H. R. 3230 

One Hundred Thirteenth Congress 

of the 

United States of America 

AT THE SECOND SESSION 

Begun and held at the City of Washington on Friday, 

the third day of January, two thousand and fourteen 

An Act 

To improve the access of veterans to medical services from the Department of 

Veterans Affairs, and for other purposes. 

Be it enacted by the Senate and House of Representatives of 

the United States of America in Congress assembled, 

SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

Access, Choice, and Accountability Act of 2014’’. 

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

is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Definitions. 

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

OF VETERANS AFFAIRS PROVIDERS 

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

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

entities. 

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

and Indian Health Service. 

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

and Native Hawaiian health care systems. Sec. 104. Reauthorization and modification of pilot program of enhanced contract 

care authority for health care needs of veterans. Sec. 105. Prompt payment by Department of Veterans Affairs. 

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

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

the chief business office of the Veterans Health Administration. 

TITLE II—HEALTH CARE ADMINISTRATIVE MATTERS 

Sec. 201. Independent assessment of the health care delivery systems and management processes of the Department of Veterans Affairs. Sec. 202. Commission on Care. 

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

Department of Veterans Affairs. Sec. 204. Improvement of access of veterans to mobile vet centers and mobile medical centers of the Department of Veterans Affairs. Sec. 205. Improved performance metrics for health care provided by Department of 

Veterans Affairs. 

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

Veterans Affairs. 

Sec. 207. Information for veterans on the credentials of Department of Veterans Affairs physicians. Sec. 208. Information in annual budget of the President on hospital care and medical services furnished through expanded use of contracts for such care. Sec. 209. Prohibition on falsification of data concerning wait times and quality 

measures at Department of Veterans Affairs. 

TITLE III—HEALTH CARE STAFFING, RECRUITMENT, AND TRAINING 

MATTERS 

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

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

Veterans Affairs Health Professionals Educational Assistance Program. Sec. 303. Clinic management training for employees at medical facilities of the Department of Veterans Affairs. 

TITLE IV—HEALTH CARE RELATED TO SEXUAL TRAUMA 

Sec. 401. Expansion of eligibility for sexual trauma counseling and treatment to 

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

Sec. 403. Reports on military sexual trauma. 

TITLE V—OTHER HEALTH CARE MATTERS 

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

traumatic brain injury. 

TITLE VI—MAJOR MEDICAL FACILITY LEASES 

Sec. 601. Authorization of major medical facility leases. 

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

TITLE VII—OTHER VETERANS MATTERS 

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

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

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

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

Veterans Affairs for certain veterans covered by Medicaid plans for services furnished by nursing facilities. Sec. 704. Extension of requirement for collection of fees for housing loans guaranteed by Secretary of Veterans Affairs. Sec. 705. Limitation on awards and bonuses paid to employees of Department of 

Veterans Affairs. 

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

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

performance or misconduct. 

TITLE VIII—OTHER MATTERS 

Sec. 801. Appropriation of amounts. 

Sec. 802. Veterans Choice Fund. 

Sec. 803. Emergency designations. 

SEC. 2. DEFINITIONS. 

In this Act: 

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

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

of title 38, United States Code. 

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

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

United States Code. 

TITLE I—IMPROVEMENT OF ACCESS TO 

CARE FROM NON-DEPARTMENT OF 

VETERANS AFFAIRS PROVIDERS 

SEC. 101. EXPANDED AVAILABILITY OF HOSPITAL CARE AND MEDICAL 

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

ENTITIES. 

(a) EXPANSION OF AVAILABLE CARE AND SERVICES.— (1) FURNISHING OF CARE.— (A) IN GENERAL.—Hospital care and medical services 

under chapter 17 of title 38, United States Code, shall 
H. R. 3230—3 

be furnished to an eligible veteran described in subsection 

(b), at the election of such veteran, through agreements 

authorized under subsection (d), or any other law administered by the Secretary of Veterans Affairs, with entities 

specified in subparagraph (B) for the furnishing of such 

care and services to veterans. 

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

subparagraph are the following: 

(i) Any health care provider that is participating 

in the Medicare program under title XVIII of the Social 

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

physician furnishing services under such program. 

(ii) Any Federally-qualified health center (as 

defined in section 1905(l)(2)(B) of the Social Security 

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

(iii) The Department of Defense. 

(iv) The Indian Health Service. 

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

an election under subsection (c) to receive hospital care or 

medical services under this section may select a provider of 

such care or services from among the entities specified in 

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

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

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

of care and services under this section to eligible veterans, 

including by ensuring that an eligible veteran receives an 

appointment for such care and services within the wait-time 

goals of the Veterans Health Administration for the furnishing 

of hospital care and medical services. 

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

purposes of this section if— 

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

the patient enrollment system of the Department of Veterans 

Affairs established and operated under section 1705 of title 

38, United States Code, including any such veteran who has 

not received hospital care or medical services from the Department and has contacted the Department seeking an initial 

appointment from the Department for the receipt of such care 

or services; or 

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

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

(2) the veteran— 

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

under chapter 17 of title 38, United States Code, but is 

unable to schedule an appointment within the wait-time 

goals of the Veterans Health Administration for the furnishing of such care or services; 

(B) resides more than 40 miles from the medical facility 

of the Department, including a community-based outpatient 

clinic, that is closest to the residence of the veteran; 

(C) resides— 

(i) in a State without a medical facility of the 

Department that provides— 

(I) hospital care; 
H. R. 3230—4 

(II) emergency medical services; and 

(III) surgical care rated by the Secretary as 

having a surgical complexity of standard; and 

(ii) more than 20 miles from a medical facility 

of the Department described in clause (i); or 

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

Guam, American Samoa, or the Republic of the Philippines, 

that is 40 miles or less from a medical facility of the 

Department, including a community-based outpatient 

clinic; and 

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

reach each medical facility described in clause (i) that 

is 40 miles or less from the residence of the veteran; 

or 

(II) faces an unusual or excessive burden in accessing 

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

miles or less from the residence of the veteran due to 

geographical challenges, as determined by the Secretary. 

(c) ELECTION AND AUTHORIZATION.— 

(1) IN GENERAL.—In the case of an eligible veteran 

described in subsection (b)(2)(A), the Secretary shall, at the 

election of the eligible veteran— 

(A) place such eligible veteran on an electronic waiting 

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

receive under this section; or 

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

to the eligible veteran under this section for a period of 

time specified by the Secretary; and 

(ii) notify the eligible veteran by the most effective 

means available, including electronic communication or 

notification in writing, describing the care or services the 

eligible veteran is eligible to receive under this section. 

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

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

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

purposes: 

(A) To determine the place of such eligible veteran 

on the waiting list. 

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

facility of the Department and type of care or service 

needed, for purposes of allowing such eligible veteran to 

make an informed election under paragraph (1). 

(d) CARE AND SERVICES THROUGH AGREEMENTS.— 

(1) AGREEMENTS.— 

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

under this section with entities specified in subsection 

(a)(1)(B). 

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

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

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

paragraph (1) with an entity specified in subsection 

(a)(1)(B), the Secretary shall— 

(i) negotiate rates for the furnishing of care and 

services under this section; and 

(ii) reimburse the entity for such care and services 

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

(B) LIMIT ON RATES.— 

(i) IN GENERAL.—Except as provided in clause (ii), 

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

be more than the rates paid by the United States 

to a provider of services (as defined in section 1861(u) 

of the Social Security Act (42 U.S.C. 1395x(u))) or 

a supplier (as defined in section 1861(d) of such Act 

(42 U.S.C. 1395x(d))) under the Medicare program 

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

1395 et seq.) for the same care or services. 

(ii) EXCEPTION.— 

(I) IN GENERAL.—The Secretary may negotiate 

a rate that is more than the rate paid by the 

United States as described in clause (i) with 

respect to the furnishing of care or services under 

this section to an eligible veteran who resides in 

a highly rural area. 

(II) HIGHLY RURAL AREA DEFINED.—In this 

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

area located in a county that has fewer than seven 

individuals residing in that county per square mile. 

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

or services pursuant to an agreement under paragraph 

(1), an entity specified in subsection (a)(1)(B) may not collect any amount that is greater than the rate negotiated 

pursuant to subparagraph (A)(i). 

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

paragraph (1) with an entity described in subparagraph 

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

procedures relating to reimbursement, available for 

entering into provider agreements under section 1866(a) 

of the Social Security Act (42 U.S.C. 1395cc(a)) and participation agreements under section 1842(h) of such Act (42 

U.S.C. 1395u(h)). During the period in which such entity 

furnishes care or services pursuant to this section, such 

entity may not be treated as a Federal contractor or subcontractor by the Office of Federal Contract Compliance Programs of the Department of Labor by virtue of furnishing 

such care or services. 

(B) ENTITIES DESCRIBED.—The entities described in this 

subparagraph are the following: 

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

(42 U.S.C. 1395cc(a)) and any physician or other supplier who has entered into a participation agreement 

under section 1842(h) of such Act (42 U.S.C. 1395u(h)); 

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

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

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

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

(A) Information on applicable policies and procedures 

for submitting bills or claims for authorized care or services 

furnished to eligible veterans under this section. 

(B) Access to a telephone hotline maintained by the 

Department that such entity may call for information on 

the following: 

(i) Procedures for furnishing care and services 

under this section. 

(ii) Procedures for submitting bills or claims for 

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

(iii) Whether particular care or services under this 

section are authorized, and the procedures for 

authorization of such care or services. 

(e) OTHER HEALTH-CARE PLAN.— 

(1) SUBMITTAL OF INFORMATION TO SECRETARY.—Before 

receiving hospital care or medical services under this section, 

an eligible veteran shall provide to the Secretary information 

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

the eligible veteran is covered. 

(2) DISCLOSURE OF INFORMATION TO NON-DEPARTMENT

ENTITY.—Notwithstanding section 5701 of title 38, United 

States Code, for purposes of furnishing hospital care or medical 

services to an eligible veteran under this section, the Secretary 

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

subsection (a) with which the Secretary has entered into an 

agreement described in such subsection— 

(A) whether the eligible veteran is covered under a 

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

(B) whether the hospital care or medical services 

sought by the eligible veteran is for a medical condition 

that is related to a non-service-connected disability 

described in paragraph (3)(C). 

(3) CARE FOR WHICH THE DEPARTMENT IS SECONDARILY

RESPONSIBLE.— 

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

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

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

health-care plan shall be primarily responsible for paying 

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

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

shall be secondarily responsible for paying for such care 

or services in accordance with subparagraph (B)(ii). 

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

in which the Secretary is secondarily responsible for paying 

for hospital care or medical services as described in 

subparagraph (A)— 
H. R. 3230—7 

(i) the health care provider that furnishes such 

care or services pursuant to an agreement described 

in subsection (a) shall be responsible for seeking 

reimbursement for the cost of such care or services 

from the health-care plan described in paragraph (4) 

under which the eligible veteran is covered; and 

(ii) the Secretary shall be responsible for promptly 

paying only the amount that is not covered by such 

health-care plan, except that such responsibility for 

payment may not exceed the rate determined for such 

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

(C) NON-SERVICE-CONNECTED DISABILITY DESCRIBED.— 

A non-service-connected disability described in this subsection is a non-service-connected disability (as defined in 

section 101 of title 38, United States Code)— 

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

cost of health care and services provided to the veteran 

by reason of the disability; 

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

accident to which applies a State law that requires 

the owners or operators of motor vehicles registered 

in that State to have in force automobile accident 

reparations insurance; 

(iii) that is incurred as the result of a crime of 

personal violence that occurred in a State, or a political 

subdivision of a State, in which a person injured as 

the result of such a crime is entitled to receive health 

care and services at such State’s or subdivision’s 

expense for personal injuries suffered as the result 

of such crime; 

(iv) that is incurred by a veteran— 

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

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

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

or 

(v) for which care and services are furnished under 

this section to a veteran who— 

(I) has a service-connected disability; and 

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

expenses of care) under a health-care plan. 

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

this paragraph— 

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

for individuals are provided or the expenses of such services 

are paid; and 

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

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

or chapter 55 of title 10, United States Code. 

