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[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3230 Enrolled Bill (ENR)]

        H.R.3230

                     One Hundred Thirteenth Congress

                                 of the

                        United States of America

                          AT THE SECOND SESSION

           Begun and held at the City of Washington on Friday,
           the third day of January, two thousand and fourteen

                                 An Act

 
     To improve the access of veterans to medical services from the 
         Department of Veterans Affairs, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
    (a) Short Title.--This Act may be cited as the ``Veterans Access, 
Choice, and Accountability Act of 2014''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Definitions.

 TITLE I--IMPROVEMENT OF ACCESS TO CARE FROM NON-DEPARTMENT OF VETERANS 
                            AFFAIRS PROVIDERS

Sec. 101. Expanded availability of hospital care and medical services 
          for veterans through the use of agreements with non-Department 
          of Veterans Affairs entities.
Sec. 102. Enhancement of collaboration between Department of Veterans 
          Affairs and Indian Health Service.
Sec. 103. Enhancement of collaboration between Department of Veterans 
          Affairs and Native Hawaiian health care systems.
Sec. 104. Reauthorization and modification of pilot program of enhanced 
          contract care authority for health care needs of veterans.
Sec. 105. Prompt payment by Department of Veterans Affairs.
Sec. 106. Transfer of authority for payments for hospital care, medical 
          services, and other health care from non-Department of 
          Veterans Affairs providers to the chief business office of the 
          Veterans Health Administration.

              TITLE II--HEALTH CARE ADMINISTRATIVE MATTERS

Sec. 201. Independent assessment of the health care delivery systems and 
          management processes of the Department of Veterans Affairs.
Sec. 202. Commission on Care.
Sec. 203. Technology task force on review of scheduling system and 
          software of the Department of Veterans Affairs.
Sec. 204. Improvement of access of veterans to mobile vet centers and 
          mobile medical centers of the Department of Veterans Affairs.
Sec. 205. Improved performance metrics for health care provided by 
          Department of Veterans Affairs.
Sec. 206. Improved transparency concerning health care provided by 
          Department of Veterans Affairs.
Sec. 207. Information for veterans on the credentials of Department of 
          Veterans Affairs physicians.
Sec. 208. Information in annual budget of the President on hospital care 
          and medical services furnished through expanded use of 
          contracts for such care.
Sec. 209. Prohibition on falsification of data concerning wait times and 
          quality measures at Department of Veterans Affairs.

   TITLE III--HEALTH CARE STAFFING, RECRUITMENT, AND TRAINING MATTERS

Sec. 301. Treatment of staffing shortage and biennial report on staffing 
          of medical facilities of the Department of Veterans Affairs.
Sec. 302. Extension and modification of certain programs within the 
          Department of Veterans Affairs Health Professionals 
          Educational Assistance Program.
Sec. 303. Clinic management training for employees at medical facilities 
          of the Department of Veterans Affairs.

             TITLE IV--HEALTH CARE RELATED TO SEXUAL TRAUMA

Sec. 401. Expansion of eligibility for sexual trauma counseling and 
          treatment to veterans on inactive duty training.
Sec. 402. Provision of counseling and treatment for sexual trauma by the 
          Department of Veterans Affairs to members of the Armed Forces.
Sec. 403. Reports on military sexual trauma.

                   TITLE V--OTHER HEALTH CARE MATTERS

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

                 TITLE VI--MAJOR MEDICAL FACILITY LEASES

Sec. 601. Authorization of major medical facility leases.
Sec. 602. Budgetary treatment of Department of Veterans Affairs major 
          medical facilities leases.

                    TITLE VII--OTHER VETERANS MATTERS

Sec. 701. Expansion of Marine Gunnery Sergeant John David Fry 
          Scholarship.
Sec. 702. Approval of courses of education provided by public 
          institutions of higher learning for purposes of All-Volunteer 
          Force Educational Assistance Program and Post-9/11 Educational 
          Assistance conditional on in-State tuition rate for veterans.
Sec. 703. Extension of reduction in amount of pension furnished by 
          Department of Veterans Affairs for certain veterans covered by 
          Medicaid plans for services furnished by nursing facilities.
Sec. 704. Extension of requirement for collection of fees for housing 
          loans guaranteed by Secretary of Veterans Affairs.
Sec. 705. Limitation on awards and bonuses paid to employees of 
          Department of Veterans Affairs.
Sec. 706. Extension of authority to use income information.
Sec. 707. Removal of senior executives of the Department of Veterans 
          Affairs for performance or misconduct.

                        TITLE VIII--OTHER MATTERS

Sec. 801. Appropriation of amounts.
Sec. 802. Veterans Choice Fund.
Sec. 803. Emergency designations.
SEC. 2. DEFINITIONS.
    In this Act:
        (1) The term ``facility of the Department'' has the meaning 
    given the term ``facilities of the Department'' in section 1701 of 
    title 38, United States Code.
        (2) The terms ``hospital care'' and ``medical services'' have 
    the meanings given such terms in section 1701 of title 38, United 
    States Code.

TITLE I--IMPROVEMENT OF ACCESS TO CARE FROM NON-DEPARTMENT OF VETERANS 
                           AFFAIRS PROVIDERS

    SEC. 101. EXPANDED AVAILABILITY OF HOSPITAL CARE AND MEDICAL 
      SERVICES FOR VETERANS THROUGH THE USE OF AGREEMENTS WITH NON-
      DEPARTMENT OF VETERANS AFFAIRS ENTITIES.
    (a) Expansion of Available Care and Services.--
        (1) Furnishing of care.--
            (A) In general.--Hospital care and medical services under 
        chapter 17 of title 38, United States Code, shall be furnished 
        to an eligible veteran described in subsection (b), at the 
        election of such veteran, through agreements authorized under 
        subsection (d), or any other law administered by the Secretary 
        of Veterans Affairs, with entities specified in subparagraph 
        (B) for the furnishing of such care and services to veterans.
            (B) Entities specified.--The entities specified in this 
        subparagraph are the following:
                (i) Any health care provider that is participating in 
            the Medicare program under title XVIII of the Social 
            Security Act (42 U.S.C. 1395 et seq.), including any 
            physician furnishing services under such program.
                (ii) Any Federally-qualified health center (as defined 
            in section 1905(l)(2)(B) of the Social Security Act (42 
            U.S.C. 1396d(l)(2)(B))).
                (iii) The Department of Defense.
                (iv) The Indian Health Service.
        (2) Choice of provider.--An eligible veteran who makes an 
    election under subsection (c) to receive hospital care or medical 
    services under this section may select a provider of such care or 
    services from among the entities specified in paragraph (1)(B) that 
    are accessible to the veteran.
        (3) Coordination of care and services.--The Secretary shall 
    coordinate, through the Non-VA Care Coordination Program of the 
    Department of Veterans Affairs, the furnishing of care and services 
    under this section to eligible veterans, including by ensuring that 
    an eligible veteran receives an appointment for such care and 
    services within the wait-time goals of the Veterans Health 
    Administration for the furnishing of hospital care and medical 
    services.
    (b) Eligible Veterans.--A veteran is an eligible veteran for 
purposes of this section if--
        (1)(A) as of August 1, 2014, the veteran is enrolled in the 
    patient enrollment system of the Department of Veterans Affairs 
    established and operated under section 1705 of title 38, United 
    States Code, including any such veteran who has not received 
    hospital care or medical services from the Department and has 
    contacted the Department seeking an initial appointment from the 
    Department for the receipt of such care or services; or
        (B) the veteran is eligible for hospital care and medical 
    services under section 1710(e)(1)(D) of such title and is a veteran 
    described in section 1710(e)(3) of such title; and
        (2) the veteran--
            (A) attempts, or has attempted, to schedule an appointment 
        for the receipt of hospital care or medical services under 
        chapter 17 of title 38, United States Code, but is unable to 
        schedule an appointment within the wait-time goals of the 
        Veterans Health Administration for the furnishing of such care 
        or services;
            (B) resides more than 40 miles from the medical facility of 
        the Department, including a community-based outpatient clinic, 
        that is closest to the residence of the veteran;
            (C) resides--
                (i) in a State without a medical facility of the 
            Department that provides--

                    (I) hospital care;
                    (II) emergency medical services; and
                    (III) surgical care rated by the Secretary as 
                having a surgical complexity of standard; and

                (ii) more than 20 miles from a medical facility of the 
            Department described in clause (i); or
            (D)(i) resides in a location, other than a location in 
        Guam, American Samoa, or the Republic of the Philippines, that 
        is 40 miles or less from a medical facility of the Department, 
        including a community-based outpatient clinic; and
            (ii)(I) is required to travel by air, boat, or ferry to 
        reach each medical facility described in clause (i) that is 40 
        miles or less from the residence of the veteran; or
            (II) faces an unusual or excessive burden in accessing each 
        medical facility described in clause (i) that is 40 miles or 
        less from the residence of the veteran due to geographical 
        challenges, as determined by the Secretary.
    (c) Election and Authorization.--
        (1) In general.--In the case of an eligible veteran described 
    in subsection (b)(2)(A), the Secretary shall, at the election of 
    the eligible veteran--
            (A) place such eligible veteran on an electronic waiting 
        list described in paragraph (2) for an appointment for hospital 
        care or medical services the veteran has elected to receive 
        under this section; or
            (B)(i) authorize that such care or services be furnished to 
        the eligible veteran under this section for a period of time 
        specified by the Secretary; and
            (ii) notify the eligible veteran by the most effective 
        means available, including electronic communication or 
        notification in writing, describing the care or services the 
        eligible veteran is eligible to receive under this section.
        (2) Electronic waiting list.--The electronic waiting list 
    described in this paragraph shall be maintained by the Department 
    and allow access by each eligible veteran via www.myhealth.va.gov 
    or any successor website for the following purposes:
            (A) To determine the place of such eligible veteran on the 
        waiting list.
            (B) To determine the average length of time an individual 
        spends on the waiting list, disaggregated by medical facility 
        of the Department and type of care or service needed, for 
        purposes of allowing such eligible veteran to make an informed 
        election under paragraph (1).
    (d) Care and Services Through Agreements.--
        (1) Agreements.--
            (A) In general.--The Secretary shall enter into agreements 
        for furnishing care and services to eligible veterans under 
        this section with entities specified in subsection (a)(1)(B).
            (B) Agreement defined.--In this paragraph, the term 
        ``agreement'' includes contracts, intergovernmental agreements, 
        and provider agreements, as appropriate.
        (2) Rates and reimbursement.--
            (A) In general.--In entering into an agreement under 
        paragraph (1) with an entity specified in subsection (a)(1)(B), 
        the Secretary shall--
                (i) negotiate rates for the furnishing of care and 
            services under this section; and
                (ii) reimburse the entity for such care and services at 
            the rates negotiated pursuant to clause (i) as provided in 
            such agreement.
            (B) Limit on rates.--
                (i) In general.--Except as provided in clause (ii), 
            rates negotiated under subparagraph (A)(i) shall not be 
            more than the rates paid by the United States to a provider 
            of services (as defined in section 1861(u) of the Social 
            Security Act (42 U.S.C. 1395x(u))) or a supplier (as 
            defined in section 1861(d) of such Act (42 U.S.C. 
            1395x(d))) under the Medicare program under title XVIII of 
            the Social Security Act (42 U.S.C. 1395 et seq.) for the 
            same care or services.
                (ii) Exception.--

                    (I) In general.--The Secretary may negotiate a rate 
                that is more than the rate paid by the United States as 
                described in clause (i) with respect to the furnishing 
                of care or services under this section to an eligible 
                veteran who resides in a highly rural area.
                    (II) Highly rural area defined.--In this clause, 
                the term ``highly rural area'' means an area located in 
                a county that has fewer than seven individuals residing 
                in that county per square mile.

            (C) Limit on collection.--For the furnishing of care or 
        services pursuant to an agreement under paragraph (1), an 
        entity specified in subsection (a)(1)(B) may not collect any 
        amount that is greater than the rate negotiated pursuant to 
        subparagraph (A)(i).
        (3) Certain procedures.--
            (A) In general.--In entering into an agreement under 
        paragraph (1) with an entity described in subparagraph (B), the 
        Secretary may use the procedures, including those procedures 
        relating to reimbursement, available for entering into provider 
        agreements under section 1866(a) of the Social Security Act (42 
        U.S.C. 1395cc(a)) and participation agreements under section 
        1842(h) of such Act (42 U.S.C. 1395u(h)). During the period in 
        which such entity furnishes care or services pursuant to this 
        section, such entity may not be treated as a Federal contractor 
        or subcontractor by the Office of Federal Contract Compliance 
        Programs of the Department of Labor by virtue of furnishing 
        such care or services.
            (B) Entities described.--The entities described in this 
        subparagraph are the following:
                (i) In the case of the Medicare program, any provider 
            of services that has entered into a provider agreement 
            under section 1866(a) of the Social Security Act (42 U.S.C. 
            1395cc(a)) and any physician or other supplier who has 
            entered into a participation agreement under section 
            1842(h) of such Act (42 U.S.C. 1395u(h)); and
                (ii) In the case of the Medicaid program, any provider 
            participating under a State plan under title XIX of such 
            Act (42 U.S.C. 1396 et seq.).
        (4) Information on policies and procedures.--The Secretary 
    shall provide to any entity with which the Secretary has entered 
    into an agreement under paragraph (1) the following:
            (A) Information on applicable policies and procedures for 
        submitting bills or claims for authorized care or services 
        furnished to eligible veterans under this section.
            (B) Access to a telephone hotline maintained by the 
        Department that such entity may call for information on the 
        following:
                (i) Procedures for furnishing care and services under 
            this section.
                (ii) Procedures for submitting bills or claims for 
            authorized care and services furnished to eligible veterans 
            under this section and being reimbursed for furnishing such 
            care and services.
                (iii) Whether particular care or services under this 
            section are authorized, and the procedures for 
            authorization of such care or services.
    (e) Other Health-Care Plan.--
        (1) Submittal of information to secretary.--Before receiving 
    hospital care or medical services under this section, an eligible 
    veteran shall provide to the Secretary information on any health-
    care plan described in paragraph (4) under which the eligible 
    veteran is covered.
        (2) Disclosure of information to non-department entity.--
    Notwithstanding section 5701 of title 38, United States Code, for 
    purposes of furnishing hospital care or medical services to an 
    eligible veteran under this section, the Secretary shall disclose 
    to the entity specified in paragraph (1)(B) of subsection (a) with 
    which the Secretary has entered into an agreement described in such 
    subsection--
            (A) whether the eligible veteran is covered under a health-
        care plan described in paragraph (4); and
            (B) whether the hospital care or medical services sought by 
        the eligible veteran is for a medical condition that is related 
        to a non-service-connected disability described in paragraph 
        (3)(C).
        (3) Care for which the department is secondarily responsible.--
            (A) In general.--If an eligible veteran is covered under a 
        health-care plan described in paragraph (4) and receives 
        hospital care or medical services for a non-service-connected 
        disability described in subparagraph (C), such health-care plan 
        shall be primarily responsible for paying for such care or 
        services, to the extent such care or services is covered by 
        such health-care plan, and the Secretary shall be secondarily 
        responsible for paying for such care or services in accordance 
        with subparagraph (B)(ii).
            (B) Responsibility for costs of care.--In a case in which 
        the Secretary is secondarily responsible for paying for 
        hospital care or medical services as described in subparagraph 
        (A)--
                (i) the health care provider that furnishes such care 
            or services pursuant to an agreement described in 
            subsection (a) shall be responsible for seeking 
            reimbursement for the cost of such care or services from 
            the health-care plan described in paragraph (4) under which 
            the eligible veteran is covered; and
                (ii) the Secretary shall be responsible for promptly 
            paying only the amount that is not covered by such health-
            care plan, except that such responsibility for payment may 
            not exceed the rate determined for such care or services 
            pursuant to subsection (d)(2).
            (C) Non-service-connected disability described.--A non-
        service-connected disability described in this subsection is a 
        non-service-connected disability (as defined in section 101 of 
        title 38, United States Code)--
                (i) that is incurred incident to a veteran's employment 
            and that is covered under a workers' compensation law or 
            plan that provides for payment for the cost of health care 
            and services provided to the veteran by reason of the 
            disability;
                (ii) that is incurred as the result of a motor vehicle 
            accident to which applies a State law that requires the 
            owners or operators of motor vehicles registered in that 
            State to have in force automobile accident reparations 
            insurance;
                (iii) that is incurred as the result of a crime of 
            personal violence that occurred in a State, or a political 
            subdivision of a State, in which a person injured as the 
            result of such a crime is entitled to receive health care 
            and services at such State's or subdivision's expense for 
            personal injuries suffered as the result of such crime;
                (iv) that is incurred by a veteran--

                    (I) who does not have a service-connected 
                disability; and
                    (II) who is entitled to care (or payment of the 
                expenses of care) under a health-care plan; or

                (v) for which care and services are furnished under 
            this section to a veteran who--

                    (I) has a service-connected disability; and
                    (II) is entitled to care (or payment of the 
                expenses of care) under a health-care plan.

