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[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 2193 Placed on Calendar Senate (PCS)]

<DOC>

                                                       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.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Caring for our 
Veterans Act of 2017''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. References to title 38, United States Code.
       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

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.
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.

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

    Except as otherwise expressly provided, whenever in this Act an 
amendment or repeal is expressed in terms of an amendment to, or repeal 
of, a section or other provision, the reference shall be considered to 
be made to a section or other provision of title 38, United States 
Code.

       TITLE I--DEVELOPING AN INTEGRATED HIGH-PERFORMING NETWORK

            Subtitle A--Establishing Community Care Programs

SEC. 101. ESTABLISHMENT OF VETERANS COMMUNITY CARE PROGRAM.

    (a) Establishment of Program.--
            (1) In general.--Section 1703 is amended to read as 
        follows:
``Sec. 1703. Veterans Community Care Program
    ``(a) In General.--(1) There is established a program to furnish 
hospital care, medical services, and extended care services to covered 
veterans through health care providers specified in subsection (c).
    ``(2) The Secretary shall coordinate the furnishing of hospital 
care, medical services, and extended care services under this section 
to covered veterans, including coordination of, at a minimum, the 
following:
            ``(A) Ensuring the scheduling of medical appointments in a 
        timely manner and the establishment of a mechanism to receive 
        medical records from non-Department providers.
            ``(B) Ensuring continuity of care and services.
            ``(C) Ensuring coordination among regional networks if the 
        covered veteran accesses care and services in a different 
        network than the regional network in which the covered veteran 
        resides.
            ``(D) Ensuring that covered veterans do not experience a 
        lapse resulting from errors or delays by the Department or its 
        contractors or an unusual or excessive burden in accessing 
        hospital care, medical services, or extended care services.
    ``(b) Covered Veterans.--For purposes of this section, a covered 
veteran is any veteran who--
            ``(1) is enrolled in the system of annual patient 
        enrollment established and operated under section 1705 of this 
        title; or
            ``(2) is not enrolled in such system but is otherwise 
        entitled to hospital care, medical services, or extended care 
        services under subsection (c)(2) of such section.
    ``(c) Health Care Providers Specified.--Health care providers 
specified in this subsection are the following:
            ``(1) Any health care provider that is participating in the 
        Medicare program under title XVIII of the Social Security Act 
        (42 U.S.C. 1395 et seq.), including any physician furnishing 
        services under such a program.
            ``(2) The Department of Defense.
            ``(3) The Indian Health Service.
            ``(4) Any Federally-qualified health center (as defined in 
        section 1905(l)(2)(B) of the Social Security Act (42 U.S.C. 
        1396d(l)(2)(B))).
            ``(5) Any health care provider not otherwise covered under 
        any of paragraphs (1) through (4) that meets criteria 
        established by the Secretary for purposes of this section.
    ``(d) Conditions Under Which Care Is Required To Be Furnished 
Through Non-Department Providers.--(1) The Secretary shall, subject to 
the availability of appropriations, furnish hospital care, medical 
services, and extended care services to a covered veteran through 
health care providers specified in subsection (c) if--
            ``(A) the Department does not offer the care or services 
        the veteran requires;
            ``(B) the Department does not operate a full-service 
        medical facility in the State in which the covered veteran 
        resides;
            ``(C) the covered veteran was an eligible veteran under 
        section 101(b)(2)(B) of the Veterans Access, Choice, and 
        Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 1701 
        note) as of the day before the date of the enactment of the 
        Caring for our Veterans Act of 2017; or
            ``(D) the covered veteran and the covered veteran's primary 
        care provider agree that furnishing care and services through a 
        non-Department entity or provider would be in the best medical 
        interest of the covered veteran based upon criteria developed 
        by the Secretary.
    ``(2) The Secretary shall ensure that the criteria developed under 
paragraph (1)(D) include consideration of the following:
            ``(A) The distance between the covered veteran and the 
        facility that provides the hospital care, medical services, or 
        extended care services the veteran needs.
            ``(B) The nature of the hospital care, medical services, or 
        extended care services required.
            ``(C) The frequency that the hospital care, medical 
        services, or extended care services needs to be furnished.
            ``(D) Whether an appointment for the hospital care, medical 
        services, or extended care services the covered veteran 
        requires is available from a health care provider of the 
        Department within the lesser of--
                    ``(i) the access guidelines for such hospital care, 
                medical services, or extended care services as 
                established by the Secretary; and
                    ``(ii) a period determined by a health care 
                provider of the Department to be clinically necessary 
                for the receipt of such hospital care, medical 
                services, or extended care services.
            ``(E) Whether the covered veteran faces an unusual or 
        excessive burden to access hospital care, medical services, or 
        extended care services from the Department medical facility 
        where a covered veteran seeks hospital care, medical services, 
        or extended care services, which shall include consideration of 
        the following:
                    ``(i) Whether the covered veteran faces an 
                excessive driving distance, geographical challenge, or 
                environmental factor that impedes the access of the 
                covered veteran.
                    ``(ii) Whether the hospital care, medical services, 
                or extended care services sought by the veteran is 
                provided by a medical facility of the Department that 
                is reasonably accessible to a covered veteran.
                    ``(iii) Whether a medical condition of the covered 
                veteran affects the ability of the covered veteran to 
                travel.
                    ``(iv) Whether there is compelling reason, as 
                determined by the Secretary, that the veteran needs to 
                receive hospital care, medical services, or extended 
                care services from a medical facility other than a 
                medical facility of the Department.
                    ``(v) Such other considerations as the Secretary 
                considers appropriate.
    ``(3) If the Secretary has determined that the Department does not 
offer the care or services the covered veteran requires under 
subparagraph (A) of paragraph (1), that the Department does not operate 
a full-service medical facility in the State in which the covered 
veteran resides under subparagraph (B) of such paragraph, or that the 
covered veteran is described under subparagraph (C) of such paragraph, 
the decision to receive hospital care, medical services, or extended 
care services under such subparagraphs from a health care provider 
specified in subsection (c) shall be at the election of the veteran.
    ``(e) Conditions Under Which Care Is Authorized to Be Furnished 
Through Non-Department Providers.--(1)(A) The Secretary may furnish 
hospital care, medical services, or extended care services through a 
health care provider specified in subsection (c) to a covered veteran 
served by a medical service line of the Department that the Secretary 
has determined is not providing care that meets such quality and access 
standards as the Secretary shall develop.
    ``(B) In carrying out subparagraph (A), the Secretary shall--
            ``(i) measure access of the medical service line at a 
        facility of the Department when compared with the same medical 
        service line at different Department facilities; and
            ``(ii) measure quality at a medical service line of a 
        facility of the Department by comparing it with two or more 
        distinct and appropriate quality measures at non-Department 
        medical service lines.
    ``(C)(i) The Secretary may not concurrently furnish hospital care, 
medical services, or extended care services under subparagraph (A) with 
respect to more than three medical service lines described in such 
subparagraph at any one health care facility of the Department.
    ``(ii) The Secretary may not concurrently furnish hospital care, 
medical services, or extended care services under subparagraph (A) with 
respect to more than 36 medical service lines nationally described in 
such subparagraph.
    ``(2) The Secretary may limit the types of hospital care, medical 
services, or extended care services covered veterans may receive under 
paragraph (1) because of an access and quality deficiency of a medical 
service line in terms of the length of time such care and services will 
be available, the location at which such care and services will be 
available, and the clinical care and services that will be available.
    ``(3) The hospital care, medical services, and extended care 
services authorized under paragraph (1) with respect to a medical 
service line shall cease when the remediation described in subsection 
(g) with respect to such medical service line is complete.
    ``(4) The Secretary shall publish in the Federal Register, and 
shall take all reasonable steps to provide direct notice to covered 
veterans affected under this subsection, at least once each year 
stating the time period during which such care and services will be 
available, the location or locations where such care and services will 
be available, and the clinical services available at each location 
under this subsection in accordance with regulations the Secretary 
shall prescribe.
    ``(5) When the Secretary exercises the authority under paragraph 
(1), the decision to receive care or services under such paragraph from 
a health care provider specified in subsection (c) shall be at the 
election of the covered veteran.
    ``(f) Review of Decisions.--The review of any decision under 
subsection (d) or (e) shall be subject to the Department's local 
clinical appeals process, and such decisions may not be appealed to the 
Board of Veterans' Appeals.
    ``(g) Remediation of Medical Service Lines.--(1) Not later than 30 
days after determining under subsection (e)(1) that a medical service 
line of the Department is providing hospital care, medical services, or 
extended care services that does not comply with the access guidelines 
and meet the standards of quality established by the Secretary, the 
Secretary shall submit to Congress an assessment of the factors that 
led the Secretary to make such determination and a plan with specific 
actions, and the time to complete them, to be taken to comply with such 
access guidelines and meet such standards of quality, including the 
following:
            ``(A) Increasing personnel or temporary personnel 
        assistance, including mobile deployment teams.
            ``(B) Special hiring incentives, including the Education 
        Debt Reduction Program under subchapter VII of chapter 76 of 
        this title and recruitment, relocation, and retention 
        incentives.
            ``(C) Utilizing direct hiring authority.
            ``(D) Providing improved training opportunities for staff.
            ``(E) Acquiring improved equipment.
            ``(F) Making structural modifications to the facility used 
        by the medical service line.
            ``(G) Such other actions as the Secretary considers 
        appropriate.
    ``(2) In each assessment submitted under paragraph (1) with respect 
to a medical service line, the Secretary shall identify the individuals 
at the Central Office of the Veterans Health Administration, the 
facility used by the medical service line, and the central office of 
the relevant Veterans Integrated Service Network who are responsible 
for overseeing the progress of that medical service line in complying 
with the access guidelines and meeting the standards of quality 
established by the Secretary.
    ``(3) Not later than 180 days after submitting an assessment under 
paragraph (1) with respect to a medical service line, the Secretary 
shall submit to Congress a report on the progress of that medical 
service line in complying with the access guidelines and meeting the 
standards of quality established by the Secretary and any other 
measures the Secretary will take to assist the medical service line in 
complying with such access guidelines and meeting such standards of 
quality.
    ``(4) Not less frequently than once each year, the Secretary 
shall--
            ``(A) submit to Congress an analysis of the remediation 
        actions and costs of such actions taken with respect to each 
        medical service line with respect to which the Secretary 
        submitted an assessment and plan under paragraph (1) in the 
        preceding year, including an update on the progress of each 
        such medical service line in meeting the quality and access 
        standards established by the Secretary and any other actions 
        the Secretary is undertaking to assist the medical service line 
        in complying with access guidelines and meeting standards of 
        quality as established by the Secretary; and
            ``(B) publish such analysis on the Internet website of the 
        Department.
    ``(h) Access Guidelines and Standards for Quality.--(1) The 
Secretary shall establish access guidelines under section 1703B of this 
title and standards for quality under section 1703C of this title for 
furnishing hospital care, medical services, or extended care services 
to a covered veteran for the purposes of subsections (d) and (e).
    ``(2) The Secretary shall ensure that the access guidelines and 
standards for quality required by sections 1703B and 1703C of this 
title provide covered veterans, employees of the Department, and health 
care providers in the network established under subsection (j) with 
relevant comparative information that is clear, useful, and timely, so 
that covered veterans can make informed decisions regarding their 
health care.
    ``(3) The Secretary shall consult with all pertinent Federal 
entities (including the Department of Defense, the Department of Health 
and Human Services, and the Centers for Medicare & Medicaid Services), 
entities in the private sector, and other nongovernmental entities in 
establishing access guidelines and standards for quality as required by 
sections 1703B and 1703C of this title.
    ``(4) Not later than 270 days after the date of the enactment of 
the Caring for our Veterans Act of 2017, the Secretary shall submit to 
the appropriate committees of Congress a report detailing the access 
guidelines and standards for quality established under sections 1703B 
and 1703C of this title.
    ``(5) Not later than three years after the date on which the 
Secretary establishes access guidelines and standards for quality under 
paragraph (1) and not less frequently than once every three years 
thereafter, the Secretary shall--
            ``(A) conduct a review of such guidelines and standards; 
        and
            ``(B) submit to the appropriate committees of Congress a 
        report on the findings and any modification to the access 
        guidelines and standards for quality with respect to the review 
        conducted under subparagraph (A).
    ``(6) The Secretary shall ensure health care providers specified 
under subsection (c) are able to meet the applicable access guidelines 
and standards of quality established by the Secretary.
    ``(i) Tiered Network.--(1) To promote the provision of high-quality 
and high-value hospital care, medical services, and extended care 
services under this section, the Secretary may develop a tiered 
provider network of eligible providers based on criteria established by 
the Secretary for purposes of this section.
    ``(2) In developing a tiered provider network of eligible providers 
under paragraph (1), the Secretary shall not prioritize providers in a 
tier over providers in any other tier in a manner that limits the 
choice of a covered veteran in selecting a health care provider 
specified in subsection (c) for receipt of hospital care, medical 
services, or extended care services under this section.
    ``(j) Contracts To Establish Networks of Health Care Providers.--
(1) The Secretary shall enter into consolidated, competitively bid 
contracts to establish networks of health care providers specified in 
paragraphs (1) and (5) of subsection (c) for purposes of providing 
sufficient access to hospital care, medical services, or extended care 
services under this section.
    ``(2)(A) The Secretary shall, to the extent practicable, ensure 
that covered veterans are able to make their own appointments using 
advanced technology.
    ``(B) To the extent practicable, the Secretary shall be responsible 
for the scheduling of appointments for hospital care, medical services, 
and extended care services under this section.
    ``(3)(A) The Secretary may terminate a contract with an entity 
entered into under paragraph (1) at such time and upon such notice to 
the entity as the Secretary may specify for purposes of this section, 
if the Secretary notifies the appropriate committees of Congress that, 
at a minimum--
            ``(i) the entity--
                    ``(I) failed to comply substantially with the 
                provisions of the contract or with the provisions of 
                this section and the regulations prescribed under this 
                section;
                    ``(II) failed to comply with the access guidelines 
                or meet the standards of quality established by the 
                Secretary;
                    ``(III) is excluded from participation in a Federal 
                health care program (as defined in section 1128B(f) of 
                the Social Security Act (42 U.S.C. 1320a-7b(f))) under 
                section 1128 or 1128A of the Social Security Act (42 
                U.S.C. 1320a-7 and 1320a-7a);
                    ``(IV) is identified as an excluded source on the 
                list maintained in the System for Award Management, or 
                any successor system; or
                    ``(V) has been convicted of a felony or other 
                serious offense under Federal or State law and the 
                continued participation of the entity would be 
                detrimental to the best interests of veterans or the 
                Department;
            ``(ii) it is reasonable to terminate the contract based on 
        the health care needs of veterans; or
            ``(iii) it is reasonable to terminate the contract based on 
        coverage provided by contracts or sharing agreements entered 
        into under authorities other than this section.
    ``(B) Nothing in subparagraph (A) may be construed to restrict the 
authority of the Secretary to terminate a contract entered into under 
paragraph (1) under any other provision of law.
    ``(4) Whenever the Secretary provides notice to an entity that the 
entity is failing to meet contractual obligations entered into under 
paragraph (1), the Secretary shall submit to the Committee on Veterans' 
Affairs of the Senate and the Committee on Veterans' Affairs of the 
House of Representatives a report on such failure. Such report shall 
include the following:
            ``(A) An explanation of the reasons for providing such 
        notice.
            ``(B) A description of the effect of such failure, 
        including with respect to cost, schedule, and requirements.
            ``(C) A description of the actions taken by the Secretary 
        to mitigate such failure.
            ``(D) A description of the actions taken by the contractor 
        to address such failure.
            ``(E) A description of any effect on the community provider 
        market for veterans in the affected area.
    ``(5)(A) The Secretary shall instruct each entity awarded a 
contract under paragraph (1) to recognize and accept, on an interim 
basis, the credentials and qualifications of health care providers who 
are authorized to furnished hospital care and medical services to 
veterans under a community care program of the Department in effect as 
of the day before the date of the enactment of the Caring for our 
Veterans Act of 2017, including under the Patient-Centered Community 
Care Program and the Veterans Choice Program under section 101 of the 
Veterans Access, Choice, and Accountability Act of 2014 (Public Law 
113-146; 38 U.S.C. 1701 note), as qualified providers under the program 
established under this section.
    ``(B) The interim acceptance period under subparagraph (A) shall be 
determined by the Secretary based on the following criteria:
            ``(i) With respect to a health care provider, when the 
        current certification agreement for the health care provider 
        expires.
            ``(ii) Whether the Department has enacted certification and 
        eligibility criteria and regulatory procedures by which non-
        Department providers will be authorized under this section.
    ``(6) The Secretary shall establish through regulation a system or 
systems for monitoring the quality of care provided to covered veterans 
through a network under this subsection and for assessing the quality 
of hospital care, medical services, and extended care services 
furnished through such network before the renewal of the contract for 
such network.
    ``(k) Payment Rates for Care and Services.--(1) Except as provided 
in paragraph (2), and to the extent practicable, the rate paid for 
hospital care, medical services, or extended care services under any 
provision in this title may not exceed the rate paid by the United 
States to a provider of services (as defined in section 1861(u) of the 
Social Security Act (42 U.S.C. 1395x(u))) or a supplier (as defined in 
section 1861(d) of such Act (42 U.S.C. 1395x(d))) under the Medicare 
program under title XI or title XVIII of the Social Security Act (42 
U.S.C. 1301 et seq.) for the same care or services.
    ``(2)(A) A higher rate than the rate paid by the United States as 
described in paragraph (1) may be negotiated with respect to the 
furnishing of care or services to a covered veteran who resides in a 
highly rural area.
    ``(B) In this paragraph, the term `highly rural area' means an area 
located in a county that has fewer than seven individuals residing in 
that county per square mile.
    ``(3) With respect to furnishing care or services under this 
section in Alaska, the Alaska Fee Schedule of the Department of 
Veterans Affairs shall be followed, except for when another payment 
agreement, including a contract or provider agreement, is in effect.
    ``(4) With respect to furnishing hospital care, medical services, 
or extended care services under this section in a State with an All-
Payer Model Agreement under section 1814(b)(3) of the Social Security 
Act (42 U.S.C. 1395f(b)(3)) that became effective on or after January 
1, 2014, the Medicare payment rates under paragraph (2)(A) shall be 
calculated based on the payment rates under such agreement.
    ``(5) Notwithstanding paragraph (1), the Secretary may incorporate, 
to the greatest extent practicable, the use of value-based 
reimbursement models to promote the provision of high-quality care.
    ``(6) With respect to hospital care, medical services, or extended 
care services for which there is not a rate paid under the Medicare 
program as described in paragraph (1), the rate paid for such care or 
services shall be determined by the Secretary.
    ``(l) Treatment of Other Health Care Plans.--(1) In any case in 
which a covered veteran is furnished hospital care, medical services, 
or extended care services under this section for a non-service-
connected disability described in subsection (a)(2) of section 1729 of 
this title, the Secretary shall recover or collect reasonable charges 
for such care or services from a health care plan described in 
paragraph (2) in accordance with such section.
    ``(2) A health care plan described in this paragraph--
            ``(A) is an insurance policy or contract, medical or 
        hospital service agreement, membership or subscription 
        contract, or similar arrangement not administered by the 
        Secretary, under which hospital care, medical services, or 
        extended care services for individuals are provided or the 
        expenses of such care or services are paid; and
            ``(B) does not include any such policy, contract, 
        agreement, or similar arrangement pursuant to title XVIII or 
        XIX of the Social Security Act (42 U.S.C. 1395 et seq.) or 
        chapter 55 of title 10.
    ``(m) Payment by Veteran.--A covered veteran shall not pay a 
greater amount for receiving care or services under this section than 
the amount the veteran would pay for receiving the same or comparable 
care or services at a medical facility of the Department or from a 
health care provider of the Department.
    ``(n) Monitoring of Care Provided.--(1)(A) Not later than 540 days 
after the date of the enactment of the Caring for our Veterans Act of 
2017, and not less frequently than annually thereafter, the Secretary 
shall submit to appropriate committees of Congress a review of the 
types and frequency of care sought under subsection (d).
    ``(B) The review submitted under subparagraph (A) shall include an 
assessment of the following:
            ``(i) The top 25 percent of types of care and services most 
        frequently provided under subsection (d) due to the Department 
        not offering such care and services.
            ``(ii) The frequency such care and services were sought by 
        covered veterans under this section.
            ``(iii) An analysis of the reasons the Department was 
        unable to provide such care and services.
            ``(iv) Any steps the Department took to provide such care 
        and services at a medical facility of the Department.
            ``(v) The cost of such care and services.
    ``(2) In monitoring the hospital care, medical services, and 
extended care services furnished under this section, the Secretary 
shall do the following:
            ``(A) With respect to hospital care, medical services, and 
        extended care services furnished through provider networks 
        established under subsection (j)--
                    ``(i) compile data on the types of hospital care, 
                medical services, and extended care services furnished 
                through such networks and how many patients used each 
                type of care and service;
                    ``(ii) identify gaps in hospital care, medical 
                services, or extended care services furnished through 
                such networks;
                    ``(iii) identify how such gaps may be fixed through 
                new contracts within such networks or changes in the 
                manner in which hospital care, medical services, or 
                extended care services are furnished through such 
                networks;
                    ``(iv) assess the total amounts spent by the 
                Department on hospital care, medical services, and 
                extended care services furnished through such networks;
                    ``(v) assess the timeliness of the Department in 
                referring hospital care, medical services, and extended 
                care services to such networks; and
                    ``(vi) assess the timeliness of such networks in--
                            ``(I) accepting referrals; and
                            ``(II) scheduling and completing 
                        appointments.
            ``(B) Report the number of medical service lines the 
        Secretary has determined under subsection (e)(1) not to be 
        providing hospital care, medical services, or extended care 
        services that comply with the access guidelines or meet the 
        standards of quality established by the Secretary.
            ``(C) Assess the use of academic affiliates and centers of 
        excellence of the Department to furnish hospital care, medical 
        services, and extended care services to covered veterans under 
        this section.
            ``(D) Assess the hospital care, medical services, and 
        extended care services furnished to covered veterans under this 
        section by medical facilities operated by Federal agencies 
        other than the Department.
    ``(3) Not later than 540 days after the date of the enactment of 
the Caring for our Veterans Act of 2017 and not less frequently than 
once each year thereafter, the Secretary shall submit to the Committee 
on Veterans' Affairs of the Senate and the Committee on Veterans' 
Affairs of the House of Representatives a report on the information 
gathered under paragraph (2).
    ``(o) Prohibition on Certain Limitations.--The Secretary shall not 
limit the types of hospital care, medical services, or extended care 
services covered veterans may receive under this section if it is in 
the best interest of the veteran to receive such hospital care, medical 
services, or extended care services, as determined by the veteran and 
the veteran's health care provider.
    ``(p) Definitions.--In this section:
            ``(1) The term `appropriate committees of Congress' means--
                    ``(A) the Committee on Veterans' Affairs and the 
                Committee on Appropriations of the Senate; and
                    ``(B) the Committee on Veterans' Affairs and the 
                Committee on Appropriations of the House of 
                Representatives.
            ``(2) The term `medical service line' means a clinic within 
        a Department medical center.''.
            (2) Clerical amendment.--The table of sections at the 
        beginning of chapter 17 is amended by striking the item 
        relating to section 1703 and inserting the following new item:

