II 

115TH CONGRESS 

1ST SESSION S. 2184 

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

benefits, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

DECEMBER 1, 2017 

Mr. MCCAIN (for himself and Mr. MORAN) introduced the following bill; which 

was read twice and referred to the Committee on Veterans’ Affairs 

A BILL 

To amend title 38, United States Code, to improve veterans’ 

health care benefits, and for other purposes. 

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

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

5 ‘‘Veterans Community Care and Access Act of 2017’’. 

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

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

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

TITLE I—DEVELOPING AN INTEGRATED HIGH-PERFORMING 

NETWORK 

Subtitle A—Establishing the Veterans Community Care Program 


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Sec. 101. Establishment of Veterans Community Care Program. 

Sec. 102. Strategy regarding the High Performing Integrated Healthcare Network of the Department. 

Sec. 103. Access standards and standards for quality. 

Subtitle B—Forming Partnerships and Agreements 

Sec. 111. Continuity of care and existing agreements. 

Sec. 112. Authorization of agreements between Department of Veterans Affairs 

and non-Department providers. 

Sec. 113. Prevention of certain health care providers from providing non-Department health care services to veterans. 

Sec. 114. Conforming amendments for State veterans homes. 

Subtitle C—Paying Providers 

Sec. 121. Prompt payment to providers. 

Sec. 122. Payment rates for community care. 

Sec. 123. Authority to pay for authorized care not subject to an agreement. 

TITLE II—STREAMLINING COMMUNITY CARE PROGRAMS 

Subtitle A—Streamlining Community Care Programs 

Sec. 201. Access to walk-in care. 

Sec. 202. Veterans Choice Fund flexibility. 

Sec. 203. Conforming amendments. 

Subtitle B—Improving Information Sharing With Providers 

Sec. 211. Improving information sharing with community providers. 

Sec. 212. Establishment of processes to ensure safe opioid prescribing practices 

by non-Department of Veterans Affairs health care providers. 

Subtitle C—Improving Collections 

Sec. 221. Aligning with best practices on collection of health insurance information. 

Sec. 222. Improving authority to collect. 

TITLE III—IMPROVING DEPARTMENT OF VETERANS AFFAIRS 

CARE DELIVERY 

Subtitle A—Improving Personnel Practices 

Sec. 301. Licensure of health care professionals of the Department of Veterans 

Affairs providing treatment via telemedicine. 

Sec. 302. Graduate medical education and residency. 

Sec. 303. Annual report on awards or bonuses awarded to certain high-level 

employees of the department of veterans affairs. 

Subtitle B—Facilities, Construction, and Leases 

Sec. 311. Facilitating sharing of medical facilities with other Federal agencies. 

Sec. 312. Review of enhanced use leases. 

TITLE IV—INNOVATIVE PILOT PROGRAMS 


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Sec. 401. 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. 402. Authority for Department of Veterans Affairs Center for Innovation 

for Care and Payment. 

TITLE V—OTHER HEALTH CARE MATTERS 

Sec. 501. Authorization of appropriations for health care from Department of 

Veterans Affairs. 

Sec. 502. Appropriation of amounts for Veterans Choice Program. 

Sec. 503. Applicability of Directive of Office of Federal Contract Compliance 

Programs. 

Sec. 504. Amending statutory requirements for the position of the Chief Officer 

of the Readjustment Counseling Service. 

Sec. 505. Authorization of certain major medical facility projects of the Department of Veterans Affairs. 

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

2 Except as otherwise expressly provided, whenever in 

3 this Act an amendment or repeal is expressed in terms 

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

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

7 TITLE I—DEVELOPING AN INTE8 GRATED HIGH-PERFORMING 

9 NETWORK 

10 Subtitle A—Establishing the Vet11 erans Community Care Program 

12 SEC. 101. ESTABLISHMENT OF VETERANS COMMUNITY 

13 CARE PROGRAM. 

14 (a) ESTABLISHMENT.— 

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

16 read as follows: 


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1 ‘‘§ 1703. Veterans Community Care Program 

2 ‘‘(a) IN GENERAL.—(1) Subject to the availability of 

3 appropriations for such purpose and subject to paragraph 

4 (4), hospital care, medical services, and extended care 

5 services under this chapter shall be furnished to a covered 

6 veteran described in subsection (b) by health care pro7 viders specified in subsection (c) in accordance with this 

8 section. 

9 ‘‘(2) The furnishing of care and services under this 

10 section may be referred to as the ‘Veterans Community 

11 Care Program’. 

12 ‘‘(3)(A) In carrying out this section, the Secretary 

13 may develop categories of certain health care providers 

14 specified in subsection (c) for the purpose of providing a 

15 covered veteran hospital care, medical services, and ex16 tended care services when the covered veteran does not 

17 state a preference for a health care provider. 

18 ‘‘(B) In developing categories of health care providers 

19 under subparagraph (A), the Secretary shall not— 

20 ‘‘(i) prioritize or rank such categories in a man21 ner that limits the options a covered veteran may 

22 have in selecting a health care provider specified in 

23 subsection (c); or 

24 ‘‘(ii) direct a covered veteran to receive care or 

25 services from certain health care providers instead of 

26 other health care providers. 


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

2 not limit any hospital care, medical service, extended care 

3 service, or class of hospital care, medical service, or ex4 tended care service that are set forth in the Medical Bene5 fits Package of the Department, as modified as deter6 mined by the Secretary. 

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

8 section, a covered veteran is any veteran who— 

9 ‘‘(1)(A) is enrolled in the patient enrollment 

10 system of the Department established and operated 

11 under section 1705 of this title; or 

12 ‘‘(B) is not enrolled in such system but is oth13 erwise entitled to hospital care, a medical service, or 

14 an extended care service under subsection (c)(2) of 

15 such section; and 

16 ‘‘(2)(A) has been furnished hospital care or 

17 medical services under this chapter on at least one 

18 occasion during the preceding two-year period; or 

19 ‘‘(B) requested a first-time appointment for 

20 hospital care or medical services at a Department fa21 cility. 

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

23 care providers specified in this subsection are the fol24 lowing: 


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1 ‘‘(1) Any health care provider that is partici2 pating in the Medicare program under title XVIII of 

3 the Social Security Act (42 U.S.C. 1395 et seq.), in4 cluding any physician furnishing services under such 

5 a program. 

6 ‘‘(2) The Department of Defense. 

7 ‘‘(3) The Indian Health Service. 

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

9 defined in section 1905(l)(2)(B) of the Social Secu10 rity Act (42 U.S.C. 1396d(l)(2)(B))). 

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

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

13 that meets criteria established by the Secretary for 

14 purposes of this section. 

15 ‘‘(d) CONTRACTS TO ESTABLISH NETWORKS OF

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

17 enter into consolidated, competitively bid contracts, which 

18 may be regional contracts, to establish networks of non19 Department health care providers specified in paragraphs 

20 (1) and (5) of subsection (c) for contract purposes of— 

21 ‘‘(A) providing sufficient access to hospital care, 

22 medical services, and extended care services under 

23 this section; 

24 ‘‘(B) managing the operations of such health 

25 care providers; and 


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1 ‘‘(C) managing the delivery of hospital care, 

2 medical services, and extended care services under 

3 this section. 

4 ‘‘(2) The Secretary may terminate a contract with an 

5 entity entered into under paragraph (1) at such time and 

6 upon such notice to the entity as the Secretary may specify 

7 for purposes of this section. 

8 ‘‘(3)(A) Whenever the Secretary provides notice to an 

9 entity under paragraph (2) that the entity is failing to 

10 meet contractual obligations entered into under paragraph 

11 (1), the Secretary shall submit to the Committee on Vet12 erans’ Affairs of the Senate and the Committee on Vet13 erans’ Affairs of the House of Representatives a report 

14 on such failure and the decision of the Secretary to termi15 nate the contract under paragraph (2). 

16 ‘‘(B) Each report submitted under subparagraph (A) 

17 shall include the following: 

18 ‘‘(i) An explanation of the reasons for termi19 nating the contract. 

20 ‘‘(ii) A description of the effect of the failure of 

21 the entity to meet contractual obligations and the 

22 termination of the contract, including with respect to 

23 cost, schedule, and requirements. 

24 ‘‘(iii) A description of the actions taken by the 

25 Secretary to mitigate such failure and termination. 


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1 ‘‘(e) COORDINATION OF CARE AND SERVICES.—(1) 

2 The Secretary shall ensure that for each covered veteran 

3 seeking care or services under this section, a care coordi4 nation team is provided by a medical facility of the De5 partment. 

6 ‘‘(2) The Secretary shall ensure that each care co7 ordination team provided under this section, with respect 

8 to a covered veteran, is responsible for the following: 

9 ‘‘(A) Coordination and management of hospital 

10 care, medical services (including telemedicine), and 

11 extended care services furnished under this title, in12 cluding the following: 

13 ‘‘(i) Collaboration with the patient aligned 

14 care teams (PACT) within the medical facility 

15 of the Department; and 

16 ‘‘(ii) Coordination within and across Vet17 erans Integrated Service Networks with non18 Department health care providers acting under 

19 a contract or agreement to furnish hospital 

20 care, a medical service, or an extended care 

21 service on behalf of the Department and who 

22 meets such terms and conditions as the Sec23 retary may require. 

24 ‘‘(B) Ensure continuity of care for the covered 

25 veteran to avoid any delay or lapse in care or servVerDate Sep 11 2014 22:33 Dec 08, 2017 Jkt 079200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S2184.IS S2184

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1 ices from an action or error of the Department or 

2 any individual of the care coordination team of the 

3 covered veteran. 

4 ‘‘(C) Submitting information to the Secretary 

5 in furtherance of analysis conducted under section 

6 1730B(a) of this title. 

7 ‘‘(3) The Secretary shall develop an organizational 

8 construct for care coordination teams at medical facilities 

9 of the Department that may include the following individ10 uals: 

11 ‘‘(A) An employee of the Department who fur12 nishes hospital care, a medical service, or an ex13 tended care service at the facility. 

14 ‘‘(B) A non-Department health care provider 

15 acting under a contract or agreement to furnish hos16 pital care, a medical service, or an extended care 

17 service on behalf of the Department and who meets 

18 such terms and conditions as the Secretary may re19 quire. 

20 ‘‘(C) An employee of the Department or a 

21 health care provider described in subparagraph (B) 

22 who serves to seamlessly coordinate the delivery of 

23 hospital care, medical services, and extended care 

24 services to covered veterans. 


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1 ‘‘(f) ELIGIBILITY REFORM AND CONDITIONS THAT

2 REQUIRE ACCESS TO COMMUNITY CARE.—(1) Subject to 

3 the availability of appropriations, the Secretary shall fur4 nish hospital care, medical services, and extended care 

5 services to a covered veteran, at the election of a covered 

6 veteran, through health care providers specified in sub7 section (c) as follows: 

8 ‘‘(A) When a medical facility of the Department 

9 does not offer the hospital care, medical services, or 

10 extended care services the covered veteran requires. 

11 ‘‘(B) When a medical facility of the Department 

12 cannot furnish or schedule an appointment for hos13 pital care, medical services, or extended care services 

14 in accordance with access standards established 

15 under section 1703B of this title. 

16 ‘‘(C) When the covered veteran and a referring 

17 clinician of the covered veteran agree that furnishing 

18 hospital care, medical services, or extended care 

19 services through a non-Department entity or pro20 vider would be in the best medical interest of the 

21 covered veteran, after consideration of the standards 

22 established under sections 1703B and 1703C of this 

23 title or due to a non-clinical reason, compelling cir24 cumstance, or other considerations that are in the 

25 best medical interest of the covered veteran. 


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1 ‘‘(2) Not later than 120 days after the date of the 

2 enactment of the Veterans Community Care and Access 

3 Act of 2017, the Secretary shall submit to the appropriate 

4 committees of Congress a report describing the guidelines 

5 and standards the Secretary intends to use to carry out 

6 paragraph (1) in accordance with sections 1703B and 

7 1703C of this title. 

8 ‘‘(g) SCHEDULING SERVICES.—(1) The Secretary 

9 shall ensure that services are established in order to sched10 ule appointments for hospital care, medical services, and 

11 extended care services under this chapter. 

12 ‘‘(2)(A) In carrying out paragraph (1), the Secretary 

13 shall determine whether services established under such 

14 paragraph should reside within the respective medical fa15 cility of the Department or reside with an entity with 

16 whom the Secretary enters into a contract for such serv17 ices. 

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

19 shall assess the following: 

20 ‘‘(i) Whether a medical facility of the Depart21 ment is currently managing scheduling services and 

22 the Secretary determines such medical facility has 

23 the capability to continue to manage scheduling. 


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1 ‘‘(ii) Whether a medical facility of the Depart2 ment has the capacity to manage scheduling services 

3 based on the following: 

4 ‘‘(I) An initial review of the medical facil5 ity to acquire scheduling service responsibilities 

6 and the preference of the medical facility to ac7 quire such responsibilities. 

8 ‘‘(II) The market area assessment cur9 rently underway pursuant to section 1730B(c) 

10 of this title. 

11 ‘‘(III) The capacity of the medical facility 

12 to perform scheduling services that meet stand13 ards established under sections 1703B and 

14 1703C of this title. 

15 ‘‘(iii) Whether one or more contracts were in ef16 fect on the day before the date of the enactment of 

17 the Veterans Community Care and Access Act of 

18 2017 that include scheduling services, as determined 

19 by the Secretary, and may be modified by the Sec20 retary for services under this subsection. 

21 ‘‘(h) DEFINITIONS.—In this section: 

22 ‘‘(1) The term ‘appropriate committees of Con23 gress’ means— 


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

2 and the Committee on Appropriations of the 

3 Senate; and 

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

5 and the Committee on Appropriations of the 

6 House of Representatives. 

7 ‘‘(2) The term ‘clinician’ has the meaning given 

8 that term by the Centers for Medicare & Medicaid 

9 Services and includes Doctors of Medicine (MD), 

10 Doctors of Osteopathy (DO), Doctors of Dental Sur11 gery or Dental Medicine (DMD/DDS), Doctors of 

12 Podiatry, Doctors of Optometry, Chiropractors, Phy13 sician Assistants (PA), Nurse Practitioners (NP), 

14 Clinical Nurse Specialists, Certified Registered 

15 Nurse Anesthetists, and such other health profes16 sionals as the Secretary may specify for purposes of 

17 this section. 

18 ‘‘(3) The term ‘medical facility of the Depart19 ment’ includes a medical center, a community-based 

20 outpatient clinic, an outpatient clinic, or any other 

21 facility of the Department at which hospital care, 

22 medical services, or extended care services are fur23 nished.’’. 

24 (2) CLERICAL AMENDMENT.—The table of sec25 tions at the beginning of chapter 17 of such title is 


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1 amended by striking the item relating to section 

2 1703 and inserting the following new item: 

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

3 (b) REGULATIONS.—Not later than one year after the 

4 date of the enactment of this Act, the Secretary of Vet5 erans Affairs shall promulgate regulations to carry out 

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

7 by subsection (a). 

8 (c) EFFECTIVE DATE.—The amendments made by 

9 subsection (a) shall take effect on the date that the Sec10 retary promulgates regulations under subsection (b). 

11 SEC. 102. STRATEGY REGARDING THE HIGH PERFORMING 

12 INTEGRATED HEALTHCARE NETWORK OF 

13 THE DEPARTMENT. 

14 (a) IN GENERAL.—Subchapter III of chapter 17 is 

15 amended by inserting after section 1730A the following 

16 new section: 

17 ‘‘§ 1730B. Quadrennial Veterans Health Administra18 tion review, management of high-per19 forming integrated healthcare network, 

20 and market area assessments 

21 ‘‘(a) QUADRENNIAL VETERANS HEALTH ADMINIS22 TRATION REVIEW.—(1) Not later than one year after the 

23 date of the enactment of the Veterans Community Care 

24 and Access Act of 2017 and not less frequently than once 

25 every four years thereafter, the Secretary shall conduct a 


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1 comprehensive examination (to be known as a ‘quadren2 nial Veterans Health Administration review’) of programs 

3 and policies of the Department regarding the delivery of 

4 health care services and the need for health care services 

5 for veterans in future years. 

6 ‘‘(2) The Secretary shall designate an individual in 

7 a Senior Executive Service position (as defined in section 

8 3132(a) of title 5) or equivalent as the Director of the 

9 High-Performing Integrated Healthcare Network of the 

10 Department (in this section referred to as the ‘Director’) 

11 who shall be responsible for carrying out this section and 

12 advising the Secretary and the Under Secretary for Health 

13 on matters pertaining to this section. 

