II 

Calendar No. 273 

115TH CONGRESS 

1ST SESSION S. 2193 

To amend title 38, United States Code, to improve health care for veterans, 

and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

DECEMBER 5, 2017 

Mr. ISAKSON, from the Committee on Veterans’ Affairs, reported the following 

original bill; which was read twice and placed on the calendar 

A BILL 

To amend title 38, United States Code, to improve health 

care for veterans, and for other purposes. 

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

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

5 ‘‘Caring for our Veterans Act of 2017’’. 

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

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. References to title 38, United States Code. 


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TITLE I—DEVELOPING AN INTEGRATED HIGH-PERFORMING 

NETWORK 

Subtitle A—Establishing Community Care Programs 

Sec. 101. Establishment of Veterans Community Care Program. 

Sec. 102. Authorization of agreements between Department of Veterans Affairs 

and non-Department providers. 

Sec. 103. Conforming amendments for State veterans homes. 

Sec. 104. Access guidelines and standards for quality. 

Sec. 105. Access to walk-in care. 

Sec. 106. Strategy regarding the Department of Veterans Affairs High-Performing Integrated Health Care Network. 

Sec. 107. Applicability of Directive of Office of Federal Contract Compliance 

Programs. 

Sec. 108. Prevention of certain health care providers from providing non-Department health care services to veterans. 

Subtitle B—Paying Providers and Improving Collections 

Sec. 111. Prompt payment to providers. 

Sec. 112. Authority to pay for authorized care not subject to an agreement. 

Sec. 113. Improvement of authority to recover the cost of services furnished for 

non-service-connected disabilities. 

Sec. 114. Processing of claims for reimbursement through electronic interface. 

Subtitle C—Education and Training Programs 

Sec. 121. Education program on health care options. 

Sec. 122. Training program for administration of non-Department of Veterans 

Affairs health care. 

Sec. 123. Continuing medical education for non-Department medical professionals. 

Subtitle D—Other Matters Relating to Non-Department of Veterans Affairs 

Providers 

Sec. 131. Establishment of processes to ensure safe opioid prescribing practices 

by non-Department of Veterans Affairs health care providers. 

Sec. 132. Improving information sharing with community providers. 

Sec. 133. Competency standards for non-Department of Veterans Affairs health 

care providers. 

Subtitle E—Other Non-Department Health Care Matters 

Sec. 141. Plans for Use of Supplemental Appropriations Required. 

Sec. 142. Veterans Choice Fund flexibility. 

Sec. 143. Sunset of Veterans Choice Program. 

Sec. 144. Conforming amendments. 

TITLE II—IMPROVING DEPARTMENT OF VETERANS AFFAIRS 

HEALTH CARE DELIVERY 

Subtitle A—Personnel Practices 

PART I—ADMINISTRATION


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Sec. 201. Licensure of health care professionals of the Department of Veterans 

Affairs providing treatment via telemedicine. 

Sec. 202. Role of podiatrists in Department of Veterans Affairs. 

Sec. 203. Modification of treatment of certified clinical perfusionists of the Department. 

Sec. 204. Amending statutory requirements for the position of the Chief Officer 

of the Readjustment Counseling Service. 

Sec. 205. Technical amendment to appointment and compensation system for 

directors of medical centers and directors of Veterans Integrated Service Networks. 

Sec. 206. Identification and staffing of certain health care vacancies. 

Sec. 207. Department of Veterans Affairs personnel transparency. 

Sec. 208. Program on establishment of peer specialists in patient aligned care 

team settings within medical centers of Department of Veterans Affairs. 

Sec. 209. Pilot program on increasing the use of medical scribes to maximize 

the efficiency of physicians at medical facilities of the Department of Veterans Affairs. 

Sec. 210. Sense of Congress regarding Department of Veterans Affairs staffing 

levels. 

PART II—EDUCATION AND TRAINING

Sec. 211. Graduate medical education and residency. 

Sec. 212. Pilot program to establish or affiliate with graduate medical residency 

programs at facilities operated by Indian tribes, tribal organizations, and the Indian Health Service in rural areas. 

Sec. 213. Reimbursement of continuing professional education requirements for 

board certified advanced practice registered nurses. 

Sec. 214. Increase in maximum amount of debt that may be reduced under 

Education Debt Reduction Program of Department of Veterans Affairs. 

Sec. 215. Demonstration program on training and employment of alternative 

dental health care providers for dental health care services for 

veterans in rural and other underserved communities. 

PART III—OTHER PERSONNEL MATTERS

Sec. 221. Exception on limitation on awards and bonuses for recruitment, relocation, and retention. 

Sec. 222. Annual report on performance awards and bonuses awarded to certain high-level employees of the Department. 

Sec. 223. Authority to regulate additional pay for certain health care employees 

of the Department. 

Sec. 224. Modification of pay cap for nurses. 

Subtitle B—Improvement of Underserved Facilities of the Department 

Sec. 231. Development of criteria for designation of certain medical facilities of 

the Department of Veterans Affairs as underserved facilities 

and plan to address problem of underserved facilities. 

Sec. 232. Pilot program on tuition reimbursement and loan repayment for 

health care providers of the Department of Veterans Affairs at 

underserved facilities. 

Sec. 233. Program to furnish mobile deployment teams to underserved facilities. 


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Sec. 234. Inclusion of Vet Center employees in education debt reduction program of Department of Veterans Affairs. 

Subtitle C—Construction and Leases 

Sec. 241. Definition of major medical facility project and major medical facility 

lease. 

Sec. 242. Facilitating sharing of medical facilities with other Federal agencies. 

Sec. 243. Review of enhanced use leases. 

Sec. 244. Authorization of certain major medical facility projects of the Department of Veterans Affairs. 

Subtitle D—Other Health Care Matters 

Sec. 251. Program on use of wellness programs as complementary approach to 

mental health care for veterans and family members of veterans. 

Sec. 252. Authorization to provide for operations on live donors for purposes 

of conducting transplant procedures for veterans. 

Sec. 253. Sense of the Senate. 

TITLE III—FAMILY CAREGIVERS 

Sec. 301. Expansion of family caregiver program of Department of Veterans 

Affairs. 

Sec. 302. Implementation of information technology system of Department of 

Veterans Affairs to assess and improve the family caregiver 

program. 

Sec. 303. Modifications to annual evaluation report on caregiver program of 

Department of Veterans Affairs. 

TITLE IV—APPROPRIATION OF AMOUNTS 

Sec. 401. Appropriation of amounts for health care from Department of Veterans Affairs. 

Sec. 402. Appropriation of amounts for Veterans Choice Program. 

1 SEC. 2. REFERENCES TO TITLE 38, UNITED STATES CODE. 

2 Except as otherwise expressly provided, whenever in 

3 this Act an amendment or repeal is expressed in terms 

4 of an amendment to, or repeal of, a section or other provi5 sion, the reference shall be considered to be made to a 

6 section or other provision of title 38, United States Code. 


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1 TITLE I—DEVELOPING AN INTE2 GRATED HIGH-PERFORMING 

3 NETWORK 

4 Subtitle A—Establishing 

5 Community Care Programs 

6 SEC. 101. ESTABLISHMENT OF VETERANS COMMUNITY 

7 CARE PROGRAM. 

8 (a) ESTABLISHMENT OF PROGRAM.— 

9 (1) IN GENERAL.—Section 1703 is amended to 

10 read as follows: 

11 ‘‘§ 1703. Veterans Community Care Program 

12 ‘‘(a) IN GENERAL.—(1) There is established a pro13 gram to furnish hospital care, medical services, and ex14 tended care services to covered veterans through health 

15 care providers specified in subsection (c). 

16 ‘‘(2) The Secretary shall coordinate the furnishing of 

17 hospital care, medical services, and extended care services 

18 under this section to covered veterans, including coordina19 tion of, at a minimum, the following: 

20 ‘‘(A) Ensuring the scheduling of medical ap21 pointments in a timely manner and the establish22 ment of a mechanism to receive medical records 

23 from non-Department providers. 

24 ‘‘(B) Ensuring continuity of care and services. 


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1 ‘‘(C) Ensuring coordination among regional 

2 networks if the covered veteran accesses care and 

3 services in a different network than the regional net4 work in which the covered veteran resides. 

5 ‘‘(D) Ensuring that covered veterans do not ex6 perience a lapse resulting from errors or delays by 

7 the Department or its contractors or an unusual or 

8 excessive burden in accessing hospital care, medical 

9 services, or extended care services. 

10 ‘‘(b) COVERED VETERANS.—For purposes of this 

11 section, a covered veteran is any veteran who— 

12 ‘‘(1) is enrolled in the system of annual patient 

13 enrollment established and operated under section 

14 1705 of this title; or 

15 ‘‘(2) is not enrolled in such system but is other16 wise entitled to hospital care, medical services, or ex17 tended care services under subsection (c)(2) of such 

18 section. 

19 ‘‘(c) HEALTH CARE PROVIDERS SPECIFIED.—Health 

20 care providers specified in this subsection are the fol21 lowing: 

22 ‘‘(1) Any health care provider that is partici23 pating in the Medicare program under title XVIII of 

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1 cluding any physician furnishing services under such 

2 a program. 

3 ‘‘(2) The Department of Defense. 

4 ‘‘(3) The Indian Health Service. 

5 ‘‘(4) Any Federally-qualified health center (as 

6 defined in section 1905(l)(2)(B) of the Social Secu7 rity Act (42 U.S.C. 1396d(l)(2)(B))). 

8 ‘‘(5) Any health care provider not otherwise 

9 covered under any of paragraphs (1) through (4) 

10 that meets criteria established by the Secretary for 

11 purposes of this section. 

12 ‘‘(d) CONDITIONS UNDER WHICH CARE IS RE13 QUIRED TO BE FURNISHED THROUGH NON-DEPART14 MENT PROVIDERS.—(1) The Secretary shall, subject to 

15 the availability of appropriations, furnish hospital care, 

16 medical services, and extended care services to a covered 

17 veteran through health care providers specified in sub18 section (c) if— 

19 ‘‘(A) the Department does not offer the care or 

20 services the veteran requires; 

21 ‘‘(B) the Department does not operate a full22 service medical facility in the State in which the cov23 ered veteran resides; 

24 ‘‘(C) the covered veteran was an eligible veteran 

25 under section 101(b)(2)(B) of the Veterans Access, 


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1 Choice, and Accountability Act of 2014 (Public Law 

2 113–146; 38 U.S.C. 1701 note) as of the day before 

3 the date of the enactment of the Caring for our Vet4 erans Act of 2017; or 

5 ‘‘(D) the covered veteran and the covered vet6 eran’s primary care provider agree that furnishing 

7 care and services through a non-Department entity 

8 or provider would be in the best medical interest of 

9 the covered veteran based upon criteria developed by 

10 the Secretary. 

11 ‘‘(2) The Secretary shall ensure that the criteria de12 veloped under paragraph (1)(D) include consideration of 

13 the following: 

14 ‘‘(A) The distance between the covered veteran 

15 and the facility that provides the hospital care, med16 ical services, or extended care services the veteran 

17 needs. 

18 ‘‘(B) The nature of the hospital care, medical 

19 services, or extended care services required. 

20 ‘‘(C) The frequency that the hospital care, med21 ical services, or extended care services needs to be 

22 furnished. 

23 ‘‘(D) Whether an appointment for the hospital 

24 care, medical services, or extended care services the 

25 covered veteran requires is available from a health 


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1 care provider of the Department within the lesser 

2 of— 

3 ‘‘(i) the access guidelines for such hospital 

4 care, medical services, or extended care services 

5 as established by the Secretary; and 

6 ‘‘(ii) a period determined by a health care 

7 provider of the Department to be clinically nec8 essary for the receipt of such hospital care, 

9 medical services, or extended care services. 

10 ‘‘(E) Whether the covered veteran faces an un11 usual or excessive burden to access hospital care, 

12 medical services, or extended care services from the 

13 Department medical facility where a covered veteran 

14 seeks hospital care, medical services, or extended 

15 care services, which shall include consideration of 

16 the following: 

17 ‘‘(i) Whether the covered veteran faces an 

18 excessive driving distance, geographical chal19 lenge, or environmental factor that impedes the 

20 access of the covered veteran. 

21 ‘‘(ii) Whether the hospital care, medical 

22 services, or extended care services sought by the 

23 veteran is provided by a medical facility of the 

24 Department that is reasonably accessible to a 

25 covered veteran. 


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1 ‘‘(iii) Whether a medical condition of the 

2 covered veteran affects the ability of the covered 

3 veteran to travel. 

4 ‘‘(iv) Whether there is compelling reason, 

5 as determined by the Secretary, that the vet6 eran needs to receive hospital care, medical 

7 services, or extended care services from a med8 ical facility other than a medical facility of the 

9 Department. 

10 ‘‘(v) Such other considerations as the Sec11 retary considers appropriate. 

12 ‘‘(3) If the Secretary has determined that the Depart13 ment does not offer the care or services the covered vet14 eran requires under subparagraph (A) of paragraph (1), 

15 that the Department does not operate a full-service med16 ical facility in the State in which the covered veteran re17 sides under subparagraph (B) of such paragraph, or that 

18 the covered veteran is described under subparagraph (C) 

19 of such paragraph, the decision to receive hospital care, 

20 medical services, or extended care services under such sub21 paragraphs from a health care provider specified in sub22 section (c) shall be at the election of the veteran. 

23 ‘‘(e) CONDITIONS UNDER WHICH CARE IS AUTHOR24 IZED TO BE FURNISHED THROUGH NON-DEPARTMENT

25 PROVIDERS.—(1)(A) The Secretary may furnish hospital 


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1 care, medical services, or extended care services through 

2 a health care provider specified in subsection (c) to a cov3 ered veteran served by a medical service line of the De4 partment that the Secretary has determined is not pro5 viding care that meets such quality and access standards 

6 as the Secretary shall develop. 

7 ‘‘(B) In carrying out subparagraph (A), the Secretary 

8 shall— 

9 ‘‘(i) measure access of the medical service line 

10 at a facility of the Department when compared with 

11 the same medical service line at different Depart12 ment facilities; and 

13 ‘‘(ii) measure quality at a medical service line 

14 of a facility of the Department by comparing it with 

15 two or more distinct and appropriate quality meas16 ures at non-Department medical service lines. 

17 ‘‘(C)(i) The Secretary may not concurrently furnish 

18 hospital care, medical services, or extended care services 

19 under subparagraph (A) with respect to more than three 

20 medical service lines described in such subparagraph at 

21 any one health care facility of the Department. 

22 ‘‘(ii) The Secretary may not concurrently furnish hos23 pital care, medical services, or extended care services 

24 under subparagraph (A) with respect to more than 36 


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1 medical service lines nationally described in such subpara2 graph. 

3 ‘‘(2) The Secretary may limit the types of hospital 

4 care, medical services, or extended care services covered 

5 veterans may receive under paragraph (1) because of an 

6 access and quality deficiency of a medical service line in 

7 terms of the length of time such care and services will 

8 be available, the location at which such care and services 

9 will be available, and the clinical care and services that 

10 will be available. 

11 ‘‘(3) The hospital care, medical services, and ex12 tended care services authorized under paragraph (1) with 

13 respect to a medical service line shall cease when the reme14 diation described in subsection (g) with respect to such 

15 medical service line is complete. 

16 ‘‘(4) The Secretary shall publish in the Federal Reg17 ister, and shall take all reasonable steps to provide direct 

18 notice to covered veterans affected under this subsection, 

19 at least once each year stating the time period during 

20 which such care and services will be available, the location 

21 or locations where such care and services will be available, 

22 and the clinical services available at each location under 

23 this subsection in accordance with regulations the Sec24 retary shall prescribe. 


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1 ‘‘(5) When the Secretary exercises the authority 

2 under paragraph (1), the decision to receive care or serv3 ices under such paragraph from a health care provider 

4 specified in subsection (c) shall be at the election of the 

5 covered veteran. 

6 ‘‘(f) REVIEW OF DECISIONS.—The review of any de7 cision under subsection (d) or (e) shall be subject to the 

8 Department’s local clinical appeals process, and such deci9 sions may not be appealed to the Board of Veterans’ Ap10 peals. 

11 ‘‘(g) REMEDIATION OF MEDICAL SERVICE LINES.— 

12 (1) Not later than 30 days after determining under sub13 section (e)(1) that a medical service line of the Depart14 ment is providing hospital care, medical services, or ex15 tended care services that does not comply with the access 

16 guidelines and meet the standards of quality established 

17 by the Secretary, the Secretary shall submit to Congress 

18 an assessment of the factors that led the Secretary to 

19 make such determination and a plan with specific actions, 

20 and the time to complete them, to be taken to comply with 

21 such access guidelines and meet such standards of quality, 

22 including the following: 

23 ‘‘(A) Increasing personnel or temporary per24 sonnel assistance, including mobile deployment 

25 teams. 


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1 ‘‘(B) Special hiring incentives, including the 

2 Education Debt Reduction Program under sub3 chapter VII of chapter 76 of this title and recruit4 ment, relocation, and retention incentives. 

5 ‘‘(C) Utilizing direct hiring authority. 

6 ‘‘(D) Providing improved training opportunities 

7 for staff. 

8 ‘‘(E) Acquiring improved equipment. 

9 ‘‘(F) Making structural modifications to the fa10 cility used by the medical service line. 

11 ‘‘(G) Such other actions as the Secretary con12 siders appropriate. 

13 ‘‘(2) In each assessment submitted under paragraph 

14 (1) with respect to a medical service line, the Secretary 

15 shall identify the individuals at the Central Office of the 

16 Veterans Health Administration, the facility used by the 

17 medical service line, and the central office of the relevant 

18 Veterans Integrated Service Network who are responsible 

19 for overseeing the progress of that medical service line in 

20 complying with the access guidelines and meeting the 

21 standards of quality established by the Secretary. 

22 ‘‘(3) Not later than 180 days after submitting an as23 sessment under paragraph (1) with respect to a medical 

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1 plying with the access guidelines and meeting the stand2 ards of quality established by the Secretary and any other 

3 measures the Secretary will take to assist the medical 

4 service line in complying with such access guidelines and 

5 meeting such standards of quality. 

6 ‘‘(4) Not less frequently than once each year, the Sec7 retary shall— 

8 ‘‘(A) submit to Congress an analysis of the re9 mediation actions and costs of such actions taken 

10 with respect to each medical service line with respect 

11 to which the Secretary submitted an assessment and 

12 plan under paragraph (1) in the preceding year, in13 cluding an update on the progress of each such med14 ical service line in meeting the quality and access 

15 standards established by the Secretary and any 

16 other actions the Secretary is undertaking to assist 

17 the medical service line in complying with access 

18 guidelines and meeting standards of quality as es19 tablished by the Secretary; and 

20 ‘‘(B) publish such analysis on the Internet 

21 website of the Department. 

22 ‘‘(h) ACCESS GUIDELINES AND STANDARDS FOR

23 QUALITY.—(1) The Secretary shall establish access guide24 lines under section 1703B of this title and standards for 

25 quality under section 1703C of this title for furnishing 


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1 hospital care, medical services, or extended care services 

2 to a covered veteran for the purposes of subsections (d) 

3 and (e). 

4 ‘‘(2) The Secretary shall ensure that the access 

5 guidelines and standards for quality required by sections 

6 1703B and 1703C of this title provide covered veterans, 

7 employees of the Department, and health care providers 

8 in the network established under subsection (j) with rel9 evant comparative information that is clear, useful, and 

10 timely, so that covered veterans can make informed deci11 sions regarding their health care. 

12 ‘‘(3) The Secretary shall consult with all pertinent 

13 Federal entities (including the Department of Defense, the 

14 Department of Health and Human Services, and the Cen15 ters for Medicare & Medicaid Services), entities in the pri16 vate sector, and other nongovernmental entities in estab17 lishing access guidelines and standards for quality as re18 quired by sections 1703B and 1703C of this title. 

19 ‘‘(4) Not later than 270 days after the date of the 

20 enactment of the Caring for our Veterans Act of 2017, 

21 the Secretary shall submit to the appropriate committees 

22 of Congress a report detailing the access guidelines and 

23 standards for quality established under sections 1703B 

24 and 1703C of this title. 


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1 ‘‘(5) Not later than three years after the date on 

2 which the Secretary establishes access guidelines and 

3 standards for quality under paragraph (1) and not less 

4 frequently than once every three years thereafter, the Sec5 retary shall— 

6 ‘‘(A) conduct a review of such guidelines and 

7 standards; and 

8 ‘‘(B) submit to the appropriate committees of 

9 Congress a report on the findings and any modifica10 tion to the access guidelines and standards for qual11 ity with respect to the review conducted under sub12 paragraph (A). 

13 ‘‘(6) The Secretary shall ensure health care providers 

14 specified under subsection (c) are able to meet the applica15 ble access guidelines and standards of quality established 

16 by the Secretary. 

17 ‘‘(i) TIERED NETWORK.—(1) To promote the provi18 sion of high-quality and high-value hospital care, medical 

19 services, and extended care services under this section, the 

20 Secretary may develop a tiered provider network of eligible 

21 providers based on criteria established by the Secretary 

22 for purposes of this section. 

23 ‘‘(2) In developing a tiered provider network of eligi24 ble providers under paragraph (1), the Secretary shall not 

25 prioritize providers in a tier over providers in any other 


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1 tier in a manner that limits the choice of a covered veteran 

2 in selecting a health care provider specified in subsection 

3 (c) for receipt of hospital care, medical services, or ex4 tended care services under this section. 

5 ‘‘(j) CONTRACTS TO ESTABLISH NETWORKS OF

6 HEALTH CARE PROVIDERS.—(1) The Secretary shall 

7 enter into consolidated, competitively bid contracts to es8 tablish networks of health care providers specified in para9 graphs (1) and (5) of subsection (c) for purposes of pro10 viding sufficient access to hospital care, medical services, 

11 or extended care services under this section. 

12 ‘‘(2)(A) The Secretary shall, to the extent practicable, 

13 ensure that covered veterans are able to make their own 

14 appointments using advanced technology. 

15 ‘‘(B) To the extent practicable, the Secretary shall 

16 be responsible for the scheduling of appointments for hos17 pital care, medical services, and extended care services 

18 under this section. 

19 ‘‘(3)(A) The Secretary may terminate a contract with 

20 an entity entered into under paragraph (1) at such time 

21 and upon such notice to the entity as the Secretary may 

22 specify for purposes of this section, if the Secretary noti23 fies the appropriate committees of Congress that, at a 

24 minimum— 

25 ‘‘(i) the entity— 


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1 ‘‘(I) failed to comply substantially with the 

2 provisions of the contract or with the provisions 

3 of this section and the regulations prescribed 

4 under this section; 

5 ‘‘(II) failed to comply with the access 

6 guidelines or meet the standards of quality es7 tablished by the Secretary; 

8 ‘‘(III) is excluded from participation in a 

9 Federal health care program (as defined in sec10 tion 1128B(f) of the Social Security Act (42 

11 U.S.C. 1320a–7b(f))) under section 1128 or 

12 1128A of the Social Security Act (42 U.S.C. 

13 1320a–7 and 1320a–7a); 

14 ‘‘(IV) is identified as an excluded source 

15 on the list maintained in the System for Award 

16 Management, or any successor system; or 

17 ‘‘(V) has been convicted of a felony or 

18 other serious offense under Federal or State 

19 law and the continued participation of the enti20 ty would be detrimental to the best interests of 

21 veterans or the Department; 

22 ‘‘(ii) it is reasonable to terminate the contract 

23 based on the health care needs of veterans; or 

24 ‘‘(iii) it is reasonable to terminate the contract 

25 based on coverage provided by contracts or sharing 


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1 agreements entered into under authorities other 

2 than this section. 