        (4) Health-care plan.--A health-care plan described in this 
    paragraph--
            (A) is an insurance policy or contract, medical or hospital 
        service agreement, membership or subscription contract, or 
        similar arrangement not administered by the Secretary of 
        Veterans Affairs, under which health services for individuals 
        are provided or the expenses of such services are paid; and
            (B) does not include any such policy, contract, agreement, 
        or similar arrangement pursuant to title XVIII or XIX of the 
        Social Security Act (42 U.S.C. 1395 et seq.) or chapter 55 of 
        title 10, United States Code.
    (f) Veterans Choice Card.--
        (1) In general.--For purposes of receiving care and services 
    under this section, the Secretary shall, not later than 90 days 
    after the date of the enactment of this Act, issue to each veteran 
    described in subsection (b)(1) a card that may be presented to a 
    health care provider to facilitate the receipt of care or services 
    under this section.
        (2) Name of card.--Each card issued under paragraph (1) shall 
    be known as a ``Veterans Choice Card''.
        (3) Details of card.--Each Veterans Choice Card issued to a 
    veteran under paragraph (1) shall include the following:
            (A) The name of the veteran.
            (B) An identification number for the veteran that is not 
        the social security number of the veteran.
            (C) The contact information of an appropriate office of the 
        Department for health care providers to confirm that care or 
        services under this section are authorized for the veteran.
            (D) Contact information and other relevant information for 
        the submittal of claims or bills for the furnishing of care or 
        services under this section.
            (E) The following statement: ``This card is for qualifying 
        medical care outside the Department of Veterans Affairs. Please 
        call the Department of Veterans Affairs phone number specified 
        on this card to ensure that treatment has been authorized.''.
        (4) Information on use of card.--Upon issuing a Veterans Choice 
    Card to a veteran, the Secretary shall provide the veteran with 
    information clearly stating the circumstances under which the 
    veteran may be eligible for care or services under this section.
    (g) Information on Availability of Care.--The Secretary shall 
provide information to a veteran about the availability of care and 
services under this section in the following circumstances:
        (1) In the case of a veteran described in subsection (b)(1)(B), 
    when the veteran enrolls in the patient enrollment system of the 
    Department under section 1705 of title 38, United States Code.
        (2) When the veteran attempts to schedule an appointment for 
    the receipt of hospital care or medical services from the 
    Department but is unable to schedule an appointment within the 
    wait-time goals of the Veterans Health Administration for the 
    furnishing of such care or services.
        (3) When the veteran becomes eligible for hospital care or 
    medical services under this section under subparagraph (B), (C), or 
    (D) of subsection (b)(2).
    (h) Follow-Up Care.--In carrying out this section, the Secretary 
shall ensure that, at the election of an eligible veteran who receives 
hospital care or medical services from a health care provider in an 
episode of care under this section, the veteran receives such hospital 
care and medical services from such health care provider through the 
completion of the episode of care (but for a period not exceeding 60 
days), including all specialty and ancillary services deemed necessary 
as part of the treatment recommended in the course of such hospital 
care or medical services.
    (i) Providers.--To be eligible to furnish care or services under 
this section, a health care provider must--
        (1) maintain at least the same or similar credentials and 
    licenses as those credentials and licenses that are required of 
    health care providers of the Department, as determined by the 
    Secretary for purposes of this section; and
        (2) submit, not less frequently than once each year during the 
    period in which the Secretary is authorized to carry out this 
    section pursuant to subsection (p), verification of such licenses 
    and credentials maintained by such health care provider.
    (j) Cost-Sharing.--
        (1) In general.--The Secretary shall require an eligible 
    veteran to pay a copayment for the receipt of care or services 
    under this section only if such eligible veteran would be required 
    to pay a copayment for the receipt of such care or services at a 
    medical facility of the Department or from a health care provider 
    of the Department pursuant to chapter 17 of title 38, United States 
    Code.
        (2) Limitation.--The amount of a copayment charged under 
    paragraph (1) may not exceed the amount of the copayment that would 
    be payable by such eligible veteran for the receipt of such care or 
    services at a medical facility of the Department or from a health 
    care provider of the Department pursuant to chapter 17 of title 38, 
    United States Code.
        (3) Collection of copayment.--A health care provider that 
    furnishes care or services to an eligible veteran under this 
    section shall collect the copayment required under paragraph (1) 
    from such eligible veteran at the time of furnishing such care or 
    services.
    (k) Claims Processing System.--
        (1) In general.--The Secretary shall provide for an efficient 
    nationwide system for processing and paying bills or claims for 
    authorized care and services furnished to eligible veterans under 
    this section.
        (2) Regulations.--Not later than 90 days after the date of the 
    enactment of this Act, the Secretary of Veterans Affairs shall 
    prescribe regulations for the implementation of such system.
        (3) Oversight.--The Chief Business Office of the Veterans 
    Health Administration shall oversee the implementation and 
    maintenance of such system.
        (4) Accuracy of payment.--
            (A) In general.--The Secretary shall ensure that such 
        system meets such goals for accuracy of payment as the 
        Secretary shall specify for purposes of this section.
            (B) Quarterly report.--
                (i) In general.--The Secretary shall submit to the 
            Committee on Veterans' Affairs of the Senate and the 
            Committee on Veterans' Affairs of the House of 
            Representatives a quarterly report on the accuracy of such 
            system.
                (ii) Elements.--Each report required by clause (i) 
            shall include the following:

                    (I) A description of the goals for accuracy for 
                such system specified by the Secretary under 
                subparagraph (A).
                    (II) An assessment of the success of the Department 
                in meeting such goals during the quarter covered by the 
                report.

                (iii) Deadline.--The Secretary shall submit each report 
            required by clause (i) not later than 20 days after the end 
            of the quarter covered by the report.
    (l) Medical Records.--
        (1) In general.--The Secretary shall ensure that any health 
    care provider that furnishes care or services under this section to 
    an eligible veteran submits to the Department any medical record 
    related to the care or services provided to such eligible veteran 
    by such health care provider for inclusion in the electronic 
    medical record of such eligible veteran maintained by the 
    Department upon the completion of the provision of such care or 
    services to such eligible veteran.
        (2) Electronic format.--Any medical record submitted to the 
    Department under paragraph (1) shall, to the extent possible, be in 
    an electronic format.
    (m) Tracking of Missed Appointments.--The Secretary shall implement 
a mechanism to track any missed appointments for care or services under 
this section by eligible veterans to ensure that the Department does 
not pay for such care or services that were not furnished to an 
eligible veteran.
    (n) Implementation.--Not later than 90 days after the date of the 
enactment of this Act, the Secretary shall prescribe interim final 
regulations on the implementation of this section and publish such 
regulations in the Federal Register.
    (o) Inspector General Report.--Not later than 30 days after the 
date on which the Secretary determines that 75 percent of the amounts 
deposited in the Veterans Choice Fund established by section 802 have 
been exhausted, the Inspector General of the Department shall submit to 
the Secretary a report on the results of an audit of the care and 
services furnished under this section to ensure the accuracy and 
timeliness of payments by the Department for the cost of such care and 
services, including any findings and recommendations of the Inspector 
General.
    (p) Authority To Furnish Care and Services.--
        (1) In general.--The Secretary may not use the authority under 
    this section to furnish care and services after the date specified 
    in paragraph (2).
        (2) Date specified.--The date specified in this paragraph is 
    the date on which the Secretary has exhausted all amounts deposited 
    in the Veterans Choice Fund established by section 802, or the date 
    that is 3 years after the date of the enactment of this Act, 
    whichever occurs first.
        (3) Publication.--The Secretary shall publish such date in the 
    Federal Register and on an Internet website of the Department 
    available to the public not later than 30 days before such date.
    (q) Reports.--
        (1) Initial report.--Not later than 90 days after the 
    publication of the interim final regulations under subsection (n), 
    the Secretary shall submit to the Committee on Veterans' Affairs of 
    the Senate and the Committee on Veterans' Affairs of the House of 
    Representatives a report on the furnishing of care and services 
    under this section that includes the following:
            (A) The number of eligible veterans who have received care 
        or services under this section.
            (B) A description of the types of care and services 
        furnished to eligible veterans under this section.
        (2) Final report.--Not later than 30 days after the date on 
    which the Secretary determines that 75 percent of the amounts 
    deposited in the Veterans Choice Fund established by section 802 
    have been exhausted, the Secretary shall submit to the Committee on 
    Veterans' Affairs of the Senate and the Committee on Veterans' 
    Affairs of the House of Representatives a report on the furnishing 
    of care and services under this section that includes the 
    following:
            (A) The total number of eligible veterans who have received 
        care or services under this section, disaggregated by--
                (i) eligible veterans described in subsection 
            (b)(2)(A);
                (ii) eligible veterans described in subsection 
            (b)(2)(B);
                (iii) eligible veterans described in subsection 
            (b)(2)(C); and
                (iv) eligible veterans described in subsection 
            (b)(2)(D).
            (B) A description of the types of care and services 
        furnished to eligible veterans under this section.
            (C) An accounting of the total cost of furnishing care and 
        services to eligible veterans under this section.
            (D) The results of a survey of eligible veterans who have 
        received care or services under this section on the 
        satisfaction of such eligible veterans with the care or 
        services received by such eligible veterans under this section.
            (E) An assessment of the effect of furnishing care and 
        services under this section on wait times for appointments for 
        the receipt of hospital care and medical services from the 
        Department.
            (F) An assessment of the feasibility and advisability of 
        continuing furnishing care and services under this section 
        after the termination date specified in subsection (p).
    (r) Rule of Construction.--Nothing in this section shall be 
construed to alter the process of the Department for filling and paying 
for prescription medications.
    (s) Wait-Time Goals of the Veterans Health Administration.--
        (1) In general.--Except as provided in paragraph (2), in this 
    section, the term ``wait-time goals of the Veterans Health 
    Administration'' means not more than 30 days from the date on which 
    a veteran requests an appointment for hospital care or medical 
    services from the Department.
        (2) Alternate goals.--If the Secretary submits to Congress, not 
    later than 60 days after the date of the enactment of this Act, a 
    report stating that the actual wait-time goals of the Veterans 
    Health Administration are different from the wait-time goals 
    specified in paragraph (1)--
            (A) for purposes of this section, the wait-time goals of 
        the Veterans Health Administration shall be the wait-time goals 
        submitted by the Secretary under this paragraph; and
            (B) the Secretary shall publish such wait-time goals in the 
        Federal Register and on an Internet website of the Department 
        available to the public.
    SEC. 102. ENHANCEMENT OF COLLABORATION BETWEEN DEPARTMENT OF 
      VETERANS AFFAIRS AND INDIAN HEALTH SERVICE.
    (a) Outreach to Tribal-Run Medical Facilities.--The Secretary of 
Veterans Affairs shall, in consultation with the Director of the Indian 
Health Service, conduct outreach to each medical facility operated by 
an Indian tribe or tribal organization through a contract or compact 
with the Indian Health Service under the Indian Self-Determination and 
Education Assistance Act (25 U.S.C. 450 et seq.) to raise awareness of 
the ability of such facilities, Indian tribes, and tribal organizations 
to enter into agreements with the Department of Veterans Affairs under 
which the Secretary reimburses such facilities, Indian tribes, or 
tribal organizations, as the case may be, for health care provided to 
veterans who are--
        (1) eligible for health care at such facilities; and
        (2)(A) enrolled in the patient enrollment system of the 
    Department established and operated under section 1705 of title 38, 
    United States Code; or
        (B) eligible for hospital care and medical services pursuant to 
    subsection (c)(2) of such section.
    (b) Performance Metrics for Memorandum of Understanding.--The 
Secretary of Veterans Affairs shall establish performance metrics for 
assessing the performance by the Department of Veterans Affairs and the 
Indian Health Service under the memorandum of understanding entitled 
``Memorandum of Understanding between the Department of Veterans 
Affairs (VA) and the Indian Health Service (IHS)'' in increasing access 
to health care, improving quality and coordination of health care, 
promoting effective patient-centered collaboration and partnerships 
between the Department and the Service, and ensuring health-promotion 
and disease-prevention services are appropriately funded and available 
for beneficiaries under both health care systems.
    (c) Report.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs and the 
Director of the Indian Health Service shall jointly submit to Congress 
a report on the feasibility and advisability of the following:
        (1) Entering into agreements for the reimbursement by the 
    Secretary of the costs of direct care services provided through 
    organizations receiving amounts pursuant to grants made or 
    contracts entered into under section 503 of the Indian Health Care 
    Improvement Act (25 U.S.C. 1653) to veterans who are otherwise 
    eligible to receive health care from such organizations.
        (2) Including the reimbursement of the costs of direct care 
    services provided to veterans who are not Indians in agreements 
    between the Department and the following:
            (A) The Indian Health Service.
            (B) An Indian tribe or tribal organization operating a 
        medical facility through a contract or compact with the Indian 
        Health Service under the Indian Self-Determination and 
        Education Assistance Act (25 U.S.C. 450 et seq.).
            (C) A medical facility of the Indian Health Service.
    (d) Definitions.--In this section:
        (1) Indian.--The terms ``Indian'' and ``Indian tribe'' have the 
    meanings given those terms in section 4 of the Indian Health Care 
    Improvement Act (25 U.S.C. 1603).
        (2) Medical facility of the indian health service.--The term 
    ``medical facility of the Indian Health Service'' includes a 
    facility operated by an Indian tribe or tribal organization through 
    a contract or compact with the Indian Health Service under the 
    Indian Self-Determination and Education Assistance Act (25 U.S.C. 
    450 et seq.).
        (3) Tribal organization.--The term ``tribal organization'' has 
    the meaning given the term in section 4 of the Indian Self-
    Determination and Education Assistance Act (25 U.S.C. 450b).
    SEC. 103. ENHANCEMENT OF COLLABORATION BETWEEN DEPARTMENT OF 
      VETERANS AFFAIRS AND NATIVE HAWAIIAN HEALTH CARE SYSTEMS.
    (a) In General.--The Secretary of Veterans Affairs shall, in 
consultation with Papa Ola Lokahi and such other organizations involved 
in the delivery of health care to Native Hawaiians as the Secretary 
considers appropriate, enter into contracts or agreements with Native 
Hawaiian health care systems that are in receipt of funds from the 
Secretary of Health and Human Services pursuant to grants awarded or 
contracts entered into under section 6(a) of the Native Hawaiian Health 
Care Improvement Act (42 U.S.C. 11705(a)) for the reimbursement of 
direct care services provided to eligible veterans as specified in such 
contracts or agreements.
    (b) Definitions.--In this section, the terms ``Native Hawaiian'', 
``Native Hawaiian health care system'', and ``Papa Ola Lokahi'' have 
the meanings given those terms in section 12 of the Native Hawaiian 
Health Care Improvement Act (42 U.S.C. 11711).
    SEC. 104. REAUTHORIZATION AND MODIFICATION OF PILOT PROGRAM OF 
      ENHANCED CONTRACT CARE AUTHORITY FOR HEALTH CARE NEEDS OF 
      VETERANS.
    Section 403 of the Veterans' Mental Health and Other Care 
Improvements Act of 2008 (Public Law 110-387; 38 U.S.C. 1703 note) is 
amended--
        (1) in subsection (a)--
            (A) in paragraph (3), by striking ``only during the'' and 
        all that follows through the period at the end and inserting 
        ``only during the period beginning on the date of the 
        commencement of the pilot program under paragraph (2) and 
        ending on the date that is two years after the date of the 
        enactment of the Veterans Access, Choice, and Accountability 
        Act of 2014.''; and
            (B) by amending paragraph (4) to read as follows:
        ``(4) Program locations.--The Secretary shall carry out the 
    pilot program at locations in the following Veterans Integrated 
    Service Networks (and such other locations as the Secretary 
    considers appropriate):
            ``(A) Veterans Integrated Service Network 1.
            ``(B) Veterans Integrated Service Network 6.
            ``(C) Veterans Integrated Service Network 15.
            ``(D) Veterans Integrated Service Network 18.
            ``(E) Veterans Integrated Service Network 19.'';
        (2) in subsection (b)(1)(A), by striking ``as of the date of 
    the commencement of the pilot program under subsection (a)(2)'' and 
    inserting ``as of August 1, 2014'';
        (3) by redesignating subsection (h) as subsection (k);
        (4) by inserting after subsection (g) the following new 
    subsections:
    ``(h) Appointments.--In carrying out the pilot program under this 
section, the Secretary shall ensure that medical appointments for 
covered veterans--
        ``(1) are scheduled not later than 5 days after the date on 
    which the appointment is requested; and
        ``(2) occur not later than 30 days after such date.
    ``(i) Outreach.--The Secretary shall ensure that covered veterans 
are informed about the pilot program under this section.
    ``(j) Use of Existing Contracts.--In carrying out the pilot program 
under this section after the date of the enactment of the Veterans 
Access, Choice, and Accountability Act of 2014, the Secretary shall 
make use of contracts entered into before such date or may enter into 
new contracts.''; and
        (5) in paragraph (2)(B) of subsection (k), as redesignated by 
    paragraph (3) of this section, by striking the semicolon at the end 
    and inserting ``; and''.
    SEC. 105. PROMPT PAYMENT BY DEPARTMENT OF VETERANS AFFAIRS.
    (a) Sense of Congress on Prompt Payment by Department.--It is the 
sense of Congress that the Secretary of Veterans Affairs shall comply 
with section 1315 of title 5, Code of Federal Regulations (commonly 
known as the ``prompt payment rule''), or any corresponding similar 
regulation or ruling, in paying for health care pursuant to contracts 
entered into with non-Department of Veterans Affairs providers to 
provide health care under the laws administered by the Secretary.
    (b) Establishment of Claims Processing System.--
        (1) Claims processing system.--The Secretary of Veterans 
    Affairs shall establish and implement a system to process and pay 
    claims for payment for hospital care, medical services, and other 
    health care furnished by non-Department of Veterans Affairs health 
    care providers under the laws administered by the Secretary.
        (2) Compliance with prompt payment act.--The system established 
    and implemented under paragraph (1) shall comply with all 
    requirements of chapter 39, United States Code (commonly referred 
    to as the ``Prompt Payment Act'').
    (c) Report.--Not later than 1 year after the date of the enactment 
of this Act, the Comptroller General of the United States shall submit 
to Congress a report on the timeliness of payments by the Secretary for 
hospital care, medical services, and other health care furnished by 
non-Department of Veterans Affairs health care providers under the laws 
administered by the Secretary.
    (d) Elements.--The report required by subsection (b) shall include 
the following:
        (1) The results of a survey of non-Department health care 
    providers who have submitted claims to the Department for hospital 
    care, medical services, or other health care furnished to veterans 
    for which payment is authorized under the laws administered by the 
    Secretary during the one-year period preceding the submittal of the 
    report, which survey shall include the following:
            (A) The amount of time it took for such health care 
        providers, after submitting such claims, to receive payment 
        from the Department for such care or services.
            (B) A comparison of the amount of time under subparagraph 
        (A) and the amount of time it takes such health care providers 
        to receive payments from the United States for similar care or 
        services provided to the following, if applicable:
                (i) Beneficiaries under the Medicare program under 
            title XVIII of the Social Security Act (42 U.S.C. 1395 et 
            seq.).
                (ii) Covered beneficiaries under the TRICARE program 
            under chapter 55 of title 10, United States Code.
        (2) Such recommendations for legislative or administrative 
    action as the Comptroller General considers appropriate.
    (e) Survey Elements.--In carrying out the survey, the Comptroller 
General shall seek responses from non-Department health care providers 
in a manner that ensures that the survey reflects the responses of such 
providers that--
        (1) are located in different geographic areas;
        (2) furnish a variety of different hospital care, medical 
    services, and other health care; and
        (3) furnish such care and services in a variety of different 
    types of medical facilities.
    SEC. 106. TRANSFER OF AUTHORITY FOR PAYMENTS FOR HOSPITAL CARE, 
      MEDICAL SERVICES, AND OTHER HEALTH CARE FROM NON-DEPARTMENT OF 
      VETERANS AFFAIRS PROVIDERS TO THE CHIEF BUSINESS OFFICE OF THE 
      VETERANS HEALTH ADMINISTRATION.
    (a) Transfer of Authority.--
        (1) In general.--Effective as of October 1, 2014, the Secretary 
    of Veterans Affairs shall transfer the authority to pay for 
    hospital care, medical services, and other health care furnished 
    through non-Department of Veterans Affairs providers from--
            (A) the Veterans Integrated Service Networks and medical 
        centers of the Department of Veterans Affairs, to
            (B) the Chief Business Office of the Veterans Health 
        Administration of the Department of Veterans Affairs.
        (2) Manner of care.--The Chief Business Office shall work in 
    consultation with the Office of Clinical Operations and Management 
    of the Department to ensure that care and services described in 
    paragraph (1) are provided in a manner that is clinically 
    appropriate and in the best interest of the veterans receiving such 
    care and services.
        (3) No delay in payment.--The transfer of authority under 
    paragraph (1) shall be carried out in a manner that does not delay 
    or impede any payment by the Department for hospital care, medical 
    services, or other health care furnished through a non-Department 
    provider under the laws administered by the Secretary.
    (b) Budget Matters.--The budget of the Department of Veterans 
Affairs for any fiscal year beginning after the date of the enactment 
of this Act (as submitted to Congress pursuant to section 1105(a) of 
title 31, United States Code) shall specify funds for the payment for 
hospital care, medical services, and other health care furnished 
through non-Department of Veterans Affairs providers, including any 
administrative costs associated with such payment, as funds for the 
Chief Business Office of the Veterans Health Administration rather than 
as funds for the Veterans Integrated Service Networks or medical 
centers of the Department.