``1703. Veterans Community Care Program.''.
    (b) Effective Date.--Section 1703 of title 38, United States Code, 
as amended by subsection (a), shall take effect on the later of--
            (1) the date that is 30 days after the date on which the 
        Secretary of Veterans Affairs submits the report required under 
        section 101(q)(2) of the Veterans Access, Choice, and 
        Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 1701 
        note); or
            (2) the date on which the Secretary promulgates regulations 
        pursuant to subsection (c).
    (c) Regulations.--Not later than one year after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall 
promulgate regulations to carry out section 1703 of title 38, United 
States Code, as amended by subsection (a) of this section.
    (d) Continuity of Existing Agreements.--
            (1) In general.--Notwithstanding section 1703 of title 38, 
        United States Code, as amended by subsection (a), the Secretary 
        of Veterans Affairs shall continue all contracts, memorandums 
        of understanding, memorandums of agreements, and other 
        arrangements that were in effect on the day before the date of 
        the enactment of this Act between the Department of Veterans 
        Affairs and the American Indian and Alaska Native health care 
        systems as established under the terms of the Department of 
        Veterans Affairs and Indian Health Service Memorandum of 
        Understanding, signed October 1, 2010, the National 
        Reimbursement Agreement, signed December 5, 2012, and 
        agreements entered into under sections 102 and 103 of the 
        Veterans Access, Choice, and Accountability Act of 2014 (Public 
        Law 113-146).
            (2) Modifications.--Paragraph (1) shall not be construed to 
        prohibit the Secretary and the parties to the contracts, 
        memorandums of understanding, memorandums of agreements, and 
        other arrangements described in such paragraph from making such 
        changes to such contracts, memorandums of understanding, 
        memorandums of agreements, and other arrangements as may be 
        otherwise authorized pursuant to other provisions of law or the 
        terms of the contracts, memorandums of understanding, 
        memorandums of agreements, and other arrangements.

SEC. 102. AUTHORIZATION OF AGREEMENTS BETWEEN DEPARTMENT OF VETERANS 
              AFFAIRS AND NON-DEPARTMENT PROVIDERS.

    (a) In General.--Subchapter I of chapter 17 is amended by inserting 
after section 1703 the following new section:
``Sec. 1703A. Agreements with eligible entities or providers; 
              certification processes
    ``(a) Agreements Authorized.--(1)(A) When hospital care, a medical 
service, or an extended care service required by a veteran who is 
entitled to such care or service under this chapter is not feasibly 
available to the veteran from a facility of the Department or through a 
contract or sharing agreement entered into pursuant to another 
provision of law, the Secretary may furnish such care or service to 
such veteran by entering into an agreement under this section with an 
eligible entity or provider to provide such hospital care, medical 
service, or extended care service.
    ``(B) An agreement entered into under this section to provide 
hospital care, a medical service, or an extended care service shall be 
known as a `Veterans Care Agreement'.
    ``(C) For purposes of subparagraph (A), hospital care, a medical 
service, or an extended care service may be considered not feasibly 
available to a veteran from a facility of the Department or through a 
contract or sharing agreement described in such subparagraph when the 
Secretary determines the veteran's medical condition, the travel 
involved, the nature of the care or services required, or a combination 
of these factors make the use of a facility of the Department or a 
contract or sharing agreement described in such subparagraph 
impracticable or inadvisable.
    ``(D) A Veterans Care Agreement may be entered into by the 
Secretary or any Department official authorized by the Secretary.
    ``(2)(A) Subject to subparagraph (B), the Secretary shall review 
each Veterans Care Agreement of material size, as determined by the 
Secretary or set forth in paragraph (3), for hospital care, a medical 
service, or an extended care service to determine whether it is 
feasible and advisable to provide such care or service within a 
facility of the Department or by contract or sharing agreement entered 
into pursuant to another provision of law and, if so, take action to do 
so.
    ``(B)(i) The Secretary shall review each Veterans Care Agreement of 
material size that has been in effect for at least six months within 
the first two years of its taking effect, and not less frequently than 
once every four years thereafter.
    ``(ii) If a Veterans Care Agreement has not been in effect for at 
least six months by the date of the review required by subparagraph 
(A), the agreement shall be reviewed during the next cycle required by 
subparagraph (A), and such review shall serve as its review within the 
first two years of its taking effect for purposes of clause (i).
    ``(3)(A) In fiscal year 2018 and in each fiscal year thereafter, in 
addition to such other Veterans Care Agreements as the Secretary may 
determine are of material size, a Veterans Care Agreement for the 
purchase of extended care services that exceeds $5,000,000 annually 
shall be considered of material size.
    ``(B) From time to time, the Secretary may publish a notice in the 
Federal Register to adjust the dollar amount specified in subparagraph 
(A) to account for changes in the cost of health care based upon 
recognized health care market surveys and other available data.
    ``(b) Eligible Entities and Providers.--For purposes of this 
section, an eligible entity or provider is--
            ``(1) any provider of services that has enrolled and 
        entered into a provider agreement under section 1866(a) of the 
        Social Security Act (42 U.S.C. 1395cc(a)) and any physician or 
        other supplier who has enrolled and entered into a 
        participation agreement under section 1842(h) of such Act (42 
        U.S.C. 1395u(h));
            ``(2) any provider participating under a State plan under 
        title XIX of such Act (42 U.S.C. 1396 et seq.); or
            ``(3) any entity or provider not described in paragraph (1) 
        or (2) of this subsection that the Secretary determines to be 
        eligible pursuant to the certification process described in 
        subsection (c).
    ``(c) Eligible Entity or Provider Certification Process.--The 
Secretary shall establish by regulation a process for the certification 
of eligible entities or providers or recertification of eligible 
entities or providers under this section. Such a process shall, at a 
minimum--
            ``(1) establish deadlines for actions on applications for 
        certification;
            ``(2) set forth standards for an approval or denial of 
        certification, duration of certification, revocation of an 
        eligible entity or provider's certification, and 
        recertification of eligible entities or providers;
            ``(3) require the denial of certification if the Secretary 
        determines the eligible entity or provider is excluded from 
        participation in a Federal health care program under section 
        1128 or section 1128A of the Social Security Act (42 U.S.C. 
        1320a-7 or 1320a-7a) or is currently identified as an excluded 
        source on the System for Award Management Exclusions list 
        described in part 9 of title 48, Code of Federal Regulations, 
        and part 180 of title 2 of such Code, or successor regulations;
            ``(4) establish procedures for screening eligible entities 
        or providers according to the risk of fraud, waste, and abuse 
        that are similar to the standards under section 1866(j)(2)(B) 
        of the Social Security Act (42 U.S.C. 1395cc(j)(2)(B)) and 
        section 9.104 of title 48, Code of Federal Regulations, or 
        successor regulations; and
            ``(5) incorporate and apply the restrictions and penalties 
        set forth in chapter 21 of title 41 and treat this section as a 
        procurement program only for purposes of applying such 
        provisions.
    ``(d) Rates.--To the extent practicable, the rates paid by the 
Secretary for hospital care, medical services, and extended care 
services provided under a Veterans Care Agreement shall be in 
accordance with the rates paid by the United States under the Medicare 
program.
    ``(e) Terms of Veterans Care Agreements.--(1) Pursuant to 
regulations promulgated under subsection (k), the Secretary may define 
the requirements for providers and entities entering into agreements 
under this section based upon such factors as the number of patients 
receiving care or services, the number of employees employed by the 
entity or provider furnishing such care or services, the amount paid by 
the Secretary to the provider or entity, or other factors as determined 
by the Secretary.
    ``(2) To furnish hospital care, medical services, or extended care 
services under this section, an eligible entity or provider shall 
agree--
            ``(A) to accept payment at the rates established in 
        regulations prescribed under this section;
            ``(B) that payment by the Secretary under this section on 
        behalf of a veteran to a provider of services or care shall, 
        unless rejected and refunded by the provider within 30 days of 
        receipt, constitute payment in full and extinguish any 
        liability on the part of the veteran for the treatment or care 
        provided, and no provision of a contract, agreement, or 
        assignment to the contrary shall operate to modify, limit, or 
        negate this requirement;
            ``(C) to provide only the care and services authorized by 
        the Department under this section and to obtain the prior 
        written consent of the Department to furnish care or services 
        outside the scope of such authorization;
            ``(D) to bill the Department in accordance with the 
        methodology outlined in regulations prescribed under this 
        section;
            ``(E) to not seek to recover or collect from a health plan 
        contract or third party, as those terms are defined in section 
        1729 of this title, for any care or service that is furnished 
        or paid for by the Department;
            ``(F) to provide medical records to the Department in the 
        time frame and format specified by the Department; and
            ``(G) to meet such other terms and conditions, including 
        quality of care assurance standards, as the Secretary may 
        specify in regulation.
    ``(f) Discontinuation or Nonrenewal of a Veterans Care Agreement.--
(1) An eligible entity or provider may discontinue a Veterans Care 
Agreement at such time and upon such notice to the Secretary as may be 
provided in regulations prescribed under this section.
    ``(2) The Secretary may discontinue a Veterans Care Agreement with 
an eligible entity or provider at such time and upon such reasonable 
notice to the eligible entity or provider as may be specified in 
regulations prescribed under this section, if an official designated by 
the Secretary--
            ``(A) has determined that the eligible entity or provider 
        failed to comply substantially with the provisions of the 
        Veterans Care Agreement, or with the provisions of this section 
        or regulations prescribed under this section;
            ``(B) has determined the eligible entity or provider is 
        excluded from participation in a Federal health care program 
        under section 1128 or section 1128A of the Social Security Act 
        (42 U.S.C. 1320a-7 or 1320a-7a) or is identified on the System 
        for Award Management Exclusions list as provided in part 9 of 
        title 48, Code of Federal Regulations, and part 180 of title 2 
        of such Code, or successor regulations;
            ``(C) has ascertained that the eligible entity or provider 
        has been convicted of a felony or other serious offense under 
        Federal or State law and determines the eligible entity or 
        provider's continued participation would be detrimental to the 
        best interests of veterans or the Department; or
            ``(D) has determined that it is reasonable to terminate the 
        agreement based on the health care needs of a veteran.
    ``(g) Quality of Care.--The Secretary shall establish through 
regulation a system or systems for monitoring the quality of care 
provided to veterans through Veterans Care Agreements and for assessing 
the quality of hospital care, medical services, and extended care 
services furnished by eligible entities and providers before the 
renewal of Veterans Care Agreements.
    ``(h) Disputes.--(1) The Secretary shall promulgate administrative 
procedures for eligible entities and providers to present all disputes 
arising under or related to Veterans Care Agreements.
    ``(2) Such procedures constitute the eligible entities' and 
providers' exhaustive and exclusive administrative remedies.
    ``(3) Eligible entities or providers must first exhaust such 
administrative procedures before seeking any judicial review under 
section 1346 of title 28 (known as the `Tucker Act').
    ``(4) Disputes under this section must pertain to either the scope 
of authorization under the Veterans Care Agreement or claims for 
payment subject to the Veterans Care Agreement and are not claims for 
the purposes of such laws that would otherwise require application of 
sections 7101 through 7109 of title 41, United States Code.
    ``(i) Applicability of Other Provisions of Law.--(1) A Veterans 
Care Agreement may be authorized by the Secretary or any Department 
official authorized by the Secretary, and such action shall not be 
treated as--
            ``(A) an award for the purposes of such laws that would 
        otherwise require the use of competitive procedures for the 
        furnishing of care and services; or
            ``(B) a Federal contract for the acquisition of goods or 
        services for purposes of any provision of Federal law governing 
        Federal contracts for the acquisition of goods or services.
    ``(2)(A) Except as provided in subparagraph (B), and unless 
otherwise provided in this section or regulations prescribed pursuant 
to this section, an eligible entity or provider that enters into an 
agreement under this section is not subject to, in the carrying out of 
the agreement, any law to which providers of services and suppliers 
under the Medicare program under title XVIII of the Social Security Act 
(42 U.S.C. 1395 et seq.) are not subject.
    ``(B) An eligible entity or provider that enters into an agreement 
under this section is subject to--
            ``(i) all laws regarding integrity, ethics, or fraud, or 
        that subject a person to civil or criminal penalties; and
            ``(ii) all laws that protect against employment 
        discrimination or that otherwise ensure equal employment 
        opportunities.
    ``(3) Notwithstanding paragraph (2)(B)(i), an eligible entity or 
provider that enters into an agreement under this section shall not be 
treated as a Federal contractor or subcontractor for purposes of 
chapter 67 of title 41 (commonly known as the `McNamara-O'Hara Service 
Contract Act of 1965').
    ``(j) Parity of Treatment.--Eligibility for hospital care, medical 
services, and extended care services furnished to any veteran pursuant 
to a Veterans Care Agreement shall be subject to the same terms as 
though provided in a facility of the Department, and provisions of this 
chapter applicable to veterans receiving such care and services in a 
facility of the Department shall apply to veterans treated under this 
section.
    ``(k) Rulemaking.--The Secretary shall promulgate regulations to 
carry out this section.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by inserting after the item related to section 
1703 the following new item:

``1703A. Agreements with eligible entities or providers; certification 
                            processes.''.

SEC. 103. CONFORMING AMENDMENTS FOR STATE VETERANS HOMES.

    (a) In General.--Section 1745(a) is amended--
            (1) in paragraph (1), by striking ``(or agreement under 
        section 1720(c)(1) of this title)'' and inserting ``(or an 
        agreement)''; and
            (2) by adding at the end the following new paragraph:
    ``(4)(A) An agreement under this section may be authorized by the 
Secretary or any Department official authorized by the Secretary, and 
any such action is not an award for purposes of such laws that would 
otherwise require the use of competitive procedures for the furnishing 
of hospital care, medical services, and extended care services.
    ``(B)(i) Except as provided in clause (ii), and unless otherwise 
provided in this section or regulations prescribed pursuant to this 
section, a State home that enters into an agreement under this section 
is not subject to, in the carrying out of the agreement, any provision 
of law to which providers of services and suppliers under the Medicare 
program under title XVIII of the Social Security Act (42 U.S.C. 1395 et 
seq.) are not subject.
    ``(ii) A State home that enters into an agreement under this 
section is subject to--
            ``(I) all provisions of law regarding integrity, ethics, or 
        fraud, or that subject a person to civil or criminal penalties; 
        and
            ``(II) all provisions of law that protect against 
        employment discrimination or that otherwise ensure equal 
        employment opportunities.
    ``(iii) Notwithstanding subparagraph (B)(ii)(I), a State home that 
enters into an agreement under this section may not be treated as a 
Federal contractor or subcontractor for purposes of chapter 67 of title 
41 (known as the `McNamara-O'Hara Service Contract Act of 1965').''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to care provided on or after the effective date of regulations 
issued by the Secretary of Veterans Affairs to carry out this section.

SEC. 104. ACCESS GUIDELINES AND STANDARDS FOR QUALITY.