3 ‘‘(B) Nothing in subparagraph (A) may be construed 

4 to restrict the authority of the Secretary to terminate a 

5 contract entered into under paragraph (1) under any other 

6 provision of law. 

7 ‘‘(4) Whenever the Secretary provides notice to an 

8 entity that the entity is failing to meet contractual obliga9 tions entered into under paragraph (1), the Secretary shall 

10 submit to the Committee on Veterans’ Affairs of the Sen11 ate and the Committee on Veterans’ Affairs of the House 

12 of Representatives a report on such failure. Such report 

13 shall include the following: 

14 ‘‘(A) An explanation of the reasons for pro15 viding such notice. 

16 ‘‘(B) A description of the effect of such failure, 

17 including with respect to cost, schedule, and require18 ments. 

19 ‘‘(C) A description of the actions taken by the 

20 Secretary to mitigate such failure. 

21 ‘‘(D) A description of the actions taken by the 

22 contractor to address such failure. 

23 ‘‘(E) A description of any effect on the commu24 nity provider market for veterans in the affected 

25 area. 


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1 ‘‘(5)(A) The Secretary shall instruct each entity 

2 awarded a contract under paragraph (1) to recognize and 

3 accept, on an interim basis, the credentials and qualifica4 tions of health care providers who are authorized to fur5 nished hospital care and medical services to veterans 

6 under a community care program of the Department in 

7 effect as of the day before the date of the enactment of 

8 the Caring for our Veterans Act of 2017, including under 

9 the Patient-Centered Community Care Program and the 

10 Veterans Choice Program under section 101 of the Vet11 erans Access, Choice, and Accountability Act of 2014 

12 (Public Law 113–146; 38 U.S.C. 1701 note), as qualified 

13 providers under the program established under this sec14 tion. 

15 ‘‘(B) The interim acceptance period under subpara16 graph (A) shall be determined by the Secretary based on 

17 the following criteria: 

18 ‘‘(i) With respect to a health care provider, 

19 when the current certification agreement for the 

20 health care provider expires. 

21 ‘‘(ii) Whether the Department has enacted cer22 tification and eligibility criteria and regulatory pro23 cedures by which non-Department providers will be 

24 authorized under this section. 


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1 ‘‘(6) The Secretary shall establish through regulation 

2 a system or systems for monitoring the quality of care pro3 vided to covered veterans through a network under this 

4 subsection and for assessing the quality of hospital care, 

5 medical services, and extended care services furnished 

6 through such network before the renewal of the contract 

7 for such network. 

8 ‘‘(k) PAYMENT RATES FOR CARE AND SERVICES.— 

9 (1) Except as provided in paragraph (2), and to the extent 

10 practicable, the rate paid for hospital care, medical serv11 ices, or extended care services under any provision in this 

12 title may not exceed the rate paid by the United States 

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

14 of the Social Security Act (42 U.S.C. 1395x(u))) or a sup15 plier (as defined in section 1861(d) of such Act (42 U.S.C. 

16 1395x(d))) under the Medicare program under title XI or 

17 title XVIII of the Social Security Act (42 U.S.C. 1301 

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

19 ‘‘(2)(A) A higher rate than the rate paid by the 

20 United States as described in paragraph (1) may be nego21 tiated with respect to the furnishing of care or services 

22 to a covered veteran who resides in a highly rural area. 

23 ‘‘(B) In this paragraph, the term ‘highly rural area’ 

24 means an area located in a county that has fewer than 

25 seven individuals residing in that county per square mile. 


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1 ‘‘(3) With respect to furnishing care or services under 

2 this section in Alaska, the Alaska Fee Schedule of the De3 partment of Veterans Affairs shall be followed, except for 

4 when another payment agreement, including a contract or 

5 provider agreement, is in effect. 

6 ‘‘(4) With respect to furnishing hospital care, medical 

7 services, or extended care services under this section in 

8 a State with an All-Payer Model Agreement under section 

9 1814(b)(3) of the Social Security Act (42 U.S.C. 

10 1395f(b)(3)) that became effective on or after January 1, 

11 2014, the Medicare payment rates under paragraph 

12 (2)(A) shall be calculated based on the payment rates 

13 under such agreement. 

14 ‘‘(5) Notwithstanding paragraph (1), the Secretary 

15 may incorporate, to the greatest extent practicable, the 

16 use of value-based reimbursement models to promote the 

17 provision of high-quality care. 

18 ‘‘(6) With respect to hospital care, medical services, 

19 or extended care services for which there is not a rate paid 

20 under the Medicare program as described in paragraph 

21 (1), the rate paid for such care or services shall be deter22 mined by the Secretary. 

23 ‘‘(l) TREATMENT OF OTHER HEALTH CARE

24 PLANS.—(1) In any case in which a covered veteran is 

25 furnished hospital care, medical services, or extended care 


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1 services under this section for a non-service-connected dis2 ability described in subsection (a)(2) of section 1729 of 

3 this title, the Secretary shall recover or collect reasonable 

4 charges for such care or services from a health care plan 

5 described in paragraph (2) in accordance with such sec6 tion. 

7 ‘‘(2) A health care plan described in this paragraph— 

8 ‘‘(A) is an insurance policy or contract, medical 

9 or hospital service agreement, membership or sub10 scription contract, or similar arrangement not ad11 ministered by the Secretary, under which hospital 

12 care, medical services, or extended care services for 

13 individuals are provided or the expenses of such care 

14 or services are paid; and 

15 ‘‘(B) does not include any such policy, contract, 

16 agreement, or similar arrangement pursuant to title 

17 XVIII or XIX of the Social Security Act (42 U.S.C. 

18 1395 et seq.) or chapter 55 of title 10. 

19 ‘‘(m) PAYMENT BY VETERAN.—A covered veteran 

20 shall not pay a greater amount for receiving care or serv21 ices under this section than the amount the veteran would 

22 pay for receiving the same or comparable care or services 

23 at a medical facility of the Department or from a health 

24 care provider of the Department. 


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1 ‘‘(n) MONITORING OF CARE PROVIDED.—(1)(A) Not 

2 later than 540 days after the date of the enactment of 

3 the Caring for our Veterans Act of 2017, and not less 

4 frequently than annually thereafter, the Secretary shall 

5 submit to appropriate committees of Congress a review of 

6 the types and frequency of care sought under subsection 

7 (d). 

8 ‘‘(B) The review submitted under subparagraph (A) 

9 shall include an assessment of the following: 

10 ‘‘(i) The top 25 percent of types of care and 

11 services most frequently provided under subsection 

12 (d) due to the Department not offering such care 

13 and services. 

14 ‘‘(ii) The frequency such care and services were 

15 sought by covered veterans under this section. 

16 ‘‘(iii) An analysis of the reasons the Depart17 ment was unable to provide such care and services. 

18 ‘‘(iv) Any steps the Department took to provide 

19 such care and services at a medical facility of the 

20 Department. 

21 ‘‘(v) The cost of such care and services. 

22 ‘‘(2) In monitoring the hospital care, medical serv23 ices, and extended care services furnished under this sec24 tion, the Secretary shall do the following: 


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1 ‘‘(A) With respect to hospital care, medical 

2 services, and extended care services furnished 

3 through provider networks established under sub4 section (j)— 

5 ‘‘(i) compile data on the types of hospital 

6 care, medical services, and extended care serv7 ices furnished through such networks and how 

8 many patients used each type of care and serv9 ice; 

10 ‘‘(ii) identify gaps in hospital care, medical 

11 services, or extended care services furnished 

12 through such networks; 

13 ‘‘(iii) identify how such gaps may be fixed 

14 through new contracts within such networks or 

15 changes in the manner in which hospital care, 

16 medical services, or extended care services are 

17 furnished through such networks; 

18 ‘‘(iv) assess the total amounts spent by the 

19 Department on hospital care, medical services, 

20 and extended care services furnished through 

21 such networks; 

22 ‘‘(v) assess the timeliness of the Depart23 ment in referring hospital care, medical serv24 ices, and extended care services to such net25 works; and 


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1 ‘‘(vi) assess the timeliness of such net2 works in— 

3 ‘‘(I) accepting referrals; and 

4 ‘‘(II) scheduling and completing ap5 pointments. 

6 ‘‘(B) Report the number of medical service lines 

7 the Secretary has determined under subsection 

8 (e)(1) not to be providing hospital care, medical 

9 services, or extended care services that comply with 

10 the access guidelines or meet the standards of qual11 ity established by the Secretary. 

12 ‘‘(C) Assess the use of academic affiliates and 

13 centers of excellence of the Department to furnish 

14 hospital care, medical services, and extended care 

15 services to covered veterans under this section. 

16 ‘‘(D) Assess the hospital care, medical services, 

17 and extended care services furnished to covered vet18 erans under this section by medical facilities oper19 ated by Federal agencies other than the Depart20 ment. 

21 ‘‘(3) Not later than 540 days after the date of the 

22 enactment of the Caring for our Veterans Act of 2017 and 

23 not less frequently than once each year thereafter, the Sec24 retary shall submit to the Committee on Veterans’ Affairs 

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


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1 the House of Representatives a report on the information 

2 gathered under paragraph (2). 

3 ‘‘(o) PROHIBITION ON CERTAIN LIMITATIONS.—The 

4 Secretary shall not limit the types of hospital care, medical 

5 services, or extended care services covered veterans may 

6 receive under this section if it is in the best interest of 

7 the veteran to receive such hospital care, medical services, 

8 or extended care services, as determined by the veteran 

9 and the veteran’s health care provider. 

10 ‘‘(p) DEFINITIONS.—In this section: 

11 ‘‘(1) The term ‘appropriate committees of Con12 gress’ means— 

13 ‘‘(A) the Committee on Veterans’ Affairs 

14 and the Committee on Appropriations of the 

15 Senate; and 

16 ‘‘(B) the Committee on Veterans’ Affairs 

17 and the Committee on Appropriations of the 

18 House of Representatives. 

19 ‘‘(2) The term ‘medical service line’ means a 

20 clinic within a Department medical center.’’. 

21 (2) CLERICAL AMENDMENT.—The table of sec22 tions at the beginning of chapter 17 is amended by 

23 striking the item relating to section 1703 and insert24 ing the following new item: 

‘‘1703. Veterans Community Care Program.’’. 


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1 (b) EFFECTIVE DATE.—Section 1703 of title 38, 

2 United States Code, as amended by subsection (a), shall 

3 take effect on the later of— 

4 (1) the date that is 30 days after the date on 

5 which the Secretary of Veterans Affairs submits the 

6 report required under section 101(q)(2) of the Vet7 erans Access, Choice, and Accountability Act of 

8 2014 (Public Law 113–146; 38 U.S.C. 1701 note); 

9 or 

10 (2) the date on which the Secretary promul11 gates regulations pursuant to subsection (c). 

12 (c) REGULATIONS.—Not later than one year after the 

13 date of the enactment of this Act, the Secretary of Vet14 erans Affairs shall promulgate regulations to carry out 

15 section 1703 of title 38, United States Code, as amended 

16 by subsection (a) of this section. 

17 (d) CONTINUITY OF EXISTING AGREEMENTS.— 

18 (1) IN GENERAL.—Notwithstanding section 

19 1703 of title 38, United States Code, as amended by 

20 subsection (a), the Secretary of Veterans Affairs 

21 shall continue all contracts, memorandums of under22 standing, memorandums of agreements, and other 

23 arrangements that were in effect on the day before 

24 the date of the enactment of this Act between the 

25 Department of Veterans Affairs and the American 


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1 Indian and Alaska Native health care systems as es2 tablished under the terms of the Department of Vet3 erans Affairs and Indian Health Service Memo4 randum of Understanding, signed October 1, 2010, 

5 the National Reimbursement Agreement, signed De6 cember 5, 2012, and agreements entered into under 

7 sections 102 and 103 of the Veterans Access, 

8 Choice, and Accountability Act of 2014 (Public Law 

9 113–146). 

10 (2) MODIFICATIONS.—Paragraph (1) shall not 

11 be construed to prohibit the Secretary and the par12 ties to the contracts, memorandums of under13 standing, memorandums of agreements, and other 

14 arrangements described in such paragraph from 

15 making such changes to such contracts, memoran16 dums of understanding, memorandums of agree17 ments, and other arrangements as may be otherwise 

18 authorized pursuant to other provisions of law or the 

19 terms of the contracts, memorandums of under20 standing, memorandums of agreements, and other 

21 arrangements. 


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1 SEC. 102. AUTHORIZATION OF AGREEMENTS BETWEEN DE2 PARTMENT OF VETERANS AFFAIRS AND NON3 DEPARTMENT PROVIDERS. 

4 (a) IN GENERAL.—Subchapter I of chapter 17 is 

5 amended by inserting after section 1703 the following new 

6 section: 

7 ‘‘§ 1703A. Agreements with eligible entities or pro8 viders; certification processes 

9 ‘‘(a) AGREEMENTS AUTHORIZED.—(1)(A) When hos10 pital care, a medical service, or an extended care service 

11 required by a veteran who is entitled to such care or serv12 ice under this chapter is not feasibly available to the vet13 eran from a facility of the Department or through a con14 tract or sharing agreement entered into pursuant to an15 other provision of law, the Secretary may furnish such 

16 care or service to such veteran by entering into an agree17 ment under this section with an eligible entity or provider 

18 to provide such hospital care, medical service, or extended 

19 care service. 

20 ‘‘(B) An agreement entered into under this section 

21 to provide hospital care, a medical service, or an extended 

22 care service shall be known as a ‘Veterans Care Agree23 ment’. 

24 ‘‘(C) For purposes of subparagraph (A), hospital 

25 care, a medical service, or an extended care service may 

26 be considered not feasibly available to a veteran from a 


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1 facility of the Department or through a contract or shar2 ing agreement described in such subparagraph when the 

3 Secretary determines the veteran’s medical condition, the 

4 travel involved, the nature of the care or services required, 

5 or a combination of these factors make the use of a facility 

6 of the Department or a contract or sharing agreement de7 scribed in such subparagraph impracticable or inadvisable. 

8 ‘‘(D) A Veterans Care Agreement may be entered 

9 into by the Secretary or any Department official author10 ized by the Secretary. 

11 ‘‘(2)(A) Subject to subparagraph (B), the Secretary 

12 shall review each Veterans Care Agreement of material 

13 size, as determined by the Secretary or set forth in para14 graph (3), for hospital care, a medical service, or an ex15 tended care service to determine whether it is feasible and 

16 advisable to provide such care or service within a facility 

17 of the Department or by contract or sharing agreement 

18 entered into pursuant to another provision of law and, if 

19 so, take action to do so. 

20 ‘‘(B)(i) The Secretary shall review each Veterans 

21 Care Agreement of material size that has been in effect 

22 for at least six months within the first two years of its 

23 taking effect, and not less frequently than once every four 

24 years thereafter. 


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1 ‘‘(ii) If a Veterans Care Agreement has not been in 

2 effect for at least six months by the date of the review 

3 required by subparagraph (A), the agreement shall be re4 viewed during the next cycle required by subparagraph 

5 (A), and such review shall serve as its review within the 

6 first two years of its taking effect for purposes of clause 

7 (i). 

8 ‘‘(3)(A) In fiscal year 2018 and in each fiscal year 

9 thereafter, in addition to such other Veterans Care Agree10 ments as the Secretary may determine are of material size, 

11 a Veterans Care Agreement for the purchase of extended 

12 care services that exceeds $5,000,000 annually shall be 

13 considered of material size. 

14 ‘‘(B) From time to time, the Secretary may publish 

15 a notice in the Federal Register to adjust the dollar 

16 amount specified in subparagraph (A) to account for 

17 changes in the cost of health care based upon recognized 

18 health care market surveys and other available data. 

19 ‘‘(b) ELIGIBLE ENTITIES AND PROVIDERS.—For 

20 purposes of this section, an eligible entity or provider is— 

21 ‘‘(1) any provider of services that has enrolled 

22 and entered into a provider agreement under section 

23 1866(a) of the Social Security Act (42 U.S.C. 

24 1395cc(a)) and any physician or other supplier who 

25 has enrolled and entered into a participation agreeVerDate Sep 11 2014 23:02 Dec 05, 2017 Jkt 079200 PO 00000 Frm 00033 Fmt 6652 Sfmt 6201 E:\BILLS\S2193.PCS S2193

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1 ment under section 1842(h) of such Act (42 U.S.C. 

2 1395u(h)); 

3 ‘‘(2) any provider participating under a State 

4 plan under title XIX of such Act (42 U.S.C. 1396 

5 et seq.); or 

6 ‘‘(3) any entity or provider not described in 

7 paragraph (1) or (2) of this subsection that the Sec8 retary determines to be eligible pursuant to the cer9 tification process described in subsection (c). 

10 ‘‘(c) ELIGIBLE ENTITY OR PROVIDER CERTIFI11 CATION PROCESS.—The Secretary shall establish by regu12 lation a process for the certification of eligible entities or 

13 providers or recertification of eligible entities or providers 

14 under this section. Such a process shall, at a minimum— 

15 ‘‘(1) establish deadlines for actions on applica16 tions for certification; 

17 ‘‘(2) set forth standards for an approval or de18 nial of certification, duration of certification, revoca19 tion of an eligible entity or provider’s certification, 

20 and recertification of eligible entities or providers; 

21 ‘‘(3) require the denial of certification if the 

22 Secretary determines the eligible entity or provider 

23 is excluded from participation in a Federal health 

24 care program under section 1128 or section 1128A 

25 of the Social Security Act (42 U.S.C. 1320a–7 or 


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1 1320a–7a) or is currently identified as an excluded 

2 source on the System for Award Management Exclu3 sions list described in part 9 of title 48, Code of 

4 Federal Regulations, and part 180 of title 2 of such 

5 Code, or successor regulations; 

6 ‘‘(4) establish procedures for screening eligible 

7 entities or providers according to the risk of fraud, 

8 waste, and abuse that are similar to the standards 

9 under section 1866(j)(2)(B) of the Social Security 

10 Act (42 U.S.C. 1395cc(j)(2)(B)) and section 9.104 

11 of title 48, Code of Federal Regulations, or suc12 cessor regulations; and 

13 ‘‘(5) incorporate and apply the restrictions and 

14 penalties set forth in chapter 21 of title 41 and treat 

15 this section as a procurement program only for pur16 poses of applying such provisions. 

17 ‘‘(d) RATES.—To the extent practicable, the rates 

18 paid by the Secretary for hospital care, medical services, 

19 and extended care services provided under a Veterans 

20 Care Agreement shall be in accordance with the rates paid 

21 by the United States under the Medicare program. 

22 ‘‘(e) TERMS OF VETERANS CARE AGREEMENTS.—(1) 

23 Pursuant to regulations promulgated under subsection 

24 (k), the Secretary may define the requirements for pro25 viders and entities entering into agreements under this 


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1 section based upon such factors as the number of patients 

2 receiving care or services, the number of employees em3 ployed by the entity or provider furnishing such care or 

4 services, the amount paid by the Secretary to the provider 

5 or entity, or other factors as determined by the Secretary. 

6 ‘‘(2) To furnish hospital care, medical services, or ex7 tended care services under this section, an eligible entity 

8 or provider shall agree— 

9 ‘‘(A) to accept payment at the rates established 

10 in regulations prescribed under this section; 

11 ‘‘(B) that payment by the Secretary under this 

12 section on behalf of a veteran to a provider of serv13 ices or care shall, unless rejected and refunded by 

14 the provider within 30 days of receipt, constitute 

15 payment in full and extinguish any liability on the 

16 part of the veteran for the treatment or care pro17 vided, and no provision of a contract, agreement, or 

18 assignment to the contrary shall operate to modify, 

19 limit, or negate this requirement; 

20 ‘‘(C) to provide only the care and services au21 thorized by the Department under this section and 

22 to obtain the prior written consent of the Depart23 ment to furnish care or services outside the scope of 

24 such authorization; 


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1 ‘‘(D) to bill the Department in accordance with 

2 the methodology outlined in regulations prescribed 

3 under this section; 

4 ‘‘(E) to not seek to recover or collect from a 

5 health plan contract or third party, as those terms 

6 are defined in section 1729 of this title, for any care 

7 or service that is furnished or paid for by the De8 partment; 

9 ‘‘(F) to provide medical records to the Depart10 ment in the time frame and format specified by the 

11 Department; and 

12 ‘‘(G) to meet such other terms and conditions, 

13 including quality of care assurance standards, as the 

14 Secretary may specify in regulation. 

15 ‘‘(f) DISCONTINUATION OR NONRENEWAL OF A VET16 ERANS CARE AGREEMENT.—(1) An eligible entity or pro17 vider may discontinue a Veterans Care Agreement at such 

18 time and upon such notice to the Secretary as may be 

19 provided in regulations prescribed under this section. 

20 ‘‘(2) The Secretary may discontinue a Veterans Care 

21 Agreement with an eligible entity or provider at such time 

22 and upon such reasonable notice to the eligible entity or 

23 provider as may be specified in regulations prescribed 

24 under this section, if an official designated by the Sec25 retary— 


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1 ‘‘(A) has determined that the eligible entity or 

2 provider failed to comply substantially with the pro3 visions of the Veterans Care Agreement, or with the 

4 provisions of this section or regulations prescribed 

5 under this section; 

6 ‘‘(B) has determined the eligible entity or pro7 vider is excluded from participation in a Federal 

8 health care program under section 1128 or section 

9 1128A of the Social Security Act (42 U.S.C. 1320a– 

10 7 or 1320a–7a) or is identified on the System for 

11 Award Management Exclusions list as provided in 

12 part 9 of title 48, Code of Federal Regulations, and 

13 part 180 of title 2 of such Code, or successor regula14 tions; 

15 ‘‘(C) has ascertained that the eligible entity or 

16 provider has been convicted of a felony or other seri17 ous offense under Federal or State law and deter18 mines the eligible entity or provider’s continued par19 ticipation would be detrimental to the best interests 

20 of veterans or the Department; or 

21 ‘‘(D) has determined that it is reasonable to 

22 terminate the agreement based on the health care 

23 needs of a veteran. 

24 ‘‘(g) QUALITY OF CARE.—The Secretary shall estab25 lish through regulation a system or systems for monitoring 


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1 the quality of care provided to veterans through Veterans 

2 Care Agreements and for assessing the quality of hospital 

3 care, medical services, and extended care services fur4 nished by eligible entities and providers before the renewal 

5 of Veterans Care Agreements. 

6 ‘‘(h) DISPUTES.—(1) The Secretary shall promulgate 

7 administrative procedures for eligible entities and pro8 viders to present all disputes arising under or related to 

9 Veterans Care Agreements. 

10 ‘‘(2) Such procedures constitute the eligible entities’ 

11 and providers’ exhaustive and exclusive administrative 

12 remedies. 

13 ‘‘(3) Eligible entities or providers must first exhaust 

14 such administrative procedures before seeking any judicial 

15 review under section 1346 of title 28 (known as the ‘Tuck16 er Act’). 

17 ‘‘(4) Disputes under this section must pertain to ei18 ther the scope of authorization under the Veterans Care 

19 Agreement or claims for payment subject to the Veterans 

20 Care Agreement and are not claims for the purposes of 

21 such laws that would otherwise require application of sec22 tions 7101 through 7109 of title 41, United States Code. 

23 ‘‘(i) APPLICABILITY OF OTHER PROVISIONS OF

24 LAW.—(1) A Veterans Care Agreement may be authorized 


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1 by the Secretary or any Department official authorized by 

2 the Secretary, and such action shall not be treated as— 

3 ‘‘(A) an award for the purposes of such laws 

4 that would otherwise require the use of competitive 

5 procedures for the furnishing of care and services; or 

6 ‘‘(B) a Federal contract for the acquisition of 

7 goods or services for purposes of any provision of 

8 Federal law governing Federal contracts for the ac9 quisition of goods or services. 

10 ‘‘(2)(A) Except as provided in subparagraph (B), and 

11 unless otherwise provided in this section or regulations 

12 prescribed pursuant to this section, an eligible entity or 

13 provider that enters into an agreement under this section 

14 is not subject to, in the carrying out of the agreement, 

15 any law to which providers of services and suppliers under 

16 the Medicare program under title XVIII of the Social Se17 curity Act (42 U.S.C. 1395 et seq.) are not subject. 