              TITLE II--HEALTH CARE ADMINISTRATIVE MATTERS

    SEC. 201. INDEPENDENT ASSESSMENT OF THE HEALTH CARE DELIVERY 
      SYSTEMS AND MANAGEMENT PROCESSES OF THE DEPARTMENT OF VETERANS 
      AFFAIRS.
    (a) Independent Assessment.--
        (1) Assessment.--Not later than 90 days after the date of the 
    enactment of this Act, the Secretary of Veterans Affairs shall 
    enter into one or more contracts with a private sector entity or 
    entities described in subsection (b) to conduct an independent 
    assessment of the hospital care, medical services, and other health 
    care furnished in medical facilities of the Department. Such 
    assessment shall address each of the following:
            (A) Current and projected demographics and unique health 
        care needs of the patient population served by the Department.
            (B) Current and projected health care capabilities and 
        resources of the Department, including hospital care, medical 
        services, and other health care furnished by non-Department 
        facilities under contract with the Department, to provide 
        timely and accessible care to veterans.
            (C) The authorities and mechanisms under which the 
        Secretary may furnish hospital care, medical services, and 
        other health care at non-Department facilities, including 
        whether the Secretary should have the authority to furnish such 
        care and services at such facilities through the completion of 
        episodes of care.
            (D) The appropriate system-wide access standard applicable 
        to hospital care, medical services, and other health care 
        furnished by and through the Department, including an 
        identification of appropriate access standards for each 
        individual specialty and post-care rehabilitation.
            (E) The workflow process at each medical facility of the 
        Department for scheduling appointments for veterans to receive 
        hospital care, medical services, or other health care from the 
        Department.
            (F) The organization, workflow processes, and tools used by 
        the Department to support clinical staffing, access to care, 
        effective length-of-stay management and care transitions, 
        positive patient experience, accurate documentation, and 
        subsequent coding of inpatient services.
            (G) The staffing level at each medical facility of the 
        Department and the productivity of each health care provider at 
        such medical facility, compared with health care industry 
        performance metrics, which may include an assessment of any of 
        the following:
                (i) The case load of, and number of patients treated 
            by, each health care provider at such medical facility 
            during an average week.
                (ii) The time spent by such health care provider on 
            matters other than the case load of such health care 
            provider, including time spent by such health care provider 
            as follows:

                    (I) At a medical facility that is affiliated with 
                the Department.
                    (II) Conducting research.
                    (III) Training or supervising other health care 
                professionals of the Department.

            (H) The information technology strategies of the Department 
        with respect to furnishing and managing health care, including 
        an identification of any weaknesses and opportunities with 
        respect to the technology used by the Department, especially 
        those strategies with respect to clinical documentation of 
        episodes of hospital care, medical services, and other health 
        care, including any clinical images and associated textual 
        reports, furnished by the Department in Department or non-
        Department facilities.
            (I) Business processes of the Veterans Health 
        Administration, including processes relating to furnishing non-
        Department health care, insurance identification, third-party 
        revenue collection, and vendor reimbursement, including an 
        identification of mechanisms as follows:
                (i) To avoid the payment of penalties to vendors.
                (ii) To increase the collection of amounts owed to the 
            Department for hospital care, medical services, or other 
            health care provided by the Department for which 
            reimbursement from a third party is authorized and to 
            ensure that such amounts collected are accurate.
                (iii) To increase the collection of any other amounts 
            owed to the Department with respect to hospital care, 
            medical services, and other health care and to ensure that 
            such amounts collected are accurate.
                (iv) To increase the accuracy and timeliness of 
            Department payments to vendors and providers.
            (J) The purchasing, distribution, and use of 
        pharmaceuticals, medical and surgical supplies, medical 
        devices, and health care related services by the Department, 
        including the following:
                (i) The prices paid for, standardization of, and use by 
            the Department of the following:

                    (I) Pharmaceuticals.
                    (II) Medical and surgical supplies.
                    (III) Medical devices.

                (ii) The use by the Department of group purchasing 
            arrangements to purchase pharmaceuticals, medical and 
            surgical supplies, medical devices, and health care related 
            services.
                (iii) The strategy and systems used by the Department 
            to distribute pharmaceuticals, medical and surgical 
            supplies, medical devices, and health care related services 
            to Veterans Integrated Service Networks and medical 
            facilities of the Department.
            (K) The process of the Department for carrying out 
        construction and maintenance projects at medical facilities of 
        the Department and the medical facility leasing program of the 
        Department.
            (L) The competency of leadership with respect to culture, 
        accountability, reform readiness, leadership development, 
        physician alignment, employee engagement, succession planning, 
        and performance management.
        (2) Particular elements of certain assessments.--
            (A) Scheduling assessment.--In carrying out the assessment 
        required by paragraph (1)(E), the private sector entity or 
        entities shall do the following:
                (i) Review all training materials pertaining to 
            scheduling of appointments at each medical facility of the 
            Department.
                (ii) Assess whether all employees of the Department 
            conducting tasks related to scheduling are properly trained 
            for conducting such tasks.
                (iii) Assess whether changes in the technology or 
            system used in scheduling appointments are necessary to 
            limit access to the system to only those employees that 
            have been properly trained in conducting such tasks.
                (iv) Assess whether health care providers of the 
            Department are making changes to their schedules that 
            hinder the ability of employees conducting such tasks to 
            perform such tasks.
                (v) Assess whether the establishment of a centralized 
            call center throughout the Department for scheduling 
            appointments at medical facilities of the Department would 
            improve the process of scheduling such appointments.
                (vi) Assess whether booking templates for each medical 
            facility or clinic of the Department would improve the 
            process of scheduling such appointments.
                (vii) Assess any interim technology changes or attempts 
            by Department to internally develop a long-term scheduling 
            solutions with respect to the feasibility and cost 
            effectiveness of such internally developed solutions 
            compared to commercially available solutions.
                (viii) Recommend actions, if any, to be taken by the 
            Department to improve the process for scheduling such 
            appointments, including the following:

                    (I) Changes in training materials provided to 
                employees of the Department with respect to conducting 
                tasks related to scheduling such appointments.
                    (II) Changes in monitoring and assessment conducted 
                by the Department of wait times of veterans for such 
                appointments.
                    (III) Changes in the system used to schedule such 
                appointments, including changes to improve how the 
                Department--

                        (aa) measures wait times of veterans for such 
                    appointments;
                        (bb) monitors the availability of health care 
                    providers of the Department; and
                        (cc) provides veterans the ability to schedule 
                    such appointments.

                    (IV) Such other actions as the private sector 
                entity or entities considers appropriate.

            (B) Medical construction and maintenance project and 
        leasing program assessment.--In carrying out the assessment 
        required by paragraph (1)(K), the private sector entity or 
        entities shall do the following:
                (i) Review the process of the Department for 
            identifying and designing proposals for construction and 
            maintenance projects at medical facilities of the 
            Department and leases for medical facilities of the 
            Department.
                (ii) Assess the process through which the Department 
            determines the following:

                    (I) That a construction or maintenance project or 
                lease is necessary with respect to a medical facility 
                or proposed medical facility of the Department.
                    (II) The proper size of such medical facility or 
                proposed medical facility with respect to treating 
                veterans in the catchment area of such medical facility 
                or proposed medical facility.

