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[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 141 Engrossed in Senate (ES)]

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118th CONGRESS
  2d Session
                                 S. 141

_______________________________________________________________________

                                 AN ACT

 
 To amend title 38, United States Code, to improve certain programs of 
    the Department of Veterans Affairs for home and community based 
             services for veterans, and for other purposes.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Senator Elizabeth 
Dole 21st Century Veterans Healthcare and Benefits Improvement Act''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
                      TITLE I--HEALTH CARE MATTERS

          Subtitle A--Veterans Community Care Program Matters

Sec. 101. Implementation of provision of care under Veterans Community 
                            Care Program upon determination of 
                            eligibility by veteran and veteran's 
                            referring clinician.
Sec. 102. Outreach regarding care and services under Veterans Community 
                            Care Program.
Sec. 103. Annual review and report on waivers of certain payment rates 
                            under Veterans Community Care Program.
Sec. 104. Modification of requirements for standards for quality of 
                            care from Department of Veterans Affairs.
Sec. 105. Pilot program to improve administration of care under 
                            Veterans Community Care Program.
Sec. 106. Pilot program on consolidating approval process of Department 
                            of Veterans Affairs for covered dental 
                            care.
Sec. 107. Strategic plan on value-based health care system for Veterans 
                            Health Administration; pilot program.
Sec. 108. Plan on adoption of certain health information standards for 
                            Department of Veterans Affairs and certain 
                            health care providers.
Sec. 109. Report on use of value-based reimbursement models under 
                            Veterans Community Care Program.
Sec. 110. Inspector General assessment of implementation of Veterans 
                            Community Care Program.
Sec. 111. Comptroller General report on dentistry under Veterans 
                            Community Care Program.
 Subtitle B--Matters Relating to Nursing Home and Other Long Term Care 
                         and Family Caregivers

Sec. 120. Increase of expenditure cap for noninstitutional care 
                            alternatives to nursing home care.
Sec. 121. Coordination with Program of All-Inclusive Care for the 
                            Elderly.
Sec. 122. Authority for Secretary of Veterans Affairs to award grants 
                            or contracts to entities to improve 
                            provision of mental health support to 
                            family caregivers of veterans.
Sec. 123. Home- and community-based services: programs.
Sec. 124. Coordination with assistance and support services for 
                            caregivers.
Sec. 125. Improvements to program of comprehensive assistance for 
                            family caregivers.
Sec. 126. Improvements relating to Homemaker and Home Health Aide 
                            program.
Sec. 127. Pilot program to furnish assisted living services to certain 
                            veterans.
Sec. 128. Provision of medicine, equipment, and supplies available to 
                            Department of Veterans Affairs to State 
                            homes.
Sec. 129. Recognition of organizations and individuals to assist 
                            veterans, family members, and caregivers 
                            navigating programs and services of 
                            Veterans Health Administration.
Sec. 130. Reviews and other improvements relating to home- and 
                            community-based services.
Sec. 131. GAO report on mental health support for caregivers.
Sec. 132. Development of centralized website for program information.
Sec. 133. Definitions.
            Subtitle C--Medical Treatment and Other Matters

Sec. 140. Quarterly report on referrals for non-Department of Veterans 
                            Affairs health care.
Sec. 141. Elimination of certain requirements for certain Department of 
                            Veterans Affairs Assistant Under 
                            Secretaries.
Sec. 142. Modification of pay limitation for physicians, podiatrists, 
                            optometrists, and dentists of Department of 
                            Veterans Affairs.
Sec. 143. Reimbursement of ambulance cost for care for certain rural 
                            veterans.
Sec. 144. Pilot program to furnish dental care from the Department of 
                            Veterans Affairs to certain veterans 
                            diagnosed with ischemic heart disease.
Sec. 145. Documentation of preferences of veterans for scheduling of 
                            appointments for health care under laws 
                            administered by Secretary of Veterans 
                            Affairs.
Sec. 146. Staffing model and performance metrics for certain employees 
                            of the Department of Veterans Affairs.
Sec. 147. Online health education portal for veterans enrolled in 
                            patient enrollment system of Department of 
                            Veterans Affairs.
Sec. 148. Limitation on detail of directors of medical centers of 
                            Department of Veterans Affairs to different 
                            positions.
Sec. 149. National Veteran Suicide Prevention Annual Report.
Sec. 150. Report on physical infrastructure required by medical 
                            facilities of Department of Veterans 
                            Affairs to provide dental care services.
Sec. 151. Comptroller General report on certain oral health care 
                            programs under laws administered by 
                            Secretary of Veterans Affairs.
Sec. 152. Review of workflows associated with processing referrals 
                            between facilities of the Veterans Health 
                            Administration.
Sec. 153. Plan for timely scheduling of appointments at medical 
                            facilities of Department of Veterans 
                            Affairs.
Sec. 154. Authorization of appropriations to support initiatives for 
                            mobile mammography services for veterans.
                 TITLE II--ECONOMIC OPPORTUNITY MATTERS