14 ‘‘(3) Each quadrennial Veterans Health Administra15 tion review conducted under paragraph (1) shall include 

16 a strategic plan to meet future requirements and demand 

17 for hospital care, medical services, and extended care serv18 ices under the laws administered by the Secretary that in19 cludes a five-year budget forecast for meeting such re20 quirements and demand based on the information con21 tained in the market area assessments conducted under 

22 subsection (c) and such other information as the Secretary 

23 considers appropriate. 


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1 ‘‘(4) In preparing the quadrennial Veterans Health 

2 Administration review under paragraph (1), including the 

3 strategic plan under paragraph (3), the Secretary shall— 

4 ‘‘(A) consider the access and quality standards 

5 established under sections 1703B and 1703C of this 

6 title, respectively; 

7 ‘‘(B) consider the needs of the Department to 

8 furnish health care services to veterans based on— 

9 ‘‘(i) identified health care services that 

10 provide management of health conditions or dis11 orders related to military service for which 

12 there is limited experience or access to such 

13 health care services from non-Department 

14 health care providers in the commercial market; 

15 ‘‘(ii) the overall health of veterans through16 out their lifespan; or 

17 ‘‘(iii) such other services as the Secretary 

18 determines appropriate; 

19 ‘‘(C) consult with key stakeholders within the 

20 Department, the heads of other Federal agencies, 

21 and other relevant governmental and nongovern22 mental entities, including State, local, and tribal 

23 government officials, members of Congress, veterans 

24 service organizations, private sector representatives, 

25 academics, and other policy experts; 


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1 ‘‘(D) identify emerging issues, trends, problems, 

2 and opportunities that could affect health care serv3 ices furnished under the laws administered by the 

4 Secretary; 

5 ‘‘(E) develop recommendations regarding both 

6 short- and long-term priorities for health care serv7 ices furnished under the laws administered by the 

8 Secretary; 

9 ‘‘(F) compare the Veterans Equitable Resource 

10 Allocation (VERA) system to other resource alloca11 tion systems or models for the purpose of analyzing 

12 the effectiveness of such systems in allocating re13 sources to furnish hospital care, medical services, 

14 and extended care services to veterans; and 

15 ‘‘(G) consider the work of the Center for Inno16 vation for Care and Payment under section 1703F 

17 of this title with respect to research, development, 

18 and testing payment and service delivery models. 

19 ‘‘(b) MANAGEMENT OF HIGH-PERFORMING INTE20 GRATED HEALTHCARE NETWORK.—(1) The Director 

21 shall be responsible for the management, design, imple22 mentation, and assessment of the high-performing inte23 grated healthcare network of the Department. 

24 ‘‘(2) In managing, designing, implementing, and as25 sessing the high-performing integrated healthcare network 


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1 of the Department under this subsection, the Director 

2 shall be responsible for the following: 

3 ‘‘(A) Overseeing the transformation and organi4 zational change across the Department to achieve 

5 such high-performing integrated healthcare network. 

6 ‘‘(B) Developing and implementing the quad7 rennial Veterans Health Administration review and 

8 strategic plan under subsection (a). 

9 ‘‘(C) Overseeing the market area assessments 

10 performed under subsection (c). 

11 ‘‘(D) Developing the capital infrastructure plan12 ning and procurement processes, whether minor or 

13 major construction projects or leases, in coordination 

14 with other offices of the Department. 

15 ‘‘(E) Developing a multi-year budget process 

16 that is capable of forecasting future year budget re17 quirements and projecting the cost of delivering 

18 health care services under a high-performing inte19 grated healthcare network. 

20 ‘‘(3) To ensure that the Director is able to carry out 

21 the responsibilities under paragraph (2), the Secretary 

22 shall ensure that coordination and information sharing oc23 curs with other relevant offices of the Department, includ24 ing the following offices: 

25 ‘‘(A) The Office of Management. 


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1 ‘‘(B) The Office of Acquisition, Logistics and 

2 Construction. 

3 ‘‘(C) The Office of Information and Tech4 nology. 

5 ‘‘(4) In carrying out this subsection, the Director 

6 shall confer with the Director of the Defense Health Agen7 cy and consider best practices and recommendations from 

8 non-Department entities, including entities carrying out 

9 market area assessments under subsection (c), that have 

10 developed plans, implemented systems, or advised other 

11 healthcare systems. 

12 ‘‘(5)(A) Not less frequently than once every three 

13 months, the Secretary or the Director shall brief the ap14 propriate committees of Congress on the activities con15 ducted under this subsection. 

16 ‘‘(B) Each briefing conducted under subparagraph 

17 (A) shall include the following: 

18 ‘‘(i) An assessment of any remediation or im19 provement conducted by the Department with re20 spect to a medical service line of the Department 

21 that the Secretary has determined does not meet an 

22 access standard or standard for quality established 

23 under section 1703B or 1703C of this title, respec24 tively, in providing hospital care, a medical service, 

25 or an extended care service, including the following: 


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1 ‘‘(I) An assessment of the factors that led 

2 the Secretary to make such determination. 

3 ‘‘(II) An assessment of the medical service 

4 line in relation to the market area assessment 

5 most recently performed under subsection (c), 

6 particularly with respect to how it relates to the 

7 demand for the medical service line in the area 

8 and by veterans using a medical facility of the 

9 Department for such medical service line. 

10 ‘‘(III) A plan with specific actions, and the 

11 time to complete them, to meet the access 

12 standards and standards for quality established 

13 under sections 1703B and 1703C of this title, 

14 respectively, which shall include consideration 

15 of— 

16 ‘‘(aa) increasing personnel or tem17 porary personnel assistance, including mo18 bile deployment teams; 

19 ‘‘(bb) special hiring incentives, includ20 ing the Education Debt Reduction Pro21 gram under subchapter VII of chapter 76 

22 of this title and recruitment, relocation, 

23 and retention incentives; 

24 ‘‘(cc) using direct hiring authority; 


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1 ‘‘(dd) providing improved training op2 portunities for staff; 

3 ‘‘(ee) acquiring improved equipment; 

4 ‘‘(ff) making structural modifications 

5 to the facility used by the medical service 

6 line; 

7 ‘‘(gg) partnering with health care pro8 viders that have the capacity to meet the 

9 demand in the market area and meet ac10 cess and quality standards established 

11 under sections 1703B and 1703C of this 

12 title; and 

13 ‘‘(hh) such other actions as the Sec14 retary considers appropriate. 

15 ‘‘(ii) An assessment of the progress made by 

16 the Department with respect to the responsibilities 

17 of the Director under paragraph (2). 

18 ‘‘(c) MARKET AREA ASSESSMENTS.—(1) Not less 

19 frequently than once every four years, the Secretary shall 

20 perform market area assessments regarding the health 

21 care services furnished under the laws administered by the 

22 Secretary. 

23 ‘‘(2) Each market area assessment performed under 

24 paragraph (1) shall include the following: 


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1 ‘‘(A) An assessment of the demand for hospital 

2 care, medical services, and extended care services 

3 from the Department, disaggregated by geographic 

4 market areas that are consistent with industry mar5 ket areas or boundaries, including the number of re6 quests for such care and services under the laws ad7 ministered by the Secretary. 

8 ‘‘(B) An inventory of the health care capacity 

9 of the Department across the facilities of the De10 partment. 

11 ‘‘(C) An assessment of the health care capacity 

12 to be provided through contracted community care 

13 providers and providers who entered into a provider 

14 agreement with the Department under section 

15 1703A of this title, including the number of pro16 viders, the geographic location of the providers, and 

17 categories or types of health care services provided 

18 by the providers. 

19 ‘‘(D) An assessment obtained from other Fed20 eral direct delivery systems of their capacity to pro21 vide health care to veterans. 

22 ‘‘(E) An assessment of the health care capacity 

23 of non-contracted providers where there is insuffi24 cient network supply. 


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1 ‘‘(F) An assessment of the health care capacity 

2 of academic affiliates and other collaborations of the 

3 Department as it relates to providing health care to 

4 veterans. 

5 ‘‘(G) An assessment of the effects on health 

6 care capacity by the access and quality standards es7 tablished under sections 1703B and 1703C of this 

8 title, respectively. 

9 ‘‘(H) The number of appointments for health 

10 care services under the laws administered by the 

11 Secretary, disaggregated by— 

12 ‘‘(i) appointments at facilities of the De13 partment; and 

14 ‘‘(ii) appointments with non-Department 

15 health care providers. 

16 ‘‘(I) Analysis of information submitted from 

17 care coordination teams under section 1703(e)(2)(D) 

18 of this title from each Department medical facility 

19 that includes the following: 

20 ‘‘(i) An analysis of coordination and man21 agement best practices. 

22 ‘‘(ii) Satisfaction survey data from the cov23 ered veterans from each care coordination team 

24 under section 1703(e) of this title. 


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1 ‘‘(iii) Findings and determinations related 

2 to the coordination of care under section 

3 1703(e) of this title to assist the Director in the 

4 design, implementation, and assessment of the 

5 high-performing integrated healthcare network 

6 of the Department. 

7 ‘‘(iv) A standardized climate survey devel8 oped jointly with the Centers for Medicare & 

9 Medicaid Services Alliance to Modernize 

10 Healthcare (CAMH) for the employees of each 

11 medical facility of the Department that com12 piles data on culture, communication, team13 work, quality of worklife, rewards or recogni14 tion, leadership, and productivity. 

15 ‘‘(3) The Secretary shall submit to the appropriate 

16 committees of Congress each market area assessment per17 formed under paragraph (1) and the complete market area 

18 assessment being performed on the day before the date 

19 of the enactment of the Veterans Community Care and 

20 Access Act of 2017 in the same form as such assessments 

21 are delivered to the Secretary. 

22 ‘‘(4) The Secretary shall use the market area assess23 ments performed under paragraph (1) to inform the quad24 rennial Veterans Health Administration review and stra25 tegic plan under subsection (a) and to determine the caVerDate Sep 11 2014 22:33 Dec 08, 2017 Jkt 079200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 E:\BILLS\S2184.IS S2184

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1 pacity of the Department and the capacity of the health 

2 care provider networks established under section 1703(d) 

3 of this title. 

4 ‘‘(5) The Secretary shall publish the capacity findings 

5 and results from the market area assessments performed 

6 under paragraph (1) with respect to the Department and 

7 health care provider networks established under section 

8 1703(d) of this title on a publicly accessible Internet 

9 website of the Department. 

10 ‘‘(d) DEPARTMENT BUDGET.—The Secretary shall 

11 ensure that the budget request of the Department for any 

12 fiscal year (as submitted with the budget of the President 

13 under section 1105(a) of title 31) reflects the findings of 

14 the Secretary with respect to the most recent information 

15 described in subsection (b)(5) and is consistent with the 

16 quadrennial Veterans Health Administration review and 

17 strategic plan under subsection (a). 

18 ‘‘(e) APPROPRIATE COMMITTEES OF CONGRESS DE19 FINED.—In this section, the term ‘appropriate committees 

20 of Congress’ means— 

21 ‘‘(1) the Committee on Veterans’ Affairs and 

22 the Committee on Appropriations of the Senate; and 

23 ‘‘(2) the Committee on Veterans’ Affairs and 

24 the Committee on Appropriations of the House of 

25 Representatives.’’. 


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

2 at the beginning of chapter 17 is amended by inserting 

3 after the item relating to section 1730A the following new 

4 item: 

‘‘1730B. Quadrennial Veterans Health Administration review, management of 

high-performing integrated healthcare network, and market 

area assessments.’’. 

5 (c) WAIVER OF CERTAIN REQUIREMENTS FOR MAR6 KET ASSESSMENT IN PROGRESS.—Paragraph (2) of sec7 tion 1730B(c) of title 38, United States Code, as added 

8 by subsection (a), shall not apply to a market area assess9 ment that was being performed by the Secretary of Vet10 erans Affairs on the day before the date of the enactment 

11 of this Act. 

12 SEC. 103. ACCESS STANDARDS AND STANDARDS FOR QUAL13 ITY. 

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

15 amended by inserting after section 1703 the following new 

16 sections: 

17 ‘‘§ 1703B. Access standards 

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

19 access standards for hospital care, medical services, and 

20 extended care services furnished by the Department, in21 cluding through health care providers under section 1703 

22 of this title. 

23 ‘‘(2) The Secretary shall ensure that the hospital 

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1 nished to a veteran by the Department, including through 

2 health care providers under section 1703 of this title, is 

3 furnished within the access standards established under 

4 paragraph (1). 

5 ‘‘(3) The access standards established under para6 graph (1) shall align with the categories of hospital care, 

7 medical services, and extended care services set forth 

8 under subsection (b) and shall be informed by the market 

9 area assessments performed under section 1730B(c) of 

10 this title. 

11 ‘‘(b) CATEGORIES OF HOSPITAL CARE, MEDICAL

12 SERVICES, AND EXTENDED CARE SERVICES FUR13 NISHED.—The categories of hospital care, medical serv14 ices, and extended care services subject to access stand15 ards established under subsection (a) are as follows: 

16 ‘‘(1) Primary care services. 

17 ‘‘(2) Specialty care services, including services 

18 that may require a referral and services that may be 

19 considered wellness or preventative care. 

20 ‘‘(3) Behavioral health services, including men21 tal health and substance abuse disorder treatment. 

22 ‘‘(4) Urgent care. 

23 ‘‘(5) Home health services, including services 

24 that may be virtual. 

25 ‘‘(6) Dental services. 


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1 ‘‘(7) As determined by the Secretary, any addi2 tional types of services for which the Department or 

3 the networks established under section 1703(d) of 

4 this title have experienced increased demand accord5 ing to the market area assessments performed under 

6 section 1730B(c) of this title or an increase in ac7 cess complaints to network health care providers or 

8 the Department. 

9 ‘‘(c) APPLICATION.—(1) The Secretary may establish 

10 and apply access standards under subsection (a) according 

11 to the market area assessments under section 1730B(c) 

12 of this title. 

13 ‘‘(2) In carrying out section 1703 of this title, the 

14 Secretary shall apply access standards established under 

15 subsection (a) to a covered veteran under such section 

16 with respect to the residence, as defined in section 

17 17.1505 of title 38, Code of Federal Regulations (or any 

18 successor regulation), of the covered veteran. 

19 ‘‘(d) COMPARATIVE INFORMATION.—The Secretary 

20 shall ensure that the access standards required by sub21 section (a) provide veterans, employees of the Department, 

22 and health providers in the Veterans Community Care 

23 Program established under section 1703 of this title with 

24 relevant comparative information that is clear, useful, and 

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1 sible decisions regarding their hospital care, medical serv2 ices, and extended care services. 

3 ‘‘(e) COORDINATION.—The Secretary shall coordinate 

4 with the Secretary of Defense, and may consult with the 

5 Secretary of Health and Human Services, the Adminis6 trator of the Centers for Medicare & Medicaid Services, 

7 entities in the private sector, and other nongovernmental 

8 entities in establishing access standards under subsection 

9 (a). 

10 ‘‘(f) PERIODIC REVIEW.—Not later than two years 

11 after the date on which the Secretary establishes access 

12 standards under this section and not less frequently than 

13 once every three years thereafter, the Secretary shall— 

14 ‘‘(1) conduct a review of such standards; and 

15 ‘‘(2) submit to the appropriate committees of 

16 Congress a report that includes the following: 

17 ‘‘(A) A report on the findings of the Sec18 retary with respect to the review conducted 

19 under paragraph (1) and any modification to 

20 such standards as the Secretary considers ap21 propriate. 

22 ‘‘(B) For each medical service line that the 

23 Secretary determined, during the period covered 

24 by the report, did not meet a standard estab25 lished under this section, identification of the 


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1 leadership team in the facility and the Veterans 

2 Integrated Service Network that are responsible 

3 for overseeing the progress of the medical serv4 ice line in meeting such standard. 

5 ‘‘(g) PUBLICATION.—The Secretary shall publish the 

6 health care access standards established under subsection 

7 (a) and any modifications to such standards in the Federal 

8 Register and on a publicly accessible Internet website of 

9 the Department. 

