In the Senate of the United States, 

June 11, 2014. 

Resolved, That the bill from the House of Representatives (H.R. 3230) entitled ‘‘An Act making continuing appropriations during a Government shutdown to provide pay and 

allowances to members of the reserve components of the 

Armed Forces who perform inactive-duty training during 

such period.’’, do pass with the following 

AMENDMENTS: 

Strike all after the enacting clause, and insert in lieu 

thereof: 

1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

2 (a) SHORT TITLE.—This Act may be cited as the ‘‘Vet3 erans’ Access to Care through Choice, Accountability, and 

4 Transparency Act of 2014’’. 

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

6 this Act is as follows: 

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

† HR 3230 EAS 

TITLE I—IMPROVEMENT OF SCHEDULING SYSTEM FOR HEALTH 

CARE APPOINTMENTS 

Sec. 101. Independent assessment of the scheduling of appointments and other 

health care management processes of the Department of Veterans 

Affairs. 

Sec. 102. Technology task force on review of scheduling system and software of 

the Department of Veterans Affairs. 

TITLE II—TRAINING AND HIRING OF HEALTH CARE STAFF 

Sec. 201. Treatment of staffing shortage and biannual report on staffing of medical facilities of the Department of Veterans Affairs. 

Sec. 202. Clinic management training for managers and health care providers of 

the Department of Veterans Affairs. 

Sec. 203. Use of unobligated amounts to hire additional health care providers for 

the Veterans Health Administration. 

TITLE III—IMPROVEMENT OF ACCESS TO CARE FROM NONDEPARTMENT OF VETERANS AFFAIRS PROVIDERS 

Sec. 301. Expanded availability of hospital care and medical services for veterans 

through the use of contracts. 

Sec. 302. Transfer of authority for payments for hospital care, medical services, 

and other health care from non-Department providers to the 

Chief Business Office of the Veterans Health Administration of 

the Department. 

Sec. 303. Enhancement of collaboration between Department of Veterans Affairs 

and Indian Health Service. 

Sec. 304. Enhancement of collaboration between Department of Veterans Affairs 

and Native Hawaiian health care systems. 

Sec. 305. Sense of Congress on prompt payment by Department of Veterans Affairs. 

TITLE IV—HEALTH CARE ADMINISTRATIVE MATTERS 

Sec. 401. Improvement of access of veterans to mobile vet centers of the Department of Veterans Affairs. 

Sec. 402. Commission on construction projects of the Department of Veterans Affairs. 

Sec. 403. Commission on Access to Care. 

Sec. 404. Improved performance metrics for health care provided by Department 

of Veterans Affairs. 

Sec. 405. Improved transparency concerning health care provided by Department 

of Veterans Affairs. 

Sec. 406. Information for veterans on the credentials of Department of Veterans 

Affairs physicians. 

Sec. 407. Information in annual budget of the President on hospital care and 

medical services furnished through expanded use of contracts for 

such care. 

Sec. 408. Prohibition on falsification of data concerning wait times and quality 

measures at Department of Veterans Affairs. 

Sec. 409. Removal of Senior Executive Service employees of the Department of 

Veterans Affairs for performance. 
3 

† HR 3230 EAS 

TITLE V—HEALTH CARE RELATED TO SEXUAL TRAUMA 

Sec. 501. Expansion of eligibility for sexual trauma counseling and treatment to 

veterans on inactive duty training. 

Sec. 502. Provision of counseling and treatment for sexual trauma by the Department of Veterans Affairs to members of the Armed Forces. 

Sec. 503. Reports on military sexual trauma. 

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—VETERANS BENEFITS 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. 

TITLE VIII—APPROPRIATION AND EMERGENCY DESIGNATIONS 

Sec. 801. Appropriation of emergency amounts. 

Sec. 802. Emergency designations. 

1 TITLE I—IMPROVEMENT OF 

2 SCHEDULING SYSTEM FOR 

3 HEALTH CARE APPOINT4 MENTS 

5 SEC. 101. INDEPENDENT ASSESSMENT OF THE SCHED6 ULING OF APPOINTMENTS AND OTHER 

7 HEALTH CARE MANAGEMENT PROCESSES OF 

8 THE DEPARTMENT OF VETERANS AFFAIRS. 

9 (a) INDEPENDENT ASSESSMENT.— 

10 (1) ASSESSMENT.—Not later than 30 days after 

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

12 Veterans Affairs shall enter into a contract with an 

13 independent third party to assess the following: 
4 

† HR 3230 EAS 

1 (A) The process at each medical facility of 

2 the Department of Veterans Affairs for sched3 uling appointments for veterans to receive hos4 pital care, medical services, or other health care 

5 from the Department. 

6 (B) The staffing level and productivity of 

7 each medical facility of the Department, includ8 ing the following: 

9 (i) The case load of each health care 

10 provider of the Department. 

11 (ii) The time spent by each health care 

12 provider of the Department on matters other 

13 than the case load of such health care pro14 vider, including time spent by such health 

15 care provider as follows: 

16 (I) At a medical facility that is 

17 affiliated with the Department. 

18 (II) Conducting research. 

19 (III) Training or overseeing other 

20 health care professionals of the Depart21 ment. 

22 (C) The organization, processes, and tools 

23 used by the Department to support clinical docu24 mentation and the subsequent coding of inpa25 tient services. 
5 

† HR 3230 EAS 

1 (D) The purchasing, distribution, and use 

2 of pharmaceuticals, medical and surgical sup3 plies, and medical devices by the Department, 

4 including the following: 

5 (i) The prices paid for, standardiza6 tion of, and use by the Department of the 

7 following: 

8 (I) High-cost pharmaceuticals. 

9 (II) Medical and surgical sup10 plies. 

11 (III) Medical devices. 

12 (ii) The use by the Department of 

13 group purchasing arrangements to purchase 

14 pharmaceuticals, medical and surgical sup15 plies, medical devices, and health care re16 lated services. 

17 (iii) The strategy used by the Depart18 ment to distribute pharmaceuticals, medical 

19 and surgical supplies, and medical devices 

20 to Veterans Integrated Service Networks and 

21 medical facilities of the Department. 

22 (E) The performance of the Department in 

23 paying amounts owed to third parties and col24 lecting amounts owed to the Department with re25 spect to hospital care, medical services, and other 
6 

† HR 3230 EAS 

1 health care, including any recommendations of 

2 the independent third party as follows: 

3 (i) To avoid the payment of penalties 

4 to vendors. 

5 (ii) To increase the collection of 

6 amounts owed to the Department for hos7 pital care, medical services, or other health 

8 care provided by the Department for which 

9 reimbursement from a third party is au10 thorized. 

11 (iii) To increase the collection of any 

12 other amounts owed to the Department. 

13 (2) ELEMENTS OF SCHEDULING ASSESSMENT.— 

14 In carrying out the assessment required by paragraph 

15 (1)(A), the independent third party shall do the fol16 lowing: 

17 (A) Review all training materials per18 taining to scheduling of appointments at each 

19 medical facility of the Department. 

20 (B) Assess whether all employees of the De21 partment conducting tasks related to scheduling 

22 are properly trained for conducting such tasks. 

23 (C) Assess whether changes in the technology 

24 or system used in scheduling appointments are 

25 necessary to limit access to the system to only 
7 

† HR 3230 EAS 

1 those employees that have been properly trained 

2 in conducting such tasks. 

3 (D) Assess whether health care providers of 

4 the Department are making changes to their 

5 schedules that hinder the ability of employees 

6 conducting such tasks to perform such tasks. 

7 (E) Assess whether the establishment of a 

8 centralized call center throughout the Depart9 ment for scheduling appointments at medical fa10 cilities of the Department would improve the 

11 process of scheduling such appointments. 

12 (F) Assess whether booking templates for 

13 each medical facility or clinic of the Department 

14 would improve the process of scheduling such ap15 pointments. 

16 (G) Recommend any actions to be taken by 

17 the Department to improve the process for sched18 uling such appointments, including the fol19 lowing: 

20 (i) Changes in training materials pro21 vided to employees of the Department with 

22 respect to conducting tasks related to sched23 uling such appointments. 
8 

† HR 3230 EAS 

1 (ii) Changes in monitoring and assess2 ment conducted by the Department of wait 

3 times of veterans for such appointments. 

4 (iii) Changes in the system used to 

5 schedule such appointments, including 

6 changes to improve how the Department— 

7 (I) measures wait times of vet8 erans for such appointments; 

9 (II) monitors the availability of 

10 health care providers of the Depart11 ment; and 

12 (III) provides veterans the ability 

13 to schedule such appointments. 

14 (iv) Such other actions as the inde15 pendent third party considers appropriate. 

16 (3) TIMING.—The independent third party car17 rying out the assessment required by paragraph (1) 

18 shall complete such assessment not later than 180 

19 days after entering into the contract described in such 

20 paragraph. 

21 (b) REPORT.— 

22 (1) IN GENERAL.—Not later than 90 days after 

23 the date on which the independent third party com24 pletes the assessment under this section, the Secretary 

25 shall submit to the Committee on Veterans’ Affairs of 
9 

† HR 3230 EAS 

1 the Senate and the Committee on Veterans’ Affairs of 

2 the House of Representatives a report on the results 

3 of such assessment. 

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

5 submitting the report under paragraph (1), the Sec6 retary shall publish such report in the Federal Reg7 ister and on an Internet website of the Department 

8 accessible to the public. 

9 SEC. 102. TECHNOLOGY TASK FORCE ON REVIEW OF SCHED10 ULING SYSTEM AND SOFTWARE OF THE DE11 PARTMENT OF VETERANS AFFAIRS. 

12 (a) TASK FORCE REVIEW.— 

13 (1) IN GENERAL.—The Secretary of Veterans Af14 fairs shall, through the use of a technology task force, 

15 conduct a review of the needs of the Department of 

16 Veterans Affairs with respect to the scheduling system 

17 and scheduling software of the Department of Vet18 erans Affairs that is used by the Department to sched19 ule appointments for veterans for hospital care, med20 ical services, and other health care from the Depart21 ment. 

22 (2) AGREEMENT.— 

23 (A) IN GENERAL.—The Secretary shall seek 

24 to enter into an agreement with a technology or-
10 

† HR 3230 EAS 

1 ganization or technology organizations to carry 

2 out the review required by paragraph (1). 

3 (B) PROHIBITION ON USE OF FUNDS.—No 

4 Federal funds may be used to assist the tech5 nology organization or technology organizations 

6 under subparagraph (A) in carrying out the re7 view required by paragraph (1). 

8 (b) REPORT.— 

9 (1) IN GENERAL.—Not later than 45 days after 

10 the date of the enactment of this Act, the technology 

11 task force required under subsection (a)(1) shall sub12 mit to the Secretary, the Committee on Veterans’ Af13 fairs of the Senate, and the Committee on Veterans’ 

14 Affairs of the House of Representatives a report set15 ting forth the findings and recommendations of the 

16 technology task force regarding the needs of the De17 partment with respect to the scheduling system and 

18 scheduling software of the Department described in 

19 such subsection. 

20 (2) ELEMENTS.—The report required by para21 graph (1) shall include the following: 

22 (A) Proposals for specific actions to be 

23 taken by the Department to improve the sched24 uling system and scheduling software of the De25 partment described in subsection (a)(1). 
11 

† HR 3230 EAS 

1 (B) A determination as to whether an exist2 ing off-the-shelf system would— 

3 (i) meet the needs of the Department to 

4 schedule appointments for veterans for hos5 pital care, medical services, and other 

6 health care from the Department; and 

7 (ii) improve the access of veterans to 

8 such care and services. 

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

10 the receipt of the report required by paragraph (1), 

11 the Secretary shall publish such report in the Federal 

12 Register and on an Internet website of the Depart13 ment accessible to the public. 

14 (c) IMPLEMENTATION OF TASK FORCE RECOMMENDA15 TIONS.—Not later than one year after the receipt of the re16 port required by subsection (b)(1), the Secretary shall im17 plement the recommendations set forth in such report that 

18 the Secretary considers are feasible, advisable, and cost-ef19 fective. 
12 

† HR 3230 EAS 

1 TITLE II—TRAINING AND HIRING 

2 OF HEALTH CARE STAFF 

3 SEC. 201. TREATMENT OF STAFFING SHORTAGE AND BIAN4 NUAL REPORT ON STAFFING OF MEDICAL FA5 CILITIES OF THE DEPARTMENT OF VETERANS 

6 AFFAIRS. 

7 (a) STAFFING SHORTAGE.— 

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

9 the date of the enactment of this Act, and not later 

10 than September 30 each year thereafter, the Inspector 

11 General of the Department of Veterans Affairs shall 

12 determine, and the Secretary of Veterans Affairs shall 

13 publish in the Federal Register, the five occupations 

14 of health care providers of the Department of Veterans 

15 Affairs for which there is the largest staffing shortage 

16 throughout the Department. 

17 (2) RECRUITMENT AND APPOINTMENT.—Notwith18 standing sections 3304 and 3309 through 3318 of title 

19 5, United States Code, the Secretary may, upon a de20 termination by the Inspector General under para21 graph (1) that there is a staffing shortage throughout 

22 the Department with respect to a particular occupa23 tion of health care provider, recruit and directly ap24 point highly qualified health care providers to serve 
13 

† HR 3230 EAS 

1 as health care providers in that particular occupation 

2 for the Department. 