(f) VETERANS CHOICE CARD.— 
H. R. 3230—8 

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

90 days after the date of the enactment of this Act, issue 

to each veteran described in subsection (b)(1) a card that may 

be presented to a health care provider to facilitate the receipt 

of care or services under this section. 

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

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

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

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

(A) The name of the veteran. 

(B) An identification number for the veteran that is 

not the social security number of the veteran. 

(C) The contact information of an appropriate office 

of the Department for health care providers to confirm 

that care or services under this section are authorized 

for the veteran. 

(D) Contact information and other relevant information 

for the submittal of claims or bills for the furnishing of 

care or services under this section. 

(E) The following statement: ‘‘This card is for qualifying 

medical care outside the Department of Veterans Affairs. 

Please call the Department of Veterans Affairs phone 

number specified on this card to ensure that treatment 

has been authorized.’’. 

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

the veteran with information clearly stating the circumstances 

under which the veteran may be eligible for care or services 

under this section. 

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

shall provide information to a veteran about the availability of 

care and services under this section in the following circumstances: 

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

when the veteran enrolls in the patient enrollment system 

of the Department under section 1705 of title 38, United States 

Code. 

(2) When the veteran attempts to schedule an appointment 

for the receipt of hospital care or medical services from the 

Department but is unable to schedule an appointment within 

the wait-time goals of the Veterans Health Administration for 

the furnishing of such care or services. 

(3) When the veteran becomes eligible for hospital care 

or medical services under this section under subparagraph (B), 

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

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

who receives hospital care or medical services from a health care 

provider in an episode of care under this section, the veteran 

receives such hospital care and medical services from such health 

care provider through the completion of the episode of care (but 

for a period not exceeding 60 days), including all specialty and 

ancillary services deemed necessary as part of the treatment recommended in the course of such hospital care or medical services. 

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

this section, a health care provider must— 
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(1) maintain at least the same or similar credentials and 

licenses as those credentials and licenses that are required 

of health care providers of the Department, as determined 

by the Secretary for purposes of this section; and 

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

the period in which the Secretary is authorized to carry out 

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

licenses and credentials maintained by such health care provider. 

(j) COST-SHARING.— 

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

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

under this section only if such eligible veteran would be 

required to pay a copayment for the receipt of such care or 

services at a medical facility of the Department or from a 

health care provider of the Department pursuant to chapter 

17 of title 38, United States Code. 

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

under paragraph (1) may not exceed the amount of the 

copayment that would be payable by such eligible veteran for 

the receipt of such care or services at a medical facility of 

the Department or from a health care provider of the Department pursuant to chapter 17 of title 38, United States Code. 

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

that furnishes care or services to an eligible veteran under 

this section shall collect the copayment required under paragraph (1) from such eligible veteran at the time of furnishing 

such care or services. 

(k) CLAIMS PROCESSING SYSTEM.— 

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

claims for authorized care and services furnished to eligible 

veterans under this section. 

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

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

shall prescribe regulations for the implementation of such 

system. 

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

Health Administration shall oversee the implementation and 

maintenance of such system. 

(4) ACCURACY OF PAYMENT.— 

(A) IN GENERAL.—The Secretary shall ensure that such 

system meets such goals for accuracy of payment as the 

Secretary shall specify for purposes of this section. 

(B) QUARTERLY REPORT.— 

(i) IN GENERAL.—The Secretary shall submit to 

the Committee on Veterans’ Affairs of the Senate and 

the Committee on Veterans’ Affairs of the House of 

Representatives a quarterly report on the accuracy 

of such system. 

(ii) ELEMENTS.—Each report required by clause 

(i) shall include the following: 

(I) A description of the goals for accuracy for 

such system specified by the Secretary under 

subparagraph (A). 
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(II) An assessment of the success of the 

Department in meeting such goals during the 

quarter covered by the report. 

(iii) DEADLINE.—The Secretary shall submit each 

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

after the end of the quarter covered by the report. 

(l) MEDICAL RECORDS.— 

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

health care provider that furnishes care or services under this 

section to an eligible veteran submits to the Department any 

medical record related to the care or services provided to such 

eligible veteran by such health care provider for inclusion in 

the electronic medical record of such eligible veteran maintained by the Department upon the completion of the provision 

of such care or services to such eligible veteran. 

(2) ELECTRONIC FORMAT.—Any medical record submitted 

to the Department under paragraph (1) shall, to the extent 

possible, be in an electronic format. 

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

implement a mechanism to track any missed appointments for 

care or services under this section by eligible veterans to ensure 

that the Department does not pay for such care or services that 

were not furnished to an eligible veteran. 

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

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

final regulations on the implementation of this section and publish 

such regulations in the Federal Register. 

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

the date on which the Secretary determines that 75 percent of 

the amounts deposited in the Veterans Choice Fund established 

by section 802 have been exhausted, the Inspector General of the 

Department shall submit to the Secretary a report on the results 

of an audit of the care and services furnished under this section 

to ensure the accuracy and timeliness of payments by the Department for the cost of such care and services, including any findings 

and recommendations of the Inspector General. 

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

under this section to furnish care and services after the date 

specified in paragraph (2). 

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

is the date on which the Secretary has exhausted all amounts 

deposited in the Veterans Choice Fund established by section 

802, or the date that is 3 years after the date of the enactment 

of this Act, whichever occurs first. 

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

in the Federal Register and on an Internet website of the 

Department available to the public not later than 30 days 

before such date. 

(q) REPORTS.— 

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

publication of the interim final regulations under subsection 

(n), the Secretary shall submit to the Committee on Veterans’ 

Affairs of the Senate and the Committee on Veterans’ Affairs 

of the House of Representatives a report on the furnishing 

of care and services under this section that includes the following: 
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(A) The number of eligible veterans who have received 

care or services under this section. 

(B) A description of the types of care and services 

furnished to eligible veterans under this section. 

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

on which the Secretary determines that 75 percent of the 

amounts deposited in the Veterans Choice Fund established 

by section 802 have been exhausted, the Secretary shall submit 

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

Committee on Veterans’ Affairs of the House of Representatives 

a report on the furnishing of care and services under this 

section that includes the following: 

(A) The total number of eligible veterans who have 

received care or services under this section, disaggregated 

by— 

(i) eligible veterans described in subsection 

(b)(2)(A); 

(ii) eligible veterans described in subsection 

(b)(2)(B); 

(iii) eligible veterans described in subsection 

(b)(2)(C); and 

(iv) eligible veterans described in subsection 

(b)(2)(D). 

(B) A description of the types of care and services 

furnished to eligible veterans under this section. 

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

and services to eligible veterans under this section. 

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

have received care or services under this section on the 

satisfaction of such eligible veterans with the care or services received by such eligible veterans under this section. 

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

services under this section on wait times for appointments 

for the receipt of hospital care and medical services from 

the Department. 

(F) An assessment of the feasibility and advisability 

of continuing furnishing care and services under this section after the termination date specified in subsection (p). 

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

construed to alter the process of the Department for filling and 

paying for prescription medications. 

(s) WAIT-TIME GOALS OF THE VETERANS HEALTH ADMINISTRATION.— 

(1) IN GENERAL.—Except as provided in paragraph (2), in 

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

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

on which a veteran requests an appointment for hospital care 

or medical services from the Department. 

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

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

of the Veterans Health Administration are different from the 

wait-time goals specified in paragraph (1)— 

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

of the Veterans Health Administration shall be the waittime goals submitted by the Secretary under this paragraph; and 
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(B) the Secretary shall publish such wait-time goals 

in the Federal Register and on an Internet website of 

the Department available to the public. 

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

SERVICE. 

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

of the Indian Health Service, conduct outreach to each medical 

facility operated by an Indian tribe or tribal organization through 

a contract or compact with the Indian Health Service under the 

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

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

Indian tribes, and tribal organizations to enter into agreements 

with the Department of Veterans Affairs under which the Secretary 

reimburses such facilities, Indian tribes, or tribal organizations, 

as the case may be, for health care provided to veterans who 

are— 

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

(2)(A) enrolled in the patient enrollment system of the 

Department established and operated under section 1705 of 

title 38, United States Code; or 

(B) eligible for hospital care and medical services pursuant 

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

(b) PERFORMANCE METRICS FOR MEMORANDUM OF UNDER- STANDING.—The Secretary of Veterans Affairs shall establish 

performance metrics for assessing the performance by the Department of Veterans Affairs and the Indian Health Service under 

the memorandum of understanding entitled ‘‘Memorandum of 

Understanding between the Department of Veterans Affairs (VA) 

and the Indian Health Service (IHS)’’ in increasing access to health 

care, improving quality and coordination of health care, promoting 

effective patient-centered collaboration and partnerships between 

the Department and the Service, and ensuring health-promotion 

and disease-prevention services are appropriately funded and available for beneficiaries under both health care systems. 

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

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

Director of the Indian Health Service shall jointly submit to Congress a report on the feasibility and advisability of the following: 

(1) Entering into agreements for the reimbursement by 

the Secretary of the costs of direct care services provided 

through organizations receiving amounts pursuant to grants 

made or contracts entered into under section 503 of the Indian 

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

who are otherwise eligible to receive health care from such 

organizations. 

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

services provided to veterans who are not Indians in agreements 

between the Department and the following: 

(A) The Indian Health Service. 

(B) An Indian tribe or tribal organization operating 

a medical facility through a contract or compact with the 

Indian Health Service under the Indian Self-Determination 

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

(C) A medical facility of the Indian Health Service. 
H. R. 3230—13 

(d) DEFINITIONS.—In this section: 

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

the meanings given those terms in section 4 of the Indian 

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

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

The term ‘‘medical facility of the Indian Health Service’’ 

includes a facility operated by an Indian tribe or tribal organization through a contract or compact with the Indian Health 

Service under the Indian Self-Determination and Education 

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

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

has the meaning given the term in section 4 of the Indian 

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

450b). 

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

HEALTH CARE SYSTEMS. 

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

consultation with Papa Ola Lokahi and such other organizations 

involved in the delivery of health care to Native Hawaiians as 

the Secretary considers appropriate, enter into contracts or agreements with Native Hawaiian health care systems that are in receipt 

of funds from the Secretary of Health and Human Services pursuant 

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

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

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

to eligible veterans as specified in such contracts or agreements. 

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

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

have the meanings given those terms in section 12 of the Native 

Hawaiian Health Care Improvement Act (42 U.S.C. 11711). 

SEC. 104. REAUTHORIZATION AND MODIFICATION OF PILOT PROGRAM 

OF ENHANCED CONTRACT CARE AUTHORITY FOR HEALTH 

CARE NEEDS OF VETERANS. 

Section 403 of the Veterans’ Mental Health and Other Care 

Improvements Act of 2008 (Public Law 110–387; 38 U.S.C. 1703 

note) is amended— 

(1) in subsection (a)— 

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

and all that follows through the period at the end and 

inserting ‘‘only during the period beginning on the date 

of the commencement of the pilot program under paragraph 

(2) and ending on the date that is two years after the 

date of the enactment of the Veterans Access, Choice, and 

Accountability Act of 2014.’’; and 

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

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

the pilot program at locations in the following Veterans 

Integrated Service Networks (and such other locations as the 

Secretary considers appropriate): 

‘‘(A) Veterans Integrated Service Network 1. 

‘‘(B) Veterans Integrated Service Network 6. 

‘‘(C) Veterans Integrated Service Network 15. 

‘‘(D) Veterans Integrated Service Network 18. 

‘‘(E) Veterans Integrated Service Network 19.’’; 
H. R. 3230—14 

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

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

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

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

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

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

this section, the Secretary shall ensure that medical appointments 

for covered veterans— 

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

on which the appointment is requested; and 

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

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

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

program under this section after the date of the enactment of 

the Veterans Access, Choice, and Accountability Act of 2014, the 

Secretary shall make use of contracts entered into before such 

date or may enter into new contracts.’’; and 

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

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

at the end and inserting ‘‘; and’’. 

