In the House of Representatives, U. S., 

May 16, 2018. 

Resolved, That the bill from the Senate (S. 2372) entitled ‘‘An Act to amend title 38, United States Code, to provide outer burial receptacles for remains buried in National 

Parks, and for other purposes.’’, do pass with the following 

AMENDMENT: 

Strike out all after the enacting clause and insert: 

1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

3 ‘‘John S. McCain III, Daniel K. Akaka, and Samuel R. 

4 Johnson VA Maintaining Internal Systems and Strength5 ening Integrated Outside Networks Act of 2018’’ or the ‘‘VA 

6 MISSION Act of 2018’’. 

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

8 this Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—CARING FOR OUR VETERANS 

Sec. 100. Short title; references to title 38, United States Code. 

Subtitle A—Developing an Integrated High-Performing Network 

CHAPTER 1—ESTABLISHING COMMUNITY CARE PROGRAMS

Sec. 101. Establishment of Veterans Community Care Program. 

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

and non-Department providers. 

Sec. 103. Conforming amendments for State veterans homes. 

Sec. 104. Access standards and standards for quality. 

Sec. 105. Access to walk-in care. 
2 

•S 2372 EAH 

Sec. 106. Strategy regarding the Department of Veterans Affairs High-Performing 

Integrated Health Care Network. 

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

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

Sec. 109. Remediation of medical service lines. 

CHAPTER 2—PAYING PROVIDERS AND IMPROVING COLLECTIONS

Sec. 111. Prompt payment to providers. 

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

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

non-service-connected disabilities. 

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

CHAPTER 3—EDUCATION AND TRAINING PROGRAMS

Sec. 121. Education program on health care options. 

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

Affairs health care. 

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

CHAPTER 4—OTHER MATTERS RELATING TO NON-DEPARTMENT OF VETERANS

AFFAIRS PROVIDERS

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

non-Department of Veterans Affairs health care providers. 

Sec. 132. Improving information sharing with community providers. 

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

care providers. 

Sec. 134. Department of Veterans Affairs participation in national network of 

State-based prescription drug monitoring programs. 

CHAPTER 5—OTHER NON-DEPARTMENT HEALTH CARE MATTERS

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

Sec. 142. Veterans Choice Fund flexibility. 

Sec. 143. Sunset of Veterans Choice Program. 

Sec. 144. Conforming amendments. 

Subtitle B—Improving Department of Veterans Affairs Health Care Delivery 

Sec. 151. Licensure of health care professionals of the Department of Veterans Affairs providing treatment via telemedicine. 

Sec. 152. Authority for Department of Veterans Affairs Center for Innovation for 

Care and Payment. 

Sec. 153. Authorization to provide for operations on live donors for purposes of 

conducting transplant procedures for veterans. 

Subtitle C—Family Caregivers 

Sec. 161. Expansion of family caregiver program of Department of Veterans Affairs. 

Sec. 162. Implementation of information technology system of Department of Veterans Affairs to assess and improve the family caregiver program. 
3 

•S 2372 EAH 

Sec. 163. Modifications to annual evaluation report on caregiver program of Department of Veterans Affairs. 

TITLE II—VA ASSET AND INFRASTRUCTURE REVIEW 

Subtitle A—Asset and Infrastructure Review 

Sec. 201. Short title. 

Sec. 202. The Commission. 

Sec. 203. Procedure for making recommendations. 

Sec. 204. Actions regarding infrastructure and facilities of the Veterans Health 

Administration. 

Sec. 205. Implementation. 

Sec. 206. Department of Veterans Affairs Asset and Infrastructure Review Account. 

Sec. 207. Congressional consideration of Commission report. 

Sec. 208. Other matters. 

Sec. 209. Definitions. 

Subtitle B—Other Infrastructure Matters 

Sec. 211. Improvement to training of construction personnel. 

Sec. 212. Review of enhanced use leases. 

Sec. 213. Assessment of health care furnished by the Department to veterans who 

live in the Pacific territories. 

TITLE III—IMPROVEMENTS TO RECRUITMENT OF HEALTH CARE 

PROFESSIONALS 

Sec. 301. Designated scholarships for physicians and dentists under Department 

of Veterans Affairs Health Professional Scholarship Program. 

Sec. 302. Increase in maximum amount of debt that may be reduced under Education Debt Reduction Program of Department of Veterans Affairs. 

Sec. 303. Establishing the Department of Veterans Affairs Specialty Education 

Loan Repayment Program. 

Sec. 304. Veterans healing veterans medical access and scholarship program. 

Sec. 305. Bonuses for recruitment, relocation, and retention. 

Sec. 306. Inclusion of Vet Center employees in Education Debt Reduction Program of Department of Veterans Affairs. 

TITLE IV—HEALTH CARE IN UNDERSERVED AREAS 

Sec. 401. Development of criteria for designation of certain medical facilities of 

the Department of Veterans Affairs as underserved facilities and 

plan to address problem of underserved facilities. 

Sec. 402. Pilot program to furnish mobile deployment teams to underserved facilities. 

Sec. 403. Pilot program on graduate medical education and residency. 

TITLE V—OTHER MATTERS 

Sec. 501. Annual report on performance awards and bonuses awarded to certain 

high-level employees of the department. 

Sec. 502. Role of podiatrists in Department of Veterans Affairs. 

Sec. 503. Definition of major medical facility project. 

Sec. 504. Authorization of certain major medical facility projects of the Department of Veterans Affairs. 
4 

•S 2372 EAH 

Sec. 505. Department of Veterans Affairs personnel transparency. 

Sec. 506. Program on establishment of peer specialists in patient aligned care 

team settings within medical centers of Department of Veterans 

Affairs. 

Sec. 507. Department of Veterans Affairs medical scribe pilot program. 

Sec. 508. Extension of requirement to collect fees for housing loans guaranteed by 

Secretary of Veterans Affairs. 

Sec. 509. Extension of reduction in amount of pension furnished by Department 

of Veterans Affairs for certain veterans covered by Medicaid 

plans for services furnished by nursing facilities. 

Sec. 510. Appropriation of amounts. 

Sec. 511. Technical correction. 

Sec. 512. Budgetary effects. 

1 TITLE I—CARING FOR OUR 

2 VETERANS 

3 SEC. 100. SHORT TITLE; REFERENCES TO TITLE 38, UNITED 

4 STATES CODE. 

5 (a) SHORT TITLE.—This title may be cited as the 

6 ‘‘Caring for Our Veterans Act of 2018’’. 

7 (b) REFERENCES TO TITLE 38, UNITED STATES

8 CODE.—Except as otherwise expressly provided, whenever 

9 in this title an amendment or repeal is expressed in terms 

10 of an amendment to, or repeal of, a section or other provi11 sion, the reference shall be considered to be made to a section 

12 or other provision of title 38, United States Code. 
5 

•S 2372 EAH 

1 Subtitle A—Developing an Inte2 grated High-Performing Net3 work 

4 CHAPTER 1—ESTABLISHING COMMUNITY 

5 CARE PROGRAMS 

6 SEC. 101. ESTABLISHMENT OF VETERANS COMMUNITY 

7 CARE PROGRAM. 

8 (a) ESTABLISHMENT OF PROGRAM.— 

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

10 read as follows: 

11 ‘‘§ 1703. Veterans Community Care Program 

12 ‘‘(a) IN GENERAL.—(1) There is established a program 

13 to furnish hospital care, medical services, and extended care 

14 services to covered veterans through health care providers 

15 specified in subsection (c). 

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

17 hospital care, medical services, and extended care services 

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

20 ‘‘(A) Ensuring the scheduling of medical ap21 pointments in a timely manner and the establishment 

22 of a mechanism to receive medical records from non23 Department providers. 

24 ‘‘(B) Ensuring continuity of care and services. 
6 

•S 2372 EAH 

1 ‘‘(C) Ensuring coordination among regional net2 works if the covered veteran accesses care and services 

3 in a different network than the regional network in 

4 which the covered veteran resides. 

5 ‘‘(D) Ensuring that covered veterans do not expe6 rience a lapse in care resulting from errors or delays 

7 by the Department or its contractors or an unusual 

8 or excessive burden in accessing hospital care, medical 

9 services, or extended care services. 

10 ‘‘(3) A covered veteran may only receive care or serv11 ices under this section upon the authorization of such care 

12 or services by the Secretary. 

13 ‘‘(b) COVERED VETERANS.—For purposes of this sec14 tion, a covered veteran is any veteran who— 

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

16 enrollment established and operated under section 

17 1705 of this title; or 

18 ‘‘(2) is not enrolled in such system but is other19 wise entitled to hospital care, medical services, or ex20 tended care services under subsection (c)(2) of such 

21 section. 

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

23 care providers specified in this subsection are the following: 

24 ‘‘(1) Any health care provider that is partici25 pating in the Medicare program under title XVIII of 
7 

•S 2372 EAH 

1 the Social Security Act (42 U.S.C. 1395 et seq.), in2 cluding any physician furnishing services under such 

3 a program. 

4 ‘‘(2) The Department of Defense. 

5 ‘‘(3) The Indian Health Service. 

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

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

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

9 ‘‘(5) Any health care provider not otherwise cov10 ered under any of paragraphs (1) through (4) that 

11 meets criteria established by the Secretary for pur12 poses of this section. 

13 ‘‘(d) CONDITIONS UNDER WHICH CARE IS REQUIRED

14 TO BE FURNISHED THROUGH NON-DEPARTMENT PRO15 VIDERS.—(1) The Secretary shall, subject to the availability 

16 of appropriations, furnish hospital care, medical services, 

17 and extended care services to a covered veteran through 

18 health care providers specified in subsection (c) if— 

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

20 services the veteran requires; 

21 ‘‘(B) the Department does not operate a full-serv22 ice medical facility in the State in which the covered 

23 veteran resides; 

24 ‘‘(C)(i) the covered veteran was an eligible vet25 eran under section 101(b)(2)(B) of the Veterans Ac-
8 

•S 2372 EAH 

1 cess, Choice, and Accountability Act of 2014 (Public 

2 Law 113–146; 38 U.S.C. 1701 note) as of the day be3 fore the date of the enactment of the Caring for Our 

4 Veterans Act of 2018; 

5 ‘‘(ii) continues to reside in a location that would 

6 qualify the veteran for eligibility under such section; 

7 and 

8 ‘‘(iii) either— 

9 ‘‘(I) resides in one of the five States with 

10 the lowest population density as determined by 

11 data from the 2010 decennial census; or 

12 ‘‘(II) resides in a State not described in 

13 subclause (I) and— 

14 ‘‘(aa) received care or services under 

15 this title in the year preceding the enact16 ment of the Caring for Our Veterans Act of 

17 2018; and 

18 ‘‘(bb) is seeking care or services within 

19 2 years of the date of the enactment of the 

20 Caring for Our Veterans Act of 2018; 

21 ‘‘(D) the covered veteran has contacted the De22 partment to request care or services and the Depart23 ment is not able to furnish such care or services in 

24 a manner that complies with designated access stand-
9 

•S 2372 EAH 

1 ards developed by the Secretary under section 1703B 

2 of this title; or 

3 ‘‘(E) the covered veteran and the covered vet4 eran’s referring clinician agree that furnishing care 

5 and services through a non-Department entity or pro6 vider would be in the best medical interest of the cov7 ered veteran based upon criteria developed by the Sec8 retary. 

9 ‘‘(2) The Secretary shall ensure that the criteria devel10 oped under paragraph (1)(E) include consideration of the 

11 following: 

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

13 and the facility that provides the hospital care, med14 ical services, or extended care services the veteran 

15 needs. 

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

17 services, or extended care services required. 

18 ‘‘(C) The frequency that the hospital care, med19 ical services, or extended care services needs to be fur20 nished. 

21 ‘‘(D) The timeliness of available appointments 

22 for the hospital care, medical services, or extended 

23 care services the veteran needs. 

24 ‘‘(E) Whether the covered veteran faces an un25 usual or excessive burden to access hospital care, med-
10 

•S 2372 EAH 

1 ical services, or extended care services from the De2 partment medical facility where a covered veteran 

3 seeks hospital care, medical services, or extended care 

4 services, which shall include consideration of the fol5 lowing: 

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

7 excessive driving distance, geographical chal8 lenge, or environmental factor that impedes the 

9 access of the covered veteran. 

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

11 services, or extended care services sought by the 

12 veteran is provided by a medical facility of the 

13 Department that is reasonably accessible to a 

14 covered veteran. 

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

16 covered veteran affects the ability of the covered 

17 veteran to travel. 

18 ‘‘(iv) Whether there is compelling reason, as 

19 determined by the Secretary, that the veteran 

20 needs to receive hospital care, medical services, 

21 or extended care services from a medical facility 

22 other than a medical facility of the Department. 

23 ‘‘(v) Such other considerations as the Sec24 retary considers appropriate. 
11 

•S 2372 EAH 

1 ‘‘(3) If the Secretary has determined that the Depart2 ment does not offer the care or services the covered veteran 

3 requires under subparagraph (A) of paragraph (1), that the 

4 Department does not operate a full-service medical facility 

5 in the State in which the covered veteran resides under sub6 paragraph (B) of such paragraph, that the covered veteran 

7 is described under subparagraph (C) of such paragraph, or 

8 that the Department is not able to furnish care or services 

9 in a manner that complies with designated access standards 

10 developed by the Secretary under section 1703B of this title 

11 under subparagraph (D) of such paragraph, the decision 

12 to receive hospital care, medical services, or extended care 

13 services under such subparagraphs from a health care pro14 vider specified in subsection (c) shall be at the election of 

15 the veteran. 

16 ‘‘(e) CONDITIONS UNDER WHICH CARE IS AUTHOR17 IZED TO BE FURNISHED THROUGH NON-DEPARTMENT

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

19 care, medical services, or extended care services through a 

20 health care provider specified in subsection (c) to a covered 

21 veteran served by a medical service line of the Department 

22 that the Secretary has determined is not providing care that 

23 complies with the standards for quality the Secretary shall 

24 establish under section 1703C. 
12 

•S 2372 EAH 

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

2 shall— 

3 ‘‘(i) measure timeliness of the medical service 

4 line at a facility of the Department when compared 

5 with the same medical service line at different De6 partment facilities; and 

7 ‘‘(ii) measure quality at a medical service line of 

8 a facility of the Department by comparing it with 

9 two or more distinct and appropriate quality meas10 ures at non-Department medical service lines. 

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

12 hospital care, medical services, or extended care services 

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

14 medical service lines described in such subparagraph at any 

15 one health care facility of the Department. 

16 ‘‘(ii) The Secretary may not concurrently furnish hos17 pital care, medical services, or extended care services under 

18 subparagraph (A) with respect to more than 36 medical 

19 service lines nationally described in such subparagraph. 

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

21 care, medical services, or extended care services covered vet22 erans may receive under paragraph (1) in terms of the 

23 length of time such care and services will be available, the 

24 location at which such care and services will be available, 

25 and the clinical care and services that will be available. 
13 

•S 2372 EAH 

1 ‘‘(3)(A) Except as provided for in subparagraph (B), 

2 the hospital care, medical services, and extended care serv3 ices authorized under paragraph (1) with respect to a med4 ical service line shall cease when the remediation described 

5 in section 1706A with respect to such medical service line 

6 is complete. 

7 ‘‘(B) The Secretary shall ensure continuity and coordi8 nation of care for any veteran who elects to receive care 

9 or services under paragraph (1) from a health care provider 

10 specified in subsection (c) through the completion of an epi11 sode of care. 

12 ‘‘(4) The Secretary shall publish in the Federal Reg13 ister, and shall take all reasonable steps to provide direct 

14 notice to covered veterans affected under this subsection, at 

15 least once each year stating the time period during which 

16 such care and services will be available, the location or loca17 tions where such care and services will be available, and 

18 the clinical services available at each location under this 

19 subsection in accordance with regulations the Secretary 

20 shall prescribe. 

21 ‘‘(5) When the Secretary exercises the authority under 

22 paragraph (1), the decision to receive care or services under 

23 such paragraph from a health care provider specified in 

24 subsection (c) shall be at the election of the covered veteran. 
14 

•S 2372 EAH 

1 ‘‘(f) REVIEW OF DECISIONS.—The review of any deci2 sion under subsection (d) or (e) shall be subject to the De3 partment’s clinical appeals process, and such decisions may 

4 not be appealed to the Board of Veterans’ Appeals. 

5 ‘‘(g) TIERED NETWORK.—(1) To promote the provi6 sion of high-quality and high-value hospital care, medical 

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

8 Secretary may develop a tiered provider network of eligible 

9 providers based on criteria established by the Secretary for 

10 purposes of this section. 

11 ‘‘(2) In developing a tiered provider network of eligible 

12 providers under paragraph (1), the Secretary shall not 

13 prioritize providers in a tier over providers in any other 

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

15 in selecting a health care provider specified in subsection 

16 (c) for receipt of hospital care, medical services, or extended 

17 care services under this section. 

18 ‘‘(h) CONTRACTS TO ESTABLISH NETWORKS OF

19 HEALTH CARE PROVIDERS.—(1) The Secretary shall enter 

20 into consolidated, competitively bid contracts to establish 

21 networks of health care providers specified in paragraphs 

22 (1) and (5) of subsection (c) for purposes of providing suffi23 cient access to hospital care, medical services, or extended 

24 care services under this section. 
15 

•S 2372 EAH 

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

2 ensure that covered veterans are able to make their own ap3 pointments using advanced technology. 

4 ‘‘(B) To the extent practicable, the Secretary shall be 

5 responsible for the scheduling of appointments for hospital 

6 care, medical services, and extended care services under this 

7 section. 

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

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

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

11 specify for purposes of this section, if the Secretary notifies 

12 the appropriate committees of Congress that, at a min13 imum— 

14 ‘‘(i) the entity— 

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

16 provisions of the contract or with the provisions 

17 of this section and the regulations prescribed 

18 under this section; 

19 ‘‘(II) failed to comply with the access stand20 ards or the standards for quality established by 

21 the Secretary; 

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

23 Federal health care program (as defined in sec24 tion 1128B(f) of the Social Security Act (42 

25 U.S.C. 1320a–7b(f))) under section 1128 or 
16 

•S 2372 EAH 

1 1128A of the Social Security Act (42 U.S.C. 

2 1320a–7 and 1320a–7a); 

3 ‘‘(IV) is identified as an excluded source on 

4 the list maintained in the System for Award 

5 Management, or any successor system; or 

6 ‘‘(V) has been convicted of a felony or other 

7 serious offense under Federal or State law and 

8 the continued participation of the entity would 

9 be detrimental to the best interests of veterans or 

10 the Department; 

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

12 based on the health care needs of veterans; or 

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

14 based on coverage provided by contracts or sharing 

15 agreements entered into under authorities other than 

16 this section. 

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

18 to restrict the authority of the Secretary to terminate a con19 tract entered into under paragraph (1) under any other 

20 provision of law. 

21 ‘‘(4) Whenever the Secretary provides notice to an enti22 ty that the entity is failing to meet contractual obligations 

23 entered into under paragraph (1), the Secretary shall sub24 mit to the Committee on Veterans’ Affairs of the Senate and 

25 the Committee on Veterans’ Affairs of the House of Rep-
17 

•S 2372 EAH 

1 resentatives a report on such failure. Such report shall in2 clude the following: 

3 ‘‘(A) An explanation of the reasons for providing 

4 such notice. 

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

6 including with respect to cost, schedule, and require7 ments. 

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

9 Secretary to mitigate such failure. 

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

11 contractor to address such failure. 

12 ‘‘(E) A description of any effect on the commu13 nity provider market for veterans in the affected area. 

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

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

16 accept, on an interim basis, the credentials and qualifica17 tions of health care providers who are authorized to furnish 

18 hospital care and medical services to veterans under a com19 munity care program of the Department in effect as of the 

20 day before the date of the enactment of the Caring for Our 

21 Veterans Act of 2018, including under the Patient-Centered 

22 Community Care Program and the Veterans Choice Pro23 gram under section 101 of the Veterans Access, Choice, and 

24 Accountability Act of 2014 (Public Law 113–146; 38 U.S.C. 
18 

•S 2372 EAH 

1 1701 note), as qualified providers under the program estab2 lished under this section. 

3 ‘‘(B) The interim acceptance period under subpara4 graph (A) shall be determined by the Secretary based on 

5 the following criteria: 

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

7 the current certification agreement for the health care 

8 provider expires. 

9 ‘‘(ii) Whether the Department has enacted cer10 tification and eligibility criteria and regulatory pro11 cedures by which non-Department providers will be 

12 authorized under this section. 

13 ‘‘(6) The Secretary shall establish a system or systems 

14 for monitoring the quality of care provided to covered vet15 erans through a network under this subsection and for as16 sessing the quality of hospital care, medical services, and 

17 extended care services furnished through such network before 

18 the renewal of the contract for such network. 

19 ‘‘(i) PAYMENT RATES FOR CARE AND SERVICES.—(1) 

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

21 practicable, the rate paid for hospital care, medical services, 

22 or extended care services under any provision in this title 

23 may not exceed the rate paid by the United States to a 

24 provider of services (as defined in section 1861(u) of the 

25 Social Security Act (42 U.S.C. 1395x(u))) or a supplier 
19 

•S 2372 EAH 

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

2 1395x(d))) under the Medicare program under title XI or 

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

4 seq.), including section 1834 of such Act (42 U.S.C. 1395m), 

5 for the same care or services. 

6 ‘‘(2)(A) A higher rate than the rate paid by the United 

7 States as described in paragraph (1) may be negotiated 

8 with respect to the furnishing of care or services to a covered 

9 veteran who resides in a highly rural area. 

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

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

12 seven individuals residing in that county per square mile. 

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

14 this section in Alaska, the Alaska Fee Schedule of the De15 partment of Veterans Affairs shall be followed, except for 

16 when another payment agreement, including a contract or 

17 provider agreement, is in effect. 

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

19 services, or extended care services under this section in a 

20 State with an All-Payer Model Agreement under section 

21 1814(b)(3) of the Social Security Act (42 U.S.C. 

22 1395f(b)(3)) that became effective on or after January 1, 

23 2014, the Medicare payment rates under paragraph (2)(A) 

24 shall be calculated based on the payment rates under such 

25 agreement. 
20 

•S 2372 EAH 

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

2 may incorporate, to the extent practicable, the use of value3 based reimbursement models to promote the provision of 

4 high-quality care. 

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

6 extended care services for which there is not a rate paid 

7 under the Medicare program as described in paragraph (1), 

8 the rate paid for such care or services shall be determined 

9 by the Secretary. 

10 ‘‘(j) TREATMENT OF OTHER HEALTH PLAN CON11 TRACTS.—In any case in which a covered veteran is fur12 nished hospital care, medical services, or extended care serv13 ices under this section for a non-service-connected disability 

14 described in subsection (a)(2) of section 1729 of this title, 

15 the Secretary shall recover or collect reasonable charges for 

16 such care or services from a health plan contract described 

17 in section 1729 in accordance with such section. 

18 ‘‘(k) PAYMENT BY VETERAN.—A covered veteran shall 

19 not pay a greater amount for receiving care or services 

20 under this section than the amount the veteran would pay 

21 for receiving the same or comparable care or services at a 

22 medical facility of the Department or from a health care 

23 provider of the Department. 

24 ‘‘(l) TRANSPLANT AUTHORITY FOR IMPROVED AC25 CESS.—(1) In the case of a covered veteran described in 
21 

•S 2372 EAH 

1 paragraph (2), the Secretary shall determine whether to au2 thorize an organ or bone marrow transplant for that cov3 ered veteran at a non-Department facility. 

4 ‘‘(2) A covered veteran described in this paragraph— 

5 ‘‘(A) requires an organ or bone marrow trans6 plant; and 

7 ‘‘(B) has, in the opinion of the primary care 

8 provider of the veteran, a medically compelling reason 

9 to travel outside the region of the Organ Procurement 

10 and Transplantation Network, established under sec11 tion 372 of the National Organ Transplantation Act 

12 (Public Law 98–507; 42 U.S.C. 274), in which the 

13 veteran resides, to receive such transplant. 

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

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

16 Caring for Our Veterans Act of 2018, and not less frequently 

17 than annually thereafter, the Secretary shall submit to ap18 propriate committees of Congress a review of the types and 

19 frequency of care sought under subsection (d). 

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

21 shall include an assessment of the following: 

22 ‘‘(i) The top 25 percent of types of care and serv23 ices most frequently provided under subsection (d) due 

24 to the Department not offering such care and services. 
22 

•S 2372 EAH 

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

2 sought by covered veterans under this section. 

3 ‘‘(iii) An analysis of the reasons the Department 

4 was unable to provide such care and services. 

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

6 such care and services at a medical facility of the De7 partment. 

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

9 ‘‘(2) In monitoring the hospital care, medical services, 

10 and extended care services furnished under this section, the 

11 Secretary shall do the following: 

12 ‘‘(A) With respect to hospital care, medical serv13 ices, and extended care services furnished through 

14 provider networks established under subsection (i)— 

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

16 care, medical services, and extended care services 

17 furnished through such networks and how many 

18 patients used each type of care and service; 

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

20 services, or extended care services furnished 

21 through such networks; 

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

23 through new contracts within such networks or 

24 changes in the manner in which hospital care, 
23 

•S 2372 EAH 

1 medical services, or extended care services are 

2 furnished through such networks; 

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

4 Department on hospital care, medical services, 

5 and extended care services furnished through 

6 such networks; 

7 ‘‘(v) assess the timeliness of the Department 

8 in referring hospital care, medical services, and 

9 extended care services to such networks; and 

10 ‘‘(vi) assess the timeliness of such networks 

11 in— 

12 ‘‘(I) accepting referrals; and 

13 ‘‘(II) scheduling and completing ap14 pointments. 

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

16 the Secretary has determined under subsection (e)(1) 

17 not to be providing hospital care, medical services, or 

18 extended care services that comply with the standards 

19 for quality established by the Secretary. 

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

21 centers of excellence of the Department to furnish hos22 pital care, medical services, and extended care serv23 ices to covered veterans under this section. 

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

25 and extended care services furnished to covered vet-
24 

•S 2372 EAH 

1 erans under this section by medical facilities operated 

2 by Federal agencies other than the Department. 

3 ‘‘(3) Not later than 540 days after the date of the en4 actment of the Caring for Our Veterans Act of 2018 and 

5 not less frequently than once each year thereafter, the Sec6 retary shall submit to the Committee on Veterans’ Affairs 

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

8 the House of Representatives a report on the information 

9 gathered under paragraph (2). 

10 ‘‘(n) PROHIBITION ON CERTAIN LIMITATIONS.—(1) 

11 The Secretary shall not limit the types of hospital care, 

12 medical services, or extended care services covered veterans 

13 may receive under this section if it is in the best medical 

14 interest of the veteran to receive such hospital care, medical 

15 services, or extended care services, as determined by the vet16 eran and the veteran’s health care provider. 

17 ‘‘(2) No provision in this section may be construed to 

18 alter or modify any other provision of law establishing spe19 cific eligibility criteria for certain hospital care, medical 

20 services, or extended care services. 

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

22 ‘‘(1) The term ‘appropriate committees of Con23 gress’ means— 
25 

•S 2372 EAH 

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 ‘medical service line’ means a 

8 clinic within a Department medical center.’’. 

9 (2) CLERICAL AMENDMENT.—The table of sec10 tions at the beginning of chapter 17 is amended by 

11 striking the item relating to section 1703 and insert12 ing the following new item: 

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

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

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

15 take effect on the later of— 

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

17 which the Secretary of Veterans Affairs submits the 

18 report required under section 101(q)(2) of the Vet19 erans Access, Choice, and Accountability Act of 2014 

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

21 (2) the date on which the Secretary promulgates 

22 regulations pursuant to subsection (c). 

23 (c) REGULATIONS.— 

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

25 the date of the enactment of this Act, the Secretary of 
26 

•S 2372 EAH 

1 Veterans Affairs shall promulgate regulations to carry 

2 out section 1703 of title 38, United States Code, as 

3 amended by subsection (a) of this section. 

4 (2) UPDATES.— 

5 (A) PERIODIC.—Before promulgating the 

6 regulations required under paragraph (1), the 

7 Secretary shall provide to the appropriate com8 mittees of Congress periodic updates to confirm 

9 the progress of the Secretary toward developing 

10 such regulations. 

11 (B) FIRST UPDATE.—The first update 

12 under subparagraph (A) shall occur no later 

13 than 120 days from the date of the enactment of 

14 this Act. 

15 (C) APPROPRIATE COMMITTEES OF CON16 GRESS DEFINED.—In this paragraph, the term 

17 ‘‘appropriate committees of Congress’’ means— 

18 (i) the Committee on Veterans’ Affairs 

19 and the Committee on Appropriations of the 

20 Senate; and 

21 (ii) the Committee on Veterans’ Affairs 

22 and the Committee on Appropriations of the 

23 House of Representatives. 

24 (d) CONTINUITY OF EXISTING AGREEMENTS.— 
27 

•S 2372 EAH 

1 (1) IN GENERAL.—Notwithstanding section 1703 

2 of title 38, United States Code, as amended by sub3 section (a), the Secretary of Veterans Affairs shall 

4 continue all contracts, memorandums of under5 standing, memorandums of agreements, and other ar6 rangements that were in effect on the day before the 

7 date of the enactment of this Act between the Depart8 ment of Veterans Affairs and the American Indian 

9 and Alaska Native health care systems as established 

10 under the terms of the Department of Veterans Affairs 

11 and Indian Health Service Memorandum of Under12 standing, signed October 1, 2010, the National Reim13 bursement Agreement, signed December 5, 2012, ar14 rangements under section 405 of the Indian Health 

15 Care Improvement Act (25 U.S.C. 1645), and agree16 ments entered into under sections 102 and 103 of the 

17 Veterans Access, Choice, and Accountability Act of 

18 2014 (Public Law 113–146). 

19 (2) MODIFICATIONS.—Paragraph (1) shall not be 

20 construed to prohibit the Secretary and the parties to 

21 the contracts, memorandums of understanding, memo22 randums of agreements, and other arrangements de23 scribed in such paragraph from making such changes 

24 to such contracts, memorandums of understanding, 

25 memorandums of agreements, and other arrangements 
28 

•S 2372 EAH 

1 as may be otherwise authorized pursuant to other 

2 provisions of law or the terms of the contracts, memo3 randums of understanding, memorandums of agree4 ments, and other arrangements. 

5 SEC. 102. AUTHORIZATION OF AGREEMENTS BETWEEN DE6 PARTMENT OF VETERANS AFFAIRS AND NON7 DEPARTMENT PROVIDERS. 

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

9 amended by inserting after section 1703 the following new 

10 section: 

11 ‘‘§ 1703A. Agreements with eligible entities or pro12 viders; certification processes 

13 ‘‘(a) AGREEMENTS AUTHORIZED.—(1)(A) When hos14 pital care, a medical service, or an extended care service 

15 required by a veteran who is entitled to such care or service 

16 under this chapter is not feasibly available to the veteran 

17 from a facility of the Department or through a contract 

18 or sharing agreement entered into pursuant to another pro19 vision of law, the Secretary may furnish such care or service 

20 to such veteran through an agreement under this section 

21 with an eligible entity or provider to provide such hospital 

22 care, medical service, or extended care service. 

23 ‘‘(B) An agreement entered into under this section to 

24 provide hospital care, a medical service, or an extended care 

25 service shall be known as a ‘Veterans Care Agreement’. 
29 

•S 2372 EAH 

1 ‘‘(C) For purposes of subparagraph (A), hospital care, 

2 a medical service, or an extended care service may be con3 sidered not feasibly available to a veteran from a facility 

4 of the Department or through a contract or sharing agree5 ment described in such subparagraph when the Secretary 

6 determines the veteran’s medical condition, the travel in7 volved, the nature of the care or services required, or a com8 bination of these factors make the use of a facility of the 

9 Department or a contract or sharing agreement described 

10 in such subparagraph impracticable or inadvisable. 