10 ‘‘(h) APPROPRIATE COMMITTEES OF CONGRESS DE11 FINED.—In this section, the term ‘appropriate committees 

12 of Congress’ means— 

13 ‘‘(1) the Committee on Veterans’ Affairs and 

14 the Committee on Appropriations of the Senate; and 

15 ‘‘(2) the Committee on Veterans’ Affairs and 

16 the Committee on Appropriations of the House of 

17 Representatives. 

18 ‘‘§ 1703C. Standards for quality 

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

20 standards for quality regarding hospital care, medical 

21 services, and extended care services furnished by the De22 partment, including through health care providers under 

23 section 1703 of this title. 

24 ‘‘(2) The Secretary shall ensure that the hospital 

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1 nished to a veteran by the Department, including through 

2 health care providers under section 1703 of this title, is 

3 furnished within the standards for quality established 

4 under paragraph (1). 

5 ‘‘(3) The standards for quality established under 

6 paragraph (1) shall align with the Department of Defense 

7 according to categories of hospital care, medical services, 

8 and extended care services set forth under section 

9 1703B(b) of this title and shall be informed by the market 

10 area assessments performed under section 1730B(c) of 

11 this title. 

12 ‘‘(4) In establishing standards for quality under para13 graph (1), the Secretary shall— 

14 ‘‘(A) conduct a survey of covered veterans de15 scribed in section 1703(b) of this title through a 

16 third party entity to assess the satisfaction of such 

17 veterans with service and quality of care; and 

18 ‘‘(B) collect data sets that include, at a min19 imum— 

20 ‘‘(i) general information; 

21 ‘‘(ii) surveys of patients’ experiences; 

22 ‘‘(iii) timely and effective care; 

23 ‘‘(iv) complications; 

24 ‘‘(v) readmissions and deaths; 

25 ‘‘(vi) use of medical imaging; 


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1 ‘‘(vii) payment and value of care; and 

2 ‘‘(viii) use of telemedicine. 

3 ‘‘(5) The Secretary shall develop such standards for 

4 quality and collect data according to health care settings 

5 consistent with the Department of Defense and the Cen6 ters for Medicare & Medicaid Services, including, at a min7 imum, the following: 

8 ‘‘(A) Inpatient hospitals. 

9 ‘‘(B) Nursing homes. 

10 ‘‘(C) Individual health care providers. 

11 ‘‘(D) Dialysis facilities. 

12 ‘‘(E) Hospice. 

13 ‘‘(F) Inpatient rehabilitation facilities. 

14 ‘‘(G) Long-term care hospitals. 

15 ‘‘(H) Outpatient facilities. 

16 ‘‘(6) The standards for quality established under 

17 paragraph (1) shall be informed by existing health quality 

18 measures, such as those defined by the HealthCare Effec19 tiveness Data and Information Set, that are applied to 

20 public and privately sponsored health care systems with 

21 the purpose of providing veterans relevant comparative in22 formation to make informed decisions regarding their 

23 health care. 

24 ‘‘(b) IMPROVING AND STRENGTHENING QUALITY

25 STANDARDS.—Not later than one year after the date on 


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1 which the Secretary establishes standards under sub2 section (a), the Secretary shall— 

3 ‘‘(1) publish the quality rating of medical facili4 ties of the Department on a publicly available Inter5 net website, such as a website of the Centers for 

6 Medicare & Medicaid Services, for the purpose of 

7 providing veterans with information that allows them 

8 to compare performance measure information among 

9 Department and community health care providers 

10 who provide hospital care, medical services, or ex11 tended care services under section 1703 of this title; 

12 and 

13 ‘‘(2) consider and solicit public comment on po14 tential changes to the established quality measures 

15 to ensure that they include the most up-to-date and 

16 applicable industry measures for veterans. 

17 ‘‘(c) COORDINATION.—The Secretary shall coordinate 

18 with the Secretary of Defense, and may consult with the 

19 Secretary of Health and Human Services, the Adminis20 trator of the Centers for Medicare & Medicaid Services, 

21 entities in the private sector, and other nongovernmental 

22 entities in establishing standards for quality under this 

23 section. 

24 ‘‘(d) PERIODIC REVIEW.—Not later than two years 

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1 ards for quality under this section and not less frequently 

2 than once every three years thereafter, the Secretary 

3 shall— 

4 ‘‘(1) conduct a review of such standards across 

5 the Department; and 

6 ‘‘(2) submit to the appropriate committees of 

7 Congress a report that includes the following: 

8 ‘‘(A) A report on the findings of the Sec9 retary with respect to the review conducted 

10 under paragraph (1) and any modification to 

11 such standards as the Secretary considers ap12 propriate. 

13 ‘‘(B) For each medical service line that the 

14 Secretary determined, during the period covered 

15 by the report, did not meet a standard estab16 lished under this section, identification of the 

17 leadership team in the facility and the Veterans 

18 Integrated Service Network that are responsible 

19 for overseeing the progress of the medical serv20 ice line in meeting such standard. 

21 ‘‘(e) PUBLICATION.—The Secretary shall publish the 

22 health care quality standards established under subsection 

23 (a) and any modifications to such standards in the Federal 

24 Register and on a publicly accessible Internet website of 

25 the Department. 


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1 ‘‘(f) APPROPRIATE COMMITTEES OF CONGRESS DE2 FINED.—In this section, the term ‘appropriate committees 

3 of Congress’ means— 

4 ‘‘(1) the Committee on Veterans’ Affairs and 

5 the Committee on Appropriations of the Senate; and 

6 ‘‘(2) the Committee on Veterans’ Affairs and 

7 the Committee on Appropriations of the House of 

8 Representatives.’’. 

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

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

11 102, is further amended by inserting after the item relat12 ing to section 1703 the following new items: 

‘‘1703B. Access standards. 

‘‘1703C. Standards for quality.’’. 

13 (c) SUBMITTAL OF ACCESS STANDARDS AND STAND14 ARDS FOR QUALITY.— 

15 (1) IN GENERAL.—Not later than July 1, 2018, 

16 the Secretary of Veterans Affairs shall submit to the 

17 appropriate committees of Congress a report detail18 ing the access standards and standards for quality 

19 established under sections 1703B and 1703C of title 

20 38, United States Code, respectively, as added by 

21 subsection (a). 

22 (2) APPROPRIATE COMMITTEES OF CONGRESS

23 DEFINED.—In this subsection, the term ‘‘appro24 priate committees of Congress’’ means— 


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1 (A) the Committee on Veterans’ Affairs 

2 and the Committee on Appropriations of the 

3 Senate; and 

4 (B) the Committee on Veterans’ Affairs 

5 and the Committee on Appropriations of the 

6 House of Representatives. 

7 Subtitle B—Forming Partnerships 

8 and Agreements 

9 SEC. 111. CONTINUITY OF CARE AND EXISTING AGREE10 MENTS. 

11 (a) IN GENERAL.—Notwithstanding section 1703 of 

12 title 38, United States Code, as amended by section 101 

13 of this Act, the Secretary of Veterans Affairs shall ensure 

14 veterans do not experience a delay or lapse in care or serv15 ices by continuing the following: 

16 (1) All contracts, memorandums of under17 standing, and memorandums of agreements that 

18 were in effect on the day before the date of the en19 actment of this Act between the Department of Vet20 erans Affairs and the American Indian and Alaska 

21 Native health care systems as established under the 

22 auspices of the Department of Veterans Affairs and 

23 Indian Health Service Memorandum of Under24 standing, signed October 1, 2010. 


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1 (2) The National Reimbursement Agreement, 

2 signed December 5, 2012. 

3 (3) Agreements that were in effect on the day 

4 before the date of the enactment of this Act and en5 tered into under section 101, 102, or 103 of the Vet6 erans Access, Choice, and Accountability Act of 

7 2014 (Public Law 113–146). 

8 (4) Agreements that were in effect on the day 

9 before the date of the enactment of this Act for the 

10 purpose of dialysis treatment, only if the contracts 

11 or agreements established under section 1703 of title 

12 38, United States Code, as amended by section 101 

13 of this Act, do not stipulate that such treatments be 

14 furnished by providers under such contracts or 

15 agreements. 

16 (b) MODIFICATIONS.—Subsection (a) shall not be 

17 construed to prohibit the Secretary and the parties to the 

18 contracts, agreements, memorandums of understanding, 

19 and memorandums of agreements described in such sub20 section from making such changes to such contracts, 

21 agreements, memorandums of understanding, and memo22 randums of agreements as may be otherwise authorized 

23 pursuant to other provisions of law or the terms of the 

24 contracts, agreements, memorandums of understanding, 

25 and memorandums of agreements. 


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1 (c) TREATMENT OF EXISTING CONTRACTORS.—To 

2 the extent practicable, the Secretary shall give health care 

3 providers who are providing hospital care, medical serv4 ices, or extended care services pursuant to a contract with 

5 the Secretary under section 1703 of title 38, United States 

6 Code, as in effect on the day before the date of the enact7 ment of this Act, the opportunity to furnish hospital care, 

8 medical services, or extended care services under such sec9 tion as amended by section 101 of this Act. 

10 SEC. 112. AUTHORIZATION OF AGREEMENTS BETWEEN DE11 PARTMENT OF VETERANS AFFAIRS AND NON12 DEPARTMENT PROVIDERS. 

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

14 amended by sections 101 and 103, is further amended by 

15 inserting after section 1703 the following new section: 

16 ‘‘§ 1703A. Agreements with eligible entities or pro17 viders; certification processes 

18 ‘‘(a) AGREEMENTS AUTHORIZED.—(1)(A) When hos19 pital care, a medical service, or an extended care service 

20 is not available to a veteran described in section 1703(b) 

21 of this title from a medical facility of the Department or 

22 through a contract or sharing agreement entered into 

23 under this title under an authority other than this section, 

24 the Secretary may furnish such care or service to such 

25 veteran to avoid a delay or lapse in such care or service 


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1 by entering into an agreement under this section with a 

2 health care provider specified in section 1703(c) of this 

3 title to provide such care or service. 

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

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

6 care service shall be known as a ‘Veterans Care Agree7 ment’. 

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

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

10 be considered not available to a veteran from a medical 

11 facility of the Department or through a contract or shar12 ing agreement described in such subparagraph when the 

13 Secretary determines the veteran’s medical condition, the 

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

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

16 of the Department or a contract or sharing agreement de17 scribed in such subparagraph impracticable or inadvisable. 

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

19 into by the Secretary or any Department official author20 ized by the Secretary. 

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

22 shall review each Veterans Care Agreement of material 

23 size, as determined by the Secretary or set forth in para24 graph (3), for hospital care, a medical service, or an ex25 tended care service to determine whether it is feasible and 


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1 advisable to provide such care or service within a facility 

2 of the Department or by contract or sharing agreement 

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

4 so, take action to do so. 

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

6 Care Agreement of material size that has been in effect 

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

8 taking effect, and no less frequently than once every four 

9 years thereafter. 

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

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

12 required by subparagraph (A), the agreement will be re13 viewed during the next cycle required by subparagraph 

14 (A), and such review will serve as its review within the 

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

16 (i). 

17 ‘‘(3) In addition to such other Veterans Care Agree18 ments as the Secretary may determine are of material size, 

19 each Veterans Care Agreement that takes effect after the 

20 date of the enactment of the Veterans Community Care 

21 and Access Act of 2017 shall be considered of material 

22 size. 

23 ‘‘(4)(A) The Secretary, and any other Department of24 ficial authorized by the Secretary, may enter into an 

25 agreement under this section for extended care services 


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1 only if the Secretary does not expect such agreement 

2 would result in an obligation of the Department that ex3 ceeds a rate of $5,000,000 annually. 

4 ‘‘(B) If the Secretary enters into an agreement with 

5 a provider under this section and pursuant to the agree6 ment the Department incurs an obligation that exceeds 

7 an annual rate of, with respect to extended care services, 

8 the rate set forth in subparagraph (A), and with respect 

9 to services that are not extended care services, 

10 $2,000,000, the Secretary shall submit to the appropriate 

11 committees of Congress notice that such obligation has ex12 ceeded such rate and an accounting of the cost and need 

13 for such agreement if such provider is unable or unwilling 

14 to enter into a contract or other agreement under section 

15 1703 of this title. 

16 ‘‘(C) In this paragraph, the term ‘appropriate com17 mittees of Congress’ means— 

18 ‘‘(i) the Committee on Veterans’ Affairs and 

19 the Committee on Appropriations of the Senate; and 

20 ‘‘(ii) the Committee on Veterans’ Affairs and 

21 the Committee on Appropriations of the House of 

22 Representatives. 

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

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


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

2 and entered into a provider agreement under section 

3 1866(a) of the Social Security Act (42 U.S.C. 

4 1395cc(a)) and any physician or other supplier who 

5 has enrolled and entered into a participation agree6 ment under section 1842(h) of such Act (42 U.S.C. 

7 1395u(h)); 

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

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

10 et seq.); or 

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

12 paragraph (1) or (2) of this subsection that the Sec13 retary determines to be eligible pursuant to the cer14 tification process described in subsection (c). 

15 ‘‘(c) ELIGIBLE ENTITY OR PROVIDER CERTIFI16 CATION PROCESS.—The Secretary shall establish by regu17 lation a process for the certification of eligible entities or 

18 providers or recertification of eligible entities or providers 

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

20 ‘‘(1) establish deadlines for actions on applica21 tions for certification; 

22 ‘‘(2) set forth standards for an approval or de23 nial of certification, duration of certification, revoca24 tion of an eligible entity or provider’s certification, 

25 and recertification of eligible entities or providers; 


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

2 Secretary determines the eligible entity or provider 

3 is excluded from participation in a Federal health 

4 care program under section 1128 or section 1128A 

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

6 1320a–7a) or is currently identified as an excluded 

7 source on the System for Award Management Exclu8 sions list described in part 9 of title 48, Code of 

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

10 Code, or successor regulations; 

11 ‘‘(4) establish procedures for screening eligible 

12 entities or providers according to the risk of fraud, 

13 waste, and abuse that are similar to the standards 

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

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

16 and subpart 9.4 of title 48, Code of Federal Regula17 tions, or successor regulations; and 

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

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

20 this section as a procurement program only for pur21 poses of applying such provisions. 

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

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

24 and extended care services provided under a Veterans 


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1 Care Agreement shall be in accordance with the rates paid 

2 by the United States under the Medicare program. 

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

4 Pursuant to regulations promulgated under subsection 

5 (k), the Secretary may define the requirements for pro6 viders and entities entering into agreements under this 

7 section based upon such factors as the number of patients 

8 receiving care or services, the number of employees em9 ployed by the entity or provider furnishing such care or 

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

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

12 ‘‘(2) To furnish hospital care, medical services, or ex13 tended care services under this section, an eligible entity 

14 or provider shall agree— 

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

16 in regulations prescribed under this section; 

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

18 section on behalf of a veteran to a provider of serv19 ices or care shall, unless rejected and refunded by 

20 the provider within 30 days of receipt, constitute 

21 payment in full and extinguish any liability on the 

22 part of the veteran for the treatment or care pro23 vided, and no provision of a contract, agreement, or 

24 assignment to the contrary shall operate to modify, 

25 limit, or negate this requirement; 


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1 ‘‘(C) to provide only the care and services au2 thorized by the Department under this section and 

3 to obtain the prior written consent of the Depart4 ment to furnish care or services outside the scope of 

5 such authorization; 

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

7 the methodology outlined in regulations prescribed 

8 under this section; 

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

10 health plan contract or third party, as those terms 

11 are defined in section 1729 of this title, for any 

12 service for which payment is made by the Depart13 ment; 

14 ‘‘(F) to provide medical records to the Depart15 ment in the time frame and format specified by the 

16 Department; and 

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

18 including quality of care assurance standards, as the 

19 Secretary may specify in regulation. 

20 ‘‘(f) DISCONTINUATION OR NONRENEWAL OF A VET21 ERANS CARE AGREEMENTS.—(1) An eligible entity or pro22 vider may discontinue a Veterans Care Agreement at such 

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

24 provided in regulations prescribed under this section. 


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

2 Agreement with an eligible entity or provider at such time 

3 and upon such reasonable notice to the eligible entity or 

4 provider as may be specified in regulations prescribed 

5 under this section, if an official designated by the Sec6 retary— 

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

8 provider failed to comply substantially with the pro9 visions of the Veterans Care Agreement, or with the 

10 provisions of this section or regulations prescribed 

11 under this section; 

12 ‘‘(B) has determined the eligible entity or pro13 vider is excluded from participation in a Federal 

14 health care program under section 1128 or section 

15 1128A of the Social Security Act (42 U.S.C. 1320a– 

16 7 or 1320a–7a) or is identified on the System for 

17 Award Management Exclusions list as provided in 

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

19 part 180 of title 2 of such Code, or successor regula20 tions; 

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

22 provider has been convicted of a felony or other seri23 ous offense under Federal or State law and deter24 mines the eligible entity or provider’s continued parVerDate Sep 11 2014 22:33 Dec 08, 2017 Jkt 079200 PO 00000 Frm 00046 Fmt 6652 Sfmt 6201 E:\BILLS\S2184.IS S2184

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1 ticipation would be detrimental to the best interests 

2 of veterans or the Department; or 

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

4 terminate the agreement based on the health care 

5 needs of a veteran. 