                   Subtitle A--Educational Assistance

Sec. 201. Temporary expansion of eligibility for Marine Gunnery 
                            Sergeant John David Fry Scholarship.
Sec. 202. Removal of expiration on entitlement to Marine Gunnery 
                            Sergeant John David Fry Scholarship for 
                            surviving spouses.
Sec. 203. Sole liability for transferred educational assistance by an 
                            individual who fails to complete a service 
                            agreement.
Sec. 204. Notice to educational institutions of risk-based surveys.
Sec. 205. Relationship of participation by an educational institution 
                            in certain Federal student financial aid 
                            programs to approval of such institution 
                            for purposes of Department of Veterans 
                            Affairs educational assistance programs.
Sec. 206. Expansion of Department of Veterans Affairs oversight of 
                            certain educational institutions.
Sec. 207. Requirement that educational institutions approved for 
                            purposes of Department of Veterans Affairs 
                            educational assistance programs provide 
                            digital official transcripts.
Sec. 208. Payment of full monthly housing stipend for veterans enrolled 
                            in final semester using educational 
                            assistance under Post-9/11 Educational 
                            Assistance Program.
Sec. 209. Modification of rules for approval of commercial driver 
                            education programs for purposes of 
                            educational assistance programs of the 
                            Department of Veterans Affairs.
Sec. 210. Provision of certificates of eligibility and award letters 
                            using electronic means.
Sec. 211. Retroactive effective date of law regarding charge to 
                            entitlement to educational assistance for 
                            individuals who do not transfer credits 
                            from certain closed or disapproved programs 
                            of education.
Sec. 212. Department of Veterans Affairs high technology program.
Sec. 213. Notice of changes to Department of Veterans Affairs policies 
                            and guidance affecting the educational 
                            assistance programs of the Department.
Sec. 214. Payment of VA educational assistance via electronic fund 
                            transfer to a foreign institution of higher 
                            education.
Sec. 215. Improving transparency and accountability of educational 
                            institutions for purposes of veterans 
                            educational assistance.
                  Subtitle B--Employment and Training

Sec. 221. Improvements to reemployment rights of members of the Armed 
                            Forces.
Sec. 222. Review of investigations manual of Veterans' Employment and 
                            Training Service.
Sec. 223. Warrior Training Advancement Course.
                         Subtitle C--Home Loans

Sec. 231. Improvements to program for direct housing loans made to 
                            Native American veterans by the Secretary 
                            of Veterans Affairs.
Sec. 232. Native community development financial institution relending 
                            program.
           TITLE III--DISABILITY AND MEMORIAL AFFAIRS MATTERS

Sec. 301. Burial allowance for certain veterans who die at home while 
                            in receipt of hospice care furnished by 
                            Department of Veterans Affairs.
Sec. 302. Authority for Secretary of Veterans Affairs to award grants 
                            to States and Indian Tribes to improve 
                            outreach to veterans.
Sec. 303. Definition of surviving spouse.
Sec. 304. Ensuring only licensed health care professionals perform 
                            medical disability examinations under 
                            certain Department of Veterans Affairs 
                            pilot program.
Sec. 305. Provision of information regarding an agent or attorney to a 
                            licensed health care professional who 
                            performs a medical disability examination 
                            under certain Department of Veterans 
                            Affairs pilot program.
Sec. 306. Modernization of Department of Veterans Affairs disability 
                            benefit questionnaires.
Sec. 307. Department of Veterans Affairs automatic processing of 
                            certain claims for temporary disability 
                            ratings.
                     TITLE IV--HOMELESSNESS MATTERS