                (iii) Assess the management processes of the Department 
            with respect to the capital management programs of the 
            Department, including processes relating to the methodology 
            for construction and design of medical facilities of the 
            Department, the management of projects relating to the 
            construction and design of such facilities, and the 
            activation of such facilities.
                (iv) Assess the medical facility leasing program of the 
            Department.
        (3) Timing.--The private sector entity or entities carrying out 
    the assessment required by paragraph (1) shall complete such 
    assessment not later than 240 days after entering into the contract 
    described in such paragraph.
    (b) Private Sector Entities Described.--A private entity described 
in this subsection is a private entity that--
        (1) has experience and proven outcomes in optimizing the 
    performance of the health care delivery systems of the Veterans 
    Health Administration and the private sector and in health care 
    management; and
        (2) specializes in implementing large-scale organizational and 
    cultural transformations, especially with respect to health care 
    delivery systems.
    (c) Program Integrator.--
        (1) In general.--If the Secretary enters into contracts with 
    more than one private sector entity under subsection (a), the 
    Secretary shall designate one such entity that is predominately a 
    health care organization as the program integrator.
        (2) Responsibilities.--The program integrator designated 
    pursuant to paragraph (1) shall be responsible for coordinating the 
    outcomes of the assessments conducted by the private entities 
    pursuant to such contracts.
    (d) Report on Assessment.--
        (1) In general.--Not later than 60 days after completing the 
    assessment required by subsection (a), the private sector entity or 
    entities carrying out such assessment shall submit to the Secretary 
    of Veterans Affairs, the Committee on Veterans' Affairs of the 
    Senate, the Committee on Veterans' Affairs of the House of 
    Representatives, and the Commission on Care established under 
    section 202 a report on the findings and recommendations of the 
    private sector entity or entities with respect to such assessment.
        (2) Publication.--Not later than 30 days after receiving the 
    report under paragraph (1), the Secretary shall publish such report 
    in the Federal Register and on an Internet website of the 
    Department of Veterans Affairs that is accessible to the public.
    (e) Non-Department Facilities Defined.--In this section, the term 
``non-Department facilities'' has the meaning given that term in 
section 1701 of title 38, United States Code.
    SEC. 202. COMMISSION ON CARE.
    (a) Establishment of Commission.--
        (1) In general.--There is established a commission, to be known 
    as the ``Commission on Care'' (in this section referred to as the 
    ``Commission''), to examine the access of veterans to health care 
    from the Department of Veterans Affairs and strategically examine 
    how best to organize the Veterans Health Administration, locate 
    health care resources, and deliver health care to veterans during 
    the 20-year period beginning on the date of the enactment of this 
    Act.
        (2) Membership.--
            (A) Voting members.--The Commission shall be composed of 15 
        voting members who are appointed as follows:
                (i) Three members appointed by the Speaker of the House 
            of Representatives, at least one of whom shall be a 
            veteran.
                (ii) Three members appointed by the Minority Leader of 
            the House of Representatives, at least one of whom shall be 
            a veteran.
                (iii) Three members appointed by the Majority Leader of 
            the Senate, at least one of whom shall be a veteran.
                (iv) Three members appointed by the Minority Leader of 
            the Senate, at least one of whom shall be a veteran.
                (v) Three members appointed by the President, at least 
            two of whom shall be veterans.
            (B) Qualifications.--Of the members appointed under 
        subparagraph (A)--
                (i) at least one member shall represent an organization 
            recognized by the Secretary of Veterans Affairs for the 
            representation of veterans under section 5902 of title 38, 
            United States Code;
                (ii) at least one member shall have experience as 
            senior management for a private integrated health care 
            system with an annual gross revenue of more than 
            $50,000,000;
                (iii) at least one member shall be familiar with 
            government health care systems, including those systems of 
            the Department of Defense, the Indian Health Service, and 
            Federally-qualified health centers (as defined in section 
            1905(l)(2)(B) of the Social Security Act (42 U.S.C. 
            1396d(l)(2)(B)));
                (iv) at least one member shall be familiar with the 
            Veterans Health Administration but shall not be currently 
            employed by the Veterans Health Administration; and
                (v) at least one member shall be familiar with medical 
            facility construction and leasing projects carried out by 
            government entities and have experience in the building 
            trades, including construction, engineering, and 
            architecture.
            (C) Date.--The appointments of members of the Commission 
        shall be made not later than 1 year after the date of the 
        enactment of this Act.
        (3) Period of appointment.--
            (A) In general.--Members shall be appointed for the life of 
        the Commission.
            (B) Vacancies.--Any vacancy in the Commission shall not 
        affect its powers, but shall be filled in the same manner as 
        the original appointment.
        (4) Initial meeting.--Not later than 15 days after the date on 
    which eight voting members of the Commission have been appointed, 
    the Commission shall hold its first meeting.
        (5) Meetings.--The Commission shall meet at the call of the 
    Chairperson.
        (6) Quorum.--A majority of the members of the Commission shall 
    constitute a quorum, but a lesser number of members may hold 
    hearings.
        (7) Chairperson and vice chairperson.--The President shall 
    designate a member of the commission to serve as Chairperson of the 
    Commission. The Commission shall select a Vice Chairperson from 
    among its members.
    (b) Duties of Commission.--
        (1) Evaluation and assessment.--The Commission shall undertake 
    a comprehensive evaluation and assessment of access to health care 
    at the Department of Veterans Affairs.
        (2) Matters evaluated and assessed.--In undertaking the 
    comprehensive evaluation and assessment required by paragraph (1), 
    the Commission shall evaluate and assess the results of the 
    assessment conducted by the private sector entity or entities under 
    section 201, including any findings, data, or recommendations 
    included in such assessment.
        (3) Reports.--The Commission shall submit to the President, 
    through the Secretary of Veterans Affairs, reports as follows:
            (A) Not later than 90 days after the date of the initial 
        meeting of the Commission, an interim report on--
                (i) the findings of the Commission with respect to the 
            evaluation and assessment required by this subsection; and
                (ii) such recommendations as the Commission may have 
            for legislative or administrative action to improve access 
            to health care through the Veterans Health Administration.
            (B) Not later than 180 days after the date of the initial 
        meeting of the Commission, a final report on--
                (i) the findings of the Commission with respect to the 
            evaluation and assessment required by this subsection; and
                (ii) such recommendations as the Commission may have 
            for legislative or administrative action to improve access 
            to health care through the Veterans Health Administration.
    (c) Powers of the Commission.--
        (1) Hearings.--The Commission may hold such hearings, sit and 
    act at such times and places, take such testimony, and receive such 
    evidence as the Commission considers advisable to carry out this 
    section.
        (2) Information from federal agencies.--The Commission may 
    secure directly from any Federal agency such information as the 
    Commission considers necessary to carry out this section. Upon 
    request of the Chairperson of the Commission, the head of such 
    agency shall furnish such information to the Commission.
    (d) Commission Personnel Matters.--
        (1) Compensation of members.--
            (A) In general.--Each member of the Commission who is not 
        an officer or employee of the Federal Government shall be 
        compensated at a rate equal to the daily equivalent of the 
        annual rate of basic pay prescribed for level IV of the 
        Executive Schedule under section 5315 of title 5, United States 
        Code, for each day (including travel time) during which such 
        member is engaged in the performance of the duties of the 
        Commission.
            (B) Officers or employees of the united states.--All 
        members of the Commission who are officers or employees of the 
        United States shall serve without compensation in addition to 
        that received for their services as officers or employees of 
        the United States.
        (2) Travel expenses.--The members of the Commission shall be 
    allowed travel expenses, including per diem in lieu of subsistence, 
    at rates authorized for employees of agencies under subchapter I of 
    chapter 57 of title 5, United States Code, while away from their 
    homes or regular places of business in the performance of services 
    for the Commission.
        (3) Staff.--
            (A) In general.--The Chairperson of the Commission may, 
        without regard to the civil service laws and regulations, 
        appoint and terminate an executive director and such other 
        additional personnel as may be necessary to enable the 
        Commission to perform its duties. The employment of an 
        executive director shall be subject to confirmation by the 
        Commission.
            (B) Compensation.--The Chairperson of the Commission may 
        fix the compensation of the executive director and other 
        personnel without regard to chapter 51 and subchapter III of 
        chapter 53 of title 5, United States Code, relating to 
        classification of positions and General Schedule pay rates, 
        except that the rate of pay for the executive director and 
        other personnel may not exceed the rate payable for level V of 
        the Executive Schedule under section 5316 of such title.
        (4) Detail of government employees.--Any Federal Government 
    employee may be detailed to the Commission without reimbursement, 
    and such detail shall be without interruption or loss of civil 
    service status or privilege.
        (5) Procurement of temporary and intermittent services.--The 
    Chairperson of the Commission may procure temporary and 
    intermittent services under section 3109(b) of title 5, United 
    States Code, at rates for individuals that do not exceed the daily 
    equivalent of the annual rate of basic pay prescribed for level V 
    of the Executive Schedule under section 5316 of such title.
    (e) Termination of the Commission.--The Commission shall terminate 
30 days after the date on which the Commission submits the report under 
subsection (b)(3)(B).
    (f) Funding.--The Secretary of Veterans Affairs shall make 
available to the Commission from amounts appropriated or otherwise made 
available to the Secretary such amounts as the Secretary and the 
Chairperson of the Commission jointly consider appropriate for the 
Commission to perform its duties under this section.
    (g) Executive Action.--
        (1) Action on recommendations.--The President shall require the 
    Secretary of Veterans Affairs and such other heads of relevant 
    Federal departments and agencies to implement each recommendation 
    set forth in a report submitted under subsection (b)(3) that the 
    President--
            (A) considers feasible and advisable; and
            (B) determines can be implemented without further 
        legislative action.
        (2) Reports.--Not later than 60 days after the date on which 
    the President receives a report under subsection (b)(3), the 
    President shall submit to the Committee on Veterans' Affairs of the 
    Senate and the Committee on Veterans' Affairs of the House of 
    Representatives and such other committees of Congress as the 
    President considers appropriate a report setting forth the 
    following:
            (A) An assessment of the feasibility and advisability of 
        each recommendation contained in the report received by the 
        President.
            (B) For each recommendation assessed as feasible and 
        advisable under subparagraph (A) the following:
                (i) Whether such recommendation requires legislative 
            action.
                (ii) If such recommendation requires legislative 
            action, a recommendation concerning such legislative 
            action.
                (iii) A description of any administrative action 
            already taken to carry out such recommendation.
                (iv) A description of any administrative action the 
            President intends to be taken to carry out such 
            recommendation and by whom.
    SEC. 203. TECHNOLOGY TASK FORCE ON REVIEW OF SCHEDULING SYSTEM AND 
      SOFTWARE OF THE DEPARTMENT OF VETERANS AFFAIRS.
    (a) Task Force Review.--
        (1) In general.--The Secretary of Veterans Affairs shall, 
    through the use of a technology task force, conduct a review of the 
    needs of the Department of Veterans Affairs with respect to the 
    scheduling system and scheduling software of the Department of 
    Veterans Affairs that is used by the Department to schedule 
    appointments for veterans for hospital care, medical services, and 
    other health care from the Department.
        (2) Agreement.--
            (A) In general.--The Secretary shall seek to enter into an 
        agreement with a technology organization or technology 
        organizations to carry out the review required by paragraph 
        (1).
            (B) Prohibition on use of funds.--Notwithstanding any other 
        provision of law, no Federal funds may be used to assist the 
        technology organization or technology organizations under 
        subparagraph (A) in carrying out the review required by 
        paragraph (1).
    (b) Report.--
        (1) In general.--Not later than 45 days after the date of the 
    enactment of this Act, the technology task force required under 
    subsection (a)(1) shall submit to the Secretary, the Committee on 
    Veterans' Affairs of the Senate, and the Committee on Veterans' 
    Affairs of the House of Representatives a report setting forth the 
    findings and recommendations of the technology task force regarding 
    the needs of the Department with respect to the scheduling system 
    and scheduling software of the Department described in such 
    subsection.
        (2) Elements.--The report required by paragraph (1) shall 
    include the following:
            (A) Proposals for specific actions to be taken by the 
        Department to improve the scheduling system and scheduling 
        software of the Department described in subsection (a)(1).
            (B) A determination as to whether one or more existing off-
        the-shelf systems would--
                (i) meet the needs of the Department to schedule 
            appointments for veterans for hospital care, medical 
            services, and other health care from the Department; and
                (ii) improve the access of veterans to such care and 
            services.
        (3) Publication.--Not later than 30 days after the receipt of 
    the report required by paragraph (1), the Secretary shall publish 
    such report in the Federal Register and on an Internet website of 
    the Department accessible to the public.
    (c) Implementation of Task Force Recommendations.--Not later than 1 
year after the receipt of the report required by subsection (b)(1), the 
Secretary shall implement the recommendations set forth in such report 
that the Secretary considers are feasible, advisable, and cost 
effective.
    SEC. 204. IMPROVEMENT OF ACCESS OF VETERANS TO MOBILE VET CENTERS 
      AND MOBILE MEDICAL CENTERS OF THE DEPARTMENT OF VETERANS AFFAIRS.
    (a) Improvement of Access.--
        (1) In general.--The Secretary of Veterans Affairs shall 
    improve the access of veterans to telemedicine and other health 
    care through the use of mobile vet centers and mobile medical 
    centers of the Department of Veterans Affairs by providing 
    standardized requirements for the operation of such centers.
        (2) Requirements.--The standardized requirements required by 
    paragraph (1) shall include the following:
            (A) The number of days each mobile vet center and mobile 
        medical center of the Department is expected to travel per 
        year.
            (B) The number of locations each center is expected to 
        visit per year.
            (C) The number of appointments each center is expected to 
        conduct per year.
            (D) The method and timing of notifications given by each 
        center to individuals in the area to which the center is 
        traveling, including notifications informing veterans of the 
        availability to schedule appointments at the center.
        (3) Use of telemedicine.--The Secretary shall ensure that each 
    mobile vet center and mobile medical center of the Department has 
    the capability to provide telemedicine services.
    (b) Reports.--
        (1) In general.--Not later than 1 year after the date of the 
    enactment of this Act, and not later than September 30 each year 
    thereafter, the Secretary of Veterans Affairs shall submit to the 
    Committee on Veterans' Affairs of the Senate and the Committee on 
    Veterans' Affairs of the House of Representatives a report on 
    access to health care through the use of mobile vet centers and 
    mobile medical centers of the Department that includes statistics 
    on each of the requirements set forth in subsection (a)(2) for the 
    year covered by the report.
        (2) Elements.--Each report required by paragraph (1) shall 
    include the following:
            (A) A description of the use of mobile vet centers and 
        mobile medical centers to provide telemedicine services to 
        veterans during the year preceding the submittal of the report, 
        including the following:
                (i) The number of days each mobile vet center and 
            mobile medical center was open to provide such services.
                (ii) The number of days each center traveled to a 
            location other than the headquarters of the center to 
            provide such services.
                (iii) The number of appointments each center conducted 
            to provide such services on average per month and in total 
            during such year.
            (B) An analysis of the effectiveness of using mobile vet 
        centers and mobile medical centers to provide health care 
        services to veterans through the use of telemedicine.
            (C) Any recommendations for an increase in the number of 
        mobile vet centers and mobile medical centers of the 
        Department.
            (D) Any recommendations for an increase in the telemedicine 
        capabilities of each mobile vet center and mobile medical 
        center.
            (E) The feasibility and advisability of using temporary 
        health care providers, including locum tenens, to provide 
        direct health care services to veterans at mobile vet centers 
        and mobile medical centers.
            (F) Such other recommendations on improvement of the use of 
        mobile vet centers and mobile medical centers by the Department 
        as the Secretary considers appropriate.
    SEC. 205. IMPROVED PERFORMANCE METRICS FOR HEALTH CARE PROVIDED BY 
      DEPARTMENT OF VETERANS AFFAIRS.
    (a) Prohibition on Use of Scheduling and Wait-Time Metrics in 
Determination of Performance Awards.--The Secretary of Veterans Affairs 
shall ensure that scheduling and wait-time metrics or goals are not 
used as factors in determining the performance of the following 
employees for purposes of determining whether to pay performance awards 
to such employees:
        (1) Directors, associate directors, assistant directors, deputy 
    directors, chiefs of staff, and clinical leads of medical centers 
    of the Department of Veterans Affairs.
        (2) Directors, assistant directors, and quality management 
    officers of Veterans Integrated Service Networks of the Department 
    of Veterans Affairs.
    (b) Modification of Performance Plans.--
        (1) In general.--Not later than 30 days after the date of the 
    enactment of this Act, the Secretary shall modify the performance 
    plans of the directors of the medical centers of the Department and 
    the directors of the Veterans Integrated Service Networks to ensure 
    that such plans are based on the quality of care received by 
    veterans at the health care facilities under the jurisdictions of 
    such directors.
        (2) Factors.--In modifying performance plans under paragraph 
    (1), the Secretary shall ensure that assessment of the quality of 
    care provided at health care facilities under the jurisdiction of a 
    director described in paragraph (1) includes consideration of the 
    following:
            (A) Recent reviews by the Joint Commission (formerly known 
        as the ``Joint Commission on Accreditation of Healthcare 
        Organizations'') of such facilities.
            (B) The number and nature of recommendations concerning 
        such facilities by the Inspector General of the Department in 
        reviews conducted through the Combined Assessment Program, in 
        the reviews by the Inspector General of community-based 
        outpatient clinics and primary care clinics, and in reviews 
        conducted through the Office of Healthcare Inspections during 
        the two most recently completed fiscal years.
            (C) The number of recommendations described in subparagraph 
        (B) that the Inspector General of the Department determines 
        have not been carried out satisfactorily with respect to such 
        facilities.
            (D) Reviews of such facilities by the Commission on 
        Accreditation of Rehabilitation Facilities.
            (E) The number and outcomes of administrative investigation 
        boards, root cause analyses, and peer reviews conducted at such 
        facilities during the fiscal year for which the assessment is 
        being conducted.
            (F) The effectiveness of any remedial actions or plans 
        resulting from any Inspector General recommendations in the 
        reviews and analyses described in subparagraphs (A) through 
        (E).
        (3) Additional leadership positions.--To the degree 
    practicable, the Secretary shall assess the performance of other 
    employees of the Department in leadership positions at Department 
    medical centers, including associate directors, assistant 
    directors, deputy directors, chiefs of staff, and clinical leads, 
    and in Veterans Integrated Service Networks, including assistant 
    directors and quality management officers, using factors and 
    criteria similar to those used in the performance plans modified 
    under paragraph (1).
    (c) Removal of Certain Performance Goals.--For each fiscal year 
that begins after the date of the enactment of this Act, the Secretary 
shall not include in the performance goals of any employee of a 
Veterans Integrated Service Network or medical center of the Department 
any performance goal that might disincentivize the payment of 
Department amounts to provide hospital care, medical services, or other 
health care through a non-Department provider.
    SEC. 206. IMPROVED TRANSPARENCY CONCERNING HEALTH CARE PROVIDED BY 
      DEPARTMENT OF VETERANS AFFAIRS.
    (a) Publication of Wait Times.--Not later than 90 days after the 
date of the enactment of this Act, the Secretary of Veterans Affairs 
shall publish in the Federal Register, and on a publicly accessible 
Internet website of each medical center of the Department of Veterans 
Affairs, the wait-times for the scheduling of an appointment in each 
Department facility by a veteran for the receipt of primary care, 
specialty care, and hospital care and medical services based on the 
general severity of the condition of the veteran. Whenever the wait-
times for the scheduling of such an appointment changes, the Secretary 
shall publish the revised wait-times--
        (1) on a publicly accessible Internet website of each medical 
    center of the Department by not later than 30 days after such 
    change; and
        (2) in the Federal Register by not later than 90 days after 
    such change.
    (b) Publicly Available Database of Patient Safety, Quality of Care, 
and Outcome Measures.--
        (1) In general.--Not later than 180 days after the date of the 
    enactment of this Act, the Secretary shall develop and make 
    available to the public a comprehensive database containing all 
    applicable patient safety, quality of care, and outcome measures 
    for health care provided by the Department that are tracked by the 
    Secretary.
        (2) Update frequency.--The Secretary shall update the database 
    required by paragraph (1) not less frequently than once each year.
        (3) Unavailable measures.--For all measures that the Secretary 
    would otherwise publish in the database required by paragraph (1) 
    but has not done so because such measures are not available, the 
    Secretary shall publish notice in the database of the reason for 
    such unavailability and a timeline for making such measures 
    available in the database.
        (4) Accessibility.--The Secretary shall ensure that the 
    database required by paragraph (1) is accessible to the public 
    through the primary Internet website of the Department and through 
    each primary Internet website of a Department medical center.
    (c) Hospital Compare Website of Department of Health and Human 
Services.--
        (1) Agreement required.--Not later than 180 days after the date 
    of the enactment of this Act, the Secretary of Veterans Affairs 
    shall enter into an agreement with the Secretary of Health and 
    Human Services for the provision by the Secretary of Veterans 
    Affairs of such information as the Secretary of Health and Human 
    Services may require to report and make publicly available patient 
    quality and outcome information concerning Department of Veterans 
    Affairs medical centers through the Hospital Compare Internet 
    website of the Department of Health and Human Services or any 
    successor Internet website.
        (2) Information provided.--The information provided by the 
    Secretary of Veterans Affairs to the Secretary of Health and Human 
    Services under paragraph (1) shall include the following:
            (A) Measures of timely and effective health care.
            (B) Measures of readmissions, complications of death, 
        including with respect to 30-day mortality rates and 30-day 
        readmission rates, surgical complication measures, and health 
        care related infection measures.
            (C) Survey data of patient experiences, including the 
        Hospital Consumer Assessment of Healthcare Providers and 
        Systems or any similar successor survey developed by the 
        Department of Health and Human Services.
            (D) Any other measures required of or reported with respect 
        to hospitals participating in the Medicare program under title 
        XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).
        (3) Unavailable information.--For any applicable metric 
    collected by the Department of Veterans Affairs or required to be 
    provided under paragraph (2) and withheld from or unavailable in 
    the Hospital Compare Internet website or any successor Internet 
    website, the Secretary of Veterans Affairs shall publish a notice 
    on such Internet website stating the reason why such metric was 
    withheld from public disclosure and a timeline for making such 
    metric available, if applicable.
    (d) Comptroller General Review of Publicly Available Safety and 
Quality Metrics.--Not later than 3 years after the date of the 
enactment of this Act, the Comptroller General of the United States 
shall conduct a review of the safety and quality metrics made publicly 
available by the Secretary of Veterans Affairs under this section to 
assess the degree to which the Secretary is complying with the 
provisions of this section.
    SEC. 207. INFORMATION FOR VETERANS ON THE CREDENTIALS OF DEPARTMENT 
      OF VETERANS AFFAIRS PHYSICIANS.
    (a) Improvement of ``Our Doctors'' Internet Website Links.--
        (1) Availability through department of veterans affairs 
    homepage.--A link to the ``Our Doctors'' health care providers 
    database of the Department of Veterans Affairs, or any successor 
    database, shall be available on and through the homepage of the 
    Internet website of the Department that is accessible to the 
    public.
        (2) Information on location of residency training.--The 
    Internet website of the Department that is accessible to the public 
    shall include under the link to the ``Our Doctors'' health care 
    providers database of the Department, or any successor database, 
    the name of the facility at which each licensed physician of the 
    Department underwent residency training.
        (3) Information on physicians at particular facilities.--The 
    ``Our Doctors'' health care providers database of the Department, 
    or any successor database, shall identify whether each licensed 
    physician of the Department is a physician in residency.
    (b) Information on Credentials of Physicians for Veterans 
Undergoing Surgical Procedures.--
        (1) In general.--Each veteran who is undergoing a surgical 
    procedure by or through the Department shall be provided 
    information described in paragraph (2) with respect to the surgeon 
    to be performing such procedure at such time in advance of the 
    procedure as is appropriate to permit such veteran to evaluate such 
    information.
        (2) Information described.--The information described in this 
    paragraph with respect to a surgeon described in paragraph (1) is 
    as follows:
            (A) The education and training of the surgeon.
            (B) The licensure, registration, and certification of the 
        surgeon by the State or national entity responsible for such 
        licensure, registration, or certification.
        (3) Other individuals.--If a veteran is unable to evaluate the 
    information provided under paragraph (1) due to the health or 
    mental competence of the veteran, such information shall be 
    provided to an individual acting on behalf of the veteran.
    (c) Comptroller General Report and Plan.--
        (1) Report.--Not later than 2 years after the date of the 
    enactment of this Act, the Comptroller General of the United States 
    shall submit to the Committee on Veterans' Affairs of the Senate 
    and the Committee on Veterans' Affairs of the House of 
    Representatives a report setting forth an assessment by the 
    Comptroller General of the following:
            (A) The manner in which contractors under the Patient-
        Centered Community Care initiative of the Department perform 
        oversight of the credentials of physicians within the networks 
        of such contractors under the initiative.
            (B) The oversight by the Department of the contracts under 
        the Patient-Centered Community Care initiative.
            (C) The verification by the Department of the credentials 
        and licenses of health care providers furnishing hospital care 
        and medical services under section 101.
        (2) Plan.--
            (A) In general.--Not later than 30 days after the submittal 
        of the report under paragraph (1), the Secretary shall submit 
        to the Comptroller General, the Committee on Veterans' Affairs 
        of the Senate, and the Committee on Veterans' Affairs of the 
        House of Representatives a plan to address any findings and 
        recommendations of the Comptroller General included in such 
        report.
            (B) Implementation.--Not later than 90 days after the 
        submittal of the report under paragraph (1), the Secretary 
        shall carry out such plan.
    SEC. 208. INFORMATION IN ANNUAL BUDGET OF THE PRESIDENT ON HOSPITAL 
      CARE AND MEDICAL SERVICES FURNISHED THROUGH EXPANDED USE OF 
      CONTRACTS FOR SUCH CARE.
    The materials on the Department of Veterans Affairs in the budget 
of the President for a fiscal year, as submitted to Congress pursuant 
to section 1105(a) of title 31, United States Code, shall set forth the 
following:
        (1) The number of veterans who received hospital care and 
    medical services under section 101 during the fiscal year preceding 
    the fiscal year in which such budget is submitted.
        (2) The amount expended by the Department on furnishing care 
    and services under such section during the fiscal year preceding 
    the fiscal year in which such budget is submitted.
        (3) The amount requested in such budget for the costs of 
    furnishing care and services under such section during the fiscal 
    year covered by such budget, set forth in aggregate and by amounts 
    for each account for which amounts are so requested.
        (4) The number of veterans that the Department estimates will 
    receive hospital care and medical services under such section 
    during the fiscal years covered by the budget submission.
        (5) The number of employees of the Department on paid 
    administrative leave at any point during the fiscal year preceding 
    the fiscal year in which such budget is submitted.
    SEC. 209. PROHIBITION ON FALSIFICATION OF DATA CONCERNING WAIT 
      TIMES AND QUALITY MEASURES AT DEPARTMENT OF VETERANS AFFAIRS.
    Not later than 60 days after the date of the enactment of this Act, 
and in accordance with title 5, United States Code, the Secretary of 
Veterans Affairs shall establish policies whereby any employee of the 
Department of Veterans Affairs who knowingly submits false data 
concerning wait times for health care or quality measures with respect 
to health care to another employee of the Department or knowingly 
requires another employee of the Department to submit false data 
concerning such wait times or quality measures to another employee of 
the Department is subject to a penalty the Secretary considers 
appropriate after notice and an opportunity for a hearing, including 
civil penalties, unpaid suspensions, or termination.

