39–006 

113TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 2d Session 113–564 

VETERANS ACCESS, CHOICE, AND ACCOUNTABILITY ACT 

OF 2014 

JULY 28, 2014.—Ordered to be printed 

Mr. MILLER of Florida, from the committee of conference, 

submitted the following 

CONFERENCE REPORT 

[To accompany H.R. 3230] 

The committee of conference on the disagreeing votes of the 

two Houses on the amendment of the House to the amendment of 

the Senate to the bill (H.R. 3230), making continuing appropriations during a Government shutdown to provide pay and allowances to members of the reserve components of the Armed Forces 

who perform inactive-duty training during such period, having met, 

after full and free conference, have agreed to recommend and do 

recommend to their respective Houses as follows: 

That the Senate recede from its disagreement to the amendment of the House and agree to the same with an amendment as 

follows: 

In lieu of the matter proposed to be inserted by the House 

amendment, insert the following: 

SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

(a) SHORT TITLE.—This Act may be cited as the ‘‘Veterans Access, Choice, and Accountability Act of 2014’’. 

(b) TABLE OF CONTENTS.—The table of contents for this Act is 

as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Definitions. 

TITLE I—IMPROVEMENT OF ACCESS TO CARE FROM NON-DEPARTMENT 

OF VETERANS AFFAIRS PROVIDERS 

Sec. 101. Expanded availability of hospital care and medical services for veterans 

through the use of agreements with non-Department of Veterans Affairs 

entities. 

Sec. 102. Enhancement of collaboration between Department of Veterans Affairs and 

Indian Health Service. 

Sec. 103. Enhancement of collaboration between Department of Veterans Affairs and 

Native Hawaiian health care systems. 


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Sec. 104. Reauthorization and modification of pilot program of enhanced contract 

care authority for health care needs of veterans. 

Sec. 105. Prompt payment by Department of Veterans Affairs. 

Sec. 106. Transfer of authority for payments for hospital care, medical services, and 

other health care from non-Department of Veterans Affairs providers to 

the chief business office of the Veterans Health Administration. 

TITLE II—HEALTH CARE ADMINISTRATIVE MATTERS 

Sec. 201. Independent assessment of the health care delivery systems and management processes of the Department of Veterans Affairs. 

Sec. 202. Commission on Care. 

Sec. 203. Technology task force on review of scheduling system and software of the 

Department of Veterans Affairs. 

Sec. 204. Improvement of access of veterans to mobile vet centers and mobile medical centers of the Department of Veterans Affairs. 

Sec. 205. Improved performance metrics for health care provided by Department of 

Veterans Affairs. 

Sec. 206. Improved transparency concerning health care provided by Department of 

Veterans Affairs. 

Sec. 207. Information for veterans on the credentials of Department of Veterans Affairs physicians. 

Sec. 208. Information in annual budget of the President on hospital care and medical services furnished through expanded use of contracts for such care. 

Sec. 209. Prohibition on falsification of data concerning wait times and quality 

measures at Department of Veterans Affairs. 

TITLE III—HEALTH CARE STAFFING, RECRUITMENT, AND TRAINING 

MATTERS 

Sec. 301. Treatment of staffing shortage and biennial report on staffing of medical 

facilities of the Department of Veterans Affairs. 

Sec. 302. Extension and modification of certain programs within the Department of 

Veterans Affairs Health Professionals Educational Assistance Program. 

Sec. 303. Clinic management training for employees at medical facilities of the Department of Veterans Affairs. 

TITLE IV—HEALTH CARE RELATED TO SEXUAL TRAUMA 

Sec. 401. Expansion of eligibility for sexual trauma counseling and treatment to veterans on inactive duty training. 

Sec. 402. Provision of counseling and treatment for sexual trauma by the Department of Veterans Affairs to members of the Armed Forces. 

Sec. 403. Reports on military sexual trauma. 

TITLE V—OTHER HEALTH CARE MATTERS 

Sec. 501. Extension of pilot program on assisted living services for veterans with 

traumatic brain injury. 

TITLE VI—MAJOR MEDICAL FACILITY LEASES 

Sec. 601. Authorization of major medical facility leases. 

Sec. 602. Budgetary treatment of Department of Veterans Affairs major medical facilities leases. 

TITLE VII—OTHER VETERANS MATTERS 

Sec. 701. Expansion of Marine Gunnery Sergeant John David Fry Scholarship. 

Sec. 702. Approval of courses of education provided by public institutions of higher 

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

Sec. 703. Extension of reduction in amount of pension furnished by Department of 

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

Sec. 704. Extension of requirement for collection of fees for housing loans guaranteed by Secretary of Veterans Affairs. 

Sec. 705. Limitation on awards and bonuses paid to employees of Department of 

Veterans Affairs. 

Sec. 706. Extension of authority to use income information. 

Sec. 707. Removal of senior executives of the Department of Veterans Affairs for performance or misconduct. 


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TITLE VIII—OTHER MATTERS 

Sec. 801. Appropriation of amounts. 

Sec. 802. Veterans Choice Fund. 

Sec. 803. Emergency designations. 

SEC. 2. DEFINITIONS. 

In this Act: 

(1) The term ‘‘facility of the Department’’ has the meaning 

given the term ‘‘facilities of the Department’’ in section 1701 of 

title 38, United States Code. 

(2) The terms ‘‘hospital care’’ and ‘‘medical services’’ have 

the meanings given such terms in section 1701 of title 38, 

United States Code. 

TITLE I—IMPROVEMENT OF ACCESS TO CARE FROM 

NON-DEPARTMENT OF VETERANS AFFAIRS PROVIDERS 

SEC. 101. EXPANDED AVAILABILITY OF HOSPITAL CARE AND MEDICAL 

SERVICES FOR VETERANS THROUGH THE USE OF AGREEMENTS WITH NON-DEPARTMENT OF VETERANS AFFAIRS 

ENTITIES. 

(a) EXPANSION OF AVAILABLE CARE AND SERVICES.— 

(1) FURNISHING OF CARE.— 

(A) IN GENERAL.—Hospital care and medical services 

under chapter 17 of title 38, United States Code, shall be 

furnished to an eligible veteran described in subsection (b), 

at the election of such veteran, through agreements authorized under subsection (d), or any other law administered by 

the Secretary of Veterans Affairs, with entities specified in 

subparagraph (B) for the furnishing of such care and services to veterans. 

(B) ENTITIES SPECIFIED.—The entities specified in this 

subparagraph are the following: 

(i) Any health care provider that is participating in 

the Medicare program under title XVIII of the Social 

Security Act (42 U.S.C. 1395 et seq.). 

(ii) Any Federally-qualified health center (as defined in section 1905(l)(2)(B) of the Social Security Act 

(42 U.S.C. 1396d(l)(2)(B))). 

(iii) The Department of Defense. 

(iv) The Indian Health Service. 

(2) CHOICE OF PROVIDER.—An eligible veteran who makes 

an election under subsection (c) to receive hospital care or medical services under this section may select a provider of such 

care or services from among the entities specified in paragraph 

(1)(B) that are accessible to the veteran. 

(3) COORDINATION OF CARE AND SERVICES.—The Secretary 

shall coordinate, through the Non-VA Care Coordination Program of the Department of Veterans Affairs, the furnishing of 

care and services under this section to eligible veterans, including by ensuring that an eligible veteran receives an appointment for such care and services within the wait-time goals of 

the Veterans Health Administration for the furnishing of hospital care and medical services. 

(b) ELIGIBLE VETERANS.—A veteran is an eligible veteran for 

purposes of this section if— 


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(1)(A) as of August 1, 2014, the veteran is enrolled in the 

patient enrollment system of the Department of Veterans Affairs 

established and operated under section 1705 of title 38, United 

States Code, including any such veteran who has not received 

hospital care or medical services from the Department and has 

contacted the Department seeking an initial appointment from 

the Department for the receipt of such care or services; or 

(B) the veteran is eligible for hospital care and medical 

services under section 1710(e)(1)(D) of such title and is a veteran described in section 1710(e)(3) of such title; and 

(2) the veteran— 

(A) attempts, or has attempted, to schedule an appointment for the receipt of hospital care or medical services 

under chapter 17 of title 38, United States Code, but is unable to schedule an appointment within the wait-time goals 

of the Veterans Health Administration for the furnishing of 

such care or services; 

(B) resides more than 40 miles from the medical facility of the Department, including a community-based outpatient clinic, that is closest to the residence of the veteran; 

(C) resides— 

(i) in a State without a medical facility of the Department that provides— 

(I) hospital care; 

(II) emergency medical services; and 

(III) surgical care rated by the Secretary as 

having a surgical complexity of standard; and 

(ii) more than 20 miles from a medical facility of 

the Department described in clause (i); or 

(D)(i) resides in a location, other than a location in 

Guam, American Samoa, or the Republic of the Philippines, that is 40 miles or less from a medical facility of 

the Department, including a community-based outpatient 

clinic; and 

(ii)(I) is required to travel by air, boat, or ferry to reach 

each medical facility described in clause (i) that is 40 miles 

or less from the residence of the veteran; or 

(II) faces an unusual or excessive burden in accessing 

each medical facility described in clause (i) that is 40 miles 

or less from the residence of the veteran due to geographical 

challenges, as determined by the Secretary. 

(c) ELECTION AND AUTHORIZATION.— 

(1) IN GENERAL.—In the case of an eligible veteran described in subsection (b)(2)(A), the Secretary shall, at the election of the eligible veteran— 

(A) place such eligible veteran on an electronic waiting 

list described in paragraph (2) for an appointment for hospital care or medical services the veteran has elected to receive under this section; or 

(B)(i) authorize that such care or services be furnished 

to the eligible veteran under this section for a period of time 

specified by the Secretary; and 

(ii) notify the eligible veteran by the most effective 

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tification in writing, describing the care or services the eligible veteran is eligible to receive under this section. 

(2) ELECTRONIC WAITING LIST.—The electronic waiting list 

described in this paragraph shall be maintained by the Department and allow access by each eligible veteran via 

www.myhealth.va.gov or any successor website for the following 

purposes: 

(A) To determine the place of such eligible veteran on 

the waiting list. 

(B) To determine the average length of time an individual spends on the waiting list, disaggregated by medical 

facility of the Department and type of care or service needed, for purposes of allowing such eligible veteran to make 

an informed election under paragraph (1). 

(d) CARE AND SERVICES THROUGH AGREEMENTS.— 

(1) AGREEMENTS.— 

(A) IN GENERAL.—The Secretary shall enter into agreements for furnishing care and services to eligible veterans 

under this section with entities specified in subsection 

(a)(1)(B). 

(B) AGREEMENT DEFINED.—In this paragraph, the term 

‘‘agreement’’ includes contracts, intergovernmental agreements, and provider agreements, as appropriate. 

(2) RATES AND REIMBURSEMENT.— (A) IN GENERAL.—In entering into an agreement under 

paragraph (1) with an entity specified in subsection 

(a)(1)(B), the Secretary shall— 

(i) negotiate rates for the furnishing of care and 

services under this section; and 

(ii) reimburse the entity for such care and services 

at the rates negotiated pursuant to clause (i) as provided in such agreement. 

(B) LIMIT ON RATES.— (i) IN GENERAL.—Except as provided in clause (ii), 

rates negotiated under subparagraph (A)(i) shall not be 

more than the rates paid by the United States to a provider of services (as defined in section 1861(u) of the 

Social Security Act (42 U.S.C. 1395x(u))) or a supplier 

(as defined in section 1861(d) of such Act (42 U.S.C. 

1395x(d))) under the Medicare program under title 

XVIII of the Social Security Act (42 U.S.C. 1395 et 

seq.) for the same care or services. 

(ii) EXCEPTION.— 

(I) IN GENERAL.—The Secretary may negotiate 

a rate that is more than the rate paid by the 

United States as described in clause (i) with respect to the furnishing of care or services under 

this section to an eligible veteran who resides in a 

highly rural area. 

(II) HIGHLY RURAL AREA DEFINED.—In this 

clause, the term ‘‘highly rural area’’ means an area 

located in a county that has fewer than seven individuals residing in that county per square mile. 

(C) LIMIT ON COLLECTION.—For the furnishing of care 

or services pursuant to an agreement under paragraph (1), 


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an entity specified in subsection (a)(1)(B) may not collect 

any amount that is greater than the rate negotiated pursuant to subparagraph (A)(i). 

(3) CERTAIN PROCEDURES.— (A) IN GENERAL.—In entering into an agreement under 

paragraph (1) with an entity described in subparagraph 

(B), the Secretary may use the procedures, including those 

procedures relating to reimbursement, available for entering into provider agreements under section 1866(a) of the 

Social Security Act (42 U.S.C. 1395cc(a)). During the period in which such entity furnishes care or services pursuant to this section, such entity may not be treated as a Federal contractor or subcontractor by the Office of Federal 

Contract Compliance Programs of the Department of Labor 

by virtue of furnishing such care or services. 

(B) ENTITIES DESCRIBED.—The entities described in 

this subparagraph are the following: 

(i) In the case of the Medicare program, any provider of service that has entered into a provider agreement under section 1866(a) of the Social Security Act 

(42 U.S.C. 1395cc(a)); and 

(ii) In the case of the Medicaid program, any provider participating under a State plan under title XIX 

of such Act (42 U.S.C. 1396 et seq.). 

(4) INFORMATION ON POLICIES AND PROCEDURES.—The Secretary shall provide to any entity with which the Secretary has 

entered into an agreement under paragraph (1) the following: 

(A) Information on applicable policies and procedures 

for submitting bills or claims for authorized care or services furnished to eligible veterans under this section. 

(B) Access to a telephone hotline maintained by the Department that such entity may call for information on the 

following: 

(i) Procedures for furnishing care and services 

under this section. 

(ii) Procedures for submitting bills or claims for 

authorized care and services furnished to eligible veterans under this section and being reimbursed for furnishing such care and services. 

(iii) Whether particular care or services under this 

section are authorized, and the procedures for authorization of such care or services. 

(e) OTHER HEALTH-CARE PLAN.— 

(1) SUBMITTAL OF INFORMATION TO SECRETARY.—Before receiving hospital care or medical services under this section, an 

eligible veteran shall provide to the Secretary information on 

any health-care plan described in paragraph (4) under which 

the eligible veteran is covered. 

(2) DISCLOSURE OF INFORMATION TO NON-DEPARTMENT EN- TITY.—Notwithstanding section 5701 of title 38, United States 

Code, for purposes of furnishing hospital care or medical services to an eligible veteran under this section, the Secretary shall 

disclose to the entity specified in paragraph (1)(B) of subsection 

(a) with which the Secretary has entered into an agreement described in such subsection— 


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(A) whether the eligible veteran is covered under a 

health-care plan described in paragraph (4); and 

(B) whether the hospital care or medical services 

sought by the eligible veteran is for a medical condition 

that is related to a non-service-connected disability described in paragraph (3)(C). 

(3) CARE FOR WHICH THE DEPARTMENT IS SECONDARILY RE- SPONSIBLE.— 

(A) IN GENERAL.—If an eligible veteran is covered 

under a health-care plan described in paragraph (4) and 

receives hospital care or medical services for a non-serviceconnected disability described in subparagraph (C), such 

health-care plan shall be primarily responsible for paying 

for such care or services, to the extent such care or services 

is covered by such health-care plan, and the Secretary shall 

be secondarily responsible for paying for such care or services in accordance with subparagraph (B)(ii). 

(B) RESPONSIBILITY FOR COSTS OF CARE.—In a case in 

which the Secretary is secondarily responsible for paying 

for hospital care or medical services as described in subparagraph (A)— 

(i) the health care provider that furnishes such 

care or services pursuant to an agreement described in 

subsection (a) shall be responsible for seeking reimbursement for the cost of such care or services from the 

health-care plan described in paragraph (4) under 

which the eligible veteran is covered; and 

(ii) the Secretary shall be responsible for promptly 

paying only the amount that is not covered by such 

health-care plan, except that such responsibility for 

payment may not exceed the rate determined for such 

care or services pursuant to subsection (d)(2). 

(C) NON-SERVICE-CONNECTED DISABILITY DESCRIBED.— A non-service-connected disability described in this subsection is a non-service-connected disability (as defined in 

section 101 of title 38, United States Code)— 

(i) that is incurred incident to a veteran’s employment and that is covered under a workers’ compensation law or plan that provides for payment for the cost 

of health care and services provided to the veteran by 

reason of the disability; 

(ii) that is incurred as the result of a motor vehicle 

accident to which applies a State law that requires the 

owners or operators of motor vehicles registered in that 

State to have in force automobile accident reparations 

insurance; 

(iii) that is incurred as the result of a crime of personal violence that occurred in a State, or a political 

subdivision of a State, in which a person injured as the 

result of such a crime is entitled to receive health care 

and services at such State’s or subdivision’s expense for 

personal injuries suffered as the result of such crime; 

(iv) that is incurred by a veteran— 

(I) who does not have a service-connected disability; and 


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(II) who is entitled to care (or payment of the 

expenses of care) under a health-care plan; or 

(v) for which care and services are furnished under 

this section to a veteran who— 

(I) has a service-connected disability; and 

(II) is entitled to care (or payment of the expenses of care) under a health-care plan. 

(4) HEALTH-CARE PLAN.—A health-care plan described in 

this paragraph— 

(A) is an insurance policy or contract, medical or hospital service agreement, membership or subscription contract, or similar arrangement not administered by the Secretary of Veterans Affairs, under which health services for 

individuals are provided or the expenses of such services 

are paid; and 

(B) does not include any such policy, contract, agreement, or similar arrangement pursuant to title XVIII or 

XIX of the Social Security Act (42 U.S.C. 1395 et seq.) or 

chapter 55 of title 10, United States Code. 

(f) VETERANS CHOICE CARD.— 

(1) IN GENERAL.—For purposes of receiving care and services under this section, the Secretary shall, not later than 90 

days after the date of the enactment of this Act, issue to each 

veteran described in subsection (b)(1) a card that may be presented to a health care provider to facilitate the receipt of care 

or services under this section. 

(2) NAME OF CARD.—Each card issued under paragraph (1) 

shall be known as a ‘‘Veterans Choice Card’’. 

(3) DETAILS OF CARD.—Each Veterans Choice Card issued 

to a veteran under paragraph (1) shall include the following: 

(A) The name of the veteran. 

(B) An identification number for the veteran that is not 

the social security number of the veteran. 

(C) The contact information of an appropriate office of 

the Department for health care providers to confirm that 

care or services under this section are authorized for the 

veteran. 

(D) Contact information and other relevant information for the submittal of claims or bills for the furnishing 

of care or services under this section. 

(E) The following statement: ‘‘This card is for qualifying medical care outside the Department of Veterans Affairs. Please call the Department of Veterans Affairs phone 

number specified on this card to ensure that treatment has 

been authorized.’’. 

(4) INFORMATION ON USE OF CARD.—Upon issuing a Veterans Choice Card to a veteran, the Secretary shall provide the 

veteran with information clearly stating the circumstances 

under which the veteran may be eligible for care or services 

under this section. 

(g) INFORMATION ON AVAILABILITY OF CARE.—The Secretary 

shall provide information to a veteran about the availability of care 

and services under this section in the following circumstances: 


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(1) In the case of a veteran described in subsection (b)(1)(B), 

when the veteran enrolls in the patient enrollment system of the 

Department under section 1705 of title 38, United States Code. 

(2) When the veteran attempts to schedule an appointment 

for the receipt of hospital care or medical services from the Department but is unable to schedule an appointment within the 

wait-time goals of the Veterans Health Administration for the 

furnishing of such care or services. 

(3) When the veteran becomes eligible for hospital care or 

medical services under this section under subparagraph (B), 

(C), or (D) of subsection (b)(2). 

(h) FOLLOW-UP CARE.—In carrying out this section, the Secretary shall ensure that, at the election of an eligible veteran who 

receives hospital care or medical services from a health care provider in an episode of care under this section, the veteran receives 

such hospital care and medical services from such health care provider through the completion of the episode of care (but for a period 

not exceeding 60 days), including all specialty and ancillary services 

deemed necessary as part of the treatment recommended in the 

course of such hospital care or medical services. 

(i) PROVIDERS.—To be eligible to furnish care or services under 

this section, a health care provider must— 

(1) maintain at least the same or similar credentials and 

licenses as those credentials and licenses that are required of 

health care providers of the Department, as determined by the 

Secretary for purposes of this section; and 

(2) submit, not less frequently than once each year during 

the period in which the Secretary is authorized to carry out this 

section pursuant to subsection (p), verification of such licenses 

and credentials maintained by such health care provider. 

(j) COST-SHARING.— 

(1) IN GENERAL.—The Secretary shall require an eligible 

veteran to pay a copayment for the receipt of care or services 

under this section only if such eligible veteran would be required to pay a copayment for the receipt of such care or services at a medical facility of the Department or from a health 

care provider of the Department pursuant to chapter 17 of title 

38, United States Code. 

(2) LIMITATION.—The amount of a copayment charged 

under paragraph (1) may not exceed the amount of the copayment that would be payable by such eligible veteran for the receipt of such care or services at a medical facility of the Department or from a health care provider of the Department pursuant to chapter 17 of title 38, United States Code. 

(3) COLLECTION OF COPAYMENT.—A health care provider 

that furnishes care or services to an eligible veteran under this 

section shall collect the copayment required under paragraph 

(1) from such eligible veteran at the time of furnishing such 

care or services. 

(k) CLAIMS PROCESSING SYSTEM.— 

(1) IN GENERAL.—The Secretary shall provide for an efficient nationwide system for processing and paying bills or 

claims for authorized care and services furnished to eligible veterans under this section. 


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(2) REGULATIONS.—Not later than 90 days after the date of 

the enactment of this Act, the Secretary of Veterans Affairs shall 

prescribe regulations for the implementation of such system. 

(3) OVERSIGHT.—The Chief Business Office of the Veterans 

Health Administration shall oversee the implementation and 

maintenance of such system. 

(4) ACCURACY OF PAYMENT.— (A) IN GENERAL.—The Secretary shall ensure that such 

system meets such goals for accuracy of payment as the 

Secretary shall specify for purposes of this section. 

(B) QUARTERLY REPORT.— (i) IN GENERAL.—The Secretary shall submit to the 

Committee on Veterans’ Affairs of the Senate and the 

Committee on Veterans’ Affairs of the House of Representatives a quarterly report on the accuracy of such 

system. 

(ii) ELEMENTS.—Each report required by clause (i) 

shall include the following: 

(I) A description of the goals for accuracy for 

such system specified by the Secretary under subparagraph (A). 

(II) An assessment of the success of the Department in meeting such goals during the quarter covered by the report. 

(iii) DEADLINE.—The Secretary shall submit each 

report required by clause (i) not later than 20 days 

after the end of the quarter covered by the report. 

(l) MEDICAL RECORDS.— (1) IN GENERAL.—The Secretary shall ensure that any 

health care provider that furnishes care or services under this 

section to an eligible veteran submits to the Department any 

medical record related to the care or services provided to such 

eligible veteran by such health care provider for inclusion in the 

electronic medical record of such eligible veteran maintained by 

the Department upon the completion of the provision of such 

care or services to such eligible veteran. 

(2) ELECTRONIC FORMAT.—Any medical record submitted to 

the Department under paragraph (1) shall, to the extent possible, be in an electronic format. 

(m) TRACKING OF MISSED APPOINTMENTS.—The Secretary shall 

implement a mechanism to track any missed appointments for care 

or services under this section by eligible veterans to ensure that the 

Department does not pay for such care or services that were not furnished to an eligible veteran. 

(n) IMPLEMENTATION.—Not later than 90 days after the date of 

the enactment of this Act, the Secretary shall prescribe interim final 

regulations on the implementation of this section and publish such 

regulations in the Federal Register. 

(o) INSPECTOR GENERAL REPORT.—Not later than 30 days after 

the date on which the Secretary determines that 75 percent of the 

amounts deposited in the Veterans Choice Fund established by section 802 have been exhausted, the Inspector General of the Department shall submit to the Secretary a report on the results of an 

audit of the care and services furnished under this section to ensure 

the accuracy and timeliness of payments by the Department for the 


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cost of such care and services, including any findings and recommendations of the Inspector General. 