18 ‘‘(B) An eligible entity or provider that enters into 

19 an agreement under this section is subject to— 

20 ‘‘(i) all laws regarding integrity, ethics, or 

21 fraud, or that subject a person to civil or criminal 

22 penalties; and 

23 ‘‘(ii) all laws that protect against employment 

24 discrimination or that otherwise ensure equal em25 ployment opportunities. 


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1 ‘‘(3) Notwithstanding paragraph (2)(B)(i), an eligible 

2 entity or provider that enters into an agreement under this 

3 section shall not be treated as a Federal contractor or sub4 contractor for purposes of chapter 67 of title 41 (com5 monly known as the ‘McNamara-O’Hara Service Contract 

6 Act of 1965’). 

7 ‘‘(j) PARITY OF TREATMENT.—Eligibility for hospital 

8 care, medical services, and extended care services fur9 nished to any veteran pursuant to a Veterans Care Agree10 ment shall be subject to the same terms as though pro11 vided in a facility of the Department, and provisions of 

12 this chapter applicable to veterans receiving such care and 

13 services in a facility of the Department shall apply to vet14 erans treated under this section. 

15 ‘‘(k) RULEMAKING.—The Secretary shall promulgate 

16 regulations to carry out this section.’’. 

17 (b) CLERICAL AMENDMENT.—The table of sections 

18 at the beginning of such chapter is amended by inserting 

19 after the item related to section 1703 the following new 

20 item: 

‘‘1703A. Agreements with eligible entities or providers; certification processes.’’. 

21 SEC. 103. CONFORMING AMENDMENTS FOR STATE VET22 ERANS HOMES. 

23 (a) IN GENERAL.—Section 1745(a) is amended— 


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1 (1) in paragraph (1), by striking ‘‘(or agree2 ment under section 1720(c)(1) of this title)’’ and in3 serting ‘‘(or an agreement)’’; and 

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

5 paragraph: 

6 ‘‘(4)(A) An agreement under this section may be au7 thorized by the Secretary or any Department official au8 thorized by the Secretary, and any such action is not an 

9 award for purposes of such laws that would otherwise re10 quire the use of competitive procedures for the furnishing 

11 of hospital care, medical services, and extended care serv12 ices. 

13 ‘‘(B)(i) Except as provided in clause (ii), and unless 

14 otherwise provided in this section or regulations prescribed 

15 pursuant to this section, a State home that enters into 

16 an agreement under this section is not subject to, in the 

17 carrying out of the agreement, any provision of law to 

18 which providers of services and suppliers under the Medi19 care program under title XVIII of the Social Security Act 

20 (42 U.S.C. 1395 et seq.) are not subject. 

21 ‘‘(ii) A State home that enters into an agreement 

22 under this section is subject to— 

23 ‘‘(I) all provisions of law regarding integrity, 

24 ethics, or fraud, or that subject a person to civil or 

25 criminal penalties; and 


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1 ‘‘(II) all provisions of law that protect against 

2 employment discrimination or that otherwise ensure 

3 equal employment opportunities. 

4 ‘‘(iii) Notwithstanding subparagraph (B)(ii)(I), a 

5 State home that enters into an agreement under this sec6 tion may not be treated as a Federal contractor or subcon7 tractor for purposes of chapter 67 of title 41 (known as 

8 the ‘McNamara-O’Hara Service Contract Act of 1965’).’’. 

9 (b) EFFECTIVE DATE.—The amendment made by 

10 subsection (a) shall apply to care provided on or after the 

11 effective date of regulations issued by the Secretary of 

12 Veterans Affairs to carry out this section. 

13 SEC. 104. ACCESS GUIDELINES AND STANDARDS FOR QUAL14 ITY. 

15 (a) IN GENERAL.—Subchapter I of chapter 17, as 

16 amended by section 102, is further amended by inserting 

17 after section 1703A the following new sections: 

18 ‘‘§ 1703B. Access guidelines 

19 ‘‘The Secretary shall consult with all pertinent Fed20 eral entities to examine health care access measurements 

21 and establish localized benchmarking guidelines that can 

22 inform provider and veteran clinical decisionmaking. The 

23 Secretary shall establish such guidelines for all hospital 

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1 tered by the Secretary, including through non-Department 

2 health care providers. 

3 ‘‘§ 1703C. Standards for quality 

4 ‘‘(a) IN GENERAL.—(1) The Secretary shall establish 

5 standards for quality, in coordination or consultation with 

6 entities pursuant to section 1703(h)(3) of this title, re7 garding hospital care, medical services, and extended care 

8 services furnished by the Department pursuant to this 

9 title, including through non-Department health care pro10 viders pursuant to section 1703 of this title. 

11 ‘‘(2) In establishing standards for quality under para12 graph (1), the Secretary shall consider existing health 

13 quality measures that are applied to public and privately 

14 sponsored health care systems with the purpose of pro15 viding covered veterans relevant comparative information 

16 to make informed decisions regarding their health care. 

17 ‘‘(3) The Secretary shall collect and consider data for 

18 purposes of establishing the standards under paragraph 

19 (1). Such data collection shall include— 

20 ‘‘(A) after consultation with veterans service or21 ganizations and other key stakeholders on survey de22 velopment or modification of an existing survey, a 

23 survey of veterans who have used hospital care, med24 ical services, or extended care services furnished by 

25 the Veterans Health Administration during the most 


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1 recent two-year period to assess the satisfaction of 

2 the veterans with service and quality of care; and 

3 ‘‘(B) datasets that include, at a minimum, ele4 ments relating to the following: 

5 ‘‘(i) Timely care. 

6 ‘‘(ii) Effective care. 

7 ‘‘(iii) Safety, including, at a minimum, 

8 complications, readmissions, and deaths. 

9 ‘‘(iv) Efficiency. 

10 ‘‘(b) PUBLICATION AND CONSIDERATION OF PUBLIC

11 COMMENTS.—(1) Not later than one year after the date 

12 on which the Secretary establishes standards for quality 

13 under subsection (a), the Secretary shall publish the qual14 ity rating of medical facilities of the Department in the 

15 publicly available Hospital Compare website through the 

16 Centers for Medicare & Medicaid Services for the purpose 

17 of providing veterans with information that allows them 

18 to compare performance measure information among De19 partment and non-Department health care providers. 

20 ‘‘(2) Not later than two years after the date on which 

21 the Secretary establishes standards for quality under sub22 section (a), the Secretary shall consider and solicit public 

23 comment on potential changes to the measures used in 

24 such standards to ensure that they include the most up25 to-date and applicable industry measures for veterans.’’. 


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1 (b) CLERICAL AMENDMENT.—The table of sections 

2 at the beginning of chapter 17, as amended by section 

3 102, is further amended by inserting after the item relat4 ing to section 1703A the following new items: 

‘‘1703B. Access guidelines. 

‘‘1703C. Standards for quality.’’. 

5 SEC. 105. ACCESS TO WALK-IN CARE. 

6 (a) IN GENERAL.—Chapter 17 is amended by insert7 ing after section 1725 the following new section: 

8 ‘‘§ 1725A. Access to walk-in care 

9 ‘‘(a) PROCEDURES TO ENSURE ACCESS TO WALK10 IN CARE.—The Secretary shall develop procedures to en11 sure that eligible veterans are able to access walk-in care 

12 from qualifying non-Department entities or providers. 

13 ‘‘(b) ELIGIBLE VETERANS.—For purposes of this 

14 section, an eligible veteran is any individual who— 

15 ‘‘(1) is enrolled in the health care system estab16 lished under section 1705(a) of this title; and 

17 ‘‘(2) has received care under this chapter within 

18 the 24-month period preceding the furnishing of 

19 walk-in care under this section. 

20 ‘‘(c) QUALIFYING NON-DEPARTMENT ENTITIES OR

21 PROVIDERS.—For purposes of this section, a qualifying 

22 non-Department entity or provider is a non-Department 

23 entity or provider that has entered into a contract or other 


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1 agreement with the Secretary to furnish services under 

2 this section. 

3 ‘‘(d) FEDERALLY-QUALIFIED HEALTH CENTERS.— 

4 Whenever practicable, the Secretary may use a Federally5 qualified health center (as defined in section 1905(l)(2)(B) 

6 of the Social Security Act (42 U.S.C. 1396d(l)(2)(B))) to 

7 carry out this section. 

8 ‘‘(e) CONTINUITY OF CARE.—The Secretary shall en9 sure continuity of care for those veterans who receive 

10 walk-in care services under this section, including through 

11 the establishment of a mechanism to receive medical 

12 records from walk-in care providers and provide pertinent 

13 patient medical records to providers of walk-in care. 

14 ‘‘(f) COPAYMENTS.—(1)(A) The Secretary shall re15 quire all eligible veterans to pay the United States a co16 payment for each episode of hospital care and medical 

17 service provided under this section if otherwise required 

18 to pay a copayment under this title. 

19 ‘‘(B) Those not required to pay a copayment under 

20 this title may access walk-in care without a copayment for 

21 the first two visits in a calendar year. For any additional 

22 visits, a copayment at an amount determined by the Sec23 retary shall be paid. 

24 ‘‘(C) For those veterans required to pay a copayment 

25 under title 38, they are required to pay their regular coVerDate Sep 11 2014 23:02 Dec 05, 2017 Jkt 079200 PO 00000 Frm 00047 Fmt 6652 Sfmt 6201 E:\BILLS\S2193.PCS S2193

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1 payment for their first two walk-in care visits in a cal2 endar year. For any additional visits, a higher copayment 

3 at an amount determined by the Secretary shall be paid. 

4 ‘‘(2) After the first two episodes of care furnished 

5 to a veteran under this section, the Secretary may adjust 

6 the copayment required of the veteran under this sub7 section based upon the priority group of enrollment of the 

8 veteran, the number of episodes of care furnished to the 

9 veteran during a year, and other factors the Secretary con10 siders appropriate under this section. 

11 ‘‘(3) The amount or amounts of the copayments re12 quired under this subsection shall be prescribed by the 

13 Secretary by rule. 

14 ‘‘(4) Section 8153(c) of this title shall not apply to 

15 this subsection. 

16 ‘‘(g) REGULATIONS.—Not later than one year after 

17 the date of the enactment of the Caring for our Veterans 

18 Act of 2017, the Secretary shall promulgate regulations 

19 to carry out this section. 

20 ‘‘(h) WALK-IN CARE DEFINED.—In this section, the 

21 term ‘walk-in care’ means non-emergent care provided by 

22 a qualifying non-Department entity or provider that fur23 nishes episodic care and not longitudinal management of 

24 conditions and is otherwise defined through regulations 

25 the Secretary shall promulgate.’’. 


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1 (b) EFFECTIVE DATE.—Section 1725A of title 38, 

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

3 effect on the date upon which final regulations imple4 menting such section take effect. 

5 (c) CLERICAL AMENDMENT.—The table of sections 

6 at the beginning of such chapter is amended by inserting 

7 after the item related to section 1725 the following new 

8 item: 

‘‘§1725A. Access to walk-in care.’’. 

9 SEC. 106. STRATEGY REGARDING THE DEPARTMENT OF 

10 VETERANS AFFAIRS HIGH-PERFORMING IN11 TEGRATED HEALTH CARE NETWORK. 

12 (a) MARKET AREA ASSESSMENTS.— 

13 (1) IN GENERAL.—Not less frequently than 

14 every four years, the Secretary of Veterans Affairs 

15 shall perform market area assessments regarding the 

16 health care services furnished under the laws admin17 istered by the Secretary. 

18 (2) ELEMENTS.—Each market area assessment 

19 established under paragraph (1) shall include the 

20 following: 

21 (A) An assessment of the demand for 

22 health care from the Department, disaggregated 

23 by geographic market areas as determined by 

24 the Secretary, including the number of requests 


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1 for health care services under the laws adminis2 tered by the Secretary. 

3 (B) An inventory of the health care capac4 ity of the Department of Veterans Affairs 

5 across the Department’s system of facilities. 

6 (C) An assessment of the health care ca7 pacity to be provided through contracted com8 munity care providers and providers who en9 tered into a provider agreement with the De10 partment under section 1703A of title 38, 

11 United States Code, as added by section 

12 102(a), including the number of providers, the 

13 geographic location of the providers, and cat14 egories or types of health care services provided 

15 by the providers. 

16 (D) An assessment obtained from other 

17 Federal direct delivery systems of their capacity 

18 to provide health care to veterans. 

19 (E) An assessment of the health care ca20 pacity of non-contracted providers where there 

21 is insufficient network supply. 

22 (F) An assessment of the health care ca23 pacity of academic affiliates and other collabo24 rations of the Department as it relates to pro25 viding health care to veterans. 


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1 (G) An assessment of the effects on health 

2 care capacity by the access guidelines and 

3 standards for quality established under section 

4 1703(h) of title 38, United States Code, as 

5 amended by section 101(a)(1). 

6 (H) The number of appointments for 

7 health care services under the laws adminis8 tered by the Secretary, disaggregated by— 

9 (i) appointments at facilities of the 

10 Department of Veterans Affairs; and 

11 (ii) appointments with non-Depart12 ment health care providers. 

13 (3) SUBMITTAL TO CONGRESS.—The Secretary 

14 shall submit to the appropriate committees of Con15 gress the market area assessments established in 

16 paragraph (1). 

17 (4) USE OF MARKET AREA ASSESSMENTS FOR

18 INTEGRATED HEALTH CARE DELIVERY.— 

19 (A) IN GENERAL.—The Secretary shall use 

20 the market area assessments established under 

21 paragraph (1) in determining the capacity of 

22 the health care provider networks established 

23 under section 1703(j) of title 38, United States 

24 Code, as amended by section 101(a)(1). 


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1 (B) BUDGET.—The Secretary shall ensure 

2 that the Department budget for any fiscal year 

3 (as submitted with the budget of the President 

4 under section 1105(a) of title 31, United States 

5 Code) reflects the findings of the Secretary with 

6 respect to the most recent market area assess7 ments under paragraph (1). 

8 (5) EFFECTIVE DATE.—The amendments made 

9 by subsection (a) shall take effect on September 30, 

10 2018. 

11 (b) STRATEGIC PLAN TO MEET HEALTH CARE DE12 MAND.— 

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

14 after the date of the enactment of this Act and not 

15 less frequently than once every four years thereafter, 

16 the Secretary shall submit to the appropriate com17 mittees of Congress a strategic plan that specifies a 

18 four-year forecast of— 

19 (A) the demand for health care from the 

20 Department, disaggregated by geographic area 

21 as determined by the Secretary; 

22 (B) the health care capacity to be provided 

23 at each medical center of the Department; and 

24 (C) the health care capacity to be provided 

25 through community care providers. 


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1 (2) ELEMENTS.—In preparing the strategic 

2 plan under paragraph (1), the Secretary shall— 

3 (A) consider the access guidelines and 

4 standards for quality established under section 

5 1703(h) of title 38, United States Code, as 

6 amended by section 101(a)(1); 

7 (B) consider the market area assessments 

8 established under subsection (a); 

9 (C) consider the needs of the Department 

10 based on identified services that provide man11 agement of conditions or disorders related to 

12 military service for which there is limited expe13 rience or access in the national market, the 

14 overall health of veterans throughout their life15 span, or other services as the Secretary deter16 mines appropriate; 

17 (D) consult with key stakeholders within 

18 the Department, the heads of other Federal 

19 agencies, and other relevant governmental and 

20 nongovernmental entities, including State, local, 

21 and tribal government officials, members of 

22 Congress, veterans service organizations, pri23 vate sector representatives, academics, and 

24 other policy experts; 


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1 (E) identify emerging issues, trends, prob2 lems, and opportunities that could affect health 

3 care services furnished under the laws adminis4 tered by the Secretary; 

5 (F) develop recommendations regarding 

6 both short- and long-term priorities for health 

7 care services furnished under the laws adminis8 tered by the Secretary; 

9 (G) after consultation with veterans service 

10 organizations and other key stakeholders on 

11 survey development or modification of an exist12 ing survey, consider a survey of veterans who 

13 have used hospital care, medical services, or ex14 tended care services furnished by the Veterans 

15 Health Administration during the most recent 

16 two-year period to assess the satisfaction of the 

17 veterans with service and quality of care; and 

18 (H) consider such other matters as the 

19 Secretary considers appropriate. 

20 (c) APPROPRIATE COMMITTEES OF CONGRESS DE21 FINED.—In this section, the term ‘‘appropriate commit22 tees of Congress’’ means— 

23 (1) the Committee on Veterans’ Affairs and the 

24 Committee on Appropriations of the Senate; and 


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1 (2) the Committee on Veterans’ Affairs and the 

2 Committee on Appropriations of the House of Rep3 resentatives. 

4 SEC. 107. APPLICABILITY OF DIRECTIVE OF OFFICE OF 

5 FEDERAL CONTRACT COMPLIANCE PRO6 GRAMS. 

7 (a) IN GENERAL.—Notwithstanding the treatment of 

8 certain laws under subsection (i) of section 1703A of title 

9 38, United States Code, as added by section 102 of this 

10 Act, Directive 2014–01 of the Office of Federal Contract 

11 Compliance Programs of the Department of Labor (effec12 tive as of May 7, 2014) shall apply to any entity entering 

13 into an agreement under such section 1703A or section 

14 1745 of such title, as amended by section 103, in the same 

15 manner as such directive applies to subcontractors under 

16 the TRICARE program for the duration of the morato17 rium provided under such directive. 

18 (b) APPLICABILITY PERIOD.—The directive described 

19 in subsection (a), and the moratorium provided under such 

20 directive, shall not be altered or rescinded before May 7, 

21 2019. 

22 (c) TRICARE PROGRAM DEFINED.—In this section, 

23 the term ‘‘TRICARE program’’ has the meaning given 

24 that term in section 1072 of title 10, United States Code. 


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1 SEC. 108. PREVENTION OF CERTAIN HEALTH CARE PRO2 VIDERS FROM PROVIDING NON-DEPARTMENT 

3 HEALTH CARE SERVICES TO VETERANS. 

4 (a) IN GENERAL.—On and after the date that is one 

5 year after the date of the enactment of this Act, the Sec6 retary of Veterans Affairs shall deny or revoke the eligi7 bility of a health care provider to provide non-Department 

8 health care services to veterans if the Secretary determines 

9 that the health care provider— 

10 (1) was removed from employment with the De11 partment of Veterans Affairs due to conduct that 

12 violated a policy of the Department relating to the 

13 delivery of safe and appropriate health care; or 

14 (2) violated the requirements of a medical li15 cense of the health care provider that resulted in the 

16 loss of such medical license. 

17 (b) PERMISSIVE ACTION.—On and after the date that 

18 is one year after the date of the enactment of this Act, 

19 the Secretary may deny, revoke, or suspend the eligibility 

20 of a health care provider to provide non-Department 

21 health care services if the Secretary determines such ac22 tion is necessary to immediately protect the health, safety, 

23 or welfare of veterans and the health care provider is 

24 under investigation by the medical licensing board of a 

25 State in which the health care provider is licensed or prac26 tices. 


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1 (c) SUSPENSION.—The Secretary shall suspend the 

2 eligibility of a health care provider to provide non-Depart3 ment health care services to veterans if the health care 

4 provider is suspended from serving as a health care pro5 vider of the Department. 

6 (d) COMPTROLLER GENERAL REPORT.—Not later 

7 than two years after the date of the enactment of this Act, 

8 the Comptroller General of the United States shall submit 

9 to Congress a report on the implementation by the Sec10 retary of this section, including the following: 

11 (1) The aggregate number of health care pro12 viders denied or suspended under this section from 

13 participation in providing non-Department health 

14 care services. 

15 (2) An evaluation of any impact on access to 

16 health care for patients or staffing shortages in pro17 grams of the Department providing non-Department 

18 health care services. 

19 (3) An explanation of the coordination of the 

20 Department with the medical licensing boards of 

21 States in implementing this section, the amount of 

22 involvement of such boards in such implementation, 

23 and efforts by the Department to address any con24 cerns raised by such boards with respect to such im25 plementation. 


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1 (4) Such recommendations as the Comptroller 

2 General considers appropriate regarding harmo3 nizing eligibility criteria between health care pro4 viders of the Department and health care providers 

5 eligible to provide non-Department health care serv6 ices. 

7 (e) NON-DEPARTMENT HEALTH CARE SERVICES

8 DEFINED.—In this section, the term ‘‘non-Department 

9 health care services’’ means services— 

10 (1) provided under subchapter I of chapter 17 

11 of title 38, United States Code, at non-Department 

12 facilities (as defined in section 1701 of such title); 

13 (2) provided under section 101 of the Veterans 

14 Access, Choice, and Accountability Act of 2014 

15 (Public Law 113–146; 38 U.S.C. 1701 note); 

16 (3) purchased through the Medical Community 

17 Care account of the Department; or 

18 (4) purchased with amounts deposited in the 

19 Veterans Choice Fund under section 802 of the Vet20 erans Access, Choice, and Accountability Act of 

21 2014. 


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1 Subtitle B—Paying Providers and 

2 Improving Collections 

3 SEC. 111. PROMPT PAYMENT TO PROVIDERS. 

4 (a) IN GENERAL.—Subchapter I of chapter 17 is 

5 amended by inserting after section 1703C, as added by 

6 section 104 of this Act, the following new section: 

7 ‘‘§ 1703D. Prompt payment standard 

8 ‘‘(a) IN GENERAL.—(1) Notwithstanding any other 

9 provision of this title or of any other provision of law, the 

10 Secretary shall pay for hospital care, medical services, or 

11 extended care services furnished by health care entities or 

12 providers under this chapter within 45 calendar days upon 

13 receipt of a clean paper claim or 30 calendar days upon 

14 receipt of a clean electronic claim. 

15 ‘‘(2) If a claim is denied, the Secretary shall, within 

16 45 calendar days of denial for a paper claim and 30 cal17 endar days of denial for an electronic claim, notify the 

18 health care entity or provider of the reason for denying 

19 the claim and what, if any, additional information is re20 quired to process the claim. 

21 ‘‘(3) Upon the receipt of the additional information, 

22 the Secretary shall ensure that the claim is paid, denied, 

23 or otherwise adjudicated within 30 calendar days from the 

24 receipt of the requested information. 


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1 ‘‘(4) This section shall only apply to payments made 

2 on an invoice basis and shall not apply to capitation or 

3 other forms of periodic payment to entities or providers. 

4 ‘‘(b) SUBMITTAL OF CLAIMS BY HEALTH CARE EN5 TITIES AND PROVIDERS.—A health care entity or provider 

6 that furnishes hospital care, a medical service, or an ex7 tended care service under this chapter shall submit to the 

8 Secretary a claim for payment for furnishing the hospital 

9 care, medical service, or extended care service not later 

10 than 180 days after the date on which the entity or pro11 vider furnished the hospital care, medical service, or ex12 tended care service. 

13 ‘‘(c) FRAUDULENT CLAIMS.—(1) Sections 3729 

14 through 3733 of title 31 shall apply to fraudulent claims 

15 for payment submitted to the Secretary by a health care 

16 entity or provider under this chapter. 

17 ‘‘(2) Pursuant to regulations prescribed by the Sec18 retary, the Secretary shall bar a health care entity or pro19 vider from furnishing hospital care, medical services, and 

20 extended care services under this chapter when the Sec21 retary determines the entity or provider has submitted to 

22 the Secretary fraudulent health care claims for payment 

23 by the Secretary. 