11 ‘‘(D) A Veterans Care Agreement may be entered into 

12 by the Secretary or any Department official authorized by 

13 the Secretary. 

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

15 shall review each Veterans Care Agreement of material size, 

16 as determined by the Secretary or set forth in paragraph 

17 (3), for hospital care, a medical service, or an extended care 

18 service to determine whether it is feasible and advisable to 

19 provide such care or service within a facility of the Depart20 ment or by contract or sharing agreement entered into pur21 suant to another provision of law and, if so, take action 

22 to do so. 

23 ‘‘(B)(i) The Secretary shall review each Veterans Care 

24 Agreement of material size that has been in effect for at 
30 

•S 2372 EAH 

1 least 6 months within the first 2 years of its taking effect, 

2 and not less frequently than once every 4 years thereafter. 

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

4 effect for at least 6 months by the date of the review required 

5 by subparagraph (A), the agreement shall be reviewed dur6 ing the next cycle required by subparagraph (A), and such 

7 review shall serve as its review within the first 2 years of 

8 its taking effect for purposes of clause (i). 

9 ‘‘(3)(A) In fiscal year 2019 and in each fiscal year 

10 thereafter, in addition to such other Veterans Care Agree11 ments as the Secretary may determine are of material size, 

12 a Veterans Care Agreement for the purchase of extended care 

13 services that exceeds $5,000,000 annually shall be consid14 ered of material size. 

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

16 a notice in the Federal Register to adjust the dollar amount 

17 specified in subparagraph (A) to account for changes in the 

18 cost of health care based upon recognized health care market 

19 surveys and other available data. 

20 ‘‘(b) ELIGIBLE ENTITIES AND PROVIDERS.—For pur21 poses of this section, an eligible entity or provider is— 

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

23 and entered into a provider agreement under section 

24 1866(a) of the Social Security Act (42 U.S.C. 

25 1395cc(a)) and any physician or other supplier who 
31 

•S 2372 EAH 

1 has enrolled and entered into a participation agree2 ment under section 1842(h) of such Act (42 U.S.C. 

3 1395u(h)); 

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

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

6 seq.); 

7 ‘‘(3) an Aging and Disability Resource Center, 

8 an area agency on aging, or a State agency (as de9 fined in section 102 of the Older Americans Act of 

10 1965 (42 U.S.C. 3002)); 

11 ‘‘(4) a center for independent living (as defined 

12 in section 702 of the Rehabilitation Act of 1973 (29 

13 U.S.C. 796a)); or 

14 ‘‘(5) any entity or provider not described in 

15 paragraph (1) or (2) of this subsection that the Sec16 retary determines to be eligible pursuant to the cer17 tification process described in subsection (c). 

18 ‘‘(c) ELIGIBLE ENTITY OR PROVIDER CERTIFICATION

19 PROCESS.—The Secretary shall establish by regulation a 

20 process for the certification of eligible entities or providers 

21 or recertification of eligible entities or providers under this 

22 section. Such a process shall, at a minimum— 

23 ‘‘(1) establish deadlines for actions on applica24 tions for certification; 
32 

•S 2372 EAH 

1 ‘‘(2) set forth standards for an approval or de2 nial of certification, duration of certification, revoca3 tion of an eligible entity or provider’s certification, 

4 and recertification of eligible entities or providers; 

5 ‘‘(3) require the denial of certification if the Sec6 retary determines the eligible entity or provider is ex7 cluded from participation in a Federal health care 

8 program under section 1128 or section 1128A of the 

9 Social Security Act (42 U.S.C. 1320a–7 or 1320a–7a) 

10 or is currently identified as an excluded source on the 

11 System for Award Management Exclusions list de12 scribed in part 9 of title 48, Code of Federal Regula13 tions, and part 180 of title 2 of such Code, or suc14 cessor regulations; 

15 ‘‘(4) establish procedures for screening eligible 

16 entities or providers according to the risk of fraud, 

17 waste, and abuse that are similar to the standards 

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

19 (42 U.S.C. 1395cc(j)(2)(B)) and section 9.104 of title 

20 48, Code of Federal Regulations, or successor regula21 tions; and 

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

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

24 this section as a procurement program only for pur25 poses of applying such provisions. 
33 

•S 2372 EAH 

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

2 by the Secretary for hospital care, medical services, and ex3 tended care services provided under a Veterans Care Agree4 ment shall be in accordance with the rates paid by the 

5 United States under section 1703(i) of this title. 

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

7 Pursuant to regulations promulgated under subsection (k), 

8 the Secretary may define the requirements for providers and 

9 entities entering into agreements under this section based 

10 upon such factors as the number of patients receiving care 

11 or services, the number of employees employed by the entity 

12 or provider furnishing such care or services, the amount 

13 paid by the Secretary to the provider or entity, or other 

14 factors as determined by the Secretary. 

15 ‘‘(2) To furnish hospital care, medical services, or ex16 tended care services under this section, an eligible entity 

17 or provider shall agree— 

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

19 in regulations prescribed under this section; 

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

21 section on behalf of a veteran to a provider of services 

22 or care shall, unless rejected and refunded by the pro23 vider within 30 days of receipt, constitute payment in 

24 full and extinguish any liability on the part of the 

25 veteran for the treatment or care provided, and no 
34 

•S 2372 EAH 

1 provision of a contract, agreement, or assignment to 

2 the contrary shall operate to modify, limit, or negate 

3 this requirement; 

4 ‘‘(C) to provide only the care and services au5 thorized by the Department under this section and to 

6 obtain the prior written consent of the Department to 

7 furnish care or services outside the scope of such au8 thorization; 

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

10 the methodology outlined in regulations prescribed 

11 under this section; 

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

13 health plan contract or third party, as those terms 

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

15 or service that is furnished or paid for by the Depart16 ment; 

17 ‘‘(F) to provide medical records to the Depart18 ment in the time frame and format specified by the 

19 Department; and 

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

21 including quality of care assurance standards, as the 

22 Secretary may specify in regulation. 

23 ‘‘(f) DISCONTINUATION OR NONRENEWAL OF A VET24 ERANS CARE AGREEMENT.—(1) An eligible entity or pro25 vider may discontinue a Veterans Care Agreement at such 
35 

•S 2372 EAH 

1 time and upon such notice to the Secretary as may be pro2 vided in regulations prescribed under this section. 

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

4 Agreement with an eligible entity or provider at such time 

5 and upon such reasonable notice to the eligible entity or 

6 provider as may be specified in regulations prescribed 

7 under this section, if an official designated by the Sec8 retary— 

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

10 provider failed to comply substantially with the pro11 visions of the Veterans Care Agreement, or with the 

12 provisions of this section or regulations prescribed 

13 under this section; 

14 ‘‘(B) has determined the eligible entity or pro15 vider is excluded from participation in a Federal 

16 health care program under section 1128 or section 

17 1128A of the Social Security Act (42 U.S.C. 1320a– 

18 7 or 1320a–7a) or is identified on the System for 

19 Award Management Exclusions list as provided in 

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

21 part 180 of title 2 of such Code, or successor regula22 tions; 

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

24 provider has been convicted of a felony or other seri25 ous offense under Federal or State law and deter-
36 

•S 2372 EAH 

1 mines the eligible entity or provider’s continued par2 ticipation would be detrimental to the best interests of 

3 veterans or the Department; or 

4 ‘‘(D) has determined that it is reasonable to ter5 minate the agreement based on the health care needs 

6 of a veteran. 

7 ‘‘(g) QUALITY OF CARE.—The Secretary shall establish 

8 a system or systems for monitoring the quality of care pro9 vided to veterans through Veterans Care Agreements and 

10 for assessing the quality of hospital care, medical services, 

11 and extended care services furnished by eligible entities and 

12 providers before the renewal of Veterans Care Agreements. 

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

14 administrative procedures for eligible entities and providers 

15 to present all disputes arising under or related to Veterans 

16 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 ‘Tucker 

23 Act’). 

24 ‘‘(4) Disputes under this section must pertain to either 

25 the scope of authorization under the Veterans Care Agree-
37 

•S 2372 EAH 

1 ment or claims for payment subject to the Veterans Care 

2 Agreement and are not claims for the purposes of such laws 

3 that would otherwise require application of sections 7101 

4 through 7109 of title 41, United States Code. 

5 ‘‘(i) APPLICABILITY OF OTHER PROVISIONS OF LAW.— 

6 (1) A Veterans Care Agreement may be authorized by the 

7 Secretary or any Department official authorized by the Sec8 retary, and such action shall not be treated as— 

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

10 would otherwise require the use of competitive proce11 dures for the furnishing of care and services; or 

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

13 goods or services for purposes of any provision of Fed14 eral law governing Federal contracts for the acquisi15 tion of goods or services except section 4706(d) of title 

16 41. 

17 ‘‘(2)(A) Except as provided in the agreement itself, in 

18 subparagraph (B), and unless otherwise provided in this 

19 section or regulations prescribed pursuant to this section, 

20 an eligible entity or provider that enters into an agreement 

21 under this section is not subject to, in the carrying out of 

22 the agreement, any law to which providers of services and 

23 suppliers under the Medicare program under title XVIII of 

24 the Social Security Act (42 U.S.C. 1395 et seq.) are not 

25 subject. 
38 

•S 2372 EAH 

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

2 agreement under this section is subject to— 

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

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

5 penalties; and 

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

7 discrimination or that otherwise ensure equal employ8 ment opportunities. 

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

10 entity or provider that enters into an agreement under this 

11 section shall not be treated as a Federal contractor or sub12 contractor for purposes of chapter 67 of title 41 (commonly 

13 known as the ‘McNamara-O’Hara Service Contract Act of 

14 1965’). 

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

16 care, medical services, and extended care services furnished 

17 to any veteran pursuant to a Veterans Care Agreement shall 

18 be subject to the same terms as though provided in a facility 

19 of the Department, and provisions of this chapter applicable 

20 to veterans receiving such care and services in a facility 

21 of the Department shall apply to veterans treated under this 

22 section. 

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

24 regulations to carry out this section.’’. 
39 

•S 2372 EAH 

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

2 the beginning of such chapter is amended by inserting after 

3 the item relating to section 1703 the following new item: 

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

4 SEC. 103. CONFORMING AMENDMENTS FOR STATE VET5 ERANS HOMES. 

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

7 (1) in paragraph (1), by striking ‘‘(or agreement 

8 under section 1720(c)(1) of this title)’’ and inserting 

9 ‘‘(or an agreement)’’; and 

10 (2) by adding at the end the following new para11 graph: 

12 ‘‘(4)(A) An agreement under this section may be au13 thorized by the Secretary or any Department official au14 thorized by the Secretary, and any such action is not an 

15 award for purposes of such laws that would otherwise re16 quire the use of competitive procedures for the furnishing 

17 of hospital care, medical services, and extended care serv18 ices. 

19 ‘‘(B)(i) Except as provided in the agreement itself, in 

20 clause (ii), and unless otherwise provided in this section 

21 or regulations prescribed pursuant to this section, a State 

22 home that enters into an agreement under this section is 

23 not subject to, in the carrying out of the agreement, any 

24 provision of law to which providers of services and suppliers 
40 

•S 2372 EAH 

1 under the Medicare program under title XVIII of the Social 

2 Security Act (42 U.S.C. 1395 et seq.) are not subject. 

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

4 under this section is subject to— 

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

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

7 criminal penalties; 

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

9 employment discrimination or that otherwise ensure 

10 equal employment opportunities; and 

11 ‘‘(III) all provisions in subchapter V of chapter 

12 17 of this title. 

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

14 State home that enters into an agreement under this section 

15 may not be treated as a Federal contractor or subcontractor 

16 for purposes of chapter 67 of title 41 (known as the ‘McNa17 mara-O’Hara Service Contract Act of 1965’).’’. 

18 (b) EFFECTIVE DATE.—The amendment made by sub19 section (a) shall apply to care provided on or after the effec20 tive date of regulations issued by the Secretary of Veterans 

21 Affairs to carry out this section. 
41 

•S 2372 EAH 

1 SEC. 104. ACCESS STANDARDS AND STANDARDS FOR QUAL2 ITY. 

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

4 amended by section 102, is further amended by inserting 

5 after section 1703A the following new sections: 

6 ‘‘§ 1703B. Access standards 

7 ‘‘(a)(1) The Secretary shall establish access standards 

8 for furnishing hospital care, medical services, or extended 

9 care services to covered veterans for the purposes of section 

10 1703(d). 

11 ‘‘(2) The Secretary shall ensure that the access stand12 ards established under paragraph (1) define such categories 

13 of care to cover all care and services within the medical 

14 benefits package of the Department of Veterans Affairs. 

15 ‘‘(b) The Secretary shall ensure that the access stand16 ards provide covered veterans, employees of the Department, 

17 and health care providers in the network established under 

18 section 1703(h) with relevant comparative information that 

19 is clear, useful, and timely, so that covered veterans can 

20 make informed decisions regarding their health care. 

21 ‘‘(c) The Secretary shall consult with all pertinent 

22 Federal entities (including the Department of Defense, the 

23 Department of Health and Human Services, and the Cen24 ters for Medicare & Medicaid Services), entities in the pri25 vate sector, and other nongovernmental entities in estab26 lishing access standards. 
42 

•S 2372 EAH 

1 ‘‘(d)(1) Not later than 270 days after the date of the 

2 enactment of the Caring for Our Veterans Act of 2018, the 

3 Secretary shall submit to the appropriate committees of 

4 Congress a report detailing the access standards. 

5 ‘‘(2)(A) Before submitting the report required under 

6 paragraph (1), the Secretary shall provide periodic updates 

7 to the appropriate committees of Congress to confirm the 

8 Department’s progress towards developing the access stand9 ards required by this section. 

10 ‘‘(B) The first update under subparagraph (A) shall 

11 occur no later than 120 days from the date of the enactment 

12 of the Caring for Our Veterans Act of 2018. 

13 ‘‘(3) Not later than 540 days after the date on which 

14 the Secretary implements the access standards established 

15 under subsection (a), the Secretary shall submit to the ap16 propriate committees of Congress a report detailing the im17 plementation of and compliance with such access standards 

18 by Department and non-Department entities or providers. 

19 ‘‘(e) Not later than 3 years after the date on which 

20 the Secretary establishes access standards under subsection 

21 (a) and not less frequently than once every 3 years there22 after, the Secretary shall— 

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

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

25 Congress a report on the findings and any modifica-
43 

•S 2372 EAH 

1 tion to the access standards with respect to the review 

2 conducted under paragraph (1). 

3 ‘‘(f) The Secretary shall ensure health care providers 

4 specified under section 1703(c) are able to comply with the 

5 applicable access standards established by the Secretary. 

6 ‘‘(g) The Secretary shall publish in the Federal Reg7 ister and on an internet website of the Department the des8 ignated access standards established under this section for 

9 purposes of section 1703(d)(1)(D). 

10 ‘‘(h)(1) Consistent with paragraphs (1)(D) and (3) of 

11 section 1703(d), covered veterans may contact the Depart12 ment at any time to request a determination regarding 

13 whether they are eligible to receive care and services from 

14 a non-Department entity or provider based on the Depart15 ment being unable to furnish such care and services in a 

16 manner that complies with the designated access standards 

17 established under this section. 

18 ‘‘(2) The Secretary shall establish a process to review 

19 such requests from covered veterans to determine whether— 

20 ‘‘(A) the requested care is clinically necessary; 

21 and 

22 ‘‘(B) the Department is able to provide such care 

23 in a manner that complies with designated access 

24 standards established under this section. 
44 

•S 2372 EAH 

1 ‘‘(3) The Secretary shall promptly respond to any such 

2 request by a covered veteran. 

3 ‘‘(i)(1) The term ‘appropriate committees of Congress’ 

4 means— 

5 ‘‘(A) the Committee on Veterans’ Affairs and the 

6 Committee on Appropriations of the Senate; and 

7 ‘‘(B) the Committee on Veterans’ Affairs and the 

8 Committee on Appropriations of the House of Rep9 resentatives. 

10 ‘‘(2) The term ‘covered veterans’ refers to veterans de11 scribed in section 1703(b) of this title. 

12 ‘‘§ 1703C. Standards for quality 

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

14 standards for quality regarding hospital care, medical serv15 ices, and extended care services furnished by the Depart16 ment pursuant to this title, including through non-Depart17 ment health care providers pursuant to section 1703 of this 

18 title. 

19 ‘‘(2) In establishing standards for quality under para20 graph (1), the Secretary shall consider existing health qual21 ity measures that are applied to public and privately spon22 sored health care systems with the purpose of providing cov23 ered veterans relevant comparative information to make in24 formed decisions regarding their health care. 
45 

•S 2372 EAH 

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

2 purposes of establishing the standards under paragraph (1). 

3 Such data collection shall include— 

4 ‘‘(A) after consultation with veterans service or5 ganizations and other key stakeholders on survey de6 velopment or modification of an existing survey, a 

7 survey of veterans who have used hospital care, med8 ical services, or extended care services furnished by 

9 the Veterans Health Administration during the most 

10 recent 2-year period to assess the satisfaction of the 

11 veterans with service and quality of care; and 

12 ‘‘(B) datasets that include, at a minimum, ele13 ments relating to the following: 

14 ‘‘(i) Timely care. 

15 ‘‘(ii) Effective care. 

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

17 complications, readmissions, and deaths. 

18 ‘‘(iv) Efficiency. 

19 ‘‘(4) The Secretary shall consult with all pertinent 

20 Federal entities (including the Department of Defense, the 

21 Department of Health and Human Services, and the Cen22 ters for Medicare & Medicaid Services), entities in the pri23 vate sector, and other nongovernmental entities in estab24 lishing standards for quality. 
46 

•S 2372 EAH 

1 ‘‘(5)(A) Not later than 270 days after the date of the 

2 enactment of the Caring for Our Veterans Act of 2018, the 

3 Secretary shall submit to the appropriate committees of 

4 Congress a report detailing the standards for quality. 

5 ‘‘(B)(i) Before submitting the report required under 

6 subparagraph (A), the Secretary shall provide periodic up7 dates to the appropriate committees of Congress to confirm 

8 the Department’s progress towards developing the standards 

9 for quality required by this section. 

10 ‘‘(ii) The first update under clause (i) shall occur no 

11 later than 120 days from the date of the enactment of the 

12 Caring for Our Veterans Act of 2018. 

13 ‘‘(b) PUBLICATION AND CONSIDERATION OF PUBLIC

14 COMMENTS.—(1) Not later than 1 year after the date on 

15 which the Secretary establishes standards for quality under 

16 subsection (a), the Secretary shall publish the quality rating 

17 of medical facilities of the Department in the publicly avail18 able Hospital Compare website through the Centers for 

19 Medicare & Medicaid Services for the purpose of providing 

20 veterans with information that allows them to compare per21 formance measure information among Department and 

22 non-Department health care providers. 

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

24 the Secretary establishes standards for quality under sub25 section (a), the Secretary shall consider and solicit public 
47 

•S 2372 EAH 

1 comment on potential changes to the measures used in such 

2 standards to ensure that they include the most up-to-date 

3 and applicable industry measures for veterans. 

4 ‘‘(c)(1) The term ‘appropriate committees of Congress’ 

5 means— 

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

7 Committee on Appropriations of the Senate; and 

8 ‘‘(B) the Committee on Veterans’ Affairs and the 

9 Committee on Appropriations of the House of Rep10 resentatives. 

11 ‘‘(2) The term ‘covered veterans’ refers to veterans de12 scribed in section 1703(b) of this title.’’. 

13 (b) CLERICAL AMENDMENT.—The table of sections at 

14 the beginning of chapter 17, as amended by section 102, 

15 is further amended by inserting after the item relating to 

16 section 1703A the following new items: 

‘‘1703B. Access standards. 

‘‘1703C. Standards for quality.’’. 

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

18 (a) IN GENERAL.—Chapter 17 is amended by insert19 ing after section 1725 the following new section: 

20 ‘‘§ 1725A. Access to walk-in care 

21 ‘‘(a) PROCEDURES TO ENSURE ACCESS TO WALK-IN

22 CARE.—The Secretary shall develop procedures to ensure 

23 that eligible veterans are able to access walk-in care from 

24 qualifying non-Department entities or providers. 
48 

•S 2372 EAH 

1 ‘‘(b) ELIGIBLE VETERANS.—For purposes of this sec2 tion, an eligible veteran is any individual who— 

3 ‘‘(1) is enrolled in the health care system estab4 lished under section 1705(a) of this title; and 

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

6 the 24-month period preceding the furnishing of walk7 in care under this section. 

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

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

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

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

12 agreement with the Secretary to furnish services under this 

13 section. 

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

15 Whenever practicable, the Secretary may use a Federally16 qualified health center (as defined in section 1905(l)(2)(B) 

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

18 carry out this section. 

19 ‘‘(e) CONTINUITY OF CARE.—The Secretary shall en20 sure continuity of care for those eligible veterans who receive 

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

22 the establishment of a mechanism to receive medical records 

23 from walk-in care providers and provide pertinent patient 

24 medical records to providers of walk-in care. 
49 

•S 2372 EAH 

1 ‘‘(f) COPAYMENTS.—(1)(A) The Secretary may require 

2 an eligible veteran to pay the United States a copayment 

3 for each episode of hospital care or medical services pro4 vided under this section if the eligible veteran would be re5 quired to pay a copayment under this title. 

6 ‘‘(B) An eligible veteran not required to pay a copay7 ment under this title may access walk-in care without a 

8 copayment for the first two visits in a calendar year. For 

9 any additional visits, a copayment at an amount deter10 mined by the Secretary may be required. 

11 ‘‘(C) An eligible veteran required to pay a copayment 

12 under this title may be required to pay a regular copayment 

13 for the first two walk-in care visits in a calendar year. For 

14 any additional visits, a higher copayment at an amount 

15 determined by the Secretary may be required. 

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

17 an eligible veteran under this section, the Secretary may 

18 adjust the copayment required of the veteran under this sub19 section based upon the priority group of enrollment of the 

20 eligible veteran, the number of episodes of care furnished 

21 to the eligible veteran during a year, and other factors the 

22 Secretary considers appropriate under this section. 

23 ‘‘(3) The amount or amounts of the copayments re24 quired under this subsection shall be prescribed by the Sec25 retary by rule. 
50 

•S 2372 EAH 

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

2 this subsection. 

3 ‘‘(g) REGULATIONS.—Not later than 1 year after the 

4 date of the enactment of the Caring for Our Veterans Act 

5 of 2018, the Secretary shall promulgate regulations to carry 

6 out this section. 

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

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

9 a qualifying non-Department entity or provider that fur10 nishes episodic care and not longitudinal management of 

11 conditions and is otherwise defined through regulations the 

12 Secretary shall promulgate.’’. 

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

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

15 effect on the date upon which final regulations imple16 menting such section take effect. 

17 (c) CLERICAL AMENDMENT.—The table of sections at 

18 the beginning of such chapter is amended by inserting after 

19 the item relating to section 1725 the following new item: 

‘‘1725A. Access to walk-in care.’’. 

20 SEC. 106. STRATEGY REGARDING THE DEPARTMENT OF 

21 VETERANS AFFAIRS HIGH-PERFORMING INTE22 GRATED HEALTH CARE NETWORK. 

23 (a) IN GENERAL.—Subchapter II of chapter 73 is 

24 amended by inserting after section 7330B the following new 

25 section: 
51 

•S 2372 EAH 

1 ‘‘§ 7330C. Quadrennial Veterans Health Administra2 tion review 

3 ‘‘(a) MARKET AREA ASSESSMENTS.—(1) Not less fre4 quently than every 4 years, the Secretary of Veterans Af5 fairs shall perform market area assessments regarding the 

6 health care services furnished under the laws administered 

7 by the Secretary. 

8 ‘‘(2) Each market area assessment established under 

9 paragraph (1) shall include the following: 

10 ‘‘(A) An assessment of the demand for health 

11 care from the Department, disaggregated by geo12 graphic market areas as determined by the Secretary, 

13 including the number of requests for health care serv14 ices under the laws administered by the Secretary. 

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

16 the Department of Veterans Affairs across the Depart17 ment’s system of facilities. 

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

19 to be provided through contracted community care 

20 providers and providers who entered into a provider 

21 agreement with the Department under section 1703A 

22 of title 38, as added by section 102, including the 

23 number of providers, the geographic location of the 

24 providers, and categories or types of health care serv25 ices provided by the providers. 
52 

•S 2372 EAH 

1 ‘‘(D) An assessment obtained from other Federal 

2 direct delivery systems of their capacity to provide 

3 health care to veterans. 

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

5 of non-contracted providers where there is insufficient 

6 network supply. 

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

8 of academic affiliates and other collaborations of the 

9 Department as it relates to providing health care to 

10 veterans. 

11 ‘‘(G) An assessment of the effects on health care 

12 capacity of the access standards and standards for 

13 quality established under sections 1703B and 1703C 

14 of this title. 

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

16 care services under the laws administered by the Sec17 retary, disaggregated by— 

18 ‘‘(i) appointments at facilities of the De19 partment of Veterans Affairs; and 

20 ‘‘(ii) appointments with non-Department 

21 health care providers. 

22 ‘‘(3)(A) The Secretary shall submit to the appropriate 

23 committees of Congress the market area assessments estab24 lished in paragraph (1). 
53 

•S 2372 EAH 

1 ‘‘(B) The Secretary also shall submit to the appro2 priate committees of Congress the market area assessments 

3 completed by or being performed on the day before the date 

4 of the enactment of the Caring for Our Veterans Act of 2018. 

5 ‘‘(4)(A) The Secretary shall use the market area assess6 ments established under paragraph (1) to— 

7 ‘‘(i) determine the capacity of the health care 

8 provider networks established under section 1703(h) of 

9 this title; 

10 ‘‘(ii) inform the Department budget, in accord11 ance with subparagraph (B); and 

12 ‘‘(iii) inform and assess the appropriateness of 

13 the access standards established under section 1703B 

14 of this title and standards for quality under section 

15 1703C and to make recommendations for any changes 

16 to such standards. 

17 ‘‘(B) The Secretary shall ensure that the Department 

18 budget for any fiscal year (as submitted with the budget 

19 of the President under section 1105(a) of title 31) reflects 

20 the findings of the Secretary with respect to the most recent 

21 market area assessments under paragraph (1) and health 

22 care utilization data from the Department and non-Depart23 ment entities or providers furnishing care and services to 

24 covered veterans as described in section 1703(b). 
54 

•S 2372 EAH 

1 ‘‘(b) STRATEGIC PLAN TO MEET HEALTH CARE DE2 MAND.—(1) Not later than 1 year after the date of the enact3 ment of the Caring for Our Veterans Act of 2018 and not 

4 less frequently than once every 4 years thereafter, the Sec5 retary shall submit to the appropriate committees of Con6 gress a strategic plan that specifies a 4-year forecast of— 

7 ‘‘(A) the demand for health care from the De8 partment, disaggregated by geographic area as deter9 mined by the Secretary; 

10 ‘‘(B) the health care capacity to be provided at 

11 each medical center of the Department; and 

12 ‘‘(C) the health care capacity to be provided 

13 through community care providers. 

14 ‘‘(2) In preparing the strategic plan under paragraph 

15 (1), the Secretary shall— 

16 ‘‘(A) assess the access standards and standards 

17 for quality established under sections 1703B and 

18 1703C of this title; 

19 ‘‘(B) assess the market area assessments estab20 lished under subsection (a); 

21 ‘‘(C) assess the needs of the Department based on 

22 identified services that provide management of condi23 tions or disorders related to military service for which 

24 there is limited experience or access in the national 

25 market, the overall health of veterans throughout their 
55 

•S 2372 EAH 

1 lifespan, or other services as the Secretary determines 

2 appropriate; 

3 ‘‘(D) consult with key stakeholders within the 

4 Department, the heads of other Federal agencies, and 

5 other relevant governmental and nongovernmental en6 tities, including State, local, and tribal government 

7 officials, members of Congress, veterans service orga8 nizations, private sector representatives, academics, 

9 and other policy experts; 

10 ‘‘(E) identify emerging issues, trends, problems, 

11 and opportunities that could affect health care serv12 ices furnished under the laws administered by the 

13 Secretary; 

14 ‘‘(F) develop recommendations regarding both 

15 short- and long-term priorities for health care services 

16 furnished under the laws administered by the Sec17 retary; 

18 ‘‘(G) after consultation with veterans service or19 ganizations and other key stakeholders on survey de20 velopment or modification of an existing survey, con21 sider a survey of veterans who have used hospital 

22 care, medical services, or extended care services fur23 nished by the Veterans Health Administration during 

24 the most recent 2-year period to assess the satisfaction 

25 of the veterans with service and quality of care; 
56 

•S 2372 EAH 

1 ‘‘(H) conduct a comprehensive examination of 

2 programs and policies of the Department regarding 

3 the delivery of health care services and the demand of 

4 health care services for veterans in future years; 

5 ‘‘(I) assess the remediation of medical service 

6 lines of the Department as described in section 1706A 

7 in conjunction with the utilization of non-Depart8 ment entities or providers to offset remediation; and 

9 ‘‘(J) consider such other matters as the Secretary 

10 considers appropriate. 

11 ‘‘(c) RESPONSIBILITIES.—The Secretary shall be re12 sponsible for— 

13 ‘‘(1) overseeing the transformation and organiza14 tional change across the Department to achieve such 

15 high performing integrated health care network; 

16 ‘‘(2) developing the capital infrastructure plan17 ning and procurement processes, whether minor or 

18 major construction projects or leases; and 

19 ‘‘(3) developing a multi-year budget process that 

20 is capable of forecasting future year budget require21 ments and projecting the cost of delivering health care 

22 services under a high-performing integrated health 

23 care network. 
57 

•S 2372 EAH 

1 ‘‘(d) 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 the 

5 Committee on Appropriations of the Senate; and 

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

7 Committee on Appropriations of the House of Rep8 resentatives.’’. 

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

10 the beginning of such chapter is amended by inserting after 

11 the item relating to section 7330B the following new item: 

‘‘7330C. Quadrennial Veterans Health Administration review.’’. 

12 SEC. 107. APPLICABILITY OF DIRECTIVE OF OFFICE OF FED13 ERAL CONTRACT COMPLIANCE PROGRAMS. 

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

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

16 38, United States Code, as added by section 102 of this title, 

17 Directive 2014–01 of the Office of Federal Contract Compli18 ance Programs of the Department of Labor (effective as of 

19 May 7, 2014) shall apply to any entity entering into an 

20 agreement under such section 1703A or section 1745 of such 

21 title, as amended by section 103, in the same manner as 

22 such directive applies to subcontractors under the 

23 TRICARE program for the duration of the moratorium 

24 provided under such directive. 
58 

•S 2372 EAH 

1 (b) APPLICABILITY PERIOD.—The directive described 

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

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

4 2019. 

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

6 the term ‘‘TRICARE program’’ has the meaning given that 

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

8 SEC. 108. PREVENTION OF CERTAIN HEALTH CARE PRO9 VIDERS FROM PROVIDING NON-DEPARTMENT 

10 HEALTH CARE SERVICES TO VETERANS. 

11 (a) IN GENERAL.—On and after the date that is 1 year 

12 after the date of the enactment of this Act, the Secretary 

13 of Veterans Affairs shall deny or revoke the eligibility of 

14 a health care provider to provide non-Department health 

15 care services to veterans if the Secretary determines that 

16 the health care provider— 

17 (1) was removed from employment with the De18 partment of Veterans Affairs due to conduct that vio19 lated a policy of the Department relating to the deliv20 ery of safe and appropriate health care; or 

21 (2) violated the requirements of a medical license 

22 of the health care provider that resulted in the loss of 

23 such medical license. 