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

(a) SENSE OF CONGRESS ON PROMPT PAYMENT BY DEPARTMENT.—It is the sense of Congress that the Secretary of Veterans 

Affairs shall comply with section 1315 of title 5, Code of Federal 

Regulations (commonly known as the ‘‘prompt payment rule’’), or 

any corresponding similar regulation or ruling, in paying for health 

care pursuant to contracts entered into with non-Department of 

Veterans Affairs providers to provide health care under the laws 

administered by the Secretary. 

(b) ESTABLISHMENT OF CLAIMS PROCESSING SYSTEM.— 

(1) CLAIMS PROCESSING SYSTEM.—The Secretary of Veterans 

Affairs shall establish and implement a system to process and 

pay claims for payment for hospital care, medical services, 

and other health care furnished by non-Department of Veterans 

Affairs health care providers under the laws administered by 

the Secretary. 

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

established and implemented under paragraph (1) shall comply 

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

(c) REPORT.—Not later than 1 year after the date of the enactment of this Act, the Comptroller General of the United States 

shall submit to Congress a report on the timeliness of payments 

by the Secretary for hospital care, medical services, and other 

health care furnished by non-Department of Veterans Affairs health 

care providers under the laws administered by the Secretary. 

(d) ELEMENTS.—The report required by subsection (b) shall 

include the following: 

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

providers who have submitted claims to the Department for 

hospital care, medical services, or other health care furnished 

to veterans for which payment is authorized under the laws 
H. R. 3230—15 

administered by the Secretary during the one-year period preceding the submittal of the report, which survey shall include 

the following: 

(A) The amount of time it took for such health care 

providers, after submitting such claims, to receive payment 

from the Department for such care or services. 

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

care providers to receive payments from the United States 

for similar care or services provided to the following, if 

applicable: 

(i) Beneficiaries under the Medicare program 

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

1395 et seq.). 

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

(2) Such recommendations for legislative or administrative 

action as the Comptroller General considers appropriate. 

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

care providers in a manner that ensures that the survey reflects 

the responses of such providers that— 

(1) are located in different geographic areas; 

(2) furnish a variety of different hospital care, medical 

services, and other health care; and 

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

types of medical facilities. 

SEC. 106. TRANSFER OF AUTHORITY FOR PAYMENTS FOR HOSPITAL 

CARE, MEDICAL SERVICES, AND OTHER HEALTH CARE 

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

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

for hospital care, medical services, and other health care furnished through non-Department of Veterans Affairs providers 

from— 

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

(B) the Chief Business Office of the Veterans Health 

Administration of the Department of Veterans Affairs. 

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

work in consultation with the Office of Clinical Operations 

and Management of the Department to ensure that care and 

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

that is clinically appropriate and in the best interest of the 

veterans receiving such care and services. 

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

paragraph (1) shall be carried out in a manner that does 

not delay or impede any payment by the Department for hospital care, medical services, or other health care furnished 

through a non-Department provider under the laws administered by the Secretary. 

(b) BUDGET MATTERS.—The budget of the Department of Veterans Affairs for any fiscal year beginning after the date of the 
H. R. 3230—16 

enactment of this Act (as submitted to Congress pursuant to section 

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

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

care furnished through non-Department of Veterans Affairs providers, including any administrative costs associated with such 

payment, as funds for the Chief Business Office of the Veterans 

Health Administration rather than as funds for the Veterans 

Integrated Service Networks or medical centers of the Department. 

TITLE II—HEALTH CARE 

ADMINISTRATIVE MATTERS 

SEC. 201. INDEPENDENT ASSESSMENT OF THE HEALTH CARE 

DELIVERY SYSTEMS AND MANAGEMENT PROCESSES OF 

THE DEPARTMENT OF VETERANS AFFAIRS. 

(a) INDEPENDENT ASSESSMENT.— 

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

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

shall enter into one or more contracts with a private sector 

entity or entities described in subsection (b) to conduct an 

independent assessment of the hospital care, medical services, 

and other health care furnished in medical facilities of the 

Department. Such assessment shall address each of the following: 

(A) Current and projected demographics and unique 

health care needs of the patient population served by the 

Department. 

(B) Current and projected health care capabilities and 

resources of the Department, including hospital care, medical services, and other health care furnished by nonDepartment facilities under contract with the Department, 

to provide timely and accessible care to veterans. 

(C) The authorities and mechanisms under which the 

Secretary may furnish hospital care, medical services, and 

other health care at non-Department facilities, including 

whether the Secretary should have the authority to furnish 

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

(D) The appropriate system-wide access standard 

applicable to hospital care, medical services, and other 

health care furnished by and through the Department, 

including an identification of appropriate access standards 

for each individual specialty and post-care rehabilitation. 

(E) The workflow process at each medical facility of 

the Department for scheduling appointments for veterans 

to receive hospital care, medical services, or other health 

care from the Department. 

(F) The organization, workflow processes, and tools 

used by the Department to support clinical staffing, access 

to care, effective length-of-stay management and care 

transitions, positive patient experience, accurate documentation, and subsequent coding of inpatient services. 

(G) The staffing level at each medical facility of the 

Department and the productivity of each health care provider at such medical facility, compared with health care 
H. R. 3230—17 

industry performance metrics, which may include an 

assessment of any of the following: 

(i) The case load of, and number of patients treated 

by, each health care provider at such medical facility 

during an average week. 

(ii) The time spent by such health care provider 

on matters other than the case load of such health 

care provider, including time spent by such health 

care provider as follows: 

(I) At a medical facility that is affiliated with 

the Department. 

(II) Conducting research. 

(III) Training or supervising other health care 

professionals of the Department. 

(H) The information technology strategies of the 

Department with respect to furnishing and managing 

health care, including an identification of any weaknesses 

and opportunities with respect to the technology used by 

the Department, especially those strategies with respect 

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

images and associated textual reports, furnished by the 

Department in Department or non-Department facilities. 

(I) Business processes of the Veterans Health Administration, including processes relating to furnishing nonDepartment health care, insurance identification, thirdparty revenue collection, and vendor reimbursement, 

including an identification of mechanisms as follows: 

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

(ii) To increase the collection of amounts owed 

to the Department for hospital care, medical services, 

or other health care provided by the Department for 

which reimbursement from a third party is authorized 

and to ensure that such amounts collected are accurate. 

(iii) To increase the collection of any other amounts 

owed to the Department with respect to hospital care, 

medical services, and other health care and to ensure 

that such amounts collected are accurate. 

(iv) To increase the accuracy and timeliness of 

Department payments to vendors and providers. 

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

and health care related services by the Department, 

including the following: 

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

use by the Department of the following: 

(I) Pharmaceuticals. 

(II) Medical and surgical supplies. 

(III) Medical devices. 

(ii) The use by the Department of group purchasing 

arrangements to purchase pharmaceuticals, medical 

and surgical supplies, medical devices, and health care 

related services. 

(iii) The strategy and systems used by the Department to distribute pharmaceuticals, medical and surgical supplies, medical devices, and health care related 
H. R. 3230—18 

services to Veterans Integrated Service Networks and 

medical facilities of the Department. 

(K) The process of the Department for carrying out 

construction and maintenance projects at medical facilities 

of the Department and the medical facility leasing program 

of the Department. 

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

(2) PARTICULAR ELEMENTS OF CERTAIN ASSESSMENTS.— (A) SCHEDULING ASSESSMENT.—In carrying out the 

assessment required by paragraph (1)(E), the private sector 

entity or entities shall do the following: 

(i) Review all training materials pertaining to 

scheduling of appointments at each medical facility 

of the Department. 

(ii) Assess whether all employees of the Department conducting tasks related to scheduling are properly trained for conducting such tasks. 

(iii) Assess whether changes in the technology or 

system used in scheduling appointments are necessary 

to limit access to the system to only those employees 

that have been properly trained in conducting such 

tasks. 

(iv) Assess whether health care providers of the 

Department are making changes to their schedules 

that hinder the ability of employees conducting such 

tasks to perform such tasks. 

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

appointments. 

(vi) Assess whether booking templates for each 

medical facility or clinic of the Department would 

improve the process of scheduling such appointments. 

(vii) Assess any interim technology changes or 

attempts by Department to internally develop a longterm scheduling solutions with respect to the feasibility 

and cost effectiveness of such internally developed solutions compared to commercially available solutions. 

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

the Department to improve the process for scheduling 

such appointments, including the following: 

(I) Changes in training materials provided to 

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

(II) Changes in monitoring and assessment 

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

(III) Changes in the system used to schedule 

such appointments, including changes to improve 

how the Department— 

(aa) measures wait times of veterans for 

such appointments; 
H. R. 3230—19 

(bb) monitors the availability of health 

care providers of the Department; and 

(cc) provides veterans the ability to 

schedule such appointments. 

(IV) Such other actions as the private sector 

entity or entities considers appropriate. 

(B) MEDICAL CONSTRUCTION AND MAINTENANCE

PROJECT AND LEASING PROGRAM ASSESSMENT.—In carrying 

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

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

maintenance projects at medical facilities of the 

Department and leases for medical facilities of the 

Department. 

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

(I) That a construction or maintenance project 

or lease is necessary with respect to a medical 

facility or proposed medical facility of the Department. 

(II) The proper size of such medical facility 

or proposed medical facility with respect to 

treating veterans in the catchment area of such 

medical facility or proposed medical facility. 

(iii) Assess the management processes of the 

Department with respect to the capital management 

programs of the Department, including processes 

relating to the methodology for construction and design 

of medical facilities of the Department, the management of projects relating to the construction and design 

of such facilities, and the activation of such facilities. 

(iv) Assess the medical facility leasing program 

of the Department. 

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

out the assessment required by paragraph (1) shall complete 

such assessment not later than 240 days after entering into 

the contract described in such paragraph. 

(b) PRIVATE SECTOR ENTITIES DESCRIBED.—A private entity 

described in this subsection is a private entity that— 

(1) has experience and proven outcomes in optimizing the 

performance of the health care delivery systems of the Veterans 

Health Administration and the private sector and in health 

care management; and 

(2) specializes in implementing large-scale organizational 

and cultural transformations, especially with respect to health 

care delivery systems. 

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

with more than one private sector entity under subsection 

(a), the Secretary shall designate one such entity that is 

predominately a health care organization as the program integrator. 

(2) RESPONSIBILITIES.—The program integrator designated 

pursuant to paragraph (1) shall be responsible for coordinating 

the outcomes of the assessments conducted by the private entities pursuant to such contracts. 
H. R. 3230—20 

(d) REPORT ON ASSESSMENT.— 

(1) IN GENERAL.—Not later than 60 days after completing 

the assessment required by subsection (a), the private sector 

entity or entities carrying out such assessment shall submit 

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

of the House of Representatives, and the Commission on Care 

established under section 202 a report on the findings and 

recommendations of the private sector entity or entities with 

respect to such assessment. 

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

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

such report in the Federal Register and on an Internet website 

of the Department of Veterans Affairs that is accessible to 

the public. 

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

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

in section 1701 of title 38, United States Code. 

SEC. 202. COMMISSION ON CARE. 

(a) ESTABLISHMENT OF COMMISSION.— 

(1) IN GENERAL.—There is established a commission, to 

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

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

to health care from the Department of Veterans Affairs and 

strategically examine how best to organize the Veterans Health 

Administration, locate health care resources, and deliver health 

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

date of the enactment of this Act. 

(2) MEMBERSHIP.— 

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

(i) Three members appointed by the Speaker of 

the House of Representatives, at least one of whom 

shall be a veteran. 

(ii) Three members appointed by the Minority 

Leader of the House of Representatives, at least one 

of whom shall be a veteran. 

(iii) Three members appointed by the Majority 

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

a veteran. 

(iv) Three members appointed by the Minority 

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

a veteran. 

(v) Three members appointed by the President, 

at least two of whom shall be veterans. 

(B) QUALIFICATIONS.—Of the members appointed under 

subparagraph (A)— 

(i) at least one member shall represent an 

organization recognized by the Secretary of Veterans 

Affairs for the representation of veterans under section 

5902 of title 38, United States Code; 

(ii) at least one member shall have experience 

as senior management for a private integrated health 

care system with an annual gross revenue of more 

than $50,000,000; 
H. R. 3230—21 

(iii) at least one member shall be familiar with 

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

Service, and Federally-qualified health centers (as 

defined in section 1905(l)(2)(B) of the Social Security 

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

(iv) at least one member shall be familiar with 

the Veterans Health Administration but shall not be 

currently employed by the Veterans Health Administration; and 

(v) at least one member shall be familiar with 

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

in the building trades, including construction, 

engineering, and architecture. 

