I 

118TH CONGRESS 

2D SESSION H. R. 8371 

To make certain improvements in the laws administered by the Secretary 

of Veterans Affairs, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 14, 2024 

Mr. CISCOMANI (for himself, Mr. ELLZEY, Mr. CAREY, Mr. BAIRD, Mr. 

BERGMAN, Mr. LUTTRELL, Mr. BACON, Mr. MURPHY, Mr. BOST, Mrs. 

KIGGANS of Virginia, Mrs. MILLER-MEEKS, Mr. GIMENEZ, Mr. WILLIAMS of New York, Mr. EDWARDS, and Mrs. STEEL) introduced the following bill; which was referred to the Committee on Veterans’ Affairs, 

and in addition to the Committees on Natural Resources, and Armed 

Services, for a period to be subsequently determined by the Speaker, in 

each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To make certain improvements in the laws administered by 

the Secretary of Veterans Affairs, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Senator Elizabeth Dole 21st Century Veterans 

6 Healthcare and Benefits Improvement Act’’. 


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1 (b) TABLE OF CONTENTS.—The table of contents for 

2 this Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—HEALTH CARE MATTERS 

Subtitle A—Veterans Community Care Program Matters 

Sec. 101. Finality of decisions by veteran and referring clinician under Veterans Community Care Program. 

Sec. 102. Outreach regarding care and services under Veterans Community 

Care Program. 

Sec. 103. Annual review and report on waivers of certain payment rates under 

Veterans Community Care Program. 

Sec. 104. Modification of requirements for standards for quality of care from 

Department of Veterans Affairs. 

Sec. 105. Standardized process to determine eligibility of covered veterans for 

participation in certain mental health treatment programs. 

Sec. 106. Improvements to Department of Veterans Affairs Mental Health Residential Rehabilitation Treatment Program. 

Sec. 107. Pilot program to improve administration of care under Veterans 

Community Care Program. 

Sec. 108. Pilot program on consolidating approval process of Department of 

Veterans Affairs for covered dental care. 

Sec. 109. Strategic plan on value-based health care system for Veterans Health 

Administration; pilot program. 

Sec. 110. Plan on adoption of certain health information standards for Department of Veterans Affairs and certain health care providers. 

Sec. 111. Report on use of value-based reimbursement models under Veterans 

Community Care Program. 

Sec. 112. Inspector General assessment of implementation of Veterans Community Care Program. 

Sec. 113. Comptroller General report on dentistry under Veterans Community 

Care Program. 

Subtitle B—Matters Relating to Nursing Home and Other Long Term Care 

and Family Caregivers 

Sec. 120. Increase of expenditure cap for noninstitutional care alternatives to 

nursing home care. 

Sec. 121. Coordination with Program of All-Inclusive Care for the Elderly. 

Sec. 122. Authority for Secretary of Veterans Affairs to award grants or contracts to entities to improve provision of mental health support 

to family caregivers of veterans. 

Sec. 123. Home- and community-based services: programs. 

Sec. 124. Coordination with assistance and support services for caregivers. 

Sec. 125. Improvements to program of comprehensive assistance for family 

caregivers. 

Sec. 126. Improvements relating to Homemaker and Home Health Aide program. 

Sec. 127. Pilot program to furnish assisted living services to certain veterans. 

Sec. 128. Provision of medicine, equipment, and supplies available to Department of Veterans Affairs to State homes. 


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Sec. 129. Recognition of organizations and individuals to assist veterans, family 

members, and caregivers navigating programs and services of 

Veterans Health Administration. 

Sec. 130. Reviews and other improvements relating to home- and communitybased services. 

Sec. 131. GAO report on mental health support for caregivers. 

Sec. 132. Development of centralized website for program information. 

Sec. 133. Definitions. 

Subtitle C—Medical Treatment and Other Matters 

Sec. 140. Quarterly report on referrals for non-Department of Veterans Affairs 

health care. 

Sec. 141. Elimination of certain requirements for certain Department of Veterans Affairs Assistant Under Secretaries. 

Sec. 142. Modification of pay limitation for physicians, podiatrists, optometrists, and dentists of Department of Veterans Affairs. 

Sec. 143. Reimbursement of ambulance cost for care for certain rural veterans. 

Sec. 144. Pilot program to furnish dental care from the Department of Veterans Affairs to certain veterans diagnosed with ischemic heart 

disease. 

Sec. 145. Documentation of preferences of veterans for scheduling of appointments for health care under laws administered by Secretary of 

Veterans Affairs. 

Sec. 146. Staffing model and performance metrics for certain employees of the 

Department of Veterans Affairs. 

Sec. 147. Online health education portal for veterans enrolled in patient enrollment system of Department of Veterans Affairs. 

Sec. 148. Limitation on detail of directors of medical centers of Department of 

Veterans Affairs to different positions. 

Sec. 149. National Veteran Suicide Prevention Annual Report. 

Sec. 150. Report on physical infrastructure required by medical facilities of Department of Veterans Affairs to provide dental care services. 

Sec. 151. Comptroller General report on certain oral health care programs 

under laws administered by Secretary of Veterans Affairs. 

Sec. 152. Review of workflows associated with processing referrals between facilities of the Veterans Health Administration. 

Sec. 153. Plan for timely scheduling of appointments at medical facilities of 

Department of Veterans Affairs. 

Sec. 154. Authorization of appropriations to support initiatives for mobile 

mammography services for veterans. 

TITLE II—ECONOMIC OPPORTUNITY MATTERS 

Subtitle A—Educational Assistance 

Sec. 201. Temporary expansion of eligibility for Marine Gunnery Sergeant John 

David Fry Scholarship. 

Sec. 202. Removal of expiration on entitlement to Marine Gunnery Sergeant 

John David Fry Scholarship for surviving spouses. 

Sec. 203. Sole liability for transferred educational assistance by an individual 

who fails to complete a service agreement. 

Sec. 204. Notice to educational institutions of risk-based surveys. 


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Sec. 205. Relationship of participation by an educational institution in certain 

Federal student financial aid programs to approval of such institution for purposes of Department of Veterans Affairs educational assistance programs. 

Sec. 206. Expansion of Department of Veterans Affairs oversight of certain 

educational institutions. 

Sec. 207. Requirement that educational institutions approved for purposes of 

Department of Veterans Affairs educational assistance programs provide digital official transcripts. 

Sec. 208. Payment of full monthly housing stipend for veterans enrolled in final 

semester using educational assistance under Post-9/11 Educational Assistance Program. 

Sec. 209. Modification of rules for approval of commercial driver education programs for purposes of educational assistance programs of the 

Department of Veterans Affairs. 

Sec. 210. Provision of certificates of eligibility and award letters using electronic means. 

Sec. 211. Retroactive effective date of law regarding charge to entitlement to 

educational assistance for individuals who do not transfer credits from certain closed or disapproved programs of education. 

Sec. 212. Department of Veterans Affairs high technology program. 

Sec. 213. Notice of changes to Department of Veterans Affairs policies and 

guidance affecting the educational assistance programs of the 

Department. 

Sec. 214. Payment of VA educational assistance via electronic fund transfer to 

a foreign institution of higher education. 

Sec. 215. Improving transparency and accountability of educational institutions 

for purposes of veterans educational assistance. 

Subtitle B—Employment and Training 

Sec. 221. Improvements to reemployment rights of members of the Armed 

Forces. 

Sec. 222. Review of investigations manual of Veterans’ Employment and Training Service. 

Sec. 223. Warrior Training Advancement Course. 

Subtitle C—Home Loans 

Sec. 231. Improvements to program for direct housing loans made to Native 

American veterans by the Secretary of Veterans Affairs. 

Sec. 232. Native community development financial institution relending program. 

TITLE III—DISABILITY AND MEMORIAL AFFAIRS MATTERS 

Sec. 301. Burial allowance for certain veterans who die at home while in receipt 

of hospice care furnished by Department of Veterans Affairs. 

Sec. 302. Authority for Secretary of Veterans Affairs to award grants to States 

and Indian Tribes to improve outreach to veterans. 

Sec. 303. Definition of surviving spouse. 

Sec. 304. Ensuring only licensed health care professionals perform medical disability examinations under certain Department of Veterans Affairs pilot program. 


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Sec. 305. Provision of information regarding an agent or attorney to a licensed 

health care professional who performs a medical disability examination under certain Department of Veterans Affairs pilot 

program. 

Sec. 306. Modernization of Department of Veterans Affairs disability benefit 

questionnaires. 

Sec. 307. Department of Veterans Affairs automatic processing of certain 

claims for temporary disability ratings. 

TITLE IV—HOMELESSNESS MATTERS 

Sec. 401. Short title. 

Sec. 402. Per diem payments provided by the Secretary of Veterans Affairs for 

services furnished to homeless veterans. 

Sec. 403. Authorization for Secretary of Veterans Affairs to use of certain 

funds for improved flexibility in assistance to homeless veterans. 

Sec. 404. Access to Department of Veterans Affairs telehealth services. 

TITLE V—ELECTRONIC HEALTH RECORD MATTERS 

Sec. 501. Short title. 

Sec. 502. Definitions. 

Subtitle A—Electronic Health Record System and Health Information 

Technology Modernization 

Sec. 511. Modernization of Department of Veterans Affairs electronic health 

record system and health information technology. 

Sec. 512. Responsibility for electronic health record program and health information technology. 

Sec. 513. Protection of personal information. 

Subtitle B—Implementation Requirements 

Sec. 521. Veterans Health Administration workflow baseline. 

Sec. 522. Requirements for electronic health record system implementation. 

Sec. 523. Conditional restructuring of Electronic Health Record Modernization 

Program. 

Subtitle C—Reporting 

Sec. 531. Report on additional purposes. 

Sec. 532. Reports on baseline of clinical workflows. 

Sec. 533. Report on health care quality metrics. 

Sec. 534. Report on support strategy for existing sites. 

Sec. 535. Report on resources required for future sites. 

Sec. 536. Report on alternative modernization strategies. 

Sec. 537. Report on health information technology strategy and roadmap. 

Sec. 538. Annual report on efforts to maintain VistA electronic health record 

system. 

Sec. 539. Modification of quarterly reports. 

Sec. 540. Report on protection of personal information. 

Sec. 541. Report on organization and needs. 

Sec. 542. Report on governance, performance criteria, and readiness. 

TITLE VI—OVERSIGHT AND INVESTIGATIONS MATTERS 


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Sec. 601. Department of Veterans Affairs employee training regarding Office of 

Inspector General. 

Sec. 602. Annual review of security at covered facilities of the Department of 

Veterans Affairs. 

Sec. 603. Modification of certain housing loan fees. 

1 TITLE I—HEALTH CARE 

2 MATTERS 

3 Subtitle A—Veterans Community 

4 Care Program Matters 

5 SEC. 101. FINALITY OF DECISIONS BY VETERAN AND RE6 FERRING CLINICIAN UNDER VETERANS COM7 MUNITY CARE PROGRAM. 

8 (a) IN GENERAL.—During the period specified in 

9 subsection (c), and subject to subsection (b), an agreement 

10 under section 1703(d)(1)(E) of title 38, United States 

11 Code, between a covered veteran and the referring clini12 cian of such veteran regarding the best medical interest 

13 of the veteran is final and is not subject to review, ap14 proval, or change by the Department of Veterans Affairs 

15 unless a statutory or regulatory barrier prevents the De16 partment from providing the care or services required 

17 under such agreement. 

18 (b) CORRECTION OF ERRORS.—A covered veteran 

19 and the referring clinician of such veteran may correct any 

20 errors made with respect to an agreement described in 

21 subsection (a). 

22 (c) PERIOD SPECIFIED.—The period specified in this 

23 subsection is the two-year period beginning on the date 


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1 that is 180 days after the date of the enactment of this 

2 Act. 

3 (d) ANNUAL REPORT.—Not later than one year and 

4 not later than two years after the commencement of the 

5 period specified under subsection (c), the Secretary of Vet6 erans Affairs shall submit to Congress a report on the care 

7 provided under section 1703(d)(1)(E) of title 38, United 

8 States Code, during the one-year period preceding the date 

9 of the report, including— 

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

11 (2) the type of care provided; and 

12 (3) the cost of such care. 

13 (e) COVERED VETERAN DEFINED.—In this section, 

14 the term ‘‘covered veteran’’ has the meaning given that 

15 term in section 1703(b) of title 38, United States Code. 

16 SEC. 102. OUTREACH REGARDING CARE AND SERVICES 

17 UNDER VETERANS COMMUNITY CARE PRO18 GRAM. 

19 (a) REQUIREMENT.—Section 1703 of title 38, United 

20 States Code, is further amended— 

21 (1) by redesignating subsection (o) as sub22 section (p); and 

23 (2) by inserting after subsection (n) the fol24 lowing new subsection (o): 


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1 ‘‘(o) OUTREACH REGARDING AVAILABILITY OF CARE

2 AND SERVICES.—(1) The Secretary shall conduct out3 reach to inform veterans of the following: 

4 ‘‘(A) The conditions for care or services under 

5 subsections (d) and (e). 

6 ‘‘(B) How to request such care or services. 

7 ‘‘(C) How to appeal a denial of a request for 

8 such care or services using the clinical appeals proc9 ess of the Veterans Health Administration. 

10 ‘‘(2) Upon enrollment of a veteran in the system of 

11 annual patient enrollment established and operated under 

12 section 1705 of this title, and not less frequently than 

13 every two years thereafter, the Secretary shall inform the 

14 veteran of information described in paragraph (1). 

15 ‘‘(3) The Secretary shall ensure that information de16 scribed in paragraph (1) is— 

17 ‘‘(A) publicly displayed in each medical facility 

18 of the Department; 

19 ‘‘(B) prominently displayed on a website of the 

20 Department; and 

21 ‘‘(C) included in other outreach campaigns and 

22 activities conducted by the Secretary.’’. 

23 (b) TRANSITIONAL SERVICES.—Section 

24 1144(f)(1)(B)(i) of title 10, United States Code, is amend25 ed by inserting ‘‘, including how to enroll in the system 


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1 of annual patient enrollment established and operated 

2 under section 1705 of title 38 and the ability to seek care 

3 and services under sections 1703 and 1710 of such title’’ 

4 before the semicolon. 

5 (c) SOLID START PROGRAM.—Section 6320(a)(2)(A) 

6 of title 38, United States Code, is amended by inserting 

7 ‘‘, including how to enroll in the system of annual patient 

8 enrollment established and operated under section 1705 

9 of this title and the ability to seek care and services under 

10 sections 1703 and 1710 of this title’’ before the semicolon. 

11 (d) COMPTROLLER GENERAL REPORT ON OUT12 REACH.—Not later than two years after the date of the 

13 enactment of this Act, the Comptroller General of the 

14 United Stats shall submit to Congress a report on the ef15 forts of the Secretary of Veterans Affairs to ensure that 

16 veterans are informed of the conditions for eligibility for 

17 care and services under section 1703 of title 38, United 

18 States Code, including such efforts to conduct outreach 

19 pursuant to subsection (q) of such section (as added by 

20 subsection (a)). 

21 SEC. 103. ANNUAL REVIEW AND REPORT ON WAIVERS OF 

22 CERTAIN PAYMENT RATES UNDER VETERANS 

23 COMMUNITY CARE PROGRAM. 

24 (a) IN GENERAL.—Section 1703 of title 38, United 

25 States Code, is further amended— 


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1 (1) by redesignating subsection (p) as sub2 section (q); and 

3 (2) by inserting after subsection (p) the fol4 lowing new subsection (q): 

5 ‘‘(q) ANNUAL REVIEW AND REPORT ON WAIVERS OF

6 PAYMENT RATES.—(1) On an annual basis, the Secretary 

7 shall— 

8 ‘‘(A) conduct a review of waivers of payment 

9 rates under subsection (i) for Third Party Adminis10 trators to identify whether such waivers help to al11 leviate community-specific challenges, including scar12 city of medical services associated with access to 

13 health care; and 

14 ‘‘(B) submit to Congress a report on the results 

15 of such review. 

16 ‘‘(2) Each report under paragraph (1)(B) shall in17 clude, with respect to the period covered by the report— 

18 ‘‘(A) a statement, disaggregated by region, of 

19 the total number of waivers described in subpara20 graph (A) of such paragraph requested by Third 

21 Party Administrators; 

22 ‘‘(B) a statement of the total number of such 

23 waivers that were— 

24 ‘‘(i) granted by the Secretary; 

25 ‘‘(ii) denied by the Secretary; or 


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1 ‘‘(iii) withdrawn by a Third Party Admin2 istrator; 

3 ‘‘(C) a description of the process for the review 

4 required under paragraph (1); 

5 ‘‘(D) a statement, disaggregated by region, of 

6 the average time to process such waivers; 

7 ‘‘(E) an assessment, disaggregated by region, of 

8 the extent to which such waivers that were granted 

9 by the Secretary improved access to health care for 

10 covered veterans; and 

11 ‘‘(F) a description of trends, if any, identified 

12 by the Secretary with respect to such waivers. 

13 ‘‘(3) In this subsection, the term ‘Third Party Ad14 ministrator’ has the meaning given such term in section 

15 1703B of this title.’’. 

16 (b) DEADLINE.—The Secretary shall submit the first 

17 report required under subsection (q) of section 1703 of 

18 such title (as added by subsection (a)) not later than 180 

19 days after the date of the enactment of this Act. 

20 SEC. 104. MODIFICATION OF REQUIREMENTS FOR STAND21 ARDS FOR QUALITY OF CARE FROM DEPART22 MENT OF VETERANS AFFAIRS. 

23 (a) IN GENERAL.—Section 1703C of title 38, United 

24 States Code, is amended— 

25 (1) in subsection (a)— 


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1 (A) in paragraph (2)— 

2 (i) by striking ‘‘In establishing’’ and 

3 inserting ‘‘(A) In establishing’’; and 

4 (ii) by adding at the end the following 

5 new subparagraph: 

6 ‘‘(B) The Secretary shall ensure that the stand7 ards for quality established under paragraph (1) are 

8 comparable to industry standards to ensure there is 

9 adequate data transference between care furnished 

10 by the Department and care furnished by a non-De11 partment provider.’’; 

12 (B) in paragraph (3), by adding at the end 

13 the following new clauses: 

14 ‘‘(v) Equitable care. 

15 ‘‘(vi) Outcomes relating to patient 

16 quality of life.’’; 

17 (C) in paragraph (4)— 

18 (i) by striking ‘‘and the Centers for 

19 Medicare & Medicaid Services’’ and insert20 ing ‘‘the Centers for Medicare & Medicaid 

21 Services, and the Indian Health Service’’; 

22 and 

23 (ii) by striking ‘‘and other nongovern24 mental entities’’ and inserting ‘‘and other 


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1 non-governmental entities including Third 

2 Party Administrators’’; and 

3 (D) by striking paragraph (5) and insert4 ing the following new paragraphs: 

5 ‘‘(5) When collecting, considering, and applying data 

6 related to patient care for purposes of establishing stand7 ards for quality under paragraph (1), the Secretary shall 

8 ensure no metric is being over or under analyzed. 

9 ‘‘(6) In establishing standards for quality under para10 graph (1), the Secretary shall— 

11 ‘‘(A) utilize the most up-to-date practices for 

12 extracting and analyzing relevant data; 

13 ‘‘(B) utilize all relevant data available to the 

14 Secretary; 

15 ‘‘(C) ensure the most efficient use of time and 

16 resources related to the use of data scientists em17 ployed by the Department; and 

18 ‘‘(D) collaborate, as appropriate, with entities 

19 specified in paragraph (4). 

20 ‘‘(7)(A) Not less frequently than once every five 

21 years, the Secretary shall update the standards for quality 

22 established under paragraph (1) pursuant to the require23 ments for the establishment of such standards under this 

24 subsection. 


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1 ‘‘(B) Not later than 30 days after any date on which 

2 the Secretary updates, pursuant to subparagraph (A), the 

3 standards for quality under paragraph (1), the Secretary 

4 shall submit to the appropriate committees of Congress 

5 a report on such updated standards for quality.’’; and 

6 (2) in subsection (b)— 

7 (A) in paragraph (1)— 

8 (i) by striking ‘‘Not later than 1 year 

9 after the date on which the Secretary es10 tablishes standards for quality under sub11 section (a)’’ and inserting ‘‘Not less fre12 quently than once every three years’’; and 

13 (ii) by inserting ‘‘pursuant to stand14 ards for quality under subsection (a)’’ 

15 after ‘‘medical facilities of the Depart16 ment’’; and 

17 (B) in paragraph (2), by inserting ‘‘or up18 dates’’ after ‘‘establishes’’. 

19 (b) DEADLINE FOR UPDATE.—The Secretary, pursu20 ant to paragraph (7) of section 1703C(a) of title 38, 

21 United States Code (as added by subsection (a)), shall 

22 make the first update to the standards for quality estab23 lished under paragraph (1) of such section not later than 

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1 retary submits the report under paragraph (2) of sub2 section (d). 

3 (c) REPORT.—Not later than one year after the date 

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

5 Affairs shall submit to the appropriate committees of Con6 gress a report on how the Secretary— 

7 (1) has consulted with entities specified in para8 graph (4) of section 1703C(a) of title 38, United 

9 States Code, before the date of the enactment of this 

10 Act in establishing standards for quality under such 

11 section; 

12 (2) has continued to consult with those entities 

13 on and after such date of enactment; and 

14 (3) intends to leverage data sciences to improve 

15 standards for quality care furnished by the Depart16 ment of Veterans Affairs. 

17 (d) UPDATES TO QUALITY CARE METRICS.— 

18 (1) INITIAL REPORT.—Not later than one year 

19 after the date of the enactment of this Act, the Sec20 retary of Veterans Affairs shall submit to the appro21 priate committees of Congress a report on how the 

22 Secretary plans to implement the amendments made 

23 by subsection (a). 


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1 (2) DEADLINE; SUMMARY REPORT.—Not later 

2 than two years after the date of the enactment of 

3 this Act, the Secretary shall— 

4 (A) implement the amendments made by 

5 subsection (a), including by updating the stand6 ards for quality established under section 

7 1703C of title 38, United States Code; and 

8 (B) submit to the appropriate committees 

9 of Congress a report detailing the standards for 

10 quality updated pursuant to such amendments. 

11 (e) AUDIT OF QUALITY CARE METRICS.— 

12 (1) IN GENERAL.—Not later than 180 days 

13 after the date of the enactment of this Act, the Sec14 retary of Veterans Affairs shall enter into one or 

15 more contracts with a non-Department entity de16 scribed in paragraph (2) to conduct an audit on the 

17 quality of care from the Department of Veterans Af18 fairs, including through non-Department health care 

19 providers pursuant to section 1703 of title 38 

20 United States Code. 

21 (2) NON-DEPARTMENT ENTITY DESCRIBED.—A 

22 non-Department entity described in this paragraph 

23 is an entity that— 

24 (A) specializes in analyzing large-scale or25 ganizational data collection and analysis efforts, 


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1 especially with respect to the health care sector; 

2 and 

3 (B) has experience and proven outcomes in 

4 optimizing the accuracy and comprehensiveness 

5 of data collection and analysis related to the 

6 quality of health care services. 

7 (3) ELEMENTS.—The audit required under 

8 paragraph (1) shall include the following: 

9 (A) An assessment of the methodology 

10 used by the Department to collect and assess 

11 data on the quality of care furnished by the De12 partment, including any vulnerabilities in such 

13 methodology. 

14 (B) An assessment of the accuracy and re15 liability of the data sources used by the Depart16 ment to compile data on the quality of care fur17 nished by the Department. 

18 (C) The extent to which the standards the 

19 Department uses to assess the quality of care 

20 furnished by the Department are— 

21 (i) comparable with industry stand22 ards; 

23 (ii) easily accessible to, and under24 stood by— 

25 (I) veterans; 


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1 (II) employees of the Depart2 ment; and 

3 (III) other individuals, as the pri4 vate sector entity considers appro5 priate. 

6 (D) Any recommendations of such private 

7 sector entity with respect to improvements that 

8 the Secretary could administer to more accu9 rately capture the quality of care furnished by 

10 the Department. 

11 (4) REPORTS ON AUDIT.— 

12 (A) REPORT ON FINDINGS AND REC13 OMMENDATIONS.—Not later than 60 days after 

14 any date on which a private sector entity de15 scribed in paragraph (2) completes an audit 

16 under paragraph (1), such private sector entity 

17 shall submit to the Secretary, the Committee on 

18 Veterans’ Affairs of the Senate, and the Com19 mittee on Veterans’ Affairs of the House of 

20 Representatives a report that includes— 

21 (i) the findings of such audit; and 

22 (ii) recommendations of such private 

23 sector entity with respect to such audit. 

24 (B) REPORT ON PLANNED IMPROVE25 MENTS.—Not later than 60 days after any date 


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1 on which the Secretary receives a report under 

2 subparagraph (A), the Secretary shall submit to 

3 the Committee on Veterans’ Affairs of the Sen4 ate and the Committee on Veterans’ Affairs of 

5 the House of Representatives a report on how 

6 the Secretary plans to improve the standards 

7 for quality of care of the Department. 

8 (f) APPROPRIATE COMMITTEES OF CONGRESS DE9 FINED.—In this section, the term ‘‘appropriate commit10 tees of Congress’’ has the meaning given such term in sec11 tion 1703C of title 38, United States Code. 

12 SEC. 105. STANDARDIZED PROCESS TO DETERMINE ELIGI13 BILITY OF COVERED VETERANS FOR PAR14 TICIPATION IN CERTAIN MENTAL HEALTH 

15 TREATMENT PROGRAMS. 

16 (a) STANDARDIZED SCREENING PROCESS.—Not 

17 later than one year after the date of the enactment of this 

18 Act, the Secretary of Veterans Affairs shall establish a 

19 standardized screening process to determine, based on 

20 clinical need, whether a covered veteran satisfies criteria 

21 for priority or routine admission to a covered treatment 

22 program. 

23 (b) ELIGIBILITY CRITERIA.— 

24 (1) IN GENERAL.—Under the standardized 

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1 ered veteran shall be eligible for priority admission 

2 to a covered treatment program if the covered vet3 eran meets criteria that include, but are not limited 

4 to, the following: 

5 (A) Symptoms that— 

6 (i) significantly affect activities of 

7 daily life; and 

8 (ii) increase the risk of such veteran 

9 for adverse outcomes. 

10 (B) An unsafe living situation. 

11 (C) A high-risk flag for suicide. 

12 (D) A determination of being a high risk 

13 for suicide. 

14 (E) Risk factors for overdose. 

15 (F) Non-responsive, relapsed, or unable to 

16 find recovery from one other course of treat17 ment, such as outpatient or intensive outpatient 

18 treatment. 

19 (G) Other such criteria as the Secretary 

20 determines appropriate. 

21 (2) CONSIDERATION.—In making a determina22 tion under paragraph (1), the Secretary shall con23 sider any referral of a health care provider of a cov24 ered veteran for such covered veteran to be admitted 

25 to a covered treatment program. 


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1 (c) TIME FOR SCREENING AND ADMISSION.—Under 

2 the standardized screening process required by subsection 

3 (a), the Secretary shall ensure a covered veteran— 

4 (1) is screened not later than 48 hours after the 

5 date on which the covered veteran, or a relevant 

6 health care provider, makes a request for the cov7 ered veteran to be admitted to a covered treatment 

8 program. 

9 (2) determined eligible for priority admission to 

10 a covered treatment program is admitted to such 

11 covered treatment program not later than 48 hours 

12 after the date of such determination. 

13 (d) ACCESS STANDARDS FOR ROUTINE ADMIS14 SION.—The Secretary shall include the standardized 

15 screening process under this section in the wait time ac16 cess standards for eligibility for mental health care under 

17 section 1703(d) of such title established by the Secretary 

18 under section 1703B of such title. 

19 (e) CONDITIONS UNDER WHICH CARE SHALL BE

20 FURNISHED THROUGH NON-DEPARTMENT PROVIDERS.— 

21 If the Secretary determines a covered veteran to be eligible 

22 for either priority or routine admission to a covered treat23 ment program pursuant to the standardized screening 

24 process required by subsection (a), and the Secretary is 

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1 priate covered treatment program at a facility of the De2 partment of Veterans Affairs within the State of residence 

3 of the covered veteran in a manner that complies with the 

4 applicable wait time standards established pursuant to 

5 this section, the Secretary shall offer the covered veteran 

6 the option to receive care— 

7 (1) at another facility of the Department; or 

8 (2) at a non-Department facility that— 

9 (A) can admit the covered veteran within 

10 the period required by the applicable standards 

11 of the Department; and 

12 (B) is party to a contract or agreement 

13 with the Department or enters into such a con14 tract or agreement under which the Department 

15 furnishes a program that is equivalent to a cov16 ered treatment program to a veteran through 

17 such non-Departmental facility. 

18 (f) SUNSET.— 

19 (1) IN GENERAL.—The authority of the Sec20 retary to make a determination under this section 

21 expires on the day that is two years after the date 

22 of the enactment of this Act. 

23 (2) RULE OF CONSTRUCTION.—Paragraph (1) 

24 shall not be construed to affect a covered veteran in 

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1 mination made on or before the date in such para2 graph. 

3 (g) DEFINITIONS.—In this section: 

4 (1) The term ‘‘covered treatment program’’— 

5 (A) means a mental health residential re6 habilitation treatment program of the Depart7 ment of Veterans Affairs; 

8 (B) a program of the Department for resi9 dential care for mental health and substance 

10 abuse disorders; 

11 (C) includes— 

12 (i) the programs designated as of the 

13 date of the enactment of this section as 

14 domiciliary residential rehabilitation treat15 ment programs; and 

16 (ii) any programs designated as domi17 ciliary residential rehabilitation treatment 

18 programs on or after such date of enact19 ment; and 

20 (D) does not include Compensated Work 

21 Therapy Transition Residence programs of the 

22 Department. 

23 (2) The term ‘‘covered veteran’’ means a vet24 eran described in section 1703(b) of title 38, United 

25 States Code. 


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1 SEC. 106. IMPROVEMENTS TO DEPARTMENT OF VETERANS 

2 AFFAIRS MENTAL HEALTH RESIDENTIAL RE3 HABILITATION TREATMENT PROGRAM. 

4 (a) PERFORMANCE METRICS.— 

5 (1) IN GENERAL.—The Secretary shall develop 

6 metrics to track, and shall subsequently track, the 

7 performance of medical facilities and Veterans Inte8 grated Service Networks of the Department in meet9 ing the requirements for— 

10 (A) screening, under section 105 of this 

11 Act, for the Mental Health Residential Rehabili12 tation Treatment Program (in this section re13 ferred to as the ‘‘Program’’) ; and 

14 (B) timely admission, under such screen15 ing, to the Program. 

16 (2) ELEMENTS.—The metrics developed under 

17 paragraph (1) shall include metrics for tracking the 

18 performance of such medical facilities and Veterans 

19 Integrated Service Networks with respect to routine 

20 and priority admission under the Program. 

21 (b) PLACEMENT; TRANSPORTATION.— 

22 (1) LOCATIONS.—If the Secretary determines 

23 that a covered veteran is in need of residential care 

24 under the Program, the Secretary shall provide to 

25 the covered veteran a list of locations at which such 


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1 covered veteran can receive such residential care 

2 that meets— 

3 (A) the standards for screening under sec4 tion 105 of this Act; and 

5 (B) the care needs of the covered veteran, 

6 including applicable treatment tracks. 

7 (2) TRANSPORTATION COVERAGE.—The Sec8 retary shall provide transportation or pay for or re9 imburse the costs of transportation for any covered 

10 veteran who is admitted into the Program and needs 

11 transportation assistance— 

12 (A) from the residence of the covered vet13 eran or a facility of the Department or author14 ized non-Department facility that does not pro15 vide such care to another such facility that pro16 vides residential care covered under the Pro17 gram; and 

18 (B) back to the residence of the covered 

19 veteran after the conclusion of the Program, if 

20 applicable. 

21 (c) CONSIDERATIONS.—In making placement deci22 sions under the Program, the Secretary shall consider the 

23 input of the covered veteran and the treating clinicians 

24 of the covered veteran, including with respect to program 

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1 ered veteran, and the geographic placement of the covered 

2 veteran, including family- or occupation-related pref3 erences or circumstances. 

4 (d) APPEALS.— 

5 (1) IN GENERAL.—The Secretary shall develop 

6 a national policy and associated procedures under 

7 which a covered veteran, a representative of a cov8 ered veteran, or a provider who requests a covered 

9 veteran be admitted to the Program, including a 

10 provider of the Department or a non-Department 

11 provider, may file a clinical appeal pursuant to this 

12 subsection if the covered veteran is— 

13 (A) denied admission into the Program; or 

14 (B) accepted into the Program but is not 

15 offered bed placement in a timely manner. 

16 (2) TIMELINESS STANDARDS FOR REVIEW.— 

17 (A) IN GENERAL.—The national policy and 

18 procedures developed under paragraph (1) for 

19 appeals described in such paragraph shall in20 clude timeliness standards for the Department 

21 to review and make a decision on such an ap22 peal. 

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1 graph (1) not later than 72 hours after the Sec2 retary receives such appeal. 

3 (3) PUBLIC GUIDANCE.—The Secretary shall 

4 develop, and make available to the public, guidance 

5 on how a covered veteran, a representative of the 

6 covered veteran, or a provider of the covered veteran 

7 can file a clinical appeal pursuant to this sub8 section— 

9 (A) if the covered veteran is denied admis10 sion into the Program; 

11 (B) if the first date on which the covered 

12 veteran may enter the Program does not comply 

13 with the standards established by the Depart14 ment under section 1703B of title 38, United 

15 States Code for purposes of determining eligi16 bility for mental health care under subsections 

17 (d) and (h) of section 1703 of such title; or 

18 (C) with respect to such other factors as 

19 the Secretary may specify. 

20 (4) RULE OF CONSTRUCTION.—Nothing in this 

21 subsection may be construed as granting a covered 

22 covered veteran the right to appeal a decision of the 

23 Secretary with respect to admission to the Program 

24 to the Board of Veterans’ Appeals under chapter 71 

25 of title 38, United States Code. 


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1 (e) TRACKING OF AVAILABILITY AND WAIT TIMES.— 

2 (1) IN GENERAL.—The Secretary shall, to the 

3 extent practicable, create a method for tracking 

4 availability and wait times under the Program across 

5 all facilities of the Department, Veterans Integrated 

6 Service Networks of the Department, and non-De7 partment providers throughout the United States. 

8 (2) AVAILABILITY OF INFORMATION.—The Sec9 retary shall, to the extent practicable, make the in10 formation tracked under paragraph (1) available in 

11 real time to— 

12 (A) the mental health treatment coordina13 tors at each facility of the Department; 

14 (B) the leadership of each medical center 

15 of the Department; 

16 (C) the leadership of each Veterans Inte17 grated Service Network; and 

18 (D) the Office of the Under Secretary for 

19 Health of the Department. 

20 (f) TRAINING AND OVERSIGHT.— 

21 (1) TRAINING.— 

22 (A) IN GENERAL.—The Secretary shall up23 date and implement training for staff of the 

24 Department directly involved in the Program 

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1 ment decisions, and appeals for the Program, 

2 including all changes to processes and guidance 

3 under the Program required by this section and 

4 under section 105 of this Act. 

5 (B) COVERED VETERANS AWAITING ADMIS6 SION.—The training under subparagraph (A) 

7 shall include procedures for the care of covered 

8 veterans awaiting admission into the Program 

9 and communication with such covered veterans 

10 and the providers of such covered veterans. 

11 (C) TIMING OF TRAINING.— 

12 (i) IN GENERAL.—The Secretary shall 

13 require the training under subparagraph 

14 (A) to be completed by staff required to 

15 complete such training— 

16 (I) not later than 60 days after 

17 beginning employment at the Depart18 ment in a position that includes work 

19 directly involving the Program; and 

20 (II) not less frequently than an21 nually. 

22 (ii) TRACKING.—The Secretary shall 

23 track completion of training required 

24 under clause (i) by staff required to com25 plete such training. 


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1 (2) OVERSIGHT STANDARDS.—The Secretary 

2 shall review and revise oversight standards for the 

3 leadership of the Veterans Integrated Service Net4 works and the Veterans Health Administration to 

5 ensure that facilities and staff of the Department 

6 are adhering to the policy of the Program on access 

7 to care. 

8 (g) CARE COORDINATION AND FOLLOW-UP CARE.— 

9 (1) CONTINUITY OF CARE.—The Secretary shall 

10 ensure each covered veteran who is screened for ad11 mission to the Program is offered, and provided if 

12 agreed upon, care options during the period between 

13 screening of the covered veteran and admission of 

14 the covered veteran to the Program to ensure the 

15 covered veteran does not experience any lapse in 

16 care. 

17 (2) CARE COORDINATION FOR SUBSTANCE USE

18 DISORDER.—For a covered veteran being treated for 

19 substance use disorder, the Secretary shall— 

20 (A) ensure there is a care plan in place 

21 during the period between any detoxification 

22 services or inpatient care received by the cov23 ered veteran and admission of the covered vet24 eran to the Program; and 


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1 (B) communicate that care plan to the cov2 ered veteran, the primary care provider of the 

3 covered veteran, and the facility of the Program 

4 where the covered veteran is or will be residing. 

5 (3) CARE PLANNING PRIOR TO DISCHARGE.— 

6 (A) IN GENERAL.—The Secretary, in con7 sultation with the covered veteran and the 

8 treating providers of the covered veteran in the 

9 Program, shall ensure the completion of a care 

10 plan prior to the covered veteran being dis11 charged from the Program. 

12 (B) MATTERS TO BE INCLUDED.—The 

13 care plan required under subparagraph (A) for 

14 a covered veteran shall include details on the 

15 course of treatment for the covered veteran fol16 lowing completion of treatment under the Pro17 gram, including any necessary follow-up care. 

18 (C) SHARING OF CARE PLAN.—The care 

19 plan required under subparagraph (A) shall be 

20 shared with the covered veteran, the primary 

21 care provider of the covered veteran, and any 

22 other providers with which the covered veteran 

23 consents to sharing the plan. 

24 (D) DISCHARGE FROM NON-DEPARTMENT

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1 eran under the Program from a non-Depart2 ment facility, the facility shall share with the 

3 Department all care records maintained by the 

4 facility with respect to the covered veteran and 

5 shall work in consultation with the Department 

6 on the care plan of the covered veteran required 

7 under subparagraph (A). 

8 (h) REPORTS TO CONGRESS.— 

9 (1) REPORT ON MODIFICATIONS TO PRO10 GRAM.— 

11 (A) IN GENERAL.—Not later than two 

12 years after the date of the enactment of this 

13 Act, the Secretary of Veterans Affairs shall 

14 submit to the Committees on Veterans’ Affairs 

15 of the House of Representatives and the Senate 

16 a report on modifications made to the guidance, 

17 operation, and oversight of the Program to ful18 fill the requirements of this section. 

19 (B) ELEMENTS.—The report required by 

20 subparagraph (A) shall include— 

21 (i) an assessment of whether costs of 

22 the Program, including for residential care 

23 provided through facilities of the Depart24 ment and non-Department facilities, serve 


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1 as a disincentive to placement in the Pro2 gram; 

3 (ii) a description of actions taken by 

4 the Department to address the findings 

5 and recommendations by the Secretary 

6 contained in the report under section 

7 503(c) of the STRONG Veterans Act of 

8 2022 (division V of Public Law 117–328), 

9 including such actions with respect to— 

10 (I) any new locations of the Pro11 gram added; 

12 (II) any beds added at existing 

13 facilities of the Program; and 

14 (III) any additional treatment 

15 tracks or sex-specific programs cre16 ated or added at facilities of the De17 partment; and 

18 (iii) such recommendations as the 

19 Secretary may have for legislative or ad20 ministrative action to address any funding 

21 constraints or disincentives for use of the 

22 Program. 

23 (2) ANNUAL REPORT ON OPERATION OF PRO24 GRAM.— 


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1 (A) IN GENERAL.—Not later than one year 

2 after the submission of the report under para3 graph (1)(A), and not less frequently than an4 nually thereafter during the duration of the 

5 Program, the Secretary shall submit to the 

6 Committees on Veterans’ Affairs of the House 

7 of Representatives and the Senate a report on 

8 the operation of the Program. 

9 (B) ELEMENTS.—Subject to subparagraph 

10 (C), each report required by subparagraph (A) 

11 shall include the following: 

12 (i) The number of covered veterans 

13 served by the Program, disaggregated by— 

14 (I) Veterans Integrated Service 

15 Network in which the covered veteran 

16 receives care; 

17 (II) facility, including facilities of 

18 the Department and non-Department 

19 facilities, at which the covered veteran 

20 receives care; 

21 (III) type of residential rehabili22 tation treatment care received by the 

23 covered veteran under the Program; 

24 (IV) sex of the covered veteran; 

25 and 


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1 (V) race or ethnicity of the cov2 ered veteran. 

3 (ii) Wait times under the Program for 

4 the most recent year data is available, 

5 disaggregated by— 

6 (I) treatment track or specificity 

7 of residential rehabilitation treatment 

8 care sought by the covered veteran; 

9 (II) sex of the covered veteran; 

10 (III) State or territory in which 

11 the covered veteran is located; 

12 (IV) Veterans Integrated Service 

13 Network in which the covered veteran 

14 is located; and 

15 (V) facility of the Department at 

16 which the covered veteran seeks care. 

17 (iii) A list of all locations of the Pro18 gram and number of bed spaces at each 

19 such location, disaggregated by residential 

20 rehabilitation treatment care or treatment 

21 track provided under the Program at such 

22 location. 

23 (iv) A list of any new Program loca24 tions added or removed and any bed spaces 


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1 added or removed during the one-year pe2 riod preceding the date of the report. 

3 (v) Average cost of a stay under the 

4 Program, including total stay average and 

5 daily average, at— 

6 (I) a facility of the Department; 

7 and 

8 (II) a non-Department facility. 

9 (vi) A review of staffing needs and 

10 gaps with respect to the Program. 

11 (vii) Any recommendations for 

12 changes to the operation of the Program, 

13 including any policy changes, guidance 

14 changes, training changes, or other 

15 changes. 

16 (C) ANONYMITY.—The Secretary shall pro17 vide the data under this paragraph pursuant to 

18 Federal laws and in a manner that is wholly 

19 consistent with applicable Federal privacy and 

20 confidentiality laws, including the Privacy Act 

21 (5 U.S.C. 552a), the Health Insurance Port22 ability and Accountability Act (Public Law 

23 104–191; 42 U.S.C. 201 note) and regulations 

24 (title 45, Code of Federal Regulations, parts 

25 160 and 164, or successor regulations), and 


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1 sections 5701, 5705, and 7332 of title 38, 

2 United States Code, to ensure that the provided 

3 data, or some portion of the data, will not un4 dermine the anonymity of a veteran. 