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

25 is 1 year after the date of the enactment of this Act, the 
59 

•S 2372 EAH 

1 Secretary may deny, revoke, or suspend the eligibility of 

2 a health care provider to provide non-Department health 

3 care services if the Secretary determines such action is nec4 essary to immediately protect the health, safety, or welfare 

5 of veterans and the health care provider is under investiga6 tion by the medical licensing board of a State in which 

7 the health care provider is licensed or practices. 

8 (c) SUSPENSION.—The Secretary shall suspend the eli9 gibility of a health care provider to provide non-Depart10 ment health care services to veterans if the health care pro11 vider is suspended from serving as a health care provider 

12 of the Department. 

13 (d) COMPTROLLER GENERAL REPORT.—Not later than 

14 2 years after the date of the enactment of this Act, the 

15 Comptroller General of the United States shall submit to 

16 Congress a report on the implementation by the Secretary 

17 of this section, including the following: 

18 (1) The aggregate number of health care pro19 viders denied or suspended under this section from 

20 participation in providing non-Department health 

21 care services. 

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

23 health care for patients or staffing shortages in pro24 grams of the Department providing non-Department 

25 health care services. 
60 

•S 2372 EAH 

1 (3) An explanation of the coordination of the De2 partment with the medical licensing boards of States 

3 in implementing this section, the amount of involve4 ment of such boards in such implementation, and ef5 forts by the Department to address any concerns 

6 raised by such boards with respect to such implemen7 tation. 

8 (4) Such recommendations as the Comptroller 

9 General considers appropriate regarding harmonizing 

10 eligibility criteria between health care providers of the 

11 Department and health care providers eligible to pro12 vide non-Department health care services. 

13 (e) NON-DEPARTMENT HEALTH CARE SERVICES DE14 FINED.—In this section, the term ‘‘non-Department health 

15 care services’’ means services— 

16 (1) provided under subchapter I of chapter 17 of 

17 title 38, United States Code, at non-Department fa18 cilities (as defined in section 1701 of such title); 

19 (2) provided under section 101 of the Veterans 

20 Access, Choice, and Accountability Act of 2014 (Pub21 lic Law 113–146; 38 U.S.C. 1701 note); 

22 (3) purchased through the Medical Community 

23 Care account of the Department; or 
61 

•S 2372 EAH 

1 (4) purchased with amounts deposited in the Vet2 erans Choice Fund under section 802 of the Veterans 

3 Access, Choice, and Accountability Act of 2014. 

4 SEC. 109. REMEDIATION OF MEDICAL SERVICE LINES. 

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

6 amended by inserting after section 1706 the following new 

7 section: 

8 ‘‘§ 1706A. Remediation of medical service lines 

9 ‘‘(a) IN GENERAL.—Not later than 30 days after deter10 mining under section 1703(e)(1) that a medical service line 

11 of the Department is providing hospital care, medical serv12 ices, or extended care services that does not comply with 

13 the standards for quality established by the Secretary, the 

14 Secretary shall submit to Congress an assessment of the fac15 tors that led the Secretary to make such determination and 

16 a plan with specific actions, and the time to complete them, 

17 to be taken to comply with such standards for quality, in18 cluding the following: 

19 ‘‘(1) Increasing personnel or temporary per20 sonnel assistance, including mobile deployment teams. 

21 ‘‘(2) Special hiring incentives, including the 

22 Education Debt Reduction Program under subchapter 

23 VII of chapter 76 of this title and recruitment, reloca24 tion, and retention incentives. 

25 ‘‘(3) Utilizing direct hiring authority. 
62 

•S 2372 EAH 

1 ‘‘(4) Providing improved training opportunities 

2 for staff. 

3 ‘‘(5) Acquiring improved equipment. 

4 ‘‘(6) Making structural modifications to the fa5 cility used by the medical service line. 

6 ‘‘(7) Such other actions as the Secretary con7 siders appropriate. 

8 ‘‘(b) RESPONSIBLE PARTIES.—In each assessment sub9 mitted under subsection (a) with respect to a medical serv10 ice line, the Secretary shall identify the individuals at the 

11 Central Office of the Veterans Health Administration, the 

12 facility used by the medical service line, and the central 

13 office of the relevant Veterans Integrated Service Network 

14 who are responsible for overseeing the progress of that med15 ical service line in complying with the standards for quality 

16 established by the Secretary. 

17 ‘‘(c) INTERIM REPORTS.—Not later than 180 days 

18 after submitting an assessment under subsection (a) with 

19 respect to a medical service line, the Secretary shall submit 

20 to Congress a report on the progress of that medical service 

21 line in complying with the standards for quality established 

22 by the Secretary and any other measures the Secretary will 

23 take to assist the medical service line in complying with 

24 such standards for quality. 
63 

•S 2372 EAH 

1 ‘‘(d) ANNUAL REPORTS.—Not less frequently than once 

2 each year, the Secretary shall— 

3 ‘‘(1) submit to Congress an analysis of the reme4 diation actions and costs of such actions taken with 

5 respect to each medical service line with respect to 

6 which the Secretary submitted an assessment and 

7 plan under paragraph (1) in the preceding year, in8 cluding an update on the progress of each such med9 ical service line in complying with the standards for 

10 quality and timeliness established by the Secretary 

11 and any other actions the Secretary is undertaking to 

12 assist the medical service line in complying with 

13 standards for quality as established by the Secretary; 

14 and 

15 ‘‘(2) publish such analysis on the internet 

16 website of the Department.’’. 

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

18 the beginning of such chapter is amended by inserting after 

19 the item relating to section 1706 the following new item: 

‘‘1706A. Remediation of medical service lines.’’. 

20 CHAPTER 2—PAYING PROVIDERS AND 

21 IMPROVING COLLECTIONS 

22 SEC. 111. PROMPT PAYMENT TO PROVIDERS. 

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

24 amended by inserting after section 1703C, as added by sec25 tion 104 of this title, the following new section: 
64 

•S 2372 EAH 

1 ‘‘§ 1703D. Prompt payment standard 

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

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

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

5 extended care services furnished by health care entities or 

6 providers under this chapter within 45 calendar days upon 

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

8 receipt of a clean electronic claim. 

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

10 45 calendar days of denial for a paper claim and 30 cal11 endar days of denial for an electronic claim, notify the 

12 health care entity or provider of the reason for denying the 

13 claim and what, if any, additional information is required 

14 to process the claim. 

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

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

17 or otherwise adjudicated within 30 calendar days from the 

18 receipt of the requested information. 

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

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

21 other forms of periodic payment to entities or providers. 

22 ‘‘(b) SUBMITTAL OF CLAIMS BY HEALTH CARE ENTI23 TIES AND PROVIDERS.—A health care entity or provider 

24 that furnishes hospital care, a medical service, or an ex25 tended care service under this chapter shall submit to the 

26 Secretary a claim for payment for furnishing the hospital 
65 

•S 2372 EAH 

1 care, medical service, or extended care service not later than 

2 180 days after the date on which the entity or provider fur3 nished the hospital care, medical service, or extended care 

4 service. 

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

6 through 3733 of title 31 shall apply to fraudulent claims 

7 for payment submitted to the Secretary by a health care 

8 entity or provider under this chapter. 

9 ‘‘(2) Pursuant to regulations prescribed by the Sec10 retary, the Secretary shall bar a health care entity or pro11 vider from furnishing hospital care, medical services, and 

12 extended care services under this chapter when the Sec13 retary determines the entity or provider has submitted to 

14 the Secretary fraudulent health care claims for payment by 

15 the Secretary. 

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

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

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

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

20 entity provider within the time periods specified in sub21 section (a). 

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

23 the Secretary may, under the requirements established by 

24 subsection (a) and consistent with the provisions of chapter 
66 

•S 2372 EAH 

1 39 of title 31 (commonly referred to as the ‘Prompt Pay2 ment Act’), require that interest be paid on clean claims. 

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

4 computed at the rate of interest established by the Secretary 

5 of the Treasury under section 3902 of title 31 and published 

6 in the Federal Register. 

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

8 shall submit to Congress a report on payment of overdue 

9 claims under this subsection, disaggregated by paper and 

10 electronic claims, that includes the following: 

11 ‘‘(A) The amount paid in overdue claims de12 scribed in this subsection, disaggregated by the 

13 amount of the overdue claim and the amount of inter14 est paid on such overdue claim. 

15 ‘‘(B) The number of such overdue claims and the 

16 average number of days late each claim was paid, 

17 disaggregated by facility of the Department and Vet18 erans Integrated Service Network region. 

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

20 the amount of any overpayment from payments due a 

21 health care entity or provider under this chapter. 

22 ‘‘(2) Deductions may not be made under this sub23 section unless the Secretary has made reasonable efforts to 

24 notify a health care entity or provider of the right to dispute 
67 

•S 2372 EAH 

1 the existence or amount of such indebtedness and the right 

2 to request a compromise of such indebtedness. 

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

4 respect to any such dispute or request prior to deducting 

5 any overpayment unless the time required to make such a 

6 determination before making any deductions would jeop7 ardize the Secretary’s ability to recover the full amount of 

8 such indebtedness. 

9 ‘‘(f) INFORMATION AND DOCUMENTATION RE10 QUIRED.—(1) The Secretary shall provide to all health care 

11 entities and providers participating in a program to fur12 nish hospital care, medical services, or extended care serv13 ices under this chapter a list of information and docu14 mentation that is required to establish a clean claim under 

15 this section. 

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

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

18 determine the information and documentation to include in 

19 the list under paragraph (1). 

20 ‘‘(3) If the Secretary modifies the information and doc21 umentation included in the list under paragraph (1), the 

22 Secretary shall notify all health care entities and providers 

23 described in paragraph (1) not later than 30 days before 

24 such modifications take effect. 
68 

•S 2372 EAH 

1 ‘‘(g) PROCESSING OF CLAIMS.—(1) In processing a 

2 claim for compensation for hospital care, medical services, 

3 or extended care services furnished by a non-Department 

4 health care entity or provider under this chapter, the Sec5 retary may act through— 

6 ‘‘(A) a non-Department entity that is under con7 tract or agreement for the program established under 

8 section 1703(a) of this title; or 

9 ‘‘(B) a non-Department entity that specializes in 

10 such processing for other Federal agency health care 

11 systems. 

12 ‘‘(2) The Secretary shall seek to contract with a third 

13 party to conduct a review of claims described in paragraph 

14 (3) that includes— 

15 ‘‘(A) a feasibility assessment to determine the ca16 pacity of the Department to process such claims in a 

17 timely manner; and 

18 ‘‘(B) a cost benefit analysis comparing the ca19 pacity of the Department to a third party entity ca20 pable of processing such claims. 

21 ‘‘(3) The review required under paragraph (2) shall 

22 apply to claims for hospital care, medical services, or ex23 tended care services furnished under section 1703 of this 

24 Act, as amended by the Caring for Our Veterans Act of 

25 2018, that are processed by the Department. 
69 

•S 2372 EAH 

1 ‘‘(h) REPORT ON ENCOUNTER DATA SYSTEM.—(1) Not 

2 later than 90 days after the date of the enactment of the 

3 Caring for Our Veterans Act of 2018, the Secretary shall 

4 submit to the appropriate committees of Congress a report 

5 on the feasibility and advisability of adopting a funding 

6 mechanism similar to what is utilized by other Federal 

7 agencies to allow a contracted entity to act as a fiscal inter8 mediary for the Federal Government to distribute, or pass 

9 through, Federal Government funds for certain non-under10 written hospital care, medical services, or extended care 

11 services. 

12 ‘‘(2) The Secretary may coordinate with the Depart13 ment of Defense, the Department of Health and Human 

14 Services, and the Department of the Treasury in developing 

15 the report required by paragraph (1). 

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

17 ‘‘(1) The term ‘appropriate committees of Con18 gress’ means— 

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

20 and the Committee on Appropriations of the 

21 Senate; and 

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

23 and the Committee on Appropriations of the 

24 House of Representatives. 
70 

•S 2372 EAH 

1 ‘‘(2) The term ‘clean electronic claim’ means the 

2 transmission of data for purposes of payment of cov3 ered health care expenses that is submitted to the Sec4 retary which contains substantially all of the required 

5 data elements necessary for accurate adjudication, 

6 without obtaining additional information from the 

7 entity or provider that furnished the care or service, 

8 submitted in such format as prescribed by the Sec9 retary in regulations for the purpose of paying claims 

10 for care or services. 

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

12 paper claim for payment of covered health care ex13 penses that is submitted to the Secretary which con14 tains substantially all of the required data elements 

15 necessary for accurate adjudication, without obtain16 ing additional information from the entity or pro17 vider that furnished the care or service, submitted in 

18 such format as prescribed by the Secretary in regula19 tions for the purpose of paying claims for care or 

20 services. 

21 ‘‘(4) The term ‘fraudulent claims’ means the 

22 knowing misrepresentation of a material fact or facts 

23 by a health care entity or provider made to induce 

24 the Secretary to pay a claim that was not legally 

25 payable to that provider. 
71 

•S 2372 EAH 

1 ‘‘(5) The term ‘health care entity or provider’ in2 cludes any non-Department health care entity or pro3 vider, but does not include any Federal health care 

4 entity or provider.’’. 

5 (b) CLERICAL AMENDMENT.—The table of sections at 

6 the beginning of such chapter is amended by inserting after 

7 the item relating to section 1703C, as added by section 104 

8 of this title, the following new item: 

‘‘1703D. Prompt payment standard.’’. 

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

10 SUBJECT TO AN AGREEMENT. 

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

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

13 ‘‘§ 8159. Authority to pay for services authorized but 

14 not subject to an agreement 

15 ‘‘(a) IN GENERAL.—If, in the course of furnishing hos16 pital care, a medical service, or an extended care service 

17 authorized by the Secretary and pursuant to a contract, 

18 agreement, or other arrangement with the Secretary, a pro19 vider who is not a party to the contract, agreement, or other 

20 arrangement furnishes hospital care, a medical service, or 

21 an extended care service that the Secretary considers nec22 essary, the Secretary may compensate the provider for the 

23 cost of such care or service. 

24 ‘‘(b) NEW CONTRACTS AND AGREEMENTS.—The Sec25 retary shall take reasonable efforts to enter into a contract, 
72 

•S 2372 EAH 

1 agreement, or other arrangement with a provider described 

2 in subsection (a) to ensure that future care and services au3 thorized by the Secretary and furnished by the provider are 

4 subject to such a contract, agreement, or other arrange5 ment.’’. 

6 (b) CLERICAL AMENDMENT.—The table of sections at 

7 the beginning of such chapter is amended by inserting after 

8 the item relating to section 8158 the following new item: 

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

9 SEC. 113. IMPROVEMENT OF AUTHORITY TO RECOVER THE 

10 COST OF SERVICES FURNISHED FOR NON11 SERVICE-CONNECTED DISABILITIES. 

12 (a) BROADENING SCOPE OF APPLICABILITY.—Section 

13 1729 is amended— 

14 (1) in subsection (a)— 

15 (A) in paragraph (2)(A)— 

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

18 (ii) by striking ‘‘the veteran’’ and in19 serting ‘‘the individual’’; and 

20 (B) in paragraph (3)— 

21 (i) in the matter preceding subpara22 graph (A), by striking ‘‘the veteran’’ and 

23 inserting ‘‘the individual’’; and 
73 

•S 2372 EAH 

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

2 ‘‘the veteran’s’’ and inserting ‘‘the individ3 ual’s’’; 

4 (2) in subsection (b)— 

5 (A) in paragraph (1)— 

6 (i) by striking ‘‘the veteran’’ and in7 serting ‘‘the individual’’; and 

8 (ii) by striking ‘‘the veteran’s’’ and in9 serting ‘‘the individual’s’’; and 

10 (B) in paragraph (2)— 

11 (i) in subparagraph (A)— 

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

13 inserting ‘‘the individual’’; and 

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

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

16 (ii) in subparagraph (B)— 

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

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

20 (II) in clause (ii)— 

21 (aa) by striking ‘‘the vet22 eran’’ and inserting ‘‘the indi23 vidual’’; and 
74 

•S 2372 EAH 

1 (bb) by striking ‘‘the vet2 eran’s’’ each place it appears and 

3 inserting ‘‘the individual’s’’; 

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

5 and inserting ‘‘An individual’’; and 

6 (4) in subsection (h)— 

7 (A) in paragraph (1)— 

8 (i) in the matter preceding subpara9 graph (A), by striking ‘‘a veteran’’ and in10 serting ‘‘an individual’’; 

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

12 ‘‘the veteran’’ and inserting ‘‘the indi13 vidual’’; and 

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

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

17 (B) in paragraph (2)— 

18 (i) by striking ‘‘A veteran’’ and insert19 ing ‘‘An individual’’; 

20 (ii) by striking ‘‘a veteran’’ and insert21 ing ‘‘an individual’’; and 

22 (iii) by striking ‘‘the veteran’’ and in23 serting ‘‘the individual’’. 

24 (b) MODIFICATION OF AUTHORITY.—Subsection (a)(1) 

25 of such section is amended by striking ‘‘(1) Subject’’ and 
75 

•S 2372 EAH 

1 all that follows through the period and inserting the fol2 lowing: ‘‘(1) Subject to the provisions of this section, in any 

3 case in which the United States is required by law to fur4 nish or pay for care or services under this chapter for a 

5 non-service-connected disability described in paragraph (2) 

6 of this subsection, the United States has the right to recover 

7 or collect from a third party the reasonable charges of care 

8 or services so furnished or paid for to the extent that the 

9 recipient or provider of the care or services would be eligible 

10 to receive payment for such care or services from such third 

11 party if the care or services had not been furnished or paid 

12 for by a department or agency of the United States.’’. 

13 (c) MODIFICATION OF ELIGIBLE INDIVIDUALS.—Sub14 paragraph (D) of subsection (a)(2) of such section is amend15 ed to read as follows: 

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

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

18 under a health-plan contract.’’. 

19 SEC. 114. PROCESSING OF CLAIMS FOR REIMBURSEMENT 

20 THROUGH ELECTRONIC INTERFACE. 

21 The Secretary of Veterans Affairs may enter into an 

22 agreement with a third-party entity to process, through the 

23 use of an electronic interface, claims for reimbursement for 

24 health care provided under the laws administered by the 

25 Secretary. 
76 

•S 2372 EAH 

1 CHAPTER 3—EDUCATION AND TRAINING 

2 PROGRAMS 

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

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

6 shall develop and administer an education program that 

7 teaches veterans about their health care options through the 

8 Department of Veterans Affairs. 

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

10 shall— 

11 (1) teach veterans about— 

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

14 amended by section 101 of this title, and 1710 

15 of title 38, United States Code; 

16 (B) priority groups for enrollment in the 

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

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

21 for certain services; and 

22 (D) how to utilize the access standards and 

23 standards for quality established under sections 

24 1703B and 1703C of such title; 
77 

•S 2372 EAH 

1 (2) teach veterans about the interaction between 

2 health insurance (including private insurance, Medi3 care, Medicaid, the TRICARE program, the Indian 

4 Health Service, tribal health programs, and other 

5 forms of insurance) and health care from the Depart6 ment; and 

7 (3) provide veterans with information on what 

8 to do when they have a complaint about health care 

9 received from the Department (whether about the pro10 vider, the Department, or any other type of com11 plaint). 

12 (c) ACCESSIBILITY.—In developing the education pro13 gram under this section, the Secretary shall ensure that ma14 terials under such program are accessible— 

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

16 internet; and 

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

18 the Americans with Disabilities Act of 1990 (42 

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

20 (d) ANNUAL EVALUATION AND REPORT.— 

21 (1) EVALUATION.—The Secretary shall develop a 

22 method to evaluate the effectiveness of the education 

23 program under this section and evaluate the program 

24 using the method not less frequently than once each 

25 year. 
78 

•S 2372 EAH 

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

2 year, the Secretary shall submit to Congress a report 

3 on the findings of the Secretary with respect to the 

4 most recent evaluation conducted by the Secretary 

5 under paragraph (1). 

6 (e) DEFINITIONS.—In this section: 

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

8 Medicaid program under title XIX of the Social Secu9 rity Act (42 U.S.C. 1396 et seq.). 

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

11 Medicare program under title XVIII of such Act (42 

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

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

14 program’’ has the meaning given that term in section 

15 1072 of title 10, United States Code. 

16 SEC. 122. TRAINING PROGRAM FOR ADMINISTRATION OF 

17 NON-DEPARTMENT OF VETERANS AFFAIRS 

18 HEALTH CARE. 

19 (a) ESTABLISHMENT OF PROGRAM.—The Secretary of 

20 Veterans Affairs shall develop and implement a training 

21 program to train employees and contractors of the Depart22 ment of Veterans Affairs on how to administer non-Depart23 ment health care programs, including the following: 

24 (1) Reimbursement for non-Department emer25 gency room care. 
79 

•S 2372 EAH 

1 (2) The Veterans Community Care Program 

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

4 (3) Management of prescriptions pursuant to 

5 improvements under section 131. 

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

8 (1) develop a method to evaluate the effectiveness 

9 of the training program developed and implemented 

10 under subsection (a); 

11 (2) evaluate such program not less frequently 

12 than once each year; and 

13 (3) not less frequently than once each year, sub14 mit to Congress the findings of the Secretary with re15 spect to the most recent evaluation carried out under 

16 paragraph (2). 

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

19 (a) ESTABLISHMENT OF PROGRAM.— 

20 (1) IN GENERAL.—The Secretary of Veterans Af21 fairs shall establish a program to provide continuing 

22 medical education material to non-Department med23 ical professionals. 
80 

•S 2372 EAH 

1 (2) EDUCATION PROVIDED.—The program estab2 lished under paragraph (1) shall include education on 

3 the following: 

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

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

9 (C) Such other matters as the Secretary 

10 considers appropriate. 

11 (b) MATERIAL PROVIDED.—The continuing medical 

12 education material provided to non-Department medical 

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

15 professionals of the Department to ensure that all medical 

16 professionals treating veterans have access to the same ma17 terials, which supports core competencies throughout the 

18 community. 

19 (c) ADMINISTRATION OF PROGRAM.— 

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

22 participating non-Department medical professionals 

23 through an internet website of the Department of Vet24 erans Affairs. 
81 

•S 2372 EAH 

1 (2) CURRICULUM AND CREDIT PROVIDED.—The 

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

4 participating non-Department medical professionals 

5 for continuing medical education. 

6 (3) ACCREDITATION.—The Secretary shall ensure 

7 that the program is accredited in as many States as 

8 practicable. 

9 (4) CONSISTENCY WITH EXISTING RULES.—The 

10 Secretary shall ensure that the program is consistent 

11 with the rules and regulations of the following: 

12 (A) The medical licensing agency of each 

13 State in which the program is accredited. 

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

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

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

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

20 The Secretary shall monitor the utilization of the pro21 gram established under subsection (a), evaluate its ef22 fectiveness, and report to Congress on utilization and 

23 effectiveness not less frequently than once each year. 

24 (d) NON-DEPARTMENT MEDICAL PROFESSIONAL DE25 FINED.—In this section, the term ‘‘non-Department medical 
82 

•S 2372 EAH 

1 professional’’ means any individual who is licensed by an 

2 appropriate medical authority in the United States and is 

3 in good standing, is not an employee of the Department 

4 of Veterans Affairs, and provides care to veterans or family 

5 members of veterans under the laws administered by the 

6 Secretary of Veterans Affairs. 

7 CHAPTER 4—OTHER MATTERS RELATING 

8 TO NON-DEPARTMENT OF VETERANS 

9 AFFAIRS PROVIDERS 

10 SEC. 131. ESTABLISHMENT OF PROCESSES TO ENSURE 

11 SAFE OPIOID PRESCRIBING PRACTICES BY 

12 NON-DEPARTMENT OF VETERANS AFFAIRS 

13 HEALTH CARE PROVIDERS. 

14 (a) RECEIPT AND REVIEW OF GUIDELINES.—The Sec15 retary of Veterans Affairs shall ensure that all covered 

16 health care providers are provided a copy of and certify 

17 that they have reviewed the evidence-based guidelines for 

18 prescribing opioids set forth by the Opioid Safety Initiative 

19 of the Department of Veterans Affairs. 

20 (b) INCLUSION OF MEDICAL HISTORY AND CURRENT

21 MEDICATIONS.—The Secretary shall implement a process to 

22 ensure that, if care of a veteran by a covered health care 

23 provider is authorized under the laws administered by the 

24 Secretary, the document authorizing such care includes the 

25 available and relevant medical history of the veteran and 
83 

•S 2372 EAH 

1 a list of all medications prescribed to the veteran as known 

2 by the Department. 

3 (c) SUBMITTAL OF MEDICAL RECORDS AND PRESCRIP4 TIONS.— 

5 (1) IN GENERAL.—The Secretary shall, consistent 

6 with section 1703(a)(2)(A), as amended by section 

7 101 of this title, and section 1703A(e)(2)(F), as added 

8 by section 102 of this title, require each covered health 

9 care provider to submit medical records of any care 

10 or services furnished, including records of any pre11 scriptions for opioids, to the Department in the time12 frame and format specified by the Secretary. 

13 (2) RESPONSIBILITY OF DEPARTMENT FOR RE14 CORDING AND MONITORING.—In carrying out para15 graph (1) and upon the receipt by the Department of 

16 the medical records described in paragraph (1), the 

17 Secretary shall— 

18 (A) ensure the Department is responsible for 

19 the recording of the prescription in the electronic 

20 health record of the veteran; and 

21 (B) enable other monitoring of the prescrip22 tion as outlined in the Opioid Safety Initiative 

23 of the Department. 

24 (3) REPORT.—Not less frequently than annually, 

25 the Secretary shall submit to the Committee on Vet-
84 

•S 2372 EAH 

1 erans’ Affairs of the Senate and the Committee on 

2 Veterans’ Affairs of the House of Representatives a re3 port evaluating the compliance of covered health care 

4 providers with the requirements under this section. 

5 (d) USE OF OPIOID SAFETY INITIATIVE GUIDE6 LINES.— 

7 (1) IN GENERAL.—If the Secretary determines 

8 that the opioid prescribing practices of a covered 

9 health care provider, when treating covered veterans, 

10 satisfy a condition described in paragraph (3), the 

11 Secretary shall take such action as the Secretary con12 siders appropriate to ensure the safety of all veterans 

13 receiving care from that health care provider, includ14 ing removing or directing the removal of any such 

15 health care provider from provider networks or other16 wise refusing to authorize care of veterans by such 

17 health care provider in any program authorized 

18 under the laws administered by the Secretary. 

19 (2) INCLUSION IN CONTRACTS.—The Secretary 

20 shall ensure that any contracts, agreements, or other 

21 arrangements entered into by the Secretary with third 

22 parties involved in administering programs that pro23 vide care in the community to veterans under the 

24 laws administered by the Secretary specifically grant 
85 

•S 2372 EAH 

1 the authority set forth in paragraph (1) to such third 

2 parties and to the Secretary, as the case may be. 

3 (3) CONDITIONS FOR EXCLUSION OR LIMITA4 TION.—The Secretary shall take such action as is con5 sidered appropriate under paragraph (1) when the 

6 opioid prescribing practices of a covered health care 

7 provider when treating covered veterans— 

8 (A) conflict with or are otherwise incon9 sistent with the standards of appropriate and 

10 safe care; 

11 (B) violate the requirements of a medical li12 cense of the health care provider; or 

13 (C) may place at risk the veterans receiving 

14 health care from the provider. 

15 (e) COVERED HEALTH CARE PROVIDER DEFINED.— 

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

17 means a non-Department of Veterans Affairs health care 

18 provider who provides health care to veterans under the 

19 laws administered by the Secretary of Veterans Affairs, but 

20 does not include a health care provider employed by another 

21 agency of the Federal Government. 

22 SEC. 132. IMPROVING INFORMATION SHARING WITH COM23 MUNITY PROVIDERS. 

24 Section 7332(b)(2) is amended by striking subpara25 graph (H) and inserting the following new subparagraphs: 
86 

•S 2372 EAH 

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

2 private entities and other Federal agencies) for pur3 poses of providing health care, including hospital 

4 care, medical services, and extended care services, to 

5 patients or performing other health care-related ac6 tivities or functions. 

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

8 under this subparagraph may not disclose or use such 

9 record for a purpose other than that for which the dis10 closure was made or as permitted by law. 

11 ‘‘(I) To a third party in order to recover or col12 lect reasonable charges for care furnished to, or paid 

13 on behalf of, a patient in connection with a non-serv14 ice connected disability as permitted by section 1729 

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

16 authorized or with respect to which the United States 

17 is deemed to be a third party beneficiary under the 

18 Act entitled ‘An Act to provide for the recovery from 

19 tortiously liable third persons of the cost of hospital 

20 and medical care and treatment furnished by the 

21 United States’ (Public Law 87–693; 42 U.S.C. 2651 

22 et seq.; commonly known as the ‘Federal Medical Care 

23 Recovery Act’).’’. 
87 

•S 2372 EAH 

1 SEC. 133. COMPETENCY STANDARDS FOR NON-DEPART2 MENT OF VETERANS AFFAIRS HEALTH CARE 

3 PROVIDERS. 

4 (a) ESTABLISHMENT OF STANDARDS AND REQUIRE5 MENTS.—The Secretary of Veterans Affairs shall establish 

6 standards and requirements for the provision of care by 

7 non-Department of Veterans Affairs health care providers 

8 in clinical areas for which the Department of Veterans Af9 fairs has special expertise, including post-traumatic stress 

10 disorder, military sexual trauma-related conditions, and 

11 traumatic brain injuries. 

12 (b) CONDITION FOR ELIGIBILITY TO FURNISH

13 CARE.—(1) Each non-Department of Veterans Affairs 

14 health care provider shall, to the extent practicable as deter15 mined by the Secretary or otherwise provided for in para16 graph (2), meet the standards and requirements established 

17 pursuant to subsection (a) before furnishing care pursuant 

18 to a contract, agreement, or other arrangement with the De19 partment of Veterans Affairs. Non-Department of Veterans 

20 Affairs health care providers furnishing care pursuant to 

21 a contract, agreement, or other arrangement shall, to the 

22 extent practicable as determined by the Secretary, fulfill 

23 training requirements established by the Secretary on how 

24 to deliver evidence-based treatments in the clinical areas for 

25 which the Department of Veterans Affairs has special exper26 tise. 
88 

•S 2372 EAH 

1 (2) Each non-Department of Veterans Affairs health 

2 care provider who enters into a contract, agreement, or 

3 other arrangement after the effective date identified in sub4 section (c) shall, to the extent practicable, meet the stand5 ards and requirements established pursuant to subsection 

6 (a) within 6 months of the contract, agreement, or other 

7 arrangement taking effect. 

8 (c) EFFECTIVE DATE.—This section shall take effect 

9 on the day that is 1 year after the date of the enactment 

10 of this Act. 

11 SEC. 134. DEPARTMENT OF VETERANS AFFAIRS PARTICIPA12 TION IN NATIONAL NETWORK OF STATE13 BASED PRESCRIPTION DRUG MONITORING 

14 PROGRAMS. 

15 (a) IN GENERAL.—Chapter 17 is amended by insert16 ing after section 1730A the following new section: 

17 ‘‘§ 1730B. Access to State prescription drug moni18 toring programs 

19 ‘‘(a) ACCESS TO PROGRAMS.—(1) Any licensed health 

20 care provider or delegate of such a provider shall be consid21 ered an authorized recipient or user for the purpose of 

22 querying and receiving data from the national network of 

23 State-based prescription drug monitoring programs to sup24 port the safe and effective prescribing of controlled sub25 stances to covered patients. 
89 

•S 2372 EAH 

1 ‘‘(2) Under the authority granted by paragraph (1)— 

2 ‘‘(A) licensed health care providers or delegates of 

3 such providers shall query such network in accordance 

4 with applicable regulations and policies of the Vet5 erans Health Administration; and 

6 ‘‘(B) notwithstanding any general or specific 

7 provision of law, rule, or regulation of a State, no 

8 State may restrict the access of licensed health care 

9 providers or delegates of such providers from accessing 

10 that State’s prescription drug monitoring programs. 