    (a) In General.--Subchapter I of chapter 17, as amended by section 
102, is further amended by inserting after section 1703A the following 
new sections:
``Sec. 1703B. Access guidelines
    ``The Secretary shall consult with all pertinent Federal entities 
to examine health care access measurements and establish localized 
benchmarking guidelines that can inform provider and veteran clinical 
decisionmaking. The Secretary shall establish such guidelines for all 
hospital care, medical services, and extended care services furnished 
or otherwise made available under laws administered by the Secretary, 
including through non-Department health care providers.
``Sec. 1703C. Standards for quality
    ``(a) In General.--(1) The Secretary shall establish standards for 
quality, in coordination or consultation with entities pursuant to 
section 1703(h)(3) of this title, regarding hospital care, medical 
services, and extended care services furnished by the Department 
pursuant to this title, including through non-Department health care 
providers pursuant to section 1703 of this title.
    ``(2) In establishing standards for quality under paragraph (1), 
the Secretary shall consider existing health quality measures that are 
applied to public and privately sponsored health care systems with the 
purpose of providing covered veterans relevant comparative information 
to make informed decisions regarding their health care.
    ``(3) The Secretary shall collect and consider data for purposes of 
establishing the standards under paragraph (1). Such data collection 
shall include--
            ``(A) after consultation with veterans service 
        organizations and other key stakeholders on survey development 
        or modification of an existing survey, a survey of veterans who 
        have used hospital care, medical services, or extended care 
        services furnished by the Veterans Health Administration during 
        the most recent two-year period to assess the satisfaction of 
        the veterans with service and quality of care; and
            ``(B) datasets that include, at a minimum, elements 
        relating to the following:
                    ``(i) Timely care.
                    ``(ii) Effective care.
                    ``(iii) Safety, including, at a minimum, 
                complications, readmissions, and deaths.
                    ``(iv) Efficiency.
    ``(b) Publication and Consideration of Public Comments.--(1) Not 
later than one year after the date on which the Secretary establishes 
standards for quality under subsection (a), the Secretary shall publish 
the quality rating of medical facilities of the Department in the 
publicly available Hospital Compare website through the Centers for 
Medicare & Medicaid Services for the purpose of providing veterans with 
information that allows them to compare performance measure information 
among Department and non-Department health care providers.
    ``(2) Not later than two years after the date on which the 
Secretary establishes standards for quality under subsection (a), the 
Secretary shall consider and solicit public comment on potential 
changes to the measures used in such standards to ensure that they 
include the most up-to-date and applicable industry measures for 
veterans.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 17, as amended by section 102, is further amended by inserting 
after the item relating to section 1703A the following new items:

``1703B. Access guidelines.
``1703C. Standards for quality.''.

SEC. 105. ACCESS TO WALK-IN CARE.

    (a) In General.--Chapter 17 is amended by inserting after section 
1725 the following new section:
``Sec. 1725A. Access to walk-in care
    ``(a) Procedures To Ensure Access to Walk-in Care.--The Secretary 
shall develop procedures to ensure that eligible veterans are able to 
access walk-in care from qualifying non-Department entities or 
providers.
    ``(b) Eligible Veterans.--For purposes of this section, an eligible 
veteran is any individual who--
            ``(1) is enrolled in the health care system established 
        under section 1705(a) of this title; and
            ``(2) has received care under this chapter within the 24-
        month period preceding the furnishing of walk-in care under 
        this section.
    ``(c) Qualifying Non-Department Entities or Providers.--For 
purposes of this section, a qualifying non-Department entity or 
provider is a non-Department entity or provider that has entered into a 
contract or other agreement with the Secretary to furnish services 
under this section.
    ``(d) Federally-qualified Health Centers.--Whenever practicable, 
the Secretary may use a Federally-qualified health center (as defined 
in section 1905(l)(2)(B) of the Social Security Act (42 U.S.C. 
1396d(l)(2)(B))) to carry out this section.
    ``(e) Continuity of Care.--The Secretary shall ensure continuity of 
care for those veterans who receive walk-in care services under this 
section, including through the establishment of a mechanism to receive 
medical records from walk-in care providers and provide pertinent 
patient medical records to providers of walk-in care.
    ``(f) Copayments.--(1)(A) The Secretary shall require all eligible 
veterans to pay the United States a copayment for each episode of 
hospital care and medical service provided under this section if 
otherwise required to pay a copayment under this title.
    ``(B) Those not required to pay a copayment under this title may 
access walk-in care without a copayment for the first two visits in a 
calendar year. For any additional visits, a copayment at an amount 
determined by the Secretary shall be paid.
    ``(C) For those veterans required to pay a copayment under title 
38, they are required to pay their regular copayment for their first 
two walk-in care visits in a calendar year. For any additional visits, 
a higher copayment at an amount determined by the Secretary shall be 
paid.
    ``(2) After the first two episodes of care furnished to a veteran 
under this section, the Secretary may adjust the copayment required of 
the veteran under this subsection based upon the priority group of 
enrollment of the veteran, the number of episodes of care furnished to 
the veteran during a year, and other factors the Secretary considers 
appropriate under this section.
    ``(3) The amount or amounts of the copayments required under this 
subsection shall be prescribed by the Secretary by rule.
    ``(4) Section 8153(c) of this title shall not apply to this 
subsection.
    ``(g) Regulations.--Not later than one year after the date of the 
enactment of the Caring for our Veterans Act of 2017, the Secretary 
shall promulgate regulations to carry out this section.
    ``(h) Walk-in Care Defined.--In this section, the term `walk-in 
care' means non-emergent care provided by a qualifying non-Department 
entity or provider that furnishes episodic care and not longitudinal 
management of conditions and is otherwise defined through regulations 
the Secretary shall promulgate.''.
    (b) Effective Date.--Section 1725A of title 38, United States Code, 
as added by subsection (a) shall take effect on the date upon which 
final regulations implementing such section take effect.
    (c) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by inserting after the item related to section 
1725 the following new item:

``Sec. 1725A. Access to walk-in care.''.

SEC. 106. STRATEGY REGARDING THE DEPARTMENT OF VETERANS AFFAIRS HIGH-
              PERFORMING INTEGRATED HEALTH CARE NETWORK.

    (a) Market Area Assessments.--
            (1) In general.--Not less frequently than every four years, 
        the Secretary of Veterans Affairs shall perform market area 
        assessments regarding the health care services furnished under 
        the laws administered by the Secretary.
            (2) Elements.--Each market area assessment established 
        under paragraph (1) shall include the following:
                    (A) An assessment of the demand for health care 
                from the Department, disaggregated by geographic market 
                areas as determined by the Secretary, including the 
                number of requests for health care services under the 
                laws administered by the Secretary.
                    (B) An inventory of the health care capacity of the 
                Department of Veterans Affairs across the Department's 
                system of facilities.
                    (C) An assessment of the health care capacity to be 
                provided through contracted community care providers 
                and providers who entered into a provider agreement 
                with the Department under section 1703A of title 38, 
                United States Code, as added by section 102(a), 
                including the number of providers, the geographic 
                location of the providers, and categories or types of 
                health care services provided by the providers.
                    (D) An assessment obtained from other Federal 
                direct delivery systems of their capacity to provide 
                health care to veterans.
                    (E) An assessment of the health care capacity of 
                non-contracted providers where there is insufficient 
                network supply.
                    (F) An assessment of the health care capacity of 
                academic affiliates and other collaborations of the 
                Department as it relates to providing health care to 
                veterans.
                    (G) An assessment of the effects on health care 
                capacity by the access guidelines and standards for 
                quality established under section 1703(h) of title 38, 
                United States Code, as amended by section 101(a)(1).
                    (H) The number of appointments for health care 
                services under the laws administered by the Secretary, 
                disaggregated by--
                            (i) appointments at facilities of the 
                        Department of Veterans Affairs; and
                            (ii) appointments with non-Department 
                        health care providers.
            (3) Submittal to congress.--The Secretary shall submit to 
        the appropriate committees of Congress the market area 
        assessments established in paragraph (1).
            (4) Use of market area assessments for integrated health 
        care delivery.--
                    (A) In general.--The Secretary shall use the market 
                area assessments established under paragraph (1) in 
                determining the capacity of the health care provider 
                networks established under section 1703(j) of title 38, 
                United States Code, as amended by section 101(a)(1).
                    (B) Budget.--The Secretary shall ensure that the 
                Department budget for any fiscal year (as submitted 
                with the budget of the President under section 1105(a) 
                of title 31, United States Code) reflects the findings 
                of the Secretary with respect to the most recent market 
                area assessments under paragraph (1).
            (5) Effective date.--The amendments made by subsection (a) 
        shall take effect on September 30, 2018.
    (b) Strategic Plan To Meet Health Care Demand.--
            (1) In general.--Not later than one year after the date of 
        the enactment of this Act and not less frequently than once 
        every four years thereafter, the Secretary shall submit to the 
        appropriate committees of Congress a strategic plan that 
        specifies a four-year forecast of--
                    (A) the demand for health care from the Department, 
                disaggregated by geographic area as determined by the 
                Secretary;
                    (B) the health care capacity to be provided at each 
                medical center of the Department; and
                    (C) the health care capacity to be provided through 
                community care providers.
            (2) Elements.--In preparing the strategic plan under 
        paragraph (1), the Secretary shall--
                    (A) consider the access guidelines and standards 
                for quality established under section 1703(h) of title 
                38, United States Code, as amended by section 
                101(a)(1);
                    (B) consider the market area assessments 
                established under subsection (a);
                    (C) consider the needs of the Department based on 
                identified services that provide management of 
                conditions or disorders related to military service for 
                which there is limited experience or access in the 
                national market, the overall health of veterans 
                throughout their lifespan, or other services as the 
                Secretary determines appropriate;
                    (D) consult with key stakeholders within the 
                Department, the heads of other Federal agencies, and 
                other relevant governmental and nongovernmental 
                entities, including State, local, and tribal government 
                officials, members of Congress, veterans service 
                organizations, private sector representatives, 
                academics, and other policy experts;
                    (E) identify emerging issues, trends, problems, and 
                opportunities that could affect health care services 
                furnished under the laws administered by the Secretary;
                    (F) develop recommendations regarding both short- 
                and long-term priorities for health care services 
                furnished under the laws administered by the Secretary;
                    (G) after consultation with veterans service 
                organizations and other key stakeholders on survey 
                development or modification of an existing survey, 
                consider a survey of veterans who have used hospital 
                care, medical services, or extended care services 
                furnished by the Veterans Health Administration during 
                the most recent two-year period to assess the 
                satisfaction of the veterans with service and quality 
                of care; and
                    (H) consider such other matters as the Secretary 
                considers appropriate.
    (c) Appropriate Committees of Congress Defined.--In this section, 
the term ``appropriate committees of Congress'' means--
            (1) the Committee on Veterans' Affairs and the Committee on 
        Appropriations of the Senate; and
            (2) the Committee on Veterans' Affairs and the Committee on 
        Appropriations of the House of Representatives.

SEC. 107. APPLICABILITY OF DIRECTIVE OF OFFICE OF FEDERAL CONTRACT 
              COMPLIANCE PROGRAMS.

    (a) In General.--Notwithstanding the treatment of certain laws 
under subsection (i) of section 1703A of title 38, United States Code, 
as added by section 102 of this Act, Directive 2014-01 of the Office of 
Federal Contract Compliance Programs of the Department of Labor 
(effective as of May 7, 2014) shall apply to any entity entering into 
an agreement under such section 1703A or section 1745 of such title, as 
amended by section 103, in the same manner as such directive applies to 
subcontractors under the TRICARE program for the duration of the 
moratorium provided under such directive.
    (b) Applicability Period.--The directive described in subsection 
(a), and the moratorium provided under such directive, shall not be 
altered or rescinded before May 7, 2019.
    (c) TRICARE Program Defined.--In this section, the term ``TRICARE 
program'' has the meaning given that term in section 1072 of title 10, 
United States Code.

SEC. 108. PREVENTION OF CERTAIN HEALTH CARE PROVIDERS FROM PROVIDING 
              NON-DEPARTMENT HEALTH CARE SERVICES TO VETERANS.

    (a) In General.--On and after the date that is one year after the 
date of the enactment of this Act, the Secretary of Veterans Affairs 
shall deny or revoke the eligibility of a health care provider to 
provide non-Department health care services to veterans if the 
Secretary determines that the health care provider--
            (1) was removed from employment with the Department of 
        Veterans Affairs due to conduct that violated a policy of the 
        Department relating to the delivery of safe and appropriate 
        health care; or
            (2) violated the requirements of a medical license of the 
        health care provider that resulted in the loss of such medical 
        license.
    (b) Permissive Action.--On and after the date that is one year 
after the date of the enactment of this Act, the Secretary may deny, 
revoke, or suspend the eligibility of a health care provider to provide 
non-Department health care services if the Secretary determines such 
action is necessary to immediately protect the health, safety, or 
welfare of veterans and the health care provider is under investigation 
by the medical licensing board of a State in which the health care 
provider is licensed or practices.
    (c) Suspension.--The Secretary shall suspend the eligibility of a 
health care provider to provide non-Department health care services to 
veterans if the health care provider is suspended from serving as a 
health care provider of the Department.
    (d) Comptroller General Report.--Not later than two years after the 
date of the enactment of this Act, the Comptroller General of the 
United States shall submit to Congress a report on the implementation 
by the Secretary of this section, including the following:
            (1) The aggregate number of health care providers denied or 
        suspended under this section from participation in providing 
        non-Department health care services.
            (2) An evaluation of any impact on access to health care 
        for patients or staffing shortages in programs of the 
        Department providing non-Department health care services.
            (3) An explanation of the coordination of the Department 
        with the medical licensing boards of States in implementing 
        this section, the amount of involvement of such boards in such 
        implementation, and efforts by the Department to address any 
        concerns raised by such boards with respect to such 
        implementation.
            (4) Such recommendations as the Comptroller General 
        considers appropriate regarding harmonizing eligibility 
        criteria between health care providers of the Department and 
        health care providers eligible to provide non-Department health 
        care services.
    (e) Non-Department Health Care Services Defined.--In this section, 
the term ``non-Department health care services'' means services--
            (1) provided under subchapter I of chapter 17 of title 38, 
        United States Code, at non-Department facilities (as defined in 
        section 1701 of such title);
            (2) provided under section 101 of the Veterans Access, 
        Choice, and Accountability Act of 2014 (Public Law 113-146; 38 
        U.S.C. 1701 note);
            (3) purchased through the Medical Community Care account of 
        the Department; or
            (4) purchased with amounts deposited in the Veterans Choice 
        Fund under section 802 of the Veterans Access, Choice, and 
        Accountability Act of 2014.

         Subtitle B--Paying Providers and Improving Collections

SEC. 111. PROMPT PAYMENT TO PROVIDERS.

    (a) In General.--Subchapter I of chapter 17 is amended by inserting 
after section 1703C, as added by section 104 of this Act, the following 
new section:
``Sec. 1703D. Prompt payment standard
    ``(a) In General.--(1) Notwithstanding any other provision of this 
title or of any other provision of law, the Secretary shall pay for 
hospital care, medical services, or extended care services furnished by 
health care entities or providers under this chapter within 45 calendar 
days upon receipt of a clean paper claim or 30 calendar days upon 
receipt of a clean electronic claim.
    ``(2) If a claim is denied, the Secretary shall, within 45 calendar 
days of denial for a paper claim and 30 calendar days of denial for an 
electronic claim, notify the health care entity or provider of the 
reason for denying the claim and what, if any, additional information 
is required to process the claim.
    ``(3) Upon the receipt of the additional information, the Secretary 
shall ensure that the claim is paid, denied, or otherwise adjudicated 
within 30 calendar days from the receipt of the requested information.
    ``(4) This section shall only apply to payments made on an invoice 
basis and shall not apply to capitation or other forms of periodic 
payment to entities or providers.
    ``(b) Submittal of Claims by Health Care Entities and Providers.--A 
health care entity or provider that furnishes hospital care, a medical 
service, or an extended care service under this chapter shall submit to 
the Secretary a claim for payment for furnishing the hospital care, 
medical service, or extended care service not later than 180 days after 
the date on which the entity or provider furnished the hospital care, 
medical service, or extended care service.
    ``(c) Fraudulent Claims.--(1) Sections 3729 through 3733 of title 
31 shall apply to fraudulent claims for payment submitted to the 
Secretary by a health care entity or provider under this chapter.
    ``(2) Pursuant to regulations prescribed by the Secretary, the 
Secretary shall bar a health care entity or provider from furnishing 
hospital care, medical services, and extended care services under this 
chapter when the Secretary determines the entity or provider has 
submitted to the Secretary fraudulent health care claims for payment by 
the Secretary.
    ``(d) Overdue Claims.--(1) Any claim that has not been denied with 
notice, made pending with notice, or paid to the health care entity or 
provider by the Secretary shall be overdue if the notice or payment is 
not received by the entity provider within the time periods specified 
in subsection (a).
    ``(2)(A) If a claim is overdue under this subsection, the Secretary 
may, under the requirements established by subsection (a) and 
consistent with the provisions of chapter 39 of title 31 (commonly 
referred to as the `Prompt Payment Act'), require that interest be paid 
on clean claims.
    ``(B) Interest paid under subparagraph (A) shall be computed at the 
rate of interest established by the Secretary of the Treasury under 
section 3902 of title 31 and published in the Federal Register.
    ``(3) Not less frequently than annually, the Secretary shall submit 
to Congress a report on payment of overdue claims under this 
subsection, disaggregated by paper and electronic claims, that includes 
the following:
            ``(A) The amount paid in overdue claims described in this 
        subsection, disaggregated by the amount of the overdue claim 
        and the amount of interest paid on such overdue claim.
            ``(B) The number of such overdue claims and the average 
        number of days late each claim was paid, disaggregated by 
        facility of the Department and Veterans Integrated Service 
        Network region.
    ``(e) Overpayment.--(1) The Secretary shall deduct the amount of 
any overpayment from payments due a health care entity or provider 
under this chapter.
    ``(2) Deductions may not be made under this subsection unless the 
Secretary has made reasonable efforts to notify a health care entity or 
provider of the right to dispute the existence or amount of such 
indebtedness and the right to request a compromise of such 
indebtedness.
    ``(3) The Secretary shall make a determination with respect to any 
such dispute or request prior to deducting any overpayment unless the 
time required to make such a determination before making any deductions 
would jeopardize the Secretary's ability to recover the full amount of 
such indebtedness.
    ``(f) Information and Documentation Required.--(1) The Secretary 
shall provide to all health care entities and providers participating 
in a program to furnish hospital care, medical services, or extended 
care services under this chapter a list of information and 
documentation that is required to establish a clean claim under this 
section.
    ``(2) The Secretary shall consult with entities in the health care 
industry, in the public and private sector, to determine the 
information and documentation to include in the list under paragraph 
(1).
    ``(3) If the Secretary modifies the information and documentation 
included in the list under paragraph (1), the Secretary shall notify 
all health care entities and providers described in paragraph (1) not 
later than 30 days before such modifications take effect.
    ``(g) Processing of Claims.--In processing a claim for compensation 
for hospital care, medical services, or extended care services 
furnished by a health care entity or provider under this chapter, the 
Secretary shall act through--
            ``(1) a non-Department entity that is under contract or 
        agreement for the program established under section 1703(a) of 
        this title; or
            ``(2) a non-Department entity that specializes in such 
        processing for other Federal agency health care systems.
    ``(h) Report on Encounter Data System.--(1) Not later than 90 days 
after the date of the enactment of the Caring for our Veterans Act of 
2017, the Secretary shall submit to the appropriate committees of 
Congress a report on the feasibility and advisability of adopting a 
funding mechanism similar to what is utilized by other Federal agencies 
to allow a contracted entity to act as a fiscal intermediary for the 
Federal Government to distribute, or pass through, Federal Government 
funds for certain non-underwritten hospital care, medical services, or 
extended care services.
    ``(2) The Secretary may coordinate with the Department of Defense, 
the Department of Health and Human Services, and the Department of the 
Treasury in developing the report required by paragraph (1).
    ``(i) Definitions.--In this section:
            ``(1) The term `appropriate committees of Congress' means--
                    ``(A) the Committee on Veterans' Affairs and the 
                Committee on Appropriations of the Senate; and
                    ``(B) the Committee on Veterans' Affairs and the 
                Committee on Appropriations of the House of 
                Representatives.
            ``(2) The term `clean electronic claim' means the 
        transmission of data for purposes of payment of covered health 
        care expenses that is submitted to the Secretary which contains 
        substantially all of the required data elements necessary for 
        accurate adjudication, without obtaining additional information 
        from the entity or provider that furnished the care or service, 
        submitted in such format as prescribed by the Secretary in 
        regulations for the purpose of paying claims for care or 
        services.
            ``(3) The term `clean paper claim' means a paper claim for 
        payment of covered health care expenses that is submitted to 
        the Secretary which contains substantially all of the required 
        data elements necessary for accurate adjudication, without 
        obtaining additional information from the entity or provider 
        that furnished the care or service, submitted in such format as 
        prescribed by the Secretary in regulations for the purpose of 
        paying claims for care or services.
            ``(4) The term `fraudulent claims' means the intentional 
        and deliberate misrepresentation of a material fact or facts by 
        a health care entity or provider made to induce the Secretary 
        to pay a claim that was not legally payable to that provider. 
        This term, as used in this section, shall not include a good 
        faith interpretation by a health care entity or provider of 
        utilization, medical necessity, coding, and billing 
        requirements of the Secretary.
            ``(5) The term `health care entity or provider' includes 
        any non-Department health care entity or provider, but does not 
        include any Federal health care entity or provider.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by inserting after the item related to section 
1703C, as added by section 104 of this Act, the following new item:

``1703D. Prompt payment standard.''.