Sec. 401. Short title.
Sec. 402. Per diem payments provided by the Secretary of Veterans 
                            Affairs for services furnished to homeless 
                            veterans.
Sec. 403. Authorization for Secretary of Veterans Affairs to use 
                            certain funds for improved flexibility in 
                            assistance to homeless veterans.
Sec. 404. Access to Department of Veterans Affairs telehealth services.
             TITLE V--OVERSIGHT AND INVESTIGATIONS MATTERS

Sec. 501. Department of Veterans Affairs employee training regarding 
                            Office of Inspector General.
Sec. 502. Annual review of security at covered facilities of the 
                            Department of Veterans Affairs.
Sec. 503. Modification of certain housing loan fees.

                      TITLE I--HEALTH CARE MATTERS

          Subtitle A--Veterans Community Care Program Matters

SEC. 101. IMPLEMENTATION OF PROVISION OF CARE UNDER VETERANS COMMUNITY 
              CARE PROGRAM UPON DETERMINATION OF ELIGIBILITY BY VETERAN 
              AND VETERAN'S REFERRING CLINICIAN.

    (a) In General.--During the period specified in subsection (c), the 
Secretary of Veterans Affairs shall implement section 1703(d)(1)(E) of 
title 38, United States Code, in compliance with the implementing 
regulations for such section under section 17.4010(a)(5) of title 38, 
Code of Federal Regulations, such that the determination of eligibility 
for care is final and shall be made by the veteran and the veteran's 
referring clinician.
    (b) Correction of Errors.--A covered veteran and the referring 
clinician of such veteran may correct any errors made with respect to a 
determination described in subsection (a).
    (c) Period Specified.--The period specified in this subsection is 
the two-year period beginning on the date that is 90 days after the 
date of the enactment of this Act.
    (d) Report.--Not later than one year and not later than two years 
after the commencement of the period specified by subsection (c), the 
Secretary of Veterans Affairs shall submit to Congress a report on the 
care provided under section 1703(d)(1)(E) of title 38, United States 
Code, during the one-year period preceding the date of the report, 
including--
            (1) the number of instances of care provided;
            (2) the type of care provided; and
            (3) the cost of such care.
    (e) Rule of Construction.--Nothing in this section shall be 
construed to limit the Secretary's authority to prescribe, amend, or 
rescind regulations under section 1703 of title 38, United States Code.
    (f) Covered Veteran Defined.--In this section, the term ``covered 
veteran'' has the meaning given that term in section 1703(b) of title 
38, United States Code.

SEC. 102. OUTREACH REGARDING CARE AND SERVICES UNDER VETERANS COMMUNITY 
              CARE PROGRAM.

    (a) Requirement.--Section 1703 of title 38, United States Code, is 
amended--
            (1) by redesignating subsection (o) as subsection (p); and
            (2) by inserting after subsection (n) the following new 
        subsection (o):
    ``(o) Outreach Regarding Availability of Care and Services.--(1) 
The Secretary shall conduct outreach to inform veterans of the 
following:
            ``(A) The conditions for care or services under subsections 
        (d) and (e).
            ``(B) How to request such care or services.
            ``(C) How to appeal a denial of a request for such care or 
        services using the clinical appeals process of the Veterans 
        Health Administration.
    ``(2) Upon enrollment of a veteran in the system of annual patient 
enrollment established and operated under section 1705 of this title, 
and not less frequently than every two years thereafter, the Secretary 
shall inform the veteran of information described in paragraph (1).
    ``(3) The Secretary shall ensure that information described in 
paragraph (1) is--
            ``(A) publicly displayed in each medical facility of the 
        Department;
            ``(B) prominently displayed on a website of the Department; 
        and
            ``(C) included in other outreach campaigns and activities 
        conducted by the Secretary.''.
    (b) Solid Start Program.--Section 6320(a)(2)(A) of title 38, United 
States Code, is amended by inserting ``, including how to enroll in the 
system of annual patient enrollment established and operated under 
section 1705 of this title and the ability to seek care and services 
under sections 1703 and 1710 of this title'' before the semicolon.
    (c) Comptroller General Report on Outreach.--Not later than two 
years after the date of the enactment of this Act, the Comptroller 
General of the United States shall submit to Congress a report on the 
efforts of the Secretary of Veterans Affairs to ensure that veterans 
are informed of the conditions for eligibility for care and services 
under section 1703 of title 38, United States Code, including such 
efforts to conduct outreach pursuant to subsection (o) of such section 
(as added by subsection (a)).