11 ‘‘(3) No State shall deny or revoke the license, registra12 tion, or certification of a licensed health care provider or 

13 delegate who otherwise meets that State’s qualifications for 

14 holding the license, registration, or certification on the basis 

15 that the licensed health care provider or delegate queried 

16 or received data, or attempted to query or receive data, from 

17 the national network of State-based prescription drug moni18 toring programs under this section. 

19 ‘‘(b) COVERED PATIENTS.—For purposes of this sec20 tion, a covered patient is a patient who— 

21 ‘‘(1) receives a prescription for a controlled sub22 stance; and 

23 ‘‘(2) is not receiving palliative care or enrolled 

24 in hospice care. 

25 ‘‘(c) DEFINITIONS.—In this section: 
90 

•S 2372 EAH 

1 ‘‘(1) The term ‘controlled substance’ has the 

2 meaning given such term in section 102(6) of the 

3 Controlled Substances Act (21 U.S.C. 802(6)). 

4 ‘‘(2) The term ‘delegate’ means a person or auto5 mated system accessing the national network of State6 based prescription monitoring programs at the direc7 tion or under the supervision of a licensed health care 

8 provider. 

9 ‘‘(3) The term ‘licensed health care provider’ 

10 means a health care provider employed by the De11 partment who is licensed, certified, or registered with12 in any State to fill or prescribe medications within 

13 the scope of his or her practice as a Department em14 ployee. 

15 ‘‘(4) The term ‘national network of State-based 

16 prescription monitoring programs’ means an inter17 connected nation-wide system that facilitates the 

18 transfer to State prescription drug monitoring pro19 gram data across State lines. 

20 ‘‘(5) The term ‘State’ means a State, as defined 

21 in section 101(20) of this title, or a political subdivi22 sion of a State.’’. 

23 (b) CLERICAL AMENDMENT.—The table of sections at 

24 the beginning of chapter 17 of such title is amended by in-
91 

•S 2372 EAH 

1 serting after the item relating to section 1730A the following 

2 new item: 

‘‘1730B. Access to State prescription drug monitoring programs.’’. 

3 CHAPTER 5—OTHER NON-DEPARTMENT 

4 HEALTH CARE MATTERS 

5 SEC. 141. PLANS FOR USE OF SUPPLEMENTAL APPROPRIA6 TIONS REQUIRED. 

7 Whenever the Secretary submits to Congress a request 

8 for supplemental appropriations or any other appropria9 tion outside the standard budget process to address a budg10 etary issue affecting the Department of Veterans Affairs, the 

11 Secretary shall, not later than 45 days before the date on 

12 which such budgetary issue would start affecting a program 

13 or service, submit to Congress a justification for the request, 

14 including a plan that details how the Secretary intends to 

15 use the requested appropriation and how long the requested 

16 appropriation is expected to meet the needs of the Depart17 ment and certification that the request was made using an 

18 updated and sound actuarial analysis. 

19 SEC. 142. VETERANS CHOICE FUND FLEXIBILITY. 

20 Section 802 of the Veterans Access, Choice, and Ac21 countability Act of 2014 (Public Law 113–146; 38 U.S.C. 

22 1701 note) is amended— 

23 (1) in subsection (c)— 
92 

•S 2372 EAH 

1 (A) in paragraph (1), by striking ‘‘by para2 graph (3)’’ and inserting ‘‘in paragraphs (3) 

3 and (4)’’; and 

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

5 paragraph: 

6 ‘‘(4) PERMANENT AUTHORITY FOR OTHER

7 USES.—Beginning on March 1, 2019, amounts re8 maining in the Veterans Choice Fund may be used to 

9 furnish hospital care, medical services, and extended 

10 care services to individuals pursuant to chapter 17 of 

11 title 38, United States Code, at non-Department fa12 cilities, including pursuant to non-Department pro13 vider programs other than the program established by 

14 section 101. Such amounts shall be available in addi15 tion to amounts available in other appropriations ac16 counts for such purposes.’’; and 

17 (2) in subsection (d)(1), by striking ‘‘to sub18 section (c)(3)’’ and inserting ‘‘to paragraphs (3) and 

19 (4) of subsection (c)’’. 

20 SEC. 143. SUNSET OF VETERANS CHOICE PROGRAM. 

21 Subsection (p) of section 101 of the Veterans Access, 

22 Choice, and Accountability Act of 2014 (Public Law 113– 

23 146; 38 U.S.C. 1701 note) is amended to read as follows: 

24 ‘‘(p) AUTHORITY TO FURNISH CARE AND SERVICES.— 

25 The Secretary may not use the authority under this section 
93 

•S 2372 EAH 

1 to furnish care and services after the date that is 1 year 

2 after the date of the enactment of the Caring for Our Vet3 erans Act of 2018.’’. 

4 SEC. 144. CONFORMING AMENDMENTS. 

5 (a) IN GENERAL.— 

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

7 amended— 

8 (A) in section 1712(a)— 

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

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

11 1703(a) of this title’’ and inserting ‘‘or en12 tered an agreement’’; and 

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

14 ‘‘under the provisions of this subsection and 

15 section 1703 of this title’’; 

16 (B) in section 1712A(e)(1)— 

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

18 ‘‘contracts’’; and 

19 (ii) by striking ‘‘(under sections 

20 1703(a)(2) and 1710(a)(1)(B) of this title)’’; 

21 and 

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

23 ‘‘with section 1703’’ and inserting ‘‘with sections 

24 1703A, 8111, and 8153’’. 
94 

•S 2372 EAH 

1 (2) SOCIAL SECURITY ACT.—Section 

2 1866(a)(1)(L) of the Social Security Act (42 U.S.C. 

3 1395cc(a)(1)(L)) is amended by striking ‘‘under sec4 tion 603’’ and inserting ‘‘under chapter 17’’. 

5 (3) VETERANS’ BENEFITS IMPROVEMENTS ACT OF

6 1994.—Section 104(a)(4)(A) of the Veterans’ Benefits 

7 Improvements Act of 1994 (Public Law 103–446; 38 

8 U.S.C. 1117 note) is amended by striking ‘‘in section 

9 1703’’ and inserting ‘‘in sections 1703A, 8111, and 

10 8153’’. 

11 (b) EFFECTIVE DATE.—The amendments made by sub12 section (a) shall take effect on the date described in section 

13 101(b). 

14 Subtitle B—Improving Department 

15 of Veterans Affairs Health Care 

16 Delivery 

17 SEC. 151. LICENSURE OF HEALTH CARE PROFESSIONALS OF 

18 THE DEPARTMENT OF VETERANS AFFAIRS 

19 PROVIDING TREATMENT VIA TELEMEDICINE. 

20 (a) IN GENERAL.—Chapter 17 is amended by insert21 ing after section 1730B, as added by section 134, the fol22 lowing new section: 
95 

•S 2372 EAH 

1 ‘‘§ 1730C. Licensure of health care professionals pro2 viding treatment via telemedicine 

3 ‘‘(a) IN GENERAL.—Notwithstanding any provision of 

4 law regarding the licensure of health care professionals, a 

5 covered health care professional may practice the health 

6 care profession of the health care professional at any loca7 tion in any State, regardless of where the covered health 

8 care professional or the patient is located, if the covered 

9 health care professional is using telemedicine to provide 

10 treatment to an individual under this chapter. 

11 ‘‘(b) COVERED HEALTH CARE PROFESSIONALS.—For 

12 purposes of this section, a covered health care professional 

13 is any health care professional who— 

14 ‘‘(1) is an employee of the Department appointed 

15 under the authority under section 7306, 7401, 7405, 

16 7406, or 7408 of this title or title 5; 

17 ‘‘(2) is authorized by the Secretary to provide 

18 health care under this chapter; 

19 ‘‘(3) is required to adhere to all standards for 

20 quality relating to the provision of medicine in ac21 cordance with applicable policies of the Department; 

22 and 

23 ‘‘(4) has an active, current, full, and unrestricted 

24 license, registration, or certification in a State to 

25 practice the health care profession of the health care 

26 professional. 
96 

•S 2372 EAH 

1 ‘‘(c) PROPERTY OF FEDERAL GOVERNMENT.—Sub2 section (a) shall apply to a covered health care professional 

3 providing treatment to a patient regardless of whether the 

4 covered health care professional or patient is located in a 

5 facility owned by the Federal Government during such 

6 treatment. 

7 ‘‘(d) RELATION TO STATE LAW.—(1) The provisions 

8 of this section shall supersede any provisions of the law of 

9 any State to the extent that such provision of State law 

10 are inconsistent with this section. 

11 ‘‘(2) No State shall deny or revoke the license, registra12 tion, or certification of a covered health care professional 

13 who otherwise meets the qualifications of the State for hold14 ing the license, registration, or certification on the basis 

15 that the covered health care professional has engaged or in16 tends to engage in activity covered by subsection (a). 

17 ‘‘(e) RULE OF CONSTRUCTION.—Nothing in this sec18 tion may be construed to remove, limit, or otherwise affect 

19 any obligation of a covered health care professional under 

20 the Controlled Substances Act (21 U.S.C. 801 et seq.). 

21 ‘‘(f) STATE DEFINED.—In this section, the term ‘State’ 

22 means a State, as defined in section 101(20) of this title, 

23 or a political subdivision of a State.’’. 

24 (b) CLERICAL AMENDMENT.—The table of sections at 

25 the beginning of chapter 17 of such title is amended by in-
97 

•S 2372 EAH 

1 serting after the item relating to section 1730B, as added 

2 by section 134, the following new item: 

‘‘1730C. Licensure of health care professionals providing treatment via telemedicine.’’. 

3 (c) REPORT ON TELEMEDICINE.— 

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

5 the earlier of the date on which services provided 

6 under section 1730B of title 38, United States Code, 

7 as added by subsection (a), first occur or regulations 

8 are promulgated to carry out such section, the Sec9 retary of Veterans Affairs shall submit to the Com10 mittee on Veterans’ Affairs of the Senate and the 

11 Committee on Veterans’ Affairs of the House of Rep12 resentatives a report on the effectiveness of the use of 

13 telemedicine by the Department of Veterans Affairs. 

14 (2) ELEMENTS.—The report required by para15 graph (1) shall include an assessment of the following: 

16 (A) The satisfaction of veterans with tele17 medicine furnished by the Department. 

18 (B) The satisfaction of health care providers 

19 in providing telemedicine furnished by the De20 partment. 

21 (C) The effect of telemedicine furnished by 

22 the Department on the following: 

23 (i) The ability of veterans to access 

24 health care, whether from the Department 
98 

•S 2372 EAH 

1 or from non-Department health care pro2 viders. 

3 (ii) The frequency of use by veterans of 

4 telemedicine. 

5 (iii) The productivity of health care 

6 providers. 

7 (iv) Wait times for an appointment for 

8 the receipt of health care from the Depart9 ment. 

10 (v) The use by veterans of in-person 

11 services at Department facilities and non12 Department facilities. 

13 (D) The types of appointments for the re14 ceipt of telemedicine furnished by the Depart15 ment that were provided during the 1-year pe16 riod preceding the submittal of the report. 

17 (E) The number of appointments for the re18 ceipt of telemedicine furnished by the Depart19 ment that were requested during such period, 

20 disaggregated by medical facility. 

21 (F) Savings by the Department, if any, in22 cluding travel costs, from furnishing health care 

23 through the use of telemedicine during such pe24 riod. 
99 

•S 2372 EAH 

1 SEC. 152. AUTHORITY FOR DEPARTMENT OF VETERANS AF2 FAIRS CENTER FOR INNOVATION FOR CARE 

3 AND PAYMENT. 

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

5 amended by this title, is further amended by inserting after 

6 section 1703D, as added by section 111, the following new 

7 section: 

8 ‘‘§ 1703E. Center for Innovation for Care and Payment 

9 ‘‘(a) IN GENERAL.—(1) There is established within the 

10 Department a Center for Innovation for Care and Payment 

11 (in this section referred to as the ‘Center’). 

12 ‘‘(2) The Secretary, acting through the Center, may 

13 carry out such pilot programs the Secretary determines to 

14 be appropriate to develop innovative approaches to testing 

15 payment and service delivery models in order to reduce ex16 penditures while preserving or enhancing the quality of care 

17 furnished by the Department. 

18 ‘‘(3) The Secretary, acting through the Center, shall 

19 test payment and service delivery models to determine 

20 whether such models— 

21 ‘‘(A) improve access to, and quality, timeliness, 

22 and patient satisfaction of care and services; and 

23 ‘‘(B) create cost savings for the Department. 

24 ‘‘(4)(A) The Secretary shall test a model in a location 

25 where the Secretary determines that the model will address-
100 

•S 2372 EAH 

1 es deficits in care (including poor clinical outcomes or po2 tentially avoidable expenditures) for a defined population. 

3 ‘‘(B) The Secretary shall focus on models the Secretary 

4 expects to reduce program costs while preserving or enhanc5 ing the quality of care received by individuals receiving 

6 benefits under this chapter. 

7 ‘‘(C) The models selected may include those described 

8 in section 1115A(b)(2)(B) of the Social Security Act (42 

9 U.S.C. 1315a(b)(2)(B)). 

10 ‘‘(5) In selecting a model for testing, the Secretary may 

11 consider, in addition to other factors identified in this sub12 section, the following factors: 

13 ‘‘(A) Whether the model includes a regular proc14 ess for monitoring and updating patient care plans 

15 in a manner that is consistent with the needs and 

16 preferences of individuals receiving benefits under this 

17 chapter. 

18 ‘‘(B) Whether the model places the individual re19 ceiving benefits under this chapter (including family 

20 members and other caregivers of such individual) at 

21 the center of the care team of such individual. 

22 ‘‘(C) Whether the model uses technology or new 

23 systems to coordinate care over time and across set24 tings. 
101 

•S 2372 EAH 

1 ‘‘(D) Whether the model demonstrates effective 

2 linkage with other public sector payers, private sector 

3 payers, or statewide payment models. 

4 ‘‘(6)(A) Models tested under this section may not be 

5 designed in such a way that would allow the United States 

6 to recover or collect reasonable charges from a Federal 

7 health care program for care or services furnished by the 

8 Secretary to a veteran under pilot programs carried out 

9 under this section. 

10 ‘‘(B) In this paragraph, the term ‘Federal health care 

11 program’ means— 

12 ‘‘(i) an insurance program described in section 

13 1811 of the Social Security Act (42 U.S.C. 1395c) or 

14 established by section 1831 of such Act (42 U.S.C. 

15 1395j); 

16 ‘‘(ii) a State plan for medical assistance ap17 proved under title XIX of such Act (42 U.S.C. 1396 

18 et seq.); or 

19 ‘‘(iii) a TRICARE program operated under sec20 tions 1075, 1075a, 1076, 1076a, 1076c, 1076d, 1076e, 

21 or 1076f of title 10. 

22 ‘‘(b) DURATION.—Each pilot program carried out by 

23 the Secretary under this section shall terminate no later 

24 than 5 years after the date of the commencement of the pilot 

25 program. 
102 

•S 2372 EAH 

1 ‘‘(c) LOCATION.—The Secretary shall ensure that each 

2 pilot program carried out under this section occurs in an 

3 area or areas appropriate for the intended purposes of the 

4 pilot program. To the extent practicable, the Secretary shall 

5 ensure that the pilot programs are located in geographically 

6 diverse areas of the United States. 

7 ‘‘(d) BUDGET.—Funding for each pilot program car8 ried out by the Secretary under this section shall come from 

9 appropriations— 

10 ‘‘(1) provided in advance in appropriations acts 

11 for the Veterans Health Administration; and 

12 ‘‘(2) provided for information technology sys13 tems. 

14 ‘‘(e) NOTICE.—The Secretary shall— 

15 ‘‘(1) publish information about each pilot pro16 gram under this section in the Federal Register; and 

17 ‘‘(2) take reasonable actions to provide direct no18 tice to veterans eligible to participate in such pilot 

19 programs. 

20 ‘‘(f) WAIVER OF AUTHORITIES.—(1) Subject to report21 ing under paragraph (2) and approval under paragraph 

22 (3), in implementing a pilot program under this section, 

23 the Secretary may waive such requirements in subchapters 

24 I, II, and III of this chapter as the Secretary determines 
103 

•S 2372 EAH 

1 necessary solely for the purposes of carrying out this section 

2 with respect to testing models described in subsection (a). 

3 ‘‘(2) Before waiving any authority under paragraph 

4 (1), the Secretary shall submit to the Speaker of the House 

5 of Representatives, the minority leader of the House of Rep6 resentatives, the majority leader of the Senate, the minority 

7 leader of the Senate, and each standing committee with ju8 risdiction under the rules of the Senate and of the House 

9 of Representatives to report a bill to amend the provision 

10 or provisions of law that would be waived by the Depart11 ment, a report on a request for waiver that describes in 

12 detail the following: 

13 ‘‘(A) The specific authorities to be waived under 

14 the pilot program. 

15 ‘‘(B) The standard or standards to be used in the 

16 pilot program in lieu of the waived authorities. 

17 ‘‘(C) The reasons for such waiver or waivers. 

18 ‘‘(D) A description of the metric or metrics the 

19 Secretary will use to determine the effect of the waiver 

20 or waivers upon the access to and quality, timeliness, 

21 or patient satisfaction of care and services furnished 

22 through the pilot program. 

23 ‘‘(E) The anticipated cost savings, if any, of the 

24 pilot program. 
104 

•S 2372 EAH 

1 ‘‘(F) The schedule for interim reports on the 

2 pilot program describing the results of the pilot pro3 gram so far and the feasibility and advisability of 

4 continuing the pilot program. 

5 ‘‘(G) The schedule for the termination of the pilot 

6 program and the submission of a final report on the 

7 pilot program describing the result of the pilot pro8 gram and the feasibility and advisability of making 

9 the pilot program permanent. 

10 ‘‘(H) The estimated budget of the pilot program. 

11 ‘‘(3)(A) Upon receipt of a report submitted under 

12 paragraph (2), each House of Congress shall provide copies 

13 of the report to the chairman and ranking member of each 

14 standing committee with jurisdiction under the rules of the 

15 House of Representatives or the Senate to report a bill to 

16 amend the provision or provisions of law that would be 

17 waived by the Department under this subsection. 

18 ‘‘(B) The waiver requested by the Secretary under 

19 paragraph (2) shall be considered approved under this 

20 paragraph if there is enacted into law a joint resolution 

21 approving such request in its entirety. 

22 ‘‘(C) For purposes of this paragraph, the term ‘joint 

23 resolution’ means only a joint resolution which is intro24 duced within the period of five legislative days beginning 
105 

•S 2372 EAH 

1 on the date on which the Secretary transmits the report to 

2 the Congress under such paragraph (2), and— 

3 ‘‘(i) which does not have a preamble; and 

4 ‘‘(ii) the matter after the resolving clause of 

5 which is as follows: ‘that Congress approves the re6 quest for a waiver under section 1703E(f) of title 38, 

7 United States Code, as submitted by the Secretary on 

8 lll’, the blank space being filled with the appro9 priate date. 

10 ‘‘(D)(i) Any committee of the House of Representatives 

11 to which a joint resolution is referred shall report it to the 

12 House without amendment not later than 15 legislative 

13 days after the date of introduction thereof. If a committee 

14 fails to report the joint resolution within that period, the 

15 committee shall be discharged from further consideration of 

16 the joint resolution. 

17 ‘‘(ii) It shall be in order at any time after the third 

18 legislative day after each committee authorized to consider 

19 a joint resolution has reported or has been discharged from 

20 consideration of a joint resolution, to move to proceed to 

21 consider the joint resolution in the House. All points of 

22 order against the motion are waived. Such a motion shall 

23 not be in order after the House has disposed of a motion 

24 to proceed on a joint resolution addressing a particular sub25 mission. The previous question shall be considered as or-
106 

•S 2372 EAH 

1 dered on the motion to its adoption without intervening mo2 tion. The motion shall not be debatable. A motion to recon3 sider the vote by which the motion is disposed of shall not 

4 be in order. 

5 ‘‘(iii) The joint resolution shall be considered as read. 

6 All points of order against the joint resolution and against 

7 its consideration are waived. The previous question shall 

8 be considered as ordered on the joint resolution to its pas9 sage without intervening motion except two hours of debate 

10 equally divided and controlled by the proponent and an op11 ponent. A motion to reconsider the vote on passage of the 

12 joint resolution shall not be in order. 

13 ‘‘(E)(i) A joint resolution introduced in the Senate 

14 shall be referred to the Committee on Veterans’ Affairs. 

15 ‘‘(ii) Any committee of the Senate to which a joint res16 olution is referred shall report it to the Senate without 

17 amendment not later than 15 session days after the date 

18 of introduction of a joint resolution described in paragraph 

19 (C). If a committee fails to report the joint resolution with20 in that period, the committee shall be discharged from fur21 ther consideration of the joint resolution and the joint reso22 lution shall be placed on the calendar. 

23 ‘‘(iii)(I) Notwithstanding Rule XXII of the Standing 

24 Rules of the Senate, it is in order at any time after the 

25 third session day on which the Committee on Veterans’ Af-
107 

•S 2372 EAH 

1 fairs has reported or has been discharged from consideration 

2 of a joint resolution described in paragraph (C) (even 

3 though a previous motion to the same effect has been dis4 agreed to) to move to proceed to the consideration of the 

5 joint resolution, and all points of order against the joint 

6 resolution (and against consideration of the joint resolu7 tion) are waived. The motion to proceed is not debatable. 

8 The motion is not subject to a motion to postpone. A motion 

9 to reconsider the vote by which the motion is agreed to or 

10 disagreed to shall not be in order. If a motion to proceed 

11 to the consideration of the resolution is agreed to, the joint 

12 resolution shall remain the unfinished business until dis13 posed of. 

14 ‘‘(II) Consideration of the joint resolution, and on all 

15 debatable motions and appeals in connection therewith, 

16 shall be limited to not more than two hours, which shall 

17 be divided equally between the majority and minority lead18 ers or their designees. A motion further to limit debate is 

19 in order and not debatable. An amendment to, or a motion 

20 to postpone, or a motion to proceed to the consideration 

21 of other business, or a motion to recommit the joint resolu22 tion is not in order. 

23 ‘‘(III) If the Senate has voted to proceed to a joint reso24 lution, the vote on passage of the joint resolution shall occur 

25 immediately following the conclusion of consideration of the 
108 

•S 2372 EAH 

1 joint resolution, and a single quorum call at the conclusion 

2 of the debate if requested in accordance with the rules of 

3 the Senate. 

4 ‘‘(IV) Appeals from the decisions of the Chair relating 

5 to the application of the rules of the Senate, as the case 

6 may be, to the procedure relating to a joint resolution shall 

7 be decided without debate. 

8 ‘‘(F) A joint resolution considered pursuant to this 

9 paragraph shall not be subject to amendment in either the 

10 House of Representatives or the Senate. 

11 ‘‘(G)(i) If, before the passage by one House of the joint 

12 resolution of that House, that House receives the joint reso13 lution from the other House, then the following procedures 

14 shall apply: 

15 ‘‘(I) The joint resolution of the other House shall 

16 not be referred to a committee. 

17 ‘‘(II) With respect to the joint resolution of the 

18 House receiving the joint resolution— 

19 ‘‘(aa) the procedure in that House shall 

20 be the same as if no joint resolution had 

21 been received from the other House; but 

22 ‘‘(bb) the vote on passage shall be on 

23 the joint resolution of the other House. 

24 ‘‘(ii) If the Senate fails to introduce or consider 

25 a joint resolution under this paragraph, the joint res-
109 

•S 2372 EAH 

1 olution of the House shall be entitled to expedited 

2 floor procedures under this subparagraph. 

3 ‘‘(iii) If, following passage of the joint resolution 

4 in the Senate, the Senate then receives the companion 

5 measure from the House of Representatives, the com6 panion measure shall not be debatable. 

7 ‘‘(H) This subparagraph is enacted by Congress— 

8 ‘‘(i) as an exercise of the rulemaking power of 

9 the Senate and House of Representatives, respectively, 

10 and as such it is deemed a part of the rules of each 

11 House, respectively, but applicable only with respect 

12 to the procedure to be followed in that House in the 

13 case of a joint resolution, and it supersedes other rules 

14 only to the extent that it is inconsistent with such 

15 rules; and 

16 ‘‘(ii) with full recognition of the constitutional 

17 right of either House to change the rules (so far as re18 lating to the procedure of that House) at any time, 

19 in the same manner, and to the same extent as in the 

20 case of any other rule of that House. 

21 ‘‘(g) LIMITATIONS.—(1) The Secretary may not carry 

22 out more than 10 pilot programs concurrently. 

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

24 may not expend more than $50,000,000 in any fiscal year 

25 from amounts under subsection (d). 
110 

•S 2372 EAH 

1 ‘‘(B) The Secretary may expend more than the amount 

2 in subparagraph (A) if— 

3 ‘‘(i) the Secretary determines that the additional 

4 expenditure is necessary to carry out pilot programs 

5 under this section; 

6 ‘‘(ii) the Secretary submits to the Committees on 

7 Veterans’ Affairs of the Senate and the House of Rep8 resentatives a report setting forth the amount of the 

9 additional expenditure and a justification for the ad10 ditional expenditure; and 

11 ‘‘(iii) the Chairmen of the Committees on Vet12 erans’ Affairs of the Senate and the House of Rep13 resentatives transmit to the Secretary a letter approv14 ing of the additional expenditure. 

15 ‘‘(3) The waiver provisions in subsection (f) shall not 

16 apply unless the Secretary, in accordance with the require17 ments in subsection (f), submits the first proposal for a pilot 

18 program not later than 18 months after the date of the en19 actment of the Caring for Our Veterans Act of 2018. 

20 ‘‘(4) Notwithstanding section 502 of this title, decisions 

21 by the Secretary under this section shall, consistent with 

22 section 511 of this title, be final and conclusive and may 

23 not be reviewed by any other official or by any court, wheth24 er by an action in the nature of mandamus or otherwise. 
111 

•S 2372 EAH 

1 ‘‘(5)(A) If the Secretary determines that a pilot pro2 gram is not improving the quality of care or producing cost 

3 savings, the Secretary shall— 

4 ‘‘(i) propose a modification to the pilot program 

5 in the interim report that shall also be considered a 

6 report under subsection (f)(2) and shall be subject to 

7 the terms and conditions of subsection (f)(2); or 

8 ‘‘(ii) terminate such pilot program not later 

9 than 30 days after submitting the interim report to 

10 Congress. 

11 ‘‘(B) If the Secretary terminates a pilot program 

12 under subparagraph (A)(ii), for purposes of subparagraphs 

13 (F) and (G) of subsection (f)(2), such interim report will 

14 also serve as the final report for that pilot program. 

15 ‘‘(h) EVALUATION AND REPORTING REQUIREMENTS.— 

16 (1) The Secretary shall conduct an evaluation of each model 

17 tested, which shall include, at a minimum, an analysis of— 

18 ‘‘(A) the quality of care furnished under the 

19 model, including the measurement of patient-level 

20 outcomes and patient-centeredness criteria determined 

21 appropriate by the Secretary; and 

22 ‘‘(B) the changes in spending by reason of that 

23 model. 

24 ‘‘(2) The Secretary shall make the results of each eval25 uation under this subsection available to the public in a 
112 

•S 2372 EAH 

1 timely fashion and may establish requirements for other en2 tities participating in the testing of models under this sec3 tion to collect and report information that the Secretary 

4 determines is necessary to monitor and evaluate such mod5 els. 

6 ‘‘(i) COORDINATION AND ADVICE.—(1) The Secretary 

7 shall obtain advice from the Under Secretary for Health 

8 and the Special Medical Advisory Group established pursu9 ant to section 7312 of this title in the development and im10 plementation of any pilot program operated under this sec11 tion. 

12 ‘‘(2) In carrying out the duties under this section, the 

13 Secretary shall consult representatives of relevant Federal 

14 agencies, and clinical and analytical experts with expertise 

15 in medicine and health care management. The Secretary 

16 shall use appropriate mechanisms to seek input from inter17 ested parties. 

18 ‘‘(j) EXPANSION OF SUCCESSFUL PILOT PROGRAMS.— 

19 Taking into account the evaluation under subsection (f), the 

20 Secretary may, through rulemaking, expand (including im21 plementation on a nationwide basis) the duration and the 

22 scope of a model that is being tested under subsection (a) 

23 to the extent determined appropriate by the Secretary, if— 

24 ‘‘(1) the Secretary determines that such expan25 sion is expected to— 
113 

•S 2372 EAH 

1 ‘‘(A) reduce spending without reducing the 

2 quality of care; or 

3 ‘‘(B) improve the quality of patient care 

4 without increasing spending; and 

5 ‘‘(2) the Secretary determines that such expan6 sion would not deny or limit the coverage or provi7 sion of benefits for individuals receiving benefits 

8 under this chapter.’’. 

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

10 at the beginning of such chapter, as amended by this title, 

11 is further amended by inserting after the item relating to 

12 section 1703D the following new item: 

‘‘1703E. Center for Innovation for Care and Payment.’’. 

13 SEC. 153. AUTHORIZATION TO PROVIDE FOR OPERATIONS 

14 ON LIVE DONORS FOR PURPOSES OF CON15 DUCTING TRANSPLANT PROCEDURES FOR 

16 VETERANS. 

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

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

19 ‘‘§ 1788. Transplant procedures with live donors and 

20 related services 

21 ‘‘(a) IN GENERAL.—Subject to subsections (b) and (c), 

22 in a case in which a veteran is eligible for a transplant 

23 procedure from the Department, the Secretary may provide 

24 for an operation on a live donor to carry out such procedure 
114 

•S 2372 EAH 

1 for such veteran, notwithstanding that the live donor may 

2 not be eligible for health care from the Department. 

3 ‘‘(b) OTHER SERVICES.—Subject to the availability of 

4 appropriations for such purpose, the Secretary shall furnish 

5 to a live donor any care or services before and after con6 ducting the transplant procedure under subsection (a) that 

7 may be required in connection with such procedure. 

8 ‘‘(c) USE OF NON-DEPARTMENT FACILITIES.—In car9 rying out this section, the Secretary may provide for the 

10 operation described in subsection (a) on a live donor and 

11 furnish to the live donor the care and services described in 

12 subsection (b) at a non-Department facility pursuant to an 

13 agreement entered into by the Secretary under this chapter. 

14 The live donor shall be deemed to be an individual eligible 

15 for hospital care and medical services at a non-Department 

16 facility pursuant to such an agreement solely for the pur17 poses of receiving such operation, care, and services at the 

18 non-Department facility.’’. 

19 (b) CLERICAL AMENDMENT.—The table of sections at 

20 the beginning of chapter 17 is amended by inserting after 

21 the item relating to section 1787 the following new item: 

‘‘1788. Transplant procedures with live donors and related services.’’. 