   TITLE III--HEALTH CARE STAFFING, RECRUITMENT, AND TRAINING MATTERS

    SEC. 301. TREATMENT OF STAFFING SHORTAGE AND BIENNIAL REPORT ON 
      STAFFING OF MEDICAL FACILITIES OF THE DEPARTMENT OF VETERANS 
      AFFAIRS.
    (a) Staffing Shortages.--
        (1) In general.--Subchapter I of chapter 74 of title 38, United 
    States Code, is amended by adding at the end the following new 
    section:
``Sec. 7412. Annual determination of staffing shortages; recruitment 
    and appointment for needed occupations
    ``(a) In General.--Not later than September 30 of each year, the 
Inspector General of the Department shall determine, and the Secretary 
shall publish in the Federal Register, the five occupations of 
personnel of this title of the Department covered under section 7401 of 
this title for which there are the largest staffing shortages 
throughout the Department as calculated over the five-year period 
preceding the determination.
    ``(b) Recruitment and Appointment.--Notwithstanding sections 3304 
and 3309 through 3318 of title 5, the Secretary may, upon a 
determination by the Inspector General under paragraph (1) that there 
is a staffing shortage throughout the Department with respect to a 
particular occupation, recruit and directly appoint, during the fiscal 
year after the fiscal year during which such determination is made, 
qualified personnel to serve in that particular occupation for the 
Department.''.
        (2) Clerical amendment.--The table of sections at the beginning 
    of such chapter is amended by inserting after the item relating to 
    section 7411 the following new item:

``7412. Annual determination of staffing shortages; recruitment and 
          appointment for needed occupations.''.

        (3) Deadline for first determination.--Notwithstanding the 
    deadline under section 7412 of title 38, United States Code, as 
    added by paragraph (1), for the annual determination of staffing 
    shortages in the Veterans Health Administration, the Inspector 
    General of the Department of Veterans Affairs shall make the first 
    determination required under such section, and the Secretary of 
    Veterans Affairs shall publish in the Federal Register such 
    determination, by not later than the date that is 180 days after 
    the date of the enactment of this Act.
    (b) Increase of Graduate Medical Education Residency Positions.--
        (1) In general.--Section 7302 of title 38, United States Code, 
    is amended by adding at the end the following new subsection:
    ``(e)(1) In carrying out this section, the Secretary shall 
establish medical residency programs, or ensure that already 
established medical residency programs have a sufficient number of 
residency positions, at any medical facility of the Department that the 
Secretary determines--
        ``(A) is experiencing a shortage of physicians; and
        ``(B) is located in a community that is designated as a health 
    professional shortage area (as defined in section 332 of the Public 
    Health Service Act (42 U.S.C. 254e)).
    ``(2) In carrying out paragraph (1), the Secretary shall--
        ``(A) allocate the residency positions under such paragraph 
    among occupations included in the most current determination 
    published in the Federal Register pursuant to section 7412(a) of 
    this title; and
        ``(B) give priority to residency positions and programs in 
    primary care, mental health, and any other specialty the Secretary 
    determines appropriate.''.
        (2) Five-year increase.--
            (A) In general.--In carrying out section 7302(e) of title 
        38, United States Code, as added by paragraph (1), during the 
        5-year period beginning on the day that is 1 year after the 
        date of the enactment of this Act, the Secretary of Veterans 
        Affairs shall increase the number of graduate medical education 
        residency positions at medical facilities of the Department by 
        up to 1,500 positions.
            (B) Priority.--In increasing the number of graduate medical 
        education residency positions at medical facilities of the 
        Department under subparagraph (A), the Secretary shall give 
        priority to medical facilities that--
                (i) as of the date of the enactment of this Act, do not 
            have a medical residency program; and
                (ii) are located in a community that has a high 
            concentration of veterans.
        (3) Report.--
            (A) In general.--Not later than 60 days after the date of 
        the enactment of this Act, and not later than October 1 each 
        year thereafter until 2019, the Secretary shall submit to the 
        Committee on Veterans' Affairs of the Senate and the Committee 
        on Veterans' Affairs of the House of Representatives a report 
        on graduate medical education residency positions at medical 
        facilities of the Department.
            (B) Elements.--Each report required by subparagraph (A) 
        shall include the following:
                (i) For the year preceding the submittal of the report, 
            the number of graduate medical education residency 
            positions at medical facilities of the Department as 
            follows:

                    (I) That were filled.
                    (II) That were not filled.
                    (III) That the Department anticipated filling.