5 (i) REVISION OF GUIDANCE.—The Secretary shall 

6 update the guidance of the Department of Veterans Af7 fairs on the operation of the Mental Health Residential 

8 Rehabilitation Treatment Program to reflect each of the 

9 requirements under subsections (b) through (h). 

10 (j) DEADLINE.—The Secretary of Veterans Affairs 

11 shall carry out each requirement under this section by not 

12 later than one year after the date of the enactment of this 

13 Act, unless otherwise specified. 

14 (k) COMPTROLLER GENERAL REVIEW.— 

15 (1) IN GENERAL.—Not later than two years 

16 after the date of the enactment of this Act, the 

17 Comptroller General of the United States shall re18 view access to care under the Program for covered 

19 veterans in need of residential mental health care 

20 and substance use disorder care. 

21 (2) ELEMENTS.—The review required by para22 graph (1) shall include the following: 

23 (A) A review of wait times under the Pro24 gram, disaggregated by— 


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1 (i) treatment track or specificity of 

2 residential rehabilitation treatment care 

3 needed; 

4 (ii) sex of the covered veteran; 

5 (iii) home State of the covered vet6 eran; 

7 (iv) home Veterans Integrated Service 

8 Network of the covered veteran; and 

9 (v) wait times for— 

10 (I) facilities of the Department; 

11 and 

12 (II) non-Department facilities. 

13 (B) A review of policy and training of the 

14 Department on screening, admission, and place15 ment under the Program. 

16 (C) A review of the rights of covered vet17 erans and providers to appeal admission deci18 sions under the Program and how the Depart19 ment adjudicates appeals. 

20 (D) When determining the facility at which 

21 a covered veteran admitted to the Program will 

22 be placed in the Program, a review of how the 

23 input of the covered veteran is taken into con24 sideration with respect to— 


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1 (i) program specialty, subtype, or 

2 treatment track offered to the covered vet3 eran; and 

4 (ii) the geographic placement of the 

5 covered veteran, including family- or occu6 pation-related preferences or cir7 cumstances. 

8 (E) A review of staffing and staffing needs 

9 and gaps of the Program, including with re10 spect to— 

11 (i) mental health providers and coor12 dinators at the facility level; 

13 (ii) staff of Program facilities; 

14 (iii) staff of Veterans Integrated Serv15 ice Networks; and 

16 (iv) overall administration of the Pro17 gram at the national level. 

18 (F) Recommendations for improvement of 

19 access by covered veterans to care under the 

20 Program, including with respect to— 

21 (i) any new sites or types of programs 

22 needed or in development; 

23 (ii) changes in training or policy; 

24 (iii) changes in communications with 

25 covered veterans; and 


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1 (iv) oversight of the Program by the 

2 Department. 

3 (l) DEFINITIONS.—In this section: 

4 (1) The term ‘‘covered veteran’’ means a vet5 eran described in section 1703(b) of title 38, United 

6 States Code. 

7 (2) The term ‘‘Mental Health Residential Reha8 bilitation Treatment Program’’— 

9 (A) means— 

10 (i) a mental health residential reha11 bilitation treatment program of the De12 partment under sections 103 and 104 of 

13 the Veterans Mental Health and Other 

14 Care Improvement Act of 2008 (Public 

15 Law 110–387); and 

16 (ii) the array of programs and serv17 ices of the Department that comprise resi18 dential care for mental health and sub19 stance use disorders; 

20 (B) includes— 

21 (i) the programs designated as of the 

22 date of the enactment of this Act as domi23 ciliary residential rehabilitation treatment 

24 programs; and 


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1 (ii) any programs designated as domi2 ciliary residential rehabilitation treatment 

3 programs on or after such date of enact4 ment; and 

5 (C) does not include compensated work 

6 therapy transition resident programs of the De7 partment. 

8 (3) The term ‘‘treatment track’’ means a spe9 cialized treatment program that is provided to a sub10 set of covered veterans in the Program who receive 

11 the same or similar intensive treatment and rehabili12 tative services. 

13 (m) SUNSET.—This section shall terminate on the 

14 day that is two years after that date on which the Sec15 retary completes carrying out each requirement pursuant 

16 to subsection (j). 

17 SEC. 107. PILOT PROGRAM TO IMPROVE ADMINISTRATION 

18 OF CARE UNDER VETERANS COMMUNITY 

19 CARE PROGRAM. 

20 (a) ESTABLISHMENT.—Pursuant to section 1703E of 

21 title 38, United States Code, the Secretary of Veterans 

22 Affairs shall carry out a pilot program to seek to develop 

23 and implement a plan— 

24 (1) to provide monetary and non-monetary in25 centives to a covered health care provider— 


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1 (A) to allow the Secretary to see the sched2 uling system of the provider, to assess the avail3 ability of, and to assist in scheduling appoint4 ments for, veterans under the Veterans Com5 munity Care Program under section 1703 of 

6 such title, including through synchronous, asyn7 chronous, and asynchronous assisted digital 

8 scheduling; 

9 (B) to complete continuing professional 

10 educational training available through the VHA 

11 TRAIN program (or any successor program or 

12 initiative) regarding veteran cultural com13 petency, the opioid safety initiative (or any suc14 cessor program or initiative), and other subjects 

15 determined appropriate by the Secretary; 

16 (C) to improve methods of accounting for 

17 non-Department training that is equivalent or 

18 substantially similar to the continuing profes19 sional educational training described in sub20 paragraph (B); 

21 (D) to improve the rate of the timely re22 turn to the Secretary of medical record docu23 mentation for care or services provided under 

24 the Veterans Community Care Program; 


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1 (E) to improve the timeliness and quality 

2 of the delivery of care and services to veterans 

3 under such program; and 

4 (F) to achieve other objectives determined 

5 appropriate by the Secretary; and 

6 (2) to decrease the rate of no-show appoint7 ments under such program. 

8 (b) REPORT.—Not later than one year after the date 

9 of the establishment of the pilot program under this sec10 tion, annually thereafter during the term of the pilot pro11 gram, the Secretary of Veterans Affairs shall submit to 

12 the Committees on Veterans’ Affairs of the House of Rep13 resentatives and the Senate a report on the pilot program 

14 that includes, with respect to the period covered by the 

15 report— 

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

17 (A) the system of the Department of Vet18 erans Affairs for scheduling appointments for 

19 veterans under the Veterans Community Care 

20 Program has improved; 

21 (B) the rate of timely return to the Sec22 retary of medical record documentation de23 scribed in subparagraph (D) of subsection 

24 (a)(1) has improved; 


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1 (C) the timeliness and quality of the deliv2 ery of care and services described in subpara3 graph (E) of such subsection has improved; and 

4 (D) the frequency of no-show appointments 

5 described in paragraph (2) of such subsection 

6 decreased; 

7 (2) a list of the continuing professional edu8 cational training courses under subparagraph (B) of 

9 such subsection available to covered health care pro10 viders; 

11 (3) the rate of participation in such continuing 

12 professional education training courses; and 

13 (4) any other matter the Secretary determines 

14 appropriate. 

15 (c) DEFINITIONS.—In this section: 

16 (1) The term ‘‘covered health care provider’’ 

17 means a health care provider— 

18 (A) described in subsection (c) of section 

19 1703 of title 38, United States Code, that fur20 nishes care or services under the Veterans Com21 munity Care Program pursuant to a contract or 

22 agreement with a Third Party Administrator; 

23 or 

24 (B) that otherwise furnishes care or serv25 ices outside of Department facilities pursuant 


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1 to a contract or agreement with the Secretary 

2 of Veterans Affairs. 

3 (2) The term ‘‘opioid safety initiative’’ means 

4 the programs, processes, and guidelines of the Vet5 erans Health Administration of the Department of 

6 Veterans Affairs relating to the management of 

7 opioid therapy and chronic pain. 

8 (3) The term ‘‘Third Party Administrator’’ 

9 means an entity that manages a network of health 

10 care providers and performs administrative services 

11 related to such network under section 1703 of such 

12 title. 

13 (4) The term ‘‘VHA TRAIN program’’ means 

14 the free program of the Veterans Health Adminis15 tration that offers veteran-specific continuing med16 ical education courses. 

17 SEC. 108. PILOT PROGRAM ON CONSOLIDATING APPROVAL 

18 PROCESS OF DEPARTMENT OF VETERANS AF19 FAIRS FOR COVERED DENTAL CARE. 

20 (a) IN GENERAL.—Not later than 180 days after the 

21 date of the enactment of this Act, the Secretary of Vet22 erans Affairs shall carry out a pilot program to hire— 

23 (1) general dentists at medical facilities of the 

24 Department of Veterans Affairs to manage approval 

25 by the Department of treatment plans requested by 


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1 dental providers in providing covered dental care; 

2 and 

3 (2) dental specialists at Veterans Integrated 

4 Service Networks of the Department to manage ap5 proval by the Department of treatment plans for 

6 specialty dental care requested by dental providers 

7 in providing covered dental care. 

8 (b) LOCATIONS.—The Secretary shall carry out the 

9 pilot program in not fewer than two Veterans Integrated 

10 Service Networks of the Department. 

11 (c) REPORTS.— 

12 (1) INITIAL REPORT.—Not later than one year 

13 after the date of the commencement of such pilot 

14 program, the Secretary shall submit to the Commit15 tees on Veterans’ Affairs of the Senate and the 

16 House of Representatives a report on the pilot pro17 gram, that includes— 

18 (A) an identification of the Veterans Inte19 grated Service Networks participating in such 

20 pilot program; 

21 (B) a description of the implementation of 

22 such pilot program; 

23 (C) an identification of any barriers or 

24 challenges to implementing such pilot program; 


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1 (D) an assessment of the efficacy of hiring 

2 general dentists and dental specialists pursuant 

3 to such pilot program; 

4 (E) aggregated feedback with respect to 

5 such pilot program from dentists of the Depart6 ment in Veterans Integrated Service Networks 

7 participating in such pilot program; and 

8 (F) aggregated feedback from dental pro9 viders providing covered dental care within such 

10 Veterans Integrated Service Networks regard11 ing any changes in the timeliness of treatment 

12 plan approvals by the Department. 

13 (2) FINAL REPORT.—Not later than 90 days 

14 before the date of the completion of such pilot pro15 gram, the Secretary shall submit to the Committees 

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

17 Representatives a report on the pilot program that— 

18 (A) includes, with respect to the period 

19 covered by the report, each element of the re20 port required under paragraph (1) described in 

21 subparagraphs (A) through (F) of such para22 graph; 

23 (B) includes recommendations of the Sec24 retary on whether the pilot program should 

25 be— 


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1 (i) extended; 

2 (ii) expanded; or 

3 (iii) adopted throughout the Depart4 ment; and 

5 (C) indicates whether the Secretary re6 quests action by Congress to make the pilot 

7 program permanent. 

8 (d) SUNSET.—The authority to carry out the pilot 

9 program under this section shall terminate on the date 

10 that is two years after the date of the enactment of this 

11 Act. 

12 (e) COVERED DENTAL CARE DEFINED.—In this sec13 tion, the term ‘‘covered dental care’’ means dental care 

14 provided— 

15 (1) under section 1703 of title 38, United 

16 States Code; or 

17 (2) pursuant to a Veterans Care Agreement 

18 under section 1703A of such title. 

19 SEC. 109. STRATEGIC PLAN ON VALUE-BASED HEALTH 

20 CARE SYSTEM FOR VETERANS HEALTH AD21 MINISTRATION; PILOT PROGRAM. 

22 (a) ESTABLISHMENT OF WORKING GROUP.— 

23 (1) IN GENERAL.—Not later than one year 

24 after the date of the enactment of this Act, the Sec25 retary of Veterans Affairs shall— 


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1 (A) establish a working group on value2 based care; and 

3 (B) submit to the Committees on Veterans’ 

4 Affairs of the House of Representatives and the 

5 Senate the strategic plan developed by the 

6 working group pursuant to subsection (b). 

7 (2) MEMBERSHIP.— 

8 (A) REQUIRED MEMBERS.—The working 

9 group shall include, at a minimum, the fol10 lowing members: 

11 (i) The Under Secretary for Health of 

12 the Department of Veterans Affairs. 

13 (ii) The Director of the Office of Men14 tal Health and Suicide Prevention of the 

15 Department of Veterans Affairs (or any 

16 successor office). 

17 (iii) The Director of the Office of In18 tegrated Veteran Care of the Department 

19 (or any successor office). 

20 (iv) The Director of the Office of 

21 Rural Health of the Department (or any 

22 successor office). 

23 (v) The Director of the Office of Con24 nected Care of the Department (or any 

25 successor office). 


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1 (vi) The Assistant Secretary for the 

2 Office of Information Technology (or any 

3 successor office). 

4 (vii) The Chief Officer of the Office of 

5 Healthcare Innovation and Learning of the 

6 Office of Discovery, Education, and Affil7 iate Networks of the Veterans Health Ad8 ministration (or any successor office). 

9 (viii) An individual designated by the 

10 Secretary from the Center for Innovation 

11 for Care and Payment of the Department 

12 under section 1703E of title 38, United 

13 States Code. 

14 (ix) An individual designated by the 

15 Administrator of the Centers for Medicare 

16 & Medicaid Services from the Center for 

17 Medicare and Medicaid Innovation. 

18 (x) An individual designated by the 

19 Secretary of Health and Human Services 

20 from the Federal Office of Rural Health 

21 Policy of the Health Resources and Serv22 ices Administration. 

23 (xi) The Chief of Human Capital 

24 Management for the Veterans Health Ad25 ministration. 


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1 (xii) An individual designated by the 

2 Secretary of Defense that is a representa3 tive of the Defense Health Agency. 

4 (xiii) An individual selected by the 

5 Secretary of Veterans Affairs from the spe6 cial medical advisory group established 

7 under section 7312 of title 38, United 

8 States Code. 

9 (B) OPTIONAL MEMBERS.—The Secretary 

10 of Veterans Affairs may appoint any of the fol11 lowing individuals as members of the working 

12 group: 

13 (i) An individual representing the 

14 Health and Medicine Division of the Na15 tional Academies of Sciences, Engineering, 

16 and Medicine. 

17 (ii) Three individuals representing a 

18 private health care system that has made 

19 the transition to value-based care. 

20 (iii) Three individuals representing an 

21 organization recognized by the Secretary of 

22 Veterans Affairs under section 5902 of 

23 title 38, United States Code. 


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1 (3) EXEMPTION FROM FACA.—Chapter 10 of 

2 title 5, United States Code, shall not apply to the 

3 working group established under paragraph (1). 

4 (b) DEVELOPMENT OF STRATEGIC PLAN.—The 

5 working group shall develop a strategic plan to implement 

6 value-based care into the Veterans Health Administration 

7 that includes the following: 

8 (1) An identification of the state of the Vet9 erans Health Administration as of the date of the 

10 enactment of this Act, including an assessment of 

11 the current model of health care delivery used by the 

12 Veterans Health Administration in medical facilities 

13 of the Department of Veterans Affairs. 

14 (2) An assessment of the capacity needs of the 

15 Veterans Health Administration during the five-year 

16 period beginning on the date of the enactment of 

17 this Act. 

18 (3) An analysis of the leadership of the Vet19 erans Health Administration, including an assess20 ment of leadership acumen and ability to implement 

21 a clear, shared vision and effective change manage22 ment and care coordination. 

23 (4) An identification of goals for the future of 

24 the Veterans Health Administration. 


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1 (5) An identification and classification of the 

2 current capabilities, capacity, and gaps in access and 

3 quality of the health care system of the Department 

4 of Veterans Affairs. 

5 (6) An analysis of value-based care models, in6 cluding— 

7 (A) a selection of potential models that 

8 would best work for the Veterans Health Ad9 ministration; 

10 (B) the capacity and capabilities of each 

11 such model; and 

12 (C) a thorough justification of the selection 

13 of each selected model, including an summary 

14 of the ability of such model to improve the 

15 metrics described under paragraph (9). 

16 (7) A definition of what quality means with re17 spect to— 

18 (A) access to health care under the laws 

19 administered by the Secretary of Veterans Af20 fairs; and 

21 (B) delivery of such health care. 

22 (8) A definition of what value means with re23 spect to care furnished by the Veterans Health Ad24 ministration, 


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1 (9) A system for measuring value within the 

2 Veterans Health Administration that includes 

3 metrics for— 

4 (A) outcomes; 

5 (B) safety; 

6 (C) service; 

7 (D) access; 

8 (E) productivity; 

9 (F) capacity; 

10 (G) equity; and 

11 (H) total cost of patient care. 

12 (10) With respect to the system described in 

13 subparagraph (H), an analysis of variable value with 

14 respect to patient outcomes across different health 

15 care types and specialties. 

16 (11) An assessment of— 

17 (A) previous or ongoing assessments of the 

18 current information technology infrastructure of 

19 the Veterans Health Administration, includ20 ing— 

21 (i) such assessments conducted pursu22 ant to the Electronic Health Record Mod23 ernization program of the Department of 

24 Veterans Affairs; and 


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1 (ii) any other ongoing information 

2 technology modernization programs of such 

3 Department and any unimplemented rel4 evant recommendations from such assess5 ments; 

6 (B) the information technology infrastruc7 ture of the Veterans Health Administration in 

8 effect as of the date of the enactment of this 

9 Act; 

10 (C) the value-driven framework of the De11 partment, in effect as of the date of the enact12 ment of this Act, for evaluating health care in13 novations, and how improvements in such 

14 framework could be used to encourage innova15 tion; and 

16 (D) workforce challenges and needs of the 

17 Veterans Health Administration based on— 

18 (i) reviews of workforce assessment 

19 data available as of the date of the enact20 ment of this Act; and 

21 (ii) the findings of— 

22 (I) the report required by section 

23 301(d) of the Veterans Access, 

24 Choice, and Accountability Act of 

25 2014 (Public Law 113–146); 


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1 (II) the reports required by sec2 tion 505 of the John S. McCain III, 

3 Daniel K. Akaka and Samuel R. 

4 Johnson VA Maintaining Internal 

5 Systems and Strengthening Inte6 grated Outside Networks Act of 2018 

7 (Public Law 115–182); 

8 (III) the report required by sec9 tion 301 of the VA Choice and Qual10 ity Employment Act of 2017 (Public 

11 Law 115–46); and 

12 (IV) any comprehensive health 

13 care inspection conducted by the In14 spector General of the Department of 

15 Veterans Affairs as of the date of the 

16 enactment of this Act. 

17 (12) Any recommendations of the working 

18 group with respect to improving the information 

19 technology infrastructure described in clause (i) of 

20 subparagraph (J). 

21 (13) An analysis of how the value-driven frame22 work described in clause (iii) of such subparagraph 

23 could be used to improve the model of care delivery 

24 by the Department. 


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1 (14) A description of how a value-based care 

2 system would apply to primary care, inpatient and 

3 outpatient mental health care, and inpatient and 

4 outpatient substance use treatment, spinal cord in5 jury disorder care, and polytrauma care furnished by 

6 the Veterans Health Administration. 

7 (15) With respect to legislative or administra8 tive action necessary to incorporate value-based care 

9 models into the Veterans Health Administration, a 

10 description of the estimated timelines, effect on 

11 workforce, and costs. 

12 (c) PILOT PROGRAM.— 

13 (1) IN GENERAL.—Not later than 180 days 

14 after the submission of the strategic plan pursuant 

15 to subsection (b), the Secretary of Veterans Affairs 

16 shall commence a three-year pilot program to imple17 ment the elements of such strategic plan relating to 

18 the delivery, by the Veterans Health Administration, 

19 of primary care, inpatient and outpatient mental 

20 health treatment, inpatient and outpatient substance 

21 abuse treatment, spinal cord injury disorder care, 

22 and polytrauma care. 

23 (2) LOCATIONS.—The Secretary shall carry out 

24 such pilot program in four Veterans Integrated 


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1 Service Networks that are geographically dispersed 

2 and shall include the following: 

3 (A) A Veterans Integrated Service Net4 work that predominately serves veterans in 

5 rural and highly rural areas. 

6 (B) A Veterans Integrated Service Net7 work that predominately serves veterans in 

8 urban areas. 

9 (C) A Veterans Integrated Service Net10 work that has a high rate of suicide among vet11 erans. 

12 (D) A Veterans Integrated Service Net13 work that has a high rate of substance use dis14 order among veterans. 

15 (E) A Veterans Integrated Service Net16 work that has access or productivity challenges. 

17 (3) REPORTS TO CONGRESS.— 

18 (A) ANNUAL REPORT.—Not later than one 

19 year after the commencement of the pilot pro20 gram, and annually thereafter during the dura21 tion of the pilot program, the Secretary shall 

22 submit to Congress a report on the pilot pro23 gram. 

24 (B) FINAL REPORT.—Not later than 90 

25 days before the conclusion of the pilot program, 


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1 the Secretary shall submit to Congress a final 

2 report on the pilot program that includes— 

3 (i) lessons learned during the adminis4 tration of such pilot program; and 

5 (ii) specific health outcomes in veteran 

6 patient care compared to the Veterans 

7 Health Administration system of care in 

8 effect as of the date of the enactment of 

9 this Act. 

10 SEC. 110. PLAN ON ADOPTION OF CERTAIN HEALTH INFOR11 MATION STANDARDS FOR DEPARTMENT OF 

12 VETERANS AFFAIRS AND CERTAIN HEALTH 

13 CARE PROVIDERS. 

14 (a) PLAN FOR CERTAIN HEALTH INFORMATION

15 STANDARDS.— 

16 (1) IN GENERAL.—The Secretary of Veterans 

17 Affairs, in consultation with the Secretary of Health 

18 and Human Services, the Administrator of the Cen19 ters for Medicare & Medicaid Services, and the Na20 tional Coordinator for Health Information Tech21 nology of the Department of Health and Human 

22 Services, shall create and implement a plan to adopt, 

23 as rapidly and to the most comprehensive extent fea24 sible, national health information interoperability 


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1 standards for the Department of Veterans Affairs 

2 and community care providers with respect to— 

3 (A) coordination of— 

4 (i) care; and 

5 (ii) benefits; 

6 (B) patient identity matching; 

7 (C) measurement and reporting of quality; 

8 (D) population health; and 

9 (E) public health. 

10 (2) CONSIDERATION.—In developing the plan 

11 under paragraph (1), the Secretary of Veterans Af12 fairs shall consider challenges faced by— 

13 (A) small community care providers; and 

14 (B) community care providers located in 

15 rural areas. 

16 (b) PLAN ON ELECTRONIC HEALTH RECORD EX17 CHANGE.— 

18 (1) IN GENERAL.—Not later than one year 

19 after the date of enactment of this Act, the Sec20 retary shall submit to the Committees on Veterans’ 

21 Affairs of the Senate and the House of Representa22 tives a plan to provide, at no cost, to community 

23 care providers of the Department, through Third 

24 Party Administrators, a capability to facilitate the 


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1 electronic direct exchange, between such providers 

2 and the Department, of— 

3 (A) the health records of veterans; and 

4 (B) documents relating to health care of 

5 veterans, clinical notes, and any other informa6 tion the Secretary determines necessary. 

7 (2) PRIORITIZATION.—In developing the plan 

8 required under paragraph (1), the Secretary shall 

9 prioritize providing the capability described in such 

10 paragraph to community care providers that— 

11 (A) provide care under the laws adminis12 tered by the Secretary to— 

13 (i) a lower volume of veterans; and 

14 (ii) veterans who are located in rural 

15 areas; and 

16 (B) are unable or unwilling to exchange 

17 the records and documents described in sub18 paragraphs (A) and (B) of such paragraph with 

19 the Department through standards-based or di20 rect exchange mechanisms in effect as of the 

21 date of the enactment of this Act. 

22 (c) REPORTS ON PLAN FOR INTEROPERABILITY

23 STANDARDS.— 

24 (1) INITIAL REPORT.—Not later than one year 

25 after the date of the enactment of this Act, the SecVerDate Sep 11 2014 18:49 May 29, 2024 Jkt 049200 PO 00000 Frm 00061 Fmt 6652 Sfmt 6201 E:\BILLS\H8371.IH H8371

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1 retary of Veterans Affairs shall submit to the Com2 mittees on Veterans’ Affairs of the Senate and the 

3 House of Representatives— 

4 (A) the plan required by subsection (a); 

5 and 

6 (B) a report that includes— 

7 (i) an analysis of gaps, if any, be8 tween the use, by the Department and 

9 other agencies, health information ex10 changes, and technology companies, of na11 tional health information interoperability 

12 standards and the potential, or optimal, 

13 use of such national health information 

14 interoperability standards; 

15 (ii) an analysis and description of the 

16 participation by the Department, commu17 nity care providers, and other relevant en18 tities in the Trusted Exchange Framework 

19 and Common Agreement program of the 

20 Department of Health and Human Serv21 ices as of the date of the enactment of this 

22 Act; 

23 (iii) recommendations of the Secretary 

24 with respect to development of health in25 formation interoperability standards; 


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1 (iv) timelines or schedules to imple2 ment the plan required by subsection (a); 

3 and 

4 (v) an identification of any legislative 

5 authorities or resources the Secretary re6 quires to implement such plan. 

7 (2) RECURRING REPORT REQUIREMENT.— 

8 (A) IN GENERAL.—Not later than 18 

9 months after the date of the enactment of this 

10 Act, and every 180 days thereafter for four 

11 years, the Secretary of Veterans Affairs shall 

12 submit to Committees on Veterans’ Affairs of 

13 the Senate and the House of Representatives a 

14 report on the status of implementation of the 

15 plan required under subsection (a). 

16 (B) ELEMENTS OF SUBSEQUENT RE17 PORTS.—Each report under subparagraph (A) 

18 submitted after the date on which the first re19 port required by such subparagraph is sub20 mitted shall include a description of any revi21 sions to— 

22 (i) the plan required by subsection (a) 

23 made during the period covered by the re24 port; and 


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1 (ii) the analysis, recommendations, 

2 timelines, and legislative authorities re3 ported pursuant to paragraph (1). 

4 (d) DEFINITIONS.—In this section: 

5 (1) The term ‘‘community care provider’’ means 

6 a non-Department health care provider providing 

7 care (including dental care)— 

8 (A) under section 1703 of title 38, United 

9 States Code; 

10 (B) pursuant to a Veterans Care Agree11 ment under section 1703A of such title; or 

12 (C) under any other law administered by 

13 the Secretary of Veterans Affairs. 

14 (2) The term ‘‘Third Party Administrator’’ 

15 means an entity that manages a provider network 

16 and performs administrative services related to such 

17 network under section 1703 of title 38, United 

18 States Code. 

19 SEC. 111. REPORT ON USE OF VALUE-BASED REIMBURSE20 MENT MODELS UNDER VETERANS COMMU21 NITY CARE PROGRAM. 

22 (a) REPORT ON VALUE-BASED REIMBURSEMENT

23 MODELS.—Not later than one year after the date of the 

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

25 in consultation with the Center for Innovation for Care 


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1 and Payment of the Department of Veterans Affairs under 

2 section 1703E of title 38 United States Code, the Office 

3 of Integrated Veteran Care of the Department, or suc4 cessor office, and Third Party Administrators, shall sub5 mit to the Committees on Veterans’ Affairs of the House 

6 of Representatives and the Senate a report containing— 

7 (1) an assessment of the efforts of the Depart8 ment pursuant to section 1703(i)(5) of such title, to 

9 incorporate value-based reimbursement models under 

10 the Veterans Community Care Program to promote 

11 the provision of high-quality care to veterans; and 

12 (2) such recommendations for legislative or ad13 ministrative action as the Secretary considers appro14 priate regarding the use of value-based reimburse15 ment models throughout the Veterans Community 

16 Care Program under section 1703 of such title. 

17 (b) RULE OF CONSTRUCTION.—This section shall not 

18 be construed to be a pilot program subject to the require19 ments of section 1703E of title 38, United States Code. 

20 (c) THIRD PARTY ADMINISTRATOR DEFINED.—In 

21 this section, the term ‘‘Third Party Administrator’’ means 

22 an entity that manages a provider network and performs 

23 administrative services related to such network under sec24 tion 1703 of title 38, United States Code. 


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1 SEC. 112. INSPECTOR GENERAL ASSESSMENT OF IMPLE2 MENTATION OF VETERANS COMMUNITY 

3 CARE PROGRAM. 

4 (a) IN GENERAL.—Not later than two years after the 

5 date of the enactment of this Act, and periodically there6 after, the Inspector General shall assess the performance 

7 of a representative sample of medical centers in each Vet8 erans Integrated Service Network of the Department of 

9 Veterans Affairs in— 

10 (1) appropriately identifying veterans eligible 

11 for care and services under section 1703 of title 38, 

12 United States Code; 

13 (2) informing veterans of their eligibility for 

14 such care and services; and 

15 (3) delivering such care and services in a timely 

16 manner. 

17 (b) BRIEFING ON ASSESSMENTS.—Upon the submis18 sion of the initial assessment required by subsection (a), 

19 the Inspector General of the Department of Veterans Af20 fairs shall provide to the Committees on Veterans Affairs 

21 of the House of Representatives and the Senate a briefing 

22 on the plans of such Inspector General with respect to the 

23 findings, frequency, and methodology relating to such as24 sessment. 


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1 SEC. 113. COMPTROLLER GENERAL REPORT ON DENTISTRY 

2 UNDER VETERANS COMMUNITY CARE PRO3 GRAM. 

4 (a) IN GENERAL.—Not later than one year after the 

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

6 of the United States shall submit to the Committees on 

7 Veterans’ Affairs of the Senate and the House of Rep8 resentatives a report on dental care furnished by the Sec9 retary of Veterans Affairs under the Veterans Community 

10 Care Program under section 1703 of title 38, United 

11 States Code, that includes a review of— 

12 (1) the impact current reimbursement rates 

13 provided by the Department of Veterans Affairs to 

14 dental providers under such program have on— 

15 (A) the availability of dental care for vet16 erans; and 

17 (B) the ability of Third Party Administra18 tors to meet their contractual obligations for 

19 network adequacy; 

20 (2) the satisfaction of dental providers pro21 viding dental care under such program with the 

22 processes of the Department for approving dental 

23 care under such program; and 

24 (3) the current processes of the Department for 

25 approving emergent dental care under such program. 


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1 (b) THIRD PARTY ADMINISTRATOR DEFINED.—In 

2 this section, the term ‘‘Third Party Administrator’’ means 

3 an entity that manages a provider network and performs 

4 administrative services related to such network under sec5 tion 1703 of title 38, United States Code. 

6 Subtitle B—Matters Relating to 

7 Nursing Home and Other Long 

8 Term Care and Family Care9 givers 

10 SEC. 120. INCREASE OF EXPENDITURE CAP FOR NON11 INSTITUTIONAL CARE ALTERNATIVES TO 

12 NURSING HOME CARE. 

13 (a) INCREASE OF EXPENDITURE CAP.—Section 

14 1720C(d) of title 38, United States Code, is amended— 

15 (1) by striking ‘‘The total cost’’ and inserting 

16 ‘‘(1) Except as provided in paragraph (2), the total 

17 cost’’; 

18 (2) by striking ‘‘65 percent’’ and inserting ‘‘100 

19 percent’’; and 

20 (3) by adding at the end the following new 

21 paragraph: 

22 ‘‘(2)(A) The total cost of providing services or in-kind 

23 assistance in the case of any veteran described in subpara24 graph (B) for any fiscal year under the program may ex25 ceed 100 percent of the cost that would otherwise have 


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1 been incurred as specified in paragraph (1) if the Sec2 retary determines, based on a consideration of clinical 

3 need, geographic market factors, and such other matters 

4 as the Secretary may prescribe through regulation, that 

5 such higher total cost is in the best interest of the veteran. 

6 ‘‘(B) A veteran described in this subparagraph is a 

7 veteran with amyotrophic lateral sclerosis, a spinal cord 

8 injury, or a condition the Secretary determines to be simi9 lar to such conditions.’’. 

10 (b) APPLICABILITY.—The amendments made by sub11 section (a) shall apply with respect to fiscal years begin12 ning on or after the date of the enactment of this Act. 

13 SEC. 121. COORDINATION WITH PROGRAM OF ALL-INCLU14 SIVE CARE FOR THE ELDERLY. 

15 Section 1720C of title 38, United States Code, as 

16 amended by section 120, is further amended by adding 

17 at the end the following new subsection: 

18 ‘‘(f) In furnishing services to a veteran under the pro19 gram conducted pursuant to subsection (a), if a medical 

20 center of the Department through which such program is 

21 administered is located in a geographic area in which serv22 ices are available to the veteran under a PACE program 

23 (as such term is defined in sections 1894(a)(2) and 

24 1934(a)(2) of the Social Security Act (42 U.S.C. 

25 1395eee(a)(2); 1396u–4(a)(2))), the Secretary shall seek 


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1 to enter into an agreement with the PACE program oper2 ating in that area for the furnishing of such services.’’. 

3 SEC. 122. AUTHORITY FOR SECRETARY OF VETERANS AF4 FAIRS TO AWARD GRANTS OR CONTRACTS TO 

5 ENTITIES TO IMPROVE PROVISION OF MEN6 TAL HEALTH SUPPORT TO FAMILY CARE7 GIVERS OF VETERANS. 

8 Subchapter II of chapter 17 of title 38, United States 

9 Code, is amended by adding at the end the following new 

10 section (and conforming the table of sections at the begin11 ning of such chapter accordingly): 

12 ‘‘§ 1720K. Grants or contracts to provide mental 

13 health support to family caregivers of 

14 veterans 

15 ‘‘(a) AUTHORITY.—The Secretary may award grants 

16 to carry out, coordinate, improve, or otherwise enhance 

17 mental health counseling, treatment, or support to the 

18 family caregivers of veterans participating in the family 

19 caregiver program. 

20 ‘‘(b) APPLICATION.—(1) To be eligible for a grant or 

21 contract under this section, an entity shall submit to the 

22 Secretary an application therefor at such time, in such 

23 manner, and containing such information as the Secretary 

24 may require. 


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1 ‘‘(2) Each application submitted under paragraph (1) 

2 shall include the following: 

3 ‘‘(A) A detailed plan for the use of the grant 

4 or contract. 

5 ‘‘(B) A description of the programs or efforts 

6 through which the entity will meet the outcome 

7 measures developed by the Secretary under sub8 section (g). 

9 ‘‘(C) A description of how the entity will dis10 tribute grant or contract amounts equitably among 

11 areas with varying levels of urbanization. 

12 ‘‘(D) A plan for how the grant or contract will 

13 be used to meet the unique needs of veterans resid14 ing in rural areas, Native American, Native Hawai15 ian, or Alaska Native veterans, elderly veterans, 

16 women veterans, and veterans from other under17 served communities. 

18 ‘‘(c) DISTRIBUTION.—The Secretary shall seek to en19 sure that grants and contracts awarded under this section 

20 are equitably distributed among entities located in States 

21 with varying levels of urbanization. 

22 ‘‘(d) PRIORITY.—The Secretary shall prioritize 

23 awarding grants or contracts under this section that will 

24 serve the following areas: 


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1 ‘‘(1) Areas with high rates of veterans enrolled 

2 in the family caregiver program. 

3 ‘‘(2) Areas with high rates of— 

4 ‘‘(A) suicide among veterans; or 

5 ‘‘(B) referrals to the Veterans Crisis Line. 

6 ‘‘(e) REQUIRED ACTIVITIES.—Any grant or contract 

7 awarded under this section shall be used— 

8 ‘‘(1) to expand existing programs, activities, 

9 and services; 

10 ‘‘(2) to establish new or additional programs, 

11 activities, and services; or 

12 ‘‘(3) for travel and transportation to facilitate 

13 carrying out paragraph (1) or (2). 

14 ‘‘(f) OUTCOME MEASURES.—(1) The Secretary shall 

15 develop and provide to each entity that receives a grant 

16 or contract under this section written guidance on the fol17 lowing: 

18 ‘‘(A) Outcome measures. 

19 ‘‘(B) Policies of the Department. 

20 ‘‘(2) In developing outcome measures under para21 graph (1), the Secretary shall consider the following goals: 

22 ‘‘(A) Increasing the utilization of mental health 

23 services among family caregivers of veterans partici24 pating in the family caregiver program. 


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1 ‘‘(B) Reducing barriers to mental health serv2 ices among family caregivers of veterans partici3 pating in such program. 

4 ‘‘(g) TRACKING REQUIREMENTS.—(1) The Secretary 

5 shall establish appropriate tracking requirements with re6 spect to the entities receiving a grant or contract under 

7 this section. 

8 ‘‘(2) Not less frequently than annually, the Secretary 

9 shall submit to Congress a report on such tracking re10 quirements. 

11 ‘‘(h) PERFORMANCE REVIEW.—The Secretary 

12 shall— 

13 ‘‘(1) review the performance of each entity that 

14 receives a grant or contract under this section; and 

15 ‘‘(2) make information regarding such perform16 ance publicly available. 

17 ‘‘(i) REMEDIATION PLAN.—(1) In the case of an enti18 ty that receives a grant or contract under this section and 

19 does not meet the outcome measures developed by the Sec20 retary under subsection (g), the Secretary shall require the 

21 entity to submit to the Secretary a remediation plan under 

22 which the entity shall describe how and when it plans to 

23 meet such outcome measures. 

24 ‘‘(2) The Secretary may not award a subsequent 

25 grant or contract under this section to an entity described 


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1 in paragraph (1) unless the Secretary approves the reme2 diation plan submitted by the entity under such para3 graph. 

4 ‘‘(j) MAXIMUM AMOUNT.—The amount of a grant or 

5 contract awarded under this section may not exceed 10 

6 percent of amounts made available for grants or contracts 

7 under this section for the fiscal year in which the grant 

8 or contract is awarded. 

9 ‘‘(k) SUPPLEMENT, NOT SUPPLANT.—Any grant or 

10 contract awarded under this section shall be used to sup11 plement and not supplant funding that is otherwise avail12 able through the Department to provide mental health 

13 support among family caregivers of veterans participating 

14 in the family caregiver program. 

15 ‘‘(l) OUTREACH TO FAMILY CAREGIVERS.—The Sec16 retary shall include, in the outreach materials regularly 

17 provided to a family caregiver who participates in the fam18 ily caregiver program, notice of mental health support pro19 vided by recipients of grants or contracts under this sec20 tion that are located in the relevant Veterans Integrated 

21 Service Network. 

22 ‘‘(m) FUNDING.—(1) Amounts for the activities of 

23 the Department under this section shall be budgeted and 

24 appropriated through a separate appropriation account. 


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1 ‘‘(2) In the budget justification materials submitted 

2 to Congress in support of the budget of the Department 

3 for any fiscal year (as submitted with the budget of the 

4 President under section 1105(a) of title 31), the Secretary 

5 shall include a separate statement of the amount re6 quested to be appropriated for that fiscal year for the ac7 count specified in paragraph (1). 

8 ‘‘(n) AUTHORIZATION OF APPROPRIATIONS.—There 

9 is authorized to be appropriated to the Secretary, for each 

10 of fiscal years 2025 and 2026, $10,000,000 to carry out 

11 this section. 

12 ‘‘(o) DEFINITIONS.—In this section: 

13 ‘‘(1) The terms ‘caregiver’ and ‘family care14 giver’ have the meanings given those terms in sec15 tion 1720G of this title. 

16 ‘‘(2) The term ‘family caregiver program’ 

17 means the program of comprehensive assistance for 

18 family caregivers under section 1720G of this title. 

19 ‘‘(3) The term ‘Veterans Crisis Line’ means the 

20 toll-free hotline for veterans established under sec21 tion 1720F of this title.’’. 

22 SEC. 123. HOME- AND COMMUNITY-BASED SERVICES: PRO23 GRAMS. 

24 (a) PROGRAMS.—Such subchapter is further amend25 ed by inserting after section 1720K (as added by section 


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1 122) the following new section (and conforming the table 

2 of sections at the beginning of such chapter accordingly): 

3 ‘‘§ 1720L. Home- and community-based services: pro4 grams 

5 ‘‘(a) IN GENERAL.—In furnishing noninstitutional al6 ternatives to nursing home care pursuant to the authority 

7 of section 1720C of this title (or any other authority under 

8 this chapter or other provision of law administered by the 

9 Secretary of Veterans Affairs), the Secretary shall carry 

10 out each of the programs specified in this section in ac11 cordance with such relevant authorities except as other12 wise provided in this section. 

13 ‘‘(b) VETERAN-DIRECTED CARE PROGRAM.—(1) The 

14 Secretary of Veterans Affairs, in collaboration with the 

15 Secretary of Health and Human Services, shall carry out 

16 a program to be known as the ‘Veteran-Directed Care pro17 gram’. Under such program, the Secretary of Veterans Af18 fairs may enter into agreements with the providers de19 scribed in paragraph (2) to provide to eligible veterans 

20 funds, to the extent practicable, to obtain such in-home 

21 care services and related items that support clinical need 

22 and improve quality of life, as may be determined appro23 priate by the Secretary of Veterans Affairs and selected 

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1 viduals to provide such services and items or directly pur2 chasing such services and items. 

3 ‘‘(2) The providers described in this paragraph are 

4 the following: 

5 ‘‘(A) An Aging and Disability Resource Center, 

6 an area agency on aging, or a State agency. 

7 ‘‘(B) A center for independent living. 

8 ‘‘(C) An Indian tribe or tribal organization re9 ceiving assistance under title VI of the Older Ameri10 cans Act of 1965 (42 U.S.C. 3057 et seq.). 

11 ‘‘(D) Any other entity that the Secretary, in 

12 consultation with the Secretary of Health and 

13 Human Services, determines appropriate. 

14 ‘‘(3) In carrying out the Veteran-Directed Care pro15 gram, the Secretary of Veterans Affairs shall— 

16 ‘‘(A) administer such program through each 

17 medical center of the Department of Veterans Af18 fairs; 

19 ‘‘(B) seek to ensure the availability of such pro20 gram in American Samoa, Guam, the Common21 wealth of the Northern Mariana Islands, the Com22 monwealth of Puerto Rico, the Virgin Islands of the 

23 United States, and any other territory or possession 

24 of the United States, to the extent practicable; and 


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1 ‘‘(C) seek to ensure the availability of such pro2 gram for eligible veterans who are Native American 

3 veterans receiving care and services furnished by the 

4 Indian Health Service, a tribal health program, an 

5 Urban Indian organization, or (in the case of a Na6 tive Hawaiian veteran) a Native Hawaiian health 

7 care system, to the extent practicable. 

