TREATMENT OF
DEPARTMENT OF VETERANS AFFAIRS MAJOR
MEDICAL FACILITIES LEASES.
(a) Findings.--Congress finds the following:
(1) Title 31, United States Code, requires the Department of
Veterans Affairs to record the full cost of its contractual
obligation against funds available at the time a contract is
executed.
(2) Office of Management and Budget Circular A-11 provides
guidance to agencies in meeting the statutory requirements under
title 31, United States Code, with respect to leases.
(3) For operating leases, Office of Management and Budget
Circular A-11 requires the Department of Veterans Affairs to
record up-front budget authority in an ``amount equal to total
payments under the full term of the lease or [an] amount
sufficient to cover first year lease payments plus cancellation
costs''.
(b) Requirement for Obligation of Full Cost.--
(1) <<NOTE: Records.>> In general.--Subject to the
availability of appropriations provided in advance, in
exercising the authority of the Secretary of Veterans Affairs to
enter into leases provided in this Act, the Secretary shall
record, pursuant to section 1501 of title 31, United States
Code, as the full cost of the contractual obligation at the time
a contract is executed either--
(A) an amount equal to total payments under the full
term of the lease; or
(B) if the lease specifies payments to be made in
the event the lease is terminated before its full term,
an amount sufficient to cover the first year lease
payments plus the specified cancellation costs.
(2) Self-insuring authority.--The requirements of paragraph
(1) may be satisfied through the use of the self-insuring
authority identified in title 40, United States Code, consistent
with Office of Management and Budget Circular A-11.
(c) Transparency.--
(1) Compliance.--Subsection (b) of section 8104 of title 38,
United States Code, is amended by adding at the end the
following new paragraph:
``(7) In the case of a prospectus proposing funding for a
major medical facility lease, a detailed analysis of how the
lease is expected to comply with Office of Management and Budget
Circular A-11 and section 1341 of title 31 (commonly
[[Page 128 STAT. 1795]]
referred to as the `Anti-Deficiency Act'). Any such analysis
shall include--
``(A) an analysis of the classification of the lease
as a `lease-purchase', `capital lease', or `operating
lease' as those terms are defined in Office of
Management and Budget Circular A-11;
``(B) an analysis of the obligation of budgetary
resources associated with the lease; and
``(C) an analysis of the methodology used in
determining the asset cost, fair market value, and
cancellation costs of the lease.''.
(2) Submittal to congress.--Such section 8104 is further
amended by adding at the end the following new subsection:
``(h)(1) <<NOTE: Deadline.>> Not less than 30 days before entering
into a major medical facility lease, the Secretary shall submit to the
Committees on Veterans' Affairs of the Senate and the House of
Representatives--
``(A) <<NOTE: Notice.>> notice of the Secretary's intention
to enter into the lease;
``(B) a detailed summary of the proposed lease;
``(C) a description and analysis of any differences between
the prospectus submitted pursuant to subsection (b) and the
proposed lease; and
``(D) a scoring analysis demonstrating that the proposed
lease fully complies with Office of Management and Budget
Circular A-11.
``(2) <<NOTE: Confidentiality.>> Each committee described in
paragraph (1) shall ensure that any information submitted to the
committee under such paragraph is treated by the committee with the same
level of confidentiality as is required by law of the Secretary and
subject to the same statutory penalties for unauthorized disclosure or
use as the Secretary.
``(3) <<NOTE: Deadline. Reports.>> Not more than 30 days after
entering into a major medical facility lease, the Secretary shall submit
to each committee described in paragraph (1) a report on any material
differences between the lease that was entered into and the proposed
lease described under such paragraph, including how the lease that was
entered into changes the previously submitted scoring analysis described
in subparagraph (D) of such paragraph.''.
(d) Rule of Construction.--Nothing in this section, or the
amendments made by this section, shall be construed to in any way
relieve the Department of Veterans Affairs from any statutory or
regulatory obligations or requirements existing prior to the enactment
of this section and such amendments.
TITLE VII--OTHER VETERANS MATTERS
SEC. 701. EXPANSION OF MARINE GUNNERY SERGEANT JOHN DAVID FRY
SCHOLARSHIP.
(a) Expansion of Entitlement.--Subsection (b)(9) of section 3311 of
title 38, United States Code, is amended by inserting ``or spouse''
after ``child''.