24 ‘‘(d) OVERDUE CLAIMS.—(1) Any claim that has not 

25 been denied with notice, made pending with notice, or paid 


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1 to the health care entity or provider by the Secretary shall 

2 be overdue if the notice or payment is not received by the 

3 entity provider within the time periods specified in sub4 section (a). 

5 ‘‘(2)(A) If a claim is overdue under this subsection, 

6 the Secretary may, under the requirements established by 

7 subsection (a) and consistent with the provisions of chap8 ter 39 of title 31 (commonly referred to as the ‘Prompt 

9 Payment Act’), require that interest be paid on clean 

10 claims. 

11 ‘‘(B) Interest paid under subparagraph (A) shall be 

12 computed at the rate of interest established by the Sec13 retary of the Treasury under section 3902 of title 31 and 

14 published in the Federal Register. 

15 ‘‘(3) Not less frequently than annually, the Secretary 

16 shall submit to Congress a report on payment of overdue 

17 claims under this subsection, disaggregated by paper and 

18 electronic claims, that includes the following: 

19 ‘‘(A) The amount paid in overdue claims de20 scribed in this subsection, disaggregated by the 

21 amount of the overdue claim and the amount of in22 terest paid on such overdue claim. 

23 ‘‘(B) The number of such overdue claims and 

24 the average number of days late each claim was 


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1 paid, disaggregated by facility of the Department 

2 and Veterans Integrated Service Network region. 

3 ‘‘(e) OVERPAYMENT.—(1) The Secretary shall deduct 

4 the amount of any overpayment from payments due a 

5 health care entity or provider under this chapter. 

6 ‘‘(2) Deductions may not be made under this sub7 section unless the Secretary has made reasonable efforts 

8 to notify a health care entity or provider of the right to 

9 dispute the existence or amount of such indebtedness and 

10 the right to request a compromise of such indebtedness. 

11 ‘‘(3) The Secretary shall make a determination with 

12 respect to any such dispute or request prior to deducting 

13 any overpayment unless the time required to make such 

14 a determination before making any deductions would jeop15 ardize the Secretary’s ability to recover the full amount 

16 of such indebtedness. 

17 ‘‘(f) INFORMATION AND DOCUMENTATION RE18 QUIRED.—(1) The Secretary shall provide to all health 

19 care entities and providers participating in a program to 

20 furnish hospital care, medical services, or extended care 

21 services under this chapter a list of information and docu22 mentation that is required to establish a clean claim under 

23 this section. 

24 ‘‘(2) The Secretary shall consult with entities in the 

25 health care industry, in the public and private sector, to 


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1 determine the information and documentation to include 

2 in the list under paragraph (1). 

3 ‘‘(3) If the Secretary modifies the information and 

4 documentation included in the list under paragraph (1), 

5 the Secretary shall notify all health care entities and pro6 viders described in paragraph (1) not later than 30 days 

7 before such modifications take effect. 

8 ‘‘(g) PROCESSING OF CLAIMS.—In processing a claim 

9 for compensation for hospital care, medical services, or ex10 tended care services furnished by a health care entity or 

11 provider under this chapter, the Secretary shall act 

12 through— 

13 ‘‘(1) a non-Department entity that is under 

14 contract or agreement for the program established 

15 under section 1703(a) of this title; or 

16 ‘‘(2) a non-Department entity that specializes 

17 in such processing for other Federal agency health 

18 care systems. 

19 ‘‘(h) REPORT ON ENCOUNTER DATA SYSTEM.—(1) 

20 Not later than 90 days after the date of the enactment 

21 of the Caring for our Veterans Act of 2017, the Secretary 

22 shall submit to the appropriate committees of Congress 

23 a report on the feasibility and advisability of adopting a 

24 funding mechanism similar to what is utilized by other 

25 Federal agencies to allow a contracted entity to act as a 


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1 fiscal intermediary for the Federal Government to dis2 tribute, or pass through, Federal Government funds for 

3 certain non-underwritten hospital care, medical services, 

4 or extended care services. 

5 ‘‘(2) The Secretary may coordinate with the Depart6 ment of Defense, the Department of Health and Human 

7 Services, and the Department of the Treasury in devel8 oping the report required by paragraph (1). 

9 ‘‘(i) DEFINITIONS.—In this section: 

10 ‘‘(1) The term ‘appropriate committees of Con11 gress’ means— 

12 ‘‘(A) the Committee on Veterans’ Affairs 

13 and the Committee on Appropriations of the 

14 Senate; and 

15 ‘‘(B) the Committee on Veterans’ Affairs 

16 and the Committee on Appropriations of the 

17 House of Representatives. 

18 ‘‘(2) The term ‘clean electronic claim’ means 

19 the transmission of data for purposes of payment of 

20 covered health care expenses that is submitted to the 

21 Secretary which contains substantially all of the re22 quired data elements necessary for accurate adju23 dication, without obtaining additional information 

24 from the entity or provider that furnished the care 

25 or service, submitted in such format as prescribed by 


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1 the Secretary in regulations for the purpose of pay2 ing claims for care or services. 

3 ‘‘(3) The term ‘clean paper claim’ means a 

4 paper claim for payment of covered health care ex5 penses that is submitted to the Secretary which con6 tains substantially all of the required data elements 

7 necessary for accurate adjudication, without obtain8 ing additional information from the entity or pro9 vider that furnished the care or service, submitted in 

10 such format as prescribed by the Secretary in regu11 lations for the purpose of paying claims for care or 

12 services. 

13 ‘‘(4) The term ‘fraudulent claims’ means the in14 tentional and deliberate misrepresentation of a mate15 rial fact or facts by a health care entity or provider 

16 made to induce the Secretary to pay a claim that 

17 was not legally payable to that provider. This term, 

18 as used in this section, shall not include a good faith 

19 interpretation by a health care entity or provider of 

20 utilization, medical necessity, coding, and billing re21 quirements of the Secretary. 

22 ‘‘(5) The term ‘health care entity or provider’ 

23 includes any non-Department health care entity or 

24 provider, but does not include any Federal health 

25 care entity or provider.’’. 


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1 (b) CLERICAL AMENDMENT.—The table of sections 

2 at the beginning of such chapter is amended by inserting 

3 after the item related to section 1703C, as added by sec4 tion 104 of this Act, the following new item: 

‘‘1703D. Prompt payment standard.’’. 

5 SEC. 112. AUTHORITY TO PAY FOR AUTHORIZED CARE NOT 

6 SUBJECT TO AN AGREEMENT. 

7 (a) IN GENERAL.—Subchapter IV of chapter 81 is 

8 amended by adding at the end the following new section: 

9 ‘‘§ 8159. Authority to pay for services authorized but 

10 not subject to an agreement 

11 ‘‘(a) IN GENERAL.—If, in the course of furnishing 

12 hospital care, a medical service, or an extended care serv13 ice authorized by the Secretary and pursuant to a con14 tract, agreement, or other arrangement with the Sec15 retary, a provider who is not a party to the contract, 

16 agreement, or other arrangement furnishes hospital care, 

17 a medical service, or an extended care service that the Sec18 retary considers necessary, the Secretary may compensate 

19 the provider for the cost of such care or service. 

20 ‘‘(b) NEW CONTRACTS AND AGREEMENTS.—The 

21 Secretary shall take reasonable efforts to enter into a con22 tract, agreement, or other arrangement with a provider 

23 described in subsection (a) to ensure that future care and 

24 services authorized by the Secretary and furnished by the 


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1 provider are subject to such a contract, agreement, or 

2 other arrangement.’’. 

3 (b) CLERICAL AMENDMENT.—The table of sections 

4 at the beginning of such chapter is amended by inserting 

5 after the item relating to section 8158 the following new 

6 item: 

‘‘8159. Authority to pay for services authorized but not subject to an agreement.’’. 

7 SEC. 113. IMPROVEMENT OF AUTHORITY TO RECOVER THE 

8 COST OF SERVICES FURNISHED FOR NON9 SERVICE-CONNECTED DISABILITIES. 

10 (a) BROADENING SCOPE OF APPLICABILITY.—Sec11 tion 1729 is amended— 

12 (1) in subsection (a)— 

13 (A) in paragraph (2)(A)— 

14 (i) by striking ‘‘the veteran’s’’ and in15 serting ‘‘the individual’s’’; and 

16 (ii) by striking ‘‘the veteran’’ and in17 serting ‘‘the individual’’; and 

18 (B) in paragraph (3)— 

19 (i) in the matter preceding subpara20 graph (A), by striking ‘‘the veteran’’ and 

21 inserting ‘‘the individual’’; and 

22 (ii) in subparagraph (A), by striking 

23 ‘‘the veteran’s’’ and inserting ‘‘the individ24 ual’s’’; 


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1 (2) in subsection (b)— 

2 (A) in paragraph (1)— 

3 (i) by striking ‘‘the veteran’’ and in4 serting ‘‘the individual’’; and 

5 (ii) by striking ‘‘the veteran’s’’ and in6 serting ‘‘the individual’s’’; and 

7 (B) in paragraph (2)— 

8 (i) in subparagraph (A)— 

9 (I) by striking ‘‘the veteran’’ and 

10 inserting ‘‘the individual’’; and 

11 (II) by striking ‘‘the veteran’s’’ 

12 and inserting ‘‘the individual’s’’; and 

13 (ii) in subparagraph (B)— 

14 (I) in clause (i), by striking ‘‘the 

15 veteran’’ and inserting ‘‘the indi16 vidual’’; and 

17 (II) in clause (ii)— 

18 (aa) by striking ‘‘the vet19 eran’’ and inserting ‘‘the indi20 vidual’’; and 

21 (bb) by striking ‘‘the vet22 eran’s’’ each place it appears and 

23 inserting ‘‘the individual’s’’; 

24 (3) in subsection (e), by striking ‘‘A veteran’’ 

25 and inserting ‘‘An individual’’; and 


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1 (4) in subsection (h)— 

2 (A) in paragraph (1)— 

3 (i) in the matter preceding subpara4 graph (A), by striking ‘‘a veteran’’ and in5 serting ‘‘an individual’’; 

6 (ii) in subparagraph (A), by striking 

7 ‘‘the veteran’’ and inserting ‘‘the indi8 vidual’’; and 

9 (iii) in subparagraph (B), by striking 

10 ‘‘the veteran’’ and inserting ‘‘the indi11 vidual’’; and 

12 (B) in paragraph (2)— 

13 (i) by striking ‘‘A veteran’’ and insert14 ing ‘‘An individual’’; 

15 (ii) by striking ‘‘a veteran’’ and in16 serting ‘‘an individual’’; and 

17 (iii) by striking ‘‘the veteran’’ and in18 serting ‘‘the individual’’. 

19 (b) MODIFICATION OF AUTHORITY.—Subsection 

20 (a)(1) of such section is amended by striking ‘‘(1) Sub21 ject’’ and all that follows through the period and inserting 

22 the following: ‘‘(1) Subject to the provisions of this sec23 tion, in any case in which the United States is required 

24 by law to furnish or pay for care or services under this 

25 chapter for a non-service-connected disability described in 


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1 paragraph (2) of this subsection, the United States has 

2 the right to recover or collect from a third party the rea3 sonable charges of care or services so furnished or paid 

4 for to the extent that the recipient or provider of the care 

5 or services would be eligible to receive payment for such 

6 care or services from such third party if the care or serv7 ices had not been furnished or paid for by a department 

8 or agency of the United States.’’ 

9 (c) MODIFICATION OF ELIGIBLE INDIVIDUALS.— 

10 Subparagraph (D) of subsection (a)(2) of such section is 

11 amended to read as follows: 

12 ‘‘(D) that is incurred by an individual who is 

13 entitled to care (or payment of the expenses of care) 

14 under a health-plan contract.’’. 

15 SEC. 114. PROCESSING OF CLAIMS FOR REIMBURSEMENT 

16 THROUGH ELECTRONIC INTERFACE. 

17 The Secretary of Veterans Affairs may enter into an 

18 agreement with a third-party entity to process, through 

19 the use of an electronic interface, claims for reimburse20 ment for health care provided under the laws administered 

21 by the Secretary. 


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1 Subtitle C—Education and 

2 Training Programs 

3 SEC. 121. EDUCATION PROGRAM ON HEALTH CARE OP4 TIONS. 

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

6 shall develop and administer an education program that 

7 teaches veterans about their health care options through 

8 the Department of Veterans Affairs. 

9 (b) ELEMENTS.—The program under subsection (a) 

10 shall— 

11 (1) teach veterans about— 

12 (A) eligibility criteria for care from the De13 partment set forth under sections 1703, as 

14 amended by section 101 of this Act, and 1710 

15 of title 38, United States Code; 

16 (B) priority groups for enrollment in the 

17 system of annual patient enrollment under sec18 tion 1705(a) of such title; 

19 (C) the copayments and other financial ob20 ligations, if any, required of certain individuals 

21 for certain services; and 

22 (D) how to utilize the access guidelines 

23 and standards for quality established under sec24 tions 1703B and 1703C of such title. 


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1 (2) teach veterans about the interaction be2 tween health insurance (including private insurance, 

3 Medicare, Medicaid, the TRICARE program, the In4 dian Health Service, tribal health programs, and 

5 other forms of insurance) and health care from the 

6 Department; and 

7 (3) provide veterans with information on what 

8 to do when they have a complaint about health care 

9 received from the Department (whether about the 

10 provider, the Department, or any other type of com11 plaint). 

12 (c) ACCESSIBILITY.—In developing the education 

13 program under this section, the Secretary shall ensure 

14 that materials under such program are accessible — 

15 (1) to veterans who may not have access to the 

16 Internet; and 

17 (2) to veterans in a manner that complies with 

18 the Americans with Disabilities Act of 1990 (42 

19 U.S.C. 12101 et seq.). 

20 (d) ANNUAL EVALUATION AND REPORT.— 

21 (1) EVALUATION.—The Secretary shall develop 

22 a method to evaluate the effectiveness of the edu23 cation program under this section and evaluate the 

24 program using the method not less frequently than 

25 once each year. 


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1 (2) REPORT.—Not less frequently than once 

2 each year, the Secretary shall submit to Congress a 

3 report on the findings of the Secretary with respect 

4 to the most recent evaluation conducted by the Sec5 retary under paragraph (1). 

6 (e) DEFINITIONS.—In this section: 

7 (1) MEDICAID.—The term ‘‘Medicaid’’ means 

8 the Medicaid program under title XIX of the Social 

9 Security Act (42 U.S.C. 1396 et seq.). 

10 (2) MEDICARE.—The term ‘‘Medicare’’ means 

11 the Medicare program under title XVIII of such Act 

12 (42 U.S.C. 1395 et seq.). 

13 (3) TRICARE PROGRAM.—The term ‘‘TRICARE 

14 program’’ has the meaning given that term in sec15 tion 1072 of title 10, United States Code. 

16 SEC. 122. TRAINING PROGRAM FOR ADMINISTRATION OF 

17 NON-DEPARTMENT OF VETERANS AFFAIRS 

18 HEALTH CARE. 

19 (a) ESTABLISHMENT OF PROGRAM.—The Secretary 

20 of Veterans Affairs shall develop and implement a training 

21 program to train employees and contractors of the Depart22 ment of Veterans Affairs on how to administer non-De23 partment health care programs, including the following: 

24 (1) Reimbursement for non-Department emer25 gency room care. 


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1 (2) The Veterans Community Care Program 

2 under section 1703 of such title, as amended by sec3 tion 101. 

4 (3) Management of prescriptions pursuant to 

5 improvements under section 131. 

6 (b) ANNUAL EVALUATION AND REPORT.—The Sec7 retary shall— 

8 (1) develop a method to evaluate the effective9 ness of the training program developed and imple10 mented under subsection (a); 

11 (2) evaluate such program not less frequently 

12 than once each year; and 

13 (3) not less frequently than once each year, 

14 submit to Congress the findings of the Secretary 

15 with respect to the most recent evaluation carried 

16 out under paragraph (2). 

17 SEC. 123. CONTINUING MEDICAL EDUCATION FOR NON-DE18 PARTMENT MEDICAL PROFESSIONALS. 

19 (a) ESTABLISHMENT OF PROGRAM.— 

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

21 Affairs shall establish a program to provide con22 tinuing medical education material to non-Depart23 ment medical professionals. 


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1 (2) EDUCATION PROVIDED.—The program es2 tablished under paragraph (1) shall include edu3 cation on the following: 

4 (A) Identifying and treating common men5 tal and physical conditions of veterans and fam6 ily members of veterans. 

7 (B) The health care system of the Depart8 ment of Veterans Affairs. 

9 (C) Such other matters as the Secretary 

10 considers appropriate. 

11 (b) MATERIAL PROVIDED.—The continuing medical 

12 education material provided to non-Department medical 

13 professionals under the program established under sub14 section (a) shall be the same material provided to medical 

15 professionals of the Department to ensure that all medical 

16 professionals treating veterans have access to the same 

17 materials, which supports core competencies throughout 

18 the community. 

19 (c) ADMINISTRATION OF PROGRAM.— 

20 (1) IN GENERAL.—The Secretary shall admin21 ister the program established under subsection (a) to 

22 participating non-Department medical professionals 

23 through an Internet website of the Department of 

24 Veterans Affairs. 


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1 (2) CURRICULUM AND CREDIT PROVIDED.—The 

2 Secretary shall determine the curriculum of the pro3 gram and the number of hours of credit to provide 

4 to participating non-Department medical profes5 sionals for continuing medical education. 

6 (3) ACCREDITATION.—The Secretary shall en7 sure that the program is accredited in as many 

8 States as practicable. 

9 (4) CONSISTENCY WITH EXISTING RULES.—The 

10 Secretary shall ensure that the program is consistent 

11 with the rules and regulations of the following: 

12 (A) The medical licensing agency of each 

13 State in which the program is accredited. 

14 (B) Such medical credentialing organiza15 tions as the Secretary considers appropriate. 

16 (5) USER COST.—The Secretary shall carry out 

17 the program at no cost to participating non-Depart18 ment medical professionals. 

19 (6) MONITORING, EVALUATION, AND REPORT.— 

20 The Secretary shall monitor the utilization of the 

21 program established under subsection (a), evaluate 

22 its effectiveness, and report to Congress on utiliza23 tion and effectiveness not less frequently than once 

24 each year. 


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1 (d) NON-DEPARTMENT MEDICAL PROFESSIONAL

2 DEFINED.—In this section, the term ‘‘non-Department 

3 medical professional’’ means any individual who is licensed 

4 by an appropriate medical authority in the United States 

5 and is in good standing, is not an employee of the Depart6 ment of Veterans Affairs, and provides care to veterans 

7 or family members of veterans under the laws adminis8 tered by the Secretary of Veterans Affairs. 

9 Subtitle D—Other Matters Relating 

10 to Non-Department of Veterans 

11 Affairs Providers 

12 SEC. 131. ESTABLISHMENT OF PROCESSES TO ENSURE 

13 SAFE OPIOID PRESCRIBING PRACTICES BY 

14 NON-DEPARTMENT OF VETERANS AFFAIRS 

15 HEALTH CARE PROVIDERS. 

16 (a) RECEIPT AND REVIEW OF GUIDELINES.—The 

17 Secretary of Veterans Affairs shall ensure that all covered 

18 health care providers are provided a copy of and certify 

19 that they have reviewed the evidence-based guidelines for 

20 prescribing opioids set forth by the Opioid Safety Initia21 tive of the Department of Veterans Affairs under sections 

22 911(a)(2) and 912(c) of the Jason Simcakoski Memorial 

23 and Promise Act (Public Law 114–198; 38 U.S.C. 1701 

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1 tered by the Secretary and at any time when those guide2 lines are modified thereafter. 

3 (b) INCLUSION OF MEDICAL HISTORY AND CURRENT

4 MEDICATIONS.—The Secretary shall implement a process 

5 to ensure that, if care of a veteran by a covered health 

6 care provider is authorized under the laws administered 

7 by the Secretary, the document authorizing such care in8 cludes the relevant medical history of the veteran and a 

9 list of all medications prescribed to the veteran. 

10 (c) SUBMITTAL OF PRESCRIPTIONS.— 

11 (1) IN GENERAL.—Except as provided in para12 graph (3), the Secretary shall require, to the max13 imum extent practicable, each non-Department 

14 health care provider to submit prescriptions for 

15 opioids— 

16 (A) to the Department for prior authoriza17 tion for the prescribing of a limited amount of 

18 opioids under contracts the Department has 

19 with retail pharmacies; or 

20 (B) directly to a pharmacy of the Depart21 ment for dispensing of the prescriptions. 

22 (2) RESPONSIBILITY OF DEPARTMENT FOR RE23 CORDING AND MONITORING.—In carrying out para24 graph (1) and upon the receipt by the Department 


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1 of the prescription for opioids to veterans under laws 

2 administered by the Secretary, the Secretary shall— 

3 (A) ensure the Department is responsible 

4 for the recording of the prescription in the elec5 tronic health record of the veteran; and 

6 (B) enable other monitoring of the pre7 scription as outlined in the Opioid Safety Initia8 tive of the Department. 

9 (3) EXCEPTION.— 

10 (A) IN GENERAL.—A covered health care 

11 provider is not required under paragraph (1)(B) 

12 to submit an opioid prescription directly to a 

13 pharmacy of the Department if— 

14 (i) the health care provider determines 

15 that there is an immediate medical need 

16 for the prescription, including an urgent or 

17 emergent prescription or a prescription dis18 pensed as part of an opioid treatment pro19 gram that provides office-based medica20 tions; and 

21 (ii)(I) following an inquiry into the 

22 matter, a pharmacy of the Department no23 tifies the health care provider that it can24 not fill the prescription in a timely man25 ner; or 


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1 (II) the health care provider deter2 mines that the requirement under para3 graph (1)(B) would impose an undue hard4 ship on the veteran, including with respect 

5 to travel distances, as determined by the 

6 Secretary. 

7 (B) NOTIFICATION TO DEPARTMENT.—If a 

8 covered health care provider uses an exception 

9 under subparagraph (A) with respect to an 

10 opioid prescription for a veteran, the health 

11 care provider shall, on the same day the pre12 scription is written, submit to the Secretary for 

13 inclusion in the electronic health record of the 

14 veteran a notice, in such form as the Secretary 

15 may establish, providing information about the 

16 prescription and describing the reason for the 

17 exception. 

18 (C) REPORT.— 

19 (i) IN GENERAL.—Not less frequently 

20 than quarterly, the Secretary shall submit 

21 to the Committee on Veterans’ Affairs of 

22 the Senate and the Committee on Vet23 erans’ Affairs of the House of Representa24 tives a report evaluating the compliance of 

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1 quirements under this paragraph and set2 ting forth data on the use by health care 

3 providers of exceptions under subpara4 graph (A) and notices under subparagraph 

5 (B). 

6 (ii) ELEMENTS.—Each report re7 quired by clause (i) shall include the fol8 lowing with respect to the quarter covered 

9 by the report: 

10 (I) The number of exceptions 

11 used under subparagraph (A) and no12 tices received under subparagraph 

13 (B). 

14 (II) The rate of compliance by 

15 the Department with the requirement 

16 under subparagraph (B) to include 

17 such notices in the health records of 

18 veterans. 

19 (III) The identification of any 

20 covered health care providers that, 

21 based on criteria prescribed by the 

22 Secretary, are determined by the Sec23 retary to be statistical outliers regard24 ing the use of exceptions under sub25 paragraph (A). 