8 ‘‘(4) If a veteran participating in the Veteran-Di9 rected Care program is hospitalized, the veteran may con10 tinue to use funds under the program during a period of 

11 hospitalization in the same manner that the veteran would 

12 be authorized to use such funds under the program if the 

13 veteran were not hospitalized. 

14 ‘‘(c) HOMEMAKER AND HOME HEALTH AIDE PRO15 GRAM.—(1) The Secretary shall carry out a program to 

16 be known as the ‘Homemaker and Home Health Aide pro17 gram’ under which the Secretary may enter into agree18 ments with home health agencies to provide to eligible vet19 erans such home health aide services as may be deter20 mined appropriate by the Secretary. 

21 ‘‘(2) In carrying out the Homemaker and Home 

22 Health Aide program, the Secretary shall— 

23 ‘‘(A) administer such program in the locations 

24 specified in subparagraph (A) of subsection (b)(3); 


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1 ‘‘(B) seek to ensure the availability of such pro2 gram in the locations specified in subparagraph (B) 

3 of subsection (b)(3); and 

4 ‘‘(C) seek to ensure the availability of such pro5 gram for the veteran populations specified in sub6 paragraph (C) of subsection (b)(3). 

7 ‘‘(d) HOME-BASED PRIMARY CARE PROGRAM.—The 

8 Secretary shall carry out a program to be known as the 

9 ‘Home-Based Primary Care program’ under which the 

10 Secretary may furnish to eligible veterans in-home health 

11 care, the provision of which is overseen by a provider of 

12 the Department. 

13 ‘‘(e) PURCHASED SKILLED HOME CARE PROGRAM.— 

14 The Secretary shall carry out a program to be known as 

15 the ‘Purchased Skilled Home Care program’ under which 

16 the Secretary may furnish to eligible veterans such in17 home care services as may be determined appropriate and 

18 selected by the Secretary for the veteran. 

19 ‘‘(f) CAREGIVER SUPPORT.—(1) With respect to a 

20 resident eligible caregiver of a veteran participating in a 

21 program under this section, the Secretary shall— 

22 ‘‘(A) if the veteran meets the requirements of 

23 a covered veteran under section 1720G(b) of this 

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1 ing in the program of general caregiver support serv2 ices under such section; 

3 ‘‘(B) provide to such caregiver covered respite 

4 care of not less than 30 days annually; and 

5 ‘‘(C) conduct on an annual basis (and, to the 

6 extent practicable, in connection with in-person serv7 ices provided under the program in which the vet8 eran is participating), a wellness contact of such 

9 caregiver. 

10 ‘‘(2) Covered respite care provided to a resident eligi11 ble caregiver of a veteran under paragraph (1) may exceed 

12 30 days annually if such extension is requested by the resi13 dent eligible caregiver or veteran and determined medi14 cally appropriate by the Secretary. 

15 ‘‘(g) RULE OF CONSTRUCTION.—Nothing in this sec16 tion shall be construed to limit the authority of the Sec17 retary to carry out programs providing home- and commu18 nity-based services under any other provision of law. 

19 ‘‘(h) DEFINITIONS.—In this section: 

20 ‘‘(1) The terms ‘Aging and Disability Resource 

21 Center’, ‘area agency on aging’, and ‘State agency’ 

22 have the meanings given those terms in section 102 

23 of the Older Americans Act of 1965 (42 U.S.C. 

24 3002). 


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1 ‘‘(2) The terms ‘caregiver’ and ‘family care2 giver’, with respect to a veteran, have the meanings 

3 given those terms, respectively, under subsection (e) 

4 of section 1720G of this title with respect to an eli5 gible veteran under subsection (a) of such section or 

6 a covered veteran under subsection (b) of such sec7 tion, as the case may be. 

8 ‘‘(3) The term ‘center for independent living’ 

9 has the meaning given that term in section 702 of 

10 the Rehabilitation Act of 1973 (29 U.S.C. 796a). 

11 ‘‘(4) The term ‘covered respite care’ has the 

12 meaning given such term in section 1720G(d) of this 

13 title. 

14 ‘‘(5) The term ‘eligible veteran’ means any vet15 eran— 

16 ‘‘(A) for whom the Secretary determines 

17 participation in a specific program under this 

18 section is medically necessary to promote, pre19 serve, or restore the health of the veteran; and 

20 ‘‘(B) who absent such participation would 

21 be at increased risk for hospitalization, place22 ment in a nursing home, or emergency room 

23 care. 


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1 ‘‘(6) The term ‘home health aide’ means an in2 dividual employed by a home health agency to pro3 vide in-home care services. 

4 ‘‘(7) The term ‘in-home care service’ means any 

5 service, including a personal care service, provided to 

6 enable the recipient of such service to live at home. 

7 ‘‘(8) The terms ‘Indian tribe’ and ‘tribal organi8 zation’ have the meanings given those terms in sec9 tion 4 of the Indian Self-Determination and Edu10 cation Assistance Act (25 U.S.C. 5304). 

11 ‘‘(9) The terms ‘Native American’ and ‘Native 

12 American veteran’ have the meanings given those 

13 terms in section 3765 of this title. 

14 ‘‘(10) The terms ‘Native Hawaiian’ and ‘Native 

15 Hawaiian health care system’ have the meanings 

16 given those terms in section 12 of the Native Hawai17 ian Health Care Improvement Act (42 U.S.C. 

18 11711). 

19 ‘‘(11) The terms ‘tribal health programs’ and 

20 ‘Urban Indian organizations’ have the meanings 

21 given those terms in section 4 of the Indian Health 

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

23 ‘‘(12) The term ‘resident eligible caregiver’ 

24 means an individual who— 


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1 ‘‘(A) is a caregiver, or a family caregiver, 

2 of a veteran and resides with that veteran; and 

3 ‘‘(B) has not entered into a contract, 

4 agreement, or other arrangement for such indi5 vidual to act as a caregiver for that veteran un6 less such individual is a family member of the 

7 veteran or is furnishing caregiver services 

8 through a medical foster home.’’. 

9 (b) DEADLINE FOR IMPROVED ADMINISTRATION.— 

10 The Secretary of Veterans Affairs shall ensure that the 

11 Veteran-Directed Care program and the Homemaker and 

12 Home Health Aide program are administered through 

13 each medical center of the Department of Veterans Affairs 

14 in accordance with section 1720L of title 38, United 

15 States Code (as added by subsection (a)), by not later 

16 than two years after the date of the enactment of this Act. 

17 (c) ADMINISTRATION OF VETERAN-DIRECTED CARE

18 PROGRAM.— 

19 (1) PROCEDURES.— 

20 (A) The Secretary shall establish proce21 dures to— 

22 (i) identify the staffing needs for the 

23 Veteran-Directed Care program of the De24 partment of Veterans Affairs under such 

25 section (as added by subsection (a)); and 


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1 (ii) define the roles and responsibil2 ities for personnel of the Department re3 sponsible for the administration of such 

4 program, including such personnel em5 ployed at the national, Veterans Integrated 

6 Service Network, or medical facility level. 

7 (B) The responsibilities described in clause 

8 (ii) of subparagraph (A) shall include respon9 sibilities for engagement with— 

10 (i) veterans participating in such pro11 gram; 

12 (ii) veterans interested in partici13 pating in such program; and 

14 (iii) providers described in section 

15 1720L(b)(2) (as added by subsection (a)). 

16 (2) STAFFING MODEL; REPORT.—Not later 

17 than two years after enactment of this Act, the Sec18 retary of Veterans Affairs shall— 

19 (A) establish a staffing model for the ad20 ministration of such program at each medical 

21 facility of the Department of Veterans Affairs; 

22 and 

23 (B) submit to the Committees on Veterans’ 

24 Affairs of the House of Representatives and the 

25 Senate a report containing the following: 


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1 (i) A description of— 

2 (I) the staffing model described 

3 in subparagraph (A); and 

4 (II) the rationale for such staff5 ing model. 

6 (ii) An identification of the ratio of 

7 staff required to administer such program 

8 to the number of veterans served by such 

9 program, disaggregated by each medical 

10 facility of the Department of Veterans Af11 fairs. 

12 (iii) A description of budgetary re13 sources or other support, if any, required 

14 to accommodate an increase in staffing at 

15 medical facilities of the Department of 

16 Veterans Affairs pursuant to the require17 ments of the staffing model described in 

18 subparagraph (A). 

19 (iv) Such other matters as the Sec20 retary of Veterans Affairs determines ap21 propriate. 

22 SEC. 124. COORDINATION WITH ASSISTANCE AND SUPPORT 

23 SERVICES FOR CAREGIVERS. 

24 (a) COORDINATION WITH PROGRAM OF COMPREHEN25 SIVE ASSISTANCE FOR FAMILY CAREGIVERS.— 


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1 (1) COORDINATION.—Section 1720G(a) of title 

2 38, United States Code, is amended by adding at 

3 the end the following new paragraph: 

4 ‘‘(14)(A) In the case of a veteran or caregiver who 

5 seeks services under this subsection and is denied such 

6 services, or a veteran or the family caregiver of a veteran 

7 who is discharged from the program under this subsection, 

8 the Secretary shall— 

9 ‘‘(i) if the veteran meets the requirements of a 

10 covered veteran under subsection (b), provide to 

11 such caregiver the option of enrolling in the program 

12 of general caregiver support services under such sub13 section; 

14 ‘‘(ii) assess the veteran or caregiver for partici15 pation in any other available program of the Depart16 ment for home- and community-based services (in17 cluding the programs specified in section 1720L of 

18 this title) for which the veteran or caregiver may be 

19 eligible and, with respect to the veteran, store (and 

20 make accessible to the veteran) the results of such 

21 assessment in the electronic medical record of the 

22 veteran; and 

23 ‘‘(iii) provide to the veteran or caregiver written 

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1 formation about facilities, eligibility requirements, 

2 and relevant contact information for each such pro3 gram. 

4 ‘‘(B) The Secretary shall, to the extent practicable, 

5 provide to a veteran or family caregiver the option of ob6 taining clinically appropriate services under any other 

7 available program of the Department for home- and com8 munity-based services (including the programs specified in 

9 section 1720L of this title) for which the veteran or family 

10 caregiver may be eligible prior to discharging the veteran 

11 or family caregiver from the program under this sub12 section. 

13 ‘‘(C) For each veteran or family caregiver who is dis14 charged from the program under this subsection, a care15 giver support coordinator shall provide for a smooth and 

16 personalized transition from such program to an appro17 priate program of the Department for home- and commu18 nity-based services (including the programs specified in 

19 section 1720L of this title), including by integrating care20 giver support across programs.’’. 

21 (2) APPLICABILITY.—The amendments made 

22 by paragraph (1) shall apply with respect to denials 

23 and discharges occurring on or after the date that 

24 is 180 days after the date of the enactment of this 

25 Act. 


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1 (3) TECHNICAL AND CONFORMING AMEND2 MENTS.—Section 1720G(d) of such title is amend3 ed— 

4 (A) by striking ‘‘or a covered veteran’’ 

5 each place it appears and inserting ‘‘, a veteran 

6 denied or discharged as specified in paragraph 

7 (14) of such subsection, or a covered veteran’’; 

8 and 

9 (B) by striking ‘‘under subsection (a), 

10 means’’ each place it appears and inserting 

11 ‘‘under subsection (a) or a veteran denied or 

12 discharged as specified in paragraph (14) of 

13 such subsection, means’’. 

14 (b) CONFORMITY OF RESPITE CARE ACROSS PRO15 GRAMS.—Section 1720G of title 38, United States Code, 

16 as amended by subsection (a)(3), is further amended— 

17 (1) in subsection (a)(3)— 

18 (A) by amending subparagraph (A)(ii)(III) 

19 to read as follows: 

20 ‘‘(III) covered respite care of not less than 

21 30 days annually;’’; and 

22 (B) by striking subparagraph (B) and re23 designating subparagraphs (C) and (D) as sub24 paragraphs (B) through (C), respectively; and 


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1 (2) by amending subsection (b)(3)(A)(iii) to 

2 read as follows: 

3 ‘‘(iii) Covered respite care of not less than 30 

4 days annually.’’; and 

5 (3) in subsection (d)— 

6 (A) by redesignating paragraphs (2) 

7 through (4) as paragraphs (3) through (5), re8 spectively; and 

9 (B) by inserting after paragraph (1) the 

10 following new paragraph: 

11 ‘‘(2) The term ‘covered respite care’ means, 

12 with respect to a caregiver of a veteran, respite care 

13 under section 1720B of this title that— 

14 ‘‘(A) is medically and age appropriate for 

15 the veteran (including 24-hour per day care of 

16 the veteran commensurate with the care pro17 vided by the caregiver); and 

18 ‘‘(B) includes in-home care.’’. 

19 (c) REVIEW RELATING TO CAREGIVER CONTACT.— 

20 The Secretary shall conduct a review of the capacity of 

21 the Department to establish a streamlined system for con22 tacting all caregivers enrolled in the program of general 

23 caregiver support services under section 1720G(b) of title 

24 38, United States Code, to provide to such caregivers pro25 gram updates and alerts relating to emerging services for 


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1 which such caregivers or the veterans for which they pro2 vide care may be eligible. 

3 SEC. 125. IMPROVEMENTS TO PROGRAM OF COMPREHEN4 SIVE ASSISTANCE FOR FAMILY CAREGIVERS. 

5 Section 1720G(a) of title 38, United States Code, as 

6 amended by section 124, is further amended— 

7 (1) in paragraph (12)— 

8 (A) in subparagraph (A), by inserting ‘‘, 

9 which shall include all criteria used to deter10 mine eligibility for such assistance and, in the 

11 case of a completed evaluation, how such cri12 teria were used to evaluate information pro13 vided in assessments to determine such eligi14 bility’’ before the period at the end; and 

15 (B) in subparagraph (C)(i), by striking 

16 ‘‘who submits’’ and all that follows through the 

17 end of the clause and inserting the following: 

18 ‘‘who— 

19 ‘‘(I) submits an application for the pro20 gram established under paragraph (1); or 

21 ‘‘(II) is being reassessed for eligibility to 

22 continue in such program.’’; and 

23 (2) by adding at the end the following new 

24 paragraph: 


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1 ‘‘(15)(A) Not less frequently than annually, the Sec2 retary shall submit to the Committees on Veterans’ Affairs 

3 of the Senate and the House of Representatives a com4 prehensive report on the program required by paragraph 

5 (1) that includes, with respect to one-year period pre6 ceding the date of the submission of such report, the fol7 lowing: 

8 ‘‘(i) The number of applications received for 

9 such program. 

10 ‘‘(ii) The number, disaggregated by race, sex, 

11 and era and branch of service in the Armed Forces 

12 of the applicant, of— 

13 ‘‘(I) approvals of such applications; and 

14 ‘‘(II) denials of such applications. 

15 ‘‘(iii) The number of reassessments conducted 

16 for such program. 

17 ‘‘(iv) An identification of each decision made 

18 with respect to a reassessment conducted for such 

19 program, disaggregated by decisions resulting in— 

20 ‘‘(I) disenrollment, including removal, dis21 charge, or voluntary withdrawal; 

22 ‘‘(II) tier reduction; and 

23 ‘‘(III) tier continuation. 


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1 ‘‘(v) The number of appeals of decisions made 

2 with respect to such program, disaggregated by type 

3 of appeal. 

4 ‘‘(vi) With respect to each appeal described in 

5 clause (v), the decision rendered, if any. 

6 ‘‘(vii) A description of all tools used in assess7 ments conducted for such program, including an ex8 planation of how and by whom such tools are admin9 istered. 

10 ‘‘(viii) A description of procedures used under 

11 such program for reviewing and integrating clinical 

12 records from health care providers that includes an 

13 explanation of how such records are used in deter14 minations of eligibility for such program. 

15 ‘‘(ix) A description of procedures available 

16 under such program for health care providers to 

17 communicate medical opinions to the teams con18 ducting assessments to determine eligibility for such 

19 program, including health care providers in the pri20 vate sector and health care providers specified in 

21 subsection (c) of section 1703 of this title. 

22 ‘‘(x) A description of information technology 

23 systems and processes used under such program to 

24 upload and integrate all clinical records from all 

25 non-Department providers, including providers in 


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1 the private sector and providers under the Veterans 

2 Community Care Program established under such 

3 section. 

4 ‘‘(B) The Secretary shall ensure that all data in5 cluded in a report under subparagraph (A)— 

6 ‘‘(i) relating to a decision made under the pro7 gram required by paragraph (1), are disaggregated 

8 by the specific reason for the decision; 

9 ‘‘(ii) relating to a veteran, include comprehen10 sive demographic information of the veteran, includ11 ing the time period of the injuries, if any, of the vet12 eran and the Veterans Integrated Service Network 

13 in which the veteran is located; and 

14 ‘‘(iii) with respect to eligibility determinations 

15 relating to a serious injury of a veteran, specify— 

16 ‘‘(I) how many such determinations relate 

17 to the ability of the veteran to perform activi18 ties of daily living; and 

19 ‘‘(II) how many such determinations relate 

20 to the need of a veteran for supervision and 

21 protection. 

22 ‘‘(C) The Secretary shall provide the data under 

23 paragraph (B) pursuant to Federal laws and in a manner 

24 that is wholly consistent with applicable Federal privacy 

25 and confidentiality laws, including but the Privacy Act (5 


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1 U.S.C. 552a), the Health Insurance Portability and Ac2 countability Act (Public Law 104–191; 42 U.S.C. 201 

3 note) and regulations (title 45, Code of Federal Regula4 tions, parts 160 and 164, or successor regulations), and 

5 sections 5701, 5705, and 7332 of this title to ensure that 

6 the provided data, or some portion of the data, will not 

7 undermine the anonymity of a veteran.’’. 

8 SEC. 126. IMPROVEMENTS RELATING TO HOMEMAKER AND 

9 HOME HEALTH AIDE PROGRAM. 

10 (a) PILOT PROGRAM FOR COMMUNITIES WITH

11 SHORTAGE OF HOME HEALTH AIDES.— 

12 (1) PROGRAM.—Beginning not later than 18 

13 months after the date of the enactment of this Act, 

14 the Secretary shall carry out a three-year pilot pro15 gram under which the Secretary shall provide home16 maker and home health aide services to veterans 

17 who reside in communities with a shortage of home 

18 health aides. 

19 (2) LOCATIONS.—The Secretary shall select not 

20 fewer than five geographic locations in which the 

21 Secretary determines there is a shortage of home 

22 health aides at which to carry out the pilot program 

23 under paragraph (1). 

24 (3) NURSING ASSISTANTS.— 


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1 (A) IN GENERAL.—In carrying out the 

2 pilot program under paragraph (1), the Sec3 retary may hire nursing assistants as new em4 ployees of the Department of Veterans Affairs, 

5 or reassign nursing assistants who are existing 

6 employees of the Department, to provide to vet7 erans in-home care services (including basic 

8 tasks authorized by the State certification of 

9 the nursing assistant) under the pilot program, 

10 in lieu of or in addition to the provision of such 

11 services through non-Department home health 

12 aides. 

13 (B) RELATIONSHIP TO HOME-BASED PRI14 MARY CARE PROGRAM.—Nursing assistants 

15 hired or reassigned under subparagraph (A) 

16 may provide services to a veteran under the 

17 pilot program under paragraph (1) while serv18 ing as part of a health care team for the vet19 eran under the Home-Based Primary Care pro20 gram. 

21 (4) REPORT TO CONGRESS.—Not later than one 

22 year before the date of the termination of the pilot 

23 program under paragraph (1), the Secretary shall 

24 submit to the Committees on Veterans’ Affairs of 


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1 the House of Representatives and the Senate a re2 port that includes— 

3 (A) a statement of the results of such pilot 

4 program; and 

5 (B) an assessment of the feasibility and 

6 advisability of— 

7 (i) extending such pilot program; or 

8 (ii) making such pilot program a per9 manent program of the Department of 

10 Veterans Affairs. 

11 (b) REPORT ON USE OF FUNDS.—Not later than one 

12 year after the date of the enactment of this Act, the Sec13 retary of Veterans Affairs shall submit to the Committees 

14 on Veterans’ Affairs of the House of Representatives and 

15 the Senate a report containing, with respect to the period 

16 beginning in fiscal year 2012 and ending in fiscal year 

17 2023, the following: 

18 (1) An identification of the amount of funds 

19 that were included in a budget of the Department of 

20 Veterans Affairs during such period for the provision 

21 of in-home care to veterans under the Homemaker 

22 and Home Health Aide program but were not ex23 pended for such provision, disaggregated by medical 

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1 pended funds were budgeted (if such disaggregation 

2 is possible). 

3 (2) To the extent practicable, an identification 

4 of the number of veterans for whom, during such pe5 riod, the hours during which a home health aide was 

6 authorized to provide services to the veteran under 

7 the Homemaker and Home Health Aide program 

8 were reduced for a reason other than a change in 

9 the health care needs of the veteran, and a detailed 

10 description of the reasons why any such reductions 

11 may have occurred. 

12 (c) UPDATED GUIDANCE ON PROGRAM.—Not later 

13 than one year after the date of the enactment of this Act, 

14 the Secretary shall issue updated guidance for the Home15 maker and Home Health Aide program. Such updated 

16 guidance shall include the following: 

17 (1) A process for the transition of veterans 

18 from the Homemaker and Home Health Aide pro19 gram to other covered programs. 

20 (2) A requirement for the directors of the med21 ical facilities of the Department to complete such 

22 process whenever a veteran with care needs has been 

23 denied services from home health agencies under the 

24 Homemaker and Home Health Aide program as a 


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1 result of the clinical needs or behavioral issues of the 

2 veteran. 

3 SEC. 127. PILOT PROGRAM TO FURNISH ASSISTED LIVING 

4 SERVICES TO CERTAIN VETERANS. 

5 (a) ESTABLISHMENT.—Beginning not later than two 

6 years after the date of the enactment of this Act, the Sec7 retary of Veterans Affairs shall carry out a pilot program 

8 to assess— 

9 (1) the effectiveness of providing assisted living 

10 services to eligible veterans, at the election of such 

11 veterans; and 

12 (2) the satisfaction with the pilot program of 

13 veterans participating in such pilot program. 

14 (b) PROGRAM LOCATIONS.— 

15 (1) VETERANS INTEGRATED SERVICE NET16 WORKS.—The Secretary shall select two Veterans 

17 Integrated Service Networks of the Department of 

18 Veterans Affairs at which to carry out the pilot pro19 gram under subsection (a). 

20 (2) FACILITIES.— 

21 (A) IN GENERAL.—Within the Veterans 

22 Integrated Service Networks selected under 

23 paragraph (1), the Secretary shall select facili24 ties at which to carry out the pilot program 

25 under subsection (a)(1). 


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1 (B) SELECTION CRITERIA.—In selecting 

2 facilities under subparagraph (A) at which to 

3 carry out the pilot program under subsection 

4 (a)(1), the Secretary shall ensure that— 

5 (i) the locations of such facilities are 

6 in geographically diverse areas; 

7 (ii) not fewer than one such facility 

8 serves veterans in rural or highly rural 

9 areas (as determined through the use of 

10 the Rural-Urban Commuting Areas coding 

11 system of the Department of Agriculture); 

12 (iii) not fewer than one such facility is 

13 located in each Veterans Integrated Service 

14 Network selected under paragraph (1); and 

15 (iv) not fewer than one such facility is 

16 a State home. 

17 (c) PROGRAM PARTICIPANTS.—Not more than 60 eli18 gible veterans may participate in the pilot program under 

19 subsection (a)(1) in each Veterans Integrated Service Net20 work selected under subsection (b)(1). 

21 (d) PROVISION OF ASSISTED LIVING SERVICES.— 

22 (1) AGREEMENTS.—In carrying out the pilot 

23 program under subsection (a)(1), the Secretary may 

24 enter into agreements for the provision of assisted 

25 living services on behalf of eligible veterans with— 


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1 (A) a provider participating under a State 

2 plan or waiver under title XIX of the Social Se3 curity Act (42 U.S.C. 1396 et seq.); or 

4 (B) a State home recognized and certified 

5 under subpart B of part 51 of title 38, Code of 

6 Federal Regulations, or successor regulations. 

7 (2) STANDARDS.—The Secretary may not place, 

8 transfer, or admit a veteran to any facility for as9 sisted living services under the pilot program under 

10 subsection (a)(1) unless the Secretary determines 

11 that— 

12 (A) the facility meets the standards for 

13 community residential care established under 

14 sections 17.61 through 17.72 of title 38, Code 

15 of Federal Regulations, or successor regula16 tions, and any additional standards of care as 

17 the Secretary may specify; or 

18 (B) in the case of a facility that is a State 

19 home, the State home meets such standards of 

20 care as the Secretary may specify. 

21 (3) INSPECTION.—The Secretary shall inspect 

22 facilities at which veterans are placed under the pilot 

23 program under subsection (a)(1)— 

24 (A) with respect to a facility that is a 

25 State home, not less frequently than annually 


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1 and in the same manner as the Secretary con2 ducts inspection of State homes under section 

3 1742 of title 38, United States Code; and 

4 (B) with respect to any other facility, not 

5 less frequently than annually and in the same 

6 manner as the Secretary conducts inspection of 

7 facilities under section 1730 of such title. 

8 (4) PAYMENT TO CERTAIN FACILITIES.— 

9 (A) STATE HOMES.—In the case of a facil10 ity participating in the pilot program under 

11 subsection (a)(1) that is a State home, the Sec12 retary shall pay to the State home a per diem 

13 for each veteran participating in the pilot pro14 gram at a rate agreed to by the Secretary and 

15 the State home. 

16 (B) COMMUNITY ASSISTED LIVING FACILI17 TIES.—In the case of a facility participating in 

18 the pilot program under subsection (a)(1) that 

19 is a community assisted living facility, the Sec20 retary shall— 

21 (i) pay to the facility an amount that 

22 is less than the average rate paid by the 

23 Department for placement in a community 

24 nursing home in the same Veterans Inte25 grated Service Network; and 


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1 (ii) re-evaluate payment rates annu2 ally to account for current economic condi3 tions and current costs of assisted living 

4 services. 

5 (e) CONTINUITY OF CARE.—Upon the termination of 

6 the pilot program under subsection (a)(1), the Secretary 

7 shall— 

8 (1) provide to all veterans participating in the 

9 pilot program at the time of such termination the 

10 option to continue to receive assisted living services 

11 at the site they were assigned to under the pilot pro12 gram, at the expense of the Department; and 

13 (2) for such veterans who do not opt to con14 tinue to receive such services— 

15 (A) ensure such veterans do not experience 

16 lapses in care; and 

17 (B) provide such veterans with information 

18 on, and furnish such veterans with, other ex19 tended care services based on their preferences 

20 and best medical interest. 

21 (f) DETERMINATION OF QUALITY.—The Secretary 

22 shall determine a method for assessment of quality of care 

23 provided to veterans participating in the pilot program 

24 under subsection (a)(1) and shall communicate that meth25 od to providers of services under the pilot program. 


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1 (g) ANNUAL REPORT.—Not later than one year after 

2 the initiation of the pilot program under subsection (a)(1), 

3 and annually thereafter for the duration of such pilot pro4 gram, the Secretary shall submit to the Committees on 

5 Veterans’ Affairs of the House of Representatives and the 

6 Senate a report on the pilot program that includes— 

7 (1) an identification of Veterans Integrated 

8 Services Networks and facilities of the Department 

9 participating in the pilot program and assisted living 

10 facilities and State homes at which veterans are 

11 placed under the pilot program; 

12 (2) the number of participants in the pilot pro13 gram, disaggregated by facility; 

14 (3) general demographic information of partici15 pants in the pilot program, including average age, 

16 sex, and race or ethnicity; 

17 (4) disability status of participants in the pilot 

18 program; 

19 (5) an identification of any barriers or chal20 lenges to furnishing care to veterans under the pilot 

21 program, conducting oversight of the pilot program, 

22 or any other barriers or challenges; 

23 (6) the cost of care at each assisted living facil24 ity and State home participating in the pilot pro25 gram, including an analysis of any cost savings by 


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1 the Department when comparing that cost to the 

2 cost of nursing home care; 

3 (7) aggregated feedback from participants in 

4 the pilot program, including from veteran resident 

5 surveys and interviews; and 

6 (8) such other matters the Secretary considers 

7 appropriate. 

8 (h) FINAL REPORT.—Not later than one year after 

9 the pilot program terminates under subsection (j), the 

10 Secretary shall submit to the Committees on Veterans’ Af11 fairs of the House of Representatives and the Senate a 

12 report on the pilot program that— 

13 (1) includes the matters required under para14 graphs (1) through (8) of subsection (g); 

15 (2) includes recommendations on whether the 

16 model studied in the pilot program should be contin17 ued or adopted throughout the Department; and 

18 (3) indicates whether the Secretary requests ac19 tion by Congress to make the pilot program perma20 nent. 

21 (i) INSPECTOR GENERAL REPORT.— 

22 (1) IN GENERAL.—Not later than three years 

23 after the initiation of the pilot program under sub24 section (a)(1), the Inspector General of the Depart25 ment of Veterans Affairs shall submit to the SecVerDate Sep 11 2014 18:49 May 29, 2024 Jkt 049200 PO 00000 Frm 00104 Fmt 6652 Sfmt 6201 E:\BILLS\H8371.IH H8371

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1 retary of Veterans Affairs and the Committees on 

2 Veterans’ Affairs of the House of Representatives 

3 and the Senate a report on the pilot program. 

4 (2) ELEMENTS.—The report required by para5 graph (1) shall include an assessment of— 

6 (A) the quality of care provided to veterans 

7 at facilities participating in the pilot program, 

8 measured pursuant to the method determined 

9 under subsection (f); 

10 (B) the oversight of such facilities, as con11 ducted by the Department, the Centers for 

12 Medicare & Medicaid Services, State agencies, 

13 and other relevant entities; and 

14 (C) such other matters as the Inspector 

15 General considers appropriate. 

16 (3) PLAN REQUIRED.—Not later than 90 days 

17 after the submission of the report under paragraph 

18 (1), the Secretary shall submit to the Committees on 

19 Veterans’ Affairs of the House of Representatives 

20 and the Senate a plan to address the deficiencies 

21 identified in the report, if any. 

22 (j) TERMINATION.— 

23 (1) IN GENERAL.—Subject to paragraph (2), 

24 the pilot program under subsection (a)(1) shall ter25 minate on September 30, 2026. 


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1 (2) EXTENSION.—The Secretary may extend 

2 the duration of the pilot program for an additional 

3 two-year period if the Secretary, based on the results 

4 of the reports submitted under subsection (g), deter5 mines such an extension is appropriate. 

6 (k) DEFINITIONS.—In this section: 

7 (1) The term ‘‘assisted living services’’ means 

8 services of a facility in providing room, board, and 

9 personal care for and supervision of residents for 

10 their health, safety, and welfare. 

11 (2) The term ‘‘eligible veteran’’ means a vet12 eran who is— 

13 (A) receiving nursing home care paid for 

14 by the Department of Veterans Affairs, eligible 

15 to receive such care pursuant to section 1710A 

16 of title 38, United States Code, or requires a 

17 higher level of care than the domiciliary care 

18 provided by the Department of Veterans Af19 fairs, but does not meet the requirements for 

20 nursing home level care provided by the Depart21 ment pursuant to such section; and 

22 (B) eligible for assisted living services, as 

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1 gram under subsection (a)(1) as the Secretary 

2 may establish. 

3 (3) The term ‘‘State home’’ has the meaning 

4 given that term in section 101 of title 38, United 

5 States Code. 

6 SEC. 128. PROVISION OF MEDICINE, EQUIPMENT, AND SUP7 PLIES AVAILABLE TO DEPARTMENT OF VET8 ERANS AFFAIRS TO STATE HOMES. 

9 (a) PROVISION AUTHORIZED.—The Secretary of Vet10 erans Affairs may provide to State homes medicine, per11 sonal protective equipment, medical supplies, and any 

12 other equipment, supplies, and assistance available to the 

13 Department of Veterans Affairs. 

14 (b) DEFINITION.—In this section: 

15 (1) The term ‘‘personal protective equipment’’ 

16 means any protective equipment required to prevent 

17 the wearer from contracting an infectious disease, 

18 including gloves, N–95 respirator masks, gowns, 

19 goggles, face shields, or other equipment required 

20 for safety. 

21 (2) The term ‘‘State home’’ has the meaning 

22 given such term in section 101 of title 38, United 

23 States Code. 


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1 SEC. 129. RECOGNITION OF ORGANIZATIONS AND INDIVID2 UALS TO ASSIST VETERANS, FAMILY MEM3 BERS, AND CAREGIVERS NAVIGATING PRO4 GRAMS AND SERVICES OF VETERANS 

5 HEALTH ADMINISTRATION. 

6 (a) IN GENERAL.—Not later than one year after the 

7 date of the enactment of this Act, the Secretary of Vet8 erans Affairs shall establish a process through which the 

9 Department of Veterans Affairs may recognize organiza10 tions and individuals to assist a veteran, a family member 

11 of a veteran, or a caregiver of a veteran (as defined in 

12 section 1720G(d) of title 38, United States Code) in navi13 gating the programs and services of the Veterans Health 

14 Administration. 

15 (b) SOLICITATION OF FEEDBACK.—The Secretary 

16 shall solicit feedback and recommendations in the creation 

17 of the process under subsection (a) from such organiza18 tions as the Secretary may consider relevant. 

19 (c) LIMITATION.—The Secretary may not recognize 

20 an organization or individual pursuant to the process es21 tablished under subsection (a) unless the organization or 

22 individual has certified to the Secretary that no fee or 

23 compensation of any nature will be charged to any indi24 vidual for services rendered in providing assistance pursu25 ant to such subsection. 


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1 SEC. 130. REVIEWS AND OTHER IMPROVEMENTS RELATING 

2 TO HOME- AND COMMUNITY-BASED SERV3 ICES. 

4 (a) OFFICE OF GERIATRIC AND EXTENDED CARE.— 

5 (1) REVIEW OF PROGRAMS.—The Under Sec6 retary for Health of the Department of Veterans Af7 fairs shall conduct a review of each program admin8 istered through the Office of Geriatric and Extended 

9 Care of the Department and the Caregiver Support 

10 Program Office of the Department, or any successor 

11 offices, to— 

12 (A) eliminate service gaps at the medical 

13 center level; and 

14 (B) ensure— 

15 (i) the clinical needs of veterans are 

16 met; 

17 (ii) consistency in program manage18 ment; 

19 (iii) the availability of, and the access 

20 by veterans to, home- and community21 based services, including for veterans living 

22 in rural areas; and 

23 (iv) proper coordination between cov24 ered programs. 

25 (2) ASSESSMENT OF STAFFING NEEDS.—The 

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1 sessment of the staffing needs of the Office of Geri2 atric and Extended Care of the Department and the 

3 Caregiver Support Program Office of the Depart4 ment, or any successor offices. 

5 (3) GOALS FOR GEOGRAPHIC ALIGNMENT OF

6 CARE.— 

7 (A) ESTABLISHMENT OF GOALS.—The Di8 rector of the Office of Geriatric and Extended 

9 Care, or successor office, shall establish quan10 titative goals to enable aging or disabled vet11 erans who are not located near medical centers 

12 of the Department to access extended care serv13 ices (including by improving access to home14 and community-based services for such vet15 erans). 

16 (B) IMPLEMENTATION TIMELINE.—Each 

17 goal established under subparagraph (A) shall 

18 include a timeline for the implementation of the 

19 goal at each medical center of the Department. 

20 (4) GOALS FOR IN-HOME SPECIALTY CARE.— 

21 The Director of the Office of Geriatric and Extended 

22 Care, or successor office, shall establish quantitative 

23 goals to address the specialty care needs of veterans 

24 through in-home care, including by ensuring the 


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1 education of home health aides and caregivers of vet2 erans in the following areas: 

3 (A) Dementia care. 

4 (B) Care for spinal cord injuries and dis5 eases. 

6 (C) Ventilator care. 

7 (D) Other speciality care areas as deter8 mined by the Secretary. 

9 (5) INPUT ON GOALS.—To the extent prac10 ticable, the head of the Caregiver Support Program 

11 Office, or successor office, shall provide to the Direc12 tor of the Office of Geriatric and Extended Care, or 

13 successor office, input with respect to the establish14 ment of the goals under paragraphs (3) and (4). 

15 (6) REPORT TO CONGRESS.—Not later than one 

16 year after the date of the enactment of this Act, the 

17 Secretary shall submit to the Committees on Vet18 erans’ Affairs of the House of Representatives and 

19 the Senate a report containing the findings of the 

20 review under paragraph (1), the results of the as21 sessment under paragraph (2), and the goals estab22 lished under paragraphs (3) and (4). 

23 (b) REVIEW OF INCENTIVES AND EFFORTS RELAT24 ING TO HOME- AND COMMUNITY-BASED SERVICES.— 


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1 (1) REVIEW.—The Secretary of Veterans Af2 fairs shall conduct a review of the following: 

3 (A) The financial and organizational incen4 tives or disincentives for the directors of med5 ical centers of the Department to establish or 

6 expand covered programs at such medical cen7 ters. 

8 (B) Any incentives or disincentives for 

9 such directors to provide to veterans home- and 

10 community-based services in lieu of institutional 

11 care. 

12 (C) The efforts taken by the Secretary to 

13 enhance spending of the Department for ex14 tended care by balancing spending between in15 stitutional care and home- and community16 based services consistent with the demand for 

17 such services. 

18 (D) The plan of the Under Secretary for 

19 Health of the Department to accelerate efforts 

20 to enhance spending as specified in subpara21 graph (C), to match the progress of similar ef22 forts taken by the Administrator of the Centers 

23 for Medicare & Medicaid Services with respect 

24 to spending of the Centers for Medicare & Med25 icaid Services for extended care. 


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1 (2) REPORT TO CONGRESS.—Not later than one 

2 year after the date of the enactment of this Act, the 

3 Secretary shall submit to the Committees on Vet4 erans’ Affairs of the House of Representatives and 

5 the Senate a report on the findings of the review 

6 under paragraph (1). 

7 (c) REVIEW OF RESPITE CARE SERVICES.—Not later 

8 than two years after the date of the enactment of this Act, 

9 the Secretary of Veterans Affairs shall conduct a review 

10 of the use, availability, cost, and effectiveness, of the res11 pite care services furnished by the Secretary under chapter 

12 17 of title 38, United States Code, including— 

13 (1) the frequency at which the Department of 

14 Veterans Affairs is unable to meet demand for such 

15 services; 

16 (2) a detailed description of— 

17 (A) the reasons the Department of Vet18 erans Affairs is unable to meet the demand for 

19 such services; and 

20 (B) any actions, or planned actions, of the 

21 Secretary of Veterans Affairs to ensure such 

22 demand is met. 

23 (d) COLLABORATION TO IMPROVE HOME- AND COM24 MUNITY-BASED SERVICES.— 

25 (1) RECOMMENDATIONS.— 


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1 (A) DEVELOPMENT.—The Secretary of 

2 Veterans Affairs shall develop recommendations 

3 as follows: 

4 (i) With respect to home- and commu5 nity-based services for veterans, the Sec6 retary of Veterans Affairs shall develop 

7 recommendations regarding new services 

8 (in addition to those furnished as of the 

9 date of enactment of this Act) in collabora10 tion with the Secretary of Health and 

11 Human Services. 

12 (ii) With respect to the national short13 age of home health aides, the Secretary of 

14 Veterans Affairs shall develop rec15 ommendations regarding methods to ad16 dress such shortage in collaboration with 

17 the Secretary of Health and Human Serv18 ices and the Secretary of Labor. 

19 (B) SUBMISSION TO CONGRESS.—The Sec20 retary of Veterans Affairs shall submit to the 

21 Committees on Veterans’ Affairs of the House 

22 of Representatives and the Senate a report con23 taining the recommendations developed under 

24 subparagraph (A) and an identification of any 

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1 thority necessary to implement the rec2 ommendations, as determined by the Secretary. 

3 (C) CONSULTATION WITH SECRETARY OF

4 LABOR.—In carrying out this paragraph, the 

5 Secretary of Veterans Affairs shall consult with 

6 the Secretary of Labor. 

7 (2) FEEDBACK AND RECOMMENDATIONS ON

8 CAREGIVER SUPPORT.— 

9 (A) FEEDBACK AND RECOMMENDA10 TIONS.—The Secretary of Veterans Affairs shall 

11 solicit from the entities described in subpara12 graph (B) feedback and recommendations re13 garding opportunities for the Secretary to en14 hance home- and community-based services for 

15 veterans and the caregivers of veterans, includ16 ing through the potential provision by the entity 

17 of care and respite services to veterans and 

18 caregivers who may not be eligible for any pro19 gram under section 1720G of title 38, United 

20 States Code, or section 1720L of such title (as 

21 added by section 124), but have a need for as22 sistance. 

23 (B) COVERED ENTITIES.—The entities de24 scribed in this subparagraph are veterans serv25 ice organizations and nonprofit organizations 


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1 with a focus on caregiver support or long term 

2 care (as determined by the Secretary). 

3 (3) COLLABORATION FOR CERTAIN VET4 ERANS.—The Secretary of Veterans Affairs shall col5 laborate with the Director of the Indian Health 

6 Service and representatives from tribal health pro7 grams and Urban Indian organizations to ensure the 

8 availability of home- and community-based services 

9 for— 

10 (A) Native American veterans, including 

11 Native American veterans receiving health care 

12 and medical services under multiple health care 

13 systems; and 

14 (B) Native Hawaiian veterans, including 

15 Native Hawaiian veterans receiving health care 

16 and medical services under the Native Hawaiian 

17 health care system. 

18 SEC. 131. GAO REPORT ON MENTAL HEALTH SUPPORT FOR 

19 CAREGIVERS. 

20 (a) REPORT REQUIRED.—Not later than one year 

21 after the date of the enactment of this Act, the Comp22 troller General of the United States shall submit to the 

23 Committee on Veterans’ Affairs of the Senate and the 

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1 resentatives a report on the provision of mental health 

2 support to caregivers of veterans. 

3 (b) CONTENTS.—The report submitted under sub4 section (a) shall include the following: 

5 (1) An assessment of the need for mental 

6 health support among caregivers participating in the 

7 caregiver programs. 

8 (2) An assessment of options for mental health 

9 support in facilities of the Department of Veterans 

10 Affairs and in the community for caregivers partici11 pating in the caregiver programs. 

12 (3) An assessment of the availability and acces13 sibility of mental health support in facilities of the 

14 Department and in the community for caregivers 

15 participating in the caregiver programs. 