3 (3) PRIORITY IN HEALTH PROFESSIONALS EDU4 CATIONAL ASSISTANCE PROGRAM TO CERTAIN PRO5 VIDERS.—Section 7612(b)(5) of title 38, United 

6 States Code, is amended— 

7 (A) in subparagraph (A), by striking ‘‘and’’ 

8 at the end; 

9 (B) by redesignating subparagraph (B) as 

10 subparagraph (C); and 

11 (C) by inserting after subparagraph (A) the 

12 following new subparagraph (B): 

13 ‘‘(B) shall give priority to applicants pursuing 

14 a course of education or training towards a career in 

15 an occupation for which the Secretary has, in the 

16 most current determination published in the Federal 

17 Register pursuant to section 201(a)(1) of the Vet18 erans’ Access to Care through Choice, Accountability, 

19 and Transparency Act of 2014, determined that there 

20 is one of the largest staffing shortages throughout the 

21 Department with respect to such occupation; and’’. 

22 (b) REPORTS.— 

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

24 the date of the enactment of this Act, and not later 

25 than December 31 of each even numbered year there-
14 

† HR 3230 EAS 

1 after until 2024, the Secretary of Veterans Affairs 

2 shall submit to the Committee on Veterans’ Affairs of 

3 the Senate and the Committee on Veterans’ Affairs of 

4 the House of Representatives a report assessing the 

5 staffing of each medical facility of the Department of 

6 Veterans Affairs. 

7 (2) ELEMENTS.—Each report submitted under 

8 paragraph (1) shall include the following: 

9 (A) The results of a system-wide assessment 

10 of all medical facilities of the Department to en11 sure the following: 

12 (i) Appropriate staffing levels for 

13 health care providers to meet the goals of the 

14 Secretary for timely access to care for vet15 erans. 

16 (ii) Appropriate staffing levels for sup17 port personnel, including clerks. 

18 (iii) Appropriate sizes for clinical pan19 els. 

20 (iv) Appropriate numbers of full-time 

21 staff, or full-time equivalents, dedicated to 

22 direct care of patients. 

23 (v) Appropriate physical plant space 

24 to meet the capacity needs of the Depart25 ment in that area. 
15 

† HR 3230 EAS 

1 (vi) Such other factors as the Secretary 

2 considers necessary. 

3 (B) A plan for addressing any issues identi4 fied in the assessment described in subparagraph 

5 (A), including a timeline for addressing such 

6 issues. 

7 (C) A list of the current wait times and 

8 workload levels for the following clinics in each 

9 medical facility: 

10 (i) Mental health. 

11 (ii) Primary care. 

12 (iii) Gastroenterology. 

13 (iv) Women’s health. 

14 (v) Such other clinics as the Secretary 

15 considers appropriate. 

16 (D) A description of the results of the most 

17 current determination of the Inspector General 

18 under paragraph (1) of subsection (a) and a 

19 plan to use direct appointment authority under 

20 paragraph (2) of such subsection to fill staffing 

21 shortages, including recommendations for im22 proving the speed at which the credentialing and 

23 privileging process can be conducted. 
16 

† HR 3230 EAS 

1 (E) The current staffing models of the De2 partment for the following clinics, including rec3 ommendations for changes to such models: 

4 (i) Mental health. 

5 (ii) Primary care. 

6 (iii) Gastroenterology. 

7 (iv) Women’s health. 

8 (v) Such other clinics as the Secretary 

9 considers appropriate. 

10 (F) A detailed analysis of succession plan11 ning at medical facilities of the Department, in12 cluding the following: 

13 (i) The number of positions in medical 

14 facilities throughout the Department that 

15 are not filled by a permanent employee. 

16 (ii) The length of time each position 

17 described in clause (i) remained vacant or 

18 filled by a temporary or acting employee. 

19 (iii) A description of any barriers to 

20 filling the positions described in clause (i). 

21 (iv) A plan for filling any positions 

22 that are vacant or filled by a temporary or 

23 acting employee for more than 180 days. 
17 

† HR 3230 EAS 

1 (v) A plan for handling emergency cir2 cumstances, such as administrative leave or 

3 sudden medical leave for senior officials. 

4 (G) The number of health care providers of 

5 the Department who have been removed from 

6 their positions, have retired, or have left their 

7 positions for another reason, disaggregated by 

8 provider type, during the two-year period pre9 ceding the submittal of the report. 

10 (H) Of the health care providers specified in 

11 subparagraph (G) who have been removed from 

12 their positions, the following: 

13 (i) The number of such health care pro14 viders who were reassigned to other posi15 tions in the Department. 

16 (ii) The number of such health care 

17 providers who left the Department. 

18 (iii) The number of such health care 

19 providers who left the Department and were 

20 subsequently rehired by the Department. 

21 SEC. 202. CLINIC MANAGEMENT TRAINING FOR MANAGERS 

22 AND HEALTH CARE PROVIDERS OF THE DE23 PARTMENT OF VETERANS AFFAIRS. 

24 (a) CLINIC MANAGEMENT TRAINING PROGRAM.— 
18 

† HR 3230 EAS 

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

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

3 Veterans Affairs shall commence a clinic management 

4 training program to provide in-person, standardized 

5 education on health care management to all managers 

6 of, and health care providers at, medical facilities of 

7 the Department of Veterans Affairs. 

8 (2) ELEMENTS.—The clinic management train9 ing program required by paragraph (1) shall include 

10 the following: 

11 (A) Training on how to manage the sched12 ules of health care providers of the Department, 

13 including the following: 

14 (i) Maintaining such schedules in a 

15 manner that allows appointments to be 

16 booked at least eight weeks in advance. 

17 (ii) Proper planning procedures for va18 cation, leave, and graduate medical edu19 cation training schedules. 

20 (B) Training on the appropriate number of 

21 appointments that a health care provider should 

22 conduct on a daily basis, based on specialty. 

23 (C) Training on how to determine whether 

24 there are enough available appointment slots to 

25 manage demand for different appointment types 
19 

† HR 3230 EAS 

1 and mechanisms for alerting management of in2 sufficient slots. 

3 (D) Training on how to properly use the 

4 appointment scheduling system of the Depart5 ment, including any new scheduling system im6 plemented by the Department. 

7 (E) Training on how to optimize the use of 

8 technology, including the following: 

9 (i) Telemedicine. 

10 (ii) Electronic mail. 

11 (iii) Text messaging. 

12 (iv) Such other technologies as speci13 fied by the Secretary. 

14 (F) Training on how to properly use phys15 ical plant space at medical facilities of the De16 partment to ensure efficient flow and privacy for 

17 patients and staff. 

18 (3) SUNSET.—The clinic management training 

19 program required by paragraph (1) shall terminate 

20 on the date that is two years after the date on which 

21 the Secretary commences such program. 

22 (b) TRAINING MATERIALS.— 

23 (1) IN GENERAL.—After the termination of the 

24 clinic management training program required by 

25 subsection (a), the Secretary shall provide training 
20 

† HR 3230 EAS 

1 materials on health care management to each of the 

2 following employees of the Department upon the com3 mencement of employment of such employee: 

4 (A) Any manager of a medical facility of 

5 the Department. 

6 (B) Any health care provider at a medical 

7 facility of the Department. 

8 (C) Such other employees of the Department 

9 as the Secretary considers appropriate. 

10 (2) UPDATE.—The Secretary shall regularly up11 date the training materials required under paragraph 

12 (1). 

13 SEC. 203. USE OF UNOBLIGATED AMOUNTS TO HIRE ADDI14 TIONAL HEALTH CARE PROVIDERS FOR THE 

15 VETERANS HEALTH ADMINISTRATION. 

16 (a) IN GENERAL.—At the end of each of fiscal years 

17 2014 and 2015, all covered amounts shall be made available 

18 to the Secretary of Veterans Affairs to hire additional health 

19 care providers for the Veterans Health Administration of 

20 the Department of Veterans Affairs, or to carry out any 

21 provision of this Act or the amendments made by this Act, 

22 and shall remain available until expended. 

23 (b) PRIORITY IN HIRING.—The Secretary shall 

24 prioritize hiring additional health care providers under 

25 subsection (a) at medical facilities of the Department and 
21 

† HR 3230 EAS 

1 in geographic areas in which the Secretary identifies the 

2 greatest shortage of health care providers. 

3 (c) COVERED AMOUNTS DEFINED.—In this section, the 

4 term ‘‘covered amounts’’ means amounts— 

5 (1) that are made available to the Veterans 

6 Health Administration of the Department for an ap7 propriations account— 

8 (A) under the heading ‘‘MEDICAL SERV9 ICES’’; 

10 (B) under the heading ‘‘MEDICAL SUPPORT

11 AND COMPLIANCE’’; or 

12 (C) under the heading ‘‘MEDICAL FACILI13 TIES’’; and 

14 (2) that are unobligated at the end of the appli15 cable fiscal year. 

16 TITLE III—IMPROVEMENT OF AC17 CESS TO CARE FROM NON-DE18 PARTMENT OF VETERANS AF19 FAIRS PROVIDERS 

20 SEC. 301. EXPANDED AVAILABILITY OF HOSPITAL CARE 

21 AND MEDICAL SERVICES FOR VETERANS 

22 THROUGH THE USE OF CONTRACTS. 

23 (a) EXPANSION OF AVAILABLE CARE AND SERVICES.— 

24 (1) FURNISHING OF CARE.— 
22 

† HR 3230 EAS 

1 (A) IN GENERAL.—Hospital care and med2 ical services under chapter 17 of title 38, United 

3 States Code, shall be furnished to an eligible vet4 eran described in subsection (b), at the election 

5 of such veteran, through contracts authorized 

6 under subsection (d), or any other law adminis7 tered by the Secretary of Veterans Affairs, with 

8 entities specified in subparagraph (B) for the 

9 furnishing of such care and services to veterans. 

10 (B) ENTITIES SPECIFIED.—The entities 

11 specified in this subparagraph are the following: 

12 (i) Any health care provider that is 

13 participating in the Medicare program 

14 under title XVIII of the Social Security Act 

15 (42 U.S.C. 1395 et seq.). 

16 (ii) Any Federally-qualified health cen17 ter (as defined in section 1905(l)(2)(B) of 

18 the Social Security Act (42 U.S.C. 

19 1396d(l)(2)(B))). 

20 (iii) The Department of Defense. 

21 (iv) The Indian Health Service. 

22 (2) CHOICE OF PROVIDER.—An eligible veteran 

23 who elects to receive care and services under this sec24 tion may select the provider of such care and services 

25 from among any source of provider of such care and 
23 

† HR 3230 EAS 

1 services through an entity specified in paragraph 

2 (1)(B) that is accessible to the veteran. 

3 (3) COORDINATION OF CARE AND SERVICES.— 

4 The Secretary shall coordinate, through the Non-VA 

5 Care Coordination Program of the Department of Vet6 erans Affairs, the furnishing of care and services 

7 under this section to eligible veterans, including by 

8 ensuring that an eligible veteran receives an appoint9 ment for such care and services within the current 

10 wait-time goals of the Veterans Health Administra11 tion for the furnishing of hospital care and medical 

12 services. 

13 (b) ELIGIBLE VETERANS.—A veteran is an eligible vet14 eran for purposes of this section if— 

15 (1)(A) the veteran is enrolled in the patient en16 rollment system of the Department of Veterans Affairs 

17 established and operated under section 1705 of title 

18 38, United States Code; or 

19 (B) the veteran is enrolled in such system, has 

20 not received hospital care or medical services from the 

21 Department, and has contacted the Department seek22 ing an initial appointment from the Department for 

23 the receipt of such care or services; and 

24 (2) the veteran— 
24 

† HR 3230 EAS 

1 (A)(i) attempts, or has attempted under 

2 paragraph (1)(B), to schedule an appointment 

3 for the receipt of hospital care or medical serv4 ices under chapter 17 of title 38, United States 

5 Code, but is unable to schedule an appointment 

6 within the current wait-time goals of the Vet7 erans Health Administration for the furnishing 

8 of such care or services; and 

9 (ii) elects, and is authorized, to be furnished 

10 such care or services pursuant to subsection 

11 (c)(2); 

12 (B) resides more than 40 miles from the 

13 nearest medical facility of the Department, in14 cluding a community-based outpatient clinic, 

15 that is closest to the residence of the veteran; or 

16 (C) resides— 

17 (i) in a State without a medical facil18 ity of the Department that provides— 

19 (I) hospital care; 

20 (II) emergency medical services; 

21 and 

22 (III) surgical care rated by the 

23 Secretary as having a surgical com24 plexity of standard; and 
25 

† HR 3230 EAS 

1 (ii) more than 20 miles from a medical 

2 facility of the Department described in 

3 clause (i). 

4 (c) ELECTION AND AUTHORIZATION.— 

5 (1) IN GENERAL.—If the Secretary confirms that 

6 an appointment for an eligible veteran described in 

7 subsection (b)(2)(A) for the receipt of hospital care or 

8 medical services under chapter 17 of title 38, United 

9 States Code, is unavailable within the current wait10 time goals of the Department for the furnishing of 

11 such care or services, the Secretary shall, at the elec12 tion of the eligible veteran— 

13 (A) place such eligible veteran on an elec14 tronic waiting list described in paragraph (2) 

15 for such an appointment; or 

16 (B)(i) authorize that such care and services 

17 be furnished to the eligible veteran under this 

18 section for a period of time specified by the Sec19 retary; and 

20 (ii) send a letter to the eligible veteran de21 scribing the care and services the eligible veteran 

22 is eligible to receive under this section. 

23 (2) ELECTRONIC WAITING LIST.—The electronic 

24 waiting list described in this paragraph shall be 

25 maintained by the Department and allow access by 
26 

† HR 3230 EAS 

1 each eligible veteran via www.myhealth.va.gov or any 

2 successor website for the following purposes: 

3 (A) To determine the place of such eligible 

4 veteran on the waiting list. 

5 (B) To determine the average length of time 

6 an individual spends on the waiting list, 

7 disaggregated by medical facility of the Depart8 ment and type of care or service needed, for pur9 poses of allowing such eligible veteran to make 

10 an informed election under paragraph (1). 

11 (d) CARE AND SERVICES THROUGH CONTRACTS.— 

12 (1) IN GENERAL.—The Secretary shall enter into 

13 contracts with health care providers that are partici14 pating in the Medicare program under title XVIII of 

15 the Social Security Act (42 U.S.C. 1395 et seq.) to 

16 furnish care and services to eligible veterans under 

17 this section. 