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

                    (I) the geographic location of each such position; 
                and
                    (II) if such position was filled, the academic 
                affiliation of the medical resident that filled such 
                position.

                (iii) The policy at each medical facility of the 
            Department with respect to the ratio of medical residents 
            to staff supervising medical residents.
                (iv) During the 1-year period preceding the submittal 
            of the report, the number of individuals who declined an 
            offer from the Department to serve as a medical resident at 
            a medical facility of the Department and the reason why 
            each such individual declined such offer.
                (v) During the 1-year period preceding the submittal of 
            the report, a description of--

                    (I) challenges, if any, faced by the Department in 
                filling graduate medical education residency positions 
                at medical facilities of the Department; and
                    (II) actions, if any, taken by the Department to 
                address such challenges.

                (vi) A description of efforts of the Department, as of 
            the date of the submittal of the report, to recruit and 
            retain medical residents to work for the Veterans Health 
            Administration as full-time employees.
    (c) Priority in Scholarship Program of Health Professionals 
Educational Assistance Program to Certain Providers.--Section 
7612(b)(5) of title 38, United States Code, is amended--
        (1) in subparagraph (A), by striking ``and'' at the end;
        (2) by redesignating subparagraph (B) as subparagraph (C); and
        (3) by inserting after subparagraph (A) the following new 
    subparagraph (B):
        ``(B) shall give priority to applicants pursuing a course of 
    education or training toward a career in an occupation for which 
    the Inspector General of the Department has, in the most current 
    determination published in the Federal Register pursuant to section 
    7412(a) of this title, determined that there is one of the largest 
    staffing shortages throughout the Department with respect to such 
    occupation; and''.
    (d) Reports.--
        (1) In general.--Not later than 180 days after the date of the 
    enactment of this Act, and not later than December 31 of each even-
    numbered year thereafter until 2024, the Secretary of Veterans 
    Affairs shall submit to the Committees on Veterans' Affairs of the 
    Senate and House of Representatives a report assessing the staffing 
    of each medical facility of the Department.
        (2) Elements.--Each report submitted under paragraph (1) shall 
    include the following:
            (A) The results of a system-wide assessment of all medical 
        facilities of the Department to ensure the following:
                (i) Appropriate staffing levels for health care 
            professionals to meet the goals of the Secretary for timely 
            access to care for veterans.
                (ii) Appropriate staffing levels for support personnel, 
            including clerks.
                (iii) Appropriate sizes for clinical panels.
                (iv) Appropriate numbers of full-time staff, or full-
            time equivalents, dedicated to direct care of patients.
                (v) Appropriate physical plant space to meet the 
            capacity needs of the Department in that area.
                (vi) Such other factors as the Secretary considers 
            necessary.
            (B) A plan for addressing any issues identified in the 
        assessment described in subparagraph (A), including a timeline 
        for addressing such issues.
            (C) A list of the current wait times and workload levels 
        for the following clinics in each medical facility:
                (i) Mental health.
                (ii) Primary care.
                (iii) Gastroenterology.
                (iv) Women's health.
                (v) Such other clinics as the Secretary considers 
            appropriate.
            (D) A description of the results of the most current 
        determination of the Inspector General under subsection (a) of 
        section 7412 of title 38, United States Code, as added by 
        subsection (a)(1) of this section, and a plan to use direct 
        appointment authority under subsection (b) of such section 7412 
        to fill staffing shortages, including recommendations for 
        improving the speed at which the credentialing and privileging 
        process can be conducted.
            (E) The current staffing models of the Department for the 
        following clinics, including recommendations for changes to 
        such models:
                (i) Mental health.
                (ii) Primary care.
                (iii) Gastroenterology.
                (iv) Women's health.
                (v) Such other clinics as the Secretary considers 
            appropriate.
            (F) A detailed analysis of succession planning at medical 
        facilities of the Department, including the following:
                (i) The number of positions in medical facilities 
            throughout the Department that are not filled by a 
            permanent employee.
                (ii) The length of time each position described in 
            clause (i) remained vacant or filled by a temporary or 
            acting employee.
                (iii) A description of any barriers to filling the 
            positions described in clause (i).
                (iv) A plan for filling any positions that are vacant 
            or filled by a temporary or acting employee for more than 
            180 days.
                (v) A plan for handling emergency circumstances, such 
            as administrative leave or sudden medical leave for senior 
            officials.
            (G) The number of health care providers of the Department 
        who have been removed from their positions, have retired, or 
        have left their positions for another reason, disaggregated by 
        provider type, during the 2-year period preceding the submittal 
        of the report.
            (H) Of the health care providers specified in subparagraph 
        (G) who have been removed from their positions, the following:
                (i) The number of such health care providers who were 
            reassigned to other positions in the Department.
                (ii) The number of such health care providers who left 
            the Department.
                (iii) The number of such health care providers who left 
            the Department and were subsequently rehired by the 
            Department.
    SEC. 302. EXTENSION AND MODIFICATION OF CERTAIN PROGRAMS WITHIN THE 
      DEPARTMENT OF VETERANS AFFAIRS HEALTH PROFESSIONALS EDUCATIONAL 
      ASSISTANCE PROGRAM.
    (a) Extension of Scholarship Program.--Section 7619 of title 38, 
United States Code, is amended by striking ``December 31, 2014'' and 
inserting ``December 31, 2019''.
    (b) Modification of Education Debt Reduction Program.--
        (1) Modification of amount and duration of eligibility.--
    Paragraph (1) of section 7683(d) of such title is amended--
            (A) by striking ``$60,000'' and inserting ``$120,000''; and
            (B) by striking ``$12,000 of such payments'' and all that 
        follows through the period at the end and inserting ``$24,000 
        of such payments may be made in each year of participation in 
        the Program''.
        (2) Elimination of limitation.--
            (A) In general.--Such section is further amended--
                (i) by striking paragraph (2);
                (ii) by redesignating paragraph (3) as paragraph (2); 
            and
                (iii) in paragraph (2), as redesignated by clause (ii), 
            by striking ``paragraphs (1) and (2)'' and inserting 
            ``paragraph (1)''.
            (B) Conforming amendment.--Paragraph (1) of such section, 
        as amended by paragraph (1), is further amended by striking 
        ``Subject to paragraph (2), the amount'' and inserting ``The 
        amount''.
    SEC. 303. CLINIC MANAGEMENT TRAINING FOR EMPLOYEES AT MEDICAL 
      FACILITIES OF THE DEPARTMENT OF VETERANS AFFAIRS.
    (a) Clinic Management Training Program.--
        (1) In general.--Not later than 180 days after the date of the 
    enactment of this Act, the Secretary of Veterans Affairs shall 
    commence a role-specific clinic management training program to 
    provide in-person, standardized education on systems and processes 
    for health care practice management and scheduling to all 
    appropriate employees, as determined by the Secretary, at medical 
    facilities of the Department.
        (2) Elements.--
            (A) In general.--The clinic management training program 
        required by paragraph (1) shall include the following:
                (i) Training on how to manage the schedules of health 
            care providers of the Department, including the following:

                    (I) Maintaining such schedules in a manner that 
                allows appointments to be booked at least eight weeks 
                in advance.
                    (II) Proper planning procedures for vacation, 
                leave, and graduate medical education training 
                schedules.

                (ii) Training on the appropriate number of appointments 
            that a health care provider should conduct on a daily 
            basis, based on specialty.
                (iii) Training on how to determine whether there are 
            enough available appointment slots to manage demand for 
            different appointment types and mechanisms for alerting 
            management of insufficient slots.
                (iv) Training on how to properly use the appointment 
            scheduling system of the Department, including any new 
            scheduling system implemented by the Department.
                (v) Training on how to optimize the use of technology, 
            including the following:

                    (I) Telemedicine.
                    (II) Electronic mail.
                    (III) Text messaging.
                    (IV) Such other technologies as specified by the 
                Secretary.

                (vi) Training on how to properly use physical plant 
            space at medical facilities of the Department to ensure 
            efficient flow and privacy for patients and staff.
            (B) Role-specific.--The Secretary shall ensure that each 
        employee of the Department included in the clinic management 
        training program required by paragraph (1) receives education 
        under such program that is relevant to the responsibilities of 
        such employee.
        (3) Sunset.--The clinic management training program required by 
    paragraph (1) shall terminate on the date that is 2 years after the 
    date on which the Secretary commences such program.
    (b) Training Materials.--
        (1) In general.--After the termination of the clinic management 
    training program required by subsection (a), the Secretary shall 
    provide training materials on health care management to each of the 
    following employees of the Department that are relevant to the 
    position and responsibilities of such employee upon the 
    commencement of employment of such employee:
            (A) Any manager of a medical facility of the Department.
            (B) Any health care provider at a medical facility of the 
        Department.
            (C) Such other employees of the Department as the Secretary 
        considers appropriate.
        (2) Update.--The Secretary shall regularly update the training 
    materials required under paragraph (1).

             TITLE IV--HEALTH CARE RELATED TO SEXUAL TRAUMA

    SEC. 401. EXPANSION OF ELIGIBILITY FOR SEXUAL TRAUMA COUNSELING AND 
      TREATMENT TO VETERANS ON INACTIVE DUTY TRAINING.
    Section 1720D(a)(1) of title 38, United States Code, is amended by 
striking ``or active duty for training'' and inserting ``, active duty 
for training, or inactive duty training''.
    SEC. 402. PROVISION OF COUNSELING AND TREATMENT FOR SEXUAL TRAUMA 
      BY THE DEPARTMENT OF VETERANS AFFAIRS TO MEMBERS OF THE ARMED 
      FORCES.
    (a) Expansion of Coverage to Members of the Armed Forces.--
Subsection (a) of section 1720D of title 38, United States Code, is 
amended--
        (1) by redesignating paragraph (2) as paragraph (3);
        (2) by inserting after paragraph (1) the following new 
    paragraph (2):
    ``(2)(A) In operating the program required by paragraph (1), the 
Secretary may, in consultation with the Secretary of Defense, provide 
counseling and care and services to members of the Armed Forces 
(including members of the National Guard and Reserves) on active duty 
to overcome psychological trauma described in that paragraph.
    ``(B) A member described in subparagraph (A) shall not be required 
to obtain a referral before receiving counseling and care and services 
under this paragraph.''; and
        (3) in paragraph (3), as redesignated by paragraph (1)--
            (A) by striking ``a veteran'' and inserting ``an 
        individual''; and
            (B) by striking ``that veteran'' each place it appears and 
        inserting ``that individual''.
    (b) Information to Members on Availability of Counseling and 
Services.--Subsection (c) of such section is amended--
        (1) by striking ``to veterans'' each place it appears; and
        (2) in paragraph (3), by inserting ``members of the Armed 
    Forces and'' before ``individuals''.
    (c) Inclusion of Members in Reports on Counseling and Services.--
Subsection (e) of such section is amended--
        (1) in the matter preceding paragraph (1), by striking ``to 
    veterans'';
        (2) in paragraph (2)--
            (A) by striking ``women veterans'' and inserting 
        ``individuals''; and
            (B) by striking ``training under subsection (d).'' and 
        inserting ``training under subsection (d), disaggregated by--
            ``(A) veterans;
            ``(B) members of the Armed Forces (including members of the 
        National Guard and Reserves) on active duty; and
            ``(C) for each of subparagraphs (A) and (B)--
                ``(i) men; and
                ``(ii) women.'';
        (3) in paragraph (4), by striking ``veterans'' and inserting 
    ``individuals''; and
        (4) in paragraph (5)--
            (A) by striking ``women veterans'' and inserting 
        ``individuals''; and
            (B) by inserting ``, including specific recommendations for 
        individuals specified in subparagraphs (A), (B), and (C) of 
        paragraph (2)'' before the period at the end.
    (d) Effective Date.--The amendments made by this section shall take 
effect on the date that is 1 year after the date of the enactment of 
this Act.
    SEC. 403. REPORTS ON MILITARY SEXUAL TRAUMA.
    (a) Report on Services Available for Military Sexual Trauma in the 
Department of Veterans Affairs.--Not later than 630 days after the date 
of the enactment of this Act, the Secretary of Veterans Affairs shall 
submit to the Committee on Veterans' Affairs of the Senate and the 
Committee on Veterans' Affairs of the House of Representatives a report 
on the treatment and services available from the Department of Veterans 
Affairs for male veterans who experience military sexual trauma 
compared to such treatment and services available to female veterans 
who experience military sexual trauma.
    (b) Reports on Transition of Military Sexual Trauma Treatment From 
Department of Defense to Department of Veterans Affairs.--Not later 
than 630 days after the date of the enactment of this Act, and annually 
thereafter for 5 years, the Department of Veterans Affairs-Department 
of Defense Joint Executive Committee established by section 320(a) of 
title 38, United States Code, shall submit to the appropriate 
committees of Congress a report on military sexual trauma that includes 
the following:
        (1) The processes and procedures utilized by the Department of 
    Veterans Affairs and the Department of Defense to facilitate 
    transition of treatment of individuals who have experienced 
    military sexual trauma from treatment provided by the Department of 
    Defense to treatment provided by the Department of Veterans 
    Affairs.
        (2) A description and assessment of the collaboration between 
    the Department of Veterans Affairs and the Department of Defense in 
    assisting veterans in filing claims for disabilities related to 
    military sexual trauma, including permitting veterans access to 
    information and evidence necessary to develop or support such 
    claims.
    (c) Definitions.--In this section:
        (1) Appropriate committees of congress.--The term ``appropriate 
    committees of Congress'' means--
            (A) the Committee on Veterans' Affairs and the Committee on 
        Armed Services of the Senate; and
            (B) the Committee on Veterans' Affairs and the Committee on 
        Armed Services of the House of Representatives.
        (2) Military sexual trauma.--The term ``military sexual 
    trauma'' means psychological trauma, which in the judgment of a 
    mental health professional employed by the Department, resulted 
    from a physical assault of a sexual nature, battery of a sexual 
    nature, or sexual harassment which occurred while the veteran was 
    serving on active duty, active duty for training, or inactive duty 
    training.
        (3) Sexual harassment.--The term ``sexual harassment'' means 
    repeated, unsolicited verbal or physical contact of a sexual nature 
    which is threatening in character.
        (4) Sexual trauma.--The term ``sexual trauma'' shall have the 
    meaning given that term by the Secretary of Veterans Affairs for 
    purposes of this section.
    (d) Effective Date.--This section shall take effect on the date 
that is 270 days after the date of the enactment of this Act.