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1 (d) USE OF OPIOID SAFETY INITIATIVE GUIDE2 LINES.— 

3 (1) IN GENERAL.—If a director of a medical 

4 center of the Department or a Veterans Integrated 

5 Service Network determines that the opioid pre6 scribing practices of a covered health care provider 

7 conflicts with or is otherwise inconsistent with the 

8 standards of appropriate and safe care, as that term 

9 is used in section 913(d) of the Jason Simcakoski 

10 Memorial and Promise Act (Public Law 114–198; 

11 38 U.S.C. 1701 note), the director shall take such 

12 action as the director considers appropriate to en13 sure the safety of all veterans receiving care from 

14 that health care provider, including removing or di15 recting the removal of any such health care provider 

16 from provider networks or otherwise refusing to au17 thorize care of veterans by such health care provider 

18 in any program authorized under the laws adminis19 tered by the Secretary. 

20 (2) INCLUSION IN CONTRACTS.—The Secretary 

21 shall ensure that any contracts entered into by the 

22 Secretary with third parties involved in admin23 istering programs that provide care in the commu24 nity to veterans under the laws administered by the 

25 Secretary specifically grant the authority set forth in 


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1 paragraph (1) to such third parties and to the direc2 tors described in that paragraph, as the case may 

3 be. 

4 (e) DENIAL OR REVOCATION OF ELIGIBILITY OF

5 NON-DEPARTMENT PROVIDERS.—The Secretary shall 

6 deny or revoke the eligibility of a non-Department health 

7 care provider to provide health care to veterans under the 

8 laws administered by the Secretary if the Secretary deter9 mines that the opioid prescribing practices of the pro10 vider— 

11 (1) violate the requirements of a medical license 

12 of the health care provider; or 

13 (2) detract from the ability of the health care 

14 provider to deliver safe and appropriate health care. 

15 (f) COVERED HEALTH CARE PROVIDER DEFINED.— 

16 In this section, the term ‘‘covered health care provider’’ 

17 means a non-Department of Veterans Affairs health care 

18 provider who provides health care to veterans under the 

19 laws administered by the Secretary of Veterans Affairs. 

20 SEC. 132. IMPROVING INFORMATION SHARING WITH COM21 MUNITY PROVIDERS. 

22 Section 7332(b)(2) is amended by striking subpara23 graph (H) and inserting the following new subparagraphs: 

24 ‘‘(H)(i) To a non-Department entity (including 

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1 poses of providing health care, including hospital 

2 care, medical services, and extended care services, to 

3 patients. 

4 ‘‘(ii) An entity to which a record is disclosed 

5 under this subparagraph may not disclose or use 

6 such record for a purpose other than that for which 

7 the disclosure was made. 

8 ‘‘(I) To a third party in order to recover or col9 lect reasonable charges for care furnished to, or paid 

10 on behalf of, a patient in connection with a non-serv11 ice connected disability as permitted by section 1729 

12 of this title or for a condition for which recovery is 

13 authorized or with respect to which the United 

14 States is deemed to be a third party beneficiary 

15 under the Act entitled ‘An Act to provide for the re16 covery from tortiously liable third persons of the cost 

17 of hospital and medical care and treatment fur18 nished by the United States’ (Public Law 87–693; 

19 42 U.S.C. 2651 et seq.; commonly known as the 

20 ‘Federal Medical Care Recovery Act’).’’. 

21 SEC. 133. COMPETENCY STANDARDS FOR NON-DEPART22 MENT OF VETERANS AFFAIRS HEALTH CARE 

23 PROVIDERS. 

24 (a) ESTABLISHMENT OF STANDARDS AND REQUIRE25 MENTS.—The Secretary of Veterans Affairs shall establish 


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1 standards and requirements for the provision of care by 

2 non-Department of Veterans Affairs health care providers 

3 in clinical areas for which the Department of Veterans Af4 fairs has special expertise, including post-traumatic stress 

5 disorder, military sexual trauma-related conditions, and 

6 traumatic brain injuries. 

7 (b) CONDITION FOR ELIGIBILITY TO PARTICIPATE IN

8 VETERANS CHOICE PROGRAM.—Each non-Department of 

9 Veterans Affairs health care provider shall meet the stand10 ards and requirements established pursuant to subsection 

11 (a) before entering into a contact with the Department 

12 of Veterans Affairs to participate in the Veterans Choice 

13 Program under section 101 of the Veterans Access, 

14 Choice, and Accountability Act of 2014 (Public Law 113– 

15 146; 38 U.S.C. 1701 note). Non-Department of Veterans 

16 Affairs health care providers participating in the Veterans 

17 Choice Program shall fulfill training requirements estab18 lished by the Secretary on how to deliver evidence-based 

19 treatments in the clinical areas for which the Department 

20 of Veterans Affairs has special expertise. 


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1 Subtitle E—Other Non-Department 

2 Health Care Matters 

3 SEC. 141. PLANS FOR USE OF SUPPLEMENTAL APPROPRIA4 TIONS REQUIRED. 

5 Whenever the Secretary submits to Congress a re6 quest for supplemental appropriations or any other appro7 priation outside the standard budget process to address 

8 a budgetary issue affecting the Department of Veterans 

9 Affairs, the Secretary shall, not later than 45 days before 

10 the date on which such budgetary issue would start affect11 ing a program or service, submit to Congress a justifica12 tion for the request, including a plan that details how the 

13 Secretary intends to use the requested appropriation and 

14 how long the requested appropriation is expected to meet 

15 the needs of the Department and certification that the re16 quest was made using an updated and sound actuarial 

17 analysis. 

18 SEC. 142. VETERANS CHOICE FUND FLEXIBILITY. 

19 Section 802 of the Veterans Access, Choice, and Ac20 countability Act of 2014 (Public Law 113–146; 38 U.S.C. 

21 1701 note) is amended— 

22 (1) in subsection (c)— 

23 (A) in paragraph (1), by striking ‘‘by para24 graph (3)’’ and inserting ‘‘in paragraphs (3) 

25 and (4)’’; and 


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1 (B) by adding at the end the following new 

2 paragraph: 

3 ‘‘(4) PERMANENT AUTHORITY FOR OTHER

4 USES.—Beginning in fiscal year 2019, amounts re5 maining in the Veterans Choice Fund may be used 

6 to furnish hospital care, medical services, and ex7 tended care services to individuals pursuant to chap8 ter 17 of title 38, United States Code, at non-De9 partment facilities, including pursuant to non-De10 partment provider programs other than the program 

11 established by section 101. Such amounts shall be 

12 available in addition to amounts available in other 

13 appropriations accounts for such purposes.’’; and 

14 (2) in subsection (d)(1), by striking ‘‘to sub15 section (c)(3)’’ and inserting ‘‘to paragraphs (3) and 

16 (4) of subsection (c)’’. 

17 SEC. 143. SUNSET OF VETERANS CHOICE PROGRAM. 

18 Subsection (p) of section 101 of the Veterans Access, 

19 Choice, and Accountability Act of 2014 (Public Law 113– 

20 146; 38 U.S.C. 1701 note) is amended to read as follows: 

21 ‘‘(p) AUTHORITY TO FURNISH CARE AND SERV22 ICES.—The Secretary may not use the authority under 

23 this section to furnish care and services after December 

24 31, 2018.’’. 


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1 SEC. 144. CONFORMING AMENDMENTS. 

2 (a) IN GENERAL.— 

3 (1) TITLE 38.—Title 38, United States Code, is 

4 amended— 

5 (A) in section 1712(a)— 

6 (i) in paragraph (3), by striking 

7 ‘‘under clause (1), (2), or (5) of section 

8 1703(a) of this title’’ and inserting ‘‘or en9 tered an agreement’’; and 

10 (ii) in paragraph (4)(A), by striking 

11 ‘‘under the provisions of this subsection 

12 and section 1703 of this title’’; 

13 (B) in section 1712A(e)(1)— 

14 (i) by inserting ‘‘or agreements’’ after 

15 ‘‘contracts’’; and 

16 (ii) by striking ‘‘(under sections 

17 1703(a)(2) and 1710(a)(1)(B) of this 

18 title)’’; and 

19 (C) in section 2303(a)(2)(B)(i), by striking 

20 ‘‘with section 1703’’ and inserting ‘‘with sec21 tions 1703A, 8111, and 8153’’. 

22 (2) SOCIAL SECURITY ACT.—Section 

23 1866(a)(1)(L) of the Social Security Act (42 U.S.C. 

24 1395cc(a)(1)(L)) is amended by striking ‘‘under sec25 tion 1703’’ and inserting ‘‘under chapter 17’’. 


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1 (3) VETERANS’ BENEFITS IMPROVEMENTS ACT

2 OF 1994.—Section 104(a)(4)(A) of the Veterans’ 

3 Benefits Improvements Act of 1994 (Public Law 

4 103–446; 38 U.S.C. 1117 note) is amended by strik5 ing ‘‘in section 1703’’ and inserting ‘‘in sections 

6 1703A, 8111, and 8153’’. 

7 (b) EFFECTIVE DATE.—The amendments made by 

8 subsection (a) shall take effect on the date described in 

9 section 101(b). 

10 TITLE II—IMPROVING DEPART11 MENT OF VETERANS AFFAIRS 

12 HEALTH CARE DELIVERY 

13 Subtitle A—Personnel Practices 

14 PART I—ADMINISTRATION 

15 SEC. 201. LICENSURE OF HEALTH CARE PROFESSIONALS 

16 OF THE DEPARTMENT OF VETERANS AF17 FAIRS PROVIDING TREATMENT VIA TELE18 MEDICINE. 

19 (a) IN GENERAL.—Chapter 17 is amended by insert20 ing after section 1730A the following new section: 

21 ‘‘§ 1730B. Licensure of health care professionals pro22 viding treatment via telemedicine 

23 ‘‘(a) IN GENERAL.—Notwithstanding any provision 

24 of law regarding the licensure of health care professionals, 

25 a covered health care professional may practice the health 


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1 care profession of the health care professional at any loca2 tion in any State, regardless of where the covered health 

3 care professional or the patient is located, if the covered 

4 health care professional is using telemedicine to provide 

5 treatment to an individual under this chapter. 

6 ‘‘(b) COVERED HEALTH CARE PROFESSIONALS.— 

7 For purposes of this section, a covered health care profes8 sional is any health care professional who— 

9 ‘‘(1) is an employee of the Department ap10 pointed under the authority under section 7306, 

11 7401, 7405, 7406, or 7408 of this title or title 5; 

12 ‘‘(2) is authorized by the Secretary to provide 

13 health care under this chapter; 

14 ‘‘(3) is required to adhere to all standards of 

15 quality relating to the provision of medicine in ac16 cordance with applicable policies of the Department; 

17 and 

18 ‘‘(4) has an active, current, full, and unre19 stricted license, registration, or certification in a 

20 State to practice the health care profession of the 

21 health care professional. 

22 ‘‘(c) PROPERTY OF FEDERAL GOVERNMENT.—Sub23 section (a) shall apply to a covered health care professional 

24 providing treatment to a patient regardless of whether the 

25 covered health care professional or patient is located in 


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1 a facility owned by the Federal Government during such 

2 treatment. 

3 ‘‘(d) RELATION TO STATE LAW.—(1) The provisions 

4 of this section shall supersede any provisions of the law 

5 of any State to the extent that such provision of State 

6 law are inconsistent with this section. 

7 ‘‘(2) No State shall deny or revoke the license, reg8 istration, or certification of a covered health care profes9 sional who otherwise meets the qualifications of the State 

10 for holding the license, registration, or certification on the 

11 basis that the covered health care professional has en12 gaged or intends to engage in activity covered by sub13 section (a). 

14 ‘‘(e) RULE OF CONSTRUCTION.—Nothing in this sec15 tion may be construed to remove, limit, or otherwise affect 

16 any obligation of a covered health care professional under 

17 the Controlled Substances Act (21 U.S.C. 801 et seq.).’’. 

18 (b) CLERICAL AMENDMENT.—The table of sections 

19 at the beginning of chapter 17 of such title is amended 

20 by inserting after the item relating to section 1730A the 

21 following new item: 

‘‘1730B. Licensure of health care professionals providing treatment via telemedicine.’’. 

22 (c) REPORT ON TELEMEDICINE.— 

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

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1 vided under section 1730B of title 38, United States 

2 Code, as added by subsection (a), first occur or reg3 ulations are promulgated to carry out such section, 

4 the Secretary of Veterans Affairs shall submit to the 

5 Committee on Veterans’ Affairs of the Senate and 

6 the Committee on Veterans’ Affairs of the House of 

7 Representatives a report on the effectiveness of the 

8 use of telemedicine by the Department of Veterans 

9 Affairs. 

10 (2) ELEMENTS.—The report required by para11 graph (1) shall include an assessment of the fol12 lowing: 

13 (A) The satisfaction of veterans with tele14 medicine furnished by the Department. 

15 (B) The satisfaction of health care pro16 viders in providing telemedicine furnished by 

17 the Department. 

18 (C) The effect of telemedicine furnished by 

19 the Department on the following: 

20 (i) The ability of veterans to access 

21 health care, whether from the Department 

22 or from non-Department health care pro23 viders. 

24 (ii) The frequency of use by veterans 

25 of telemedicine. 


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1 (iii) The productivity of health care 

2 providers. 

3 (iv) Wait times for an appointment 

4 for the receipt of health care from the De5 partment. 

6 (v) The use by veterans of in-person 

7 services at Department facilities and non8 Department facilities. 

9 (D) The types of appointments for the re10 ceipt of telemedicine furnished by the Depart11 ment that were provided during the one-year 

12 period preceding the submittal of the report. 

13 (E) The number of appointments for the 

14 receipt of telemedicine furnished by the Depart15 ment that were requested during such period, 

16 disaggregated by medical facility. 

17 (F) Savings by the Department, if any, in18 cluding travel costs, from furnishing health care 

19 through the use of telemedicine during such pe20 riod. 

21 SEC. 202. ROLE OF PODIATRISTS IN DEPARTMENT OF VET22 ERANS AFFAIRS. 

23 (a) INCLUSION AS PHYSICIAN.— 


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

2 is amended by adding at the end the following new 

3 section: 

4 ‘‘§ 7413. Treatment of podiatrists; clinical oversight 

5 standards 

6 ‘‘(a) PODIATRISTS.—Except as provided by sub7 section (b), a doctor of podiatric medicine who is ap8 pointed as a podiatrist under section 7401(1) of this title 

9 is eligible for any supervisory position in the Veterans 

10 Health Administration to the same degree that a physician 

11 appointed under such section is eligible for the position. 

12 ‘‘(b) ESTABLISHMENT OF CLINICAL OVERSIGHT

13 STANDARDS.—The Secretary, in consultation with appro14 priate stakeholders, shall establish standards to ensure 

15 that specialists appointed in the Veterans Health Adminis16 tration to supervisory positions do not provide direct clin17 ical oversight for purposes of peer review or practice eval18 uation for providers of other clinical specialties.’’. 

19 (2) CLERICAL AMENDMENT.—The table of sec20 tions at the beginning of chapter 74 is amended by 

21 inserting after the item relating to section 7412 the 

22 following new item: 

‘‘7413. Treatment of podiatrists; clinical oversight standards.’’. 

23 (b) MODIFICATION AND CLARIFICATION OF PAY

24 GRADE.— 


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1 (1) GRADE.—The list in section 7404(b) of 

2 such title is amended— 

3 (A) by striking ‘‘PHYSICIAN AND DEN4 TIST SCHEDULE’’ and inserting ‘‘PHYSI5 CIAN AND SURGEON (MD/DO), 

6 PODIATRIC SURGEON (DPM), AND DEN7 TIST AND ORAL SURGEON (DDS, DMD) 

8 SCHEDULE’’; 

9 (B) by striking, ‘‘Physician grade’’ and in10 serting ‘‘Physician and surgeon grade’’; and 

11 (C) by striking ‘‘PODIATRIST, CHIRO12 PRACTOR, AND’’ and inserting ‘‘CHIRO13 PRACTOR AND’’. 

14 (2) APPLICATION.—The amendments made by 

15 paragraph (1) shall apply with respect to a pay pe16 riod of the Department of Veterans Affairs begin17 ning on or after the date that is 30 days after the 

18 date of the enactment of this Act. 

19 SEC. 203. MODIFICATION OF TREATMENT OF CERTIFIED 

20 CLINICAL PERFUSIONISTS OF THE DEPART21 MENT. 

22 (a) APPOINTMENT.—Section 7401(1) is amended by 

23 inserting ‘‘certified clinical perfusionists,’’ after ‘‘physician 

24 assistants,’’. 


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1 (b) INCREASES IN RATES OF BASIC PAY.—Section 

2 7455(c)(1) is amended by inserting ‘‘certified clinical 

3 perfusionists,’’ after ‘‘pharmacists,’’. 

4 SEC. 204. AMENDING STATUTORY REQUIREMENTS FOR THE 

5 POSITION OF THE CHIEF OFFICER OF THE 

6 READJUSTMENT COUNSELING SERVICE. 

7 Section 7309(b)(2) is amended— 

8 (1) in subparagraph (B), by striking ‘‘in the 

9 Readjustment Counseling Service’’; and 

10 (2) in subparagraph (C), by striking ‘‘in the 

11 Readjustment Counseling Service’’. 

12 SEC. 205. TECHNICAL AMENDMENT TO APPOINTMENT AND 

13 COMPENSATION SYSTEM FOR DIRECTORS OF 

14 MEDICAL CENTERS AND DIRECTORS OF VET15 ERANS INTEGRATED SERVICE NETWORKS. 

16 Section 7404(d) is amended by striking ‘‘Except’’ 

17 and inserting ‘‘Except for positions described in section 

18 7401(4) of this title and except’’. 

19 SEC. 206. IDENTIFICATION AND STAFFING OF CERTAIN 

20 HEALTH CARE VACANCIES. 

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

22 date of the enactment of this Act, the Secretary of Vet23 erans Affairs shall identify and fully staff— 

24 (1) all mental health vacancies within the De25 partment of Veterans Affairs; and 


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1 (2) all primary care and mental health vacan2 cies in Patient Aligned Care Teams of the Depart3 ment. 

4 (b) REPORT.—Not later than 210 days after the date 

5 of the enactment of this Act, the Secretary shall submit 

6 to Congress a report that specifies— 

7 (1) whether the Department has complied with 

8 the requirements under subsection (a); and 

9 (2) if the Secretary has not complied with such 

10 requirements— 

11 (A) how many vacancies described in sub12 section (a) remain; and 

13 (B) why the Department was unable to fill 

14 such vacancies. 

15 SEC. 207. DEPARTMENT OF VETERANS AFFAIRS PER16 SONNEL TRANSPARENCY. 

17 (a) PUBLICATION OF STAFFING AND VACANCIES.— 

18 (1) WEBSITE REQUIRED.—Not later than 30 

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

20 Secretary of Veterans Affairs shall make publicly 

21 available on an Internet website of the Department 

22 of Veterans Affairs the following information, which 

23 shall be displayed by departmental component or, in 

24 the case of information relating to Veterans Health 

25 Administration positions, by medical facility: 


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1 (A) The number of personnel encumbering 

2 positions. 

3 (B) The number of accessions and de-ac4 cessions of personnel during the month pre5 ceding the date of the publication of the infor6 mation. 

7 (C) The number of vacancies, by occupa8 tion. 

9 (D) The number of active job postings that 

10 have been filled during the 30-day period end11 ing on the date of publication of the informa12 tion, including the length of time for which each 

13 position was posted prior to being filled. 

14 (2) UPDATE OF INFORMATION.—The Secretary 

15 shall update the information on the website required 

16 under paragraph (1) on a monthly basis. 

17 (3) TREATMENT OF CONTRACTOR POSITIONS.— 

18 Any Department of Veterans Affairs position that is 

19 filled through a contractor employee may not be 

20 treated as a Department position for purposes of the 

21 information required to be published under para22 graph (1). 

23 (4) INSPECTOR GENERAL REVIEW.—On a semi24 annual basis, the Inspector General of the Depart25 ment shall review the administration of the website 


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1 required under paragraph (1) and make rec2 ommendations relating to the improvement of such 

3 administration. 

4 (b) REPORT TO CONGRESS.—The Secretary of Vet5 erans Affairs shall submit to Congress an annual report 

6 on the steps the Department is taking to achieve full staff7 ing capacity. Each such report shall include the amount 

8 of additional funds necessary to enable the Department 

9 to reach full staffing capacity. 

10 SEC. 208. PROGRAM ON ESTABLISHMENT OF PEER SPE11 CIALISTS IN PATIENT ALIGNED CARE TEAM 

12 SETTINGS WITHIN MEDICAL CENTERS OF DE13 PARTMENT OF VETERANS AFFAIRS. 

14 (a) PROGRAM REQUIRED.—The Secretary of Vet15 erans Affairs shall carry out a program to establish not 

16 fewer than two peer specialists in patient aligned care 

17 teams at medical centers of the Department of Veterans 

18 Affairs to promote the use and integration of services for 

19 mental health, substance use disorder, and behavior health 

20 in a primary care setting. 

21 (b) TIMEFRAME FOR ESTABLISHMENT OF PRO22 GRAM.—The Secretary shall carry out the program at 

23 medical centers of the Department as follows: 

24 (1) Not later than December 31, 2018, at not 

25 fewer than 25 medical centers of the Department. 


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1 (2) Not later than December 31, 2019, at not 

2 fewer than 50 medical centers of the Department. 

3 (c) SELECTION OF LOCATIONS.— 

4 (1) IN GENERAL.—The Secretary shall select 

5 medical centers for the program as follows: 

6 (A) Not fewer than five shall be medical 

7 centers of the Department that are designated 

8 by the Secretary as polytrauma centers. 

9 (B) Not fewer than ten shall be medical 

10 centers of the Department that are not des11 ignated by the Secretary as polytrauma centers. 

12 (2) CONSIDERATIONS.—In selecting medical 

13 centers for the program under paragraph (1), the 

14 Secretary shall consider the feasibility and advis15 ability of selecting medical centers in the following 

16 areas: 

17 (A) Rural areas and other areas that are 

18 underserved by the Department. 

19 (B) Areas that are not in close proximity 

20 to an active duty military installation. 

21 (C) Areas representing different geo22 graphic locations, such as census tracts estab23 lished by the Bureau of the Census. 


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1 (d) GENDER-SPECIFIC SERVICES.—In carrying out 

2 the program at each location selected under subsection (c), 

3 the Secretary shall ensure that— 

4 (1) the needs of female veterans are specifically 

5 considered and addressed; and 

6 (2) female peer specialists are made available to 

7 female veterans who are treated at each location. 

8 (e) ENGAGEMENT WITH COMMUNITY PROVIDERS.— 

9 At each location selected under subsection (c), the Sec10 retary shall consider ways in which peer specialists can 

11 conduct outreach to health care providers in the commu12 nity who are known to be serving veterans to engage with 

13 those providers and veterans served by those providers. 

14 (f) REPORTS.— 

15 (1) PERIODIC REPORTS.— 

16 (A) IN GENERAL.—Not later than 180 

17 days after the date of the enactment of this 

18 Act, and not less frequently than once every 

19 180 days thereafter until the Secretary deter20 mines that the program is being carried out at 

21 the last location to be selected under subsection 

22 (c), the Secretary shall submit to Congress a 

23 report on the program. 

24 (B) ELEMENTS.—Each report required by 

25 subparagraph (A) shall, with respect to the 


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1 180-day period preceding the submittal of the 

2 report, include the following: 

3 (i) The findings and conclusions of 

4 the Secretary with respect to the program. 

5 (ii) An assessment of the benefits of 

6 the program to veterans and family mem7 bers of veterans. 

8 (iii) An assessment of the effective9 ness of peer specialists in engaging under 

10 subsection (e) with health care providers in 

11 the community and veterans served by 

12 those providers. 

13 (2) FINAL REPORT.—Not later than 180 days 

14 after the Secretary determines that the program is 

15 being carried out at the last location to be selected 

16 under subsection (c), the Secretary shall submit to 

17 Congress a report detailing the recommendations of 

18 the Secretary as to the feasibility and advisability of 

19 expanding the program to additional locations. 