6 ‘‘(g) QUALITY OF CARE.—The standards for quality 

7 established under section 1703C of this title shall be ap8 plied in monitoring the quality of care provided to veterans 

9 through Veterans Care Agreements and for assessing the 

10 quality of hospital care, medical services, and extended 

11 care services furnished by eligible entities and providers 

12 before the renewal of Veterans Care Agreements. 

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

14 administrative procedures for eligible entities and pro15 viders to present all disputes arising under or related to 

16 Veterans Care Agreements. 

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

18 and providers’ exhaustive and exclusive administrative 

19 remedies. 

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

21 such administrative procedures before seeking any judicial 

22 review under section 1346 of title 28 (known as the ‘Tuck23 er Act’). 

24 ‘‘(4) Disputes under this section must pertain to ei25 ther the scope of authorization under the Veterans Care 


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1 Agreement or claims for payment subject to the Veterans 

2 Care Agreement and are not claims for the purposes of 

3 such laws that would otherwise require application of sec4 tions 7101 through 7109 of title 41, United States Code. 

5 ‘‘(i) APPLICABILITY OF OTHER PROVISIONS OF

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

7 by the Secretary or any Department official authorized by 

8 the Secretary, and such action is not an award for the 

9 purposes of such laws that would otherwise require the 

10 use of competitive procedures for furnishing of care and 

11 services. 

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

13 unless otherwise provided in this section or regulations 

14 prescribed pursuant to this section, an eligible entity or 

15 provider that enters into an agreement under this section 

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

17 any law to which providers of services and suppliers under 

18 the Medicare program under title XVIII of the Social Se19 curity Act (42 U.S.C. 1395 et seq.) are not subject. 

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

21 an agreement under this section is subject to— 

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

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

24 penalties; and 


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

2 discrimination or that otherwise ensure equal em3 ployment opportunities. 

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

5 care, medical services, and extended care services fur6 nished to any veteran pursuant to a Veterans Care Agree7 ment shall be subject to the same terms as though pro8 vided in a facility of the Department, and provisions of 

9 this chapter applicable to veterans receiving such care and 

10 services in a facility of the Department shall apply to vet11 erans treated under this section. 

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

13 regulations to carry out this section.’’. 

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

15 at the beginning of such chapter is amended by inserting 

16 after the item related to section 1703 the following new 

17 item: 

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

18 SEC. 113. PREVENTION OF CERTAIN HEALTH CARE PRO19 VIDERS FROM PROVIDING NON-DEPARTMENT 

20 HEALTH CARE SERVICES TO VETERANS. 

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

22 year after the date of the enactment of this Act, the Sec23 retary of Veterans Affairs shall deny or revoke the eligi24 bility of a health care provider to provide non-Department 


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1 health care services to veterans if the Secretary determines 

2 that the health care provider— 

3 (1) was removed from employment with the De4 partment of Veterans Affairs due to conduct that 

5 violated a policy of the Department relating to the 

6 delivery of safe and appropriate health care; or 

7 (2) violated the requirements of a medical li8 cense of the health care provider that resulted in the 

9 loss of such medical license. 

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

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

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

13 of a health care provider to provide non-Department 

14 health care services if the Secretary determines such ac15 tion is necessary to immediately protect the health, safety, 

16 or welfare of veterans and the health care provider is 

17 under investigation by the medical licensing board of a 

18 State in which the health care provider is licensed or prac19 tices. 

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

21 eligibility of a health care provider to provide non-Depart22 ment health care services to veterans if the health care 

23 provider is suspended from serving as a health care pro24 vider of the Department. 


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1 (d) COMPTROLLER GENERAL REPORT.—Not later 

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

3 the Comptroller General of the United States shall submit 

4 to Congress a report on the implementation by the Sec5 retary of this section, including the following: 

6 (1) The aggregate number of health care pro7 viders denied or suspended under this section from 

8 participation in providing non-Department health 

9 care services. 

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

11 health care for patients or staffing shortages in pro12 grams of the Department providing non-Department 

13 health care services. 

14 (3) An explanation of the coordination of the 

15 Department with the medical licensing boards of 

16 States in implementing this section, the amount of 

17 involvement of such boards in such implementation, 

18 and efforts by the Department to address any con19 cerns raised by such boards with respect to such im20 plementation. 

21 (4) Such recommendations as the Comptroller 

22 General considers appropriate regarding harmo23 nizing eligibility criteria between health care pro24 viders of the Department and health care providers 


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1 eligible to provide non-Department health care serv2 ices. 

3 (e) NON-DEPARTMENT HEALTH CARE SERVICES

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

5 health care services’’ means hospital care, medical serv6 ices, and extended care services furnished at non-Depart7 ment facilities under chapter 17 of title 38, United States 

8 Code. 

9 SEC. 114. CONFORMING AMENDMENTS FOR STATE VET10 ERANS HOMES. 

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

12 (1) in paragraph (1), by striking ‘‘(or agree13 ment under section 1720(c)(1) of this title)’’ and in14 serting ‘‘(or an agreement)’’; and 

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

16 paragraph: 

17 ‘‘(4)(A) An agreement under this section may be au18 thorized by the Secretary or any Department official au19 thorized by the Secretary, and any such action is not an 

20 award for purposes of such laws that would otherwise re21 quire the use of competitive procedures for the furnishing 

22 of hospital care, medical services, and extended care serv23 ices. 

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

25 otherwise provided in this section or regulations prescribed 


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

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

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

4 which providers of services and suppliers under the Medi5 care program under title XVIII of the Social Security Act 

6 (42 U.S.C. 1395 et seq.) are not subject. 

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

8 under this section is subject to— 

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

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

11 criminal penalties; and 

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

13 employment discrimination or that otherwise ensure 

14 equal employment opportunities. 

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

16 State home that enters into an agreement under this sec17 tion may not be treated as a Federal contractor or subcon18 tractor for purposes of chapter 67 of title 41 (known as 

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

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

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

22 effective date of regulations issued by the Secretary of 

23 Veterans Affairs to carry out this section. 


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1 Subtitle C—Paying Providers 

2 SEC. 121. PROMPT PAYMENT TO PROVIDERS. 

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

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

5 section 103 of this Act, the following new section: 

6 ‘‘§ 1703D. Prompt payment standard 

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

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

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

10 extended care services furnished by health care entities or 

11 providers under this chapter within 45 calendar days upon 

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

13 receipt of a clean electronic claim. 

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

15 45 calendar days of denial for a paper claim and 30 cal16 endar days of denial for an electronic claim, notify the 

17 health care entity or provider of the reason for denying 

18 the claim and what, if any, additional information is re19 quired to process the claim. 

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

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

22 or otherwise adjudicated within 30 calendar days from the 

23 receipt of the requested information. 


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

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

3 other forms of periodic payment to entities or providers. 

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

6 that furnishes hospital care, medical services, or extended 

7 care services under this chapter shall submit to the Sec8 retary a claim for payment for furnishing the care or serv9 ices not later than 180 days after the date on which the 

10 entity or provider furnished the care or services. 

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

12 through 3733 of title 31 shall apply to fraudulent claims 

13 for payment submitted to the Secretary by a health care 

14 entity or provider under this chapter. 

15 ‘‘(2) Pursuant to regulations prescribed by the Sec16 retary, the Secretary shall bar a health care entity or pro17 vider from furnishing hospital care, medical services, and 

18 extended care services under this chapter when the Sec19 retary determines the entity or provider has submitted to 

20 the Secretary fraudulent health care claims for payment 

21 by the Secretary. 

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

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

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

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


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1 entity or provider within the time periods specified in sub2 section (a). 

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

4 the Secretary may, under the requirements established by 

5 subsection (a) and consistent with the provisions of chap6 ter 39 of title 31 (commonly referred to as the ‘Prompt 

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

8 claims. 

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

10 computed at the rate of interest established by the Sec11 retary of the Treasury under section 3902 of title 31 and 

12 published in the Federal Register. 

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

14 the amount of any overpayment from payments due a 

15 health care entity or provider under this chapter. 

16 ‘‘(2) Deductions may not be made under this sub17 section unless the Secretary has made reasonable efforts 

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

19 dispute the existence or amount of such indebtedness and 

20 the right to request a compromise of such indebtedness. 

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

22 respect to any such dispute or request prior to deducting 

23 any overpayment unless the time required to make such 

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1 ardize the Secretary’s ability to recover the full amount 

2 of such indebtedness. 

3 ‘‘(f) INFORMATION AND DOCUMENTATION RE4 QUIRED.—(1) The Secretary shall provide to all health 

5 care entities and providers participating in a program to 

6 furnish hospital care, medical services, or extended care 

7 services under this chapter a list of information and docu8 mentation that is required to establish a clean claim under 

9 this section. 

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

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

12 determine the information and documentation to include 

13 in the list under paragraph (1). 

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

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

16 the Secretary shall notify all health care entities and pro17 viders described in paragraph (1) not later than 30 days 

18 before such modifications take effect. 

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

20 for compensation for hospital care, medical services, or ex21 tended care services furnished by a health care entity or 

22 provider under this chapter, the Secretary shall act 

23 through— 


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

2 contract or agreement for the program established 

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

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

5 in such processing for other Federal agency health 

6 care systems. 

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

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

9 of the Veterans Community Care and Access Act of 2017, 

10 the Secretary shall submit to the appropriate committees 

11 of Congress a report on the feasibility and advisability of 

12 adopting a funding mechanism similar to what is utilized 

13 by other Federal agencies to allow a contracted entity to 

14 act as a fiscal intermediary for the Federal Government 

15 to distribute, or pass through, Federal Government funds 

16 for certain non-underwritten hospital care, medical serv17 ices, or extended care services. 

18 ‘‘(2) The Secretary may coordinate with the Depart19 ment of Defense, the Department of Health and Human 

20 Services, and the Department of the Treasury in devel21 oping the report required by paragraph (1). 

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

23 ‘‘(1) The term ‘appropriate committees of Con24 gress’ means— 


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

2 and the Committee on Appropriations of the 

3 Senate; and 

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

5 and the Committee on Appropriations of the 

6 House of Representatives. 

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

8 the transmission of data for purposes of payment of 

9 covered health care expenses that is submitted to the 

10 Secretary which contains substantially all of the re11 quired data elements necessary for accurate adju12 dication, without obtaining additional information 

13 from the entity or provider that furnished the care 

14 or service, submitted in such format as prescribed by 

15 the Secretary in regulations for the purpose of pay16 ing claims for care or services. 

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

18 paper claim for payment of covered health care ex19 penses that is submitted to the Secretary which con20 tains substantially all of the required data elements 

21 necessary for accurate adjudication, without obtain22 ing additional information from the entity or pro23 vider that furnished the care or service, submitted in 

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1 lations for the purpose of paying claims for care or 

2 services. 

3 ‘‘(4) The term ‘fraudulent claims’ means the in4 tentional and deliberate misrepresentation of a mate5 rial fact or facts by a health care entity or provider 

6 made to induce the Secretary to pay a claim that 

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

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

9 interpretation by a health care entity or provider of 

10 utilization, medical necessity, coding, and billing re11 quirements of the Secretary. 

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

13 includes any non-Department health care entity or 

14 provider, but does not include any Federal health 

15 care entity or provider.’’. 

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

17 at the beginning of such chapter is amended by inserting 

18 after the item related to section 1703C, as added by sec19 tion 103 of this Act, the following new item: 

‘‘1703D. Prompt payment standard.’’. 

20 SEC. 122. PAYMENT RATES FOR COMMUNITY CARE. 

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

22 amended by section 121 of this Act, is further amended 

23 by inserting after section 1703D the following new section: 


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1 ‘‘§ 1703E. Payment rates for community care 

2 ‘‘(a) IN GENERAL.—Except as provided in subsection 

3 (b), and to the extent practicable, the rate paid for hos4 pital care or medical services under any provision in this 

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

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

7 of the Social Security Act (1395x(u))) or a supplier (as 

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

9 1395x(d))) under the Medicare program under title XI or 

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

11 et seq. and 1395 et seq.) for the same care or services, 

12 including rates adjusted for critical access hospitals under 

13 section 1834(g) of such Act (42 U.S.C. 1395m(g)). 

14 ‘‘(b) EXCEPTION.—(1)(A) A higher rate than the 

15 rate paid by the United States as described in subsection 

16 (a) may be negotiated with respect to the furnishing of 

17 care or services to a veteran described in section 1703(b) 

18 of this title who resides in a highly rural area or in a mar19 ket area where the availability of care or services is limited 

20 and a higher rate of pay may be required. 

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

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

23 seven individuals residing in that county per square mile. 

24 ‘‘(2) With respect to furnishing care or services under 

25 this section in Alaska, the Alaska Fee Schedule of the De26 partment of Veterans Affairs shall be followed, except for 


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1 when another payment agreement, including a contract, 

2 provider agreement or Veterans Care Agreement, is in 

3 place. 

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

5 this section in a State with an All-Payer Model Agreement 

6 under section 1814(b)(3) of the Social Security Act (42 

7 U.S.C. 1395f(b)(3)) that became effective on or after Jan8 uary 1, 2014, the Medicare payment rates under subpara9 graph (A) shall be calculated based on the payment rates 

10 under such agreement. 

11 ‘‘(c) VALUE-BASED REIMBURSEMENT.—Notwith12 standing subsection (a), the Secretary shall incorporate, 

13 to the greatest extent practicable, the use of value-based 

14 reimbursement models to promote the provision of high 

15 quality care.’’. 

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

17 at the beginning of such chapter is amended by inserting 

18 after the item relating to section 1703D, as added by sec19 tion 121 of this Act, the following new item: 

‘‘1703E. Payment Rates for Community Care.’’. 

20 SEC. 123. AUTHORITY TO PAY FOR AUTHORIZED CARE NOT 

21 SUBJECT TO AN AGREEMENT. 

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

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


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1 ‘‘§ 8159. Authority to pay for services authorized but 

2 not subject to an agreement 

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

4 hospital care, a medical service, or an extended care serv5 ice authorized by the Secretary and pursuant to a con6 tract, agreement, or other arrangement with the Sec7 retary, a provider that is not a party to the contract, 

8 agreement, or other arrangement furnishes hospital care, 

9 a medical service, or an extended care service that the Sec10 retary considers necessary, the Secretary may compensate 

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

12 ‘‘(b) REPORTS ON USE OF AUTHORITY.—Whenever 

13 the Secretary compensates a provider under subsection (a) 

14 for the furnishing of hospital care, a medical service, or 

15 an extended care service, the care coordination team that 

16 coordinated the furnishing of such care or service under 

17 section 1703(e)(1) of this title shall— 

18 ‘‘(1) submit to the appropriate committees of 

19 Congress a report on the furnishing of such care; 

20 and 

21 ‘‘(2) analyze the future demand for such care 

22 or service from such provider. 

23 ‘‘(c) NEW CONTRACTS AND AGREEMENTS.—The Sec24 retary shall take reasonable efforts to enter into a con25 tract, agreement, or other arrangement with a provider 

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


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1 services authorized by the Secretary and furnished by the 

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

3 other arrangement. 

4 ‘‘(d) DEFINITIONS.—In this section: 

5 ‘‘(1) The term ‘appropriate committees of Con6 gress’ means— 

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

8 and the Committee on Appropriations of the 

9 Senate; and 

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

11 and the Committee on Appropriations of the 

12 House of Representatives. 

13 ‘‘(2) The terms ‘hospital care’ and ‘medical 

14 service’ have the meanings given such terms in sec15 tion 1701 of this title.’’. 

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

17 at the beginning of such chapter is amended by inserting 

18 after the item relating to section 8158 the following new 

19 item: 

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


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1 TITLE II—STREAMLINING 

2 COMMUNITY CARE PROGRAMS 

3 Subtitle A—Streamlining 

4 Community Care Programs 

5 SEC. 201. ACCESS TO WALK-IN CARE. 

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

8 ‘‘§ 1725A. Access to walk-in care 

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

12 from qualifying non-Department entities or providers. 

