38 U.S.C. § 1703 (2024) — Title 38: VETERANS' BENEFITS / Chapter 17 / Subchapter I / Section 1703: Veterans Community Care Program
Veterans Community Care Program
Status: in_force

(a) In General.—(1) There is established a program to furnish hospital care, medical services, and extended care services to covered veterans through health care providers specified in subsection (c).

(2) The Secretary shall coordinate the furnishing of hospital care, medical services, and extended care services under this section to covered veterans, including coordination of, at a minimum, the following:

(A) Ensuring the scheduling of medical appointments in a timely manner and the establishment of a mechanism to receive medical records from non-Department providers.

(B) Ensuring continuity of care and services.

(C) Ensuring coordination among regional networks if the covered veteran accesses care and services in a different network than the regional network in which the covered veteran resides.

(D) Ensuring that covered veterans do not experience a lapse in care resulting from errors or delays by the Department or its contractors or an unusual or excessive burden in accessing hospital care, medical services, or extended care services.

(3) A covered veteran may only receive care or services under this section upon the authorization of such care or services by the Secretary.

(4) Nothing in this section shall be construed to authorize the Secretary to suspend the program established under paragraph (1).

(b) Covered Veterans.—For purposes of this section, a covered veteran is any veteran who—

(1) is enrolled in the system of annual patient enrollment established and operated under section 1705 of this title; or

(2) is not enrolled in such system but is otherwise entitled to hospital care, medical services, or extended care services under subsection (c)(2) of such section.

(c) Health Care Providers Specified.—Health care providers specified in this subsection are the following:

(1) Any health care provider that is participating in the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), including any physician furnishing services under such a program.

(2) The Department of Defense.

(3) The Indian Health Service.

(4) Any Federally-qualified health center (as defined in section 1905(l)(2)(B) of the Social Security Act (42 U.S.C. 1396d(l)(2)(B))).

(5) Any health care provider not otherwise covered under any of paragraphs (1) through (4) that meets criteria established by the Secretary for purposes of this section.

(d) Conditions Under Which Care Is Required To Be Furnished Through Non-Department Providers.—(1) The Secretary shall, subject to the availability of appropriations, furnish hospital care, medical services, and extended care services to a covered veteran through health care providers specified in subsection (c) if—

(A) the Department does not offer the care or services the veteran requires;

(B) the Department does not operate a full-service medical facility in the State in which the covered veteran resides;

(C)(i) the covered veteran was an eligible veteran under section 101(b)(2)(B) of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113–146; 38 U.S.C. 1701 note) as of the day before the date of the enactment of the Caring for Our Veterans Act of 2018;

(ii) continues to reside in a location that would qualify the veteran for eligibility under such section; and

(iii) either—

(I) resides in one of the five States with the lowest population density as determined by data from the 2010 decennial census; or

(II) resides in a State not described in subclause (I) and—

(aa) received care or services under this title in the year preceding the enactment of the Caring for Our Veterans Act of 2018; and

(bb) is seeking care or services within 2 years of the date of the enactment of the Caring for Our Veterans Act of 2018;

(D) the covered veteran has contacted the Department to request care or services and the Department is not able to furnish such care or services in a manner that complies with designated access standards developed by the Secretary under section 1703B of this title; or

(E) the covered veteran and the covered veteran's referring clinician agree that furnishing care and services through a non-Department entity or provider would be in the best medical interest of the covered veteran based upon criteria developed by the Secretary.

(2) The Secretary shall ensure that the criteria developed under paragraph (1)(E) include consideration of the following:

(A) The distance between the covered veteran and the facility that provides the hospital care, medical services, or extended care services the veteran needs.

(B) The nature of the hospital care, medical services, or extended care services required.

(C) The frequency that the hospital care, medical services, or extended care services needs to be furnished.

(D) The timeliness of available appointments for the hospital care, medical services, or extended care services the veteran needs.

(E) Whether the covered veteran faces an unusual or excessive burden to access hospital care, medical services, or extended care services from the Department medical facility where a covered veteran seeks hospital care, medical services, or extended care services, which shall include consideration of the following:

(i) Whether the covered veteran faces an excessive driving distance, geographical challenge, or environmental factor that impedes the access of the covered veteran.

(ii) Whether the hospital care, medical services, or extended care services sought by the veteran is provided by a medical facility of the Department that is reasonably accessible to a covered veteran.

(iii) Whether a medical condition of the covered veteran affects the ability of the covered veteran to travel.

(iv) Whether there is compelling reason, as determined by the Secretary, that the veteran needs to receive hospital care, medical services, or extended care services from a medical facility other than a medical facility of the Department.

(v) Such other considerations as the Secretary considers appropriate.

(3) If the Secretary has determined that the Department does not offer the care or services the covered veteran requires under subparagraph (A) of paragraph (1), that the Department does not operate a full-service medical facility in the State in which the covered veteran resides under subparagraph (B) of such paragraph, that the covered veteran is described under subparagraph (C) of such paragraph, or that the Department is not able to furnish care or services in a manner that complies with designated access standards developed by the Secretary under section 1703B of this title under subparagraph (D) of such paragraph, the decision to receive hospital care, medical services, or extended care services under such subparagraphs from a health care provider specified in subsection (c) shall be at the election of the veteran.

(4) In determining under paragraph (1)(D) whether the Department is able to furnish care or services in a manner that complies with designated access standards developed by the Secretary under section 1703B of this title, for purposes of calculating a wait time for a veteran to schedule an appointment at a medical facility of the Department, the Secretary shall measure from the date of request for the appointment, unless a later date has been agreed to by the veteran in consultation with a health care provider of the Department, to the first next available appointment date relevant to the requested medical service.

(e) Conditions Under Which Care Is Authorized To Be Furnished Through Non-Department Providers.—(1)(A) The Secretary may furnish hospital care, medical services, or extended care services through a health care provider specified in subsection (c) to a covered veteran served by a medical service line of the Department that the Secretary has determined is not providing care that complies with the standards for quality the Secretary shall establish under section 1703C.

(B) In carrying out subparagraph (A), the Secretary shall—

(i) measure timeliness of the medical service line at a facility of the Department when compared with the same medical service line at different Department facilities; and

(ii) measure quality at a medical service line of a facility of the Department by comparing it with two or more distinct and appropriate quality measures at non-Department medical service lines.

(C)(i) The Secretary may not concurrently furnish hospital care, medical services, or extended care services under subparagraph (A) with respect to more than three medical service lines described in such subparagraph at any one health care facility of the Department.

(ii) The Secretary may not concurrently furnish hospital care, medical services, or extended care services under subparagraph (A) with respect to more than 36 medical service lines nationally described in such subparagraph.

(2) The Secretary may limit the types of hospital care, medical services, or extended care services covered veterans may receive under paragraph (1) in terms of the length of time such care and services will be available, the location at which such care and services will be available, and the clinical care and services that will be available.

(3)(A) Except as provided for in subparagraph (B), the hospital care, medical services, and extended care services authorized under paragraph (1) with respect to a medical service line shall cease when the remediation described in section 1706A with respect to such medical service line is complete.

(B) The Secretary shall ensure continuity and coordination of care for any veteran who elects to receive care or services under paragraph (1) from a health care provider specified in subsection (c) through the completion of an episode of care.

(4) The Secretary shall publish in the Federal Register, and shall take all reasonable steps to provide direct notice to covered veterans affected under this subsection, at least once each year stating the time period during which such care and services will be available, the location or locations where such care and services will be available, and the clinical services available at each location under this subsection in accordance with regulations the Secretary shall prescribe.

(5) When the Secretary exercises the authority under paragraph (1), the decision to receive care or services under such paragraph from a health care provider specified in subsection (c) shall be at the election of the covered veteran.

(f) Review of Decisions.—The review of any decision under subsection (d) or (e) shall be subject to the Department's clinical appeals process, and such decisions may not be appealed to the Board of Veterans' Appeals.

(g) Tiered Network.—(1) To promote the provision of high-quality and high-value hospital care, medical services, and extended care services under this section, the Secretary may develop a tiered provider network of eligible providers based on criteria established by the Secretary for purposes of this section.

(2) In developing a tiered provider network of eligible providers under paragraph (1), the Secretary shall not prioritize providers in a tier over providers in any other tier in a manner that limits the choice of a covered veteran in selecting a health care provider specified in subsection (c) for receipt of hospital care, medical services, or extended care services under this section.

(h) Contracts To Establish Networks of Health Care Providers.—(1)(A) The Secretary shall enter into consolidated, competitively bid contracts to establish networks of health care providers specified in paragraphs (1) and (5) of subsection (c) for purposes of providing sufficient access to hospital care, medical services, or extended care services under this section.

(B) For purposes of subparagraph (A), the requirement to enter into consolidated, competitively bid contracts shall not restrict the authority of the Secretary under other provisions of law when modifying such a contract after entering into the contract.

(2)(A) The Secretary shall, to the extent practicable, ensure that covered veterans are able to make their own appointments using advanced technology.

(B) To the extent practicable, the Secretary shall be responsible for the scheduling of appointments for hospital care, medical services, and extended care services under this section.

(3)(A) The Secretary may terminate a contract with an entity entered into under paragraph (1) at such time and upon such notice to the entity as the Secretary may specify for purposes of this section, if the Secretary notifies the appropriate committees of Congress that, at a minimum—

(i) the entity—

(I) failed to comply substantially with the provisions of the contract or with the provisions of this section and the regulations prescribed under this section;

(II) failed to comply with the access standards or the standards for quality established by the Secretary;

(III) is excluded from participation in a Federal health care program (as defined in section 1128B(f) of the Social Security Act (42 U.S.C. 1320a–7b(f))) under section 1128 or 1128A of the Social Security Act (42 U.S.C. 1320a–7 and 1320a–7a);

(IV) is identified as an excluded source on the list maintained in the System for Award Management, or any successor system; or

(V) has been convicted of a felony or other serious offense under Federal or State law and the continued participation of the entity would be detrimental to the best interests of veterans or the Department;

(ii) it is reasonable to terminate the contract based on the health care needs of veterans; or

(iii) it is reasonable to terminate the contract based on coverage provided by contracts or sharing agreements entered into under authorities other than this section.

(B) Nothing in subparagraph (A) may be construed to restrict the authority of the Secretary to terminate a contract entered into under paragraph (1) under any other provision of law.

(4) Whenever the Secretary provides notice to an entity that the entity is failing to meet contractual obligations entered into under paragraph (1), the Secretary shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report on such failure. Such report shall include the following:

(A) An explanation of the reasons for providing such notice.

(B) A description of the effect of such failure, including with respect to cost, schedule, and requirements.

(C) A description of the actions taken by the Secretary to mitigate such failure.

(D) A description of the actions taken by the contractor to address such failure.

(E) A description of any effect on the community provider market for veterans in the affected area.

(5)(A) The Secretary shall instruct each entity awarded a contract under paragraph (1) to recognize and accept, on an interim basis, the credentials and qualifications of health care providers who are authorized to furnish hospital care and medical services to veterans under a community care program of the Department in effect as of the day before the effective date specified in section 101(b) of the Caring for Our Veterans Act of 2018, including under the Patient-Centered Community Care Program and the Veterans Choice Program under section 101 of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113–146; 38 U.S.C. 1701 note), as qualified providers under the program established under this section.

(B) The interim acceptance period under subparagraph (A) shall be determined by the Secretary based on the following criteria:

(i) With respect to a health care provider, when the current certification agreement for the health care provider expires.

(ii) Whether the Department has enacted certification and eligibility criteria and regulatory procedures by which non-Department providers will be authorized under this section.

(6) The Secretary shall establish a system or systems for monitoring the quality of care provided to covered veterans through a network under this subsection and for assessing the quality of hospital care, medical services, and extended care services furnished through such network before the renewal of the contract for such network.

(i) Payment Rates for Care and Services.—(1) Except as provided in paragraph (2), and to the extent practicable, the rate paid for hospital care, medical services, or extended care services under any provision in this title may not exceed the rate paid by the United States to a provider of services (as defined in section 1861(u) of the Social Security Act (42 U.S.C. 1395x(u))) or a supplier (as defined in section 1861(d) of such Act (42 U.S.C. 1395x(d))) under the Medicare program under title XI or title XVIII of the Social Security Act (42 U.S.C. 1301 et seq.), including section 1834 of such Act (42 U.S.C. 1395m), for the same care or services.

(2)(A) A higher rate than the rate paid by the United States as described in paragraph (1) may be negotiated with respect to the furnishing of care or services to a covered veteran who resides in a highly rural area.

(B) In this paragraph, the term "highly rural area" means an area located in a county that has fewer than seven individuals residing in that county per square mile.

(3) With respect to furnishing care or services under this section in Alaska, the Alaska Fee Schedule of the Department of Veterans Affairs shall be followed, except for when another payment agreement, including a contract or provider agreement, is in effect.

(4) With respect to furnishing hospital care, medical services, or extended care services under this section in a State with an All-Payer Model Agreement under section 1814(b)(3) of the Social Security Act (42 U.S.C. 1395f(b)(3)) that became effective on or after January 1, 2014, the Medicare payment rates under paragraph (2)(A) shall be calculated based on the payment rates under such agreement.

(5) Notwithstanding paragraph (1), the Secretary may incorporate, to the extent practicable, the use of value-based reimbursement models to promote the provision of high-quality care.

(6) With respect to hospital care, medical services, or extended care services for which there is not a rate paid under the Medicare program as described in paragraph (1), the rate paid for such care or services shall be determined by the Secretary.

(j) Treatment of Other Health Plan Contracts.—In any case in which a covered veteran is furnished hospital care, medical services, or extended care services under this section for a non-service-connected disability described in subsection (a)(2) of section 1729 of this title, the Secretary shall recover or collect reasonable charges for such care or services from a health plan contract described in section 1729 in accordance with such section.

(k) Payment by Veteran.—A covered veteran shall not pay a greater amount for receiving care or services under this section than the amount the veteran would pay for receiving the same or comparable care or services at a medical facility of the Department or from a health care provider of the Department.

(l) Transplant Authority for Improved Access.—(1) In the case of a covered veteran described in paragraph (2), the Secretary shall determine whether to authorize an organ or bone marrow transplant for that covered veteran at a non-Department facility.