(p) AUTHORITY TO FURNISH CARE AND SERVICES.— (1) IN GENERAL.—The Secretary may not use the authority 

under this section to furnish care and services after the date 

specified in paragraph (2). 

(2) DATE SPECIFIED.—The date specified in this paragraph 

is the date on which the Secretary has exhausted all amounts 

deposited in the Veterans Choice Fund established by section 

802, or the date that is three years after the date of the enactment of this Act, whichever occurs first. 

(3) PUBLICATION.—The Secretary shall publish such date in 

the Federal Register and on an Internet website of the Department available to the public not later than 30 days before such 

date. 

(q) REPORTS.— 

(1) INITIAL REPORT.—Not later than 90 days after the publication of the interim final regulations under subsection (n), the 

Secretary shall submit to the Committee on Veterans’ Affairs of 

the Senate and the Committee on Veterans’ Affairs of the House 

of Representatives a report on the furnishing of care and services under this section that includes the following: 

(A) The number of eligible veterans who have received 

care or services under this section. 

(B) A description of the types of care and services furnished to eligible veterans under this section. 

(2) FINAL REPORT.—Not later than 30 days after the date 

on which the Secretary determines that 75 percent of the 

amounts deposited in the Veterans Choice Fund established by 

section 802 have been exhausted, the Secretary shall submit to 

the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on the furnishing of care and services under this section 

that includes the following: 

(A) The total number of eligible veterans who have received care or services under this section, disaggregated 

by— 

(i) eligible veterans described in subsection 

(b)(2)(A); 

(ii) eligible veterans described in subsection 

(b)(2)(B); 

(iii) eligible veterans described in subsection 

(b)(2)(C); and 

(iv) eligible veterans described in subsection 

(b)(2)(D). 

(B) A description of the types of care and services furnished to eligible veterans under this section. 

(C) An accounting of the total cost of furnishing care 

and services to eligible veterans under this section. 

(D) The results of a survey of eligible veterans who 

have received care or services under this section on the satisfaction of such eligible veterans with the care or services 

received by such eligible veterans under this section. 

(E) An assessment of the effect of furnishing care and 

services under this section on wait times for appointments 


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for the receipt of hospital care and medical services from 

the Department. 

(F) An assessment of the feasibility and advisability of 

continuing furnishing care and services under this section 

after the termination date specified in subsection (p). 

(r) RULE OF CONSTRUCTION.—Nothing in this section shall be 

construed to alter the process of the Department for filling and paying for prescription medications. 

(s) WAIT-TIME GOALS OF THE VETERANS HEALTH ADMINISTRA- TION.— (1) IN GENERAL.—Except as provided in paragraph (2), in 

this section, the term ‘‘wait-time goals of the Veterans Health 

Administration’’ means not more than 30 days from the date on 

which a veteran requests an appointment for hospital care or 

medical services from the Department. 

(2) ALTERNATE GOALS.—If the Secretary submits to Congress, not later than 60 days after the date of the enactment of 

this Act, a report stating that the actual wait-time goals of the 

Veterans Health Administration are different from the waittime goals specified in paragraph (1)— 

(A) for purposes of this section, the wait-time goals of 

the Veterans Health Administration shall be the wait-time 

goals submitted by the Secretary under this paragraph; 

and 

(B) the Secretary shall publish such wait-time goals in 

the Federal Register and on an Internet website of the Department available to the public. 

SEC. 102. ENHANCEMENT OF COLLABORATION BETWEEN DEPARTMENT OF VETERANS AFFAIRS AND INDIAN HEALTH SERVICE. 

(a) OUTREACH TO TRIBAL-RUN MEDICAL FACILITIES.—The Secretary of Veterans Affairs shall, in consultation with the Director of 

the Indian Health Service, conduct outreach to each medical facility 

operated by an Indian tribe or tribal organization through a contract or compact with the Indian Health Service under the Indian 

Self-Determination and Education Assistance Act (25 U.S.C. 450 et 

seq.) to raise awareness of the ability of such facilities, Indian 

tribes, and tribal organizations to enter into agreements with the 

Department of Veterans Affairs under which the Secretary reimburses such facilities, Indian tribes, or tribal organizations, as the 

case may be, for health care provided to veterans who are— 

(1) eligible for health care at such facilities; and 

(2)(A) enrolled in the patient enrollment system of the Department established and operated under section 1705 of title 

38, United States Code; or 

(B) eligible for hospital care and medical services pursuant 

to subsection (c)(2) of such section. 

(b) PERFORMANCE METRICS FOR MEMORANDUM OF UNDERSTANDING.—The Secretary of Veterans Affairs shall establish performance metrics for assessing the performance by the Department 

of Veterans Affairs and the Indian Health Service under the memorandum of understanding entitled ‘‘Memorandum of Understanding 

between the Department of Veterans Affairs (VA) and the Indian 

Health Service (IHS)’’ in increasing access to health care, improving 

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centered collaboration and partnerships between the Department 

and the Service, and ensuring health-promotion and disease-prevention services are appropriately funded and available for beneficiaries under both health care systems. 

(c) REPORT.—Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs and the Director of the Indian Health Service shall jointly submit to Congress a 

report on the feasibility and advisability of the following: 

(1) Entering into agreements for the reimbursement by the 

Secretary of the costs of direct care services provided through 

organizations receiving amounts pursuant to grants made or 

contracts entered into under section 503 of the Indian Health 

Care Improvement Act (25 U.S.C. 1653) to veterans who are 

otherwise eligible to receive health care from such organizations. 

(2) Including the reimbursement of the costs of direct care 

services provided to veterans who are not Indians in agreements 

between the Department and the following: 

(A) The Indian Health Service. 

(B) An Indian tribe or tribal organization operating a 

medical facility through a contract or compact with the Indian Health Service under the Indian Self-Determination 

and Education Assistance Act (25 U.S.C. 450 et seq.). 

(C) A medical facility of the Indian Health Service. 

(d) DEFINITIONS.—In this section: 

(1) INDIAN.—The terms ‘‘Indian’’ and ‘‘Indian tribe’’ have 

the meanings given those terms in section 4 of the Indian 

Health Care Improvement Act (25 U.S.C. 1603). 

(2) MEDICAL FACILITY OF THE INDIAN HEALTH SERVICE.— 

The term ‘‘medical facility of the Indian Health Service’’ includes a facility operated by an Indian tribe or tribal organization through a contract or compact with the Indian Health 

Service under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.). 

(3) TRIBAL ORGANIZATION.—The term ‘‘tribal organization’’ 

has the meaning given the term in section 4 of the Indian SelfDetermination and Education Assistance Act (25 U.S.C. 450b). 

SEC. 103. ENHANCEMENT OF COLLABORATION BETWEEN DEPARTMENT OF VETERANS AFFAIRS AND NATIVE HAWAIIAN 

HEALTH CARE SYSTEMS. 

(a) IN GENERAL.—The Secretary of Veterans Affairs shall, in 

consultation with Papa Ola Lokahi and such other organizations 

involved in the delivery of health care to Native Hawaiians as the 

Secretary considers appropriate, enter into contracts or agreements 

with Native Hawaiian health care systems that are in receipt of 

funds from the Secretary of Health and Human Services pursuant 

to grants awarded or contracts entered into under section 6(a) of the 

Native Hawaiian Health Care Improvement Act (42 U.S.C. 

11705(a)) for the reimbursement of direct care services provided to 

eligible veterans as specified in such contracts or agreements. 

(b) DEFINITIONS.—In this section, the terms ‘‘Native Hawaiian’’, 

‘‘Native Hawaiian health care system’’, and ‘‘Papa Ola Lokahi’’ have 

the meanings given those terms in section 12 of the Native Hawaiian Health Care Improvement Act (42 U.S.C. 11711). 


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SEC. 104. REAUTHORIZATION AND MODIFICATION OF PILOT PROGRAM 

OF ENHANCED CONTRACT CARE AUTHORITY FOR HEALTH 

CARE NEEDS OF VETERANS. 

Section 403 of the Veterans’ Mental Health and Other Care Improvements Act of 2008 (Public Law 110–387; 38 U.S.C. 1703 note) 

is amended— 

(1) in subsection (a)— 

(A) in paragraph (3), by striking ‘‘only during the’’ and 

all that follows through the period at the end and inserting 

‘‘only during the period beginning on the date of the commencement of the pilot program under paragraph (2) and 

ending on the date that is two years after the date of the 

enactment of the Veterans Access, Choice, and Accountability Act of 2014.’’; and 

(B) by amending paragraph (4) to read as follows: 

‘‘(4) PROGRAM LOCATIONS.—The Secretary shall carry out 

the pilot program at locations in the following Veterans Integrated Service Networks (and such other locations as the Secretary considers appropriate): 

‘‘(A) Veterans Integrated Service Network 1. 

‘‘(B) Veterans Integrated Service Network 6. 

‘‘(C) Veterans Integrated Service Network 15. 

‘‘(D) Veterans Integrated Service Network 18. 

‘‘(E) Veterans Integrated Service Network 19.’’; 

(2) in subsection (b)(1)(A), by striking ‘‘as of the date of the 

commencement of the pilot program under subsection (a)(2)’’ 

and inserting ‘‘as of August 1, 2014’’; 

(3) by redesignating subsection (h) as subsection (k); 

(4) by inserting after subsection (g) the following new subsections: 

‘‘(h) APPOINTMENTS.—In carrying out the pilot program under 

this section, the Secretary shall ensure that medical appointments 

for covered veterans— 

‘‘(1) are scheduled not later than 5 days after the date on 

which the appointment is requested; and 

‘‘(2) occur not later than 30 days after such date. 

‘‘(i) OUTREACH.—The Secretary shall ensure that covered veterans are informed about the pilot program under this section. 

‘‘(j) USE OF EXISTING CONTRACTS.—In carrying out the pilot 

program under this section after the date of the enactment of the 

Veterans Access, Choice, and Accountability Act of 2014, the Secretary shall make use of contracts entered into before such date or 

may enter into new contracts.’’; and 

(5) in paragraph (2)(B) of subsection (k), as redesignated by 

paragraph (3) of this section, by striking the semicolon at the 

end and inserting ‘‘; and’’. 

SEC. 105. PROMPT PAYMENT BY DEPARTMENT OF VETERANS AFFAIRS. 

(a) SENSE OF CONGRESS ON PROMPT PAYMENT BY DEPARTMENT.—It is the sense of Congress that the Secretary of Veterans Affairs shall comply with section 1315 of title 5, Code of Federal Regulations (commonly known as the ‘‘prompt payment rule’’), or any 

corresponding similar regulation or ruling, in paying for health 

care pursuant to contracts entered into with non-Department of Veterans Affairs providers to provide health care under the laws administered by the Secretary. 


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(b) ESTABLISHMENT OF CLAIMS PROCESSING SYSTEM.— 

(1) CLAIMS PROCESSING SYSTEM.—The Secretary of Veterans Affairs shall establish and implement a system to process 

and pay claims for payment for hospital care, medical services, 

and other health care furnished by non-Department of Veterans 

Affairs health care providers under the laws administered by 

the Secretary. 

(2) COMPLIANCE WITH PROMPT PAYMENT ACT.—The system 

established and implemented under paragraph (1) shall comply 

with all requirements of chapter 39, United States Code (commonly referred to as the ‘‘Prompt Payment Act’’). 

(c) REPORT.—Not later than one year after the date of the enactment of this Act, the Comptroller General of the United States shall 

submit to Congress a report on the timeliness of payments by the 

Secretary for hospital care, medical services, and other health care 

furnished by non-Department of Veterans Affairs health care providers under the laws administered by the Secretary. 

(d) ELEMENTS.—The report required by subsection (b) shall include the following: 

(1) The results of a survey of non-Department health care 

providers who have submitted claims to the Department for 

hospital care, medical services, or other health care furnished 

to veterans for which payment is authorized under the laws administered by the Secretary during the one-year period preceding the submittal of the report, which survey shall include 

the following: 

(A) The amount of time it took for such health care providers, after submitting such claims, to receive payment 

from the Department for such care or services. 

(B) A comparison of the amount of time under subparagraph (A) and the amount of time it takes such health 

care providers to receive payments from the United States 

for similar care or services provided to the following, if applicable: 

(i) Beneficiaries under the Medicare program 

under title XVIII of the Social Security Act (42 U.S.C. 

1395 et seq.). 

(ii) Covered beneficiaries under the TRICARE program under chapter 55 of title 10, United States Code. 

(2) Such recommendations for legislative or administrative 

action as the Comptroller General considers appropriate. 

(e) SURVEY ELEMENTS.—In carrying out the survey, the Comptroller General shall seek responses from non-Department health 

care providers in a manner that ensures that the survey reflects the 

responses of such providers that— 

(1) are located in different geographic areas; 

(2) furnish a variety of different hospital care, medical services, and other health care; and 

(3) furnish such care and services in a variety of different 

types of medical facilities. 


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SEC. 106. TRANSFER OF AUTHORITY FOR PAYMENTS FOR HOSPITAL 

CARE, MEDICAL SERVICES, AND OTHER HEALTH CARE 

FROM NON-DEPARTMENT OF VETERANS AFFAIRS PROVIDERS TO THE CHIEF BUSINESS OFFICE OF THE VETERANS HEALTH ADMINISTRATION. 

(a) TRANSFER OF AUTHORITY.— 

(1) IN GENERAL.—Effective as of October 1, 2014, the Secretary of Veterans Affairs shall transfer the authority to pay for 

hospital care, medical services, and other health care furnished 

through non-Department of Veterans Affairs providers from— 

(A) the Veterans Integrated Service Networks and medical centers of the Department of Veterans Affairs, to 

(B) the Chief Business Office of the Veterans Health 

Administration of the Department of Veterans Affairs. 

(2) MANNER OF CARE.—The Chief Business Office shall 

work in consultation with the Office of Clinical Operations and 

Management of the Department to ensure that care and services 

described in paragraph (1) are provided in a manner that is 

clinically appropriate and in the best interest of the veterans receiving such care and services. 

(3) NO DELAY IN PAYMENT.—The transfer of authority under 

paragraph (1) shall be carried out in a manner that does not 

delay or impede any payment by the Department for hospital 

care, medical services, or other health care furnished through a 

non-Department provider under the laws administered by the 

Secretary. 

(b) BUDGET MATTERS.—The budget of the Department of Veterans Affairs for any fiscal year beginning after the date of the enactment of this Act (as submitted to Congress pursuant to section 

1105(a) of title 31, United States Code) shall specify funds for the 

payment for hospital care, medical services, and other health care 

furnished through non-Department of Veterans Affairs providers, 

including any administrative costs associated with such payment, 

as funds for the Chief Business Office of the Veterans Health Administration rather than as funds for the Veterans Integrated Service Networks or medical centers of the Department. 

TITLE II—HEALTH CARE ADMINISTRATIVE MATTERS 

SEC. 201. INDEPENDENT ASSESSMENT OF THE HEALTH CARE DELIVERY SYSTEMS AND MANAGEMENT PROCESSES OF THE DEPARTMENT OF VETERANS AFFAIRS. 

(a) INDEPENDENT ASSESSMENT.— 

(1) ASSESSMENT.—Not later than 90 days after the date of 

the enactment of this Act, the Secretary of Veterans Affairs shall 

enter into one or more contracts with a private sector entity or 

entities described in subsection (b) to conduct an independent 

assessment of the hospital care, medical services, and other 

health care furnished in medical facilities of the Department. 

Such assessment shall address each of the following: 

(A) Current and projected demographics and unique 

health care needs of the patient population served by the 

Department. 

(B) Current and projected health care capabilities and 

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partment facilities under contract with the Department, to 

provide timely and accessible care to veterans. 

(C) The authorities and mechanisms under which the 

Secretary may furnish hospital care, medical services, and 

other health care at non-Department facilities, including 

whether the Secretary should have the authority to furnish 

such care and services at such facilities through the completion of episodes of care. 

(D) The appropriate system-wide access standard applicable to hospital care, medical services, and other health 

care furnished by and through the Department, including 

an identification of appropriate access standards for each 

individual specialty and post-care rehabilitation. 

(E) The workflow process at each medical facility of the 

Department for scheduling appointments for veterans to receive hospital care, medical services, or other health care 

from the Department. 

(F) The organization, workflow processes, and tools 

used by the Department to support clinical staffing, access 

to care, effective length-of-stay management and care transitions, positive patient experience, accurate documentation, 

and subsequent coding of inpatient services. 

(G) The staffing level at each medical facility of the Department and the productivity of each health care provider 

at such medical facility, compared with health care industry performance metrics, which may include an assessment 

of any of the following: 

(i) The case load of, and number of patients treated by, each health care provider at such medical facility during an average week. 

(ii) The time spent by such health care provider on 

matters other than the case load of such health care 

provider, including time spent by such health care provider as follows: 

(I) At a medical facility that is affiliated with 

the Department. 

(II) Conducting research. 

(III) Training or supervising other health care 

professionals of the Department. 

(H) The information technology strategies of the Department with respect to furnishing and managing health 

care, including an identification of any weaknesses and opportunities with respect to the technology used by the Department, especially those strategies with respect to clinical 

documentation of episodes of hospital care, medical services, and other health care, including any clinical images 

and associated textual reports, furnished by the Department in Department or non-Department facilities. 

(I) Business processes of the Veterans Health Administration, including processes relating to furnishing non-Department health care, insurance identification, third-party 

revenue collection, and vendor reimbursement, including an 

identification of mechanisms as follows: 

(i) To avoid the payment of penalties to vendors. 


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(ii) To increase the collection of amounts owed to 

the Department for hospital care, medical services, or 

other health care provided by the Department for 

which reimbursement from a third party is authorized 

and to ensure that such amounts collected are accurate. 

(iii) To increase the collection of any other amounts 

owed to the Department with respect to hospital care, 

medical services, and other health care and to ensure 

that such amounts collected are accurate. 

(iv) To increase the accuracy and timeliness of Department payments to vendors and providers. 

(J) The purchasing, distribution, and use of pharmaceuticals, medical and surgical supplies, medical devices, 

and health care related services by the Department, including the following: 

(i) The prices paid for, standardization of, and use 

by the Department of the following: 

(I) Pharmaceuticals. 

(II) Medical and surgical supplies. 

(III) Medical devices. 

(ii) The use by the Department of group purchasing arrangements to purchase pharmaceuticals, 

medical and surgical supplies, medical devices, and 

health care related services. 

(iii) The strategy and systems used by the Department to distribute pharmaceuticals, medical and surgical supplies, medical devices, and health care related 

services to Veterans Integrated Service Networks and 

medical facilities of the Department. 

(K) The process of the Department for carrying out construction and maintenance projects at medical facilities of 

the Department and the medical facility leasing program of 

the Department. 

(L) The competency of leadership with respect to culture, accountability, reform readiness, leadership development, physician alignment, employee engagement, succession planning, and performance management. 

(2) PARTICULAR ELEMENTS OF CERTAIN ASSESSMENTS.— 

(A) SCHEDULING ASSESSMENT.—In carrying out the assessment required by paragraph (1)(E), the private sector 

entity or entities shall do the following: 

(i) Review all training materials pertaining to 

scheduling of appointments at each medical facility of 

the Department. 

(ii) Assess whether all employees of the Department 

conducting tasks related to scheduling are properly 

trained for conducting such tasks. 

(iii) Assess whether changes in the technology or 

system used in scheduling appointments are necessary 

to limit access to the system to only those employees 

that have been properly trained in conducting such 

tasks. 

(iv) Assess whether health care providers of the Department are making changes to their schedules that 


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hinder the ability of employees conducting such tasks 

to perform such tasks. 

(v) Assess whether the establishment of a centralized call center throughout the Department for scheduling appointments at medical facilities of the Department would improve the process of scheduling such appointments. 

(vi) Assess whether booking templates for each 

medical facility or clinic of the Department would improve the process of scheduling such appointments. 

(vii) Assess any interim technology changes or attempts by Department to internally develop a long-term 

scheduling solutions with respect to the feasibility and 

cost effectiveness of such internally developed solutions 

compared to commercially available solutions. 

(viii) Recommend actions, if any, to be taken by the 

Department to improve the process for scheduling such 

appointments, including the following: 

(I) Changes in training materials provided to 

employees of the Department with respect to conducting tasks related to scheduling such appointments. 

(II) Changes in monitoring and assessment 

conducted by the Department of wait times of veterans for such appointments. 

(III) Changes in the system used to schedule 

such appointments, including changes to improve 

how the Department— 

(aa) measures wait times of veterans for 

such appointments; 

(bb) monitors the availability of health 

care providers of the Department; and 

(cc) provides veterans the ability to schedule such appointments. 

(IV) Such other actions as the private sector 

entity or entities considers appropriate. 

(B) MEDICAL CONSTRUCTION AND MAINTENANCE

PROJECT AND LEASING PROGRAM ASSESSMENT.—In carrying 

out the assessment required by paragraph (1)(K), the private sector entity or entities shall do the following: 

(i) Review the process of the Department for identifying and designing proposals for construction and 

maintenance projects at medical facilities of the Department and leases for medical facilities of the Department. 

(ii) Assess the process through which the Department determines the following: 

(I) That a construction or maintenance project 

or lease is necessary with respect to a medical facility or proposed medical facility of the Department. 

(II) The proper size of such medical facility or 

proposed medical facility with respect to treating 

veterans in the catchment area of such medical facility or proposed medical facility. 


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(iii) Assess the management processes of the Department with respect to the capital management programs of the Department, including processes relating 

to the methodology for construction and design of medical facilities of the Department, the management of 

projects relating to the construction and design of such 

facilities, and the activation of such facilities. 

(iv) Assess the medical facility leasing program of 

the Department. 

(3) TIMING.—The private sector entity or entities carrying 

out the assessment required by paragraph (1) shall complete 

such assessment not later than 240 days after entering into the 

contract described in such paragraph. 

(b) PRIVATE SECTOR ENTITIES DESCRIBED.—A private entity described in this subsection is a private entity that— 

(1) has experience and proven outcomes in optimizing the 

performance of the health care delivery systems of the Veterans 

Health Administration and the private sector and in health 

care management; and 

(2) specializes in implementing large-scale organizational 

and cultural transformations, especially with respect to health 

care delivery systems. 

(c) PROGRAM INTEGRATOR.— (1) IN GENERAL.—If the Secretary enters into contracts with 

more than one private sector entity under subsection (a), the 

Secretary shall designate one such entity that is predominately 

a health care organization as the program integrator. 

(2) RESPONSIBILITIES.—The program integrator designated 

pursuant to paragraph (1) shall be responsible for coordinating 

the outcomes of the assessments conducted by the private entities pursuant to such contracts. 

(d) REPORT ON ASSESSMENT.— (1) IN GENERAL.—Not later than 60 days after completing 

the assessment required by subsection (a), the private sector entity or entities carrying out such assessment shall submit to the 

Secretary of Veterans Affairs, the Committee on Veterans’ Affairs of the Senate, the Committee on Veterans’ Affairs of the 

House of Representatives, and the Commission on Care established under section 202 a report on the findings and recommendations of the private sector entity or entities with respect to such assessment. 

(2) PUBLICATION.—Not later than 30 days after receiving 

the report under paragraph (1), the Secretary shall publish 

such report in the Federal Register and on an Internet website 

of the Department of Veterans Affairs that is accessible to the 

public. 

(e) NON-DEPARTMENT FACILITIES DEFINED.—In this section, the 

term ‘‘non-Department facilities’’ has the meaning given that term 

in section 1701 of title 38, United States Code. 

SEC. 202. COMMISSION ON CARE. 

(a) ESTABLISHMENT OF COMMISSION.— (1) IN GENERAL.—There is established a commission, to be 

known as the ‘‘Commission on Care’’ (in this section referred to 

as the ‘‘Commission’’), to examine the access of veterans to 

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gically examine how best to organize the Veterans Health Administration, locate health care resources, and deliver health 

care to veterans during the 20-year period beginning on the 

date of the enactment of this Act. 

(2) MEMBERSHIP.— (A) VOTING MEMBERS.—The Commission shall be composed of 15 voting members who are appointed as follows: 

(i) Three members appointed by the Speaker of the 

House of Representatives, at least one of whom shall be 

a veteran. 