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

14 section, a covered veteran is any veteran described in sec15 tion 1703(b) of this title. 

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

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

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

19 entity or provider that— 

20 ‘‘(1) has entered into a contract or other agree21 ment with the Secretary to furnish services under 

22 this section; or 

23 ‘‘(2) entered into an agreement with the Sec24 retary that was in effect on the day before the date 


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1 of the enactment of the Veterans Community Care 

2 and Access Act of 2017 to furnish walk-in care. 

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

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

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

7 carry out this section. 

8 ‘‘(e) CONTINUITY OF CARE.—(1) The Secretary shall 

9 ensure continuity of care for each covered veteran who re10 ceives a walk-in care service under this section through 

11 the care coordination team provided such covered veteran 

12 under section 1703(e)(1) of this title. 

13 ‘‘(2) The Secretary shall inform and educate covered 

14 veterans on procedures to utilize and access walk-in care 

15 under this section. 

16 ‘‘(3) The Secretary shall develop a mechanism to co17 ordinate with qualifying non-Department entities or pro18 viders through the care coordination teams provided under 

19 section 1703(e)(1) of this title that includes the use of 

20 medical records from walk-in care providers to accurately 

21 represent access to care, health needs of the covered vet22 erans, and to monitor conditions of covered veterans. 

23 ‘‘(f) COPAYMENTS.—(1) The Secretary shall require 

24 each covered veteran to pay the United States a copay25 ment for each episode of walk-in care provided under this 


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1 section, except if the episode of walk-in care for the cov2 ered veteran is related to a service-connected disability of 

3 the covered veteran. 

4 ‘‘(2) The Secretary may adjust the copayment re5 quired of a covered veteran under this subsection based 

6 upon the priority group of enrollment of the veteran, the 

7 number of episodes of care furnished to a covered veteran 

8 during a year, and other factors the Secretary considers 

9 appropriate under this section. 

10 ‘‘(3) The amount or amounts of the copayments re11 quired under this subsection shall be prescribed by the 

12 Secretary by rule. 

13 ‘‘(4) Copayments required by this subsection shall 

14 apply notwithstanding any other provision of law that 

15 would allow the Secretary to offset a covered veteran’s co16 payment obligation with amounts recovered from a third 

17 party under section 1729 of this title. 

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

19 the date of the enactment of the Veterans Community 

20 Care and Access Act of 2017, the Secretary shall promul21 gate regulations to carry out this section. 

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

23 term ‘walk-in care’ means non-urgent, non-emergent, con24 venience care provided by a qualifying non-Department 

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1 gitudinal management of conditions and certain services 

2 as defined through contracts or agreements described in 

3 subsection (c) or regulations the Secretary shall prescribe 

4 for purposes of this section.’’. 

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

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

7 effect on the date upon which final regulations imple8 menting such section take effect. 

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

10 at the beginning of such chapter is amended by inserting 

11 after the item related to section 1725 the following new 

12 item: 

‘‘§1725A. Access to walk-in care.’’. 

13 SEC. 202. VETERANS CHOICE FUND FLEXIBILITY. 

14 Section 802 of the Veterans Access, Choice, and Ac15 countability Act of 2014 (Public Law 113–146; 38 U.S.C. 

16 1701 note) is amended— 

17 (1) in subsection (c)— 

18 (A) in paragraph (1), by striking ‘‘by para19 graph (3)’’ and inserting ‘‘in paragraphs (3) 

20 and (4)’’; and 

21 (B) by adding at the end the following new 

22 paragraph: 

23 ‘‘(4) PERMANENT AUTHORITY FOR OTHER

24 USES.—Beginning in fiscal year 2019, amounts re25 maining in the Veterans Choice Fund may be used 


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1 to furnish hospital care, medical services, and ex2 tended care services to individuals pursuant to chap3 ter 17 of title 38, United States Code, at non-De4 partment facilities or through non-Department pro5 viders at Department facilities, including pursuant 

6 to non-Department provider programs other than 

7 the program established by section 101. Such 

8 amounts shall be available in addition to amounts 

9 available in other appropriations accounts for such 

10 purposes.’’; and 

11 (2) in subsection (d)(1), by striking ‘‘to sub12 section (c)(3)’’ and inserting ‘‘to paragraphs (3) and 

13 (4) of subsection (c)’’. 

14 SEC. 203. CONFORMING AMENDMENTS. 

15 (a) IN GENERAL.— 

16 (1) TITLE 38.—Title 38, United States Code, is 

17 amended— 

18 (A) in section 1712(a)— 

19 (i) in paragraph (3), by striking 

20 ‘‘under clause (1), (2), or (5) of section 

21 1703(a) of this title’’ and inserting ‘‘or en22 tered an agreement’’; and 

23 (ii) in paragraph (4)(A), by striking 

24 ‘‘under the provisions of this subsection 

25 and section 1703 of this title’’; 


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1 (B) in section 1712A(e)(1)— 

2 (i) by inserting ‘‘or agreements’’ after 

3 ‘‘contracts’’; and 

4 (ii) by striking ‘‘(under sections 

5 1703(a)(2) and 1710(a)(1)(B) of this 

6 title)’’; and 

7 (C) in section 2303(a)(2)(B)(i), by striking 

8 ‘‘with section 1703’’ and inserting ‘‘with sec9 tions 1703A, 8111, and 8153’’. 

10 (2) SOCIAL SECURITY ACT.—Section 

11 1866(a)(1)(L) of the Social Security Act (42 U.S.C. 

12 1395cc(a)(1)(L)) is amended by striking ‘‘under sec13 tion 1703’’ and inserting ‘‘under chapter 17’’. 

14 (3) VETERANS’ BENEFITS IMPROVEMENTS ACT

15 OF 1994.—Section 104(a)(4)(A) of the Veterans’ 

16 Benefits Improvements Act of 1994 (Public Law 

17 103–446; 38 U.S.C. 1117 note) is amended by strik18 ing ‘‘in section 1703’’ and inserting ‘‘in sections 

19 1703A, 8111, and 8153’’. 

20 (b) EFFECTIVE DATE.—The amendments made by 

21 subsection (a) shall take effect on the date described in 

22 section 101(b)(2). 


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1 Subtitle B—Improving Information 

2 Sharing With Providers 

3 SEC. 211. IMPROVING INFORMATION SHARING WITH COM4 MUNITY PROVIDERS. 

5 Section 7332(b)(2) is amended by striking subpara6 graph (H) and inserting the following new subparagraphs: 

7 ‘‘(H)(i) To a non-Department entity (including 

8 private entities and other Federal agencies) for pur9 poses of providing health care, including hospital 

10 care, medical services, and extended care services, to 

11 patients. 

12 ‘‘(ii) An entity to which a record is disclosed 

13 under this subparagraph may not disclose or use 

14 such record for a purpose other than that for which 

15 the disclosure was made. 

16 ‘‘(I) To a third party in order to recover or col17 lect reasonable charges for care furnished to, or paid 

18 on behalf of, a patient in connection with a non-serv19 ice connected disability as permitted by section 1729 

20 of this title or for a condition for which recovery is 

21 authorized or with respect to which the United 

22 States is deemed to be a third party beneficiary 

23 under the Act entitled ‘An Act to provide for the re24 covery from tortiously liable third persons of the cost 

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1 nished by the United States’ (Public Law 87–693; 

2 42 U.S.C. 2651 et seq.; commonly known as the 

3 ‘Federal Medical Care Recovery Act’).’’. 

4 SEC. 212. ESTABLISHMENT OF PROCESSES TO ENSURE 

5 SAFE OPIOID PRESCRIBING PRACTICES BY 

6 NON-DEPARTMENT OF VETERANS AFFAIRS 

7 HEALTH CARE PROVIDERS. 

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

9 Secretary of Veterans Affairs shall ensure that all covered 

10 health care providers are provided a copy of and certify 

11 that they have reviewed the evidence-based guidelines for 

12 prescribing opioids set forth by the Opioid Safety Initia13 tive of the Department of Veterans Affairs under sections 

14 911(a)(2) and 912(c) of the Jason Simcakoski Memorial 

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

16 note) before first providing care under the laws adminis17 tered by the Secretary and at any time when those guide18 lines are modified thereafter. 

19 (b) INCLUSION OF MEDICAL HISTORY AND CURRENT

20 MEDICATIONS.—The Secretary shall implement a process 

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

22 care provider is authorized under the laws administered 

23 by the Secretary, the document authorizing such care in24 cludes the relevant medical history of the veteran and a 

25 list of all medications prescribed to the veteran. 


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1 (c) SUBMITTAL OF PRESCRIPTIONS.— 

2 (1) IN GENERAL.—Except as provided in para3 graph (3), the Secretary shall require, to the max4 imum extent practicable, each covered health care 

5 provider to submit prescriptions for opioids— 

6 (A) to the Department for prior authoriza7 tion for the prescribing of a limited amount of 

8 opioids under contracts the Department has 

9 with retail pharmacies; or 

10 (B) directly to a pharmacy of the Depart11 ment for the dispensing of such prescription. 

12 (2) DEPARTMENT RESPONSIBILITY.—In car13 rying out paragraph (1), upon receipt by the De14 partment of a prescription for opioids for a veteran 

15 under the laws administered by the Secretary, the 

16 Secretary shall— 

17 (A) record such prescription in the elec18 tronic health record of the veteran; and 

19 (B) monitor such prescription as outlined 

20 in the Opioid Safety Initiative of the Depart21 ment. 

22 (3) EXCEPTION.— 

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

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


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1 to submit an opioid prescription directly to a 

2 pharmacy of the Department if— 

3 (i) the health care provider determines 

4 that there is an immediate medical need 

5 for the prescription, including an urgent or 

6 emergent prescription or a prescription dis7 pensed as part of an opioid treatment pro8 gram that provides office-based medica9 tions; and 

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

11 matter, a pharmacy of the Department no12 tifies the health care provider that it can13 not fill the prescription in a timely man14 ner; or 

15 (II) the health care provider deter16 mines that the requirement under para17 graph (1)(B) would impose an undue hard18 ship on the veteran, including with respect 

19 to travel distances, as determined by the 

20 Secretary. 

21 (B) NOTIFICATION TO DEPARTMENT.—If a 

22 covered health care provider uses an exception 

23 under subparagraph (A) with respect to an 

24 opioid prescription for a veteran, the health 

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1 scription is written, submit to the Secretary for 

2 inclusion in the electronic health record of the 

3 veteran a notice, in such form as the Secretary 

4 may establish, providing information about the 

5 prescription and describing the reason for the 

6 exception. 

7 (C) REPORT.— 

8 (i) IN GENERAL.—Not less frequently 

9 than quarterly, the Secretary shall submit 

10 to the Committee on Veterans’ Affairs of 

11 the Senate and the Committee on Vet12 erans’ Affairs of the House of Representa13 tives a report evaluating the compliance of 

14 covered health care providers with the re15 quirements under this paragraph and set16 ting forth data on the use by health care 

17 providers of exceptions under subpara18 graph (A) and notices under subparagraph 

19 (B). 

20 (ii) ELEMENTS.—Each report re21 quired by clause (i) shall include the fol22 lowing with respect to the quarter covered 

23 by the report: 

24 (I) The number of exceptions 

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1 tices received under subparagraph 

2 (B). 

3 (II) The rate of compliance by 

4 the Department with the requirement 

5 under subparagraph (B) to include 

6 such notices in the health records of 

7 veterans. 

8 (III) The identification of any 

9 covered health care providers that, 

10 based on criteria prescribed the Sec11 retary, are determined by the Sec12 retary to be statistical outliers regard13 ing the use of exceptions under sub14 paragraph (A). 

15 (d) USE OF OPIOID SAFETY INITIATIVE GUIDE16 LINES.— 

17 (1) IN GENERAL.—If a director of a medical 

18 center of the Department or a Veterans Integrated 

19 Service Network determines that the opioid pre20 scribing practices of a covered health care provider 

21 conflicts with or is otherwise inconsistent with the 

22 standards of appropriate and safe care, as that term 

23 is used in section 913(d) of the Jason Simcakoski 

24 Memorial and Promise Act (Public Law 114–198; 

25 38 U.S.C. 1701 note), the director shall take such 


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1 action as the director considers appropriate to en2 sure the safety of all veterans receiving care from 

3 that health care provider, including removing or di4 recting the removal of any such health care provider 

5 from provider networks or otherwise refusing to au6 thorize care of veterans by such health care provider 

7 in any program authorized under the laws adminis8 tered by the Secretary. 

9 (2) INCLUSION IN CONTRACTS.—The Secretary 

10 shall ensure that any contracts entered into by the 

11 Secretary with third parties involved in admin12 istering programs that provide care in the commu13 nity to veterans under the laws administered by the 

14 Secretary specifically grant the authority set forth in 

15 paragraph (1) to such third parties and to the direc16 tors described in that paragraph, as the case may 

17 be. 

18 (e) DENIAL OR REVOCATION OF ELIGIBILITY OF

19 NON-DEPARTMENT PROVIDERS.—The Secretary shall 

20 deny or revoke the eligibility of a non-Department health 

21 care provider to provide health care to veterans under the 

22 laws administered by the Secretary if the Secretary deter23 mines that the opioid prescribing practices of the pro24 vider— 


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1 (1) violate the requirements of a medical license 

2 of the health care provider; or 

3 (2) detract from the ability of the health care 

4 provider to deliver safe and appropriate health care. 

5 (f) COVERED HEALTH CARE PROVIDER DEFINED.— 

6 In this section, the term ‘‘covered health care provider’’ 

7 means a non-Department of Veterans Affairs health care 

8 provider who provides health care to veterans under the 

9 laws administered by the Secretary of Veterans Affairs. 

10 Subtitle C—Improving Collections 

11 SEC. 221. ALIGNING WITH BEST PRACTICES ON COLLEC12 TION OF HEALTH INSURANCE INFORMATION. 

13 Section 1705A is amended— 

14 (1) in subsection (a)(1), by striking ‘‘Any indi15 vidual’’ and all that follows through ‘‘covered.’’ and 

16 inserting the following: ‘‘Any individual who applies 

17 for or seeks hospital care or medical services under 

18 this chapter shall, at the time of such application, or 

19 otherwise when requested by the Secretary, furnish 

20 the Secretary with such current information as the 

21 Secretary may require to identify any health-plan 

22 contract, as defined in subsection (i)(l) of section 

23 1729, under which such individual is covered, to in24 clude, as applicable, the name, address, and tele25 phone number of such health-plan contract; the 


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1 name of the policy holder, if coverage under a 

2 health-plan contract is in the name of a person other 

3 than such individual; the plan identification number; 

4 and the group code of the plans.’’; and 

5 (2) in subsection (c)— 

6 (A) by striking ‘‘The Secretary’’ and in7 serting ‘‘(1) Except as provided in paragraph 

8 (2), the Secretary’’; and 

9 (B) by adding at the end the following new 

10 paragraph: 

11 ‘‘(2) The Secretary may charge an individual who 

12 does not provide the information required by subsection 

13 (a) reasonable charges for the provision of such care and 

14 services.’’. 

15 SEC. 222. IMPROVING AUTHORITY TO COLLECT. 

16 (a) BROADENING SCOPE OF APPLICABILITY.—Sec17 tion 1729 is amended— 

18 (1) in subsection (a)— 

19 (A) in paragraph (2)(A)— 

20 (i) by striking ‘‘the veteran’s’’ and in21 serting ‘‘the individual’s’’; and 

22 (ii) by striking ‘‘the veteran’’ and in23 serting ‘‘the individual’’; and 

24 (B) in paragraph (3)— 


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1 (i) in the matter preceding subpara2 graph (A), by striking ‘‘the veteran’’ and 

3 inserting ‘‘the individual’’; and 

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

5 ‘‘the veteran’s’’ and inserting ‘‘the individ6 ual’s’’; 

7 (2) in subsection (b)— 

8 (A) in paragraph (1)— 

9 (i) by striking ‘‘the veteran’’ and in10 serting ‘‘the individual’’; and 

11 (ii) by striking ‘‘the veteran’s’’ and in12 serting ‘‘the individual’s’’; and 

13 (B) in paragraph (2)— 

14 (i) in subparagraph (A)— 

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

16 inserting ‘‘the individual’’; and 

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

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

19 (ii) in subparagraph (B)— 

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

21 veteran’’ and inserting ‘‘the indi22 vidual’’; and 

23 (II) in clause (ii)— 


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1 (aa) by striking ‘‘the vet2 eran’’ and inserting ‘‘the indi3 vidual’’; and 

4 (bb) by striking ‘‘the vet5 eran’s’’ each place it appears and 

6 inserting ‘‘the individual’s’’; 

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

8 and inserting ‘‘An individual’’; and 

9 (4) in subsection (h)— 

10 (A) in paragraph (1)— 

11 (i) in the matter preceding subpara12 graph (A), by striking ‘‘a veteran’’ and in13 serting ‘‘an individual’’; 

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

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

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

18 ‘‘the veteran’’ and inserting ‘‘the indi19 vidual’’; and 

20 (B) in paragraph (2)— 

21 (i) by striking ‘‘A veteran’’ and insert22 ing ‘‘An individual’’; 

23 (ii) by striking ‘‘a veteran’’ and in24 serting ‘‘an individual’’; and 


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1 (iii) by striking ‘‘the veteran’’ and in2 serting ‘‘the individual’’. 