22 Subtitle C—Family Caregivers 

23 SEC. 161. EXPANSION OF FAMILY CAREGIVER PROGRAM OF 

24 DEPARTMENT OF VETERANS AFFAIRS. 

25 (a) FAMILY CAREGIVER PROGRAM.— 
115 

•S 2372 EAH 

1 (1) EXPANSION OF ELIGIBILITY.— 

2 (A) IN GENERAL.—Subparagraph (B) of 

3 subsection (a)(2) of section 1720G is amended to 

4 read as follows: 

5 ‘‘(B) for assistance provided under this sub6 section— 

7 ‘‘(i) before the date on which the Secretary 

8 submits to Congress a certification that the De9 partment has fully implemented the information 

10 technology system required by section 162(a) of 

11 the Caring for Our Veterans Act of 2018, has a 

12 serious injury (including traumatic brain in13 jury, psychological trauma, or other mental dis14 order) incurred or aggravated in the line of duty 

15 in the active military, naval, or air service on 

16 or after September 11, 2001; 

17 ‘‘(ii) during the 2-year period beginning on 

18 the date on which the Secretary submitted to 

19 Congress the certification described in clause (i), 

20 has a serious injury (including traumatic brain 

21 injury, psychological trauma, or other mental 

22 disorder) incurred or aggravated in the line of 

23 duty in the active military, naval, or air serv24 ice— 

25 ‘‘(I) on or before May 7, 1975; or 
116 

•S 2372 EAH 

1 ‘‘(II) on or after September 11, 2001; 

2 or 

3 ‘‘(iii) after the date that is 2 years after the 

4 date on which the Secretary submits to Congress 

5 the certification described in clause (i), has a se6 rious injury (including traumatic brain injury, 

7 psychological trauma, or other mental disorder) 

8 incurred or aggravated in the line of duty in the 

9 active military, naval, or air service; and’’. 

10 (B) PUBLICATION IN FEDERAL REGISTER.— 

11 Not later than 30 days after the date on which 

12 the Secretary of Veterans Affairs submits to Con13 gress the certification described in subsection 

14 (a)(2)(B)(i) of section 1720G of such title, as 

15 amended by subparagraph (A) of this paragraph, 

16 the Secretary shall publish the date specified in 

17 such subsection in the Federal Register. 

18 (2) EXPANSION OF NEEDED SERVICES IN ELIGI19 BILITY CRITERIA.—Subsection (a)(2)(C) of such sec20 tion is amended— 

21 (A) in clause (ii), by striking ‘‘; or’’ and in22 serting a semicolon; 

23 (B) by redesignating clause (iii) as clause 

24 (iv); and 
117 

•S 2372 EAH 

1 (C) by inserting after clause (ii) the fol2 lowing new clause (iii): 

3 ‘‘(iii) a need for regular or extensive in4 struction or supervision without which the abil5 ity of the veteran to function in daily life would 

6 be seriously impaired; or’’. 

7 (3) EXPANSION OF SERVICES PROVIDED.—Sub8 section (a)(3)(A)(ii) of such section is amended— 

9 (A) in subclause (IV), by striking ‘‘; and’’ 

10 and inserting a semicolon; 

11 (B) in subclause (V), by striking the period 

12 at the end and inserting ‘‘; and’’; and 

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

14 subclause: 

15 ‘‘(VI) through the use of contracts with, or 

16 the provision of grants to, public or private enti17 ties— 

18 ‘‘(aa) financial planning services relat19 ing to the needs of injured veterans and 

20 their caregivers; and 

21 ‘‘(bb) legal services, including legal ad22 vice and consultation, relating to the needs 

23 of injured veterans and their caregivers.’’. 

24 (4) MODIFICATION OF STIPEND CALCULATION.— 

25 Subsection (a)(3)(C) of such section is amended— 
118 

•S 2372 EAH 

1 (A) by redesignating clause (iii) as clause 

2 (iv); and 

3 (B) by inserting after clause (ii) the fol4 lowing new clause (iii): 

5 ‘‘(iii) In determining the amount and degree of per6 sonal care services provided under clause (i) with respect 

7 to an eligible veteran whose need for personal care services 

8 is based in whole or in part on a need for supervision or 

9 protection under paragraph (2)(C)(ii) or regular instruc10 tion or supervision under paragraph (2)(C)(iii), the Sec11 retary shall take into account the following: 

12 ‘‘(I) The assessment by the family caregiver of 

13 the needs and limitations of the veteran. 

14 ‘‘(II) The extent to which the veteran can func15 tion safely and independently in the absence of such 

16 supervision, protection, or instruction. 

17 ‘‘(III) The amount of time required for the fam18 ily caregiver to provide such supervision, protection, 

19 or instruction to the veteran.’’. 

20 (5) PERIODIC EVALUATION OF NEED FOR CER21 TAIN SERVICES.—Subsection (a)(3) of such section is 

22 amended by adding at the end the following new sub23 paragraph: 

24 ‘‘(D) In providing instruction, preparation, and 

25 training under subparagraph (A)(i)(I) and technical sup-
119 

•S 2372 EAH 

1 port under subparagraph (A)(i)(II) to each family care2 giver who is approved as a provider of personal care serv3 ices for an eligible veteran under paragraph (6), the Sec4 retary shall periodically evaluate the needs of the eligible 

5 veteran and the skills of the family caregiver of such veteran 

6 to determine if additional instruction, preparation, train7 ing, or technical support under those subparagraphs is nec8 essary.’’. 

9 (6) USE OF PRIMARY CARE TEAMS.—Subsection 

10 (a)(5) of such section is amended, in the matter pre11 ceding subparagraph (A), by inserting ‘‘(in collabora12 tion with the primary care team for the eligible vet13 eran to the maximum extent practicable)’’ after 

14 ‘‘evaluate’’. 

15 (7) ASSISTANCE FOR FAMILY CAREGIVERS.—Sub16 section (a) of such section is amended by adding at 

17 the end the following new paragraph: 

18 ‘‘(11)(A) In providing assistance under this subsection 

19 to family caregivers of eligible veterans, the Secretary may 

20 enter into contracts, provider agreements, and memoranda 

21 of understanding with Federal agencies, States, and pri22 vate, nonprofit, and other entities to provide such assistance 

23 to such family caregivers. 

24 ‘‘(B) The Secretary may provide assistance under this 

25 paragraph only if such assistance is reasonably accessible 
120 

•S 2372 EAH 

1 to the family caregiver and is substantially equivalent or 

2 better in quality to similar services provided by the Depart3 ment. 

4 ‘‘(C) The Secretary may provide fair compensation to 

5 Federal agencies, States, and other entities that provide as6 sistance under this paragraph.’’. 

7 (b) MODIFICATION OF DEFINITION OF PERSONAL CARE

8 SERVICES.—Subsection (d)(4) of such section is amended— 

9 (1) in subparagraph (A), by striking ‘‘inde10 pendent’’; 

11 (2) by redesignating subparagraph (B) as sub12 paragraph (D); and 

13 (3) by inserting after subparagraph (A) the fol14 lowing new subparagraphs: 

15 ‘‘(B) Supervision or protection based on 

16 symptoms or residuals of neurological or other 

17 impairment or injury. 

18 ‘‘(C) Regular or extensive instruction or su19 pervision without which the ability of the vet20 eran to function in daily life would be seriously 

21 impaired.’’. 
121 

•S 2372 EAH 

1 SEC. 162. IMPLEMENTATION OF INFORMATION TECH2 NOLOGY SYSTEM OF DEPARTMENT OF VET3 ERANS AFFAIRS TO ASSESS AND IMPROVE 

4 THE FAMILY CAREGIVER PROGRAM. 

5 (a) IMPLEMENTATION OF NEW SYSTEM.— 

6 (1) IN GENERAL.—Not later than October 1, 

7 2018, the Secretary of Veterans Affairs shall imple8 ment an information technology system that fully 

9 supports the Program and allows for data assessment 

10 and comprehensive monitoring of the Program. 

11 (2) ELEMENTS OF SYSTEM.—The information 

12 technology system required to be implemented under 

13 paragraph (1) shall include the following: 

14 (A) The ability to easily retrieve data that 

15 will allow all aspects of the Program (at the 

16 medical center and aggregate levels) and the 

17 workload trends for the Program to be assessed 

18 and comprehensively monitored. 

19 (B) The ability to manage data with respect 

20 to a number of caregivers that is more than the 

21 number of caregivers that the Secretary expects 

22 to apply for the Program. 

23 (C) The ability to integrate the system with 

24 other relevant information technology systems of 

25 the Veterans Health Administration. 
122 

•S 2372 EAH 

1 (b) ASSESSMENT OF PROGRAM.—Not later than 180 

2 days after implementing the system described in subsection 

3 (a), the Secretary shall, through the Under Secretary for 

4 Health, use data from the system and other relevant data 

5 to conduct an assessment of how key aspects of the Program 

6 are structured and carried out. 

7 (c) ONGOING MONITORING OF AND MODIFICATIONS TO

8 PROGRAM.— 

9 (1) MONITORING.—The Secretary shall use the 

10 system implemented under subsection (a) to monitor 

11 and assess the workload of the Program, including 

12 monitoring and assessment of data on— 

13 (A) the status of applications, appeals, and 

14 home visits in connection with the Program; and 

15 (B) the use by caregivers participating in 

16 the Program of other support services under the 

17 Program such as respite care. 

18 (2) MODIFICATIONS.—Based on the monitoring 

19 and assessment conducted under paragraph (1), the 

20 Secretary shall identify and implement such modi21 fications to the Program as the Secretary considers 

22 necessary to ensure the Program is functioning as in23 tended and providing veterans and caregivers partici24 pating in the Program with services in a timely man25 ner. 
123 

•S 2372 EAH 

1 (d) REPORTS.— 

2 (1) INITIAL REPORT.— 

3 (A) IN GENERAL.—Not later than 90 days 

4 after the date of the enactment of this Act, the 

5 Secretary shall submit to the Committee on Vet6 erans’ Affairs of the Senate, the Committee on 

7 Veterans’ Affairs of the House of Representatives, 

8 and the Comptroller General of the United States 

9 a report that includes— 

10 (i) the status of the planning, develop11 ment, and deployment of the system re12 quired to be implemented under subsection 

13 (a), including any changes in the timeline 

14 for the implementation of the system; and 

15 (ii) an assessment of the needs of fam16 ily caregivers of veterans described in sub17 paragraph (B), the resources needed for the 

18 inclusion of such family caregivers in the 

19 Program, and such changes to the Program 

20 as the Secretary considers necessary to en21 sure the successful expansion of the Program 

22 to include such family caregivers. 

23 (B) VETERANS DESCRIBED.—Veterans de24 scribed in this subparagraph are veterans who 

25 are eligible for the Program under clause (ii) or 
124 

•S 2372 EAH 

1 (iii) of section 1720G(a)(2)(B) of title 38, United 

2 States Code, as amended by section 161(a)(1) of 

3 this title, solely due to a serious injury (includ4 ing traumatic brain injury, psychological trau5 ma, or other mental disorder) incurred or aggra6 vated in the line of duty in the active military, 

7 naval, or air service before September 11, 2001. 

8 (2) NOTIFICATION BY COMPTROLLER GENERAL.— 

9 The Comptroller General shall review the report sub10 mitted under paragraph (1) and notify the Committee 

11 on Veterans’ Affairs of the Senate and the Committee 

12 on Veterans’ Affairs of the House of Representatives 

13 with respect to the progress of the Secretary in— 

14 (A) fully implementing the system required 

15 under subsection (a); and 

16 (B) implementing a process for using such 

17 system to monitor and assess the Program under 

18 subsection (c)(1) and modify the Program as 

19 considered necessary under subsection (c)(2). 

20 (3) FINAL REPORT.— 

21 (A) IN GENERAL.—Not later than October 1, 

22 2019, the Secretary shall submit to the Com23 mittee on Veterans’ Affairs of the Senate, the 

24 Committee on Veterans’ Affairs of the House of 

25 Representatives, and the Comptroller General a 
125 

•S 2372 EAH 

1 report on the implementation of subsections (a) 

2 through (c). 

3 (B) ELEMENTS.—The report required by 

4 subparagraph (A) shall include the following: 

5 (i) A certification by the Secretary 

6 that the information technology system de7 scribed in subsection (a) has been imple8 mented. 

9 (ii) A description of how the Secretary 

10 has implemented such system. 

11 (iii) A description of the modifications 

12 to the Program, if any, that were identified 

13 and implemented under subsection (c)(2). 

14 (iv) A description of how the Secretary 

15 is using such system to monitor the work16 load of the Program. 

17 (e) DEFINITIONS.—In this section: 

18 (1) ACTIVE MILITARY, NAVAL, OR AIR SERVICE.— 

19 The term ‘‘active military, naval, or air service’’ has 

20 the meaning given that term in section 101 of title 

21 38, United States Code. 

22 (2) PROGRAM.—The term ‘‘Program’’ means the 

23 program of comprehensive assistance for family care24 givers under section 1720G(a) of title 38, United 

25 States Code, as amended by section 161 of this title. 
126 

•S 2372 EAH 

1 SEC. 163. MODIFICATIONS TO ANNUAL EVALUATION RE2 PORT ON CAREGIVER PROGRAM OF DEPART3 MENT OF VETERANS AFFAIRS. 

4 (a) BARRIERS TO CARE AND SERVICES.—Subpara5 graph (A)(iv) of section 101(c)(2) of the Caregivers and Vet6 erans Omnibus Health Services Act of 2010 (Public Law 

7 111–163; 38 U.S.C. 1720G note) is amended by inserting 

8 ‘‘, including a description of any barriers to accessing and 

9 receiving care and services under such programs’’ before the 

10 semicolon. 

11 (b) SUFFICIENCY OF TRAINING FOR FAMILY CARE12 GIVER PROGRAM.—Subparagraph (B) of such section is 

13 amended— 

14 (1) in clause (i), by striking ‘‘; and’’ and insert15 ing a semicolon; 

16 (2) in clause (ii), by striking the period at the 

17 end and inserting ‘‘; and’’; and 

18 (3) by adding at the end the following new 

19 clause: 

20 ‘‘(iii) an evaluation of the sufficiency 

21 and consistency of the training provided to 

22 family caregivers under such program in 

23 preparing family caregivers to provide care 

24 to veterans under such program.’’. 
127 

•S 2372 EAH 

1 TITLE II—VA ASSET AND 

2 INFRASTRUCTURE REVIEW 

3 Subtitle A—Asset and 

4 Infrastructure Review 

5 SEC. 201. SHORT TITLE. 

6 This subtitle may be cited as the ‘‘VA Asset and Infra7 structure Review Act of 2018’’. 

8 SEC. 202. THE COMMISSION. 

9 (a) ESTABLISHMENT.—There is established an inde10 pendent commission to be known as the ‘‘Asset and Infra11 structure Review Commission’’ (in this subtitle referred to 

12 as the ‘‘Commission’’). 

13 (b) DUTIES.—The Commission shall carry out the du14 ties specified for it in this subtitle. 

15 (c) APPOINTMENT.— 

16 (1) IN GENERAL.— 

17 (A) APPOINTMENT.—The Commission shall 

18 be composed of nine members appointed by the 

19 President, by and with the advice and consent of 

20 the Senate. 

21 (B) TRANSMISSION OF NOMINATIONS.—The 

22 President shall transmit to the Senate the nomi23 nations for appointment to the Commission not 

24 later than May 31, 2021. 
128 

•S 2372 EAH 

1 (2) CONSULTATION IN SELECTION PROCESS.—In 

2 selecting individuals for nominations for appoint3 ments to the Commission, the President shall consult 

4 with— 

5 (A) the Speaker of the House of Representa6 tives; 

7 (B) the majority leader of the Senate; 

8 (C) the minority leader of the House of 

9 Representatives; 

10 (D) the minority leader of the Senate; and 

11 (E) congressionally chartered, membership 

12 based veterans service organizations concerning 

13 the appointment of three members. 

14 (3) DESIGNATION OF CHAIR.—At the time the 

15 President nominates individuals for appointment to 

16 the Commission under paragraph (1)(B), the Presi17 dent shall designate one such individual who shall 

18 serve as Chair of the Commission and one such indi19 vidual who shall serve as Vice Chair of the Commis20 sion. 

21 (4) MEMBER REPRESENTATION.—In nominating 

22 individuals under this subsection, the President shall 

23 ensure that— 

24 (A) veterans, reflecting current demo25 graphics of veterans enrolled in the system of an-
129 

•S 2372 EAH 

1 nual patient enrollment under section 1705 of 

2 title 38, United States Code, are adequately rep3 resented in the membership of the Commission; 

4 (B) at least one member of the Commission 

5 has experience working for a private integrated 

6 health care system that has annual gross reve7 nues of more than $50,000,000; 

8 (C) at least one member has experience as 

9 a senior manager for an entity specified in 

10 clause (ii), (iii), or (iv) of section 101(a)(1)(B) 

11 of the Veterans Access, Choice, and Account12 ability Act of 2014 (Public Law 113–146; 38 

13 U.S.C. 1701 note); 

14 (D) at least one member— 

15 (i) has experience with capital asset 

16 management for the Federal Government; 

17 and 

18 (ii) is familiar with trades related to 

19 building and real property, including con20 struction, engineering, architecture, leasing, 

21 and strategic partnerships; and 

22 (E) at least three members represent con23 gressionally chartered, membership-based, vet24 erans service organizations. 

25 (d) MEETINGS.— 
130 

•S 2372 EAH 

1 (1) IN GENERAL.—The Commission shall meet 

2 only during calendar years 2022 and 2023. 

3 (2) PUBLIC NATURE OF MEETINGS AND PRO4 CEEDINGS.— 

5 (A) PUBLIC MEETINGS.—Each meeting of 

6 the Commission shall be open to the public. 

7 (B) OPEN PARTICIPATION.—All the pro8 ceedings, information, and deliberations of the 

9 Commission shall be available for review by the 

10 public. 

11 (e) VACANCIES.—A vacancy in the Commission shall 

12 be filled in the same manner as the original appointment, 

13 but the individual appointed to fill the vacancy shall serve 

14 only for the unexpired portion of the term for which the 

15 individual’s predecessor was appointed. 

16 (f) PAY.— 

17 (1) IN GENERAL.—Members of the Commission 

18 shall serve without pay. 

19 (2) OFFICERS OR EMPLOYEES OF THE UNITED

20 STATES.—Each member of the Commission who is an 

21 officer or employee of the United States shall serve 

22 without compensation in addition to that received for 

23 service as an officer or employee of the United States. 

24 (3) TRAVEL EXPENSES.—Members shall receive 

25 travel expenses, including per diem in lieu of subsist-
131 

•S 2372 EAH 

1 ence, in accordance with sections 5702 and 5703 of 

2 title 5, United States Code. 

3 (g) DIRECTOR OF STAFF.— 

4 (1) APPOINTMENT.—The Commission shall ap5 point a Director who— 

6 (A) has not served as an employee of the 

7 Department of Veterans Affairs during the 1- 

8 year period preceding the date of such appoint9 ment; and 

10 (B) is not otherwise barred or prohibited 

11 from serving as Director under Federal ethics 

12 laws and regulations, by reason of post-employ13 ment conflict of interest. 

14 (2) RATE OF PAY.—The Director shall be paid at 

15 the rate of basic pay payable for level IV of the Exec16 utive Schedule under section 5315 of title 5, United 

17 States Code. 

18 (h) STAFF.— 

19 (1) PAY OF PERSONNEL.—Subject to paragraphs 

20 (2) and (3), the Director, with the approval of the 

21 Commission, may appoint and fix the pay of addi22 tional personnel. 

23 (2) EXEMPTION FROM CERTAIN REQUIRE24 MENTS.—The Director may make such appointments 

25 without regard to the provisions of title 5, United 
132 

•S 2372 EAH 

1 States Code, governing appointments in the competi2 tive service, and any personnel so appointed may be 

3 paid without regard to the provisions of chapter 51 

4 and subchapter III of chapter 53 of that title relating 

5 to classification and General Schedule pay rates, ex6 cept that an individual so appointed may not receive 

7 pay in excess of the annual rate of basic pay payable 

8 for GS–15 of the General Schedule. 

9 (3) DETAILEES.— 

10 (A) LIMITATION ON NUMBER.—Not more 

11 than two-thirds of the personnel employed by or 

12 detailed to the Commission may be on detail 

13 from the Department of Veterans Affairs. 

14 (B) PROFESSIONAL ANALYSTS.—Not more 

15 than half of the professional analysts of the Com16 mission staff may be persons detailed from the 

17 Department of Veterans Affairs to the Commis18 sion. 

19 (C) PROHIBITION ON DETAIL OF CERTAIN

20 PERSONNEL.—A person may not be detailed 

21 from the Department of Veterans Affairs to the 

22 Commission if, within 6 months before the detail 

23 is to begin, that person participated personally 

24 and substantially in any matter within the De25 partment of Veterans Affairs concerning the 
133 

•S 2372 EAH 

1 preparation of recommendations regarding fa2 cilities of the Veterans Health Administration. 

3 (4) AUTHORITY TO REQUEST DETAILED PER4 SONNEL.—Subject to paragraph (3), the head of any 

5 Federal department or agency, upon the request of the 

6 Director, may detail any of the personnel of that de7 partment or agency to the Commission to assist the 

8 Commission in carrying out its duties under this sub9 title. 

10 (5) INFORMATION FROM FEDERAL AGENCIES.— 

11 The Commission may secure directly from any Fed12 eral agency such information the Commission con13 siders necessary to carry out this subtitle. Upon re14 quest of the Chair, the head of such agency shall fur15 nish such information to the Commission. 

16 (i) OTHER AUTHORITY.— 

17 (1) TEMPORARY AND INTERMITTENT SERV18 ICES.—The Commission may procure by contract, to 

19 the extent funds are available, the temporary or inter20 mittent services of experts or consultants pursuant to 

21 section 3109 of title 5, United States Code. 

22 (2) LEASING AND ACQUISITION OF PROPERTY.— 

23 To the extent funds are available, the Commission 

24 may lease real property and acquire personal prop-
134 

•S 2372 EAH 

1 erty either of its own accord or in consultation with 

2 the General Services Administration. 

3 (j) TERMINATION.—The Commission shall terminate 

4 on December 31, 2023. 

5 (k) PROHIBITION AGAINST RESTRICTING COMMUNICA6 TIONS.— 

7 (1) IN GENERAL.—Except as provided in para8 graph (2), no person may restrict an employee of the 

9 Department of Veterans Affairs in communicating 

10 with the Commission. 

11 (2) UNLAWFUL COMMUNICATIONS.—Paragraph 

12 (1) does not apply to a communication that is unlaw13 ful. 

14 SEC. 203. PROCEDURE FOR MAKING RECOMMENDATIONS. 

15 (a) SELECTION CRITERIA.— 

16 (1) PUBLICATION.—The Secretary shall, not later 

17 than February 1, 2021, and after consulting with vet18 erans service organizations, publish in the Federal 

19 Register and transmit to the Committees on Veterans’ 

20 Affairs of the Senate and the House of Representatives 

21 the criteria proposed to be used by the Department of 

22 Veterans Affairs in assessing and making rec23 ommendations regarding the modernization or re24 alignment of facilities of the Veterans Health Admin25 istration under this subtitle. Such criteria shall in-
135 

•S 2372 EAH 

1 clude the preferences of veterans regarding health care 

2 furnished by the Department. 

3 (2) PUBLIC COMMENT.—The Secretary shall pro4 vide an opportunity for public comment on the pro5 posed criteria under paragraph (1) for a period of at 

6 least 90 days and shall include notice of that oppor7 tunity in the publication required under such para8 graph. 

9 (3) PUBLICATION OF FINAL CRITERIA.—The Sec10 retary shall, not later than May 31, 2021, publish in 

11 the Federal Register and transmit to the Committees 

12 on Veterans’ Affairs of the Senate and the House of 

13 Representatives the final criteria to be used in mak14 ing recommendations regarding the closure, mod15 ernization, or realignment of facilities of the Veterans 

16 Health Administration under this subtitle. 

17 (b) RECOMMENDATIONS OF THE SECRETARY.— 

18 (1) PUBLICATION IN FEDERAL REGISTER.—The 

19 Secretary shall, not later than January 31, 2022, and 

20 after consulting with veterans service organizations, 

21 publish in the Federal Register and transmit to the 

22 Committees on Veterans’ Affairs of the Senate and the 

23 House of Representatives and to the Commission a re24 port detailing the recommendations regarding the 

25 modernization or realignment of facilities of the Vet-
136 

•S 2372 EAH 

1 erans Health Administration on the basis of the final 

2 criteria referred to in subsection (a)(2) that are ap3 plicable. 

4 (2) FACTORS FOR CONSIDERATION.—In making 

5 recommendations under this subsection, the Secretary 

6 shall consider each of the following factors: 

7 (A) The degree to which any health care de8 livery or other site for providing services to vet9 erans reflect the metrics of the Department of 

10 Veterans Affairs regarding market area health 

11 system planning. 

12 (B) The provision of effective and efficient 

13 access to high-quality health care and services for 

14 veterans. 

15 (C) The extent to which the real property 

16 that no longer meets the needs of the Federal 

17 Government could be reconfigured, repurposed, 

18 consolidated, realigned, exchanged, outleased, re19 placed, sold, or disposed. 

20 (D) The need of the Veterans Health Ad21 ministration to acquire infrastructure or facili22 ties that will be used for the provision of health 

23 care and services to veterans. 

24 (E) The extent to which the operating and 

25 maintenance costs are reduced through consoli-
137 

•S 2372 EAH 

1 dating, colocating, and reconfiguring space, and 

2 through realizing other operational efficiencies. 

3 (F) The extent and timing of potential costs 

4 and savings, including the number of years such 

5 costs or savings will be incurred, beginning with 

6 the date of completion of the proposed rec7 ommendation. 

8 (G) The extent to which the real property 

9 aligns with the mission of the Department of 

10 Veterans Affairs. 

11 (H) The extent to which any action would 

12 impact other missions of the Department (in13 cluding education, research, or emergency pre14 paredness). 

15 (I) Local stakeholder inputs and any factors 

16 identified through public field hearings. 

17 (J) The assessments under paragraph (3). 

18 (K) The extent to which the Veterans Health 

19 Administration has appropriately staffed the 

20 medical facility, including determinations 

21 whether there has been insufficient resource allo22 cation or deliberate understaffing. 

23 (L) Any other such factors the Secretary de24 termines appropriate. 
138 

•S 2372 EAH 

1 (3) CAPACITY AND COMMERCIAL MARKET AS2 SESSMENTS.— 

3 (A) ASSESSMENTS.—The Secretary shall as4 sess the capacity of each Veterans Integrated 

5 Service Network and medical facility of the De6 partment to furnish hospital care or medical 

7 services to veterans under chapter 17 of title 38, 

8 United States Code. Each such assessment 

9 shall— 

10 (i) identify gaps in furnishing such 

11 care or services at such Veterans Integrated 

12 Service Network or medical facility; 

13 (ii) identify how such gaps can be 

14 filled by— 

15 (I) entering into contracts or 

16 agreements with network providers 

17 under this section or with entities 

18 under other provisions of law; 

19 (II) making changes in the way 

20 such care and services are furnished at 

21 such Veterans Integrated Service Net22 work or medical facility, including— 

23 (aa) extending hours of oper24 ation; 

25 (bb) adding personnel; or 
139 

•S 2372 EAH 

1 (cc) expanding space through 

2 the construction, leasing, or shar3 ing of health care facilities; and 

4 (III) the building or realignment 

5 of Department resources or personnel; 

6 (iii) forecast, based on future projec7 tions and historical trends, both the short8 and long-term demand in furnishing care 

9 or services at such Veterans Integrated Serv10 ice Network or medical facility and assess 

11 how such demand affects the needs to use 

12 such network providers; 

13 (iv) include a commercial health care 

14 market assessment of designated catchment 

15 areas in the United States conducted by a 

16 non-governmental entity; and 

17 (v) consider the unique ability of the 

18 Federal Government to retain a presence in 

19 an area otherwise devoid of commercial 

20 health care providers or from which such 

21 providers are at risk of leaving. 

22 (B) CONSULTATION.—In carrying out the 

23 assessments under subparagraph (A), the Sec24 retary shall consult with veterans service organi25 zations and veterans served by each such Vet-
140 

•S 2372 EAH 

1 erans Integrated Service Network and medical 

2 facility. 

3 (C) SUBMITTAL.—The Secretary shall sub4 mit such assessments to the Committees on Vet5 erans’ Affairs of the House of Representatives 

6 and the Senate with the recommendations of the 

7 Secretary under this subsection and make the as8 sessments publicly available. 

9 (4) SUMMARY OF SELECTION PROCESS.—The 

10 Secretary shall include, with the list of recommenda11 tions published and transmitted pursuant to para12 graph (1), a summary of the selection process that re13 sulted in the recommendation for each facility of the 

14 Veterans Health Administration, including a jus15 tification for each recommendation. The Secretary 

16 shall transmit the matters referred to in the preceding 

17 sentence not later than 7 days after the date of the 

18 transmittal to the Committees on Veterans’ Affairs of 

19 the Senate and the House of Representatives and the 

20 Commission of the report referred to in paragraph 

21 (1). 

22 (5) TREATMENT OF FACILITIES.—In assessing 

23 facilities of the Veterans Health Administration, the 

24 Secretary shall consider all such facilities equally 

25 without regard to whether the facility has been pre-
141 

•S 2372 EAH 

1 viously considered or proposed for reuse, closure, mod2 ernization, or realignment by the Department of Vet3 erans Affairs. 

4 (6) AVAILABILITY OF INFORMATION TO CON5 GRESS.—In addition to making all information used 

6 by the Secretary to prepare the recommendations 

7 under this subsection available to Congress (including 

8 any committee or Member of Congress), the Secretary 

9 shall also make such information available to the 

10 Commission and the Comptroller General of the 

11 United States. 

12 (7) CERTIFICATION OF ACCURACY.— 

13 (A) IN GENERAL.—Each person referred to 

14 in subparagraph (B), when submitting informa15 tion to the Secretary or the Commission con16 cerning the modernization or realignment of a 

17 facility of the Veterans Health Administration, 

18 shall certify that such information is accurate 

19 and complete to the best of that person’s knowl20 edge and belief. 

21 (B) COVERED PERSONS.—Subparagraph 

22 (A) applies to the following persons: 

23 (i) Each Under Secretary of the De24 partment of Veterans Affairs. 
142 

•S 2372 EAH 

1 (ii) Each director of a Veterans Inte2 grated Service Network. 

3 (iii) Each director of a medical center 

4 of the Department of Veterans Affairs. 

5 (iv) Each director of a program office 

6 of the Department of Veterans Affairs. 

7 (v) Each person who is in a position 

8 the duties of which include personal and 

9 substantial involvement in the preparation 

10 and submission of information and rec11 ommendations concerning the moderniza12 tion or realignment of facilities of the Vet13 erans Health Administration. 

14 (c) REVIEW AND RECOMMENDATIONS BY THE COMMIS15 SION.— 

16 (1) PUBLIC HEARINGS.— 

17 (A) IN GENERAL.—After receiving the rec18 ommendations from the Secretary pursuant to 

19 subsection (b), the Commission shall conduct 

20 public hearings on the recommendations. 

21 (B) LOCATIONS.—The Commission shall 

22 conduct public hearings in regions affected by a 

23 recommendation of the Secretary to close a facil24 ity of the Veterans Health Administration. To 

25 the greatest extent practicable, the Commission 
143 

•S 2372 EAH 

1 shall conduct public hearings in regions affected 

2 by a recommendation of the Secretary to mod3 ernize or realign such a facility. 

4 (C) REQUIRED WITNESSES.—Witnesses at 

5 each public hearing shall include at a min6 imum— 

7 (i) a veteran— 

8 (I) enrolled under section 1705 of 

9 title 38, United States Code; and 

10 (II) identified by a local veterans 

11 service organization; and 

12 (ii) a local elected official. 