(C) DATE.—The appointments of members of the 

Commission shall be made not later than 1 year after 

the date of the enactment of this Act. 

(3) PERIOD OF APPOINTMENT.— 

(A) IN GENERAL.—Members shall be appointed for the 

life of the Commission. 

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

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

as the original appointment. 

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

date on which eight voting members of the Commission have 

been appointed, the Commission shall hold its first meeting. 

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

of the Chairperson. 

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

may hold hearings. 

(7) CHAIRPERSON AND VICE CHAIRPERSON.—The President 

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

Chairperson from among its members. 

(b) DUTIES OF COMMISSION.— 

(1) EVALUATION AND ASSESSMENT.—The Commission shall 

undertake a comprehensive evaluation and assessment of access 

to health care at the Department of Veterans Affairs. 

(2) MATTERS EVALUATED AND ASSESSED.—In undertaking 

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

of the assessment conducted by the private sector entity or 

entities under section 201, including any findings, data, or 

recommendations included in such assessment. 

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

follows: 

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

meeting of the Commission, an interim report on— 

(i) the findings of the Commission with respect 

to the evaluation and assessment required by this subsection; and 

(ii) such recommendations as the Commission may 

have for legislative or administrative action to improve 
H. R. 3230—22 

access to health care through the Veterans Health 

Administration. 

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

initial meeting of the Commission, a final report on— 

(i) the findings of the Commission with respect 

to the evaluation and assessment required by this subsection; and 

(ii) such recommendations as the Commission may 

have for legislative or administrative action to improve 

access to health care through the Veterans Health 

Administration. 

(c) POWERS OF THE COMMISSION.— 

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

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

and receive such evidence as the Commission considers advisable to carry out this section. 

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

section. Upon request of the Chairperson of the Commission, 

the head of such agency shall furnish such information to 

the Commission. 

(d) COMMISSION PERSONNEL MATTERS.— 

(1) COMPENSATION OF MEMBERS.— 

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

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

equivalent of the annual rate of basic pay prescribed for 

level IV of the Executive Schedule under section 5315 

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

travel time) during which such member is engaged in the 

performance of the duties of the Commission. 

(B) OFFICERS OR EMPLOYEES OF THE UNITED STATES.— All members of the Commission who are officers or 

employees of the United States shall serve without compensation in addition to that received for their services 

as officers or employees of the United States. 

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

shall be allowed travel expenses, including per diem in lieu 

of subsistence, at rates authorized for employees of agencies 

under subchapter I of chapter 57 of title 5, United States 

Code, while away from their homes or regular places of business 

in the performance of services for the Commission. 

(3) STAFF.— 

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

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

such other additional personnel as may be necessary to 

enable the Commission to perform its duties. The employment of an executive director shall be subject to confirmation by the Commission. 

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

and other personnel without regard to chapter 51 and 

subchapter III of chapter 53 of title 5, United States Code, 

relating to classification of positions and General Schedule 

pay rates, except that the rate of pay for the executive 
H. R. 3230—23 

director and other personnel may not exceed the rate payable for level V of the Executive Schedule under section 

5316 of such title. 

(4) DETAIL OF GOVERNMENT EMPLOYEES.—Any Federal 

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

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

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

exceed the daily equivalent of the annual rate of basic pay 

prescribed for level V of the Executive Schedule under section 

5316 of such title. 

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

terminate 30 days after the date on which the Commission submits 

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

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

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

and the Chairperson of the Commission jointly consider appropriate 

for the Commission to perform its duties under this section. 

(g) EXECUTIVE ACTION.— 

(1) ACTION ON RECOMMENDATIONS.—The President shall 

require the Secretary of Veterans Affairs and such other heads 

of relevant Federal departments and agencies to implement 

each recommendation set forth in a report submitted under 

subsection (b)(3) that the President— 

(A) considers feasible and advisable; and 

(B) determines can be implemented without further 

legislative action. 

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

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

the President shall submit to the Committee on Veterans’ 

Affairs of the Senate and the Committee on Veterans’ Affairs 

of the House of Representatives and such other committees 

of Congress as the President considers appropriate a report 

setting forth the following: 

(A) An assessment of the feasibility and advisability 

of each recommendation contained in the report received 

by the President. 

(B) For each recommendation assessed as feasible and 

advisable under subparagraph (A) the following: 

(i) Whether such recommendation requires legislative action. 

(ii) If such recommendation requires legislative 

action, a recommendation concerning such legislative 

action. 

(iii) A description of any administrative action 

already taken to carry out such recommendation. 

(iv) A description of any administrative action the 

President intends to be taken to carry out such recommendation and by whom. 
H. R. 3230—24 

SEC. 203. TECHNOLOGY TASK FORCE ON REVIEW OF SCHEDULING 

SYSTEM AND SOFTWARE OF THE DEPARTMENT OF VETERANS AFFAIRS. 

(a) TASK FORCE REVIEW.— 

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

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

of the needs of the Department of Veterans Affairs with respect 

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

schedule appointments for veterans for hospital care, medical 

services, and other health care from the Department. 

(2) AGREEMENT.— 

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

into an agreement with a technology organization or technology organizations to carry out the review required by 

paragraph (1). 

(B) PROHIBITION ON USE OF FUNDS.—Notwithstanding 

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

to assist the technology organization or technology 

organizations under subparagraph (A) in carrying out the 

review required by paragraph (1). 

(b) REPORT.— 

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

of the enactment of this Act, the technology task force required 

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

on Veterans’ Affairs of the House of Representatives a report 

setting forth the findings and recommendations of the technology task force regarding the needs of the Department with 

respect to the scheduling system and scheduling software of 

the Department described in such subsection. 

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

include the following: 

(A) Proposals for specific actions to be taken by the 

Department to improve the scheduling system and scheduling software of the Department described in subsection 

(a)(1). 

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

off-the-shelf systems would— 

(i) meet the needs of the Department to schedule 

appointments for veterans for hospital care, medical 

services, and other health care from the Department; 

and 

(ii) improve the access of veterans to such care 

and services. 

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

of the report required by paragraph (1), the Secretary shall 

publish such report in the Federal Register and on an Internet 

website of the Department accessible to the public. 

(c) IMPLEMENTATION OF TASK FORCE RECOMMENDATIONS.—Not 

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

set forth in such report that the Secretary considers are feasible, 

advisable, and cost effective. 
H. R. 3230—25 

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

CENTERS AND MOBILE MEDICAL CENTERS OF THE 

DEPARTMENT OF VETERANS AFFAIRS. 

(a) IMPROVEMENT OF ACCESS.— 

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

improve the access of veterans to telemedicine and other health 

care through the use of mobile vet centers and mobile medical 

centers of the Department of Veterans Affairs by providing 

standardized requirements for the operation of such centers. 

(2) REQUIREMENTS.—The standardized requirements 

required by paragraph (1) shall include the following: 

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

mobile medical center of the Department is expected to 

travel per year. 

(B) The number of locations each center is expected 

to visit per year. 

(C) The number of appointments each center is 

expected to conduct per year. 

(D) The method and timing of notifications given by 

each center to individuals in the area to which the center 

is traveling, including notifications informing veterans of 

the availability to schedule appointments at the center. 

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

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

(b) REPORTS.— 

(1) IN GENERAL.—Not later than 1 year after the date 

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

30 each year thereafter, the Secretary of Veterans Affairs shall 

submit to the Committee on Veterans’ Affairs of the Senate 

and the Committee on Veterans’ Affairs of the House of Representatives a report on access to health care through the 

use of mobile vet centers and mobile medical centers of the 

Department that includes statistics on each of the requirements 

set forth in subsection (a)(2) for the year covered by the report. 

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

shall include the following: 

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

mobile medical centers to provide telemedicine services 

to veterans during the year preceding the submittal of 

the report, including the following: 

(i) The number of days each mobile vet center 

and mobile medical center was open to provide such 

services. 

(ii) The number of days each center traveled to 

a location other than the headquarters of the center 

to provide such services. 

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

and in total during such year. 

(B) An analysis of the effectiveness of using mobile 

vet centers and mobile medical centers to provide health 

care services to veterans through the use of telemedicine. 

(C) Any recommendations for an increase in the 

number of mobile vet centers and mobile medical centers 

of the Department. 
H. R. 3230—26 

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

medical center. 

(E) The feasibility and advisability of using temporary 

health care providers, including locum tenens, to provide 

direct health care services to veterans at mobile vet centers 

and mobile medical centers. 

(F) Such other recommendations on improvement of 

the use of mobile vet centers and mobile medical centers 

by the Department as the Secretary considers appropriate. 

SEC. 205. IMPROVED PERFORMANCE METRICS FOR HEALTH CARE 

PROVIDED BY DEPARTMENT OF VETERANS AFFAIRS. 

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

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

performance of the following employees for purposes of determining 

whether to pay performance awards to such employees: 

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

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

of the Department of Veterans Affairs. 

(2) Directors, assistant directors, and quality management 

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

(b) MODIFICATION OF PERFORMANCE PLANS.— 

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

of the enactment of this Act, the Secretary shall modify the 

performance plans of the directors of the medical centers of 

the Department and the directors of the Veterans Integrated 

Service Networks to ensure that such plans are based on the 

quality of care received by veterans at the health care facilities 

under the jurisdictions of such directors. 

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

quality of care provided at health care facilities under the 

jurisdiction of a director described in paragraph (1) includes 

consideration of the following: 

(A) Recent reviews by the Joint Commission (formerly 

known as the ‘‘Joint Commission on Accreditation of 

Healthcare Organizations’’) of such facilities. 

(B) The number and nature of recommendations concerning such facilities by the Inspector General of the 

Department in reviews conducted through the Combined 

Assessment Program, in the reviews by the Inspector General of community-based outpatient clinics and primary 

care clinics, and in reviews conducted through the Office 

of Healthcare Inspections during the two most recently 

completed fiscal years. 

(C) The number of recommendations described in 

subparagraph (B) that the Inspector General of the Department determines have not been carried out satisfactorily 

with respect to such facilities. 

(D) Reviews of such facilities by the Commission on 

Accreditation of Rehabilitation Facilities. 
H. R. 3230—27 

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

the assessment is being conducted. 

(F) The effectiveness of any remedial actions or plans 

resulting from any Inspector General recommendations in 

the reviews and analyses described in subparagraphs (A) 

through (E). 

(3) ADDITIONAL LEADERSHIP POSITIONS.—To the degree 

practicable, the Secretary shall assess the performance of other 

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

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

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

and criteria similar to those used in the performance plans 

modified under paragraph (1). 

(c) REMOVAL OF CERTAIN PERFORMANCE GOALS.—For each fiscal 

year that begins after the date of the enactment of this Act, the 

Secretary shall not include in the performance goals of any employee 

of a Veterans Integrated Service Network or medical center of 

the Department any performance goal that might disincentivize 

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

SEC. 206. IMPROVED TRANSPARENCY CONCERNING HEALTH CARE 

PROVIDED BY DEPARTMENT OF VETERANS AFFAIRS. 

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

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

Affairs shall publish in the Federal Register, and on a publicly 

accessible Internet website of each medical center of the Department 

of Veterans Affairs, the wait-times for the scheduling of an appointment in each Department facility by a veteran for the receipt 

of primary care, specialty care, and hospital care and medical 

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

appointment changes, the Secretary shall publish the revised waittimes— 

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

center of the Department by not later than 30 days after 

such change; and 

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

after such change. 

(b) PUBLICLY AVAILABLE DATABASE OF PATIENT SAFETY, 

QUALITY OF CARE, AND OUTCOME MEASURES.— (1) IN GENERAL.—Not later than 180 days after the date 

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

make available to the public a comprehensive database containing all applicable patient safety, quality of care, and outcome measures for health care provided by the Department 

that are tracked by the Secretary. 