3 (b) ADDITIONAL AMENDMENTS.—Such section is fur4 ther amended— 

5 (1) in subsection (a)— 

6 (A) in paragraph (1), by striking ‘‘(1) Sub7 ject’’ and all that follows through the period 

8 and inserting the following: ‘‘(1) Subject to the 

9 provisions of this section, in any case in which 

10 the United States is required by law to furnish 

11 or pay for care or services under this chapter 

12 for a non-service-connected disability described 

13 in paragraph (2) of this subsection, the United 

14 States has the right to recover or collect from 

15 a third party the reasonable charges of care or 

16 services so furnished or paid for to the extent 

17 that the recipient or provider of the care or 

18 services would be eligible to receive payment for 

19 such care or services from such third party if 

20 the care or services had not been furnished or 

21 paid for by a department or agency of the 

22 United States.’’; 

23 (B) in paragraph (2)— 

24 (i) in subparagraph (C), by striking 

25 the semicolon and inserting ‘‘; or’’; 


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1 (ii) by amending subparagraph (D) to 

2 read as follows: 

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

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

5 under a health-plan contract.’’; and 

6 (iii) by striking subparagraph (E); 

7 and 

8 (C) by adding at the end the following new 

9 paragraph: 

10 ‘‘(4) In the case of a health-plan contract where the 

11 United States has a right to recover or collect reasonable 

12 charges, the Secretary shall collect from a veteran or re13 sponsible individual any copayment or cost-share required 

14 under this chapter.’’; 

15 (2) in subsection (b), by adding at the end the 

16 following new paragraph: 

17 ‘‘(3)(A) The obligation of the third party to pay is 

18 not dependent upon an individual executing an assignment 

19 of benefits to the United States, nor is the obligation to 

20 pay dependent upon any other submission by the bene21 ficiary to the third party, including any claim or appeal. 

22 ‘‘(B) In any case in which the Secretary makes a 

23 claim, appeal, representation, or other filing under the au24 thority of this chapter, any procedural requirement in any 

25 third-party plan for the beneficiary of such plan to make 


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1 the claim, appeal, representation, or other filing is deemed 

2 to be satisfied.’’; and 

3 (3) in subsection (f)— 

4 (A) by inserting ‘‘(1)’’ before ‘‘No law’’; 

5 and 

6 (B) by adding at the end the following new 

7 paragraph: 

8 ‘‘(2) The absence of a participating provider agree9 ment, Veterans Care Agreement, or other contractual ar10 rangement with a third party described in subsection 

11 (i)(3)(D) shall not operate to prevent, or reduce the 

12 amount of, any such recovery or collection by the United 

13 States. For purposes of this section, the Department shall 

14 recover or collect as if it were a participating provider.’’; 

15 and 

16 (c) DEFINITIONS.—Subsection (i) of such section is 

17 amended to read as follows: 

18 ‘‘(i) In this section: 

19 ‘‘(1) The term ‘health-plan contract’ includes 

20 any of the following: 

21 ‘‘(A) An insurance policy or contract in22 cluding any health maintenance organization, 

23 preferred provider organization, point of service 

24 organization, accountable care organization, or 

25 any other type of health insurance policy or 


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1 contract, medical or hospital service agreement, 

2 membership or subscription contract, or similar 

3 arrangement under which hospital care or med4 ical services for individuals are provided or the 

5 expenses of such services are paid. 

6 ‘‘(B) A workers’ compensation law or plan. 

7 ‘‘(2) The term ‘payment’ includes reimburse8 ment and indemnification. 

9 ‘‘(3) The term ‘third party’ means any of the 

10 following: 

11 ‘‘(A) A State or political subdivision of a 

12 State. 

13 ‘‘(B) An employer or an employer’s insur14 ance carrier. 

15 ‘‘(C) An automobile accident reparations 

16 or liability insurance carrier. 

17 ‘‘(D) A person or entity obligated to pro18 vide, or to pay the expenses of, health services 

19 under a health-plan contract. 

20 ‘‘(4) The term ‘reasonable charges’ shall include 

21 the following: 

22 ‘‘(A) For hospital care or medical services 

23 furnished by the Department, charges estab24 lished in accordance with this section. 


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1 ‘‘(B) For hospital care or medical services 

2 paid for under subparagraphs (A) and (B) of 

3 subsection (a)(2), the amount paid to a non-De4 partment entity or provider.’’. 

5 TITLE III—IMPROVING DEPART6 MENT OF VETERANS AFFAIRS 

7 CARE DELIVERY 

8 Subtitle A—Improving Personnel 

9 Practices 

10 SEC. 301. LICENSURE OF HEALTH CARE PROFESSIONALS 

11 OF THE DEPARTMENT OF VETERANS AF12 FAIRS PROVIDING TREATMENT VIA TELE13 MEDICINE. 

14 (a) IN GENERAL.—Chapter 17, as amended by sec15 tion 102, is further amended by adding at the end the 

16 following new section: 

17 ‘‘§ 1730C. Licensure of health care professionals pro18 viding treatment via telemedicine 

19 ‘‘(a) IN GENERAL.—Notwithstanding any provision 

20 of law regarding the licensure of health care professionals, 

21 a covered health care professional may practice the health 

22 care profession of the health care professional at any loca23 tion in any State, regardless of where in a State the cov24 ered health care professional or the patient is located, if 


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1 the covered health care professional is using telemedicine 

2 to provide treatment to an individual under this chapter. 

3 ‘‘(b) COVERED HEALTH CARE PROFESSIONALS.— 

4 For purposes of this section, a covered health care profes5 sional is any health care professional who— 

6 ‘‘(1) is an employee of the Department ap7 pointed under this title or title 5; 

8 ‘‘(2) is authorized by the Secretary to provide 

9 health care under this chapter; 

10 ‘‘(3) is required to adhere to all standards for 

11 quality relating to the provision of medicine in ac12 cordance with applicable policies of the Department; 

13 and 

14 ‘‘(4) has an active, current, full, and unre15 stricted license, registration, or certification in a 

16 State to practice the health care profession of the 

17 health care professional. 

18 ‘‘(c) PROPERTY OF FEDERAL GOVERNMENT.—Sub19 section (a) shall apply to a covered health care professional 

20 providing treatment to a patient regardless of whether the 

21 covered health care professional or patient is located in 

22 a facility owned by the Federal Government during such 

23 treatment. 

24 ‘‘(d) RELATION TO STATE LAW.—(1) The provisions 

25 of this section shall supersede any provisions of the law 


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1 of any State to the extent that such provision of State 

2 law are inconsistent with this section. 

3 ‘‘(2) No State shall deny or revoke the license, reg4 istration, or certification of a covered health care profes5 sional who otherwise meets the qualifications of the State 

6 for holding the license, registration, or certification on the 

7 basis that the covered health care professional has en8 gaged or intends to engage in activity covered by sub9 section (a). 

10 ‘‘(e) RULE OF CONSTRUCTION.—Nothing in this sec11 tion may be construed to remove, limit, or otherwise affect 

12 any obligation of a covered health care professional under 

13 the Controlled Substances Act (21 U.S.C. 801 et seq.).’’. 

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

15 at the beginning of chapter 17 of such title is amended 

16 by inserting after the item relating to section 1730B, as 

17 added by section 102, the following new item: 

‘‘1730C. Licensure of health care professionals providing treatment via telemedicine.’’. 

18 (c) REPORT ON TELEMEDICINE.— 

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

20 after the earlier of the date on which services pro21 vided under section 1730C of title 38, United States 

22 Code, as added by subsection (a), first occur or reg23 ulations are promulgated to carry out such section, 

24 the Secretary of Veterans Affairs shall submit to the 


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1 Committee on Veterans’ Affairs of the Senate and 

2 the Committee on Veterans’ Affairs of the House of 

3 Representatives a report on the effectiveness of the 

4 use of telemedicine by the Department of Veterans 

5 Affairs. 

6 (2) ELEMENTS.—The report required by para7 graph (1) shall include an assessment of the fol8 lowing: 

9 (A) The satisfaction of veterans with tele10 medicine furnished by the Department. 

11 (B) The satisfaction of health care pro12 viders in providing telemedicine furnished by 

13 the Department. 

14 (C) The effect of telemedicine furnished by 

15 the Department on the following: 

16 (i) The ability of veterans to access 

17 health care, whether from the Department 

18 or from non-Department health care pro19 viders. 

20 (ii) The frequency of use by veterans 

21 of telemedicine. 

22 (iii) The productivity of health care 

23 providers. 


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1 (iv) Wait times for an appointment 

2 for the receipt of health care from the De3 partment. 

4 (v) The use by veterans of in-person 

5 services at Department facilities and non6 Department facilities. 

7 (D) The types of appointments for the re8 ceipt of telemedicine furnished by the Depart9 ment that were provided during the one-year 

10 period preceding the submittal of the report. 

11 (E) The number of appointments for the 

12 receipt of telemedicine furnished by the Depart13 ment that were requested during such period, 

14 disaggregated by medical facility. 

15 (F) Savings by the Department, if any, in16 cluding travel costs, from furnishing health care 

17 through the use of telemedicine during such pe18 riod. 

19 SEC. 302. GRADUATE MEDICAL EDUCATION AND RESI20 DENCY. 

21 (a) INCREASE IN NUMBER OF GRADUATE MEDICAL

22 EDUCATION RESIDENCY POSITIONS.— 

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

24 Affairs shall increase the number of graduate med25 ical education residency positions at covered facilities 


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1 by not fewer than 1,500 positions in the 10-year pe2 riod beginning on the date of the enactment of this 

3 Act. 

4 (2) COVERED FACILITIES.—For purposes of 

5 this section, a covered facility is any of the following: 

6 (A) A facility of the Department of Vet7 erans Affairs. 

8 (B) A facility operated by an Indian tribe 

9 or a tribal organization, as those terms are de10 fined in section 4 of the Indian Self-Determina11 tion and Education Assistance Act (25 U.S.C. 

12 5304). 

13 (C) A facility operated by the Indian 

14 Health Service. 

15 (D) A Federally-qualified health center, as 

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

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

18 (E) A community health center. 

19 (F) A facility operated by the Department 

20 of Defense. 

21 (G) Such other health care facility as the 

22 Secretary considers appropriate for purposes of 

23 this section. 

24 (3) STIPENDS AND BENEFITS.—The Secretary 

25 may pay stipends and provide benefits for residents 


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1 in positions under paragraph (1), regardless of 

2 whether they have been assigned in a Department 

3 facility. 

4 (4) PARAMETERS FOR LOCATION, AFFILIATE

5 SPONSOR, AND DURATION.—When determining char6 acteristics of residency positions under paragraph 

7 (1), the Secretary shall consider the extent to which 

8 there is a clinical need for providers, as determined 

9 by the market area assessment most recently per10 formed under section 1730B(c) of title 38, United 

11 States Code, as added by section 102. 

12 (5) PARAMETERS FOR TYPES OF SPECIAL13 TIES.—When determining the types of specialties to 

14 be included in residency positions under paragraph 

15 (1), the Secretary shall consider the following: 

16 (A) The types of specialties that improve 

17 the quality and coverage of medical services 

18 provided to veterans. 

19 (B) The range of clinical specialties cov20 ered by providers in standardized geographic 

21 areas surrounding facilities. 

22 (C) Whether the specialty is included in 

23 the most recent staffing shortage determination 

24 of the Department under section 7412 of title 

25 38, United States Code. 


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1 (D) The most recent market area assess2 ment performed under section 1730B(c) of title 

3 38, United States Code, as added by section 

4 102. 

5 (b) APPLICATION TO PARTICIPATE.—To participate 

6 as a resident in one of the positions increased under sub7 section (a)(1), an individual shall submit to the Secretary 

8 an application therefor together with an agreement de9 scribed in subsection (d) under which the participant 

10 agrees to serve a period of obligated service in the Vet11 erans Health Administration as provided in the agreement 

12 in return for payment of stipend and benefit support as 

13 provided in the agreement. 

14 (c) SELECTION.— 

15 (1) IN GENERAL.—An individual becomes a 

16 participant in a residency program under this sec17 tion upon the Secretary’s approval of the individual’s 

18 application under subsection (b) and the Secretary’s 

19 acceptance of the agreement under subsection (d) (if 

20 required). 

21 (2) NOTICE.—Upon the Secretary’s approval of 

22 an individual’s participation in the program under 

23 paragraph (1), the Secretary shall promptly notify 

24 the individual of that approval. Such notice shall be 

25 in writing. 


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1 (d) AGREEMENT.— 

2 (1) IN GENERAL.—An agreement between the 

3 Secretary and a resident in a position under sub4 section (a)(1) shall be in writing and shall be signed 

5 by the resident containing such terms as the Sec6 retary may specify. 

7 (2) REQUIREMENTS.—The agreement must 

8 specify the terms of the service obligation resulting 

9 from participating as a resident under this section, 

10 including by requiring a service obligation equal to 

11 the number of years of stipend and benefit support. 

12 (e) CONDITIONS OF EMPLOYMENT.—The Secretary 

13 may prescribe the conditions of employment of persons ap14 pointed to positions under subsection (a)(1), including 

15 necessary training, and the customary amount and terms 

16 of pay for such positions during the period of such employ17 ment and training. 

18 (f) OBLIGATED SERVICE.— 

19 (1) IN GENERAL.—Each person appointed to a 

20 position under subsection (a)(1) shall provide service 

21 as a full-time employee of the Department for the 

22 period of obligated service provided in the agreement 

23 of the participant entered into under subsection (d). 

24 Such service shall be provided in the full-time clin25 ical practice of such participant’s profession or in 


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1 another health-care position in an assignment or lo2 cation determined by the Secretary. 

3 (2) COMMENCEMENT DATE.—Not later than 60 

4 days before the date on which a person commences 

5 serving in a position under subsection (a)(1), the 

6 Secretary shall notify the person of such date. Such 

7 date shall be the first day of the person’s period of 

8 obligated service. 

9 (g) BREACH OF AGREEMENT: LIABILITY.— 

10 (1) PENALTY.—A person appointed under this 

11 section to a position under subsection (a)(1) (other 

12 than a person who is liable under paragraph (2)) 

13 who fails to accept payment, or instructs the edu14 cational institution in which the person is enrolled 

15 not to accept payment, in whole or in part, for a 

16 residency under the agreement entered into under 

17 subsection (d) of this title shall be liable to the 

18 United States for liquidated damages in the amount 

19 of $1,500. Such liability is in addition to any period 

20 of obligated service or other obligation or liability 

21 under the agreement. 

22 (2) LIABILITY.— 

23 (A) IN GENERAL.—A person appointed to 

24 a position under subsection (a)(1) shall be liable 

25 to the United States for the amount which has 


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1 been paid to or on behalf of the person under 

2 the agreement if any of the following occurs: 

3 (i) The person is dismissed from the 

4 position for disciplinary reasons. 

5 (ii) The person voluntarily terminates 

6 the residency before the completion of such 

7 course of training. 

8 (iii) The person loses the person’s li9 cense, registration, or certification to prac10 tice the person’s health care profession in 

11 a State. 

12 (B) LIABILITY SUPPLANTS SERVICE OBLI13 GATION.—Liability under this paragraph is in 

14 lieu of any service obligation arising under the 

15 person’s agreement under subsection (d). 