(b) Limitation and Election on Certain Benefits.--Subsection (f) of
such section is amended--
(1) by redesignating paragraph (2) as paragraph (4); and
[[Page 128 STAT. 1796]]
(2) by inserting after paragraph (1) the following new
paragraphs:
``(2) <<NOTE: Expiration date.>> Limitation.--The
entitlement of an individual to assistance under subsection (a)
pursuant to paragraph (9) of subsection (b) because the
individual was a spouse of a person described in such paragraph
shall expire on the earlier of--
``(A) the date that is 15 years after the date on
which the person died; or
``(B) the date on which the individual remarries.
``(3) Election on receipt of certain benefits.--A surviving
spouse entitled to assistance under subsection (a) pursuant to
paragraph (9) of subsection (b) who is also entitled to
educational assistance under chapter 35 of this title may not
receive assistance under both this section and such chapter, but
shall make an irrevocable election (in such form and manner as
the Secretary may prescribe) under which section or chapter to
receive educational assistance.''.
(c) Conforming Amendment.--Section 3321(b)(4) of such title is
amended--
(1) by striking ``an individual'' and inserting ``a child'';
and
(2) by striking ``such individual's'' each time it appears
and inserting ``such child's''.
(d) <<NOTE: Applicability. 38 USC 3311 note.>> Effective Date.--The
amendments made by this section shall apply with respect to a quarter,
semester, or term, as applicable, commencing on or after January 1,
2015.
SEC. 702. APPROVAL OF COURSES OF EDUCATION PROVIDED BY PUBLIC
INSTITUTIONS OF HIGHER LEARNING FOR
PURPOSES OF ALL-VOLUNTEER FORCE
EDUCATIONAL ASSISTANCE PROGRAM AND POST-9/
11 EDUCATIONAL ASSISTANCE CONDITIONAL ON
IN-STATE TUITION RATE FOR VETERANS.
(a) In General.--Section 3679 of title 38, United States Code, is
amended by adding at the end the following new subsection:
``(c)(1) Notwithstanding any other provision of this chapter and
subject to paragraphs (3) through (6), the Secretary shall disapprove a
course of education provided by a public institution of higher learning
to a covered individual pursuing a course of education with educational
assistance under chapter 30 or 33 of this title while living in the
State in which the public institution of higher learning is located if
the institution charges tuition and fees for that course for the covered
individual at a rate that is higher than the rate the institution
charges for tuition and fees for that course for residents of the State
in which the institution is located, regardless of the covered
individual's State of residence.
``(2) <<NOTE: Definition.>> For purposes of this subsection, a
covered individual is any individual as follows:
``(A) <<NOTE: Time period.>> A veteran who was discharged
or released from a period of not fewer than 90 days of service
in the active military, naval, or air service less than three
years before the date of enrollment in the course concerned.
``(B) An individual who is entitled to assistance under
section 3311(b)(9) or 3319 of this title by virtue of such
individual's relationship to a veteran described in subparagraph
(A).
``(3) If after enrollment in a course of education that is subject
to disapproval under paragraph (1) by reason of paragraph (2)(A)
[[Page 128 STAT. 1797]]
or (2)(B) a covered individual pursues one or more courses of education
at the same public institution of higher learning while remaining
continuously enrolled (other than during regularly scheduled breaks
between courses, semesters or terms) at that institution of higher
learning, any course so pursued by the covered individual at that
institution of higher learning while so continuously enrolled shall also
be subject to disapproval under paragraph (1).
``(4) It shall not be grounds to disapprove a course of education
under paragraph (1) if a public institution of higher learning requires
a covered individual pursuing a course of education at the institution
to demonstrate an intent, by means other than satisfying a physical
presence requirement, to establish residency in the State in which the
institution is located, or to satisfy other requirements not relating to
the establishment of residency, in order to be charged tuition and fees
for that course at a rate that is equal to or less than the rate the
institution charges for tuition and fees for that course for residents
of the State.
``(5) <<NOTE: Waiver authority.>> The Secretary may waive such
requirements of paragraph (1) as the Secretary considers appropriate.
``(6) <<NOTE: Applicability.>> Disapproval under paragraph (1)
shall apply only with respect to educational assistance under chapters
30 and 33 of this title.''.