SEC. 112. AUTHORITY TO PAY FOR AUTHORIZED CARE NOT SUBJECT TO AN 
              AGREEMENT.

    (a) In General.--Subchapter IV of chapter 81 is amended by adding 
at the end the following new section:
``Sec. 8159. Authority to pay for services authorized but not subject 
              to an agreement
    ``(a) In General.--If, in the course of furnishing hospital care, a 
medical service, or an extended care service authorized by the 
Secretary and pursuant to a contract, agreement, or other arrangement 
with the Secretary, a provider who is not a party to the contract, 
agreement, or other arrangement furnishes hospital care, a medical 
service, or an extended care service that the Secretary considers 
necessary, the Secretary may compensate the provider for the cost of 
such care or service.
    ``(b) New Contracts and Agreements.--The Secretary shall take 
reasonable efforts to enter into a contract, agreement, or other 
arrangement with a provider described in subsection (a) to ensure that 
future care and services authorized by the Secretary and furnished by 
the provider are subject to such a contract, agreement, or other 
arrangement.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by inserting after the item relating to section 
8158 the following new item:

``8159. Authority to pay for services authorized but not subject to an 
                            agreement.''.

SEC. 113. IMPROVEMENT OF AUTHORITY TO RECOVER THE COST OF SERVICES 
              FURNISHED FOR NON-SERVICE-CONNECTED DISABILITIES.

    (a) Broadening Scope of Applicability.--Section 1729 is amended--
            (1) in subsection (a)--
                    (A) in paragraph (2)(A)--
                            (i) by striking ``the veteran's'' and 
                        inserting ``the individual's''; and
                            (ii) by striking ``the veteran'' and 
                        inserting ``the individual''; and
                    (B) in paragraph (3)--
                            (i) in the matter preceding subparagraph 
                        (A), by striking ``the veteran'' and inserting 
                        ``the individual''; and
                            (ii) in subparagraph (A), by striking ``the 
                        veteran's'' and inserting ``the individual's'';
            (2) in subsection (b)--
                    (A) in paragraph (1)--
                            (i) by striking ``the veteran'' and 
                        inserting ``the individual''; and
                            (ii) by striking ``the veteran's'' and 
                        inserting ``the individual's''; and
                    (B) in paragraph (2)--
                            (i) in subparagraph (A)--
                                    (I) by striking ``the veteran'' and 
                                inserting ``the individual''; and
                                    (II) by striking ``the veteran's'' 
                                and inserting ``the individual's''; and
                            (ii) in subparagraph (B)--
                                    (I) in clause (i), by striking 
                                ``the veteran'' and inserting ``the 
                                individual''; and
                                    (II) in clause (ii)--
                                            (aa) by striking ``the 
                                        veteran'' and inserting ``the 
                                        individual''; and
                                            (bb) by striking ``the 
                                        veteran's'' each place it 
                                        appears and inserting ``the 
                                        individual's'';
            (3) in subsection (e), by striking ``A veteran'' and 
        inserting ``An individual''; and
            (4) in subsection (h)--
                    (A) in paragraph (1)--
                            (i) in the matter preceding subparagraph 
                        (A), by striking ``a veteran'' and inserting 
                        ``an individual'';
                            (ii) in subparagraph (A), by striking ``the 
                        veteran'' and inserting ``the individual''; and
                            (iii) in subparagraph (B), by striking 
                        ``the veteran'' and inserting ``the 
                        individual''; and
                    (B) in paragraph (2)--
                            (i) by striking ``A veteran'' and inserting 
                        ``An individual'';
                            (ii) by striking ``a veteran'' and 
                        inserting ``an individual''; and
                            (iii) by striking ``the veteran'' and 
                        inserting ``the individual''.
    (b) Modification of Authority.--Subsection (a)(1) of such section 
is amended by striking ``(1) Subject'' and all that follows through the 
period and inserting the following: ``(1) Subject to the provisions of 
this section, in any case in which the United States is required by law 
to furnish or pay for care or services under this chapter for a non-
service-connected disability described in paragraph (2) of this 
subsection, the United States has the right to recover or collect from 
a third party the reasonable charges of care or services so furnished 
or paid for to the extent that the recipient or provider of the care or 
services would be eligible to receive payment for such care or services 
from such third party if the care or services had not been furnished or 
paid for by a department or agency of the United States.''
    (c) Modification of Eligible Individuals.--Subparagraph (D) of 
subsection (a)(2) of such section is amended to read as follows:
            ``(D) that is incurred by an individual who is entitled to 
        care (or payment of the expenses of care) under a health-plan 
        contract.''.

SEC. 114. PROCESSING OF CLAIMS FOR REIMBURSEMENT THROUGH ELECTRONIC 
              INTERFACE.

    The Secretary of Veterans Affairs may enter into an agreement with 
a third-party entity to process, through the use of an electronic 
interface, claims for reimbursement for health care provided under the 
laws administered by the Secretary.

              Subtitle C--Education and Training Programs

SEC. 121. EDUCATION PROGRAM ON HEALTH CARE OPTIONS.

    (a) In General.--The Secretary of Veterans Affairs shall develop 
and administer an education program that teaches veterans about their 
health care options through the Department of Veterans Affairs.
    (b) Elements.--The program under subsection (a) shall--
            (1) teach veterans about--
                    (A) eligibility criteria for care from the 
                Department set forth under sections 1703, as amended by 
                section 101 of this Act, and 1710 of title 38, United 
                States Code;
                    (B) priority groups for enrollment in the system of 
                annual patient enrollment under section 1705(a) of such 
                title;
                    (C) the copayments and other financial obligations, 
                if any, required of certain individuals for certain 
                services; and
                    (D) how to utilize the access guidelines and 
                standards for quality established under sections 1703B 
                and 1703C of such title.
            (2) teach veterans about the interaction between health 
        insurance (including private insurance, Medicare, Medicaid, the 
        TRICARE program, the Indian Health Service, tribal health 
        programs, and other forms of insurance) and health care from 
        the Department; and
            (3) provide veterans with information on what to do when 
        they have a complaint about health care received from the 
        Department (whether about the provider, the Department, or any 
        other type of complaint).
    (c) Accessibility.--In developing the education program under this 
section, the Secretary shall ensure that materials under such program 
are accessible --
            (1) to veterans who may not have access to the Internet; 
        and
            (2) to veterans in a manner that complies with the 
        Americans with Disabilities Act of 1990 (42 U.S.C. 12101 et 
        seq.).
    (d) Annual Evaluation and Report.--
            (1) Evaluation.--The Secretary shall develop a method to 
        evaluate the effectiveness of the education program under this 
        section and evaluate the program using the method not less 
        frequently than once each year.
            (2) Report.--Not less frequently than once each year, the 
        Secretary shall submit to Congress a report on the findings of 
        the Secretary with respect to the most recent evaluation 
        conducted by the Secretary under paragraph (1).
    (e) Definitions.--In this section:
            (1) Medicaid.--The term ``Medicaid'' means the Medicaid 
        program under title XIX of the Social Security Act (42 U.S.C. 
        1396 et seq.).
            (2) Medicare.--The term ``Medicare'' means the Medicare 
        program under title XVIII of such Act (42 U.S.C. 1395 et seq.).
            (3) Tricare program.--The term ``TRICARE program'' has the 
        meaning given that term in section 1072 of title 10, United 
        States Code.

SEC. 122. TRAINING PROGRAM FOR ADMINISTRATION OF NON-DEPARTMENT OF 
              VETERANS AFFAIRS HEALTH CARE.

    (a) Establishment of Program.--The Secretary of Veterans Affairs 
shall develop and implement a training program to train employees and 
contractors of the Department of Veterans Affairs on how to administer 
non-Department health care programs, including the following:
            (1) Reimbursement for non-Department emergency room care.
            (2) The Veterans Community Care Program under section 1703 
        of such title, as amended by section 101.
            (3) Management of prescriptions pursuant to improvements 
        under section 131.
    (b) Annual Evaluation and Report.--The Secretary shall--
            (1) develop a method to evaluate the effectiveness of the 
        training program developed and implemented under subsection 
        (a);
            (2) evaluate such program not less frequently than once 
        each year; and
            (3) not less frequently than once each year, submit to 
        Congress the findings of the Secretary with respect to the most 
        recent evaluation carried out under paragraph (2).

SEC. 123. CONTINUING MEDICAL EDUCATION FOR NON-DEPARTMENT MEDICAL 
              PROFESSIONALS.

    (a) Establishment of Program.--
            (1) In general.--The Secretary of Veterans Affairs shall 
        establish a program to provide continuing medical education 
        material to non-Department medical professionals.
            (2) Education provided.--The program established under 
        paragraph (1) shall include education on the following:
                    (A) Identifying and treating common mental and 
                physical conditions of veterans and family members of 
                veterans.
                    (B) The health care system of the Department of 
                Veterans Affairs.
                    (C) Such other matters as the Secretary considers 
                appropriate.
    (b) Material Provided.--The continuing medical education material 
provided to non-Department medical professionals under the program 
established under subsection (a) shall be the same material provided to 
medical professionals of the Department to ensure that all medical 
professionals treating veterans have access to the same materials, 
which supports core competencies throughout the community.
    (c) Administration of Program.--
            (1) In general.--The Secretary shall administer the program 
        established under subsection (a) to participating non-
        Department medical professionals through an Internet website of 
        the Department of Veterans Affairs.
            (2) Curriculum and credit provided.--The Secretary shall 
        determine the curriculum of the program and the number of hours 
        of credit to provide to participating non-Department medical 
        professionals for continuing medical education.
            (3) Accreditation.--The Secretary shall ensure that the 
        program is accredited in as many States as practicable.
            (4) Consistency with existing rules.--The Secretary shall 
        ensure that the program is consistent with the rules and 
        regulations of the following:
                    (A) The medical licensing agency of each State in 
                which the program is accredited.
                    (B) Such medical credentialing organizations as the 
                Secretary considers appropriate.
            (5) User cost.--The Secretary shall carry out the program 
        at no cost to participating non-Department medical 
        professionals.
            (6) Monitoring, evaluation, and report.--The Secretary 
        shall monitor the utilization of the program established under 
        subsection (a), evaluate its effectiveness, and report to 
        Congress on utilization and effectiveness not less frequently 
        than once each year.
    (d) Non-Department Medical Professional Defined.--In this section, 
the term ``non-Department medical professional'' means any individual 
who is licensed by an appropriate medical authority in the United 
States and is in good standing, is not an employee of the Department of 
Veterans Affairs, and provides care to veterans or family members of 
veterans under the laws administered by the Secretary of Veterans 
Affairs.

   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.

    (a) Receipt and Review of Guidelines.--The Secretary of Veterans 
Affairs shall ensure that all covered health care providers are 
provided a copy of and certify that they have reviewed the evidence-
based guidelines for prescribing opioids set forth by the Opioid Safety 
Initiative of the Department of Veterans Affairs under sections 
911(a)(2) and 912(c) of the Jason Simcakoski Memorial and Promise Act 
(Public Law 114-198; 38 U.S.C. 1701 note) before first providing care 
under the laws administered by the Secretary and at any time when those 
guidelines are modified thereafter.
    (b) Inclusion of Medical History and Current Medications.--The 
Secretary shall implement a process to ensure that, if care of a 
veteran by a covered health care provider is authorized under the laws 
administered by the Secretary, the document authorizing such care 
includes the relevant medical history of the veteran and a list of all 
medications prescribed to the veteran.
    (c) Submittal of Prescriptions.--
            (1) In general.--Except as provided in paragraph (3), the 
        Secretary shall require, to the maximum extent practicable, 
        each non-Department health care provider to submit 
        prescriptions for opioids--
                    (A) to the Department for prior authorization for 
                the prescribing of a limited amount of opioids under 
                contracts the Department has with retail pharmacies; or
                    (B) directly to a pharmacy of the Department for 
                dispensing of the prescriptions.
            (2) Responsibility of department for recording and 
        monitoring.--In carrying out paragraph (1) and upon the receipt 
        by the Department of the prescription for opioids to veterans 
        under laws administered by the Secretary, the Secretary shall--
                    (A) ensure the Department is responsible for the 
                recording of the prescription in the electronic health 
                record of the veteran; and
                    (B) enable other monitoring of the prescription as 
                outlined in the Opioid Safety Initiative of the 
                Department.
            (3) Exception.--
                    (A) In general.--A covered health care provider is 
                not required under paragraph (1)(B) to submit an opioid 
                prescription directly to a pharmacy of the Department 
                if--
                            (i) the health care provider determines 
                        that there is an immediate medical need for the 
                        prescription, including an urgent or emergent 
                        prescription or a prescription dispensed as 
                        part of an opioid treatment program that 
                        provides office-based medications; and
                            (ii)(I) following an inquiry into the 
                        matter, a pharmacy of the Department notifies 
                        the health care provider that it cannot fill 
                        the prescription in a timely manner; or
                            (II) the health care provider determines 
                        that the requirement under paragraph (1)(B) 
                        would impose an undue hardship on the veteran, 
                        including with respect to travel distances, as 
                        determined by the Secretary.
                    (B) Notification to department.--If a covered 
                health care provider uses an exception under 
                subparagraph (A) with respect to an opioid prescription 
                for a veteran, the health care provider shall, on the 
                same day the prescription is written, submit to the 
                Secretary for inclusion in the electronic health record 
                of the veteran a notice, in such form as the Secretary 
                may establish, providing information about the 
                prescription and describing the reason for the 
                exception.
                    (C) Report.--
                            (i) In general.--Not less frequently than 
                        quarterly, the Secretary shall submit to the 
                        Committee on Veterans' Affairs of the Senate 
                        and the Committee on Veterans' Affairs of the 
                        House of Representatives a report evaluating 
                        the compliance of covered health care providers 
                        with the requirements under this paragraph and 
                        setting forth data on the use by health care 
                        providers of exceptions under subparagraph (A) 
                        and notices under subparagraph (B).
                            (ii) Elements.--Each report required by 
                        clause (i) shall include the following with 
                        respect to the quarter covered by the report:
                                    (I) The number of exceptions used 
                                under subparagraph (A) and notices 
                                received under subparagraph (B).
                                    (II) The rate of compliance by the 
                                Department with the requirement under 
                                subparagraph (B) to include such 
                                notices in the health records of 
                                veterans.
                                    (III) The identification of any 
                                covered health care providers that, 
                                based on criteria prescribed by the 
                                Secretary, are determined by the 
                                Secretary to be statistical outliers 
                                regarding the use of exceptions under 
                                subparagraph (A).
    (d) Use of Opioid Safety Initiative Guidelines.--
            (1) In general.--If a director of a medical center of the 
        Department or a Veterans Integrated Service Network determines 
        that the opioid prescribing practices of a covered health care 
        provider conflicts with or is otherwise inconsistent with the 
        standards of appropriate and safe care, as that term is used in 
        section 913(d) of the Jason Simcakoski Memorial and Promise Act 
        (Public Law 114-198; 38 U.S.C. 1701 note), the director shall 
        take such action as the director considers appropriate to 
        ensure the safety of all veterans receiving care from that 
        health care provider, including removing or directing the 
        removal of any such health care provider from provider networks 
        or otherwise refusing to authorize care of veterans by such 
        health care provider in any program authorized under the laws 
        administered by the Secretary.
            (2) Inclusion in contracts.--The Secretary shall ensure 
        that any contracts entered into by the Secretary with third 
        parties involved in administering programs that provide care in 
        the community to veterans under the laws administered by the 
        Secretary specifically grant the authority set forth in 
        paragraph (1) to such third parties and to the directors 
        described in that paragraph, as the case may be.
    (e) Denial or Revocation of Eligibility of Non-Department 
Providers.--The Secretary shall deny or revoke the eligibility of a 
non-Department health care provider to provide health care to veterans 
under the laws administered by the Secretary if the Secretary 
determines that the opioid prescribing practices of the provider--
            (1) violate the requirements of a medical license of the 
        health care provider; or
            (2) detract from the ability of the health care provider to 
        deliver safe and appropriate health care.
    (f) Covered Health Care Provider Defined.--In this section, the 
term ``covered health care provider'' means a non-Department of 
Veterans Affairs health care provider who provides health care to 
veterans under the laws administered by the Secretary of Veterans 
Affairs.

SEC. 132. IMPROVING INFORMATION SHARING WITH COMMUNITY PROVIDERS.