(2) A covered veteran described in this paragraph—

(A) requires an organ or bone marrow transplant; and

(B) has, in the opinion of the primary care provider of the veteran, a medically compelling reason to travel outside the region of the Organ Procurement and Transplantation Network, established under section 372 of the National Organ Transplantation Act 1 (Public Law 98–507; 42 U.S.C. 274), in which the veteran resides, to receive such transplant.

(m) Monitoring of Care Provided.—(1)(A) Not later than 540 days after the date of the enactment of the Caring for Our Veterans Act of 2018, and not less frequently than annually thereafter, the Secretary shall submit to appropriate committees of Congress a review of the types and frequency of care sought under subsection (d).

(B) The review submitted under subparagraph (A) shall include an assessment of the following:

(i) The top 25 percent of types of care and services most frequently provided under subsection (d) due to the Department not offering such care and services.

(ii) The frequency such care and services were sought by covered veterans under this section.

(iii) An analysis of the reasons the Department was unable to provide such care and services.

(iv) Any steps the Department took to provide such care and services at a medical facility of the Department.

(v) The cost of such care and services.

(2) In monitoring the hospital care, medical services, and extended care services furnished under this section, the Secretary shall do the following:

(A) With respect to hospital care, medical services, and extended care services furnished through provider networks established under subsection (i)—

(i) compile data on the types of hospital care, medical services, and extended care services furnished through such networks and how many patients used each type of care and service;

(ii) identify gaps in hospital care, medical services, or extended care services furnished through such networks;

(iii) identify how such gaps may be fixed through new contracts within such networks or changes in the manner in which hospital care, medical services, or extended care services are furnished through such networks;

(iv) assess the total amounts spent by the Department on hospital care, medical services, and extended care services furnished through such networks;

(v) assess the timeliness of the Department in referring hospital care, medical services, and extended care services to such networks; and

(vi) assess the timeliness of such networks in—

(I) accepting referrals; and

(II) scheduling and completing appointments.

(B) Report the number of medical service lines the Secretary has determined under subsection (e)(1) not to be providing hospital care, medical services, or extended care services that comply with the standards for quality established by the Secretary.

(C) Assess the use of academic affiliates and centers of excellence of the Department to furnish hospital care, medical services, and extended care services to covered veterans under this section.

(D) Assess the hospital care, medical services, and extended care services furnished to covered veterans under this section by medical facilities operated by Federal agencies other than the Department.

(3) Not later than 540 days after the date of the enactment of the Caring for Our Veterans Act of 2018 and not less frequently than once each year thereafter, the Secretary shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report on the information gathered under paragraph (2).

(n) Prohibition on Certain Limitations.—(1) The Secretary shall not limit the types of hospital care, medical services, or extended care services covered veterans may receive under this section if it is in the best medical interest of the veteran to receive such hospital care, medical services, or extended care services, as determined by the veteran and the veteran's health care provider.

(2) No provision in this section may be construed to alter or modify any other provision of law establishing specific eligibility criteria for certain hospital care, medical services, or extended care services.

(o) Outreach Regarding Availability of Care and Services.—(1) The Secretary shall conduct outreach to inform veterans of the following:

(A) The conditions for care or services under subsections (d) and (e).

(B) How to request such care or services.

(C) How to appeal a denial of a request for such care or services using the clinical appeals process of the Veterans Health Administration.

(2) Upon enrollment of a veteran in the system of annual patient enrollment established and operated under section 1705 of this title, and not less frequently than every two years thereafter, the Secretary shall inform the veteran of information described in paragraph (1).

(3) The Secretary shall ensure that information described in paragraph (1) is—

(A) publicly displayed in each medical facility of the Department;

(B) prominently displayed on a website of the Department; and

(C) included in other outreach campaigns and activities conducted by the Secretary.

(p) Annual Review and Report on Waivers of Payment Rates.—(1) On an annual basis, the Secretary shall—

(A) conduct a review of waivers of payment rates under subsection (i) for Third Party Administrators to identify whether such waivers help to alleviate community-specific challenges, including scarcity of medical services associated with access to health care; and

(B) submit to Congress a report on the results of such review.

(2) Each report under paragraph (1)(B) shall include, with respect to the period covered by the report—

(A) a statement, disaggregated by region, of the total number of waivers described in subparagraph (A) of such paragraph requested by Third Party Administrators;

(B) a statement of the total number of such waivers that were—

(i) granted by the Secretary;

(ii) denied by the Secretary; or

(iii) withdrawn by a Third Party Administrator;

(C) a description of the process for the review required under paragraph (1);

(D) a statement, disaggregated by region, of the average time to process such waivers;

(E) an assessment, disaggregated by region, of the extent to which such waivers that were granted by the Secretary improved access to health care for covered veterans; and

(F) a description of trends, if any, identified by the Secretary with respect to such waivers.

(3) In this subsection, the term "Third Party Administrator" has the meaning given such term in section 1703B of this title.

(q) Definitions.—In this section:

(1) The term "appropriate committees of Congress" means—

(A) the Committee on Veterans' Affairs and the Committee on Appropriations of the Senate; and

(B) the Committee on Veterans' Affairs and the Committee on Appropriations of the House of Representatives.

(2) The term "medical service line" means a clinic within a Department medical center.

(Added Pub. L. 99–272, title XIX, §19012(b)(1), Apr. 7, 1986, 100 Stat. 380, §603; amended Pub. L. 99–166, title I, §102(b)(1), Dec. 3, 1985, 99 Stat. 943; Pub. L. 99–272, title XIX, §19012(c)(5)(A), Apr. 7, 1986, 100 Stat. 382; Pub. L. 100–322, title I, §§101(e)(3), 104, 112(a), May 20, 1988, 102 Stat. 492, 493, 499; Pub. L. 100–687, div. B, title XV, §1503(a)(1), Nov. 18, 1988, 102 Stat. 4133; Pub. L. 102–54, §14(b)(9), June 13, 1991, 105 Stat. 283; renumbered §1703 and amended Pub. L. 102–83, §§4(a)(1), (3)–(5), (b)(1), (2)(E), 5(a), (c)(1), Aug. 6, 1991, 105 Stat. 403–406; Pub. L. 102–585, title V, §501, Nov. 4, 1992, 106 Stat. 4955; Pub. L. 104–262, title I, §104(b), Oct. 9, 1996, 110 Stat. 3184; Pub. L. 108–422, title VI, §601, Nov. 30, 2004, 118 Stat. 2396; Pub. L. 109–13, div. A, title VI, §6080, May 11, 2005, 119 Stat. 302; Pub. L. 110–387, title VIII, §802, Oct. 10, 2008, 122 Stat. 4141; Pub. L. 112–37, §10(a), Oct. 5, 2011, 125 Stat. 396; Pub. L. 115–182, title I, §101(a)(1), June 6, 2018, 132 Stat. 1395; Pub. L. 115–251, title II, §§201(a), 202, Sept. 29, 2018, 132 Stat. 3171, 3172; Pub. L. 117–328, div. U, title I, §§121, 125(b), Dec. 29, 2022, 136 Stat. 5415, 5418; Pub. L. 118–210, title I, §§102(a), 103(a), Jan. 2, 2025, 138 Stat. 2709, 2710.)

Editorial Notes

References in Text

The Social Security Act, referred to in subsecs. (c)(1) and (i)(1), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Titles XI and XVIII of the Act are classified generally to subchapters XI (§1301 et seq.) and XVIII (§1395 et seq.), respectively, of chapter 7 of Title 42, The Public Health and Welfare. For complete classification of this Act to the Code, see section 1305 of Title 42 and Tables.

The date of the enactment of the Caring for Our Veterans Act of 2018, referred to in subsecs. (d)(1)(C) and (m)(1), (3), is the date of enactment of Pub. L. 115–182, which was approved June 6, 2018.

For the effective date specified in section 101(b) of the Caring for Our Veterans Act of 2018, referred to in subsec. (h)(5)(A), see section 101(b) of Pub. L. 115–182, which is set out as an Effective Date of 2018 Amendment note below.

Section 372 of the National Organ Transplantation Act, referred to in subsec. (l)(2)(B), probably means section 372 of the Public Health Service Act, act July 1, 1944, ch. 373, which was enacted by section 201 of the National Organ Transplant Act, Pub. L. 98–507, and is classified to section 274 of Title 42, The Public Health and Welfare.

Amendments

2025—Subsec. (o). Pub. L. 118–210, §102(a)(2), added subsec. (o). Former subsec. (o) redesignated (p), then (q).

Subsec. (p). Pub. L. 118–210, §103(a)(2), added subsec. (p).

Subsec. (q). Pub. L. 118–210, §§102(a)(1), 103(a)(1), redesignated subsec. (o) as (p), then (q).

2022—Subsec. (a)(4). Pub. L. 117–328, §125(b), added par. (4).

Subsec. (d)(4). Pub. L. 117–328, §121, added par. (4).

2018—Pub. L. 115–182 amended section generally. Prior to amendment, section related to contracts for hospital care and medical services in non-Department facilities.

Subsec. (h)(1). Pub. L. 115–251, §201(a), designated existing provisions as subpar. (A) and added subpar. (B).

Subsec. (h)(5)(A). Pub. L. 115–251, §202, substituted "the effective date specified in section 101(b)" for "the date of the enactment".

2011—Subsec. (d)(4). Pub. L. 112–37 substituted "September 30, 2020" for "September 30, 2013".

2008—Subsec. (d)(4). Pub. L. 110–387 substituted "September 30, 2013" for "September 30, 2008".

2005—Subsec. (d)(2). Pub. L. 109–13 substituted "shall be available, without fiscal year limitation, for the purposes" for "shall be available for the purposes".

2004—Subsec. (d). Pub. L. 108–422 added subsec. (d).

1996—Subsec. (a). Pub. L. 104–262, §104(b)(1), struck out "or 1712" after ", as authorized in section 1710" in introductory provisions.

Subsec. (a)(2)(A). Pub. L. 104–262, §104(b)(2)(A), substituted "1710(a)(1)(B)" for "1712(a)(1)(B)".

Subsec. (a)(2)(B). Pub. L. 104–262, §104(b)(2)(B), added subpar. (B) and struck out former subpar. (B) which read as follows: "a veteran described in paragraph (2), (3), or (4) of section 1712(a) of this title, for a purpose described in section 1712(a)(5)(B) of this title;".

Subsec. (a)(2)(C). Pub. L. 104–262, §104(b)(2)(C), substituted "section 1710(a)(2)(E) of this title, or a veteran who is in receipt of increased pension, or additional compensation or allowances based on the need of regular aid and attendance or by reason of being permanently housebound (or who, but for the receipt of retired pay, would be in receipt of such pension, compensation, or allowance)," for "section 1712(a)(3) (other than a veteran who is a former prisoner of war) of this title".

Subsec. (a)(7). Pub. L. 104–262, §104(b)(3), substituted "1712(a)(1)(F)" for "1712(b)(1)(F)".

1992—Subsec. (a)(1)(C). Pub. L. 102–585 added subpar. (C).

1991—Pub. L. 102–83, §5(a), renumbered section 603 of this title as this section.

Pub. L. 102–83, §4(a)(5), substituted "non-Department" for "non-Veterans' Administration" in section catchline.

Subsec. (a). Pub. L. 102–83, §5(c)(1), substituted "1710 or 1712" for "610 or 612" in introductory provisions, "1712(a)(1)(B)" for "612(a)(1)(B)" in par. (2)(A), "1712(a)" for "612(a)" and "1712(a)(5)(B)" for "612(a)(5)(B)" in par. (2)(B), "1712(a)(3)" for "612(a)(3)" in par. (2)(C), "1720" for "620" in par. (3), and "1712(b)(1)(F)" for "612(b)(1)(F)" in par. (7).

Pub. L. 102–83, §4(b)(1), (2)(E), substituted "Secretary" for "Administrator" in introductory provisions and in par. (2)(C).

Pub. L. 102–83, §4(a)(5), substituted "non-Department" for "non-Veterans' Administration" in introductory provisions and in pars. (3) and (5).

Pub. L. 102–83, §4(a)(3), (4), substituted "Department" for "Veterans' Administration" wherever appearing in introductory provisions and pars. (2), (3), (5), and (6).

Subsec. (a)(2)(B). Pub. L. 102–54, §14(b)(9)(A), struck out "section" before "paragraph".

Subsec. (a)(7). Pub. L. 102–54, §14(b)(9)(B), substituted "section 612(b)(1)(F)" for "section 612(b)(1)(G)".

Subsec. (a)(8). Pub. L. 102–83, §4(a)(1), substituted "administered by the Secretary" for "administered by the Veterans' Administration".

Subsec. (b). Pub. L. 102–83, §4(b)(1), (2)(E), substituted "Secretary" for "Administrator" in two places.

Pub. L. 102–83, §4(a)(5), substituted "non-Department" for "non-Veterans' Administration".

Subsec. (c). Pub. L. 102–83, §5(c)(1), substituted "1712A, 1720, 1720A, 1724, and 1732" for "612A, 620, 620A, 624, and 632".

Pub. L. 102–83, §4(b)(1), (2)(E), substituted "Secretary" for "Administrator" in two places.

Pub. L. 102–54, §14(b)(9)(C), inserted before period at end "(Public Law 100–322; 102 Stat. 501)".

1988—Subsec. (a). Pub. L. 100–322, §104(b)(1), substituted  "furnish  any  of  the  following:"  for "furnish—".

Subsec. (a)(1). Pub. L. 100–322, §104(b)(2), (3), substituted "Hospital" for "hospital" and the period for semicolon at end.

Subsec. (a)(2). Pub. L. 100–322, §104(b)(2), (3), substituted "Medical" for "medical" and the period for semicolon at end.

Subsec. (a)(2)(B). Pub. L. 100–687 substituted "paragraph (2), (3), or (4) of section 612(a)" for "612(a)(4)", and "612(a)(5)(B)" for "612(a)(5)".

Pub. L. 100–322, §101(e)(3)(A), substituted "section 612(a)(4) of this title, for a purpose described in section 612(a)(5) of this title" for "section 612(f)(1)(A)(ii) of this title".

Subsec. (a)(2)(C). Pub. L. 100–322, §101(e)(3)(B), substituted "section 612(a)(3) (other than a veteran who is a former prisoner of war)" for "section 612(g)".

Subsec. (a)(3). Pub. L. 100–322, §104(a)(1), (b)(2), (3), substituted "Hospital" for "hospital", inserted "or nursing home care under section 620 of this title", and substituted the period for semicolon at end.

