II 

113TH CONGRESS 

1ST SESSION S. 543 

To require the Secretary of Veterans Affairs to reorganize the Veterans 

Integrated Service Networks of the Veterans Health Administration, and 

for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MARCH 13, 2013 

Mr. BURR (for himself and Mr. COBURN) introduced the following bill; which 

was read twice and referred to the Committee on Veterans’ Affairs 

A BILL 

To require the Secretary of Veterans Affairs to reorganize 

the Veterans Integrated Service Networks of the Veterans Health Administration, 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. 

4 This Act may be cited as the ‘‘VISN Reorganization 

5 Act of 2013’’. 

6 SEC. 2. ADMINISTRATION OF VETERANS INTEGRATED 

7 SERVICE NETWORKS. 

8 (a) VETERANS INTEGRATED SERVICE NETWORKS.— 


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1 (1) IN GENERAL.—Subchapter I of chapter 73 

2 of title 38, United States Code, is amended by add3 ing at the end the following new section: 

4 ‘‘§ 7310. Veterans Integrated Service Networks 

5 ‘‘(a) ORGANIZATION.—The Secretary shall organize 

6 the Veterans Health Administration in 12 geographically 

7 defined Veterans Integrated Service Networks. 

8 ‘‘(b) ALIGNMENT WITH MISSION OF DEPART9 MENT.—The Secretary shall ensure that the staff, serv10 ices, and programs of each Veterans Integrated Service 

11 Network are aligned with the mission of the Department 

12 and the specific health care requirements of each popu13 lation of veterans in each Network. 

14 ‘‘(c) IMPLEMENTATION OF NATIONAL GOALS.—The 

15 Secretary shall ensure that each Veterans Integrated Serv16 ice Network takes appropriate measures to implement the 

17 national goals of the Department within their networks 

18 and associated medical centers. 

19 ‘‘(d) INTEGRATED HEALTH CARE SYSTEM.—The 

20 Secretary shall ensure that each Veterans Integrated Serv21 ice Network maintains a regional integrated healthcare 

22 system by— 

23 ‘‘(1) implementing alliances with such other 

24 governmental, public, and private health care organi25 zations and practitioners as the Secretary considers 


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1 appropriate to meet the needs of veterans in the 

2 Network; 

3 ‘‘(2) providing oversight and management of, 

4 and taking responsibility for, a regional budget for 

5 the activities of the Veterans Health Administration 

6 in the geographic area of the Network that— 

7 ‘‘(A) is aligned with the budget guidelines 

8 of the Department and the Veterans Health 

9 Administration; and 

10 ‘‘(B) is balanced at the end of each fiscal 

11 year; 

12 ‘‘(3) using national metrics to develop systems 

13 to provide effective, efficient, and safe delivery of 

14 health care that is rated as highly satisfactory by 

15 patients and families of patients; and 

16 ‘‘(4) ensuring high quality clinical programs 

17 and services are rendered in and through— 

18 ‘‘(A) the medical centers and outpatient 

19 clinics of the Department that are located in 

20 the Network; and 

21 ‘‘(B) other non-Department clinical or 

22 health care delivery settings located in the Net23 work. 

24 ‘‘(e) REDUCTION IN DUPLICATE FUNCTIONS.—The 

25 Secretary shall ensure that the Veterans Integrated ServVerDate Mar 14 2013 03:04 Mar 20, 2013 Jkt 029200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S543.IS S543

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1 ice Networks identify and reduce, whenever practicable, 

2 the duplication of functions in clinical, administrative, and 

3 operational processes and practices of the Veterans Health 

4 Administration. 

5 ‘‘(f) COLLABORATION AND COOPERATION.—The Sec6 retary shall ensure that each Veteran Integrated Service 

7 Network— 

8 ‘‘(1) works to achieve maximum effectiveness in 

9 patient care and safety, graduate medical education, 

10 and research; and 

11 ‘‘(2) assesses the consolidation or realignment 

12 of institutional functions, including capital asset, 

13 safety, and operational support functions, in collabo14 ration and cooperation with other Veterans Inte15 grated Service Networks and the following offices or 

16 entities within the geographical area of the Network: 

17 ‘‘(A) The offices of the Veterans Benefits 

18 Administration and the National Cemetery Ad19 ministration. 

20 ‘‘(B) The offices, installations, and facili21 ties of the Department of Defense, including 

22 the offices, installations, and facilities of each 

23 branch of the Armed Forces and the reserve 

24 components of the Armed Forces. 