    Section 7332(b)(2) is amended by striking subparagraph (H) and 
inserting the following new subparagraphs:
            ``(H)(i) To a non-Department entity (including private 
        entities and other Federal agencies) for purposes of providing 
        health care, including hospital care, medical services, and 
        extended care services, to patients.
            ``(ii) An entity to which a record is disclosed under this 
        subparagraph may not disclose or use such record for a purpose 
        other than that for which the disclosure was made.
            ``(I) To a third party in order to recover or collect 
        reasonable charges for care furnished to, or paid on behalf of, 
        a patient in connection with a non-service connected disability 
        as permitted by section 1729 of this title or for a condition 
        for which recovery is authorized or with respect to which the 
        United States is deemed to be a third party beneficiary under 
        the Act entitled `An Act to provide for the recovery from 
        tortiously liable third persons of the cost of hospital and 
        medical care and treatment furnished by the United States' 
        (Public Law 87-693; 42 U.S.C. 2651 et seq.; commonly known as 
        the `Federal Medical Care Recovery Act').''.

SEC. 133. COMPETENCY STANDARDS FOR NON-DEPARTMENT OF VETERANS AFFAIRS 
              HEALTH CARE PROVIDERS.

    (a) Establishment of Standards and Requirements.--The Secretary of 
Veterans Affairs shall establish standards and requirements for the 
provision of care by non-Department of Veterans Affairs health care 
providers in clinical areas for which the Department of Veterans 
Affairs has special expertise, including post-traumatic stress 
disorder, military sexual trauma-related conditions, and traumatic 
brain injuries.
    (b) Condition for Eligibility to Participate in Veterans Choice 
Program.--Each non-Department of Veterans Affairs health care provider 
shall meet the standards and requirements established pursuant to 
subsection (a) before entering into a contact with the Department of 
Veterans Affairs to participate in the Veterans Choice Program under 
section 101 of the Veterans Access, Choice, and Accountability Act of 
2014 (Public Law 113-146; 38 U.S.C. 1701 note). Non-Department of 
Veterans Affairs health care providers participating in the Veterans 
Choice Program shall fulfill training requirements established by the 
Secretary on how to deliver evidence-based treatments in the clinical 
areas for which the Department of Veterans Affairs has special 
expertise.

          Subtitle E--Other Non-Department Health Care Matters

SEC. 141. PLANS FOR USE OF SUPPLEMENTAL APPROPRIATIONS REQUIRED.

    Whenever the Secretary submits to Congress a request for 
supplemental appropriations or any other appropriation outside the 
standard budget process to address a budgetary issue affecting the 
Department of Veterans Affairs, the Secretary shall, not later than 45 
days before the date on which such budgetary issue would start 
affecting a program or service, submit to Congress a justification for 
the request, including a plan that details how the Secretary intends to 
use the requested appropriation and how long the requested 
appropriation is expected to meet the needs of the Department and 
certification that the request was made using an updated and sound 
actuarial analysis.

SEC. 142. VETERANS CHOICE FUND FLEXIBILITY.

    Section 802 of the Veterans Access, Choice, and Accountability Act 
of 2014 (Public Law 113-146; 38 U.S.C. 1701 note) is amended--
            (1) in subsection (c)--
                    (A) in paragraph (1), by striking ``by paragraph 
                (3)'' and inserting ``in paragraphs (3) and (4)''; and
                    (B) by adding at the end the following new 
                paragraph:
            ``(4) Permanent authority for other uses.--Beginning in 
        fiscal year 2019, amounts remaining in the Veterans Choice Fund 
        may be used to furnish hospital care, medical services, and 
        extended care services to individuals pursuant to chapter 17 of 
        title 38, United States Code, at non-Department facilities, 
        including pursuant to non-Department provider programs other 
        than the program established by section 101. Such amounts shall 
        be available in addition to amounts available in other 
        appropriations accounts for such purposes.''; and
            (2) in subsection (d)(1), by striking ``to subsection 
        (c)(3)'' and inserting ``to paragraphs (3) and (4) of 
        subsection (c)''.

SEC. 143. SUNSET OF VETERANS CHOICE PROGRAM.

    Subsection (p) of section 101 of the Veterans Access, Choice, and 
Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 1701 note) is 
amended to read as follows:
    ``(p) Authority To Furnish Care and Services.--The Secretary may 
not use the authority under this section to furnish care and services 
after December 31, 2018.''.

SEC. 144. CONFORMING AMENDMENTS.

    (a) In General.--
            (1) Title 38.--Title 38, United States Code, is amended--
                    (A) in section 1712(a)--
                            (i) in paragraph (3), by striking ``under 
                        clause (1), (2), or (5) of section 1703(a) of 
                        this title'' and inserting ``or entered an 
                        agreement''; and
                            (ii) in paragraph (4)(A), by striking 
                        ``under the provisions of this subsection and 
                        section 1703 of this title'';
                    (B) in section 1712A(e)(1)--
                            (i) by inserting ``or agreements'' after 
                        ``contracts''; and
                            (ii) by striking ``(under sections 
                        1703(a)(2) and 1710(a)(1)(B) of this title)''; 
                        and
                    (C) in section 2303(a)(2)(B)(i), by striking ``with 
                section 1703'' and inserting ``with sections 1703A, 
                8111, and 8153''.
            (2) Social security act.--Section 1866(a)(1)(L) of the 
        Social Security Act (42 U.S.C. 1395cc(a)(1)(L)) is amended by 
        striking ``under section 1703'' and inserting ``under chapter 
        17''.
            (3) Veterans' benefits improvements act of 1994.--Section 
        104(a)(4)(A) of the Veterans' Benefits Improvements Act of 1994 
        (Public Law 103-446; 38 U.S.C. 1117 note) is amended by 
        striking ``in section 1703'' and inserting ``in sections 1703A, 
        8111, and 8153''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
take effect on the date described in section 101(b).

TITLE II--IMPROVING DEPARTMENT OF VETERANS AFFAIRS HEALTH CARE DELIVERY

                    Subtitle A--Personnel Practices

                         PART I--ADMINISTRATION

SEC. 201. LICENSURE OF HEALTH CARE PROFESSIONALS OF THE DEPARTMENT OF 
              VETERANS AFFAIRS PROVIDING TREATMENT VIA TELEMEDICINE.

    (a) In General.--Chapter 17 is amended by inserting after section 
1730A the following new section:
``Sec. 1730B. Licensure of health care professionals providing 
              treatment via telemedicine
    ``(a) In General.--Notwithstanding any provision of law regarding 
the licensure of health care professionals, a covered health care 
professional may practice the health care profession of the health care 
professional at any location in any State, regardless of where the 
covered health care professional or the patient is located, if the 
covered health care professional is using telemedicine to provide 
treatment to an individual under this chapter.
    ``(b) Covered Health Care Professionals.--For purposes of this 
section, a covered health care professional is any health care 
professional who--
            ``(1) is an employee of the Department appointed under the 
        authority under section 7306, 7401, 7405, 7406, or 7408 of this 
        title or title 5;
            ``(2) is authorized by the Secretary to provide health care 
        under this chapter;
            ``(3) is required to adhere to all standards of quality 
        relating to the provision of medicine in accordance with 
        applicable policies of the Department; and
            ``(4) has an active, current, full, and unrestricted 
        license, registration, or certification in a State to practice 
        the health care profession of the health care professional.
    ``(c) Property of Federal Government.--Subsection (a) shall apply 
to a covered health care professional providing treatment to a patient 
regardless of whether the covered health care professional or patient 
is located in a facility owned by the Federal Government during such 
treatment.
    ``(d) Relation to State Law.--(1) The provisions of this section 
shall supersede any provisions of the law of any State to the extent 
that such provision of State law are inconsistent with this section.
    ``(2) No State shall deny or revoke the license, registration, or 
certification of a covered health care professional who otherwise meets 
the qualifications of the State for holding the license, registration, 
or certification on the basis that the covered health care professional 
has engaged or intends to engage in activity covered by subsection (a).
    ``(e) Rule of Construction.--Nothing in this section may be 
construed to remove, limit, or otherwise affect any obligation of a 
covered health care professional under the Controlled Substances Act 
(21 U.S.C. 801 et seq.).''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 17 of such title is amended by inserting after the item 
relating to section 1730A the following new item:

``1730B. Licensure of health care professionals providing treatment via 
                            telemedicine.''.
    (c) Report on Telemedicine.--
            (1) In general.--Not later than one year after the earlier 
        of the date on which services provided under section 1730B of 
        title 38, United States Code, as added by subsection (a), first 
        occur or regulations are promulgated to carry out such section, 
        the Secretary of Veterans Affairs shall submit to the Committee 
        on Veterans' Affairs of the Senate and the Committee on 
        Veterans' Affairs of the House of Representatives a report on 
        the effectiveness of the use of telemedicine by the Department 
        of Veterans Affairs.
            (2) Elements.--The report required by paragraph (1) shall 
        include an assessment of the following:
                    (A) The satisfaction of veterans with telemedicine 
                furnished by the Department.
                    (B) The satisfaction of health care providers in 
                providing telemedicine furnished by the Department.
                    (C) The effect of telemedicine furnished by the 
                Department on the following:
                            (i) The ability of veterans to access 
                        health care, whether from the Department or 
                        from non-Department health care providers.
                            (ii) The frequency of use by veterans of 
                        telemedicine.
                            (iii) The productivity of health care 
                        providers.
                            (iv) Wait times for an appointment for the 
                        receipt of health care from the Department.
                            (v) The use by veterans of in-person 
                        services at Department facilities and non-
                        Department facilities.
                    (D) The types of appointments for the receipt of 
                telemedicine furnished by the Department that were 
                provided during the one-year period preceding the 
                submittal of the report.
                    (E) The number of appointments for the receipt of 
                telemedicine furnished by the Department that were 
                requested during such period, disaggregated by medical 
                facility.
                    (F) Savings by the Department, if any, including 
                travel costs, from furnishing health care through the 
                use of telemedicine during such period.

SEC. 202. ROLE OF PODIATRISTS IN DEPARTMENT OF VETERANS AFFAIRS.

    (a) Inclusion as Physician.--
            (1) In general.--Subchapter I of chapter 74 is amended by 
        adding at the end the following new section:
``Sec. 7413. Treatment of podiatrists; clinical oversight standards
    ``(a) Podiatrists.--Except as provided by subsection (b), a doctor 
of podiatric medicine who is appointed as a podiatrist under section 
7401(1) of this title is eligible for any supervisory position in the 
Veterans Health Administration to the same degree that a physician 
appointed under such section is eligible for the position.
    ``(b) Establishment of Clinical Oversight Standards.--The 
Secretary, in consultation with appropriate stakeholders, shall 
establish standards to ensure that specialists appointed in the 
Veterans Health Administration to supervisory positions do not provide 
direct clinical oversight for purposes of peer review or practice 
evaluation for providers of other clinical specialties.''.
            (2) Clerical amendment.--The table of sections at the 
        beginning of chapter 74 is amended by inserting after the item 
        relating to section 7412 the following new item:

``7413. Treatment of podiatrists; clinical oversight standards.''.
    (b) Modification and Clarification of Pay Grade.--
            (1) Grade.--The list in section 7404(b) of such title is 
        amended--
                    (A) by striking ``PHYSICIAN AND DENTIST SCHEDULE'' 
                and inserting ``PHYSICIAN AND SURGEON (MD/DO), 
                PODIATRIC SURGEON (DPM), AND DENTIST AND ORAL SURGEON 
                (DDS, DMD) SCHEDULE'';
                    (B) by striking, ``Physician grade'' and inserting 
                ``Physician and surgeon grade''; and
                    (C) by striking ``PODIATRIST, CHIROPRACTOR, AND'' 
                and inserting ``CHIROPRACTOR AND''.
            (2) Application.--The amendments made by paragraph (1) 
        shall apply with respect to a pay period of the Department of 
        Veterans Affairs beginning on or after the date that is 30 days 
        after the date of the enactment of this Act.

SEC. 203. MODIFICATION OF TREATMENT OF CERTIFIED CLINICAL PERFUSIONISTS 
              OF THE DEPARTMENT.

    (a) Appointment.--Section 7401(1) is amended by inserting 
``certified clinical perfusionists,'' after ``physician assistants,''.
    (b) Increases in Rates of Basic Pay.--Section 7455(c)(1) is amended 
by inserting ``certified clinical perfusionists,'' after 
``pharmacists,''.

SEC. 204. AMENDING STATUTORY REQUIREMENTS FOR THE POSITION OF THE CHIEF 
              OFFICER OF THE READJUSTMENT COUNSELING SERVICE.

    Section 7309(b)(2) is amended--
            (1) in subparagraph (B), by striking ``in the Readjustment 
        Counseling Service''; and
            (2) in subparagraph (C), by striking ``in 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.

    Section 7404(d) is amended by striking ``Except'' and inserting 
``Except for positions described in section 7401(4) of this title and 
except''.

SEC. 206. IDENTIFICATION AND STAFFING OF CERTAIN HEALTH CARE VACANCIES.

    (a) In General.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall identify 
and fully staff--
            (1) all mental health vacancies within the Department of 
        Veterans Affairs; and
            (2) all primary care and mental health vacancies in Patient 
        Aligned Care Teams of the Department.
    (b) Report.--Not later than 210 days after the date of the 
enactment of this Act, the Secretary shall submit to Congress a report 
that specifies--
            (1) whether the Department has complied with the 
        requirements under subsection (a); and
            (2) if the Secretary has not complied with such 
        requirements--
                    (A) how many vacancies described in subsection (a) 
                remain; and
                    (B) why the Department was unable to fill such 
                vacancies.

SEC. 207. DEPARTMENT OF VETERANS AFFAIRS PERSONNEL TRANSPARENCY.

    (a) Publication of Staffing and Vacancies.--
            (1) Website required.--Not later than 30 days after the 
        date of the enactment of this Act, the Secretary of Veterans 
        Affairs shall make publicly available on an Internet website of 
        the Department of Veterans Affairs the following information, 
        which shall be displayed by departmental component or, in the 
        case of information relating to Veterans Health Administration 
        positions, by medical facility:
                    (A) The number of personnel encumbering positions.
                    (B) The number of accessions and de-accessions of 
                personnel during the month preceding the date of the 
                publication of the information.
                    (C) The number of vacancies, by occupation.
                    (D) The number of active job postings that have 
                been filled during the 30-day period ending on the date 
                of publication of the information, including the length 
                of time for which each position was posted prior to 
                being filled.
            (2) Update of information.--The Secretary shall update the 
        information on the website required under paragraph (1) on a 
        monthly basis.
            (3) Treatment of contractor positions.--Any Department of 
        Veterans Affairs position that is filled through a contractor 
        employee may not be treated as a Department position for 
        purposes of the information required to be published under 
        paragraph (1).
            (4) Inspector general review.--On a semi-annual basis, the 
        Inspector General of the Department shall review the 
        administration of the website required under paragraph (1) and 
        make recommendations relating to the improvement of such 
        administration.
    (b) Report to Congress.--The Secretary of Veterans Affairs shall 
submit to Congress an annual report on the steps the Department is 
taking to achieve full staffing capacity. Each such report shall 
include the amount of additional funds necessary to enable the 
Department to reach full staffing capacity.

SEC. 208. PROGRAM ON ESTABLISHMENT OF PEER SPECIALISTS IN PATIENT 
              ALIGNED CARE TEAM SETTINGS WITHIN MEDICAL CENTERS OF 
              DEPARTMENT OF VETERANS AFFAIRS.

    (a) Program Required.--The Secretary of Veterans Affairs shall 
carry out a program to establish not fewer than two peer specialists in 
patient aligned care teams at medical centers of the Department of 
Veterans Affairs to promote the use and integration of services for 
mental health, substance use disorder, and behavior health in a primary 
care setting.
    (b) Timeframe for Establishment of Program.--The Secretary shall 
carry out the program at medical centers of the Department as follows:
            (1) Not later than December 31, 2018, at not fewer than 25 
        medical centers of the Department.
            (2) Not later than December 31, 2019, at not fewer than 50 
        medical centers of the Department.
    (c) Selection of Locations.--
            (1) In general.--The Secretary shall select medical centers 
        for the program as follows:
                    (A) Not fewer than five shall be medical centers of 
                the Department that are designated by the Secretary as 
                polytrauma centers.
                    (B) Not fewer than ten shall be medical centers of 
                the Department that are not designated by the Secretary 
                as polytrauma centers.
            (2) Considerations.--In selecting medical centers for the 
        program under paragraph (1), the Secretary shall consider the 
        feasibility and advisability of selecting medical centers in 
        the following areas:
                    (A) Rural areas and other areas that are 
                underserved by the Department.
                    (B) Areas that are not in close proximity to an 
                active duty military installation.
                    (C) Areas representing different geographic 
                locations, such as census tracts established by the 
                Bureau of the Census.
    (d) Gender-Specific Services.--In carrying out the program at each 
location selected under subsection (c), the Secretary shall ensure 
that--
            (1) the needs of female veterans are specifically 
        considered and addressed; and
            (2) female peer specialists are made available to female 
        veterans who are treated at each location.
    (e) Engagement With Community Providers.--At each location selected 
under subsection (c), the Secretary shall consider ways in which peer 
specialists can conduct outreach to health care providers in the 
community who are known to be serving veterans to engage with those 
providers and veterans served by those providers.
    (f) Reports.--
            (1) Periodic reports.--
                    (A) In general.--Not later than 180 days after the 
                date of the enactment of this Act, and not less 
                frequently than once every 180 days thereafter until 
                the Secretary determines that the program is being 
                carried out at the last location to be selected under 
                subsection (c), the Secretary shall submit to Congress 
                a report on the program.
                    (B) Elements.--Each report required by subparagraph 
                (A) shall, with respect to the 180-day period preceding 
                the submittal of the report, include the following:
                            (i) The findings and conclusions of the 
                        Secretary with respect to the program.
                            (ii) An assessment of the benefits of the 
                        program to veterans and family members of 
                        veterans.
                            (iii) An assessment of the effectiveness of 
                        peer specialists in engaging under subsection 
                        (e) with health care providers in the community 
                        and veterans served by those providers.
            (2) Final report.--Not later than 180 days after the 
        Secretary determines that the program is being carried out at 
        the last location to be selected under subsection (c), the 
        Secretary shall submit to Congress a report detailing the 
        recommendations of the Secretary as to the feasibility and 
        advisability of expanding the program to additional locations.

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.