13 (2) TRANSMITTAL TO PRESIDENT.— 

14 (A) IN GENERAL.—The Commission shall, 

15 not later than January 31, 2023, transmit to the 

16 President a report containing the Commission’s 

17 findings and conclusions based on a review and 

18 analysis of the recommendations made by the 

19 Secretary, together with the Commission’s rec20 ommendations, for modernizations and realign21 ments of facilities of the Veterans Health Admin22 istration. 

23 (B) AUTHORITY TO MAKE CHANGES TO REC24 OMMENDATIONS.—Subject to subparagraph (C), 

25 in making its recommendations, the Commission 
144 

•S 2372 EAH 

1 may change any recommendation made by the 

2 Secretary if the Commission— 

3 (i) determines that the Secretary devi4 ated substantially from the final criteria re5 ferred to in subsection (a)(2) in making 

6 such recommendation; 

7 (ii) determines that the change is con8 sistent with the final criteria referred to in 

9 subsection (a)(2); 

10 (iii) publishes a notice of the proposed 

11 change in the Federal Register not less than 

12 45 days before transmitting its rec13 ommendations to the President pursuant to 

14 subparagraph (A); and 

15 (iv) conducts public hearings on the 

16 proposed change. 

17 (3) JUSTIFICATION FOR CHANGES.—The Com18 mission shall explain and justify in its report sub19 mitted to the President pursuant to paragraph (2) 

20 any recommendation made by the Commission that is 

21 different from the recommendations made by the Sec22 retary pursuant to subsection (b). The Commission 

23 shall transmit a copy of such report to the Commit24 tees on Veterans’ Affairs of the Senate and the House 

25 of Representatives on the same date on which it 
145 

•S 2372 EAH 

1 transmits its recommendations to the President under 

2 paragraph (2). 

3 (4) PROVISION OF INFORMATION TO CON4 GRESS.—After the Commission transmits its report to 

5 the President, the Commission shall promptly pro6 vide, upon request, to any Member of Congress, infor7 mation used by the Commission in making its rec8 ommendations. 

9 (d) REVIEW BY THE PRESIDENT.— 

10 (1) REPORT.—The President shall, not later 

11 than February 15, 2023, transmit to the Commission 

12 and to the Congress a report containing the Presi13 dent’s approval or disapproval of the Commission’s 

14 recommendations. 

15 (2) PRESIDENTIAL APPROVAL.—If the President 

16 approves all the recommendations of the Commission, 

17 the President shall transmit a copy of such rec18 ommendations to the Congress, together with a certifi19 cation of such approval. 

20 (3) PRESIDENTIAL DISAPPROVAL.—If the Presi21 dent disapproves the recommendations of the Commis22 sion, in whole or in part, the President shall transmit 

23 to the Commission and the Congress, not later than 

24 March 1, 2023, the reasons for that disapproval. The 

25 Commission, after consideration of the President’s 
146 

•S 2372 EAH 

1 reasons for disapproval, shall then transmit to the 

2 President, not later than March 15, 2023, a report 

3 containing— 

4 (A) the Commission’s findings and conclu5 sions based on a review and analysis of those 

6 reasons for disapproval provided by the Presi7 dent; and 

8 (B) recommendations that the Commission 

9 determines are appropriate for modernizations 

10 and realignments of facilities of the Veterans 

11 Health Administration. 

12 (4) TRANSMITTAL OF RECOMMENDATIONS TO

13 CONGRESS.—If the President approves all rec14 ommendations of the Commission transmitted to the 

15 President under paragraph (3), the President shall 

16 transmit a copy of such recommendations to the Con17 gress, together with a certification of such approval. 

18 (5) FAILURE TO TRANSMIT.—If the President 

19 does not transmit to the Congress an approval and 

20 certification described in paragraph (2) or (4) by 

21 March 30, 2023, the process by which facilities of the 

22 Veterans Health Administration may be selected for 

23 modernization or realignment under this subtitle shall 

24 be terminated. 
147 

•S 2372 EAH 

1 SEC. 204. ACTIONS REGARDING INFRASTRUCTURE AND FA2 CILITIES OF THE VETERANS HEALTH ADMIN3 ISTRATION. 

4 (a) IN GENERAL.—Subject to subsection (b), the Sec5 retary shall begin to implement the recommended mod6 ernizations and realignments in the report under section 

7 203(d) not later than 3 years after the date on which the 

8 President transmits such report to Congress. In any fiscal 

9 year, such implementation includes— 

10 (1) the planning of modernizations and realign11 ments of facilities of the Veterans Health Administra12 tion as recommended in such report; and 

13 (2) providing detailed information on the budget 

14 for such modernizations or realignments in documents 

15 submitted to Congress by the Secretary in support of 

16 the President’s budget for that fiscal year. 

17 (b) CONGRESSIONAL DISAPPROVAL.— 

18 (1) IN GENERAL.—The Secretary may not carry 

19 out any modernization or realignment recommended 

20 by the Commission in a report transmitted from the 

21 President pursuant to section 203(d) if a joint resolu22 tion is enacted, in accordance with the provisions of 

23 section 207, disapproving such recommendations of 

24 the Commission before the earlier of— 
148 

•S 2372 EAH 

1 (A) the end of the 45-day period beginning 

2 on the date on which the President transmits 

3 such report; or 

4 (B) the adjournment of Congress sine die 

5 for the session during which such report is trans6 mitted. 

7 (2) COMPUTATION OF PERIOD.—For purposes of 

8 paragraph (1) and subsections (a) and (c) of section 

9 207, the days on which either House of Congress is 

10 not in session because of an adjournment of more 

11 than three days to a day certain shall be excluded in 

12 the computation of a period. 

13 SEC. 205. IMPLEMENTATION. 

14 (a) IN GENERAL.— 

15 (1) MODERNIZING AND REALIGNING FACILI16 TIES.—In modernizing or realigning any facility of 

17 the Veterans Health Administration under this sub18 title, the Secretary may— 

19 (A) take such actions as may be necessary 

20 to modernize or realign any such facility, in21 cluding the alteration of such facilities, the ac22 quisition of such land, the leasing or construc23 tion of such replacement facilities, the disposi24 tion of such land or facilities, the performance of 

25 such activities, and the conduct of such advance 
149 

•S 2372 EAH 

1 planning and design as may be required to 

2 transfer functions from a facility of the Veterans 

3 Health Administration to another such facility, 

4 and may use for such purpose funds in the Ac5 count or funds appropriated to the Department 

6 of Veterans Affairs for such purposes; 

7 (B) carry out activities for the purposes of 

8 environmental mitigation, abatement, or restora9 tion at any such facility, and shall use for such 

10 purposes funds in the Account; 

11 (C) reimburse other Federal agencies for ac12 tions performed at the request of the Secretary 

13 with respect to any such closure or realignment, 

14 and may use for such purpose funds in the Ac15 count or funds appropriated to the Department 

16 of Veterans Affairs and available for such pur17 pose; and 

18 (D) exercise the authority of the Secretary 

19 under subchapter V of chapter 81 of title 38, 

20 United States Code. 

21 (2) ENVIRONMENTAL RESTORATION; HISTORIC

22 PRESERVATION.—In carrying out any closure or re23 alignment under this subtitle, the Secretary, with re24 gards to any property made excess to the needs of the 

25 Department of Veterans Affairs as a result of such 
150 

•S 2372 EAH 

1 closure or realignment, shall carry out, as soon as 

2 possible with funds available for such purpose, any of 

3 the following for which the Secretary is responsible: 

4 (A) Environmental mitigation. 

5 (B) Environmental abatement. 

6 (C) Environmental restoration. 

7 (D) Compliance with historic preservation 

8 requirements. 

9 (b) MANAGEMENT AND DISPOSAL OF PROPERTY.— 

10 (1) EXISTING DISPOSAL AUTHORITIES.—To 

11 transfer or dispose of surplus real property or infra12 structure located at any facility of the Veterans 

13 Health Administration that is modernized or re14 aligned under this title, the Secretary may exercise 

15 the authorities of the Secretary under subchapters I 

16 and II of chapter 81 of title 38, United States Code, 

17 or the authorities delegated to the Secretary by the 

18 Administrator of General Services under subchapter 

19 III of chapter 5 of title 40, United States Code. 

20 (2) EFFECTS ON LOCAL COMMUNITIES.— 

21 (A) CONSULTATION WITH STATE AND LOCAL

22 GOVERNMENT.—Before any action may be taken 

23 with respect to the disposal of any surplus real 

24 property or infrastructure located at any facility 

25 of the Veterans Health Administration to be 
151 

•S 2372 EAH 

1 closed or realigned under this subtitle, the Sec2 retary of Veterans Affairs shall consult with the 

3 Governor of the State and the heads of the local 

4 governments concerned for the purpose of consid5 ering any plan for the use of such property by 

6 the local community concerned. 

7 (B) TREATMENT OF ROADS.—If infrastruc8 ture or a facility of the Veterans Health Admin9 istration to be closed or realigned under this sub10 title includes a road used for public access 

11 through, into, or around the facility, the Sec12 retary— 

13 (i) shall consult with the Government 

14 of the State and the heads of the local gov15 ernments concerned for the purpose of con16 sidering the continued availability of the 

17 road for public use after the recommended 

18 action is complete; and 

19 (ii) may exercise the authority of the 

20 Secretary under section 8108 of title 38, 

21 United States Code. 

22 (3) LEASES; CERCLA.— 

23 (A) LEASE AUTHORITY.— 

24 (i) TRANSFER TO REDEVELOPMENT AU25 THORITY FOR LEASE.—The Secretary may 
152 

•S 2372 EAH 

1 transfer title to a facility of the Veterans 

2 Health Administration approved for closure 

3 or realignment under this subtitle (includ4 ing property at a facility of the Veterans 

5 Health Administration approved for re6 alignment which will be retained by the De7 partment of Veterans Affairs or another 

8 Federal agency after realignment) to the re9 development authority for the facility if the 

10 redevelopment authority agrees to lease, di11 rectly upon transfer, one or more portions 

12 of the property transferred under this sub13 paragraph to the Secretary or to the head 

14 of another department or agency of the Fed15 eral Government. 

16 (ii) TERM OF LEASE.—A lease under 

17 clause (i) shall be for a term of not to exceed 

18 50 years, but may provide for options for 

19 renewal or extension of the term by the de20 partment or agency concerned. 

21 (iii) LIMITATION.—A lease under 

22 clause (i) may not require rental payments 

23 by the United States. 

24 (iv) TREATMENT OF REMAINDERED

25 LEASE TERMS.—A lease under clause (i) 
153 

•S 2372 EAH 

1 shall include a provision specifying that if 

2 the department or agency concerned ceases 

3 requiring the use of the leased property be4 fore the expiration of the term of the lease, 

5 the remainder of the lease term may be sat6 isfied by the same or another department or 

7 agency of the Federal Government using the 

8 property for a use similar to the use under 

9 the lease. Exercise of the authority provided 

10 by this clause shall be made in consultation 

11 with the redevelopment authority concerned. 

12 (v) FACILITY SERVICES.—Notwith13 standing clause (iii), if a lease under clause 

14 (i) involves a substantial portion of the fa15 cility, the department or agency concerned 

16 may obtain facility services for the leased 

17 property and common area maintenance 

18 from the redevelopment authority or the re19 development authority’s assignee as a provi20 sion of the lease. The facility services and 

21 common area maintenance shall be provided 

22 at a rate no higher than the rate charged to 

23 non-Federal tenants of the transferred prop24 erty. Facility services and common area 
154 

•S 2372 EAH 

1 maintenance covered by the lease shall not 

2 include— 

3 (I) municipal services that a 

4 State or local government is required 

5 by law to provide to all landowners in 

6 its jurisdiction without direct charge; 

7 or 

8 (II) firefighting or security-guard 

9 functions. 

10 (B) APPLICATION OF CERCLA.—The provi11 sions of section 120(h) of the Comprehensive En12 vironmental Response, Compensation, and Li13 ability Act of 1980 (42 U.S.C. 9620(h)) shall 

14 apply to any transfer of real property under this 

15 paragraph. 

16 (C) ADDITIONAL TERMS AND CONDITIONS.— 

17 The Secretary may require any additional terms 

18 and conditions in connection with a transfer 

19 under this paragraph as such Secretary con20 siders appropriate to protect the interests of the 

21 United States. 

22 (4) APPLICATION OF MCKINNEY-VENTO HOME23 LESS ASSISTANCE ACT.—Nothing in this subtitle shall 

24 limit or otherwise affect the application of the provi25 sions of the McKinney-Vento Homeless Assistance Act 
155 

•S 2372 EAH 

1 (42 U.S.C. 11301 et seq.) to facilities of the Veterans 

2 Health Administration closed under this subtitle. 

3 (c) APPLICABILITY OF NATIONAL ENVIRONMENTAL

4 POLICY ACT OF 1969.— 

5 (1) IN GENERAL.—The provisions of the National 

6 Environmental Policy Act of 1969 (42 U.S.C. 4321 et 

7 seq.) shall not apply to the actions of the President, 

8 the Commission, and, except as provided in para9 graph (2), the Department of Veterans Affairs in car10 rying out this subtitle. 

11 (2) DEPARTMENT OF VETERANS AFFAIRS.— 

12 (A) COVERED ACTIVITIES.—The provisions 

13 of the National Environmental Policy Act of 

14 1969 shall apply to actions of the Department of 

15 Veterans Affairs under this subtitle— 

16 (i) during the process of property dis17 posal; and 

18 (ii) during the process of relocating 

19 functions from a facility of the Veterans 

20 Health Administration being closed or re21 aligned to another facility after the receiv22 ing facility has been selected but before the 

23 functions are relocated. 

24 (B) OTHER ACTIVITIES.—In applying the 

25 provisions of the National Environmental Policy 
156 

•S 2372 EAH 

1 Act of 1969 to the processes referred to in sub2 paragraph (A), the Secretary shall not have to 

3 consider— 

4 (i) the need for closing or realigning 

5 the facility of the Veterans Health Adminis6 tration as recommended by the Commission; 

7 (ii) the need for transferring functions 

8 to any facility of the Veterans Health Ad9 ministration which has been selected as the 

10 receiving facility; or 

11 (iii) facilities of the Veterans Health 

12 Administration alternative to those rec13 ommended or selected. 

14 (d) WAIVER.— 

15 (1) RESTRICTIONS ON USE OF FUNDS.—The Sec16 retary may close or realign facilities of the Veterans 

17 Health Administration under this subtitle without re18 gard to any provision of law restricting the use of 

19 funds for closing or realigning facilities of the Vet20 erans Health Administration included in any appro21 priation or authorization Act. 

22 (2) RESTRICTIONS ON AUTHORITIES.—The Sec23 retary may close or realign facilities of the Veterans 

24 Health Administration under this subtitle without re-
157 

•S 2372 EAH 

1 gard to the restrictions of section 8110 of title 38, 

2 United States Code. 

3 (e) TRANSFER AUTHORITY IN CONNECTION WITH PAY4 MENT OF ENVIRONMENTAL REMEDIATION COSTS.— 

5 (1) IN GENERAL.— 

6 (A) TRANSFER BY DEED.—Subject to para7 graph (2) of this subsection and section 120(h) 

8 of the Comprehensive Environmental Response, 

9 Compensation, and Liability Act of 1980 (42 

10 U.S.C. 9620(h)), the Secretary may enter into 

11 an agreement to transfer by deed a facility of the 

12 Veterans Health Administration with any person 

13 who agrees to perform all environmental restora14 tion, waste management, and environmental 

15 compliance activities that are required for the 

16 property or facilities under Federal and State 

17 laws, administrative decisions, agreements (in18 cluding schedules and milestones), and concur19 rences. 

20 (B) ADDITIONAL TERMS OR CONDITIONS.— 

21 The Secretary may require any additional terms 

22 and conditions in connection with an agreement 

23 authorized by subparagraph (A) as the Secretary 

24 considers appropriate to protect the interests of 

25 the United States. 
158 

•S 2372 EAH 

1 (2) LIMITATION.—A transfer of a facility of the 

2 Veterans Health Administration may be made under 

3 paragraph (1) only if the Secretary certifies to Con4 gress that— 

5 (A) the costs of all environmental restora6 tion, waste management, and environmental 

7 compliance activities otherwise to be paid by the 

8 Secretary with respect to the facility of the Vet9 erans Health Administration are equal to or 

10 greater than the fair market value of the prop11 erty or facilities to be transferred, as determined 

12 by the Secretary; or 

13 (B) if such costs are lower than the fair 

14 market value of the facility of the Veterans 

15 Health Administration, the recipient of such 

16 transfer agrees to pay the difference between the 

17 fair market value and such costs. 

18 (3) PAYMENT BY THE SECRETARY FOR CERTAIN

19 TRANSFERS.—In the case of a facility of the Veterans 

20 Health Administration covered by a certification 

21 under paragraph (2)(A), the Secretary may pay the 

22 recipient of such facility an amount equal to the less23 er of— 

24 (A) the amount by which the costs incurred 

25 by the recipient of the facility of the Veterans 
159 

•S 2372 EAH 

1 Health Administration for all environmental res2 toration, waste, management, and environmental 

3 compliance activities with respect to such facility 

4 exceed the fair market value of such property as 

5 specified in such certification; or 

6 (B) the amount by which the costs (as deter7 mined by the Secretary) that would otherwise 

8 have been incurred by the Secretary for such res9 toration, management, and activities with re10 spect to such facility of the Veterans Health Ad11 ministration exceed the fair market value of 

12 property as so specified. 

13 (4) DISCLOSURE.—As part of an agreement 

14 under paragraph (1), the Secretary shall disclose to 

15 the person to whom the facility of the Veterans Health 

16 Administration will be transferred any information 

17 of the Secretary regarding the environmental restora18 tion, waste management, and environmental compli19 ance activities described in paragraph (1) that relate 

20 to the facility of the Veterans Health Administration. 

21 The Secretary shall provide such information before 

22 entering into the agreement. 

23 (5) APPLICABILITY OF CERTAIN ENVIRONMENTAL

24 LAWS.—Nothing in this subsection shall be construed 

25 to modify, alter, or amend the Comprehensive Envi-
160 

•S 2372 EAH 

1 ronmental Response, Compensation, and Liability 

2 Act of 1980 (42 U.S.C. 9601 et seq.) or the Solid 

3 Waste Disposal Act (42 U.S.C. 6901 et seq.). 

4 SEC. 206. DEPARTMENT OF VETERANS AFFAIRS ASSET AND 

5 INFRASTRUCTURE REVIEW ACCOUNT. 

6 (a) ESTABLISHMENT.—There is hereby established in 

7 the ledgers of the Treasury an account to be known as the 

8 ‘‘Department of Veterans Affairs Asset and Infrastructure 

9 Review Account’’ which shall be administered by the Sec10 retary as a single account. 

11 (b) CREDITS TO ACCOUNT.—There shall be credited to 

12 the Account the following: 

13 (1) Funds authorized for and appropriated to 

14 the Account. 

15 (2) Proceeds received from the lease, transfer, or 

16 disposal of any property at a facility of the Veterans 

17 Health Administration closed or realigned under this 

18 subtitle. 

19 (c) USE OF ACCOUNT.—The Secretary may use the 

20 funds in the Account only for the following purposes: 

21 (1) To carry out this subtitle. 

22 (2) To cover property management and disposal 

23 costs incurred at facilities of the Veterans Health Ad24 ministration closed, modernized, or realigned under 

25 this subtitle. 
161 

•S 2372 EAH 

1 (3) To cover costs associated with supervision, 

2 inspection, overhead, engineering, and design of con3 struction projects undertaken under this subtitle, and 

4 subsequent claims, if any, related to such activities. 

5 (4) Other purposes that the Secretary determines 

6 support the mission and operations of the Department 

7 of Veterans Affairs. 

8 (d) CONSOLIDATED BUDGET JUSTIFICATION DISPLAY

9 FOR ACCOUNT.— 

10 (1) CONSOLIDATED BUDGET INFORMATION RE11 QUIRED.—The Secretary shall establish a consolidated 

12 budget justification display in support of the Account 

13 that for each fiscal year— 

14 (A) details the amount and nature of credits 

15 to, and expenditures from, the Account during 

16 the preceding fiscal year; 

17 (B) separately details the environmental re18 mediation costs associated with facility of the 

19 Veterans Health Administration for which a 

20 budget request is made; 

21 (C) specifies the transfers into the Account 

22 and the purposes for which these transferred 

23 funds will be further obligated, to include care24 taker and environment remediation costs associ-
162 

•S 2372 EAH 

1 ated with each facility of the Veterans Health 

2 Administration; and 

3 (D) details any intra-budget activity trans4 fers within the Account that exceeded $1,000,000 

5 during the preceding fiscal year or that are pro6 posed for the next fiscal year and will exceed 

7 $1,000,000. 

8 (2) SUBMISSION.—The Secretary shall include 

9 the information required by paragraph (1) in the ma10 terials that the Secretary submits to Congress in sup11 port of the budget for a fiscal year submitted by the 

12 President pursuant to section 1105 of title 31, United 

13 States Code. 

14 (e) CLOSURE OF ACCOUNT; TREATMENT OF REMAIN15 ING FUNDS.— 

16 (1) CLOSURE.—The Account shall be closed at 

17 the time and in the manner provided for appropria18 tion accounts under section 1555 of title 31, United 

19 States Code, except that unobligated funds which re20 main in the Account upon closure shall be held by the 

21 Secretary of the Treasury until transferred to the Sec22 retary of Veterans Affairs by law after the Committees 

23 on Veterans’ Affairs of the Senate and the House of 

24 Representatives receive the final report transmitted 

25 under paragraph (2). 
163 

•S 2372 EAH 

1 (2) FINAL REPORT.—No later than 60 days after 

2 the closure of the Account under paragraph (1), the 

3 Secretary shall transmit to the Committees on Vet4 erans’ Affairs of the Senate and the House of Rep5 resentatives and the Committees on Appropriations of 

6 the House of Representatives and the Senate a report 

7 containing an accounting of— 

8 (A) all the funds credited to and expended 

9 from the Account or otherwise expended under 

10 this subtitle; and 

11 (B) any funds remaining in the Account. 

12 SEC. 207. CONGRESSIONAL CONSIDERATION OF COMMIS13 SION REPORT. 

14 (a) DISAPPROVAL RESOLUTION.—For purposes of this 

15 subtitle, the term ‘‘joint resolution’’ means only a joint reso16 lution which is introduced within the 5-day period begin17 ning on the date on which the President transmits the re18 port to the Congress under section 203(d), and— 

19 (1) which does not have a preamble; 

20 (2) the matter after the resolving clause of which 

21 is as follows: ‘‘that Congress disapproves the rec22 ommendations of the VHA Asset and Infrastructure 

23 Review Commission as submitted by the President on 

24 lll’’, the blank space being filled with the appro25 priate date; and 
164 

•S 2372 EAH 

1 (3) the title of which is as follows: ‘‘Joint resolu2 tion disapproving the recommendations of the VHA 

3 Asset and Infrastructure Review Commission.’’. 

4 (b) CONSIDERATION IN THE HOUSE OF REPRESENTA5 TIVES.— 

6 (1) REPORTING AND DISCHARGE.—Any com7 mittee of the House of Representatives to which a 

8 joint resolution is referred shall report it to the House 

9 without amendment not later than 15 legislative days 

10 after the date of introduction thereof. If a committee 

11 fails to report the joint resolution within that period, 

12 the committee shall be discharged from further consid13 eration of the joint resolution. 

14 (2) PROCEEDING TO CONSIDERATION.—It shall 

15 be in order at any time after the third legislative day 

16 after each committee authorized to consider a joint 

17 resolution has reported or has been discharged from 

18 consideration of a joint resolution, to move to proceed 

19 to consider the joint resolution in the House. All 

20 points of order against the motion are waived. Such 

21 a motion shall not be in order after the House has 

22 disposed of a motion to proceed on a joint resolution 

23 addressing a particular submission. The previous 

24 question shall be considered as ordered on the motion 

25 to its adoption without intervening motion. The mo-
165 

•S 2372 EAH 

1 tion shall not be debatable. A motion to reconsider the 

2 vote by which the motion is disposed of shall not be 

3 in order. 

4 (3) CONSIDERATION.—The joint resolution shall 

5 be considered as read. All points of order against the 

6 joint resolution and against its consideration are 

7 waived. The previous question shall be considered as 

8 ordered on the joint resolution to its passage without 

9 intervening motion except 2 hours of debate equally 

10 divided and controlled by the proponent and an oppo11 nent. A motion to reconsider the vote on passage of 

12 the joint resolution shall not be in order. 

13 (c) CONSIDERATION IN THE SENATE.— 

14 (1) REFERRAL.—A joint resolution introduced in 

15 the Senate shall be referred to the Committee on Vet16 erans’ Affairs. 

17 (2) REPORTING AND DISCHARGE.—Any com18 mittee of the Senate to which a joint resolution is re19 ferred shall report it to the Senate without amend20 ment not later than 15 session days after the date of 

21 introduction of a joint resolution described in sub22 section (a). If a committee fails to report the joint res23 olution within that period, the committee shall be dis24 charged from further consideration of the joint resolu-
166 

•S 2372 EAH 

1 tion and the joint resolution shall be placed on the 

2 calendar. 

3 (3) FLOOR CONSIDERATION.— 

4 (A) IN GENERAL.—Notwithstanding Rule 

5 XXII of the Standing Rules of the Senate, it is 

6 in order at any time after the third session day 

7 on which the Committee on Veterans’ Affairs has 

8 reported or has been discharged from consider9 ation of a joint resolution described in subsection 

10 (a) (even though a previous motion to the same 

11 effect has been disagreed to) to move to proceed 

12 to the consideration of the joint resolution, and 

13 all points of order against the joint resolution 

14 (and against consideration of the joint resolu15 tion) are waived. The motion to proceed is not 

16 debatable. The motion is not subject to a motion 

17 to postpone. A motion to reconsider the vote by 

18 which the motion is agreed to or disagreed to 

19 shall not be in order. If a motion to proceed to 

20 the consideration of the resolution is agreed to, 

21 the joint resolution shall remain the unfinished 

22 business until disposed of. 

23 (B) CONSIDERATION.—Consideration of the 

24 joint resolution, and on all debatable motions 

25 and appeals in connection therewith, shall be 
167 

•S 2372 EAH 

1 limited to not more than 2 hours, which shall be 

2 divided equally between the majority and minor3 ity leaders or their designees. A motion further 

4 to limit debate is in order and not debatable. An 

5 amendment to, or a motion to postpone, or a mo6 tion to proceed to the consideration of other busi7 ness, or a motion to recommit the joint resolu8 tion is not in order. 

9 (C) VOTE ON PASSAGE.—If the Senate has 

10 voted to proceed to a joint resolution, the vote on 

11 passage of the joint resolution shall occur imme12 diately following the conclusion of consideration 

13 of the joint resolution, and a single quorum call 

14 at the conclusion of the debate if requested in ac15 cordance with the rules of the Senate. 

16 (D) RULINGS OF THE CHAIR ON PROCE17 DURE.—Appeals from the decisions of the Chair 

18 relating to the application of the rules of the 

19 Senate, as the case may be, to the procedure re20 lating to a joint resolution shall be decided with21 out debate. 

22 (d) AMENDMENT NOT IN ORDER.—A joint resolution 

23 of disapproval considered pursuant to this section shall not 

24 be subject to amendment in either the House of Representa25 tives or the Senate. 
168 

•S 2372 EAH 

1 (e) COORDINATION WITH ACTION BY OTHER

2 HOUSE.— 

3 (1) IN GENERAL.—If, before the passage by one 

4 House of the joint resolution of that House, that 

5 House receives the joint resolution from the other 

6 House, then the following procedures shall apply: 

7 (A) The joint resolution of the other House 

8 shall not be referred to a committee. 

9 (B) With respect to the joint resolution of 

10 the House receiving the joint resolution— 

11 (i) the procedure in that House shall be 

12 the same as if no joint resolution had been 

13 received from the other House; but 

14 (ii) the vote on passage shall be on the 

15 joint resolution of the other House. 

16 (2) TREATMENT OF JOINT RESOLUTION OF

17 OTHER HOUSE.—If the Senate fails to introduce or 

18 consider a joint resolution under this section, the joint 

19 resolution of the House shall be entitled to expedited 

20 floor procedures under this section. 

21 (3) TREATMENT OF COMPANION MEASURES.—If, 

22 following passage of the joint resolution in the Senate, 

23 the Senate then receives the companion measure from 

24 the House of Representatives, the companion measure 

25 shall not be debatable. 
169 

•S 2372 EAH 

1 (f) RULES OF THE HOUSE OF REPRESENTATIVES AND

2 SENATE.—This section is enacted by Congress— 

3 (1) as an exercise of the rulemaking power of the 

4 Senate and House of Representatives, respectively, 

5 and as such it is deemed a part of the rules of each 

6 House, respectively, but applicable only with respect 

7 to the procedure to be followed in that House in the 

8 case of a joint resolution, and it supersedes other rules 

9 only to the extent that it is inconsistent with such 

10 rules; and 

11 (2) with full recognition of the constitutional 

12 right of either House to change the rules (so far as re13 lating to the procedure of that House) at any time, 

14 in the same manner, and to the same extent as in the 

15 case of any other rule of that House. 

16 SEC. 208. OTHER MATTERS. 

17 (a) ONLINE PUBLICATION OF COMMUNICATIONS.— 

18 (1) IN GENERAL.—Not later than 24 hours after 

19 the transmission or receipt of any communication 

20 under this subtitle that is transmitted or received by 

21 a party specified in paragraph (2), the Secretary of 

22 Veterans Affairs shall publish such communication 

23 online. 

24 (2) PARTIES SPECIFIED.—The parties specified 

25 under this paragraph are the following: 
170 

•S 2372 EAH 

1 (A) The Secretary of Veterans Affairs. 

2 (B) The Commission. 

3 (C) The President. 

4 (b) CONTINUATION OF EXISTING CONSTRUCTION

5 PROJECTS AND PLANNING.—During activities that the 

6 Commission, President, or Congress carry out under this 

7 subtitle, the Secretary of Veterans Affairs may not stop, 

8 solely because of such activities— 

9 (1) a construction or leasing project of the Vet10 erans Health Administration; 

11 (2) long term planning regarding infrastructure 

12 and assets of the Veterans Health Administration; or 

13 (3) budgetary processes for the Veterans Health 

14 Administration. 

15 (c) RECOMMENDATIONS FOR FUTURE ASSET RE16 VIEWS.—The Secretary of Veterans Affairs may, after con17 sulting with veterans service organizations, include in 

18 budget submissions the Secretary submits after the termi19 nation of the Commission recommendations for future such 

20 commissions or other capital asset realignment and man21 agement processes. 

22 SEC. 209. DEFINITIONS. 

23 In this subtitle: 
171 

•S 2372 EAH 

1 (1) The term ‘‘Account’’ means the Department 

2 of Veterans Affairs Asset and Infrastructure Review 

3 Account established by section 206(a). 

4 (2) The term ‘‘Commission’’ means the Commis5 sion established by section 202. 

6 (3) The term ‘‘date of approval’’, with respect to 

7 a modernization or realignment of a facility of the 

8 Veterans Health Administration, means the date on 

9 which the authority of Congress to disapprove a rec10 ommendation of modernization or realignment, as the 

11 case may be, of such facility under this subtitle ex12 pires. 

13 (4) The term ‘‘facility of the Veterans Health Ad14 ministration’’— 

15 (A) means any land, building, structure, or 

16 infrastructure (including any medical center, 

17 nursing home, domiciliary facility, outpatient 

18 clinic, center that provides readjustment coun19 seling, or leased facility) that is— 

20 (i) under the jurisdiction of the De21 partment of Veterans Affairs; 

22 (ii) under the control of the Veterans 

23 Health Administration; and 

24 (iii) not under the control of the Gen25 eral Services Administration; or 
172 

•S 2372 EAH 

1 (B) with respect to a colocated facility of 

2 the Department of Veterans Affairs, includes any 

3 land, building, or structure— 

4 (i) under the jurisdiction of the De5 partment of Veterans Affairs; 

6 (ii) under the control of another ad7 ministration of the Department of Veterans 

8 Affairs; and 

9 (iii) not under the control of the Gen10 eral Services Administration. 