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1 ‘‘(C) The offices, installations, and facili2 ties of the Coast Guard. 

3 ‘‘(D) Offices of State and local agencies 

4 that have a mission to provide assistance to vet5 erans. 

6 ‘‘(E) Medical schools and other affiliates. 

7 ‘‘(F) Offices of Congress, offices of State 

8 and local elected officials, and other government 

9 offices. 

10 ‘‘(G) Federal, State and local emergency 

11 preparedness organizations. 

12 ‘‘(H) Community and faith-based organiza13 tions. 

14 ‘‘(I) Such other offices of the Federal Gov15 ernment as the Secretary considers appropriate. 

16 ‘‘(g) DEVELOPMENT AND SHARING OF INNOVATIONS

17 AND PRACTICES.—The Secretary shall ensure that the 

18 Veterans Integrated Service Networks develop and share 

19 innovations and best practices with each other at the local, 

20 regional, and national levels. 

21 ‘‘(h) HEADQUARTERS.—(1) The Secretary shall en22 sure that each Veterans Integrated Service Network has 

23 only one headquarters office. 

24 ‘‘(2) The location of a headquarters office for a Vet25 erans Integrated Service Network shall be determined by 


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1 the Secretary and co-located with a Department of Vet2 erans Affairs medical center. 

3 ‘‘(3)(A) The Secretary may employ or contract for 

4 the services of not more than 65 full time equivalent em5 ployees and contractors at the headquarters of each Vet6 erans Integrated Service Network. 

7 ‘‘(B) Not less frequently than once each year, the 

8 Secretary shall submit to the Committee on Veterans’ Af9 fairs of the Senate and the Committee on Veterans’ Af10 fairs of the House of Representatives a report on employ11 ment at the headquarters of Veterans Integrated Service 

12 Networks during the most recently completed fiscal year. 

13 ‘‘(C) Each report submitted under subparagraph (B) 

14 shall include the following for the year covered by the re15 port: 

16 ‘‘(i) The number of individuals employed at 

17 each headquarters of a Veterans Integrated Service 

18 Network. 

19 ‘‘(ii) The number of individuals employed by the 

20 Veterans Health Administration in each Veterans 

21 Integrated Service Network who are not employed at 

22 the same location as the headquarters of the Net23 work. 


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1 ‘‘(iii) The title for each position of employment 

2 at a headquarters of a Veterans Integrated Service 

3 Network. 

4 ‘‘(iv) The title for each position of employment 

5 with the Veterans Health Administration in each 

6 Veterans Integrated Service Network that is not at 

7 the same location as the headquarters of the Net8 work. 

9 ‘‘(v) An assessment of the impact on the budget 

10 of the Department by the employment of individuals 

11 at the headquarters of the Veterans Integrated Serv12 ice Networks. 

13 ‘‘(i) TRIENNIAL STRUCTURE REVIEW, REASSESS14 MENT, AND REPORT.—(1) Beginning three years after the 

15 date of the enactment of this section and not less fre16 quently than once every three years thereafter, the Sec17 retary shall conduct a review and assessment of the struc18 ture and operations of the Veterans Integrated Service 

19 Networks. 

20 ‘‘(2) Not later than 180 days after conducting a re21 view and assessment under paragraph (1), the Secretary 

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

23 Senate and the Committee on Veterans’ Affairs of the 

24 House of Representatives a report on such review and as25 sessment, which shall include such recommendations for 


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1 legislative or regulatory action as the Secretary considers 

2 appropriate to improve the Veterans Integrated Service 

3 Networks.’’. 

4 (2) CLERICAL AMENDMENT.—The table of sec5 tions at the beginning of chapter 73 of such title is 

6 amended by inserting after the item relating to sec7 tion 7309 the following new item: 

‘‘7310. Veterans Integrated Service Networks.’’. 

8 (b) CONSOLIDATION OF NETWORKS.— 

9 (1) IN GENERAL.—In order to comply with sec10 tion 7310(a) of title 38, United States Code, as 

11 added by subsection (a), not later than one year 

12 after the date of the enactment of this Act, the Sec13 retary of Veterans Affairs shall geographically re14 align and combine the 21 Veterans Integrated Serv15 ice Networks in effect on the day before the date of 

16 the enactment of this Act into 12 geographically de17 fined Veterans Integrated Service Networks as fol18 lows: 

19 (A) Veterans Integrated Service Network 

20 1, Veterans Integrated Service Network 2, and 

21 Veterans Integrated Service Network 3 shall be 

22 combined into a single Veterans Integrated 

23 Service Network. 

24 (B) Veterans Integrated Service Network 4 

25 and Veterans Integrated Service Network 5 


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1 shall be combined into a single Veterans Inte2 grated Service Network. 