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1 SEC. 209. PILOT PROGRAM ON INCREASING THE USE OF 

2 MEDICAL SCRIBES TO MAXIMIZE THE EFFI3 CIENCY OF PHYSICIANS AT MEDICAL FACILI4 TIES OF THE DEPARTMENT OF VETERANS AF5 FAIRS. 

6 (a) IN GENERAL.—Commencing not later than 120 

7 days after the date of the enactment of this Act, the Sec8 retary of Veterans Affairs shall carry out a pilot program 

9 to increase the use of medical scribes to maximize the effi10 ciency of physicians at medical facilities of the Depart11 ment of Veterans Affairs. 

12 (b) DURATION.—The Secretary shall carry out the 

13 pilot program during the 18-month period beginning on 

14 the date of the commencement of the pilot program. 

15 (c) LOCATIONS.—The Secretary shall carry out the 

16 pilot program at not fewer than five medical facilities of 

17 the Department— 

18 (1) at which the Secretary has determined there 

19 is a high volume of patients; or 

20 (2) that are located in rural areas and at which 

21 the Secretary has determined there is a shortage of 

22 physicians and each physician has a high caseload. 

23 (d) CONTRACTS.— 

24 (1) IN GENERAL.—In carrying out the pilot 

25 program, the Secretary shall enter into a contract 


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1 with one or more appropriate nongovernmental enti2 ties described in paragraph (2). 

3 (2) APPROPRIATE NONGOVERNMENTAL ENTI4 TIES DESCRIBED.—An appropriate nongovernmental 

5 entity described in this paragraph is an entity that 

6 trains and employs professional medical scribes who 

7 specialize in the collection of medical data and data 

8 entry into electronic health records. 

9 (e) COLLECTION OF DATA.— 

10 (1) IN GENERAL.—The Secretary shall collect 

11 data on the pilot program to determine the effective12 ness of the pilot program in increasing the efficiency 

13 of physicians at medical facilities of the Department. 

14 (2) ELEMENTS.—The data collected under 

15 paragraph (1) shall include the following with re16 spect to each medical facility participating in the 

17 pilot program: 

18 (A) The average wait time for a veteran to 

19 receive care from a physician at such medical 

20 facility before implementation of the pilot pro21 gram. 

22 (B) The average wait time for a veteran to 

23 receive care from such a physician after imple24 mentation of the pilot program. 


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1 (C) The average number of patients that 

2 such a physician is able to see on a daily basis 

3 before implementation of the pilot program. 

4 (D) The average number of patients that 

5 such a physician is able to see on a daily basis 

6 after implementation of the pilot program. 

7 (E) The average amount of time such a 

8 physician spends on documentation on a daily 

9 basis before implementation of the pilot pro10 gram. 

11 (F) The average amount of time such a 

12 physician spends on documentation on a daily 

13 basis after implementation of the pilot program. 

14 (G) The satisfaction and retention scores 

15 of each such physician before implementation of 

16 the pilot program. 

17 (H) The satisfaction and retention scores 

18 of each such physician after implementation of 

19 the pilot program. 

20 (I) The patient satisfaction scores for each 

21 such physician before implementation of the 

22 pilot program. 

23 (J) The patient satisfaction scores for each 

24 such physician after implementation of the pilot 

25 program. 


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1 (K) The patient satisfaction scores for 

2 their health care experience before implementa3 tion of the pilot program. 

4 (L) The patient satisfaction scores for 

5 their health care experience after implementa6 tion of the pilot program. 

7 (f) REPORT.— 

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

9 after the commencement of the pilot program, and 

10 not less frequently than once every 180 days there11 after for the duration of the pilot program, the Sec12 retary shall submit to Congress a report on the pilot 

13 program. 

14 (2) ELEMENTS.—Each report required by para15 graph (1) shall include the following: 

16 (A) The number of medical facilities of the 

17 Department that are participating in the pilot 

18 program. 

19 (B) With respect to each such medical fa20 cility, an assessment of the effects that partici21 pation in the pilot program has had on the fol22 lowing— 

23 (i) Maximizing the efficiency of physi24 cians at such medical facility. 


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1 (ii) Reducing average wait times for 

2 appointments. 

3 (iii) Improving access of patients to 

4 electronic medical records. 

5 (iv) Mitigating physician shortages by 

6 increasing the productivity of physicians. 

7 (C) All data collected under subsection (e). 

8 (D) Such recommendations as the Sec9 retary may have with respect to the extension 

10 or expansion of the pilot program. 

11 (g) MEDICAL SCRIBE DEFINED.—In this section, the 

12 term ‘‘medical scribe’’ means a member of the medical 

13 team hired and trained specifically and exclusively to per14 form documentation in an electronic health record to 

15 maximize the productivity of a physician. 

16 SEC. 210. SENSE OF CONGRESS REGARDING DEPARTMENT 

17 OF VETERANS AFFAIRS STAFFING LEVELS. 

18 (a) FINDINGS.—Congress makes the following find19 ings: 

20 (1) The Department of Veterans Affairs needs 

21 to fill at least 35,000 positions. 

22 (2) Prolonged personnel vacancies in the De23 partment result in staffing shortages that cause vet24 erans to receive delayed benefits and services. 


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1 (b) SENSE OF CONGRESS.—It is the sense of Con2 gress that the Department should make the resolution of 

3 staffing shortages a top priority. 

4 PART II—EDUCATION AND TRAINING 

5 SEC. 211. GRADUATE MEDICAL EDUCATION AND RESI6 DENCY. 

7 (a) INCREASE IN NUMBER OF GRADUATE MEDICAL

8 EDUCATION RESIDENCY POSITIONS.— 

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

10 Affairs shall increase the number of graduate med11 ical education residency positions at covered facilities 

12 by up to 1,500 positions in the 10-year period begin13 ning on the date of the enactment of this Act. 

14 (2) COVERED FACILITIES.—For purposes of 

15 this section, a covered facility is any of the following: 

16 (A) A facility of the Department of Vet17 erans Affairs. 

18 (B) A facility operated by an Indian tribe 

19 or a tribal organization, as those terms are de20 fined in section 4 of the Indian Self-Determina21 tion and Education Assistance Act (25 U.S.C. 

22 5304). 

23 (C) A facility operated by the Indian 

24 Health Service. 


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1 (D) A Federally-qualified health center, as 

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

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

4 (E) A community health center. 

5 (F) A facility operated by the Department 

6 of Defense. 

7 (G) Such other health care facility as the 

8 Secretary considers appropriate for purposes of 

9 this section. 

10 (3) STIPENDS AND BENEFITS.—The Secretary 

11 may pay stipends and provide benefits for residents 

12 in positions under paragraph (1), regardless of 

13 whether they have been assigned in a Department 

14 facility. 

15 (4) PARAMETERS FOR LOCATION, AFFILIATE

16 SPONSOR, AND DURATION.—When determining char17 acteristics of residency positions under paragraph 

18 (1), the Secretary shall consider the extent to which 

19 there is a clinical need for providers, as determined 

20 by the following: 

21 (A) The ratio of veterans to health care 

22 providers of the Department for a standardized 

23 geographic area surrounding a facility, includ24 ing a separate ratio for general practitioners 

25 and specialists. 


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1 (B) Whether the local community is medi2 cally underserved. 

3 (C) Whether the facility is located in a 

4 rural or remote area. 

5 (D) Such other criteria as the Secretary 

6 considers important in determining which facili7 ties are not adequately serving area veterans. 

8 (5) PARAMETERS FOR TYPES OF SPECIAL9 TIES.—When determining the types of specialties to 

10 be included in residency positions under paragraph 

11 (1), the Secretary shall consider the following: 

12 (A) The types of specialties that improve 

13 the quality and coverage of medical services 

14 provided to veterans. 

15 (B) The range of clinical specialties cov16 ered by providers in standardized geographic 

17 areas surrounding facilities. 

18 (C) Whether the specialty is included in 

19 the most recent staffing shortage determination 

20 of the Department under section 7412 of title 

21 38, United States Code. 

22 (b) APPLICATION TO PARTICIPATE.—To participate 

23 as a resident in one of the positions increased under sub24 section (a)(1), an individual shall submit to the Secretary 

25 an application therefor together with an agreement deVerDate Sep 11 2014 23:02 Dec 05, 2017 Jkt 079200 PO 00000 Frm 00110 Fmt 6652 Sfmt 6201 E:\BILLS\S2193.PCS S2193

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1 scribed in subsection (d) under which the participant 

2 agrees to serve a period of obligated service in the Vet3 erans Health Administration as provided in the agreement 

4 in return for payment of stipend and benefit support as 

5 provided in the agreement. 

6 (c) SELECTION.— 

7 (1) IN GENERAL.—An individual becomes a 

8 participant in a residency program under this sec9 tion upon the Secretary’s approval of the individual’s 

10 application under subsection (b) and the Secretary’s 

11 acceptance of the agreement under subsection (d) (if 

12 required). 

13 (2) NOTICE.—Upon the Secretary’s approval of 

14 an individual’s participation in the program under 

15 paragraph (1), the Secretary shall promptly notify 

16 the individual of that approval. Such notice shall be 

17 in writing. 

18 (d) AGREEMENT.— 

19 (1) IN GENERAL.—An agreement between the 

20 Secretary and a resident in a position under sub21 section (a)(1) shall be in writing and shall be signed 

22 by the resident containing such terms as the Sec23 retary may specify. 

24 (2) REQUIREMENTS.—The agreement must 

25 specify the terms of the service obligation resulting 


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1 from participating as a resident under this section, 

2 including by requiring a service obligation equal to 

3 the number of years of stipend and benefit support. 

4 (e) CONDITIONS OF EMPLOYMENT.—The Secretary 

5 may prescribe the conditions of employment of individuals 

6 appointed to positions under subsection (a)(1), including 

7 necessary training, and the customary amount and terms 

8 of pay for such positions during the period of such employ9 ment and training. 

10 (f) OBLIGATED SERVICE.— 

11 (1) IN GENERAL.—Each individual appointed to 

12 a position under subsection (a)(1) shall provide serv13 ice as a full-time employee of the Department for 

14 the period of obligated service provided in the agree15 ment of the participant entered into under sub16 section (d). Such service shall be provided in the 

17 full-time clinical practice of such participant’s pro18 fession or in another health care position in an as19 signment or location determined by the Secretary. 

20 (2) COMMENCEMENT DATE.—Not later than 60 

21 days before the date on which an individual com22 mences serving in a position under subsection (a)(1), 

23 the Secretary shall notify the individual of such 

24 date. Such date shall be the first day of the individ25 ual’s period of obligated service. 


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1 (g) BREACH OF AGREEMENT: LIABILITY.— 

2 (1) PENALTY.—An individual appointed under 

3 this section to a position under subsection (a)(1) 

4 (other than an individual who is liable under para5 graph (2)) who fails to accept payment, or instructs 

6 the educational institution in which the individual is 

7 enrolled not to accept payment, in whole or in part, 

8 for a residency under the agreement entered into 

9 under subsection (d) of this title shall be liable to 

10 the United States for liquidated damages in the 

11 amount of $1,500. Such liability is in addition to 

12 any period of obligated service or other obligation or 

13 liability under the agreement. 

14 (2) LIABILITY.— 

15 (A) IN GENERAL.—An individual ap16 pointed to a position under subsection (a)(1) 

17 shall be liable to the United States for the 

18 amount which has been paid to or on behalf of 

19 the individual under the agreement if any of the 

20 following occurs: 

21 (i) The individual is dismissed from 

22 the position for disciplinary reasons. 

23 (ii) The individual voluntarily termi24 nates the residency before the completion 

25 of such course of training. 


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1 (iii) The individual loses the individ2 ual’s license, registration, or certification 

3 to practice the individual’s health care pro4 fession in a State. 

5 (B) LIABILITY SUPPLANTS SERVICE OBLI6 GATION.—Liability under this paragraph is in 

7 lieu of any service obligation arising under the 

8 individual’s agreement under subsection (d). 

9 (h) RECOVERY.— 

10 (1) IN GENERAL.—If an individual breaches the 

11 individuals’s agreement under subsection (d) by fail12 ing (for any reason) to complete such individual’s 

13 period of obligated service, the United States shall 

14 be entitled to recover from the individual an amount 

15 equal to the product of— 

16 (A) three; 

17 (B) the sum of— 

18 (i) the amounts paid under this sec19 tion to or on behalf of the individual; and 

20 (ii) the interest on such amounts that 

21 would be payable if at the time the 

22 amounts were paid they were loans bearing 

23 interest at the maximum legal prevailing 

24 rate, as determined by the Treasurer of 

25 the United States; and 


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1 (C) the quotient of— 

2 (i) the difference between— 

3 (I) the total number of months in 

4 the individual’s period of obligated 

5 service; and 

6 (II) the number of months of 

7 such period served by the individual; 

8 and 

9 (ii) the total number of months in the 

10 individual’s period of obligated service. 

11 (2) PERIOD OF RECOVERY.—Any amount which 

12 the United States is entitled to recover under this 

13 subsection shall be paid to the United States not 

14 later than the date that is one year after the date 

15 of the breach of the agreement. 

16 (i) ANNUAL REPORT.— 

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

18 after the date of the enactment of this Act and not 

19 less frequently than once each year thereafter, the 

20 Secretary shall submit to the appropriate committees 

21 of Congress a report on the implementation of this 

22 section during the previous year. 

23 (2) CONTENTS.—Each report submitted under 

24 paragraph (1) shall include, for the period covered 

25 by the report, the following: 


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1 (A) The number of positions described in 

2 subsection (a) that were filled. 

3 (B) The location of each such position. 

4 (C) The academic affiliate associated with 

5 each such position. 

6 (D) A description of the challenges faced 

7 in filling the positions described in subsection 

8 (a) and the actions the Secretary has taken to 

9 address such challenges. 

10 (3) APPROPRIATE COMMITTEES OF CONGRESS

11 DEFINED.—In this subsection, the term ‘‘appro12 priate committees of Congress’’ means— 

13 (A) the Committee on Veterans’ Affairs 

14 and the Committee on Appropriations of the 

15 Senate; and 

16 (B) the Committee on Veterans’ Affairs 

17 and the Committee on Appropriations of the 

18 House of Representatives. 

19 SEC. 212. PILOT PROGRAM TO ESTABLISH OR AFFILIATE 

20 WITH GRADUATE MEDICAL RESIDENCY PRO21 GRAMS AT FACILITIES OPERATED BY INDIAN 

22 TRIBES, TRIBAL ORGANIZATIONS, AND THE 

23 INDIAN HEALTH SERVICE IN RURAL AREAS. 

24 (a) PILOT PROGRAM REQUIRED.—The Secretary of 

25 Veterans Affairs, in consultation with the Director of the 


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1 Indian Health Service and such other persons as the Sec2 retary considers appropriate, shall carry out a pilot pro3 gram— 

4 (1) to establish graduate medical education 

5 residency training programs at covered facilities; or 

6 (2) to affiliate with established programs de7 scribed in paragraph (1). 

8 (b) COVERED FACILITIES.—For purposes of the pilot 

9 program, a covered facility is any facility— 

10 (1)(A) described in subparagraph (B) or (C) of 

11 section 211(a)(2); or 

12 (B) with an agreement with the Department de13 scribed in section 101(d)(1); and 

14 (2) located in a rural or remote area. 

15 (c) LOCATIONS.— 

16 (1) IN GENERAL.—The Secretary shall carry 

17 out the pilot program at not more than five covered 

18 facilities that have been selected by the Secretary for 

19 purposes of the pilot program. 

20 (2) CRITERIA.—The Secretary shall establish 

21 criteria for selecting covered facilities under para22 graph (1). 

23 (d) DURATION.—The Secretary shall carry out the 

24 pilot program during the eight-year period beginning on 


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

2 of this Act. 

3 (e) REIMBURSEMENT OF COSTS.—The Secretary 

4 shall reimburse each covered facility participating in the 

5 pilot program for the following costs associated with the 

6 pilot program: 

7 (1) Curriculum development. 

8 (2) Recruitment, training, supervision, and re9 tention of residents and faculty. 

10 (3) Accreditation of programs of education 

11 under the pilot program by the Accreditation Coun12 cil for Graduate Medical Education (ACGME) or the 

13 American Osteopathic Association (AOA). 

14 (4) The portion of faculty salaries attributable 

15 to activities relating to carrying out the pilot pro16 gram. 

17 (5) Payment for expenses relating to providing 

18 medical education under the pilot program. 

19 (6) Stipends and benefits. 

20 (f) PERIOD OF OBLIGATED SERVICE.— 

21 (1) IN GENERAL.—The Secretary shall enter 

22 into an agreement with each individual who partici23 pates in the pilot program under which such indi24 vidual agrees to serve under the same terms as es25 tablished under section 211. 


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1 (2) LOAN REPAYMENT.—During the period of 

2 obligated service of an individual under paragraph 

3 (1), the individual— 

4 (A) shall be deemed to be an eligible indi5 vidual under subsection (b) of section 108 of 

6 the Indian Health Care Improvement Act (25 

7 U.S.C. 1616a) for purposes of participation in 

8 the Indian Health Service Loan Repayment 

9 Program under such section during the portion 

10 of such period that the individual serves at a 

11 covered facility; and 

12 (B) shall be deemed to be an eligible indi13 vidual under section 7682(a) of title 38, United 

14 States Code, for purposes of participation in 

15 the Department of Veterans Affairs Education 

16 Debt Reduction Program under subchapter VII 

17 of chapter 76 of such title during the portion 

18 of such period that the individual serves at a fa19 cility of the Department. 

20 (3) CONCURRENT SERVICE.—Any period of ob21 ligated service required of an individual under para22 graph (1) shall be served— 

23 (A) with respect to service at a covered fa24 cility, concurrently with any period of obligated 


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1 service required of the individual by the Indian 

2 Health Service; and 

3 (B) with respect to service at a facility of 

4 the Department of Veterans Affairs, concur5 rently with any period of obligated service re6 quired of the individual by the Department. 

7 (g) TREATMENT OF PARTICIPANTS.—A residency po8 sition into which a participant in the pilot program is 

9 placed as part of the pilot program shall be considered 

10 a position referred to in section 211(a)(1) for purposes 

11 of the limitation on number of new positions authorized 

12 under such section. 

13 (h) REPORT.—Not later than three years before the 

14 date on which the pilot program terminates, the Secretary 

15 of Veterans Affairs shall submit to the Committee on Vet16 erans’ Affairs of the Senate and the Committee on Vet17 erans’ Affairs of the House of Representatives a report 

18 on the feasibility and advisability of— 

19 (1) expanding the pilot program to additional 

20 locations; and 

21 (2) making the pilot program or any aspect of 

22 the pilot program permanent. 


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1 SEC. 213. REIMBURSEMENT OF CONTINUING PROFES2 SIONAL EDUCATION REQUIREMENTS FOR 

3 BOARD CERTIFIED ADVANCED PRACTICE 

4 REGISTERED NURSES. 

5 (a) IN GENERAL.—Section 7411 is amended to read 

6 as follows: 

7 ‘‘§ 7411. Reimbursement of continuing professional 

8 education expenses 

9 ‘‘The Secretary shall reimburse any full-time board10 certified advanced practice registered nurse, physician, or 

11 dentist appointed under section 7401(1) of this title for 

12 expenses incurred, up to $1,000 per year, for continuing 

13 professional education.’’. 

14 (b) CLERICAL AMENDMENT.—The table of sections 

15 at the beginning of chapter 74 is amended by striking the 

16 item relating to section 7411 and inserting the following 

17 new item: 

‘‘7411. Reimbursement of continuing professional education expenses.’’. 

18 SEC. 214. INCREASE IN MAXIMUM AMOUNT OF DEBT THAT 

19 MAY BE REDUCED UNDER EDUCATION DEBT 

20 REDUCTION PROGRAM OF DEPARTMENT OF 

21 VETERANS AFFAIRS. 

22 (a) INCREASE IN AMOUNT.—Section 7683(d)(1) is 

23 amended— 

24 (1) by striking ‘‘$120,000’’ and inserting 

25 ‘‘$240,000’’; and 


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1 (2) by striking ‘‘$24,000’’ and inserting 

2 ‘‘$48,000’’. 

3 (b) STUDY.— 

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

5 after the date of the enactment of this Act, the Sec6 retary of Veterans Affairs shall— 

7 (A) conduct a study on the demand for 

8 education debt reduction under subchapter VII 

9 of chapter 76 of title 38, United States Code; 

10 and 

11 (B) submit to the Committee on Veterans’ 

12 Affairs of the Senate and the Committee on 

13 Veterans’ Affairs of the House of Representa14 tives a report on the findings of the Secretary 

15 with respect to the study carried out under sub16 paragraph (A). 

17 (2) CONSIDERATIONS.—In carrying out the 

18 study required by paragraph (1)(A), the Secretary 

19 shall consider the following: 

20 (A) The total number of vacancies within 

21 the Veterans Health Administration whose ap22 plicants are eligible to participate in the Edu23 cation Debt Reduction Program pursuant to 

24 section 7682(a) of such title. 


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1 (B) The types of medical professionals in 

2 greatest demand in the United States. 

3 (C) Projections by the Secretary of the 

4 numbers and types of medical professions that 

5 meet the needs of veterans. 

6 SEC. 215. DEMONSTRATION PROGRAM ON TRAINING AND 

7 EMPLOYMENT OF ALTERNATIVE DENTAL 

8 HEALTH CARE PROVIDERS FOR DENTAL 

9 HEALTH CARE SERVICES FOR VETERANS IN 

10 RURAL AND OTHER UNDERSERVED COMMU11 NITIES. 

12 (a) DEMONSTRATION PROGRAM AUTHORIZED.—The 

13 Secretary of Veterans Affairs may carry out a demonstra14 tion program to establish programs to train and employ 

15 alternative dental health care providers in order to in16 crease access to dental health care services for veterans 

17 who are entitled to such services from the Department of 

18 Veterans Affairs and reside in rural and other underserved 

19 communities. 

20 (b) PRIORITY.—The Secretary shall prioritize the es21 tablishment of programs under the demonstration pro22 gram under this section in States that do not have a facil23 ity of the Department that offers on-site dental services. 

24 (c) TELEHEALTH.—For purposes of alternative den25 tal health care providers and other dental care providers 


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1 who are licensed to provide clinical care, dental services 

2 provided under the demonstration program under this sec3 tion may be administered by such providers through tele4 health-enabled collaboration and supervision when appro5 priate and feasible. 

6 (d) AUTHORIZATION OF APPROPRIATIONS.—There 

7 are authorized to be appropriated to the Secretary such 

8 sums as are necessary to carry out the demonstration pro9 gram under this section. 

10 (e) ALTERNATIVE DENTAL HEALTH CARE PRO11 VIDERS DEFINED.—In this section, the term ‘‘alternative 

12 dental health care providers’’ has the meaning given that 

13 term in section 340G–1(a)(2) of the Public Health Service 

14 Act (42 U.S.C. 256g–1(a)(2)). 

15 PART III—OTHER PERSONNEL MATTERS 

16 SEC. 221. EXCEPTION ON LIMITATION ON AWARDS AND BO17 NUSES FOR RECRUITMENT, RELOCATION, 

18 AND RETENTION. 

19 Section 705(a) of the Veterans Access, Choice, and 

20 Accountability Act of 2014 (Public Law 113–146; 38 

21 U.S.C. 703 note) is amended, in the matter preceding 

22 paragraph (1), by inserting ‘‘other than recruitment, relo23 cation, or retention incentives,’’ after ‘‘title 38, United 

24 States Code,’’. 


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1 SEC. 222. ANNUAL REPORT ON PERFORMANCE AWARDS 

2 AND BONUSES AWARDED TO CERTAIN HIGH3 LEVEL EMPLOYEES OF THE DEPARTMENT. 

4 (a) IN GENERAL.—Chapter 7 is amended by adding 

5 at the end the following new section: 

6 ‘‘§ 726. Annual report on performance awards and bo7 nuses awarded to certain high-level em8 ployees 

9 ‘‘(a) IN GENERAL.—Not later than 30 days after the 

10 end of each fiscal year, the Secretary shall submit to the 

11 appropriate committees of Congress a report that con12 tains, for the most recent fiscal year ending before the 

13 submittal of the report, a description of the performance 

14 awards and bonuses awarded to Regional Office Directors 

15 of the Department, Directors of Medical Centers of the 

16 Department, and Directors of Veterans Integrated Service 

17 Networks. 

18 ‘‘(b) ELEMENTS.—Each report submitted under sub19 section (a) shall include the following with respect to each 

20 performance award or bonus awarded to an individual de21 scribed in such subsection: 

22 ‘‘(1) The amount of each award or bonus. 