(b) <<NOTE: Applicability. 38 USC 3679 note.>> Effective Date.--
Subsection (c) of section 3679 of title 38, United States Code (as added
by subsection (a) of this section), shall apply with respect to
educational assistance provided for pursuit of a program of education
during a quarter, semester, or term, as applicable, that begins after
July 1, 2015.
SEC. 703. EXTENSION OF REDUCTION IN AMOUNT OF PENSION FURNISHED BY
DEPARTMENT OF VETERANS AFFAIRS FOR CERTAIN
VETERANS COVERED BY MEDICAID PLANS FOR
SERVICES FURNISHED BY NURSING FACILITIES.
Section 5503(d)(7) of title 38, United States Code, is amended by
striking ``November 30, 2016'' and inserting ``September 30, 2024''.
SEC. 704. EXTENSION OF REQUIREMENT FOR COLLECTION OF FEES FOR
HOUSING LOANS GUARANTEED BY SECRETARY OF
VETERANS AFFAIRS.
Section 3729(b)(2) of title 38, United States Code, is amended--
(1) in subparagraph (A)--
(A) in clause (iii), by striking ``October 1, 2017''
and inserting ``September 30, 2024''; and
(B) in clause (iv), by striking ``October 1, 2017''
and inserting ``September 30, 2024'';
(2) in subparagraph (B)--
(A) in clause (i), by striking ``October 1, 2017''
and inserting ``September 30, 2024''; and
(B) in clause (ii), by striking ``October 1, 2017''
and inserting ``September 30, 2024'';
(3) in subparagraph (C)--
(A) in clause (i), by striking ``October 1, 2017''
and inserting ``September 30, 2024''; and
(B) in clause (ii), by striking ``October 1, 2017''
and inserting ``September 30, 2024''; and
(4) in subparagraph (D)--
(A) in clause (i), by striking ``October 1, 2017''
and inserting ``September 30, 2024''; and
[[Page 128 STAT. 1798]]
(B) in clause (ii), by striking ``October 1, 2017''
and inserting ``September 30, 2024''.
SEC. 705. <<NOTE: 38 USC 703 note.>> LIMITATION ON AWARDS AND
BONUSES PAID TO EMPLOYEES OF DEPARTMENT OF
VETERANS AFFAIRS.
In each of fiscal years 2015 through 2024, the Secretary of Veterans
Affairs shall ensure that the aggregate amount of awards and bonuses
paid by the Secretary in a fiscal year under chapter 45 or 53 of title
5, United States Code, or any other awards or bonuses authorized under
such title does not exceed $360,000,000.
SEC. 706. EXTENSION OF AUTHORITY TO USE INCOME INFORMATION.
Section 5317(g) of title 38, United States Code, is amended by
striking ``September 30, 2016'' and inserting ``September 30, 2024''.
SEC. 707. REMOVAL OF SENIOR EXECUTIVES OF THE DEPARTMENT OF
VETERANS AFFAIRS FOR PERFORMANCE OR
MISCONDUCT.
(a) Removal or Transfer.--
(1) In general.--Chapter 7 of title 38, United States Code,
is amended by adding at the end the following new section:
``Sec. 713. <<NOTE: 38 USC 713.>> Senior executives: removal
based on performance or misconduct
``(a) In General.--(1) The Secretary may remove an individual
employed in a senior executive position at the Department of Veterans
Affairs from the senior executive position if the Secretary determines
the performance or misconduct of the individual warrants such removal.
If the Secretary so removes such an individual, the Secretary may--
``(A) remove the individual from the civil service (as
defined in section 2101 of title 5); or
``(B) in the case of an individual described in paragraph
(2), transfer the individual from the senior executive position
to a General Schedule position at any grade of the General
Schedule for which the individual is qualified and that the
Secretary determines is appropriate.
``(2) An individual described in this paragraph is an individual
who--
``(A) previously occupied a permanent position within the
competitive service (as that term is defined in section 2102 of
title 5);
``(B) previously occupied a permanent position within the
excepted service (as that term is defined in section 2103 of
title 5); or
``(C) prior to employment in a senior executive position at
the Department of Veterans Affairs, did not occupy any position
within the Federal Government.