18 (2) RATES AND REIMBURSEMENT.— 

19 (A) IN GENERAL.—In entering into a con20 tract under this subsection, the Secretary shall— 

21 (i) negotiate rates for the furnishing of 

22 care and services under this section; and 

23 (ii) reimburse the health care provider 

24 for such care and services at the rates nego-
27 

† HR 3230 EAS 

1 tiated pursuant to clause (i) as provided in 

2 such contract. 

3 (B) LIMIT ON RATES.— 

4 (i) IN GENERAL.—Except as provided 

5 in clause (ii), rates negotiated under sub6 paragraph (A)(i) shall not be more than the 

7 rates paid by the United States to a pro8 vider of services (as defined in section 

9 1861(u) of the Social Security Act (42 

10 U.S.C. 1395x(u))) or a supplier (as defined 

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

12 1395x(d))) under the Medicare program 

13 under title XVIII of the Social Security Act 

14 (42 U.S.C. 1395 et seq.) for the same care 

15 and services. 

16 (ii) EXCEPTION.—The Secretary may 

17 negotiate a rate that is more than the rate 

18 paid by the United States as described in 

19 clause (i) with respect to the furnishing of 

20 care or services under this section to an eli21 gible veteran if the Secretary determines 

22 that there is no health care provider that 

23 will provide such care or services to such el24 igible veteran at the rate required under 

25 such clause— 
28 

† HR 3230 EAS 

1 (I) within the current wait-time 

2 goals of the Veterans Health Adminis3 tration for the furnishing of such care 

4 or services; and 

5 (II) at a location not more than 

6 40 miles from the residence of such eli7 gible veteran. 

8 (C) LIMIT ON COLLECTION.—For the fur9 nishing of care and services pursuant to a con10 tract under this section, a health care provider 

11 may not collect any amount that is greater than 

12 the rate negotiated pursuant to subparagraph 

13 (A)(i). 

14 (3) INFORMATION ON POLICIES AND PROCE15 DURES.—The Secretary shall provide to any health 

16 care provider with which the Secretary has entered 

17 into a contract under paragraph (1) the following: 

18 (A) Information on applicable policies and 

19 procedures for submitting bills or claims for au20 thorized care and services furnished to eligible 

21 veterans under this section. 

22 (B) Access to a telephone hotline main23 tained by the Department that such health care 

24 provider may call for information on the fol25 lowing: 
29 

† HR 3230 EAS 

1 (i) Procedures for furnishing care and 

2 services under this section. 

3 (ii) Procedures for submitting bills or 

4 claims for authorized care and services fur5 nished to eligible veterans under this section 

6 and being reimbursed for furnishing such 

7 care and services. 

8 (iii) Whether particular care or serv9 ices under this section are authorized, and 

10 the procedures for authorization of such care 

11 or services. 

12 (e) CHOICE CARD.— 

13 (1) IN GENERAL.—For purposes of receiving care 

14 and services under this section, the Secretary shall 

15 issue to each eligible veteran a card that the eligible 

16 veteran shall present to a health care provider that is 

17 eligible to furnish care and services under this section 

18 before receiving such care and services. 

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

20 paragraph (1) shall be known as a ‘‘Choice Card’’. 

21 (3) DETAILS OF CARD.—Each Choice Card 

22 issued to an eligible veteran under paragraph (1) 

23 shall include the following: 

24 (A) The name of the eligible veteran. 
30 

† HR 3230 EAS 

1 (B) An identification number for the eligi2 ble veteran that is not the social security number 

3 of the eligible veteran. 

4 (C) The contact information of an appro5 priate office of the Department for health care 

6 providers to confirm that care and services under 

7 this section are authorized for the eligible vet8 eran. 

9 (D) Contact information and other relevant 

10 information for the submittal of claims or bills 

11 for the furnishing of care and services under this 

12 section. 

13 (E) The following statement: ‘‘This card is 

14 for qualifying medical care outside the Depart15 ment of Veterans Affairs. Please call the Depart16 ment of Veterans Affairs phone number specified 

17 on this card to ensure that treatment has been 

18 authorized.’’. 

19 (4) INFORMATION ON USE OF CARD.—Upon 

20 issuing a Choice Card to an eligible veteran, the Sec21 retary shall provide the eligible veteran with informa22 tion clearly stating the circumstances under which the 

23 veteran may be eligible for care and services under 

24 this section. 
31 

† HR 3230 EAS 

1 (f) INFORMATION ON AVAILABILITY OF CARE.—The 

2 Secretary shall provide information to a veteran about the 

3 availability of care and services under this section in the 

4 following circumstances: 

5 (1) When the veteran enrolls in the patient en6 rollment system of the Department under section 1705 

7 of title 38, United States Code. 

8 (2) When the veteran attempts to schedule an ap9 pointment for the receipt of hospital care or medical 

10 services from the Department but is unable to sched11 ule an appointment within the current wait-time 

12 goals of the Veterans Health Administration for deliv13 ery of such care or services. 

14 (g) PROVIDERS.—To be eligible to furnish care and 

15 services under this section, a health care provider must— 

16 (1) maintain at least the same or similar creden17 tials and licenses as those credentials and licenses 

18 that are required of health care providers of the De19 partment, as determined by the Secretary for pur20 poses of this section; and 

21 (2) submit, not less frequently than once each 

22 year, verification of such licenses and credentials 

23 maintained by such health care provider. 

24 (h) COST-SHARING.— 
32 

† HR 3230 EAS 

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

2 an eligible veteran to pay a copayment to the Depart3 ment for the receipt of care and services under this 

4 section only if such eligible veteran would be required 

5 to pay such copayment for the receipt of such care 

6 and services at a medical facility of the Department. 

7 (2) LIMITATION.—The copayment required under 

8 paragraph (1) shall not be greater than the copay9 ment required of such eligible veteran by the Depart10 ment for the receipt of such care and services at a 

11 medical facility of the Department. 

12 (i) CLAIMS PROCESSING SYSTEM.— 

13 (1) IN GENERAL.—The Secretary shall provide 

14 for an efficient nationwide system for processing and 

15 paying bills or claims for authorized care and services 

16 furnished to eligible veterans under this section. 

17 (2) REGULATIONS.—Not later than 90 days after 

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

19 Veterans Affairs shall prescribe regulations for the 

20 implementation of such system. 

21 (3) OVERSIGHT.—The Chief Business Office of 

22 the Veterans Health Administration shall oversee the 

23 implementation and maintenance of such system. 

24 (4) ACCURACY OF PAYMENT.— 
33 

† HR 3230 EAS 

1 (A) IN GENERAL.—The Secretary shall en2 sure that such system meets such goals for accu3 racy of payment as the Secretary shall specify 

4 for purposes of this section. 

5 (B) ANNUAL REPORT.— 

6 (i) IN GENERAL.—Not later than one 

7 year after the date of the enactment of this 

8 Act, and annually thereafter until the ter9 mination date specified in subsection (n), 

10 the Secretary shall submit to the Committee 

11 on Veterans’ Affairs of the Senate and the 

12 Committee on Veterans’ Affairs of the House 

13 of Representatives a report on the goals for 

14 accuracy of such system. 

15 (ii) ELEMENTS.—Each report required 

16 by clause (i) shall include the following: 

17 (I) A description of the goals for 

18 accuracy for such system specified by 

19 the Secretary under subparagraph (A). 

20 (II) An assessment of the success 

21 of the Department in meeting such 

22 goals during the year preceding the 

23 submittal of the report. 

24 (j) MEDICAL RECORDS.—The Secretary shall ensure 

25 that any health care provider that furnishes care and serv-
34 

† HR 3230 EAS 

1 ices under this section to an eligible veteran submits to the 

2 Department any medical record related to the care and 

3 services provided to such eligible veteran by such health care 

4 provider for inclusion in the electronic medical record of 

5 such eligible veteran maintained by the Department upon 

6 the completion of the provision of such care and services 

7 to such eligible veteran. 

8 (k) TRACKING OF MISSED APPOINTMENTS.—The Sec9 retary shall implement a mechanism to track any missed 

10 appointments for care and services under this section by 

11 eligible veterans to ensure that the Department does not pay 

12 for such care and services that were not furnished to an 

13 eligible veteran. 

14 (l) IMPLEMENTATION.—Not later than 90 days after 

15 the date of the enactment of this Act, the Secretary shall 

16 prescribe interim final regulations on the implementation 

17 of this section and publish such regulations in the Federal 

18 Register. 

19 (m) INSPECTOR GENERAL REPORT.—Not later than 

20 540 days after the publication of the interim final regula21 tions under subsection (l), the Inspector General of the De22 partment shall submit to the Secretary a report on the re23 sults of an audit of the care and services furnished under 

24 this section to ensure the accuracy and timeliness of pay25 ments by the Department for the cost of such care and serv-
35 

† HR 3230 EAS 

1 ices, including any findings and recommendations of the 

2 Inspector General. 

3 (n) TERMINATION.—The requirement of the Secretary 

4 to furnish care and services under this section terminates 

5 on the date that is two years after the date on which the 

6 Secretary publishes the interim final regulations under sub7 section (l). 

8 (o) REPORTS.— 

9 (1) INITIAL REPORT.—Not later than 90 days 

10 after the publication of the interim final regulations 

11 under subsection (l), the Secretary shall submit to the 

12 Committee on Veterans’ Affairs of the Senate and the 

13 Committee on Veterans’ Affairs of the House of Rep14 resentatives a report on the furnishing of care and 

15 services under this section that includes the following: 

16 (A) The number of eligible veterans who 

17 have received care and services under this sec18 tion. 

19 (B) A description of the type of care and 

20 services furnished to eligible veterans under this 

21 section. 

22 (2) FINAL REPORT.—Not later than 540 days 

23 after the publication of the interim final regulations 

24 under subsection (l), the Secretary shall submit to the 

25 Committee on Veterans’ Affairs of the Senate and the 
36 

† HR 3230 EAS 

1 Committee on Veterans’ Affairs of the House of Rep2 resentatives a report on the furnishing of care and 

3 services under this section that includes the following: 

4 (A) The total number of eligible veterans 

5 who have received care and services under this 

6 section, disaggregated by— 

7 (i) eligible veterans described in sub8 section (b)(2)(A); and 

9 (ii) eligible veterans described in sub10 section (b)(2)(B). 

11 (B) A description of the type of care and 

12 services furnished to eligible veterans under this 

13 section. 

14 (C) An accounting of the total cost of fur15 nishing care and services to eligible veterans 

16 under this section. 

17 (D) The results of a survey of eligible vet18 erans who have received care or services under 

19 this section on the satisfaction of such eligible 

20 veterans with the care or services received by 

21 such eligible veterans under this section. 

22 (E) An assessment of the effect of furnishing 

23 care and services under this section on wait 

24 times for an appointment for the receipt of hos-
37 

† HR 3230 EAS 

1 pital care and medical services from the Depart2 ment. 

3 (F) An assessment of the feasibility and ad4 visability of continuing furnishing care and 

5 services under this section after the termination 

6 date specified in subsection (n). 

7 (p) RULES OF CONSTRUCTION.— 

8 (1) NO MODIFICATION OF CONTRACTS.—Nothing 

9 in this section shall be construed to require the Sec10 retary to renegotiate contracts for the furnishing of 

11 hospital care or medical services to veterans entered 

12 into by the Department before the date of the enact13 ment of this Act. 

14 (2) FILLING AND PAYING FOR PRESCRIPTION

15 MEDICATIONS.—Nothing in this section shall be con16 strued to alter the process of the Department for fill17 ing and paying for prescription medications. 

18 SEC. 302. TRANSFER OF AUTHORITY FOR PAYMENTS FOR 

19 HOSPITAL CARE, MEDICAL SERVICES, AND 

20 OTHER HEALTH CARE FROM NON-DEPART21 MENT PROVIDERS TO THE CHIEF BUSINESS 

22 OFFICE OF THE VETERANS HEALTH ADMINIS23 TRATION OF THE DEPARTMENT. 

24 (a) TRANSFER OF AUTHORITY.— 
38 

† HR 3230 EAS 

1 (1) IN GENERAL.—Effective on October 1, 2014, 

2 the Secretary of Veterans Affairs shall transfer the au3 thority to pay for hospital care, medical services, and 

4 other health care through non-Department providers 

5 to the Chief Business Office of the Veterans Health 

6 Administration of the Department of Veterans Affairs 

7 from the Veterans Integrated Service Networks and 

8 medical centers of the Department of Veterans Affairs. 

9 (2) MANNER OF CARE.—The Chief Business Of10 fice shall work in consultation with the Office of Clin11 ical Operations and Management of the Department 

12 of Veterans Affairs to ensure that care and services 

13 described in paragraph (1) are provided in a manner 

14 that is clinically appropriate and effective. 

15 (3) NO DELAY IN PAYMENT.—The transfer of au16 thority under paragraph (1) shall be carried out in 

17 a manner that does not delay or impede any payment 

18 by the Department for hospital care, medical services, 

19 or other health care provided through a non-Depart20 ment provider under the laws administered by the 

21 Secretary. 

22 (b) BUDGETARY EFFECT.—The Secretary shall, for 

23 each fiscal year that begins after the date of the enactment 

24 of this Act— 
39 

† HR 3230 EAS 

1 (1) include in the budget for the Chief Business 

2 Office of the Veterans Health Administration amounts 

3 to pay for hospital care, medical services, and other 

4 health care provided through non-Department pro5 viders, including any amounts necessary to carry out 

6 the transfer of authority to pay for such care and 

7 services under subsection (a), including any increase 

8 in staff; and 

9 (2) not include in the budget of each Veterans 

10 Integrated Service Network and medical center of the 

11 Department amounts to pay for such care and serv12 ices. 

13 SEC. 303. ENHANCEMENT OF COLLABORATION BETWEEN 

14 DEPARTMENT OF VETERANS AFFAIRS AND IN15 DIAN HEALTH SERVICE. 

16 (a) OUTREACH TO TRIBAL-RUN MEDICAL FACILI17 TIES.—The Secretary of Veterans Affairs shall, in consulta18 tion with the Director of the Indian Health Service, conduct 

19 outreach to each medical facility operated by an Indian 

20 tribe or tribal organization through a contract or compact 

21 with the Indian Health Service under the Indian Self-De22 termination and Education Assistance Act (25 U.S.C. 450 

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

24 Indian tribes, and tribal organizations to enter into agree25 ments with the Department of Veterans Affairs under which 
40 

† HR 3230 EAS 

1 the Secretary reimburses such facilities, Indian tribes, or 

2 tribal organizations, as the case may be, for health care pro3 vided to veterans eligible for health care at such facilities. 