Subsec. (a)(4), (5). Pub. L. 100–322, §104(b)(2), (3), substituted "Hospital" for "hospital" and the period for semicolon at end.

Subsec. (a)(6). Pub. L. 100–322, §104(b)(2), (4), substituted "Diagnostic" for "diagnostic" and the period for "; or".

Subsec. (a)(7). Pub. L. 100–322, §104(b)(2), substituted "Outpatient" for "outpatient".

Subsec. (a)(8). Pub. L. 100–322, §104(a)(2), added par. (8).

Subsec. (c). Pub. L. 100–322, §112(a), added subsec. (c).

1986—Subsec. (a)(5). Pub. L. 99–272, §19012(c)(5)(A), made conforming amendment to Pub. L. 99–166, §102(b)(1). See 1985 Amendment note below.

1985—Subsec. (a)(5). Pub. L. 99–166, §102(b)(1), as amended by Pub. L. 99–272, §19012(c)(5)(A), inserted "(other than the Commonwealth of Puerto Rico)" after "in a State" and substituted "contiguous States and the Commonwealth of Puerto Rico" for "contiguous States, but the authority of the Administrator under this paragraph with respect to the Commonwealth of Puerto Rico shall expire on September 30, 1988, and until such date the Administrator may, if necessary to prevent hardship, waive the applicability to the Commonwealth of Puerto Rico of the restrictions in this paragraph with respect to hospital patient loads and the incidence of the furnishing of medical services".

Statutory Notes and Related Subsidiaries

Effective Date of 2018 Amendment

Pub. L. 115–251, title II, §201(b), Sept. 29, 2018, 132 Stat. 3172, provided that: "The amendments made by subsection (a) [amending this section] shall take effect on the effective date specified in section 101(b) of the John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018 (Public Law 115–182) [set out below]."

Pub. L. 115–182, title I, §101(b), June 6, 2018, 132 Stat. 1403, provided that: "Section 1703 of title 38, United States Code, as amended by subsection (a), shall take effect on the later of—

"(1) the date that is 30 days after the date on which the Secretary of Veterans Affairs submits the report required under section 101(q)(2) of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113–146; 38 U.S.C. 1701 note) [June 29, 2017]; or

"(2) the date on which the Secretary promulgates regulations pursuant to subsection (c) [set out as a Regulations note below] [regulations effective June 6, 2019, see 84 F.R. 26278]."

Effective Date of 1988 Amendment

Pub. L. 100–687, div. B, title XV, §1503(b), Nov. 18, 1988, 102 Stat. 4134, provided that: "The amendments made by subsection (a)(1) [amending this section] shall apply with respect to the furnishing of medical services by contract to veterans who apply to the Veterans' Administration for medical services after June 30, 1988."

Pub. L. 100–322, title I, §101(i), May 20, 1988, 102 Stat. 492, provided that: "The amendments made by this section [amending this section and sections 612 and 617 [now 1712 and 1717] of this title] shall apply with respect to the furnishing of medical services to veterans who apply for such services after June 30, 1988."

Effective Date of 1985 Amendment

Pub. L. 99–166, title I, §102(b)(1), Dec. 3, 1985, 99 Stat. 943, as amended by Pub. L. 99–272, title XIX, §19012(c)(5)(A), Apr. 7, 1986, 100 Stat. 382, provided that the amendment made by that section is effective Oct. 1, 1988.

Regulations

Pub. L. 115–182, title I, §101(c), June 6, 2018, 132 Stat. 1403, provided that:

"(1) In general.—Not later than 1 year after the date of the enactment of this Act [June 6, 2018], the Secretary of Veterans Affairs shall promulgate regulations to carry out section 1703 of title 38, United States Code, as amended by subsection (a) of this section.

"(2) Updates.—

"(A) Periodic.—Before promulgating the regulations required under paragraph (1), the Secretary shall provide to the appropriate committees of Congress periodic updates to confirm the progress of the Secretary toward developing such regulations.

"(B) First update.—The first update under subparagraph (A) shall occur no later than 120 days from the date of the enactment of this Act.

"(C) Appropriate committees of congress defined.—In this paragraph, the term 'appropriate committees of Congress' means—

"(i) the Committee on Veterans' Affairs and the Committee on Appropriations of the Senate; and

"(ii) the Committee on Veterans' Affairs and the Committee on Appropriations of the House of Representatives."

Implementation of Provision of Care Under Veterans Community Care Program Upon Determination of Eligibility by Veteran and Veteran's Referring Clinician

Pub. L. 118–210, title I, §101, Jan. 2, 2025, 138 Stat. 2708, provided that:

"(a) In General.—During the period specified in subsection (c), the Secretary of Veterans Affairs shall implement section 1703(d)(1)(E) of title 38, United States Code, in compliance with the implementing regulations for such section under section 17.4010(a)(5) of title 38, Code of Federal Regulations, such that the determination of eligibility for care is final and shall be made by the veteran and the veteran's referring clinician.

"(b) Correction of Errors.—A covered veteran and the referring clinician of such veteran may correct any errors made with respect to a determination described in subsection (a).

"(c) Period Specified.—The period specified in this subsection is the two-year period beginning on the date that is 90 days after the date of the enactment of this Act [Jan. 2, 2025].

"(d) Report.—Not later than one year and not later than two years after the commencement of the period specified by subsection (c), the Secretary of Veterans Affairs shall submit to Congress a report on the care provided under section 1703(d)(1)(E) of title 38, United States Code, during the one-year period preceding the date of the report, including—

"(1) the number of instances of care provided;

"(2) the type of care provided; and

"(3) the cost of such care.

"(e) Rule of Construction.—Nothing in this section shall be construed to limit the Secretary's authority to prescribe, amend, or rescind regulations under section 1703 of title 38, United States Code.

"(f) Covered Veteran Defined.—In this section, the term 'covered veteran' has the meaning given that term in section 1703(b) of title 38, United States Code."

Deadline to Submit First Report

Pub. L. 118–210, title I, §103(b), Jan. 2, 2025, 138 Stat. 2710, provided that: "The Secretary shall submit the first report required under subsection (p) of section 1703 of such title [title 38] (as added by subsection (a)) not later than 180 days after the date of the enactment of this Act [Jan. 2, 2025]."

Pilot Program to Improve Administration of Care Under Veterans Community Care Program

Pub. L. 118–210, title I, §105, Jan. 2, 2025, 138 Stat. 2713, provided that:

"(a) Establishment.—Pursuant to section 1703E of title 38, United States Code, the Secretary of Veterans Affairs, acting through the Center for Innovation for Care and Payment established under such section, shall carry out a pilot program to seek to develop and implement a plan—

"(1) to provide monetary and non-monetary incentives to a covered health care provider—

"(A) to allow the Secretary to see the scheduling system of the provider, to assess the availability of, and to assist in scheduling appointments for, veterans under the Veterans Community Care Program under section 1703 of such title, including through synchronous, asynchronous, and asynchronous assisted digital scheduling;

"(B) to complete continuing professional educational training available through the VHA TRAIN program (or any successor program or initiative) regarding veteran cultural competency, the opioid safety initiative (or any successor program or initiative), and other subjects determined appropriate by the Secretary;

"(C) to improve methods of accounting for non-Department training that is equivalent or substantially similar to the continuing professional educational training described in subparagraph (B);

"(D) to improve the rate of the timely return to the Secretary of medical record documentation for care or services provided under the Veterans Community Care Program;

"(E) to improve the timeliness and quality of the delivery of care and services to veterans under such program; and

"(F) to achieve other objectives determined appropriate by the Secretary; and

"(2) to decrease the rate of no-show appointments under such program.

"(b) Report.—Not later than one year after the date of the establishment of the pilot program under this section, and annually thereafter during the term of the pilot program, the Secretary of Veterans Affairs shall submit to the Committees on Veterans' Affairs of the House of Representatives and the Senate a report on the pilot program that includes, with respect to the period covered by the report—

"(1) an assessment of the extent to which—

"(A) the system of the Department of Veterans Affairs for scheduling appointments for veterans under the Veterans Community Care Program has improved;

"(B) the rate of timely return to the Secretary of medical record documentation described in subparagraph (D) of subsection (a)(1) has improved;

"(C) the timeliness and quality of the delivery of care and services described in subparagraph (E) of such subsection has improved; and

"(D) the frequency of no-show appointments described in paragraph (2) of such subsection decreased;

"(2) a list of the continuing professional educational training courses under subparagraph (B) of such subsection available to covered health care providers;

"(3) the rate of participation in such continuing professional education training courses; and

"(4) any other matter the Secretary determines appropriate.

"(c) Definitions.—In this section:

"(1) The term 'covered health care provider' means a health care provider—

"(A) described in subsection (c) of section 1703 of title 38, United States Code, that furnishes care or services under the Veterans Community Care Program pursuant to a contract or agreement with a Third Party Administrator; or

"(B) that otherwise furnishes care or services outside of Department facilities pursuant to a contract or agreement with the Secretary of Veterans Affairs.

"(2) The term 'opioid safety initiative' means the programs, processes, and guidelines of the Veterans Health Administration of the Department of Veterans Affairs relating to the management of opioid therapy and chronic pain.

"(3) The term 'Third Party Administrator' means an entity that manages a network of health care providers and performs administrative services related to such network under section 1703 of such title.

"(4) The term 'VHA TRAIN program' means the free program of the Veterans Health Administration that offers veteran-specific continuing medical education courses."

Pilot Program on Consolidating Approval Process of Department of Veterans Affairs for Covered Dental Care

Pub. L. 118–210, title I, §106, Jan. 2, 2025, 138 Stat. 2715, provided that:

"(a) In General.—Not later than 180 days after the date of the enactment of this Act [Jan. 2, 2025], the Secretary of Veterans Affairs, acting through the Center for Innovation for Care and Payment established under section 1703E of title 38, United States Code, shall carry out a pilot program under which the Secretary shall hire—

"(1) general dentists at medical facilities of the Department of Veterans Affairs to manage approval by the Department of treatment plans requested by dental providers in providing covered dental care; and

"(2) dental specialists at Veterans Integrated Service Networks of the Department to manage approval by the Department of treatment plans for specialty dental care requested by dental providers in providing covered dental care.

"(b) Locations.—The Secretary shall carry out the pilot program in not fewer than two Veterans Integrated Service Networks of the Department.

"(c) Reports.—

"(1) Initial report.—Not later than one year after the date of the commencement of such pilot program, the Secretary shall submit to the Committees on Veterans' Affairs of the Senate and the House of Representatives a report on the pilot program, that includes—

"(A) an identification of the Veterans Integrated Service Networks participating in such pilot program;

"(B) a description of the implementation of such pilot program;

"(C) an identification of any barriers or challenges to implementing such pilot program;

"(D) an assessment of the efficacy of hiring general dentists and dental specialists pursuant to such pilot program;

"(E) aggregated feedback with respect to such pilot program from dentists of the Department in Veterans Integrated Service Networks participating in such pilot program; and

"(F) aggregated feedback from dental providers providing covered dental care within such Veterans Integrated Service Networks regarding any changes in the timeliness of treatment plan approvals by the Department.

"(2) Final report.—Not later than 90 days before the date of the completion of such pilot program, the Secretary shall submit to the Committees on Veterans' Affairs of the Senate and the House of Representatives a report on the pilot program that—

"(A) includes, with respect to the period covered by the report, each element of the report required under paragraph (1) described in subparagraphs (A) through (F) of such paragraph;

"(B) includes recommendations of the Secretary on whether the pilot program should be—

"(i) extended;

"(ii) expanded; or

"(iii) adopted throughout the Department; and

"(C) indicates whether the Secretary requests action by Congress to make the pilot program permanent.

"(d) Sunset.—The authority to carry out the pilot program under this section shall terminate on the date that is two years after the date of the enactment of this Act.

"(e) Covered Dental Care Defined.—In this section, the term 'covered dental care' means dental care provided—

"(1) under section 1703 of title 38, United States Code; or

"(2) pursuant to a Veterans Care Agreement under section 1703A of such title."

Inspector General Assessment of Implementation of Veterans Community Care Program

Pub. L. 118–210, title I, §110, Jan. 2, 2025, 138 Stat. 2722, provided that:

"(a) In General.—Not later than 18 months after the date of the enactment of this Act [Jan. 2, 2025], and periodically thereafter, the Inspector General shall assess the performance of the Department of Veterans Affairs in—

"(1) appropriately identifying veterans eligible for care and services under section 1703 of title 38, United States Code;

"(2) informing veterans of their eligibility for such care and services; and

"(3) delivering such care and services in a timely manner.

"(b) Briefing on Assessments.—Upon the submission of the assessment required by subsection (a), the Inspector General of the Department of Veterans Affairs shall provide to the Committees on Veterans['] Affairs of the House of Representatives and the Senate a briefing on the results of such assessment."

Plan Regarding Informing Veterans of Expected Wait Times for Appointments for Care

Pub. L. 117–328, div. U, title I, §122, Dec. 29, 2022, 136 Stat. 5415, provided that:

"(a) In General.—Not later than October 1, 2023, the Secretary of Veterans Affairs shall develop a plan to ensure that veterans eligible for care or services pursuant to section 1703(d)(1) of title 38, United States Code, including veterans making their own appointments using advanced technology, are informed of the expected number of days between the date on which the veteran requested care until—

"(1) the date on which the veteran will be able to receive care through a non-Department of Veterans Affairs provider under such section;

"(2) the date on which the veteran will be able to receive care through a provider of the Department;

"(3) the date on which—

"(A) the Department will schedule an appointment for care through a non-Department provider under such section; or

"(B) for veterans making their own appointments using advanced technology, the veteran would be able to schedule an appointment for care through a provider of the Department or through a non-Department provider under such section;

"(4) the date on which the Department will schedule an appointment for care through a provider of the Department.

"(b) Implementation.—The Secretary shall implement the plan required under subsection (a) not later than three years after the date of the enactment of this Act [Dec. 29, 2022].

"(c) Matters To Be Included.—The Secretary shall include in the plan required under subsection (a) a list of the information technology systems, contracting mechanisms, staff, legislative authorities, pilot programs, and other components that the Secretary determines necessary to implement the plan within the three-year implementation deadline under subsection (b), as well as their associated milestones and resource requirements.