(ii) Three members appointed by the Minority 

Leader of the House of Representatives, at least one of 

whom shall be a veteran. 

(iii) Three members appointed by the Majority 

Leader of the Senate, at least one of whom shall be a 

veteran. 

(iv) Three members appointed by the Minority 

Leader of the Senate, at least one of whom shall be a 

veteran. 

(v) Three members appointed by the President, at 

least two of whom shall be veterans. 

(B) QUALIFICATIONS.—Of the members appointed under 

subparagraph (A)— 

(i) at least one member shall represent an organization recognized by the Secretary of Veterans Affairs 

for the representation of veterans under section 5902 of 

title 38, United States Code; 

(ii) at least one member shall have experience as 

senior management for a private integrated health care 

system with an annual gross revenue of more than 

$50,000,000; 

(iii) at least one member shall be familiar with 

government health care systems, including those systems of the Department of Defense, the Indian Health 

Service, and Federally-qualified health centers (as defined in section 1905(l)(2)(B) of the Social Security Act 

(42 U.S.C. 1396d(l)(2)(B))); 

(iv) at least one member shall be familiar with the 

Veterans Health Administration but shall not be currently employed by the Veterans Health Administration; and 

(v) at least one member shall be familiar with 

medical facility construction and leasing projects carried out by government entities and have experience in 

the building trades, including construction, engineering, and architecture. 

(C) DATE.—The appointments of members of the Commission shall be made not later than one year after the date 

of the enactment of this Act. 

(3) PERIOD OF APPOINTMENT.— (A) IN GENERAL.—Members shall be appointed for the 

life of the Commission. 

(B) VACANCIES.—Any vacancy in the Commission shall 

not affect its powers, but shall be filled in the same manner 

as the original appointment. 


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(4) INITIAL MEETING.—Not later than 15 days after the date 

on which eight voting members of the Commission have been 

appointed, the Commission shall hold its first meeting. 

(5) MEETINGS.—The Commission shall meet at the call of 

the Chairperson. 

(6) QUORUM.—A majority of the members of the Commission shall constitute a quorum, but a lesser number of members 

may hold hearings. 

(7) CHAIRPERSON AND VICE CHAIRPERSON.—The President 

shall designate a member of the commission to serve as Chairperson of the Commission. The Commission shall select a Vice 

Chairperson from among its members. 

(b) DUTIES OF COMMISSION.— 

(1) EVALUATION AND ASSESSMENT.—The Commission shall 

undertake a comprehensive evaluation and assessment of access 

to health care at the Department of Veterans Affairs. 

(2) MATTERS EVALUATED AND ASSESSED.—In undertaking 

the comprehensive evaluation and assessment required by paragraph (1), the Commission shall evaluate and assess the results 

of the assessment conducted by the private sector entity or entities under section 201, including any findings, data, or recommendations included in such assessment. 

(3) REPORTS.—The Commission shall submit to the President, through the Secretary of Veterans Affairs, reports as follows: 

(A) Not later than 90 days after the date of the initial 

meeting of the Commission, an interim report on— 

(i) the findings of the Commission with respect to 

the evaluation and assessment required by this subsection; and 

(ii) such recommendations as the Commission may 

have for legislative or administrative action to improve 

access to health care through the Veterans Health Administration. 

(B) Not later than 180 days after the date of the initial 

meeting of the Commission, a final report on— 

(i) the findings of the Commission with respect to 

the evaluation and assessment required by this subsection; and 

(ii) such recommendations as the Commission may 

have for legislative or administrative action to improve 

access to health care through the Veterans Health Administration. 

(c) POWERS OF THE COMMISSION.— 

(1) HEARINGS.—The Commission may hold such hearings, 

sit and act at such times and places, take such testimony, and 

receive such evidence as the Commission considers advisable to 

carry out this section. 

(2) INFORMATION FROM FEDERAL AGENCIES.—The Commission may secure directly from any Federal agency such information as the Commission considers necessary to carry out this 

section. Upon request of the Chairperson of the Commission, the 

head of such agency shall furnish such information to the Commission. 

(d) COMMISSION PERSONNEL MATTERS.— 


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(1) COMPENSATION OF MEMBERS.— 

(A) IN GENERAL.—Each member of the Commission 

who is not an officer or employee of the Federal Government shall be compensated at a rate equal to the daily 

equivalent of the annual rate of basic pay prescribed for 

level IV of the Executive Schedule under section 5315 of 

title 5, United States Code, for each day (including travel 

time) during which such member is engaged in the performance of the duties of the Commission. 

(B) OFFICERS OR EMPLOYEES OF THE UNITED STATES.— 

All members of the Commission who are officers or employees of the United States shall serve without compensation 

in addition to that received for their services as officers or 

employees of the United States. 

(2) TRAVEL EXPENSES.—The members of the Commission 

shall be allowed travel expenses, including per diem in lieu of 

subsistence, at rates authorized for employees of agencies under 

subchapter I of chapter 57 of title 5, United States Code, while 

away from their homes or regular places of business in the performance of services for the Commission. 

(3) STAFF.— 

(A) IN GENERAL.—The Chairperson of the Commission 

may, without regard to the civil service laws and regulations, appoint and terminate an executive director and such 

other additional personnel as may be necessary to enable 

the Commission to perform its duties. The employment of 

an executive director shall be subject to confirmation by the 

Commission. 

(B) COMPENSATION.—The Chairperson of the Commission may fix the compensation of the executive director and 

other personnel without regard to chapter 51 and subchapter III of chapter 53 of title 5, United States Code, relating to classification of positions and General Schedule 

pay rates, except that the rate of pay for the executive director and other personnel may not exceed the rate payable for 

level V of the Executive Schedule under section 5316 of 

such title. 

(4) DETAIL OF GOVERNMENT EMPLOYEES.—Any Federal 

Government employee may be detailed to the Commission without reimbursement, and such detail shall be without interruption or loss of civil service status or privilege. 

(5) PROCUREMENT OF TEMPORARY AND INTERMITTENT SERVICES.—The Chairperson of the Commission may procure temporary and intermittent services under section 3109(b) of title 5, 

United States Code, at rates for individuals that do not exceed 

the daily equivalent of the annual rate of basic pay prescribed 

for level V of the Executive Schedule under section 5316 of such 

title. 

(e) TERMINATION OF THE COMMISSION.—The Commission shall 

terminate 30 days after the date on which the Commission submits 

the report under subsection (b)(3)(B). 

(f) FUNDING.—The Secretary of Veterans Affairs shall make 

available to the Commission from amounts appropriated or otherwise made available to the Secretary such amounts as the Secretary 


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and the Chairperson of the Commission jointly consider appropriate 

for the Commission to perform its duties under this section. 

(g) EXECUTIVE ACTION.— (1) ACTION ON RECOMMENDATIONS.—The President shall require the Secretary of Veterans Affairs and such other heads of 

relevant Federal departments and agencies to implement each 

recommendation set forth in a report submitted under subsection (b)(3) that the President— 

(A) considers feasible and advisable; and 

(B) determines can be implemented without further legislative action. 

(2) REPORTS.—Not later than 60 days after the date on 

which the President receives a report under subsection (b)(3), 

the President shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of 

the House of Representatives and such other committees of Congress as the President considers appropriate a report setting 

forth the following: 

(A) An assessment of the feasibility and advisability of 

each recommendation contained in the report received by 

the President. 

(B) For each recommendation assessed as feasible and 

advisable under subparagraph (A) the following: 

(i) Whether such recommendation requires legislative action. 

(ii) If such recommendation requires legislative action, a recommendation concerning such legislative action. 

(iii) A description of any administrative action already taken to carry out such recommendation. 

(iv) A description of any administrative action the 

President intends to be taken to carry out such recommendation and by whom. 

SEC. 203. TECHNOLOGY TASK FORCE ON REVIEW OF SCHEDULING SYSTEM AND SOFTWARE OF THE DEPARTMENT OF VETERANS 

AFFAIRS. 

(a) TASK FORCE REVIEW.— (1) IN GENERAL.—The Secretary of Veterans Affairs shall, 

through the use of a technology task force, conduct a review of 

the needs of the Department of Veterans Affairs with respect to 

the scheduling system and scheduling software of the Department of Veterans Affairs that is used by the Department to 

schedule appointments for veterans for hospital care, medical 

services, and other health care from the Department. 

(2) AGREEMENT.— 

(A) IN GENERAL.—The Secretary shall seek to enter into 

an agreement with a technology organization or technology 

organizations to carry out the review required by paragraph (1). 

(B) PROHIBITION ON USE OF FUNDS.—Notwithstanding 

any other provision of law, no Federal funds may be used 

to assist the technology organization or technology organizations under subparagraph (A) in carrying out the review 

required by paragraph (1). 

(b) REPORT.— 


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(1) IN GENERAL.—Not later than 45 days after the date of 

the enactment of this Act, the technology task force required 

under subsection (a)(1) shall submit to the Secretary, the Committee on Veterans’ Affairs of the Senate, and the Committee on 

Veterans’ Affairs of the House of Representatives a report setting forth the findings and recommendations of the technology 

task force regarding the needs of the Department with respect 

to the scheduling system and scheduling software of the Department described in such subsection. 

(2) ELEMENTS.—The report required by paragraph (1) shall 

include the following: 

(A) Proposals for specific actions to be taken by the Department to improve the scheduling system and scheduling 

software of the Department described in subsection (a)(1). 

(B) A determination as to whether one or more existing 

off-the-shelf systems would— 

(i) meet the needs of the Department to schedule 

appointments for veterans for hospital care, medical 

services, and other health care from the Department; 

and 

(ii) improve the access of veterans to such care and 

services. 

(3) PUBLICATION.—Not later than 30 days after the receipt 

of the report required by paragraph (1), the Secretary shall publish such report in the Federal Register and on an Internet 

website of the Department accessible to the public. 

(c) IMPLEMENTATION OF TASK FORCE RECOMMENDATIONS.—Not 

later than one year after the receipt of the report required by subsection (b)(1), the Secretary shall implement the recommendations 

set forth in such report that the Secretary considers are feasible, advisable, and cost effective. 

SEC. 204. IMPROVEMENT OF ACCESS OF VETERANS TO MOBILE VET 

CENTERS AND MOBILE MEDICAL CENTERS OF THE DEPARTMENT OF VETERANS AFFAIRS. 

(a) IMPROVEMENT OF ACCESS.— 

(1) IN GENERAL.—The Secretary of Veterans Affairs shall 

improve the access of veterans to telemedicine and other health 

care through the use of mobile vet centers and mobile medical 

centers of the Department of Veterans Affairs by providing 

standardized requirements for the operation of such centers. 

(2) REQUIREMENTS.—The standardized requirements required by paragraph (1) shall include the following: 

(A) The number of days each mobile vet center and mobile medical center of the Department is expected to travel 

per year. 

(B) The number of locations each center is expected to 

visit per year. 

(C) The number of appointments each center is expected to conduct per year. 

(D) The method and timing of notifications given by 

each center to individuals in the area to which the center 

is traveling, including notifications informing veterans of 

the availability to schedule appointments at the center. 


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(3) USE OF TELEMEDICINE.—The Secretary shall ensure that 

each mobile vet center and mobile medical center of the Department has the capability to provide telemedicine services. 

(b) REPORTS.— (1) IN GENERAL.—Not later than one year after the date of 

the enactment of this Act, and not later than September 30 each 

year thereafter, the Secretary of Veterans Affairs shall submit 

to the Committee on Veterans’ Affairs of the Senate and the 

Committee on Veterans’ Affairs of the House of Representatives 

a report on access to health care through the use of mobile vet 

centers and mobile medical centers of the Department that includes statistics on each of the requirements set forth in subsection (a)(2) for the year covered by the report. 

(2) ELEMENTS.—Each report required by paragraph (1) 

shall include the following: 

(A) A description of the use of mobile vet centers and 

mobile medical centers to provide telemedicine services to 

veterans during the year preceding the submittal of the report, including the following: 

(i) The number of days each mobile vet center and 

mobile medical center was open to provide such services. 

(ii) The number of days each center traveled to a 

location other than the headquarters of the center to 

provide such services. 

(iii) The number of appointments each center conducted to provide such services on average per month 

and in total during such year. 

(B) An analysis of the effectiveness of using mobile vet 

centers and mobile medical centers to provide health care 

services to veterans through the use of telemedicine. 

(C) Any recommendations for an increase in the number of mobile vet centers and mobile medical centers of the 

Department. 

(D) Any recommendations for an increase in the telemedicine capabilities of each mobile vet center and mobile 

medical center. 

(E) The feasibility and advisability of using temporary 

health care providers, including locum tenens, to provide 

direct health care services to veterans at mobile vet centers 

and mobile medical centers. 

(F) Such other recommendations on improvement of the 

use of mobile vet centers and mobile medical centers by the 

Department as the Secretary considers appropriate. 

SEC. 205. IMPROVED PERFORMANCE METRICS FOR HEALTH CARE PROVIDED BY DEPARTMENT OF VETERANS AFFAIRS. 

(a) PROHIBITION ON USE OF SCHEDULING AND WAIT-TIME

METRICS IN DETERMINATION OF PERFORMANCE AWARDS.—The Secretary of Veterans Affairs shall ensure that scheduling and waittime metrics or goals are not used as factors in determining the performance of the following employees for purposes of determining 

whether to pay performance awards to such employees: 

(1) Directors, associate directors, assistant directors, deputy 

directors, chiefs of staff, and clinical leads of medical centers of 

the Department of Veterans Affairs. 


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(2) Directors, assistant directors, and quality management 

officers of Veterans Integrated Service Networks of the Department of Veterans Affairs. 

(b) MODIFICATION OF PERFORMANCE PLANS.— (1) IN GENERAL.—Not later than 30 days after the date of 

the enactment of this Act, the Secretary shall modify the performance plans of the directors of the medical centers of the Department and the directors of the Veterans Integrated Service 

Networks to ensure that such plans are based on the quality of 

care received by veterans at the health care facilities under the 

jurisdictions of such directors. 

(2) FACTORS.—In modifying performance plans under paragraph (1), the Secretary shall ensure that assessment of the 

quality of care provided at health care facilities under the jurisdiction of a director described in paragraph (1) includes consideration of the following: 

(A) Recent reviews by the Joint Commission (formerly 

known as the ‘‘Joint Commission on Accreditation of 

Healthcare Organizations’’) of such facilities. 

(B) The number and nature of recommendations concerning such facilities by the Inspector General of the Department in reviews conducted through the Combined Assessment Program, in the reviews by the Inspector General 

of community-based outpatient clinics and primary care 

clinics, and in reviews conducted through the Office of 

Healthcare Inspections during the two most recently completed fiscal years. 

(C) The number of recommendations described in subparagraph (B) that the Inspector General of the Department 

determines have not been carried out satisfactorily with respect to such facilities. 

(D) Reviews of such facilities by the Commission on Accreditation of Rehabilitation Facilities. 

(E) The number and outcomes of administrative investigation boards, root cause analyses, and peer reviews conducted at such facilities during the fiscal year for which the 

assessment is being conducted. 

(F) The effectiveness of any remedial actions or plans 

resulting from any Inspector General recommendations in 

the reviews and analyses described in subparagraphs (A) 

through (E). 

(3) ADDITIONAL LEADERSHIP POSITIONS.—To the degree 

practicable, the Secretary shall assess the performance of other 

employees of the Department in leadership positions at Department medical centers, including associate directors, assistant 

directors, deputy directors, chiefs of staff, and clinical leads, 

and in Veterans Integrated Service Networks, including assistant directors and quality management officers, using factors 

and criteria similar to those used in the performance plans 

modified under paragraph (1). 

(c) REMOVAL OF CERTAIN PERFORMANCE GOALS.—For each fiscal year that begins after the date of the enactment of this Act, the 

Secretary shall not include in the performance goals of any employee of a Veterans Integrated Service Network or medical center 

of the Department any performance goal that might disincentivize 


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the payment of Department amounts to provide hospital care, medical services, or other health care through a non-Department provider. 

SEC. 206. IMPROVED TRANSPARENCY CONCERNING HEALTH CARE 

PROVIDED BY DEPARTMENT OF VETERANS AFFAIRS. 

(a) PUBLICATION OF WAIT TIMES.—Not later than 90 days after 

the date of the enactment of this Act, the Secretary of Veterans Affairs shall publish in the Federal Register, and on a publicly accessible Internet website of each medical center of the Department of 

Veterans Affairs, the wait-times for the scheduling of an appointment in each Department facility by a veteran for the receipt of primary care, specialty care, and hospital care and medical services 

based on the general severity of the condition of the veteran. Whenever the wait-times for the scheduling of such an appointment 

changes, the Secretary shall publish the revised wait-times— 

(1) on a publicly accessible Internet website of each medical 

center of the Department by not later than 30 days after such 

change; and 

(2) in the Federal Register by not later than 90 days after 

such change. 

(b) PUBLICLY AVAILABLE DATABASE OF PATIENT SAFETY, QUALITY OF CARE, AND OUTCOME MEASURES.— 

(1) IN GENERAL.—Not later than 180 days after the date of 

the enactment of this Act, the Secretary shall develop and make 

available to the public a comprehensive database containing all 

applicable patient safety, quality of care, and outcome measures 

for health care provided by the Department that are tracked by 

the Secretary. 

(2) UPDATE FREQUENCY.—The Secretary shall update the 

database required by paragraph (1) not less frequently than 

once each year. 

(3) UNAVAILABLE MEASURES.—For all measures that the 

Secretary would otherwise publish in the database required by 

paragraph (1) but has not done so because such measures are 

not available, the Secretary shall publish notice in the database 

of the reason for such unavailability and a timeline for making 

such measures available in the database. 

(4) ACCESSIBILITY.—The Secretary shall ensure that the 

database required by paragraph (1) is accessible to the public 

through the primary Internet website of the Department and 

through each primary Internet website of a Department medical 

center. 

(c) HOSPITAL COMPARE WEBSITE OF DEPARTMENT OF HEALTH

AND HUMAN SERVICES.— 

(1) AGREEMENT REQUIRED.—Not later than 180 days after 

the date of the enactment of this Act, the Secretary of Veterans 

Affairs shall enter into an agreement with the Secretary of 

Health and Human Services for the provision by the Secretary 

of Veterans Affairs of such information as the Secretary of 

Health and Human Services may require to report and make 

publicly available patient quality and outcome information concerning Department of Veterans Affairs medical centers through 

the Hospital Compare Internet website of the Department of 

Health and Human Services or any successor Internet website. 


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(2) INFORMATION PROVIDED.—The information provided by 

the Secretary of Veterans Affairs to the Secretary of Health and 

Human Services under paragraph (1) shall include the following: 

(A) Measures of timely and effective health care. 

(B) Measures of readmissions, complications of death, 

including with respect to 30-day mortality rates and 30-day 

readmission rates, surgical complication measures, and 

health care related infection measures. 

(C) Survey data of patient experiences, including the 

Hospital Consumer Assessment of Healthcare Providers 

and Systems or any similar successor survey developed by 

the Department of Health and Human Services. 

(D) Any other measures required of or reported with respect to hospitals participating in the Medicare program 

under title XVIII of the Social Security Act (42 U.S.C. 1395 

et seq.). 

(3) UNAVAILABLE INFORMATION.—For any applicable metric 

collected by the Department of Veterans Affairs or required to 

be provided under paragraph (2) and withheld from or unavailable in the Hospital Compare Internet website or any successor 

Internet website, the Secretary of Veterans Affairs shall publish 

a notice on such Internet website stating the reason why such 

metric was withheld from public disclosure and a timeline for 

making such metric available, if applicable. 

(d) COMPTROLLER GENERAL REVIEW OF PUBLICLY AVAILABLE

SAFETY AND QUALITY METRICS.—Not later than three years after the 

date of the enactment of this Act, the Comptroller General of the 

United States shall conduct a review of the safety and quality 

metrics made publicly available by the Secretary of Veterans Affairs 

under this section to assess the degree to which the Secretary is 

complying with the provisions of this section. 

SEC. 207. INFORMATION FOR VETERANS ON THE CREDENTIALS OF DEPARTMENT OF VETERANS AFFAIRS PHYSICIANS. 

(a) IMPROVEMENT OF ‘‘OUR DOCTORS’’ INTERNET WEBSITE

LINKS.— 

(1) AVAILABILITY THROUGH DEPARTMENT OF VETERANS AFFAIRS HOMEPAGE.—A link to the ‘‘Our Doctors’’ health care providers database of the Department of Veterans Affairs, or any 

successor database, shall be available on and through the 

homepage of the Internet website of the Department that is accessible to the public. 

(2) INFORMATION ON LOCATION OF RESIDENCY TRAINING.— 

The Internet website of the Department that is accessible to the 

public shall include under the link to the ‘‘Our Doctors’’ health 

care providers database of the Department, or any successor 

database, the name of the facility at which each licensed physician of the Department underwent residency training. 

(3) INFORMATION ON PHYSICIANS AT PARTICULAR FACILITIES.—The ‘‘Our Doctors’’ health care providers database of the 

Department, or any successor database, shall identify whether 

each licensed physician of the Department is a physician in 

residency. 

(b) INFORMATION ON CREDENTIALS OF PHYSICIANS FOR VETERANS UNDERGOING SURGICAL PROCEDURES.— 


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(1) IN GENERAL.—Each veteran who is undergoing a surgical procedure by or through the Department shall be provided 

information described in paragraph (2) with respect to the surgeon to be performing such procedure at such time in advance 

of the procedure as is appropriate to permit such veteran to 

evaluate such information. 

(2) INFORMATION DESCRIBED.—The information described 

in this paragraph with respect to a surgeon described in paragraph (1) is as follows: 

(A) The education and training of the surgeon. 

(B) The licensure, registration, and certification of the 

surgeon by the State or national entity responsible for such 

licensure, registration, or certification. 

(3) OTHER INDIVIDUALS.—If a veteran is unable to evaluate 

the information provided under paragraph (1) due to the health 

or mental competence of the veteran, such information shall be 

provided to an individual acting on behalf of the veteran. 

(c) COMPTROLLER GENERAL REPORT AND PLAN.— 

(1) REPORT.—Not later than two years after the date of the 

enactment of this Act, the Comptroller General of the United 

States shall submit to the Committee on Veterans’ Affairs of the 

Senate and the Committee on Veterans’ Affairs of the House of 

Representatives a report setting forth an assessment by the 

Comptroller General of the following: 

(A) The manner in which contractors under the Patient-Centered Community Care initiative of the Department perform oversight of the credentials of physicians 

within the networks of such contractors under the initiative. 

(B) The oversight by the Department of the contracts 

under the Patient-Centered Community Care initiative. 

(C) The verification by the Department of the credentials and licenses of health care providers furnishing hospital care and medical services under section 101. 

(2) PLAN.— 

(A) IN GENERAL.—Not later than 30 days after the submittal of the report under paragraph (1), the Secretary 

shall submit to the Comptroller General, the Committee on 

Veterans’ Affairs of the Senate, and the Committee on Veterans’ Affairs of the House of Representatives a plan to address any findings and recommendations of the Comptroller General included in such report. 

(B) IMPLEMENTATION.—Not later than 90 days after the 

submittal of the report under paragraph (1), the Secretary 

shall carry out such plan. 

SEC. 208. INFORMATION IN ANNUAL BUDGET OF THE PRESIDENT ON 

HOSPITAL CARE AND MEDICAL SERVICES FURNISHED 

THROUGH EXPANDED USE OF CONTRACTS FOR SUCH 

CARE. 

The materials on the Department of Veterans Affairs in the 

budget of the President for a fiscal year, as submitted to Congress 

pursuant to section 1105(a) of title 31, United States Code, shall set 

forth the following: 


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(1) The number of veterans who received hospital care and 

medical services under section 101 during the fiscal year preceding the fiscal year in which such budget is submitted. 

(2) The amount expended by the Department on furnishing 

care and services under such section during the fiscal year preceding the fiscal year in which such budget is submitted. 

(3) The amount requested in such budget for the costs of 

furnishing care and services under such section during the fiscal year covered by such budget, set forth in aggregate and by 

amounts for each account for which amounts are so requested. 