3 (C) Veterans Integrated Service Network 9 

4 and Veterans Integrated Service Network 10 

5 shall be combined into a single Veterans Inte6 grated Service Network. 

7 (D) Veterans Integrated Service Network 

8 11 and Veterans Integrated Service Network 12 

9 shall be combined into a single Veterans Inte10 grated Service Network. 

11 (E) Veterans Integrated Service Network 

12 15 and Veterans Integrated Service Network 23 

13 shall be combined into a single Veterans Inte14 grated Service Network. 

15 (F) Veterans Integrated Service Network 

16 17 and Veterans Integrated Service Network 18 

17 shall be combined into a single Veterans Inte18 grated Service Network. 

19 (G) Veterans Integrated Service Network 

20 19 and Veterans Integrated Service Network 20 

21 shall be combined into a single Veterans Inte22 grated Service Network. 

23 (H) Veterans Integrated Service Network 

24 21 and Veterans Integrated Service Network 22 


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1 shall be combined into a single Veterans Inte2 grated Service Network. 

3 (2) CONSOLIDATION OF HEADQUARTERS.— 

4 (A) IN GENERAL.—Except as provided in 

5 subsection (c), for each set of Veterans Inte6 grated Service Networks consolidated under 

7 paragraph (1), the Secretary shall retain one of 

8 the headquarters of such set in effect on the 

9 day before the date of the enactment of this Act 

10 in the same location as in effect on the day be11 fore such date and eliminate any other head12 quarters of such set to meet the requirements 

13 of section 7310(h) of such title, as added by 

14 subsection (a). 

15 (B) REEMPLOYMENT ASSISTANCE.—For 

16 each individual whose position of employment is 

17 eliminated as a result of eliminating a head18 quarters under subparagraph (A), the Secretary 

19 shall take such measures as the Secretary con20 siders practicable to find a new position of em21 ployment for such individual within the Depart22 ment of Veterans Affairs. 

23 (3) IMPLEMENTATION PLAN.—Not later than 

24 180 days after the date of the enactment of this Act, 

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1 erans’ Affairs of the Senate and the Committee on 

2 Veterans’ Affairs of the House of Representatives a 

3 plan to carry out this subsection. 

4 (c) RELOCATION OF HEADQUARTERS.— 

5 (1) IN GENERAL.—In the case of a head6 quarters office of a Veterans Integrated Service Net7 work that on the day before the date of the enact8 ment of this Act was in a location that was not co9 located with a Department of Veterans Affairs med10 ical center and the Secretary is engaged in a lease 

11 for such location, the Secretary may— 

12 (A) relocate such headquarters upon the 

13 expiration of such lease so that such head14 quarters is co-located as required by section 

15 7310(h)(2) of such title, as added by subsection 

16 (a); or 

17 (B) notwithstanding section 7310(h)(2) of 

18 such title, as so added, renew such lease or 

19 enter into a new lease to keep such head20 quarters in such location. 

21 (2) REPORT.—If the Secretary renews a lease 

22 or engages in a new lease under paragraph (1)(B), 

23 the Secretary shall submit to the Committee on Vet24 erans’ Affairs of the Senate and the Committee on 

25 Veterans’ Affairs of the House of Representatives, 


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1 before renewing such lease or engaging in such 

2 lease, a report describing the reasons for such re3 newal or engagement. Such report shall include the 

4 following: 

5 (A) A list of Department of Veterans Af6 fairs medical centers in the Veterans Integrated 

7 Service Network of the headquarters with un8 derutilized buildings, the number of such build9 ings, and the total underutilized square footage 

10 for each such medical center. 

11 (B) The cost of the current lease (the an12 nual amount of rent, the total cost over the life 

13 of the lease, and the total cost per square foot) 

14 and the current square footage being leased. 

15 (C) The cost of the new lease (the annual 

16 amount of rent, the total cost over the life of 

17 the lease, and the total cost per square foot) 

18 and the square footage to be leased. 