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

database required by paragraph (1) not less frequently than 

once each year. 

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

Secretary would otherwise publish in the database required 
H. R. 3230—28 

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

are not available, the Secretary shall publish notice in the 

database of the reason for such unavailability and a timeline 

for making such measures available in the database. 

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

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

through the primary Internet website of the Department and 

through each primary Internet website of a Department medical 

center. 

(c) HOSPITAL COMPARE WEBSITE OF DEPARTMENT OF HEALTH

AND HUMAN SERVICES.— 

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

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

Affairs shall enter into an agreement with the Secretary of 

Health and Human Services for the provision by the Secretary 

of Veterans Affairs of such information as the Secretary of 

Health and Human Services may require to report and make 

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

through the Hospital Compare Internet website of the Department of Health and Human Services or any successor Internet 

website. 

(2) INFORMATION PROVIDED.—The information provided by 

the Secretary of Veterans Affairs to the Secretary of Health 

and Human Services under paragraph (1) shall include the 

following: 

(A) Measures of timely and effective health care. 

(B) Measures of readmissions, complications of death, 

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

day readmission rates, surgical complication measures, and 

health care related infection measures. 

(C) Survey data of patient experiences, including the 

Hospital Consumer Assessment of Healthcare Providers 

and Systems or any similar successor survey developed 

by the Department of Health and Human Services. 

(D) Any other measures required of or reported with 

respect to hospitals participating in the Medicare program 

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

1395 et seq.). 

(3) UNAVAILABLE INFORMATION.—For any applicable metric 

collected by the Department of Veterans Affairs or required 

to be provided under paragraph (2) and withheld from or 

unavailable in the Hospital Compare Internet website or any 

successor Internet website, the Secretary of Veterans Affairs 

shall publish a notice on such Internet website stating the 

reason why such metric was withheld from public disclosure 

and a timeline for making such metric available, if applicable. 

(d) COMPTROLLER GENERAL REVIEW OF PUBLICLY AVAILABLE

SAFETY AND QUALITY METRICS.—Not later than 3 years after the 

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

the United States shall conduct a review of the safety and quality 

metrics made publicly available by the Secretary of Veterans Affairs 

under this section to assess the degree to which the Secretary 

is complying with the provisions of this section. 
H. R. 3230—29 

SEC. 207. INFORMATION FOR VETERANS ON THE CREDENTIALS OF 

DEPARTMENT OF VETERANS AFFAIRS PHYSICIANS. 

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

LINKS.— (1) AVAILABILITY THROUGH DEPARTMENT OF VETERANS

AFFAIRS HOMEPAGE.—A link to the ‘‘Our Doctors’’ health care 

providers database of the Department of Veterans Affairs, or 

any successor database, shall be available on and through 

the homepage of the Internet website of the Department that 

is accessible to the public. 

(2) INFORMATION ON LOCATION OF RESIDENCY TRAINING.— The Internet website of the Department that is accessible to 

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

health care providers database of the Department, or any successor database, the name of the facility at which each licensed 

physician of the Department underwent residency training. 

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

the Department, or any successor database, shall identify 

whether each licensed physician of the Department is a physician in residency. 

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

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

information described in paragraph (2) with respect to the 

surgeon to be performing such procedure at such time in 

advance of the procedure as is appropriate to permit such 

veteran to evaluate such information. 

(2) INFORMATION DESCRIBED.—The information described 

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

(A) The education and training of the surgeon. 

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

surgeon by the State or national entity responsible for 

such licensure, registration, or certification. 

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

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

or mental competence of the veteran, such information shall 

be provided to an individual acting on behalf of the veteran. 

(c) COMPTROLLER GENERAL REPORT AND PLAN.— 

(1) REPORT.—Not later than 2 years after the date of the 

enactment of this Act, the Comptroller General of the United 

States shall submit to the Committee on Veterans’ Affairs 

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

House of Representatives a report setting forth an assessment 

by the Comptroller General of the following: 

(A) The manner in which contractors under the 

Patient-Centered Community Care initiative of the Department perform oversight of the credentials of physicians 

within the networks of such contractors under the initiative. 

(B) The oversight by the Department of the contracts 

under the Patient-Centered Community Care initiative. 

(C) The verification by the Department of the credentials and licenses of health care providers furnishing hospital care and medical services under section 101. 
H. R. 3230—30 

(2) PLAN.— 

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

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

shall submit to the Comptroller General, the Committee 

on Veterans’ Affairs of the Senate, and the Committee 

on Veterans’ Affairs of the House of Representatives a 

plan to address any findings and recommendations of the 

Comptroller General included in such report. 

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

the submittal of the report under paragraph (1), the Secretary shall carry out such plan. 

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

HOSPITAL CARE AND MEDICAL SERVICES FURNISHED 

THROUGH EXPANDED USE OF CONTRACTS FOR SUCH 

CARE. 

The materials on the Department of Veterans Affairs in the 

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

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

set forth the following: 

(1) The number of veterans who received hospital care 

and medical services under section 101 during the fiscal year 

preceding the fiscal year in which such budget is submitted. 

(2) The amount expended by the Department on furnishing 

care and services under such section during the fiscal year 

preceding the fiscal year in which such budget is submitted. 

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

of furnishing care and services under such section during the 

fiscal year covered by such budget, set forth in aggregate and 

by amounts for each account for which amounts are so 

requested. 

(4) The number of veterans that the Department estimates 

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

(5) The number of employees of the Department on paid 

administrative leave at any point during the fiscal year preceding the fiscal year in which such budget is submitted. 

SEC. 209. PROHIBITION ON FALSIFICATION OF DATA CONCERNING 

WAIT TIMES AND QUALITY MEASURES AT DEPARTMENT 

OF VETERANS AFFAIRS. 

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

this Act, and in accordance with title 5, United States Code, the 

Secretary of Veterans Affairs shall establish policies whereby any 

employee of the Department of Veterans Affairs who knowingly 

submits false data concerning wait times for health care or quality 

measures with respect to health care to another employee of the 

Department or knowingly requires another employee of the Department to submit false data concerning such wait times or quality 

measures to another employee of the Department is subject to 

a penalty the Secretary considers appropriate after notice and an 

opportunity for a hearing, including civil penalties, unpaid suspensions, or termination. 
H. R. 3230—31 

TITLE III—HEALTH CARE STAFFING, 

RECRUITMENT, AND TRAINING MATTERS 

SEC. 301. TREATMENT OF STAFFING SHORTAGE AND BIENNIAL 

REPORT ON STAFFING OF MEDICAL FACILITIES OF THE 

DEPARTMENT OF VETERANS AFFAIRS. 

(a) STAFFING SHORTAGES.— 

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

United States Code, is amended by adding at the end the 

following new section: 

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

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

the Inspector General of the Department shall determine, and the 

Secretary shall publish in the Federal Register, the five occupations 

of personnel of this title of the Department covered under section 

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

throughout the Department as calculated over the five-year period 

preceding the determination. 

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

upon a determination by the Inspector General under paragraph 

(1) that there is a staffing shortage throughout the Department 

with respect to a particular occupation, recruit and directly appoint, 

during the fiscal year after the fiscal year during which such 

determination is made, qualified personnel to serve in that particular occupation for the Department.’’. 

(2) CLERICAL AMENDMENT.—The table of sections at the 

beginning of such chapter is amended by inserting after the 

item relating to section 7411 the following new item: 

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

needed occupations.’’. 

(3) DEADLINE FOR FIRST DETERMINATION.—Notwithstanding 

the deadline under section 7412 of title 38, United States 

Code, as added by paragraph (1), for the annual determination 

of staffing shortages in the Veterans Health Administration, 

the Inspector General of the Department of Veterans Affairs 

shall make the first determination required under such section, 

and the Secretary of Veterans Affairs shall publish in the 

Federal Register such determination, by not later than the 

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

Act. 

(b) INCREASE OF GRADUATE MEDICAL EDUCATION RESIDENCY

POSITIONS.— 

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

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

subsection: 

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

medical residency programs, or ensure that already established 

medical residency programs have a sufficient number of residency 

positions, at any medical facility of the Department that the Secretary determines— 
H. R. 3230—32 

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

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

health professional shortage area (as defined in section 332 

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

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

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

among occupations included in the most current determination 

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

of this title; and 

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

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

(2) FIVE-YEAR INCREASE.— 

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

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

during the 5-year period beginning on the day that is 

1 year after the date of the enactment of this Act, the 

Secretary of Veterans Affairs shall increase the number 

of graduate medical education residency positions at medical facilities of the Department by up to 1,500 positions. 

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

medical education residency positions at medical facilities 

of the Department under subparagraph (A), the Secretary 

shall give priority to medical facilities that— 

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

do not have a medical residency program; and 

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

concentration of veterans. 

(3) REPORT.— 

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

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

October 1 each year thereafter until 2019, the Secretary 

shall submit to the Committee on Veterans’ Affairs of the 

Senate and the Committee on Veterans’ Affairs of the 

House of Representatives a report on graduate medical 

education residency positions at medical facilities of the 

Department. 

(B) ELEMENTS.—Each report required by subparagraph 

(A) shall include the following: 

(i) For the year preceding the submittal of the 

report, the number of graduate medical education residency positions at medical facilities of the Department 

as follows: 

(I) That were filled. 

(II) That were not filled. 

(III) That the Department anticipated filling. 

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

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

(II) if such position was filled, the academic 

affiliation of the medical resident that filled such 

position. 

(iii) The policy at each medical facility of the 

Department with respect to the ratio of medical residents to staff supervising medical residents. 
H. R. 3230—33 

(iv) During the 1-year period preceding the submittal of the report, the number of individuals who 

declined an offer from the Department to serve as 

a medical resident at a medical facility of the Department and the reason why each such individual declined 

such offer. 

(v) During the 1-year period preceding the submittal of the report, a description of— 

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

in filling graduate medical education residency 

positions at medical facilities of the Department; 

and 

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

to address such challenges. 

(vi) A description of efforts of the Department, 

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

and retain medical residents to work for the Veterans 

Health Administration as full-time employees. 

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

amended— 

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

(2) by redesignating subparagraph (B) as subparagraph 

(C); and 

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

subparagraph (B): 

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

of education or training toward a career in an occupation for 

which the Inspector General of the Department has, in the 

most current determination published in the Federal Register 

pursuant to section 7412(a) of this title, determined that there 

is one of the largest staffing shortages throughout the Department with respect to such occupation; and’’. 

(d) REPORTS.— 

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

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

31 of each even-numbered year thereafter until 2024, the Secretary of Veterans Affairs shall submit to the Committees on 

Veterans’ Affairs of the Senate and House of Representatives 

a report assessing the staffing of each medical facility of the 

Department. 

(2) ELEMENTS.—Each report submitted under paragraph 

(1) shall include the following: 

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

medical facilities of the Department to ensure the following: 

(i) Appropriate staffing levels for health care 

professionals to meet the goals of the Secretary for 

timely access to care for veterans. 

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

(iii) Appropriate sizes for clinical panels. 

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

(v) Appropriate physical plant space to meet the 

capacity needs of the Department in that area. 
H. R. 3230—34 

(vi) Such other factors as the Secretary considers 

necessary. 

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

assessment described in subparagraph (A), including a 

timeline for addressing such issues. 

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

levels for the following clinics in each medical facility: 

(i) Mental health. 

(ii) Primary care. 

(iii) Gastroenterology. 

(iv) Women’s health. 

(v) Such other clinics as the Secretary considers 

appropriate. 

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

determination of the Inspector General under subsection 

(a) of section 7412 of title 38, United States Code, as 

added by subsection (a)(1) of this section, and a plan to 

use direct appointment authority under subsection (b) of 

such section 7412 to fill staffing shortages, including recommendations for improving the speed at which the 

credentialing and privileging process can be conducted. 

(E) The current staffing models of the Department 

for the following clinics, including recommendations for 

changes to such models: 

(i) Mental health. 

(ii) Primary care. 

(iii) Gastroenterology. 

(iv) Women’s health. 

(v) Such other clinics as the Secretary considers 

appropriate. 