``(b) Pay of Transferred Individual.--(1) Notwithstanding any other
provision of law, including the requirements of section 3594 of title 5,
any individual transferred to a General Schedule position under
subsection (a)(2) shall, beginning on the date of such transfer, receive
the annual rate of pay applicable to such position.
``(2) An individual so transferred may not be placed on
administrative leave or any other category of paid leave during the
period
[[Page 128 STAT. 1799]]
during which an appeal (if any) under this section is ongoing, and may
only receive pay if the individual reports for duty. If an individual so
transferred does not report for duty, such individual shall not receive
pay or other benefits pursuant to subsection (e)(5).
``(c) <<NOTE: Deadline.>> Notice to Congress.--Not later than 30
days after removing or transferring an individual from a senior
executive position under subsection (a), the Secretary shall submit to
the Committees on Veterans' Affairs of the Senate and House of
Representatives notice in writing of such removal or transfer and the
reason for such removal or transfer.
``(d) Procedure.--(1) The procedures under section 7543(b) of title
5 shall not apply to a removal or transfer under this section.
``(2)(A) Subject to subparagraph (B) and subsection (e), any removal
or transfer under subsection (a) may be appealed to the Merit Systems
Protection Board under section 7701 of title 5.
``(B) <<NOTE: Deadline.>> An appeal under subparagraph (A) of a
removal or transfer may only be made if such appeal is made not later
than seven days after the date of such removal or transfer.
``(e) Expedited Review by Administrative Judge.--(1) Upon receipt of
an appeal under subsection (d)(2)(A), the Merit Systems Protection Board
shall refer such appeal to an administrative judge pursuant to section
7701(b)(1) of title 5. <<NOTE: Deadline.>> The administrative judge
shall expedite any such appeal under such section and, in any such case,
shall issue a decision not later than 21 days after the date of the
appeal.
``(2) Notwithstanding any other provision of law, including section
7703 of title 5, the decision of an administrative judge under paragraph
(1) shall be final and shall not be subject to any further appeal.
``(3) In any case in which the administrative judge cannot issue a
decision in accordance with the 21-day requirement under paragraph (1),
the removal or transfer is final. <<NOTE: Deadline. Reports.>> In such
a case, the Merit Systems Protection Board shall, within 14 days after
the date that such removal or transfer is final, submit to Congress and
the Committees on Veterans' Affairs of the Senate and House of
Representatives a report that explains the reasons why a decision was
not issued in accordance with such requirement.
``(4) The Merit Systems Protection Board or administrative judge may
not stay any removal or transfer under this section.
``(5) <<NOTE: Time period.>> During the period beginning on the
date on which an individual appeals a removal from the civil service
under subsection (d) and ending on the date that the administrative
judge issues a final decision on such appeal, such individual may not
receive any pay, awards, bonuses, incentives, allowances, differentials,
student loan repayments, special payments, or benefits.
``(6) To the maximum extent practicable, the Secretary shall provide
to the Merit Systems Protection Board, and to any administrative judge
to whom an appeal under this section is referred, such information and
assistance as may be necessary to ensure an appeal under this subsection
is expedited.
``(f) Relation to Title 5.--(1) The authority provided by this
section is in addition to the authority provided by section 3592 or
subchapter V of chapter 75 of title 5.
``(2) Section 3592(b)(1) of title 5 does not apply to an action to
remove or transfer an individual under this section.
``(g) Definitions.--In this section:
[[Page 128 STAT. 1800]]
``(1) The term `individual' means--
``(A) a career appointee (as that term is defined in
section 3132(a)(4) of title 5); or
``(B) any individual who occupies an administrative
or executive position and who was appointed under
section 7306(a) or section 7401(1) of this title.
``(2) The term `misconduct' includes neglect of duty,
malfeasance, or failure to accept a directed reassignment or to
accompany a position in a transfer of function.
``(3) The term `senior executive position' means--
``(A) with respect to a career appointee (as that
term is defined in section 3132(a)(4) of title 5), a
Senior Executive Service position (as such term is
defined in section 3132(a)(2) of title 5); and
``(B) with respect to an individual appointed under
section 7306(a) or section 7401(1) of this title, an
administrative or executive position.''.
(2) Clerical amendment.--The table of sections at the
beginning of such chapter is amended by adding at the end the
following new item:
``713. Senior executives: removal based on performance or misconduct.''.