(4) The number of veterans that the Department estimates 

will receive hospital care and medical services under such section during the fiscal years covered by the budget submission. 

(5) The number of employees of the Department on paid administrative leave at any point during the fiscal year preceding 

the fiscal year in which such budget is submitted. 

SEC. 209. PROHIBITION ON FALSIFICATION OF DATA CONCERNING 

WAIT TIMES AND QUALITY MEASURES AT DEPARTMENT 

OF VETERANS AFFAIRS. 

Not later than 60 days after the date of the enactment of this 

Act, and in accordance with title 5, United States Code, the Secretary of Veterans Affairs shall establish policies whereby any employee of the Department of Veterans Affairs who knowingly submits 

false data concerning wait times for health care or quality measures 

with respect to health care to another employee of the Department 

or knowingly requires another employee of the Department to submit 

false data concerning such wait times or quality measures to another employee of the Department is subject to a penalty the Secretary considers appropriate after notice and an opportunity for a 

hearing, including civil penalties, unpaid suspensions, or termination. 

TITLE III—HEALTH CARE STAFFING, RECRUITMENT, 

AND TRAINING MATTERS 

SEC. 301. TREATMENT OF STAFFING SHORTAGE AND BIENNIAL REPORT ON STAFFING OF MEDICAL FACILITIES OF THE DEPARTMENT OF VETERANS AFFAIRS. 

(a) STAFFING SHORTAGES.— 

(1) IN GENERAL.—Subchapter I of chapter 74 of title 38, 

United States Code, is amended by adding at the end the following new section: 

‘‘§ 7412. Annual determination of staffing shortages; recruitment and appointment for needed occupations 

‘‘(a) IN GENERAL.—Not later than September 30 of each year, 

the Inspector General of the Department shall determine, and the 

Secretary shall publish in the Federal Register, the five occupations 

of personnel of this title of the Department covered under section 

7401 of this title for which there are the largest staffing shortages 

throughout the Department as calculated over the five-year period 

preceding the determination. 

‘‘(b) RECRUITMENT AND APPOINTMENT.—Notwithstanding sections 3304 and 3309 through 3318 of title 5, the Secretary may, 

upon a determination by the Inspector General under paragraph (1) 

that there is a staffing shortage throughout the Department with reVerDate Mar 15 2010 10:07 Jul 29, 2014 Jkt 039006 PO 00000 Frm 00031 Fmt 6659 Sfmt 6603 E:\HR\OC\HR564.XXX HR564

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spect to a particular occupation, recruit and directly appoint, during the fiscal year after the fiscal year during which such determination is made, qualified personnel to serve in that particular occupation for the Department.’’. 

(2) CLERICAL AMENDMENT.—The table of sections at the beginning of such chapter is amended by inserting after the item 

relating to section 7411 the following new item: 

‘‘7412. Annual determination of staffing shortages; recruitment and appointment for 

needed occupations.’’. 

(3) DEADLINE FOR FIRST DETERMINATION.—Notwithstanding the deadline under section 7412 of title 38, United 

States Code, as added by paragraph (1), for the annual determination of staffing shortages in the Veterans Health Administration, the Inspector General of the Department of Veterans Affairs shall make the first determination required under such 

section, and the Secretary of Veterans Affairs shall publish in 

the Federal Register such determination, by not later than the 

date that is 180 days after the date of the enactment of this Act. 

(b) INCREASE OF GRADUATE MEDICAL EDUCATION RESIDENCY

POSITIONS.— 

(1) IN GENERAL.—Section 7302 of title 38, United States 

Code, is amended by adding at the end the following new subsection: 

‘‘(e)(1) In carrying out this section, the Secretary shall establish 

medical residency programs, or ensure that already established 

medical residency programs have a sufficient number of residency 

positions, at any medical facility of the Department that the Secretary determines— 

‘‘(A) is experiencing a shortage of physicians; and 

‘‘(B) is located in a community that is designated as a 

health professional shortage area (as defined in section 332 of 

the Public Health Service Act (42 U.S.C. 254e)). 

‘‘(2) In carrying out paragraph (1), the Secretary shall— 

‘‘(A) allocate the residency positions under such paragraph 

among occupations included in the most current determination 

published in the Federal Register pursuant to section 7412(a) of 

this title; and 

‘‘(B) give priority to residency positions and programs in 

primary care, mental health, and any other specialty the Secretary determines appropriate.’’. 

(2) FIVE-YEAR INCREASE.— 

(A) IN GENERAL.—In carrying out section 7302(e) of 

title 38, United States Code, as added by paragraph (1), 

during the five-year period beginning on the day that is one 

year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall increase the number of 

graduate medical education residency positions at medical 

facilities of the Department by up to 1,500 positions. 

(B) PRIORITY.—In increasing the number of graduate 

medical education residency positions at medical facilities 

of the Department under subparagraph (A), the Secretary 

shall give priority to medical facilities that— 

(i) as of the date of the enactment of this Act, do 

not have a medical residency program; and 


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(ii) are located in a community that has a high 

concentration of veterans. 

(3) REPORT.— (A) IN GENERAL.—Not later than 60 days after the date 

of the enactment of this Act, and not later than October 1 

each year thereafter until 2019, the Secretary shall submit 

to the Committee on Veterans’ Affairs of the Senate and the 

Committee on Veterans’ Affairs of the House of Representatives a report on graduate medical education residency positions at medical facilities of the Department. 

(B) ELEMENTS.—Each report required by subparagraph 

(A) shall include the following: 

(i) For the year preceding the submittal of the report, the number of graduate medical education residency positions at medical facilities of the Department 

as follows: 

(I) That were filled. 

(II) That were not filled. 

(III) That the Department anticipated filling. 

(ii) With respect to each graduate medical education residency position specified in clause (i)— 

(I) the geographic location of each such position; and 

(II) if such position was filled, the academic 

affiliation of the medical resident that filled such 

position. 

(iii) The policy at each medical facility of the Department with respect to the ratio of medical residents 

to staff supervising medical residents. 

(iv) During the one-year period preceding the submittal of the report, the number of individuals who declined an offer from the Department to serve as a medical resident at a medical facility of the Department 

and the reason why each such individual declined such 

offer. 

(v) During the one-year period preceding the submittal of the report, a description of— 

(I) challenges, if any, faced by the Department 

in filling graduate medical education residency positions at medical facilities of the Department; and 

(II) actions, if any, taken by the Department to 

address such challenges. 

(vi) A description of efforts of the Department, as 

of the date of the submittal of the report, to recruit and 

retain medical residents to work for the Veterans 

Health Administration as full-time employees. 

(c) PRIORITY IN SCHOLARSHIP PROGRAM OF HEALTH PROFES- SIONALS EDUCATIONAL ASSISTANCE PROGRAM TO CERTAIN PROVIDERS.—Section 7612(b)(5) of title 38, United States Code, is 

amended— 

(1) in subparagraph (A), by striking ‘‘and’’ at the end; 

(2) by redesignating subparagraph (B) as subparagraph 

(C); and 

(3) by inserting after subparagraph (A) the following new 

subparagraph (B): 


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‘‘(B) shall give priority to applicants pursuing a course of 

education or training toward a career in an occupation for 

which the Inspector General of the Department has, in the most 

current determination published in the Federal Register pursuant to section 7412(a) of this title, determined that there is one 

of the largest staffing shortages throughout the Department 

with respect to such occupation; and’’. 

(d) REPORTS.— (1) IN GENERAL.—Not later than 180 days after the date of 

the enactment of this Act, and not later than December 31 of 

each even-numbered year thereafter until 2024, the Secretary of 

Veterans Affairs shall submit to the Committees on Veterans’ 

Affairs of the Senate and House of Representatives a report assessing the staffing of each medical facility of the Department. 

(2) ELEMENTS.—Each report submitted under paragraph 

(1) shall include the following: 

(A) The results of a system-wide assessment of all medical facilities of the Department to ensure the following: 

(i) Appropriate staffing levels for health care professionals to meet the goals of the Secretary for timely 

access to care for veterans. 

(ii) Appropriate staffing levels for support personnel, including clerks. 

(iii) Appropriate sizes for clinical panels. 

(iv) Appropriate numbers of full-time staff, or fulltime equivalents, dedicated to direct care of patients. 

(v) Appropriate physical plant space to meet the 

capacity needs of the Department in that area. 

(vi) Such other factors as the Secretary considers 

necessary. 

(B) A plan for addressing any issues identified in the 

assessment described in subparagraph (A), including a 

timeline for addressing such issues. 

(C) A list of the current wait times and workload levels 

for the following clinics in each medical facility: 

(i) Mental health. 

(ii) Primary care. 

(iii) Gastroenterology. 

(iv) Women’s health. 

(v) Such other clinics as the Secretary considers 

appropriate. 

(D) A description of the results of the most current determination of the Inspector General under subsection (a) of 

section 7412 of title 38, United States Code, as added by 

subsection (a)(1) of this section, and a plan to use direct appointment authority under subsection (b) of such section 

7412 to fill staffing shortages, including recommendations 

for improving the speed at which the credentialing and 

privileging process can be conducted. 

(E) The current staffing models of the Department for 

the following clinics, including recommendations for 

changes to such models: 

(i) Mental health. 

(ii) Primary care. 

(iii) Gastroenterology. 


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(iv) Women’s health. 

(v) Such other clinics as the Secretary considers 

appropriate. 

(F) A detailed analysis of succession planning at medical facilities of the Department, including the following: 

(i) The number of positions in medical facilities 

throughout the Department that are not filled by a permanent employee. 

(ii) The length of time each position described in 

clause (i) remained vacant or filled by a temporary or 

acting employee. 

(iii) A description of any barriers to filling the positions described in clause (i). 

(iv) A plan for filling any positions that are vacant 

or filled by a temporary or acting employee for more 

than 180 days. 

(v) A plan for handling emergency circumstances, 

such as administrative leave or sudden medical leave 

for senior officials. 

(G) The number of health care providers of the Department who have been removed from their positions, have retired, or have left their positions for another reason, 

disaggregated by provider type, during the two-year period 

preceding the submittal of the report. 

(H) Of the health care providers specified in subparagraph (G) who have been removed from their positions, the 

following: 

(i) The number of such health care providers who 

were reassigned to other positions in the Department. 

(ii) The number of such health care providers who 

left the Department. 

(iii) The number of such health care providers who 

left the Department and were subsequently rehired by 

the Department. 

SEC. 302. EXTENSION AND MODIFICATION OF CERTAIN PROGRAMS 

WITHIN THE DEPARTMENT OF VETERANS AFFAIRS 

HEALTH PROFESSIONALS EDUCATIONAL ASSISTANCE 

PROGRAM. 

(a) EXTENSION OF SCHOLARSHIP PROGRAM.—Section 7619 of 

title 38, United States Code, is amended by striking ‘‘December 31, 

2014’’ and inserting ‘‘December 31, 2019’’. 

(b) MODIFICATION OF EDUCATION DEBT REDUCTION PROGRAM.— (1) MODIFICATION OF AMOUNT AND DURATION OF ELIGI- BILITY.—Paragraph (1) of section 7683(d) of such title is amended— 

(A) by striking ‘‘$60,000’’ and inserting ‘‘$120,000’’; and 

(B) by striking ‘‘$12,000 of such payments’’ and all that 

follows through the period at the end and inserting 

‘‘$24,000 of such payments may be made in each year of 

participation in the Program’’. 

(2) ELIMINATION OF LIMITATION.— 

(A) IN GENERAL.—Such section is further amended— 

(i) by striking paragraph (2); 

(ii) by redesignating paragraph (3) as paragraph 

(2); and 


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(iii) in paragraph (2), as redesignated by clause 

(ii), by striking ‘‘paragraphs (1) and (2)’’ and inserting 

‘‘paragraph (1)’’. 

(B) CONFORMING AMENDMENT.—Paragraph (1) of such 

section, as amended by paragraph (1), is further amended 

by striking ‘‘Subject to paragraph (2), the amount’’ and inserting ‘‘The amount’’. 

SEC. 303. CLINIC MANAGEMENT TRAINING FOR EMPLOYEES AT MEDICAL FACILITIES OF THE DEPARTMENT OF VETERANS AFFAIRS. 

(a) CLINIC MANAGEMENT TRAINING PROGRAM.— 

(1) IN GENERAL.—Not later than 180 days after the date of 

the enactment of this Act, the Secretary of Veterans Affairs shall 

commence a role-specific clinic management training program 

to provide in-person, standardized education on systems and 

processes for health care practice management and scheduling 

to all appropriate employees, as determined by the Secretary, at 

medical facilities of the Department. 

(2) ELEMENTS.— 

(A) IN GENERAL.—The clinic management training program required by paragraph (1) shall include the following: 

(i) Training on how to manage the schedules of 

health care providers of the Department, including the 

following: 

(I) Maintaining such schedules in a manner 

that allows appointments to be booked at least 

eight weeks in advance. 

(II) Proper planning procedures for vacation, 

leave, and graduate medical education training 

schedules. 

(ii) Training on the appropriate number of appointments that a health care provider should conduct 

on a daily basis, based on specialty. 

(iii) Training on how to determine whether there 

are enough available appointment slots to manage demand for different appointment types and mechanisms 

for alerting management of insufficient slots. 

(iv) Training on how to properly use the appointment scheduling system of the Department, including 

any new scheduling system implemented by the Department. 

(v) Training on how to optimize the use of technology, including the following: 

(I) Telemedicine. 

(II) Electronic mail. 

(III) Text messaging. 

(IV) Such other technologies as specified by the 

Secretary. 

(vi) Training on how to properly use physical plant 

space at medical facilities of the Department to ensure 

efficient flow and privacy for patients and staff. 

(B) ROLE-SPECIFIC.—The Secretary shall ensure that 

each employee of the Department included in the clinic 

management training program required by paragraph (1) 


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receives education under such program that is relevant to 

the responsibilities of such employee. 

(3) SUNSET.—The clinic management training program required by paragraph (1) shall terminate on the date that is two 

years after the date on which the Secretary commences such 

program. 

(b) TRAINING MATERIALS.— (1) IN GENERAL.—After the termination of the clinic management training program required by subsection (a), the Secretary shall provide training materials on health care management to each of the following employees of the Department that 

are relevant to the position and responsibilities of such employee upon the commencement of employment of such employee: 

(A) Any manager of a medical facility of the Department. 

(B) Any health care provider at a medical facility of the 

Department. 

(C) Such other employees of the Department as the Secretary considers appropriate. 

(2) UPDATE.—The Secretary shall regularly update the 

training materials required under paragraph (1). 

TITLE IV—HEALTH CARE RELATED TO SEXUAL TRAUMA 

SEC. 401. EXPANSION OF ELIGIBILITY FOR SEXUAL TRAUMA COUNSELING AND TREATMENT TO VETERANS ON INACTIVE 

DUTY TRAINING. 

Section 1720D(a)(1) of title 38, United States Code, is amended 

by striking ‘‘or active duty for training’’ and inserting ‘‘, active duty 

for training, or inactive duty training’’. 

SEC. 402. PROVISION OF COUNSELING AND TREATMENT FOR SEXUAL 

TRAUMA BY THE DEPARTMENT OF VETERANS AFFAIRS TO 

MEMBERS OF THE ARMED FORCES. 

(a) EXPANSION OF COVERAGE TO MEMBERS OF THE ARMED

FORCES.—Subsection (a) of section 1720D of title 38, United States 

Code, is amended— 

(1) by redesignating paragraph (2) as paragraph (3); 

(2) by inserting after paragraph (1) the following new paragraph (2): 

‘‘(2)(A) In operating the program required by paragraph (1), the 

Secretary may, in consultation with the Secretary of Defense, provide counseling and care and services to members of the Armed 

Forces (including members of the National Guard and Reserves) on 

active duty to overcome psychological trauma described in that 

paragraph. 

‘‘(B) A member described in subparagraph (A) shall not be required to obtain a referral before receiving counseling and care and 

services under this paragraph.’’; and 

(3) in paragraph (3), as redesignated by paragraph (1)— 

(A) by striking ‘‘a veteran’’ and inserting ‘‘an individual’’; and 

(B) by striking ‘‘that veteran’’ each place it appears and 

inserting ‘‘that individual’’. 

(b) INFORMATION TO MEMBERS ON AVAILABILITY OF COUNSELING AND SERVICES.—Subsection (c) of such section is amended— 


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(1) by striking ‘‘to veterans’’ each place it appears; and 

(2) in paragraph (3), by inserting ‘‘members of the Armed 

Forces and’’ before ‘‘individuals’’. 

(c) INCLUSION OF MEMBERS IN REPORTS ON COUNSELING AND

SERVICES.—Subsection (e) of such section is amended— 

(1) in the matter preceding paragraph (1), by striking ‘‘to 

veterans’’; 

(2) in paragraph (2)— 

(A) by striking ‘‘women veterans’’ and inserting ‘‘individuals’’; and 

(B) by striking ‘‘training under subsection (d).’’ and inserting ‘‘training under subsection (d), disaggregated by— 

‘‘(A) veterans; 

‘‘(B) members of the Armed Forces (including members 

of the National Guard and Reserves) on active duty; and 

‘‘(C) for each of subparagraphs (A) and (B)— 

‘‘(i) men; and 

‘‘(ii) women.’’; 

(3) in paragraph (4), by striking ‘‘veterans’’ and inserting 

‘‘individuals’’; and 

(4) in paragraph (5)— 

(A) by striking ‘‘women veterans’’ and inserting ‘‘individuals’’; and 

(B) by inserting ‘‘, including specific recommendations 

for individuals specified in subparagraphs (A), (B), and (C) 

of paragraph (2)’’ before the period at the end. 

(d) EFFECTIVE DATE.—The amendments made by this section 

shall take effect on the date that is one year after the date of the 

enactment of this Act. 

SEC. 403. REPORTS ON MILITARY SEXUAL TRAUMA. 

(a) REPORT ON SERVICES AVAILABLE FOR MILITARY SEXUAL

TRAUMA IN THE DEPARTMENT OF VETERANS AFFAIRS.—Not later 

than 630 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs 

of the House of Representatives a report on the treatment and services available from the Department of Veterans Affairs for male veterans who experience military sexual trauma compared to such 

treatment and services available to female veterans who experience 

military sexual trauma. 

(b) REPORTS ON TRANSITION OF MILITARY SEXUAL TRAUMA

TREATMENT FROM DEPARTMENT OF DEFENSE TO DEPARTMENT OF

VETERANS AFFAIRS.—Not later than 630 days after the date of the 

enactment of this Act, and annually thereafter for five years, the Department of Veterans Affairs-Department of Defense Joint Executive 

Committee established by section 320(a) of title 38, United States 

Code, shall submit to the appropriate committees of Congress a report on military sexual trauma that includes the following: 

(1) The processes and procedures utilized by the Department of Veterans Affairs and the Department of Defense to facilitate transition of treatment of individuals who have experienced military sexual trauma from treatment provided by the 

Department of Defense to treatment provided by the Department 

of Veterans Affairs. 


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(2) A description and assessment of the collaboration between the Department of Veterans Affairs and the Department 

of Defense in assisting veterans in filing claims for disabilities 

related to military sexual trauma, including permitting veterans access to information and evidence necessary to develop 

or support such claims. 

(c) DEFINITIONS.—In this section: 

(1) APPROPRIATE COMMITTEES OF CONGRESS.—The term 

‘‘appropriate committees of Congress’’ means— 

(A) the Committee on Veterans’ Affairs and the Committee on Armed Services of the Senate; and 

(B) the Committee on Veterans’ Affairs and the Committee on Armed Services of the House of Representatives. 

(2) MILITARY SEXUAL TRAUMA.—The term ‘‘military sexual 

trauma’’ means psychological trauma, which in the judgment of 

a mental health professional employed by the Department, resulted from a physical assault of a sexual nature, battery of a 

sexual nature, or sexual harassment which occurred while the 

veteran was serving on active duty, active duty for training, or 

inactive duty training. 

(3) SEXUAL HARASSMENT.—The term ‘‘sexual harassment’’ 

means repeated, unsolicited verbal or physical contact of a sexual nature which is threatening in character. 

(4) SEXUAL TRAUMA.—The term ‘‘sexual trauma’’ shall have 

the meaning given that term by the Secretary of Veterans Affairs for purposes of this section. 

(d) EFFECTIVE DATE.—This section shall take effect on the date 

that is 270 days after the date of the enactment of this Act. 

TITLE V—OTHER HEALTH CARE MATTERS 

SEC. 501. EXTENSION OF PILOT PROGRAM ON ASSISTED LIVING SERVICES FOR VETERANS WITH TRAUMATIC BRAIN INJURY. 

(a) IN GENERAL.—Section 1705 of the National Defense Authorization Act for Fiscal Year 2008 (Public Law 110–181; 38 U.S.C. 

1710C note) is amended by adding at the end the following: 

‘‘(g) TERMINATION.—The pilot program shall terminate on October 6, 2017.’’. 

(b) CONFORMING AMENDMENT.—Subsection (a) of such section 

is amended by striking ‘‘five-year’’. 

TITLE VI—MAJOR MEDICAL FACILITY LEASES 

SEC. 601. AUTHORIZATION OF MAJOR MEDICAL FACILITY LEASES. 

(a) IN GENERAL.—The Secretary of Veterans Affairs may carry 

out the following major medical facility leases at the locations specified, and in an amount for each lease not to exceed the amount 

shown for such location (not including any estimated cancellation 

costs): 

(1) For a clinical research and pharmacy coordinating center, Albuquerque, New Mexico, an amount not to exceed 

$9,560,000. 

(2) For a community-based outpatient clinic, Brick, New 

Jersey, an amount not to exceed $7,280,000. 


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(3) For a new primary care and dental clinic annex, 

Charleston, South Carolina, an amount not to exceed 

$7,070,250. 

(4) For a community-based outpatient clinic, Cobb County, 

Georgia, an amount not to exceed $6,409,000. 

(5) For the Leeward Outpatient Healthcare Access Center, 

Honolulu, Hawaii, including a co-located clinic with the Department of Defense and the co-location of the Honolulu Regional Office of the Veterans Benefits Administration and the 

Kapolei Vet Center of the Department of Veterans Affairs, an 

amount not to exceed $15,887,370. 

(6) For a community-based outpatient clinic, Johnson 

County, Kansas, an amount not to exceed $2,263,000. 

(7) For a replacement community-based outpatient clinic, 

Lafayette, Louisiana, an amount not to exceed $2,996,000. 

(8) For a community-based outpatient clinic, Lake Charles, 

Louisiana, an amount not to exceed $2,626,000. 

(9) For outpatient clinic consolidation, New Port Richey, 

Florida, an amount not to exceed $11,927,000. 

(10) For an outpatient clinic, Ponce, Puerto Rico, an 

amount not to exceed $11,535,000. 

(11) For lease consolidation, San Antonio, Texas, an 

amount not to exceed $19,426,000. 

(12) For a community-based outpatient clinic, San Diego, 

California, an amount not to exceed $11,946,100. 

(13) For an outpatient clinic, Tyler, Texas, an amount not 

to exceed $4,327,000. 

(14) For the Errera Community Care Center, West Haven, 

Connecticut, an amount not to exceed $4,883,000. 

(15) For the Worcester Community-Based Outpatient Clinic, 

Worcester, Massachusetts, an amount not to exceed $4,855,000. 

(16) For the expansion of a community-based outpatient 

clinic, Cape Girardeau, Missouri, an amount not to exceed 

$4,232,060. 

(17) For a multispecialty clinic, Chattanooga, Tennessee, an 

amount not to exceed $7,069,000. 

(18) For the expansion of a community-based outpatient 

clinic, Chico, California, an amount not to exceed $4,534,000. 

(19) For a community-based outpatient clinic, Chula Vista, 

California, an amount not to exceed $3,714,000. 

(20) For a new research lease, Hines, Illinois, an amount 

not to exceed $22,032,000. 

(21) For a replacement research lease, Houston, Texas, an 

amount not to exceed $6,142,000. 

(22) For a community-based outpatient clinic, Lincoln, Nebraska, an amount not to exceed $7,178,400. 

(23) For a community-based outpatient clinic, Lubbock, 

Texas, an amount not to exceed $8,554,000. 