                   TITLE V--OTHER HEALTH CARE MATTERS

    SEC. 501. EXTENSION OF PILOT PROGRAM ON ASSISTED LIVING SERVICES 
      FOR VETERANS WITH TRAUMATIC BRAIN INJURY.
    (a) In General.--Section 1705 of the National Defense Authorization 
Act for Fiscal Year 2008 (Public Law 110-181; 38 U.S.C. 1710C note) is 
amended by adding at the end the following:
    ``(g) Termination.--The pilot program shall terminate on October 6, 
2017.''.
    (b) Conforming Amendment.--Subsection (a) of such section is 
amended by striking ``five-year''.

                TITLE VI--MAJOR MEDICAL FACILITY LEASES

    SEC. 601. AUTHORIZATION OF MAJOR MEDICAL FACILITY LEASES.
    (a) In General.--The Secretary of Veterans Affairs may carry out 
the following major medical facility leases at the locations specified, 
and in an amount for each lease not to exceed the amount shown for such 
location (not including any estimated cancellation costs):
        (1) For a clinical research and pharmacy coordinating center, 
    Albuquerque, New Mexico, an amount not to exceed $9,560,000.
        (2) For a community-based outpatient clinic, Brick, New Jersey, 
    an amount not to exceed $7,280,000.
        (3) For a new primary care and dental clinic annex, Charleston, 
    South Carolina, an amount not to exceed $7,070,250.
        (4) For a community-based outpatient clinic, Cobb County, 
    Georgia, an amount not to exceed $6,409,000.
        (5) For the Leeward Outpatient Healthcare Access Center, 
    Honolulu, Hawaii, including a co-located clinic with the Department 
    of Defense and the co-location of the Honolulu Regional Office of 
    the Veterans Benefits Administration and the Kapolei Vet Center of 
    the Department of Veterans Affairs, an amount not to exceed 
    $15,887,370.
        (6) For a community-based outpatient clinic, Johnson County, 
    Kansas, an amount not to exceed $2,263,000.
        (7) For a replacement community-based outpatient clinic, 
    Lafayette, Louisiana, an amount not to exceed $2,996,000.
        (8) For a community-based outpatient clinic, Lake Charles, 
    Louisiana, an amount not to exceed $2,626,000.
        (9) For outpatient clinic consolidation, New Port Richey, 
    Florida, an amount not to exceed $11,927,000.
        (10) For an outpatient clinic, Ponce, Puerto Rico, an amount 
    not to exceed $11,535,000.
        (11) For lease consolidation, San Antonio, Texas, an amount not 
    to exceed $19,426,000.
        (12) For a community-based outpatient clinic, San Diego, 
    California, an amount not to exceed $11,946,100.
        (13) For an outpatient clinic, Tyler, Texas, an amount not to 
    exceed $4,327,000.
        (14) For the Errera Community Care Center, West Haven, 
    Connecticut, an amount not to exceed $4,883,000.
        (15) For the Worcester Community-Based Outpatient Clinic, 
    Worcester, Massachusetts, an amount not to exceed $4,855,000.
        (16) For the expansion of a community-based outpatient clinic, 
    Cape Girardeau, Missouri, an amount not to exceed $4,232,060.
        (17) For a multispecialty clinic, Chattanooga, Tennessee, an 
    amount not to exceed $7,069,000.
        (18) For the expansion of a community-based outpatient clinic, 
    Chico, California, an amount not to exceed $4,534,000.
        (19) For a community-based outpatient clinic, Chula Vista, 
    California, an amount not to exceed $3,714,000.
        (20) For a new research lease, Hines, Illinois, an amount not 
    to exceed $22,032,000.
        (21) For a replacement research lease, Houston, Texas, an 
    amount not to exceed $6,142,000.
        (22) For a community-based outpatient clinic, Lincoln, 
    Nebraska, an amount not to exceed $7,178,400.
        (23) For a community-based outpatient clinic, Lubbock, Texas, 
    an amount not to exceed $8,554,000.
        (24) For a community-based outpatient clinic consolidation, 
    Myrtle Beach, South Carolina, an amount not to exceed $8,022,000.
        (25) For a community-based outpatient clinic, Phoenix, Arizona, 
    an amount not to exceed $20,757,000.
        (26) For the expansion of a community-based outpatient clinic, 
    Redding, California, an amount not to exceed $8,154,000.
        (27) For the expansion of a community-based outpatient clinic, 
    Tulsa, Oklahoma, an amount not to exceed $13,269,200.
    (b) Requirements for Clinic in Tulsa.--
        (1) In general.--In carrying out the expansion of the 
    community-based outpatient clinic in Tulsa, Oklahoma, authorized by 
    subsection (a)(27), the Secretary of Veterans Affairs shall ensure 
    that such clinic satisfies the following requirements:
            (A) Consist of not more than 140,000 gross square feet.
            (B) Have an annual cost per square foot of not more than 
        the average market rate in Tulsa, Oklahoma, for an equivalent 
        medical facility plus 20 percent.
            (C) Satisfy the mandate of the Department of Veterans 
        Affairs to provide veterans in Oklahoma with access to quality 
        and efficient care.
            (D) Expand clinical capacity in the region in which the 
        clinic is located in a cost efficient manner based upon 
        regional cost comparisons, taking into account the needs of 
        current veterans and the potential demand by veterans for care 
        in the future.
            (E) Be the most cost effective option for the Department as 
        predicted over a 30-year life cycle for such clinic.
        (2) Cost effective determination.--
            (A) In general.--If the Secretary determines that the most 
        cost effective option over a 30-year life cycle would be to 
        purchase or construct a facility in Tulsa, Oklahoma, instead of 
        entering into a major medical facility lease in such location 
        as authorized by subsection (a)(27), the Secretary shall not 
        enter into such lease.
            (B) Major medical facility project.--If the Secretary makes 
        the determination described in subparagraph (A), the Secretary 
        may request authority for a major medical facility project in 
        Tulsa, Oklahoma, from Congress pursuant to section 8104(b) of 
        title 38, United States Code.
            (C) Cost-benefit analysis.--If the Secretary requests 
        authority for the major medical facility project described in 
        subparagraph (B), not later than 90 days after making the 
        determination described in subparagraph (A), the Secretary 
        shall submit to Congress a detailed cost-benefit analysis of 
        such major medical facility project.
    SEC. 602. BUDGETARY TREATMENT OF DEPARTMENT OF VETERANS AFFAIRS 
      MAJOR MEDICAL FACILITIES LEASES.
    (a) Findings.--Congress finds the following:
        (1) Title 31, United States Code, requires the Department of 
    Veterans Affairs to record the full cost of its contractual 
    obligation against funds available at the time a contract is 
    executed.
        (2) Office of Management and Budget Circular A-11 provides 
    guidance to agencies in meeting the statutory requirements under 
    title 31, United States Code, with respect to leases.
        (3) For operating leases, Office of Management and Budget 
    Circular A-11 requires the Department of Veterans Affairs to record 
    up-front budget authority in an ``amount equal to total payments 
    under the full term of the lease or [an] amount sufficient to cover 
    first year lease payments plus cancellation costs''.
    (b) Requirement for Obligation of Full Cost.--
        (1) In general.--Subject to the availability of appropriations 
    provided in advance, in exercising the authority of the Secretary 
    of Veterans Affairs to enter into leases provided in this Act, the 
    Secretary shall record, pursuant to section 1501 of title 31, 
    United States Code, as the full cost of the contractual obligation 
    at the time a contract is executed either--
            (A) an amount equal to total payments under the full term 
        of the lease; or
            (B) if the lease specifies payments to be made in the event 
        the lease is terminated before its full term, an amount 
        sufficient to cover the first year lease payments plus the 
        specified cancellation costs.
        (2) Self-insuring authority.--The requirements of paragraph (1) 
    may be satisfied through the use of the self-insuring authority 
    identified in title 40, United States Code, consistent with Office 
    of Management and Budget Circular A-11.
    (c) Transparency.--
        (1) Compliance.--Subsection (b) of section 8104 of title 38, 
    United States Code, is amended by adding at the end the following 
    new paragraph:
        ``(7) In the case of a prospectus proposing funding for a major 
    medical facility lease, a detailed analysis of how the lease is 
    expected to comply with Office of Management and Budget Circular A-
    11 and section 1341 of title 31 (commonly referred to as the `Anti-
    Deficiency Act'). Any such analysis shall include--
            ``(A) an analysis of the classification of the lease as a 
        `lease-purchase', `capital lease', or `operating lease' as 
        those terms are defined in Office of Management and Budget 
        Circular A-11;
            ``(B) an analysis of the obligation of budgetary resources 
        associated with the lease; and
            ``(C) an analysis of the methodology used in determining 
        the asset cost, fair market value, and cancellation costs of 
        the lease.''.
        (2) Submittal to congress.--Such section 8104 is further 
    amended by adding at the end the following new subsection:
    ``(h)(1) Not less than 30 days before entering into a major medical 
facility lease, the Secretary shall submit to the Committees on 
Veterans' Affairs of the Senate and the House of Representatives--
        ``(A) notice of the Secretary's intention to enter into the 
    lease;
        ``(B) a detailed summary of the proposed lease;
        ``(C) a description and analysis of any differences between the 
    prospectus submitted pursuant to subsection (b) and the proposed 
    lease; and
        ``(D) a scoring analysis demonstrating that the proposed lease 
    fully complies with Office of Management and Budget Circular A-11.
    ``(2) Each committee described in paragraph (1) shall ensure that 
any information submitted to the committee under such paragraph is 
treated by the committee with the same level of confidentiality as is 
required by law of the Secretary and subject to the same statutory 
penalties for unauthorized disclosure or use as the Secretary.
    ``(3) Not more than 30 days after entering into a major medical 
facility lease, the Secretary shall submit to each committee described 
in paragraph (1) a report on any material differences between the lease 
that was entered into and the proposed lease described under such 
paragraph, including how the lease that was entered into changes the 
previously submitted scoring analysis described in subparagraph (D) of 
such paragraph.''.
    (d) Rule of Construction.--Nothing in this section, or the 
amendments made by this section, shall be construed to in any way 
relieve the Department of Veterans Affairs from any statutory or 
regulatory obligations or requirements existing prior to the enactment 
of this section and such amendments.