"(d) Updates.—Not less frequently than quarterly, the Secretary shall brief the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives and submit to those committees a report in writing regarding the status of the implementation of the plan required under subsection (a), to include an assessment of the progress of the Secretary in meeting the three-year implementation deadline under subsection (b)."

Community Care Self-Scheduling Pilot Program

Pub. L. 117–328, div. U, title I, §§131–134, Dec. 29, 2022, 136 Stat. 5419–5422, provided that:

"SEC. 131. DEFINITIONS.

"In this chapter [chapter 3 (§§131–134) of title I of div. U of Pub. L. 117–328, enacting this note]:

"(1) Appropriate congressional committees.—The term 'appropriate congressional committees' means—

"(A) the Committee on Veterans' Affairs and the Committee on Appropriations of the Senate; and

"(B) the Committee on Veterans' Affairs and the Committee on Appropriations of the House of Representatives.

"(2) Covered veteran.—The term 'covered veteran' means a covered veteran under section 1703(b) of title 38, United States Code.

"(3) Pilot program.—The term 'pilot program' means the pilot program required under section 132(a).

"(4) Veterans community care program.—The term 'Veterans Community Care Program' means the program to furnish hospital care, medical services, and extended care services to covered veterans under section 1703 of title 38, United States Code.

"SEC. 132. PILOT PROGRAM ESTABLISHING COMMUNITY CARE APPOINTMENT SELF-SCHEDULING TECHNOLOGY.

"(a) Pilot Program.—Not later than one year after the date of the enactment of this Act [Dec. 29, 2022], the Secretary of Veterans Affairs shall commence a pilot program under which covered veterans eligible for hospital care, medical services, or extended care services under subsection (d)(1) of section 1703 of title 38, United States Code, may use a technology that has the capabilities specified in section 133(a) to schedule and confirm medical appointments with health care providers participating in the Veterans Community Care Program.

"(b) Expansion or Development of New Technology.—In carrying out the pilot program, the Secretary may expand capabilities of an existing appointment self-scheduling technology of the Department of Veterans Affairs or purchase a new appointment self-scheduling technology.

"(c) Competition.—In contracting for the expansion of capabilities of an existing appointment self-scheduling technology of the Department or the purchase of a new appointment self-scheduling technology under the pilot program, the Secretary shall comply with section 3301 of title 41, United States Code, and award any such contract not later than 270 days after the date of the enactment of this Act.

"(d) Selection of Locations.—The Secretary shall select not fewer than two Veterans Integrated Services Networks of the Department in which to carry out the pilot program.

"(e) Duration of Pilot Program.—

"(1) In general.—Except as provided in paragraph (2), the Secretary shall carry out the pilot program for an 18-month period.

"(2) Extension.—The Secretary may extend the duration of the pilot program and may expand the selection of Veterans Integrated Services Networks under subsection (d) if the Secretary determines that the pilot program is reducing the wait times of veterans seeking hospital care, medical services, or extended care services under the Veterans Community Care Program.

"(f) Outreach.—The Secretary shall ensure that veterans participating in the Veterans Community Care Program in Veterans Integrated Services Networks in which the pilot program is being carried out are informed about the pilot program.

"SEC. 133. APPOINTMENT SELF-SCHEDULING CAPABILITIES.

"(a) In General.—The Secretary of Veterans Affairs shall ensure that the appointment self-scheduling technology used in the pilot program includes the following capabilities:

"(1) Capability to self-schedule, modify, and cancel appointments directly online for primary care, specialty care, and mental health care under the Veterans Community Care Program with regard to each category of eligibility under section 1703(d)(1) of title 38, United States Code.

"(2) Capability to support appointments for the provision of health care under the Veterans Community Care Program regardless of whether such care is provided in person or through telehealth services.

"(3) Not fewer than two of the following capabilities:

"(A) Capability to view appointment availability in real time to the extent practicable.

"(B) Capability to load relevant patient information from the Decision Support Tool of the Department or any other information technology system of the Department used to determine the eligibility of veterans for health care under section 1703(d)(1) of title 38, United States Code.

"(C) Capability to search for providers and facilities participating in the Veterans Community Care Program based on distance from the residential address of a veteran.

"(D) Capability to filter provider results by clinical expertise, ratings, reviews, sex, languages spoken, and other criteria as determined by the Secretary.

"(E) Capability to provide telephonic and electronic contact information for all such providers that do not offer online scheduling at the time.

"(F) Capability to store and print authorization letters for veterans for health care under the Veterans Community Care Program.

"(G) Capability to provide prompts or reminders to veterans to schedule initial appointments or follow-up appointments.

"(H) Capability to be used 24 hours per day, seven days per week.

"(I) Capability to ensure veterans who self-schedule appointments through the appointment self-scheduling technology have scheduled such appointment with a provider possessing the required specialty and clinical expertise.

"(J) Capability to integrate with the Veterans Health Information Systems and Technology Architecture of the Department and the health record deployed by the Electronic Health Record Modernization program, or any successor information technology system or health record of the Department.

"(K) Capability to integrate with information technology systems of Third Party Administrators.

"(b) Independent Validation and Verification.—

"(1) In general.—The Comptroller General of the United States shall evaluate whether the appointment self-scheduling technology used in the pilot program includes the capabilities required under subsection (a) and successfully performs such capabilities.

"(2) Briefing.—Not later than 30 days after the date on which the Comptroller General completes the evaluation under paragraph (1), the Comptroller General shall brief the appropriate congressional committees on such evaluation.

"(c) Certification.—Not later than 18 months after commencement of the pilot program, the Secretary shall certify to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives whether the appointment self-scheduling technology used in the pilot program and any other patient self-scheduling technology developed or used by the Department of Veterans Affairs to schedule appointments under the Veterans Community Care Program as of the date of the certification includes the capabilities required under subsection (a).

"(d) Third Party Administrator Defined.—In this section, the term 'Third Party Administrator' means an entity that manages a provider network and performs administrative services related to such network within the Veterans Community Care Program under section 1703 of title 38, United States Code.

"SEC. 134. REPORT.

"Not later than 180 days after the date of the enactment of this Act, and every 180 days thereafter, the Secretary of Veterans Affairs shall submit to the appropriate congressional committees a report that includes—

"(1) an assessment by the Secretary of the pilot program during the 180-day period preceding the date of the report, including—

"(A) the cost of the pilot program;

"(B) the volume of usage of the appointment self-scheduling technology under the pilot program;

"(C) the quality of the pilot program;

"(D) patient satisfaction with the pilot program;

"(E) benefits to veterans of using the pilot program;

"(F) the feasibility of allowing self-scheduling for different specialties under the pilot program;

"(G) participation in the pilot program by health care providers under the Veterans Community Care Program; and

"(H) such other findings and conclusions with respect to the pilot program as the Secretary considers appropriate; and

"(2) such recommendations as the Secretary considers appropriate regarding—

"(A) extension of the pilot program to other or all Veterans Integrated Service Networks of the Department of Veterans Affairs; and

"(B) making the pilot program permanent."

Support by Department of Veterans Affairs of Maternity Care Coordination

Pub. L. 117–69, §§2, 3, Nov. 30, 2021, 135 Stat. 1495, 1496, provided that:

"SEC. 2. DEFINITIONS.

"In this Act [enacting this note, provisions set out as a note under section 101 of this title, and provisions not classified to the Code]:

"(1) Maternal mortality.—The term 'maternal mortality' means a death occurring during pregnancy or within a one-year period after pregnancy that is caused by pregnancy-related or childbirth complications, including suicide, overdose, or other death resulting from a mental health or substance use disorder attributed to or aggravated by pregnancy-related or childbirth complications.

"(2) Postpartum.—The term 'postpartum', with respect to an individual, means the one-year period beginning on the last day of the pregnancy of the individual.

"(3) Pregnancy-associated death.—The term 'pregnancy-associated death' means the death of a pregnant or postpartum individual, by any cause, that occurs during pregnancy or within one year following pregnancy, regardless of the outcome, duration, or site of the pregnancy.

"(4) Pregnancy-related death.—The term 'pregnancy-related death' means the death of a pregnant or postpartum individual that occurs during pregnancy or within one year following pregnancy from a pregnancy complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiologic effects of pregnancy.

"(5) Racial and ethnic minority group.—The term 'racial and ethnic minority group' has the meaning given that term in section 1707(g)(1) of the Public Health Service Act (42 U.S.C. 300u–6(g)(1)).

"(6) Severe maternal morbidity.—The term 'severe maternal morbidity' means a health condition, including a mental health condition or substance use disorder, attributed to or aggravated by pregnancy or childbirth that results in significant short-term or long-term consequences to the health of the individual who was pregnant.

"SEC. 3. SUPPORT BY DEPARTMENT OF VETERANS AFFAIRS OF MATERNITY CARE COORDINATION.

"(a) Program on Maternity Care Coordination.—

"(1) In general.—The Secretary of Veterans Affairs shall carry out the maternity care coordination program described in Veterans Health Administration Directive 1330.03.

"(2) Training and support.—In carrying out the program under paragraph (1), the Secretary shall provide to community maternity care providers training and support with respect to the unique needs of pregnant and postpartum veterans, particularly regarding mental and behavioral health conditions relating to the service of those veterans in the Armed Forces.

"(b) Authorization of Appropriations.—

"(1) In general.—There is authorized to be appropriated to the Secretary $15,000,000 for fiscal year 2022 for the program under subsection (a)(1).

"(2) Supplement not supplant.—Amounts authorized under paragraph (1) are authorized in addition to any other amounts authorized for maternity health care and coordination for the Department of Veterans Affairs.

"(c) Definitions.—In this section:

"(1) Community maternity care providers.—The term 'community maternity care providers' means maternity care providers located at non-Department facilities who provide maternity care to veterans under section 1703 of title 38, United States Code, or any other law administered by the Secretary of Veterans Affairs.

"(2) Non-department facilities.—The term 'non-Department facilities' has the meaning given that term in section 1701 of title 38, United States Code."

Administration of Non-Department of Veterans Affairs Health Care

Pub. L. 116–315, title III, §3103, Jan. 5, 2021, 134 Stat. 5004, provided that:

"(a) Certification of Proper Administration of Non-Department Care.—

"(1) Review.—

"(A) In general.—The Secretary of Veterans Affairs shall conduct a review of the staffing, training, and other requirements necessary to administer section 1703 of title 38, United States Code.

"(B) Elements.—The review conducted under subparagraph (A) shall include, with respect to each medical facility of the Department of Veterans Affairs—

"(i) an assessment of the type of positions required to be staffed at the medical facility;

"(ii) the number of such positions authorized;

"(iii) the number of such positions funded;

"(iv) the number of such positions filled; and

"(v) the number of additional such positions required to be authorized.

"(2) Submittal to congress.—Not later than 180 days after the date of the enactment of this Act [Jan. 5, 2021], and every 180 days thereafter, the Secretary shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives—

"(A) the results of the review conducted under paragraph (1); and

"(B) a certification that the Secretary has established all staffing, training, and other requirements required to be reviewed under such paragraph.

"(b) Scheduling of Appointments.—

"(1) Measurement of timeliness for each facility.—Not later than 120 days after the date of the enactment of this Act, the Secretary shall measure, with respect to referrals for non-Department health care originating from medical facilities of the Department, for each such facility—

"(A) the period of time between—

"(i) the date that a clinician of the Department determines that a veteran requires care, or a veteran presents to the Department requesting care, and the date that the referral for care is sent to a non-Department health care provider;

"(ii) the date that the referral for care is sent to a non-Department health care provider and the date that a non-Department health care provider accepts the referral;

"(iii) the date that a non-Department health care provider accepts the referral and the date that the referral to a non-Department health care provider is completed;

"(iv) the date that the referral to a non-Department health care provider is completed and the date that an appointment with a non-Department health care provider is made; and

"(v) the date that an appointment with a non-Department health care provider is made and the date that an appointment with a non-Department health care provider occurs; and

"(B) any other period of time that the Secretary determines necessary to measure.

"(2) Submissions to congress.—

"(A) In general.—Not later than one year after the date of the enactment of this Act, the Secretary shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives the data measured under paragraph (1), disaggregated by medical facility.

"(B) Update.—Not less frequently than biweekly, the Secretary shall update the data submitted under subparagraph (A).

"(c) Comptroller General Report.—

"(1) Review.—Beginning not later than one year after the date of the enactment of this Act [Jan. 5, 2021], the Comptroller General of the United States shall review compliance by the Secretary with the requirements of this section, including a review of the validity and reliability of data submitted by the Secretary under subsection (b)(2).

"(2) Report.—Not later than three years after the date of the enactment of this Act, the Comptroller General shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives the results of the review conducted under paragraph (1)."

Establishment of Women Veteran Training Module for Non-Department of Veterans Affairs Health Care Providers

Pub. L. 116–315, title V, §5203, Jan. 5, 2021, 134 Stat. 5034, provided that:

"(a) In General.—Not later than one year after the date of the enactment of this Act [Jan. 5, 2021], the Secretary of Veterans Affairs shall establish and make available to community providers a training module that is specific to women veterans.

"(b) Training Materials Provided.—Under the training module established and made available to community providers under subsection (a), the Secretary shall provide to community providers the same training materials relating to treatment of women veterans that is provided to health care providers of the Department of Veterans Affairs to ensure that all health care providers treating women veterans have access to the same materials to support competency throughout the community.

"(c) Administration of Training Module.—The Secretary shall administer the training module established under subsection (a) to community providers through an internet website of the Department.

"(d) Annual Report.—Not later than one year after the establishment of the training module under subsection (a), and annually thereafter, the Secretary shall submit to Congress a report on—

"(1) the utilization by community providers of the training module; and

"(2) the effectiveness of the training module.

"(e) Definitions.—In this section:

"(1) Community provider.—The term 'community provider' means a non-Department of Veterans Affairs health care provider who provides preauthorized health care to veterans under the laws administered by the Secretary of Veterans Affairs.

"(2) Preauthorized health care.—The term 'preauthorized health care' means health care provided to a veteran that is authorized by the Secretary before being provided."