16 (4) An assessment of the awareness among 

17 caregivers of the availability of mental health sup18 port in facilities of the Department and in the com19 munity for caregivers participating in the caregiver 

20 programs. 

21 (5) An assessment of barriers to mental health 

22 support in facilities of the Department and in the 

23 community for caregivers participating in the care24 giver programs. 

25 (c) DEFINITIONS.—In this section: 


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1 (1) The term ‘‘caregiver’’ has the meaning 

2 given that term in section 1720G of title 38, United 

3 States Code. 

4 (2) The term ‘‘caregiver programs’’ means— 

5 (A) the program of comprehensive assist6 ance for family caregivers under subsection (a) 

7 of section 1720G of title 38, United States 

8 Code; and 

9 (B) the program of support services for 

10 caregivers under subsection (b) of such section. 

11 SEC. 132. DEVELOPMENT OF CENTRALIZED WEBSITE FOR 

12 PROGRAM INFORMATION. 

13 (a) CENTRALIZED WEBSITE.—The Secretary shall 

14 develop and maintain a centralized and publicaly acces15 sible internet website of the Department as a clearing16 house for information and resources relating to covered 

17 programs. 

18 (b) CONTENTS.—The website under subsection (a) 

19 shall contain the following: 

20 (1) A description of each covered program. 

21 (2) An informational assessment tool that— 

22 (A) explains the administrative eligibility, 

23 if applicable, of a veteran, or a caregiver of a 

24 veteran, for any covered program; and 


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1 (B) provides information, as a result of 

2 such explanation, on any covered program for 

3 which the veteran or caregiver (as the case may 

4 be) may be eligible. 

5 (3) A list of required procedures for the direc6 tors of the medical facilities of the Department to 

7 follow in determining the eligibility and suitability of 

8 veterans for participation in a covered program, in9 cluding procedures applicable to instances in which 

10 the resource constraints of a facility (or of a commu11 nity in which a facility is located) may result in the 

12 inability to address the health needs of a veteran 

13 under a covered program in a timely manner. 

14 (c) UPDATES.—The Secretary shall ensure the 

15 website under subsection (a) is updated on a periodic 

16 basis. 

17 SEC. 133. DEFINITIONS. 

18 In this title: 

19 (1) The terms ‘‘caregiver’’ and ‘‘family care20 giver’’ have the meanings given those terms under 

21 section 1720L(h) of title 38, United States Code (as 

22 added by section 123). 

23 (2) The term ‘‘covered program’’— 


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1 (A) means any program of the Department 

2 of Veterans Affairs for home- and community3 based services; and 

4 (B) includes the programs specified in sec5 tion 1720L of title 38, United States Code (as 

6 added by section 123). 

7 (3) The term ‘‘home- and community-based 

8 services’’— 

9 (A) means the services referred to in sec10 tion 1701(6)(E) of title 38, United States Code; 

11 and 

12 (B) includes services furnished under a 

13 program specified in section 1720L of such title 

14 (as added by section 123). 

15 (4) The terms ‘‘Home-Based Primary Care pro16 gram’’, ‘‘Homemaker and Home Health Aide pro17 gram’’, and ‘‘Veteran-Directed Care program’’ mean 

18 the programs of the Department of Veterans Affairs 

19 specified in subsection (d), (c), and (b) of such sec20 tion 1720L, respectively. 

21 (5) The terms ‘‘home health aide’’, ‘‘Native 

22 American’’, ‘‘Native American veteran’’, ‘‘tribal 

23 health programs’’, and ‘‘Urban Indian organiza24 tions’’ have the meanings given those terms in sub25 section (h) of such section 1720L. 


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1 (6) The term ‘‘Vet Center’’ has the meaning 

2 given that term in section 1712A(h) of title 38, 

3 United States Code. 

4 (7) The term ‘‘veterans service organization’’ 

5 means any organization recognized by the Secretary 

6 under section 5902 of such title. 

7 Subtitle C—Medical Treatment and 

8 Other Matters 

9 SEC. 140. QUARTERLY REPORT ON REFERRALS FOR NON10 DEPARTMENT OF VETERANS AFFAIRS 

11 HEALTH CARE. 

12 Subchapter I of chapter 5 of title 38, United States 

13 Code, is amended by adding at the end the following new 

14 section (and amending the table of sections at the begin15 ning of such chapter accordingly): 

16 ‘‘§ 534. Quarterly report on referrals for non-Depart17 ment health care 

18 ‘‘Not later than 180 days after the date of the enact19 ment of this section, and not less frequently than quarterly 

20 thereafter, the Secretary shall submit to the Committees 

21 on Veterans’ Affairs of the Senate and the House of Rep22 resentatives a report containing, with respect to referrals 

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1 ceding the date of the submission of the report, a measure2 ment of, for each such medical facility— 

3 ‘‘(1) the period of time between— 

4 ‘‘(A) the date on which a clinician em5 ployed by the Department determines that a 

6 veteran requires care, or a veteran presents to 

7 the Department requesting care, and the date 

8 on which the referral for care is sent to a non9 Department health care provider; 

10 ‘‘(B) the date on which such referral is 

11 sent to a non-Department health care provider 

12 and the date on which such non-Department 

13 health care provider accepts such referral; 

14 ‘‘(C) the date on which such non-Depart15 ment health care provider accepts such referral 

16 and the date on which such referral is com17 pleted; 

18 ‘‘(D) the date on which such referral is 

19 completed and the date on which an appoint20 ment with a non-Department health care pro21 vider is made; and 

22 ‘‘(E) the date on which such an appoint23 ment is made and the date on which such ap24 pointment occurs; and 


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1 ‘‘(2) any other period of time that the Secretary 

2 determines necessary.’’. 

3 SEC. 141. ELIMINATION OF CERTAIN REQUIREMENTS FOR 

4 CERTAIN DEPARTMENT OF VETERANS AF5 FAIRS ASSISTANT UNDER SECRETARIES. 

6 Section 7306 of title 38, United States Code, is 

7 amended— 

8 (1) by striking subsection (b); 

9 (2) by redesignating subsections (c) through (g) 

10 as subsections (b) through (f), respectively; and 

11 (3) in subsection (c) (as so redesignated), by 

12 striking ‘‘subsection (e)’’ and inserting ‘‘subsection 

13 (f)’’. 

14 SEC. 142. MODIFICATION OF PAY LIMITATION FOR PHYSI15 CIANS, PODIATRISTS, OPTOMETRISTS, AND 

16 DENTISTS OF DEPARTMENT OF VETERANS 

17 AFFAIRS. 

18 (a) PAY.— 

19 (1) IN GENERAL.—Section 7431 of title 38, 

20 United States Code, is amended— 

21 (A) by inserting ‘‘optometrists,’’ after ‘‘po22 diatrists,’’ each place it appears; 

23 (B) by inserting ‘‘optometrist’’ after ‘‘podi24 atrist,’’ each place it appears; 

25 (C) in subsection (c)— 


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1 (i) in paragraph (5), by adding at the 

2 end the following new sentence: ‘‘Such a 

3 notice shall include a statement of whether 

4 the market pay will increase, decrease, or 

5 remain unchanged following such evalua6 tion.’’; and 

7 (ii) by adding at the end the following 

8 new paragraphs: 

9 ‘‘(7) The Secretary shall ensure that each phy10 sician, podiatrist, optometrist, and dentist in the 

11 Veterans Health Administration is— 

12 ‘‘(A) advised, on an annual basis, of the 

13 criteria described in subparagraph (F) of para14 graph (4); 

15 ‘‘(B) evaluated in accordance with such 

16 criteria; and 

17 ‘‘(C) compensated in accordance with— 

18 ‘‘(i) applicable assignment and pay 

19 levels, subject to relevant pay limitations; 

20 and 

21 ‘‘(ii) the extent to which such criteria 

22 is met. 

23 ‘‘(8) Not later than 120 days after the end of 

24 each fiscal year, the Secretary shall submit to the 

25 Committees on Veterans’ Affairs of the Senate and 


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1 the House of Representatives a report that includes 

2 the following: 

3 ‘‘(A) A list of each facility and specialty 

4 that conducted an evaluation of pay during the 

5 period covered by the report. 

6 ‘‘(B) For each evaluation described in sub7 paragraph (A)— 

8 ‘‘(i) a list of occupations for which 

9 pay was evaluated, disaggregated by med10 ical specialty, number of authorized full11 time employees, and onsite full-time em12 ployees as of the date of the evaluation; 

13 ‘‘(ii) the date such evaluation was 

14 completed; 

15 ‘‘(iii) whether a market pay adjust16 ment was made following the evaluation 

17 per each occupation and specialty evalu18 ated; 

19 ‘‘(iv) whether applicable employees 

20 were notified of such evaluation; 

21 ‘‘(v) whether local labor partners were 

22 notified of such evaluation; and 

23 ‘‘(vi) in the case of an evaluation that 

24 resulted in an adjustment of pay— 

25 ‘‘(I) the date such adjustment— 


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1 ‘‘(aa) was implemented; and 

2 ‘‘(bb) became effective; and 

3 ‘‘(II) the percentage of employees 

4 of each occupation and specialty for 

5 which pay was adjusted pursuant to 

6 such evaluation. 

7 ‘‘(C) A list of facilities of the Department 

8 that have not conducted an evaluation of mar9 ket pay, pursuant to paragraph (5), during the 

10 18-month period that precedes the date of the 

11 submission of such report.’’; 

12 (D) in subsection (e)— 

13 (i) in paragraph (1)(A), by inserting 

14 ‘‘optometrists,’’ after ‘‘podiatrists,’’; and 

15 (ii) by adding at the end the following 

16 new paragraphs: 

17 ‘‘(5) Notwithstanding any compensation or pay 

18 limitations under this title or title 5, the Secretary 

19 may authorize the Under Secretary for Health to 

20 pay physicians, podiatrists, optometrists and den21 tists— 

22 ‘‘(A) awards authorized under this title; 

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1 thorized under section 7410(a) of this title or 

2 as otherwise provided by law; 

3 ‘‘(C) incentives or bonuses under section 

4 706 of this title or as otherwise provided by 

5 law; and 

6 ‘‘(D) earnings from fee-basis appointments 

7 under section 7405(a)(2) of this title. 

8 ‘‘(6)(A) The Secretary may waive any pay limi9 tation described in this section (including tier limita10 tions) that the Secretary determines necessary for 

11 the recruitment or retention of critical health care 

12 personnel whom the Secretary determines would pro13 vide direct patient care. 

14 ‘‘(B) Priority for such waivers shall be given for 

15 positions, locations, and care provided through con16 tracts at a high cost to the Department. 

17 ‘‘(C) The Chief Human Capital Officer of the 

18 Department, the Chief Financial Officer of the De19 partment, and the Office of the General Counsel of 

20 the Department shall review any waiver issued under 

21 subparagraph (A). 

22 ‘‘(D) During the period the authority under 

23 subparagraph (A) is effective, the Secretary may not 

24 issue more than 300 waivers under such subpara25 graph. 


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1 ‘‘(E) The Secretary may prescribe require2 ments, limitations, and other considerations for 

3 waivers under such subparagraph. 

4 ‘‘(F) Not later than 180 days after the date of 

5 the enactment of the Senator Elizabeth Dole 21st 

6 Century Veterans Healthcare and Benefits Improve7 ment Act, and annually thereafter, the Secretary 

8 shall submit to the Committees on Veterans’ Affairs 

9 of the Senate and the House of Representatives a 

10 report that includes— 

11 ‘‘(i) any updates to the requirements, limi12 tations, and considerations prescribed under 

13 subparagraph (B) during the period covered by 

14 the report; 

15 ‘‘(ii) a description of the findings of each 

16 review, if any, conducted pursuant to subpara17 graph (C); 

18 ‘‘(iii) a description of each waiver under 

19 subparagraph (A) in effect as of the date of the 

20 submission of the report, including the— 

21 ‘‘(I) duty location, position, specialty, 

22 market and performance considerations for 

23 the waiver; and 


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1 ‘‘(II) impact, if any, of the waiver on 

2 contracted care purchased by the Depart3 ment for the region; and 

4 ‘‘(iv) a list of any separation actions dur5 ing the period covered by the report with re6 spect to a position for which a waiver under 

7 subparagraph (A) is in effect. 

8 ‘‘(G) The authority of the Secretary under sub9 paragraph (A) shall terminate on the last day of the 

10 third full fiscal year following the date of the enact11 ment of the Senator Elizabeth Dole 21st Century 

12 Veterans Healthcare and Benefits Improvement 

13 Act.’’. 

14 (2) REPORT ON WAIVER AUTHORITY.—Not 

15 later than 180 days after the date of the enactment 

16 of this Act, the Secretary of Veterans Affairs shall 

17 submit to the Committees on Veterans’ Affairs of 

18 the Senate and the House of Representatives a re19 port that includes a description of the requirements, 

20 limitations, and other considerations prescribed 

21 under section 7431(b)(6)(D) of title 38, United 

22 States Code, as added by paragraph (1). 

23 (3) CONFORMING AMENDMENTS.— 

24 (A) PAY OF UNDER SECRETARY FOR

25 HEALTH.—Section 7432(b)(1) of such title is 


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1 amended by inserting ‘‘, podiatrist, optom2 etrist,’’ after ‘‘physician’’. 

3 (B) ADMINISTRATIVE MATTERS.—Section 

4 7433 of such title is amended by inserting ‘‘op5 tometrists,’’ after ‘‘physicians,’’ each place it 

6 appears. 

7 (C) COMPETITIVE PAY.—Section 

8 7451(a)(2)(C) of such title is amended by in9 serting ‘‘optometrist,’’ after ‘‘physician,’’. 

10 (4) CLERICAL AMENDMENTS.— 

11 (A) SUBCHAPTER HEADING.—Subchapter 

12 III of chapter 74 of such title is amended in the 

13 heading by inserting ‘‘Optometrists,’’ after 

14 ‘‘PODIATRISTS,’’. 

15 (B) TABLE OF SECTIONS.—The table of 

16 sections for such chapter is amended by strik17 ing the item relating to subchapter III and in18 serting the following: 

‘‘SUBCHAPTER III—PAY FOR PHYSICIANS AND OTHER HEALTH-CARE

PERSONNEL’’. 

19 (5) APPLICABILITY DATES.—The amendments 

20 made by this subsection shall apply to any pay pe21 riod of the Department of Veterans Affairs begin22 ning on or after the date that is 180 days after the 

23 date of the enactment of this Act. 


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1 (b) MODIFICATION AND CLARIFICATION OF PAY

2 GRADE FOR OPTOMETRISTS.—Section 7404 of title 38, 

3 United States Code, is amended— 

4 (1) in subsection (a)(2)(A), by striking ‘‘podia5 trists, and dentists’’ and inserting ‘‘podiatrists, op6 tometrists, and dentists’’; and 

7 (2) in subsection (b)— 

8 (A) by striking ‘‘podiatrist (dpm), and den9 tist’’ and inserting ‘‘podiatrist (dpm), optom10 etrist (od), and dentist’’; 

11 (B) by striking ‘‘clinical chiropractor and 

12 optometrist schedule,’’ and inserting ‘‘clinical 

13 chiropractor schedule’’; and 

14 (C) by inserting ‘‘optometrist grade’’ after 

15 ‘‘Podiatrist grade’’. 

16 (c) RETROACTIVE AUTHORITY FOR COMPENSA17 TION.— 

18 (1) IN GENERAL.—The Secretary of Veterans 

19 Affairs may pay retroactive compensation to a cov20 ered employee in an amount that equals the amount 

21 of compensation that was authorized to be paid to 

22 such covered employee during the period specified in 

23 paragraph (2), but was deferred and paid to such 

24 employee in the calendar year following the calender 

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1 cause the payment for such compensation would 

2 have exceeded an applicable cap on annual com3 pensation. 

4 (2) PERIOD SPECIFIED.—The period specified 

5 in this paragraph is the period beginning on Janu6 ary 8, 2006, and ending on December 31, 2017. 

7 (3) EXCLUSION.—Compensation authorized 

8 under this subsection shall not be included in the 

9 calculation of any aggregate limit on compensation 

10 for a covered employee for the year in which it is 

11 paid. 

12 (4) CHARGING OF COMPENSATION.—Compensa13 tion authorized under this subsection shall be 

14 charged to the appropriate medical care appropria15 tion account of the Department of Veterans Affairs 

16 for the fiscal year in which the work was performed 

17 except as follows: 

18 (A) In the case of an account that has 

19 closed pursuant to section 1552 of title 31, 

20 United States Code, the compensation shall be 

21 charged to a current appropriation account in 

22 accordance with section 1553 of such title. 

23 (B) In the case of an expired account that 

24 has not closed, if charging the compensation to 

25 the expired account would cause such account 


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1 to have a negative unliquidated or unexpended 

2 balance, the compensation may be charged to a 

3 current appropriation account available for the 

4 same purpose. 

5 (5) DEFINITIONS.—In this subsection: 

6 (A) The term ‘‘compensation’’ means any 

7 pay, including salary, awards, and incentives. 

8 (B) The term ‘‘covered employee’’ means a 

9 physician, podiatrist, or dentist subject to mar10 ket pay under section 7431 of title 38, United 

11 States Code. 

12 SEC. 143. REIMBURSEMENT OF AMBULANCE COST FOR 

13 CARE FOR CERTAIN RURAL VETERANS. 

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

15 shall pay, or reimburse a covered veteran for, the cost of 

16 transporting the veteran by ambulance, including air am17 bulance, from a covered location to a provider of the De18 partment of Veterans Affairs, a non-Department provider, 

19 or the nearest hospital that can meet the needs of the vet20 eran (including a hospital that compacts with the Indian 

21 Health Service) for covered care. 

22 (b) AMOUNT COVERED.—The maximum cumulative 

23 amount covered under this section for a covered veteran 

24 is $46,000. 


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1 (c) SUNSET.—This section shall cease to be effective 

2 on September 30, 2026. 

3 (d) DEFINITIONS.—In this section: 

4 (1) The term ‘‘covered care’’ means care for a 

5 veteran eligible for care provided by the Department 

6 of Veterans Affairs under title 38, United States 

7 Code, or any other law administered by the Sec8 retary of Veterans Affairs, even if the care associ9 ated with the transport described in subsection (a) 

10 is not authorized by the Department. 

11 (2) The term ‘‘covered location’’ means a loca12 tion that is— 

13 (A) in a State that is 100 miles or more 

14 from the nearest medical center of the Depart15 ment of Veterans Affairs; and 

16 (B) in an area rated as a 10 or higher 

17 under the rural-urban commuting areas coding 

18 system of the Department of Agriculture. 

19 (3) The term ‘‘covered veteran’’ means a vet20 eran who— 

21 (A) has a service-connected disability rated 

22 by the Secretary as between 0 and 30 percent 

23 disabling; 

24 (B) is not eligible for payments or reim25 bursements for beneficiary travel or other 


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1 transportation under the laws administered by 

2 the Secretary of Veterans Affairs, other than 

3 under this section; and 

4 (C) is not entitled to care or services under 

5 a non-Department of Veterans Affairs health6 plan contract. 

7 (4) The term ‘‘health-plan contract’’ has the 

8 meaning given that term in section 1725 of title 38, 

9 United States Code. 

10 (5) The term ‘‘service-connected’’ has the 

11 meaning given that term in section 101 of such title. 

12 SEC. 144. PILOT PROGRAM TO FURNISH DENTAL CARE 

13 FROM THE DEPARTMENT OF VETERANS AF14 FAIRS TO CERTAIN VETERANS DIAGNOSED 

15 WITH ISCHEMIC HEART DISEASE. 

16 (a) IN GENERAL.—Beginning not later than one year 

17 after the date of the enactment of this Act, the Secretary 

18 of Veterans Affairs shall carry out a two-year pilot pro19 gram (in this section referred to as the ‘‘pilot program’’) 

20 under which the Secretary shall furnish covered care to 

21 covered veterans through means that include the use of 

22 community care. 

23 (b) LOCATIONS.— 


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1 (1) IN GENERAL.—The Secretary shall select 

2 not more than four States in which to carry out the 

3 pilot program. 

4 (2) SELECTION CRITERIA.—In selecting States 

5 under paragraph (1), the Secretary shall prioritize 

6 States in which— 

7 (A) the Department of Veterans Affairs 

8 serves a high proportion, as determined by the 

9 Secretary, of veterans residing in rural or high10 ly rural areas (as determined through the use 

11 of the Rural-Urban Commuting Areas coding 

12 system of the Department of Agriculture); 

13 (B) dental clinics operated by the Depart14 ment of Veterans Affairs currently utilize tele15 dentistry; 

16 (C) the Department of Veterans Affairs 

17 does not currently operate a dental clinic; or 

18 (D) the Secretary determines a large per19 centage of veterans enrolled in the system of 

20 annual patient enrollment of the Department of 

21 Veterans Affairs established and operated under 

22 paragraphs (1) or (2) of section 1705(a) of title 

23 38, United States Code, visit emergency rooms 

24 for dental emergencies at high rates. 


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1 (c) PARTICIPATION LIMITATION.—Participation in a 

2 pilot program established pursuant to this section shall be 

3 limited to a covered veteran who receives health care in 

4 a facility of the Department located in a State selected 

5 under subsection (b). 

6 (d) USE OF CERTAIN METHODS TO PROVIDE

7 CARE.— 

8 (1) MOBILE DENTAL CLINICS.—In carrying out 

9 the pilot program, the Secretary shall test the effi10 cacy of mobile dental clinics to service rural areas 

11 that do not have a population base to warrant a full12 time clinic but where there are covered veterans in 

13 need of dental care. 

14 (2) HOME-BASED DENTAL CARE.—In carrying 

15 out the pilot program, the Secretary shall test the 

16 efficacy of portable dental care units to service rural 

17 veterans in their homes, as the Secretary considers 

18 medically appropriate. 

19 (e) ADMINISTRATION.— 

20 (1) COMMUNITY CARE NETWORK REVIEW.— 

21 (A) IN GENERAL.—Before commencing the 

22 pilot program, the Secretary shall work with 

23 third party administrators to conduct a review 

24 of dental providers who are part of the commu25 nity care network of the Department in each 


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1 State selected under subsection (b)(1) to en2 sure— 

3 (i) dental providers who are no longer 

4 accepting patients from the Department— 

5 (I) are not still listed as pro6 viders accepting referrals from the 

7 Department; and 

8 (II) are not sent referrals from 

9 the Department; and 

10 (ii) dental providers participating in 

11 each such network are capable of receiving 

12 an influx of patients from the Department 

13 under the pilot program. 

14 (B) EXPANSION OF NETWORK.—If, pursu15 ant to a review under subparagraph (A), the 

16 Secretary determines the community care net17 work in a State selected under subsection (b)(1) 

18 is not capable of receiving an influx of patients 

19 under the pilot program, the Secretary shall co20 ordinate with the Third Party Administrator 

21 for such State to ensure the dental provider 

22 network of such community care network is suf23 ficiently expanded before the initiation of the 

24 pilot program. 


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1 (2) NOTICE TO COVERED VETERANS.—In car2 rying out the pilot program, the Secretary shall in3 form all covered veterans in States selected under 

4 subsection (b)(1) of the covered care available under 

5 the pilot program. 

6 (3) LOSS OF ELIGIBILITY.—Any veteran par7 ticipating in the pilot program who ceases to be a 

8 covered veteran shall be removed from the pilot pro9 gram on the date that is 90 days after the Secretary 

10 determines the participant is no longer a covered 

11 veteran. 

12 (4) CONTINUITY OF CARE.— 

13 (A) IN GENERAL.—Upon the termination 

14 of the pilot program, the Secretary shall provide 

15 to all veterans participating in the pilot pro16 gram at the time of such termination— 

17 (i) information on how to enroll in the 

18 dental insurance plan of the Department of 

19 Veterans Affairs under section 1712C of 

20 title 38, United States Code; 

21 (ii) if appropriate, information on the 

22 VETSmile program of the Department of 

23 Veterans Affairs, or any successor pro24 gram; or 


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1 (iii) contact information for dental 

2 providers in the surrounding community 

3 who provide low- or no-cost dental care 

4 and whom the Secretary has confirmed are 

5 available to take on new patients. 

6 (B) CONTINUATION OF TREATMENT

7 PLAN.—Any veteran participating in the pilot 

8 program may continue to receive services under 

9 the pilot program after the termination of the 

10 pilot program to complete a treatment plan 

11 commenced under the pilot program, as deter12 mined necessary by the Secretary. 

13 (f) REPORTS.— 

14 (1) ANNUAL REPORT.—Not later than one year 

15 after the commencement of the pilot program, and 

16 annually thereafter for the duration of the pilot pro17 gram, the Secretary of Veterans Affairs shall submit 

18 to the Committees on Veterans’ Affairs of the House 

19 of Representatives and the Senate a report on the 

20 pilot program that includes— 

21 (A) an identification of the States partici22 pating in the pilot program; 

23 (B) a description of the implementation 

24 and operation of the pilot program; 


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1 (C) the number of participants in the pilot 

2 program, disaggregated by— 

3 (i) State; and 

4 (ii) disability rating; 

5 (D) an identification of any barriers or 

6 challenges to implementing the pilot program; 

7 (E) aggregated feedback from participants 

8 in the pilot program, including from interviews 

9 and surveys; 

10 (F) the average annual cost of providing 

11 covered care to a participant in the pilot pro12 gram, disaggregated by— 

13 (i) State; 

14 (ii) disability rating; and 

15 (iii) whether the care was provided 

16 through the community care network or 

17 through a provider of the Department; 

18 (G) an analysis of the communication and 

19 collaboration of the Department with Third 

20 Party Administrators and community care den21 tal providers, disaggregated by State; 

22 (H) an analysis of any cost savings by the 

23 Department with respect to the treatment of 

24 ischemic heart disease; 


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1 (I) an assessment of the impact of the 

2 pilot program on appointments for care, pre3 scriptions, hospitalizations, emergency room vis4 its, wellness, employability, satisfaction, and 

5 perceived quality of life of covered veterans re6 lated to their diagnosis of ischemic heart dis7 ease; 

8 (J) an analysis and assessment of the effi9 cacy of mobile clinics and portable dental care 

10 units, to the extent such modalities are used, to 

11 service the needs of covered veterans under the 

12 pilot program; 

13 (K) an analysis and assessment of the 

14 usage of teledentistry to service the needs of 

15 covered veterans under the pilot program, to in16 clude a cost benefit analysis of such services; 

17 and 

18 (L) such other matters as the Secretary 

19 considers appropriate. 

20 (2) FINAL REPORT.—Not later than 90 days 

21 before the completion of the pilot program, the Sec22 retary shall submit to the Committees on Veterans’ 

23 Affairs of the House of Representatives and the Sen24 ate a report on the pilot program that— 


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1 (A) includes the matters required under 

2 paragraph (1); 

3 (B) includes recommendations on whether 

4 the pilot program should be continued, ex5 panded, or adopted throughout the Department; 

6 and 

7 (C) indicates whether the Secretary re8 quests action by Congress to make the pilot 

9 program permanent. 

10 (g) IMPACT ON COMMUNITY CARE.—Participants in 

11 the pilot program shall be able to access covered care in 

12 the community under section 1703 of title 38, United 

13 States Code. 

14 (h) DEFINITIONS.—In this section: 

15 (1) The term ‘‘covered care’’ means dental care 

16 that is consistent with the dental services and treat17 ment furnished by the Secretary of Veterans Affairs 

18 to veterans pursuant to section 1712(a)(1)(G) of 

19 title 38, United States Code. 

20 (2) The term ‘‘covered veteran’’ means a vet21 eran who— 

22 (A) is enrolled in the system of annual pa23 tient enrollment of the Department established 

24 and operated under paragraphs (1) or (2) of 

25 section 1705(a) of title 38, United States Code; 


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1 (B) is not eligible for dental services and 

2 treatment and related dental appliances under 

3 the laws administered by the Secretary as of 

4 the date of the enactment of this Act; and 

5 (C) has a diagnosis of ischemic heart dis6 ease. 

7 (3) The term ‘‘Third Party Administrator’’ has 

8 the meaning given such term in section 1703F of 

9 such title. 

10 SEC. 145. DOCUMENTATION OF PREFERENCES OF VET11 ERANS FOR SCHEDULING OF APPOINTMENTS 

12 FOR HEALTH CARE UNDER LAWS ADMINIS13 TERED BY SECRETARY OF VETERANS AF14 FAIRS. 

15 (a) IN GENERAL.—Not later than one year after the 

16 date of the enactment of this Act, the Secretary of Vet17 erans Affairs shall develop a mechanism to solicit informa18 tion regarding the preference of veterans enrolled in the 

19 system of annual patient enrollment of the Department 

20 of Veterans Affairs established and operated under section 

21 1705(a) of title 38, United States Code, for scheduling 

22 of appointments for health care and related services under 

23 the laws administered by the Secretary, including through 

24 non-Department providers. 


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1 (b) DOCUMENTATION OF PREFERENCE.—Pref2 erences provided voluntarily by a veteran pursuant to sub3 section (a) shall be documented on My HealtheVet or an4 other system designated by the Secretary that allows the 

5 veteran to view and change such preferences at any time. 

6 (c) INCLUSION IN PREFERENCE.—Preferences solic7 ited under subsection (a) shall include the following: 

8 (1) How and when the veteran prefers to be 

9 contacted about an appointment for health care. 

10 (2) Whether the veteran prefers to schedule ap11 pointments without the assistance of the Depart12 ment, if able. 

13 (3) Whether the veteran prefers to select a pro14 vider without the assistance of the Department, if 

15 able. 

16 (4) Whether the veteran prefers appointments 

17 to be scheduled during certain days or times. 

18 (d) USE OF PREFERENCE.—The Secretary shall 

19 make the preferences provided under subsection (a) easily 

20 accessible to medical support assistants and other staff of 

21 the Department, or non-Department staff, as the Sec22 retary determines appropriate, who assist in the appoint23 ment scheduling process. 

24 (e) DEPLOYMENT OF MECHANISM.— 


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1 (1) IN GENERAL.—Beginning after the date on 

2 which the Secretary develops the mechanism re3 quired under subsection (a), the Secretary shall— 

4 (A) test the mechanism in not fewer than 

5 three geographically diverse Veterans Inte6 grated Service Networks; and 

7 (B) gather feedback about the effectiveness 

8 of such mechanism from veterans, medical sup9 port assistants, staff and other stakeholders as 

10 the Secretary determines appropriate. 

11 (2) LIMITATION.—The Secretary may not im12 plement such mechanism across the Veterans Health 

13 Administration of the Department before the Sec14 retary addresses the feedback described in para15 graph (1)(B). 

16 SEC. 146. STAFFING MODEL AND PERFORMANCE METRICS 

17 FOR CERTAIN EMPLOYEES OF THE DEPART18 MENT OF VETERANS AFFAIRS. 

19 (a) STAFFING MODEL.— 

20 (1) IN GENERAL.—Not later than one year 

21 after the date of the enactment of this Act, the Sec22 retary of Veterans Affairs shall— 

23 (A) develop, validate, and implement a 

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1 fairs, or successor office, Veterans Integrated 

2 Services Networks, and medical centers of the 

3 Department that includes appropriate target 

4 staffing levels nationally, regionally, and locally 

5 to ensure timely access to care and effectively 

6 oversee the provision of care by the Depart7 ment, whether at a facility of the Department 

8 or through a non-Department provider; and 

9 (B) provide to Congress a briefing on such 

10 staffing model, which shall include— 

11 (i) the metrics and measures used by 

12 the Secretary in developing such staffing 

13 model; 

14 (ii) an analysis of how such staffing 

15 model compares to the staffing models of 

16 other relevant Government-owned and pri17 vate sector health care systems; and 

18 (iii) an estimate of the portion of the 

19 roles in such staffing model that will be 

20 filled by contracted staff at any given time. 

21 (2) REPORT ON IMPLEMENTATION OF STAFF22 ING MODEL.—Not later than one year after the date 

23 on which the Secretary implements the staffing 

24 model required under paragraph (1), the Secretary 


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1 shall submit to Congress and the Comptroller Gen2 eral of the United States a report containing— 

3 (A) an update on such implementation; 

4 and 

5 (B) information on the outcomes yielded 

6 by such staffing model in terms of improved ac7 cess to care for veterans and improved compli8 ance with relevant laws, regulations, policy di9 rectives, and guidance governing access to care. 

10 (b) PERFORMANCE METRICS.— 

11 (1) IN GENERAL.—Not later than one year 

12 after the date of the enactment of this Act, the Sec13 retary shall develop and implement a plan, with an 

14 appropriate tracking system, to incorporate appro15 priate standardized performance metrics and over16 sight measures within the performance appraisal 

17 systems for employees of the Department specified 

18 in paragraph (2). 

19 (2) EMPLOYEES OF THE DEPARTMENT SPECI20 FIED.—Employees of the Department specified in 

21 this paragraph are employees who are responsible 

22 for ensuring timely access to care from the Depart23 ment, compliance with relevant statutes and regula24 tions relating to the provision of care, including sec25 tion 1703 of title 38, United States Code, and overVerDate Sep 11 2014 18:49 May 29, 2024 Jkt 049200 PO 00000 Frm 00148 Fmt 6652 Sfmt 6201 E:\BILLS\H8371.IH H8371

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1 seeing the provision of care, whether at a facility of 

2 the Department or through a non-Department pro3 vider, including employees within the Office of Inte4 grated Veteran Care of the Department, or suc5 cessor office, employees of a Veterans Integrated 

6 Service Network, and employees of a medical center 

7 of the Department. 

8 (3) REPORT ON IMPLEMENTATION OF PER9 FORMANCE METRICS.—Not later than one year after 

10 implementing the performance metrics required 

11 under paragraph (1), the Secretary shall submit to 

12 Congress and the Comptroller General of the United 

13 States a report containing— 

14 (A) an update on such implementation; 

15 and 

16 (B) information on the outcomes yielded 

17 by such performance metrics in terms of im18 proved access to care for veterans and improved 

19 compliance with relevant laws, policy directives, 

20 and guidance governing access to care. 

21 (c) GAO REPORT.—Not later than two years after 

22 the later of the date on which the Comptroller General 

23 receives the report under subsection (a)(2) or the report 

24 under subsection (b)(3), the Comptroller General shall 

25 submit to Congress a report that includes— 


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1 (1) an assessment of the performance of the Of2 fice of Integrated Veteran Care of the Department, 

3 or successor office, in improving access to care for 

4 veterans in facilities of the Department and pursu5 ant to section 1703 of title 38, United States Code; 

6 and 

7 (2) such recommendations as the Comptroller 

8 General considers appropriate with respect to im9 proving access to the care described in paragraph 

10 (1) for veterans. 

11 SEC. 147. ONLINE HEALTH EDUCATION PORTAL FOR VET12 ERANS ENROLLED IN PATIENT ENROLLMENT 

13 SYSTEM OF DEPARTMENT OF VETERANS AF14 FAIRS. 

15 Not later than one year after the date of the enact16 ment of this Act, the Secretary of Veterans Affairs shall 

17 establish, on an Internet website of the Department, a 

18 health education portal that includes interactive edu19 cational modules to ensure veterans enrolled in the patient 

20 enrollment system of the Department of Veterans Affairs 

21 established and operated under section 1705(a) of title 38, 

22 United States Code, understand the basic health care eli23 gibilities and entitlements of veterans under the laws ad24 ministered by the Secretary, including under the Veterans 


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1 Community Care Program under section 1703 of such 

2 title. 

3 SEC. 148. LIMITATION ON DETAIL OF DIRECTORS OF MED4 ICAL CENTERS OF DEPARTMENT OF VET5 ERANS AFFAIRS TO DIFFERENT POSITIONS. 

6 (a) NOTIFICATION.— 

7 (1) IN GENERAL.—Not later than 90 days after 

8 detailing a director of a medical center of the De9 partment of Veterans Affairs to a different position 

10 within the Department, the Secretary of Veterans 

11 Affairs shall notify the Committee on Veterans’ Af12 fairs of the Senate and the Committee on Veterans’ 

13 Affairs of the House of Representatives of such de14 tail. 

15 (2) MATTERS TO BE INCLUDED.—The notifica16 tion required by paragraph (1) shall include, with re17 spect to a director of a medical center who is de18 tailed to a different position within the Department, 

19 the following information: 

20 (A) The location at which the director is 

21 detailed. 

22 (B) The position title of the detail. 

23 (C) The estimated time the director is ex24 pected to be absent from their duties at the 

25 medical center. 


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1 (D) Such other information as the Sec2 retary may determine appropriate. 

3 (b) APPOINTMENT OF ACTING DIRECTOR.—Not later 

4 than 120 days after detailing a director of a medical cen5 ter of the Department to a different position within the 

6 Department, the Secretary shall appoint an individual as 

7 acting director of such medical center with all of the au8 thority and responsibilities of the detailed director. 

9 (c) UPDATE ON DETAIL.—Not later than 120 days 

10 after detailing a director of a medical center of the De11 partment to a different position within the Department, 

12 and not less frequently than every 30 days thereafter while 

13 the detail is in effect or while the director position at the 

14 medical center is vacant, the Secretary shall submit to the 

15 Committee on Veterans’ Affairs of the Senate and the 

16 Committee on Veterans’ Affairs of the House of Rep17 resentatives an update regarding the status of the detail. 

18 (d) RETURN TO POSITION OR REASSIGNMENT.— 

19 (1) IN GENERAL.—Except as provided in para20 graph (2), not later than 180 days after detailing a 

21 director of a medical center of the Department to a 

22 different position within the Department, for a rea23 son other than an ongoing investigation or adminis24 trative action with respect to the director, the Sec25 retary shall— 


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1 (A) return the individual to the position as 

2 director of the medical center; or 

3 (B) reassign the individual from the posi4 tion as director of the medical center and begin 

5 the process of hiring a new director for such po6 sition. 

7 (2) WAIVER.— 

8 (A) IN GENERAL.—The Secretary may 

9 waive the requirement under paragraph (1) 

10 with respect to an individual for successive 90- 

11 day increments for a total period of not more 

12 than 540 days from the original date the indi13 vidual was detailed away from their position as 

14 director of a medical center. 

15 (B) NOTIFICATION.—Not later than 30 

16 days after exercising a waiver under subpara17 graph (A), the Secretary shall notify Congress 

18 of the waiver and provide to Congress informa19 tion as to why the waiver is necessary. 

20 SEC. 149. NATIONAL VETERAN SUICIDE PREVENTION AN21 NUAL REPORT. 

22 (a) NATIONAL VETERAN SUICIDE PREVENTION AN23 NUAL REPORT.— 

24 (1) IN GENERAL.—Not later than 18 months 

25 after the date of the enactment of this Act, and not 


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1 later than September 30 of each year thereafter, the 

2 Secretary of Veterans Affairs shall submit to the ap3 propriate congressional committees and publish on a 

4 publicly available website of the Department of Vet5 erans Affairs a report to be known as the ‘‘National 

6 Veteran Suicide Prevention Annual Report’’. 

7 (2) EXTENSION.— 

8 (A) IN GENERAL.—If the Secretary re9 quires an extension of the deadline for a report 

10 under subsection (a), the Secretary shall submit 

11 to the appropriate congressional committees a 

12 written request for such an extension. 

13 (B) ELEMENTS.—Each written request 

14 under paragraph (1) for an extension for a re15 port shall include the following: 

16 (i) The rationale for the delay in the 

17 submission of the report. 

18 (ii) An explanation of the need for an 

19 extension. 

20 (iii) A proposed amended date for the 

21 submission and publication of the report. 

22 (3) BRIEFING.—With respect to each report re23 quired under paragraph (1), the Secretary shall, be24 fore the date on which the Secretary submits such 


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1 report, provide to the appropriate congressional com2 mittees a briefing on such report. 

3 (4) ELEMENTS.— 

4 (A) IN GENERAL.—Each report required 

5 under paragraph (1) shall include— 

6 (i) the findings of the national anal7 ysis of veteran suicide rates for the latest 

8 year for which data is available; 

9 (ii) an identification of trends, if any, 

10 demonstrated by such data; and 

11 (iii) a comparison of such data to data 

12 on veteran suicide rates during preceding 

13 years. 

14 (B) ADDITIONAL ELEMENTS.—Each report 

15 under paragraph (1) shall include, for the year 

16 covered by the report, the following: 

17 (i) Suicide rates of veterans 

18 disaggregated by age, gender, and race or 

19 ethnicity. 

20 (ii) Trends in suicide rates of veterans 

21 compared to engagement of those veterans 

22 with health care from the Veterans Health 

23 Administration, including an examination 

24 of trends in suicide rates or deaths 

25 among— 


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1 (I) veterans who have recently re2 ceived health care from the Veterans 

3 Health Administration as compared to 

4 veterans who have never received 

5 health care from the Veterans Health 

6 Administration; 

7 (II) veterans who are enrolled in 

8 the patient enrollment system of the 

9 Department of Veterans Affairs under 

10 section 1705(a) of title 38, United 

11 States Code, as compared to veterans 

12 who have never enrolled in such sys13 tem; 

14 (III) veterans who have recently 

15 used services from a Vet Center as 

16 compared to veterans who have never 

17 used such services; 

18 (IV) to the extent practicable, 

19 veterans who have a diagnosis of sub20 stance use disorder; and 

21 (V) other groups of veterans re22 lating to engagement with health care 

23 from the Veterans Health Administra24 tion, as the Secretary considers prac25 ticable. 