16 (h) RECOVERY.— 

17 (1) IN GENERAL.—If a person breaches the per18 son’s agreement under subsection (d) by failing (for 

19 any reason) to complete such person’s period of obli20 gated service, the United States shall be entitled to 

21 recover from the person an amount equal to the 

22 product of— 

23 (A) three; 

24 (B) the sum of— 


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1 (i) the amounts paid under this sec2 tion to or on behalf of the person; and 

3 (ii) the interest on such amounts that 

4 would be payable if at the time the 

5 amounts were paid they were loans bearing 

6 interest at the maximum legal prevailing 

7 rate, as determined by the Treasurer of 

8 the United States; and 

9 (C) the quotient of— 

10 (i) the difference between— 

11 (I) the total number of months in 

12 the person’s period of obligated serv13 ice; and 

14 (II) the number of months of 

15 such period served by the person; and 

16 (ii) the total number of months in the 

17 person’s period of obligated service. 

18 (2) PERIOD OF RECOVERY.—Any amount which 

19 the United States is entitled to recover under this 

20 subsection shall be paid to the United States not 

21 later than the date that is one year after the date 

22 of the breach of the agreement. 

23 (i) ANNUAL REPORT.— 

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

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


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1 less frequently than once each year thereafter, the 

2 Secretary shall submit to the appropriate committees 

3 of Congress a report on the implementation of this 

4 section during the previous year. 

5 (2) CONTENTS.—Each report submitted under 

6 paragraph (1) shall include, for the period covered 

7 by the report, the following: 

8 (A) The number of positions described in 

9 subsection (a) that were filled. 

10 (B) The location of each such position. 

11 (C) The academic affiliate associated with 

12 each such position. 

13 (D) A description of the challenges faced 

14 in filling the positions described in subsection 

15 (a) and the actions the Secretary has taken to 

16 address such challenges. 

17 (3) APPROPRIATE COMMITTEES OF CONGRESS

18 DEFINED.—In this subsection, the term ‘‘appro19 priate committees of Congress’’ means— 

20 (A) the Committee on Veterans’ Affairs 

21 and the Committee on Appropriations of the 

22 Senate; and 

23 (B) the Committee on Veterans’ Affairs 

24 and the Committee on Appropriations of the 

25 House of Representatives. 


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1 SEC. 303. ANNUAL REPORT ON AWARDS OR BONUSES 

2 AWARDED TO CERTAIN HIGH-LEVEL EMPLOY3 EES OF THE DEPARTMENT OF VETERANS AF4 FAIRS. 

5 (a) IN GENERAL.—Chapter 7 is amended by adding 

6 at the end the following new section: 

7 ‘‘§ 726. Annual report on awards to certain high-level 

8 employees 

9 ‘‘(a) IN GENERAL.—Not later than 30 days after the 

10 end of each fiscal year, the Secretary shall submit to the 

11 appropriate committees of Congress a report that con12 tains, for the most recent fiscal year ending before the 

13 submittal of the report, a description of the performance 

14 awards and bonuses awarded to Regional Office Directors 

15 of the Department, Directors of Medical Centers of the 

16 Department, and Directors of Veterans Integrated Service 

17 Networks. 

18 ‘‘(b) ELEMENTS.—Each report submitted under sub19 section (a) shall include the following with respect to each 

20 award or bonus awarded to an individual described in such 

21 subsection: 

22 ‘‘(1) The type of award or bonus, specifically 

23 those awarded for performance or on the basis of re24 cruitment, relocation and retention as the case may 

25 be. 

26 ‘‘(2) The amount of each award or bonus. 


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1 ‘‘(3) The job title of the individual awarded the 

2 award or bonus. 

3 ‘‘(4) The location where the individual awarded 

4 the award or bonus works. 

5 ‘‘(c) APPROPRIATE COMMITTEES OF CONGRESS.—In 

6 this section, the term ‘appropriate committees of Con7 gress’ means— 

8 ‘‘(1) the Committee on Veterans’ Affairs and 

9 the Committee on Appropriations of the Senate; and 

10 ‘‘(2) the Committee on Veterans’ Affairs and 

11 the Committee on Appropriations of the House of 

12 Representatives.’’. 

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

14 at the beginning of chapter 7 of such title is amended by 

15 inserting after the item relating to section 725 the fol16 lowing new item: 

‘‘726. Annual report on awards to certain high-level employees.’’. 

17 Subtitle B—Facilities, 

18 Construction, and Leases 

19 SEC. 311. FACILITATING SHARING OF MEDICAL FACILITIES 

20 WITH OTHER FEDERAL AGENCIES. 

21 (a) CONSTRUCTION OR LEASE OF SHARED FACIL22 ITY.— 

23 (1) IN GENERAL.—Subchapter I of chapter 81 

24 is amended by inserting after section 8111A the fol25 lowing new section: 


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1 ‘‘§ 8111B. Authority to plan, design, construct, or 

2 lease a shared medical facility 

3 ‘‘(a) IN GENERAL.—(1) The Secretary may enter 

4 into agreements with other Federal agencies for the plan5 ning, designing, constructing, or leasing shared medical 

6 facilities with the goal of improving access to, and quality 

7 and cost effectiveness of, health care provided by the De8 partment and other Federal agencies. 

9 ‘‘(2) Facilities planned, designed, constructed, or 

10 leased under paragraph (1) shall be managed by the Di11 rector of the High-Performing Integrated Healthcare Net12 work of the Department designated under section 

13 1730B(a) of this title. 

14 ‘‘(b) TRANSFER OF AMOUNTS TO OTHER FEDERAL

15 AGENCIES.—(1) The Secretary may transfer to another 

16 Federal agency amounts appropriated to the Department 

17 for ‘Construction, Minor Projects’ for use for the plan18 ning, design, or construction of a shared medical facility 

19 if the estimated share of the project costs to be borne by 

20 the Department does not exceed the threshold for a major 

21 medical facility construction project under section 

22 8104(a)(3)(A) of this title. 

23 ‘‘(2) The Secretary may transfer to another Federal 

24 agency amounts appropriated to the Department for ‘Con25 struction, Major Projects’ for use for the planning, design, 

26 or construction of a shared medical facility if— 


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1 ‘‘(A) the estimated share of the project costs to 

2 be borne by the Department is more than the 

3 threshold for a major medical facility construction 

4 project under subsection (a)(3)(A) of section 8104 of 

5 this title; and 

6 ‘‘(B) the requirements for such a project under 

7 such section have been met. 

8 ‘‘(3) The Secretary may transfer to another Federal 

9 agency amounts appropriated to the applicable appropria10 tions account of the Department for the purpose of leasing 

11 space for a shared medical facility if the estimated share 

12 of the lease costs to be borne by the Department does not 

13 exceed the threshold for a major medical facility lease 

14 under section 8104(a)(3)(B) of this title. 

15 ‘‘(c) TRANSFER OF AMOUNTS TO DEPARTMENT.—(1) 

16 Amounts transferred to the Department by another Fed17 eral agency for the necessary expenses of planning, design18 ing, or constructing a shared medical facility for which 

19 the estimated share of the project costs to be borne by 

20 the Department does not exceed the threshold for a major 

21 medical facility project under section 8104(a)(3)(A) of this 

22 title may be deposited in the ‘Construction, Minor 

23 Projects’ account of the Department and used for such 

24 necessary expenses. 


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1 ‘‘(2) Amounts transferred to the Department by an2 other Federal agency for the necessary expenses of plan3 ning, designing, or constructing a shared medical facility 

4 for which the estimated share of the project costs to be 

5 borne by the Department is more than the threshold for 

6 a major medical facility project under section 

7 8104(a)(3)(A) of this title may be deposited in the ‘Con8 struction, Major Projects’ account of the Department and 

9 used for such necessary expenses if the requirements for 

10 such project under section 8104 of this title have been 

11 met. 

12 ‘‘(3) Amounts transferred to the Department by an13 other Federal agency for the purpose of leasing space for 

14 a shared medical facility may be credited to the applicable 

15 appropriations account of the Department and shall be 

16 available without fiscal year limitation. 

17 ‘‘(4) Amounts transferred under paragraphs (1) and 

18 (2) shall be available for the same time period as amounts 

19 in the account to which those amounts are transferred.’’. 

20 (2) CLERICAL AMENDMENT.—The table of sec21 tions at the beginning of such chapter is amended 

22 by inserting after the item relating to section 8111A 

23 the following new item: 

‘‘8111B. Authority to plan, design, construct, or lease a shared medical facility.’’ 


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1 (b) MODIFICATION OF DEFINITION OF MEDICAL FA2 CILITY.—Paragraph (3) of section 8101 is amended to 

3 read as follows: 

4 ‘‘(3) The term ‘medical facility’ means any fa5 cility or part thereof that is, or will be, under the 

6 jurisdiction of the Secretary, or as otherwise des7 ignated by law, for the provision of healthcare serv8 ices (including hospital care, outpatient care, nurs9 ing home care, domiciliary care, or medical services), 

10 including any necessary building and auxiliary struc11 ture, garage, parking facility, mechanical equipment, 

12 trackage facilities leading thereto, abutting side13 walks, accommodations for attending personnel, and 

14 recreation facilities associated therewith.’’. 

15 SEC. 312. REVIEW OF ENHANCED USE LEASES. 

16 Section 8162 is amended— 

17 (1) in subsection (a), by amending paragraph 

18 (2) to read as follows: 

19 ‘‘(2) With respect to enhanced-use leases entered into 

20 on or after the date of enactment of the Veterans Commu21 nity Care and Access Act of 2017, the Secretary may enter 

22 into an enhanced-use lease only if the Secretary deter23 mines that— 


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1 ‘‘(A) the lease will not be inconsistent with and 

2 will not adversely affect the mission of the Depart3 ment; and 

4 ‘‘(B)(i) the lease will enhance the use of the 

5 property; or 

6 ‘‘(ii) the leased property will provide supportive 

7 housing as defined in section 8161 of this title.’’; 

8 and 

9 (2) in subsection (b), by amending paragraph 

10 (6) to read as follows: 

11 ‘‘(6) The Director of the Office of Management and 

12 Budget shall review each such enhanced-use lease prior 

13 to execution for compliance with paragraph (5) of this 

14 subsection.’’. 

15 TITLE IV—INNOVATIVE PILOT 

16 PROGRAMS 

17 SEC. 401. PILOT PROGRAM TO ESTABLISH OR AFFILIATE 

18 WITH GRADUATE MEDICAL RESIDENCY PRO19 GRAMS AT FACILITIES OPERATED BY INDIAN 

20 TRIBES, TRIBAL ORGANIZATIONS, AND THE 

21 INDIAN HEALTH SERVICE IN RURAL AREAS. 

22 (a) PILOT PROGRAM REQUIRED.—The Secretary of 

23 Veterans Affairs, in consultation with the Director of the 

24 Indian Health Service, shall carry out a pilot program— 


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1 (1) to establish graduate medical education 

2 residency training programs at covered facilities; or 

3 (2) to affiliate with established programs de4 scribed in paragraph (1). 

5 (b) COVERED FACILITIES.—For purposes of the pilot 

6 program, a covered facility is any facility— 

7 (1) described in subparagraph (B) or (C) of 

8 section 302(a)(2); and 

9 (2) located in a rural or remote area, as deter10 mined by the Secretary and the Director of the In11 dian Health Service. 

12 (c) LOCATIONS.— 

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

14 out the pilot program at not more than five covered 

15 facilities that have been selected by the Secretary for 

16 purposes of the pilot program. 

17 (2) CRITERIA.—The Secretary shall establish 

18 criteria for selecting covered facilities under para19 graph (1). 

20 (d) DURATION.—The Secretary shall carry out the 

21 pilot program during the eight-year period beginning on 

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

23 of this Act. 

24 (e) REIMBURSEMENT OF COSTS.—The Secretary 

25 shall reimburse each covered facility participating in the 


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1 pilot program for the following costs associated with the 

2 pilot program: 

3 (1) Curriculum development. 

4 (2) Recruitment, training, supervision, and re5 tention of residents and faculty. 

6 (3) Accreditation of programs of education 

7 under the pilot program by the Accreditation Coun8 cil for Graduate Medical Education (ACGME) or the 

9 American Osteopathic Association (AOA). 

10 (4) The portion of faculty salaries attributable 

11 to activities relating to carrying out the pilot pro12 gram. 

13 (5) Payment for expenses relating to providing 

14 medical education under the pilot program. 

15 (6) Stipends and benefits. 

16 (f) PERIOD OF OBLIGATED SERVICE.— 

17 (1) IN GENERAL.—The Secretary shall enter 

18 into an agreement with each individual who partici19 pates in the pilot program under which such indi20 vidual agrees to serve under the same terms as es21 tablished under section 302. 

22 (2) LOAN REPAYMENT.—During the period of 

23 obligated service of an individual under paragraph 

24 (1), the individual— 


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1 (A) shall be deemed to be an eligible indi2 vidual under subsection (b) of section 108 of 

3 the Indian Health Care Improvement Act (25 

4 U.S.C. 1616a) for purposes of participation in 

5 the Indian Health Service Loan Repayment 

6 Program under such section during the portion 

7 of such period that the individual serves at a 

8 covered facility; and 

9 (B) shall be deemed to be an eligible indi10 vidual under section 7682(a) of title 38, United 

11 States Code, for purposes of participation in 

12 the Department of Veterans Affairs Education 

13 Debt Reduction Program under subchapter VII 

14 of chapter 76 of such title during the portion 

15 of such period that the individual serves at a fa16 cility of the Department. 

17 (3) CONCURRENT SERVICE.—Any period of ob18 ligated service required of an individual under para19 graph (1) shall be served— 

20 (A) with respect to service at a covered fa21 cility, concurrently with any period of obligated 

22 service required of the individual by the Indian 

23 Health Service; and 

24 (B) with respect to service at a facility of 

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1 rently with any period of obligated service re2 quired of the individual by the Department. 

3 (g) TREATMENT OF PARTICIPANTS.—A residency po4 sition into which a participant in the pilot program is 

5 placed as part of the pilot program shall be considered 

6 a position referred to in section 302(a)(1) for purposes 

7 of the limitation on number of new positions authorized 

8 under such section. 

9 (h) REPORT.—Not later than three years before the 

10 date on which the pilot program terminates, the Secretary 

11 of Veterans Affairs shall submit to the Committee on Vet12 erans’ Affairs of the Senate and the Committee on Vet13 erans’ Affairs of the House of Representatives a report 

14 on the feasibility and advisability of— 

15 (1) expanding the pilot program to additional 

16 locations; and 

17 (2) making the pilot program or any aspect of 

18 the pilot program permanent. 

19 SEC. 402. AUTHORITY FOR DEPARTMENT OF VETERANS AF20 FAIRS CENTER FOR INNOVATION FOR CARE 

21 AND PAYMENT. 

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

23 amended by section 122, is further amended by inserting 

24 after section 1703E, as added by section 122, the fol25 lowing new section: 


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1 ‘‘§ 1703F. Center for Innovation for Care and Pay2 ment 

3 ‘‘(a) IN GENERAL.—(1) There is established within 

4 the Department a Center for Innovation for Care and Pay5 ment (in this section referred to as the ‘Center’). 

6 ‘‘(2) The Secretary, acting through the Center, may 

7 carry out such pilot programs as appropriate to develop 

8 new, innovative approaches to testing payment and service 

9 delivery models to reduce expenditures while preserving or 

10 enhancing the quality of care furnished by the Depart11 ment. 

12 ‘‘(3) The Secretary, acting through the Center, shall 

13 test payment and service delivery models to determine 

14 whether such models improve the access to and quality, 

15 timeliness, and patient satisfaction of such care and serv16 ices, as well as the cost savings associated with such mod17 els. 

18 ‘‘(4)(A) The Secretary shall test models where the 

19 Secretary determines that there is evidence that the model 

20 addresses a defined population for which there are deficits 

21 care leading to poor clinical outcomes or potentially avoid22 able expenditures. 

23 ‘‘(B) The Secretary shall focus on models expected 

24 to reduce program costs while preserving or enhancing the 

25 quality of care received by individuals receiving benefits 

26 under this chapter. 


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1 ‘‘(C) The models selected may include those described 

2 in section 1115A(b)(2)(B) of the Social Security Act (42 

3 U.S.C. 1315a(b)(2)(B)). 

4 ‘‘(5) In selecting models for testing, the Secretary 

5 may consider the following additional factors: 

6 ‘‘(A) Whether the model includes a regular 

7 process for monitoring and updating patient care 

8 plans in a manner that is consistent with the needs 

9 and preferences of applicable individuals. 

10 ‘‘(B) Whether the model places the applicable 

11 individual, including family members and other care12 givers of the applicable individual, at the center of 

13 the care team of the applicable individual. 

14 ‘‘(C) Whether the model uses technology or new 

15 systems to coordinate care over time and across set16 tings. 