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

(i) The number of positions in medical facilities 

throughout the Department that are not filled by a 

permanent employee. 

(ii) The length of time each position described in 

clause (i) remained vacant or filled by a temporary 

or acting employee. 

(iii) A description of any barriers to filling the 

positions described in clause (i). 

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

or filled by a temporary or acting employee for more 

than 180 days. 

(v) A plan for handling emergency circumstances, 

such as administrative leave or sudden medical leave 

for senior officials. 

(G) The number of health care providers of the Department who have been removed from their positions, have 

retired, or have left their positions for another reason, 

disaggregated by provider type, during the 2-year period 

preceding the submittal of the report. 

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

the following: 

(i) The number of such health care providers who 

were reassigned to other positions in the Department. 
H. R. 3230—35 

(ii) The number of such health care providers who 

left the Department. 

(iii) The number of such health care providers 

who left the Department and were subsequently 

rehired by the Department. 

SEC. 302. EXTENSION AND MODIFICATION OF CERTAIN PROGRAMS 

WITHIN THE DEPARTMENT OF VETERANS AFFAIRS 

HEALTH PROFESSIONALS EDUCATIONAL ASSISTANCE 

PROGRAM. 

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

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

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

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

amended— 

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

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

that follows through the period at the end and inserting 

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

of participation in the Program’’. 

(2) ELIMINATION OF LIMITATION.— (A) IN GENERAL.—Such section is further amended— 

(i) by striking paragraph (2); 

(ii) by redesignating paragraph (3) as paragraph 

(2); and 

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

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

‘‘paragraph (1)’’. 

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

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

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

inserting ‘‘The amount’’. 

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

AFFAIRS. 

(a) CLINIC MANAGEMENT TRAINING PROGRAM.— (1) IN GENERAL.—Not later than 180 days after the date 

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

shall commence a role-specific clinic management training program to provide in-person, standardized education on systems 

and processes for health care practice management and scheduling to all appropriate employees, as determined by the Secretary, at medical facilities of the Department. 

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

(i) Training on how to manage the schedules of 

health care providers of the Department, including 

the following: 

(I) Maintaining such schedules in a manner 

that allows appointments to be booked at least 

eight weeks in advance. 

(II) Proper planning procedures for vacation, 

leave, and graduate medical education training 

schedules. 
H. R. 3230—36 

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

a daily basis, based on specialty. 

(iii) Training on how to determine whether there 

are enough available appointment slots to manage 

demand for different appointment types and mechanisms for alerting management of insufficient slots. 

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

any new scheduling system implemented by the 

Department. 

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

(I) Telemedicine. 

(II) Electronic mail. 

(III) Text messaging. 

(IV) Such other technologies as specified by 

the Secretary. 

(vi) Training on how to properly use physical plant 

space at medical facilities of the Department to ensure 

efficient flow and privacy for patients and staff. 

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

each employee of the Department included in the clinic 

management training program required by paragraph (1) 

receives education under such program that is relevant 

to the responsibilities of such employee. 

(3) SUNSET.—The clinic management training program 

required by paragraph (1) shall terminate on the date that 

is 2 years after the date on which the Secretary commences 

such program. 

(b) TRAINING MATERIALS.— (1) IN GENERAL.—After the termination of the clinic 

management training program required by subsection (a), the 

Secretary shall provide training materials on health care 

management to each of the following employees of the Department that are relevant to the position and responsibilities of 

such employee upon the commencement of employment of such 

employee: 

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

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

the Department. 

(C) Such other employees of the Department as the 

Secretary considers appropriate. 

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

training materials required under paragraph (1). 

TITLE IV—HEALTH CARE RELATED TO 

SEXUAL TRAUMA 

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

DUTY TRAINING. 

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

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

duty for training, or inactive duty training’’. 
H. R. 3230—37 

SEC. 402. PROVISION OF COUNSELING AND TREATMENT FOR SEXUAL 

TRAUMA BY THE DEPARTMENT OF VETERANS AFFAIRS TO 

MEMBERS OF THE ARMED FORCES. 

(a) EXPANSION OF COVERAGE TO MEMBERS OF THE ARMED

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

Code, is amended— 

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

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

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

the Secretary may, in consultation with the Secretary of Defense, 

provide counseling and care and services to members of the Armed 

Forces (including members of the National Guard and Reserves) 

on active duty to overcome psychological trauma described in that 

paragraph. 

‘‘(B) A member described in subparagraph (A) shall not be 

required to obtain a referral before receiving counseling and care 

and services under this paragraph.’’; and 

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

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

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

and inserting ‘‘that individual’’. 

(b) INFORMATION TO MEMBERS ON AVAILABILITY OF COUNSELING

AND SERVICES.—Subsection (c) of such section is amended— 

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

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

Forces and’’ before ‘‘individuals’’. 

(c) INCLUSION OF MEMBERS IN REPORTS ON COUNSELING AND

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

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

veterans’’; 

(2) in paragraph (2)— 

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

‘‘individuals’’; and 

(B) by striking ‘‘training under subsection (d).’’ and 

inserting ‘‘training under subsection (d), disaggregated by— 

‘‘(A) veterans; 

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

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

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

‘‘(i) men; and 

‘‘(ii) women.’’; 

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

‘‘individuals’’; and 

(4) in paragraph (5)— 

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

‘‘individuals’’; and 

(B) by inserting ‘‘, including specific recommendations 

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

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

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

shall take effect on the date that is 1 year after the date of 

the enactment of this Act. 
H. R. 3230—38 

SEC. 403. REPORTS ON MILITARY SEXUAL TRAUMA. 

(a) REPORT ON SERVICES AVAILABLE FOR MILITARY SEXUAL

TRAUMA IN THE DEPARTMENT OF VETERANS AFFAIRS.—Not later 

than 630 days after the date of the enactment of this Act, the 

Secretary of Veterans Affairs shall submit to the Committee on 

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

Affairs of the House of Representatives a report on the treatment 

and services available from the Department of Veterans Affairs 

for male veterans who experience military sexual trauma compared 

to such treatment and services available to female veterans who 

experience military sexual trauma. 

(b) REPORTS ON TRANSITION OF MILITARY SEXUAL TRAUMA

TREATMENT FROM DEPARTMENT OF DEFENSE TO DEPARTMENT OF

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

the enactment of this Act, and annually thereafter for 5 years, 

the Department of Veterans Affairs-Department of Defense Joint 

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

United States Code, shall submit to the appropriate committees 

of Congress a report on military sexual trauma that includes the 

following: 

(1) The processes and procedures utilized by the Department of Veterans Affairs and the Department of Defense to 

facilitate transition of treatment of individuals who have experienced military sexual trauma from treatment provided by the 

Department of Defense to treatment provided by the Department of Veterans Affairs. 

(2) A description and assessment of the collaboration 

between the Department of Veterans Affairs and the Department of Defense in assisting veterans in filing claims for disabilities related to military sexual trauma, including permitting 

veterans access to information and evidence necessary to 

develop or support such claims. 

(c) DEFINITIONS.—In this section: 

(1) APPROPRIATE COMMITTEES OF CONGRESS.—The term 

‘‘appropriate committees of Congress’’ means— 

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

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

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

trauma’’ means psychological trauma, which in the judgment 

of a mental health professional employed by the Department, 

resulted from a physical assault of a sexual nature, battery 

of a sexual nature, or sexual harassment which occurred while 

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

or inactive duty training. 

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

means repeated, unsolicited verbal or physical contact of a 

sexual nature which is threatening in character. 

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

the meaning given that term by the Secretary of Veterans 

Affairs for purposes of this section. 

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

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

Act. 
H. R. 3230—39 

TITLE V—OTHER HEALTH CARE 

MATTERS 

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

(a) IN GENERAL.—Section 1705 of the National Defense 

Authorization Act for Fiscal Year 2008 (Public Law 110–181; 38 

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

‘‘(g) TERMINATION.—The pilot program shall terminate on 

October 6, 2017.’’. 

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

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

TITLE VI—MAJOR MEDICAL FACILITY 

LEASES 

SEC. 601. AUTHORIZATION OF MAJOR MEDICAL FACILITY LEASES. 

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

out the following major medical facility leases at the locations 

specified, and in an amount for each lease not to exceed the amount 

shown for such location (not including any estimated cancellation 

costs): 

(1) For a clinical research and pharmacy coordinating 

center, Albuquerque, New Mexico, an amount not to exceed 

$9,560,000. 

(2) For a community-based outpatient clinic, Brick, New Jersey, an amount not to exceed $7,280,000. 

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

Charleston, South Carolina, an amount not to exceed 

$7,070,250. 

(4) For a community-based outpatient clinic, Cobb County, Georgia, an amount not to exceed $6,409,000. 

(5) For the Leeward Outpatient Healthcare Access Center, 

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

Office of the Veterans Benefits Administration and the Kapolei 

Vet Center of the Department of Veterans Affairs, an amount 

not to exceed $15,887,370. 

(6) For a community-based outpatient clinic, Johnson County, Kansas, an amount not to exceed $2,263,000. 

(7) For a replacement community-based outpatient clinic, Lafayette, Louisiana, an amount not to exceed $2,996,000. 

(8) For a community-based outpatient clinic, Lake Charles, Louisiana, an amount not to exceed $2,626,000. 

(9) For outpatient clinic consolidation, New Port Richey, Florida, an amount not to exceed $11,927,000. 

(10) For an outpatient clinic, Ponce, Puerto Rico, an amount not to exceed $11,535,000. 

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

not to exceed $19,426,000. 

(12) For a community-based outpatient clinic, San Diego, California, an amount not to exceed $11,946,100. 

(13) For an outpatient clinic, Tyler, Texas, an amount not to exceed $4,327,000. 
H. R. 3230—40 

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

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

(15) For the Worcester Community-Based Outpatient 

Clinic, Worcester, Massachusetts, an amount not to exceed 

$4,855,000. 

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

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

$4,232,060. 

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

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

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

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

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

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

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

not to exceed $22,032,000. 

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

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

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

Nebraska, an amount not to exceed $7,178,400. 

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

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

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

Myrtle Beach, South Carolina, an amount not to exceed 

$8,022,000. 

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

(26) For the expansion of a community-based outpatient clinic, Redding, California, an amount not to exceed $8,154,000. 

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

(b) REQUIREMENTS FOR CLINIC IN TULSA.— 

(1) IN GENERAL.—In carrying out the expansion of the 

community-based outpatient clinic in Tulsa, Oklahoma, authorized by subsection (a)(27), the Secretary of Veterans Affairs 

shall ensure that such clinic satisfies the following requirements: 

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

feet. 

(B) Have an annual cost per square foot of not more 

than the average market rate in Tulsa, Oklahoma, for 

an equivalent medical facility plus 20 percent. 

(C) Satisfy the mandate of the Department of Veterans 

Affairs to provide veterans in Oklahoma with access to 

quality and efficient care. 

(D) Expand clinical capacity in the region in which 

the clinic is located in a cost efficient manner based upon 

regional cost comparisons, taking into account the needs 

of current veterans and the potential demand by veterans 

for care in the future. 

(E) Be the most cost effective option for the Department 

as predicted over a 30-year life cycle for such clinic. 

(2) COST EFFECTIVE DETERMINATION.— 

(A) IN GENERAL.—If the Secretary determines that the 

most cost effective option over a 30-year life cycle would 

be to purchase or construct a facility in Tulsa, Oklahoma, 

instead of entering into a major medical facility lease in 
H. R. 3230—41 

such location as authorized by subsection (a)(27), the Secretary shall not enter into such lease. 

(B) MAJOR MEDICAL FACILITY PROJECT.—If the Secretary makes the determination described in subparagraph 

(A), the Secretary may request authority for a major medical facility project in Tulsa, Oklahoma, from Congress 

pursuant to section 8104(b) of title 38, United States Code. 

(C) COST-BENEFIT ANALYSIS.—If the Secretary requests 

authority for the major medical facility project described 

in subparagraph (B), not later than 90 days after making 

the determination described in subparagraph (A), the Secretary shall submit to Congress a detailed cost-benefit analysis of such major medical facility project. 