Continuity of Existing Agreements

Pub. L. 115–182, title I, §101(d), June 6, 2018, 132 Stat. 1403, provided that:

"(1) In general.—Notwithstanding section 1703 of title 38, United States Code, as amended by subsection (a), the Secretary of Veterans Affairs shall continue all contracts, memorandums of understanding, memorandums of agreements, and other arrangements that were in effect on the day before the date of the enactment of this Act [June 6, 2018] between the Department of Veterans Affairs and the American Indian and Alaska Native health care systems as established under the terms of the Department of Veterans Affairs and Indian Health Service Memorandum of Understanding, signed October 1, 2010, the National Reimbursement Agreement, signed December 5, 2012, arrangements under section 405 of the Indian Health Care Improvement Act (25 U.S.C. 1645), and agreements entered into under sections 102 and 103 of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113–146) [38 U.S.C. 1701 note].

"(2) Modifications.—Paragraph (1) shall not be construed to prohibit the Secretary and the parties to the contracts, memorandums of understanding, memorandums of agreements, and other arrangements described in such paragraph from making such changes to such contracts, memorandums of understanding, memorandums of agreements, and other arrangements as may be otherwise authorized pursuant to other provisions of law or the terms of the contracts, memorandums of understanding, memorandums of agreements, and other arrangements."

Demonstration Projects on Alternatives for Expanding Care for Veterans in Rural Areas

Pub. L. 111–163, title III, §303, May 5, 2010, 124 Stat. 1149, provided that:

"(a) In General.—The Secretary of Veterans Affairs may, through the Director of the Office of Rural Health, carry out demonstration projects to examine the feasibility and advisability of alternatives for expanding care for veterans in rural areas, which may include the following:

"(1) Establishing a partnership between the Department of Veterans Affairs and the Centers for Medicare and Medicaid Services of the Department of Health and Human Services to coordinate care for veterans in rural areas at critical access hospitals (as designated or certified under section 1820 of the Social Security Act (42 U.S.C. 1395i–4)).

"(2) Establishing a partnership between the Department of Veterans Affairs and the Department of Health and Human Services to coordinate care for veterans in rural areas at community health centers.

"(3) Expanding coordination between the Department of Veterans Affairs and the Indian Health Service to expand care for Indian veterans.

"(b) Geographic Distribution.—The Secretary shall ensure that the demonstration projects carried out under subsection (a) are located at facilities that are geographically distributed throughout the United States.

"(c) Report.—Not later than 2 years after the date of the enactment of this Act [May 5, 2010], the Secretary shall submit a report on the results of the demonstration projects carried out under subsection (a) to—

"(1) the Committee on Veterans' Affairs and the Committee on Appropriations of the Senate; and

"(2) the Committee on Veterans' Affairs and the Committee on Appropriations of the House of Representatives.

"(d) Authorization of Appropriations.—There is authorized to be appropriated to carry out this section $5,000,000 for fiscal year 2010 and each fiscal year thereafter."

Pilot Program of Enhanced Contract Care Authority for Health Care Needs of Veterans in Highly Rural Areas

Pub. L. 110–387, title IV, §403, Oct. 10, 2008, 122 Stat. 4124, as amended by Pub. L. 111–163, title III, §308, May 5, 2010, 124 Stat. 1155; Pub. L. 113–146, title I, §104, Aug. 7, 2014, 128 Stat. 1766; Pub. L. 113–175, title IV, §409(h), Sept. 26, 2014, 128 Stat. 1908; Pub. L. 114–223, div. A, title II, §242, Sept. 29, 2016, 130 Stat. 884, provided that:

"(a) Pilot Program Required.—

"(1) In general.—The Secretary of Veterans Affairs shall conduct a pilot program under which the Secretary provides covered health services to covered veterans through qualifying non-Department of Veterans Affairs health care providers.

"(2) Commencement.—The Secretary shall commence the conduct of the pilot program on the date that is 120 days after the date of the enactment of this Act [Oct. 10, 2008].

"(3) Duration.—A veteran may receive health services under this section during the period beginning on the date specified in paragraph (2) and ending on September 30, 2017.

"(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.

"(b) Covered Veterans.—For purposes of the pilot program under this section, a covered veteran is any veteran who—

"(1) is—

"(A) enrolled in the system of patient enrollment established under section 1705(a) of title 38, United States Code, as of August 1, 2014; or

"(B) eligible for health care under section 1710(e)(3) of such title; and

"(2) resides in a location that is—

"(A) more than 60 minutes driving distance from the nearest Department health care facility providing primary care services, if the veteran is seeking such services;

"(B) more than 120 minutes driving distance from the nearest Department health care facility providing acute hospital care, if the veteran is seeking such care; or

"(C) more than 240 minutes driving distance from the nearest Department health care facility providing tertiary care, if the veteran is seeking such care.

"(c) Covered Health Services.—For purposes of the pilot program under this section, a covered health service with respect to a covered veteran is any hospital care, medical service, rehabilitative service, or preventative health service that is authorized to be provided by the Secretary to the veteran under chapter 17 of title 38, United States Code, or any other provision of law.

"(d) Qualifying Non-Department Health Care Providers.—For purposes of the pilot program under this section, an entity or individual is a qualifying non-Department health care provider of a covered health service if the Secretary determines that the entity or individual is qualified to furnish such service to veterans under the pilot program.

"(e) Election.—A covered veteran seeking to be provided covered health services under the pilot program under this section shall submit to the Secretary an application therefor in such form, and containing such information as the Secretary shall specify for purposes of the pilot program.

"(f) Provision of Services Through Contract.—The Secretary shall provide covered health services to veterans under the pilot program under this section through contracts with qualifying non-Department health care providers for the provision of such services.

"(g) Exchange of Medical Information.—In conducting the pilot program under this section, the Secretary shall develop and utilize a functional capability to provide for the exchange of appropriate medical information between the Department and non-Department health care providers providing health services under the pilot program.

"(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.—Notwithstanding any provision of law relating to the use of competitive procedures in entering into 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 [Aug. 7, 2014], the Secretary shall make use of contracts entered into under this section before such date or may enter into new contracts.

"(k) Reports.—Not later than the 30 days after the end of each year in which the pilot program under this section is conducted, the Secretary shall submit to the Committee of Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report which includes—

"(1) the assessment of the Secretary of the pilot program during the preceding year, including its cost, volume, quality, patient satisfaction, benefit to veterans, and such other findings and conclusions with respect to pilot program as the Secretary considers appropriate; and

"(2) such recommendations as the Secretary considers appropriate regarding—

"(A) the continuation of the pilot program;

"(B) extension of the pilot program to other or all Veterans Integrated Service Networks of the Department; and

"(C) making the pilot program permanent."

Ratification of Medical Services Contracts

Section 1503(c) of Pub. L. 100–687 ratified actions of the Administrator in contracting with facilities other than Veterans' Administration facilities for furnishing medical services incident to treatment of certain veterans receiving hospital, nursing home, or domiciliary care, who applied for such services during the period beginning July 1, 1988, and ending Nov. 18, 1988.

Puerto Rico Contract Care; Limitation on Incurring of Obligations

Pub. L. 99–166, title I, §102(b)(2)–(5), Dec. 3, 1985, 99 Stat. 943, as amended by Pub. L. 99–272, title XIX, §19012(c)(5)(B), Apr. 7, 1986, 100 Stat. 382, limited Administrator's authority to incur obligations for medical services for veterans residing in Puerto Rico during fiscal years 1986 to 1988.

1 See References in Text note below.
38 U.S.C. § 3709 (2024) — Title 38: VETERANS' BENEFITS / Chapter 37 / Subchapter I / Section 3709: Refinancing of housing loans
Refinancing of housing loans
Status: in_force

(a) Fee Recoupment.—Except as provided in subsection (d) and notwithstanding section 3703 of this title or any other provision of law, a loan to a veteran for a purpose specified in section 3710 of this title that is being refinanced may not be guaranteed or insured under this chapter unless—

(1) the issuer of the refinanced loan provides the Secretary with a certification of the recoupment period for fees, closing costs, and any expenses (other than taxes, amounts held in escrow, and fees paid under this chapter) that would be incurred by the borrower in the refinancing of the loan;

(2) all of the fees and incurred costs are scheduled to be recouped on or before the date that is 36 months after the date of loan issuance; and

(3) the recoupment is calculated through lower regular monthly payments (other than taxes, amounts held in escrow, and fees paid under this chapter) as a result of the refinanced loan.

(b) Net Tangible Benefit Test.—Except as provided in subsection (d) and notwithstanding section 3703 of this title or any other provision of law, a loan to a veteran for a purpose specified in section 3710 of this title that is refinanced may not be guaranteed or insured under this chapter unless—

(1) the issuer of the refinanced loan provides the borrower with a net tangible benefit test;

(2) in a case in which the original loan had a fixed rate mortgage interest rate and the refinanced loan will have a fixed rate mortgage interest rate, the refinanced loan has a mortgage interest rate that is not less than 50 basis points less than the previous loan;

(3) in a case in which the original loan had a fixed rate mortgage interest rate and the refinanced loan will have an adjustable rate mortgage interest rate, the refinanced loan has a mortgage interest rate that is not less than 200 basis points less than the previous loan; and

(4) the lower interest rate is not produced solely from discount points, unless—

(A) such points are paid at closing; and

(B) such points are not added to the principal loan amount, unless—

(i) for discount point amounts that are less than or equal to one discount point, the resulting loan balance after any fees and expenses allows the property with respect to which the loan was issued to maintain a loan to value ratio of 100 percent or less; and

(ii) for discount point amounts that are greater than one discount point, the resulting loan balance after any fees and expenses allows the property with respect to which the loan was issued to maintain a loan to value ratio of 90 percent or less.

(c) Loan Seasoning.—Except as provided in subsection (d) and notwithstanding section 3703 of this title or any other provision of law, a loan to a veteran for a purpose specified in section 3710 of this title that is a refinance may not be guaranteed or insured under this chapter until the date that is the later of—

(1) the date on which the borrower has made at least six consecutive monthly payments on the loan being refinanced; and

(2) the date that is 210 days after the first payment due date of the loan being refinanced.

(d) Cash-out Refinances.—(1) Subsections (a) through (c) shall not apply in a case of a loan refinancing in which the amount of the principal for the new loan to be guaranteed or insured under this chapter is larger than the payoff amount of the refinanced loan.

(2) Not later than 180 days after the date of the enactment of this section, the Secretary shall promulgate such rules as the Secretary considers appropriate with respect to refinancing described in paragraph (1) to ensure that such refinancing is in the financial interest of the borrower, including rules relating to recoupment, seasoning, and net tangible benefits.

(Added Pub. L. 115–174, title III, §309(a)(1), May 24, 2018, 132 Stat. 1348; amended Pub. L. 116–33, §2(b), July 25, 2019, 133 Stat. 1038.)

Editorial Notes

References in Text

The date of the enactment of this section, referred to in subsec. (d)(2), is the date of enactment of Pub. L. 115–174, which was approved May 24, 2018.

Amendments

2019—Subsec. (c). Pub. L. 116–33 substituted "is a refinance" for "is refinanced" in introductory provisions, added pars. (1) and (2), and struck out former pars. (1) and (2) which read as follows:

"(1) the date that is 210 days after the date on which the first monthly payment is made on the loan; and

"(2) the date on which the sixth monthly payment is made on the loan."

Statutory Notes and Related Subsidiaries

Regulations

Pub. L. 115–174, title III, §309(a)(2), May 24, 2018, 132 Stat. 1349, provided that:

"(A) In general.—In prescribing any regulation to carry out section 3709 of title 38, United States Code, as added by paragraph (1), the Secretary of Veterans Affairs may waive the requirements of sections 551 through 559 of title 5, United States Code, if—

"(i) the Secretary determines that urgent or compelling circumstances make compliance with such requirements impracticable or contrary to the public interest;

"(ii) the Secretary submits to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives, and publishes in the Federal Register, notice of such waiver, including a description of the determination made under clause (i); and

"(iii) a period of 10 days elapses following the notification under clause (ii).

"(B) Public notice and comment.—If a regulation prescribed pursuant to a waiver made under subparagraph (A) is in effect for a period exceeding 1 year, the Secretary shall provide the public an opportunity for notice and comment regarding such regulation.

"(C) Effective date.—This paragraph shall take effect on the date of the enactment of this Act [May 24, 2018].

"(D) Termination date.—The authorities under this paragraph shall terminate on the date that is 1 year after the date of the enactment of this Act."

Construction of 2019 Amendment

Amendment by Pub. L. 116–33 not to be construed to restrict or otherwise modify the authorities of the Government National Mortgage Association, see section 2(c) of Pub. L. 116–33, set out as a note under section 1721 of Title 12, Banks and Banking.
38 U.S.C. § 3731 (2024) — Title 38: VETERANS' BENEFITS / Chapter 37 / Subchapter III / Section 3731: Appraisals
Appraisals
Status: in_force

(a) The Secretary shall—

(1) subject to subsection (b)(2) and in consultation with appropriate representatives of institutions which are regularly engaged in making housing loans, prescribe uniform qualifications for appraisers, including the successful completion of a written test, submission of a sample appraisal, certification of an appropriate number of years of experience as an appraiser, and submission of recommendations from other appraisers;

(2) use such qualifications in determining whether to approve an appraiser to make appraisals of the reasonable value of any property, construction, repairs, or alterations for the purposes of this chapter; and

(3) in consultation with local representatives of institutions described in clause (1) of this subsection, develop and maintain lists of appraisers who are approved under clause (2) of this subsection to make appraisals for the purposes of this chapter.

(b)(1) The Secretary shall select appraisers from a list required by subsection (a)(3) of this section on a rotating basis to make appraisals for the purposes of this chapter.

(2) If uniform qualifications become applicable for appraisers who perform appraisals for or in connection with the Federal Government, the qualifications required by subsection (a)(1) of this section may be more stringent than such uniform qualifications, but the Secretary may use no written test in determining the qualifications of appraisers other than the test prescribed to implement such uniform qualifications.

(3) The Secretary shall permit an appraiser on a list developed and maintained under subsection (a)(3) to make an appraisal for the purposes of this chapter based solely on information gathered by a person with whom the appraiser has entered into an agreement for such services.

(c) Except as provided in subsection (f) of this section, the appraiser shall forward an appraisal report to the Secretary for review. Upon receipt of such report, the Secretary shall determine the reasonable value of the property, construction, repairs, or alterations for purposes of this chapter, and notify the veteran of such determination. Upon request, the Secretary shall furnish a copy of the appraisal made of property for the purposes of this chapter to the lender proposing to make the loan which is to be secured by such property and is to be guaranteed under this chapter.