4 (b) METRICS FOR MEMORANDUM OF UNDERSTANDING

5 PERFORMANCE.—The Secretary of Veterans Affairs shall 

6 implement performance metrics for assessing the perform7 ance by the Department of Veterans Affairs and the Indian 

8 Health Service under the memorandum of understanding 

9 entitled ‘‘Memorandum of Understanding between the De10 partment of Veterans Affairs (VA) and the Indian Health 

11 Service (IHS)’’ in increasing access to health care, improv12 ing quality and coordination of health care, promoting ef13 fective patient-centered collaboration and partnerships be14 tween the Department and the Service, and ensuring health15 promotion and disease-prevention services are appro16 priately funded and available for beneficiaries under both 

17 health care systems. 

18 (c) REPORT.—Not later than 180 days after the date 

19 of the enactment of this Act, the Secretary of Veterans Af20 fairs and the Director of the Indian Health Service shall 

21 jointly submit to Congress a report on the feasibility and 

22 advisability of the following: 

23 (1) Entering into agreements for the reimburse24 ment by the Secretary of the costs of direct care serv25 ices provided through organizations receiving 
41 

† HR 3230 EAS 

1 amounts pursuant to grants made or contracts en2 tered into under section 503 of the Indian Health 

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

4 who are otherwise eligible to receive health care from 

5 such organizations. 

6 (2) Including the reimbursement of the costs of 

7 direct care services provided to veterans who are not 

8 Indians in agreements between the Department and 

9 the following: 

10 (A) The Indian Health Service. 

11 (B) An Indian tribe or tribal organization 

12 operating a medical facility through a contract 

13 or compact with the Indian Health Service 

14 under the Indian Self-Determination and Edu15 cation Assistance Act (25 U.S.C. 450 et seq.). 

16 (C) A medical facility of the Indian Health 

17 Service. 

18 (d) DEFINITIONS.—In this section: 

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

20 tribe’’ have the meanings given those terms in section 

21 4 of the Indian Health Care Improvement Act (25 

22 U.S.C. 1603). 

23 (2) MEDICAL FACILITY OF THE INDIAN HEALTH

24 SERVICE.—The term ‘‘medical facility of the Indian 

25 Health Service’’ includes a facility operated by an In-
42 

† HR 3230 EAS 

1 dian tribe or tribal organization through a contract 

2 or compact with the Indian Health Service under the 

3 Indian Self-Determination and Education Assistance 

4 Act (25 U.S.C. 450 et seq.). 

5 (3) TRIBAL ORGANIZATION.—The term ‘‘tribal 

6 organization’’ has the meaning given the term in sec7 tion 4 of the Indian Self-Determination and Edu8 cation Assistance Act (25 U.S.C. 450b). 

9 SEC. 304. ENHANCEMENT OF COLLABORATION BETWEEN 

10 DEPARTMENT OF VETERANS AFFAIRS AND 

11 NATIVE HAWAIIAN HEALTH CARE SYSTEMS. 

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

13 shall, in consultation with Papa Ola Lokahi and such other 

14 organizations involved in the delivery of health care to Na15 tive Hawaiians as the Secretary considers appropriate, 

16 enter into contracts or agreements with Native Hawaiian 

17 health care systems that are in receipt of funds from the 

18 Secretary of Health and Human Services pursuant to 

19 grants awarded or contracts entered into under section 6(a) 

20 of the Native Hawaiian Health Care Improvement Act (42 

21 U.S.C. 11705(a)) for the reimbursement of direct care serv22 ices provided to eligible veterans as specified in such con23 tracts or agreements. 

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

25 Hawaiian’’, ‘‘Native Hawaiian health care system’’, and 
43 

† HR 3230 EAS 

1 ‘‘Papa Ola Lokahi’’ have the meanings given those terms 

2 in section 12 of the Native Hawaiian Health Care Improve3 ment Act (42 U.S.C. 11711). 

4 SEC. 305. SENSE OF CONGRESS ON PROMPT PAYMENT BY 

5 DEPARTMENT OF VETERANS AFFAIRS. 

6 It is the sense of Congress that the Secretary of Vet7 erans Affairs shall comply with section 1315 of title 5, Code 

8 of Federal Regulations (commonly known as the ‘‘prompt 

9 payment rule’’), or any corresponding similar regulation 

10 or ruling, in paying for health care pursuant to contracts 

11 entered into with non-Department of Veterans Affairs pro12 viders to provide health care under the laws administered 

13 by the Secretary. 

14 TITLE IV—HEALTH CARE 

15 ADMINISTRATIVE MATTERS 

16 SEC. 401. IMPROVEMENT OF ACCESS OF VETERANS TO MO17 BILE VET CENTERS OF THE DEPARTMENT OF 

18 VETERANS AFFAIRS. 

19 (a) IMPROVEMENT OF ACCESS.— 

20 (1) IN GENERAL.—The Secretary of Veterans Af21 fairs shall improve the access of veterans to telemedi22 cine and other health care through the use of mobile 

23 vet centers of the Department of Veterans Affairs by 

24 providing standardized requirements for the operation 

25 of such centers. 
44 

† HR 3230 EAS 

1 (2) REQUIREMENTS.—The standardized require2 ments required by paragraph (1) shall include the fol3 lowing: 

4 (A) The number of days each mobile vet 

5 center of the Department is expected to travel per 

6 year. 

7 (B) The number of locations each center is 

8 expected to visit per year. 

9 (C) The number of appointments each cen10 ter is expected to conduct per year. 

11 (D) The method and timing of notifications 

12 given by each center to individuals in the area 

13 to which such center is traveling, including noti14 fications informing veterans of the availability 

15 to schedule appointments at the center. 

16 (3) USE OF TELEMEDICINE.—The Secretary 

17 shall ensure that each mobile vet center of the Depart18 ment has the capability to provide telemedicine serv19 ices. 

20 (b) REPORTS.—Not later than one year after the date 

21 of the enactment of this Act, and not later than September 

22 30 each year thereafter, the Secretary of Veterans Affairs 

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

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

25 of Representatives a report on the following: 
45 

† HR 3230 EAS 

1 (1) The use of mobile vet centers to provide tele2 medicine services to veterans during the year pre3 ceding the submittal of the report, including the fol4 lowing: 

5 (A) The number of days each mobile vet 

6 center was open to provide such services. 

7 (B) The number of days each mobile vet 

8 center traveled to a location other than the head9 quarters of the mobile vet center to provide such 

10 services. 

11 (C) The number of appointments each cen12 ter conducted to provide such services on average 

13 per month and in total during such year. 

14 (2) An analysis of the effectiveness of using mo15 bile vet centers to provide health care services to vet16 erans through the use of telemedicine. 

17 (3) Any recommendations for an increase in the 

18 number of mobile vet centers of the Department. 

19 (4) Any recommendations for an increase in the 

20 telemedicine capabilities of each mobile vet center. 

21 (5) The feasibility and advisability of using tem22 porary health care providers, including locum tenens, 

23 to provide direct health care services to veterans at 

24 mobile vet centers. 
46 

† HR 3230 EAS 

1 (6) Such other recommendations on improvement 

2 of the use of mobile vet centers by the Department as 

3 the Secretary considers appropriate. 

4 SEC. 402. COMMISSION ON CONSTRUCTION PROJECTS OF 

5 THE DEPARTMENT OF VETERANS AFFAIRS. 

6 (a) ESTABLISHMENT OF COMMISSION.— 

7 (1) ESTABLISHMENT.—There is established an 

8 Independent Commission on Department of Veterans 

9 Affairs Construction Projects (in this section referred 

10 to as the ‘‘Commission’’). 

11 (2) MEMBERSHIP.— 

12 (A) VOTING MEMBERS.—The Commission 

13 shall be composed of 10 voting members as fol14 lows: 

15 (i) Three members to be appointed by 

16 the President from among members of the 

17 National Academy of Engineering who are 

18 nominated under subparagraph (B). 

19 (ii) Three members to be appointed by 

20 the President from among members of the 

21 National Institute of Building Sciences who 

22 are nominated under subparagraph (B). 

23 (iii) Four members to be appointed by 

24 the President from among veterans enrolled 

25 in the patient enrollment system of the De-
47 

† HR 3230 EAS 

1 partment of Veterans Affairs under section 

2 1705 of title 38, United States Code, who 

3 are nominated under subparagraph (B). 

4 (B) NOMINATION OF VOTING MEMBERS.— 

5 The majority leader of the Senate, the minority 

6 leader of the Senate, the speaker of the House of 

7 Representatives, and the minority leader of the 

8 House of Representatives shall jointly nominate 

9 not less than 24 individuals to be considered by 

10 the President for appointment under subpara11 graph (A). 

12 (C) NONVOTING MEMBERS.—The Commis13 sion shall be composed of the following nonvoting 

14 members: 

15 (i) The Comptroller General of the 

16 United States, or designee. 

17 (ii) The Secretary of Veterans Affairs, 

18 or designee. 

19 (iii) The Inspector General of the De20 partment of Veterans Affairs, or designee. 

21 (D) DATE OF APPOINTMENT OF MEM22 BERS.—The appointments of the members of the 

23 Commission under subparagraph (A) shall be 

24 made not later than 14 days after the date of the 

25 enactment of this Act. 
48 

† HR 3230 EAS 

1 (3) PERIOD OF APPOINTMENT; VACANCIES.— 

2 Members shall be appointed for the life of the Com3 mission. Any vacancy in the Commission shall not af4 fect its powers, but shall be filled in the same manner 

5 as the original appointment. 

6 (4) INITIAL MEETING.—Not later than five days 

7 after the date on which all members of the Commis8 sion have been appointed, the Commission shall hold 

9 its first meeting. 

10 (5) MEETINGS.—The Commission shall meet at 

11 the call of the Chairperson. 

12 (6) QUORUM.—A majority of the members of the 

13 Commission shall constitute a quorum, but a lesser 

14 number of members may hold hearings. 

15 (7) CHAIRPERSON AND VICE CHAIRPERSON.—The 

16 Commission shall select a Chairperson and Vice 

17 Chairperson from among its members. 

18 (b) DUTIES OF COMMISSION.— 

19 (1) REVIEW.—The Commission shall review cur20 rent construction and maintenance projects and the 

21 medical facility leasing program of the Department of 

22 Veterans Affairs to identify any problems experienced 

23 by the Department in carrying out such projects and 

24 program. 

25 (2) REPORTS.— 
49 

† HR 3230 EAS 

1 (A) COMMISSION REPORT.—Not later than 

2 120 days after the date of the enactment of this 

3 Act, the Commission shall submit to the Sec4 retary of Veterans Affairs, the Committee on Vet5 erans’ Affairs of the Senate, and the Committee 

6 on Veterans’ Affairs of the House of Representa7 tives a report setting forth recommendations, if 

8 any, for improving the manner in which the Sec9 retary carries out the projects and program spec10 ified in paragraph (1). 

11 (B) DEPARTMENT REPORT.—Not later than 

12 60 days after the submittal of the report under 

13 subparagraph (A), the Secretary of Veterans Af14 fairs shall submit to the Committee on Veterans’ 

15 Affairs of the Senate and the Committee on Vet16 erans’ Affairs of the House of Representatives a 

17 report on the feasibility and advisability of im18 plementing the recommendations of the Commis19 sion, if any, included in the report submitted 

20 under such subparagraph, including a timeline 

21 for the implementation of such recommendations. 

22 (c) POWERS OF COMMISSION.— 

23 (1) HEARINGS.—The Commission may hold such 

24 hearings, sit and act at such times and places, take 
50 

† HR 3230 EAS 

1 such testimony, and receive such evidence as the Com2 mission considers advisable to carry out this section. 

3 (2) INFORMATION FROM FEDERAL AGENCIES.— 

4 The Commission may secure directly from any Fed5 eral agency such information as the Commission con6 siders necessary to carry out this section. Upon re7 quest of the Chairperson of the Commission, the head 

8 of such agency shall furnish such information to the 

9 Commission. 

10 (d) COMMISSION PERSONNEL MATTERS.— 

11 (1) COMPENSATION OF MEMBERS.—Each mem12 ber of the Commission who is not an officer or em13 ployee of the Federal Government shall be com14 pensated at a rate equal to the daily equivalent of the 

15 annual rate of basic pay prescribed for level IV of the 

16 Executive Schedule under section 5315 of title 5, 

17 United States Code, for each day (including travel 

18 time) during which such member is engaged in the 

19 performance of the duties of the Commission. All 

20 members of the Commission who are officers or em21 ployees of the United States shall serve without com22 pensation in addition to that received for their serv23 ices as officers or employees of the United States. 

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

25 Commission shall be allowed travel expenses, includ-
51 

† HR 3230 EAS 

1 ing per diem in lieu of subsistence, at rates author2 ized for employees of agencies under subchapter I of 

3 chapter 57 of title 5, United States Code, while away 

4 from their homes or regular places of business in the 

5 performance of services for the Commission. 

6 (3) STAFF.— 

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

8 Commission may, without regard to the civil 

9 service laws and regulations, appoint and termi10 nate an executive director and such other addi11 tional personnel as may be necessary to enable 

12 the Commission to perform its duties. The em13 ployment of an executive director shall be subject 

14 to confirmation by the Commission. 