SEC. 103. ANNUAL REVIEW AND REPORT ON WAIVERS OF CERTAIN PAYMENT RATES 
              UNDER VETERANS COMMUNITY CARE PROGRAM.

    (a) In General.--Section 1703 of title 38, United States Code, is 
further amended--
            (1) by redesignating subsection (p) as subsection (q); and
            (2) by inserting after subsection (o) the following new 
        subsection (p):
    ``(p) Annual Review and Report on Waivers of Payment Rates.--(1) On 
an annual basis, the Secretary shall--
            ``(A) conduct a review of waivers of payment rates under 
        subsection (i) for Third Party Administrators to identify 
        whether such waivers help to alleviate community-specific 
        challenges, including scarcity of medical services associated 
        with access to health care; and
            ``(B) submit to Congress a report on the results of such 
        review.
    ``(2) Each report under paragraph (1)(B) shall include, with 
respect to the period covered by the report--
            ``(A) a statement, disaggregated by region, of the total 
        number of waivers described in subparagraph (A) of such 
        paragraph requested by Third Party Administrators;
            ``(B) a statement of the total number of such waivers that 
        were--
                    ``(i) granted by the Secretary;
                    ``(ii) denied by the Secretary; or
                    ``(iii) withdrawn by a Third Party Administrator;
            ``(C) a description of the process for the review required 
        under paragraph (1);
            ``(D) a statement, disaggregated by region, of the average 
        time to process such waivers;
            ``(E) an assessment, disaggregated by region, of the extent 
        to which such waivers that were granted by the Secretary 
        improved access to health care for covered veterans; and
            ``(F) a description of trends, if any, identified by the 
        Secretary with respect to such waivers.
    ``(3) In this subsection, the term `Third Party Administrator' has 
the meaning given such term in section 1703B of this title.''.
    (b) Deadline.--The Secretary shall submit the first report required 
under subsection (p) of section 1703 of such title (as added by 
subsection (a)) not later than 180 days after the date of the enactment 
of this Act.

SEC. 104. MODIFICATION OF REQUIREMENTS FOR STANDARDS FOR QUALITY OF 
              CARE FROM DEPARTMENT OF VETERANS AFFAIRS.