    (a) In General.--Commencing not later than 120 days after the date 
of the enactment of this Act, the Secretary of Veterans Affairs shall 
carry out a pilot program to increase the use of medical scribes to 
maximize the efficiency of physicians at medical facilities of the 
Department of Veterans Affairs.
    (b) Duration.--The Secretary shall carry out the pilot program 
during the 18-month period beginning on the date of the commencement of 
the pilot program.
    (c) Locations.--The Secretary shall carry out the pilot program at 
not fewer than five medical facilities of the Department--
            (1) at which the Secretary has determined there is a high 
        volume of patients; or
            (2) that are located in rural areas and at which the 
        Secretary has determined there is a shortage of physicians and 
        each physician has a high caseload.
    (d) Contracts.--
            (1) In general.--In carrying out the pilot program, the 
        Secretary shall enter into a contract with one or more 
        appropriate nongovernmental entities described in paragraph 
        (2).
            (2) Appropriate nongovernmental entities described.--An 
        appropriate nongovernmental entity described in this paragraph 
        is an entity that trains and employs professional medical 
        scribes who specialize in the collection of medical data and 
        data entry into electronic health records.
    (e) Collection of Data.--
            (1) In general.--The Secretary shall collect data on the 
        pilot program to determine the effectiveness of the pilot 
        program in increasing the efficiency of physicians at medical 
        facilities of the Department.
            (2) Elements.--The data collected under paragraph (1) shall 
        include the following with respect to each medical facility 
        participating in the pilot program:
                    (A) The average wait time for a veteran to receive 
                care from a physician at such medical facility before 
                implementation of the pilot program.
                    (B) The average wait time for a veteran to receive 
                care from such a physician after implementation of the 
                pilot program.
                    (C) The average number of patients that such a 
                physician is able to see on a daily basis before 
                implementation of the pilot program.
                    (D) The average number of patients that such a 
                physician is able to see on a daily basis after 
                implementation of the pilot program.
                    (E) The average amount of time such a physician 
                spends on documentation on a daily basis before 
                implementation of the pilot program.
                    (F) The average amount of time such a physician 
                spends on documentation on a daily basis after 
                implementation of the pilot program.
                    (G) The satisfaction and retention scores of each 
                such physician before implementation of the pilot 
                program.
                    (H) The satisfaction and retention scores of each 
                such physician after implementation of the pilot 
                program.
                    (I) The patient satisfaction scores for each such 
                physician before implementation of the pilot program.
                    (J) The patient satisfaction scores for each such 
                physician after implementation of the pilot program.
                    (K) The patient satisfaction scores for their 
                health care experience before implementation of the 
                pilot program.
                    (L) The patient satisfaction scores for their 
                health care experience after implementation of the 
                pilot program.
    (f) Report.--
            (1) In general.--Not later than 180 days after the 
        commencement of the pilot program, and not less frequently than 
        once every 180 days thereafter for the duration of the pilot 
        program, the Secretary shall submit to Congress a report on the 
        pilot program.
            (2) Elements.--Each report required by paragraph (1) shall 
        include the following:
                    (A) The number of medical facilities of the 
                Department that are participating in the pilot program.
                    (B) With respect to each such medical facility, an 
                assessment of the effects that participation in the 
                pilot program has had on the following--
                            (i) Maximizing the efficiency of physicians 
                        at such medical facility.
                            (ii) Reducing average wait times for 
                        appointments.
                            (iii) Improving access of patients to 
                        electronic medical records.
                            (iv) Mitigating physician shortages by 
                        increasing the productivity of physicians.
                    (C) All data collected under subsection (e).
                    (D) Such recommendations as the Secretary may have 
                with respect to the extension or expansion of the pilot 
                program.
    (g) Medical Scribe Defined.--In this section, the term ``medical 
scribe'' means a member of the medical team hired and trained 
specifically and exclusively to perform documentation in an electronic 
health record to maximize the productivity of a physician.

SEC. 210. SENSE OF CONGRESS REGARDING DEPARTMENT OF VETERANS AFFAIRS 
              STAFFING LEVELS.

    (a) Findings.--Congress makes the following findings:
            (1) The Department of Veterans Affairs needs to fill at 
        least 35,000 positions.
            (2) Prolonged personnel vacancies in the Department result 
        in staffing shortages that cause veterans to receive delayed 
        benefits and services.
    (b) Sense of Congress.--It is the sense of Congress that the 
Department should make the resolution of staffing shortages a top 
priority.

                    PART II--EDUCATION AND TRAINING

SEC. 211. GRADUATE MEDICAL EDUCATION AND RESIDENCY.

    (a) Increase in Number of Graduate Medical Education Residency 
Positions.--
            (1) In general.--The Secretary of Veterans Affairs shall 
        increase the number of graduate medical education residency 
        positions at covered facilities by up to 1,500 positions in the 
        10-year period beginning on the date of the enactment of this 
        Act.
            (2) Covered facilities.--For purposes of this section, a 
        covered facility is any of the following:
                    (A) A facility of the Department of Veterans 
                Affairs.
                    (B) A facility operated by an Indian tribe or a 
                tribal organization, as those terms are defined in 
                section 4 of the Indian Self-Determination and 
                Education Assistance Act (25 U.S.C. 5304).
                    (C) A facility operated by the Indian Health 
                Service.
                    (D) A Federally-qualified health center, as defined 
                in section 1905(l)(2)(B) of the Social Security Act (42 
                U.S.C. 1396d(l)(2)(B)).
                    (E) A community health center.
                    (F) A facility operated by the Department of 
                Defense.
                    (G) Such other health care facility as the 
                Secretary considers appropriate for purposes of this 
                section.
            (3) Stipends and benefits.--The Secretary may pay stipends 
        and provide benefits for residents in positions under paragraph 
        (1), regardless of whether they have been assigned in a 
        Department facility.
            (4) Parameters for location, affiliate sponsor, and 
        duration.--When determining characteristics of residency 
        positions under paragraph (1), the Secretary shall consider the 
        extent to which there is a clinical need for providers, as 
        determined by the following:
                    (A) The ratio of veterans to health care providers 
                of the Department for a standardized geographic area 
                surrounding a facility, including a separate ratio for 
                general practitioners and specialists.
                    (B) Whether the local community is medically 
                underserved.
                    (C) Whether the facility is located in a rural or 
                remote area.
                    (D) Such other criteria as the Secretary considers 
                important in determining which facilities are not 
                adequately serving area veterans.
            (5) Parameters for types of specialties.--When determining 
        the types of specialties to be included in residency positions 
        under paragraph (1), the Secretary shall consider the 
        following:
                    (A) The types of specialties that improve the 
                quality and coverage of medical services provided to 
                veterans.
                    (B) The range of clinical specialties covered by 
                providers in standardized geographic areas surrounding 
                facilities.
                    (C) Whether the specialty is included in the most 
                recent staffing shortage determination of the 
                Department under section 7412 of title 38, United 
                States Code.
    (b) Application To Participate.--To participate as a resident in 
one of the positions increased under subsection (a)(1), an individual 
shall submit to the Secretary an application therefor together with an 
agreement described in subsection (d) under which the participant 
agrees to serve a period of obligated service in the Veterans Health 
Administration as provided in the agreement in return for payment of 
stipend and benefit support as provided in the agreement.
    (c) Selection.--
            (1) In general.--An individual becomes a participant in a 
        residency program under this section upon the Secretary's 
        approval of the individual's application under subsection (b) 
        and the Secretary's acceptance of the agreement under 
        subsection (d) (if required).
            (2) Notice.--Upon the Secretary's approval of an 
        individual's participation in the program under paragraph (1), 
        the Secretary shall promptly notify the individual of that 
        approval. Such notice shall be in writing.
    (d) Agreement.--
            (1) In general.--An agreement between the Secretary and a 
        resident in a position under subsection (a)(1) shall be in 
        writing and shall be signed by the resident containing such 
        terms as the Secretary may specify.
            (2) Requirements.--The agreement must specify the terms of 
        the service obligation resulting from participating as a 
        resident under this section, including by requiring a service 
        obligation equal to the number of years of stipend and benefit 
        support.
    (e) Conditions of Employment.--The Secretary may prescribe the 
conditions of employment of individuals appointed to positions under 
subsection (a)(1), including necessary training, and the customary 
amount and terms of pay for such positions during the period of such 
employment and training.
    (f) Obligated Service.--
            (1) In general.--Each individual appointed to a position 
        under subsection (a)(1) shall provide service as a full-time 
        employee of the Department for the period of obligated service 
        provided in the agreement of the participant entered into under 
        subsection (d). Such service shall be provided in the full-time 
        clinical practice of such participant's profession or in 
        another health care position in an assignment or location 
        determined by the Secretary.
            (2) Commencement date.--Not later than 60 days before the 
        date on which an individual commences serving in a position 
        under subsection (a)(1), the Secretary shall notify the 
        individual of such date. Such date shall be the first day of 
        the individual's period of obligated service.
    (g) Breach of Agreement: Liability.--
            (1) Penalty.--An individual appointed under this section to 
        a position under subsection (a)(1) (other than an individual 
        who is liable under paragraph (2)) who fails to accept payment, 
        or instructs the educational institution in which the 
        individual is enrolled not to accept payment, in whole or in 
        part, for a residency under the agreement entered into under 
        subsection (d) of this title shall be liable to the United 
        States for liquidated damages in the amount of $1,500. Such 
        liability is in addition to any period of obligated service or 
        other obligation or liability under the agreement.
            (2) Liability.--
                    (A) In general.--An individual appointed to a 
                position under subsection (a)(1) shall be liable to the 
                United States for the amount which has been paid to or 
                on behalf of the individual under the agreement if any 
                of the following occurs:
                            (i) The individual is dismissed from the 
                        position for disciplinary reasons.
                            (ii) The individual voluntarily terminates 
                        the residency before the completion of such 
                        course of training.
                            (iii) The individual loses the individual's 
                        license, registration, or certification to 
                        practice the individual's health care 
                        profession in a State.
                    (B) Liability supplants service obligation.--
                Liability under this paragraph is in lieu of any 
                service obligation arising under the individual's 
                agreement under subsection (d).
    (h) Recovery.--
            (1) In general.--If an individual breaches the 
        individuals's agreement under subsection (d) by failing (for 
        any reason) to complete such individual's period of obligated 
        service, the United States shall be entitled to recover from 
        the individual an amount equal to the product of--
                    (A) three;
                    (B) the sum of--
                            (i) the amounts paid under this section to 
                        or on behalf of the individual; and
                            (ii) the interest on such amounts that 
                        would be payable if at the time the amounts 
                        were paid they were loans bearing interest at 
                        the maximum legal prevailing rate, as 
                        determined by the Treasurer of the United 
                        States; and
                    (C) the quotient of--
                            (i) the difference between--
                                    (I) the total number of months in 
                                the individual's period of obligated 
                                service; and
                                    (II) the number of months of such 
                                period served by the individual; and
                            (ii) the total number of months in the 
                        individual's period of obligated service.
            (2) Period of recovery.--Any amount which the United States 
        is entitled to recover under this subsection shall be paid to 
        the United States not later than the date that is one year 
        after the date of the breach of the agreement.
    (i) Annual Report.--
            (1) In general.--Not later than one year after the date of 
        the enactment of this Act and not less frequently than once 
        each year thereafter, the Secretary shall submit to the 
        appropriate committees of Congress a report on the 
        implementation of this section during the previous year.
            (2) Contents.--Each report submitted under paragraph (1) 
        shall include, for the period covered by the report, the 
        following:
                    (A) The number of positions described in subsection 
                (a) that were filled.
                    (B) The location of each such position.
                    (C) The academic affiliate associated with each 
                such position.
                    (D) A description of the challenges faced in 
                filling the positions described in subsection (a) and 
                the actions the Secretary has taken to address such 
                challenges.
            (3) Appropriate committees of congress defined.--In this 
        subsection, the term ``appropriate committees of Congress'' 
        means--
                    (A) the Committee on Veterans' Affairs and the 
                Committee on Appropriations of the Senate; and
                    (B) the Committee on Veterans' Affairs and the 
                Committee on Appropriations of the House of 
                Representatives.

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.

    (a) Pilot Program Required.--The Secretary of Veterans Affairs, in 
consultation with the Director of the Indian Health Service and such 
other persons as the Secretary considers appropriate, shall carry out a 
pilot program--
            (1) to establish graduate medical education residency 
        training programs at covered facilities; or
            (2) to affiliate with established programs described in 
        paragraph (1).
    (b) Covered Facilities.--For purposes of the pilot program, a 
covered facility is any facility--
            (1)(A) described in subparagraph (B) or (C) of section 
        211(a)(2); or
            (B) with an agreement with the Department described in 
        section 101(d)(1); and
            (2) located in a rural or remote area.
    (c) Locations.--
            (1) In general.--The Secretary shall carry out the pilot 
        program at not more than five covered facilities that have been 
        selected by the Secretary for purposes of the pilot program.
            (2) Criteria.--The Secretary shall establish criteria for 
        selecting covered facilities under paragraph (1).
    (d) Duration.--The Secretary shall carry out the pilot program 
during the eight-year period beginning on the date that is 180 days 
after the date of the enactment of this Act.
    (e) Reimbursement of Costs.--The Secretary shall reimburse each 
covered facility participating in the pilot program for the following 
costs associated with the pilot program:
            (1) Curriculum development.
            (2) Recruitment, training, supervision, and retention of 
        residents and faculty.
            (3) Accreditation of programs of education under the pilot 
        program by the Accreditation Council for Graduate Medical 
        Education (ACGME) or the American Osteopathic Association 
        (AOA).
            (4) The portion of faculty salaries attributable to 
        activities relating to carrying out the pilot program.
            (5) Payment for expenses relating to providing medical 
        education under the pilot program.
            (6) Stipends and benefits.
    (f) Period of Obligated Service.--
            (1) In general.--The Secretary shall enter into an 
        agreement with each individual who participates in the pilot 
        program under which such individual agrees to serve under the 
        same terms as established under section 211.
            (2) Loan repayment.--During the period of obligated service 
        of an individual under paragraph (1), the individual--
                    (A) shall be deemed to be an eligible individual 
                under subsection (b) of section 108 of the Indian 
                Health Care Improvement Act (25 U.S.C. 1616a) for 
                purposes of participation in the Indian Health Service 
                Loan Repayment Program under such section during the 
                portion of such period that the individual serves at a 
                covered facility; and
                    (B) shall be deemed to be an eligible individual 
                under section 7682(a) of title 38, United States Code, 
                for purposes of participation in the Department of 
                Veterans Affairs Education Debt Reduction Program under 
                subchapter VII of chapter 76 of such title during the 
                portion of such period that the individual serves at a 
                facility of the Department.
            (3) Concurrent service.--Any period of obligated service 
        required of an individual under paragraph (1) shall be served--
                    (A) with respect to service at a covered facility, 
                concurrently with any period of obligated service 
                required of the individual by the Indian Health 
                Service; and
                    (B) with respect to service at a facility of the 
                Department of Veterans Affairs, concurrently with any 
                period of obligated service required of the individual 
                by the Department.
    (g) Treatment of Participants.--A residency position into which a 
participant in the pilot program is placed as part of the pilot program 
shall be considered a position referred to in section 211(a)(1) for 
purposes of the limitation on number of new positions authorized under 
such section.
    (h) Report.--Not later than three years before the date on which 
the pilot program terminates, the Secretary of Veterans Affairs shall 
submit to the Committee on Veterans' Affairs of the Senate and the 
Committee on Veterans' Affairs of the House of Representatives a report 
on the feasibility and advisability of--
            (1) expanding the pilot program to additional locations; 
        and
            (2) making the pilot program or any aspect of the pilot 
        program permanent.

SEC. 213. REIMBURSEMENT OF CONTINUING PROFESSIONAL EDUCATION 
              REQUIREMENTS FOR BOARD CERTIFIED ADVANCED PRACTICE 
              REGISTERED NURSES.

    (a) In General.--Section 7411 is amended to read as follows:
``Sec. 7411. Reimbursement of continuing professional education 
              expenses
    ``The Secretary shall reimburse any full-time board-certified 
advanced practice registered nurse, physician, or dentist appointed 
under section 7401(1) of this title for expenses incurred, up to $1,000 
per year, for continuing professional education.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 74 is amended by striking the item relating to section 7411 and 
inserting the following new item:

``7411. Reimbursement of continuing professional education expenses.''.

SEC. 214. INCREASE IN MAXIMUM AMOUNT OF DEBT THAT MAY BE REDUCED UNDER 
              EDUCATION DEBT REDUCTION PROGRAM OF DEPARTMENT OF 
              VETERANS AFFAIRS.

    (a) Increase in Amount.--Section 7683(d)(1) is amended--
            (1) by striking ``$120,000'' and inserting ``$240,000''; 
        and
            (2) by striking ``$24,000'' and inserting ``$48,000''.
    (b) Study.--
            (1) In general.--Not later than one year after the date of 
        the enactment of this Act, the Secretary of Veterans Affairs 
        shall--
                    (A) conduct a study on the demand for education 
                debt reduction under subchapter VII of chapter 76 of 
                title 38, United States Code; and
                    (B) submit to the Committee on Veterans' Affairs of 
                the Senate and the Committee on Veterans' Affairs of 
                the House of Representatives a report on the findings 
                of the Secretary with respect to the study carried out 
                under subparagraph (A).
            (2) Considerations.--In carrying out the study required by 
        paragraph (1)(A), the Secretary shall consider the following:
                    (A) The total number of vacancies within the 
                Veterans Health Administration whose applicants are 
                eligible to participate in the Education Debt Reduction 
                Program pursuant to section 7682(a) of such title.
                    (B) The types of medical professionals in greatest 
                demand in the United States.
                    (C) Projections by the Secretary of the numbers and 
                types of medical professions that meet the needs of 
                veterans.

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.

    (a) Demonstration Program Authorized.--The Secretary of Veterans 
Affairs may carry out a demonstration program to establish programs to 
train and employ alternative dental health care providers in order to 
increase access to dental health care services for veterans who are 
entitled to such services from the Department of Veterans Affairs and 
reside in rural and other underserved communities.
    (b) Priority.--The Secretary shall prioritize the establishment of 
programs under the demonstration program under this section in States 
that do not have a facility of the Department that offers on-site 
dental services.
    (c) Telehealth.--For purposes of alternative dental health care 
providers and other dental care providers who are licensed to provide 
clinical care, dental services provided under the demonstration program 
under this section may be administered by such providers through 
telehealth-enabled collaboration and supervision when appropriate and 
feasible.
    (d) Authorization of Appropriations.--There are authorized to be 
appropriated to the Secretary such sums as are necessary to carry out 
the demonstration program under this section.
    (e) Alternative Dental Health Care Providers Defined.--In this 
section, the term ``alternative dental health care providers'' has the 
meaning given that term in section 340G-1(a)(2) of the Public Health 
Service Act (42 U.S.C. 256g-1(a)(2)).

                   PART III--OTHER PERSONNEL MATTERS

SEC. 221. EXCEPTION ON LIMITATION ON AWARDS AND BONUSES FOR 
              RECRUITMENT, RELOCATION, AND RETENTION.

    Section 705(a) of the Veterans Access, Choice, and Accountability 
Act of 2014 (Public Law 113-146; 38 U.S.C. 703 note) is amended, in the 
matter preceding paragraph (1), by inserting ``other than recruitment, 
relocation, or retention incentives,'' after ``title 38, United States 
Code,''.

SEC. 222. ANNUAL REPORT ON PERFORMANCE AWARDS AND BONUSES AWARDED TO 
              CERTAIN HIGH-LEVEL EMPLOYEES OF THE DEPARTMENT.

    (a) In General.--Chapter 7 is amended by adding at the end the 
following new section:
``Sec. 726. Annual report on performance awards and bonuses awarded to 
              certain high-level employees
    ``(a) In General.--Not later than 30 days after the end of each 
fiscal year, the Secretary shall submit to the appropriate committees 
of Congress a report that contains, for the most recent fiscal year 
ending before the submittal of the report, a description of the 
performance awards and bonuses awarded to Regional Office Directors of 
the Department, Directors of Medical Centers of the Department, and 
Directors of Veterans Integrated Service Networks.
    ``(b) Elements.--Each report submitted under subsection (a) shall 
include the following with respect to each performance award or bonus 
awarded to an individual described in such subsection:
            ``(1) The amount of each award or bonus.
            ``(2) The job title of the individual awarded the award or 
        bonus.
            ``(3) The location where the individual awarded the award 
        or bonus works.
    ``(c) Appropriate Committees of Congress.--In this section, the 
term `appropriate committees of Congress' means--
            ``(1) the Committee on Veterans' Affairs and the Committee 
        on Appropriations of the Senate; and
            ``(2) the Committee on Veterans' Affairs and the Committee 
        on Appropriations of the House of Representatives.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 7 is amended by inserting after the item relating to section 
725 the following new item:

``726. Annual report on performance awards and bonuses awarded to 
                            certain high-level employees.''.