15 (B) COMPENSATION.—The Chairperson of 

16 the Commission may fix the compensation of the 

17 executive director and other personnel without 

18 regard to chapter 51 and subchapter III of chap19 ter 53 of title 5, United States Code, relating to 

20 classification of positions and General Schedule 

21 pay rates, except that the rate of pay for the ex22 ecutive director and other personnel may not ex23 ceed the rate payable for level V of the Executive 

24 Schedule under section 5316 of such title. 
52 

† HR 3230 EAS 

1 (4) DETAIL OF GOVERNMENT EMPLOYEES.—Any 

2 Federal Government employee may be detailed to the 

3 Commission without reimbursement, and such detail 

4 shall be without interruption or loss of civil service 

5 status or privilege. 

6 (5) PROCUREMENT OF TEMPORARY AND INTER7 MITTENT SERVICES.—The Chairperson of the Com8 mission may procure temporary and intermittent 

9 services under section 3109(b) of title 5, United States 

10 Code, at rates for individuals that do not exceed the 

11 daily equivalent of the annual rate of basic pay pre12 scribed for level V of the Executive Schedule under 

13 section 5316 of such title. 

14 (e) TERMINATION OF COMMISSION.—The Commission 

15 shall terminate 30 days after the date on which the Com16 mission submits its report under subsection (b)(2)(A). 

17 SEC. 403. COMMISSION ON ACCESS TO CARE. 

18 (a) ESTABLISHMENT OF COMMISSION.— 

19 (1) IN GENERAL.—There is established the Com20 mission on Access to Care (in this section referred to 

21 as the ‘‘Commission’’) to examine the access of vet22 erans to health care from the Department of Veterans 

23 Affairs and strategically examine how best to organize 

24 the Veterans Health Administration, locate health 

25 care resources, and deliver health care to veterans 
53 

† HR 3230 EAS 

1 during the 10- to 20-year period beginning on the 

2 date of the enactment of this Act. 

3 (2) MEMBERSHIP.— 

4 (A) VOTING MEMBERS.—The Commission 

5 shall be composed of 10 voting members who are 

6 appointed by the President as follows: 

7 (i) At least two members who represent 

8 an organization recognized by the Secretary 

9 of Veterans Affairs for the representation of 

10 veterans under section 5902 of title 38, 

11 United States Code. 

12 (ii) At least one member from among 

13 persons who have experience as senior man14 agement for a private integrated health care 

15 system with an annual gross revenue of 

16 more than $50,000,000. 

17 (iii) At least one member from among 

18 persons who are familiar with government 

19 health care systems, including those systems 

20 of the Department of Defense, the Indian 

21 Health Service, and Federally-qualified 

22 health centers (as defined in section 

23 1905(l)(2)(B) of the Social Security Act (42 

24 U.S.C. 1396d(l)(2)(B))). 
54 

† HR 3230 EAS 

1 (iv) At least two members from among 

2 persons who are familiar with the Veterans 

3 Health Administration but are not current 

4 employees of the Veterans Health Adminis5 tration. 

6 (v) At least two members from among 

7 persons who are veterans or eligible for hos8 pital care, medical services, or other health 

9 care under the laws administered by the 

10 Secretary of Veterans Affairs. 

11 (B) NONVOTING MEMBERS.— 

12 (i) IN GENERAL.—In addition to mem13 bers appointed under subparagraph (A), the 

14 Commission shall be composed of 10 non15 voting members who are appointed by the 

16 President as follows: 

17 (I) At least two members who rep18 resent an organization recognized by 

19 the Secretary of Veterans Affairs for 

20 the representation of veterans under 

21 section 5902 of title 38, United States 

22 Code. 

23 (II) At least one member from 

24 among persons who have experience as 

25 senior management for a private inte-
55 

† HR 3230 EAS 

1 grated health care system with an an2 nual gross revenue of more than 

3 $50,000,000. 

4 (III) At least one member from 

5 among persons who are familiar with 

6 government health care systems, in7 cluding those systems of the Depart8 ment of Defense, the Indian Health 

9 Service, and Federally-qualified health 

10 centers (as defined in section 

11 1905(l)(2)(B) of the Social Security 

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

13 (IV) At least two members from 

14 among persons who are familiar with 

15 the Veterans Health Administration 

16 but are not current employees of the 

17 Veterans Health Administration. 

18 (V) At least two members from 

19 among persons who are veterans or eli20 gible for hospital care, medical services, 

21 or other health care under the laws ad22 ministered by the Secretary of Veterans 

23 Affairs. 

24 (ii) ADDITIONAL NONVOTING MEM25 BERS.—In addition to members appointed 
56 

† HR 3230 EAS 

1 under subparagraph (A) and clause (i), the 

2 Commission shall be composed of the fol3 lowing nonvoting members: 

4 (I) The Comptroller General of the 

5 United States, or designee. 

6 (II) The Inspector General of the 

7 Department of Veterans Affairs, or des8 ignee. 

9 (C) DATE.—The appointments of members 

10 of the Commission shall be made not later than 

11 60 days after the date of the enactment of this 

12 Act. 

13 (3) PERIOD OF APPOINTMENT; VACANCIES.— 

14 Members shall be appointed for the life of the Com15 mission. Any vacancy in the Commission shall not af16 fect its powers, but shall be filled in the same manner 

17 as the original appointment. 

18 (4) INITIAL MEETING.—Not later than 15 days 

19 after the date on which seven voting members of the 

20 Commission have been appointed, the Commission 

21 shall hold its first meeting. 

22 (5) MEETINGS.—The Commission shall meet at 

23 the call of the Chairperson. 
57 

† HR 3230 EAS 

1 (6) QUORUM.—A majority of the members of the 

2 Commission shall constitute a quorum, but a lesser 

3 number of members may hold hearings. 

4 (7) CHAIRPERSON AND VICE CHAIRPERSON.—The 

5 Commission shall select a Chairperson and Vice 

6 Chairperson from among its members. 

7 (b) DUTIES OF COMMISSION.— 

8 (1) EVALUATION AND ASSESSMENT.—The Com9 mission shall undertake a comprehensive evaluation 

10 and assessment of access to health care at the Depart11 ment of Veterans Affairs. 

12 (2) MATTERS EVALUATED AND ASSESSED.—The 

13 matters evaluated and assessed by the Commission 

14 shall include the following: 

15 (A) The appropriateness of current stand16 ards of the Department of Veterans Affairs con17 cerning access to health care. 

18 (B) The measurement of such standards. 

19 (C) The appropriateness of performance 

20 standards and incentives in relation to stand21 ards described in subparagraph (A). 

22 (D) Staffing levels throughout the Veterans 

23 Health Administration and whether they are suf24 ficient to meet current demand for health care 

25 from the Administration. 
58 

† HR 3230 EAS 

1 (E) The results of the assessment conducted 

2 by an independent third party under section 

3 101(a), including any data or recommendations 

4 included in such assessment. 

5 (3) REPORTS.—The Commission shall submit to 

6 the President, through the Secretary of Veterans Af7 fairs, reports as follows: 

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

9 the initial meeting of the Commission, an in10 terim report on— 

11 (i) the findings of the Commission with 

12 respect to the evaluation and assessment re13 quired by this subsection; and 

14 (ii) such recommendations as the Com15 mission may have for legislative or admin16 istrative action to improve access to health 

17 care through the Veterans Health Adminis18 tration. 

19 (B) Not later than 180 days after the date 

20 of the initial meeting of the Commission, a final 

21 report on— 

22 (i) the findings of the Commission with 

23 respect to the evaluation and assessment re24 quired by this subsection; and 
59 

† HR 3230 EAS 

1 (ii) such recommendations as the Com2 mission may have for legislative or admin3 istrative action to improve access to health 

4 care through the Veterans Health Adminis5 tration. 

6 (c) POWERS OF THE COMMISSION.— 

7 (1) HEARINGS.—The Commission may hold such 

8 hearings, sit and act at such times and places, take 

9 such testimony, and receive such evidence as the Com10 mission considers advisable to carry out this section. 

11 (2) INFORMATION FROM FEDERAL AGENCIES.— 

12 The Commission may secure directly from any Fed13 eral department or agency such information as the 

14 Commission considers necessary to carry out this sec15 tion. Upon request of the Chairperson of the Commis16 sion, the head of such department or agency shall fur17 nish such information to the Commission. 

18 (d) COMMISSION PERSONNEL MATTERS.— 

19 (1) COMPENSATION OF MEMBERS.—Each mem20 ber of the Commission who is not an officer or em21 ployee of the Federal Government shall be com22 pensated at a rate equal to the daily equivalent of the 

23 annual rate of basic pay prescribed for level IV of the 

24 Executive Schedule under section 5315 of title 5, 

25 United States Code, for each day (including travel 
60 

† HR 3230 EAS 

1 time) during which such member is engaged in the 

2 performance of the duties of the Commission. All 

3 members of the Commission who are officers or em4 ployees of the United States shall serve without com5 pensation in addition to that received for their serv6 ices as officers or employees of the United States. 

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

8 Commission shall be allowed travel expenses, includ9 ing per diem in lieu of subsistence, at rates author10 ized for employees of agencies under subchapter I of 

11 chapter 57 of title 5, United States Code, while away 

12 from their homes or regular places of business in the 

13 performance of services for the Commission. 

14 (3) STAFF.— 

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

16 Commission may, without regard to the civil 

17 service laws and regulations, appoint and termi18 nate an executive director and such other addi19 tional personnel as may be necessary to enable 

20 the Commission to perform its duties. The em21 ployment of an executive director shall be subject 

22 to confirmation by the Commission. 

23 (B) COMPENSATION.—The Chairperson of 

24 the Commission may fix the compensation of the 

25 executive director and other personnel without 
61 

† HR 3230 EAS 

1 regard to chapter 51 and subchapter III of chap2 ter 53 of title 5, United States Code, relating to 

3 classification of positions and General Schedule 

4 pay rates, except that the rate of pay for the ex5 ecutive director and other personnel may not ex6 ceed the rate payable for level V of the Executive 

7 Schedule under section 5316 of such title. 

8 (4) DETAIL OF GOVERNMENT EMPLOYEES.—Any 

9 Federal Government employee may be detailed to the 

10 Commission without reimbursement, and such detail 

11 shall be without interruption or loss of civil service 

12 status or privilege. 

13 (5) PROCUREMENT OF TEMPORARY AND INTER14 MITTENT SERVICES.—The Chairperson of the Com15 mission may procure temporary and intermittent 

16 services under section 3109(b) of title 5, United States 

17 Code, at rates for individuals that do not exceed the 

18 daily equivalent of the annual rate of basic pay pre19 scribed for level V of the Executive Schedule under 

20 section 5316 of such title. 

21 (e) TERMINATION OF THE COMMISSION.—The Com22 mission shall terminate 30 days after the date on which 

23 the Commission submits its report under subsection 

24 (b)(3)(B). 
62 

† HR 3230 EAS 

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

2 make available to the Commission from amounts appro3 priated or otherwise made available to the Secretary such 

4 amounts as the Secretary and the Chairperson of the Com5 mission jointly consider appropriate for the Commission to 

6 perform its duties under this section. 

7 (g) EXECUTIVE ACTION.— 

8 (1) ACTION ON RECOMMENDATIONS.—The Presi9 dent shall require the Secretary of Veterans Affairs 

10 and such other heads of relevant Federal departments 

11 and agencies to implement each recommendation set 

12 forth in a report submitted under subsection (b)(3) 

13 that the President— 

14 (A) considers feasible and advisable; and 

15 (B) determines can be implemented without 

16 further legislative action. 

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

18 date on which the President receives a report under 

19 subsection (b)(3), the President shall submit to the 

20 Committee on Veterans’ Affairs of the Senate and the 

21 Committee on Veterans’ Affairs of the House of Rep22 resentatives and such other committees of Congress as 

23 the President considers appropriate a report setting 

24 forth the following: 
63 

† HR 3230 EAS 

1 (A) An assessment of the feasibility and ad2 visability of each recommendation contained in 

3 the report received by the President. 

4 (B) For each recommendation assessed as 

5 feasible and advisable under subparagraph (A) 

6 the following: 

7 (i) Whether such recommendation re8 quires legislative action. 

9 (ii) If such recommendation requires 

10 legislative action, a recommendation con11 cerning such legislative action. 

12 (iii) A description of any administra13 tive action already taken to carry out such 

14 recommendation. 

15 (iv) A description of any administra16 tive action the President intends to be taken 

17 to carry out such recommendation and by 

18 whom. 

19 SEC. 404. IMPROVED PERFORMANCE METRICS FOR HEALTH 

20 CARE PROVIDED BY DEPARTMENT OF VET21 ERANS AFFAIRS. 

22 (a) PROHIBITION ON USE OF SCHEDULING AND WAIT23 TIME METRICS IN DETERMINATION OF PERFORMANCE

24 AWARDS.—The Secretary of Veterans Affairs shall ensure 

25 that scheduling and wait-time metrics or goals are not used 
64 

† HR 3230 EAS 

1 as factors in determining the performance of the following 

2 employees for purposes of determining whether to pay per3 formance awards to such employees: 

4 (1) Directors, associate directors, assistant direc5 tors, deputy directors, chiefs of staff, and clinical 

6 leads of medical centers of the Department of Veterans 

7 Affairs. 

8 (2) Directors, assistant directors, and quality 

9 management officers of Veterans Integrated Service 

10 Networks of the Department of Veterans Affairs. 

11 (b) MODIFICATION OF PERFORMANCE PLANS.— 

12 (1) IN GENERAL.—Not later than 30 days after 

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

14 shall modify the performance plans of the directors of 

15 the medical centers of the Department and the direc16 tors of the Veterans Integrated Service Networks to 

17 ensure that such plans are based on the quality of 

18 care received by veterans at the health care facilities 

19 under the jurisdictions of such directors. 