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1 (iii) To the extent practicable, trends 

2 in suicide rates of veterans compared to 

3 engagement of those veterans with benefits 

4 from the Veterans Benefits Administra5 tion, including an examination of trends in 

6 suicide rates or deaths among— 

7 (I) veterans who are currently 

8 using, have previously used, or have 

9 never used educational assistance 

10 under the laws administered by the 

11 Secretary; 

12 (II) veterans who are currently 

13 receiving, have previously received, or 

14 have never received services or assist15 ance under chapter 31 of title 38, 

16 United States Code; 

17 (III) with respect to compensa18 tion under chapter 11 of such title— 

19 (aa) veterans who were re20 cipients of such compensation as 

21 compared to veterans who never 

22 applied for such compensation 

23 prior to death; 


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1 (bb) veterans who had a 

2 claim denied for such compensa3 tion prior to death; 

4 (cc) veterans who had a 

5 pending claim for such com6 pensation at time of death; and 

7 (dd) veterans who had an 

8 entitlement for such compensa9 tion reduced prior to death; 

10 (IV) veterans who are currently 

11 receiving or have never received pen12 sion under chapter 15 of title 38, 

13 United States Code; 

14 (V) veterans who are currently 

15 using, have recently used, or have 

16 never used programs or services pro17 vided by the Homeless Programs Of18 fice of the Department, including an 

19 examination of trends in suicide rates 

20 or deaths among veterans who made 

21 contact with such office but were de22 nied or deemed ineligible for any such 

23 program or service; 

24 (VI) with respect to housing 

25 loans guaranteed by the Secretary 


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1 under chapter 37 of title 38, United 

2 States Code, veterans who are current 

3 recipients of, were recent recipients of, 

4 or have never received such a loan; 

5 (VII) veterans owing debts to the 

6 Department; 

7 (VIII) veterans who were in8 volved in a veterans treatment court 

9 program, whether they graduated suc10 cessfully or not; and 

11 (IX) veterans who were success12 fully contacted, unsuccessfully con13 tacted, or never contacted by the De14 partment through the Solid Start pro15 gram under section 6320 of title 38, 

16 United States Code. 

17 (C) STRATEGY AND RECOMMENDATIONS.— 

18 (i) INITIAL REPORT.—The initial re19 port under paragraph (1) shall include a 

20 strategy and recommendations developed 

21 by the Secretary of Veterans Affairs, in 

22 collaboration with the Director of the Cen23 ters for Disease Control and Prevention 

24 and the Secretary of Defense, for— 


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1 (I) improving data collection at 

2 the State and local levels to accurately 

3 capture suicide deaths of veterans; 

4 (II) improving the timeliness, ef5 ficacy, and standardization of data re6 porting on suicide deaths of veterans 

7 at the Federal level, including by the 

8 Centers for Disease Control and Pre9 vention, the Department of Defense, 

10 and the Department of Veterans Af11 fairs; 

12 (III) improving the timeliness of 

13 identification and analysis of suicide 

14 deaths of veterans by Federal agen15 cies, including the Centers for Disease 

16 Control and Prevention, the Depart17 ment of Defense, and the Department 

18 of Veterans Affairs; and 

19 (IV) any other necessary process 

20 improvements for improving the time21 liness, efficacy, and standardization of 

22 reporting of data relating to suicide 

23 deaths of veterans, particularly with 

24 respect to the annual report under 

25 this section. 


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1 (ii) SUBSEQUENT REPORTS.—Each 

2 report after the initial report under para3 graph (1) shall include updates on actions 

4 taken to meet the strategy and rec5 ommendations developed under subpara6 graph (A). 

7 (5) DEFINITIONS.—In this subsection: 

8 (A) The term ‘‘appropriate congressional 

9 committees’’ means the Committees on Vet10 erans’ Affairs of the Senate and the House of 

11 Representatives. 

12 (B) The term ‘‘Vet Center’’ means a cen13 ter for readjustment counseling and related 

14 mental health services for veterans under sec15 tion 1712A of title 38, United States Code. 

16 (b) INDEPENDENT ASSESSMENT OF NATIONAL VET17 ERAN SUICIDE PREVENTION ANNUAL REPORT.— 

18 (1) IN GENERAL.—Not later than 90 days after 

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

20 of Veterans Affairs shall enter into one or more con21 tracts with a private sector entity described in para22 graph (5) to conduct an independent assessment of 

23 the National Veteran Suicide Prevention Annual Re24 port required under subsection (a). 


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1 (2) FREQUENCY.—The private sector entity or 

2 entities carrying out the assessment required under 

3 paragraph (1) shall complete such assessment not 

4 later than 240 days after entering into the contract 

5 described in such subsection and not less frequently 

6 than every five years thereafter. 

7 (3) ELEMENTS.—Each assessment required 

8 under paragraph (1) shall analyze the following: 

9 (A) The methodology used by the Depart10 ment to track, analyze, categorize, and report 

11 suicide deaths and suicide rates among vet12 erans. 

13 (B) Whether data sources used by the De14 partment to compile data on suicide deaths and 

15 suicide rates among veterans are accurately re16 flecting such data. 

17 (C) Vulnerabilities in the methodology used 

18 by the Department that could lead to inac19 curate counting of suicide deaths and suicide 

20 rates among veterans. 

21 (D) The ability of the Department to 

22 cross-reference suicide deaths and suicide rates 

23 among veterans with trends in usage of pro24 grams of the Veterans Health Administration 

25 or the Veterans Benefits Administration or 


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1 other programs that could serve as widespread 

2 protective factors against suicide. 

3 (E) Improvements that could be made to 

4 ensure the National Veteran Suicide Prevention 

5 Annual Report required under subsection (a) is 

6 accurate and comprehensive and provides in7 sights for making improvements to the suicide 

8 prevention efforts of the Department. 

9 (4) REPORT ON ASSESSMENT.— 

10 (A) REPORT ON FINDINGS AND REC11 OMMENDATIONS.—Not later than 60 days after 

12 completing an assessment required by para13 graph (1), the private sector entity or entities 

14 carrying out the assessment shall submit to the 

15 Secretary of Veterans Affairs and the Commit16 tees on Veterans’ Affairs of the Senate and the 

17 House of Representatives a report on the find18 ings and recommendations of the private sector 

19 entity or entities with respect to such assess20 ment. 

21 (B) REPORT ON PLANNED IMPROVE22 MENTS.—Not later than 60 days after receiving 

23 a report under paragraph (1) with respect to an 

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1 erans’ Affairs of the Senate and the House of 

2 Representatives a report on how the Depart3 ment plans to improve the National Veteran 

4 Suicide Prevention Annual Report required 

5 under subsection (a) based on such assessment. 

6 (5) PRIVATE SECTOR ENTITY DESCRIBED.—A 

7 private sector entity described in this paragraph is 

8 a private entity that— 

9 (A) specializes in analyzing large-scale or10 ganizational data collection and analysis efforts, 

11 especially with respect to the health care sector; 

12 and 

13 (B) has experience and proven outcomes in 

14 optimizing the accuracy and comprehensiveness 

15 of data collection and analysis related to sui16 cide. 

17 (c) REPORT ON ADDITIONAL BENEFITS AND SERV18 ICES FROM DEPARTMENT OF VETERANS AFFAIRS TO

19 PREVENT VETERAN SUICIDE.— 

20 (1) IN GENERAL.—Not later than three years 

21 after the date of the enactment of this Act, the Sec22 retary of Veterans Affairs shall submit to the Com23 mittees on Veterans’ Affairs of the Senate and the 

24 House of Representatives and publish on a publicly 

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1 fairs a report that analyzes which benefits and serv2 ices under the laws administered by such Secretary, 

3 including such benefits and services furnished by the 

4 Veterans Benefits Administration, have the greatest 

5 impact on the prevention of suicide among veterans, 

6 including recommendations for potential expansion 

7 of services and benefits to reduce the number of vet8 eran suicides. 

9 (2) ASSESSMENT OF SOLID START PROGRAM.— 

10 The report required by paragraph (1) shall include 

11 an analysis of the effectiveness of the Solid Start 

12 program under section 6320 of title 38, United 

13 States Code, on prevention of suicide among vet14 erans. 

15 (d) TOOLKIT FOR STATE AND LOCAL CORONERS AND

16 MEDICAL EXAMINERS ON BEST PRACTICES FOR IDENTI17 FYING AND REPORTING ON SUICIDE DEATHS OF VET18 ERANS.— 

19 (1) IN GENERAL.—The Secretary of Veterans 

20 Affairs, in collaboration with the Director of the 

21 Centers for Disease Control and Prevention, shall 

22 develop a toolkit for State and local coroners and 

23 medical examiners that contains best practices for— 


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1 (A) accurately identifying and reporting 

2 suicide deaths of veterans, including how to 

3 identify veteran status; and 

4 (B) reporting such deaths to the Centers 

5 for Disease Control and Prevention and other 

6 applicable entities. 

7 (2) AVAILABILITY.—Not later than two years 

8 after the date of the enactment of this Act, the Sec9 retary shall make the toolkit developed under para10 graph (1) available on a publicly available website of 

11 the Department of Veterans Affairs. 

12 (3) OUTREACH.—The Secretary, in collabora13 tion with the Director of the Centers for Disease 

14 Control and Prevention, shall conduct outreach to 

15 appropriate State and local agencies to promote the 

16 availability and use of the toolkit developed under 

17 paragraph (1). 

18 SEC. 150. REPORT ON PHYSICAL INFRASTRUCTURE RE19 QUIRED BY MEDICAL FACILITIES OF DEPART20 MENT OF VETERANS AFFAIRS TO PROVIDE 

21 DENTAL CARE SERVICES. 

22 Not later than one year after the date of the enact23 ment of this Act, the Secretary of Veterans Affairs shall 

24 submit to the Committees on Veterans’ Affairs of the Sen25 ate and the House of Representatives a report, for each 


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1 medical center or other relevant health care facility of the 

2 Department of Veterans Affairs, that includes— 

3 (1) an identification of the physical infrastruc4 ture, including new facilities, renovations, remodels, 

5 leases, or other infrastructure, such medical center 

6 or health care facility requires to provide dental care 

7 services to veterans eligible for such services under 

8 the laws administered by the Secretary; and 

9 (2) an analysis of the physical infrastructure 

10 such medical center or health care facility would re11 quire if a greater number of veterans became eligible 

12 for such dental care services pursuant to a modifica13 tion of the laws administered by the Secretary. 

14 SEC. 151. COMPTROLLER GENERAL REPORT ON CERTAIN 

15 ORAL HEALTH CARE PROGRAMS UNDER 

16 LAWS ADMINISTERED BY SECRETARY OF 

17 VETERANS AFFAIRS. 

18 (a) IN GENERAL.—Not later than one year after the 

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

20 of the United States shall submit to the Committees on 

21 Veterans’ Affairs of the Senate and the House of Rep22 resentatives a report on the status of the oral health care 

23 programs of the Department of Veterans Affairs, that in24 cludes an assessment of— 


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1 (1) any issues with information technology pro2 grams, including Dental Record Manager Plus, that 

3 affect dental care staff of the Department; 

4 (2) the implementation of the dental insurance 

5 plan of the Department under section 1712C of title 

6 38, United States Code; 

7 (3) the implementation and expansion of the 

8 VETSmile program of the Department; 

9 (4) barriers preventing the Department from 

10 expanding dental care eligibility to all veterans with 

11 ischemic heart disease, including such barriers relat12 ing to physical infrastructure, workforce, and cost of 

13 such dental care; 

14 (5) barriers preventing dental clinics of the De15 partment, if any, from adopting teledentistry; 

16 (6) the demographic makeup of veterans eligible 

17 for dental care paid for by the Department as of the 

18 commencement of the pilot program under section 

19 145 of this Act, including information on— 

20 (A) age; 

21 (B) gender; 

22 (C) race or ethnicity, disaggregated by— 

23 (i) membership in an Indian Tribe; 

24 and 


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1 (ii) the major race groups used in the 

2 decennial census; 

3 (D) employment status; and 

4 (E) location of residence, disaggregated by 

5 rural, highly rural, and urban locations; and 

6 (7) changes to such demographic makeup if 

7 any, that would result from an expansion of eligi8 bility for dental care under the laws administered by 

9 the Secretary to all veterans with ischemic heart dis10 ease including changes to demographics specified in 

11 paragraph (6). 

12 (b) THIRD PARTY ADMINISTRATOR DEFINED.—In 

13 this section, the term ‘‘Third Party Administrator’’ means 

14 an entity that manages a provider network and performs 

15 administrative services related to such network under sec16 tion 1703 of title 38, United States Code. 

17 SEC. 152. REVIEW OF WORKFLOWS ASSOCIATED WITH 

18 PROCESSING REFERRALS BETWEEN FACILI19 TIES OF THE VETERANS HEALTH ADMINIS20 TRATION. 

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

22 shall conduct a review of the workflows directly associated 

23 with processing referrals of patients between facilities of 

24 the Veterans Health Administration of the Department of 


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1 Veterans Affairs to identify specific delays or bottlenecks 

2 in such referrals. 

3 (b) ELEMENTS OF REVIEW.—The review required 

4 under subsection (a) shall include a review of— 

5 (1) the interfacility consult management guid6 ance of the Veterans Health Administration that as7 sists facilities described in subsection (a) in con8 structing a workflow for consults between such fa9 cilities; and 

10 (2) the roles and responsibilities of the individ11 uals involved in the consult management process in 

12 managing such consults, including the role of the re13 ferral coordination team. 

14 (c) REPORT.—Not later than 180 days after the date 

15 of the enactment of this Act, the Secretary shall submit 

16 to Congress a report on the results of the review required 

17 under subsection (a). 

18 SEC. 153. PLAN FOR TIMELY SCHEDULING OF APPOINT19 MENTS AT MEDICAL FACILITIES OF DEPART20 MENT OF VETERANS AFFAIRS. 

21 (a) PLAN REQUIRED.—To improve responsiveness in 

22 the provision of hospital care and medical services at med23 ical facilities of the Department of Veterans Affairs, the 

24 Secretary of Veterans Affairs shall develop a plan to— 


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1 (1) ensure that whenever a covered veteran con2 tacts the Department by telephone to request the 

3 scheduling of an appointment for care or services for 

4 the covered veteran at such a facility, the scheduling 

5 for the appointment occurs during that telephone 

6 call (regardless of the prospective date of the ap7 pointment being scheduled); and 

8 (2) provide timely and, where applicable, same9 day scheduling for an appointment described in 

10 paragraph (1). 

11 (b) REPORT.—Not later than one year after the date 

12 of the enactment of this Act, the Secretary shall submit 

13 to the Committees on Veterans’ Affairs of the House of 

14 Representatives and the Senate a report on the plan under 

15 subsection (a). 

16 (c) COVERED VETERAN DEFINED.—In this section, 

17 the term ‘‘covered veteran’’ means a veteran who is en18 rolled in the system of patient enrollment of the Depart19 ment under section 1705(a) of title 38, United States 

20 Code. 

21 SEC. 154. AUTHORIZATION OF APPROPRIATIONS TO SUP22 PORT INITIATIVES FOR MOBILE MAMMOG23 RAPHY SERVICES FOR VETERANS. 

24 There is authorized to be appropriated to the Sec25 retary of Veterans Affairs $5,000,000 for fiscal year 2025 


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1 for the Office of Women’s Health of the Department of 

2 Veterans Affairs under section 7310 of title 38, United 

3 States Code, to be used by the Secretary to expand access 

4 of women veterans to— 

5 (1) mobile mammography initiatives; 

6 (2) advanced mammography equipment; and 

7 (3) outreach activities to publicize those initia8 tives and equipment. 

9 TITLE II—ECONOMIC 

10 OPPORTUNITY MATTERS 

11 Subtitle A—Educational Assistance 

12 SEC. 201. TEMPORARY EXPANSION OF ELIGIBILITY FOR MA13 RINE GUNNERY SERGEANT JOHN DAVID FRY 

14 SCHOLARSHIP. 

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

16 shall treat an individual described in subsection (b) as a 

17 covered individual described in section 3311(b) of title 38, 

18 United States Code. 

19 (b) COVERED INDIVIDUAL DESCRIBED.—An indi20 vidual described in this subsection is an individual who 

21 is the child or spouse of a person— 

22 (1) who dies from a service-connected disability 

23 during the 120-day period immediately following the 

24 day on which the person was discharged or released 

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1 out regard to whether such duty was active duty); 

2 and 

3 (2)(A) who received an honorable discharge; or 

4 (B) whose service in the Armed Forces is char5 acterized by the Secretary concerned as honorable 

6 service. 

7 (c) APPLICABILITY.—This section shall apply with re8 spect to— 

9 (1) deaths that occur before, on, or after the 

10 date of the enactment of this Act; and 

11 (2) a quarter, semester, or term, as applicable, 

12 commencing— 

13 (A) on or after August 1, 2024; and 

14 (B) before October 1, 2026. 

15 SEC. 202. REMOVAL OF EXPIRATION ON ENTITLEMENT TO 

16 MARINE GUNNERY SERGEANT JOHN DAVID 

17 FRY SCHOLARSHIP FOR SURVIVING SPOUSES. 

18 Section 3311(f) of title 38, United States Code, is 

19 amended— 

20 (1) by striking paragraph (2); 

21 (2) by redesignating paragraphs (3) through 

22 (5) as paragraphs (2) through (4), respectively; 

23 (3) in paragraph (2), as redesignated by para24 graph (2) of this section, by striking ‘‘in paragraph 

25 (4)’’ and inserting ‘‘in paragraph (3)’’; and 


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1 (4) in paragraph (3)(A), as redesignated by 

2 paragraph (2) of this section, by striking ‘‘under 

3 paragraph (3)’’ and inserting ‘‘under paragraph 

4 (2)’’. 

5 SEC. 203. SOLE LIABILITY FOR TRANSFERRED EDU6 CATIONAL ASSISTANCE BY AN INDIVIDUAL 

7 WHO FAILS TO COMPLETE A SERVICE AGREE8 MENT. 

9 Subsection (i) of section 3319 of title 38, United 

10 States Code, is amended— 

11 (1) in paragraph (1)— 

12 (A) by striking ‘‘In the event’’ and insert13 ing ‘‘Subject to paragraph (2), in the event’’; 

14 and 

15 (B) by inserting ‘‘of this title’’ after ‘‘sec16 tion 3685’’; 

17 (2) in subparagraph (A) of paragraph (2)— 

18 (A) in the heading, by striking ‘‘IN GEN19 ERAL’’ and inserting ‘‘SOLE LIABILITY’’; and 

20 (B) by striking ‘‘under paragraph (1)’’ and 

21 inserting ‘‘for which the individual shall be sole22 ly liable to the United States for the amount of 

23 the overpayment for purposes of section 3685 

24 of this title’’; and 

25 (3) in subparagraph (B) of paragraph (2)— 


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1 (A) in the matter preceding clause (i), by 

2 striking ‘‘Subparagraph (A) shall not apply’’ 

3 and inserting ‘‘Neither the individual nor the 

4 dependent shall be liable to the United States 

5 for the amount of the overpayment for purposes 

6 of section 3685 of this title’’; and 

7 (B) in clause (ii), by inserting ‘‘of this 

8 title’’ after ‘‘section 3311(c)(4)’’. 

9 SEC. 204. NOTICE TO EDUCATIONAL INSTITUTIONS OF 

10 RISK-BASED SURVEYS. 

11 Section 3673A(d) of title 38, United States Code, is 

12 amended by striking ‘‘one business day’’ and inserting 

13 ‘‘two business days’’. 

14 SEC. 205. RELATIONSHIP OF PARTICIPATION BY AN EDU15 CATIONAL INSTITUTION IN CERTAIN FED16 ERAL STUDENT FINANCIAL AID PROGRAMS 

17 TO APPROVAL OF SUCH INSTITUTION FOR 

18 PURPOSES OF DEPARTMENT OF VETERANS 

19 AFFAIRS EDUCATIONAL ASSISTANCE PRO20 GRAMS. 

21 Paragraph (4) of section 3675(b) of title 38, United 

22 States Code, is amended to read as follows: 

23 ‘‘(4) The educational institution— 


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1 ‘‘(A) is approved and participates in a pro2 gram under title IV of the Higher Education 

3 Act of 1965 (20 U.S.C. 1070 et seq.); or 

4 ‘‘(B) does not participate in such a pro5 gram and the Secretary has waived the require6 ment under this paragraph with respect to the 

7 educational institution, and submits to the 

8 Committee on Veterans’ Affairs of the Senate 

9 and the Committee on Veterans’ Affairs of the 

10 House of Representatives notice of such waiver, 

11 because the Secretary determines that the edu12 cational institution— 

13 ‘‘(i) elects not to participate in such a 

14 program; 

15 ‘‘(ii) cannot participate in such a pro16 gram; or 

17 ‘‘(iii) is in the process of making a 

18 good-faith effort to submit an initial appli19 cation for approval to participate in such a 

20 program, except that a waiver under this 

21 clause may not be provided for a period of 

22 longer than 36 months.’’. 


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1 SEC. 206. EXPANSION OF DEPARTMENT OF VETERANS AF2 FAIRS OVERSIGHT OF CERTAIN EDU3 CATIONAL INSTITUTIONS. 

4 (a) ADDITIONAL REQUIREMENT FOR APPROVAL.— 

5 Section 3675(b) of title 38, United States Code, as amend6 ed by section 205, is further amended by adding at the 

7 end the following new paragraph: 

8 ‘‘(5) The educational institution agrees to, not 

9 later than 30 days after any date on which such 

10 educational institution becomes subject to an action 

11 or event described in section 3673(e)(3) of this title, 

12 submit to the State approving agency, or the Sec13 retary when acting in the role of a State approving 

14 agency, a notification of such action or event in such 

15 form and containing such information as the Sec16 retary determines appropriate.’’. 

17 (b) ADDITIONAL REQUIREMENT FOR APPROVAL OF

18 NONACCREDITED COURSES.— 

19 (1) IN GENERAL.—Section 3676(c) of such title 

20 is amended— 

21 (A) by redesignating paragraphs (14) 

22 through (16) as paragraphs (15) through (17), 

23 respectively; and 

24 (B) by inserting after paragraph (13) the 

25 following new paragraph: 


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1 ‘‘(14) The institution agrees to, not later than 

2 30 days after any date on which such institution be3 comes subject to an action or event described in sec4 tion 3673(e)(3) of this title, submit to the State ap5 proving agency, or the Secretary when acting in the 

6 role of a State approving agency, a notification of 

7 such action or event in such form and containing 

8 such information as the Secretary determines appro9 priate.’’. 

10 (2) CONFORMING AMENDMENTS.—Such title is 

11 further amended— 

12 (A) in section 3672(b)(2)(C), by striking 

13 ‘‘paragraph (14) or (15)’’ and inserting ‘‘para14 graph (15) or (16)’’; 

15 (B) in section 3675(b)(3), by striking 

16 ‘‘(14), (15), and (16)’’ and inserting ‘‘(15), 

17 (16), and (17)’’; 

18 (C) in section 3679(d), by striking ‘‘de19 scribed in paragraph (14) or (15)’’ and insert20 ing ‘‘described in paragraph (15) or (16)’’; and 

21 (D) in section 3680A(a)(4)(C)(iii), by 

22 striking ‘‘section 3676(c)(14) and (15)’’ and in23 serting ‘‘section 3676(c)(15) and (16)’’. 


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1 (c) ADDITIONAL GROUNDS FOR SUSPENSION OF AP2 PROVAL.—Section 3679(f)(1) of such title is amended by 

3 adding at the end the following new subparagraph: 

4 ‘‘(I) Comply with the notification requirements 

5 under sections 3675(b)(5) and 3676(c)(14) of this 

6 title, when applicable.’’. 

7 (d) DEADLINE FOR RISK-BASED SURVEYS DATA8 BASE.—The Secretary of Veterans Affairs shall establish 

9 the database required under section 3673A(c) of title 38, 

10 United States Code, by not later than 180 days after the 

11 date of the enactment of this Act. 

12 SEC. 207. REQUIREMENT THAT EDUCATIONAL INSTITU13 TIONS APPROVED FOR PURPOSES OF DE14 PARTMENT OF VETERANS AFFAIRS EDU15 CATIONAL ASSISTANCE PROGRAMS PROVIDE 

16 DIGITAL OFFICIAL TRANSCRIPTS. 

17 (a) REQUIREMENT.—Section 3675(b) of title 38, 

18 United States Code, as amended by sections 205 and 206, 

19 is further amended by adding at the end the following new 

20 paragraph: 

21 ‘‘(6) The educational institution makes avail22 able to each eligible person or veteran a copy of the 

23 person or veteran’s official transcript in a digital 

24 format.’’. 

25 (b) CONFORMING AMENDMENTS.— 


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1 (1) APPROVAL OF COURSES.—Section 

2 3672(b)(2)(A) of such title is amended by striking 

3 ‘‘(b)(1) and (b)(2)’’ and inserting ‘‘paragraphs (1), 

4 (2), and (6) of section 3675(b)’’. 

5 (2) APPROVAL OF NONACCREDITED COURSES.— 

6 Section 3676(c) of such title is amended— 

7 (A) by redesignating paragraph (17) as 

8 paragraph (18); and 

9 (B) by inserting after paragraph (16) the 

10 following new paragraph (17): 

11 ‘‘(17) In the case of a course that leads to a 

12 standard college degree, the educational institution 

13 satisfies the requirements of section 3675(b)(6) of 

14 this title.’’. 

15 (3) CONFORMING AMENDMENTS.—Section 

16 3675(b)(3) of such title is amended by striking 

17 ‘‘(15), (16), and (17)’’ and inserting ‘‘(15), (16), 

18 and (18)’’. 

19 (c) EFFECTIVE DATE.—The amendments made by 

20 this section shall take effect on August 1, 2025, and apply 

21 with respect to a quarter, semester, or term, as applicable, 

22 commencing on or after such date. 


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1 SEC. 208. PAYMENT OF FULL MONTHLY HOUSING STIPEND 

2 FOR VETERANS ENROLLED IN FINAL SEMES3 TER USING EDUCATIONAL ASSISTANCE 

4 UNDER POST-9/11 EDUCATIONAL ASSISTANCE 

5 PROGRAM. 

6 (a) HOUSING ALLOWANCE.—Section 3680(a)(3) of 

7 title 38, United States Code, is amended— 

8 (1) by redesignating subparagraphs (A) and 

9 (B) as clauses (i) and (ii), respectively (and by re10 designating each subordinate provision and the mar11 gins thereof accordingly); 

12 (2) by striking ‘‘Notwithstanding paragraph 

13 (1)’’ and inserting ‘‘(A) Notwithstanding paragraph 

14 (1)’’; 

15 (3) by striking ‘‘, including a monthly housing 

16 stipend described in section 3313(c) of this title,’’; 

17 and 

18 (4) by adding at the end the following new sub19 paragraph (B): 

20 ‘‘(B) For purposes of providing a monthly housing 

21 stipend described in section 3313(c) to an eligible veteran 

22 or eligible person for whom the Secretary is providing edu23 cational assistance under chapter 33 of this title during 

24 a period that is the last semester, term, or academic period 

25 pursuant to subparagraph (A), the Secretary shall treat 


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1 the veteran or person as pursuing a program of education 

2 on a full-time basis.’’. 

3 (b) APPLICATION.—The amendments made by sub4 section (a) shall take effect on the date of the enactment 

5 of this Act and apply with respect to a quarter, semester, 

6 or term, as applicable, commencing on or after August 1, 

7 2024. 

8 SEC. 209. MODIFICATION OF RULES FOR APPROVAL OF 

9 COMMERCIAL DRIVER EDUCATION PRO10 GRAMS FOR PURPOSES OF EDUCATIONAL AS11 SISTANCE PROGRAMS OF THE DEPARTMENT 

12 OF VETERANS AFFAIRS. 

13 (a) IN GENERAL.—Section 3680A(e) of title 38, 

14 United States Code, is amended— 

15 (1) by redesignating paragraphs (1) through 

16 (3) as subparagraphs (A) though (C), respectively; 

17 (2) in the matter before subparagraph (A), as 

18 redesignated by paragraph (1), by inserting ‘‘(1)’’ 

19 before ‘‘The Secretary’’; 

20 (3) in paragraph (1)(B), as redesignated by 

21 paragraph (1), by inserting ‘‘except as provided in 

22 paragraph (2),’’ before ‘‘the course’’; and 

23 (4) by adding at the end the following new 

24 paragraph (2): 


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1 ‘‘(2)(A) Subject to this paragraph, a commercial driv2 er education program is exempt from paragraph (1)(B) 

3 for a branch of an educational institution if the commer4 cial driver education program offered at the branch by the 

5 educational institution— 

6 ‘‘(i) is appropriately licensed; and 

7 ‘‘(ii)(I) the branch is located in a State in 

8 which the same commercial driver education pro9 gram is offered by the same educational institution 

10 at another branch of that educational institution in 

11 the same State that is approved for purposes of this 

12 chapter by a State approving agency or the Sec13 retary when acting in the role of a State approving 

14 agency; or 

15 ‘‘(II)(aa) the branch is located in a State in 

16 which the same commercial driver education pro17 gram is not offered at another branch of the same 

18 educational institution in the same State; and 

19 ‘‘(bb) the branch has been operating for a pe20 riod of at least one year using the same curriculum 

21 as a commercial driver education program offered by 

22 the educational institution at another location that is 

23 approved for purposes of this chapter by a State ap24 proving agency or the Secretary when acting in the 

25 role of a State approving agency. 


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1 ‘‘(B)(i) In order for a commercial driver education 

2 program of an educational institution offered at a branch 

3 described in paragraph (1)(B) to be exempt under sub4 paragraph (A) of this paragraph, the educational institu5 tion shall submit to the Secretary each year that para6 graph (1)(B) would otherwise apply a report that dem7 onstrates that the curriculum at the new branch is the 

8 same as the curriculum at the primary location. 

9 ‘‘(ii) Reporting under clause (i) shall be submitted 

10 in accordance with such requirements as the Secretary 

11 shall establish in consultation with the State approving 

12 agencies. 

13 ‘‘(C)(i) The Secretary may withhold an exemption 

14 under subparagraph (A) for any educational institution or 

15 branch of an educational institution as the Secretary con16 siders appropriate. 

17 ‘‘(ii) In making any determination under clause (i), 

18 the Secretary may consult with the Secretary of Transpor19 tation on the performance of a provider of a commercial 

20 driver program, including the status of the provider within 

21 the Training Provider Registry of the Federal Motor Car22 rier Safety Administration when appropriate. 

23 ‘‘(D) The Secretary shall submit to the Committees 

24 on Veterans’ Affairs of the Senate and the House of Rep25 resentatives a notification not later than 30 days after the 


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1 Secretary grants an exemption under this paragraph. 

2 Such notification shall identify the educational institution 

3 and branch of such educational institution granted such 

4 exemption.’’. 

5 (b) IMPLEMENTATION.— 

6 (1) ESTABLISHMENT OF REQUIREMENTS.—Not 

7 later than 180 days after the date of the enactment 

8 of this Act, the Secretary of Veterans Affairs shall 

9 establish requirements under section 

10 3680A(e)(2)(B)(ii) of such title, as added by sub11 section (a). 

12 (2) RULEMAKING.—In promulgating any rules 

13 to carry out paragraph (2) of section 3680A(e) of 

14 title 38, United States Code, as added by subsection 

15 (a), the Secretary of Veterans Affairs shall consult 

16 with State approving agencies. 

17 (3) APPLICABILITY.—The amendments made 

18 by subsection (a) shall apply to commercial driver 

19 education programs on and after the day that is 365 

20 days after the date on which the Secretary estab21 lishes the requirements under paragraph (1) of this 

22 subsection. 

23 (c) COMPTROLLER GENERAL OF THE UNITED

24 STATES STUDY.—Not later than 365 days after the date 


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

2 the United States shall— 

3 (1) conduct a study to— 

4 (A) ascertain the effects of the amend5 ments made by subsection (a); and 

6 (B) the feasibility and advisability of simi7 larly amending the rules for approval of pro8 grams of education for other vocational pro9 grams of education; and 

10 (2) submit to the Committees on Veterans’ Af11 fairs of the Senate and the House of Representatives 

12 a report on the findings of the Comptroller General 

13 with respect to such study. 

14 SEC. 210. PROVISION OF CERTIFICATES OF ELIGIBILITY 

15 AND AWARD LETTERS USING ELECTRONIC 

16 MEANS. 

17 (a) IN GENERAL.—Chapter 36 of title 38, United 

18 States Code, is amended by inserting after section 3698 

19 the following new section (and conforming the table of sec20 tions at the beginning of such chapter accordingly): 

21 ‘‘§ 3698A. Provision of certificates of eligibility and 

22 award letters using electronic means 

23 ‘‘(a) REQUIREMENT.—Except as provided by sub24 section (b), the Secretary shall provide to an individual 

25 the following documents using electronic means: 


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1 ‘‘(1) A certificate of eligibility for the entitle2 ment of the individual to covered educational assist3 ance. 

4 ‘‘(2) An award letter regarding the authoriza5 tion of the individual to receive covered educational 

6 assistance. 

7 ‘‘(b) ELECTION TO OPT OUT.—An individual may 

8 elect to receive the documents specified in subsection (a) 

9 by mail rather than through electronic means under sub10 section (a). An individual may revoke such an election at 

11 any time, by means prescribed by the Secretary. 

12 ‘‘(c) COVERED EDUCATIONAL ASSISTANCE.—In this 

13 section, the term ‘covered educational assistance’ means 

14 educational assistance under chapter 30, 33, or 35 of this 

15 title, or section 3699C of this title.’’. 

16 (b) CLERICAL AMENDMENT.—The table of sections 

17 at the beginning of such chapter is amended by inserting 

18 after the item relating to section 3698 the following new 

19 item: 

‘‘3698A. Provision of certificates of eligibility and award letters using electronic 

means.’’. 


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1 SEC. 211. RETROACTIVE EFFECTIVE DATE OF LAW RE2 GARDING CHARGE TO ENTITLEMENT TO EDU3 CATIONAL ASSISTANCE FOR INDIVIDUALS 

4 WHO DO NOT TRANSFER CREDITS FROM CER5 TAIN CLOSED OR DISAPPROVED PROGRAMS 

6 OF EDUCATION. 

7 Section 3699(c)(2) of title 38, United States Code, 

8 is amended by striking subparagraph (C) and inserting 

9 the following new subparagraph (C): 

10 ‘‘(C) This paragraph, including clauses (ii) and (iii) 

11 of subparagraph (A), shall apply with respect to the clo12 sure or discontinuation of a course or program of edu13 cation, as described in subsection (b)(1), that occurs dur14 ing the period beginning on August 1, 2021, and ending 

15 on September 30, 2025.’’. 

16 SEC. 212. DEPARTMENT OF VETERANS AFFAIRS HIGH 

17 TECHNOLOGY PROGRAM. 

18 (a) HIGH TECHNOLOGY PROGRAM.— 

19 (1) IN GENERAL.—Chapter 36 of title 38, 

20 United States Code, as amended by section 210, is 

21 amended by adding at the end the following new sec22 tion: 

23 ‘‘§ 3699C. High technology program 

24 ‘‘(a) ESTABLISHMENT.—(1) The Secretary shall 

25 carry out a program under which the Secretary provides 

26 covered individuals with the opportunity to enroll in high 


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1 technology programs of education that the Secretary de2 termines provide training or skills sought by employers in 

3 a relevant field or industry. 

4 ‘‘(2) Not more than 4,000 covered individuals may 

5 participate in the program under this section in any fiscal 

6 year. 

7 ‘‘(b) AMOUNT OF ASSISTANCE.—(1) The Secretary 

8 shall provide, to each covered individual who pursues a 

9 high technology program of education under this section, 

10 educational assistance in amounts equal to the amounts 

11 provided under section 3313(c)(1) of this title, including, 

12 except as provided in paragraph (3), with respect to the 

13 housing stipend described in that section and in accord14 ance with the treatment of programs that are distance 

15 learning and programs that are less than half-time. 

16 ‘‘(2) Under paragraph (1), the Secretary shall pro17 vide such amounts of educational assistance to a covered 

18 individual for each of the following: 

19 ‘‘(A) A high technology program of education. 

20 ‘‘(B) A second such program if— 

21 ‘‘(i) the second such program begins at 

22 least 18 months after the covered individual 

23 graduates from the first such program; and 


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1 ‘‘(ii) the covered individual uses edu2 cational assistance under chapter 33 of this 

3 title to pursue the second such program. 

4 ‘‘(3) No covered individual may receive a housing sti5 pend under this subsection for any month if such indi6 vidual is in receipt of a housing stipend under chapter 33 

7 of this title for that month. 

8 ‘‘(c) CONTRACTS.—(1) For purposes of carrying out 

9 subsection (a), the Secretary shall seek to enter into con10 tracts with any number of qualified providers of high tech11 nology programs of education for the provision of such 

12 programs to covered individuals. Each such contract shall 

13 provide for the conditions under which the Secretary may 

14 terminate the contract with the provider and the proce15 dures for providing for the graduation of students who 

16 were enrolled in a program provided by such provider in 

17 the case of such a termination. 

18 ‘‘(2) A contract under this subsection shall provide 

19 that the Secretary shall pay to a provider— 

20 ‘‘(A) upon the enrollment of a covered indi21 vidual in the program, 25 percent of the cost of the 

22 tuition and other fees for the program of education 

23 for the individual; 

24 ‘‘(B) upon graduation of the individual from 

25 the program, 25 percent of such cost; and 


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1 ‘‘(C) 50 percent of such cost upon— 

2 ‘‘(i) the successful employment of the cov3 ered individual for a period— 

4 ‘‘(I) of 180 days in the field of study 

5 of the program; and 

6 ‘‘(II) that begins not later than 180 

7 days following graduation of the covered 

8 individual from the program; 

9 ‘‘(ii) the employment of the individual by 

10 the provider for a period of one year; or 

11 ‘‘(iii) the enrollment of the individual in a 

12 program of education to continue education in 

13 such field of study. 

14 ‘‘(3) For purposes of this section, a provider of a high 

15 technology program of education is qualified if— 

16 ‘‘(A) the provider employs instructors whom the 

17 Secretary determines are experts in their respective 

18 fields in accordance with paragraph (5); 

19 ‘‘(B) the provider has successfully provided the 

20 high technology program for at least one year; 

21 ‘‘(C) the provider does not charge tuition and 

22 fees to a covered individual who receives assistance 

23 under this section to pursue such program that are 

24 higher than the tuition and fees charged by such 

25 provider to another individual; and 


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1 ‘‘(D) the provider meets the approval criteria 

2 developed by the Secretary under paragraph (4). 

3 ‘‘(4)(A) The Secretary shall prescribe criteria for ap4 proving providers of a high technology program of edu5 cation under this section. 

6 ‘‘(B) In developing such criteria, the Secretary may 

7 consult with State approving agencies. 

8 ‘‘(C) Such criteria are not required to meet the re9 quirements of section 3672 of this title. 

10 ‘‘(D) Such criteria shall include the job placement 

11 rate, in the field of study of a program of education, of 

12 covered individuals who complete such program of edu13 cation. 

14 ‘‘(5) The Secretary shall determine whether instruc15 tors are experts under paragraph (3)(A) based on evidence 

16 furnished to the Secretary by the provider regarding the 

17 ability of the instructors to— 

18 ‘‘(A) identify professions in need of new em19 ployees to hire, tailor the programs to meet market 

20 needs, and identify the employers likely to hire grad21 uates; 

22 ‘‘(B) effectively teach the skills offered to cov23 ered individuals; 


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1 ‘‘(C) provide relevant industry experience in the 

2 fields of programs offered to incoming covered indi3 viduals; and 

4 ‘‘(D) demonstrate relevant industry experience 

5 in such fields of programs. 

6 ‘‘(6) In entering into contracts under this subsection, 

7 the Secretary shall give preference to a provider of a high 

8 technology program of education— 

9 ‘‘(A) from which at least 70 percent of grad10 uates find full-time employment in the field of study 

11 of the program during the 180-day period beginning 

12 on the date the student graduates from the program; 

13 or 

14 ‘‘(B) that offers tuition reimbursement for any 

15 student who graduates from such a program and 

16 does not find employment described in subparagraph 

17 (A). 

18 ‘‘(d) EFFECT ON OTHER ENTITLEMENT.—(1) If a 

19 covered individual enrolled in a high technology program 

20 of education under this section has remaining entitlement 

21 to educational assistance under chapter 30, 32, 33, 34, 

22 or 35 of this title, such entitlement shall be charged at 

23 the rate of one month of such entitlement for each month 

24 of educational assistance provided under this section. 


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1 ‘‘(2) If a covered individual enrolled in a high tech2 nology program of education under this section does not 

3 have remaining entitlement to educational assistance 

4 under chapter 30, 32, 33, 34, or 35 of this title, any edu5 cational assistance provided to such individual under this 

6 section shall be provided in addition to the entitlement 

7 that the individual has used. 

8 ‘‘(3) The Secretary may not consider enrollment in 

9 a high technology program of education under this section 

10 to be assistance under a provision of law referred to in 

11 section 3695 of this title. 

12 ‘‘(4)(A) An application for enrollment in a high tech13 nology program of education under this section shall in14 clude notice of the requirements relating to use of entitle15 ment under paragraphs (1) and (2), including— 

16 ‘‘(i) in the case of the enrollment of an indi17 vidual referred to under paragraph (1), the amount 

18 of entitlement that is typically charged for such en19 rollment; 

20 ‘‘(ii) an identification of any methods that may 

21 be available for minimizing the amount of entitle22 ment required for such enrollment; and 

23 ‘‘(iii) an element requiring applicants to ac24 knowledge receipt of the notice under this subpara25 graph. 


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1 ‘‘(B) If the Secretary approves the enrollment of a 

2 covered individual in a high technology program of edu3 cation under this section, the Secretary shall deliver elec4 tronically to the individual an award letter that provides 

5 notice of such approval and includes specific information 

6 describing how paragraphs (1) and (2) will be applied to 

7 the individual if the individual chooses to enroll in the pro8 gram. 

9 ‘‘(e) REQUIREMENTS FOR EDUCATIONAL INSTITU10 TIONS.—(1) The Secretary shall not approve the enroll11 ment of any covered individual, not already enrolled, in 

12 any high technology programs of education under this sec13 tion for any period during which the Secretary finds that 

14 more than 85 percent of the students enrolled in the pro15 gram are having all or part of their tuition, fees, or other 

16 charges paid to or for them by the educational institution 

17 or by the Department of Veterans Affairs under this title 

18 or under chapter 1606 or 1607 of title 10, except with 

19 respect to tuition, fees, or other charges that are paid 

20 under a payment plan at an educational institution that 

21 the Secretary determines has a history of offering pay22 ment plans that are completed not later than 180 days 

23 after the end of the applicable term, quarter, or semester. 

24 ‘‘(2) The Secretary may waive a requirement of para25 graph (1) if the Secretary determines, pursuant to regulaVerDate Sep 11 2014 18:49 May 29, 2024 Jkt 049200 PO 00000 Frm 00195 Fmt 6652 Sfmt 6201 E:\BILLS\H8371.IH H8371

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1 tions which the Secretary shall prescribe, such waiver to 

2 be in the interest of the covered individual and the Federal 

3 Government. Not later than 30 days after the Secretary 

4 waives such a requirement, the Secretary shall submit to 

5 the Committees on Veterans’ Affairs of the Senate and 

6 the House of Representatives a report regarding such 

7 waiver. 

8 ‘‘(3)(A)(i) The Secretary shall establish and maintain 

9 a process by which an educational institution may request 

10 a review of a determination that the educational institu11 tion does not meet the requirements of paragraph (1). 