(b) <<NOTE: 38 USC 713 note.>> Establishment of Expedited Review
Process.--
(1) <<NOTE: Deadline.>> In general.--Not later than 14 days
after the date of the enactment of this Act, the Merit Systems
Protection Board shall establish and put into effect a process
to conduct expedited reviews in accordance with section 713(d)
of title 38, United States Code.
(2) Inapplicability of certain regulations.--Section 1201.22
of title 5, Code of Federal Regulations, as in effect on the day
before the date of the enactment of this Act, shall not apply to
expedited reviews carried out under section 713(d) of title 38,
United States Code.
(3) Waiver.--The Merit Systems Protection Board may waive
any other regulation in order to provide for the expedited
review required under section 713(d) of title 38, United States
Code.
(4) Report by merit systems protection board.--Not later
than 14 days after the date of the enactment of this Act, the
Merit Systems Protection Board shall submit to the Committees on
Veterans' Affairs of the Senate and House of Representatives a
report on the actions the Board plans to take to conduct
expedited reviews under section 713(d) of title 38, United
States Code, as added by subsection (a). Such report shall
include a description of the resources the Board determines will
be necessary to conduct such reviews and a description of
whether any resources will be necessary to conduct such reviews
that were not available to the Board on the day before the date
of the enactment of this Act.
(c) <<NOTE: Time period. Effective date. 38 USC 713 note.>>
Temporary Exemption From Certain Limitation on Initiation of Removal
From Senior Executive Service.--During the 120-day period beginning on
the date of the enactment of this Act, an action to remove an individual
from the Senior Executive Service at the Department of Veterans Affairs
pursuant to section 7543 of title 5, United States Code, may be
initiated, notwithstanding section 3592(b) of such title, or any other
provision of law.
[[Page 128 STAT. 1801]]
(d) <<NOTE: 38 USC 713 note.>> Construction.--
(1) <<NOTE: Applicability.>> In general.--Nothing in this
section or section 713 of title 38, United States Code, as added
by subsection (a), shall be construed to apply to an appeal of a
removal, transfer, or other personnel action that was pending
before the date of the enactment of this Act.
(2) Relation to title 5.--With respect to the removal or
transfer of an individual (as that term is defined in such
section 713) employed at the Department of Veterans Affairs, the
authority provided by such section 713 is in addition to the
authority provided by section 3592 or subchapter V of chapter 75
of title 5, United States Code.
TITLE <<NOTE: 38 USC 1701 note.>> VIII--OTHER MATTERS
SEC. 801. APPROPRIATION OF AMOUNTS.
(a) In General.--There is authorized to be appropriated, and is
appropriated, to the Secretary of Veterans Affairs, out of any funds in
the Treasury not otherwise appropriated $5,000,000,000 to carry out
subsection (b). Such funds shall be available for obligation or
expenditure without fiscal year limitation.
(b) Use of Amounts.--The amount appropriated under subsection (a)
shall be used by the Secretary as follows:
(1) To increase the access of veterans to care as follows:
(A) To hire primary care and specialty care
physicians for employment in the Department of Veterans
Affairs.
(B) To hire other medical staff, including the
following:
(i) Physicians.
(ii) Nurses.
(iii) Social workers.
(iv) Mental health professionals.
(v) Other health care professionals as the
Secretary considers appropriate.
(C) To carry out sections 301 and 302, including the
amendments made by such sections.
(D) To pay for expenses, equipment, and other costs
associated with the hiring of primary care, specialty
care physicians, and other medical staff under
subparagraphs (A), (B), and (C).
(2) To improve the physical infrastructure of the Department
as follows:
(A) To maintain and operate hospitals, nursing
homes, domiciliary facilities, and other facilities of
the Veterans Health Administration.
(B) To enter into contracts or hire temporary
employees to repair, alter, or improve facilities under
the jurisdiction of the Department that are not
otherwise provided for under this paragraph.
(C) To carry out leases for facilities of the
Department.
(D) To carry out minor construction projects of the
Department.
(c) Availability.--The amount appropriated under subsection (a)
shall remain available until expended.
(d) Report.--
(1) In general.--Not later than 1 year after the date of the
enactment of this Act, the Secretary of Veterans Affairs
[[Page 128 STAT. 1802]]
shall submit to the appropriate committees of Congress a report
on how the Secretary has obligated the amounts appropriated
under subsection (a) as of the date of the submittal of the
report.