SEC. 602. BUDGETARY TREATMENT OF DEPARTMENT OF VETERANS 

AFFAIRS MAJOR MEDICAL FACILITIES LEASES. 

(a) FINDINGS.—Congress finds the following: 

(1) Title 31, United States Code, requires the Department 

of Veterans Affairs to record the full cost of its contractual 

obligation against funds available at the time a contract is 

executed. 

(2) Office of Management and Budget Circular A–11 provides guidance to agencies in meeting the statutory requirements under title 31, United States Code, with respect to 

leases. 

(3) For operating leases, Office of Management and Budget 

Circular A–11 requires the Department of Veterans Affairs 

to record up-front budget authority in an ‘‘amount equal to 

total payments under the full term of the lease or [an] amount 

sufficient to cover first year lease payments plus cancellation 

costs’’. 

(b) REQUIREMENT FOR OBLIGATION OF FULL COST.— 

(1) IN GENERAL.—Subject to the availability of appropriations provided in advance, in exercising the authority of the 

Secretary of Veterans Affairs to enter into leases provided 

in this Act, the Secretary shall record, pursuant to section 

1501 of title 31, United States Code, as the full cost of the 

contractual obligation at the time a contract is executed either— 

(A) an amount equal to total payments under the full 

term of the lease; or 

(B) if the lease specifies payments to be made in the 

event the lease is terminated before its full term, an 

amount sufficient to cover the first year lease payments 

plus the specified cancellation costs. 

(2) SELF-INSURING AUTHORITY.—The requirements of paragraph (1) may be satisfied through the use of the self-insuring 

authority identified in title 40, United States Code, consistent 

with Office of Management and Budget Circular A–11. 

(c) TRANSPARENCY.— 

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

38, United States Code, is amended by adding at the end 

the following new paragraph: 

‘‘(7) In the case of a prospectus proposing funding for a 

major medical facility lease, a detailed analysis of how the 

lease is expected to comply with Office of Management and 

Budget Circular A–11 and section 1341 of title 31 (commonly 
H. R. 3230—42 

referred to as the ‘Anti-Deficiency Act’). Any such analysis 

shall include— 

‘‘(A) an analysis of the classification of the lease as 

a ‘lease-purchase’, ‘capital lease’, or ‘operating lease’ as 

those terms are defined in Office of Management and 

Budget Circular A–11; 

‘‘(B) an analysis of the obligation of budgetary resources 

associated with the lease; and 

‘‘(C) an analysis of the methodology used in determining the asset cost, fair market value, and cancellation 

costs of the lease.’’. 

(2) SUBMITTAL TO CONGRESS.—Such section 8104 is further 

amended by adding at the end the following new subsection: 

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

medical facility lease, the Secretary shall submit to the Committees 

on Veterans’ Affairs of the Senate and the House of Representatives— 

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

lease; 

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

‘‘(C) a description and analysis of any differences between 

the prospectus submitted pursuant to subsection (b) and the 

proposed lease; and 

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

lease fully complies with Office of Management and Budget 

Circular A–11. 

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

that any information submitted to the committee under such paragraph is treated by the committee with the same level of confidentiality as is required by law of the Secretary and subject to the 

same statutory penalties for unauthorized disclosure or use as 

the Secretary. 

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

facility lease, the Secretary shall submit to each committee 

described in paragraph (1) a report on any material differences 

between the lease that was entered into and the proposed lease 

described under such paragraph, including how the lease that was 

entered into changes the previously submitted scoring analysis 

described in subparagraph (D) of such paragraph.’’. 

(d) RULE OF CONSTRUCTION.—Nothing in this section, or the 

amendments made by this section, shall be construed to in any 

way relieve the Department of Veterans Affairs from any statutory 

or regulatory obligations or requirements existing prior to the enactment of this section and such amendments. 

TITLE VII—OTHER VETERANS MATTERS 

SEC. 701. EXPANSION OF MARINE GUNNERY SERGEANT JOHN DAVID 

FRY SCHOLARSHIP. 

(a) EXPANSION OF ENTITLEMENT.—Subsection (b)(9) of section 

3311 of title 38, United States Code, is amended by inserting 

‘‘or spouse’’ after ‘‘child’’. 

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

(1) by redesignating paragraph (2) as paragraph (4); and 
H. R. 3230—43 

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

‘‘(2) LIMITATION.—The entitlement of an individual to 

assistance under subsection (a) pursuant to paragraph (9) of 

subsection (b) because the individual was a spouse of a person 

described in such paragraph shall expire on the earlier of— 

‘‘(A) the date that is 15 years after the date on which 

the person died; or 

‘‘(B) the date on which the individual remarries. 

‘‘(3) ELECTION ON RECEIPT OF CERTAIN BENEFITS.—A surviving spouse entitled to assistance under subsection (a) pursuant to paragraph (9) of subsection (b) who is also entitled 

to educational assistance under chapter 35 of this title may 

not receive assistance under both this section and such chapter, 

but shall make an irrevocable election (in such form and 

manner as the Secretary may prescribe) under which section 

or chapter to receive educational assistance.’’. 

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

is amended— 

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

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

and inserting ‘‘such child’s’’. 

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

shall apply with respect to a quarter, semester, or term, as 

applicable, commencing on or after January 1, 2015. 

SEC. 702. APPROVAL OF COURSES OF EDUCATION PROVIDED BY 

PUBLIC INSTITUTIONS OF HIGHER LEARNING FOR PURPOSES OF ALL-VOLUNTEER FORCE EDUCATIONAL ASSISTANCE PROGRAM AND POST-9/11 EDUCATIONAL ASSISTANCE CONDITIONAL ON IN-STATE TUITION RATE FOR VETERANS. 

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

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

‘‘(c)(1) Notwithstanding any other provision of this chapter and 

subject to paragraphs (3) through (6), the Secretary shall disapprove 

a course of education provided by a public institution of higher 

learning to a covered individual pursuing a course of education 

with educational assistance under chapter 30 or 33 of this title 

while living in the State in which the public institution of higher 

learning is located if the institution charges tuition and fees for 

that course for the covered individual at a rate that is higher 

than the rate the institution charges for tuition and fees for that 

course for residents of the State in which the institution is located, 

regardless of the covered individual’s State of residence. 

‘‘(2) For purposes of this subsection, a covered individual is 

any individual as follows: 

‘‘(A) A veteran who was discharged or released from a 

period of not fewer than 90 days of service in the active military, 

naval, or air service less than three years before the date 

of enrollment in the course concerned. 

‘‘(B) An individual who is entitled to assistance under section 3311(b)(9) or 3319 of this title by virtue of such individual’s 

relationship to a veteran described in subparagraph (A). 

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

to disapproval under paragraph (1) by reason of paragraph (2)(A) 
H. R. 3230—44 

or (2)(B) a covered individual pursues one or more courses of education at the same public institution of higher learning while 

remaining continuously enrolled (other than during regularly scheduled breaks between courses, semesters or terms) at that institution 

of higher learning, any course so pursued by the covered individual 

at that institution of higher learning while so continuously enrolled 

shall also be subject to disapproval under paragraph (1). 

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

under paragraph (1) if a public institution of higher learning 

requires a covered individual pursuing a course of education at 

the institution to demonstrate an intent, by means other than 

satisfying a physical presence requirement, to establish residency 

in the State in which the institution is located, or to satisfy other 

requirements not relating to the establishment of residency, in 

order to be charged tuition and fees for that course at a rate 

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

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

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

(1) as the Secretary considers appropriate. 

‘‘(6) Disapproval under paragraph (1) shall apply only with 

respect to educational assistance under chapters 30 and 33 of this 

title.’’. 

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

38, United States Code (as added by subsection (a) of this section), 

shall apply with respect to educational assistance provided for 

pursuit of a program of education during a quarter, semester, 

or term, as applicable, that begins after July 1, 2015. 

SEC. 703. EXTENSION OF REDUCTION IN AMOUNT OF PENSION FURNISHED BY DEPARTMENT OF VETERANS AFFAIRS FOR 

CERTAIN VETERANS COVERED BY MEDICAID PLANS FOR 

SERVICES FURNISHED BY NURSING FACILITIES. 

Section 5503(d)(7) of title 38, United States Code, is amended 

by striking ‘‘November 30, 2016’’ and inserting ‘‘September 30, 

2024’’. 

SEC. 704. EXTENSION OF REQUIREMENT FOR COLLECTION OF FEES 

FOR HOUSING LOANS GUARANTEED BY SECRETARY OF 

VETERANS AFFAIRS. 

Section 3729(b)(2) of title 38, United States Code, is amended— 

(1) in subparagraph (A)— 

(A) in clause (iii), by striking ‘‘October 1, 2017’’ and 

inserting ‘‘September 30, 2024’’; and 

(B) in clause (iv), by striking ‘‘October 1, 2017’’ and 

inserting ‘‘September 30, 2024’’; 

(2) in subparagraph (B)— 

(A) in clause (i), by striking ‘‘October 1, 2017’’ and 

inserting ‘‘September 30, 2024’’; and 

(B) in clause (ii), by striking ‘‘October 1, 2017’’ and 

inserting ‘‘September 30, 2024’’; 

(3) in subparagraph (C)— 

(A) in clause (i), by striking ‘‘October 1, 2017’’ and 

inserting ‘‘September 30, 2024’’; and 

(B) in clause (ii), by striking ‘‘October 1, 2017’’ and 

inserting ‘‘September 30, 2024’’; and 

(4) in subparagraph (D)— 

(A) in clause (i), by striking ‘‘October 1, 2017’’ and 

inserting ‘‘September 30, 2024’’; and 
H. R. 3230—45 

(B) in clause (ii), by striking ‘‘October 1, 2017’’ and 

inserting ‘‘September 30, 2024’’. 

SEC. 705. LIMITATION ON AWARDS AND BONUSES PAID TO EMPLOYEES 

OF DEPARTMENT OF VETERANS AFFAIRS. 

In each of fiscal years 2015 through 2024, the Secretary of 

Veterans Affairs shall ensure that the aggregate amount of awards 

and bonuses paid by the Secretary in a fiscal year under chapter 

45 or 53 of title 5, United States Code, or any other awards 

or bonuses authorized under such title does not exceed 

$360,000,000. 

SEC. 706. EXTENSION OF AUTHORITY TO USE INCOME INFORMATION. 

Section 5317(g) of title 38, United States Code, is amended 

by striking ‘‘September 30, 2016’’ and inserting ‘‘September 30, 

2024’’. 

SEC. 707. REMOVAL OF SENIOR EXECUTIVES OF THE DEPARTMENT 

OF VETERANS AFFAIRS FOR PERFORMANCE OR MISCONDUCT. 

(a) REMOVAL OR TRANSFER.— 

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

is amended by adding at the end the following new section: 

‘‘§ 713. Senior executives: removal based on performance or 

misconduct 

‘‘(a) IN GENERAL.—(1) The Secretary may remove an individual 

employed in a senior executive position at the Department of Veterans Affairs from the senior executive position if the Secretary 

determines the performance or misconduct of the individual warrants such removal. If the Secretary so removes such an individual, 

the Secretary may— 

‘‘(A) remove the individual from the civil service (as defined 

in section 2101 of title 5); or 

‘‘(B) in the case of an individual described in paragraph 

(2), transfer the individual from the senior executive position 

to a General Schedule position at any grade of the General 

Schedule for which the individual is qualified and that the 

Secretary determines is appropriate. 

‘‘(2) An individual described in this paragraph is an individual 

who— 

‘‘(A) previously occupied a permanent position within the 

competitive service (as that term is defined in section 2102 

of title 5); 

‘‘(B) previously occupied a permanent position within the 

excepted service (as that term is defined in section 2103 of 

title 5); or 

‘‘(C) prior to employment in a senior executive position 

at the Department of Veterans Affairs, did not occupy any 

position within the Federal Government. 

‘‘(b) PAY OF TRANSFERRED INDIVIDUAL.—(1) Notwithstanding 

any other provision of law, including the requirements of section 

3594 of title 5, any individual transferred to a General Schedule 

position under subsection (a)(2) shall, beginning on the date of 

such transfer, receive the annual rate of pay applicable to such 

position. 