12 ‘‘(ii) The Secretary may consult with a State approv13 ing agency regarding such process or such a review. 

14 ‘‘(iii) Not later than 180 days after the Secretary es15 tablishes or revises a process under this subparagraph, the 

16 Secretary shall submit to the Committees on Veterans’ Af17 fairs of the Senate and the House of Representatives a 

18 report regarding such process. 

19 ‘‘(B) An educational institution that requests a re20 view under subparagraph (A)— 

21 ‘‘(i) shall request the review not later than 30 

22 days after the start of the term, quarter, or semester 

23 for which the determination described in subpara24 graph (A) applies; and 


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1 ‘‘(ii) may include any information that the edu2 cational institution believes the Department should 

3 have taken into account when making the deter4 mination, including with respect to any mitigating 

5 circumstances. 

6 ‘‘(f) ANNUAL REPORTS.—Not later than one year 

7 after the date of the enactment of this section, and annu8 ally thereafter until the termination date specified in sub9 section (i), the Secretary shall submit to the Committees 

10 on Veterans’ Affairs of the Senate and the House of Rep11 resentatives a report on the operation of program under 

12 this section during the year covered by the report. Each 

13 such report shall include each of the following: 

14 ‘‘(1) The number of covered individuals enrolled 

15 in the program, disaggregated by type of educational 

16 institution, during the year covered by the report. 

17 ‘‘(2) The number of covered individuals who 

18 completed a high technology program of education 

19 under the program during the year covered by the 

20 report. 

21 ‘‘(3) The average employment rate of covered 

22 individuals who completed such a program of edu23 cation during such year, as of 180 days after the 

24 date of completion. 


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1 ‘‘(4) The average length of time between the 

2 completion of such a program of education and em3 ployment. 

4 ‘‘(5) The total number of covered individuals 

5 who completed a program of education under the 

6 program and who, as of the date of the submission 

7 of the report, are employed in a position related to 

8 technology. 

9 ‘‘(6) The average salary of a covered individual 

10 who completed a program of education under the 

11 program and who is employed in a position related 

12 to technology, in various geographic areas deter13 mined by the Secretary. 

14 ‘‘(7) The average salary of all individuals em15 ployed in positions related to technology in the geo16 graphic areas determined under subparagraph (F), 

17 and the difference, if any, between such average sal18 ary and the average salary of a covered individual 

19 who completed a program of education under the 

20 program and who is employed in a position related 

21 to technology. 

22 ‘‘(8) The number of covered individuals who 

23 completed a program of education under the pro24 gram and who subsequently enrolled in a second 

25 program of education under the program. 


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1 ‘‘(g) COLLECTION OF INFORMATION; CONSULTA2 TION.—(1) The Secretary shall develop practices to use 

3 to collect information about covered individuals and pro4 viders of high technology programs of education. 

5 ‘‘(2) For the purpose of carrying out program under 

6 this section, the Secretary may consult with providers of 

7 high technology programs of education and may establish 

8 an advisory group made up of representatives of such pro9 viders, private employers in the technology field, and other 

10 relevant groups or entities, as the Secretary determines 

11 necessary. 

12 ‘‘(h) DEFINITIONS.—In this section: 

13 ‘‘(1) The term ‘covered individual’ means any of 

14 the following: 

15 ‘‘(A) A veteran whom the Secretary deter16 mines— 

17 ‘‘(i) served an aggregate of at least 36 

18 months on active duty in the Armed 

19 Forces (including service on active duty in 

20 entry level and skill training) and was dis21 charged or released therefrom under condi22 tions other than dishonorable; and 

23 ‘‘(ii) has not attained the age of 62. 

24 ‘‘(B) A member of the Armed Forces that 

25 the Secretary determines will become a veteran 


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1 described in subparagraph (A) fewer than 180 

2 days after the date of such determination. 

3 ‘‘(2) The term ‘high technology program of edu4 cation’ means a program of education— 

5 ‘‘(A) offered by a public or private edu6 cational institution; 

7 ‘‘(B) if offered by an institution of higher 

8 learning, that is provided directly by such insti9 tution rather than by an entity other than such 

10 institution under a contract or other agreement; 

11 ‘‘(C) that does not lead to a degree; 

12 ‘‘(D) that has a term of not less than six 

13 and not more than 28 weeks; and 

14 ‘‘(E) that provides instruction in computer 

15 programming, computer software, media appli16 cation, data processing, or information sciences. 

17 ‘‘(i) TERMINATION.—The Secretary may not provide 

18 educational assistance under this section for a high tech19 nology program of education that begins after September 

20 30, 2026.’’. 

21 (2) CLERICAL AMENDMENT.—The table of sec22 tions at the beginning of such chapter is amended 

23 by inserting after the item relating to section 3699B 

24 the following new item: 

‘‘3699C. High technology program.’’. 


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1 (b) EFFECT ON HIGH TECHNOLOGY PILOT PRO2 GRAM.—Section 116 of the Harry W. Colmery Veterans 

3 Educational Assistance Act of 2017 (Public Law 115–48; 

4 38 U.S.C. 3001 note) is amended— 

5 (1) by amending subsection (d) to read as fol6 lows: 

7 ‘‘(d) HOUSING STIPEND.— 

8 ‘‘(1) IN GENERAL.—Except as provided under 

9 paragraph (2), the Secretary shall pay to each eligi10 ble veteran (not including an individual described in 

11 the second sentence of subsection (b)) who is en12 rolled in a high technology program of education 

13 under the pilot program on a full-time or part-time 

14 basis a monthly housing stipend equal to the prod15 uct— 

16 ‘‘(A) of— 

17 ‘‘(i) in the case of a veteran pursuing 

18 resident training, the monthly amount of 

19 the basic allowance for housing payable 

20 under section 403 of title 37, United 

21 States Code, for a member with depend22 ents in pay grade E–5 residing in the mili23 tary housing area that encompasses all or 

24 the majority portion of the ZIP code area 

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1 tution where the individual physically par2 ticipates in a majority of classes; or 

3 ‘‘(ii) in the case of a veteran pursuing 

4 a program of education through distance 

5 learning, a monthly amount equal to 50 

6 percent of the national average of the 

7 monthly amount of the basic allowance for 

8 housing payable under section 403 of title 

9 37, United States Code, for a member with 

10 dependents in pay grade E–5, multiplied 

11 by 

12 ‘‘(B) the lesser of— 

13 ‘‘(i) 1.0; or 

14 ‘‘(ii) the number of course hours 

15 borne by the individual in pursuit of the 

16 program of education involved, divided by 

17 the minimum number of course hours re18 quired for full-time pursuit of such pro19 gram of education, rounded to the nearest 

20 multiple of 10. 

21 ‘‘(2) BAR TO DUAL ELIGIBILITY.—No covered 

22 individual may receive a housing stipend under this 

23 subsection for any month if such individual is in re24 ceipt of a housing stipend under chapter 33 ot title 

25 38, United States Code, for that month.’’; 


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1 (2) in subsection (g), by striking paragraph (6); 

2 and 

3 (3) by striking subsection (h) and inserting the 

4 following new subsection (h): 

5 ‘‘(h) TERMINATION.—The Secretary may not, under 

6 this section, pay a provider for a high technology program 

7 of education that begins after September 30, 2024.’’. 

8 (c) APPROVAL OF CERTAIN HIGH TECHNOLOGY PRO9 GRAMS.—Section 3680A of title 38, United States Code, 

10 is amended— 

11 (1) in subsection (a), by striking paragraph (4) 

12 and inserting the following: 

13 ‘‘(4) Any independent study program except— 

14 ‘‘(A) an independent study program (in15 cluding such a program taken over open circuit 

16 television) that— 

17 ‘‘(i) is accredited by an accrediting 

18 agency or association recognized by the 

19 Secretary of Education under subpart 2 of 

20 part H of title IV of the Higher Education 

21 Act of 1965 (20 U.S.C. 1099b); 

22 ‘‘(ii) leads to— 

23 ‘‘(I) a standard college degree; 


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1 ‘‘(II) a certificate that reflects 

2 educational attainment offered by an 

3 institution of higher learning; or 

4 ‘‘(III) a certificate that reflects 

5 graduation from a course of study of6 fered by— 

7 ‘‘(aa) an area career and 

8 technical education school (as de9 fined in subparagraphs (C) and 

10 (D) of section 3(3) of the Carl D. 

11 Perkins Career and Technical 

12 Education Act of 2006 (20 

13 U.S.C. 2302(3))) that provides 

14 education at the postsecondary 

15 level; or 

16 ‘‘(bb) a postsecondary voca17 tional institution (as defined in 

18 section 102(c) of the Higher 

19 Education Act of 1965 (20 

20 U.S.C. 1002(c))) that provides 

21 education at the postsecondary 

22 level; and 

23 ‘‘(iii) in the case of a program de24 scribed in clause (ii)(III)— 


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1 ‘‘(I) provides training aligned 

2 with the requirements of employers in 

3 the State or local area where the pro4 gram is located, which may include in5 demand industry sectors or occupa6 tions; 

7 ‘‘(II) provides a student, upon 

8 graduation from the program, with a 

9 recognized postsecondary credential 

10 that is recognized by employers in the 

11 relevant industry, which may include 

12 a credential recognized by industry or 

13 sector partnerships in the State or 

14 local area where the industry is lo15 cated; and 

16 ‘‘(III) meets such content and in17 structional standards as may be re18 quired to comply with the criteria 

19 under section 3676(c)(14) and (15) of 

20 this title; or 

21 ‘‘(B) an online high technology program of 

22 education (as defined in subsection (h)(2) of 

23 section 3699C of this title)— 


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1 ‘‘(i) the provider of which has entered 

2 into a contract with the Secretary under 

3 subsection (c) of such section; 

4 ‘‘(ii) that has been provided to covered 

5 individuals (as defined in subsection (h)(1) 

6 of such section) under such contract for a 

7 period of at least five years; 

8 ‘‘(iii) regarding which the Secretary 

9 has determined that the average employ10 ment rate of covered individuals who grad11 uated from such program of education is 

12 65 percent or higher for the year preceding 

13 such determination; and 

14 ‘‘(iv) that satisfies the requirements of 

15 subsection (e) of such section.’’; and 

16 (2) in subsection (d), by adding at the end the 

17 following: 

18 ‘‘(8) Paragraph (1) shall not apply to the enrollment 

19 of a veteran in an online high technology program de20 scribed in subsection (a)(4)(B).’’. 

21 (d) EFFECTIVE DATE.—The amendments made by 

22 subsections (a) and (c) shall take effect on October 1, 

23 2024. 


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1 SEC. 213. NOTICE OF CHANGES TO DEPARTMENT OF VET2 ERANS AFFAIRS POLICIES AND GUIDANCE 

3 AFFECTING THE EDUCATIONAL ASSISTANCE 

4 PROGRAMS OF THE DEPARTMENT. 

5 (a) IN GENERAL.—Subchapter III of chapter 36 of 

6 title 38, United States Code, as amended by sections 210 

7 and 212, is further amended by adding at the end the 

8 following new section: 

9 ‘‘§ 3699D. Notice of changes to policies and guidance 

10 relating to educational assistance pro11 grams 

12 ‘‘In the case of any change to any policy or guidance 

13 provided by the Secretary that relates to any educational 

14 assistance program of the Department, the Secretary may 

15 not implement the change before the date that is 90 days 

16 after the date on which the Secretary makes available to 

17 students, educational institutions, and the Committees on 

18 Veterans’ Affairs of the Senate and House of Representa19 tives notice of, and justification for, the change.’’. 

20 (b) CLERICAL AMENDMENT.—The table of sections 

21 at the beginning of such chapter is amended by inserting 

22 after the item relating to section 3699B the following new 

23 item: 

‘‘3699D. Notice of changes to policies and guidance relating to educational assistance programs.’’. 


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1 (c) EFFECTIVE DATE.—Section 3699D of title 38, 

2 United States Code, as added by subsection (a), shall take 

3 effect on the date of the enactment of this Act and apply 

4 with respect to a rule making on or after August 1, 2024. 

5 SEC. 214. PAYMENT OF VA EDUCATIONAL ASSISTANCE VIA 

6 ELECTRONIC FUND TRANSFER TO A FOREIGN 

7 INSTITUTION OF HIGHER EDUCATION. 

8 Not later than 90 days after the date of the enact9 ment of this Act, the Secretary of Veterans Affairs shall 

10 update the payment system of the Department of Veterans 

11 Affairs to allow for electronic fund transfer of educational 

12 assistance, administered by the Secretary, to a foreign in13 stitution of higher education that— 

14 (1) provides an approved course of education to 

15 an eligible recipient of such assistance; and 

16 (2) does not have— 

17 (A) an employer identification number; or 

18 (B) an account with a domestic bank. 

19 SEC. 215. IMPROVING TRANSPARENCY AND ACCOUNT20 ABILITY OF EDUCATIONAL INSTITUTIONS 

21 FOR PURPOSES OF VETERANS EDUCATIONAL 

22 ASSISTANCE. 

23 (a) REQUIREMENT RELATING TO G.I. BILL COM24 PARISON TOOL.— 


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1 (1) REQUIREMENT TO MAINTAIN TOOL.—The 

2 Secretary of Veterans Affairs shall maintain the G.I. 

3 Bill Comparison Tool that was established pursuant 

4 to Executive Order 13607 (77 Fed. Reg. 25861; re5 lating to establishing principles of excellence for edu6 cational institutions serving service members, vet7 erans, spouses, and other family members) and in 

8 effect on the day before the date of enactment of 

9 this Act, or a successor tool, to provide relevant and 

10 timely information about programs of education ap11 proved under chapter 36 of title 38, United States 

12 Code, and the educational institutions that offer 

13 such programs. 

14 (2) DATA RETENTION.—The Secretary shall en15 sure that historical data that is reported via the tool 

16 maintained under paragraph (1) remains easily and 

17 prominently accessible on the benefits.va.gov website, 

18 or a successor website, for a period of not less than 

19 six years from the date of initial publication. 

20 (b) PROVIDING TIMELY AND RELEVANT EDUCATION

21 INFORMATION TO VETERANS, MEMBERS OF THE ARMED

22 FORCES, AND OTHER INDIVIDUALS.— 

23 (1) IN GENERAL.—Not later than one year 

24 after the date of the enactment of this Act, the Sec25 retary of Veterans Affairs, in consultation with the 


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1 Secretary of Education, the Secretary of the Treas2 ury, and the heads of other relevant Federal agen3 cies, shall make such changes to the tool maintained 

4 under subsection (a) as the Secretary of Veterans 

5 Affairs determines appropriate to ensure that such 

6 tool is an effective and efficient method for providing 

7 information pursuant to section 3698(b)(5) of title 

8 38, United States Code. 

9 (2) MEMORANDUM OF UNDERSTANDING RE10 QUIRED.—Not later than two years after the date of 

11 the enactment of this Act, the Secretary of Veterans 

12 Affairs shall seek to enter into a memorandum of 

13 understanding with the Secretary of Education and 

14 the heads other relevant Federal agencies, as the 

15 Secretary of Veterans Affairs determines appro16 priate, to obtain information on outcomes with re17 spect to individuals who are entitled to educational 

18 assistance under the laws administered by the Sec19 retary of Veterans Affairs and who are attending 

20 educational institutions. Such memorandum of un21 derstanding may include data sharing or computer 

22 matching agreements. 

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1 TION.—Section 3698 of title 38, United States Code, 

2 is amended— 

3 (A) in subsection (a), by striking ‘‘veterans 

4 and members of the Armed Forces’’ and insert5 ing ‘‘individuals entitled to educational assist6 ance under laws administered by the Secretary 

7 of Veterans Affairs’’; and 

8 (B) in subsection (b)(5)— 

9 (i) by striking ‘‘veterans and members 

10 of the Armed Forces’’ and inserting ‘‘indi11 viduals described in subsection (a)’’; and 

12 (ii) by striking ‘‘the veteran or mem13 ber’’ and inserting ‘‘the individual’’. 

14 (4) G.I. BILL COMPARISON TOOL REQUIRED

15 DISCLOSURES.—Paragraph (1) of subsection (c) of 

16 such section is amended— 

17 (A) by striking subparagraph (B) and in18 serting the following: 

19 ‘‘(B) for each individual described in subsection 

20 (a) seeking information provided under subsection 

21 (b)(5), the name of each Federal student aid pro22 gram, and a description of each such program, from 

23 which the individual may receive educational assist24 ance;’’; 

25 (B) in subparagraph (C)— 


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1 (i) in clause (i), by inserting ‘‘and a 

2 definition of each type of institution’’ be3 fore the semicolon; 

4 (ii) in clause (iv), by inserting ‘‘and if 

5 so, which programs’’ before the semicolon; 

6 (iii) by striking clause (v) and insert7 ing the following: 

8 ‘‘(v) the average annual cost and the total 

9 cost to earn an associate’s degree and a bach10 elor’s degree, with available cost information on 

11 any other degree or credential the institution 

12 awards;’’; 

13 (iv) in clause (vi), by inserting before 

14 the semicolon the following: ‘‘disaggregated 

15 by— 

16 ‘‘(I) the type of beneficiary of edu17 cational assistance; 

18 ‘‘(II) individuals who received a cre19 dential and individuals who did not; and 

20 ‘‘(II) individuals using educational as21 sistance under laws administered by the 

22 Secretary and individuals who are not’’; 

23 (v) in clause (xiv), by striking ‘‘and’’ 

24 at the end; 


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1 (vi) in clause (xv), by striking the pe2 riod at the end and inserting a semicolon; 

3 and 

4 (vii) by adding at the end the fol5 lowing new clauses: 

6 ‘‘(xvi) the number of veterans or members 

7 who completed covered education at the institu8 tion leading to— 

9 ‘‘(I) a degree, disaggregated by type 

10 of program, including— 

11 ‘‘(aa) an associate degree; 

12 ‘‘(bb) a bachelor’s degree; and 

13 ‘‘(cc) a postbaccalaureate degree; 

14 and 

15 ‘‘(II) a certificate or professional li16 cense, disaggregated by type of certificate 

17 or professional license; 

18 ‘‘(xvii) programs available and the average 

19 time for completion of each program; 

20 ‘‘(xviii) employment rate and median in21 come of graduates of the institution in general 

22 two and five years after graduation, 

23 disaggregated by— 

24 ‘‘(I) specific program; and 


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1 ‘‘(II) individuals using educational as2 sistance under laws administered by the 

3 Secretary and individuals who are not; and 

4 ‘‘(xix) the number of individuals using edu5 cational assistance under laws administered by 

6 the Secretary who are enrolled in the both the 

7 institution and specific program per year.’’. 

8 (5) CLARITY AND ANONYMITY OF INFORMATION

9 PROVIDED.—Paragraph (2) of such subsection is 

10 amended— 

11 (A) by inserting ‘‘(A)’’ before ‘‘To the ex12 tent’’; and 

13 (B) by adding at the end the following new 

14 subparagraph: 

15 ‘‘(B) The Secretary shall ensure that information 

16 provided pursuant to subsection (b)(5) is provided in a 

17 manner that is easy for, and accessible to, individuals de18 scribed in subsection (a). 

19 ‘‘(C) In providing information pursuant to subsection 

20 (b)(5), the Secretary shall maintain the anonymity of indi21 viduals described in subsection (a) and, to the extent that 

22 a portion of any data would undermine such anonymity, 

23 ensure that such data is not made available pursuant to 

24 such subsection.’’. 

25 (c) IMPROVEMENTS FOR STUDENT FEEDBACK.— 


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1 (1) IN GENERAL.—Subsection (b)(2) of such 

2 section is amended— 

3 (A) by amending subparagraph (A) to read 

4 as follows: 

5 ‘‘(A) provides institutions of higher learn6 ing— 

7 ‘‘(i) up to 30 days to review and re8 spond to feedback from individuals de9 scribed in subsection (a) and address 

10 issues regarding the feedback before the 

11 feedback is published; and 

12 ‘‘(I) if an institution of higher learn13 ing contests the accuracy of the feedback, 

14 the opportunity to challenge the inclusion 

15 of such data with an official appointed by 

16 the Secretary;’’; 

17 (B) in subparagraph (B), by striking 

18 ‘‘and’’ at the end; 

19 (C) in subparagraph (C), by striking ‘‘that 

20 conforms with criteria for relevancy that the 

21 Secretary shall determine.’’ and inserting ‘‘, 

22 and responses from institutions of higher learn23 ing to such feedback, that conform with criteria 

24 for relevancy that the Secretary shall deter25 mine;’’; and 


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1 (D) by adding at the end the following new 

2 subparagraphs: 

3 ‘‘(D) for each institution of higher learning 

4 that is approved under this chapter, retains, 

5 maintains, and publishes all of such feedback 

6 for not less than six years; and 

7 ‘‘(E) is easily accessible to individuals de8 scribed in subsection (a) and to the general 

9 public.’’. 

10 (2) ACCESSIBILITY FROM G.I. BILL COMPARISON

11 TOOL.—The Secretary shall ensure that— 

12 (A) the feedback tracked and published 

13 under subsection (b)(2) of such section, as 

14 amended by paragraph (1), is prominently dis15 played in the tool maintained under subsection 

16 (a) of this section; and 

17 (B) when such tool displays information 

18 for an institution of higher learning, the appli19 cable feedback is also displayed for such institu20 tion of higher learning. 

21 (d) TRAINING FOR PROVISION OF EDUCATION COUN22 SELING SERVICES.— 

23 (1) IN GENERAL.—Not less than one year after 

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

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1 ment of Veteran Affairs, or a contractor of the De2 partment, to provide education benefits counseling, 

3 vocational or transition assistance, or similar func4 tions, including employees or contractors of the De5 partment who provide such counseling or assistance 

6 as part of the Transition Assistance Program, are 

7 trained on how— 

8 (A) to use properly the tool maintained 

9 under subsection (a); and 

10 (B) to provide appropriate educational 

11 counseling services to individuals described in 

12 section 3698(a) of such title, as amended by 

13 subsection (b)(3)(A). 

14 (2) TRANSITION ASSISTANCE PROGRAM DE15 FINED.—In this subsection, the term ‘‘Transition 

16 Assistance Program’’ means the program of coun17 seling, information, and services under section 1142 

18 of title 10, United States Code. 

19 Subtitle B—Employment and 

20 Training 

21 SEC. 221. IMPROVEMENTS TO REEMPLOYMENT RIGHTS OF 

22 MEMBERS OF THE ARMED FORCES. 

23 (a) USERRA PURPOSES.—Section 4301(a)(1) of 

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1 courage noncareer service in the uniformed services’’ and 

2 inserting ‘‘encourage service in the uniformed services’’. 

3 (b) PROHIBITION OF RETALIATION.—Subsection (b) 

4 of section 4311 of title 38, United States Code, is amend5 ed by inserting ‘‘or other retaliatory action’’ after ‘‘em6 ployment action’’. 

7 (c) EXPANSION OF INJUNCTIVE RELIEF.—Sub8 section (e) of section 4323 of such title is amended— 

9 (1) by striking ‘‘The court shall use’’ and in10 serting ‘‘(1) The court shall use’’; and 

11 (2) by adding at the end the following new 

12 paragraphs: 

13 ‘‘(2) A person bringing an action to enforce a provi14 sion of this chapter pursuant to subsection (a) shall be 

15 entitled to an injunction under paragraph (1) if such per16 son demonstrates— 

17 ‘‘(A) a violation— 

18 ‘‘(i) of the provisions of this chapter; or 

19 ‘‘(ii) of the provisions of this chapter is 

20 threatened or is imminent; 

21 ‘‘(B) the harm to the person outweighs the in22 jury to the employer; 

23 ‘‘(C) a likelihood of success on the merits of 

24 such action; and 


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1 ‘‘(D) awarding such relief is in the public inter2 est. 

3 ‘‘(3) The court may not deny a motion for injunctive 

4 relief on the basis that a party bringing an action to en5 force a provision of this chapter may be awarded wages 

6 unearned due to an unlawful termination or denial of em7 ployment at the conclusion of such action.’’. 

8 (d) DAMAGES AGAINST A STATE OR PRIVATE EM9 PLOYER.—Section 4323 of such title is further amended, 

10 in paragraph (1) of subsection (d), by striking subpara11 graph (C) and inserting the following new subparagraphs: 

12 ‘‘(C) The court may require the employer to 

13 pay the person the amount referred to in subpara14 graph (B) and interest on such amount, calculated 

15 at a rate of 3 percent per year. 

16 ‘‘(D) The court may require the employer to 

17 pay the person the greater of $50,000 or the amount 

18 equal to the amounts referred to in subparagraphs 

19 (B) and (C) as liquidated damages, if the court de20 termines that the employer knowingly failed to com21 ply with the provisions of this chapter.’’. 

22 (e) MANDATORY ATTORNEY FEES AWARD IN SUC23 CESSFUL ACTIONS FOR REEMPLOYMENT.— 


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1 (1) MSPB ACTIONS.—Paragraph (4) of sub2 section (c) of section 4324 of such title is amend3 ed— 

4 (A) by striking ‘‘may, in its discretion,’’ 

5 and inserting ‘‘shall’’; and 

6 (B) by adding at the end the following new 

7 sentence: ‘‘The Board may, in its discretion, 

8 award reasonable attorney fees in a case settled 

9 before the issuance of an order if the person 

10 can demonstrate that significant attorney fees 

11 were incurred and that justice requires such an 

12 award.’’. 

13 (2) FEDERAL CIRCUIT ACTIONS.—Subsection 

14 (d) of such section is amended by adding at the end 

15 the following new paragraph: 

16 ‘‘(3) In such Federal Circuit proceeding, the court 

17 shall award such person reasonable attorney fees, expert 

18 witness fees, and other litigation expenses if such person— 

19 ‘‘(A) prevails in such Federal Circuit pro20 ceeding; and 

21 ‘‘(B) is not represented by the Special Counsel 

22 in such Federal Circuit proceeding.’’. 

23 (3) ACTIONS AGAINST A STATE OR PRIVATE EM24 PLOYER.—Paragraph (2) of section 4323(h) of such 

25 title is amended— 


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1 (A) by striking ‘‘subsection (a)(2)’’ and in2 serting ‘‘subsection (a)(3)’’; and 

3 (B) by striking ‘‘the court may award any 

4 such person who prevails in such action or pro5 ceeding reasonable attorney fees’’ and inserting 

6 ‘‘the court shall award any such person who 

7 prevails in such action or proceeding reasonable 

8 attorney fees’’. 

9 (f) GAO REVIEW AND REPORT ON USERRA.— 

10 (1) REVIEW.—The Comptroller General of the 

11 United States shall review the methods through 

12 which the Secretary of Labor, acting through the 

13 Veterans’ Employment and Training Service, proc14 esses actions for relief under chapter 43 of title 38, 

15 United States Code. 

16 (2) ELEMENTS.—Not later than one year after 

17 the date of the enactment of this Act, the Comp18 troller General shall submit to the Committees on 

19 Veterans’ Affairs of the House of Representatives 

20 and the Senate a report that includes— 

21 (A) the findings of the review required 

22 under paragraph (1); 

23 (B) an identification of the number of ac24 tions for relief under chapter 43 of title 38, 

25 United States Code, initiated during the period 


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1 covered by the report, disaggregated by size of 

2 employer and geographic region; 

3 (C) an identification of the number of such 

4 actions for relief that were erroneously dis5 missed, as determined by the Comptroller Gen6 eral; 

7 (D) an identification of the number of such 

8 actions for relief that were referred to the De9 partment of Justice; and 

10 (E) an assessment of trends, if any, in 

11 such actions for relief initiated during such pe12 riod. 

13 (g) GAO REVIEW OF PROTECTIONS FOR MEMBERS

14 OF THE UNIFORMED SERVICES BY FEDERAL INTEL15 LIGENCE AGENCIES.— 

16 (1) IN GENERAL.—Not later than one year 

17 after the date of the enactment of this Act, the 

18 Comptroller General of the United States shall sub19 mit to the appropriate congressional committees a 

20 report on the processes and procedures adopted and 

21 used by the intelligence community to provide the 

22 protections for members of the uniformed services 

23 otherwise established under chapter 43 of title 38, 

24 United States Code. 

25 (2) DEFINITIONS.—In this subsection: 


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1 (A) The term ‘‘appropriate congressional 

2 committees’’ means the Committees on Vet3 erans’ Affairs of the House of Representatives 

4 and Senate, the Permanent Select Committee 

5 on Intelligence of the House of Representatives, 

6 and the Select Committee on Intelligence of the 

7 Senate. 

8 (B) The term ‘‘intelligence community’’ 

9 has the meaning given such term in section 

10 3(4) of the National Security Act of 1947 (50 

11 U.S.C. 3003(4)). 

12 SEC. 222. REVIEW OF INVESTIGATIONS MANUAL OF VET13 ERANS’ EMPLOYMENT AND TRAINING SERV14 ICE. 

15 (a) IN GENERAL.—Not later than one year after the 

16 date of the enactment of this Act, and once every two 

17 years thereafter for the period of five years beginning on 

18 such date, the Secretary of Labor, shall review the manual 

19 of the Department of Labor titled ‘‘Veterans’ Employment 

20 and Training Service Investigations Manual: USERRA, 

21 VEOA, and VP’’ (or a successor manual) and make such 

22 revisions to such manual as the Secretary determines ap23 propriate. 

24 (b) REPORT.—Not later than 90 days after any date 

25 on which the Secretary completes a review required under 


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1 subsection (a), the Secretary shall submit to the Commit2 tees on Veterans’ Affairs of the House of Representatives 

3 and the Senate— 

4 (1) a report that includes a description of any 

5 revision to such manual made pursuant to such re6 view; and 

7 (2) a copy of the entire such manual which— 

8 (A) shall be provided to the Chairman and 

9 Ranking Member of each such committee; and 

10 (B) may contain a separate addendum for 

11 portions of the manual that contain law en12 forcement sensitive materials. 

13 SEC. 223. WARRIOR TRAINING ADVANCEMENT COURSE. 

14 (a) REPORTING ON THE WARRIOR TRAINING AD15 VANCEMENT COURSE.— 

16 (1) REPORTS REQUIRED.— 

17 (A) INITIAL REPORT.—Not later than six 

18 months after the date of the enactment of this 

19 Act, the Secretary of Veterans Affairs shall 

20 submit to the Committees on Veterans’ Affairs 

21 of the Senate and the House of Representatives 

22 a report on WARTAC. 

23 (B) ANNUAL REPORT.—One year after the 

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1 after, the Secretary shall submit to such Com2 mittees a report that contains the elements 

3 under subparagraphs (A) and (C) of paragraph 

4 (2) with regards to the preceding year. 

5 (2) ELEMENTS.—Except as provided in para6 graph (1)(B), the reports under this subsection shall 

7 include the following elements: 

8 (A) BEST PRACTICES.—With regards to 

9 best practices of WARTAC— 

10 (i) how many covered members have 

11 applied to participate in WARTAC; 

12 (ii) how many covered members have 

13 participated in WARTAC; 

14 (iii) how the Secretary provides train15 ing to covered members during TAP; 

16 (iv) how many covered members have 

17 completed WARTAC; and 

18 (v) any other information the Sec19 retary determines appropriate. 

20 (B) COST SAVINGS.—With regards to cost 

21 savings of WARTAC— 

22 (i) how much money the Secretary de23 termines WARTAC saves the United 

24 States each fiscal year; 


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1 (ii) how much money the Secretary 

2 determines WARTAC has saved the 

3 United States since its establishment; and 

4 (iii) the determination of the Sec5 retary whether other Federal agencies may 

6 save money by establishing a program 

7 similar to WARTAC. 

8 (C) HIRING.—With regards to hiring cov9 ered members who complete WARTAC— 

10 (i) how the Secretary identifies posi11 tions in the Department of Veterans Af12 fairs for which such covered members may 

13 qualify; 

14 (ii) the grades of such positions on 

15 the General Schedule under section 5332 

16 of title 5, United States Code; and 

17 (iii) how many such covered members 

18 the Secretary has hired to such positions. 

19 (3) DISTRIBUTION.—Not later than 30 days 

20 after submitting the report under paragraph (1)(A), 

21 the Secretary of Veterans Affairs shall transmit a 

22 copy of the report under this section to the head of 

23 each Federal agency. 

24 (4) DEFINITIONS.—In this subsection: 


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1 (A) The term ‘‘covered member’’ means 

2 members of the Armed Forces participating in 

3 TAP. 

4 (B) The term ‘‘TAP’’ means the Transi5 tion Assistance Program under sections 1142 

6 and 1144 of title 10, United States Code. 

7 (C) The term ‘‘WARTAC’’ means the 

8 Warrior Training Advancement Course of the 

9 Veterans Benefit Administration, in which the 

10 Secretary provides training to covered members 

11 so such covered members may qualify for cer12 tain employment in the Veterans Benefit Ad13 ministration. 

14 (b) PILOT PROGRAM TO EMPLOY VETERANS IN PO15 SITIONS RELATING TO CONSERVATION AND RESOURCE

16 MANAGEMENT ACTIVITIES.— 

17 (1) BEST PRACTICES FOR OTHER DEPART18 MENTS.—The Assistant Secretary of Labor for Vet19 erans’ Employment and Training, in consultation 

20 with the Secretary of Veterans Affairs, shall estab21 lish guidelines containing best practices for depart22 ments and agencies of the Federal Government that 

23 carry out programs to employ veterans who are 

24 transitioning from service in the Armed Forces. 


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1 Such guidelines shall include the findings of the ini2 tial report required under subsection (a)(1). 

3 (2) PILOT PROGRAM.— 

4 (A) ESTABLISHMENT.—The Secretary of 

5 the Interior, in consultation with the Assistant 

6 Secretary of Labor for Veterans’ Employment 

7 and Training and the Secretary of Veterans Af8 fairs, shall establish a pilot program under 

9 which veterans are employed by the Federal 

10 Government in positions that relate to the con11 servation and resource management activities of 

12 the Department of the Interior. 

13 (B) COMMENCEMENT.—The Secretary of 

14 the Interior shall commence the pilot program 

15 at least 60, but not more than 180, days after 

16 the date of the submission of the report re17 quired under subsection (a)(1)(A). 

18 (C) POSITIONS.—The Secretary of the In19 terior shall— 

20 (i) identify vacant positions in the De21 partment of the Interior that are appro22 priate to fill using the pilot program; and 

23 (ii) to the extent practicable, fill such 

24 positions using the pilot program. 


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1 (D) APPLICATION OF CIVIL SERVICE

2 LAWS.—A veteran employed under the pilot 

3 program shall be treated as an employee as de4 fined by section 2105 of title 5, United States 

5 Code. 

6 (E) BRIEFINGS AND REPORT.— 

7 (i) INITIAL BRIEFING.—Not later 

8 than 60 days after the date of the submis9 sion of the report required under sub10 section (a)(1)(A), the Secretary of the In11 terior and the Assistant Secretary of Labor 

12 for Veterans’ Employment and Training 

13 shall jointly provide to the appropriate con14 gressional committees a briefing on the 

15 pilot program under this subsection, which 

16 shall include a description of how the pilot 

17 program will be carried out in a manner to 

18 reduce the unemployment of veterans. 

19 (ii) IMPLEMENTATION BRIEFING.— 

20 Not later than one year after the date on 

21 which the pilot program under this para22 graph commences, the Secretary of the In23 terior and the Assistant Secretary of Labor 

24 for Veterans’ Employment and Training 

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1 gressional committees a briefing on the im2 plementation of the pilot program. 

3 (iii) FINAL REPORT.—Not later than 

4 30 days after the date on which the pilot 

5 program under this paragraph is com6 pleted, the Secretary of the Interior and 

7 the Assistant Secretary of Labor for Vet8 erans’ Employment and Training shall 

9 jointly submit to the appropriate congres10 sional committees a report on the pilot 

11 program that includes the following: 

12 (I) The number of veterans who 

13 applied to participate in the pilot pro14 gram. 

15 (II) The number of such veterans 

16 employed under the pilot program. 

17 (III) The number of veterans 

18 identified in subclause (II) who 

19 transitioned to full-time positions with 

20 the Federal Government after partici21 pating in the pilot program. 

22 (IV) Recommendations with re23 spect to extending the pilot or making 

24 the program permanent. 


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1 (V) Any other information the 

2 Secretary and the Assistant Secretary 

3 determine appropriate with respect to 

4 measuring the effectiveness of the 

5 pilot program. 

6 (F) DURATION.—The authority to carry 

7 out the pilot program under this paragraph 

8 shall terminate on the date that is two years 

9 after the date on which the pilot program com10 mences. 

11 (3) APPROPRIATE CONGRESSIONAL COMMIT12 TEES DEFINED.—In this subsection, the term ‘‘ap13 propriate congressional committees’’ means— 

14 (A) the Committee on Veterans’ Affairs 

15 and the Committee on Natural Resources of the 

16 House of Representatives; and 

17 (B) the Committee on Veterans’ Affairs 

18 and the Committee on Energy and Natural Re19 sources of the Senate. 

20 Subtitle C—Home Loans 

21 SEC. 231. IMPROVEMENTS TO PROGRAM FOR DIRECT 

22 HOUSING LOANS MADE TO NATIVE AMER23 ICAN VETERANS BY THE SECRETARY OF VET24 ERANS AFFAIRS. 

25 (a) GENERAL AUTHORITIES AND REQUIREMENTS.— 


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1 (1) DIRECT HOUSING LOANS TO NATIVE AMER2 ICAN VETERANS.—Section 3762(a) of title 38, 

3 United States Code, is amended to read as follows: 

4 ‘‘(a) The Secretary may make a direct housing loan 

5 to a Native American veteran under this subchapter if the 

6 Secretary ensures the following: 

7 ‘‘(1) That each Native American veteran to 

8 whom the Secretary makes a direct housing loan 

9 under this subchapter— 

10 ‘‘(A) holds, possesses, or purchases using 

11 the proceeds of the loan a meaningful interest 

12 in a lot or dwelling (or both) that is located on 

13 trust land; and 

14 ‘‘(B) will purchase, construct, or improve 

15 (as the case may be) a dwelling on the lot using 

16 the proceeds of the loan. 

17 ‘‘(2) That each such Native American veteran 

18 will convey to the Secretary by an appropriate in19 strument the interest referred to in paragraph 

20 (1)(A) as security for a direct housing loan under 

21 this subchapter. 

22 ‘‘(3) That the Secretary, including the Sec23 retary’s employees or agents, may enter upon the 

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1 tions as the Secretary determines are necessary, in2 cluding— 

3 ‘‘(A) to evaluate the advisability of the 

4 loan; 

5 ‘‘(B) to monitor any purchase, construc6 tion, or improvements carried out using the 

7 proceeds of the loan; and 

8 ‘‘(C) to manage any servicing or post-fore9 closure activities, including acquisition, property 

10 inspections, and property management. 

11 ‘‘(4) That there are established standards and 

12 procedures that apply to the foreclosure of the inter13 est conveyed by a Native American veteran pursuant 

14 to paragraph (2), including— 

15 ‘‘(A) procedures for foreclosing the inter16 est; and 

17 ‘‘(B) procedures for the resale of the lot or 

18 dwelling (or both) purchased, constructed, or 

19 improved using the proceeds of the loan. 

20 ‘‘(5) That the loan is made in a responsible and 

21 prudent manner, subject to standards and proce22 dures as are necessary for the reasonable protection 

23 of the financial interests of the United States.’’. 


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1 (2) MEMORANDUMS OF UNDERSTANDING, 

2 AGREEMENTS, AND DETERMINATIONS.—Section 

3 3762(b) of such title is amended to read as follows: 

4 ‘‘(b)(1) To carry out the purpose of subsection (a), 

5 the Secretary may— 

6 ‘‘(A) enter into a memorandum of under7 standing with a tribal organization, other entity, or 

8 individual; 

9 ‘‘(B) rely on agreements or determinations of 

10 other Federal agencies to guarantee, insure, or make 

11 loans on trust land; and 

12 ‘‘(C) enter into other agreements or take such 

13 other actions as the Secretary determines necessary. 

14 ‘‘(2) If the Secretary determines that the require15 ments under subsection (a) are not being enforced by a 

16 tribal organization, other entity, or individual that is a 

17 party to any memorandum of understanding, agreement, 

18 or determination described in paragraph (1), the Secretary 

19 may cease making new direct housing loans to Native 

20 American veterans under this subchapter within the area 

21 of the authority of the tribal organization, other entity, 

22 or individual (as the case may be).’’. 

23 (b) DIRECT LOANS TO NATIVE AMERICAN VETERANS

24 TO REFINANCE EXISTING MORTGAGE LOANS.—Section 

25 3762(h) of such title is amended to read as follows: 


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1 ‘‘(h) The Secretary may make direct loans to Native 

2 American veterans in order to enable such veterans to refi3 nance existing mortgage loans for any of the following 

4 purposes: 

5 ‘‘(1) To refinance an existing loan made under 

6 this section, if the loan— 

7 ‘‘(A) meets the requirements set forth in 

8 subparagraphs (B), (C), and (E) of paragraph 

9 (1) of section 3710(e) of this title; 

10 ‘‘(B) will bear an interest rate at least one 

11 percentage point less than the interest rate 

12 borne by the loan being refinanced; and 

13 ‘‘(C) complies with paragraphs (2) and (3) 

14 of section 3710(e) of this title, except that for 

15 the purposes of this subsection the reference to 

16 subsection (a)(8) of section 3710 of this title in 

17 such paragraphs (2) and (3) shall be deemed to 

18 be a reference to this subsection. 

19 ‘‘(2) To refinance an existing mortgage loan not 

20 made under this section on a dwelling owned and oc21 cupied by the veteran as the veteran’s home, if all 

22 of the following requirements are met: 

23 ‘‘(A) The loan will be secured by the same 

24 dwelling as was the loan being refinanced. 


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1 ‘‘(B) The loan will provide the veteran with 

2 a net tangible benefit. 

3 ‘‘(C) The nature and condition of the prop4 erty is such as to be suitable for dwelling pur5 poses. 

6 ‘‘(D) The amount of the loan does not ex7 ceed either of the following: 

8 ‘‘(i) 100 percent of the reasonable 

9 value of the dwelling, with such reasonable 

10 value determined under the procedures es11 tablished by the Secretary under sub12 section (d)(2). 