                   TITLE VII--OTHER VETERANS MATTERS

    SEC. 701. EXPANSION OF MARINE GUNNERY SERGEANT JOHN DAVID FRY 
      SCHOLARSHIP.
    (a) Expansion of Entitlement.--Subsection (b)(9) of section 3311 of 
title 38, United States Code, is amended by inserting ``or spouse'' 
after ``child''.
    (b) Limitation and Election on Certain Benefits.--Subsection (f) of 
such section is amended--
        (1) by redesignating paragraph (2) as paragraph (4); and
        (2) by inserting after paragraph (1) the following new 
    paragraphs:
        ``(2) Limitation.--The entitlement of an individual to 
    assistance under subsection (a) pursuant to paragraph (9) of 
    subsection (b) because the individual was a spouse of a person 
    described in such paragraph shall expire on the earlier of--
            ``(A) the date that is 15 years after the date on which the 
        person died; or
            ``(B) the date on which the individual remarries.
        ``(3) Election on receipt of certain benefits.--A surviving 
    spouse entitled to assistance under subsection (a) pursuant to 
    paragraph (9) of subsection (b) who is also entitled to educational 
    assistance under chapter 35 of this title may not receive 
    assistance under both this section and such chapter, but shall make 
    an irrevocable election (in such form and manner as the Secretary 
    may prescribe) under which section or chapter to receive 
    educational assistance.''.
    (c) Conforming Amendment.--Section 3321(b)(4) of such title is 
amended--
        (1) by striking ``an individual'' and inserting ``a child''; 
    and
        (2) by striking ``such individual's'' each time it appears and 
    inserting ``such child's''.
    (d) Effective Date.--The amendments made by this section shall 
apply with respect to a quarter, semester, or term, as applicable, 
commencing on or after January 1, 2015.
    SEC. 702. APPROVAL OF COURSES OF EDUCATION PROVIDED BY PUBLIC 
      INSTITUTIONS OF HIGHER LEARNING FOR PURPOSES OF ALL-VOLUNTEER 
      FORCE EDUCATIONAL ASSISTANCE PROGRAM AND POST-9/11 EDUCATIONAL 
      ASSISTANCE CONDITIONAL ON IN-STATE TUITION RATE FOR VETERANS.
    (a) In General.--Section 3679 of title 38, United States Code, is 
amended by adding at the end the following new subsection:
    ``(c)(1) Notwithstanding any other provision of this chapter and 
subject to paragraphs (3) through (6), the Secretary shall disapprove a 
course of education provided by a public institution of higher learning 
to a covered individual pursuing a course of education with educational 
assistance under chapter 30 or 33 of this title while living in the 
State in which the public institution of higher learning is located if 
the institution charges tuition and fees for that course for the 
covered individual at a rate that is higher than the rate the 
institution charges for tuition and fees for that course for residents 
of the State in which the institution is located, regardless of the 
covered individual's State of residence.
    ``(2) For purposes of this subsection, a covered individual is any 
individual as follows:
        ``(A) A veteran who was discharged or released from a period of 
    not fewer than 90 days of service in the active military, naval, or 
    air service less than three years before the date of enrollment in 
    the course concerned.
        ``(B) An individual who is entitled to assistance under section 
    3311(b)(9) or 3319 of this title by virtue of such individual's 
    relationship to a veteran described in subparagraph (A).
    ``(3) If after enrollment in a course of education that is subject 
to disapproval under paragraph (1) by reason of paragraph (2)(A) or 
(2)(B) a covered individual pursues one or more courses of education at 
the same public institution of higher learning while remaining 
continuously enrolled (other than during regularly scheduled breaks 
between courses, semesters or terms) at that institution of higher 
learning, any course so pursued by the covered individual at that 
institution of higher learning while so continuously enrolled shall 
also be subject to disapproval under paragraph (1).
    ``(4) It shall not be grounds to disapprove a course of education 
under paragraph (1) if a public institution of higher learning requires 
a covered individual pursuing a course of education at the institution 
to demonstrate an intent, by means other than satisfying a physical 
presence requirement, to establish residency in the State in which the 
institution is located, or to satisfy other requirements not relating 
to the establishment of residency, in order to be charged tuition and 
fees for that course at a rate that is equal to or less than the rate 
the institution charges for tuition and fees for that course for 
residents of the State.
    ``(5) The Secretary may waive such requirements of paragraph (1) as 
the Secretary considers appropriate.
    ``(6) Disapproval under paragraph (1) shall apply only with respect 
to educational assistance under chapters 30 and 33 of this title.''.
    (b) Effective Date.--Subsection (c) of section 3679 of title 38, 
United States Code (as added by subsection (a) of this section), shall 
apply with respect to educational assistance provided for pursuit of a 
program of education during a quarter, semester, or term, as 
applicable, that begins after July 1, 2015.
    SEC. 703. EXTENSION OF REDUCTION IN AMOUNT OF PENSION FURNISHED BY 
      DEPARTMENT OF VETERANS AFFAIRS FOR CERTAIN VETERANS COVERED BY 
      MEDICAID PLANS FOR SERVICES FURNISHED BY NURSING FACILITIES.
    Section 5503(d)(7) of title 38, United States Code, is amended by 
striking ``November 30, 2016'' and inserting ``September 30, 2024''.
    SEC. 704. EXTENSION OF REQUIREMENT FOR COLLECTION OF FEES FOR 
      HOUSING LOANS GUARANTEED BY SECRETARY OF VETERANS AFFAIRS.
    Section 3729(b)(2) of title 38, United States Code, is amended--
        (1) in subparagraph (A)--
            (A) in clause (iii), by striking ``October 1, 2017'' and 
        inserting ``September 30, 2024''; and
            (B) in clause (iv), by striking ``October 1, 2017'' and 
        inserting ``September 30, 2024'';
        (2) in subparagraph (B)--
            (A) in clause (i), by striking ``October 1, 2017'' and 
        inserting ``September 30, 2024''; and
            (B) in clause (ii), by striking ``October 1, 2017'' and 
        inserting ``September 30, 2024'';
        (3) in subparagraph (C)--
            (A) in clause (i), by striking ``October 1, 2017'' and 
        inserting ``September 30, 2024''; and
            (B) in clause (ii), by striking ``October 1, 2017'' and 
        inserting ``September 30, 2024''; and
        (4) in subparagraph (D)--
            (A) in clause (i), by striking ``October 1, 2017'' and 
        inserting ``September 30, 2024''; and
            (B) in clause (ii), by striking ``October 1, 2017'' and 
        inserting ``September 30, 2024''.
    SEC. 705. LIMITATION ON AWARDS AND BONUSES PAID TO EMPLOYEES OF 
      DEPARTMENT OF VETERANS AFFAIRS.
    In each of fiscal years 2015 through 2024, the Secretary of 
Veterans Affairs shall ensure that the aggregate amount of awards and 
bonuses paid by the Secretary in a fiscal year under chapter 45 or 53 
of title 5, United States Code, or any other awards or bonuses 
authorized under such title does not exceed $360,000,000.
    SEC. 706. EXTENSION OF AUTHORITY TO USE INCOME INFORMATION.
    Section 5317(g) of title 38, United States Code, is amended by 
striking ``September 30, 2016'' and inserting ``September 30, 2024''.
    SEC. 707. REMOVAL OF SENIOR EXECUTIVES OF THE DEPARTMENT OF 
      VETERANS AFFAIRS FOR PERFORMANCE OR MISCONDUCT.
    (a) Removal or Transfer.--
        (1) In general.--Chapter 7 of title 38, United States Code, is 
    amended by adding at the end the following new section:
``Sec. 713. Senior executives: removal based on performance or 
   misconduct
    ``(a) In General.--(1) The Secretary may remove an individual 
employed in a senior executive position at the Department of Veterans 
Affairs from the senior executive position if the Secretary determines 
the performance or misconduct of the individual warrants such removal. 
If the Secretary so removes such an individual, the Secretary may--
        ``(A) remove the individual from the civil service (as defined 
    in section 2101 of title 5); or
        ``(B) in the case of an individual described in paragraph (2), 
    transfer the individual from the senior executive position to a 
    General Schedule position at any grade of the General Schedule for 
    which the individual is qualified and that the Secretary determines 
    is appropriate.
    ``(2) An individual described in this paragraph is an individual 
who--
        ``(A) previously occupied a permanent position within the 
    competitive service (as that term is defined in section 2102 of 
    title 5);
        ``(B) previously occupied a permanent position within the 
    excepted service (as that term is defined in section 2103 of title 
    5); or
        ``(C) prior to employment in a senior executive position at the 
    Department of Veterans Affairs, did not occupy any position within 
    the Federal Government.
    ``(b) Pay of Transferred Individual.--(1) Notwithstanding any other 
provision of law, including the requirements of section 3594 of title 
5, any individual transferred to a General Schedule position under 
subsection (a)(2) shall, beginning on the date of such transfer, 
receive the annual rate of pay applicable to such position.
    ``(2) An individual so transferred may not be placed on 
administrative leave or any other category of paid leave during the 
period during which an appeal (if any) under this section is ongoing, 
and may only receive pay if the individual reports for duty. If an 
individual so transferred does not report for duty, such individual 
shall not receive pay or other benefits pursuant to subsection (e)(5).
    ``(c) Notice to Congress.--Not later than 30 days after removing or 
transferring an individual from a senior executive position under 
subsection (a), the Secretary shall submit to the Committees on 
Veterans' Affairs of the Senate and House of Representatives notice in 
writing of such removal or transfer and the reason for such removal or 
transfer.
    ``(d) Procedure.--(1) The procedures under section 7543(b) of title 
5 shall not apply to a removal or transfer under this section.
    ``(2)(A) Subject to subparagraph (B) and subsection (e), any 
removal or transfer under subsection (a) may be appealed to the Merit 
Systems Protection Board under section 7701 of title 5.
    ``(B) An appeal under subparagraph (A) of a removal or transfer may 
only be made if such appeal is made not later than seven days after the 
date of such removal or transfer.
    ``(e) Expedited Review by Administrative Judge.--(1) Upon receipt 
of an appeal under subsection (d)(2)(A), the Merit Systems Protection 
Board shall refer such appeal to an administrative judge pursuant to 
section 7701(b)(1) of title 5. The administrative judge shall expedite 
any such appeal under such section and, in any such case, shall issue a 
decision not later than 21 days after the date of the appeal.
    ``(2) Notwithstanding any other provision of law, including section 
7703 of title 5, the decision of an administrative judge under 
paragraph (1) shall be final and shall not be subject to any further 
appeal.
    ``(3) In any case in which the administrative judge cannot issue a 
decision in accordance with the 21-day requirement under paragraph (1), 
the removal or transfer is final. In such a case, the Merit Systems 
Protection Board shall, within 14 days after the date that such removal 
or transfer is final, submit to Congress and the Committees on 
Veterans' Affairs of the Senate and House of Representatives a report 
that explains the reasons why a decision was not issued in accordance 
with such requirement.
    ``(4) The Merit Systems Protection Board or administrative judge 
may not stay any removal or transfer under this section.
    ``(5) During the period beginning on the date on which an 
individual appeals a removal from the civil service under subsection 
(d) and ending on the date that the administrative judge issues a final 
decision on such appeal, such individual may not receive any pay, 
awards, bonuses, incentives, allowances, differentials, student loan 
repayments, special payments, or benefits.
    ``(6) To the maximum extent practicable, the Secretary shall 
provide to the Merit Systems Protection Board, and to any 
administrative judge to whom an appeal under this section is referred, 
such information and assistance as may be necessary to ensure an appeal 
under this subsection is expedited.
    ``(f) Relation to Title 5.--(1) The authority provided by this 
section is in addition to the authority provided by section 3592 or 
subchapter V of chapter 75 of title 5.
    ``(2) Section 3592(b)(1) of title 5 does not apply to an action to 
remove or transfer an individual under this section.
    ``(g) Definitions.--In this section:
        ``(1) The term `individual' means--
            ``(A) a career appointee (as that term is defined in 
        section 3132(a)(4) of title 5); or
            ``(B) any individual who occupies an administrative or 
        executive position and who was appointed under section 7306(a) 
        or section 7401(1) of this title.
        ``(2) The term `misconduct' includes neglect of duty, 
    malfeasance, or failure to accept a directed reassignment or to 
    accompany a position in a transfer of function.
        ``(3) The term `senior executive position' means--
            ``(A) with respect to a career appointee (as that term is 
        defined in section 3132(a)(4) of title 5), a Senior Executive 
        Service position (as such term is defined in section 3132(a)(2) 
        of title 5); and
            ``(B) with respect to an individual appointed under section 
        7306(a) or section 7401(1) of this title, an administrative or 
        executive position.''.
        (2) Clerical amendment.--The table of sections at the beginning 
    of such chapter is amended by adding at the end the following new 
    item:

``713. Senior executives: removal based on performance or misconduct.''.

    (b) Establishment of Expedited Review Process.--
        (1) In general.--Not later than 14 days after the date of the 
    enactment of this Act, the Merit Systems Protection Board shall 
    establish and put into effect a process to conduct expedited 
    reviews in accordance with section 713(d) of title 38, United 
    States Code.
        (2) Inapplicability of certain regulations.--Section 1201.22 of 
    title 5, Code of Federal Regulations, as in effect on the day 
    before the date of the enactment of this Act, shall not apply to 
    expedited reviews carried out under section 713(d) of title 38, 
    United States Code.
        (3) Waiver.--The Merit Systems Protection Board may waive any 
    other regulation in order to provide for the expedited review 
    required under section 713(d) of title 38, United States Code.
        (4) Report by merit systems protection board.--Not later than 
    14 days after the date of the enactment of this Act, the Merit 
    Systems Protection Board shall submit to the Committees on 
    Veterans' Affairs of the Senate and House of Representatives a 
    report on the actions the Board plans to take to conduct expedited 
    reviews under section 713(d) of title 38, United States Code, as 
    added by subsection (a). Such report shall include a description of 
    the resources the Board determines will be necessary to conduct 
    such reviews and a description of whether any resources will be 
    necessary to conduct such reviews that were not available to the 
    Board on the day before the date of the enactment of this Act.
    (c) Temporary Exemption From Certain Limitation on Initiation of 
Removal From Senior Executive Service.--During the 120-day period 
beginning on the date of the enactment of this Act, an action to remove 
an individual from the Senior Executive Service at the Department of 
Veterans Affairs pursuant to section 7543 of title 5, United States 
Code, may be initiated, notwithstanding section 3592(b) of such title, 
or any other provision of law.
    (d) Construction.--
        (1) In general.--Nothing in this section or section 713 of 
    title 38, United States Code, as added by subsection (a), shall be 
    construed to apply to an appeal of a removal, transfer, or other 
    personnel action that was pending before the date of the enactment 
    of this Act.
        (2) Relation to title 5.--With respect to the removal or 
    transfer of an individual (as that term is defined in such section 
    713) employed at the Department of Veterans Affairs, the authority 
    provided by such section 713 is in addition to the authority 
    provided by section 3592 or subchapter V of chapter 75 of title 5, 
    United States Code.

                       TITLE VIII--OTHER MATTERS

    SEC. 801. APPROPRIATION OF AMOUNTS.
    (a) In General.--There is authorized to be appropriated, and is 
appropriated, to the Secretary of Veterans Affairs, out of any funds in 
the Treasury not otherwise appropriated $5,000,000,000 to carry out 
subsection (b). Such funds shall be available for obligation or 
expenditure without fiscal year limitation.
    (b) Use of Amounts.--The amount appropriated under subsection (a) 
shall be used by the Secretary as follows:
        (1) To increase the access of veterans to care as follows:
            (A) To hire primary care and specialty care physicians for 
        employment in the Department of Veterans Affairs.
            (B) To hire other medical staff, including the following:
                (i) Physicians.
                (ii) Nurses.
                (iii) Social workers.
                (iv) Mental health professionals.
                (v) Other health care professionals as the Secretary 
            considers appropriate.
            (C) To carry out sections 301 and 302, including the 
        amendments made by such sections.
            (D) To pay for expenses, equipment, and other costs 
        associated with the hiring of primary care, specialty care 
        physicians, and other medical staff under subparagraphs (A), 
        (B), and (C).
        (2) To improve the physical infrastructure of the Department as 
    follows:
            (A) To maintain and operate hospitals, nursing homes, 
        domiciliary facilities, and other facilities of the Veterans 
        Health Administration.
            (B) To enter into contracts or hire temporary employees to 
        repair, alter, or improve facilities under the jurisdiction of 
        the Department that are not otherwise provided for under this 
        paragraph.
            (C) To carry out leases for facilities of the Department.
            (D) To carry out minor construction projects of the 
        Department.
    (c) Availability.--The amount appropriated under subsection (a) 
shall remain available until expended.
    (d) Report.--
        (1) In general.--Not later than 1 year after the date of the 
    enactment of this Act, the Secretary of Veterans Affairs shall 
    submit to the appropriate committees of Congress a report on how 
    the Secretary has obligated the amounts appropriated under 
    subsection (a) as of the date of the submittal of the report.
        (2) Appropriate committees of congress defined.--In this 
    subsection, the term ``appropriate committees of Congress'' means--
            (A) the Committee on Veterans' Affairs and the Committee on 
        Appropriations of the Senate; and
            (B) the Committee on Veterans' Affairs and the Committee on 
        Appropriations of the House of Representatives.
    (e) Funding Plan.--The Secretary shall submit to Congress a funding 
plan describing how the Secretary intends to use the amounts provided 
under subsection (a).
    SEC. 802. VETERANS CHOICE FUND.
    (a) In General.--There is established in the Treasury of the United 
States a fund to be known as the Veterans Choice Fund.
    (b) Administration of Fund.--The Secretary of Veterans Affairs 
shall administer the Veterans Choice Fund established by subsection 
(a).
    (c) Use of Amounts.--
        (1) In general.--Any amounts deposited in the Veteran Choice 
    Fund shall be used by the Secretary of Veterans Affairs to carry 
    out section 101, including, subject to paragraph (2), any 
    administrative requirements of such section.
        (2) Amount for administrative requirements.--
            (A) Limitation.--Except as provided by subparagraph (B), of 
        the amounts deposited in the Veterans Choice Fund, not more 
        than $300,000,000 may be used for administrative requirements 
        to carry out section 101.
            (B) Increase.--The Secretary may increase the amount set 
        forth in subparagraph (A) with respect to the amounts used for 
        administrative requirements if--
                (i) the Secretary determines that the amount of such 
            increase is necessary to carry out section 101;
                (ii) the Secretary submits to the Committees on 
            Veterans' Affairs and Appropriations of the House of 
            Representatives and the Committees on Veterans' Affairs and 
            Appropriations of the Senate a report described in 
            subparagraph (C); and
                (iii) a period of 60 days has elapsed following the 
            date on which the Secretary submits the report under clause 
            (ii).
            (C) Report.--A report described in this subparagraph is a 
        report that contains the following:
                (i) A notification of the amount of the increase that 
            the Secretary determines necessary under subparagraph 
            (B)(i).
                (ii) The justifications for such increased amount.
                (iii) The administrative requirements that the 
            Secretary will carry out using such increased amount.
    (d) Appropriation and Deposit of Amounts.--
        (1) In general.--There is authorized to be appropriated, and is 
    appropriated, to the Secretary of Veterans Affairs, out of any 
    funds in the Treasury not otherwise appropriated $10,000,000,000 to 
    be deposited in the Veterans Choice Fund established by subsection 
    (a). Such funds shall be available for obligation or expenditure 
    without fiscal year limitation, and only for the program created 
    under section 101.
        (2) Availability.--The amount appropriated under paragraph (1) 
    shall remain available until expended.
    (e) Sense of Congress.--It is the sense of Congress that the 
Veterans Choice Fund is a supplement to but distinct from the 
Department of Veterans Affairs' current and expected level of non-
Department care currently part of Department's medical care budget. 
Congress expects that the Department will maintain at least its 
existing obligations of non-Department care programs in addition to but 
distinct from the Veterans Choice Fund for each of fiscal years 2015 
through 2017.
    SEC. 803. EMERGENCY DESIGNATIONS.
    (a) In General.--This Act is designated as an emergency requirement 
pursuant to section 4(g) of the Statutory Pay-As-You-Go Act of 2010 (2 
U.S.C. 933(g)).
    (b) Designation in Senate.--In the Senate, this Act is designated 
as an emergency requirement pursuant to section 403(a) of S. Con. Res. 
13 (111th Congress), the concurrent resolution on the budget for fiscal 
year 2010.

                               Speaker of the House of Representatives.

                            Vice President of the United States and    
                                               President of the Senate.
```