20 (2) FACTORS.—In modifying performance plans 

21 under paragraph (1), the Secretary shall ensure that 

22 assessment of the quality of care provided at health 

23 care facilities under the jurisdiction of a director de24 scribed in paragraph (1) includes consideration of the 

25 following: 
65 

† HR 3230 EAS 

1 (A) Recent reviews by the Joint Commission 

2 (formerly known as the ‘‘Joint Commission on 

3 Accreditation of Healthcare Organizations’’) of 

4 such facilities. 

5 (B) The number and nature of rec6 ommendations concerning such facilities by the 

7 Inspector General of the Department in reviews 

8 conducted through the Combined Assessment Pro9 gram (CAP), in the reviews by the Inspector 

10 General of community based outpatient clinics 

11 and primary care clinics, and in reviews con12 ducted through the Office of Healthcare Inspec13 tions during the two most recently completed fis14 cal years. 

15 (C) The number of recommendations de16 scribed in subparagraph (B) that the Inspector 

17 General of the Department determines have not 

18 been carried out satisfactorily with respect to 

19 such facilities. 

20 (D) Reviews of such facilities by the Com21 mission on Accreditation of Rehabilitation Fa22 cilities. 

23 (E) The number and outcomes of adminis24 trative investigation boards, root cause analysis, 

25 and peer reviews conducted at such facilities 
66 

† HR 3230 EAS 

1 during the fiscal year for which the assessment 

2 is being conducted. 

3 (F) The effectiveness of any remedial ac4 tions or plans resulting from any Inspector Gen5 eral recommendations in the reviews and anal6 yses described in subparagraphs (A) through (E). 

7 (3) ADDITIONAL LEADERSHIP POSITIONS.—To 

8 the degree practicable, the Secretary shall assess the 

9 performance of other employees of the Department in 

10 leadership positions at Department medical centers, 

11 including associate directors, assistant directors, dep12 uty directors, chiefs of staff, and clinical leads, and 

13 in Veterans Integrated Service Networks, including 

14 assistant directors and quality management officers, 

15 using factors and criteria similar to those used in the 

16 performance plans modified under paragraph (1). 

17 (c) REMOVAL OF CERTAIN PERFORMANCE GOALS.— 

18 For each fiscal year that begins after the date of the enact19 ment of this Act, the Secretary shall not include in the per20 formance goals of any employee of a Veterans Integrated 

21 Service Network or medical center of the Department any 

22 performance goal that might disincentivize the payment of 

23 Department amounts to provide hospital care, medical serv24 ices, or other health care through a non-Department pro25 vider. 
67 

† HR 3230 EAS 

1 SEC. 405. IMPROVED TRANSPARENCY CONCERNING 

2 HEALTH CARE PROVIDED BY DEPARTMENT 

3 OF VETERANS AFFAIRS. 

4 (a) PUBLICATION OF WAIT TIMES.— 

5 (1) GOALS.— 

6 (A) INITIAL.—Not later than 90 days after 

7 the date of the enactment of this Act, the Sec8 retary of Veterans Affairs shall publish in the 

9 Federal Register, and on an Internet website ac10 cessible to the public of each medical center of the 

11 Department of Veterans Affairs, the wait-time 

12 goals of the Department for the scheduling of an 

13 appointment by a veteran for the receipt of 

14 health care from the Department. 

15 (B) SUBSEQUENT CHANGES.— 

16 (i) IN GENERAL.—If the Secretary 

17 modifies the wait-time goals described in 

18 subparagraph (A), the Secretary shall pub19 lish the new wait-times goals— 

20 (I) on an Internet website acces21 sible to the public of each medical cen22 ter of the Department not later than 30 

23 days after such modification; and 

24 (II) in the Federal Register not 

25 later than 90 days after such modifica26 tion. 
68 

† HR 3230 EAS 

1 (ii) EFFECTIVE DATE.—Any modifica2 tion under clause (i) shall take effect on the 

3 date of publication in the Federal Register. 

4 (C) GOALS DESCRIBED.—Wait-time goals 

5 published under this paragraph shall include 

6 goals for primary care appointments, specialty 

7 care appointments, and appointments based on 

8 the general severity of the condition of the vet9 eran. 

10 (2) WAIT TIMES AT MEDICAL CENTERS OF THE

11 DEPARTMENT.—Not later than one year after the date 

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

13 Affairs shall publish on an Internet website accessible 

14 to the public of each medical center of the Department 

15 the current wait time for an appointment for pri16 mary care and specialty care at the medical center. 

17 (b) PUBLICLY AVAILABLE DATABASE OF PATIENT

18 SAFETY, QUALITY OF CARE, AND OUTCOME MEASURES.— 

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

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

21 shall develop and make available to the public a com22 prehensive database containing all applicable patient 

23 safety, quality of care, and outcome measures for 

24 health care provided by the Department that are 

25 tracked by the Secretary. 
69 

† HR 3230 EAS 

1 (2) UPDATE FREQUENCY.—The Secretary shall 

2 update the database required by paragraph (1) not 

3 less frequently than once each year. 

4 (3) UNAVAILABLE MEASURES.—For all measures 

5 that the Secretary would otherwise publish in the 

6 database required by paragraph (1) but has not done 

7 so because such measures are not available, the Sec8 retary shall publish notice in the database of the rea9 son for such unavailability and a timeline for making 

10 such measures available in the database. 

11 (4) ACCESSIBILITY.—The Secretary shall ensure 

12 that the database required by paragraph (1) is acces13 sible to the public through the primary Internet 

14 website of the Department and through each primary 

15 Internet website of a Department medical center. 

16 (c) HOSPITAL COMPARE WEBSITE OF DEPARTMENT

17 OF HEALTH AND HUMAN SERVICES.— 

18 (1) AGREEMENT REQUIRED.—Not later than 180 

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

20 Secretary of Veterans Affairs shall enter into an 

21 agreement with the Secretary of Health and Human 

22 Services for the provision by the Secretary of Veterans 

23 Affairs of such information as the Secretary of Health 

24 and Human Services may require to report and make 

25 publicly available patient quality and outcome infor-
70 

† HR 3230 EAS 

1 mation concerning Department of Veterans Affairs 

2 medical centers through the Hospital Compare Inter3 net website of the Department of Health and Human 

4 Services or any successor Internet website. 

5 (2) INFORMATION PROVIDED.—The information 

6 provided by the Secretary of Veterans Affairs to the 

7 Secretary of Health and Human Services under para8 graph (1) shall include the following: 

9 (A) Measures of timely and effective health 

10 care. 

11 (B) Measures of readmissions, complications 

12 of death, including with respect to 30-day mor13 tality rates and 30-day readmission rates, sur14 gical complication measures, and health care re15 lated infection measures. 

16 (C) Survey data of patient experiences, in17 cluding the Hospital Consumer Assessment of 

18 Healthcare Providers and Systems or any simi19 lar successor survey developed by the Department 

20 of Health and Human Services. 

21 (D) Any other measures required of or re22 ported with respect to hospitals participating in 

23 the Medicare program under title XVIII of the 

24 Social Security Act (42 U.S.C. 1395 et seq.). 
71 

† HR 3230 EAS 

1 (3) UNAVAILABLE INFORMATION.—For any ap2 plicable metric collected by the Department of Vet3 erans Affairs or required to be provided under para4 graph (2) and withheld from or unavailable in the 

5 Hospital Compare Internet website, the Secretary of 

6 Veterans Affairs shall publish a notice in the Federal 

7 Register stating the reason why such metric was with8 held from public disclosure and a timeline for making 

9 such metric available, if applicable. 

10 (d) COMPTROLLER GENERAL REVIEW OF PUBLICLY

11 AVAILABLE SAFETY AND QUALITY METRICS.—Not later 

12 than three years after the date of the enactment of this Act, 

13 the Comptroller General of the United States shall conduct 

14 a review of the safety and quality metrics made publicly 

15 available by the Secretary of Veterans Affairs under this 

16 section to assess the degree to which the Secretary is com17 plying with the provisions of this section. 

18 SEC. 406. INFORMATION FOR VETERANS ON THE CREDEN19 TIALS OF DEPARTMENT OF VETERANS AF20 FAIRS PHYSICIANS. 

21 (a) IMPROVEMENT OF ‘‘OUR PROVIDERS’’ INTERNET

22 WEBSITE LINKS.— 

23 (1) AVAILABILITY THROUGH DEPARTMENT OF

24 VETERANS AFFAIRS HOMEPAGE.—A link to the ‘‘Our 

25 Providers’’ health care providers database of the De-
72 

† HR 3230 EAS 

1 partment of Veterans Affairs, or any successor data2 base, shall be available on and through the homepage 

3 of the Internet website of the Department that is ac4 cessible to the public. 

5 (2) INFORMATION ON LOCATION OF RESIDENCY

6 TRAINING.—The Internet website of the Department 

7 that is accessible to the public shall include under the 

8 link to the ‘‘Our Providers’’ health care providers 

9 database of the Department, or any successor data10 base, the location of residency training of each li11 censed physician of the Department. 

12 (3) INFORMATION ON PHYSICIANS AT PAR13 TICULAR FACILITIES.—The ‘‘Our Providers’’ health 

14 care providers database of the Department, or any 

15 successor database, shall identify whether each li16 censed physician of the Department is a physician in 

17 residency. 

18 (b) INFORMATION ON CREDENTIALS OF PHYSICIANS

19 FOR VETERANS UNDERGOING SURGICAL PROCEDURES.— 

20 (1) IN GENERAL.—Each veteran who is under21 going a surgical procedure by or through the Depart22 ment shall be provided information on the credentials 

23 of the surgeon to be performing such procedure at 

24 such time in advance of the procedure as is appro-
73 

† HR 3230 EAS 

1 priate to permit such veteran to evaluate such infor2 mation. 

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

4 to evaluate the information provided under para5 graph (1) due to the health or mental competence of 

6 the veteran, such information shall be provided to an 

7 individual acting on behalf of the veteran. 

8 (c) COMPTROLLER GENERAL REPORT AND PLAN.— 

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

10 date of the enactment of this Act, the Comptroller 

11 General of the United States shall submit to the Com12 mittee on Veterans’ Affairs of the Senate and the 

13 Committee on Veterans’ Affairs of the House of Rep14 resentatives a report setting forth an assessment by 

15 the Comptroller General of the following: 

16 (A) The manner in which contractors under 

17 the Patient-Centered Community Care initiative 

18 of the Department perform oversight of the cre19 dentials of physicians within the networks of 

20 such contractors under the initiative. 

21 (B) The oversight by the Department of the 

22 contracts under the Patient-Centered Community 

23 Care initiative. 

24 (C) The verification by the Department of 

25 the credentials and licenses of health care pro-
74 

† HR 3230 EAS 

1 viders furnishing hospital care and medical serv2 ices under section 301. 

3 (2) PLAN.— 

4 (A) IN GENERAL.—Not later than 30 days 

5 after the submittal of the report under para6 graph (1), the Secretary shall— 

7 (i) submit to the Comptroller General, 

8 the Committee on Veterans’ Affairs of the 

9 Senate, and the Committee on Veterans’ Af10 fairs of the House of Representatives a plan 

11 to address any findings and recommenda12 tions of the Comptroller General included in 

13 such report; and 

14 (ii) submit to the Committee on Vet15 erans’ Affairs of the Senate and the Com16 mittee on Veterans’ Affairs of the House of 

17 Representatives a request for additional 

18 amounts, if any, that may be necessary to 

19 carry out such plan. 

20 (B) IMPLEMENTATION.—Not later than 90 

21 days after the submittal of the report under 

22 paragraph (1), the Secretary shall carry out such 

23 plan. 
75 

† HR 3230 EAS 

1 SEC. 407. INFORMATION IN ANNUAL BUDGET OF THE 

2 PRESIDENT ON HOSPITAL CARE AND MED3 ICAL SERVICES FURNISHED THROUGH EX4 PANDED USE OF CONTRACTS FOR SUCH 

5 CARE. 

6 The materials on the Department of Veterans Affairs 

7 in the budget of the President for a fiscal year, as submitted 

8 to Congress pursuant to section 1105(a) of title 31, United 

9 States Code, shall set forth the following: 

10 (1) The number of veterans who received hospital 

11 care and medical services under section 301 during 

12 the fiscal year preceding the fiscal year in which such 

13 budget is submitted. 

14 (2) The amount expended by the Department on 

15 furnishing care and services under such section dur16 ing the fiscal year preceding the fiscal year in which 

17 such budget is submitted. 

18 (3) The amount requested in such budget for the 

19 costs of furnishing care and services under such sec20 tion during the fiscal year covered by such budget, set 

21 forth in aggregate and by amounts for each account 

22 for which amounts are so requested. 

23 (4) The number of veterans that the Department 

24 estimates will receive hospital care and medical serv25 ices under such section during the fiscal years covered 

26 by the budget submission. 
76 

† HR 3230 EAS 

1 (5) The number of employees of the Department 

2 on paid administrative leave at any point during the 

3 fiscal year preceding the fiscal year in which such 

4 budget is submitted. 

5 SEC. 408. PROHIBITION ON FALSIFICATION OF DATA CON6 CERNING WAIT TIMES AND QUALITY MEAS7 URES AT DEPARTMENT OF VETERANS AF8 FAIRS. 

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

10 of this Act, and in accordance with title 5, United States 

11 Code, the Secretary of Veterans Affairs shall establish poli12 cies whereby any employee of the Department of Veterans 

13 Affairs who knowingly submits false data concerning wait 

14 times for health care or quality measures with respect to 

15 health care to another employee of the Department or know16 ingly requires another employee of the Department to sub17 mit false data concerning such wait times or quality meas18 ures to another employee of the Department is subject to 

19 a penalty the Secretary considers appropriate after notice 

20 and an opportunity for a hearing, including civil penalties, 

21 unpaid suspensions, or termination. 