13 ‘‘(ii) An amount equal to the sum of 

14 the balance of the loan being refinanced 

15 and such closing costs (including any dis16 count points) as may be authorized by the 

17 Secretary to be included in the loan. 

18 ‘‘(E) Notwithstanding subparagraph (D), 

19 if a loan is made for both the purpose of this 

20 paragraph and to make energy efficiency im21 provements, the loan must not exceed either of 

22 the following: 

23 ‘‘(i) 100 percent of the reasonable 

24 value of the dwelling as improved for en25 ergy efficiency, with such reasonable value 


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1 determined under the procedures estab2 lished by the Secretary under subsection 

3 (d)(2). 

4 ‘‘(ii) The amount referred to under 

5 subparagraph (D)(ii), plus the applicable 

6 amount specified under section 3710(d)(2) 

7 of this title. 

8 ‘‘(F) The loan meets all other require9 ments the Secretary may establish under this 

10 subchapter. 

11 ‘‘(G) The existing mortgage being refi12 nanced is a first lien on the property and se13 cured of record. 

14 ‘‘(3) To refinance an existing mortgage loan to 

15 repair, alter, or improve a dwelling owned by the 

16 veteran and occupied by the veteran as the veteran’s 

17 home, if all of the following requirements are met: 

18 ‘‘(A) The loan will be secured by the same 

19 dwelling as was the loan being refinanced. 

20 ‘‘(B) The nature and condition of the 

21 property is such as to be suitable for dwelling 

22 purposes, and the repair, alteration, or improve23 ment substantially protects or improves the 

24 basic livability or utility of such property. 


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1 ‘‘(C) The amount of the loan, including the 

2 costs of repairs, alterations, and improvements, 

3 does not exceed either of the following: 

4 ‘‘(i) 100 percent of the reasonable 

5 value of the dwelling as repaired, altered, 

6 or improved, with such reasonable value 

7 determined under the procedures estab8 lished by the Secretary under subsection 

9 (d)(2). 

10 ‘‘(ii) An amount equal to the sum 

11 of— 

12 ‘‘(I) the balance of the loan being 

13 refinanced; 

14 ‘‘(II) the actual cost of repairs, 

15 alterations, or improvements; and 

16 ‘‘(III) such closing costs (includ17 ing any discount points) as may be 

18 authorized by the Secretary to be in19 cluded in the loan. 

20 ‘‘(D) The loan meets all other require21 ments the Secretary may establish under this 

22 subchapter. 

23 ‘‘(E) The existing mortgage loan being re24 financed is a first lien on the property and se25 cured of record.’’. 


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1 (c) EXPANSION OF OUTREACH PROGRAM ON AVAIL2 ABILITY OF DIRECT HOUSING LOANS FOR NATIVE AMER3 ICAN VETERANS.—Section 3762(i)(2) of such title is 

4 amended by adding at the end the following new subpara5 graph: 

6 ‘‘(G) Pursuant to subsection (g)(4), assisting 

7 Native American veterans in qualifying for mortgage 

8 financing by— 

9 ‘‘(i) partnering with local service providers, 

10 such as tribal organizations, tribally designated 

11 housing entities, Native community development 

12 financial institutions, and nonprofit organiza13 tions, for conducting outreach, homebuyer edu14 cation, housing counseling, and post-purchase 

15 education; and 

16 ‘‘(ii) providing other technical assistance as 

17 needed. 

18 ‘‘(H) Attending conferences and conventions 

19 conducted by the network of Native community de20 velopment financial institutions and other Native 

21 American homeownership organizations to provide 

22 information and training to Native community devel23 opment financial institutions about the availability of 

24 the relending program under section 3762A of this 

25 title.’’. 


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1 (d) ADEQUATE PERSONNEL.—Section 3762 of such 

2 title is amended by adding at the end the following new 

3 subsection: 

4 ‘‘(k) The Secretary shall assign a sufficient number 

5 of personnel of the Department dedicated to carrying out 

6 the authority of the Secretary under this subchapter, in7 cluding construction and valuation specialists to assist 

8 with issues unique to new construction and renovations 

9 on trust land.’’. 

10 (e) DEFINITIONS.—Section 3765 of such title is 

11 amended— 

12 (1) in paragraph (1)— 

13 (A) by amending subparagraph (C) to read 

14 as follows: 

15 ‘‘(C) is located in the State of Alaska with16 in a region established under section 7(a) of the 

17 Alaska Native Claims Settlement Act (43 

18 U.S.C. 1606(a));’’; 

19 (B) in subparagraph (D), by striking the 

20 period at the end and inserting a semicolon; 

21 and 

22 (C) by adding at the end the following new 

23 subparagraphs: 

24 ‘‘(E) is defined by the Secretary of the In25 terior and recognized by the United States as 


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1 land over which an Indian Tribe has govern2 mental dominion; or 

3 ‘‘(F) is on any land that the Secretary de4 termines is provided to Native American vet5 erans because of their status as Native Ameri6 cans.’’; and 

7 (2) by adding at the end the following new 

8 paragraphs: 

9 ‘‘(6) The term ‘community development finan10 cial institution’ has the meaning given that term in 

11 section 103 of the Community Development Banking 

12 and Financial Institutions Act of 1994 (12 U.S.C. 

13 4702). 

14 ‘‘(7) The term ‘Indian Tribe’ means any Indian 

15 tribe, band, nation, or other organized group or com16 munity, including any Alaska Native village or re17 gional or village corporation as defined in or estab18 lished pursuant to the Alaska Native Claims Settle19 ment Act (43 U.S.C. 1601 et seq.), which is recog20 nized as eligible for the special programs and serv21 ices provided by the United States to Indians be22 cause of their status as Indians. 

23 ‘‘(8) The term ‘Native community development 

24 financial institution’ means any entity— 


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1 ‘‘(A) that has been certified as a commu2 nity development financial institution by the 

3 Secretary of the Treasury; 

4 ‘‘(B) that is not less than 51 percent 

5 owned or controlled by Native Americans; and 

6 ‘‘(C) for which not less than 51 percent of 

7 the activities of the entity serve Native Ameri8 cans. 

9 ‘‘(9) The term ‘net tangible benefit’ shall have 

10 such meaning as the Secretary determines appro11 priate, but shall include the refinance of an interim 

12 construction loan. 

13 ‘‘(10) The term ‘other technical assistance’ 

14 means services to assist a Native American veteran 

15 to navigate the steps necessary for securing a mort16 gage loan on trust land, including pre-development 

17 activities related to utilities, identifying appropriate 

18 residential construction services, and obtaining lease 

19 clearances and title status reports from the applica20 ble tribal organization or the Bureau of Indian Af21 fairs. 

22 ‘‘(11) The term ‘tribally designated housing en23 tity’ has the meaning given that term in section 4 

24 of the Native American Housing Assistance and 

25 Self-Determination Act of 1996 (25 U.S.C. 4103).’’. 


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1 (f) INTEREST RATE REDUCTION FINANCING

2 LOAN.—Section 3729(b)(4)(F) of such title is amended 

3 by striking ‘‘3762(h)’’ and inserting ‘‘3762(h)(1)’’. 

4 (g) REGULATIONS.—Section 3761 of such title is 

5 amended by adding at the end the following new sub6 section: 

7 ‘‘(c) The Secretary shall prescribe such regulations 

8 as may be necessary to carry out this subchapter.’’. 

9 SEC. 232. NATIVE COMMUNITY DEVELOPMENT FINANCIAL 

10 INSTITUTION RELENDING PROGRAM. 

11 (a) IN GENERAL.—Subchapter V of chapter 37 of 

12 title 38, United States Code, is amended by inserting after 

13 section 3762 the following new section: 

14 ‘‘§ 3762A. Native community development financial 

15 institution relending program 

16 ‘‘(a) PURPOSE.—The Secretary may make a loan to 

17 a Native community development financial institution for 

18 the purpose of allowing the institution to relend loan 

19 amounts to qualified Native American veterans, subject to 

20 the requirements of this section. 

21 ‘‘(b) STANDARDS.—(1) The Secretary shall establish 

22 standards to be used in evaluating whether to make a loan 

23 to a Native community development financial institution 

24 under this section. 


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1 ‘‘(2) In establishing standards under paragraph (1), 

2 the Secretary shall ensure that a Native community devel3 opment financial institution— 

4 ‘‘(A) is able to originate and service loans for 

5 single-family homes; 

6 ‘‘(B) is able to operate the relending program 

7 in a manner consistent with the mission of the De8 partment to serve veterans; and 

9 ‘‘(C) uses loan amounts received under this sec10 tion only for the purpose of relending, as described 

11 in subsection (c), to Native American veterans. 

12 ‘‘(c) RELENDING REQUIREMENTS.—(1) A Native 

13 community development financial institution that receives 

14 a loan under this section shall use the loan amounts to 

15 make loans to Native American veterans residing on trust 

16 land. 

17 ‘‘(2) A loan to a Native American veteran made by 

18 a Native community development financial institution 

19 under paragraph (1) shall— 

20 ‘‘(A) be limited either to the purpose of pur21 chase, construction, or improvement of a dwelling lo22 cated on trust land or to the refinance of an existing 

23 mortgage loan for a dwelling on trust land, con24 sistent with the requirements of section 3762(h) of 

25 this title; and 


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1 ‘‘(B) comply with such terms and conditions as 

2 the Secretary determines are necessary to protect 

3 against predatory lending, including the interest rate 

4 charged on a loan to a Native American veteran. 

5 ‘‘(d) REPAYMENT.—A loan made to a Native commu6 nity development financial institution under this section 

7 shall— 

8 ‘‘(1) be payable to the Secretary upon such 

9 terms and conditions as are prescribed in regulations 

10 pursuant to this subchapter; and 

11 ‘‘(2) bear interest at a rate of one percent. 

12 ‘‘(e) OVERSIGHT.—Subject to notice and opportunity 

13 for a hearing, whenever the Secretary finds with respect 

14 to loans made under subsection (a) or (c) that any Native 

15 community development financial institution has failed to 

16 maintain adequate loan accounting records, to dem17 onstrate proper ability to service loans adequately, or to 

18 exercise proper credit judgment, or that such Native com19 munity development financial institution has willfully or 

20 negligently engaged in practices otherwise detrimental to 

21 the interest of veterans or of the Government, the Sec22 retary may take such actions as the Secretary determines 

23 necessary to protect veterans or the Government, such as 

24 requiring immediate repayment of any loans made under 


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1 subsection (a) and the assignment to the Secretary of 

2 loans made under subsection (c). 

3 ‘‘(f) SUNSET.—The Secretary may not make a loan 

4 under this section after September 30, 2026.’’. 

5 (b) CLERICAL AMENDMENT.—The table of sections 

6 at the beginning of chapter 37 of such title is amended 

7 by inserting after the item relating to section 3762 the 

8 following new item: 

‘‘3762A. Native community development financial institution relending program.’’. 

9 (c) NATIVE AMERICAN VETERAN HOUSING LOAN

10 PROGRAM ACCOUNT.—Section 3763 of such title is 

11 amended by adding at the end the following new sub12 section: 

13 ‘‘(c) Of amounts available in the Account, the Sec14 retary may use for loans made under section 3762A of 

15 this title— 

16 ‘‘(1) in fiscal year 2024, not more than 

17 $5,000,000; and 

18 ‘‘(2) in any fiscal year after fiscal year 2024, 

19 an amount determined necessary by the Secretary to 

20 meet the demand for such loans.’’. 


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1 TITLE III—DISABILITY AND 

2 MEMORIAL AFFAIRS MATTERS 

3 SEC. 301. BURIAL ALLOWANCE FOR CERTAIN VETERANS 

4 WHO DIE AT HOME WHILE IN RECEIPT OF 

5 HOSPICE CARE FURNISHED BY DEPARTMENT 

6 OF VETERANS AFFAIRS. 

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

8 shall treat a veteran described in subsection (b) as a vet9 eran described in subparagraph (A) of section 2303(a)(2) 

10 of title 38, United States Code. 

11 (b) VETERAN DESCRIBED.—A veteran described in 

12 this subsection is a veteran who dies in a home or other 

13 setting at which the deceased veteran was, at the time of 

14 death, receiving hospice care pursuant to section 1717(a) 

15 of such title if such care was directly preceded by the Sec16 retary furnishing to the veteran hospital care or nursing 

17 home care described in clause (ii) of such subparagraph. 

18 (c) EFFECTIVE DATE; APPLICABILITY.—This section 

19 shall apply with respect to deaths that occur— 

20 (1) on or after the date that is 180 days after 

21 the date of the enactment of this Act; and 

22 (2) before October 1, 2026. 


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1 SEC. 302. AUTHORITY FOR SECRETARY OF VETERANS AF2 FAIRS TO AWARD GRANTS TO STATES AND IN3 DIAN TRIBES TO IMPROVE OUTREACH TO 

4 VETERANS. 

5 (a) IN GENERAL.—Chapter 63 of title 38, United 

6 States Code, is amended— 

7 (1) by redesignating sections 6307 and 6308 as 

8 sections 6308 and 6309, respectively; and 

9 (2) by inserting after section 6306 the following 

10 new section 6307: 

11 ‘‘§ 6307. Grants to States and Indian Tribes to im12 prove outreach to veterans 

13 ‘‘(a) PURPOSE.—It is the purpose of this section to 

14 provide for assistance by the Secretary to States and In15 dian Tribes to carry out programs that improve covered 

16 outreach and assistance to veterans and the spouses, chil17 dren, and parents of veterans, to ensure that such individ18 uals are fully informed about, and assisted in applying for, 

19 any veterans and veterans-related benefits and programs 

20 (including veterans programs of a State or Indian Tribe) 

21 for which they may be eligible and facilitate opportunities 

22 for such individuals to receive competent, qualified serv23 ices in the preparation, presentation and prosecution of 

24 veterans benefits claims. 

25 ‘‘(b) AUTHORITY.—The Secretary may award grants 

26 to States and Indian Tribes— 


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1 ‘‘(1) to carry out, coordinate, improve, or other2 wise enhance— 

3 ‘‘(A) covered outreach activities; or 

4 ‘‘(B) activities to assist in the development 

5 and submittal of claims for veterans and vet6 erans-related benefits; or 

7 ‘‘(2) to increase the number of county or Tribal 

8 veterans service officers serving in the State by hir9 ing new, additional such officers. 

10 ‘‘(c) APPLICATION.—(1) To be eligible for a grant 

11 under this section, a State or Indian Tribe shall submit 

12 to the Secretary an application therefor at such time, in 

13 such manner, and containing such information as the Sec14 retary may require. 

15 ‘‘(2) Each application submitted under paragraph (1) 

16 shall include the following: 

17 ‘‘(A) A detailed plan for the use of the grant. 

18 ‘‘(B) A description of the programs through 

19 which the State or Indian Tribe will meet the out20 come measures developed by the Secretary under 

21 subsection (j). 

22 ‘‘(C) A description of how the State or Indian 

23 Tribe will distribute grant amounts equitably among 

24 counties or Tribal lands with varying levels of urban25 ization. 


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1 ‘‘(D) A plan for how the grant will be used to 

2 meet the unique needs of American Indian veterans, 

3 Alaska Native veterans, or Native Hawaiian vet4 erans, elderly veterans, and veterans from other un5 derserved communities. 

6 ‘‘(d) DISTRIBUTION.—The Secretary shall seek to en7 sure that grants awarded under this section are equitably 

8 distributed among States and Indian Tribes with varying 

9 levels of urbanization. 

10 ‘‘(e) SET-ASIDE.—Of the amounts authorized to be 

11 appropriated or otherwise made available for grants under 

12 this section for any fiscal year, the Secretary shall ensure 

13 that not less than five percent is used to make grants to 

14 Indian Tribes. 

15 ‘‘(f) PRIORITY.—The Secretary shall prioritize 

16 awarding grants under this section that will serve the fol17 lowing areas: 

18 ‘‘(1) Areas with a critical shortage of county or 

19 Tribal veterans service officers. 

20 ‘‘(2) Areas with high rates of— 

21 ‘‘(A) suicide among veterans; or 

22 ‘‘(B) referrals to the Veterans Crisis Line. 

23 ‘‘(g) USE OF COUNTY OR TRIBAL VETERANS SERV24 ICE OFFICERS.—A State or Indian Tribe that receives a 


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1 grant under this section to carry out an activity described 

2 in subsection (b)(1) shall carry out the activity through— 

3 ‘‘(1) a county or Tribal veterans service officer 

4 of the State; or 

5 ‘‘(2) if the State or Indian Tribe does not have 

6 a county or Tribal veterans service officer, or if the 

7 county or Tribal veterans service officers of the 

8 State or Indian Tribe cover only a portion of that 

9 State or Indian Tribe, an appropriate entity of a 

10 State, local, or Tribal government, as determined by 

11 the Secretary. 

12 ‘‘(h) REQUIRED ACTIVITIES.—Any grant awarded 

13 under this section shall be used— 

14 ‘‘(1) to expand existing programs, activities, 

15 and services; 

16 ‘‘(2) to hire new, additional county or Tribal 

17 veterans service officers; or 

18 ‘‘(3) for travel and transportation to facilitate 

19 carrying out paragraph (1) or (2). 

20 ‘‘(i) AUTHORIZED ACTIVITIES.—A grant under this 

21 section may be used to provide education and training, in22 cluding on-the-job training, for State, county, local, and 

23 Tribal government employees who provide (or when 

24 trained will provide) covered outreach services in order for 


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1 those employees to obtain accreditation in accordance with 

2 procedures approved by the Secretary. 

3 ‘‘(j) OUTCOME MEASURES.—(1) The Secretary shall 

4 develop and provide to each State or Indian Tribe that 

5 receives a grant under this section written guidance on 

6 the following: 

7 ‘‘(A) Outcome measures. 

8 ‘‘(B) Policies of the Department. 

9 ‘‘(2) In developing outcome measures under para10 graph (1), the Secretary shall consider the following goals: 

11 ‘‘(A) Increasing the use of veterans and vet12 erans-related benefits, particularly among vulnerable 

13 populations. 

14 ‘‘(B) Increasing the number of county and 

15 Tribal veterans service officers recognized by the 

16 Secretary for the representation of veterans under 

17 chapter 59 of this title. 

18 ‘‘(k) TRACKING REQUIREMENTS.—(1) With respect 

19 to each grant awarded under this section, the Secretary 

20 shall track the use of veterans and veterans-related bene21 fits among the population served by the grant, including 

22 the average period of time between the date on which a 

23 veteran applies for such a benefit and the date on which 

24 the veteran receives the benefit, disaggregated by type of 

25 benefit. 


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1 ‘‘(2) Not less frequently than annually during the life 

2 of the grant program established under this section, the 

3 Secretary shall submit to Congress a report on— 

4 ‘‘(A) the information tracked under paragraph 

5 (1); 

6 ‘‘(B) how the grants awarded under this section 

7 serve the unique needs of American Indian veterans, 

8 Alaska Native veterans, or Native Hawaiian vet9 erans, elderly veterans, and veterans from other un10 derserved communities; and 

11 ‘‘(C) other information provided by States and 

12 Indian Tribes pursuant to the grant reporting re13 quirements. 

14 ‘‘(l) PERFORMANCE REVIEW.—The Secretary shall— 

15 ‘‘(1) review the performance of each State or 

16 Indian Tribe that receives a grant under this sec17 tion; and 

18 ‘‘(2) make information regarding such perform19 ance publicly available. 

20 ‘‘(m) REMEDIATION PLAN.—(1) In the case of a 

21 State or Indian Tribe that receives a grant under this sec22 tion and does not meet the outcome measures developed 

23 by the Secretary under subsection (j), the Secretary shall 

24 require the State or Indian Tribe to submit a remediation 


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1 plan under which the State shall describe how and when 

2 it plans to meet such outcome measures. 

3 ‘‘(2) The Secretary may not award a subsequent 

4 grant under this section to a State or Indian Tribe de5 scribed in paragraph (1) unless the Secretary approves the 

6 remediation plan submitted by the State or Indian Tribe. 

7 ‘‘(n) DEFINITIONS.—In this section: 

8 ‘‘(1) The term ‘county or Tribal veterans serv9 ice officer’ includes a local equivalent veterans serv10 ice officer. 

11 ‘‘(2) The term ‘covered outreach’ means out12 reach with respect to— 

13 ‘‘(A) benefits administered by the Under 

14 Secretary for Benefits; or 

15 ‘‘(B) similar benefits administered by a 

16 State or Indian Tribe. 

17 ‘‘(3) The term ‘Indian Tribe’ has the meaning 

18 given such term in section 4 of the Indian Self-De19 termination and Education Assistance Act (25 

20 U.S.C. 5304). 

21 ‘‘(4) The term ‘State’ includes the District of 

22 Columbia, the Commonwealth of Puerto Rico, the 

23 Commonwealth of the Northern Mariana Islands, 

24 and any territory or possession of the United States. 


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1 ‘‘(5) The term ‘Veterans Crisis Line’ means the 

2 toll-free hotline for veterans established under sec3 tion 1720F(h) of this title.’’. 

4 (b) CLERICAL AMENDMENT.—The table of sections 

5 at the beginning of chapter 63 of such title is amended 

6 by striking the items relating to sections 6307 and 6308 

7 and inserting the following new items: 

‘‘6307. Grants to States and Indian Tribes to improve outreach to veterans 

‘‘6308. Outreach for eligible dependents 

‘‘6309. Biennial report to Congress’’. 

8 (c) AUTHORIZATION OF APPROPRIATIONS.—There is 

9 authorized to be appropriated to the Secretary of Veterans 

10 Affairs for each of fiscal years 2025 and 2026, 

11 $10,000,000 to carry out section 6307 of title 28, United 

12 States Code, as added by subsection (a). 

13 SEC. 303. DEFINITION OF SURVIVING SPOUSE. 

14 Paragraph (3) of section 101 of title 38, United 

15 States Code, is amended to read as follows: 

16 ‘‘(3) The term ‘surviving spouse’ means (except for 

17 purposes of chapter 19 of this title) a person who was 

18 the spouse of a veteran at the time of the veteran’s death, 

19 and who lived with the veteran continuously from the date 

20 of marriage to the date of the veteran’s death (except 

21 where there was a separation which was due to the mis22 conduct of, or procured by, the veteran without the fault 

23 of the spouse) and who has not remarried.’’. 


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1 SEC. 304. ENSURING ONLY LICENSED HEALTH CARE PRO2 FESSIONALS PERFORM MEDICAL DISABILITY 

3 EXAMINATIONS UNDER CERTAIN DEPART4 MENT OF VETERANS AFFAIRS PILOT PRO5 GRAM. 

6 (a) PROHIBITION ON USE OF CERTAIN HEALTH

7 CARE PROFESSIONALS.—Section 504(c)(1) of the Vet8 erans’ Benefits Improvements Act of 1996 (Public Law 

9 104–275; 38 U.S.C. 5101 note) is amended by inserting 

10 ‘‘only’’ before ‘‘a health care professional’’. 

11 (b) REMEDIES.—The Secretary of Veterans Affairs 

12 shall take such actions as the Secretary considers appro13 priate to ensure compliance with section 504(c) of the Vet14 erans’ Benefits Improvements Act of 1996 (Public Law 

15 104–275; 38 U.S.C. 5101 note), as amended by subsection 

16 (a). 

17 (c) ANNUAL REPORT.—Not later than one year after 

18 the date of the enactment of this Act and not less fre19 quently than once each year thereafter, the Secretary shall 

20 submit to the Committee on Veterans’ Affairs of the Sen21 ate and the Committee on Veterans’ Affairs of the House 

22 of Representatives a report on— 

23 (1) the conduct of the pilot program established 

24 under section 504 of the Veterans’ Benefits Im25 provements Act of 1996 (Public Law 104–275; 38 

26 U.S.C. 5101 note); and 


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1 (2) the actions of the Secretary under sub2 section (b). 

3 (d) TECHNICAL CORRECTIONS.—Section 504 of the 

4 Veterans’ Benefits Improvements Act of 1996 (Public 

5 Law 104–275; 38 U.S.C. 5101 note) is amended, in the 

6 section heading, by striking ‘‘PHYSICIANS’’ and inserting 

7 ‘‘HEALTH CARE PROFESSIONALS’’. 

8 SEC. 305. PROVISION OF INFORMATION REGARDING AN 

9 AGENT OR ATTORNEY TO A LICENSED 

10 HEALTH CARE PROFESSIONAL WHO PER11 FORMS A MEDICAL DISABILITY EXAMINATION 

12 UNDER CERTAIN DEPARTMENT OF VET13 ERANS AFFAIRS PILOT PROGRAM. 

14 (a) IN GENERAL.—Section 504 of the Veterans’ Ben15 efits Improvements Act of 1996 (Public Law 104–275; 38 

16 U.S.C. 5101 note), as amended by section 304, is further 

17 amended by adding at the end the following new sub18 section: 

19 ‘‘(f) CERTAIN INFORMATION PROVIDED TO HEALTH

20 CARE PROFESSIONAL.—The Secretary shall provide to a 

21 health care professional who performs an examination 

22 under subsection (a) the contact information of any agent 

23 or attorney recognized by the Secretary under chapter 59 

24 of title 38, United States Code, with regards to a claim 

25 for benefits that gives rise to such examination.’’. 


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1 (b) APPLICABILITY.—The amendment made by this 

2 section shall apply to an examination described in sub3 section (a) of such section that is performed on or after 

4 the date of the enactment of this Act. 

5 SEC. 306. MODERNIZATION OF DEPARTMENT OF VETERANS 

6 AFFAIRS DISABILITY BENEFIT QUESTION7 NAIRES. 

8 (a) REQUIREMENT FOR TRANSMISSION OF CERTAIN

9 INFORMATION IN MACHINE-READABLE FORMAT.— 

10 (1) REQUIREMENT.—Not later than 180 days 

11 after enactment of this Act, the Secretary of Vet12 erans Affairs shall require all disability benefit ques13 tionnaire data collected in the course of medical dis14 ability examinations made by covered non-Depart15 ment providers to be transmitted to the Department 

16 in a machine-readable format. 

17 (2) ISSUANCE OF STANDARDS.—Not later than 

18 90 days after the date of the enactment of this Act, 

19 the Secretary shall issue standards for the trans20 mission of disability benefit questionnaire data in a 

21 machine-readable format as required under para22 graph (1). 

23 (3) UPDATES.—In making updates to disability 

24 benefit questionnaires after the date specified in 

25 paragraph (1), the Secretary shall— 


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1 (A) ensure that the updates are made in a 

2 manner that allows for the data collected under 

3 the questionnaires to be in a machine-readable 

4 format as of the date on which the update goes 

5 into effect; and 

6 (B) not later than 30 days before an up7 date goes into effect, notify the covered non-De8 partment providers (or their employers) de9 scribed in such paragraph of such updates. 

10 (b) PLAN FOR INFORMATION TECHNOLOGY SYSTEM

11 MODIFICATION.—Not later than 180 days after the date 

12 of the enactment of this Act, the Secretary shall submit 

13 to the Committees on Veterans’ Affairs of the Senate and 

14 the House of Representatives a plan to modify the infor15 mation technology systems and processes of the Depart16 ment to enable a non-Department health care professional, 

17 assigned to or selected by a claimant, to transmit to the 

18 Department, in a machine-readable format, disability ben19 efit questionnaire data, including complete disability ben20 efit questionnaires rather than partial questionnaires or 

21 elements of medical evidence. 

22 (c) PUBLIC AVAILABILITY OF INFORMATION.—The 

23 Secretary shall make publicly available on the internet 

24 website of the Department referred to in section 5101(d) 

25 of title 38, United States Code— 


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1 (1) a description of the standards issued under 

2 subsection (a)(2); and 

3 (2) the plan required under subsection (b). 

4 (d) DEFINITIONS.—In this section: 

5 (1) The term ‘‘claimant’’ has the meaning given 

6 such term in section 5100 of title 38, United States 

7 Code. 

8 (2) The term ‘‘covered non-Department pro9 vider’’ means a health care provider who— 

10 (A) is not an employee of the Department 

11 of Veterans Affairs; and 

12 (B) pursuant to a contract under section 

13 504 of the Veterans Benefits Improvement Act 

14 of 1996 (Public Law 104–275; 38 U.S.C. 5101 

15 note), as amended by sections 304 and 305, ex16 amines a claimant for a medical disability. 

17 SEC. 307. DEPARTMENT OF VETERANS AFFAIRS AUTO18 MATIC PROCESSING OF CERTAIN CLAIMS 

19 FOR TEMPORARY DISABILITY RATINGS. 

20 (a) IN GENERAL.—Not later than one year after the 

21 date of the enactment of this Act, the Secretary of Vet22 erans Affairs shall modify the information technology sys23 tems of the Department of Veterans Affairs to use auto24 mation technology for claims for temporary disability ratVerDate Sep 11 2014 18:49 May 29, 2024 Jkt 049200 PO 00000 Frm 00260 Fmt 6652 Sfmt 6201 E:\BILLS\H8371.IH H8371

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1 ings for veterans described in section 1156(a)(1)(C) of 

2 title 38, United States Code. 

3 (b) ADDITIONAL REQUIREMENTS.—In providing for 

4 the automatic processing of claims as required under sub5 section (a), the Secretary shall ensure that— 

6 (1) medical evidence is obtained from the cor7 porate data warehouse of the Department or other 

8 sources of data, the Secretary determines appro9 priate; 

10 (2) employees of the Department continue to 

11 determine whether a veteran is entitled to a tem12 porary disability rating under section 1156(a)(1)(C) 

13 of title 38, United States Code; and 

14 (3) claims may be processed manually if the 

15 evidence of record is not sufficient to decide the 

16 claim or if the medical evidence is provided in a for17 mat that is not compatible with the system devel18 oped under subsection (a). 

19 TITLE IV—HOMELESSNESS 

20 MATTERS 

21 SEC. 401. SHORT TITLE. 

22 This title may be cited as the ‘‘Housing our Military 

23 Veterans Effectively Act of 2023’’ or the ‘‘HOME Act of 

24 2023’’. 


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1 SEC. 402. PER DIEM PAYMENTS PROVIDED BY THE SEC2 RETARY OF VETERANS AFFAIRS FOR SERV3 ICES FURNISHED TO HOMELESS VETERANS. 

4 (a) IN GENERAL.—Section 2012 of title 38, United 

5 States Code, is amended— 

6 (1) in subsection (a)— 

7 (A) in paragraph (2)(B)— 

8 (i) in clause (i)(II)(aa)(BB), by strik9 ing ‘‘115 percent’’ and inserting ‘‘115 per10 cent (or, during the period beginning on 

11 the date of the enactment of the the Sen12 ator Elizabeth Dole 21st Century Veterans 

13 Healthcare and Benefits Improvement Act 

14 and ending on September 30, 2026, 133 

15 percent)’’; and 

16 (ii) by adding at the end the fol17 lowing: 

18 ‘‘(iii) For each of fiscal years 2024 through 2026, 

19 the Secretary may waive the maximum rate for per diem 

20 payments under clause (i)(II)(aa)(BB) or (ii) and, subject 

21 to the availability of appropriations, provide such pay22 ments at a rate that does not exceed 200 percent of the 

23 rate authorized for State homes for domiciliary care under 

24 subsection (a)(1)(A) of section 1741 of this title, as the 

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1 section (c) of that section, if the Secretary notifies Con2 gress of such waiver. 

3 ‘‘(iv) The Secretary may not, pursuant to clause (iii), 

4 waive the maximum rate described in such clause for more 

5 than 50 percent of all grant recipients and eligible entities 

6 for a fiscal year.’’; and 

7 (B) by adding at the end the following new 

8 paragraph: 

9 ‘‘(4) The Secretary may not provide more than 

10 12,000 per diem payments under this section for a fiscal 

11 year.’’; and 

12 (2) by adding at the end the following new sub13 section: 

14 ‘‘(f) REPORTS REQUIRED.—Not later than 90 days 

15 after the date of the enactment of the HOME Act of 2023, 

16 and not less frequently than twice each year thereafter, 

17 the Secretary shall submit to the Committee on Veterans’ 

18 Affairs of the Senate and the Committee on Veterans’ Af19 fairs of the House of Representatives a report on the rate 

20 for per diem payments under this section that includes, 

21 for each Veterans Integrated Service Network of the De22 partment, the following data: 

23 ‘‘(1) The average rate for such a payment. 


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1 ‘‘(2) A list of locations where the rate for such 

2 a payment is within 10 percent of the maximum rate 

3 for such a payment authorized under this section. 

4 ‘‘(3) The average length of stay by a veteran 

5 participating in a program described in section 

6 2012(a) of this title.’’. 

7 (b) REGULATORY AUTHORITY.—The Secretary of 

8 Veterans Affairs may prescribe interim guidance to carry 

9 out the amendments made by subsection (a). 

10 (c) STRATEGIC PLAN.— 

11 (1) IN GENERAL.—Not later than the end of 

12 fiscal year 2025, the Secretary of Veterans Affairs 

13 shall submit to the Committee on Veterans’ Affairs 

14 of the Senate and the Committee on Veterans’ Af15 fairs of the House of Representatives a strategic 

16 plan for the provision of grants and per diem pay17 ments for services furnished to homeless veterans 

18 under sections 2011 and 2012 of title 38, United 

19 States Code. 

20 (2) ELEMENTS.—The plan required by para21 graph (1) shall include the following: 

22 (A) A method for administering grant 

23 funding equitably without using the rate au24 thorized for State homes for domiciliary care 

25 under subsection (a)(1)(A) of section 1741 of 


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1 title 38, United States Code, as the Secretary 

2 may increase from time to time under sub3 section (c) of that section, that takes into ac4 count— 

5 (i) the wide variety of services fur6 nished by grant recipients and eligible enti7 ties under sections 2011 and 2012 of title 

8 38, United States Code; 

9 (ii) varying costs of living across dif10 ferent geographic locations; 

11 (iii) varying availability of affordable 

12 housing in different geographic locations; 

13 (iv) circumstances of housing insecu14 rity in rural and Tribal communities; 

15 (v) veterans with significant medical 

16 care needs; and 

17 (vi) the changing dynamic of the vet18 eran population nationwide. 

19 (B) A plan and timeline for implementa20 tion of the method included under subpara21 graph (A). 

22 (C) An estimate of increased costs or sav23 ings per year under the plan. 


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1 (D) An overview of the different grants 

2 that will be available once the plan is imple3 mented. 

4 SEC. 403. AUTHORIZATION FOR SECRETARY OF VETERANS 

5 AFFAIRS TO USE OF CERTAIN FUNDS FOR IM6 PROVED FLEXIBILITY IN ASSISTANCE TO 

7 HOMELESS VETERANS. 

8 (a) USE OF FUNDS.—During the period beginning on 

9 the date of the enactment of this Act and ending on the 

10 termination date specified in subsection (d), the Secretary 

11 of Veterans Affairs may provide to a covered veteran, as 

12 the Secretary determines necessary— 

13 (1) food, shelter, clothing, blankets, and hy14 giene items required for the safety and survival of 

15 the veteran; 

16 (2) transportation required to support the sta17 bility and health of the veteran for appointments 

18 with service providers, the conduct of housing and 

19 employment searches, and the obtainment of food 

20 and supplies; and 

21 (3) tablets, smartphones, disposable phones and 

22 other technology, and related service plans required 

23 to support the stability and health of the veteran 

24 through the maintenance of contact with service pro25 viders, prospective landlords, and family members. 


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1 (b) HOMELESS VETERANS ON DEPARTMENT OF VET2 ERANS AFFAIRS LAND.— 

3 (1) IN GENERAL.—The Secretary may collabo4 rate, to the extent practicable, with one or more or5 ganizations to manage the use of land of the Depart6 ment of Veterans Affairs for homeless veterans for 

7 living and sleeping. 

8 (2) FORMS OF COLLABORATION.—Collaboration 

9 under paragraph (1) may include the provision by ei10 ther the Secretary or the head of the organization 

11 concerned of food services and security for property, 

12 buildings, and other facilities owned or controlled by 

13 the Department of Veterans Affairs. 

14 (c) REPORT REQUIRED.—Not later than six months 

15 after the date of the enactment of this Act, and annually 

16 thereafter until the date specified in subsection (d), the 

17 Secretary shall submit to Congress a report that includes, 

18 with respect to the period covered by such report— 

19 (1) a statement, disaggregated by each medical 

20 center of the Department of Veterans Affairs, of the 

21 amount of funds under this section— 

22 (A) each such medical center requested 

23 from the Secretary; and 

24 (B) to which the Secretary provided each 

25 such medical center; 


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1 (2) data, disaggregated by each such medical 

2 center, relating to how each such medical center 

3 used amounts provided by the Secretary under this 

4 section; 

5 (3) the number of covered veterans to which the 

6 Secretary provided assistance under this section; 

7 (4) the total amount of assistance the Secretary 

8 provided to covered veterans pursuant to subsection 

9 (a)(3) for communications equipment, broken down 

10 by the type of equipment provided; 

11 (5) the total amount of assistance the Secretary 

12 provided covered veterans pursuant to subsection 

13 (a)(2) for ridesharing; 

14 (6) the number of covered veterans who re15 ceived such assistance; and 

16 (7) a description, for each rideshare used by a 

17 covered veteran with such assistance, of the reasons 

18 such covered veteran used such rideshare; 

19 (8) the number of covered veterans who lived or 

20 slept on Department land; 

21 (9) the amount of funds used to make available 

22 Department land for covered veterans to live and 

23 sleep; 

24 (10) the number of Department employees 

25 whose primary responsibilities involved providing 


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1 services for covered veterans living or sleeping on 

2 Department land; 

3 (11) the average length of time a covered vet4 eran lived or slept on Department land; and 

5 (12) the period of time the Secretary expects 

6 Department land will be made available for covered 

7 veterans to live and sleep. 

8 (d) TERMINATION DATE.—The termination date 

9 specified in this subsection is September 30, 2026. 

10 (e) DEFINITIONS.—In this section, the term ‘‘covered 

11 veteran’’ means— 

12 (1) a homeless veteran, as such term is defined 

13 in section 2002 of title 38, United States Code; and 

14 (2) a veteran participating in the program car15 ried out under section 8(o)(19) of the United States 

16 Housing Act of 1937 (42 U.S.C. 1437f(o)(19)). 

17 SEC. 404. ACCESS TO DEPARTMENT OF VETERANS AFFAIRS 

18 TELEHEALTH SERVICES. 

19 (a) IN GENERAL.—Subtitle VII of chapter 20 of title 

20 38, United States Code is amended by adding at the end 

21 the following new section: 

22 ‘‘§ 2069. Access to telehealth services 

23 ‘‘To the extent practicable, the Secretary shall ensure 

24 that veterans participating in or receiving services from 

25 a program under this chapter have access to telehealth 


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1 services to which such veterans are eligible under the laws 

2 administered by the Secretary, including by ensuring that 

3 telehealth capabilities are available to— 

4 ‘‘(1) such veterans; 

5 ‘‘(2) case managers of the Department of pro6 grams for homeless veterans authorized under this 

7 chapter; and 

8 ‘‘(3) community-based service providers for 

9 homeless veterans receiving funds from the Depart10 ment through grants or contracts.’’. 

11 (b) CLERICAL AMENDMENT.—The table of sections 

12 at the beginning of chapter 20 of title 38, United States 

13 Code, is amended by adding at the end the following new 

14 item: 

‘‘2069. Access to telehealth services.’’. 

15 TITLE V—ELECTRONIC HEALTH 

16 RECORD MATTERS 

17 SEC. 501. SHORT TITLE. 

18 This title may be cited as the ‘‘Electronic Health 

19 Record Program Restructure, Enhance, Strengthen, and 

20 Empower Technology Act of 2024’’ or the ‘‘EHR Program 

21 RESET Act of 2024’’. 

22 SEC. 502. DEFINITIONS. 

23 In this title: 

24 (1) The term ‘‘appropriate congressional com25 mittees’’ means— 


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1 (A) the Committee on Veterans’ Affairs 

2 and the Committee on Appropriations of the 

3 House of Representatives; and 

4 (B) the Committee on Veterans’ Affairs 

5 and the Committee on Appropriations of the 

6 Senate. 

7 (2) The term ‘‘Electronic Health Record Mod8 ernization Program’’ means any activities being car9 ried out, as of the date of the enactment of this Act, 

10 by the Department of Veterans Affairs to procure 

11 and implement an electronic health record system to 

12 replace significant medical functions or applications 

13 of the Veterans Information Systems and Tech14 nology Architecture. 

15 (3) The term ‘‘other health information tech16 nology activities and systems of the Department’’ 

17 means health information technology activities and 

18 systems other than electronic health record systems, 

19 including functions supporting clinical care or func20 tional requirements, notwithstanding the Determina21 tion and Findings executed by the Secretary of Vet22 erans Affairs on June 1, 2017. 

23 (4) The term ‘‘preliminary program activity’’ 

24 means an activity under the Electronic Health 

25 Record Modernization Program, including any local 


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1 workshop, training, testing, or any other activity 

2 that is a direct precursor to the activation of the 

3 electronic health record system at a particular Vet4 erans Health Administration facility. 

5 Subtitle A—Electronic Health 

6 Record System and Health In7 formation Technology Mod8 ernization 

9 SEC. 511. MODERNIZATION OF DEPARTMENT OF VETERANS 

10 AFFAIRS ELECTRONIC HEALTH RECORD SYS11 TEM AND HEALTH INFORMATION TECH12 NOLOGY. 

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

14 is authorized to carry out a program to modernize— 

15 (1) the electronic health record system of the 

16 Department of Veterans Affairs, either by making 

17 changes to the Electronic Health Record Moderniza18 tion Program, as in effect on the date of the enact19 ment of this Act, or by establishing a new program; 

20 and 

21 (2) other health information technology activi22 ties and systems of the Department. 

23 (b) PURPOSE OF MODERNIZATION PROGRAM.—If the 

24 Secretary carries out a program under subsection (a), 

25 some combination of the components of such program as 


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1 described in paragraphs (1) and (2) of subsection (a) shall 

2 be designed to fulfill the following purposes: 

3 (1) To improve the quality of hospital care, 

4 medical services, and nursing home care furnished 

5 by the Department of Veterans Affairs, including— 

6 (A) by improving the delivery of care con7 sistent with quality and safety standards of the 

8 Department; 

9 (B) by improving the coordination of such 

10 care and services for such patients; and 

11 (C) by improving timely access to such 

12 care and services for such patients; 

13 (2) To increase the productivity, efficiency, and 

14 satisfaction of employees of the Veterans Health Ad15 ministration. 

16 (3) To improve the experience of patients en17 rolled in the patient enrollment system of the De18 partment of Veterans Affairs under section 1705 of 

19 title 38, United States Code. 

20 (4) To reduce unnecessary variation in care de21 livery. 