11 (5) The term ‘‘infrastructure’’ means improve12 ments to land other than buildings or structures. 

13 (6) The term ‘‘modernization’’ includes— 

14 (A) any action, including closure, required 

15 to align the form and function of a facility of the 

16 Veterans Health Administration to the provision 

17 of modern day health care, including utilities 

18 and environmental control systems; 

19 (B) the construction, purchase, lease, or 

20 sharing of a facility of the Veterans Health Ad21 ministration; and 

22 (C) realignments, disposals, exchanges, col23 laborations between the Department of Veterans 

24 Affairs and other Federal entities, and strategic 
173 

•S 2372 EAH 

1 collaborations between the Department and non2 Federal entities, including tribal organizations. 

3 (7) The term ‘‘realignment’’, with respect to a fa4 cility of the Veterans Health Administration, in5 cludes— 

6 (A) any action that changes the numbers of 

7 or relocates services, functions, and personnel po8 sitions; 

9 (B) disposals or exchanges between the De10 partment of Veterans Affairs and other Federal 

11 entities, including the Department of Defense; 

12 and 

13 (C) strategic collaborations between the De14 partment of Veterans Affairs and non-Federal 

15 entities, including tribal organizations. 

16 (8) The term ‘‘redevelopment authority’’, in the 

17 case of a facility of the Veterans Health Administra18 tion closed or modernized under this subtitle, means 

19 any entity (including an entity established by a State 

20 or local government) recognized by the Secretary of 

21 Veterans Affairs as the entity responsible for devel22 oping the redevelopment plan with respect to the fa23 cility or for directing the implementation of such 

24 plan. 
174 

•S 2372 EAH 

1 (9) The term ‘‘redevelopment plan’’ in the case 

2 of a facility of the Veterans Health Administration to 

3 be closed or realigned under this subtitle, means a 

4 plan that— 

5 (A) is agreed to by the local redevelopment 

6 authority with respect to the facility; and 

7 (B) provides for the reuse or redevelopment 

8 of the real property and personal property of the 

9 facility that is available for such reuse and rede10 velopment as a result of the closure or realign11 ment of the facility. 

12 (10) The term ‘‘Secretary’’ means the Secretary 

13 of Veterans Affairs. 

14 (11) The term ‘‘tribal organization’’ has the 

15 meaning given such term in section 3765 of title 38, 

16 United States Code. 

17 Subtitle B—Other Infrastructure 

18 Matters 

19 SEC. 211. IMPROVEMENT TO TRAINING OF CONSTRUCTION 

20 PERSONNEL. 

21 Subsection (g) of section 8103 of title 38, United States 

22 Code, is amended to read as follows: 

23 ‘‘(g)(1)(A) Not later than September 30 of the fiscal 

24 year following the fiscal year during which the VA Asset 

25 and Infrastructure Review Act of 2018 is enacted, the Sec-
175 

•S 2372 EAH 

1 retary shall implement the covered training curriculum and 

2 the covered certification program. 

3 ‘‘(B) In designing and implementing the covered 

4 training curriculum and the covered certification program 

5 under paragraph (1), the Secretary shall use as models ex6 isting training curricula and certification programs that 

7 have been established under chapter 87 of title 10, United 

8 States Code, as determined relevant by the Secretary. 

9 ‘‘(2) The Secretary may develop the training cur10 riculum under paragraph (1)(A) in a manner that provides 

11 such training in any combination of— 

12 ‘‘(A) training provided in person; 

13 ‘‘(B) training provided over an internet website; 

14 or 

15 ‘‘(C) training provided by another department or 

16 agency of the Federal Government. 

17 ‘‘(3) The Secretary may develop the certification pro18 gram under paragraph (1)(A) in a manner that uses— 

19 ‘‘(A) one level of certification; or 

20 ‘‘(B) more than one level of certification, as de21 termined appropriate by the Secretary with respect to 

22 the level of certification for different grades of the 

23 General Schedule. 

24 ‘‘(4) The Secretary may enter into a contract with an 

25 appropriate entity to provide the covered training cur-
176 

•S 2372 EAH 

1 riculum and the covered certification program under para2 graph (1)(A). 

3 ‘‘(5)(A) Not later than September 30 of the second fis4 cal year following the fiscal year during which the VA Asset 

5 and Infrastructure Review Act of 2018 is enacted, the Sec6 retary shall ensure that the majority of employees subject 

7 to the covered certification program achieve the certification 

8 or the appropriate level of certification pursuant to para9 graph (3), as the case may be. 

10 ‘‘(B) After carrying out subparagraph (A), the Sec11 retary shall ensure that each employee subject to the covered 

12 certification program achieves the certification or the ap13 propriate level of certification pursuant to paragraph (3), 

14 as the case may be, as quickly as practicable. 

15 ‘‘(6) In this subsection: 

16 ‘‘(A) The term ‘covered certification program’ 

17 means, with respect to employees of the Department 

18 of Veterans Affairs who are members of occupational 

19 series relating to construction or facilities manage20 ment, or employees of the Department who award or 

21 administer contracts for major construction, minor 

22 construction, or nonrecurring maintenance, including 

23 as contract specialists or contracting officers’ rep24 resentatives, a program to certify knowledge and skills 

25 relating to construction or facilities management and 
177 

•S 2372 EAH 

1 to ensure that such employees maintain adequate ex2 pertise relating to industry standards and best prac3 tices for the acquisition of design and construction 

4 services. 

5 ‘‘(B) The term ‘covered training curriculum’ 

6 means, with respect to employees specified in sub7 paragraph (A), a training curriculum relating to 

8 construction or facilities management.’’. 

9 SEC. 212. REVIEW OF ENHANCED USE LEASES. 

10 Section 8162(b)(6) is amended to read as follows: 

11 ‘‘(6) The Office of Management and Budget shall re12 view each enhanced-use lease before the lease goes into effect 

13 to determine whether the lease is in compliance with para14 graph (5).’’. 

15 SEC. 213. ASSESSMENT OF HEALTH CARE FURNISHED BY 

16 THE DEPARTMENT TO VETERANS WHO LIVE 

17 IN THE PACIFIC TERRITORIES. 

18 (a) IN GENERAL.—Not later than 180 days after the 

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

20 Affairs shall submit to the Committees on Veterans’ Affairs 

21 of the Senate and the House of Representatives a report re22 garding health care furnished by the Department of Vet23 erans Affairs to veterans who live in the Pacific territories. 

24 (b) ELEMENTS.—The report under subsection (a) shall 

25 include assessments of the following: 
178 

•S 2372 EAH 

1 (1) The ability of the Department to furnish to 

2 veterans who live in the Pacific territories the fol3 lowing: 

4 (A) Hospital care. 

5 (B) Medical services. 

6 (C) Mental health services. 

7 (D) Geriatric services. 

8 (2) The feasibility of establishing a community9 based outpatient clinic of the Department in any Pa10 cific territory that does not contain such a facility. 

11 (c) DEFINITION.—In this section, the term ‘‘Pacific 

12 territories’’ means American Samoa, Guam, and the North13 ern Mariana Islands. 

14 TITLE III—IMPROVEMENTS TO 

15 RECRUITMENT OF HEALTH 

16 CARE PROFESSIONALS 

17 SEC. 301. DESIGNATED SCHOLARSHIPS FOR PHYSICIANS 

18 AND DENTISTS UNDER DEPARTMENT OF VET19 ERANS AFFAIRS HEALTH PROFESSIONAL 

20 SCHOLARSHIP PROGRAM. 

21 (a) SCHOLARSHIPS FOR PHYSICIANS AND DEN22 TISTS.—Section 7612(b) of title 38, United States Code, is 

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

24 ‘‘(6)(A) Of the scholarships awarded under this sub25 chapter, the Secretary shall ensure that not less than 50 
179 

•S 2372 EAH 

1 scholarships are awarded each year to individuals who are 

2 accepted for enrollment or enrolled (as described in section 

3 7602 of this title) in a program of education or training 

4 leading to employment as a physician or dentist until such 

5 date as the Secretary determines that the staffing shortage 

6 of physicians and dentists in the Department is less than 

7 500. 

8 ‘‘(B) After such date, the Secretary shall ensure that 

9 of the scholarships awarded under this subchapter, a num10 ber of scholarships is awarded each year to individuals re11 ferred to in subparagraph (A) in an amount equal to not 

12 less than ten percent of the staffing shortage of physicians 

13 and dentists in the Department, as determined by the Sec14 retary. 

15 ‘‘(C) Notwithstanding subsection (c)(1), the agreement 

16 between the Secretary and a participant in the Scholarship 

17 Program who receives a scholarship pursuant to this para18 graph shall provide the following: 

19 ‘‘(i) The Secretary’s agreement to provide the 

20 participant with a scholarship under this subchapter 

21 for a specified number (from two to four) of school 

22 years during which the participant is pursuing a 

23 course of education or training leading to employ24 ment as a physician or dentist. 
180 

•S 2372 EAH 

1 ‘‘(ii) The participant’s agreement to serve as a 

2 full-time employee in the Veterans Health Adminis3 tration for a period of time (hereinafter in this sub4 chapter referred to as the ‘period of obligated service’) 

5 of 18 months for each school year or part thereof for 

6 which the participant was provided a scholarship 

7 under the Scholarship Program. 

8 ‘‘(D) In providing scholarships pursuant to this para9 graph, the Secretary may provide a preference for appli10 cants who are veterans. 

11 ‘‘(E) On an annual basis, the Secretary shall provide 

12 to appropriate educational institutions informational ma13 terial about the availability of scholarships under this para14 graph.’’. 

15 (b) BREACH OF AGREEMENT.—Section 7617 of such 

16 title is amended— 

17 (1) by redesignating paragraphs (4) and (5) as 

18 paragraphs (5) and (6), respectively; and 

19 (2) by inserting after paragraph (3) the fol20 lowing new paragraph (4): 

21 ‘‘(4) In the case of a participant who is enrolled 

22 in a program or education or training leading to em23 ployment as a physician, the participant fails to suc24 cessfully complete post-graduate training leading to 

25 eligibility for board certification in a specialty.’’. 
181 

•S 2372 EAH 

1 (c) EXTENSION OF PROGRAM.—Section 7619 of such 

2 title is amended by striking ‘‘December 31, 2019’’ and in3 serting ‘‘December 31, 2033’’. 

4 SEC. 302. INCREASE IN MAXIMUM AMOUNT OF DEBT THAT 

5 MAY BE REDUCED UNDER EDUCATION DEBT 

6 REDUCTION PROGRAM OF DEPARTMENT OF 

7 VETERANS AFFAIRS. 

8 (a) INCREASE IN AMOUNT.—Section 7683(d)(1) is 

9 amended— 

10 (1) by striking ‘‘$120,000’’ and inserting 

11 ‘‘$200,000’’; and 

12 (2) by striking ‘‘$24,000’’ and inserting 

13 ‘‘$40,000’’. 

14 (b) STUDY.— 

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

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

17 Veterans Affairs shall— 

18 (A) conduct a study on the demand for edu19 cation debt reduction under subchapter VII of 

20 chapter 76 of title 38, United States Code; and 

21 (B) submit to the Committee on Veterans’ 

22 Affairs of the Senate and the Committee on Vet23 erans’ Affairs of the House of Representatives a 

24 report on the findings of the Secretary with re-
182 

•S 2372 EAH 

1 spect to the study carried out under subpara2 graph (A). 

3 (2) CONSIDERATIONS.—In carrying out the 

4 study required by paragraph (1)(A), the Secretary 

5 shall consider the following: 

6 (A) The total number of vacancies within 

7 the Veterans Health Administration whose appli8 cants are eligible to participate in the Education 

9 Debt Reduction Program pursuant to section 

10 7682(a) of such title. 

11 (B) The types of medical professionals in 

12 greatest demand in the United States. 

13 (C) Projections by the Secretary of the num14 bers and types of medical professions that meet 

15 the needs of veterans. 

16 SEC. 303. ESTABLISHING THE DEPARTMENT OF VETERANS 

17 AFFAIRS SPECIALTY EDUCATION LOAN RE18 PAYMENT PROGRAM. 

19 (a) IN GENERAL.—Chapter 76 of title 38, United 

20 States Code, is amended by inserting after subchapter VII 

21 the following new subchapter: 
183 

•S 2372 EAH 

1 ‘‘SUBCHAPTER VIII—SPECIALTY EDUCATION 

2 LOAN REPAYMENT PROGRAM 

3 ‘‘§ 7691. Establishment 

4 ‘‘As part of the Educational Assistance Program, the 

5 Secretary may carry out a student loan repayment pro6 gram under section 5379 of title 5. The program shall be 

7 known as the Department of Veterans Affairs Specialty 

8 Education Loan Repayment Program (in this chapter re9 ferred to as the ‘Specialty Education Loan Repayment Pro10 gram’). 

11 ‘‘§ 7692. Purpose 

12 ‘‘The purpose of the Specialty Education Loan Repay13 ment Program is to assist, through the establishment of an 

14 incentive program for certain individuals employed in the 

15 Veterans Health Administration, in meeting the staffing 

16 needs of the Veterans Health Administration for physicians 

17 in medical specialties for which the Secretary determines 

18 recruitment or retention of qualified personnel is difficult. 

19 ‘‘§ 7693. Eligibility; preferences; covered costs 

20 ‘‘(a) ELIGIBILITY.—An individual is eligible to par21 ticipate in the Specialty Education Loan Repayment Pro22 gram if the individual— 

23 ‘‘(1) is hired under section 7401 of this title to 

24 work in an occupation described in section 7692 of 

25 this title; 
184 

•S 2372 EAH 

1 ‘‘(2) owes any amount of principal or interest 

2 under a loan, the proceeds of which were used by or 

3 on behalf of that individual to pay costs relating to 

4 a course of education or training which led to a de5 gree that qualified the individual for the position re6 ferred to in paragraph (1); and 

7 ‘‘(3) is— 

8 ‘‘(A) recently graduated from an accredited 

9 medical or osteopathic school and matched to an 

10 accredited residency program in a medical spe11 cialty described in section 7692 of this title; or 

12 ‘‘(B) a physician in training in a medical 

13 specialty described in section 7692 of this title 

14 with more than 2 years remaining in such train15 ing. 

16 ‘‘(b) PREFERENCES.—In selecting individuals for par17 ticipation in the Specialty Education Loan Repayment 

18 Program under this subchapter, the Secretary may give 

19 preference to the following: 

20 ‘‘(1) Individuals who are, or will be, partici21 pating in residency programs in health care facili22 ties— 

23 ‘‘(A) located in rural areas; 

24 ‘‘(B) operated by Indian tribes, tribal orga25 nizations, or the Indian Health Service; or 
185 

•S 2372 EAH 

1 ‘‘(C) affiliated with underserved health care 

2 facilities of the Department. 

3 ‘‘(2) Veterans. 

4 ‘‘(c) COVERED COSTS.—For purposes of subsection 

5 (a)(2), costs relating to a course of education or training 

6 include— 

7 ‘‘(1) tuition expenses; 

8 ‘‘(2) all other reasonable educational expenses, 

9 including expenses for fees, books, equipment, and lab10 oratory expenses; and 

11 ‘‘(3) reasonable living expenses. 

12 ‘‘§ 7694. Specialty education loan repayment 

13 ‘‘(a) IN GENERAL.—Payments under the Specialty 

14 Education Loan Repayment Program shall consist of pay15 ments for the principal and interest on loans described in 

16 section 7682(a)(2) of this title for individuals selected to 

17 participate in the Program to the holders of such loans. 

18 ‘‘(b) FREQUENCY OF PAYMENT.—The Secretary shall 

19 make payments for any given participant in the Specialty 

20 Education Loan Repayment Program on a schedule deter21 mined appropriate by the Secretary. 

22 ‘‘(c) MAXIMUM AMOUNT; WAIVER.—(1) The amount of 

23 payments made for a participant under the Specialty Edu24 cation Loan Repayment Program may not exceed $160,000 

25 over a total of 4 years of participation in the Program, 
186 

•S 2372 EAH 

1 of which not more than $40,000 of such payments may be 

2 made in each year of participation in the Program. 

3 ‘‘(2)(A) The Secretary may waive the limitations 

4 under paragraph (1) in the case of a participant described 

5 in subparagraph (B). In the case of such a waiver, the total 

6 amount of payments payable to or for that participant is 

7 the total amount of the principal and the interest on the 

8 participant’s loans referred to in subsection (a). 

9 ‘‘(B) A participant described in this subparagraph is 

10 a participant in the Program who the Secretary determines 

11 serves in a position for which there is a shortage of qualified 

12 employees by reason of either the location or the require13 ments of the position. 

14 ‘‘§ 7695. Choice of location 

15 ‘‘Each participant in the Specialty Education Loan 

16 Repayment Program who completes residency may select, 

17 from a list of medical facilities of the Veterans Health Ad18 ministration provided by the Secretary, at which such facil19 ity the participant will work in a medical specialty de20 scribed in section 7692 of this title. 

21 ‘‘§ 7696. Term of obligated service 

22 ‘‘(a) IN GENERAL.—In addition to any requirements 

23 under section 5379(c) of title 5, a participant in the Spe24 cialty Education Loan Repayment Program must agree, in 
187 

•S 2372 EAH 

1 writing and before the Secretary may make any payment 

2 to or for the participant, to— 

3 ‘‘(1) obtain a license to practice medicine in a 

4 State; 

5 ‘‘(2) successfully complete post-graduate training 

6 leading to eligibility for board certification in a spe7 cialty; 

8 ‘‘(3) serve as a full-time clinical practice em9 ployee of the Veterans Health Administration for 12 

10 months for every $40,000 in such benefits that the em11 ployee receives, but in no case for fewer than 24 

12 months; and 

13 ‘‘(4) except as provided in subsection (b), to 

14 begin such service as a full-time practice employee by 

15 not later than 60 days after completing a residency. 

16 ‘‘(b) FELLOWSHIP.—In the case of a participant who 

17 receives an accredited fellowship in a medical specialty 

18 other than a medical specialty described in section 7692 

19 of this title, the Secretary, on written request of the partici20 pant, may delay the term of obligated service under sub21 section (a) for the participant until after the participant 

22 completes the fellowship, but in no case later than 60 days 

23 after completion of such fellowship. 

24 ‘‘(c) PENALTY.—(1) An employee who does not com25 plete a period of obligated service under this section shall 
188 

•S 2372 EAH 

1 owe the Federal Government an amount determined in ac2 cordance with the following formula: A = B × ((T ¥ S) 

3 ÷ T)). 

4 ‘‘(2) In the formula in paragraph (1): 

5 ‘‘(A) ‘A’ is the amount the employee owes the 

6 Federal Government. 

7 ‘‘(B) ‘B’ is the sum of all payments to or for the 

8 participant under the Specialty Education Loan Re9 payment Program. 

10 ‘‘(C) ‘T’ is the number of months in the period 

11 of obligated service of the employee. 

12 ‘‘(D) ‘S’ is the number of whole months of such 

13 period of obligated service served by the employee. 

14 ‘‘§ 7697. Relationship to Educational Assistance Pro15 gram 

16 ‘‘Assistance under the Specialty Education Loan Re17 payment Program may be in addition to other assistance 

18 available to individuals under the Educational Assistance 

19 Program.’’. 

20 (b) CONFORMING AND TECHNICAL AMENDMENTS.— 

21 (1) CONFORMING AMENDMENTS.— 

22 (A) Section 7601(a) of title 38, United 

23 States Code, is amended— 

24 (i) in paragraph (4), by striking 

25 ‘‘and’’; 
189 

•S 2372 EAH 

1 (ii) in paragraph (5), by striking the 

2 period and inserting ‘‘; and’’; and 

3 (iii) by adding at the end the following 

4 new paragraph: 

5 ‘‘(6) the specialty education loan repayment pro6 gram provided for in subchapter VIII of this chap7 ter.’’. 

8 (B) Section 7603(a)(1) of title 38, United 

9 States Code, is amended by striking ‘‘or VI’’ and 

10 inserting ‘‘VI, or VIII’’. 

11 (C) Section 7604 of title 38, United States 

12 Code, is amended by striking ‘‘or VI’’ each place 

13 it appears and inserting ‘‘VI, or VIII’’. 

14 (D) Section 7631 of title 38, United States 

15 Code, is amended— 

16 (i) in subsection (a)(1)— 

17 (I) by striking ‘‘and’’ after ‘‘schol18 arship amount,’’; and 

19 (II) by inserting ‘‘, and the max20 imum specialty education loan repay21 ment amount’’ after ‘‘reduction pay22 ments amount’’; and 

23 (ii) in subsection (b) by adding at the 

24 end the following new paragraph: 
190 

•S 2372 EAH 

1 ‘‘(7) The term ‘specialty education loan repayment 

2 amount’ means the maximum amount of specialty edu3 cation loan repayment payments payable to or for a partic4 ipant in the Department of Veterans Affairs Specialty Edu5 cation Loan Repayment Program under subchapter VIII of 

6 this chapter, as specified in section 7694(c)(1) of this title 

7 and as previously adjusted (if at all) in accordance with 

8 this section.’’. 

9 (E) Section 7632 of title 38, United States 

10 Code, is amended— 

11 (i) in paragraph (1), by striking ‘‘and 

12 the Education Debt Reduction Program’’ 

13 and inserting ‘‘the Education Debt Reduc14 tion Program, and the Specialty Education 

15 Loan Repayment Program’’; and 

16 (ii) in paragraph (4), by striking ‘‘and 

17 per participant in the Education Debt Re18 duction Program’’ and inserting ‘‘per par19 ticipant in the Education Debt Reduction 

20 Program, and per participant in the Spe21 cialty Education Loan Repayment Pro22 gram’’. 

23 (2) TABLE OF SECTIONS.—The table of sections 

24 at the beginning of chapter 76 of such title is amend-
191 

•S 2372 EAH 

1 ed by inserting after the items relating to subchapter 

2 VII the following: 

‘‘SUBCHAPTER VIII—SPECIALTY EDUCATION LOAN REPAYMENT PROGRAM

‘‘7691. Establishment. 

‘‘7692. Purpose. 

‘‘7693. Eligibility; preferences; covered costs. 

‘‘7694. Specialty education loan repayment. 

‘‘7695. Choice of location. 

‘‘7696. Term of obligated service. 

‘‘7697. Relationship to Educational Assistance Program.’’. 

3 (c) NEEDS OF THE VHA.—In making determinations 

4 each year under section 7692 of title 38, United States 

5 Code, as enacted by subsection (a), the Secretary of Veterans 

6 Affairs shall consider the anticipated needs of the Veterans 

7 Health Administration during the period 2 to 6 years in 

8 the future. 

9 (d) PREFERENCE.—In granting preference under sec10 tion 7693 of title 38, United States Code, as enacted by 

11 subsection (a), the Secretary of Veterans Affairs shall deter12 mine whether a facility of the Department is underserved 

13 based on the criteria developed under section 401 of this 

14 Act. 

15 (e) OFFER DEADLINE.—In the case of an applicant 

16 who applies before receiving a residency match and whom 

17 the Secretary of Veterans Affairs selects for participation 

18 in the Specialty Education Loan Repayment Program es19 tablished by subsection (a), the Secretary shall offer partici20 pation to the applicant not later than 28 days after— 
192 

•S 2372 EAH 

1 (1) the applicant matches with a residency in a 

2 medical specialty described in section 7692 of title 38, 

3 United States Code, as enacted by subsection (a); and 

4 (2) such match is published. 

5 (f) PUBLICITY.—The Secretary of Veterans Affairs 

6 shall take such steps as the Secretary determines are appro7 priate to publicize the Specialty Education Loan Repay8 ment Program established under subchapter VIII of chapter 

9 76 of title 38, United States Code, as enacted by subsection 

10 (a). 

11 SEC. 304. VETERANS HEALING VETERANS MEDICAL ACCESS 

12 AND SCHOLARSHIP PROGRAM. 

13 (a) ESTABLISHMENT.—The Secretary of Veterans Af14 fairs, acting through the Office of Academic Affiliations of 

15 the Department of Veterans Affairs, shall carry out a pilot 

16 program under which the Secretary shall provide funding 

17 for the medical education of a total of 18 eligible veterans. 

18 Such funding shall be provided for two veterans enrolled 

19 in each covered medical schools in accordance with this sec20 tion. 

21 (b) ELIGIBLE VETERANS.—To be eligible to receive 

22 funding for medical education under this section, a veteran 

23 shall— 
193 

•S 2372 EAH 

1 (1) have been discharged from the Armed Forces 

2 not more than 10 years before the date of application 

3 for admission to a covered medical school; 

4 (2) not be entitled to educational assistance 

5 under chapter 30, 31, 32, 33, 34, or 35 of title 38, 

6 United States Code, or chapter 1606 or 1607 of title 

7 10, United States Code; 

8 (3) apply for admission to a covered medical 

9 school for the entering class of 2019; 

10 (4) indicate on such application for admission 

11 that the veteran would like to be considered for an 

12 award of funding under this section; 

13 (5) meet the minimum admissions criteria for 

14 the covered medical school to which the veteran ap15 plies; and 

16 (6) enter into an agreement described in sub17 section (e). 

18 (c) AWARD OF FUNDING.— 

19 (1) IN GENERAL.—Each covered medical school 

20 that opts to participate in the program under this 

21 section shall reserve two seats in the entering class of 

22 2019 for eligible veterans who receive funding under 

23 such program. Such funding shall be awarded to the 

24 two eligible veterans with the highest admissions 

25 rankings for such class at such school. 
194 

•S 2372 EAH 

1 (2) AMOUNT OF FUNDING.—Each eligible veteran 

2 who receives funding under this section shall receive 

3 an amount equal to the actual cost of— 

4 (A) tuition at the covered medical school at 

5 which the veteran enrolls for 4 years; 

6 (B) books, fees, and technical equipment; 

7 (C) fees associated with the National Resi8 dency Match Program; 

9 (D) two away rotations performed during 

10 the fourth year at a Department of Veterans Af11 fairs medical facility; and 

12 (E) a monthly stipend for the 4-year period 

13 during which the veteran is enrolled in medical 

14 school in an amount to be determined by the 

15 Secretary. 

16 (3) DISTRIBUTION OF FUNDING.—In the event 

17 that two or more eligible veterans do not apply for 

18 admission at one of the covered medical schools for the 

19 entering class of 2019, the Secretary shall distribute 

20 the available funding to eligible veterans who applied 

21 for admission at other covered medical schools. 

22 (d) AGREEMENT.— 

23 (1) TERMS OF AGREEMENT.—Each eligible vet24 eran who accepts funding for medical education 
195 

•S 2372 EAH 

1 under this section shall enter into an agreement with 

2 the Secretary that provides that the veteran agrees— 

3 (A) to maintain enrollment and attendance 

4 in the medical school; 

5 (B) while enrolled in such medical school, to 

6 maintain an acceptable level of academic stand7 ing (as determined by the medical school under 

8 regulations prescribed by the Secretary); 

9 (C) to complete post-graduate training lead10 ing to eligibility for board certification in a spe11 ciality applicable to the Department of Veterans 

12 Affairs, as determined by the Secretary; 

13 (D) after completion of medical school, to 

14 obtain a license to practice medicine in a State; 

15 and 

16 (E) after completion of medical school and 

17 post-graduate training, to serve as a full-time 

18 clinical practice employee in the Veterans Health 

19 Administration for a period of 4 years. 

20 (2) BREACH OF AGREEMENT.—If an eligible vet21 eran who accepts funding under this section breaches 

22 the terms of the agreement described in paragraph 

23 (1), the United States shall be entitled to recover 

24 damages in an amount equal to the total amount of 

25 such funding received by the veteran. 
196 

•S 2372 EAH 

1 (e) RULE OF CONSTRUCTION.—Nothing in this section 

2 shall be construed to prevent any covered medical school 

3 from accepting more than two eligible veterans for the enter4 ing class of 2019. 

5 (f) REPORT TO CONGRESS.—Not later than December 

6 31, 2020, and annually thereafter for the subsequent 3 

7 years, the Secretary shall submit to Congress a report on 

8 the pilot program under this section. Such report shall in9 clude the evaluation of the Secretary of the success of the 

10 pilot program, including the number of veterans who re11 ceived funding under the program who matriculated and 

12 an evaluation of the academic progress of such veterans. 

13 (g) COVERED MEDICAL SCHOOLS.—In this section, the 

14 term ‘‘covered medical school’’ means any of the following: 

15 (1) The Teague-Cranston medical schools, con16 sisting of— 

17 (A) Texas A&M College of Medicine; 

18 (B) Quillen College of Medicine at East 

19 Tennessee State University; 

20 (C) Boonshoft School of Medicine at Wright 

21 State University; 

22 (D) Joan C. Edwards School of Medicine at 

23 Marshall University; and 

24 (E) University of South Carolina School of 

25 Medicine. 
197 

•S 2372 EAH 

1 (2) Charles R Drew University of Medicine and 

2 Science. 

3 (3) Howard University College of Medicine. 

4 (4) Meharry Medical College. 

5 (5) Morehouse School of Medicine. 

6 SEC. 305. BONUSES FOR RECRUITMENT, RELOCATION, AND 

7 RETENTION. 

8 Section 705(a) of the Veterans Access, Choice, and Ac9 countability Act of 2014 (Public Law 113–146; 38 U.S.C. 

10 703 note) is amended— 

11 (1) in paragraph (1), by striking 

12 ‘‘$230,000,000’’ and inserting ‘‘$250,000,000, of 

13 which not less than $20,000,000 shall be for recruit14 ment, relocation, and retention bonuses’’; and 

15 (2) in paragraph (2), by striking 

16 ‘‘$225,000,000’’ and inserting ‘‘$290,000,000, of 

17 which not less than $20,000,000 shall be for recruit18 ment, relocation, and retention bonuses’’. 

19 SEC. 306. INCLUSION OF VET CENTER EMPLOYEES IN EDU20 CATION DEBT REDUCTION PROGRAM OF DE21 PARTMENT OF VETERANS AFFAIRS. 

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

23 shall ensure that clinical staff working at Vet Centers are 

24 eligible to participate in the Education Debt Reduction 
198 

•S 2372 EAH 

1 Program of the Department of Veterans Affairs under sub2 chapter VII of chapter 76 of title 38, United States Code. 

3 (b) REPORT.—Not later than 1 year after the date of 

4 the enactment of this Act, the Secretary shall submit to the 

5 Committee on Veterans’ Affairs of the Senate and the Com6 mittee on Veterans’ Affairs of the House of Representatives 

7 a report on the number of participants in the Education 

8 Debt Reduction Program of the Department under such sub9 chapter who work at Vet Centers. 

10 (c) VET CENTER DEFINED.—In this section, the term 

11 ‘‘Vet Center’’ has the meaning given that term in section 

12 1712A(h) of title 38, United States Code. 

13 TITLE IV—HEALTH CARE IN 

14 UNDERSERVED AREAS 

15 SEC. 401. DEVELOPMENT OF CRITERIA FOR DESIGNATION 

16 OF CERTAIN MEDICAL FACILITIES OF THE DE17 PARTMENT OF VETERANS AFFAIRS AS UN18 DERSERVED FACILITIES AND PLAN TO AD19 DRESS PROBLEM OF UNDERSERVED FACILI20 TIES. 