23 ‘‘(2) The job title of the individual awarded the 

24 award or bonus. 

25 ‘‘(3) The location where the individual awarded 

26 the award or bonus works. 


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1 ‘‘(c) APPROPRIATE COMMITTEES OF CONGRESS.—In 

2 this section, the term ‘appropriate committees of Con3 gress’ means— 

4 ‘‘(1) the Committee on Veterans’ Affairs and 

5 the Committee on Appropriations of the Senate; and 

6 ‘‘(2) the Committee on Veterans’ Affairs and 

7 the Committee on Appropriations of the House of 

8 Representatives.’’. 

9 (b) CLERICAL AMENDMENT.—The table of sections 

10 at the beginning of chapter 7 is amended by inserting 

11 after the item relating to section 725 the following new 

12 item: 

‘‘726. Annual report on performance awards and bonuses awarded to certain 

high-level employees.’’. 

13 SEC. 223. AUTHORITY TO REGULATE ADDITIONAL PAY FOR 

14 CERTAIN HEALTH CARE EMPLOYEES OF THE 

15 DEPARTMENT. 

16 Section 7454 is amended by adding at the end the 

17 following new subsection: 

18 ‘‘(d) In this section, the term ‘compensation’ includes 

19 all compensation earned by employees when performing 

20 duties authorized by the Secretary or when the employee 

21 is approved to use annual, sick, family medical, military, 

22 or court leave or during any other paid absence for which 

23 pay is not already regulated.’’. 


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1 SEC. 224. MODIFICATION OF PAY CAP FOR NURSES. 

2 Paragraph (2) of section 7451(c) is amended to read 

3 as follows: 

4 ‘‘(2)(A) The maximum rate of basic pay for any 

5 grade for health-care personnel positions referred to in 

6 paragraphs (1) and (3) of section 7401 of this title (other 

7 than the positions of physician, dentist, and registered 

8 nurse) may not exceed the rate of basic pay established 

9 for positions in level IV of the Executive Schedule under 

10 section 5315 of title 5. 

11 ‘‘(B) Pursuant to an adjustment under subsection 

12 (d), the maximum rate of basic pay for a registered nurse 

13 serving as a nurse executive or a grade for the position 

14 of certified registered nurse anesthetist may exceed the 

15 rate of basic pay established for positions in level IV of 

16 the Executive Schedule under section 5315 of title 5 but 

17 may not exceed the rate of basic pay established for posi18 tions in level I of the Executive Schedule under section 

19 5312 of title 5. 

20 ‘‘(C) Pursuant to an adjustment under subsection 

21 (d), the maximum rate of basic pay for all registered 

22 nurses not described in subparagraph (B) may exceed the 

23 rate of basic pay established for positions in level IV of 

24 the Executive Schedule under section 5315 of title 5 but 

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1 tions in level III of the Executive Schedule under section 

2 5314 of title 5.’’. 

3 Subtitle B—Improvement of Under4 served Facilities of the Depart5 ment 

6 SEC. 231. DEVELOPMENT OF CRITERIA FOR DESIGNATION 

7 OF CERTAIN MEDICAL FACILITIES OF THE 

8 DEPARTMENT OF VETERANS AFFAIRS AS UN9 DERSERVED FACILITIES AND PLAN TO AD10 DRESS PROBLEM OF UNDERSERVED FACILI11 TIES. 

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

13 date of the enactment of this Act, the Secretary of Vet14 erans Affairs shall develop criteria to designate medical 

15 centers, ambulatory care facilities, and community based 

16 outpatient clinics of the Department of Veterans Affairs 

17 as underserved facilities. 

18 (b) CONSIDERATION.—Criteria developed under sub19 section (a) shall include consideration of the following with 

20 respect to a facility: 

21 (1) The ratio of veterans to health care pro22 viders of the Department of Veterans Affairs for a 

23 standardized geographic area surrounding the facil24 ity, including a separate ratio for general practi25 tioners and specialists. 


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1 (2) The range of clinical specialties covered by 

2 such providers in such area. 

3 (3) Whether the local community is medically 

4 underserved. 

5 (4) The type, number, and age of open consults. 

6 (5) Whether the facility is meeting the wait7 time goals of the Department. 

8 (6) Such other criteria as the Secretary con9 siders important in determining which facilities are 

10 not adequately serving area veterans. 

11 (c) ANALYSIS OF FACILITIES.—Not less frequently 

12 than annually, directors of Veterans Integrated Service 

13 Networks of the Department shall perform an analysis to 

14 determine which facilities within that Veterans Integrated 

15 Service Network qualify as underserved facilities pursuant 

16 to criteria developed under subsection (a). 

17 (d) ANNUAL PLAN TO ADDRESS UNDERSERVED FA18 CILITIES.— 

19 (1) PLAN REQUIRED.—Not later than one year 

20 after the date of the enactment of this Act and not 

21 less frequently than once each year, the Secretary 

22 shall submit to Congress a plan to address the prob23 lem of underserved facilities of the Department, as 

24 designated pursuant to criteria developed under sub25 section (a). 


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1 (2) CONTENTS.—Each plan submitted under 

2 paragraph (1) shall address the following: 

3 (A) Increasing personnel or temporary per4 sonnel assistance, including mobile deployment 

5 teams furnished under section 233. 

6 (B) Providing special hiring incentives, in7 cluding under the Education Debt Reduction 

8 Program under subchapter VII of chapter 76 of 

9 title 38, United States Code, and recruitment, 

10 relocation, and retention incentives. 

11 (C) Using direct hiring authority. 

12 (D) Improving training opportunities for 

13 staff. 

14 (E) Such other actions as the Secretary 

15 considers appropriate. 

16 SEC. 232. PILOT PROGRAM ON TUITION REIMBURSEMENT 

17 AND LOAN REPAYMENT FOR HEALTH CARE 

18 PROVIDERS OF THE DEPARTMENT OF VET19 ERANS AFFAIRS AT UNDERSERVED FACILI20 TIES. 

21 (a) IN GENERAL.—Not later than 90 days after the 

22 date of the enactment of this Act, the Secretary of Vet23 erans Affairs shall commence a pilot program to assess 

24 the feasibility and advisability of providing incentives to 

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1 erans Health Administration by providing tuition reim2 bursement and loan repayment to medical students and 

3 health care providers who commit to serving in under4 served facilities selected under subsection (c). 

5 (b) DURATION.—The Secretary shall carry out the 

6 pilot program during the six-year period beginning on the 

7 date of the commencement of the pilot program. 

8 (c) SELECTION OF LOCATIONS.— 

9 (1) IN GENERAL.—The Secretary shall select 

10 not fewer than three medical centers and seven am11 bulatory care facilities or community based out12 patient clinics of the Department to participate in 

13 the pilot program. 

14 (2) RURAL AND HIGHLY RURAL AREAS.—Not 

15 fewer than two of the medical centers and five of the 

16 ambulatory care facilities or community based out17 patient clinics selected under paragraph (1) shall be 

18 in States or United States territories that are among 

19 the ten States or United States territories with— 

20 (A) the highest percentage of land des21 ignated as highly rural pursuant to the rural22 urban commuting area codes set forth by the 

23 Department of Agriculture; or 


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1 (B) the highest percentage of enrolled vet2 erans living in rural, highly rural, or insular is3 land areas. 

4 (3) STATES.—Facilities selected under para5 graph (1) shall be located in not fewer than eight 

6 different States. 

7 (d) USE OF AMOUNTS.—Of the amounts used to pro8 vide tuition reimbursement or loan repayment under the 

9 pilot program— 

10 (1) one-half shall be used to provide tuition re11 imbursement or loan repayment for individuals prac12 ticing in a general practice position; and 

13 (2) one-half shall be used to provide tuition re14 imbursement or loan repayment for individuals prac15 ticing— 

16 (A) in a specialist position; or 

17 (B) in an occupation, other than a position 

18 described in paragraph (1), included in the 

19 most recent staffing shortage determination of 

20 the Department under section 7412 of title 38, 

21 United States Code. 

22 (e) TUITION REIMBURSEMENT.—Under the pilot pro23 gram, the Secretary may provide to an individual attend24 ing medical school and seeking a degree as a Doctor of 

25 Medicine or a Doctor of Osteopathic Medicine full tuition 


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1 reimbursement in exchange for a five-year commitment to 

2 serve at an underserved facility selected under subsection 

3 (c). 

4 (f) STUDENT LOAN REPAYMENT.—Under the pilot 

5 program, in exchange for a three-year commitment to 

6 serve at an underserved facility selected under subsection 

7 (c), the Secretary may provide— 

8 (1) to an individual currently serving as a 

9 health care provider at an underserved facility, an 

10 amount not to exceed $30,000 to apply to any re11 maining student loan debt of the individual; and 

12 (2) to an individual other than an individual de13 scribed in paragraph (1), an amount not to exceed 

14 $50,000 to apply to any remaining student loan debt 

15 of the individual. 

16 (g) BREACH.—An individual who participates in the 

17 pilot program and fails to satisfy a period of obligated 

18 service under subsection (d) or (e) shall be liable to the 

19 United States, in lieu of such obligated service, for the 

20 amount that has been paid or is payable to or on behalf 

21 of the individual under the pilot program, reduced by the 

22 proportion that the number of days served for completion 

23 of the period of obligated service bears to the total number 

24 of days in the period of obligated service of such indi25 vidual. 


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1 (h) EXPEDITED HIRING.—The Secretary shall ensure 

2 that the hiring of individuals to serve in the Department 

3 under the pilot program is conducted in an expedited man4 ner. 

5 (i) CONTINUATION IN PILOT PROGRAM.—An indi6 vidual participating in the pilot program in an occupation 

7 included in a staffing shortage determination of the De8 partment under section 7412 of title 38, United States 

9 Code, may continue participating in the pilot program not10 withstanding that the occupation is no longer included in 

11 such determination under such section. 

12 (j) ANNUAL REPORT.— 

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

14 after the date of the enactment of this Act and not 

15 less frequently than once each year thereafter, the 

16 Secretary shall submit to Congress a report on the 

17 pilot program. 

18 (2) CONTENTS.—Each report submitted under 

19 paragraph (1) shall include the following: 

20 (A) The number of participants, including 

21 number receiving tuition reimbursement and 

22 student loan repayment. 

23 (B) The number of facilities where partici24 pants are located. 


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1 (C) The number of individuals who have 

2 applied to participate in the pilot program. 

3 (D) A list of the five most common occupa4 tions of the participants in the pilot program, 

5 other than general practice. 

6 (k) DEFINITIONS.—In this section: 

7 (1) ENROLLED VETERAN.—The term ‘‘enrolled 

8 veteran’’ means a veteran who is enrolled in the sys9 tem of annual patient enrollment established and op10 erated under section 1705(a) of title 38, United 

11 States Code. 

12 (2) UNDERSERVED FACILITY.—The term ‘‘un13 derserved facility’’ means a medical center, ambula14 tory care facility, or community based outpatient 

15 clinic of the Department of Veterans Affairs des16 ignated by the Secretary of Veterans Affairs pursu17 ant to criteria developed under section 231. 

18 SEC. 233. PROGRAM TO FURNISH MOBILE DEPLOYMENT 

19 TEAMS TO UNDERSERVED FACILITIES. 

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

21 shall establish a program to furnish mobile deployment 

22 teams of medical personnel to underserved facilities. 

23 (b) ELEMENTS.—In furnishing mobile deployment 

24 teams under subsection (a), the Secretary shall consider 

25 the following elements: 


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1 (1) The medical positions of greatest need at 

2 underserved facilities. 

3 (2) The size and composition of teams to be de4 ployed. 

5 (3) Such other elements as the Secretary con6 siders necessary for effective oversight of the pro7 gram established under subsection (a). 

8 (c) USE OF ANNUAL ANALYSIS.—The Secretary shall 

9 use the results of the annual analysis conducted under sec10 tion 231(c) to form mobile deployment teams under sub11 section (a) that are composed of the most needed medical 

12 personnel for underserved facilities. 

13 (d) UNDERSERVED FACILITY DEFINED.—In this sec14 tion, the term ‘‘underserved facility’’ means a medical cen15 ter, ambulatory care facility, or community based out16 patient clinic of the Department of Veterans Affairs des17 ignated by the Secretary of Veterans Affairs pursuant to 

18 criteria developed under section 231. 

19 SEC. 234. INCLUSION OF VET CENTER EMPLOYEES IN EDU20 CATION DEBT REDUCTION PROGRAM OF DE21 PARTMENT OF VETERANS AFFAIRS. 

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

23 shall ensure that clinical staff working at Vet Centers are 

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1 gram of the Department of Veterans Affairs under sub2 chapter VII of chapter 76 of title 38, United States Code. 

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

4 of the enactment of this Act, the Secretary shall submit 

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

6 the Committee on Veterans’ Affairs of the House of Rep7 resentatives a report on the number of participants in the 

8 education debt reduction program of the Department 

9 under such subchapter who work at Vet Centers. 

10 (c) VET CENTER DEFINED.—In this section, the 

11 term ‘‘Vet Center’’ has the meaning given that term in 

12 section 1712A(h) of title 38, United States Code. 

13 Subtitle C—Construction and 

14 Leases 

15 SEC. 241. DEFINITION OF MAJOR MEDICAL FACILITY 

16 PROJECT AND MAJOR MEDICAL FACILITY 

17 LEASE. 

18 (a) MODIFICATION OF DEFINITION OF MEDICAL FA19 CILITY.—Section 8101(3) is amended by striking ‘‘Sec20 retary’’ and all that follows through ‘‘nursing home,’’ and 

21 inserting ‘‘Secretary, or as otherwise authorized by law, 

22 for the provision of health-care services (including hos23 pital, outpatient clinic, nursing home,’’. 

24 (b) MODIFICATION OF DEFINITIONS OF MAJOR MED25 ICAL FACILITY PROJECT AND MAJOR MEDICAL FACILITY


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1 LEASE.—Paragraph (3) of section 8104(a) is amended to 

2 read as follows: 

3 ‘‘(3) For purposes of this subsection: 

4 ‘‘(A) The term ‘major medical facility project’ 

5 means a project for the construction, alteration, or 

6 acquisition of a medical facility involving a total ex7 penditure of more than $20,000,000, but such term 

8 does not include an acquisition by exchange, non-re9 curring maintenance projects of the Department, or 

10 the construction, alteration, or acquisition of a 

11 shared Federal medical facility for which the De12 partment’s estimated share of the project costs does 

13 not exceed $20,000,000. 

14 ‘‘(B) The term ‘major medical facility lease’ 

15 means a lease for space for use as a new medical fa16 cility at an average annual rental equal to or greater 

17 than the dollar threshold for leases procured through 

18 the General Services Administration under section 

19 3307(a)(2) of title 40, which shall be subject to an20 nual adjustment in accordance with section 3307(h) 

21 of such title.’’. 


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1 SEC. 242. FACILITATING SHARING OF MEDICAL FACILITIES 

2 WITH OTHER FEDERAL AGENCIES. 

3 (a) IN GENERAL.—Subchapter I of chapter 81 is 

4 amended by inserting after section 8111A the following 

5 new section: 

6 ‘‘§ 8111B. Authority to plan, design, construct, or 

7 lease a shared medical facility 

8 ‘‘(a) IN GENERAL.—(1) The Secretary may enter 

9 into agreements with other Federal agencies for the plan10 ning, designing, constructing, or leasing of shared medical 

11 facilities with the goal of improving access to, and quality 

12 and cost effectiveness of, health care provided by the De13 partment and other Federal agencies. 

14 ‘‘(2) Facilities planned, designed, constructed, or 

15 leased under paragraph (1) shall be managed by the 

16 Under Secretary for Health. 

17 ‘‘(b) TRANSFER OF AMOUNTS TO OTHER FEDERAL

18 AGENCIES.—(1) The Secretary may transfer to another 

19 Federal agency amounts appropriated to the Department 

20 for ‘Construction, Minor Projects’ for use for the plan21 ning, design, or construction of a shared medical facility 

22 if the estimated share of the project costs to be borne by 

23 the Department does not exceed the threshold for a major 

24 medical facility project under section 8104(a)(3)(A) of this 

25 title. 


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1 ‘‘(2) The Secretary may transfer to another Federal 

2 agency amounts appropriated to the Department for ‘Con3 struction, Major Projects’ for use for the planning, design, 

4 or construction of a shared medical facility if— 

5 ‘‘(A) the estimated share of the project costs to 

6 be borne by the Department is more than the 

7 threshold for a major medical facility project under 

8 subsection (a)(3)(A) of section 8104 of this title; 

9 and 

10 ‘‘(B) the requirements for such a project under 

11 such section have been met. 

12 ‘‘(3) The Secretary may transfer to another Federal 

13 agency amounts appropriated to the applicable appropria14 tions account of the Department for the purpose of leasing 

15 space for a shared medical facility if the estimated share 

16 of the lease costs to be borne by the Department does not 

17 exceed the threshold for a major medical facility lease 

18 under section 8104(a)(3)(B) of this title. 

19 ‘‘(c) TRANSFER OF AMOUNTS TO DEPARTMENT.—(1) 

20 Amounts transferred to the Department by another Fed21 eral agency for the necessary expenses of planning, design22 ing, or constructing a shared medical facility for which 

23 the estimated share of the project costs to be borne by 

24 the Department does not exceed the threshold for a major 

25 medical facility project under section 8104(a)(3)(A) of this 


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1 title may be deposited in the ‘Construction, Minor 

2 Projects’ account of the Department and used for such 

3 necessary expenses. 

4 ‘‘(2) Amounts transferred to the Department by an5 other Federal agency for the necessary expenses of plan6 ning, designing, or constructing a shared medical facility 

7 for which the estimated share of the project costs to be 

8 borne by the Department is more than the threshold for 

9 a major medical facility project under section 

10 8104(a)(3)(A) of this title may be deposited in the ‘Con11 struction, Major Projects’ account of the Department and 

12 used for such necessary expenses if the requirements for 

13 such project under section 8104 of this title have been 

14 met. 

15 ‘‘(3) Amounts transferred to the Department by an16 other Federal agency for the purpose of leasing space for 

17 a shared medical facility may be credited to the applicable 

18 appropriations account of the Department and shall be 

19 available without fiscal year limitation. 

20 ‘‘(4) Amounts transferred under paragraphs (1) and 

21 (2) shall be available for the same time period as amounts 

22 in the account to which those amounts are transferred.’’. 

23 (b) CLERICAL AMENDMENT.—The table of sections 

24 at the beginning of such chapter is amended by inserting 


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1 after the item relating to section 8111A the following new 

2 item: 

‘‘8111B. Authority to plan, design, construct, or lease a shared medical facility.’’. 

3 SEC. 243. REVIEW OF ENHANCED USE LEASES. 

4 Section 8162(b)(6) is amended to read as follows: 

5 ‘‘(6) The Office of Management and Budget shall re6 view each enhanced-use lease before the lease goes into 

7 effect to determine whether the lease is in compliance with 

8 paragraph (5).’’. 

9 SEC. 244. AUTHORIZATION OF CERTAIN MAJOR MEDICAL 

10 FACILITY PROJECTS OF THE DEPARTMENT 

11 OF VETERANS AFFAIRS. 

12 (a) AUTHORIZATION.—The Secretary of Veterans Af13 fairs may carry out the following major medical facility 

14 project, to be carried out in an amount not to exceed the 

15 amount specified for that project: Construction of the new 

16 East Bay Community Based Outpatient Clinic and all as17 sociated site work, utilities, parking, and landscaping, con18 struction of the Central Valley Engineering and Logistics 

19 support facility, and enhanced flood plain mitigation at the 

20 Central Valley and East Bay Community Based Out21 patient Clinics as part of the realignment of medical facili22 ties in Livermore, California, in an amount not to exceed 

23 $117,300,000. 


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1 (b) AUTHORIZATION OF APPROPRIATIONS FOR CON2 STRUCTION.—There is authorized to be appropriated to 

3 the Secretary of Veterans Affairs for fiscal year 2018 or 

4 the year in which funds are appropriated for the Construc5 tion, Major Projects account, $117,300,000 for the project 

6 authorized in subsection (a). 

7 (c) SUBMITTAL OF INFORMATION.—Not later than 

8 90 days after the date of the enactment of this Act, for 

9 the project authorized in section (a), the Secretary of Vet10 erans Affairs shall submit to the Committee on Veterans’ 

11 Affairs of the Senate and the Committee on Veterans’ Af12 fairs of the House of Representatives the following infor13 mation: 

14 (1) A line item accounting of expenditures re15 lating to construction management carried out by 

16 the Department of Veterans Affairs for such project. 

17 (2) The future amounts that are budgeted to be 

18 obligated for construction management carried out 

19 by the Department for such project. 

20 (3) A justification for the expenditures de21 scribed in paragraph (1) and the future amounts de22 scribed in paragraph (2). 

23 (4) Any agreement entered into by the Sec24 retary regarding a non-Department of Veterans Af25 fairs Federal entity providing management services 


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1 relating to such project, including reimbursement 

2 agreements and the costs to the Department for 

3 such services. 

4 Subtitle D—Other Health Care 

5 Matters 

6 SEC. 251. PROGRAM ON USE OF WELLNESS PROGRAMS AS 

7 COMPLEMENTARY APPROACH TO MENTAL 

8 HEALTH CARE FOR VETERANS AND FAMILY 

9 MEMBERS OF VETERANS. 

10 (a) PROGRAM REQUIRED.— 

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

12 Affairs shall carry out a program through the award 

13 of grants to public or private nonprofit entities to 

14 assess the feasibility and advisability of using 

15 wellness programs to complement the provision of 

16 mental health care to veterans and family members 

17 eligible for counseling under section 1712A(a)(1)(C) 

18 of title 38, United States Code. 

19 (2) MATTERS TO BE ADDRESSED.—The pro20 gram shall be carried out so as to assess the fol21 lowing: 

22 (A) Means of improving coordination be23 tween Federal, State, local, and community pro24 viders of health care in the provision of mental 


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1 health care to veterans and family members de2 scribed in paragraph (1). 

3 (B) Means of enhancing outreach, and co4 ordination of outreach, by and among providers 

5 of health care referred to in subparagraph (A) 

6 on the mental health care services available to 

7 veterans and family members described in para8 graph (1). 

9 (C) Means of using wellness programs of 

10 providers of health care referred to in subpara11 graph (A) as complements to the provision by 

12 the Department of Veterans Affairs of mental 

13 health care to veterans and family members de14 scribed in paragraph (1). 

15 (D) Whether wellness programs described 

16 in subparagraph (C) are effective in enhancing 

17 the quality of life and well-being of veterans 

18 and family members described in paragraph 

19 (1). 

20 (E) Whether wellness programs described 

21 in subparagraph (C) are effective in increasing 

22 the adherence of veterans described in para23 graph (1) to the primary mental health services 

24 provided such veterans by the Department. 