22 (5) To improve the quality, consistency, and 

23 management of— 

24 (A) data created or received by the Vet25 erans Health Administration, including such 


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1 data related to or needed for benefits deter2 minations by the Department; and 

3 (B) data generated by or exchanged with a 

4 health care provider through which the Sec5 retary furnishes such care and services under 

6 the laws administered by the Secretary. 

7 (6) To increase the interoperability of the elec8 tronic health record systems and health information 

9 technology systems of the Department by— 

10 (A) expressing the content and format of 

11 health data using a common language to im12 prove the exchange of data within and outside 

13 the Department; 

14 (B) ensuring that Department medical per15 sonnel have access to integrated, computable, 

16 and comprehensive health records and health 

17 data of patients sufficient to enable the provi18 sion of seamless care within and outside the 

19 Department; 

20 (C) surpassing the capabilities achievable 

21 through bidirectional information exchange be22 tween electronic health record systems or the 

23 exchange of read-only data; and 

24 (D) planning for and effectuating the 

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1 ability and data standards, specifically with re2 spect to the Fast Healthcare Interoperability 

3 Resources standard or successor standard, the 

4 evolution of such standards, and the obsoles5 cence of such standards. 

6 (7) To increase the amount of medical collec7 tions in the Department of Veterans Affairs Medical 

8 Care Collections Fund established under section 

9 1729A of title 38, United States Code. 

10 (8) To support and strengthen research and de11 velopment activities, including such activities re12 quired under section 7303 of title 38, United States 

13 Code. 

14 (9) To protect the personal information, includ15 ing personally identifiable information and protected 

16 health information, of veterans, patients, and other 

17 users of electronic health record systems and health 

18 information technology systems authorized under 

19 subsection (a) from cyber attacks, identity theft, and 

20 other cyber and security threats. 

21 (10) Such other purposes as the Secretary may 

22 determine appropriate. 


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1 SEC. 512. RESPONSIBILITY FOR ELECTRONIC HEALTH 

2 RECORD PROGRAM AND HEALTH INFORMA3 TION TECHNOLOGY. 

4 (a) IN GENERAL.—If the Secretary of Veterans Af5 fairs carries out a program under subsection (a) of section 

6 511— 

7 (1) with respect to the modernization of the 

8 electronic health record system of the Department of 

9 Veterans Affairs pursuant to section 511(a)(1)— 

10 (A) the Deputy Secretary of Veterans Af11 fairs shall— 

12 (i) be directly responsible to the Sec13 retary for such electronic health record 

14 system modernization; 

15 (ii) oversee such electronic health 

16 record system modernization; 

17 (iii) direct resources, subject to the 

18 availability of appropriations, to the Office 

19 of Information and Technology, the Vet20 erans Health Administration, or other or21 ganizational subdivisions of the Depart22 ment to facilitate such modernization; 

23 (iv) designate officials and offices 

24 within the Department as operationally re25 sponsible for such modernization, including 


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1 a Program Executive Director for Elec2 tronic Health Record Modernization; and 

3 (v) coordinate with the Under Sec4 retary of Veterans Affairs for Health and 

5 the Assistant Secretary of Veterans Affairs 

6 for Information and Technology; 

7 (B) the Under Secretary for Health 

8 shall— 

9 (i) have primary responsibility for de10 termining strategy and objectives of such 

11 modernization; 

12 (ii) exercise responsibility for the im13 plementation and operation of any func14 tions assigned by the Deputy Secretary 

15 pursuant to subparagraph (D); 

16 (iii) coordinate with the Deputy Sec17 retary, the Program Executive Director 

18 designated pursuant to subparagraph 

19 (A)(iv), and the Assistant Secretary for In20 formation and Technology; 

21 (C) the Assistant Secretary for Informa22 tion and Technology shall— 

23 (i) be responsible for carrying out the 

24 information technology activities of the De25 partment in accordance with— 


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1 (I) section 310 of title 38, United 

2 States Code; 

3 (II) chapter 35 of title 44, 

4 United States Code; and 

5 (III) subtitle III of title 40, 

6 United States Code; 

7 (ii) exercise responsibility for the im8 plementation and operation of any func9 tions assigned by the Deputy Secretary 

10 pursuant to subparagraph (D); 

11 (iii) coordinate with the Deputy Sec12 retary, the Program Executive Director 

13 designated pursuant to subparagraph 

14 (A)(iv), and the Under Secretary for 

15 Health; and 

16 (D) the Deputy Secretary, in consultation 

17 with the Under Secretary for Health and the 

18 Assistant Secretary for Information and Tech19 nology, shall determine the distribution or as20 signment of responsibilities among the Under 

21 Secretary for Health, the Assistant Secretary 

22 for Information and Technology, and the Pro23 gram Executive Director designated pursuant 

24 to subparagraph (A)(iv) for— 


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1 (i) defining and elaborating require2 ments; 

3 (ii) implementation schedule; 

4 (iii) system design and configuration; 

5 (iv) workflow; 

6 (v) system usability; 

7 (vi) change management; 

8 (vii) training; and 

9 (viii) other functions relevant to such 

10 modernization; and 

11 (2) with respect to the modernization of other 

12 health information technology activities and systems 

13 of the Department pursuant to section 511(a)(2)— 

14 (A) the Under Secretary for Health and 

15 the Assistant Secretary for Information and 

16 Technology shall share primary responsibility, 

17 shall coordinate with one another, and shall 

18 jointly— 

19 (i) coordinate with any other relevant 

20 organizational subdivisions of the Depart21 ment regarding the prioritization, invest22 ment in, and deployment of health infor23 mation technology regarding such mod24 ernization; and 


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1 (ii) develop the health information 

2 technology strategy and roadmap required 

3 under section 537; 

4 (B) the Assistant Secretary for Informa5 tion and Technology shall be responsible for 

6 carrying out the information technology activi7 ties of the Department in accordance with— 

8 (i) section 310 of title 38, United 

9 States Code; 

10 (ii) chapter 35 of title 44, United 

11 States Code; and 

12 (iii) subtitle III of title 40, United 

13 States Code; and 

14 (C) The Under Secretary for Health, act15 ing through the Chief Digital Health Officer of 

16 the Department or a successor or equivalent of17 ficer, shall coordinate the activities and func18 tions of the Veterans Health Administration, 

19 including health informatics. 

20 (b) EXECUTIVE DIRECTOR.—With respect to the 

21 Electronic Health Record Modernization program and any 

22 program carried out pursuant to section 511(a)(1), the 

23 Program Executive Director designated pursuant to sub24 section (a)(1)(A)(iv) shall— 


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1 (1) exercise responsibility for the implementa2 tion and operation of the functions assigned by the 

3 Deputy Secretary pursuant to subsection (a)(1)(D); 

4 (2) oversee work performed by contractors re5 lated to such programs, in coordination with the 

6 Principal Executive Director of the Office of Acqui7 sition, Logistics, and Construction; and 

8 (3) coordinate with the Under Secretary for 

9 Health, the Assistant Secretary for Information and 

10 Technology, and any other relevant organizational 

11 subdivisions of the Department. 

12 SEC. 513. PROTECTION OF PERSONAL INFORMATION. 

13 (a) IN GENERAL.—Not later than one year after the 

14 date of the enactment of this Act, the Secretary of Vet15 erans Affairs shall— 

16 (1) ensure that each covered contract includes, 

17 or is modified to include, a clause prohibiting cov18 ered information from being monetized, sold, or oth19 erwise misused by any contractor, including any sub20 contractor or affiliate thereof, or other non-Depart21 ment of Veterans Affairs entity; and 

22 (2) issue a directive or other policy providing 

23 guidance to employees and contractors of the De24 partment on how to identify the monetization, sale, 

25 or misuse of covered information in order to ensure 


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1 contractors are in compliance with clauses in covered 

2 contracts included pursuant to paragraph (1). 

3 (b) DEFINITIONS.—In this section: 

4 (1) The term ‘‘covered contract’’ means a con5 tract of the Department of Veterans Affairs that 

6 provides for the handling of covered information and 

7 is entered into— 

8 (A) after the date of the enactment of this 

9 Act; or 

10 (B) before the date of the enactment of 

11 this Act and does not expire before the date of 

12 the enactment of this Act. 

13 (2) The term ‘‘covered information’’— 

14 (A) means protected health information or 

15 personally identifiable information, including 

16 such information that has been anonymized; 

17 and 

18 (B) includes information protected 

19 under— 

20 (i) section 552a of title 5, United 

21 States Code; 

22 (ii) section 5701 or 7332 of title 38 

23 United States Code; 

24 (iii) parts 160, 161, and 164 of title 

25 45, Code of Federal Regulations; and 


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1 (iv) any other provision of law, as de2 termined by the Secretary. 

3 Subtitle B—Implementation 

4 Requirements 

5 SEC. 521. VETERANS HEALTH ADMINISTRATION 

6 WORKFLOW BASELINE. 

7 (a) ESTABLISHMENT.—The Under Secretary of Vet8 erans Affairs for Health, shall— 

9 (1) conduct an enterprise inventory of core clin10 ical and business processes relevant to the program 

11 described in section 511(a)(1), including all 

12 workflows underlying such processes throughout the 

13 Veterans Health Administration; 

14 (2) evaluate and compare the workflows re15 ferred to in paragraph (1) against relevant health 

16 care industry best practices and clinical practice 

17 guidelines; and 

18 (3) establish a baseline of clinical workflows for 

19 the Veterans Health Administration. 

20 (b) INCORPORATION.—The Under Secretary for 

21 Health shall incorporate the baseline established under 

22 subsection (a)(3) into the program described in section 

23 511(a)(1). 

24 (c) MONITORING AND CONTROL OF VARIATIONS.— 

25 The Under Secretary for Health shall— 


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1 (1) establish a process to monitor and control 

2 variations from the baseline established under sub3 section (a)(3); and 

4 (2) evaluate progress relative to such baseline. 

5 (d) STANDARDS.—The Under Secretary for Health 

6 shall establish national standards for the Veterans Health 

7 Administration, pertaining to the implementation and 

8 adoption of the electronic health record system, for— 

9 (1) order sets; 

10 (2) user roles; 

11 (3) medical devices; 

12 (4) system interfaces and connectivity of med13 ical devices; and 

14 (5) any clinical process not described in sub15 section (a) that the Under Secretary for Health de16 termines appropriate. 

17 SEC. 522. REQUIREMENTS FOR ELECTRONIC HEALTH 

18 RECORD SYSTEM IMPLEMENTATION. 

19 (a) METRICS.— 

20 (1) ESTABLISHMENT.—Not later than 90 days 

21 after the date of the enactment of this Act, the Sec22 retary of Veterans Affairs, acting through the Under 

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1 ing the implementation and adoption of the elec2 tronic health record system. Such metrics shall— 

3 (A) be uniform in composition; 

4 (B) take into account relevant differences 

5 in size, complexity, and market composition of 

6 facilities of the Veterans Health Administra7 tion; 

8 (C) incorporate the Strategic Analytics for 

9 Improvement and Learning Value Model of the 

10 Department, any other relevant methodology, or 

11 any successor methodology; and 

12 (D) reflect the purposes referred to in sec13 tion 511(b). 

14 (2) STRATEGIC ANALYTICS FOR IMPROVEMENT

15 AND LEARNING VALUE MODEL.—Upon the enact16 ment of this Act, the Secretary shall continue mak17 ing publicly available the results of the Strategic 

18 Analytics for Improvement and Learning Value 

19 Model with respect to all medical facilities where the 

20 electronic health record system pursuant to the Elec21 tronic Health Record Modernization Program is ac22 tive. 

23 (b) LIMITATION ON PRELIMINARY PROGRAM ACTIVI24 TIES AT CERTAIN FACILITIES.—In the case of any med25 ical facility of the Department where, as of the date of 


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1 the enactment of this Act, a preliminary program activity 

2 has not been initiated or is not being carried out, the Sec3 retary may not carry out such an activity at such facility 

4 before the date on which the Secretary submits to the ap5 propriate congressional committees certification that— 

6 (1) each medical facility where the electronic 

7 health record system pursuant to the Electronic 

8 Health Record Modernization Program is active as 

9 of such date of enactment, has met or exceeded the 

10 operational levels of such medical facility prior to 

11 implementing such system with respect to oper12 ational areas of the Department related to the pur13 poses described in paragraphs (1), (2), (3), and (7) 

14 of section 511(b); and 

15 (2) includes data to support such certification. 

16 (c) LIMITATION ON IMPLEMENTATION OF ELEC17 TRONIC HEALTH RECORD MODERNIZATION PROGRAM.— 

18 The Secretary may not implement the electronic health 

19 record system pursuant to the Electronic Health Record 

20 Modernization Program at a Department medical facility 

21 where such system is not active as of date of enactment 

22 unless— 

23 (1) the Secretary has made the certification de24 scribed in subsection (b); and 


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1 (2) the Under Secretary for Health, in con2 sultation with the director of the facility, submits to 

3 the Secretary, and the Secretary transmits to the 

4 appropriate congressional committees, written cer5 tification that— 

6 (A) the director has confidence that the 

7 build and configuration of the electronic health 

8 record, as proposed to be carried out at such 

9 medical facility, are accurate and complete; 

10 (B) the staff and infrastructure of such fa11 cility are adequately prepared to receive such 

12 system; 

13 (C) the facility and the Department have 

14 taken appropriate action to mitigate any ad15 verse effects of the implementation of such sys16 tem on health outcomes, coordination of care, 

17 wait times, patient safety, or veteran experience 

18 at such medical facility; and 

19 (D) such system has demonstrated a sus20 tained record of achieving the contractual re21 quirements for outage-free time and incident22 free time prior to such certification. 


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1 SEC. 523. CONDITIONAL RESTRUCTURING OF ELECTRONIC 

2 HEALTH RECORD MODERNIZATION PRO3 GRAM. 

4 (a) IN GENERAL.—Beginning on the date that is two 

5 years after the date of the enactment of this Act, the Sec6 retary of Veterans Affairs may not exercise any option pe7 riods or optional tasks or extend any contracts to carry 

8 out the Electronic Health Record Modernization Program, 

9 unless before the date that is two years after the date of 

10 enactment of this Act— 

11 (1) the Secretary submits to the appropriate 

12 congressional committees a certification, including 

13 supporting data, that the metrics described in sec14 tion 522(a) show overall improvement in each meas15 urement period during the period beginning on the 

16 date of the enactment of this Act and ending on the 

17 date on which the certification under this paragraph 

18 is made; and 

19 (2) the Secretary has made the certification de20 scribed in section 522(b). 

21 (b) RULE OF CONSTRUCTION.—Nothing in this sec22 tion may be construed to require the Secretary to termi23 nate any contract, task order, modification, or other simi24 lar instrument under the Electronic Health Record Mod25 ernization Program before the expiration of the period of 


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1 performance of such contract, task order, modification, or 

2 other similar instrument. 

3 (c) FAILURE TO MAKE CERTIFICATIONS.—In the 

4 event that each certification referred to in paragraphs (1) 

5 and (2) of subsection (a) is not made before the date that 

6 is two years after the date of the enactment of this Act, 

7 not later than 180 days after the date that is two years 

8 after the date of the enactment of this Act, the Secretary 

9 shall either— 

10 (1) ensure that each facility of the Veterans 

11 Health Administration using the electronic health 

12 record system implemented pursuant to the Elec13 tronic Health Record Modernization Program reacti14 vates and resumes using the Veterans Health Infor15 mation Systems and Technology Architecture and 

16 the Computerized Patient Record System of the De17 partment; or 

18 (2) if the Secretary has submitted the report on 

19 alternative modernization strategies under section 

20 536, select and pursue a strategy included in the re21 port. 

22 Subtitle C—Reporting 

23 SEC. 531. REPORT ON ADDITIONAL PURPOSES. 

24 If the Secretary determines any purpose to be appro25 priate pursuant to section 511(b)(10), not later than 30 


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1 days after the date of such determination, the Secretary 

2 shall submit to the appropriate congressional committees 

3 a report that includes a description of such purpose. 

4 SEC. 532. REPORTS ON BASELINE OF CLINICAL 

5 WORKFLOWS. 

6 (a) BASELINE.—Not later than 90 days after the 

7 date on which the Secretary establishes a baseline of clin8 ical workflows pursuant to section 521(a)(3), the Sec9 retary shall submit to the appropriate congressional com10 mittees a report that includes an identification of such 

11 baseline. 

12 (b) STANDARDS.—Not later than 90 days after the 

13 date on which the Secretary establishes the national stand14 ards pursuant to section 521(d), the Secretary shall sub15 mit to the appropriate congressional committees a report 

16 that describes such standards. 

17 SEC. 533. REPORT ON HEALTH CARE QUALITY METRICS. 

18 Not later than 90 days after the date on which the 

19 Secretary establishes the health care quality metrics de20 scribed in section 522(a), the Secretary shall submit to 

21 the appropriate congressional committees a report that in22 cludes an identification of such metrics. 


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1 SEC. 534. REPORT ON SUPPORT STRATEGY FOR EXISTING 

2 SITES. 

3 (a) IN GENERAL.—Not later than 180 days after the 

4 date of the enactment of this Act, the Secretary shall sub5 mit to the appropriate congressional committees a report 

6 on the strategy of the Department to enable each medical 

7 facility of the Department where the electronic health 

8 record system implemented pursuant to the Electronic 

9 Health Record Modernization Program is active as of the 

10 date of enactment of this Act to achieve full user adoption 

11 of the system and meet or exceed the operational levels 

12 of such medical center prior to implementing such system 

13 with respect to operational areas of the Department re14 lated to the purposes described in paragraphs (1), (2), (3), 

15 and (7) of section 511(b). Such report shall include an 

16 estimated budget, or revisions to an existing budget, if 

17 any, for each such facility to implement such strategy, in18 cluding with respect to costs related to— 

19 (1) training; 

20 (2) additional staff; 

21 (3) technical support; 

22 (4) support contracts; 

23 (5) mitigation strategies; and 

24 (6) any other resources determined necessary 

25 by the director of the facility. 


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1 (b) INPUT.—The report described in subsection (a) 

2 shall be developed with input from the directors of each 

3 such medical facility and the directors of each Veterans 

4 Integrated Service Network in which each such medical 

5 facility is located. 

6 SEC. 535. REPORT ON RESOURCES REQUIRED FOR FUTURE 

7 SITES. 

8 Not later than 90 days before a medical facility is 

9 scheduled to implement the electronic health record sys10 tem pursuant to the Electronic Health Record Moderniza11 tion Program, the Secretary shall submit to the appro12 priate congressional committees a report provided by the 

13 director of the medical facility, in consultation with the 

14 chief of staff of the medical facility and the director of 

15 the Veterans Integrated Service Network in which such 

16 medical facility is located. Such report shall include a de17 tailed description of the resources provided to the medical 

18 facility, and the estimated resources still required, to im19 plement such system successfully, including with respect 

20 to— 

21 (1) funding; 

22 (2) training; 

23 (3) additional staff; 

24 (4) technical support; 

25 (5) support contracts; 


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1 (6) mitigation strategies; and 

2 (7) any other resources determined necessary 

3 by the director of the facility. 

4 SEC. 536. REPORT ON ALTERNATIVE MODERNIZATION 

5 STRATEGIES. 

6 (a) IN GENERAL.—Not later than one year after 

7 completing the baseline required under section 521(a), the 

8 Secretary, in consultation with the Under Secretary of 

9 Veterans Affairs for Health, the Executive Director of the 

10 Electronic Health Record Modernization Program, and 

11 the Assistant Secretary of Veterans Affairs for Informa12 tion and Technology, shall submit to the appropriate con13 gressional committees a report that includes a description 

14 of not fewer than two alternative strategies to the Elec15 tronic Health Record Modernization Program to carry out 

16 the program described in section 511(a) and the purposes 

17 described in section 511(b) in the event that each of the 

18 certifications referred to in paragraphs (1) and (2) of sec19 tion 523(a) are not made. 

20 (b) ALTERNATIVE STRATEGIES.—The alternative 

21 strategies included in the report shall include— 

22 (1) a strategy of modernizing the Veterans 

23 Health Information Systems and Technology Archi24 tecture in conjunction with other health information 

25 technology activities and systems; 


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1 (2) a strategy of implementing a commercial 

2 electronic health record system, other than the Elec3 tronic Health Record Modernization Program, in 

4 conjunction with other health information technology 

5 activities and systems; and 

6 (3) any other strategy the Secretary determines 

7 appropriate. 

8 (c) REQUIREMENTS.—For each alternative strategy 

9 included in the report, the Secretary shall include— 

10 (1) a description of how the strategy incor11 porates the baseline required under section 521(a); 

12 (2) an indication of what combination of an 

13 electronic health record system and other health in14 formation technology activities and systems will be 

15 used to fulfill the purposes described in section 

16 511(b); 

17 (3) a notional schedule for the implementation 

18 of the strategy; 

19 (4) a preliminary life cycle cost estimate for the 

20 implementation of the strategy, including what, if 

21 any, costs incurred during the implementation of the 

22 Electronic Health Record Modernization Program 

23 may be recovered or investments made during the 

24 implementation of such program may be reused; 


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1 (5) an explanation of how the strategy, if imple2 mented, would achieve the purposes described in sec3 tion 511(b); 

4 (6) a description of any improvements in gov5 ernance, management, and oversight made by the 

6 Department or proposed to be made with respect to 

7 a program to carry out an alternative strategy; 

8 (7) an analysis of the feasibility of imple9 menting the strategy; 

10 (8) an analysis of the level of risk to taxpayers 

11 and the Department to implement the strategy as 

12 well as strategies to mitigate any such risks; 

13 (9) an analysis of the strengths and weaknesses 

14 of the strategy; and 

15 (10) a description of how the electronic health 

16 record system implemented pursuant to the Elec17 tronic Health Record Modernization Program will be 

18 sustained, deprecated, and replaced through imple19 mentation of the strategy. 

20 SEC. 537. REPORT ON HEALTH INFORMATION TECH21 NOLOGY STRATEGY AND ROADMAP. 

22 (a) IN GENERAL.—Not later than 270 days after the 

23 date of the enactment of this Act, the Chief Digital Health 

24 Officer, or any successor officer of the Department of Vet25 erans Affairs, in coordination with the Assistant Secretary 


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1 of Veterans Affairs for Information and Technology, the 

2 Chief Acquisition Officer of the Department of Veterans 

3 Affairs, and the Program Executive Director designated 

4 pursuant to section 512(a)(1)(A)(iv) shall submit to the 

5 appropriate congressional committees a report a con6 taining a health information technology strategy and road7 map. 

8 (b) CONTENTS OF REPORT.—The report required 

9 under subsection (a) shall include each of the following: 

10 (1) A health information technology strategy 

11 presenting the comprehensive approach of the De12 partment and objectives to identify, prioritize, pro13 cure and use health information technology of the 

14 Department as well as interfaces with health infor15 mation technology of non-Department entities and 

16 integration of such systems and interfaces to im17 prove— 

18 (A) health care quality; 

19 (B) health care delivery and coordination, 

20 including of interfaced medical devices; 

21 (C) efficiency of the health business and 

22 administrative functions; and 

23 (D) research functions of the Department. 


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1 (2) Goals and measurable metrics to assess im2 plementation of the strategy described in paragraph 

3 (1) and the roadmap described in paragraph (4). 

4 (3) As assessment of the current state and de5 sired future state of the Department, including tech6 nical architecture, enterprise processes, and systems 

7 integration with respect to health information tech8 nology. 

9 (4) A roadmap to implement the strategy de10 scribed in paragraph (1), consisting of— 

11 (A) a revised governance model, to include 

12 management and oversight responsibilities, to 

13 holistically organize, prioritize, and invest in 

14 health information technology initiatives of the 

15 Department, regardless of funding source, while 

16 removing duplication and fragmentation in such 

17 initiatives of the Department; 

18 (B) a timeline to implement and 

19 operationalize the strategy described in para20 graph (1); 

21 (C) a description of the acquisition and 

22 contracting strategies of the Department at the 

23 national, regional, or local levels to be created 

24 or modified to implement the strategy described 

25 in paragraph (1); and 


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1 (D) a description of any human capital 

2 needs required to implement the strategy and 

3 roadmap, including qualifications or incentives 

4 to obtain such needs. 

5 (c) UPDATE TO REPORT.—Not later than 120 days 

6 after the first day of the fiscal year after the fiscal year 

7 during which the report required under subsection (a) is 

8 submitted, and annually thereafter until the date specified 

9 in subsection (d), the Chief Digital Health Officer shall 

10 submit to the appropriate congressional committees an up11 dated report that includes each of the following: 

12 (1) An identification of any significant changes 

13 to the strategy described in subsection (b)(1) or any 

14 of the elements of the strategy. 

15 (2) An assessment of the extent to which the 

16 goals described in subsection (b)(2) have been 

17 achieved, including supporting metrics and data. 

18 (3) An assessment of the progress and mile19 stones achieved related to the timeline described in 

20 subsection (b)(4)(D). 

21 (4) A description of any corrective actions to be 

22 taken in response to failure to meet any goals or 

23 milestones. 

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1 ing all relevant accounts, for the fiscal year during 

2 which the updated report is submitted and the next 

3 fiscal year. 

4 (d) TERMINATION DATE.—The date specified in this 

5 subsection is the date that is four years after the date 

6 on which the first update is submitted under subsection 

7 (c). 

8 SEC. 538. ANNUAL REPORT ON EFFORTS TO MAINTAIN 

9 VISTA ELECTRONIC HEALTH RECORD SYS10 TEM. 

11 (a) IN GENERAL.—Not later than 120 days after the 

12 first day of each fiscal year that begins after the date of 

13 the enactment of this Act until the date specified in sub14 section (c), the Secretary shall submit to the appropriate 

15 congressional committees a report on the Veterans Infor16 mation Systems and Technology Architecture. 

17 (b) CONTENTS OF REPORT.—The report required by 

18 subsection (a) shall include— 

19 (1) the operation and maintenance costs and 

20 development and enhancement costs for the most re21 cent fiscal year that ended before the date of the 

22 submission of the report; 

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1 ing the fiscal year during which the report is sub2 mitted and subsequent fiscal years; 

3 (3) the projected operation and maintenance 

4 and development and enhancement costs for the nine 

5 fiscal years following the fiscal year during which 

6 the report is submitted; 

7 (4) a list of modules, applications, or systems 

8 within the Veterans Information Systems and Tech9 nology Architecture— 

10 (A) that have been retired or have been, or 

11 are planned to be, subsumed by other systems 

12 or applications; or 

13 (B) that the Department plans to retire 

14 during the fiscal year or in a future fiscal year; 

15 or 

16 (C) for which there is no plan to retire or 

17 subsume; 

18 (5) a list of applications or systems to be devel19 oped within, significantly modernized, or integrated 

20 with, the Veterans Information Systems and Tech21 nology Architecture during the fiscal year during 

22 which the report is submitted or during any future 

23 fiscal year; 

24 (6) a list of current, scheduled activity and as25 sociated costs towards achieving certification as a 


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1 certified electronic health record technology pursu2 ant to the program under section 3001(c) of the 

3 Public Health Service Act (42 U.S.C. 300jj–11(c)); 

4 and 

5 (7) a report on the stability of the system, in6 cluding— 

7 (A) outage-free time; 

8 (B) incident-free time; and 

9 (C) user interruptions across all instances 

10 of the Veterans Information Systems and Tech11 nology Architecture during the two previous fis12 cal years. 

13 (c) TERMINATION.—The date specified in this sub14 section is the date that is 10 years after the date of the 

15 enactment of this Act. 

16 SEC. 539. MODIFICATION OF QUARTERLY REPORTS. 

17 Section 503 of the Veterans Benefits and Transition 

18 Act of 2018 (Public Law 115–407) is amended— 

19 (1) in subsection (b)— 

20 (A) by redesignating paragraphs (1) 

21 through (6) as subparagraphs (A) through (F), 

22 respectively; 

23 (B) in the matter preceding subparagraph 

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1 ing ‘‘Not later than 30 days’’ and inserting the 

2 following: 

3 ‘‘(1) IN GENERAL.—Not later than 30 days’’; 

4 and 

5 (C) by adding at the end the following: 

6 ‘‘(2) ADDITIONAL MATTERS TO BE IN7 CLUDED.—The Secretary shall include with any up8 date submitted under paragraph (1) on or after the 

9 date of enactment of the the Senator Elizabeth Dole 

10 21st Century Veterans Healthcare and Benefits Im11 provement Act with respect to the quarter covered 

12 by the report, the following: 

13 ‘‘(A) Data on user adoption and employee 

14 satisfaction with the electronic health record 

15 system implemented pursuant to the Electronic 

16 Health Record Modernization program or suc17 cessor system implemented pursuant to section 

18 511(a)(1) of the the Senator Elizabeth Dole 

19 21st Century Veterans Healthcare and Benefits 

20 Improvement Act, including training on such 

21 system, using surveys of the Department and 

22 surveys conducted for the Department. 

23 ‘‘(B) Data on employee retention and turn24 over at medical facilities where such electronic 

25 health record system is in use. 


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1 ‘‘(C) Data on downtime, performance dis2 ruptions, or impaired functionality of such elec3 tronic health record system including— 

4 ‘‘(i) cause; 

5 ‘‘(ii) length; 

6 ‘‘(iii) responsible entity; and 

7 ‘‘(iv) corrective actions planned or 

8 taken. 

9 ‘‘(D) Data on the impact of such system 

10 on revenue and collections at medical facilities 

11 where such electronic health record system is in 

12 use, including— 

13 ‘‘(i) planned revenue and collections; 

14 ‘‘(ii) actual revenue and collections; 

15 and 

16 ‘‘(iii) steps planned or taken to 

17 achieve planned revenue and collections. 

18 ‘‘(E) Data on ticket resolution. 

19 ‘‘(F) A list of any credits, reimbursements, 

20 or monies provided by a contractor under the 

21 Electronic Health Record Modernization pro22 gram or invoice deductions or withholdings 

23 taken by the Department from such contractor 

24 in the reporting period to include due to failure 

25 to meet the terms of a service level agreement 


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1 or other terms and conditions of the contract.’’; 

2 and 

3 (2) in subsection (d)(2)(C)— 

4 (A) by striking ‘‘or dispute, and’’ and in5 serting ‘‘dispute, cure notice, letter of concern, 

6 or other official communication by the Depart7 ment to a contractor concerning contract non8 compliance or corrective action, the official re9 sponse of the contractor, and’’; and 

10 (B) by striking ‘‘or dispute (as’’ and in11 serting ‘‘dispute, cure notice, letter of concern, 

12 or other official communication concerning con13 tract noncompliance and the official response of 

14 the contractor (as’’. 

15 SEC. 540. REPORT ON PROTECTION OF PERSONAL INFOR16 MATION. 

17 Not later than one year after the date of the enact18 ment of this Act, the Secretary of Veterans Affairs shall 

19 submit to the appropriate congressional committees a re20 port that includes— 

21 (1) a copy of the contract clause required by 

22 section 513(a); 

23 (2) the guidance required by section 513(b); 

24 and 


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1 (3) a summary of any other actions taken to 

2 comply with section 513. 

3 SEC. 541. REPORT ON ORGANIZATION AND NEEDS. 

4 (a) CONGRESSIONAL NOTICE REGARDING CERTAIN

5 ACTIONS.— 

6 (1) IN GENERAL.—Not later than 90 days after 

7 the date on which an official of the Department of 

8 Veterans Affairs takes an action specified in para9 graph (2), the Secretary of Veterans Affairs shall 

10 submit to the appropriate congressional committees 

11 notice of such action. 

12 (2) ACTION SPECIFIED.—An action specified in 

13 this paragraph is any of the following: 

14 (A) The designation of any official or of15 fice by the Deputy Secretary of Veterans Af16 fairs pursuant to section 512(a)(1)(A)(iv). 

17 (B) The designation of any responsibility 

18 by the Deputy Secretary pursuant to section 

19 512(a)(1)(D). 

20 (C) Any action related to the reorganiza21 tion of a program pursuant to section 511(a)(1) 

22 or (2). 

23 (b) REPORT ON NECESSARY LEGISLATIVE

24 CHANGES.—Not later than one year after the date of the 

25 enactment of this Act, the Secretary shall submit to the 


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1 appropriate congressional committees a report that in2 cludes a description of any legislative changes the Sec3 retary determines are necessary in order to carry out the 

4 responsibilities of the Secretary with respect to the pro5 grams described in section 511(a)(1) or (2), regarding— 

6 (1) organization; 

7 (2) hiring or compensation authorities; 

8 (3) appropriations; or 

9 (4) related matters, as determined by the Sec10 retary. 

11 SEC. 542. REPORT ON GOVERNANCE, PERFORMANCE CRI12 TERIA, AND READINESS. 

13 Not later than 90 days after the date of the enact14 ment of this Act, the Secretary of Veterans Affairs shall 

15 submit to the appropriate congressional committees a re16 port describing the following: 

17 (1) The clinical decision making structure of 

18 the Department of Veterans Affairs and efforts to 

19 achieve a more uniform clinical decision making 

20 structure, pertaining to the Electronic Health 

21 Record Modernization Program, including— 

22 (A) new service requirements; 

23 (B) workflow decisions; 

24 (C) change requests; and 

25 (D) interface needs. 


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1 (2) The criteria or metrics used by the Sec2 retary to measure improvements in the Electronic 

3 Health Record Modernization Program with respect 

4 to— 

5 (A) end user experience; 

6 (B) system stability; 

7 (C) training; 

8 (D) help desk ticket management; configu9 ration; and 

10 (E) any other criteria or metrics deter11 mined appropriate by the Secretary. 

12 (3) The most recent data reported pursuant to 

13 criteria or metrics described in paragraph (2) from 

14 each facility of the Veterans Health Administration 

15 using the electronic health record system imple16 mented pursuant to the Electronic Health Record 

17 Modernization Program. 

18 (4) A description of steps being taken by the 

19 Secretary to achieve performance goals relevant to 

20 criteria or metrics described in paragraph (2). 

21 (5) The standard readiness task list used in fa22 cilities of the Veterans Health Administration to 

23 prepare for implementation of the electronic health 

24 record system pursuant to the Electronic Health 

25 Record Modernization Program. 


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1 TITLE VI—OVERSIGHT AND 

2 INVESTIGATIONS MATTERS 

3 SEC. 601. DEPARTMENT OF VETERANS AFFAIRS EMPLOYEE 

4 TRAINING REGARDING OFFICE OF INSPEC5 TOR GENERAL. 

6 (a) TRAINING.—The Secretary of Veterans Affairs 

7 shall require each employee of the Department of Veterans 

8 Affairs who begins employment with the Department on 

9 or after the date of the enactment of this Act to receive 

10 training that the Inspector General of the Department 

11 shall develop on the reporting of wrongdoing to, respond12 ing to requests from, and the duty of cooperating with 

13 the Office of Inspector General of the Department. 

14 (b) TIMING OF TRAINING.—In carrying out sub15 section (a), the Secretary shall require each employee of 

16 the Department covered under such subsection to undergo 

17 the training required by such subsection not later than 

18 one year after the date on which the employee begins em19 ployment with the Department. 

20 (c) ELEMENTS.—Training developed and required 

21 under subsection (a) shall include the following: 

22 (1) Definition of the role, responsibilities, and 

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1 ment for engaging with the Office of Inspector Gen2 eral. 

3 (2) Identification of Federal whistleblower pro4 tection rights, including the right to report fraud, 

5 waste, abuse, and other wrongdoing to Congress. 

6 (3) Identification of the circumstances and 

7 mechanisms for reporting fraud, waste, abuse, and 

8 other wrongdoing to the Inspector General, including 

9 making confidential complaints to the Inspector 

10 General. 

11 (4) Identification of the prohibitions and rem12 edies that help to protect employees of the Depart13 ment from retaliation when reporting wrongdoing to 

14 the Inspector General. 

15 (5) Recognition of opportunities to engage with 

16 staff of the Office of Inspector General to improve 

17 programs, operations, and services of the Depart18 ment. 

19 (6) Notification of the authority of the Inspec20 tor General to subpoena the attendance and testi21 mony of witnesses, including former employees of 

22 the Department, as necessary to carry out the duties 

23 of the Office of Inspector General under section 312 

24 of title 38, United States Code. 


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1 (d) DESIGN AND UPDATE.—The Inspector General of 

2 the Department shall design, and update as the Inspector 

3 General considers appropriate, the training developed and 

4 required by subsection (a). 

5 (e) SYSTEM.—The Secretary shall provide, via the 

6 talent management system of the Department, or suc7 cessor system, the training developed and required under 

8 subsection (a). 

9 (f) RELATION TO CERTAIN TRAINING.—The Sec10 retary shall ensure that training developed and required 

11 under subsection (a) is separate and distinct from training 

12 provided under section 733 of title 38, United States 

13 Code. 

14 (g) NOTICE TO EMPLOYEES.—The Secretary shall 

15 ensure that the Inspector General is afforded the oppor16 tunity, not less frequently than twice each year and more 

17 frequently if the Inspector General considers appropriate 

18 under extraordinary circumstances, to use the electronic 

19 mail system of the Department to notify all authorized 

20 users of such system of the following: 

21 (1) The roles and responsibilities of the employ22 ees of the Department when engaging with the Of23 fice of Inspector General. 

24 (2) The availability of training provided under 

25 subsection (a). 


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1 (3) How to access training provided under sub2 section (a). 

3 (4) Information about how to contact the Office 

4 of Inspector General, including a link to any 

5 website-based reporting form of the Office. 

6 SEC. 602. ANNUAL REVIEW OF SECURITY AT COVERED FA7 CILITIES OF THE DEPARTMENT OF VET8 ERANS AFFAIRS. 

9 (a) ANNUAL SURVEY.—Not later than one year after 

10 the date of the enactment of this Act, and annually there11 after for each of the following five fiscal years, the Sec12 retary of Veterans Affairs, in coordination with the Direc13 tor of the Office of Security and Law Enforcement of the 

14 Department of Veterans Affairs, shall conduct a survey 

15 of the covered employees at each covered facility to collect 

16 information regarding security. Each annual survey shall 

17 include questions about— 

18 (1) the type and frequency of criminal activity 

19 experienced at the covered facility during the fiscal 

20 year which most recently concluded including wheth21 er or not the criminal activity was related to resi22 dents at the facility or campus such as those in a 

23 residential rehabilitation treatment program or en24 hanced-use lease facility; 


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1 (2) the number of vacancies and number of 

2 days vacant for Department police officers at the 

3 covered facility at the time of the survey delineated 

4 by recruitment status and stage; 

5 (3) the availability and adequacy of covered 

6 equipment; 

7 (4) the availability and adequacy of resources, 

8 classes, or other time set aside for training Depart9 ment police officers who work at each covered facil10 ity about any skill or tactic related to law enforce11 ment, including the proper use of force, firearms 

12 qualifications and training, procedures for respond13 ing to an active threat, and any other training re14 quired for Department police officers; 

15 (5) any security weakness at covered facilities; 

16 (6) the relationship between the covered facility 

17 (including the Department police officers who work 

18 at the covered facility) and local, state, and federal 

19 law enforcement agencies including what agreements 

20 or memorandums of understanding exist between 

21 each covered facility and external law enforcement 

22 agencies; 

23 (7) efforts by the personnel of the covered facil24 ity to address and reduce criminal activity at, or in 

25 close proximity to, the covered facility; and 


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1 (8) recommendations for the Secretary to better 

2 address and reduce criminal activity at, or in close 

3 proximity to, covered facilities so as to improve the 

4 safety of veterans, employees, visitors, other author5 ized personnel, and the surrounding community. 

6 (b) REPORT.—Not later than 30 days after the end 

7 of the next full Fiscal Year after the enactment of this 

8 Act and for each of the following five fiscal years, the Sec9 retary shall submit to each of the Committees on Vet10 erans’ Affairs of the Senate and the House of Representa11 tives a report regarding the results of the surveys con12 ducted under subsection (a) during the previous fiscal 

13 year. The report shall include— 

14 (1) the results of the annual survey described 

15 under subsection (a) for the year covered by the re16 port; 

17 (2) an analysis, made in coordination with the 

18 Director of the Office of Security and Law Enforce19 ment of such Department, each director and police 

20 chief of a Veterans Integrated Service Network, and 

21 the directors and police chiefs of the medical centers 

22 within the Veterans Integrated Service Network of 

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1 dress any security weakness identified in the results 

2 of the triannual security inspections and includes 

3 clearly-stated goals with measurable benchmarks for 

4 each goal and deadlines for each benchmark; and 

5 (3) a list of all vacant positions for police chief 

6 or deputy police chief at each covered facility during 

7 the prior fiscal year, the number of individuals who 

8 filled those positions over the two years prior to the 

9 date of the survey, the number of days the positions 

10 were vacant without someone serving in an acting 

11 capacity, and the number of days the positions were 

12 filled by individuals serving in an acting capacity. 

13 (c) DEFINITIONS.—In this section: 

14 (1) The term ‘‘covered equipment’’ means any 

15 item issued by the Secretary of Veterans Affairs to 

16 a Department police officer (including firearms, 

17 weapons detecting technology, ballistic vests, body18 worn cameras, and radios) for use in the provision 

19 of services under section 902 of title 38, United 

20 States Code. 

21 (2) The term ‘‘covered employee’’ means an em22 ployee of the Department of Veterans Affairs who is 

23 employed and responsible for security operations at 

24 a covered facility including a covered facility’s police 

25 chief, facility emergency management leader, facility 


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1 director, or person carrying out the responsibilities 

2 of one of these positions in an acting capacity. 

3 (3) The term ‘‘covered facility’’ means any fa4 cility of the Department of Veterans Affairs where 

5 Department police officers have jurisdiction. 

6 (4) The term ‘‘Department police officer’’ has 

7 the meaning given to such term as used in section 

8 902 of title 38, United States Code. 

9 (5) The term ‘‘security weakness’’ means a defi10 ciency in the facilities, staffing, or covered equip11 ment at a covered facility that a covered employee 

12 of the covered facility determines presents a risk to 

13 the safety of visitors or staff, including an unsecured 

14 door, inoperable security camera, unsecured police 

15 operations room, a lack of security presence at an 

16 entrance to the covered facility, and a lack of secu17 rity presence in an area of the covered facility or the 

18 grounds of the covered facility that the director of 

19 the covered facility determines requires an increased 

20 security presence. 

21 SEC. 603. MODIFICATION OF CERTAIN HOUSING LOAN 

22 FEES. 

23 The loan fee table in section 3729(b)(2) of title 38, 

24 United States Code, is amended by striking ‘‘November 


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1 15, 2031’’ each place it appears and inserting ‘‘September 

2 30, 2034’’. 

Æ 


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