    (a) In General.--Section 1703C of title 38, United States Code, is 
amended--
            (1) in subsection (a)--
                    (A) in paragraph (2)--
                            (i) by striking ``In establishing'' and 
                        inserting ``(A) In establishing''; and
                            (ii) by adding at the end the following new 
                        subparagraph:
            ``(B) The Secretary shall ensure that the standards for 
        quality established under paragraph (1) are comparable to 
        industry standards to ensure there is adequate data 
        transference between care furnished by the Department and care 
        furnished by a non-Department provider.'';
                    (B) in paragraph (3)(B), by adding at the end the 
                following new clause:
                            ``(v) Outcomes relating to patient quality 
                        of life.'';
                    (C) in paragraph (4)--
                            (i) by striking ``and the Centers for 
                        Medicare & Medicaid Services'' and inserting 
                        ``the Centers for Medicare & Medicaid Services, 
                        and the Indian Health Service''; and
                            (ii) by striking ``and other 
                        nongovernmental entities'' and inserting ``and 
                        other non-governmental entities including Third 
                        Party Administrators''; and
                    (D) by striking paragraph (5) and inserting the 
                following new paragraphs:
    ``(5) When collecting, considering, and applying data related to 
patient care for purposes of establishing standards for quality under 
paragraph (1), the Secretary shall ensure no metric is being over or 
under analyzed.
    ``(6) In establishing standards for quality under paragraph (1), 
the Secretary shall--
            ``(A) utilize the most up-to-date practices for extracting 
        and analyzing relevant data;
            ``(B) utilize all relevant data available to the Secretary;
            ``(C) ensure the most efficient use of time and resources 
        related to the use of data scientists employed by the 
        Department; and
            ``(D) collaborate, as appropriate, with entities specified 
        in paragraph (4).
    ``(7)(A) Not less frequently than once every five years, the 
Secretary shall update the standards for quality established under 
paragraph (1) pursuant to the requirements for the establishment of 
such standards under this subsection.
    ``(B) Not later than 30 days after any date on which the Secretary 
updates, pursuant to subparagraph (A), the standards for quality under 
paragraph (1), the Secretary shall submit to the appropriate committees 
of Congress a report on such updated standards for quality.''; and
            (2) in subsection (b)--
                    (A) in paragraph (1)--
                            (i) by striking ``Not later than 1 year 
                        after the date on which the Secretary 
                        establishes standards for quality under 
                        subsection (a)'' and inserting ``Not less 
                        frequently than once every three years''; and
                            (ii) by inserting ``pursuant to standards 
                        for quality under subsection (a)'' after 
                        ``medical facilities of the Department''; and
                    (B) in paragraph (2), by inserting ``or updates'' 
                after ``establishes''.
    (b) Deadline for Update.--The Secretary, pursuant to paragraph (7) 
of section 1703C(a) of title 38, United States Code (as added by 
subsection (a)), shall make the first update to the standards for 
quality established under paragraph (1) of such section not later than 
the date that is five years after the date on which the Secretary 
submits the report under paragraph (2) of subsection (d).
    (c) Report.--Not later than one year after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall submit 
to the appropriate committees of Congress a report on how the 
Secretary--
            (1) has consulted with entities specified in paragraph (4) 
        of section 1703C(a) of title 38, United States Code, before the 
        date of the enactment of this Act in establishing standards for 
        quality under such section;
            (2) has continued to consult with those entities on and 
        after such date of enactment; and
            (3) intends to leverage data sciences to improve standards 
        for quality care furnished by the Department of Veterans 
        Affairs.
    (d) Updates to Quality Care Metrics.--
            (1) Initial report.--Not later than one year after the date 
        of the enactment of this Act, the Secretary of Veterans Affairs 
        shall submit to the appropriate committees of Congress a report 
        on how the Secretary plans to implement the amendments made by 
        subsections (a).
            (2) Deadline; summary report.--Not later than two years 
        after the date of the enactment of this Act, the Secretary 
        shall--
                    (A) implement the amendments made by subsection 
                (a), including by updating the standards for quality 
                established under section 1703C of title 38, United 
                States Code; and
                    (B) submit to the appropriate committees of 
                Congress a report detailing the standards for quality 
                updated pursuant to such amendments.
    (e) Audit of Quality Care Metrics.--
            (1) In general.--Not later than 180 days after the date of 
        the enactment of this Act, the Secretary of Veterans Affairs 
        shall enter into one or more contracts with a non-Department 
        entity described in paragraph (2) to conduct an audit on the 
        quality of care from the Department of Veterans Affairs, 
        including through non-Department health care providers pursuant 
        to section 1703 of title 38 United States Code.
            (2) Non-department entity described.--A non-Department 
        entity described in this paragraph is an entity that--
                    (A) specializes in analyzing large-scale 
                organizational data collection and analysis efforts, 
                especially with respect to the health care sector; and
                    (B) has experience and proven outcomes in 
                optimizing the accuracy and comprehensiveness of data 
                collection and analysis related to the quality of 
                health care services.
            (3) Elements.--The audit required under paragraph (1) shall 
        include the following:
                    (A) An assessment of the methodology used by the 
                Department to collect and assess data on the quality of 
                care furnished by the Department, including any 
                vulnerabilities in such methodology.
                    (B) An assessment of the accuracy and reliability 
                of the data sources used by the Department to compile 
                data on the quality of care furnished by the 
                Department.
                    (C) The extent to which the standards the 
                Department uses to assess the quality of care furnished 
                by the Department are--
                            (i) comparable with industry standards;
                            (ii) easily accessible to, and understood 
                        by--
                                    (I) veterans;
                                    (II) employees of the Department; 
                                and
                                    (III) other individuals, as the 
                                private sector entity considers 
                                appropriate.
                    (D) Any recommendations of such private sector 
                entity with respect to improvements that the Secretary 
                could administer to more accurately capture the quality 
                of care furnished by the Department.
            (4) Reports on audit.--
                    (A) Report on findings and recommendations.--Not 
                later than 60 days after any date on which a private 
                sector entity described in paragraph (2) completes an 
                audit under paragraph (1), such private sector entity 
                shall submit to the Secretary, the Committee on 
                Veterans' Affairs of the Senate, and the Committee on 
                Veterans' Affairs of the House of Representatives a 
                report that includes--
                            (i) the findings of such audit; and
                            (ii) recommendations of such private sector 
                        entity with respect to such audit.
                    (B) Report on planned improvements.--Not later than 
                60 days after any date on which the Secretary receives 
                a report under subparagraph (A), the Secretary shall 
                submit to the Committee on Veterans' Affairs of the 
                Senate and the Committee on Veterans' Affairs of the 
                House of Representatives a report on how the Secretary 
                plans to improve the standards for quality of care of 
                the Department.
    (f) Appropriate Committees of Congress Defined.--In this section, 
the term ``appropriate committees of Congress'' has the meaning given 
such term in section 1703C of title 38, United States Code.