(24) For a community-based outpatient clinic consolidation, 

Myrtle Beach, South Carolina, an amount not to exceed 

$8,022,000. 

(25) For a community-based outpatient clinic, Phoenix, Arizona, an amount not to exceed $20,757,000. 


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(26) For the expansion of a community-based outpatient 

clinic, Redding, California, an amount not to exceed 

$8,154,000. 

(27) For the expansion of a community-based outpatient clinic, Tulsa, Oklahoma, an amount not to exceed $13,269,200. 

(b) REQUIREMENTS FOR CLINIC IN TULSA.— (1) IN GENERAL.—In carrying out the expansion of the community-based outpatient clinic in Tulsa, Oklahoma, authorized 

by subsection (a)(27), the Secretary of Veterans Affairs shall ensure that such clinic satisfies the following requirements: 

(A) Consist of not more than 140,000 gross square feet. 

(B) Have an annual cost per square foot of not more 

than the average market rate in Tulsa, Oklahoma, for an 

equivalent medical facility plus 20 percent. 

(C) Satisfy the mandate of the Department of Veterans 

Affairs to provide veterans in Oklahoma with access to 

quality and efficient care. 

(D) Expand clinical capacity in the region in which the 

clinic is located in a cost efficient manner based upon regional cost comparisons, taking into account the needs of 

current veterans and the potential demand by veterans for 

care in the future. 

(E) Be the most cost effective option for the Department 

as predicted over a 30-year life cycle for such clinic. 

(2) COST EFFECTIVE DETERMINATION.— 

(A) IN GENERAL.—If the Secretary determines that the 

most cost effective option over a 30-year life cycle would be 

to purchase or construct a facility in Tulsa, Oklahoma, instead of entering into a major medical facility lease in such 

location as authorized by subsection (a)(27), the Secretary 

shall not enter into such lease. 

(B) MAJOR MEDICAL FACILITY PROJECT.—If the Secretary makes the determination described in subparagraph 

(A), the Secretary may request authority for a major medical facility project in Tulsa, Oklahoma, from Congress 

pursuant to section 8104(b) of title 38, United States Code. 

(C) COST-BENEFIT ANALYSIS.—If the Secretary requests 

authority for the major medical facility project described in 

subparagraph (B), not later than 90 days after making the 

determination described in subparagraph (A), the Secretary 

shall submit to Congress a detailed cost-benefit analysis of 

such major medical facility project. 

SEC. 602. BUDGETARY TREATMENT OF DEPARTMENT OF VETERANS AFFAIRS MAJOR MEDICAL FACILITIES LEASES. 

(a) FINDINGS.—Congress finds the following: 

(1) Title 31, United States Code, requires the Department 

of Veterans Affairs to record the full cost of its contractual obligation against funds available at the time a contract is executed. 

(2) Office of Management and Budget Circular A–11 provides guidance to agencies in meeting the statutory requirements under title 31, United States Code, with respect to leases. 

(3) For operating leases, Office of Management and Budget 

Circular A–11 requires the Department of Veterans Affairs to 

record up-front budget authority in an ‘‘amount equal to total 


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payments under the full term of the lease or [an] amount sufficient to cover first year lease payments plus cancellation costs’’. 

(b) REQUIREMENT FOR OBLIGATION OF FULL COST.— (1) IN GENERAL.—Subject to the availability of appropriations provided in advance, in exercising the authority of the 

Secretary of Veterans Affairs to enter into leases provided in 

this Act, the Secretary shall record, pursuant to section 1501 of 

title 31, United States Code, as the full cost of the contractual 

obligation at the time a contract is executed either— 

(A) an amount equal to total payments under the full 

term of the lease; or 

(B) if the lease specifies payments to be made in the 

event the lease is terminated before its full term, an amount 

sufficient to cover the first year lease payments plus the 

specified cancellation costs. 

(2) SELF-INSURING AUTHORITY.—The requirements of paragraph (1) may be satisfied through the use of the self-insuring 

authority identified in title 40, United States Code, consistent 

with Office of Management and Budget Circular A–11. 

(c) TRANSPARENCY.— 

(1) COMPLIANCE.—Subsection (b) of section 8104 of title 38, 

United States Code, is amended by adding at the end the following new paragraph: 

‘‘(7) In the case of a prospectus proposing funding for a 

major medical facility lease, a detailed analysis of how the 

lease is expected to comply with Office of Management and 

Budget Circular A–11 and section 1341 of title 31 (commonly 

referred to as the ‘Anti-Deficiency Act’). Any such analysis shall 

include— 

‘‘(A) an analysis of the classification of the lease as a 

‘lease-purchase’, ‘capital lease’, or ‘operating lease’ as those 

terms are defined in Office of Management and Budget Circular A–11; 

‘‘(B) an analysis of the obligation of budgetary resources associated with the lease; and 

‘‘(C) an analysis of the methodology used in determining the asset cost, fair market value, and cancellation 

costs of the lease.’’. 

(2) SUBMITTAL TO CONGRESS.—Such section 8104 is further 

amended by adding at the end the following new subsection: 

‘‘(h)(1) Not less than 30 days before entering into a major medical facility lease, the Secretary shall submit to the Committees on 

Veterans’ Affairs of the Senate and the House of Representatives— 

‘‘(A) notice of the Secretary’s intention to enter into the 

lease; 

‘‘(B) a detailed summary of the proposed lease; 

‘‘(C) a description and analysis of any differences between 

the prospectus submitted pursuant to subsection (b) and the 

proposed lease; and 

‘‘(D) a scoring analysis demonstrating that the proposed 

lease fully complies with Office of Management and Budget Circular A–11. 

‘‘(2) Each committee described in paragraph (1) shall ensure 

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tiality as is required by law of the Secretary and subject to the same 

statutory penalties for unauthorized disclosure or use as the Secretary. 

‘‘(3) Not more than 30 days after entering into a major medical 

facility lease, the Secretary shall submit to each committee described 

in paragraph (1) a report on any material differences between the 

lease that was entered into and the proposed lease described under 

such paragraph, including how the lease that was entered into 

changes the previously submitted scoring analysis described in subparagraph (D) of such paragraph.’’. 

(d) RULE OF CONSTRUCTION.—Nothing in this section, or the 

amendments made by this section, shall be construed to in any way 

relieve the Department of Veterans Affairs from any statutory or 

regulatory obligations or requirements existing prior to the enactment of this section and such amendments. 

TITLE VII—OTHER VETERANS MATTERS 

SEC. 701. EXPANSION OF MARINE GUNNERY SERGEANT JOHN DAVID 

FRY SCHOLARSHIP. 

(a) EXPANSION OF ENTITLEMENT.—Subsection (b)(9) of section 

3311 of title 38, United States Code, is amended by inserting ‘‘or 

spouse’’ after ‘‘child’’. 

(b) LIMITATION AND ELECTION ON CERTAIN BENEFITS.—Subsection (f) of such section is amended— 

(1) by redesignating paragraph (2) as paragraph (4); and 

(2) by inserting after paragraph (1) the following new paragraphs: 

‘‘(2) LIMITATION.—The entitlement of an individual to assistance under subsection (a) pursuant to paragraph (9) of subsection (b) because the individual was a spouse of a person described in such paragraph shall expire on the earlier of— 

‘‘(A) the date that is 15 years after the date on which 

the person died; or 

‘‘(B) the date on which the individual remarries. 

‘‘(3) ELECTION ON RECEIPT OF CERTAIN BENEFITS.—A surviving spouse entitled to assistance under subsection (a) pursuant to paragraph (9) of subsection (b) who is also entitled to 

educational assistance under chapter 35 of this title may not receive assistance under both this section and such chapter, but 

shall make an irrevocable election (in such form and manner 

as the Secretary may prescribe) under which section or chapter 

to receive educational assistance.’’. 

(c) CONFORMING AMENDMENT.—Section 3321(b)(4) of such title 

is amended— 

(1) by striking ‘‘an individual’’ and inserting ‘‘a child’’; and 

(2) by striking ‘‘such individual’s’’ each time it appears and 

inserting ‘‘such child’s’’. 

(d) EFFECTIVE DATE.—The amendments made by this section 

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SEC. 702. APPROVAL OF COURSES OF EDUCATION PROVIDED BY PUBLIC INSTITUTIONS OF HIGHER LEARNING FOR PURPOSES 

OF ALL-VOLUNTEER FORCE EDUCATIONAL ASSISTANCE 

PROGRAM AND POST-9/11 EDUCATIONAL ASSISTANCE 

CONDITIONAL ON IN-STATE TUITION RATE FOR VETERANS. 

(a) IN GENERAL.—Section 3679 of title 38, United States Code, 

is amended by adding at the end the following new subsection: 

‘‘(c)(1) Notwithstanding any other provision of this chapter and 

subject to paragraphs (3) through (6), the Secretary shall disapprove 

a course of education provided by a public institution of higher 

learning to a covered individual pursuing a course of education 

with educational assistance under chapter 30 or 33 of this title 

while living in the State in which the public institution of higher 

learning is located if the institution charges tuition and fees for that 

course for the covered individual at a rate that is higher than the 

rate the institution charges for tuition and fees for that course for 

residents of the State in which the institution is located, regardless 

of the covered individual’s State of residence. 

‘‘(2) For purposes of this subsection, a covered individual is any 

individual as follows: 

‘‘(A) A veteran who was discharged or released from a period of not fewer than 90 days of service in the active military, 

naval, or air service less than three years before the date of enrollment in the course concerned. 

‘‘(B) An individual who is entitled to assistance under section 3311(b)(9) or 3319 of this title by virtue of such individual’s relationship to a veteran described in subparagraph (A). 

‘‘(3) If after enrollment in a course of education that is subject 

to disapproval under paragraph (1) by reason of paragraph (2)(A) 

or (2)(B) a covered individual pursues one or more courses of education at the same public institution of higher learning while remaining continuously enrolled (other than during regularly scheduled breaks between courses, semesters or terms) at that institution 

of higher learning, any course so pursued by the covered individual 

at that institution of higher learning while so continuously enrolled 

shall also be subject to disapproval under paragraph (1). 

‘‘(4) It shall not be grounds to disapprove a course of education 

under paragraph (1) if a public institution of higher learning requires a covered individual pursuing a course of education at the 

institution to demonstrate an intent, by means other than satisfying 

a physical presence requirement, to establish residency in the State 

in which the institution is located, or to satisfy other requirements 

not relating to the establishment of residency, in order to be charged 

tuition and fees for that course at a rate that is equal to or less than 

the rate the institution charges for tuition and fees for that course 

for residents of the State. 

‘‘(5) The Secretary may waive such requirements of paragraph 

(1) as the Secretary considers appropriate. 

‘‘(6) Disapproval under paragraph (1) shall apply only with respect to educational assistance under chapters 30 and 33 of this 

title.’’. 

(b) EFFECTIVE DATE.—Subsection (c) of section 3679 of title 38, 

United States Code (as added by subsection (a) of this section), shall 

apply with respect to educational assistance provided for pursuit of 


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a program of education during a quarter, semester, or term, as applicable, that begins after July 1, 2015. 

SEC. 703. EXTENSION OF REDUCTION IN AMOUNT OF PENSION FURNISHED BY DEPARTMENT OF VETERANS AFFAIRS FOR 

CERTAIN VETERANS COVERED BY MEDICAID PLANS FOR 

SERVICES FURNISHED BY NURSING FACILITIES. 

Section 5503(d)(7) of title 38, United States Code, is amended 

by striking ‘‘November 30, 2016’’ and inserting ‘‘September 30, 

2024’’. 

SEC. 704. EXTENSION OF REQUIREMENT FOR COLLECTION OF FEES 

FOR HOUSING LOANS GUARANTEED BY SECRETARY OF 

VETERANS AFFAIRS. 

Section 3729(b)(2) of title 38, United States Code, is amended— 

(1) in subparagraph (A)— 

(A) in clause (iii), by striking ‘‘October 1, 2017’’ and inserting ‘‘September 30, 2024’’; and 

(B) in clause (iv), by striking ‘‘October 1, 2017’’ and inserting ‘‘September 30, 2024’’; 

(2) in subparagraph (B)— 

(A) in clause (i), by striking ‘‘October 1, 2017’’ and inserting ‘‘September 30, 2024’’; and 

(B) in clause (ii), by striking ‘‘October 1, 2017’’ and inserting ‘‘September 30, 2024’’; 

(3) in subparagraph (C)— 

(A) in clause (i), by striking ‘‘October 1, 2017’’ and inserting ‘‘September 30, 2024’’; and 

(B) in clause (ii), by striking ‘‘October 1, 2017’’ and inserting ‘‘September 30, 2024’’; and 

(4) in subparagraph (D)— 

(A) in clause (i), by striking ‘‘October 1, 2017’’ and inserting ‘‘September 30, 2024’’; and 

(B) in clause (ii), by striking ‘‘October 1, 2017’’ and inserting ‘‘September 30, 2024’’. 

SEC. 705. LIMITATION ON AWARDS AND BONUSES PAID TO EMPLOYEES 

OF DEPARTMENT OF VETERANS AFFAIRS. 

In each of fiscal years 2015 through 2024, the Secretary of Veterans Affairs shall ensure that the aggregate amount of awards and 

bonuses paid by the Secretary in a fiscal year under chapter 45 or 

53 of title 5, United States Code, or any other awards or bonuses 

authorized under such title does not exceed $360,000,000. 

SEC. 706. EXTENSION OF AUTHORITY TO USE INCOME INFORMATION. 

Section 5317(g) of title 38, United States Code, is amended by 

striking ‘‘September 30, 2016’’ and inserting ‘‘September 30, 2024’’. 

SEC. 707. REMOVAL OF SENIOR EXECUTIVES OF THE DEPARTMENT OF 

VETERANS AFFAIRS FOR PERFORMANCE OR MISCONDUCT. 

(a) REMOVAL OR TRANSFER.— 

(1) IN GENERAL.—Chapter 7 of title 38, United States Code, 

is amended by adding at the end the following new section: 

‘‘§ 713. Senior executives: removal based on performance or 

misconduct 

‘‘(a) IN GENERAL.—(1) The Secretary may remove an individual 

employed in a senior executive position at the Department of Veterans Affairs from the senior executive position if the Secretary deVerDate Mar 15 2010 10:07 Jul 29, 2014 Jkt 039006 PO 00000 Frm 00045 Fmt 6659 Sfmt 6603 E:\HR\OC\HR564.XXX HR564

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termines the performance or misconduct of the individual warrants 

such removal. If the Secretary so removes such an individual, the 

Secretary may— 

‘‘(A) remove the individual from the civil service (as defined 

in section 2101 of title 5); or 

‘‘(B) in the case of an individual described in paragraph 

(2), transfer the individual from the senior executive position to 

a General Schedule position at any grade of the General Schedule for which the individual is qualified and that the Secretary 

determines is appropriate. 

‘‘(2) An individual described in this paragraph is an individual 

who— 

‘‘(A) previously occupied a permanent position within the 

competitive service (as that term is defined in section 2102 of 

title 5); 

‘‘(B) previously occupied a permanent position within the 

excepted service (as that term is defined in section 2103 of title 

5); or 

‘‘(C) prior to employment in a senior executive position at 

the Department of Veterans Affairs, did not occupy any position 

within the Federal Government. 

‘‘(b) PAY OF TRANSFERRED INDIVIDUAL.—(1) Notwithstanding 

any other provision of law, including the requirements of section 

3594 of title 5, any individual transferred to a General Schedule position under subsection (a)(2) shall, beginning on the date of such 

transfer, receive the annual rate of pay applicable to such position. 

‘‘(2) An individual so transferred may not be placed on administrative leave or any other category of paid leave during the period 

during which an appeal (if any) under this section is ongoing, and 

may only receive pay if the individual reports for duty. If an individual so transferred does not report for duty, such individual shall 

not receive pay or other benefits pursuant to subsection (e)(5). 

‘‘(c) NOTICE TO CONGRESS.—Not later than 30 days after removing or transferring an individual from a senior executive position 

under subsection (a), the Secretary shall submit to the Committees 

on Veterans’ Affairs of the Senate and House of Representatives notice in writing of such removal or transfer and the reason for such 

removal or transfer. 

‘‘(d) PROCEDURE.—(1) The procedures under section 7543(b) of 

title 5 shall not apply to a removal or transfer under this section. 

‘‘(2)(A) Subject to subparagraph (B) and subsection (e), any removal or transfer under subsection (a) may be appealed to the Merit 

Systems Protection Board under section 7701 of title 5. 

‘‘(B) An appeal under subparagraph (A) of a removal or transfer 

may only be made if such appeal is made not later than seven days 

after the date of such removal or transfer. 

‘‘(e) EXPEDITED REVIEW BY ADMINISTRATIVE JUDGE.—(1) Upon 

receipt of an appeal under subsection (d)(2)(A), the Merit Systems 

Protection Board shall refer such appeal to an administrative judge 

pursuant to section 7701(b)(1) of title 5. The administrative judge 

shall expedite any such appeal under such section and, in any such 

case, shall issue a decision not later than 21 days after the date of 

the appeal. 

‘‘(2) Notwithstanding any other provision of law, including section 7703 of title 5, the decision of an administrative judge under 


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paragraph (1) shall be final and shall not be subject to any further 

appeal. 

‘‘(3) In any case in which the administrative judge cannot issue 

a decision in accordance with the 21-day requirement under paragraph (1), the removal or transfer is final. In such a case, the Merit 

Systems Protection Board shall, within 14 days after the date that 

such removal or transfer is final, submit to Congress and the Committees on Veterans’ Affairs of the Senate and House of Representatives a report that explains the reasons why a decision was not 

issued in accordance with such requirement. 

‘‘(4) The Merit Systems Protection Board or administrative 

judge may not stay any removal or transfer under this section. 

‘‘(5) During the period beginning on the date on which an individual appeals a removal from the civil service under subsection (d) 

and ending on the date that the administrative judge issues a final 

decision on such appeal, such individual may not receive any pay, 

awards, bonuses, incentives, allowances, differentials, student loan 

repayments, special payments, or benefits. 

‘‘(6) To the maximum extent practicable, the Secretary shall provide to the Merit Systems Protection Board, and to any administrative judge to whom an appeal under this section is referred, such 

information and assistance as may be necessary to ensure an appeal 

under this subsection is expedited. 

‘‘(f) RELATION TO TITLE 5.—(1) The authority provided by this 

section is in addition to the authority provided by section 3592 or 

subchapter V of chapter 75 of title 5. 

‘‘(2) Section 3592(b)(1) of title 5 does not apply to an action to 

remove or transfer an individual under this section. 

‘‘(g) DEFINITIONS.—In this section: 

‘‘(1) The term ‘individual’ means— 

‘‘(A) a career appointee (as that term is defined in section 3132(a)(4) of title 5); or 

‘‘(B) any individual who occupies an administrative or 

executive position and who was appointed under section 

7306(a) or section 7401(1) of this title. 

‘‘(2) The term ‘misconduct’ includes neglect of duty, malfeasance, or failure to accept a directed reassignment or to accompany a position in a transfer of function. 

‘‘(3) The term ‘senior executive position’ means— 

‘‘(A) with respect to a career appointee (as that term is 

defined in section 3132(a)(4) of title 5), a Senior Executive 

Service position (as such term is defined in section 

3132(a)(2) of title 5); and 

‘‘(B) with respect to an individual appointed under section 7306(a) or section 7401(1) of this title, an administrative or executive position.’’. 

(2) CLERICAL AMENDMENT.—The table of sections at the beginning of such chapter is amended by adding at the end the 

following new item: 

‘‘713. Senior executives: removal based on performance or misconduct.’’. 

(b) ESTABLISHMENT OF EXPEDITED REVIEW PROCESS.— 

(1) IN GENERAL.—Not later than 14 days after the date of 

the enactment of this Act, the Merit Systems Protection Board 

shall establish and put into effect a process to conduct expedited 


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reviews in accordance with section 713(d) of title 38, United 

States Code. 

(2) INAPPLICABILITY OF CERTAIN REGULATIONS.—Section 

1201.22 of title 5, Code of Federal Regulations, as in effect on 

the day before the date of the enactment of this Act, shall not 

apply to expedited reviews carried out under section 713(d) of 

title 38, United States Code. 

(3) WAIVER.—The Merit Systems Protection Board may 

waive any other regulation in order to provide for the expedited 

review required under section 713(d) of title 38, United States 

Code. 

(4) REPORT BY MERIT SYSTEMS PROTECTION BOARD.—Not 

later than 14 days after the date of the enactment of this Act, 

the Merit Systems Protection Board shall submit to the Committees on Veterans’ Affairs of the Senate and House of Representatives a report on the actions the Board plans to take to 

conduct expedited reviews under section 713(d) of title 38, 

United States Code, as added by subsection (a). Such report 

shall include a description of the resources the Board determines will be necessary to conduct such reviews and a description of whether any resources will be necessary to conduct such 

reviews that were not available to the Board on the day before 

the date of the enactment of this Act. 

(c) TEMPORARY EXEMPTION FROM CERTAIN LIMITATION ON INI- TIATION OF REMOVAL FROM SENIOR EXECUTIVE SERVICE.—During 

the 120-day period beginning on the date of the enactment of this 

Act, an action to remove an individual from the Senior Executive 

Service at the Department of Veterans Affairs pursuant to section 

7543 of title 5, United States Code, may be initiated, notwithstanding section 3592(b) of such title, or any other provision of law. 

(d) CONSTRUCTION.— (1) IN GENERAL.—Nothing in this section or section 713 of 

title 38, United States Code, as added by subsection (a), shall 

be construed to apply to an appeal of a removal, transfer, or 

other personnel action that was pending before the date of the 

enactment of this Act. 

(2) RELATION TO TITLE 5.—With respect to the removal or 

transfer of an individual (as that term is defined in such section 713) employed at the Department of Veterans Affairs, the 

authority provided by such section 713 is in addition to the authority provided by section 3592 or subchapter V of chapter 75 

of title 5, United States Code. 

TITLE VIII—OTHER MATTERS 

SEC. 801. APPROPRIATION OF AMOUNTS. 

(a) IN GENERAL.—There is authorized to be appropriated, and 

is appropriated, to the Secretary of Veterans Affairs, out of any 

funds in the Treasury not otherwise appropriated $5,000,000,000 to 

carry out subsection (b). Such funds shall be available for obligation 

or expenditure without fiscal year limitation. 

(b) USE OF AMOUNTS.—The amount appropriated under subsection (a) shall be used by the Secretary as follows: 

(1) To increase the access of veterans to care as follows: 

(A) To hire primary care and specialty care physicians 

for employment in the Department of Veterans Affairs. 


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(B) To hire other medical staff, including the following: 

(i) Physicians. 

(ii) Nurses. 

(iii) Social workers. 

(iv) Mental health professionals. 

(v) Other health care professionals as the Secretary 

considers appropriate. 

(C) To carry out sections 301 and 302, including the 

amendments made by such sections. 

(D) To pay for expenses, equipment, and other costs associated with the hiring of primary care, specialty care physicians, and other medical staff under subparagraphs (A), 

(B), and (C). 

(2) To improve the physical infrastructure of the Department as follows: 

(A) To maintain and operate hospitals, nursing homes, 

domiciliary facilities, and other facilities of the Veterans 

Health Administration. 

(B) To enter into contracts or hire temporary employees 

to repair, alter, or improve facilities under the jurisdiction 

of the Department that are not otherwise provided for 

under this paragraph. 

(C) To carry out leases for facilities of the Department. 

(D) To carry out minor construction projects of the Department. 

(c) AVAILABILITY.—The amount appropriated under subsection 

(a) shall remain available until expended. 

(d) REPORT.— (1) IN GENERAL.—Not later than one year after the date of 

the enactment of this Act, the Secretary of Veterans Affairs shall 

submit to the appropriate committees of Congress a report on 

how the Secretary has obligated the amounts appropriated 

under subsection (a) as of the date of the submittal of the report. 

(2) APPROPRIATE COMMITTEES OF CONGRESS DEFINED.—In 

this subsection, the term ‘‘appropriate committees of Congress’’ 

means— 

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

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

(e) FUNDING PLAN.—The Secretary shall submit to Congress a 

funding plan describing how the Secretary intends to use the 

amounts provided under subsection (a). 