‘‘(2) An individual so transferred may not be placed on administrative leave or any other category of paid leave during the period 
H. R. 3230—46 

during which an appeal (if any) under this section is ongoing, 

and may only receive pay if the individual reports for duty. If 

an individual so transferred does not report for duty, such individual 

shall not receive pay or other benefits pursuant to subsection (e)(5). 

‘‘(c) NOTICE TO CONGRESS.—Not later than 30 days after 

removing or transferring an individual from a senior executive 

position under subsection (a), the Secretary shall submit to the 

Committees on Veterans’ Affairs of the Senate and House of Representatives notice in writing of such removal or transfer and 

the reason for such removal or transfer. 

‘‘(d) PROCEDURE.—(1) The procedures under section 7543(b) 

of title 5 shall not apply to a removal or transfer under this 

section. 

‘‘(2)(A) Subject to subparagraph (B) and subsection (e), any 

removal or transfer under subsection (a) may be appealed to the 

Merit Systems Protection Board under section 7701 of title 5. 

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

may only be made if such appeal is made not later than seven 

days after the date of such removal or transfer. 

‘‘(e) EXPEDITED REVIEW BY ADMINISTRATIVE JUDGE.—(1) Upon 

receipt of an appeal under subsection (d)(2)(A), the Merit Systems 

Protection Board shall refer such appeal to an administrative judge 

pursuant to section 7701(b)(1) of title 5. The administrative judge 

shall expedite any such appeal under such section and, in any 

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

the date of the appeal. 

‘‘(2) Notwithstanding any other provision of law, including section 7703 of title 5, the decision of an administrative judge under 

paragraph (1) shall be final and shall not be subject to any further 

appeal. 

‘‘(3) In any case in which the administrative judge cannot 

issue a decision in accordance with the 21-day requirement under 

paragraph (1), the removal or transfer is final. In such a case, 

the Merit Systems Protection Board shall, within 14 days after 

the date that such removal or transfer is final, submit to Congress 

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

of Representatives a report that explains the reasons why a decision 

was not issued in accordance with such requirement. 

‘‘(4) The Merit Systems Protection Board or administrative 

judge may not stay any removal or transfer under this section. 

‘‘(5) During the period beginning on the date on which an 

individual appeals a removal from the civil service under subsection 

(d) and ending on the date that the administrative judge issues 

a final decision on such appeal, such individual may not receive 

any pay, awards, bonuses, incentives, allowances, differentials, student loan repayments, special payments, or benefits. 

‘‘(6) To the maximum extent practicable, the Secretary shall 

provide to the Merit Systems Protection Board, and to any administrative judge to whom an appeal under this section is referred, 

such information and assistance as may be necessary to ensure 

an appeal under this subsection is expedited. 

‘‘(f) RELATION TO TITLE 5.—(1) The authority provided by this 

section is in addition to the authority provided by section 3592 

or subchapter V of chapter 75 of title 5. 

‘‘(2) Section 3592(b)(1) of title 5 does not apply to an action 

to remove or transfer an individual under this section. 

‘‘(g) DEFINITIONS.—In this section: 
H. R. 3230—47 

‘‘(1) The term ‘individual’ means— 

‘‘(A) a career appointee (as that term is defined in 

section 3132(a)(4) of title 5); or 

‘‘(B) any individual who occupies an administrative 

or executive position and who was appointed under section 

7306(a) or section 7401(1) of this title. 

‘‘(2) The term ‘misconduct’ includes neglect of duty, malfeasance, or failure to accept a directed reassignment or to accompany a position in a transfer of function. 

‘‘(3) The term ‘senior executive position’ means— 

‘‘(A) with respect to a career appointee (as that term 

is defined in section 3132(a)(4) of title 5), a Senior Executive 

Service position (as such term is defined in section 

3132(a)(2) of title 5); and 

‘‘(B) with respect to an individual appointed under 

section 7306(a) or section 7401(1) of this title, an administrative or executive position.’’. 

(2) CLERICAL AMENDMENT.—The table of sections at the 

beginning of such chapter is amended by adding at the end 

the following new item: 

‘‘713. Senior executives: removal based on performance or misconduct.’’. 

(b) ESTABLISHMENT OF EXPEDITED REVIEW PROCESS.— 

(1) IN GENERAL.—Not later than 14 days after the date 

of the enactment of this Act, the Merit Systems Protection 

Board shall establish and put into effect a process to conduct 

expedited reviews in accordance with section 713(d) of title 

38, United States Code. 

(2) INAPPLICABILITY OF CERTAIN REGULATIONS.—Section 

1201.22 of title 5, Code of Federal Regulations, as in effect 

on the day before the date of the enactment of this Act, shall 

not apply to expedited reviews carried out under section 713(d) 

of title 38, United States Code. 

(3) WAIVER.—The Merit Systems Protection Board may 

waive any other regulation in order to provide for the expedited 

review required under section 713(d) of title 38, United States 

Code. 

(4) REPORT BY MERIT SYSTEMS PROTECTION BOARD.—Not 

later than 14 days after the date of the enactment of this 

Act, the Merit Systems Protection Board shall submit to the 

Committees on Veterans’ Affairs of the Senate and House of 

Representatives a report on the actions the Board plans to 

take to conduct expedited reviews under section 713(d) of title 

38, United States Code, as added by subsection (a). Such report 

shall include a description of the resources the Board determines will be necessary to conduct such reviews and a description of whether any resources will be necessary to conduct 

such reviews that were not available to the Board on the 

day before the date of the enactment of this Act. 

(c) TEMPORARY EXEMPTION FROM CERTAIN LIMITATION ON INITI- ATION OF REMOVAL FROM SENIOR EXECUTIVE SERVICE.—During the 

120-day period beginning on the date of the enactment of this 

Act, an action to remove an individual from the Senior Executive 

Service at the Department of Veterans Affairs pursuant to section 

7543 of title 5, United States Code, may be initiated, notwithstanding section 3592(b) of such title, or any other provision of 

law. 
H. R. 3230—48 

(d) CONSTRUCTION.— 

(1) IN GENERAL.—Nothing in this section or section 713 

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

shall be construed to apply to an appeal of a removal, transfer, 

or other personnel action that was pending before the date 

of the enactment of this Act. 

(2) RELATION TO TITLE 5.—With respect to the removal 

or transfer of an individual (as that term is defined in such 

section 713) employed at the Department of Veterans Affairs, 

the authority provided by such section 713 is in addition to 

the authority provided by section 3592 or subchapter V of 

chapter 75 of title 5, United States Code. 

TITLE VIII—OTHER MATTERS 

SEC. 801. APPROPRIATION OF AMOUNTS. 

(a) IN GENERAL.—There is authorized to be appropriated, and 

is appropriated, to the Secretary of Veterans Affairs, out of any 

funds in the Treasury not otherwise appropriated $5,000,000,000 

to carry out subsection (b). Such funds shall be available for obligation or expenditure without fiscal year limitation. 

(b) USE OF AMOUNTS.—The amount appropriated under subsection (a) shall be used by the Secretary as follows: 

(1) To increase the access of veterans to care as follows: 

(A) To hire primary care and specialty care physicians 

for employment in the Department of Veterans Affairs. 

(B) To hire other medical staff, including the following: 

(i) Physicians. 

(ii) Nurses. 

(iii) Social workers. 

(iv) Mental health professionals. 

(v) Other health care professionals as the Secretary 

considers appropriate. 

(C) To carry out sections 301 and 302, including the 

amendments made by such sections. 

(D) To pay for expenses, equipment, and other costs 

associated with the hiring of primary care, specialty care 

physicians, and other medical staff under subparagraphs 

(A), (B), and (C). 

(2) To improve the physical infrastructure of the Department as follows: 

(A) To maintain and operate hospitals, nursing homes, 

domiciliary facilities, and other facilities of the Veterans 

Health Administration. 

(B) To enter into contracts or hire temporary employees 

to repair, alter, or improve facilities under the jurisdiction 

of the Department that are not otherwise provided for 

under this paragraph. 

(C) To carry out leases for facilities of the Department. 

(D) To carry out minor construction projects of the 

Department. 

(c) AVAILABILITY.—The amount appropriated under subsection 

(a) shall remain available until expended. 

(d) REPORT.— (1) IN GENERAL.—Not later than 1 year after the date 

of the enactment of this Act, the Secretary of Veterans Affairs 
H. R. 3230—49 

shall submit to the appropriate committees of Congress a report 

on how the Secretary has obligated the amounts appropriated 

under subsection (a) as of the date of the submittal of the 

report. 

(2) APPROPRIATE COMMITTEES OF CONGRESS DEFINED.—In 

this subsection, the term ‘‘appropriate committees of Congress’’ 

means— 

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

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

(e) FUNDING PLAN.—The Secretary shall submit to Congress 

a funding plan describing how the Secretary intends to use the 

amounts provided under subsection (a). 

SEC. 802. VETERANS CHOICE FUND. 

(a) IN GENERAL.—There is established in the Treasury of the 

United States a fund to be known as the Veterans Choice Fund. 

(b) ADMINISTRATION OF FUND.—The Secretary of Veterans 

Affairs shall administer the Veterans Choice Fund established by 

subsection (a). 

(c) USE OF AMOUNTS.— 

(1) IN GENERAL.—Any amounts deposited in the Veteran 

Choice Fund shall be used by the Secretary of Veterans Affairs 

to carry out section 101, including, subject to paragraph (2), 

any administrative requirements of such section. 

(2) AMOUNT FOR ADMINISTRATIVE REQUIREMENTS.— (A) LIMITATION.—Except as provided by subparagraph 

(B), of the amounts deposited in the Veterans Choice Fund, 

not more than $300,000,000 may be used for administrative 

requirements to carry out section 101. 

(B) INCREASE.—The Secretary may increase the 

amount set forth in subparagraph (A) with respect to the 

amounts used for administrative requirements if— 

(i) the Secretary determines that the amount of 

such increase is necessary to carry out section 101; 

(ii) the Secretary submits to the Committees on 

Veterans’ Affairs and Appropriations of the House of 

Representatives and the Committees on Veterans’ 

Affairs and Appropriations of the Senate a report 

described in subparagraph (C); and 

(iii) a period of 60 days has elapsed following the 

date on which the Secretary submits the report under 

clause (ii). 

(C) REPORT.—A report described in this subparagraph 

is a report that contains the following: 

(i) A notification of the amount of the increase 

that the Secretary determines necessary under 

subparagraph (B)(i). 

(ii) The justifications for such increased amount. 

(iii) The administrative requirements that the Secretary will carry out using such increased amount. 

(d) APPROPRIATION AND DEPOSIT OF AMOUNTS.— 

(1) IN GENERAL.—There is authorized to be appropriated, 

and is appropriated, to the Secretary of Veterans Affairs, out 

of any funds in the Treasury not otherwise appropriated 

$10,000,000,000 to be deposited in the Veterans Choice Fund 
H. R. 3230—50 

established by subsection (a). Such funds shall be available 

for obligation or expenditure without fiscal year limitation, 

and only for the program created under section 101. 

(2) AVAILABILITY.—The amount appropriated under paragraph (1) shall remain available until expended. 

(e) SENSE OF CONGRESS.—It is the sense of Congress that 

the Veterans Choice Fund is a supplement to but distinct from 

the Department of Veterans Affairs’ current and expected level 

of non-Department care currently part of Department’s medical 

care budget. Congress expects that the Department will maintain 

at least its existing obligations of non-Department care programs 

in addition to but distinct from the Veterans Choice Fund for 

each of fiscal years 2015 through 2017. 

SEC. 803. EMERGENCY DESIGNATIONS. 

(a) IN GENERAL.—This Act is designated as an emergency 

requirement pursuant to section 4(g) of the Statutory Pay-As-YouGo Act of 2010 (2 U.S.C. 933(g)). 

(b) DESIGNATION IN SENATE.—In the Senate, this Act is designated as an emergency requirement pursuant to section 403(a) 

of S. Con. Res. 13 (111th Congress), the concurrent resolution 

on the budget for fiscal year 2010. 

Speaker of the House of Representatives. 

Vice President of the United States and

President of the Senate.