SEC. 105. PILOT PROGRAM TO IMPROVE ADMINISTRATION OF CARE UNDER 
              VETERANS COMMUNITY CARE PROGRAM.

    (a) Establishment.--Pursuant to section 1703E of title 38, United 
States Code, the Secretary of Veterans Affairs, acting through the 
Center for Innovation for Care and Payment established under such 
section, shall carry out a pilot program to seek to develop and 
implement a plan--
            (1) to provide monetary and non-monetary incentives to a 
        covered health care provider--
                    (A) to allow the Secretary to see the scheduling 
                system of the provider, to assess the availability of, 
                and to assist in scheduling appointments for, veterans 
                under the Veterans Community Care Program under section 
                1703 of such title, including through synchronous, 
                asynchronous, and asynchronous assisted digital 
                scheduling;
                    (B) to complete continuing professional educational 
                training available through the VHA TRAIN program (or 
                any successor program or initiative) regarding veteran 
                cultural competency, the opioid safety initiative (or 
                any successor program or initiative), and other 
                subjects determined appropriate by the Secretary;
                    (C) to improve methods of accounting for non-
                Department training that is equivalent or substantially 
                similar to the continuing professional educational 
                training described in subparagraph (B);
                    (D) to improve the rate of the timely return to the 
                Secretary of medical record documentation for care or 
                services provided under the Veterans Community Care 
                Program;
                    (E) to improve the timeliness and quality of the 
                delivery of care and services to veterans under such 
                program; and
                    (F) to achieve other objectives determined 
                appropriate by the Secretary; and
            (2) to decrease the rate of no-show appointments under such 
        program.
    (b) Report.--Not later than one year after the date of the 
establishment of the pilot program under this section, and annually 
thereafter during the term of the pilot program, the Secretary of 
Veterans Affairs shall submit to the Committees on Veterans' Affairs of 
the House of Representatives and the Senate a report on the pilot 
program that includes, with respect to the period covered by the 
report--
            (1) an assessment of the extent to which--
                    (A) the system of the Department of Veterans 
                Affairs for scheduling appointments for veterans under 
                the Veterans Community Care Program has improved;
                    (B) the rate of timely return to the Secretary of 
                medical record documentation described in subparagraph 
                (D) of subsection (a)(1) has improved;
                    (C) the timeliness and quality of the delivery of 
                care and services described in subparagraph (E) of such 
                subsection has improved; and
                    (D) the frequency of no-show appointments described 
                in paragraph (2) of such subsection decreased;
            (2) a list of the continuing professional educational 
        training courses under subparagraph (B) of such subsection 
        available to covered health care providers;
            (3) the rate of participation in such continuing 
        professional education training courses; and
            (4) any other matter the Secretary determines appropriate.
    (c) Definitions.--In this section:
            (1) The term ``covered health care provider'' means a 
        health care provider--
                    (A) described in subsection (c) of section 1703 of 
                title 38, United States Code, that furnishes care or 
                services under the Veterans Community Care Program 
                pursuant to a contract or agreement with a Third Party 
                Administrator; or
                    (B) that otherwise furnishes care or services 
                outside of Department facilities pursuant to a contract 
                or agreement with the Secretary of Veterans Affairs.
            (2) The term ``opioid safety initiative'' means the 
        programs, processes, and guidelines of the Veterans Health 
        Administration of the Department of Veterans Affairs relating 
        to the management of opioid therapy and chronic pain.
            (3) The term ``Third Party Administrator'' means an entity 
        that manages a network of health care providers and performs 
        administrative services related to such network under section 
        1703 of such title.
            (4) The term ``VHA TRAIN program'' means the free program 
        of the Veterans Health Administration that offers veteran-
        specific continuing medical education courses.