SEC. 223. AUTHORITY TO REGULATE ADDITIONAL PAY FOR CERTAIN HEALTH CARE 
              EMPLOYEES OF THE DEPARTMENT.

    Section 7454 is amended by adding at the end the following new 
subsection:
    ``(d) In this section, the term `compensation' includes all 
compensation earned by employees when performing duties authorized by 
the Secretary or when the employee is approved to use annual, sick, 
family medical, military, or court leave or during any other paid 
absence for which pay is not already regulated.''.

SEC. 224. MODIFICATION OF PAY CAP FOR NURSES.

    Paragraph (2) of section 7451(c) is amended to read as follows:
    ``(2)(A) The maximum rate of basic pay for any grade for health-
care personnel positions referred to in paragraphs (1) and (3) of 
section 7401 of this title (other than the positions of physician, 
dentist, and registered nurse) may not exceed the rate of basic pay 
established for positions in level IV of the Executive Schedule under 
section 5315 of title 5.
    ``(B) Pursuant to an adjustment under subsection (d), the maximum 
rate of basic pay for a registered nurse serving as a nurse executive 
or a grade for the position of certified registered nurse anesthetist 
may exceed the rate of basic pay established for positions in level IV 
of the Executive Schedule under section 5315 of title 5 but may not 
exceed the rate of basic pay established for positions in level I of 
the Executive Schedule under section 5312 of title 5.
    ``(C) Pursuant to an adjustment under subsection (d), the maximum 
rate of basic pay for all registered nurses not described in 
subparagraph (B) may exceed the rate of basic pay established for 
positions in level IV of the Executive Schedule under section 5315 of 
title 5 but may not exceed the rate of basic pay established for 
positions in level III of the Executive Schedule under section 5314 of 
title 5.''.

  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.

    (a) In General.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall develop 
criteria to designate medical centers, ambulatory care facilities, and 
community based outpatient clinics of the Department of Veterans 
Affairs as underserved facilities.
    (b) Consideration.--Criteria developed under subsection (a) shall 
include consideration of the following with respect to a facility:
            (1) The ratio of veterans to health care providers of the 
        Department of Veterans Affairs for a standardized geographic 
        area surrounding the facility, including a separate ratio for 
        general practitioners and specialists.
            (2) The range of clinical specialties covered by such 
        providers in such area.
            (3) Whether the local community is medically underserved.
            (4) The type, number, and age of open consults.
            (5) Whether the facility is meeting the wait-time goals of 
        the Department.
            (6) Such other criteria as the Secretary considers 
        important in determining which facilities are not adequately 
        serving area veterans.
    (c) Analysis of Facilities.--Not less frequently than annually, 
directors of Veterans Integrated Service Networks of the Department 
shall perform an analysis to determine which facilities within that 
Veterans Integrated Service Network qualify as underserved facilities 
pursuant to criteria developed under subsection (a).
    (d) Annual Plan To Address Underserved Facilities.--
            (1) Plan required.--Not later than one year after the date 
        of the enactment of this Act and not less frequently than once 
        each year, the Secretary shall submit to Congress a plan to 
        address the problem of underserved facilities of the 
        Department, as designated pursuant to criteria developed under 
        subsection (a).
            (2) Contents.--Each plan submitted under paragraph (1) 
        shall address the following:
                    (A) Increasing personnel or temporary personnel 
                assistance, including mobile deployment teams furnished 
                under section 233.
                    (B) Providing special hiring incentives, including 
                under the Education Debt Reduction Program under 
                subchapter VII of chapter 76 of title 38, United States 
                Code, and recruitment, relocation, and retention 
                incentives.
                    (C) Using direct hiring authority.
                    (D) Improving training opportunities for staff.
                    (E) Such other actions as the Secretary considers 
                appropriate.

SEC. 232. PILOT PROGRAM ON TUITION REIMBURSEMENT AND LOAN REPAYMENT FOR 
              HEALTH CARE PROVIDERS OF THE DEPARTMENT OF VETERANS 
              AFFAIRS AT UNDERSERVED FACILITIES.

    (a) In General.--Not later than 90 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall commence 
a pilot program to assess the feasibility and advisability of providing 
incentives to individuals to work at underserved facilities of the 
Veterans Health Administration by providing tuition reimbursement and 
loan repayment to medical students and health care providers who commit 
to serving in underserved facilities selected under subsection (c).
    (b) Duration.--The Secretary shall carry out the pilot program 
during the six-year period beginning on the date of the commencement of 
the pilot program.
    (c) Selection of Locations.--
            (1) In general.--The Secretary shall select not fewer than 
        three medical centers and seven ambulatory care facilities or 
        community based outpatient clinics of the Department to 
        participate in the pilot program.
            (2) Rural and highly rural areas.--Not fewer than two of 
        the medical centers and five of the ambulatory care facilities 
        or community based outpatient clinics selected under paragraph 
        (1) shall be in States or United States territories that are 
        among the ten States or United States territories with--
                    (A) the highest percentage of land designated as 
                highly rural pursuant to the rural-urban commuting area 
                codes set forth by the Department of Agriculture; or
                    (B) the highest percentage of enrolled veterans 
                living in rural, highly rural, or insular island areas.
            (3) States.--Facilities selected under paragraph (1) shall 
        be located in not fewer than eight different States.
    (d) Use of Amounts.--Of the amounts used to provide tuition 
reimbursement or loan repayment under the pilot program--
            (1) one-half shall be used to provide tuition reimbursement 
        or loan repayment for individuals practicing in a general 
        practice position; and
            (2) one-half shall be used to provide tuition reimbursement 
        or loan repayment for individuals practicing--
                    (A) in a specialist position; or
                    (B) in an occupation, other than a position 
                described in paragraph (1), included in the most recent 
                staffing shortage determination of the Department under 
                section 7412 of title 38, United States Code.
    (e) Tuition Reimbursement.--Under the pilot program, the Secretary 
may provide to an individual attending medical school and seeking a 
degree as a Doctor of Medicine or a Doctor of Osteopathic Medicine full 
tuition reimbursement in exchange for a five-year commitment to serve 
at an underserved facility selected under subsection (c).
    (f) Student Loan Repayment.--Under the pilot program, in exchange 
for a three-year commitment to serve at an underserved facility 
selected under subsection (c), the Secretary may provide--
            (1) to an individual currently serving as a health care 
        provider at an underserved facility, an amount not to exceed 
        $30,000 to apply to any remaining student loan debt of the 
        individual; and
            (2) to an individual other than an individual described in 
        paragraph (1), an amount not to exceed $50,000 to apply to any 
        remaining student loan debt of the individual.
    (g) Breach.--An individual who participates in the pilot program 
and fails to satisfy a period of obligated service under subsection (d) 
or (e) shall be liable to the United States, in lieu of such obligated 
service, for the amount that has been paid or is payable to or on 
behalf of the individual under the pilot program, reduced by the 
proportion that the number of days served for completion of the period 
of obligated service bears to the total number of days in the period of 
obligated service of such individual.
    (h) Expedited Hiring.--The Secretary shall ensure that the hiring 
of individuals to serve in the Department under the pilot program is 
conducted in an expedited manner.
    (i) Continuation in Pilot Program.--An individual participating in 
the pilot program in an occupation included in a staffing shortage 
determination of the Department under section 7412 of title 38, United 
States Code, may continue participating in the pilot program 
notwithstanding that the occupation is no longer included in such 
determination under such section.
    (j) Annual Report.--
            (1) In general.--Not later than one year after the date of 
        the enactment of this Act and not less frequently than once 
        each year thereafter, the Secretary shall submit to Congress a 
        report on the pilot program.
            (2) Contents.--Each report submitted under paragraph (1) 
        shall include the following:
                    (A) The number of participants, including number 
                receiving tuition reimbursement and student loan 
                repayment.
                    (B) The number of facilities where participants are 
                located.
                    (C) The number of individuals who have applied to 
                participate in the pilot program.
                    (D) A list of the five most common occupations of 
                the participants in the pilot program, other than 
                general practice.
    (k) Definitions.--In this section:
            (1) Enrolled veteran.--The term ``enrolled veteran'' means 
        a veteran who is enrolled in the system of annual patient 
        enrollment established and operated under section 1705(a) of 
        title 38, United States Code.
            (2) Underserved facility.--The term ``underserved 
        facility'' means a medical center, ambulatory care facility, or 
        community based outpatient clinic of the Department of Veterans 
        Affairs designated by the Secretary of Veterans Affairs 
        pursuant to criteria developed under section 231.

SEC. 233. PROGRAM TO FURNISH MOBILE DEPLOYMENT TEAMS TO UNDERSERVED 
              FACILITIES.

    (a) In General.--The Secretary of Veterans Affairs shall establish 
a program to furnish mobile deployment teams of medical personnel to 
underserved facilities.
    (b) Elements.--In furnishing mobile deployment teams under 
subsection (a), the Secretary shall consider the following elements:
            (1) The medical positions of greatest need at underserved 
        facilities.
            (2) The size and composition of teams to be deployed.
            (3) Such other elements as the Secretary considers 
        necessary for effective oversight of the program established 
        under subsection (a).
    (c) Use of Annual Analysis.--The Secretary shall use the results of 
the annual analysis conducted under section 231(c) to form mobile 
deployment teams under subsection (a) that are composed of the most 
needed medical personnel for underserved facilities.
    (d) Underserved Facility Defined.--In this section, the term 
``underserved facility'' means a medical center, ambulatory care 
facility, or community based outpatient clinic of the Department of 
Veterans Affairs designated by the Secretary of Veterans Affairs 
pursuant to criteria developed under section 231.

SEC. 234. INCLUSION OF VET CENTER EMPLOYEES IN EDUCATION DEBT REDUCTION 
              PROGRAM OF DEPARTMENT OF VETERANS AFFAIRS.

    (a) In General.--The Secretary of Veterans Affairs shall ensure 
that clinical staff working at Vet Centers are eligible to participate 
in the education debt reduction program of the Department of Veterans 
Affairs under subchapter VII of chapter 76 of title 38, United States 
Code.
    (b) Report.--Not later than one year after the date of the 
enactment of this Act, the Secretary shall submit to the Committee on 
Veterans' Affairs of the Senate and the Committee on Veterans' Affairs 
of the House of Representatives a report on the number of participants 
in the education debt reduction program of the Department under such 
subchapter who work at Vet Centers.
    (c) Vet Center Defined.--In this section, the term ``Vet Center'' 
has the meaning given that term in section 1712A(h) of title 38, United 
States Code.

                  Subtitle C--Construction and Leases

SEC. 241. DEFINITION OF MAJOR MEDICAL FACILITY PROJECT AND MAJOR 
              MEDICAL FACILITY LEASE.

    (a) Modification of Definition of Medical Facility.--Section 
8101(3) is amended by striking ``Secretary'' and all that follows 
through ``nursing home,'' and inserting ``Secretary, or as otherwise 
authorized by law, for the provision of health-care services (including 
hospital, outpatient clinic, nursing home,''.
    (b) Modification of Definitions of Major Medical Facility Project 
and Major Medical Facility Lease.--Paragraph (3) of section 8104(a) is 
amended to read as follows:
    ``(3) For purposes of this subsection:
            ``(A) The term `major medical facility project' means a 
        project for the construction, alteration, or acquisition of a 
        medical facility involving a total expenditure of more than 
        $20,000,000, but such term does not include an acquisition by 
        exchange, non-recurring maintenance projects of the Department, 
        or the construction, alteration, or acquisition of a shared 
        Federal medical facility for which the Department's estimated 
        share of the project costs does not exceed $20,000,000.
            ``(B) The term `major medical facility lease' means a lease 
        for space for use as a new medical facility at an average 
        annual rental equal to or greater than the dollar threshold for 
        leases procured through the General Services Administration 
        under section 3307(a)(2) of title 40, which shall be subject to 
        annual adjustment in accordance with section 3307(h) of such 
        title.''.

SEC. 242. FACILITATING SHARING OF MEDICAL FACILITIES WITH OTHER FEDERAL 
              AGENCIES.

    (a) In General.--Subchapter I of chapter 81 is amended by inserting 
after section 8111A the following new section:
``Sec. 8111B. Authority to plan, design, construct, or lease a shared 
              medical facility
    ``(a) In General.--(1) The Secretary may enter into agreements with 
other Federal agencies for the planning, designing, constructing, or 
leasing of shared medical facilities with the goal of improving access 
to, and quality and cost effectiveness of, health care provided by the 
Department and other Federal agencies.
    ``(2) Facilities planned, designed, constructed, or leased under 
paragraph (1) shall be managed by the Under Secretary for Health.
    ``(b) Transfer of Amounts to Other Federal Agencies.--(1) The 
Secretary may transfer to another Federal agency amounts appropriated 
to the Department for `Construction, Minor Projects' for use for the 
planning, design, or construction of a shared medical facility if the 
estimated share of the project costs to be borne by the Department does 
not exceed the threshold for a major medical facility project under 
section 8104(a)(3)(A) of this title.
    ``(2) The Secretary may transfer to another Federal agency amounts 
appropriated to the Department for `Construction, Major Projects' for 
use for the planning, design, or construction of a shared medical 
facility if--
            ``(A) the estimated share of the project costs to be borne 
        by the Department is more than the threshold for a major 
        medical facility project under subsection (a)(3)(A) of section 
        8104 of this title; and
            ``(B) the requirements for such a project under such 
        section have been met.
    ``(3) The Secretary may transfer to another Federal agency amounts 
appropriated to the applicable appropriations account of the Department 
for the purpose of leasing space for a shared medical facility if the 
estimated share of the lease costs to be borne by the Department does 
not exceed the threshold for a major medical facility lease under 
section 8104(a)(3)(B) of this title.
    ``(c) Transfer of Amounts to Department.--(1) Amounts transferred 
to the Department by another Federal agency for the necessary expenses 
of planning, designing, or constructing a shared medical facility for 
which the estimated share of the project costs to be borne by the 
Department does not exceed the threshold for a major medical facility 
project under section 8104(a)(3)(A) of this title may be deposited in 
the `Construction, Minor Projects' account of the Department and used 
for such necessary expenses.
    ``(2) Amounts transferred to the Department by another Federal 
agency for the necessary expenses of planning, designing, or 
constructing a shared medical facility for which the estimated share of 
the project costs to be borne by the Department is more than the 
threshold for a major medical facility project under section 
8104(a)(3)(A) of this title may be deposited in the `Construction, 
Major Projects' account of the Department and used for such necessary 
expenses if the requirements for such project under section 8104 of 
this title have been met.
    ``(3) Amounts transferred to the Department by another Federal 
agency for the purpose of leasing space for a shared medical facility 
may be credited to the applicable appropriations account of the 
Department and shall be available without fiscal year limitation.
    ``(4) Amounts transferred under paragraphs (1) and (2) shall be 
available for the same time period as amounts in the account to which 
those amounts are transferred.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by inserting after the item relating to section 
8111A the following new item:

``8111B. Authority to plan, design, construct, or lease a shared 
                            medical facility.''.

SEC. 243. REVIEW OF ENHANCED USE LEASES.

    Section 8162(b)(6) is amended to read as follows:
    ``(6) The Office of Management and Budget shall review each 
enhanced-use lease before the lease goes into effect to determine 
whether the lease is in compliance with paragraph (5).''.

SEC. 244. AUTHORIZATION OF CERTAIN MAJOR MEDICAL FACILITY PROJECTS OF 
              THE DEPARTMENT OF VETERANS AFFAIRS.

    (a) Authorization.--The Secretary of Veterans Affairs may carry out 
the following major medical facility project, to be carried out in an 
amount not to exceed the amount specified for that project: 
Construction of the new East Bay Community Based Outpatient Clinic and 
all associated site work, utilities, parking, and landscaping, 
construction of the Central Valley Engineering and Logistics support 
facility, and enhanced flood plain mitigation at the Central Valley and 
East Bay Community Based Outpatient Clinics as part of the realignment 
of medical facilities in Livermore, California, in an amount not to 
exceed $117,300,000.
    (b) Authorization of Appropriations for Construction.--There is 
authorized to be appropriated to the Secretary of Veterans Affairs for 
fiscal year 2018 or the year in which funds are appropriated for the 
Construction, Major Projects account, $117,300,000 for the project 
authorized in subsection (a).
    (c) Submittal of Information.--Not later than 90 days after the 
date of the enactment of this Act, for the project authorized in 
section (a), the Secretary of Veterans Affairs shall submit to the 
Committee on Veterans' Affairs of the Senate and the Committee on 
Veterans' Affairs of the House of Representatives the following 
information:
            (1) A line item accounting of expenditures relating to 
        construction management carried out by the Department of 
        Veterans Affairs for such project.
            (2) The future amounts that are budgeted to be obligated 
        for construction management carried out by the Department for 
        such project.
            (3) A justification for the expenditures described in 
        paragraph (1) and the future amounts described in paragraph 
        (2).
            (4) Any agreement entered into by the Secretary regarding a 
        non-Department of Veterans Affairs Federal entity providing 
        management services relating to such project, including 
        reimbursement agreements and the costs to the Department for 
        such services.

                 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.