(d) If a lender (other than a lender authorized under subsection (f) of this section to determine reasonable value)—

(1) has proposed to make a loan to be guaranteed under this chapter,

(2) has been furnished a certificate of reasonable value of any property or of any construction, repairs, or alterations of property which is to be the security for such loan, and

(3) within a reasonable period prescribed by the Secretary, has furnished to the Secretary an additional appraisal of the reasonable value of such property, construction, repairs, or alterations which was made by an appraiser selected by the lender from the list required by subsection (a)(3) of this section,

the Secretary shall consider both the initial appraisal and the additional appraisal and shall, if appropriate, issue a revised certificate of reasonable value of such property, construction, repairs, or alterations.

(e)(1) In no case may a veteran be required to pay all or any portion of the cost of the additional appraisal described in subsection (d)(3) of this section.

(2) If a veteran, within a reasonable period prescribed by the Secretary, has furnished to the Secretary an additional appraisal of the reasonable value of such property, construction, repairs, or alterations which was made by an appraiser selected by the veteran from the list required by subsection (a)(3) of this section, the Secretary shall consider such appraisal, along with other appraisals furnished to the Secretary, and shall, if appropriate, issue a revised certificate of reasonable value of such property, construction, repairs, or alterations.

(f)(1) Subject to the provisions of paragraphs (2) and (3) of this subsection, the Secretary may, in accordance with standards and procedures established in regulations prescribed by the Secretary, authorize a lender to determine the reasonable value of property for the purposes of this chapter if the lender is authorized to make loans which are automatically guaranteed under section 3702(d) of this title. In such a case, the appraiser selected by the Secretary pursuant to subsection (b) of this section shall submit the appraisal report directly to the lender for review, and the lender shall, as soon as possible thereafter, furnish a copy of the appraisal to the veteran who is applying for the loan concerned and to the Secretary.

(2) In exercising the authority provided in paragraph (1) of this subsection, the Secretary shall assign a sufficient number of personnel to carry out an appraisal-review system to monitor, on at least a random-sampling basis, the making of appraisals by appraisers and the effectiveness and the efficiency of the determination of reasonable value of property by lenders.

[(3) Repealed. Pub. L. 104–110, title I, §101(g), Feb. 13, 1996, 110 Stat. 768.]

(4) Not later than April 30 of each year following a year in which the Secretary authorizes lenders to determine reasonable value of property under this subsection, the Secretary shall submit to the Committees on Veterans' Affairs of the Senate and the House of Representatives a report relating to the exercise of that authority during the year in which the authority was exercised.

(5) A report submitted pursuant to paragraph (4) of this subsection shall include, for the period covered by each report—

(A) the number and value of loans made by lenders exercising the authority of this subsection;

(B) the number and value of such loans reviewed by the appraisal-review monitors referred to in paragraph (2) of this subsection;

(C) the number and value of loans made under this subsection of which the Secretary received notification of default;

(D) the amount of guaranty paid by the Secretary to such lenders by reason of defaults on loans as to which reasonable value was determined under this subsection; and

(E) such recommendations as the Secretary considers appropriate to improve the exercise of the authority provided for in this subsection and to protect the interests of the United States.

(Added Pub. L. 99–576, title IV, §407(a), Oct. 28, 1986, 100 Stat. 3282, §1831; amended Pub. L. 100–198, §11(a), (b), Dec. 21, 1987, 101 Stat. 1324; Pub. L. 101–237, title III, §313(b)(1), Dec. 18, 1989, 103 Stat. 2077; Pub. L. 102–54, §3(b), (c), June 13, 1991, 105 Stat. 267; renumbered §3731 and amended Pub. L. 102–83, §5(a), (c)(1), Aug. 6, 1991, 105 Stat. 406; Pub. L. 102–547, §7, Oct. 28, 1992, 106 Stat. 3636; Pub. L. 104–110, title I, §101(g), Feb. 13, 1996, 110 Stat. 768; Pub. L. 116–23, §7(a), June 25, 2019, 133 Stat. 976.)

Editorial Notes

Codification

Another section 11(b) of Pub. L. 100–198 amended section 1810 [now 3710] of this title.

Amendments

2019—Subsec. (b)(3). Pub. L. 116–23 added par. (3).

1996—Subsec. (f)(3). Pub. L. 104–110 struck out par. (3) which read as follows: "The authority provided in this subsection shall terminate on December 31, 1995."

1992—Subsec. (f)(3). Pub. L. 102–547 substituted "1995" for "1992".

1991—Pub. L. 102–83, §5(a), renumbered section 1831 of this title as this section.

Subsec. (f)(1). Pub. L. 102–83, §5(c)(1), substituted "3702(d)" for "1802(d)".

Subsec. (f)(3). Pub. L. 102–54, §3(b), substituted "December 31, 1992" for "October 1, 1990".

Subsec. (f)(4), (5). Pub. L. 102–54, §3(c), added pars. (4) and (5).

1989—Pub. L. 101–237 substituted "Secretary" for "Administrator" wherever appearing.

1987—Subsec. (a)(1). Pub. L. 100–198, §11(a)(1), inserted "subject to subsection (b)(2) and" at beginning and ", including the successful completion of a written test, submission of a sample appraisal, certification of an appropriate number of years of experience as an appraiser, and submission of recommendations from other appraisers" before semicolon at end.

Subsec. (b). Pub. L. 100–198, §11(a)(2), designated existing provisions as par. (1) and added par. (2).

Subsec. (c). Pub. L. 100–198, §11(b)(1), substituted "Except as provided in subsection (f) of this section, the appraiser shall forward an appraisal report to the Administrator for review. Upon receipt of such report, the Administrator shall determine the reasonable value of the property, construction, repairs, or alterations for purposes of this chapter, and notify the veteran of such determination. Upon request, the Administrator shall" for "The Administrator shall, upon request,".

Subsec. (d). Pub. L. 100–198, §11(b)(2), which directed insertion of "(other than a lender authorized under subsection (f) of this section to determine reasonable value)" after "lender" was executed by making the insertion after "lender" the first place it appears in subsec. (d), as the probable intent of Congress, notwithstanding appearance of "lender" in subsec. (d)(3).

Subsec. (f). Pub. L. 100–198, §11(b)(3), added subsec. (f).

Statutory Notes and Related Subsidiaries

Effective Date of 2019 Amendment

Pub. L. 116–23, §7(b), June 25, 2019, 133 Stat. 976, provided that: "The amendments made by this section [amending this section] shall apply with respect to an appraisal under section 3731 of such title [meaning title 38, United States Code], on or after January 1, 2020."

Improving Access to the Veterans Affairs Home Loan Benefit

Pub. L. 117–308, Dec. 27, 2022, 136 Stat. 4393, provided that:

"SECTION 1. SHORT TITLE.

"This Act may be cited as the 'Improving Access to the VA Home Loan Benefit Act of 2022'.

"SEC. 2. RECOMMENDATIONS FOR IMPROVING APPRAISAL DELIVERY TIMES.

"Not later than 90 days after the date of the enactment of this Act [Dec. 27, 2022], the Secretary of Veterans Affairs shall submit to the Committees on Veterans' Affairs of the Senate and House of Representatives recommendations for improving the delivery times for appraisals for loans guaranteed by the Department of Veterans Affairs.

"SEC. 3. UPDATE OF APPRAISAL REQUIREMENTS FOR CERTAIN LOANS GUARANTEED BY THE DEPARTMENT OF VETERANS AFFAIRS.

"(a) Updated Regulations Required.—Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall prescribe updated regulations or program requirements to clarify when an appraisal is required, how an appraisal is to be conducted, and who is eligible to conduct an appraisal for a loan guaranteed by the Department of Veterans Affairs under chapter 37 of title 38, United States Code, for any purpose described in section 3710(a) of such title. In prescribing updated regulations or program requirements under this section, the Secretary shall take into consideration the recommendations of the Secretary submitted under section 2.

"(b) Waiver of Requirement for Certain Properties.—In prescribing updated regulations or program requirements under subsection (a), the Secretary shall consider making changes applicable to—

"(1) certification requirements for appraisers;

"(2) minimum property requirements;

"(3) the process for selecting and reviewing comparable sales;

"(4) quality control processes;

"(5) the Assisted Appraisal Processing Program; and

"(6) the use of waivers or other alternatives to existing appraisal processes.

"(c) Desk Top Appraisals.—In prescribing updated regulations or program guidance under subsection (a), the Secretary shall provide guidance for the use of the authority under section 3731(b)(3) of title 38, United States Code, taking into consideration—

"(1) situations in which the use of such authority would provide for cost savings for the borrower; and

"(2) situations in which a traditional appraisal requirement could cause a delay substantial enough to jeopardize the ability of a borrower to complete a transaction.

"SEC. 4. DETERMINATION OF BUDGETARY EFFECTS.

"The budgetary effects of this Act, for the purpose of complying with the Statutory Pay-As-You-Go Act of 2010 [2 U.S.C. 931 et seq.], shall be determined by reference to the latest statement titled 'Budgetary Effects of PAYGO Legislation' for this Act, submitted for printing in the Congressional Record by the Chairman of the House Budget Committee, provided that such statement has been submitted prior to the vote on passage."

Guidance To Implement Amendment by Pub. L. 116–23

Pub. L. 116–23, §7(c), June 25, 2019, 133 Stat. 976, provided that: "Notwithstanding section 501 of such title [meaning title 38, United States Code], the Secretary of Veterans Affairs may issue guidance to implement this section [amending this section and enacting provisions set out as a note under this section] before prescribing new regulations under sections [sic] 3731 of such title, as amended by subsection (a)."

Ratification of Actions During Period of Expired Authority

Any action taken by Secretary of Veterans Affairs before Feb. 13, 1996, under provision of law amended by title I of Pub. L. 104–110 that was taken during period beginning on date on which authority of Secretary under such provision of law expired and ending on Feb. 13, 1996, considered to have same force and effect as if such amendment had been in effect at time of that action, see section 103 of Pub. L. 104–110, set out as a note under section 1710 of this title.
38 U.S.C. § 1908 (2024) — Title 38: VETERANS' BENEFITS / Chapter 19 / Subchapter I / Section 1908: Premium payments
Premium payments
Status: in_force

The Secretary shall, by regulations, prescribe the time and method of payment of the premiums on insurance, but payments of premiums in advance shall not be required for periods of more than one month each, and may at the election of the insured be deducted from the insured's active-service pay or be otherwise made. An amount equal to the first premium due under a National Service Life Insurance policy may be advanced from current appropriations for active-service pay to any person in the active service in the Army, Navy, Air Force, Marine Corps, Space Force, or Coast Guard, which amount shall constitute a lien upon any service or other pay accruing to the person for whom such advance was made and shall be collected therefrom if not otherwise paid. No disbursing or certifying officer shall be responsible for any loss incurred by reason of such advance. Any amount so advanced in excess of available service or other pay shall constitute a lien on the policy within the provisions of section 5301(b) of this title.

(Pub. L. 85–857, Sept. 2, 1958, 72 Stat. 1149, §708; Pub. L. 99–576, title VII, §701(24), Oct. 28, 1986, 100 Stat. 3292; Pub. L. 102–40, title IV, §402(d)(1), May 7, 1991, 105 Stat. 239; renumbered §1908 and amended Pub. L. 102–83, §§4(b)(1), (2)(E), 5(a), Aug. 6, 1991, 105 Stat. 404–406; Pub. L. 116–283, div. A, title IX, §926(e), Jan. 1, 2021, 134 Stat. 3831.)

Editorial Notes

Amendments

2021—Pub. L. 116–283 inserted "Space Force," after "Marine Corps,".

1991—Pub. L. 102–83 renumbered section 708 of this title as this section and substituted "Secretary" for "Administrator".

Pub. L. 102–40 substituted "5301(b)" for "3101(b)".

1986—Pub. L. 99–576 substituted "the insured's" for "his".

Statutory Notes and Related Subsidiaries

Transfer of Functions

For transfer of authorities, functions, personnel, and assets of the Coast Guard, including the authorities and functions of the Secretary of Transportation relating thereto, to the Department of Homeland Security, and for treatment of related references, see sections 468(b), 551(d), 552(d), and 557 of Title 6, Domestic Security, and the Department of Homeland Security Reorganization Plan of November 25, 2002, as modified, set out as a note under section 542 of Title 6.
38 U.S.C. § 2069 (2024) — Title 38: VETERANS' BENEFITS / Chapter 20 / Subchapter VII / Section 2069: Access to telehealth services
Access to telehealth services
Status: in_force

To the extent practicable, the Secretary shall ensure that veterans participating in or receiving services from a program under this chapter have access to telehealth services to which such veterans are eligible under the laws administered by the Secretary, including by ensuring that telehealth capabilities are available to—

(1) such veterans;

(2) case managers of the Department of programs for homeless veterans authorized under this chapter; and

(3) community-based service providers for homeless veterans receiving funds from the Department through grants or contracts.

(Added Pub. L. 118–210, title IV, §404(a), Jan. 2, 2025, 138 Stat. 2797.)

Editorial Notes

Codification

Section 404(a) of Pub. L. 118–210, which directed the addition of this section at the end of subtitle VII of this chapter, was executed by adding this section at the end of subchapter VII of this chapter, to reflect the probable intent of Congress.
38 U.S.C. § 7431 (2024) — Title 38: VETERANS' BENEFITS / Chapter 74 / Subchapter III / Section 7431: Pay
Pay
Status: in_force

(a) Elements of Pay.—Pay of physicians, podiatrists, optometrists, and dentists in the Veterans Health Administration shall consist of three elements as follows:

(1) Base pay as provided for under subsection (b).

(2) Market pay as provided for under subsection (c).

(3) Performance pay as provided under subsection (d).

(b) Base Pay.—One element of pay for physicians, podiatrists, optometrists, and dentists shall be base pay. Base pay shall meet the following requirements:

(1) Each physician, podiatrist, optometrist and dentist is entitled to base pay determined under the Physician, Podiatrist, and Dentist Base and Longevity Pay Schedule.

(2) The Physician, Podiatrist, and Dentist Base and Longevity Pay Schedule is composed of 15 rates of base pay designated, from the lowest rate of pay to the highest rate of pay, as base pay steps 1 through 15.