17 ‘‘(D) Whether the model demonstrates effective 

18 linkage with other public sector payers, private sec19 tor payers, or statewide payment models. 

20 ‘‘(6)(A) Models tested under this section may not be 

21 designed in such a way that would allow the United States 

22 to recover or collect reasonable charges from a Federal 

23 health care program for care or services furnished by the 

24 Secretary to veterans under pilot programs carried out 

25 under this section. 


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1 ‘‘(B) In this paragraph, the term ‘Federal health care 

2 program’ means— 

3 ‘‘(i) an insurance program described in section 

4 1811 of the Social Security Act (42 U.S.C. 1395c) 

5 or established by section 1831 of such Act (42 

6 U.S.C. 1395j); or 

7 ‘‘(ii) a State plan for medical assistance ap8 proved under title XIX of such Act (42 U.S.C. 1396 

9 et seq.); or 

10 ‘‘(iii) a TRICARE program operated under sec11 tions 1075, 1075a, 1076, 1076a, 1076c, 1076d, 

12 1076e, or 1076f of title 10. 

13 ‘‘(b) DURATION.—Pilot programs carried out by the 

14 Secretary under this section shall terminate no later than 

15 five years after their commencement. 

16 ‘‘(c) LOCATION.—The Secretary shall ensure that 

17 pilot programs carried out under this section occur in dif18 ferent areas that are appropriate for the intended pur19 poses of the pilot program. 

20 ‘‘(d) BUDGET.—Funding for pilot programs carried 

21 out by the Secretary under this section will be derived 

22 from appropriations provided in advance in appropriations 

23 Acts for the Veterans Health Administration and from ap24 propriations provided for information technology systems. 


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1 ‘‘(e) NOTICE.—The Secretary shall publish informa2 tion about such pilot programs in the Federal Register, 

3 and shall take reasonable actions to provide direct notice 

4 to veterans eligible to participate in a pilot program oper5 ated under this section. 

6 ‘‘(f) WAIVER OF AUTHORITIES.—(1) Subject to re7 porting under paragraph (2) and approval under para8 graph (3), in implementing the pilot programs under this 

9 section, the Secretary may waive such requirements in 

10 subchapters I, II, and III of this chapter as may be nec11 essary solely for the purposes of carrying out this section 

12 with respect to testing models described in subsection (a). 

13 ‘‘(2) Before waiving any authority under paragraph 

14 (1), the Secretary shall submit a report to the Speaker 

15 of the House of Representatives, the minority leader of 

16 the House of Representatives, the majority leader of the 

17 Senate, the minority leader of the Senate, and each stand18 ing committee with jurisdiction under the rules of the Sen19 ate of the House of Representatives to report a bill to 

20 amend the provision or provisions of law that would be 

21 waived by the Department describing in detail the fol22 lowing: 

23 ‘‘(A) The specific authorities to be waived 

24 under the pilot program. 


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1 ‘‘(B) The standard or standards to be used in 

2 the pilot program in lieu of the waived authorities. 

3 ‘‘(C) The reasons for such waiver or waivers. 

4 ‘‘(D) A description of the metric or metrics the 

5 Secretary will use to determine the effect of the 

6 waiver or waivers upon the access to and quality, 

7 timeliness, or patient satisfaction of care and serv8 ices furnished through the pilot program. 

9 ‘‘(E) The anticipated cost savings, if any, of the 

10 pilot program. 

11 ‘‘(F) The schedule for interim reports on the 

12 pilot program describing the results of the pilot pro13 gram so far and the feasibility and advisability of 

14 continuing the pilot program. 

15 ‘‘(G) The schedule for the termination of the 

16 pilot program and the submission of a final report 

17 on the pilot program describing the result of the 

18 pilot program and the feasibility and advisability of 

19 making the pilot program permanent. 

20 ‘‘(H) The estimated budget of the pilot pro21 gram. 

22 ‘‘(3)(A) Upon receipt of a report submitted under 

23 paragraph (2), each House shall provide copies of the re24 port to the chairman and ranking member of each stand25 ing committee with jurisdiction under the rules of the 


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1 House of Representatives or the Senate to report a bill 

2 to amend the provision or provisions of law that would 

3 be waived by the Department under this subsection. 

4 ‘‘(B)(i) The waiver requested by the Secretary under 

5 paragraph (2) shall be considered approved under this 

6 paragraph if there is enacted into law a bill or joint resolu7 tion approving such request in its entirety. Such bill or 

8 joint resolution shall be passed by recorded vote to reflect 

9 the vote of each member of Congress thereon. 

10 ‘‘(ii) The provisions of this paragraph are enacted by 

11 the Congress— 

12 ‘‘(I) as an exercise of the rulemaking power of 

13 the Senate and the House of Representatives and as 

14 such shall be considered as part of the rules of each 

15 House, and shall supersede other rules only to the 

16 extent that they are inconsistent therewith; and 

17 ‘‘(II) with full recognition of the constitutional 

18 right of either House to change the rules (so far as 

19 they relate to the procedures of that House) at any 

20 time, in the same manner, and to the same extent 

21 as in the case of any other rule of that House. 

22 ‘‘(C) During the 60-calendar-day period beginning on 

23 the date on which the Secretary submits the report de24 scribed in paragraph (2) to Congress, it shall be in order 

25 as a matter of highest privilege in each House of Congress 


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1 to consider a bill or joint resolution, if offered by the ma2 jority leader of such House (or a designee), approving 

3 such request in its entirety. 

4 ‘‘(g) LIMITATIONS.—(1) The waiver provisions in 

5 subsection (f) shall not be available unless the Secretary 

6 submits the first proposal, in accordance with the require7 ments in subsection (f), for a pilot program within 18 

8 months of the date of the enactment of the Veterans Com9 munity Care and Access Act of 2017. 

10 ‘‘(2) Notwithstanding section 502 of this title, deci11 sions by the Secretary under this section shall, consistent 

12 with section 511 of this title, be final and conclusive and 

13 may not be reviewed by any other official or by any court, 

14 whether by an action in the nature of mandamus or other15 wise. 

16 ‘‘(3)(A) If the Secretary determines that the pilot 

17 program is not improving the quality of care or producing 

18 cost savings, the Secretary shall— 

19 ‘‘(i) propose a modification to the pilot program 

20 in the interim report that shall also be considered a 

21 report under subsection (f)(2)(A) and shall be sub22 ject to the terms and conditions of subsection (f)(2); 

23 or 

24 ‘‘(ii) terminate such pilot program within 30 

25 days of submitting the interim report to Congress. 


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1 ‘‘(B) If the Secretary terminates the pilot program 

2 under subparagraph (A)(ii), for purposes of clauses (vi) 

3 and (vii) of subsection (f)(2)(A), such interim report will 

4 also serve as the final report for that pilot program. 

5 ‘‘(h) EVALUATION AND REPORTING REQUIRE6 MENTS.—(1) The Secretary shall conduct an evaluation 

7 of each model tested, which shall include, at a minimum, 

8 an analysis of— 

9 ‘‘(A) the quality of care furnished under the 

10 model, including the measurement of patient-level 

11 outcomes and patient-centeredness criteria deter12 mined appropriate by the Secretary; and 

13 ‘‘(B) the changes in spending by reason of that 

14 model. 

15 ‘‘(2) The Secretary shall make the results of each 

16 evaluation under this subsection available to the public in 

17 a timely fashion and may establish requirements for other 

18 entities participating in the testing of models under this 

19 section to collect and report information that the Sec20 retary determines is necessary to monitor and evaluate 

21 such models. 

22 ‘‘(i) COORDINATION AND CONSULTATION.—(1) The 

23 Secretary shall obtain advice from the Under Secretary 

24 for Health and the Special Medical Advisory Group estab25 lished pursuant to section 7312 of this title in the developVerDate Sep 11 2014 22:33 Dec 08, 2017 Jkt 079200 PO 00000 Frm 00117 Fmt 6652 Sfmt 6201 E:\BILLS\S2184.IS S2184

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1 ment and implementation of any pilot program operated 

2 under this section. 

3 ‘‘(2) In carrying out the duties under this section, 

4 the Secretary shall consult representatives of relevant 

5 Federal agencies, and clinical and analytical experts with 

6 expertise in medicine and health care management. The 

7 Secretary shall use appropriate mechanisms to seek input 

8 from interested parties. 

9 ‘‘(j) EXPANSION OF SUCCESSFUL PILOT PRO10 GRAMS.—Taking into account the evaluation under sub11 section (f), the Secretary may, through rulemaking, ex12 pand (including implementation on a nationwide basis) the 

13 duration and the scope of a model that is being tested 

14 under subsection (a) to the extent determined appropriate 

15 by the Secretary, if— 

16 ‘‘(1) the Secretary determines that such expan17 sion is expected to— 

18 ‘‘(A) reduce spending without reducing the 

19 quality of care; or 

20 ‘‘(B) improve the quality of patient care 

21 without increasing spending; and 

22 ‘‘(2) the Secretary determines that such expan23 sion would not deny or limit the coverage or provi24 sion of benefits for applicable individuals.’’. 


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1 (b) CONFORMING AMENDMENT.—The table of sec2 tions at the beginning of such chapter, as amended by sec3 tion 122, is further amended by inserting after the item 

4 relating to section 1703E the following new item: 

‘‘1703F. Center for Innovation for Care and Payment.’’. 

5 TITLE V—OTHER HEALTH CARE 

6 MATTERS 

7 SEC. 501. AUTHORIZATION OF APPROPRIATIONS FOR 

8 HEALTH CARE FROM DEPARTMENT OF VET9 ERANS AFFAIRS. 

10 (a) IN GENERAL.—There is authorized to be appro11 priated to the Secretary of Veterans Affairs such amounts 

12 as may be necessary to carry out the purposes set forth 

13 in subsection (b). 

14 (b) USE OF AMOUNTS.—The purposes set forth in 

15 this subsection are as follows: 

16 (1) To increase the access of veterans to care 

17 as follows: 

18 (A) To hire primary care and specialty 

19 care physicians for employment in the Depart20 ment of Veterans Affairs. 

21 (B) To hire other medical staff, including 

22 the following: 

23 (i) Physicians. 

24 (ii) Nurses. 

25 (iii) Social workers. 


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1 (iv) Mental health professionals. 

2 (v) Physician assistants. 

3 (vi) Other health care professionals as 

4 the Secretary considers appropriate. 

5 (C) To carry out the following: 

6 (i) Section 7412 of title 38, United 

7 States Code. 

8 (ii) Section 7302(e) of such title. 

9 (iii) Subchapters II and VII of chap10 ter 76 of such title. 

11 (iv) Section 301(b)(2) of the Veterans 

12 Access, Choice, and Accountability Act of 

13 2014 (Public Law 113–146; 38 U.S.C. 

14 7302 note). 

15 (D) To pay for expenses, equipment, and 

16 other costs associated with the hiring of pri17 mary care, specialty care physicians, and other 

18 medical staff under subparagraphs (A), (B), 

19 and (C). 

20 (2) To improve the physical infrastructure of 

21 the Department as follows: 

22 (A) To maintain and operate hospitals, 

23 nursing homes, domiciliary facilities, and other 

24 facilities of the Veterans Health Administra25 tion. 


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1 (B) To enter into contracts or hire tem2 porary employees to repair, alter, or improve fa3 cilities under the jurisdiction of the Department 

4 that are not otherwise provided for under this 

5 paragraph. 

6 (C) To carry out leases for facilities of the 

7 Department. 

8 (D) To carry out minor construction 

9 projects of the Department. 

10 (3) To carry out sections 303 and 401. 

11 (c) FUNDING PLAN AND REPORT.— 

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

13 after the date on which amounts are appropriated to 

14 the Department pursuant to the authorization in 

15 subsection (a), the Secretary of Veterans Affairs 

16 shall submit to the appropriate committees of Con17 gress a funding plan and report on how the Sec18 retary intends to obligate the amounts so appro19 priated and how it relates to the quadrennial Vet20 erans Health Administration review and strategic 

21 plan under section 1730B(a) of title 38, United 

22 States Code, as added by section 102. 

23 (2) APPROPRIATE COMMITTEES OF CONGRESS

24 DEFINED.—In this subsection, the term ‘‘appro25 priate committees of Congress’’ means— 


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1 (A) the Committee on Veterans’ Affairs 

2 and the Committee on Appropriations of the 

3 Senate; and 

4 (B) the Committee on Veterans’ Affairs 

5 and the Committee on Appropriations of the 

6 House of Representatives. 

7 SEC. 502. APPROPRIATION OF AMOUNTS FOR VETERANS 

8 CHOICE PROGRAM. 

9 (a) IN GENERAL.—There is authorized to be appro10 priated, and is appropriated, to the Secretary of Veterans 

11 Affairs, out of any funds in the Treasury not otherwise 

12 appropriated, $4,000,000,000 to be deposited in the Vet13 erans Choice Fund under section 802 of the Veterans Ac14 cess, Choice, and Accountability Act of 2014 (Public Law 

15 113–146; 38 U.S.C. 1701 note). 

16 (b) AVAILABILITY.—The amount appropriated under 

17 subsection (a) shall remain available until expended pursu18 ant to section 802(c)(4) of the Veterans Access, Choice, 

19 and Accountability Act of 2014 (Public Law 113–146; 38 

20 U.S.C. 1701 note) as added by section 202. 

21 SEC. 503. APPLICABILITY OF DIRECTIVE OF OFFICE OF 

22 FEDERAL CONTRACT COMPLIANCE PRO23 GRAMS. 

24 (a) IN GENERAL.—Directive 2014–01 of the Office 

25 of Federal Contract Compliance Programs of the DepartVerDate Sep 11 2014 22:33 Dec 08, 2017 Jkt 079200 PO 00000 Frm 00122 Fmt 6652 Sfmt 6201 E:\BILLS\S2184.IS S2184

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1 ment of Labor (effective as of May 7, 2014) shall apply 

2 to any entity entering into an agreement under section 

3 1703A or section 1745 of title 38, United States Code, 

4 as amended by sections 112 and 114, respectively, in the 

5 same manner as such directive applies to subcontractors 

6 under the TRICARE program for the duration of the mor7 atorium provided under such directive. 

8 (b) APPLICABILITY PERIOD.—The directive described 

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

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

11 2019. 

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

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

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

15 SEC. 504. AMENDING STATUTORY REQUIREMENTS FOR THE 

16 POSITION OF THE CHIEF OFFICER OF THE 

17 READJUSTMENT COUNSELING SERVICE. 

18 Section 7309(b)(2) is amended— 

19 (1) in subparagraph (B), by striking ‘‘in the 

20 Readjustment Counseling Service’’; and 

21 (2) in subparagraph (C), by striking ‘‘in the 

22 Readjustment Counseling Service’’. 


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1 SEC. 505. AUTHORIZATION OF CERTAIN MAJOR MEDICAL 

2 FACILITY PROJECTS OF THE DEPARTMENT 

3 OF VETERANS AFFAIRS. 

4 (a) AUTHORIZATION.—The Secretary of Veterans Af5 fairs may carry out the following major medical facility 

6 project, to be carried out in an amount not to exceed the 

7 amount specified for that project: Realignment of medical 

8 facilities in Livermore, California, in an amount not to ex9 ceed $117,300,000. 

10 (b) AUTHORIZATION OF APPROPRIATIONS FOR CON11 STRUCTION.—There is authorized to be appropriated to 

12 the Secretary of Veterans Affairs for fiscal year 2018 or 

13 the year in which funds are appropriated for the Construc14 tion, Major Projects account, $117,300,000 for the project 

15 authorized in subsection (a). 

16 (c) SUBMITTAL OF INFORMATION.—Not later than 

17 90 days after the date of the enactment of this Act, for 

18 the project authorized in section (a), the Secretary of Vet19 erans Affairs shall submit to the Committee on Veterans’ 

20 Affairs of the Senate and the Committee on Veterans’ Af21 fairs of the House of Representatives the following infor22 mation: 

23 (1) A line item accounting of expenditures re24 lating to construction management carried out by 

25 the Department of Veterans Affairs for such project. 


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1 (2) The future amounts that are budgeted to be 

2 obligated for construction management carried out 

3 by the Department for such project. 

4 (3) A justification for the expenditures de5 scribed in paragraph (1) and the future amounts de6 scribed in paragraph (2). 

7 (4) Any agreement entered into by the Sec8 retary regarding the Army Corps of Engineers pro9 viding services relating to such project, including re10 imbursement agreements and the costs to the De11 partment of Veterans Affairs for such services. 

Æ 


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