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1 (F) Whether wellness programs described 

2 in subparagraph (C) have an impact on the 

3 sense of wellbeing of veterans described in para4 graph (1) who receive primary mental health 

5 services from the Department. 

6 (G) Whether wellness programs described 

7 in subparagraph (C) are effective in encour8 aging veterans receiving health care from the 

9 Department to adopt a more healthy lifestyle. 

10 (b) DURATION.—The Secretary shall carry out the 

11 program for a period of three years beginning on the date 

12 that is one year after the date of the enactment of this 

13 Act. 

14 (c) LOCATIONS.—The Secretary shall carry out the 

15 program at facilities of the Department providing mental 

16 health care services to veterans and family members de17 scribed in subsection (a)(1). 

18 (d) GRANT PROPOSALS.— 

19 (1) IN GENERAL.—A public or private nonprofit 

20 entity seeking the award of a grant under this sec21 tion shall submit an application therefor to the Sec22 retary in such form and in such manner as the Sec23 retary may require. 


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1 (2) APPLICATION CONTENTS.—Each application 

2 submitted under paragraph (1) shall include the fol3 lowing: 

4 (A) A plan to coordinate activities under 

5 the program, to the extent possible, with Fed6 eral, State, and local providers of services for 

7 veterans to enhance the following: 

8 (i) Awareness by veterans of benefits 

9 and health care services provided by the 

10 Department. 

11 (ii) Outreach efforts to increase the 

12 use by veterans of services provided by the 

13 Department. 

14 (iii) Educational efforts to inform vet15 erans of the benefits of a healthy and ac16 tive lifestyle. 

17 (B) A statement of understanding from 

18 the entity submitting the application that, if se19 lected, such entity will be required to report to 

20 the Secretary periodically on standardized data 

21 and other performance data necessary to evalu22 ate individual outcomes and to facilitate evalua23 tions among entities participating in the pro24 gram. 


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1 (C) Other requirements that the Secretary 

2 may prescribe. 

3 (e) GRANT USES.— 

4 (1) IN GENERAL.—A public or private nonprofit 

5 entity awarded a grant under this section shall use 

6 the award for purposes prescribed by the Secretary. 

7 (2) ELIGIBLE VETERANS AND FAMILY.—In car8 rying out the purposes prescribed by the Secretary 

9 in paragraph (1), a public or private nonprofit entity 

10 awarded a grant under this section shall use the 

11 award to furnish services only to individuals speci12 fied in section 1712A(a)(1)(C) of title 38, United 

13 States Code. 

14 (f) REPORTS.— 

15 (1) PERIODIC REPORTS.— 

16 (A) IN GENERAL.—Not later than 180 

17 days after the date of the commencement of the 

18 program, and every 180 days thereafter, the 

19 Secretary shall submit to Congress a report on 

20 the program. 

21 (B) REPORT ELEMENTS.—Each report re22 quired by subparagraph (A) shall include the 

23 following: 

24 (i) The findings and conclusions of 

25 the Secretary with respect to the program 


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1 during the 180-day period preceding the 

2 report. 

3 (ii) An assessment of the benefits of 

4 the program to veterans and their family 

5 members during the 180-day period pre6 ceding the report. 

7 (2) FINAL REPORT.—Not later than 180 days 

8 after the end of the program, the Secretary shall 

9 submit to Congress a report detailing the rec10 ommendations of the Secretary as to the advisability 

11 of continuing or expanding the program. 

12 (g) WELLNESS DEFINED.—In this section, the term 

13 ‘‘wellness’’ has the meaning given that term in regulations 

14 prescribed by the Secretary. 

15 SEC. 252. AUTHORIZATION TO PROVIDE FOR OPERATIONS 

16 ON LIVE DONORS FOR PURPOSES OF CON17 DUCTING TRANSPLANT PROCEDURES FOR 

18 VETERANS. 

19 (a) IN GENERAL.—Subchapter VIII of chapter 17 is 

20 amended by adding at the end the following new section: 

21 ‘‘§ 1788. Transplant procedures with live donors and 

22 related services 

23 ‘‘(a) IN GENERAL.—Subject to subsections (b) and 

24 (c), in a case in which a veteran is eligible for a transplant 

25 procedure from the Department, the Secretary may proVerDate Sep 11 2014 23:02 Dec 05, 2017 Jkt 079200 PO 00000 Frm 00149 Fmt 6652 Sfmt 6201 E:\BILLS\S2193.PCS S2193

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1 vide for an operation on a live donor to carry out such 

2 procedure for such veteran, notwithstanding that the live 

3 donor may not be eligible for health care from the Depart4 ment. 

5 ‘‘(b) OTHER SERVICES.—Subject to the availability 

6 of appropriations for such purpose, the Secretary shall 

7 furnish to a live donor any care or services before and 

8 after conducting the transplant procedure under sub9 section (a) that may be required in connection with such 

10 procedure. 

11 ‘‘(c) USE OF NON-DEPARTMENT FACILITIES.—In 

12 carrying out this section, the Secretary may provide for 

13 the operation described in subsection (a) on a live donor 

14 and furnish to the live donor the care and services de15 scribed in subsection (b) at a non-Department facility pur16 suant to an agreement entered into by the Secretary under 

17 this chapter. The live donor shall be deemed to be an indi18 vidual eligible for hospital care and medical services at a 

19 non-Department facility pursuant to such an agreement 

20 solely for the purposes of receiving such operation, care, 

21 and services at the non-Department facility.’’. 

22 (b) CLERICAL AMENDMENT.—The table of sections 

23 at the beginning of chapter 17 is amended by inserting 

24 after the item relating to section 1787 the following new 

25 item: 

‘‘1788. Transplant procedures with live donors and related services.’’. 


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1 SEC. 253. SENSE OF THE SENATE. 

2 It is the sense of the Senate that— 

3 (1) a strong and fully resourced Veterans 

4 Health Administration is necessary to effectively 

5 serve our veterans community; 

6 (2) veterans overwhelmingly report that they 

7 are satisfied with the care they receive at facilities 

8 operated by the Administration; 

9 (3) research has shown that the Administration 

10 produces as good or better outcomes for its patients 

11 than private health care systems; and 

12 (4) the Senate opposes any effort that would 

13 weaken the Administration or put the Administra14 tion on a path toward privatization. 

15 TITLE III—FAMILY CAREGIVERS 

16 SEC. 301. EXPANSION OF FAMILY CAREGIVER PROGRAM OF 

17 DEPARTMENT OF VETERANS AFFAIRS. 

18 (a) FAMILY CAREGIVER PROGRAM.— 

19 (1) EXPANSION OF ELIGIBILITY.— 

20 (A) IN GENERAL.—Subparagraph (B) of 

21 subsection (a)(2) of section 1720G is amended 

22 to read as follows: 

23 ‘‘(B) for assistance provided under this sub24 section— 

25 ‘‘(i) before the date on which the Secretary 

26 submits to Congress a certification that the DeVerDate Sep 11 2014 23:02 Dec 05, 2017 Jkt 079200 PO 00000 Frm 00151 Fmt 6652 Sfmt 6201 E:\BILLS\S2193.PCS S2193

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1 partment has fully implemented the information 

2 technology system required by section 302(a) of 

3 the Caring for our Veterans Act of 2017, has 

4 a serious injury (including traumatic brain in5 jury, psychological trauma, or other mental dis6 order) incurred or aggravated in the line of 

7 duty in the active military, naval, or air service 

8 on or after September 11, 2001; 

9 ‘‘(ii) during the two-year period beginning 

10 on the date on which the Secretary submitted 

11 to Congress the certification described in clause 

12 (i), has a serious injury (including traumatic 

13 brain injury, psychological trauma, or other 

14 mental disorder) incurred or aggravated in the 

15 line of duty in the active military, naval, or air 

16 service— 

17 ‘‘(I) on or before May 7, 1975; or 

18 ‘‘(II) on or after September 11, 2001; 

19 or 

20 ‘‘(iii) after the date that is two years after 

21 the date on which the Secretary submits to 

22 Congress the certification described in clause 

23 (i), has a serious injury (including traumatic 

24 brain injury, psychological trauma, or other 

25 mental disorder) incurred or aggravated in the 


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1 line of duty in the active military, naval, or air 

2 service; and’’. 

3 (B) PUBLICATION IN FEDERAL REG4 ISTER.—Not later than 30 days after the date 

5 on which the Secretary of Veterans Affairs sub6 mits to Congress the certification described in 

7 subsection (a)(2)(B)(i) of section 1720G of 

8 such title, as amended by subparagraph (A) of 

9 this paragraph, the Secretary shall publish the 

10 date specified in such subsection in the Federal 

11 Register. 

12 (2) EXPANSION OF NEEDED SERVICES IN ELI13 GIBILITY CRITERIA.—Subsection (a)(2)(C) of such 

14 section is amended— 

15 (A) in clause (ii), by striking ‘‘; or’’ and in16 serting a semicolon; 

17 (B) by redesignating clause (iii) as clause 

18 (iv); and 

19 (C) by inserting after clause (ii) the fol20 lowing new clause (iii): 

21 ‘‘(iii) a need for regular or extensive in22 struction or supervision without which the abil23 ity of the veteran to function in daily life would 

24 be seriously impaired; or’’. 


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1 (3) EXPANSION OF SERVICES PROVIDED.—Sub2 section (a)(3)(A)(ii) of such section is amended— 

3 (A) in subclause (IV), by striking ‘‘; and’’ 

4 and inserting a semicolon; 

5 (B) in subclause (V), by striking the period 

6 at the end and inserting ‘‘; and’’; and 

7 (C) by adding at the end the following new 

8 subclause: 

9 ‘‘(VI) through the use of contracts with, or 

10 the provision of grants to, public or private en11 tities— 

12 ‘‘(aa) financial planning services relat13 ing to the needs of injured veterans and 

14 their caregivers; and 

15 ‘‘(bb) legal services, including legal 

16 advice and consultation, relating to the 

17 needs of injured veterans and their care18 givers.’’. 

19 (4) MODIFICATION OF STIPEND CALCULA20 TION.—Subsection (a)(3)(C) of such section is 

21 amended— 

22 (A) by redesignating clause (iii) as clause 

23 (iv); and 

24 (B) by inserting after clause (ii) the fol25 lowing new clause (iii): 


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1 ‘‘(iii) In determining the amount and degree of per2 sonal care services provided under clause (i) with respect 

3 to an eligible veteran whose need for personal care services 

4 is based in whole or in part on a need for supervision or 

5 protection under paragraph (2)(C)(ii) or regular instruc6 tion or supervision under paragraph (2)(C)(iii), the Sec7 retary shall take into account the following: 

8 ‘‘(I) The assessment by the family caregiver of 

9 the needs and limitations of the veteran. 

10 ‘‘(II) The extent to which the veteran can func11 tion safely and independently in the absence of such 

12 supervision, protection, or instruction. 

13 ‘‘(III) The amount of time required for the 

14 family caregiver to provide such supervision, protec15 tion, or instruction to the veteran.’’. 

16 (5) PERIODIC EVALUATION OF NEED FOR CER17 TAIN SERVICES.—Subsection (a)(3) of such section 

18 is amended by adding at the end the following new 

19 subparagraph: 

20 ‘‘(D) In providing instruction, preparation, and train21 ing under subparagraph (A)(i)(I) and technical support 

22 under subparagraph (A)(i)(II) to each family caregiver 

23 who is approved as a provider of personal care services 

24 for an eligible veteran under paragraph (6), the Secretary 

25 shall periodically evaluate the needs of the eligible veteran 


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1 and the skills of the family caregiver of such veteran to 

2 determine if additional instruction, preparation, training, 

3 or technical support under those subparagraphs is nec4 essary.’’. 

5 (6) USE OF PRIMARY CARE TEAMS.—Subsection 

6 (a)(5) of such section is amended, in the matter pre7 ceding subparagraph (A), by inserting ‘‘(in collabo8 ration with the primary care team for the eligible 

9 veteran to the maximum extent practicable)’’ after 

10 ‘‘evaluate’’. 

11 (7) ASSISTANCE FOR FAMILY CAREGIVERS.— 

12 Subsection (a) of such section is amended by adding 

13 at the end the following new paragraph: 

14 ‘‘(11)(A) In providing assistance under this sub15 section to family caregivers of eligible veterans, the Sec16 retary may enter into contracts, provider agreements, and 

17 memoranda of understanding with Federal agencies, 

18 States, and private, nonprofit, and other entities to pro19 vide such assistance to such family caregivers. 

20 ‘‘(B) The Secretary may provide assistance under 

21 this paragraph only if such assistance is reasonably acces22 sible to the family caregiver and is substantially equivalent 

23 or better in quality to similar services provided by the De24 partment. 


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1 ‘‘(C) The Secretary may provide fair compensation 

2 to Federal agencies, States, and other entities that provide 

3 assistance under this paragraph.’’. 

4 (b) MODIFICATION OF DEFINITION OF PERSONAL

5 CARE SERVICES.—Subsection (d)(4) of such section is 

6 amended— 

7 (1) in subparagraph (A), by striking ‘‘inde8 pendent’’; 

9 (2) by redesignating subparagraph (B) as sub10 paragraph (D); and 

11 (3) by inserting after subparagraph (A) the fol12 lowing new subparagraphs: 

13 ‘‘(B) Supervision or protection based on 

14 symptoms or residuals of neurological or other 

15 impairment or injury. 

16 ‘‘(C) Regular or extensive instruction or 

17 supervision without which the ability of the vet18 eran to function in daily life would be seriously 

19 impaired.’’. 

20 SEC. 302. IMPLEMENTATION OF INFORMATION TECH21 NOLOGY SYSTEM OF DEPARTMENT OF VET22 ERANS AFFAIRS TO ASSESS AND IMPROVE 

23 THE FAMILY CAREGIVER PROGRAM. 

24 (a) IMPLEMENTATION OF NEW SYSTEM.— 


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1 (1) IN GENERAL.—Not later than June 1, 

2 2018, the Secretary of Veterans Affairs shall imple3 ment an information technology system that fully 

4 supports the Program and allows for data assess5 ment and comprehensive monitoring of the Program. 

6 (2) ELEMENTS OF SYSTEM.—The information 

7 technology system required to be implemented under 

8 paragraph (1) shall include the following: 

9 (A) The ability to easily retrieve data that 

10 will allow all aspects of the Program (at the 

11 medical center and aggregate levels) and the 

12 workload trends for the Program to be assessed 

13 and comprehensively monitored. 

14 (B) The ability to manage data with re15 spect to a number of caregivers that is more 

16 than the number of caregivers that the Sec17 retary expects to apply for the Program. 

18 (C) The ability to integrate the system 

19 with other relevant information technology sys20 tems of the Veterans Health Administration. 

21 (b) ASSESSMENT OF PROGRAM.—Not later than 180 

22 days after implementing the system described in sub23 section (a), the Secretary shall, through the Under Sec24 retary for Health, use data from the system and other relVerDate Sep 11 2014 23:02 Dec 05, 2017 Jkt 079200 PO 00000 Frm 00158 Fmt 6652 Sfmt 6201 E:\BILLS\S2193.PCS S2193

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1 evant data to conduct an assessment of how key aspects 

2 of the Program are structured and carried out. 

3 (c) ONGOING MONITORING OF AND MODIFICATIONS

4 TO PROGRAM.— 

5 (1) MONITORING.—The Secretary shall use the 

6 system implemented under subsection (a) to monitor 

7 and assess the workload of the Program, including 

8 monitoring and assessment of data on— 

9 (A) the status of applications, appeals, and 

10 home visits in connection with the Program; 

11 and 

12 (B) the use by caregivers participating in 

13 the Program of other support services under 

14 the Program such as respite care. 

15 (2) MODIFICATIONS.—Based on the monitoring 

16 and assessment conducted under paragraph (1), the 

17 Secretary shall identify and implement such modi18 fications to the Program as the Secretary considers 

19 necessary to ensure the Program is functioning as 

20 intended and providing veterans and caregivers par21 ticipating in the Program with services in a timely 

22 manner. 

23 (d) REPORTS.— 

24 (1) INITIAL REPORT.— 


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

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

3 Secretary shall submit to the Committee on 

4 Veterans’ Affairs of the Senate, the Committee 

5 on Veterans’ Affairs of the House of Represent6 atives, and the Comptroller General of the 

7 United States a report that includes— 

8 (i) the status of the planning, develop9 ment, and deployment of the system re10 quired to be implemented under subsection 

11 (a), including any changes in the timeline 

12 for the implementation of the system; and 

13 (ii) an assessment of the needs of 

14 family caregivers of veterans described in 

15 subparagraph (B), the resources needed 

16 for the inclusion of such family caregivers 

17 in the Program, and such changes to the 

18 Program as the Secretary considers nec19 essary to ensure the successful expansion 

20 of the Program to include such family 

21 caregivers. 

22 (B) VETERANS DESCRIBED.—Veterans de23 scribed in this subparagraph are veterans who 

24 are eligible for the Program under clause (ii) or 

25 (iii) of section 1720G(a)(2)(B) of title 38, 


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1 United States Code, as amended by section 

2 301(a)(1) of this Act, solely due to a serious in3 jury (including traumatic brain injury, psycho4 logical trauma, or other mental disorder) in5 curred or aggravated in the line of duty in the 

6 active military, naval, or air service before Sep7 tember 11, 2001. 

8 (2) NOTIFICATION BY COMPTROLLER GEN9 ERAL.—The Comptroller General shall review the re10 port submitted under paragraph (1) and notify the 

11 Committee on Veterans’ Affairs of the Senate and 

12 the Committee on Veterans’ Affairs of the House of 

13 Representatives with respect to the progress of the 

14 Secretary in— 

15 (A) fully implementing the system required 

16 under subsection (a); and 

17 (B) implementing a process for using such 

18 system to monitor and assess the Program 

19 under subsection (c)(1) and modify the Pro20 gram as considered necessary under subsection 

21 (c)(2). 

22 (3) FINAL REPORT.— 

23 (A) IN GENERAL.—Not later than June 1, 

24 2019, the Secretary shall submit to the Com25 mittee on Veterans’ Affairs of the Senate, the 


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1 Committee on Veterans’ Affairs of the House of 

2 Representatives, and the Comptroller General a 

3 report on the implementation of subsections (a) 

4 through (c). 

5 (B) ELEMENTS.—The report required by 

6 subparagraph (A) shall include the following: 

7 (i) A certification by the Secretary 

8 with respect to whether the information 

9 technology system described in subsection 

10 (a) has been implemented. 

11 (ii) A description of how the Secretary 

12 has implemented such system. 

13 (iii) A description of the modifications 

14 to the Program, if any, that were identified 

15 and implemented under subsection (c)(2). 

16 (iv) A description of how the Sec17 retary is using such system to monitor the 

18 workload of the Program. 

19 (e) DEFINITIONS.—In this section: 

20 (1) ACTIVE MILITARY, NAVAL, OR AIR SERV21 ICE.—The term ‘‘active military, naval, or air serv22 ice’’ has the meaning given that term in section 101 

23 of title 38, United States Code. 

24 (2) PROGRAM.—The term ‘‘Program’’ means 

25 the program of comprehensive assistance for family 


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1 caregivers under section 1720G(a) of title 38, 

2 United States Code, as amended by section 301 of 

3 this Act. 

4 SEC. 303. MODIFICATIONS TO ANNUAL EVALUATION RE5 PORT ON CAREGIVER PROGRAM OF DEPART6 MENT OF VETERANS AFFAIRS. 

7 (a) BARRIERS TO CARE AND SERVICES.—Subpara8 graph (A)(iv) of section 101(c)(2) of the Caregivers and 

9 Veterans Omnibus Health Services Act of 2010 (Public 

10 Law 111–163; 38 U.S.C. 1720G note) is amended by in11 serting ‘‘, including a description of any barriers to access12 ing and receiving care and services under such programs’’ 

13 before the semicolon. 

14 (b) SUFFICIENCY OF TRAINING FOR FAMILY CARE15 GIVER PROGRAM.—Subparagraph (B) of such section is 

16 amended— 

17 (1) in clause (i), by striking ‘‘; and’’ and insert18 ing a semicolon; 

19 (2) in clause (ii), by striking the period at the 

20 end and inserting ‘‘; and’’; and 

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

22 clause: 

23 ‘‘(iii) an evaluation of the sufficiency 

24 and consistency of the training provided to 

25 family caregivers under such program in 


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1 preparing family caregivers to provide care 

2 to veterans under such program.’’. 

3 TITLE IV—APPROPRIATION OF 

4 AMOUNTS 

5 SEC. 401. APPROPRIATION OF AMOUNTS FOR HEALTH 

6 CARE FROM DEPARTMENT OF VETERANS AF7 FAIRS. 

8 (a) IN GENERAL.—There is authorized to be appro9 priated, and is appropriated, to the Secretary of Veterans 

10 Affairs, out of any funds in the Treasury not otherwise 

11 appropriated, $1,000,000,000 to carry out subsection (c). 

12 (b) AVAILABILITY OF AMOUNTS.—The amount ap13 propriated under subsection (a) shall be available for obli14 gation or expenditure without fiscal year limitation. 

15 (c) USE OF AMOUNTS.—The amount appropriated 

16 under subsection (a) shall be used by the Secretary to 

17 carry out the following: 

18 (1) Subchapters II and VII of chapter 76 of 

19 title 38, United States Code; 

20 (2) The program to increase the number of 

21 graduate medical education residency positions of 

22 the Department under sections 211 and 212; and 

23 (3) Section 221. 

24 (d) FUNDING PLAN.—Not later than 60 days after 

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


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1 submit to the appropriate committees of Congress a fund2 ing plan describing how the Secretary intends to use the 

3 amount appropriated under subsection (a). 

4 (e) SUPPLEMENT NOT SUPPLANT.—Amounts appro5 priated under subsection (a) for purposes of carrying out 

6 subchapters II and VII of chapter 76 of title 38, United 

7 States Code, shall supplement, not supplant, amounts oth8 erwise made available to the Secretary to carry out such 

9 subchapters. 

10 (f) REPORT.—Not later than one year after the date 

11 of the enactment of this Act, the Secretary shall submit 

12 to the appropriate committees of Congress a report on how 

13 the Secretary has obligated the amount appropriated 

14 under subsection (a) as of the date of the submittal of 

15 the report. 

16 (g) APPROPRIATE COMMITTEES OF CONGRESS DE17 FINED.—In this section, the term ‘‘appropriate commit18 tees of Congress’’ means— 

19 (1) the Committee on Veterans’ Affairs and the 

20 Committee on Appropriations of the Senate; and 

21 (2) the Committee on Veterans’ Affairs and the 

22 Committee on Appropriations of the House of Rep23 resentatives. 


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1 SEC. 402. APPROPRIATION OF AMOUNTS FOR VETERANS 

2 CHOICE PROGRAM. 

3 (a) IN GENERAL.—There is authorized to be appro4 priated, and is appropriated, to the Secretary of Veterans 

5 Affairs, out of any funds in the Treasury not otherwise 

6 appropriated, $4,000,000,000 to be deposited in the Vet7 erans Choice Fund under section 802 of the Veterans Ac8 cess, Choice, and Accountability Act of 2014 (Public Law 

9 113–146; 38 U.S.C. 1701 note). 

10 (b) AVAILABILITY.—The amount appropriated under 

11 subsection (a) shall remain available until expended pursu12 ant to section 802(c)(4) of the Veterans Access, Choice, 

13 and Accountability Act of 2014 (Public Law 113–146; 38 

14 U.S.C. 1701 note) as added by section 142. 


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Calendar No. 273 

115TH CONGRESS 

1ST SESSION S. 2193 

A BILL 

To amend title 38, United States Code, to improve 

health care for veterans, and for other purposes. 

DECEMBER 5, 2017 

Read twice and placed on the calendar 


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