19 SEC. 3. REGIONAL SUPPORT CENTERS FOR VETERANS IN20 TEGRATED SERVICE NETWORKS. 

21 (a) REGIONAL SUPPORT CENTERS.— 

22 (1) IN GENERAL.—Subchapter I of chapter 73 

23 of title 38, United States Code, as amended by sec24 tion 2(a), is further amended by adding at the end 

25 the following new section: 


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1 ‘‘§ 7310A. Regional support centers for Veterans Inte2 grated Service Networks 

3 ‘‘(a) ESTABLISHMENT.—The Secretary shall estab4 lish not more than four regional support centers within 

5 the Veterans Health Administration to assess the effec6 tiveness and efficiency of the Veterans Integrated Service 

7 Networks. The head of each regional support center shall 

8 report to the Under Secretary of Health. 

9 ‘‘(b) FUNCTIONS.—The functions of the regional sup10 port centers established under subsection (a) are as fol11 lows: 

12 ‘‘(1) To assess the quality of work performed 

13 within finance operations and other compliance re14 lated activities of the Veterans Integrated Service 

15 Networks. 

16 ‘‘(2) To assess how effectively and efficiently 

17 each Veterans Integrated Service Network conducts 

18 outreach to veterans who served in Operation En19 during Freedom, Operation Iraqi Freedom, Oper20 ation New Dawn, or another contingency operation 

21 (as defined in section 101 of title 10). 

22 ‘‘(3) To assess how effectively and efficiently 

23 each Veterans Integrated Service Network conducts 

24 programs for the benefit of women veterans. 

25 ‘‘(4) To assess how effectively and efficiently 

26 each Veterans Integrated Service Network conducts 


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1 programs that address homelessness among vet2 erans. 

3 ‘‘(5) To assess how effectively and efficiently 

4 each Veterans Integrated Service Network consumes 

5 energy. 

6 ‘‘(6) To assess such other matters concerning 

7 the operations and activities of the Veterans Inte8 grated Service Networks as the Secretary considers 

9 appropriate. 

10 ‘‘(c) STAFF.—The Secretary may hire such employ11 ees and contractors as the Secretary considers appropriate 

12 to carry out the functions of the regional support centers. 

13 ‘‘(d) LOCATION OF REGIONAL SUPPORT CENTERS.— 

14 (1) Except as provided in paragraph (2), the location of 

15 each regional support center established under subsection 

16 (a) shall be determined by the Secretary and co-located 

17 with a Department of Veterans Affairs medical center. 

18 ‘‘(2) The Secretary may choose a location for a re19 gional support center established under subsection (a) that 

20 is not co-located with a Department of Veterans Affairs 

21 medical center if the Secretary submits to the Committee 

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

23 Veterans’ Affairs of the House of Representatives, before 

24 engaging in a lease for such location, a report explaining 

25 the reasons for the choice of the Secretary of a location 


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1 for the regional support center that is not co-located with 

2 a Department of Veterans Affairs medical center. Such 

3 report shall include the following: 

4 ‘‘(A) A list of Department of Veterans Affairs 

5 medical centers in the Veterans Integrated Service 

6 Network of the regional support center with under7 utilized buildings, the number of all Veterans Health 

8 Administration buildings in such Network, and the 

9 total underutilized square footage for each medical 

10 center in such Network. 

11 ‘‘(B) In the case that the Secretary engages in 

12 a lease for the location of the regional support cen13 ter, the cost of such lease (the annual amount of 

14 rent, the total cost over the life of the lease, and the 

15 total cost per square foot) and the square footage to 

16 be leased.’’. 

17 (2) CLERICAL AMENDMENT.—The table of sec18 tions at the beginning of chapter 73 of such title, as 

19 amended by section 2(a)(2), is further amended by 

20 inserting after the item relating to section 7310 the 

21 following new item: 

‘‘7310A. Regional support centers for Veterans Integrated Service Networks.’’. 

22 (b) INITIAL STAFFING.—In providing for the initial 

23 staff of each regional support center established under sec24 tion 7310A(a) of title 38, United States Code, as added 

25 by subsection (a), the Secretary of Veterans Affairs shall, 


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1 to the extent practicable, transfer employees who were em2 ployed in positions at headquarters of Veterans Integrated 

3 Service Networks that covered functions similar to those 

4 described in section 7310A(b) of such title, as so added, 

5 from such headquarters to regional support centers. 

6 SEC. 4. CONSTRUCTION. 

7 Nothing in this Act shall be construed to require any 

8 change in the location or type of medical care or service 

9 provided by a Department of Veterans Affairs medical 

10 center, a Department community-based outpatient clinic, 

11 a center for readjustment counseling and related mental 

12 health services for veterans under section 1712A of title 

13 38, United States Code (known as a ‘‘vet center’’), or an14 other facility that provides direct care or services under 

15 a law administered by the Secretary of Veterans Affairs. 

Æ 


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