    (a) Program Required.--
            (1) In general.--The Secretary of Veterans Affairs shall 
        carry out a program through the award of grants to public or 
        private nonprofit entities to assess the feasibility and 
        advisability of using wellness programs to complement the 
        provision of mental health care to veterans and family members 
        eligible for counseling under section 1712A(a)(1)(C) of title 
        38, United States Code.
            (2) Matters to be addressed.--The program shall be carried 
        out so as to assess the following:
                    (A) Means of improving coordination between 
                Federal, State, local, and community providers of 
                health care in the provision of mental health care to 
                veterans and family members described in paragraph (1).
                    (B) Means of enhancing outreach, and coordination 
                of outreach, by and among providers of health care 
                referred to in subparagraph (A) on the mental health 
                care services available to veterans and family members 
                described in paragraph (1).
                    (C) Means of using wellness programs of providers 
                of health care referred to in subparagraph (A) as 
                complements to the provision by the Department of 
                Veterans Affairs of mental health care to veterans and 
                family members described in paragraph (1).
                    (D) Whether wellness programs described in 
                subparagraph (C) are effective in enhancing the quality 
                of life and well-being of veterans and family members 
                described in paragraph (1).
                    (E) Whether wellness programs described in 
                subparagraph (C) are effective in increasing the 
                adherence of veterans described in paragraph (1) to the 
                primary mental health services provided such veterans 
                by the Department.
                    (F) Whether wellness programs described in 
                subparagraph (C) have an impact on the sense of 
                wellbeing of veterans described in paragraph (1) who 
                receive primary mental health services from the 
                Department.
                    (G) Whether wellness programs described in 
                subparagraph (C) are effective in encouraging veterans 
                receiving health care from the Department to adopt a 
                more healthy lifestyle.
    (b) Duration.--The Secretary shall carry out the program for a 
period of three years beginning on the date that is one year after the 
date of the enactment of this Act.
    (c) Locations.--The Secretary shall carry out the program at 
facilities of the Department providing mental health care services to 
veterans and family members described in subsection (a)(1).
    (d) Grant Proposals.--
            (1) In general.--A public or private nonprofit entity 
        seeking the award of a grant under this section shall submit an 
        application therefor to the Secretary in such form and in such 
        manner as the Secretary may require.
            (2) Application contents.--Each application submitted under 
        paragraph (1) shall include the following:
                    (A) A plan to coordinate activities under the 
                program, to the extent possible, with Federal, State, 
                and local providers of services for veterans to enhance 
                the following:
                            (i) Awareness by veterans of benefits and 
                        health care services provided by the 
                        Department.
                            (ii) Outreach efforts to increase the use 
                        by veterans of services provided by the 
                        Department.
                            (iii) Educational efforts to inform 
                        veterans of the benefits of a healthy and 
                        active lifestyle.
                    (B) A statement of understanding from the entity 
                submitting the application that, if selected, such 
                entity will be required to report to the Secretary 
                periodically on standardized data and other performance 
                data necessary to evaluate individual outcomes and to 
                facilitate evaluations among entities participating in 
                the program.
                    (C) Other requirements that the Secretary may 
                prescribe.
    (e) Grant Uses.--
            (1) In general.--A public or private nonprofit entity 
        awarded a grant under this section shall use the award for 
        purposes prescribed by the Secretary.
            (2) Eligible veterans and family.--In carrying out the 
        purposes prescribed by the Secretary in paragraph (1), a public 
        or private nonprofit entity awarded a grant under this section 
        shall use the award to furnish services only to individuals 
        specified in section 1712A(a)(1)(C) of title 38, United States 
        Code.
    (f) Reports.--
            (1) Periodic reports.--
                    (A) In general.--Not later than 180 days after the 
                date of the commencement of the program, and every 180 
                days thereafter, the Secretary shall submit to Congress 
                a report on the program.
                    (B) Report elements.--Each report required by 
                subparagraph (A) shall include the following:
                            (i) The findings and conclusions of the 
                        Secretary with respect to the program during 
                        the 180-day period preceding the report.
                            (ii) An assessment of the benefits of the 
                        program to veterans and their family members 
                        during the 180-day period preceding the report.
            (2) Final report.--Not later than 180 days after the end of 
        the program, the Secretary shall submit to Congress a report 
        detailing the recommendations of the Secretary as to the 
        advisability of continuing or expanding the program.
    (g) Wellness Defined.--In this section, the term ``wellness'' has 
the meaning given that term in regulations prescribed by the Secretary.

SEC. 252. AUTHORIZATION TO PROVIDE FOR OPERATIONS ON LIVE DONORS FOR 
              PURPOSES OF CONDUCTING TRANSPLANT PROCEDURES FOR 
              VETERANS.

    (a) In General.--Subchapter VIII of chapter 17 is amended by adding 
at the end the following new section:
``Sec. 1788. Transplant procedures with live donors and related 
              services
    ``(a) In General.--Subject to subsections (b) and (c), in a case in 
which a veteran is eligible for a transplant procedure from the 
Department, the Secretary may provide for an operation on a live donor 
to carry out such procedure for such veteran, notwithstanding that the 
live donor may not be eligible for health care from the Department.
    ``(b) Other Services.--Subject to the availability of 
appropriations for such purpose, the Secretary shall furnish to a live 
donor any care or services before and after conducting the transplant 
procedure under subsection (a) that may be required in connection with 
such procedure.
    ``(c) Use of Non-Department Facilities.--In carrying out this 
section, the Secretary may provide for the operation described in 
subsection (a) on a live donor and furnish to the live donor the care 
and services described in subsection (b) at a non-Department facility 
pursuant to an agreement entered into by the Secretary under this 
chapter. The live donor shall be deemed to be an individual eligible 
for hospital care and medical services at a non-Department facility 
pursuant to such an agreement solely for the purposes of receiving such 
operation, care, and services at the non-Department facility.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 17 is amended by inserting after the item relating to section 
1787 the following new item:

``1788. Transplant procedures with live donors and related services.''.

SEC. 253. SENSE OF THE SENATE.

    It is the sense of the Senate that--
            (1) a strong and fully resourced Veterans Health 
        Administration is necessary to effectively serve our veterans 
        community;
            (2) veterans overwhelmingly report that they are satisfied 
        with the care they receive at facilities operated by the 
        Administration;
            (3) research has shown that the Administration produces as 
        good or better outcomes for its patients than private health 
        care systems; and
            (4) the Senate opposes any effort that would weaken the 
        Administration or put the Administration on a path toward 
        privatization.

                      TITLE III--FAMILY CAREGIVERS

SEC. 301. EXPANSION OF FAMILY CAREGIVER PROGRAM OF DEPARTMENT OF 
              VETERANS AFFAIRS.

    (a) Family Caregiver Program.--
            (1) Expansion of eligibility.--
                    (A) In general.--Subparagraph (B) of subsection 
                (a)(2) of section 1720G is amended to read as follows:
            ``(B) for assistance provided under this subsection--
                    ``(i) before the date on which the Secretary 
                submits to Congress a certification that the Department 
                has fully implemented the information technology system 
                required by section 302(a) of the Caring for our 
                Veterans Act of 2017, has a serious injury (including 
                traumatic brain injury, psychological trauma, or other 
                mental disorder) incurred or aggravated in the line of 
                duty in the active military, naval, or air service on 
                or after September 11, 2001;
                    ``(ii) during the two-year period beginning on the 
                date on which the Secretary submitted to Congress the 
                certification described in clause (i), has a serious 
                injury (including traumatic brain injury, psychological 
                trauma, or other mental disorder) incurred or 
                aggravated in the line of duty in the active military, 
                naval, or air service--
                            ``(I) on or before May 7, 1975; or
                            ``(II) on or after September 11, 2001; or
                    ``(iii) after the date that is two years after the 
                date on which the Secretary submits to Congress the 
                certification described in clause (i), has a serious 
                injury (including traumatic brain injury, psychological 
                trauma, or other mental disorder) incurred or 
                aggravated in the line of duty in the active military, 
                naval, or air service; and''.
                    (B) Publication in federal register.--Not later 
                than 30 days after the date on which the Secretary of 
                Veterans Affairs submits to Congress the certification 
                described in subsection (a)(2)(B)(i) of section 1720G 
                of such title, as amended by subparagraph (A) of this 
                paragraph, the Secretary shall publish the date 
                specified in such subsection in the Federal Register.
            (2) Expansion of needed services in eligibility criteria.--
        Subsection (a)(2)(C) of such section is amended--
                    (A) in clause (ii), by striking ``; or'' and 
                inserting a semicolon;
                    (B) by redesignating clause (iii) as clause (iv); 
                and
                    (C) by inserting after clause (ii) the following 
                new clause (iii):
                    ``(iii) a need for regular or extensive instruction 
                or supervision without which the ability of the veteran 
                to function in daily life would be seriously impaired; 
                or''.
            (3) Expansion of services provided.--Subsection 
        (a)(3)(A)(ii) of such section is amended--
                    (A) in subclause (IV), by striking ``; and'' and 
                inserting a semicolon;
                    (B) in subclause (V), by striking the period at the 
                end and inserting ``; and''; and
                    (C) by adding at the end the following new 
                subclause:
                    ``(VI) through the use of contracts with, or the 
                provision of grants to, public or private entities--
                            ``(aa) financial planning services relating 
                        to the needs of injured veterans and their 
                        caregivers; and
                            ``(bb) legal services, including legal 
                        advice and consultation, relating to the needs 
                        of injured veterans and their caregivers.''.
            (4) Modification of stipend calculation.--Subsection 
        (a)(3)(C) of such section is amended--
                    (A) by redesignating clause (iii) as clause (iv); 
                and
                    (B) by inserting after clause (ii) the following 
                new clause (iii):
    ``(iii) In determining the amount and degree of personal care 
services provided under clause (i) with respect to an eligible veteran 
whose need for personal care services is based in whole or in part on a 
need for supervision or protection under paragraph (2)(C)(ii) or 
regular instruction or supervision under paragraph (2)(C)(iii), the 
Secretary shall take into account the following:
            ``(I) The assessment by the family caregiver of the needs 
        and limitations of the veteran.
            ``(II) The extent to which the veteran can function safely 
        and independently in the absence of such supervision, 
        protection, or instruction.
            ``(III) The amount of time required for the family 
        caregiver to provide such supervision, protection, or 
        instruction to the veteran.''.
            (5) Periodic evaluation of need for certain services.--
        Subsection (a)(3) of such section is amended by adding at the 
        end the following new subparagraph:
    ``(D) In providing instruction, preparation, and training under 
subparagraph (A)(i)(I) and technical support under subparagraph 
(A)(i)(II) to each family caregiver who is approved as a provider of 
personal care services for an eligible veteran under paragraph (6), the 
Secretary shall periodically evaluate the needs of the eligible veteran 
and the skills of the family caregiver of such veteran to determine if 
additional instruction, preparation, training, or technical support 
under those subparagraphs is necessary.''.
            (6) Use of primary care teams.--Subsection (a)(5) of such 
        section is amended, in the matter preceding subparagraph (A), 
        by inserting ``(in collaboration with the primary care team for 
        the eligible veteran to the maximum extent practicable)'' after 
        ``evaluate''.
            (7) Assistance for family caregivers.--Subsection (a) of 
        such section is amended by adding at the end the following new 
        paragraph:
    ``(11)(A) In providing assistance under this subsection to family 
caregivers of eligible veterans, the Secretary may enter into 
contracts, provider agreements, and memoranda of understanding with 
Federal agencies, States, and private, nonprofit, and other entities to 
provide such assistance to such family caregivers.
    ``(B) The Secretary may provide assistance under this paragraph 
only if such assistance is reasonably accessible to the family 
caregiver and is substantially equivalent or better in quality to 
similar services provided by the Department.
    ``(C) The Secretary may provide fair compensation to Federal 
agencies, States, and other entities that provide assistance under this 
paragraph.''.
    (b) Modification of Definition of Personal Care Services.--
Subsection (d)(4) of such section is amended--
            (1) in subparagraph (A), by striking ``independent'';
            (2) by redesignating subparagraph (B) as subparagraph (D); 
        and
            (3) by inserting after subparagraph (A) the following new 
        subparagraphs:
                    ``(B) Supervision or protection based on symptoms 
                or residuals of neurological or other impairment or 
                injury.
                    ``(C) Regular or extensive instruction or 
                supervision without which the ability of the veteran to 
                function in daily life would be seriously impaired.''.

SEC. 302. IMPLEMENTATION OF INFORMATION TECHNOLOGY SYSTEM OF DEPARTMENT 
              OF VETERANS AFFAIRS TO ASSESS AND IMPROVE THE FAMILY 
              CAREGIVER PROGRAM.

    (a) Implementation of New System.--
            (1) In general.--Not later than June 1, 2018, the Secretary 
        of Veterans Affairs shall implement an information technology 
        system that fully supports the Program and allows for data 
        assessment and comprehensive monitoring of the Program.
            (2) Elements of system.--The information technology system 
        required to be implemented under paragraph (1) shall include 
        the following:
                    (A) The ability to easily retrieve data that will 
                allow all aspects of the Program (at the medical center 
                and aggregate levels) and the workload trends for the 
                Program to be assessed and comprehensively monitored.
                    (B) The ability to manage data with respect to a 
                number of caregivers that is more than the number of 
                caregivers that the Secretary expects to apply for the 
                Program.
                    (C) The ability to integrate the system with other 
                relevant information technology systems of the Veterans 
                Health Administration.
    (b) Assessment of Program.--Not later than 180 days after 
implementing the system described in subsection (a), the Secretary 
shall, through the Under Secretary for Health, use data from the system 
and other relevant data to conduct an assessment of how key aspects of 
the Program are structured and carried out.
    (c) Ongoing Monitoring of and Modifications to Program.--
            (1) Monitoring.--The Secretary shall use the system 
        implemented under subsection (a) to monitor and assess the 
        workload of the Program, including monitoring and assessment of 
        data on--
                    (A) the status of applications, appeals, and home 
                visits in connection with the Program; and
                    (B) the use by caregivers participating in the 
                Program of other support services under the Program 
                such as respite care.
            (2) Modifications.--Based on the monitoring and assessment 
        conducted under paragraph (1), the Secretary shall identify and 
        implement such modifications to the Program as the Secretary 
        considers necessary to ensure the Program is functioning as 
        intended and providing veterans and caregivers participating in 
        the Program with services in a timely manner.
    (d) Reports.--
            (1) Initial report.--
                    (A) In general.--Not later than 90 days after the 
                date of the enactment of this Act, the Secretary shall 
                submit to the Committee on Veterans' Affairs of the 
                Senate, the Committee on Veterans' Affairs of the House 
                of Representatives, and the Comptroller General of the 
                United States a report that includes--
                            (i) the status of the planning, 
                        development, and deployment of the system 
                        required to be implemented under subsection 
                        (a), including any changes in the timeline for 
                        the implementation of the system; and
                            (ii) an assessment of the needs of family 
                        caregivers of veterans described in 
                        subparagraph (B), the resources needed for the 
                        inclusion of such family caregivers in the 
                        Program, and such changes to the Program as the 
                        Secretary considers necessary to ensure the 
                        successful expansion of the Program to include 
                        such family caregivers.
                    (B) Veterans described.--Veterans described in this 
                subparagraph are veterans who are eligible for the 
                Program under clause (ii) or (iii) of section 
                1720G(a)(2)(B) of title 38, United States Code, as 
                amended by section 301(a)(1) of this Act, solely due to 
                a serious injury (including traumatic brain injury, 
                psychological trauma, or other mental disorder) 
                incurred or aggravated in the line of duty in the 
                active military, naval, or air service before September 
                11, 2001.
            (2) Notification by comptroller general.--The Comptroller 
        General shall review the report submitted under paragraph (1) 
        and notify the Committee on Veterans' Affairs of the Senate and 
        the Committee on Veterans' Affairs of the House of 
        Representatives with respect to the progress of the Secretary 
        in--
                    (A) fully implementing the system required under 
                subsection (a); and
                    (B) implementing a process for using such system to 
                monitor and assess the Program under subsection (c)(1) 
                and modify the Program as considered necessary under 
                subsection (c)(2).
            (3) Final report.--
                    (A) In general.--Not later than June 1, 2019, the 
                Secretary shall submit to the Committee on Veterans' 
                Affairs of the Senate, the Committee on Veterans' 
                Affairs of the House of Representatives, and the 
                Comptroller General a report on the implementation of 
                subsections (a) through (c).
                    (B) Elements.--The report required by subparagraph 
                (A) shall include the following:
                            (i) A certification by the Secretary with 
                        respect to whether the information technology 
                        system described in subsection (a) has been 
                        implemented.
                            (ii) A description of how the Secretary has 
                        implemented such system.
                            (iii) A description of the modifications to 
                        the Program, if any, that were identified and 
                        implemented under subsection (c)(2).
                            (iv) A description of how the Secretary is 
                        using such system to monitor the workload of 
                        the Program.
    (e) Definitions.--In this section:
            (1) Active military, naval, or air service.--The term 
        ``active military, naval, or air service'' has the meaning 
        given that term in section 101 of title 38, United States Code.
            (2) Program.--The term ``Program'' means the program of 
        comprehensive assistance for family caregivers under section 
        1720G(a) of title 38, United States Code, as amended by section 
        301 of this Act.

SEC. 303. MODIFICATIONS TO ANNUAL EVALUATION REPORT ON CAREGIVER 
              PROGRAM OF DEPARTMENT OF VETERANS AFFAIRS.

    (a) Barriers to Care and Services.--Subparagraph (A)(iv) of section 
101(c)(2) of the Caregivers and Veterans Omnibus Health Services Act of 
2010 (Public Law 111-163; 38 U.S.C. 1720G note) is amended by inserting 
``, including a description of any barriers to accessing and receiving 
care and services under such programs'' before the semicolon.
    (b) Sufficiency of Training for Family Caregiver Program.--
Subparagraph (B) of such section is amended--
            (1) in clause (i), by striking ``; and'' and inserting a 
        semicolon;
            (2) in clause (ii), by striking the period at the end and 
        inserting ``; and''; and
            (3) by adding at the end the following new clause:
                            ``(iii) an evaluation of the sufficiency 
                        and consistency of the training provided to 
                        family caregivers under such program in 
                        preparing family caregivers to provide care to 
                        veterans under such program.''.

                   TITLE IV--APPROPRIATION OF AMOUNTS

SEC. 401. APPROPRIATION OF AMOUNTS FOR HEALTH CARE FROM DEPARTMENT OF 
              VETERANS AFFAIRS.

    (a) In General.--There is authorized to be appropriated, and is 
appropriated, to the Secretary of Veterans Affairs, out of any funds in 
the Treasury not otherwise appropriated, $1,000,000,000 to carry out 
subsection (c).
    (b) Availability of Amounts.--The amount appropriated under 
subsection (a) shall be available for obligation or expenditure without 
fiscal year limitation.
    (c) Use of Amounts.--The amount appropriated under subsection (a) 
shall be used by the Secretary to carry out the following:
            (1) Subchapters II and VII of chapter 76 of title 38, 
        United States Code;
            (2) The program to increase the number of graduate medical 
        education residency positions of the Department under sections 
        211 and 212; and
            (3) Section 221.
    (d) Funding Plan.--Not later than 60 days after the date of the 
enactment of this Act, the Secretary shall submit to the appropriate 
committees of Congress a funding plan describing how the Secretary 
intends to use the amount appropriated under subsection (a).
    (e) Supplement Not Supplant.--Amounts appropriated under subsection 
(a) for purposes of carrying out subchapters II and VII of chapter 76 
of title 38, United States Code, shall supplement, not supplant, 
amounts otherwise made available to the Secretary to carry out such 
subchapters.
    (f) Report.--Not later than one year after the date of the 
enactment of this Act, the Secretary shall submit to the appropriate 
committees of Congress a report on how the Secretary has obligated the 
amount appropriated under subsection (a) as of the date of the 
submittal of the report.
    (g) Appropriate Committees of Congress Defined.--In this section, 
the term ``appropriate committees of Congress'' means--
            (1) the Committee on Veterans' Affairs and the Committee on 
        Appropriations of the Senate; and
            (2) the Committee on Veterans' Affairs and the Committee on 
        Appropriations of the House of Representatives.

SEC. 402. APPROPRIATION OF AMOUNTS FOR VETERANS CHOICE PROGRAM.

    (a) In General.--There is authorized to be appropriated, and is 
appropriated, to the Secretary of Veterans Affairs, out of any funds in 
the Treasury not otherwise appropriated, $4,000,000,000 to be deposited 
in the Veterans Choice Fund under section 802 of the Veterans Access, 
Choice, and Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 
1701 note).
    (b) Availability.--The amount appropriated under subsection (a) 
shall remain available until expended pursuant to section 802(c)(4) of 
the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 
113-146; 38 U.S.C. 1701 note) as added by section 142.
                                                       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
```