(2) Appropriate committees of congress defined.--In this
subsection, the term ``appropriate committees of Congress''
means--
(A) the Committee on Veterans' Affairs and the
Committee on Appropriations of the Senate; and
(B) the Committee on Veterans' Affairs and the
Committee on Appropriations of the House of
Representatives.
(e) Funding Plan.--The Secretary shall submit to Congress a funding
plan describing how the Secretary intends to use the amounts provided
under subsection (a).
SEC. 802. VETERANS CHOICE FUND.
(a) In General.--There is established in the Treasury of the United
States a fund to be known as the Veterans Choice Fund.
(b) Administration of Fund.--The Secretary of Veterans Affairs shall
administer the Veterans Choice Fund established by subsection (a).
(c) Use of Amounts.--
(1) In general.--Any amounts deposited in the Veteran Choice
Fund shall be used by the Secretary of Veterans Affairs to carry
out section 101, including, subject to paragraph (2), any
administrative requirements of such section.
(2) Amount for administrative requirements.--
(A) Limitation.--Except as provided by subparagraph
(B), of the amounts deposited in the Veterans Choice
Fund, not more than $300,000,000 may be used for
administrative requirements to carry out section 101.
(B) Increase.--The Secretary may increase the amount
set forth in subparagraph (A) with respect to the
amounts used for administrative requirements if--
(i) <<NOTE: Determination.>> the Secretary
determines that the amount of such increase is
necessary to carry out section 101;
(ii) <<NOTE: Reports. Time period.>> the
Secretary submits to the Committees on Veterans'
Affairs and Appropriations of the House of
Representatives and the Committees on Veterans'
Affairs and Appropriations of the Senate a report
described in subparagraph (C); and
(iii) a period of 60 days has elapsed
following the date on which the Secretary submits
the report under clause (ii).
(C) Report.--A report described in this subparagraph
is a report that contains the following:
(i) A notification of the amount of the
increase that the Secretary determines necessary
under subparagraph (B)(i).
(ii) The justifications for such increased
amount.
(iii) The administrative requirements that the
Secretary will carry out using such increased
amount.
(d) Appropriation and Deposit of Amounts.--
(1) In general.--There is authorized to be appropriated, and
is appropriated, to the Secretary of Veterans Affairs, out of
any funds in the Treasury not otherwise appropriated
$10,000,000,000 to be deposited in the Veterans Choice Fund
[[Page 128 STAT. 1803]]
established by subsection (a). Such funds shall be available for
obligation or expenditure without fiscal year limitation, and
only for the program created under section 101.
(2) Availability.--The amount appropriated under paragraph
(1) shall remain available until expended.
(e) Sense of Congress.--It is the sense of Congress that the
Veterans Choice Fund is a supplement to but distinct from the Department
of Veterans Affairs' current and expected level of non-Department care
currently part of Department's medical care budget. Congress expects
that the Department will maintain at least its existing obligations of
non-Department care programs in addition to but distinct from the
Veterans Choice Fund for each of fiscal years 2015 through 2017.
SEC. 803. EMERGENCY DESIGNATIONS.
(a) In General.--This Act is designated as an emergency requirement
pursuant to section 4(g) of the Statutory Pay-As-You-Go Act of 2010 (2
U.S.C. 933(g)).
(b) Designation in Senate.--In the Senate, this Act is designated as
an emergency requirement pursuant to section 403(a) of S. Con. Res. 13
(111th Congress), the concurrent resolution on the budget for fiscal
year 2010.
Approved August 7, 2014.
LEGISLATIVE HISTORY--H.R. 3230 (S. 2450):
---------------------------------------------------------------------------
HOUSE REPORTS: No. 113-564 (Comm. of Conference).
CONGRESSIONAL RECORD:
Vol. 159 (2013):
Oct. 3, considered and passed House.
Vol. 160 (2014):
June 11, considered and passed
Senate, amended, in lieu of S.
2450.
June 18, House concurred in Senate
amendments with an amendment.
July 30, House agreed to conference
report.
July 31, Senate agreed to conference
report.
DAILY COMPILATION OF PRESIDENTIAL DOCUMENTS (2014):
Aug. 7, Presidential remarks.
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