SEC. 802. VETERANS CHOICE FUND. 

(a) IN GENERAL.—There is established in the Treasury of the 

United States a fund to be known as the Veterans Choice Fund. 

(b) ADMINISTRATION OF FUND.—The Secretary of Veterans Affairs shall administer the Veterans Choice Fund established by subsection (a). 

(c) USE OF AMOUNTS.— 

(1) IN GENERAL.—Any amounts deposited in the Veteran 

Choice Fund shall be used by the Secretary of Veterans Affairs 

to carry out section 101, including, subject to paragraph (2), 

any administrative requirements of such section. 


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(2) AMOUNT FOR ADMINISTRATIVE REQUIREMENTS.— 

(A) LIMITATION.—Except as provided by subparagraph 

(B), of the amounts deposited in the Veterans Choice Fund, 

not more than $300,000,000 may be used for administrative requirements to carry out section 101. 

(B) INCREASE.—The Secretary may increase the 

amount set forth in subparagraph (A) with respect to the 

amounts used for administrative requirements if— 

(i) the Secretary determines that the amount of 

such increase is necessary to carry out section 101; 

(ii) the Secretary submits to the Committees on 

Veterans’ Affairs and Appropriations of the House of 

Representatives and the Committees on Veterans’ Affairs and Appropriations of the Senate a report described in subparagraph (C); and 

(iii) a period of 60 days has elapsed following the 

date on which the Secretary submits the report under 

clause (ii). 

(C) REPORT.—A report described in this subparagraph 

is a report that contains the following: 

(i) A notification of the amount of the increase that 

the Secretary determines necessary under subparagraph (B)(i). 

(ii) The justifications for such increased amount. 

(iii) The administrative requirements that the Secretary will carry out using such increased amount. 

(d) APPROPRIATION AND DEPOSIT OF AMOUNTS.— 

(1) IN GENERAL.—There is authorized to be appropriated, 

and is appropriated, to the Secretary of Veterans Affairs, out of 

any funds in the Treasury not otherwise appropriated 

$10,000,000,000 to be deposited in the Veterans Choice Fund established by subsection (a). Such funds shall be available for 

obligation or expenditure without fiscal year limitation, and 

only for the program created under section 101. 

(2) AVAILABILITY.—The amount appropriated under paragraph (1) shall remain available until expended. 

(e) SENSE OF CONGRESS.—It is the sense of Congress that the 

Veterans Choice Fund is a supplement to but distinct from the Department of Veterans Affairs’ current and expected level of non-Department care currently part of Department’s medical care budget. 

Congress expects that the Department will maintain at least its existing obligations of non-Department care programs in addition to 

but distinct from the Veterans Choice Fund for each of fiscal years 

2015 through 2017. 

SEC. 803. EMERGENCY DESIGNATIONS. 

(a) IN GENERAL.—This Act is designated as an emergency requirement pursuant to section 4(g) of the Statutory Pay-As-You-Go 

Act of 2010 (2 U.S.C. 933(g)). 

(b) DESIGNATION IN SENATE.—In the Senate, this Act is designated as an emergency requirement pursuant to section 403(a) of 

S. Con. Res. 13 (111th Congress), the concurrent resolution on the 

budget for fiscal year 2010. 

And the House agree to the same. 


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For consideration of the House amendment and the Senate 

amendment, and modifications committed to conference: 

JEFF MILLER of Florida, 

DOUG LAMBORN, DAVID P. ROE of Tennessee, 

BILL FLORES, DAN BENISHEK, MIKE COFFMAN, BRAD R. WENSTRUP, JACKIE WALORSKI, MICHAEL H. MICHAUD, CORRINE BROWN of Florida, 

MARK TAKANO, 

JULIA BROWNLEY of California, 

ANN KIRKPATRICK, 

TIMOTHY J. WALZ, 

Managers on the part of the House. 

BERNARD SANDERS, 

JOHN D. ROCKEFELLER IV, 

PATTY MURRAY, 

SHERROD BROWN, 

JON TESTER, 

MARK BEGICH, 

RICHARD BLUMENTHAL, 

MAZIE K. HIRONO, 

RICHARD BURR, 

JOHNNY ISAKSON, 

MIKE JOHANNS, 

Managers on the part of the Senate. 


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JOINT EXPLANATORY STATEMENT OF THE COMMITTEE OF 

CONFERENCE 

The managers on the part of the House and the Senate at the 

conference on the disagreeing votes of the two Houses on the 

amendment of the House to the amendment of the Senate to the 

bill (H.R. 3230), making continuing appropriations during a Government shutdown to provide pay and allowances to members of 

the reserve components of the Armed Forces who perform inactiveduty training during such period, submit the following joint statement to the House and the Senate in explanation of the effect of 

the action agreed upon by the managers and recommended in the 

accompanying conference report: 

The House amendment to the Senate amendment struck all of 

the House bill after the enacting clause and inserted a substitute 

text. 

The Senate recedes from its disagreement to the amendment 

of the House with an amendment that is a substitute for the House 

bill and the House amendment to the Senate amendment. The differences between the House amendment, the Senate amendment, 

and the substitute agreed to in conference are noted below, except 

for clerical corrections, conforming changes made necessary by 

agreements reached by the conferees, and minor drafting and clarifying changes. 

OVERVIEW 

The House amendment to the Senate amendment to the Conference bill consists of provisions from the following House bills: 

H.R. 4810, the Veteran Access to Care Act of 2014, which passed 

the House on June 10, 2014, and H.R. 4031, the Department of 

Veterans Affairs Management Accountability Act of 2014, which 

passed the House on May 21, 2014. 

The Senate amendment consists of provisions from the following Senate bill: S. 2450, the Veterans’ Access to Care through 

Choice, Accountability, and Transparency Act of 2014, which was 

incorporated as a substitute amendment to H.R. 3230 and passed 

the Senate on June 11, 2014. 

TITLE I—IMPROVEMENT OF ACCESS TO CARE FROM NON- DEPARTMENT OF VETERANS AFFAIRS PROVIDERS

EXPANDED AVAILABILITY OF HOSPITAL CARE AND MEDICAL SERVICES

FOR VETERANS THROUGH THE USE OF AGREEMENTS WITH NON-DEPARTMENT OF VETERANS AFFAIRS ENTITIES

Current Law 

Section 1710 of title 38, United States Code (hereinafter, 

‘‘U.S.C.’’), requires the Department of Veterans Affairs (hereinafter, 


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‘‘VA’’) to provide hospital care and medical services to eligible veterans. Section 1703 of title 38, U.S.C., authorizes VA to contract 

with non-Department facilities and providers to furnish hospital or 

medical services to eligible veterans when VA is not capable of providing economical care because of geographical inaccessibility or 

due to an inability to furnish such care or services required. Sections 1725 and 1728 of title 38, U.S.C., authorize VA to reimburse 

for certain types of care, such as emergency treatment, at non-Department facilities. Section 1786 of title 38, U.S.C., authorizes VA 

to provide needed post-delivery care and services. Section 8111 of 

title 38, U.S.C., authorizes VA to enter into sharing agreements at 

other government facilities. Section 8153 of title 38, U.S.C., authorizes a VA facility to enter into a contract or agreement with nonVA health care entities to secure healthcare services that are either 

unavailable or not cost-effective to provide at a VA facility. 

Senate Amendment 

The Senate amendment would require VA to provide hospital 

and medical services to an eligible veteran, at the election of such 

veteran, through non-VA health care providers, who participate in 

the Medicare program, or at Federally Qualified Health Centers 

(hereinafter, ‘‘FQHCs’’), facilities funded by the Indian Health 

Service (hereinafter, ‘‘IHS’’), or Department of Defense (hereinafter, 

‘‘DOD’’). It would also require the Secretary of Veterans Affairs 

(hereinafter, ‘‘the Secretary’’) to coordinate the delivery of such 

non-VA care and services through the Non-VA Care Coordination 

Program. 

For purposes of receiving non-VA care and services as a veteran enrolled in the VA health care system, the Senate amendment 

would define an eligible veteran as someone who is unable to 

schedule an appointment at a VA medical facility within VA’s stated wait-time goals; resides more than 40 miles from the nearest VA 

medical facility; or, in the case of a veteran who resides in a State 

without a VA medical facility that provides hospital care, emergency medical services, and surgical care, resides 20 miles from 

such VA medical facility. 

It would also authorize VA to enter into negotiated contracts 

with eligible non-VA providers for the provision of care and services to an eligible veteran. Furthermore, it would authorize VA to 

establish contracts with non-VA providers at the Medicare rate or 

to negotiate a rate that is higher than the Medicare rate, only if 

VA is unable to find a health care provider that is able to provide 

such care and services at the Medicare rate. 

House Amendment 

The House amendment would require VA, for two years after 

enactment, to offer non-VA care at the Department’s expense to 

any enrolled veteran who resides more than 40 miles from a VA 

medical facility or has waited longer than the VA’s wait-time 

goals—as of June 1, 2014—for a medical appointment or has been 

notified by VA that an appointment is not available within VA’s 

wait-time goals—as of June 1, 2014—and who elects to receive care 

at a non-VA facility. In furnishing such care, the House amendment would require VA to utilize existing contracts to the greatest 


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extent possible; to reimburse any non-VA care providers with 

which VA has not entered into an existing contract, at the greater 

of the rate set by VA, TRICARE, or Medicare, for care received by 

an eligible veteran; and, ensure that a non-VA care authorization 

encompasses the complete episode of care but does not exceed sixty 

days. 

It would also require VA to submit to Congress a quarterly report, which includes how many eligible veterans have received nonVA care or services. 

Conference Agreement 

The Conference agreement adopts the Senate provision with 

amendments to eligibility, payment rates and VA’s obligation for 

payments for non-service-connected care or services. The conference 

substitute defines an eligible veteran as a veteran who is enrolled 

in the patient enrollment system as of August 1, 2014, or any veteran who enrolls after such date and who, at any time during the 

five-year period preceding such enrollment, served on active duty 

in a theater of combat operation. It also includes those veterans 

who live within 40 miles of a medical facility and are required to 

travel by air, boat, or ferry to access a VA medical facility or who 

face geographical challenges in accessing that medical facility. In 

calculating the distance from a nearest VA medical facility, it is the 

Conferees’ expectation that VA will use geodesic distance, or the 

shortest distance between two points. The Conferees do not intend 

the 40-mile eligibility criteria included in this section to preclude 

veterans who reside closer than 40-miles from a VA facility from 

accessing care through non-VA providers, particularly if the VA facility the veteran resides near provides limited services. 

Should an appointment not be available for a veteran within 

the established wait time goals and the veteran chooses to be seen 

by non-VA entities, the veteran will be informed by electronic 

means, or by a letter if the veteran so chooses, as to the care or 

services they are authorized to receive. 

The rates for contracts established under this section shall be 

no more than the rates paid to a provider of services under Medicare with the exception VA may negotiate a higher rate for care 

provided to veterans residing in highly rural areas. 

A ‘‘Veterans Choice Card’’ will be issued to each enrolled veteran for presentation to health care providers for the delivery of 

authorized medical care and services. This card will contain identifying information as well as contact and relevant information for 

authorization and claims procedures. The Secretary will provide information to veterans about the availability of care and services 

through the use of this card. The Conferees do not intend for any 

delays that may occur in the production of the ‘‘Veterans Choice 

Card’’ to delay the implementation of the choice program. 

This election to receive care through a health care provider 

also includes what would be considered an episode of care up to a 

period of 60 days. The Conferees recognize that chronic conditions 

or illnesses may require episodes of care that extend beyond the 60 

day limit. In such cases, the Conferees expect the Secretary to authorize additional episodes of care sufficient to complete the needed 


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treatment or in the case of treatment needed to maintain a quality 

of life during a terminal illness. 

For those veterans receiving hospital care or medical services 

for non-service-connected conditions, the Department is secondarily 

responsible. The health care provider that furnishes care or services shall be responsible for seeking reimbursement from the health 

care plan contract under which the eligible veteran is covered. Eligible veterans will pay a copayment for the receipt of hospital care 

or medical services under this section only if such eligible veteran 

would be required to pay a copayment for the receipt of care and 

services at a VA medical facility. Nothing in this section amends 

health plans not administered by the Department, including with 

respect to the terms and conditions of such coverage, reimbursement, and cost-sharing. 

Numerous reports are required to document program implementation, establishment and success in meeting goals, utilization 

of and satisfaction in care and services delivered under this section, 

and Department expenditures. 

The Conferees expect VA will provide care and services under 

this section at the choice of an eligible veteran if the veteran experiences the time or distance delays described in this section. When 

coordinating care for eligible veterans through the Non-VA Care 

Coordination program, the Department should attempt to ensure 

when an appointment is authorized, the eligible veteran receives 

care within an appropriate time period, as defined by medical necessity as determined by the referring physician, or a mandatory 

time period established by the Secretary when the request for care 

is not initiated by a physician, that all medical fees are appropriately paid and health care records are returned to the Department within the prescribed time. The Conferees also expect that 

VA will utilize providers who have demonstrated success providing 

a variety of care, to veterans under an integrated model of care and 

a proven ability to partner with the Federal government. 

Congress has authorized a new program to provide care and 

choice to veterans, the funds made available for this program 

through section 802(d)(1) are available only to carry out this new 

program. 

ENHANCEMENT OF COLLABORATION BETWEEN DEPARTMENT OF

VETERANS AFFAIRS AND INDIAN HEALTH SERVICE

Current Law 

Subsection 1645(c) of title 25, U.S.C., requires VA and DOD to 

reimburse IHS, an Indian tribe, or a tribal organization for providing eligible beneficiaries with health care services. In 2010, VA 

and IHS signed an updated Memorandum of Understanding (hereinafter, ‘‘MOU’’) in order to establish ‘‘mutual goals and objectives 

for ongoing collaboration between VA and IHS in support of their 

respective missions and to establish a common mission of serving 

our nation’s American Indian and Alaska Native Veteran.’’ This 

MOU set forth five goals, to be achieved through 12 areas of collaboration between VA and IHS. One of the areas of collaboration 

focused on increasing the availability of health care services 


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through development of payment and reimbursement policies to 

support interagency care delivery. 

As a result, in December 2012, VA and IHS signed a national 

reimbursement agreement to create a mechanism by which VA can 

reimburse IHS for health services provided to eligible veterans. 

This MOU only covers direct care services provided by IHS. In addition to providing direct care, IHS also contracts with Urban Indian Health Centers and Tribal Health Programs (hereinafter, 

‘‘THP’’) to provide additional points of care to eligible Native Americans. VA has worked with individual THPs to negotiate separate 

reimbursement agreements to care for veterans. While VA’s agreement with IHS only covers dual eligible veterans, the Department’s 

agreements with health providers through the Alaska Native Tribal Health Consortium include coverage for all veterans. VA has not 

yet entered into reimbursement agreements with any Urban IHS 

Centers to treat veterans. 

In April 2013 and June 2014, the Government Accountability 

Office (hereinafter, ‘‘GAO’’) issued two reports on the VA–IHS 

MOU. GAO’s recommendations indicated that better definition of 

metrics and improved oversight and guidance would improve implementation of the MOU and its impact on access to care for veterans. 

Senate Amendment 

The Senate amendment would require VA, in consultation with 

IHS, to conduct more outreach to IHS tribal health programs to ensure they are aware of the opportunity to negotiate a reimbursement agreement. 

It would require VA, in collaboration with IHS, to define 

metrics for implementing and overseeing existing partnership efforts under the current VA–IHS MOU. 

Finally, it would require VA and IHS to jointly report to Congress, within 180 days of enactment, on the feasibility and advisability of entering into reimbursement agreements with Urban IHS 

Centers and including treatment of non-Native veterans as a reimbursable expense under existing reimbursement structures. 

House Amendment 

The House amendment contained no similar provision. 

Conference Agreement 

The Conference substitute adopts the Senate provision. 

ENHANCEMENT OF COLLABORATION BETWEEN DEPARTMENT OF

VETERANS AFFAIRS AND NATIVE HAWAIIAN HEALTH CARE SYSTEMS

Current Law 

In October 2013, the VA Pacific Islands Health Care System 

(hereinafter, ‘‘VAPIHCS’’) entered into an MOU with Papa Ola 

Lokahi, the statutorily designated statewide coordinating body for 

the five Native Hawaiian Health Care Systems, in order to improve 

communication, collaboration, and cooperation regarding health 

care for Native Hawaiian veterans. The purpose statement of the 

MOU notes that both parties, ‘‘hope to seek and develop greater 


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means of achieving efficiency of care provided and to create future 

processes for VAPIHCS reimbursement for services provided to Native Hawaiian veterans referred to Papa Ola Lokahi by VAPIHCS.’’ 

VA estimated the average waiting time for a new patient requesting a primary care appointment at VAPIHCS was nearly 130 days, 

the highest in the nation. Due to the rural nature of the state, 

VAPIHCS has received funding above and beyond its Veterans Equitable Resource Allocation in Fiscal Year (hereinafter, ‘‘FY’’) 2012 

and FY 2013, in order to account for the costs of beneficiary travel 

for eligible veterans to receive services on other islands. These 

numbers were $4.94 million and $4.65 million, respectively. 

Senate Amendment 

The Senate amendment would require VA to enter into contracts or agreements with the Native Hawaiian health care systems for reimbursement of direct care services provided to eligible 

veterans. 

House Amendment 

The House amendment contained no similar provision. 

Conference Agreement 

The Conference substitute adopts the Senate provision. 

REAUTHORIZATION AND MODIFICATION OF PILOT PROGRAM OF ENHANCED CONTRACT CARE AUTHORITY FOR HEALTH CARE NEEDS OF

VETERANS

Current Law 

Section 403 of the Veterans’ Mental Health and Other Care 

Improvements Act of 2008, Public Law 110–387, provided VA with 

authority to conduct a pilot program commonly known as Project 

ARCH (Access Received Closer to Home) in five Veterans Integrated Service Networks (hereinafter, ‘‘VISNs’’). The pilot program 

was to be carried out in at least five VISNs, restricted by various 

geographic and demographic factors. Locations included: Northern 

Maine; Farmville, Virginia; Pratt, Kansas; Flagstaff, Arizona; and, 

Billings, Montana. The aim of the pilot was to provide health care 

access to eligible veterans closer to home through a non-Department health care provider. 

Senate Amendment 

The Senate amendment contained no similar provision. 

House Amendment 

The House amendment contained no similar provision. 

Conference Agreement 

The Committee substitute would extend Project ARCH within 

specified VISNs for veterans in highly rural areas who are enrolled 

in VA health care for an additional 2 years. It would also require 

appointments to be scheduled within 5 days from the date the provider accepts a referral from VA and requires these veterans reVerDate Mar 15 2010 10:07 Jul 29, 2014 Jkt 039006 PO 00000 Frm 00058 Fmt 6601 Sfmt 6601 E:\HR\OC\HR564.XXX HR564

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ceive care within 30 days from the date the appointment was 

made. 

PROMPT PAYMENT BY THE DEPARTMENT OF VETERANS AFFAIRS

Current Law 

In general, the Prompt Payment Act, as amended, requires executive branch agencies, including VA, to pay late-payment penalties when the Department does not pay commercial payments on 

time. 

In March 2014, GAO reported that billing officials at one nonVA provider experienced ‘‘lengthy delays’’ in the processing of their 

claims, which in some cases took years. Additionally, GAO testified 

at a House Committee on Veterans’ Affairs hearing on June 18, 

2014, on claim processing discrepancies that delayed or denied payments for healthcare provided by non-VA providers. 

According to GAO, these delays or denials create an environment where non-VA entities are hesitant to provide care due to 

fears they will not be paid for services provided. This hinders access to care for veterans who need non-VA services. 

Senate Amendment 

The Senate amendment would provide a Sense of Congress 

that VA comply with section 1315 of title 5, Code of Federal Regulations (hereinafter, ‘‘CFR’’), (commonly known as the ‘‘prompt payment rule’’) in paying for health care pursuant to contracts with 

non-VA providers. 

House Amendment 

The House amendment contained no similar provision. 

Conference Agreement 

The Conference substitute adopts the Senate provision with an 

amendment that adds a GAO report on the timeliness of payments 

by VA for non-VA care and services. The Committee is concerned 

that the Department is not paying claims for services provided to 

veterans by non-Department providers in a timely manner. The 

Committee urges the Secretary to establish and implement a system for the processing and paying of those claims. 

TRANSFER OF AUTHORITY FOR PAYMENTS FOR HOSPITAL CARE, MEDICAL SERVICES, AND OTHER HEALTH CARE FROM NON-DEPARTMENT

OF VETERANS AFFAIRS PROVIDERS TO THE CHIEF BUSINESS OFFICE

OF THE VETERANS HEALTH ADMINISTRATION

Current Law 

Under current law, section 1703 of title 38, U.S.C., VA may 

contract with non-Department facilities and providers to furnish 

hospital care or medical services to eligible veterans when VA is 

not capable of furnishing the care or services required or VA is not 

capable of providing economical care because of geographical inaccessibility. Further, VA has authority, under sections 1725 and 

1728 of title 38, U.S.C., to reimburse for certain types of care, such 

as emergency treatment, at non-Department facilities. 


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The criteria for determining whether a veteran is eligible for 

non-VA care is established by each VISN or VA medical center. 

Committee oversight has determined that a decentralized eligibility 

determination process ensures eligibility is appropriate for each 

medical center’s capacity and the needs of the veterans it serves. 

However, such decentralization has caused disparity in eligibility 

criteria throughout the VA health care system and in some cases 

has led to the determination of eligibility as subject to facility 

budget considerations rather than to the determination of what is 

best for the veteran. 

The use of non-VA care has increased. In fact, non-VA care has 

been the subject of two recent reports by the GAO. Both reports 

highlighted vulnerabilities in VA’s ability to manage and oversee 

utilization of and spending on non-VA care. In its May 2013 report, 

GAO noted VA’s fee basis care spending had increased nearly $1.5 

billion from FY 2008 through FY 2012 and had witnessed an increase in utilization of 19% during that same time period. 

Without central oversight of non-VA care, VA has limited ability to collect and analyze data that could help to improve the program’s management. 

Senate Amendment 

The Senate amendment would require the Secretary to transfer the authority to pay for hospital care, medical services, and 

other health care through non-VA providers to the Chief Business 

Office from VA’s VISNs and medical centers by October 1, 2014. It 

would also require the Chief Business Office to work with the Office of Clinical Operations and Management to ensure care and 

services are provided in a manner that is clinically appropriate and 

in the best interest of the veterans receiving such care and services. 

Finally, in each FY after the date of enactment, the Secretary 

would be required to include in the Chief Business Office budget 

funds to pay for hospital care, medical services, and other health 

care provided through non-VA providers. 

House Amendment 

The House amendment contained no similar provision. 

Conference Agreement 

The Conference substitute adopts the Senate provision. 

TITLE II—HEALTH CARE ADMINISTRATIVE MATTERS

INDEPENDENT ASSESSMENT OF THE HEALTH CARE DELIVERY SYSTEMS

AND MANAGEMENT PROCESSES OF THE DEPARTMENT OF VETERANS

AFFAIRS

Current Law 

VA operates the largest integrated health care system in the 

nation, comprised of 150 VA medical centers (hereinafter, 

‘‘VAMCs’’), 820 community-based outpatient clinics, 135 community-living centers, 300 Vet Centers, 140 domiciliary treatment programs, and 70 mobile Vet Centers. These sites of care are divided 

amongst 21 VISNs. The VA health care system is overseen by the 


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Veterans Health Administration (hereinafter, ‘‘VHA’’), which operates under the leadership of the VA Under Secretary for Health. 

VHA employs a staff of approximately 288,000 employees and oversees a medical care budget of approximately $55 billion. In addition 

to providing direct health care services to eligible veterans, caregivers, and dependents, VHA also conducts education and training 

programs for health care professionals and medical residents; operates an extensive medical research program; and, serves as the 

contingency back-up to the Department of Defense during national 

emergencies. 