22 SEC. 409. REMOVAL OF SENIOR EXECUTIVE SERVICE EM23 PLOYEES OF THE DEPARTMENT OF VET24 ERANS AFFAIRS FOR PERFORMANCE. 

25 (a) REMOVAL OR TRANSFER.— 
77 

† HR 3230 EAS 

1 (1) IN GENERAL.—Chapter 7 of title 38, United 

2 States Code, is amended by adding at the end the fol3 lowing new section: 

4 ‘‘§ 713. Senior Executive Service: removal based on 

5 performance 

6 ‘‘(a) IN GENERAL.—The Secretary may remove any 

7 individual from the Senior Executive Service if the Sec8 retary determines the performance of the individual war9 rants such removal. If the Secretary so removes such an 

10 individual, the Secretary may— 

11 ‘‘(1) remove the individual from the civil service 

12 (as defined in section 2101 of title 5); or 

13 ‘‘(2) transfer the individual to a General Sched14 ule position at any grade of the General Schedule for 

15 which the individual is qualified and that the Sec16 retary determines is appropriate. 

17 ‘‘(b) NOTICE TO CONGRESS.—Not later than 30 days 

18 after removing or transferring an individual from the Sen19 ior Executive Service under subsection (a), the Secretary 

20 shall submit to the Committees on Veterans’ Affairs of the 

21 Senate and House of Representatives notice in writing of 

22 such removal or transfer and the reason for such removal 

23 or transfer. 
78 

† HR 3230 EAS 

1 ‘‘(c) PROCEDURE.—(1) The procedures under section 

2 7543 of title 5 shall not apply to a removal or transfer 

3 under this section. 

4 ‘‘(2)(A) Subject to subparagraph (B), any removal or 

5 transfer under subsection (a) may be appealed to the Merit 

6 Systems Protection Board under section 7701 of title 5. 

7 ‘‘(B) An appeal under subparagraph (A) of a removal 

8 or transfer may only be made if such appeal is made not 

9 later than 7 days after the date of such removal or transfer. 

10 ‘‘(d) EXPEDITED REVIEW BY MERIT SYSTEMS PRO11 TECTION BOARD.—(1) The Merit Systems Protection Board 

12 shall expedite any appeal under section 7701 of title 5 of 

13 a removal or transfer under subsection (a) and, in any such 

14 case, shall issue a decision not later than 21 days after the 

15 date of the appeal. 

16 ‘‘(2) In any case in which the Merit Systems Protec17 tion Board determines that it cannot issue a decision in 

18 accordance with the 21-day requirement under paragraph 

19 (1), the Merit Systems Protection Board shall submit to 

20 Congress a report that explains the reason why the Merit 

21 Systems Protection Board is unable to issue a decision in 

22 accordance with such requirement in such case. 

23 ‘‘(3) There is authorized to be appropriated such sums 

24 as may be necessary for the Merit Systems Protection Board 

25 to expedite appeals under paragraph (1). 
79 

† HR 3230 EAS 

1 ‘‘(4) The Merit Systems Protection Board may not 

2 stay any personnel action taken under this section. 

3 ‘‘(5) A person who appeals under section 7701 of title 

4 5 a removal under subsection (a)(1) may not receive any 

5 pay, awards, bonuses, incentives, allowances, differentials, 

6 student loan repayments, special payments, or benefits from 

7 the Secretary until the Merit Systems Protection Board has 

8 made a final decision on such appeal. 

9 ‘‘(6) A decision made by the Merit Systems Protection 

10 Board with respect to a removal or transfer under sub11 section (a) shall not be subject to any further appeal.’’. 

12 (2) CLERICAL AMENDMENT.—The table of sec13 tions at the beginning of such chapter is amended by 

14 adding at the end the following new item: 

‘‘713. Senior Executive Service: removal based on performance.’’. 

15 (b) ESTABLISHMENT OF EXPEDITED REVIEW PROC16 ESS.— 

17 (1) IN GENERAL.—Not later than 30 days after 

18 the date of the enactment of this Act, the Merit Sys19 tems Protection Board shall establish and put into ef20 fect a process to conduct expedited reviews in accord21 ance with section 713(d) of title 38, United States 

22 Code. 

23 (2) INAPPLICABILITY OF CERTAIN REGULA24 TIONS.—Section 1201.22 of title 5, Code of Federal 

25 Regulations, as in effect on the day before the date of 
80 

† HR 3230 EAS 

1 the enactment of this Act, shall not apply to expedited 

2 reviews carried out under section 713(d) of title 38, 

3 United States Code. 

4 (3) REPORT BY MERIT SYSTEMS PROTECTION

5 BOARD.—Not later than 30 days after the date of the 

6 enactment of this Act, the Merit Systems Protection 

7 Board shall submit to Congress a report on the ac8 tions the Board plans to take to conduct expedited re9 views under section 713(d) of title 38, United States 

10 Code, as added by subsection (a). Such report shall 

11 include a description of the resources the Board deter12 mines will be necessary to conduct such reviews and 

13 a description of whether any resources will be nec14 essary to conduct such reviews that were not available 

15 to the Board on the day before the date of the enact16 ment of this Act. 

17 (c) TEMPORARY EXEMPTION FROM CERTAIN LIMITA18 TION ON INITIATION OF REMOVAL FROM SENIOR EXECU19 TIVE SERVICE.—During the 120-day period beginning on 

20 the date of the enactment of this Act, an action to remove 

21 an individual from the Senior Executive Service at the De22 partment of Veterans Affairs pursuant to section 713 of title 

23 38, United States Code, as added by subsection (a), or sec24 tion 7543 of title 5, United States Code, may be initiated, 
81 

† HR 3230 EAS 

1 notwithstanding section 3592(b) of title 5, United States 

2 Code, or any other provision of law. 

3 (d) CONSTRUCTION.—Nothing in this section or section 

4 713 of title 38, United States Code, as added by subsection 

5 (a), shall be construed to apply to an appeal of a removal, 

6 transfer, or other personnel action that was pending before 

7 the date of the enactment of this Act. 

8 TITLE V—HEALTH CARE 

9 RELATED TO SEXUAL TRAUMA 

10 SEC. 501. EXPANSION OF ELIGIBILITY FOR SEXUAL TRAUMA 

11 COUNSELING AND TREATMENT TO VETERANS 

12 ON INACTIVE DUTY TRAINING. 

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

14 is amended by striking ‘‘or active duty for training’’ and 

15 inserting ‘‘, active duty for training, or inactive duty train16 ing’’. 

17 SEC. 502. PROVISION OF COUNSELING AND TREATMENT 

18 FOR SEXUAL TRAUMA BY THE DEPARTMENT 

19 OF VETERANS AFFAIRS TO MEMBERS OF THE 

20 ARMED FORCES. 

21 (a) EXPANSION OF COVERAGE TO MEMBERS OF THE

22 ARMED FORCES.—Subsection (a) of section 1720D of title 

23 38, United States Code, is amended— 

24 (1) by redesignating paragraph (2) as para25 graph (3); 
82 

† HR 3230 EAS 

1 (2) by inserting after paragraph (1) the fol2 lowing new paragraph (2): 

3 ‘‘(2)(A) In operating the program required by para4 graph (1), the Secretary may, in consultation with the Sec5 retary of Defense, provide counseling and care and services 

6 to members of the Armed Forces (including members of the 

7 National Guard and Reserves) on active duty to overcome 

8 psychological trauma described in that paragraph. 

9 ‘‘(B) A member described in subparagraph (A) shall 

10 not be required to obtain a referral before receiving coun11 seling and care and services under this paragraph.’’; and 

12 (3) in paragraph (3), as predesignated by para13 graph (1)— 

14 (A) by striking ‘‘a veteran’’ and inserting 

15 ‘‘an individual’’; and 

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

17 appears and inserting ‘‘that individual’’. 

18 (b) INFORMATION TO MEMBERS ON AVAILABILITY OF

19 COUNSELING AND SERVICES.—Subsection (c) of such sec20 tion is amended— 

21 (1) by striking ‘‘to veterans’’ each place it ap22 pears; and 

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

24 the Armed Forces and’’ before ‘‘individuals’’. 
83 

† HR 3230 EAS 

1 (c) INCLUSION OF MEMBERS IN REPORTS ON COUN2 SELING AND SERVICES.—Subsection (e) of such section is 

3 amended— 

4 (1) in the matter preceding paragraph (1), by 

5 striking ‘‘to veterans’’; 

6 (2) in paragraph (2)— 

7 (A) by striking ‘‘women veterans’’ and in8 serting ‘‘individuals’’; and 

9 (B) by striking ‘‘training under subsection 

10 (d).’’ and inserting ‘‘training under subsection 

11 (d), desegregated by— 

12 ‘‘(A) veterans; 

13 ‘‘(B) members of the Armed Forces (includ14 ing members of the National Guard and Re15 serves) on active duty; and 

16 ‘‘(C) for each of subparagraphs (A) and 

17 (B)— 

18 ‘‘(i) men; and 

19 ‘‘(ii) women.’’; 

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

21 inserting ‘‘individuals’’; and 

22 (4) in paragraph (5)— 

23 (A) by striking ‘‘women veterans’’ and in24 serting ‘‘individuals’’ ; and 
84 

† HR 3230 EAS 

1 (B) by inserting ‘‘, including specific rec2 ommendations for individuals specified in sub3 paragraphs (A), (B), and (C) of paragraph (2)’’ 

4 before the period at the end. 

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

6 section shall take effect on the date that is one year after 

7 the date of the enactment of this Act. 

8 SEC. 503. REPORTS ON MILITARY SEXUAL TRAUMA. 

9 (a) REPORT ON SERVICES AVAILABLE FOR MILITARY

10 SEXUAL TRAUMA IN THE DEPARTMENT OF VETERANS AF11 FAIRS.—Not later than 630 days after the date of the enact12 ment of this Act, the Secretary of Veterans Affairs shall sub13 mit to the Committee on Veterans’ Affairs of the Senate and 

14 the Committee on Veterans’ Affairs of the House of Rep15 resentatives a report on the treatment and services available 

16 from the Department of Veterans Affairs for male veterans 

17 who experience military sexual trauma compared to such 

18 treatment and services available to female veterans who ex19 perience military sexual trauma. 

20 (b) REPORTS ON TRANSITION OF MILITARY SEXUAL

21 TRAUMA TREATMENT FROM DEPARTMENT OF DEFENSE TO

22 DEPARTMENT OF VETERANS AFFAIRS.—Not later than 630 

23 days after the date of the enactment of this Act, and annu24 ally thereafter for five years, the Department of Veterans 

25 Affairs-Department of Defense Joint Executive Committee 
85 

† HR 3230 EAS 

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

2 shall submit to the appropriate committees of Congress a 

3 report on military sexual trauma that includes the fol4 lowing: 

5 (1) The processes and procedures utilized by the 

6 Department of Veterans Affairs and the Department 

7 of Defense to facilitate transition of treatment of indi8 viduals who have experienced military sexual trauma 

9 from treatment provided by the Department of De10 fense to treatment provided by the Department of Vet11 erans Affairs. 

12 (2) A description and assessment of the collabo13 ration between the Department of Veterans Affairs 

14 and the Department of Defense in assisting veterans 

15 in filing claims for disabilities related to military 

16 sexual trauma, including permitting veterans access 

17 to information and evidence necessary to develop or 

18 support such claims. 

19 (c) DEFINITIONS.—In this section: 

20 (1) APPROPRIATE COMMITTEES OF CONGRESS.— 

21 The term ‘‘appropriate committees of Congress’’ 

22 means— 

23 (A) the Committee on Veterans’ Affairs and 

24 the Committee on Armed Services of the Senate; 

25 and 
86 

† HR 3230 EAS 

1 (B) the Committee on Veterans’ Affairs and 

2 the Committee on Armed Services of the House 

3 of Representatives. 

4 (2) MILITARY SEXUAL TRAUMA.—The term 

5 ‘‘military sexual trauma’’ means psychological trau6 ma, which in the judgment of a mental health profes7 sional employed by the Department, resulted from a 

8 physical assault of a sexual nature, battery of a sex9 ual nature, or sexual harassment which occurred 

10 while the veteran was serving on active duty or active 

11 duty for training. 

12 (3) SEXUAL HARASSMENT.—The term ‘‘sexual 

13 harassment’’ means repeated, unsolicited verbal or 

14 physical contact of a sexual nature which is threat15 ening in character. 

16 (4) SEXUAL TRAUMA.—The term ‘‘sexual trau17 ma’’ shall have the meaning given that term by the 

18 Secretary of Veterans Affairs for purposes of this sec19 tion. 

20 (d) EFFECTIVE DATE.—This section shall take effect 

21 on the date that is 270 days after the date of the enactment 

22 of this Act. 
87 

† HR 3230 EAS 

1 TITLE VI—MAJOR MEDICAL 

2 FACILITY LEASES 

3 SEC. 601. AUTHORIZATION OF MAJOR MEDICAL FACILITY 

4 LEASES. 

5 The Secretary of Veterans Affairs may carry out the 

6 following major medical facility leases at the locations spec7 ified, and in an amount for each lease not to exceed the 

8 amount shown for such location (not including any esti9 mated cancellation costs): 

10 (1) For a clinical research and pharmacy coordi11 nating center, Albuquerque, New Mexico, an amount 

12 not to exceed $9,560,000. 

13 (2) For a community-based outpatient clinic, 

14 Brick, New Jersey, an amount not to exceed 

15 $7,280,000. 

16 (3) For a new primary care and dental clinic 

17 annex, Charleston, South Carolina, an amount not to 

18 exceed $7,070,250. 

19 (4) For the Cobb County community-based Out20 patient Clinic, Cobb County, Georgia, an amount not 

21 to exceed $6,409,000. 

22 (5) For the Leeward Outpatient Healthcare Ac23 cess Center, Honolulu, Hawaii, including a co-located 

24 clinic with the Department of Defense and the co-loca25 tion of the Honolulu Regional Office of the Veterans 
88 

† HR 3230 EAS 

1 Benefits Administration and the Capel Vet Center of 

2 the Department of Veterans Affairs, an amount not to 

3 exceed $15,887,370. 