21 (a) IN GENERAL.—Not later than 180 days after the 

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

23 Affairs shall develop criteria to designate medical centers, 

24 ambulatory care facilities, and community based outpatient 
199 

•S 2372 EAH 

1 clinics of the Department of Veterans Affairs as underserved 

2 facilities. 

3 (b) CONSIDERATION.—Criteria developed under sub4 section (a) shall include consideration of the following with 

5 respect to a facility: 

6 (1) The ratio of veterans to health care providers 

7 of the Department of Veterans Affairs for a standard8 ized geographic area surrounding the facility, includ9 ing a separate ratio for general practitioners and spe10 cialists. 

11 (2) The range of clinical specialties covered by 

12 such providers in such area. 

13 (3) Whether the local community is medically 

14 underserved. 

15 (4) The type, number, and age of open consults. 

16 (5) Whether the facility is meeting the wait-time 

17 goals of the Department. 

18 (6) Such other criteria as the Secretary considers 

19 important in determining which facilities are not 

20 adequately serving area veterans. 

21 (c) ANALYSIS OF FACILITIES.—Not less frequently 

22 than annually, directors of Veterans Integrated Service Net23 works of the Department shall perform an analysis to deter24 mine which facilities within that Veterans Integrated Serv-
200 

•S 2372 EAH 

1 ice Network qualify as underserved facilities pursuant to 

2 criteria developed under subsection (a). 

3 (d) ANNUAL PLAN TO ADDRESS UNDERSERVED FA4 CILITIES.— 

5 (1) PLAN REQUIRED.—Not later than 1 year 

6 after the date of the enactment of this Act and not less 

7 frequently than once each year, the Secretary shall 

8 submit to Congress a plan to address the problem of 

9 underserved facilities of the Department, as des10 ignated pursuant to criteria developed under sub11 section (a). 

12 (2) CONTENTS.—Each plan submitted under 

13 paragraph (1) shall address the following: 

14 (A) Increasing personnel or temporary per15 sonnel assistance, including mobile deployment 

16 teams furnished under section 407 of this Act. 

17 (B) Providing special hiring incentives, in18 cluding under the Education Debt Reduction 

19 Program under subchapter VII of chapter 76 of 

20 title 38, United States Code, and recruitment, 

21 relocation, and retention incentives. 

22 (C) Using direct hiring authority. 

23 (D) Improving training opportunities for 

24 staff. 
201 

•S 2372 EAH 

1 (E) Such other actions as the Secretary con2 siders appropriate. 

3 SEC. 402. PILOT PROGRAM TO FURNISH MOBILE DEPLOY4 MENT TEAMS TO UNDERSERVED FACILITIES. 

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

6 shall carry out a pilot program to furnish mobile deploy7 ment teams of medical personnel to underserved facilities. 

8 (b) ELEMENTS.—In furnishing mobile deployment 

9 teams under subsection (a), the Secretary shall consider the 

10 following elements: 

11 (1) The medical positions of greatest need at un12 derserved facilities. 

13 (2) The size and composition of teams to be de14 ployed. 

15 (3) Such other elements as the Secretary con16 siders necessary for effective oversight of the program 

17 established under subsection (a). 

18 (c) USE OF ANNUAL ANALYSIS.—The Secretary shall 

19 use the results of the annual analysis conducted under sec20 tion 401(c) of this Act to form mobile deployment teams 

21 under subsection (a) that are composed of the most needed 

22 medical personnel for underserved facilities. 

23 (d) REPORTING.— 

24 (1) PROGRESS REPORT.—Not later than 1 year 

25 after the date of the enactment of this Act, the Sec-
202 

•S 2372 EAH 

1 retary shall submit a report to Congress on the imple2 mentation of the pilot program under this section. 

3 (2) FINAL REPORT.—Not later than the termi4 nation of the pilot program under this section, the 

5 Secretary shall submit a final report to Congress that 

6 contains the recommendations of the Secretary re7 garding the feasibility and advisability of— 

8 (A) extending or expanding the pilot pro9 gram; and 

10 (B) making the pilot program (or any as11 pect thereof) permanent. 

12 (e) DURATION.—The pilot program under this section 

13 shall terminate 3 years after the date of the enactment of 

14 this Act. 

15 (f) UNDERSERVED FACILITY DEFINED.—In this sec16 tion, the term ‘‘underserved facility’’ means a medical cen17 ter, ambulatory care facility, or community based out18 patient clinic of the Department of Veterans Affairs des19 ignated by the Secretary of Veterans Affairs as underserved 

20 pursuant to criteria developed under section 401 of this Act. 

21 SEC. 403. PILOT PROGRAM ON GRADUATE MEDICAL EDU22 CATION AND RESIDENCY. 

23 (a) ESTABLISHMENT.— 

24 (1) IN GENERAL.—Subject to paragraph (5), the 

25 Secretary of Veterans Affairs shall establish a pilot 
203 

•S 2372 EAH 

1 program to establish medical residency positions au2 thorized under section 301(b)(2) of the Veterans Ac3 cess, Choice, and Accountability Act of 2014 (Public 

4 Law 113–146; 38 U.S.C. 7302 note) at covered facili5 ties. 

6 (2) COVERED FACILITIES.—For purposes of this 

7 section, a covered facility is any of the following: 

8 (A) A health care facility of the Department 

9 of Veterans Affairs. 

10 (B) A health care facility operated by an 

11 Indian tribe or a tribal organization, as those 

12 terms are defined in section 4 of the Indian Self13 Determination and Education Assistance Act (25 

14 U.S.C. 5304). 

15 (C) A health care facility operated by the 

16 Indian Health Service. 

17 (D) A Federally-qualified health center, as 

18 defined in section 1905(l)(2)(B) of the Social Se19 curity Act (42 U.S.C. 1396d(l)(2)(B)). 

20 (E) A health care facility operated by the 

21 Department of Defense. 

22 (F) Such other health care facility as the 

23 Secretary considers appropriate for purposes of 

24 this section. 
204 

•S 2372 EAH 

1 (3) AGREEMENTS.—To carry out the pilot pro2 gram under this section, the Secretary may enter into 

3 agreements with entities that operate covered facilities 

4 in which the Secretary places residents under para5 graph (1). 

6 (4) PARAMETERS FOR LOCATION, AFFILIATE

7 SPONSOR, AND DURATION.—When determining in 

8 which covered facilities to place residents under para9 graph (1), the Secretary shall consider the extent to 

10 which there is a clinical need for providers in an 

11 area, as determined by the following: 

12 (A) The ratio of veterans to health care pro13 viders of the Department for a standardized geo14 graphic area surrounding a facility, including a 

15 separate ratio for general practitioners and spe16 cialists. 

17 (B) The range of clinical specialties of pro18 viders in standardized geographic areas sur19 rounding a facility. 

20 (C) Whether the specialty of a provider is 

21 included in the most recent staffing shortage de22 termination of the Department under section 

23 7412 of title 38, United States Code. 

24 (D) Whether the local community is des25 ignated by the Secretary of Veterans Affairs as 
205 

•S 2372 EAH 

1 underserved pursuant to criteria developed under 

2 section 401 of this Act. 

3 (E) Whether the facility is located in a com4 munity that is designated by the Secretary of 

5 Health and Human Services as a health profes6 sional shortage area under section 332 of the 

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

8 (F) Whether the facility is located in a 

9 rural or remote area. 

10 (G) Such other criteria as the Secretary 

11 considers important in determining which facili12 ties are not adequately serving area veterans. 

13 (5) PRIORITY IN PLACEMENTS.—During the pilot 

14 program under this section, the Secretary shall place 

15 no fewer than 100 residents in covered facilities— 

16 (A) operated by the Indian Health Service; 

17 (B) operated by an Indian tribe; 

18 (C) operated by a tribal organization; or 

19 (D) located in communities designated by 

20 the Secretary as underserved pursuant to criteria 

21 developed under section 401 of this Act. 

22 (6) STIPENDS AND BENEFITS.—The Secretary 

23 may pay stipends and provide benefits for residents 

24 in positions under paragraph (1), regardless of wheth25 er they have been assigned in a Department facility. 
206 

•S 2372 EAH 

1 (b) REIMBURSEMENT.—If a covered facility establishes 

2 a new residency program in which the Secretary places a 

3 resident under the pilot program, the Secretary shall reim4 burse that covered facility for costs of the following: 

5 (1) Curriculum development. 

6 (2) Recruitment and retention of faculty. 

7 (3) Accreditation of the program by the Accredi8 tation Council for Graduate Medical Education. 

9 (4) The portion of faculty salaries attributable to 

10 duties under an agreement subsection (a)(3). 

11 (5) Expenses relating to educating a resident 

12 under the pilot program. 

13 (c) REPORTING.— 

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

15 the date of the enactment of this Act and not less fre16 quently than once each year thereafter until the ter17 mination of the pilot program, the Secretary shall 

18 submit to Congress a report on the implementation of 

19 the pilot program. 

20 (2) ELEMENTS.—Each report submitted under 

21 paragraph (1) shall include the following with regard 

22 to the immediately preceding year, and in compari23 son to the year immediately preceding that year: 

24 (A) The number of veterans who received 

25 care from residents under the pilot program. 
207 

•S 2372 EAH 

1 (B) The number of veterans who received 

2 care from each resident per position described in 

3 subsection (a)(1) under the pilot program. 

4 (C) The number of veterans who received 

5 care from residents under the pilot program ex6 pressed as a percentage of all individuals who re7 ceived care from such residents. 

8 (D) The number of clinical appointments 

9 for veterans conducted by each resident under the 

10 pilot program. 

11 (E) The number of clinical appointments 

12 for veterans conducted by residents per position 

13 described in subsection (a)(1) under the pilot 

14 program. 

15 (F) The number of clinical appointments 

16 for veterans expressed as a percentage of all clin17 ical appointments conducted by residents under 

18 the pilot program. 

19 (G) The number of positions described in 

20 subsection (a)(1) at each covered facility under 

21 the pilot program. 

22 (H) For each position described in sub23 section (a)(1) in a residency program affiliated 

24 with a health care facility of the Department, the 

25 time a resident under the pilot program spent 
208 

•S 2372 EAH 

1 training at that facility of the Department, ex2 pressed as a percentage of the total training time 

3 for that resident position. 

4 (I) For each residency program affiliated 

5 with a health care facility of the Department, the 

6 time all residents under the pilot program spent 

7 training at that facility of the Department, ex8 pressed as a percentage of the total training time 

9 for those residents. 

10 (J) The time that all residents under the 

11 pilot program who are assigned to programs af12 filiated with health care facilities of the Depart13 ment spent training at facilities of the Depart14 ment, expressed as a percentage of the total 

15 training time for those residents. 

16 (K) The cost to the Department of Veterans 

17 Affairs under the pilot program in the year im18 mediately preceding the report and since the be19 ginning of the pilot program. 

20 (L) The cost to the Department of Veterans 

21 Affairs per resident placed under the pilot pro22 gram at each covered facility. 

23 (M) The number of residents under the pilot 

24 program hired by the Secretary to work in the 

25 Veterans Health Administration after completion 
209 

•S 2372 EAH 

1 of residency in the year immediately preceding 

2 the report and since the beginning of the pilot 

3 program. 

4 (N) The medical specialties pursued by resi5 dents under the pilot program. 

6 (d) DURATION.—The pilot program under this section 

7 shall terminate on August 7, 2024. 

8 TITLE V—OTHER MATTERS 

9 SEC. 501. ANNUAL REPORT ON PERFORMANCE AWARDS 

10 AND BONUSES AWARDED TO CERTAIN HIGH11 LEVEL EMPLOYEES OF THE DEPARTMENT. 

12 (a) IN GENERAL.—Chapter 7 of title 38, United States 

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

14 section: 

15 ‘‘§ 726. Annual report on performance awards and bo16 nuses awarded to certain high-level em17 ployees 

18 ‘‘(a) IN GENERAL.—Not later than 100 days after the 

19 end of each fiscal year, the Secretary shall submit to the 

20 appropriate committees of Congress a report that contains, 

21 for the most recent fiscal year ending before the submittal 

22 of the report, a description of all performance awards or 

23 bonuses awarded to each of the following: 

24 ‘‘(1) Regional Office Director of the Department. 
210 

•S 2372 EAH 

1 ‘‘(2) Director of a Medical Center of the Depart2 ment. 

3 ‘‘(3) Director of a Veterans Integrated Service 

4 Network. 

5 ‘‘(4) Senior executive of the Department. 

6 ‘‘(b) ELEMENTS.—Each report submitted under sub7 section (a) shall include the following with respect to each 

8 performance award or bonus awarded to an individual de9 scribed in such subsection: 

10 ‘‘(1) The amount of each award or bonus. 

11 ‘‘(2) The job title of the individual awarded the 

12 award or bonus. 

13 ‘‘(3) The location where the individual awarded 

14 the award or bonus works. 

15 ‘‘(c) DEFINITIONS.—In this section: 

16 ‘‘(1) The term ‘appropriate committees of Con17 gress’ means the Committees on Veterans’ Affairs and 

18 Appropriations of the Senate and House of Represent19 atives. 

20 ‘‘(2) The term ‘senior executive’ means— 

21 ‘‘(A) a career appointee; or 

22 ‘‘(B) an individual— 

23 ‘‘(i) in an administrative or executive 

24 position; and 
211 

•S 2372 EAH 

1 ‘‘(ii) appointed under section 7306(a) 

2 or section 7401(1) of this title. 

3 ‘‘(3) The term ‘career appointee’ has the mean4 ing given that term in section 3132(a) of title 5, 

5 United States Code.’’. 

6 (b) CLERICAL AMENDMENT.—The table of sections at 

7 the beginning of such chapter is amended by inserting after 

8 the item relating to section 725 the following new item: 

‘‘726. Annual report on performance awards and bonuses awarded to certain highlevel employees.’’. 

9 SEC. 502. ROLE OF PODIATRISTS IN DEPARTMENT OF VET10 ERANS AFFAIRS. 

11 (a) INCLUSION AS PHYSICIAN.— 

12 (1) IN GENERAL.—Subchapter I of chapter 74 is 

13 amended by adding at the end the following new sec14 tion: 

15 ‘‘§ 7413. Treatment of podiatrists; clinical oversight 

16 standards 

17 ‘‘(a) PODIATRISTS.—Except as provided by subsection 

18 (b), a doctor of podiatric medicine who is appointed as a 

19 podiatrist under section 7401(1) of this title is eligible for 

20 any supervisory position in the Veterans Health Adminis21 tration to the same degree that a physician appointed under 

22 such section is eligible for the position. 

23 ‘‘(b) ESTABLISHMENT OF CLINICAL OVERSIGHT

24 STANDARDS.—The Secretary, in consultation with appro-
212 

•S 2372 EAH 

1 priate stakeholders, shall establish standards to ensure that 

2 specialists appointed in the Veterans Health Administra3 tion to supervisory positions do not provide direct clinical 

4 oversight for purposes of peer review or practice evaluation 

5 for providers of other clinical specialties.’’. 

6 (2) CLERICAL AMENDMENT.—The table of sec7 tions at the beginning of chapter 74 is amended by 

8 inserting after the item relating to section 7412 the 

9 following new item: 

‘‘7413. Treatment of podiatrists; clinical oversight standards.’’. 

10 (b) MODIFICATION AND CLARIFICATION OF PAY

11 GRADE.— 

12 (1) GRADE.—The list in section 7404(b) of such 

13 title is amended— 

14 (A) by striking ‘‘PHYSICIAN AND DEN15 TIST SCHEDULE’’ and inserting ‘‘PHYSI16 CIAN AND SURGEON (MD/DO), PODIATRIC 

17 SURGEON (DPM), AND DENTIST AND 

18 ORAL SURGEON (DDS, DMD) SCHEDULE’’; 

19 (B) by striking ‘‘Physician grade’’ and in20 serting ‘‘Physician and surgeon grade’’; and 

21 (C) by striking ‘‘PODIATRIST, CHIRO22 PRACTOR, AND’’ and inserting ‘‘CHIRO23 PRACTOR AND’’. 

24 (2) APPLICATION.—The amendments made by 

25 paragraph (1) shall apply with respect to a pay pe-
213 

•S 2372 EAH 

1 riod of the Department of Veterans Affairs beginning 

2 on or after the date that is 30 days after the date of 

3 the enactment of this Act. 

4 SEC. 503. DEFINITION OF MAJOR MEDICAL FACILITY 

5 PROJECT. 

6 (a) MODIFICATION OF DEFINITION OF MEDICAL FA7 CILITY.—Section 8101(3) is amended by striking ‘‘Sec8 retary’’ and all that follows through ‘‘nursing home,’’ and 

9 inserting ‘‘Secretary, or as otherwise authorized by law, for 

10 the provision of health-care services (including hospital, 

11 outpatient clinic, nursing home,’’. 

12 (b) MODIFICATION OF DEFINITION OF MAJOR MED13 ICAL FACILITY PROJECT.—Paragraph (3) of section 

14 8104(a) is amended to read as follows: 

15 ‘‘(3) For purposes of this subsection, the term ‘major 

16 medical facility project’ means a project for the construc17 tion, alteration, or acquisition of a medical facility involv18 ing a total expenditure of more than $20,000,000, but such 

19 term does not include an acquisition by exchange, non20 recurring maintenance projects of the Department, or the 

21 construction, alteration, or acquisition of a shared Federal 

22 medical facility for which the Department’s estimated share 

23 of the project costs does not exceed $20,000,000.’’. 
214 

•S 2372 EAH 

1 SEC. 504. 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: Construction of the new 

8 East Bay Community Based Outpatient Clinic and all as9 sociated site work, utilities, parking, and landscaping, con10 struction of the Central Valley Engineering and Logistics 

11 support facility, and enhanced flood plain mitigation at the 

12 Central Valley and East Bay Community Based Outpatient 

13 Clinics as part of the realignment of medical facilities in 

14 Livermore, California, in an amount not to exceed 

15 $117,300,000. 

16 (b) AUTHORIZATION OF APPROPRIATIONS FOR CON17 STRUCTION.—There is authorized to be appropriated to the 

18 Secretary of Veterans Affairs for fiscal year 2018 or the 

19 year in which funds are appropriated for the Construction, 

20 Major Projects account, $117,300,000 for the project author21 ized in subsection (a). 

22 (c) SUBMITTAL OF INFORMATION.—Not later than 90 

23 days after the date of the enactment of this Act, for the 

24 project authorized in subsection (a), the Secretary of Vet25 erans Affairs shall submit to the Committee on Veterans’ 

26 Affairs of the Senate and the Committee on Veterans’ Af-
215 

•S 2372 EAH 

1 fairs of the House of Representatives the following informa2 tion: 

3 (1) A line item accounting of expenditures relat4 ing to construction management carried out by the 

5 Department of Veterans Affairs for such project. 

6 (2) The future amounts that are budgeted to be 

7 obligated for construction management carried out by 

8 the Department for such project. 

9 (3) A justification for the expenditures described 

10 in paragraph (1) and the future amounts described in 

11 paragraph (2). 

12 (4) Any agreement entered into by the Secretary 

13 regarding a non-Department of Veterans Affairs Fed14 eral entity providing management services relating to 

15 such project, including reimbursement agreements 

16 and the costs to the Department for such services. 

17 SEC. 505. DEPARTMENT OF VETERANS AFFAIRS PER18 SONNEL TRANSPARENCY. 

19 (a) PUBLICATION OF STAFFING AND VACANCIES.— 

20 (1) WEBSITE REQUIRED.—Subject to paragraph 

21 (2) and not later than 90 days after the date of the 

22 enactment of this Act, the Secretary of Veterans Af23 fairs shall make publicly available on an Internet 

24 website of the Department of Veterans Affairs the fol25 lowing information, which shall, subject to subpara-
216 

•S 2372 EAH 

1 graph (D), be displayed by departmental component 

2 or, in the case of information relating to Veterans 

3 Health Administration positions, by medical facility: 

4 (A) The number of personnel encumbering 

5 positions. 

6 (B) The number of accessions and separa7 tion actions processed during the quarter pre8 ceding the date of the publication of the informa9 tion. 

10 (C) The number of vacancies, by occupa11 tion. 

12 (D) The percentage of new hires for the De13 partment who were hired within the time-to-hire 

14 target of the Office of Personnel Management, 

15 disaggregated by administration. 

16 (2) EXCEPTIONS.—The Secretary may withhold 

17 from publication under paragraph (1) information 

18 relating to law enforcement, information security, or 

19 such positions in the Department that the Secretary 

20 determines to be sensitive. 

21 (3) UPDATE OF INFORMATION.—The Secretary 

22 shall update the information on the website required 

23 under paragraph (1) on a quarterly basis. 

24 (4) TREATMENT OF CONTRACTOR POSITIONS.— 

25 Any Department of Veterans Affairs position that is 
217 

•S 2372 EAH 

1 filled with a contractor may not be treated as a De2 partment position for purposes of the information re3 quired to be published under paragraph (1). 

4 (5) INSPECTOR GENERAL REVIEW.—On a semi5 annual basis, the Inspector General of the Depart6 ment shall review the administration of the website 

7 required under paragraph (1) and make recommenda8 tions relating to the improvement of such administra9 tion. 

10 (b) REPORT TO CONGRESS.—The Secretary of Veterans 

11 Affairs shall submit to Congress an annual report on the 

12 steps the Department is taking to achieve full staffing ca13 pacity. Each such report shall include the amount of addi14 tional funds necessary to enable the Department to reach 

15 full staffing capacity. 

16 SEC. 506. PROGRAM ON ESTABLISHMENT OF PEER SPECIAL17 ISTS IN PATIENT ALIGNED CARE TEAM SET18 TINGS WITHIN MEDICAL CENTERS OF DE19 PARTMENT OF VETERANS AFFAIRS. 

20 (a) PROGRAM REQUIRED.—The Secretary of Veterans 

21 Affairs shall carry out a program to establish not fewer 

22 than two peer specialists in patient aligned care teams at 

23 medical centers of the Department of Veterans Affairs to 

24 promote the use and integration of services for mental 
218 

•S 2372 EAH 

1 health, substance use disorder, and behavioral health in a 

2 primary care setting. 

3 (b) TIMEFRAME FOR ESTABLISHMENT OF PROGRAM.— 

4 The Secretary shall carry out the program at medical cen5 ters of the Department as follows: 

6 (1) Not later than May 31, 2019, at not fewer 

7 than 15 medical centers of the Department. 

8 (2) Not later than May 31, 2020, at not fewer 

9 than 30 medical centers of the Department. 

10 (c) SELECTION OF LOCATIONS.— 

11 (1) IN GENERAL.—The Secretary shall select 

12 medical centers for the program as follows: 

13 (A) Not fewer than five shall be medical 

14 centers of the Department that are designated by 

15 the Secretary as polytrauma centers. 

16 (B) Not fewer than 10 shall be medical cen17 ters of the Department that are not designated 

18 by the Secretary as polytrauma centers. 

19 (2) CONSIDERATIONS.—In selecting medical cen20 ters for the program under paragraph (1), the Sec21 retary shall consider the feasibility and advisability 

22 of selecting medical centers in the following areas: 

23 (A) Rural areas and other areas that are 

24 underserved by the Department. 
219 

•S 2372 EAH 

1 (B) Areas that are not in close proximity to 

2 an active duty military installation. 

3 (C) Areas representing different geographic 

4 locations, such as census tracts established by the 

5 Bureau of the Census. 

6 (d) GENDER-SPECIFIC SERVICES.—In carrying out 

7 the program at each location selected under subsection (c), 

8 the Secretary shall ensure that— 

9 (1) the needs of female veterans are specifically 

10 considered and addressed; and 

11 (2) female peer specialists are made available to 

12 female veterans who are treated at each location. 

13 (e) ENGAGEMENT WITH COMMUNITY PROVIDERS.—At 

14 each location selected under subsection (c), the Secretary 

15 shall consider ways in which peer specialists can conduct 

16 outreach to health care providers in the community who 

17 are known to be serving veterans to engage with those pro18 viders and veterans served by those providers. 

19 (f) REPORTS.— 

20 (1) PERIODIC REPORTS.— 

21 (A) IN GENERAL.—Not later than 180 days 

22 after the date of the enactment of this Act, and 

23 not less frequently than once every 180 days 

24 thereafter until the Secretary determines that the 

25 program is being carried out at the last location 
220 

•S 2372 EAH 

1 to be selected under subsection (c), the Secretary 

2 shall submit to Congress a report on the pro3 gram. 

4 (B) ELEMENTS.—Each report required by 

5 subparagraph (A) shall, with respect to the 180- 

6 day period preceding the submittal of the report, 

7 include the following: 

8 (i) The findings and conclusions of the 

9 Secretary with respect to the program. 

10 (ii) An assessment of the benefits of the 

11 program to veterans and family members of 

12 veterans. 

13 (iii) An assessment of the effectiveness 

14 of peer specialists in engaging under sub15 section (e) with health care providers in the 

16 community and veterans served by those 

17 providers. 

18 (2) FINAL REPORT.—Not later than 180 days 

19 after the Secretary determines that the program is 

20 being carried out at the last location to be selected 

21 under subsection (c), the Secretary shall submit to 

22 Congress a report detailing the recommendations of 

23 the Secretary as to the feasibility and advisability of 

24 expanding the program to additional locations. 
221 

•S 2372 EAH 

1 SEC. 507. DEPARTMENT OF VETERANS AFFAIRS MEDICAL 

2 SCRIBE PILOT PROGRAM. 

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

4 shall carry out a 2-year pilot program under which the Sec5 retary shall increase the use of medical scribes at Depart6 ment of Veterans Affairs medical centers. 

7 (b) LOCATIONS.—The Secretary shall carry out the 

8 pilot program at the 10 medical centers of the Department 

9 as follows: 

10 (1) At least four such medical centers located in 

11 rural areas. 

12 (2) At least four such medical centers located in 

13 urban areas. 

14 (3) Two such medical centers located in areas 

15 with need for increased access or increased efficiency, 

16 as determine by the Secretary. 

17 (c) MEDICAL SCRIBES.— 

18 (1) HIRING.—Under the pilot program the Sec19 retary shall— 

20 (A) hire 20 new Department of Veterans Af21 fairs term employees as medical scribes; and 

22 (B) seek to enter into contracts with appro23 priate entities for the employment of 20 addi24 tional medical scribes. 

25 (2) DISTRIBUTION.—The Secretary shall assign 

26 four medical scribes to each of the 10 medical centers 
222 

•S 2372 EAH 

1 of the Department where the Secretary carries out the 

2 pilot program as follows: 

3 (A) Two scribes shall be assigned to each of 

4 two physicians. 

5 (B) Thirty percent of the scribes shall be 

6 employed in the provision of emergency care. 

7 (C) Seventy percent of the scribes shall be 

8 employed in the provision of speciality care in 

9 specialties with the longest patient wait times or 

10 lowest efficiency ratings, as determined by the 

11 Secretary. 

12 (d) REPORTS.— 

13 (1) REPORTS TO CONGRESS.—Not later than 180 

14 days after the commencement of the pilot program re15 quired under this section, and every 180 days there16 after for the duration of the pilot program, the Sec17 retary of Veterans Affairs shall submit to Congress a 

18 report on the pilot program. Each such report shall 

19 include each of the following: 

20 (A) A separate analysis of each the fol21 lowing with respect to medical scribes employed 

22 by the Department of Veterans Affairs and med23 ical scribes performing Department of Veterans 

24 Affairs functions under a contract: 

25 (i) Provider efficiency. 
223 

•S 2372 EAH 

1 (ii) Patient satisfaction. 

2 (iii) Average wait time. 

3 (iv) The number of patients seen per 

4 day by each physician or practitioner. 

5 (v) The amount of time required to 

6 hire and train an employee to perform med7 ical scribe functions under the pilot pro8 gram. 

9 (B) Metrics and data for analyzing the ef10 fects of the pilot program, including an evalua11 tion of the each of the elements under clauses (i) 

12 through (iv) of subparagraph (A) at medical cen13 ters who employed scribes under the pilot pro14 gram for an appropriate period preceding the 

15 hiring of such scribes. 

16 (2) COMPTROLLER GENERAL REPORT.—Not later 

17 than 90 days after the termination of the pilot pro18 gram under this section, the Comptroller General of 

19 the United States shall submit to Congress a report 

20 on the pilot program. Such report shall include a 

21 comparison of the pilot program with similar pro22 grams carried out in the private sector. 

23 (e) DEFINITIONS.—In this section: 

24 (1) The term ‘‘medical scribe’’ means an unli25 censed individual hired to enter information into the 
224 

•S 2372 EAH 

1 electronic health record or chart at the direction of a 

2 physician or licensed independent practitioner whose 

3 responsibilities include the following: 

4 (A) Assisting the physician or practitioner 

5 in navigating the electronic health record. 

6 (B) Responding to various messages as di7 rected by the physician or practitioner. 

8 (C) Entering information into the electronic 

9 health record, as directed by the physician or 

10 practitioner. 

11 (2) The terms ‘‘urban’’ and ‘‘rural’’ have the 

12 meanings given such terms under the rural-urban 

13 commuting codes developed by the Secretary of Agri14 culture and the Secretary of Health and Human 

15 Services. 

16 (f) FUNDING.—The pilot program under this section 

17 shall be carried out using amounts otherwise authorized to 

18 be appropriated for the Department of Veterans Affairs. No 

19 additional amounts are authorized to be appropriated to 

20 carry out such program. 
225 

•S 2372 EAH 

1 SEC. 508. EXTENSION OF REQUIREMENT TO COLLECT FEES 

2 FOR HOUSING LOANS GUARANTEED BY SEC3 RETARY OF VETERANS AFFAIRS. 

4 Section 3729(b)(2) of title 38, United States Code, is 

5 amended by striking ‘‘2027’’ each place it appears and in6 serting ‘‘2028’’. 

7 SEC. 509. EXTENSION OF REDUCTION IN AMOUNT OF PEN8 SION FURNISHED BY DEPARTMENT OF VET9 ERANS AFFAIRS FOR CERTAIN VETERANS 

10 COVERED BY MEDICAID PLANS FOR SERVICES 

11 FURNISHED BY NURSING FACILITIES. 

12 Section 5503(d)(7) of title 38, United States Code, is 

13 amended by striking ‘‘September 30, 2027’’ and inserting 

14 ‘‘September 30, 2028’’. 

15 SEC. 510. APPROPRIATION OF AMOUNTS. 

16 (a) VETERANS CHOICE PROGRAM.—There is author17 ized to be appropriated, and is appropriated, to the Sec18 retary of Veterans Affairs, out of any funds in the Treasury 

19 not otherwise appropriated, $5,200,000,000 to be deposited 

20 in the Veterans Choice Fund under section 802 of the Vet21 erans Access, Choice, and Accountability Act of 2014 (Pub22 lic Law 113–146; 38 U.S.C. 1701 note). 

23 (b) AVAILABILITY OF AMOUNTS.—The amounts appro24 priated under subsection (a) shall be available for obliga25 tion or expenditure without fiscal year limitation. 
226 

•S 2372 EAH 

1 SEC. 511. TECHNICAL CORRECTION. 

2 Section 1712I of title 38, United States Code, is redes3 ignated as section 1720I of such title. 

4 SEC. 512. BUDGETARY EFFECTS. 

5 (a) STATUTORY PAY-AS-YOU-GO SCORECARDS.—The 

6 budgetary effects of this Act shall not be entered on either 

7 PAYGO scorecard maintained pursuant to section 4(d) of 

8 the Statutory Pay-As-You-Go Act of 2010. 

9 (b) SENATE PAYGO SCORECARDS.—The budgetary ef10 fects of this Act shall not be entered on any PAYGO score11 card maintained for purposes of section 4106 of H. Con. 

12 Res. 71 (115th Congress). 

Attest: 

Clerk. 

115TH CONGRESS 

2D SESSION S. 2372 

AMENDMENT