VHA directive 2010–027, ‘‘VHA Outpatient Scheduling Processes and Procedures’’ (hereinafter, ‘‘the directive’’), established on 

June 9, 2010, outlines the policy for implementing processes and 

procedures for scheduling outpatient appointments using the Veterans Health Information Systems and Technology Architecture 

(hereinafter, ‘‘VistA’’). The directive also provides detail regarding 

how to ensure staff is competent in the scheduling process. This directive is set to expire on June 30, 2015. 

VA’s Office of Inspector General (hereinafter, ‘‘VAOIG’’), GAO 

and a recent VA audit have identified significant problems with 

VA’s ability to provide timely access to health care. 

Senate Amendment 

The Senate amendment would require VA to enter into a contract with an independent third party for a 180-day assessment of: 

the process for scheduling appointments at each VA medical facility; the staffing level at and productivity of each VA medical facility; the organization, processes, and tools used to support clinical 

documentation and coding of inpatient services; the purchasing, 

distribution, and use of pharmaceuticals; and the performance of 

the Department in paying amounts owed to third parties and collecting amounts owed to the Department. The independent third 

party conducting the assessment would be required to conduct a 

comprehensive review of the Department’s scheduling process and 

recommend any actions to be taken by the Department to improve 

its process for scheduling medical appointments. 

The Senate amendment would also require VA to submit a report to the Committees on Veterans’ Affairs of the Senate and the 

House of Representatives (hereinafter, ‘‘the Committees’’), no later 

than 90 days after the date on which the independent third party 

completes the assessment, on the results of such assessment. 

House Amendment 

The House amendment would require an independent assessment of hospital care and medical services furnished in VA medical 

facilities. The independent assessment would address: the current 

and projected demographics and unique needs of the patient population served by VA; the Department’s current and projected health 

care capabilities and resources; the authorities and mechanisms 

under which the Secretary may furnish hospital care and medical 

services at non-VA facilities; the appropriate system-wide access 

standard applicable to hospital care and medical services furnished 

by VA; the current organization, processes, and tools used to support clinical staffing; VA’s staffing levels and productivity standVerDate Mar 15 2010 10:07 Jul 29, 2014 Jkt 039006 PO 00000 Frm 00061 Fmt 6601 Sfmt 6601 E:\HR\OC\HR564.XXX HR564

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ards; information technology strategies; and, VHA’ s business processes. Further, the independent assessment would include: an identification of improvement areas; recommendations for how to address such improvement areas; the business case associated with 

making such improvements; and findings and supporting analysis 

on how credible conclusions were established. 

It would also require the Secretary to designate a program integrator if VA enters into contracts with more than one private sector entity to conduct the independent assessment. The program integrator would be required to be responsible for coordinating the 

outcomes of the assessments conducted by the private entities. 

Finally, the House amendment would require VA to submit to 

the Committees a report, no later than 10 months after entering 

into a contract with a private entity, on the findings of the independent assessment and a subsequent report, no later than 120 

days after the date of the submission of the first report, which 

would be required to include VA’s action plan for fully implementing the recommendations of the independent assessment. 

Conference Agreement 

The Conference substitute adopts the House provision with 

amendments to broaden the breadth of the assessment to include: 

VA leadership; access to care; length of stay management; patient 

experience; workflow; care transitions; mechanisms by which VA 

ensures timely payments to nonVA care providers; pharmaceutical; 

supply and device purchasing; distribution and use; scheduling; 

and medical construction, maintenance and leasing. 

The Conferees expect that the assessment will produce outcomes that identify improvement areas outlined both qualitatively 

and quantitatively, taking into consideration Department of Veterans Affairs’ directives and industry benchmarks from outside the 

Federal Government. The assessment is also expected to provide 

supporting analysis on how credible conclusions were established. 

The business cases associated with and the recommendations for 

how to address these identified improvement areas relating to 

structure, accountability, process changes, technology, capabilities 

and usage, staff compliance, training effectiveness, and other relevant drivers of performance are expected to better inform the 

Commission on Care in its work. 

COMMISSION ON CARE

Current Law 

Precedent exists for establishing an independent commission in 

response to concerns regarding the care provided to our nation’s 

servicemembers and veterans. In 2007, ‘‘the President’s Commission on Care for America’s Returning Wounded Warriors,’’ known 

as the Dole-Shalala Commission, was established in response to reports of substandard conditions and mismanagement at Walter 

Reed Army Hospital. The subsequent report and recommendations 

issued by the Dole-Shalala Commission have been critical to improving the health care, benefits, and services available to our nation’s veterans in recent years. 


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Another independent, high-level commission, the Capital Asset 

Realignment for Enhanced Services (‘‘CARES’’) Commission has 

been utilized in recent history to examine and recommend improvements for addressing a host of challenges facing VHA, such as how 

best to align VA’s health care system to deliver care to veterans. 

Physical infrastructure plays a significant role in VA’s ability 

to provide high quality care to veterans. With more than 2 million 

new veterans enrolling into the VA health care system since 2009, 

and veterans experiencing extended wait times for appointments, it 

is essential that VA facility leasing programs and maintenance 

projects are completed on time and within budget. 

Senate Amendment 

The Senate amendment would establish a Commission on Access to Care to examine the access of veterans to health care and 

strategically examine how best to organize VHA, locate health care 

resources, and deliver health care to veterans. The Commission 

would be required to report initial findings and recommendations 

within 90 days of its first meeting, and would be required to provide a final report within 180 days of such meeting. 

The Senate amendment would also establish an Independent 

Commission on Department of Veterans Affairs Construction 

Projects to review current construction and maintenance projects 

and the medical facility leasing program in order to identify any 

issues the Department may be experiencing as it carries out these 

projects. The Commission would be required to report to the Secretary and Congress not later than 120 days after enactment any 

recommendations for improving how VA carries out its construction 

and maintenance projects. Following submission of the Commission’s report, the Secretary would have 60 days to submit to Congress a report on the feasibility and advisability of implementing 

the recommendations of the Commission, including a timeline for 

the implementation of such recommendations. 

House Amendment 

The House amendment contained no similar provision. 

Conference Agreement 

The Conference substitute adopts the Senate provision on the 

Commission on Care with an amendment to include a representative with familiarity with medical facility construction and leasing 

projects. This amendment would allow the Commission on Care to 

examine how VA’s physical infrastructure impacts VA’s ability to 

provide high quality care to veterans and eliminate the need for a 

separate Independent Commission on Department of Veterans Affairs Construction Projects. Further, the Conference substitute increases the number of voting members to 15, eliminates non-voting 

members, and allows for appointment by the Speaker and Minority 

Leader of the House of Representatives and Majority and Minority 

Leaders of the Senate. It is the expectation of the Conferees that 

the membership of the Commission on Care will represent and reflect a bipartisan, cross-section of VHA users. 

The Commission on Care may also consider looking at the relationship and communication structure between the VHA and the 


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Veterans Benefits Administration. The Conferees are concerned the 

two administrations do not communicate and lack synergy to ensure that veterans’ benefits and services are rendered in a timely, 

safe, and veteran focused manner. 

TECHNOLOGY TASK FORCE ON REVIEW OF SCHEDULING SYSTEM AND

SOFTWARE OF THE DEPARTMENT OF VETERANS AFFAIRS

Current Law 

VHA presently relies on an outpatient scheduling system that 

is more than 25 years-old. In October 2001, due to an aging system 

with various limitations that hindered its effectiveness, VHA 

launched a scheduling replacement initiative. This process was 

wrought with setbacks, including failed information technology 

(hereinafter, ‘‘IT’’) management and acquisition practices. After expending $127 million on that effort, VA was only able to obtain defective software that could not be fixed and did not achieve the intended goal. Further, reports by GAO and VAOIG have repeatedly 

highlighted challenges with the use of the Electronic Wait List 

(hereinafter, ‘‘EWL’’), an inability to connect with the consult management system, and other change management challenges regarding training for medical appointment schedulers. 

Utilizing the America Competes Reauthorization Act of 2011, 

VA started the 21st Century Medical Scheduling contest in order 

to encourage commercial vendors to develop solutions VA can use 

and to mitigate risks VA identified in previous attempts to replace 

the existing Medical Scheduling Package. The contest ended on 

September 30, 2013, and three winners were identified and awarded slightly over $3 million for their efforts. VA is currently pursuing modernization of VistA; thus, there has been renewed focus 

within the Department on how to improve its functionality and 

user experiences across the board. VA recently held Industry Days 

and one-on-one demonstrations with potential vendors in order to 

choose an off-the-shelf product as part of a long-term scheduling 

package replacement strategy. 

Senate Amendment 

The Senate amendment would require VA to review, through 

the use of a technology task force, the needs of the Department 

with respect to the scheduling system and scheduling software. The 

task force would be required to issue a report to propose specific 

actions that VA can take to improve its scheduling software and 

determine whether an existing off-the-shelf system would meet the 

Department’s needs within 45 days of enactment. VA would be required to publish the report in the Federal Register and on a publicly accessible website. VA would also be required to implement 

any feasible, advisable, and cost-effective recommendations set 

forth in the report within one year of its receipt. 

House Amendment 

The House amendment contained no similar provision. 


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Conference Agreement 

The Conference substitute adopts the Senate provision. The 

Conferees expect VA to utilize the Northern Virginia Technology 

Task Force to implement this section. The Task Force previously 

provided a pro-bono review for Arlington National Cemetery. 

IMPROVEMENT OF ACCESS OF VETERANS TO MOBILE VET CENTERS AND

MOBILE MEDICAL CENTERS OF THE DEPARTMENT OF VETERANS AFFAIRS

Current Law 

In May 2014, VHA’s Office of Rural Health published a fact 

sheet reporting that, of the Nation’s 22 million veterans, 5.3 million 

live in rural areas. Currently, there are 70 mobile vet centers operating around the country providing readjustment counseling and 

information resources to veterans in rural areas. Mobile vet centers 

in some areas also provide limited telemedicine services. VA, however, has not issued any standard procedures for the operation of 

mobile vet centers. Currently, regional managers determine how a 

mobile vet center is employed and utilized. As a result, mobile vet 

centers are vulnerable to inconsistencies. 

In addition to mobile vet centers, VA uses mobile medical units 

(hereinafter, ‘‘MMUs’’) to increase access to care for rural veterans. 

As of March 2013, VA operated eight MMUs. In May 2014, VAOIG 

issued an audit of VA MMUs, which found that VA lacked critical 

information regarding the number, locations, purpose, patient 

workloads, operation costs, and operations of MMUs. VAOIG recommended that VA improve oversight of MMUs. 

Senate Amendment 

The Senate amendment would require VA to improve access to 

health care services, including telemedicine, by standardizing requirements for the operation of mobile vet centers. It would also require the Secretary to submit an annual report to Congress on the 

use of mobile vet centers as well as recommended improvements 

for access to telemedicine and health care via mobile vet centers. 

House Amendment 

The House amendment contained no similar provision. 

Conference Agreement 

The Conference substitute adopts the Senate provision with an 

amendment to require VA to use MMUs as well as mobile vet centers to improve access to care for veterans, particularly those residing in rural areas. 

IMPROVED PERFORMANCE METRICS FOR HEALTH CARE PROVIDED BY

DEPARTMENT OF VETERANS AFFAIRS

Current Law 

Under current law, chapter 45, chapter 53, and other provisions of title 5, U.S.C., VA has the authority to provide awards to 

certain employees. For example, chapter 45 of title 5, U.S.C., proVerDate Mar 15 2010 10:07 Jul 29, 2014 Jkt 039006 PO 00000 Frm 00065 Fmt 6601 Sfmt 6601 E:\HR\OC\HR564.XXX HR564

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vides VA with authority to grant cash awards to employees in recognition of performance. 

Senate Amendment 

The Senate amendment would require the Secretary to ensure 

that scheduling and wait-time metrics are not used as factors in 

determining the performance of certain employees for purposes of 

determining whether to pay performance awards to such employees. It would also require the Secretary to remove from the performance goals of any VISN or VA medical center employee, any 

performance goal that might disincentivize the payment of Department amounts to provide health care through non-VA providers. 

The Senate amendment would also require the Secretary to 

modify the performance plans of the directors of VISNs and VA 

medical centers to ensure that such plans are based on the quality 

of care received by veterans at VA medical facilities, including reviews and recommendations concerning such facilities by the 

VAOIG and the Joint Commission. 

House Amendment 

The House amendment contained no similar provision. 

Conference Agreement 

The Conference substitute adopts the Senate provision. 

IMPROVED TRANSPARENCY CONCERNING HEALTH CARE PROVIDED BY

DEPARTMENT OF VETERANS AFFAIRS

Current Law 

VHA operates the largest integrated health care system in the 

nation, providing care to nearly 6.5 million veterans, survivors, and 

their dependents every year. According to GAO, between FY 2005 

and FY 2012, the number of outpatient medical appointments at 

VA has increased by roughly 45 percent. VA’ s own data on wait 

times for FY 2010 suggested it was seeing virtually all its primary 

and specialty care appointments within the 30 days of desired date 

requirement that had been established in 1995. As a result, in FY 

2011, VHA shortened its goal of scheduling both primary and specialty care appointments to 14 days. While VA did not publicly publish data related to wait times, it did attempt to encourage accountability by incorporating the wait-time goal metric into the performance contracts of VISN and VAMC directors. 

Senate Amendment 

The Senate amendment would require the Secretary to publish 

wait-times for scheduling an appointment at VA facilities in the 

Federal Register and on a public website of each medical center 

within 90 days of the date of enactment of this Act. It would also 

require VA to publish, on the Internet, current wait times for appointments in primary and specialty care at each VA medical center. 

House Amendment 

The House amendment contained no similar provision. 


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Conference Agreement 

The Conference substitute adopts the Senate provision. 

INFORMATION FOR VETERANS ON THE CREDENTIALS OF DEPARTMENT

OF VETERANS AFFAIRS PHYSICIANS

Current Law 

In FY 2013, 18,342 physicians; 991 dentists; 50,862 registered 

nurses; 23,729 licensed practical nurses, licensed vocational nurses, 

and nurse assistants; and 12,102 non-physician providers delivered 

care to nearly 6.5 million veterans, survivors, and their dependents. VA makes information regarding its health care providers 

available to its patients and the public through the ‘‘Our Doctors’’ 

section on the website for each of VA’s medical centers. Congressional oversight has determined that these websites contain limited 

information regarding the credentials for VA’s physicians. 

Senate Amendment 

The Senate amendment would require VA to improve the information available to veterans regarding residency training in the 

‘‘Our Doctors’’ database located on each VA medical facility’s 

website. It would also require VA to provide information regarding 

a physician’s credentials to a veteran, or an individual acting on 

behalf of a veteran, prior to undergoing a surgical procedure by or 

through VA. 

House Amendment 

The House amendment contained no similar provision. 

Conference Agreement 

The Conference substitute adopts the Senate provision. 

INFORMATION IN ANNUAL BUDGET OF THE PRESIDENT ON HOSPITAL

CARE AND MEDICAL SERVICES FURNISHED THROUGH EXPANDED USE

OF CONTRACTS FOR SUCH CARE

Current Law 

Under current law, section 1105 of title 31, U.S.C., the President submits a budget for the U.S. Government that includes a 

message, summary and supporting information. 

Senate Amendment 

The Senate amendment would require the Secretary to include 

information in the Department’s budget submission regarding hospital care and medical services furnished through expanded use of 

contracts. 

House Amendment 

The House amendment contained no similar provision. 

Conference Agreement 

The Conference substitute adopts the Senate provision. 


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PROHIBITION ON FALSIFICATION OF DATA CONCERNING WAIT TIMES

AND QUALITY MEASURES AT DEPARTMENT OF VETERANS AFFAIRS

Current Law 

In May 2014, concerns about VA’s scheduling practices, including excessive wait times, were identified in the VAOIG’s interim report regarding the alleged patient deaths at the Phoenix Health 

Care System. The results indicated that 1,700 veterans were waiting for a primary care appointment but had not been placed on the 

EWL. In its report, the VAOIG noted that, as a direct result of not 

properly placing veterans on the EWL, the leadership at the Phoenix Health Care System had radically understated the amount of 

time new patients waited for their primary care appointments. 

Senate Amendment 

The Senate amendment would require VA to establish disciplinary procedures within 60 days of enactment of this Act for employees who knowingly submit false data pertaining to wait times 

and quality measures or knowingly require another employee of the 

Department to submit false data concerning such wait times or 

quality measures to another employee of the Department. 

House Amendment 

The House amendment contained no similar provision. 

Conference Agreement 

The Conference substitute adopts the Senate provision. 

TITLE III—HEALTH CARE STAFFING, RECRUITMENT, AND TRAINING

MATTERS

TREATMENT OF STAFFING SHORTAGE AND BIENNIAL REPORT ON

STAFFING OF MEDICAL FACILITIES OF THE DEPARTMENT OF VETERANS AFFAIRS

Current Law 

Subsection 3304(a) of title 5, U.S.C., authorizes federal agencies to appoint, without regard to certain hiring preferences and 

competitive service selection requirements, candidates directly to 

positions for which a severe shortage of candidates or a critical hiring need has been identified. 

VA’s own nation-wide access audit determined that VA faces 

staffing challenges and needs additional health care professionals, 

such as primary care physicians, specialty care physicians, and administrative and support staff, to improve access to high quality 

health care for veterans. These reviews and Congressional oversight have identified the federal government’s long hiring process 

as a barrier to recruiting qualified health care professionals to the 

VA health care system. 

Furthermore, GAO and VAOIG have reported that inadequate 

staffing and gaps in hiring health care professionals at VA medical 

facilities throughout the country have adverse effects on patient 

care. These adverse effects include increased wait times and delays 

in scheduling appointments. Current law, however, is silent on reVerDate Mar 15 2010 10:07 Jul 29, 2014 Jkt 039006 PO 00000 Frm 00068 Fmt 6601 Sfmt 6601 E:\HR\OC\HR564.XXX HR564

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quiring periodic assessments of VA’s staffing and succession planning process. 

Senate Amendment 

The Senate amendment would require VAOIG to annually 

identify the five occupations of health care providers with the largest staffing shortages and would authorize VA to utilize direct appointment authority to fill such openings in an expedited manner. 

It would also give priority for VA’ s Health Professionals Educational Assistance Program to individuals pursuing a medical degree with the intent to specialize in occupations identified by the 

VAOIG. 

It would also require VA to submit a report to the Committees, 

not later than 180 days after the date of enactment of and not later 

than December 31, biennially, thereafter through 2024, on staffing 

at each VA medical facility. Such report would be required to include: the results of a system-wide assessment of all VA medical 

facilities, including a plan for addressing any issues identified in 

such assessment; a list of the current wait times, workload levels, 

and staffing models for certain clinics; the results of the most current VAOIG findings regarding staffing shortages and VA’s plan to 

use direct appointment authority to fill such staffing shortages; an 

analysis of succession planning at VA medical facilities; and the 

number of VA health care providers who have been removed, retired, or left their positions for other reasons. 

House Amendment 

The House amendment contained no similar provision. 

Conference Agreement 

The Conference substitute adopts the Senate provision with an 

amendment that would require the Secretary to establish medical 

residency programs or ensure sufficient numbers of medical residency positions at facilities with existing programs in areas experiencing a shortage of physicians or located in a community that is 

designated as a health professional shortage area. It would also increase the number of graduate medical education residency positions by up to 1,500 over five years with a priority for primary 

care, mental health, and other specialties as VA determines appropriate. Finally, it would require an annual report to Congress. 

The Conference encourages VA to explore options of partnering 

with private sector and affiliate hospitals who could potentially 

provide vacant space to VA for care. 

EXTENSION AND MODIFICATION OF CERTAIN PROGRAMS WITHIN THE

DEPARTMENT OF VETERANS AFFAIRS HEALTH PROFESSIONALS EDUCATIONAL ASSISTANCE PROGRAM

Current Law 

Section 7601, et seq. of title 38, U.S.C., provides VA with authority to carry out the VA Health Professionals Education Assistance Program (hereinafter, ‘‘HPEAP’’) to provide scholarships, tuition assistance, debt reduction assistance, and other educational 

programs to VA health care professionals. HPEAP serves as a reVerDate Mar 15 2010 10:07 Jul 29, 2014 Jkt 039006 PO 00000 Frm 00069 Fmt 6601 Sfmt 6601 E:\HR\OC\HR564.XXX HR564

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cruitment and retention tool for the Department. For example, the 

Education Debt Reduction Program (hereinafter, ‘‘EDRP’’), which 

provides educational assistance to VHA employees in an effort to 

maintain staffing levels, has assisted 10,055 individuals from FY 

2002 through FY 2013. However, VA has acknowledged EDRP has 

experienced lower than expected utilization rates because it requires participants to pay student loan expenses upfront which are 

reimbursed later by the Department. As a result, the number of 

participants defaulting on their loans and subsequently being removed from the program is higher than anticipated. 

Senate Amendment 

The Senate amendment contained no similar provision. 

House Amendment 

The House amendment contained no similar provision. 

Conference Agreement 

The Conference substitute would extend VA’s authority to operate HPEAP through December 31, 2019. It would also increase 

the cap on debt reduction payments to an individual participant 

from $60,000 to $120,000. These amendments would bring VA’s 

Health Professionals Educational Assistance Program in line with 

other similar federal programs and ensure VA has the authority to 

provide appropriate incentives to attract health care professionals. 

CLINIC MANAGEMENT TRAINING FOR EMPLOYEES AT MEDICAL

FACILITIES OF THE DEPARTMENT OF VETERANS AFFAIRS

Current Law 

Timely access to health care requires efficient clinic management. As early as 2005, GAO noted that VHA lacked standardized 

training programs for scheduling. Further, VHA has no leadership 

or management training in access to care management. GAO, 

VAOIG and VA’s Office of Medical Inspector have identified standardization of clinic management training regarding availability of 

providers’ schedules as a VA management challenge. Specific VA 

medical centers that have experienced difficulty with standardized 

scheduling processes are the VA San Diego Health Care System, 

the Cheyenne, Wyoming, VA Medical Center, and the Phoenix VA 

Healthcare System. Moreover, the tone of VHA’s directive entitled 

Outpatient Scheduling Processes and Procedures is written in a 

manner that offers guidance rather than specific policy, seemingly 

allowing for discretion regarding its implementation. 

Senate Amendment 

The Senate amendment would require VA to implement a clinic management training program to provide in-person, standardized education on health care management to all VA managers and 

health care providers. Such training program would be required to 

include training on: managing the schedules of VA health care providers; the appropriate number of appointments that a VA health 

care provider should conduct on a daily basis; managing appointments; the proper use of VA’ s appointment scheduling system; opVerDate Mar 15 2010 10:07 Jul 29, 2014 Jkt 039006 PO 00000 Frm 00070 Fmt 6601 Sfmt 6601 E:\HR\OC\HR564.XXX HR564

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timizing the use of technology; and the proper use of physical plant 

space at VA medical facilities. 

It would also require VA to carry out the clinic management 

training program for two years and would require VA to update 

training materials on an ongoing basis and provide such training 

materials to relevant officials, as appropriate. Updating of training 

materials will need to account for new IT such as a new scheduling 

system or electronic access to care dash board. 

House Amendment 

The House amendment contained no similar provision. 

Conference Agreement 

The Conference substitute adopts the Senate provision. 

TITLE IV—HEALTH CARE RELATED TO SEXUAL TRAUMA

EXPANSION OF ELIGIBILITY FOR SEXUAL TRAUMA COUNSELING AND

TREATMENT TO VETERANS ON INACTIVE DUTY TRAINING

Current Law 

Section 1720D of title 38, U.S.C., requires VA to provide counseling and appropriate care and services to veterans to overcome 

psychological trauma, which in the judgment of a VA mental health 

professional, resulted from a physical assault of a sexual nature, 

battery of a sexual nature, or sexual harassment which occurred 

while the veteran was serving on active duty or active duty for 

training (otherwise known as military sexual trauma) (hereinafter, 

‘‘MST’’). Veterans who experienced MST while serving on active 

duty or active duty for training are included under this authority. 

However, veterans who experienced MST while on inactive duty for 

training—for example, those who were assaulted during weekend 

drill training for the National Guard and Reserve—are not included. 