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

5 Johnson County, Kansas, an amount not to exceed 

6 $2,263,000. 

7 (7) For a replacement community-based out8 patient clinic, Lafayette, Louisiana, an amount not 

9 to exceed $2,996,000. 

10 (8) For a community-based outpatient clinic, 

11 Lake Charles, Louisiana, an amount not to exceed 

12 $2,626,000. 

13 (9) For outpatient clinic consolidation, New Port 

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

15 (10) For an outpatient clinic, Pence, Puerto 

16 Rico, an amount not to exceed $11,535,000. 

17 (11) For lease consolidation, San Antonio, 

18 Texas, an amount not to exceed $19,426,000. 

19 (12) For a community-based outpatient clinic, 

20 San Diego, California, an amount not to exceed 

21 $11,946,100. 

22 (13) For an outpatient clinic, Tyler, Texas, an 

23 amount not to exceed $4,327,000. 
89 

† HR 3230 EAS 

1 (14) For the Arere Community Care Center, 

2 West Haven, Connecticut, an amount not to exceed 

3 $4,883,000. 

4 (15) For the Worcester community-based Out5 patient Clinic, Worcester, Massachusetts, an amount 

6 not to exceed $4,855,000. 

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

8 outpatient clinic, Cape Girardeau, Missouri, an 

9 amount not to exceed $4,232,060. 

10 (17) For a multi specialty clinic, Chattanooga, 

11 Tennessee, an amount not to exceed $7,069,000. 

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

13 outpatient clinic, Chico, California, an amount not to 

14 exceed $4,534,000. 

15 (19) For a community-based outpatient clinic, 

16 Chula Vista, California, an amount not to exceed 

17 $3,714,000. 

18 (20) For a new research lease, Haines, Illinois, 

19 an amount not to exceed $22,032,000. 

20 (21) For a replacement research lease, Houston, 

21 Texas, an amount not to exceed $6,142,000. 

22 (22) For a community-based outpatient clinic, 

23 Lincoln, Nebraska, an amount not to exceed 

24 $7,178,400. 
90 

† HR 3230 EAS 

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

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

3 (24) For a community-based outpatient clinic 

4 consolidation, Myrtle Beach, South Carolina, an 

5 amount not to exceed $8,022,000. 

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

7 Phoenix, Arizona, an amount not to exceed 

8 $20,757,000. 

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

10 outpatient clinic, Redding, California, an amount not 

11 to exceed $8,154,000. 

12 SEC. 602. BUDGETARY TREATMENT OF DEPARTMENT OF 

13 VETERANS AFFAIRS MAJOR MEDICAL FACILI14 TIES LEASES. 

15 (a) FINDINGS.—Congress finds the following: 

16 (1) Title 31, United States Code, requires the De17 partment of Veterans Affairs to record the full cost of 

18 its contractual obligation against funds available at 

19 the time a contract is executed. 

20 (2) Office of Management and Budget Circular 

21 A–11 provides guidance to agencies in meeting the 

22 statutory requirements under title 31, United States 

23 Code, with respect to leases. 

24 (3) For operating leases, Office of Management 

25 and Budget Circular A–11 requires the Department of 
91 

† HR 3230 EAS 

1 Veterans Affairs to record up-front budget authority 

2 in an ‘‘amount equal to total payments under the full 

3 term of the lease or [an] amount sufficient to cover 

4 first year lease payments plus cancellation costs’’. 

5 (b) REQUIREMENT FOR OBLIGATION OF FULL COST.— 

6 (1) IN GENERAL.—Subject to the availability of 

7 appropriations provided in advance, in exercising the 

8 authority of the Secretary of Veterans Affairs to enter 

9 into leases provided in this Act, the Secretary shall 

10 record, pursuant to section 1501 of title 31, United 

11 States Code, as the full cost of the contractual obliga12 tion at the time a contract is executed either— 

13 (A) an amount equal to total payments 

14 under the full term of the lease; or 

15 (B) if the lease specifies payments to be 

16 made in the event the lease is terminated before 

17 its full term, an amount sufficient to cover the 

18 first year lease payments plus the specified can19 cellation costs. 

20 (2) SELF-INSURING AUTHORITY.—The require21 ments of paragraph (1) may be satisfied through the 

22 use of a self-insuring authority consistent with Office 

23 of Management and Budget Circular A–11. 

24 (c) TRANSPARENCY.— 
92 

† HR 3230 EAS 

1 (1) COMPLIANCE.—Subsection (b) of section 8104 

2 of title 38, United States Code, is amended by adding 

3 at the end the following new paragraph: 

4 ‘‘(7) In the case of a prospectus proposing fund5 ing for a major medical facility lease, a detailed 

6 analysis of how the lease is expected to comply with 

7 Office of Management and Budget Circular A–11 and 

8 section 1341 of title 31 (commonly referred to as the 

9 ‘Anti-Deficiency Act’). Any such analysis shall in10 clude— 

11 ‘‘(A) an analysis of the classification of the 

12 lease as a ‘lease-purchase’, ‘capital lease’, or ‘op13 erating lease’ as those terms are defined in Office 

14 of Management and Budget Circular A–11; 

15 ‘‘(B) an analysis of the obligation of budg16 etary resources associated with the lease; and 

17 ‘‘(C) an analysis of the methodology used in 

18 determining the asset cost, fair market value, 

19 and cancellation costs of the lease.’’. 

20 (2) SUBMITTAL TO CONGRESS.—Such section 

21 8104 is further amended by adding at the end the fol22 lowing new subsection: 

23 ‘‘(h)(1) Not less than 30 days before entering into a 

24 major medical facility lease, the Secretary shall submit to 
93 

† HR 3230 EAS 

1 the Committees on Veterans’ Affairs of the Senate and the 

2 House of Representatives— 

3 ‘‘(A) notice of the Secretary’s intention to enter 

4 into the lease; 

5 ‘‘(B) a detailed summary of the proposed lease; 

6 ‘‘(C) a description and analysis of any dif7 ferences between the prospectus submitted pursuant to 

8 subsection (b) and the proposed lease; and 

9 ‘‘(D) a scoring analysis demonstrating that the 

10 proposed lease fully complies with Office of Manage11 ment and Budget Circular A–11. 

12 ‘‘(2) Each committee described in paragraph (1) shall 

13 ensure that any information submitted to the committee 

14 under such paragraph is treated by the committee with the 

15 same level of confidentiality as is required by law of the 

16 Secretary and subject to the same statutory penalties for 

17 unauthorized disclosure or use as the Secretary. 

18 ‘‘(3) Not more than 30 days after entering into a major 

19 medical facility lease, the Secretary shall submit to each 

20 committee described in paragraph (1) a report on any ma21 terial differences between the lease that was entered into and 

22 the proposed lease described under such paragraph, includ23 ing how the lease that was entered into changes the pre24 viously submitted scoring analysis described in subpara25 graph (D) of such paragraph.’’. 
94 

† HR 3230 EAS 

1 (d) RULE OF CONSTRUCTION.—Nothing in this sec2 tion, or the amendments made by this section, shall be con3 strued to in any way relieve the Department of Veterans 

4 Affairs from any statutory or regulatory obligations or re5 quirements existing prior to the enactment of this section 

6 and such amendments. 

7 TITLE VII—VETERANS BENEFITS 

8 MATTERS 

9 SEC. 701. EXPANSION OF MARINE GUNNERY SERGEANT 

10 JOHN DAVID FRY SCHOLARSHIP. 

11 (a) EXPANSION OF ENTITLEMENT.—Subsection (b)(9) 

12 of section 3311 of title 38, United States Code, is amended 

13 by inserting ‘‘or spouse’’ after ‘‘child’’. 

14 (b) LIMITATION AND ELECTION ON CERTAIN BENE15 FITS.—Subsection (f) of such section is amended— 

16 (1) by redesignating paragraph (2) as para17 graph (4); and 

18 (2) by inserting after paragraph (1) the fol19 lowing new paragraphs: 

20 ‘‘(2) LIMITATION.—The entitlement of an indi21 vidual to assistance under subsection (a) pursuant to 

22 paragraph (9) of subsection (b) because the individual 

23 was a spouse of a person described in such paragraph 

24 shall expire on the earlier of— 
95 

† HR 3230 EAS 

1 ‘‘(A) the date that is 15 years after the date 

2 on which the person died; and 

3 ‘‘(B) the date on which the individual re4 marries. 

5 ‘‘(3) ELECTION ON RECEIPT OF CERTAIN BENE6 FITS.—A surviving spouse entitled to assistance under 

7 subsection (a) pursuant to paragraph (9) of sub8 section (b) who is also entitled to educational assist9 ance under chapter 35 of this title may not receive as10 sistance under both this section and such chapter, but 

11 shall make an irrevocable election (in such form and 

12 manner as the Secretary may prescribe) under which 

13 section or chapter to receive educational assistance.’’. 

14 (c) CONFORMING AMENDMENT.—Section 3321(b)(4) of 

15 such title is amended— 

16 (1) by striking ‘‘an individual’’ and inserting ‘‘a 

17 child’’; and 

18 (2) by striking ‘‘such individual’s’’ each time it 

19 appears and inserting ‘‘such child’s’’. 
96 

† HR 3230 EAS 

1 SEC. 702. APPROVAL OF COURSES OF EDUCATION PRO2 VIDED BY PUBLIC INSTITUTIONS OF HIGHER 

3 LEARNING FOR PURPOSES OF ALL-VOLUN4 TEER FORCE EDUCATIONAL ASSISTANCE 

5 PROGRAM AND POST-9/11 EDUCATIONAL AS6 SISTANCE CONDITIONAL ON IN-STATE TUI7 TION RATE FOR VETERANS. 

8 (a) IN GENERAL.—Section 3679 of title 38, United 

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

10 new subsection: 

11 ‘‘(c)(1) Notwithstanding any other provision of this 

12 chapter and subject to paragraphs (3) through (6), the Sec13 retary shall disapprove a course of education provided by 

14 a public institution of higher learning to a covered indi15 vidual pursuing a course of education with educational as16 sistance under chapter 30 or 33 of this title while living 

17 in the State in which the public institution of higher learn18 ing is located if the institution charges tuition and fees for 

19 that course for the covered individual at a rate that is high20 er than the rate the institution charges for tuition and fees 

21 for that course for residents of the State in which the insti22 tution is located, regardless of the covered individual’s State 

23 of residence. 

24 ‘‘(2) For purposes of this subsection, a covered indi25 vidual is any individual as follows: 
97 

† HR 3230 EAS 

1 ‘‘(A) A veteran who was discharged or released 

2 from a period of not fewer than 90 days of service in 

3 the active military, naval, or air service less than 

4 three years before the date of enrollment in the course 

5 concerned. 

6 ‘‘(B) An individual who is entitled to assistance 

7 under section 3311(b)(9) or 3319 of this title by vir8 tue of such individual’s relationship to a veteran de9 scribed in subparagraph (A). 

10 ‘‘(3) If after enrollment in a course of education that 

11 is subject to disapproval under paragraph (1) by reason 

12 of paragraph (2)(A) or (2)(B) a covered individual pursues 

13 one or more courses of education at the same public institu14 tion of higher learning while remaining continuously en15 rolled (other than during regularly scheduled breaks between 

16 courses, semesters or terms) at that institution of higher 

17 learning, any course so pursued by the covered individual 

18 at that institution of higher learning while so continuously 

19 enrolled shall also be subject to disapproval under para20 graph (1). 

21 ‘‘(4) It shall not be grounds to disapprove a course of 

22 education under paragraph (1) if a public institution of 

23 higher learning requires a covered individual pursuing a 

24 course of education at the institution to demonstrate an in25 tent, by means other than satisfying a physical presence 
98 

† HR 3230 EAS 

1 requirement, to establish residency in the State in which 

2 the institution is located, or to satisfy other requirements 

3 not relating to the establishment of residency, in order to 

4 be charged tuition and fees for that course at a rate that 

5 is equal to or less than the rate the institution charges for 

6 tuition and fees for that course for residents of the State. 

7 ‘‘(5) The Secretary may waive such requirements of 

8 paragraph (1) as the Secretary considers appropriate. 

9 ‘‘(6) Disapproval under paragraph (1) shall apply 

10 only with respect to educational assistance under chapters 

11 30 and 33 of this title.’’. 

12 (b) EFFECTIVE DATE.—Subsection (c) of section 3679 

13 of title 38, United States Code (as added by subsection (a) 

14 of this section), shall apply with respect to educational as15 sistance provided for pursuit of programs of education dur16 ing academic terms that begin after July 1, 2015, through 

17 courses of education that commence on or after that date. 

18 TITLE VIII—APPROPRIATION 

19 AND EMERGENCY DESIGNA20 TIONS 

21 SEC. 801. APPROPRIATION OF EMERGENCY AMOUNTS. 

22 There is authorized to be appropriated, and is appro23 priated, to the Secretary of Veterans Affairs, out of any 

24 funds in the Treasury not otherwise appropriated, for fiscal 
99 

† HR 3230 EAS 

1 years 2014, 2015, and 2016, such sums as may be necessary 

2 to carry out this Act. 

3 SEC. 802. EMERGENCY DESIGNATIONS. 

4 (a) IN GENERAL.—This Act is designated as an emer5 gency requirement pursuant to section 4(g) of the Statutory 

6 Pay-As-You-Go Act of 2010 (2 U.S.C. 933(g)). 

7 (b) DESIGNATION IN SENATE.—In the Senate, this Act 

8 is designated as an emergency requirement pursuant to sec9 tion 403(a) of S. Con. Res. 13 (111th Congress), the concur10 rent resolution on the budget for fiscal year 2010. 

Amend the title so as to read: ‘‘To improve the access of veterans to medical services from the Department 

of Veterans Affairs, and for other purposes.’’ 

Attest: 

Secretary. 
113TH CONGRESS 

2D SESSION H.R. 3230 

AMENDMENTS