(3) The rate of base pay payable to a physician, podiatrist, optometrist or dentist is based on the total number of the years of the service of the physician, podiatrist, optometrist or dentist in the Veterans Health Administration as follows:

 For a physician, podiatrist, optometrist or dentist with total
  service of:
The rate of base pay is the rate payable for:

two years or less
step 1  

more than 2 years and not more than 4 years
step 2  

more than 4 years and not more than 6 years
step 3  

more than 6 years and not more than 8 years
step 4  

more than 8 years and not more than 10 years
step 5  

more than 10 years and not more than 12 years
step 6  

more than 12 years and not more than 14 years
step 7  

more than 14 years and not more than 16 years
step 8  

more than 16 years and not more than 18 years
step 9  

more than 18 years and not more than 20 years
step 10  

more than 20 years and not more than 22 years
step 11  

more than 22 years and not more than 24 years
step 12  

more than 24 years and not more than 26 years
step 13  

more than 26 years and not more than 28 years
step 14  

more than 28 years
step 15.

(4) At the same time as rates of basic pay are increased for a year under section 5303 of title 5, the Secretary shall increase the amount of base pay payable under this subsection for that year by a percentage equal to the percentage by which rates of basic pay are increased under such section for that year.

(5) The non-foreign cost of living adjustment allowance authorized under section 5941 of title 5 for physicians, podiatrists, optometrists, and dentists whose pay is set under this section shall be determined as a percentage of base pay only.

(c) Market Pay.—One element of pay for physicians, podiatrists, optometrists, and dentists shall be market pay. Market pay shall meet the following requirements:

(1) Each physician, podiatrist, optometrist and dentist is eligible for market pay.

(2) Market pay shall consist of pay intended to reflect the recruitment and retention needs for the specialty or assignment (as defined by the Secretary) of a particular physician, podiatrist, optometrist or dentist in a facility of the Department of Veterans Affairs.

(3) The annual amount of the market pay payable to a physician, podiatrist, optometrist or dentist shall be determined by the Secretary on a case-by-case basis.

(4) The determination of the amount of market pay of a physician, podiatrist, optometrist or dentist shall take into account—

(A) the level of experience of the physician, podiatrist, optometrist or dentist in the specialty or assignment of the physician, podiatrist, optometrist or dentist;

(B) the need for the specialty or assignment of the physician, podiatrist, optometrist or dentist at the medical facility of the Department concerned;

(C) the health care labor market for the specialty or assignment of the physician, podiatrist, optometrist or dentist, which may cover any geographic area the Secretary considers appropriate for the specialty or assignment;

(D) the board certifications, if any, of the physician, podiatrist, optometrist or dentist;

(E) the prior experience, if any, of the physician, podiatrist, optometrist or dentist as an employee of the Veterans Health Administration; and

(F) such other considerations as the Secretary considers appropriate.

(5) The amount of market pay of a physician, podiatrist, optometrist or dentist shall be evaluated by the Secretary not less often than once every 24 months. The amount of market pay may be adjusted as the result of an evaluation under this paragraph. A physician, podiatrist, optometrist or dentist whose market pay is evaluated under this paragraph shall receive written notice of the results of such evaluation in accordance with procedures prescribed under section 7433 of this title. Such a notice shall include a statement of whether the market pay will increase, decrease, or remain unchanged following such evaluation.

(6) No adjustment of the amount of market pay of a physician, podiatrist, optometrist or dentist under paragraph (5) may result in a reduction of the amount of market pay of the physician, podiatrist, optometrist or dentist while in the same position or assignment at the medical facility of the Department concerned, unless there is a change in board certification or reduction of privileges.

(7) The Secretary shall ensure that each physician, podiatrist, optometrist, and dentist in the Veterans Health Administration is—

(A) advised, on an annual basis, of the criteria described in subparagraph (F) of paragraph (4);

(B) evaluated in accordance with such criteria; and

(C) compensated in accordance with—

(i) applicable assignment and pay levels, subject to relevant pay limitations; and

(ii) the extent to which such criteria are met.

(8) Not later than 120 days after the end of each fiscal year, the Secretary shall submit to the Committees on Veterans' Affairs of the Senate and the House of Representatives a report that includes the following:

(A) A list of each facility and specialty that conducted an evaluation of pay during the period covered by the report.

(B) For each evaluation described in subparagraph (A)—

(i) a list of occupations for which pay was evaluated, disaggregated by medical specialty, number of authorized full-time employees, and onsite full-time employees as of the date of the evaluation;

(ii) the date such evaluation was completed;

(iii) whether a market pay adjustment was made following the evaluation per each occupation and specialty evaluated;

(iv) whether applicable employees were notified of such evaluation;

(v) whether local labor partners were notified of such evaluation; and

(vi) in the case of an evaluation that resulted in an adjustment of pay—

(I) the date such adjustment—

(aa) was implemented; and

(bb) became effective; and

(II) the percentage of employees of each occupation and specialty for which pay was adjusted pursuant to such evaluation.

(C) A list of facilities of the Department that have not conducted an evaluation of market pay, pursuant to paragraph (5), during the 18-month-period that precedes the date of the submission of such report.

(d) Performance Pay.—(1) One element of pay for physicians, podiatrists, optometrists, and dentists shall be performance pay.

(2) Performance pay shall be paid to a physician, podiatrist, optometrist or dentist on the basis of the physician's or dentist's achievement of specific goals and performance objectives prescribed by the Secretary.

(3) The Secretary shall ensure that each physician, podiatrist, optometrist and dentist of the Department is advised of the specific goals or objectives that are to be measured by the Secretary in determining the eligibility of that physician, podiatrist, optometrist or dentist for performance pay.

(4) The amount of the performance pay payable to a physician, podiatrist, optometrist or dentist may vary annually on the basis of individual achievement or attainment of the goals or objectives applicable to the physician, podiatrist, optometrist or dentist under paragraph (2).

(5) The amount of performance pay payable to a physician, podiatrist, optometrist or dentist in a fiscal year shall be determined in accordance with regulations prescribed by the Secretary, but may not exceed the lower of—

(A) $15,000; or

(B) the amount equal to 7.5 percent of the sum of the base pay and the market pay payable to such physician, podiatrist, optometrist or dentist in that fiscal year.

(6) A failure to meet goals or objectives applicable to a physician, podiatrist, optometrist or dentist under paragraph (2) may not be the sole basis for an adverse personnel action against that physician, podiatrist, optometrist or dentist.

(e) Requirements and Limitations on Total Pay.—(1)(A) Not less often than once every two years, the Secretary shall prescribe for Department-wide applicability the minimum and maximum amounts of annual pay that may be paid under this section to physicians and the minimum and maximum amounts of annual pay that may be paid under this section to podiatrists and dentists.

(B) The Secretary may prescribe for Department-wide applicability under this paragraph separate minimum and maximum amounts of pay for a specialty or assignment. If the Secretary prescribes separate minimum and maximum amounts for a specialty or assignment, the Secretary may establish up to four tiers of minimum and maximum amounts for such specialty or assignment and prescribe for each tier a minimum amount and a maximum amount that the Secretary determines appropriate for the professional responsibilities, professional achievements, and administrative duties of the physicians, podiatrists, optometrists, or dentists (as the case may be) whose pay is set within that tier.

(C) Amounts prescribed under this paragraph shall be published in the Federal Register, and shall not take effect until at least 60 days after the date of publication.

(2) Except as provided in paragraph (3) and subject to paragraph (4), the sum of the total amount of the annual rate of base pay payable to a physician, podiatrist, optometrist or dentist under subsection (b) and the market pay determined for the physician, podiatrist, optometrist or dentist under subsection (c) may not be less than the minimum amount, nor more than the maximum amount, applicable to specialty or assignment of the physician, podiatrist, optometrist or dentist under paragraph (1).

(3) The sum of the total amount of the annual rate of base pay payable to a physician, podiatrist, optometrist or dentist under subsection (b) and the market pay determined for the physician, podiatrist, optometrist or dentist under subsection (c) may exceed the maximum amount applicable to the specialty or assignment of the physician, podiatrist, optometrist or dentist under paragraph (1) as a result of an adjustment under paragraph (3) or (4) of subsection (b).

(4) Except as provided in sections 7404A(c) and 7410(a)(2) of this title, in no case may the total amount of compensation paid to a physician, podiatrist, optometrist or dentist under this title in any year exceed the amount of annual compensation (excluding expenses) specified in section 102 of title 3.

(5) Notwithstanding any compensation or pay limitations under this title or title 5, the Secretary may authorize the Under Secretary for Health to pay physicians, podiatrists, optometrists, and dentists—

(A) awards authorized under this title;

(B) advance payments, recruitment or relocation bonuses, and retention allowances authorized under section 7410(a) of this title or as otherwise provided by law;

(C) incentives or bonuses under section 706 of this title or as otherwise provided by law; and

(D) earnings from fee-basis appointments under section 7405(a)(2) of this title.

(6)(A) The Secretary may waive any pay limitation described in this section (including tier limitations) that the Secretary determines necessary for the recruitment or retention of critical health care personnel whom the Secretary determines would provide direct patient care.

(B) Priority for such waivers shall be given for positions, locations, and care provided through agreements that are costly to the Department.

(C) The Chief Human Capital Officer of the Department, the Chief Financial Officer of the Department, and the Office of the General Counsel of the Department shall review any waiver issued under subparagraph (A).

(D) During the period the authority under subparagraph (A) is effective, the Secretary may not issue more than 300 waivers under such subparagraph.

(E) The Secretary may prescribe requirements, limitations, and other considerations for waivers under such subparagraph.

(F) Not later than 180 days after the date of the enactment of the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act, and annually thereafter, the Secretary shall submit to the Committees on Veterans' Affairs of the Senate and the House of Representatives a report that includes—

(i) any updates to the requirements, limitations, and considerations prescribed under subparagraph (B) during the period covered by the report;

(ii) a description of the findings of each review, if any, conducted pursuant to subparagraph (C);

(iii) a description of each waiver under subparagraph (A) in effect as of the date of the submission of the report, including the—

(I) duty location, position, specialty, market and performance considerations for the waiver; and

(II) impact, if any, of the waiver on care furnished by the Department pursuant to an agreement regarding the geographic area; and

(iv) a list of any separation actions during the period covered by the report with respect to a position for which a waiver under subparagraph (A) is in effect.

(G) The authority of the Secretary under subparagraph (A) shall terminate on the last day of the third full fiscal year following the date of the enactment of the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act.

(f) Treatment of Pay.—Pay under subsections (b) and (c) of this section shall be considered pay for all purposes, including retirement benefits under chapters 83 and 84 of title 5 and other benefits.

(g) Ancillary Effects of Decreases in Pay.—(1) A decrease in pay of a physician, podiatrist, optometrist or dentist resulting from an adjustment in the amount of market pay of the physician, podiatrist, optometrist or dentist under subsection (c) shall not be treated as an adverse action.

(2) If the pay of a physician, podiatrist, optometrist or dentist is reduced under this subchapter as a result of an involuntary reassignment in connection with a disciplinary action taken against the physician, podiatrist, optometrist or dentist, the involuntary reassignment shall be subject to appeal under subchapter V of this chapter.

(h) Delegation of Responsibilities.—The Secretary may delegate to an appropriate officer or employee of the Department any responsibility of the Secretary under subsection (c), (d), or (e) except for the responsibilities of the Secretary under subsection (e)(1).

(Added Pub. L. 108–445, §3(b), Dec. 3, 2004, 118 Stat. 2636; amended Pub. L. 111–163, title VI, §601(f), May 5, 2010, 124 Stat. 1170; Pub. L. 114–315, title VI, §615, Dec. 16, 2016, 130 Stat. 1577; Pub. L. 116–12, §1(b)(1), Apr. 8, 2019, 133 Stat. 845; Pub. L. 117–168, title IX, §906(e), Aug. 10, 2022, 136 Stat. 1813; Pub. L. 118–210, title I, §142(a)(1), Jan. 2, 2025, 138 Stat. 2744.)

Applicability of Amendment

Amendment of section by Pub. L. 118–210 applicable to any pay period of the Department of Veterans Affairs beginning on or after the date that is 180 days after Jan. 2, 2025. See 2025 Amendment notes below.

Editorial Notes

References in Text

The date of the enactment of the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act, referred to subsec. (e)(6)(F), (G), is the date of enactment of Pub. L. 118–210, which was approved Jan. 2, 2025.

Prior Provisions

A prior section 7431, added Pub. L. 102–40, title I, §102, May 7, 1991, 105 Stat. 188; amended Pub. L. 102–405, title III, §302(c)(1), Oct. 9, 1992, 106 Stat. 1984, related to authority of Secretary to provide for special pay, prior to the general amendment of this subchapter by Pub. L. 108–445.

Amendments

2025—Subsec. (a). Pub. L. 118–210, §142(a)(1)(A), inserted "optometrists," after "podiatrists," in introductory provisions.

Subsec. (b). Pub. L. 118–210, §142(a)(1)(A), (B), inserted "optometrists," after "podiatrists," in introductory provisions and par. (5) and "optometrist" after "podiatrist," wherever appearing.

Subsec. (c). Pub. L. 118–210, §142(a)(1)(A)–(C), inserted "optometrists," after "podiatrists," in introductory provisions and "optometrist" after "podiatrist," wherever appearing, inserted at end of par. (5) "Such a notice shall include a statement of whether the market pay will increase, decrease, or remain unchanged following such evaluation.", and added pars. (7) and (8).

Subsec. (d). Pub. L. 118–210, §142(a)(1)(A), (B), inserted "optometrists," after "podiatrists," in par. (1) and "optometrist" after "podiatrist," wherever appearing.

Subsec. (e). Pub. L. 118–210, §142(a)(1)(A), (B), (D), inserted "optometrists," after "podiatrists," in subpar. (B) of par. (1) and "optometrist" after "podiatrist," wherever appearing, and added pars. (5) and (6).

Subsec. (g). Pub. L. 118–210, §142(a)(1)(B), inserted "optometrist" after "podiatrist," wherever appearing.

2022—Subsec. (e)(4). Pub. L. 117–168 substituted "Except as provided in sections 7404A(c) and 7410(a)(2) of this title, in no case" for "In no case".

2019—Pub. L. 116–12, §1(b)(1)(A)–(E), substituted "physician, podiatrist, or dentist" for "physician or dentist", "physicians, podiatrists, or dentists" for "physicians or dentists", "physician, podiatrist, and dentist" for "physician and dentist", "physicians, podiatrists, and dentists" for "physicians and dentists", and "Physician, Podiatrist, and Dentist" for "Physician and Dentist" wherever appearing.