Senate Amendment 

The Senate amendment would amend section 1720D of title 38, 

U.S.C., to provide VA with the authority to provide counseling, care 

and services to veterans, and certain other servicemembers who 

may not have veteran status, who experienced sexual trauma while 

serving on inactive duty for training. 

House Amendment 

The House amendment contained no similar provision. 

Conference Agreement 

The Conference substitute adopts the Senate provision. 

PROVISION OF COUNSELING AND TREATMENT FOR SEXUAL TRAUMA BY

THE DEPARTMENT OF VETERANS AFFAIRS TO MEMBERS OF THE

ARMED FORCES

Current Law 

Under current law, section 1720D of title 38, U.S.C., VA has 

the authority to provide counseling, care and services to veterans 


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who experienced sexual trauma while serving on active duty or active duty for training. 

Senate Amendment 

The Senate amendment would expand eligibility for care and 

services for MST at a VA facility to active duty servicemembers. 

Active duty servicemembers would not be required to initially be 

seen by DOD and receive a referral before seeking treatment at a 

VA facility for MST. It would take effect on the date that is one 

year after the date of enactment. 

House Amendment 

The House amendment contains no similar provision. 

Conference Agreement 

The Conference substitute adopts the Senate position. 

REPORTS ON MILITARY SEXUAL TRAUMA

Current Law 

Section 1720D of title 38, U.S.C., states that ‘‘each year, the 

Secretary shall submit to Congress an annual report on the counseling, care, and services provided to veterans pursuant to this section.’’ However, there is no language requiring an assessment. 

Senate Amendment 

The Senate amendment would require the VA–DOD Joint Executive Committee to conduct an annual assessment for the next 

five years of the processes and procedures regarding the transition 

and continuum of care from the DOD to VA for individuals who 

have experienced MST. The assessment would also include the 

processes and collaboration by the agencies to assist individuals filing a claim for MST related disability. Additionally, VA would be 

required to submit a report to Congress no later than 630 days 

from the date of enactment of the Act on the treatment and services available for male veterans who experience MST compared to 

such treatment and services available to female veterans. It would 

take effect on the date that is 270 days after the date of enactment 

of the Act. 

House Amendment 

The House amendment contained no similar provision. 

Conference Agreement 

The Conference substitute adopts the Senate provision. 

TITLE V—OTHER HEALTH CARE MATTERS

EXTENSION OF PILOT PROGRAM ON ASSISTED LIVING SERVICES FOR

VETERANS WITH TRAUMATIC BRAIN INJURY

Current Law 

Section 1705 of Public Law 110–181, the ‘‘National Defense 

Authorization Act for Fiscal Year 2008,’’ requires: (1) VA, in collaboration with the Defense and Veterans Brain Injury Center, to 


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carry out a five-year pilot program to assess the effectiveness of 

providing assisted living services to veterans with traumatic brain 

injury (hereinafter, ‘‘TBI’’) to enhance their rehabilitation, quality 

of life, and community integration; (2) at least one part of the pilot 

program to be carried out in a VISN that contains a VA 

polytrauma center; (3) special consideration to be given to veterans 

in rural areas; and, (4) VA to report to the Committees on the pilot 

program. To comply with this requirement, VA awarded a national 

contract to 20 contractors at more than 150 sites of care across the 

U.S. However, statutory authority for this pilot program expires on 

September 30, 2014. 

Senate Amendment 

The Senate amendment contains no similar provision. 

House Amendment 

The House amendment contains no similar provision. 

Conference Agreement 

The Conference agreement extends the statutory authority for 

VA to operate the pilot program from September 30, 2014, to October 6, 2017. 

TITLE VI—MAJOR MEDICAL FACILITY LEASES

AUTHORIZATION OF MAJOR MEDICAL FACILITY LEASES

Current Law 

Under current law, section 8104 of title 38, U.S.C., Congressional authorization is required prior to entering into any VA major 

medical facility lease that has an average annual rent of 

$1,000,000 or above. 

Senate Amendment 

The Senate amendment would authorize VA to enter into 26 

major medical facility leases in 17 states and Puerto Rico. 

House Amendment 

The House amendment contained no similar provision. 

Conference Agreement 

The Conference substitute adopts the Senate provision with an 

amendment to include a lease authorization for a VA communitybased outpatient clinic in Tulsa, Oklahoma, in an amount not to 

exceed $13.27 million. In enacting such leases, the Conferees would 

like the Secretary to consider any potential cost, energy and schedule savings that might be offered by standardized design elements 

and off-site construction methods, including prefabricated components and panelized structures. 


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BUDGETARY TREATMENT OF DEPARTMENT OF VETERANS AFFAIRS

MAJOR MEDICAL FACILITIES LEASES

Current Law 

Section 8104 of title 38, U.S.C., requires authorization of any 

major medical facility construction project or lease. Subsections 

(a)(1)(A) and (a)(1)(B) of section 1341 of title 31, U.S.C., prohibit 

any government employee from entering into contracts, or making 

or authorizing expenditures and obligations that exceed the 

amount of appropriated funds for such expenditures. 

Appendix B of the Office of Management and Budget’s (hereinafter, ‘‘OMB’’) Circular A–11 (hereinafter, ‘‘Circular’’) describes the 

processes through which budgetary treatment of lease-purchase 

and leases of capital assets will be consistent with scorekeeping 

rules originally promulgated in connection with the Budget Enforcement Act of 1990 and the Anti-Deficiency Act. According to the 

Circular, at the time an Agency enters into a binding commitment, 

the Agency must obligate sufficient budget authority to cover associated legal obligations to the government, consistent with the requirements of the Anti-Deficiency Act. For lease-purchases or capital leases, this consists of the net present value of the total estimated legal obligations over the entire life of the contract. For operating leases, this can consist of either an amount sufficient to 

cover the lease payments for the first year plus a sufficient amount 

to cover any costs associated with cancellation of the contract, if 

the contract includes a cancellation clause, or an amount sufficient 

to cover the annual lease payment, if the lease is funded through 

a self-insuring fund such as the General Services Administration’s 

Federal Building Fund. 

After receiving information about how VA has exercised the 

authority provided in prior VA major medical facilities leasing authorizations, the Congressional Budget Office (hereinafter, ‘‘CBO’’) 

concluded in 2012 that VA has been entering into binding obligations for the full period of the lease, without regard to the 

scorekeeping rules contained in the Circular. 

Senate Amendment 

The Senate amendment would require the funding prospectus 

of a proposed lease to include a detailed analysis of how the lease 

is expected to comply with OMB’s Circular and the Anti-Deficiency 

Act. It also directs VA, at least 30 days before entering into a lease, 

to submit to the Committees: (1) notice of the intention to enter 

into, and a detailed summary of, such lease; (2) a description and 

analysis of any differences between the lease prospectus submitted 

and the proposed lease; and (3) a scoring analysis demonstrating 

that the proposed lease fully complies with OMB’s Circular. VA 

must also report any material differences between the proposed 

lease and the lease entered, no later than 30 days after entering 

into a lease. 

House Amendment 

The House amendment contains no similar provision. 


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Conference Agreement 

The Conference substitute adopts the Senate provision. 

TITLE VII—OTHER VETERANS MATTERS

EXPANSION OF MARINE GUNNERY SERGEANT JOHN DAVID FRY

SCHOLARSHIP

Current Law 

Public Law 111–32, the ‘‘Supplemental Appropriations Act of 

2009,’’ amended the Post-9/11 GI Bill to establish the Marine Gunnery Sergeant John David Fry Scholarship for the children of 

servicemembers who died in the line of duty after September 10, 

2001. Eligible children are entitled to 36 months of benefits at the 

100 percent level and may use the benefit until their 33rd birthday. 

Currently, surviving spouses of servicemembers who died in 

the line of duty are only eligible to receive survivors’ and dependents’ educational assistance (hereinafter, ‘‘Chapter 35’’). Chapter 35 

benefits provide a spouse up to $1,003 per month as a full-time college student, which may require the spouse to find other sources 

of income or funding to offset the high cost of education. Additionally, recipients of Chapter 35 do not receive a separate living allowance. 

Senate Amendment 

The Senate amendment would expand the Marine Gunnery 

Sergeant John David Fry Scholarship to include surviving spouses 

of members of the Armed Forces who died or die in the line of duty 

after September 10, 2001. It would amend subsection (b)(9) of section 3311 of title 38, U.S.C., to expand the ability to receive the 

Marine Gunnery Sergeant John David Fry Scholarship to surviving 

spouses. It would limit the entitlement of the surviving spouse to 

the date that is 15 years after the date of the servicemember’s 

death or the date the surviving spouse remarries, whichever is earlier. Further, a surviving spouse, who is entitled both under 

amended section 3311 and under Chapter 35, would be required to 

make an irrevocable election to receive educational assistance 

under either amended section 3311 or Chapter 35. Finally, this provision would make a necessary conforming amendment to subsection (b)(4) of section 3321 of title 38, U.S.C. 

House Amendment 

The House amendment contained no similar provision. 

Conference Agreement 

The Conference substitute adopts the Senate position with an 

effective date of January 1, 2015. 


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APPROVAL OF COURSES OF EDUCATION PROVIDED BY PUBLIC INSTITU- TIONS OF HIGHER LEARNING FOR PURPOSES OF ALL-VOLUNTEER

FORCE EDUCATIONAL ASSISTANCE PROGRAM AND POST–9/11 EDU- CATIONAL ASSISTANCE CONDITIONAL ON IN-STATE TUITION RATE

FOR VETERANS

Current Law 

Section 3313 of title 38, U.S.C., authorizes VA to pay in-state 

tuition and fees for veterans attending a public educational institution using their Post-9/11 GI Bill educational benefits. However, a 

veteran may not always qualify for in-state tuition rates. 

Several states currently assist all or certain veterans by recognizing them as in-state students for purposes of attending a public 

educational institution, regardless of length of residency in the 

state where the veteran is attending college. Yet, many states require transitioning veterans to meet stringent residency requirements before they can be considered in-state residents. Federal law 

is silent on this matter. 

Recently-separated veterans may not be able to meet state 

residency requirements where they choose to attend school because 

they were stationed elsewhere during their military service, and 

once enrolled, they may not be able to legally establish residency 

because of their status as full-time students. The federal educational assistance provided to veterans by VA was designed, in 

part, to help them develop the skills and background necessary to 

make a successful transition from military service to a civilian life 

and career. 

Senate Amendment 

The Senate amendment would amend section 3679 of title 38, 

U.S.C., by adding a new subsection (c) to require VA to disapprove 

courses of education provided by public institutions of higher learning that charge tuition and fees at more than the in-state resident 

rate for veterans within three years from discharge from a period 

of at least 90 days service in the military, irrespective of the veteran’s current state of residence, if the veteran is living in the state 

in which the institution is located while pursuing that course of 

education. Pursuant to subsection (c), this provision would apply to 

veterans using the educational assistance programs administered 

by VA under chapters 30 and 33 of title 38, U.S.C., and to dependent beneficiaries using Post-9/11 GI Bill benefits during the three 

years after the veteran’s discharge. If the veteran or dependent enrolls within three years after the veteran’s discharge, the requirement to charge no more than the in-state tuition rate would apply 

for the duration the individual remains continuously enrolled at 

the institution. 

Subsection (c)(4) would permit a public educational institution 

to require a covered individual to demonstrate an intent, by means 

other than satisfying a physical presence requirement, to eventually establish residency in that state or to meet requirements unrelated to residency in order to be eligible for the in-state tuition 

rate. This section would also provide VA discretion to waive the established requirements in a circumstance where it is deemed appropriate in regards to approval of a specific course of education. 


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Any disapproval of courses pursuant to these new requirements 

would apply only with respect to benefits provided under chapters 

30 and 33 of title 38. This provision would apply to programs of 

education that begin during academic terms after July 1, 2015. 

House Amendment 

The House amendment contained no similar provision. 

Conference Agreement 

The Conference substitute adopts the Senate provision. 

EXTENSION OF REDUCTION IN AMOUNT OF PENSION FURNISHED BY

DEPARTMENT OF VETERANS AFFAIRS FOR CERTAIN VETERANS COVERED BY MEDICAID PLANS FOR SERVICES FURNISHED BY NURSING

FACILITIES

Current Law 

Section 5503 of title 38, U.S.C., sets forth the criteria under 

which eligibility for income-based pension payments and aid and 

attendance allowances are affected by domiciliary or nursing home 

residence. In instances where a veteran, or surviving spouse, has 

neither a spouse nor a child, and is receiving Medicaid-covered 

nursing home care, the veteran or surviving spouse is eligible to receive no more than $90 per month in VA pension or death pension 

payments. Under current law, this authority shall expire on November 30, 2016. This authority has been extended several times, 

most recently pursuant to Public Law 112–260, the ‘‘Dignified Burial and Other Veterans’ Benefits Improvement Act of 2012.’’ 

Senate Amendment 

The Senate amendment contains no similar provision. 

House Amendment 

The House amendment contains no similar provision. 

Conference Agreement 

The Committee substitute would amend section 5503( d)(7) to 

extend, through September 30, 2024, current eligibility restrictions 

for recipients of a VA pension who receive Medicaid-covered nursing home care. The VA pension program should not be used to subsidize other federal benefit programs. Further, pension recipients 

should have available funds for incidentals and personal expenses. 

EXTENSION OF REQUIREMENT FOR COLLECTION OF FEES FOR HOUSING

LOANS GUARANTEED BY SECRETARY OF VETERANS AFFAIRS

Current Law 

Under VA’s home loan guaranty program, VA may guarantee 

a loan made to eligible servicemembers, veterans, reservists, and 

certain un-remarried surviving spouses for the purchase (or refinancing) of houses, condominiums, and manufactured homes. Section 3729(b)(2) of title 38, U.S.C., sets forth a loan fee table that 

lists funding fees, expressed as a percentage of the loan amount, 

for different types of loans. 


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Senate Amendment 

The Senate amendment contains no similar provision. 

House Amendment 

The House amendment contains no similar provision. 

Conference Agreement 

The Committee substitute would extend VA’s authority to collect certain funding fees through September 30, 2024, by amending 

the fee schedule set forth in section 3729(b)(2) of title 38, U.S.C. 

LIMITATION ON AWARDS AND BONUSES PAID TO EMPLOYEES OF

DEPARTMENT OF VETERANS AFFAIRS

Current Law 

Under current law, chapter 45, chapter 53, and other provisions of title 5, U.S.C., VA has the authority to provide awards to 

certain employees. For example, chapter 45 of title 5 provides VA 

with authority to grant cash awards to employees in recognition of 

performance. 

Senate Amendment 

The Senate amendment contained no similar provision. 

House Amendment 

The House amendment would, for each of FYs 2014 through 

2016, prohibit the Secretary from paying awards or bonuses under 

chapters 45 or 53 of title 5, U.S.C., or any other awards or bonuses 

authorized under such title. 

Conference Agreement 

The Conference substitute adopts the House provision with an 

amendment that would, for each of FYs 2014 through 2024, cap the 

amount of awards or bonuses payable under chapter 45 or 53 of 

title 5, U.S.C., or any other awards or bonuses authorized under 

such title, at $360 million. It is the Conferees’ expectation that this 

cap not disproportionately impact lower-wage employees. 

EXTENSION OF AUTHORITY TO USE INCOME INFORMATION

Current Law 

Certain benefit programs administered by VA, including pension for wartime veterans and compensation for Individual 

Unemployability are available only to beneficiaries whose annual 

income is below a certain level. VA must have access to verifiable 

income information in order to ensure that those receiving benefits 

under its income-based programs are not earning a greater annual 

income than the law permits. 

Section 6103(1)(7)(D) of title 26, U.S.C., authorizes the release 

of certain income information by the Internal Revenue Service 

(hereinafter, ‘‘IRS’’) or the Social Security Administration (hereinafter, ‘‘SSA’’) to VA for the purposes of verifying income of applicants for VA needs-based benefits. Section 5317(g) of title 38, 

U.S.C., provides VA with temporary authority to obtain and use 


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this information. Under current law, this authority expires on September 30, 2016. 

Senate Amendment 

The Senate amendment contains no similar provision. 

House Amendment 

The House amendment contains no similar provision. 

Conference Agreement 

The Committee substitute would extend for eight years, until 

September 30, 2024, VA’s authority to obtain information from the 

IRS or the SSA for income verification purposes for needs-based 

benefits. 

REMOVAL OF SENIOR EXECUTIVE OF THE DEPARTMENT OF VETERANS

AFFAIRS FOR PERFORMANCE OR MISCONDUCT. 

Current Law 

Under current law, section 7543 of title 5, U.S.C., career appointees in the Senior Executive Service (hereinafter, ‘‘SES’’) may 

be removed from government service for misconduct, neglect of 

duty, malfeasance, or failure to accept a directed reassignment or 

to accompany a position in a transfer of function. Senior executives 

removed as a result of these conduct-related issues are entitled to 

certain rights, including at least 30 days advance written notice; a 

reasonable time but not less than seven days to reply; representation by an attorney or other representative; a written decision from 

the agency involved; and appeal rights to the Merit Systems Protection Board (hereinafter, ‘‘MSPB’’). 

Under current law, section 3592 of title 5, U.S.C., career appointees in the SES may be removed from the SES and placed into 

a non-SES position for performance-related issues. This removal 

may occur at any time during a one-year probationary period or at 

any time for less than fully successful executive performance. Generally, senior executives removed from the SES and placed into a 

civil service position are entitled to an informal hearing before the 

MSPB. 

Also under current law, section 3592(b) of title 5, U.S.C., there 

is a 120-day moratorium from removing a career appointee in the 

SES following the appointment of the head of the agency or the 

SES employee’s immediate supervisor. 

Senate Amendment 

The Senate amendment would provide the Secretary with the 

authority to remove or demote any individual from the SES if the 

Secretary determines the performance of the individual warrants 

such removal and requires the Secretary to notify Congress within 

30 days of removing or demoting a senior executive under this authority. The senior executive would be allowed an opportunity for 

an expedited review by the MSPB. Under such expedited appeal, 

the senior executive would have seven days to appeal a removal or 

demotion and the MSPB would be required to adjudicate the appeal within 21 days. 


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The MSPB would be required to establish and implement a 

process to conduct expedited reviews and submit to Congress a report on their established process within 30 days of enactment. 

The Senate amendment would also provide authority for the 

Secretary to immediately remove senior executives notwithstanding 

the 120-day moratorium in current law. 

House Amendment 

The House amendment would provide the Secretary with the 

authority to remove or demote any individual from the SES if the 

Secretary determines the performance of the individual warrants 

such removal and requires the Secretary to notify Congress within 

30 days of removing or demoting a senior executive under this authority. 

Conference Agreement 

The Conference substitute generally adopts the Senate provision with an amendment to change the level of review at the 

MSPB. The substitute requires that the expedited review by the 

MSPB be conducted by an Administrative Judge at the MSPB, and 

if the MSPB Administrative Judge does not conclude their review 

within 21 days then the removal or demotion is final. The substitute does not allow for any further appeal beyond the Administrative Judge, and does not allow for a second level review by the 

three-person board at the MSPB. The substitute also requires that 

if the senior executive is removed, and then appeals VA’s decision, 

the senior executive is not entitled to any type of pay, bonus, or 

benefit while appealing the decision of removal. Furthermore, the 

substitute requires that if a senior executive is demoted, and then 

appeals VA’s decision, the employee may only receive any type of 

pay, bonus, or benefit at the rate appropriate for the position they 

were demoted to, and only if the individual shows up for duty, 

while appealing the decision of demotion. The substitute requires 

that the MSPB submit to Congress a plan within 14 days of enactment of how the expedited review would be implemented. The substitute also adds language to include title 38 SES equivalents 

under this new authority and includes ‘‘misconduct’’ along with 

‘‘poor performance’’ as a reason to remove or demote a senior executive. 

TITLE VIII—OTHER MATTERS

APPROPRIATION OF AMOUNTS

Current Law 

Congress uses an appropriation to provide funding for discretionary spending programs of the Federal government. 

Senate Amendment 

The Senate amendment would authorize and appropriate for 

FYs 2014, 2015, and 2016, the emergency funds necessary to carry 

out this Act. 

In addition, the Senate amendment would make available, at 

the end of FYs 2014 and 2015, unobligated balances in VA’s medical care accounts (medical services, medical support and compliVerDate Mar 15 2010 10:07 Jul 29, 2014 Jkt 039006 PO 00000 Frm 00080 Fmt 6601 Sfmt 6601 E:\HR\OC\HR564.XXX HR564

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ance, and medical facilities) for the hiring of additional health care 

professionals. 

House Amendment 

The House amendment contained no similar provision. 

Conference Agreement 

The Conference substitute authorizes and appropriates $5 billion to increase veterans access to care through the hiring of physicians and other medical staff and by improving VA’s physical infrastructure. 

VETERANS CHOICE FUND

Current Law 

There is no provision of law establishing a Veterans Choice 

Fund. 

Senate Amendment 

The Senate amendment contained no similar provision. 

House Amendment 

The House amendment contained no similar provision. 

Conference Agreement 

The Conference substitute establishes in the Treasury a fund 

to be known as the Veterans Choice Fund to carry out the expanded availability of hospital care and medical services for veterans created by section 101 of the Conference substitute. The Conference substitute also authorizes and appropriates $10 billion for 

deposit in the Veterans Choice Fund. 

EMERGENCY DESIGNATIONS

Current Law 

Congress may exempt the budgetary effects of a provision from 

certain enforcement procedures by designating it as an emergency 

requirement. An emergency designation causes the spending and 

revenue effects estimated to result from such bills as exempt for 

purposes of enforcing budget procedures. 

Senate Amendment 

The Senate amendment would designate this Act as an emergency requirement under the Statutory Pay-As-You-Go Act of 2010 

and the Concurrent Resolution on the budget for FY 2010. 

House Amendment 

The House amendment contained no similar provision. 

Conference Agreement 

The Conference substitute adopts the Senate provision. 

JEFF MILLER, 

DOUG LAMBORN, 

DAVID P. ROE, 

BILL FLORES, 


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DAN BENISHEK, MIKE COFFMAN, BRAD R. WENSTRUP, JACKIE WALORSKI, MICHAEL H. MICHAUD, CORRINE BROWN, MARK TAKANO, JULIA BROWNLEY, ANN KIRKPATRICK, TIMOTHY J. WALZ, Managers on the part of the House. 

BERNARD SANDERS, 

JOHN D. ROCKEFELLER IV, 

PATTY MURRAY, 

SHERROD BROWN, 

JON TESTER, 

MARK BEGICH, 

RICHARD BLUMENTHAL, 

MAZIE K. HIRONO, 

RICHARD BURR, 

JOHNNY ISAKSON, 

MIKE JOHANNS, 

JOHN MCCAIN, 

TOM COBURN, 

MARCO RUBIO, 

Managers on the part of the Senate. 

COMPLIANCE WITH RULES OF THE HOUSE OF REPRESENTATIVES AND SENATE REGARDING EARMARKS AND CONGRESSIONALLY DIRECTED SPENDING ITEMS 

Pursuant to clause 9 of rule XXI of the Rules of the House of 

Representatives and rule XLIV of the Standing Rules of the Senate, neither this Conference report nor the accompanying joint 

statement of Conferees contains any congressional earmarks, congressionally directed spending items, limited tax benefits, or limited tariff benefits, as defined in such rules. 

For consideration of the House amendment and the Senate 

amendment, and modifications committed to conference: 

JEFF MILLER of Florida, 

DOUG LAMBORN, 

DAVID P. ROE of Tennessee, 

BILL FLORES, 

DAN BENISHEK, 

MIKE COFFMAN, 

BRAD R. WENSTRUP, 

JACKIE WALORSKI, 

MICHAEL H. MICHAUD, 

CORRINE BROWN of Florida, 

MARK TAKANO, 

JULIA BROWNLEY of California, 

ANN KIRKPATRICK, 

TIMOTHY J. WALZ, 

Managers on the part of the House. 


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BERNARD SANDERS, JOHN D. ROCKEFELLER IV, 

PATTY MURRAY, SHERROD BROWN, JON TESTER, MARK BEGICH, RICHARD BLUMENTHAL, MAZIE K. HIRONO, RICHARD BURR, JOHNNY ISAKSON, MIKE JOHANNS, Managers on the part of the Senate. 

Æ 


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