Subsec. (e)(1)(A). Pub. L. 116–12, §1(b)(1)(F), inserted "podiatrists and" before "dentists."

2016—Subsec. (c)(4) to (7). Pub. L. 114–315 redesignated pars. (5) to (7) as (4) to (6), respectively, substituted "under paragraph (5)" for "under paragraph (6)" in par. (6), and struck out former par. (4) which read as follows:

"(A) In determining the amount of market pay for physicians or dentists, the Secretary shall consult two or more national surveys of pay for physicians or dentists, as applicable, whether prepared by private, public, or quasi-public entities in order to make a general assessment of the range of pays payable to physicians or dentists, as applicable.

"(B)(i) In determining the amount of the market pay for a particular physician or dentist under this subsection, and in determining a tier (if any) to apply to a physician or dentist under subsection (e)(1)(B), the Secretary shall consult with and consider the recommendations of an appropriate panel or board composed of physicians or dentists (as applicable). The Secretary may exempt physicians and dentists occupying administrative or executive leadership positions from the requirements of the previous sentence.

"(ii) A physician or dentist may not be a member of the panel or board that makes recommendations under clause (i) with respect to the market pay of such physician or dentist, as the case may be.

"(iii) The Secretary should, to the extent practicable, ensure that a panel or board consulted under this subparagraph includes physicians or dentists (as applicable) who are practicing clinicians and who do not hold management positions in the medical facility of the Department at which the physician or dentist subject to the consultation is employed."

2010—Subsec. (b)(5). Pub. L. 111–163, §601(f)(1), added par. (5).

Subsec. (c)(4)(B)(i). Pub. L. 111–163, §601(f)(2), inserted at end "The Secretary may exempt physicians and dentists occupying administrative or executive leadership positions from the requirements of the previous sentence."

Subsec. (c)(7). Pub. L. 111–163, §601(f)(3), substituted "concerned, unless there is a change in board certification or reduction of privileges." for "concerned."

Statutory Notes and Related Subsidiaries

Effective Date of 2025 Amendment

Pub. L. 118–210, title I, §142(a)(5), Jan. 2, 2025, 138 Stat. 2746, provided that: "The amendments made by this subsection [amending this section and sections 7432, 7433, and 7451 of this title] shall apply to any pay period of the Department of Veterans Affairs beginning on or after the date that is 180 days after the date of the enactment of this Act [Jan. 2, 2025]."

Effective Date

Pub. L. 108–445, §3(d), Dec. 3, 2004, 118 Stat. 2641, provided that:

"(1) Notwithstanding the 60-day waiting requirement in section 7431(e)(1)(C) of title 38, United States Code (as amended by subsection (b)), pay provided for a physician or dentist under subchapter III of chapter 74 of such title, as amended by subsection (b), shall take effect on the first day of the first pay period applicable to such physician or dentist that begins on or after January 1, 2006.

"(2) Pay provided for the Under Secretary for Health under subchapter III of chapter 74 of title 38, United States Code, as amended by this section shall take effect on the first day of the first pay period applicable to the Under Secretary that begins on or after January 1, 2006."

Retroactive Authority for Compensation

Pub. L. 118–210, title I, §142(c), Jan. 2, 2025, 138 Stat. 2747, provided that:

"(1) In general.—The Secretary of Veterans Affairs may pay retroactive compensation to a covered employee in an amount that equals the amount of compensation that was authorized to be paid to such covered employee during the period specified in paragraph (2), but was deferred and paid to such employee in the calendar year following the calender [sic] year in which such compensation was authorized because the payment [of] such compensation would have exceeded an applicable cap on annual compensation.

"(2) Period specified.—The period specified in this paragraph is the period beginning on January 8, 2006, and ending on December 31, 2017.

"(3) Exclusion.—Compensation authorized under this subsection shall not be included in the calculation of any aggregate limit on compensation for a covered employee for the year in which it is paid.

"(4) Charging of compensation.—Compensation authorized under this subsection shall be charged to the appropriate medical care appropriation account of the Department of Veterans Affairs for the fiscal year in which the work was performed except as follows:

"(A) In the case of an account that has closed pursuant to section 1552 of title 31, United States Code, the compensation shall be charged to a current appropriation account in accordance with section 1553 of such title.

"(B) In the case of an expired account that has not closed, if charging the compensation to the expired account would cause such account to have a negative unliquidated or unexpended balance, the compensation may be charged to a current appropriation account available for the same purpose.

"(5) Definitions.—In this subsection:

"(A) The term 'compensation' means any pay, including salary, awards, and incentives.

"(B) The term 'covered employee' means a physician, podiatrist, or dentist subject to market pay under section 7431 of title 38, United States Code."

Pilot Program on Incentives for Physicians Who Assume Inpatient Responsibilities at Community Hospitals in Health Professional Shortage Areas

Pub. L. 111–163, title III, §306, May 5, 2010, 124 Stat. 1152, provided that:

"(a) Pilot Program Required.—The Secretary of Veterans Affairs shall carry out a pilot program to assess the feasability [sic] and advisability of each of the following:

"(1) The provision of financial incentives to eligible physicians who obtain and maintain inpatient privileges at community hospitals in health professional shortage areas in order to facilitate the provision by such physicians of primary care and mental health services to veterans at such hospitals.

"(2) The collection of payments from third-party providers for care provided by eligible physicians to nonveterans while discharging inpatient responsibilities at community hospitals in the course of exercising the privileges described in paragraph (1).

"(b) Eligible Physicians.—For purposes of this section, an eligible physician is a primary care or mental health physician employed by the Department of Veterans Affairs on a full-time basis.

"(c) Duration of Program.—The pilot program shall be carried out during the 3-year period beginning on the date of the commencement of the pilot program.

"(d) Locations.—

"(1) In general.—The pilot program shall be carried out at not less than five community hospitals in each of not less than two Veterans Integrated Services Networks. The hospitals shall be selected by the Secretary using the results of the survey required under subsection (e).

"(2) Qualifying community hospitals.—A community hospital may be selected by the Secretary as a location for the pilot program if—

"(A) the hospital is located in a health professional shortage area; and

"(B) the number of eligible physicians willing to assume inpatient responsibilities at the hospital (as determined using the result of the survey) is sufficient for purposes of the pilot program.

"(e) Survey of Physician Interest in Participation.—

"(1) In general.—Not later than 120 days after the date of the enactment of this Act [May 5, 2010], the Secretary shall conduct a survey of eligible physicians to determine the extent of the interest of such physicians in participating in the pilot program.

"(2) Elements.—The survey shall disclose the type, amount, and nature of the financial incentives to be provided under subsection (h) to physicians participating in the pilot program.

"(f) Physician Participation.—

"(1) In general.—The Secretary shall select physicians for participation in the pilot program from among eligible physicians who—

"(A) express interest in participating in the pilot program in the survey conducted under subsection (e);

"(B) are in good standing with the Department; and

"(C) primarily have clinical responsibilities with the Department.

"(2) Voluntary participation.—Participation in the pilot program shall be voluntary. Nothing in this section shall be construed to require a physician working for the Department to assume inpatient responsibilities at a community hospital unless otherwise required as a term or condition of employment with the Department.

"(g) Assumption of Inpatient Physician Responsibilities.—

"(1) In general.—Each eligible physician selected for participation in the pilot program shall assume and maintain inpatient responsibilities, including inpatient responsibilities with respect to nonveterans, at one or more community hospitals selected by the Secretary for participation in the pilot program under subsection (d).

"(2) Coverage under federal tort claims act.—If an eligible physician participating in the pilot program carries out on-call responsibilities at a community hospital where privileges to practice at such hospital are conditioned upon the provision of services to individuals who are not veterans while the physician is on call for such hospital, the provision of such services by the physician shall be considered an action within the scope of the physician's office or employment for purposes of chapter 171 of title 28, United States Code (commonly referred to as the 'Federal Tort Claims Act').

"(h) Compensation.—

"(1) In general.—The Secretary shall provide each eligible physician participating in the pilot program with such compensation (including pay and other appropriate compensation) as the Secretary considers appropriate to compensate such physician for the discharge of any inpatient responsibilities by such physician at a community hospital for which such physician would not otherwise be compensated by the Department as a full-time employee of the Department.

"(2) Written agreement.—The amount of any compensation to be provided a physician under the pilot program shall be specified in a written agreement entered into by the Secretary and the physician for purposes of the pilot program.

"(3) Treatment of compensation.—The Secretary shall consult with the Director of the Office of Personnel Management on the inclusion of a provision in the written agreement required under paragraph (2) that describes the treatment under Federal law of any compensation provided a physician under the pilot program, including treatment for purposes of retirement under the civil service laws.

"(i) Collections From Third Parties.—In carrying out the pilot program for the purpose described in subsection (a)(2), the Secretary shall implement a variety and range of requirements and mechanisms for the collection from third-party payors of amounts to reimburse the Department for health care services provided to nonveterans under the pilot program by eligible physicians discharging inpatient responsibilities under the pilot program.

"(j) Report.—Not later than 1 year after the date of the enactment of this Act [May 5, 2010] and annually thereafter, the Secretary shall submit to Congress a report on the pilot program, including the following:

"(1) The findings of the Secretary with respect to the pilot program.

"(2) The number of veterans and nonveterans provided inpatient care by physicians participating in the pilot program.

"(3) The amounts payable and collected under subsection (i).

"(k) Definitions.—In this section:

"(1) Health professional shortage area.—The term 'health professional shortage area' has the meaning given the term in section 332(a) of the Public Health Service Act (42 U.S.C. 254e(a)).

"(2) Inpatient responsibilities.—The term 'inpatient responsibilities' means on-call responsibilities customarily required of a physician by a community hospital as a condition of granting privileges to the physician to practice in the hospital."

Transition Provisions

Pub. L. 108–445, §3(e), Dec. 3, 2004, 118 Stat. 2641, provided that:

"(1) Physicians and dentists.—

"(A) Pay.—(i) The amount of the pay payable on and after the date of the enactment of this Act [Dec. 3, 2004] to a physician or dentist in receipt of pay under section 7404 or 7405 of title 38, United States Code, as of the day before such date shall continue to be determined under such section (as in effect on the day before such date) until the effective date that is applicable under subsection (d) [set out as a note above] to such physician or dentist, as the case may be.

"(ii) A physician or dentist appointed or reassigned on or after the date of the enactment of this Act, but before the effective date applicable under subsection (d) to such physician or dentist, shall be compensated in accordance with applicable provisions of section 7404 or 7405 of title 38, United States Code (as in effect on the day before date of the enactment of this Act), until such effective date.

"(B) Special pay.—(i) A special pay agreement entered into by a physician or dentist under subchapter III of chapter 74 of title 38, United States Code, before the date of the enactment of this Act shall terminate on the date of the enactment of this Act. However, a physician or dentist in receipt of special pay pursuant to such an agreement on that date shall continue to receive special pay under the terms of such agreement until the effective date that is applicable under subsection (d) to such physician or dentist.

"(ii) A physician or dentist described in subparagraph (A)(ii) may be paid special pay under applicable provisions of section 7433, 7434, 7435, or 7436 of title 38, United States Code (as in effect on the day before the date of the enactment of this Act), during the period beginning on the date of the appointment or reassignment of such physician or dentist, as the case may be, and ending on the effective date applicable under subsection (d) to such physician or dentist. However, no special pay agreement shall be required for the payment of special pay under this clause.

"(C) Treatment of special pay.—(i) Special pay paid under subparagraph (B) to a physician or dentist during the period beginning on the date of the enactment of this Act and ending on the effective date applicable under subsection (d) to such physician or dentist shall be subject to the provisions of paragraphs (1), (2), (4), (5), and (6) of section 7438(b) of title 38, United States Code (as in effect on the day before the date of the enactment of this Act).

"(ii) Special pay paid to a physician or dentist under section 7438 of title 38, United States Code (as in effect on the day before the date of the enactment of this Act), shall be fully creditable for purposes of computing benefits under chapters 83 and 84 of title 5, United States Code.

"(D) Preservation of pay.—The amount of pay paid to a physician or dentist after the effective date of this Act shall not be less than the amount of pay paid to such physician or dentist on the day before the effective date of this Act while such physician or dentist remains in the same position or assignment.

"(2) Under secretary for health.—

"(A) Special pay.—(i) The current special pay agreement entered into by the Under Secretary for Health under subchapters I and III of chapter 74 of title 38, United States Code, before the date of the enactment of this Act [Dec. 3, 2004] shall terminate on the date of the enactment of this Act. However, the Under Secretary shall continue to receive special pay under the terms of such agreement until the effective date that is applicable under subsection (d) [set out as a note above] to the Under Secretary.

"(ii) An individual appointed as Under Secretary for Health on or after the date of the enactment of this Act and before the effective date applicable under subsection (d) to the Under Secretary shall be paid special pay in accordance with the provisions of sections 7432(d)(2) and 7433 of title 38, United States Code (as in effect on the day before the date of the enactment of this Act), during the period beginning on the date of appointment and ending on such effective date. However, no special pay agreement shall be required for the payment of special pay under this clause.

"(B) Treatment of special pay.—Special pay paid under subparagraph (A) during the period beginning on the date of the enactment of this Act and ending on the effective date applicable under subsection (d) to the Under Secretary—

"(i) shall be subject to the provisions of paragraphs (1), (2), (4), (5), and (6) of section 7438(b) of title 38, United States Code (as in effect on the day before the date of the enactment of this Act); and

"(ii) shall be fully creditable for purposes of computing benefits under chapters 83 and 84 of title 5, United States Code."

Initial Rates of Base Pay for Physicians and Dentists

Pub. L. 108–445, §3(c), Dec. 3, 2004, 118 Stat. 2641, provided that: "The initial rates of base pay established for the base pay steps under the Physician and Dentist Base and Longevity Pay Schedule provided in section 7431(b) of title 38, United States Code (as added by subsection (b)), are as follows:

 "Base Pay Step:Rate of Pay:

1
$90,000 

2
$93,000 

3
$96,000 

4
$99,000 

5
$102,000 

6
$105,000 

7
$108,000 

8
$111,000 

9
$114,000 

10
$117,000 

11
$120,000 

12
$123,000 

13
$126,000 

14
$129,000 

15
$132,000."