SEC. 106. PILOT PROGRAM ON CONSOLIDATING APPROVAL PROCESS OF DEPARTMENT 
              OF VETERANS AFFAIRS FOR COVERED DENTAL CARE.

    (a) In General.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs, acting 
through the Center for Innovation for Care and Payment established 
under section 1703E of title 38, United States Code, shall carry out a 
pilot program under which the Secretary shall hire--
            (1) general dentists at medical facilities of the 
        Department of Veterans Affairs to manage approval by the 
        Department of treatment plans requested by dental providers in 
        providing covered dental care; and
            (2) dental specialists at Veterans Integrated Service 
        Networks of the Department to manage approval by the Department 
        of treatment plans for specialty dental care requested by 
        dental providers in providing covered dental care.
    (b) Locations.--The Secretary shall carry out the pilot program in 
not fewer than two Veterans Integrated Service Networks of the 
Department.
    (c) Reports.--
            (1) Initial report.--Not later than one year after the date 
        of the commencement of such pilot program, the Secretary shall 
        submit to the Committees on Veterans' Affairs of the Senate and 
        the House of Representatives a report on the pilot program, 
        that includes--
                    (A) an identification of the Veterans Integrated 
                Service Networks participating in such pilot program;
                    (B) a description of the implementation of such 
                pilot program;
                    (C) an identification of any barriers or challenges 
                to implementing such pilot program;
                    (D) an assessment of the efficacy of hiring general 
                dentists and dental specialists pursuant to such pilot 
                program;
                    (E) aggregated feedback with respect to such pilot 
                program from dentists of the Department in Veterans 
                Integrated Service Networks participating in such pilot 
                program; and
                    (F) aggregated feedback from dental providers 
                providing covered dental care within such Veterans 
                Integrated Service Networks regarding any changes in 
                the timeliness of treatment plan approvals by the 
                Department.
            (2) Final report.--Not later than 90 days before the date 
        of the completion of such pilot program, the Secretary shall 
        submit to the Committees on Veterans' Affairs of the Senate and 
        the House of Representatives a report on the pilot program 
        that--
                    (A) includes, with respect to the period covered by 
                the report, each element of the report required under 
                paragraph (1) described in subparagraphs (A) through 
                (F) of such paragraph;
                    (B) includes recommendations of the Secretary on 
                whether the pilot program should be--
                            (i) extended;
                            (ii) expanded; or
                            (iii) adopted throughout the Department; 
                        and
                    (C) indicates whether the Secretary requests action 
                by Congress to make the pilot program permanent.
    (d) Sunset.--The authority to carry out the pilot program under 
this section shall terminate on the date that is two years after the 
date of the enactment of this Act.
    (e) Covered Dental Care Defined.--In this section, the term 
``covered dental care'' means dental care provided--
            (1) under section 1703 of title 38, United States Code; or
            (2) pursuant to a Veterans Care Agreement under section 
        1703A of such title.

SEC. 107. STRATEGIC PLAN ON VALUE-BASED HEALTH CARE SYSTEM FOR VETERANS 
              HEALTH ADMINISTRATION; PILOT PROGRAM.

    (a) Establishment of Working Group.--
            (1) In general.--Not later than one year after the date of 
        the enactment of this Act, the Secretary of Veterans Affairs 
        shall--
                    (A) establish a working group on value-based care; 
                and
                    (B) submit to the Committees on Veterans' Affairs 
                of the House of Representatives and the Senate the 
                strategic plan developed by the working group pursuant 
                to subsection (b).
            (2) Membership.--
                    (A) Required members.--The working group shall 
                include, at a minimum, the following members:
                            (i) The Under Secretary for Health of the 
                        Department of Veterans Affairs.
                            (ii) The Director of the Office of Mental 
                        Health and Suicide Prevention of the Department 
                        of Veterans Affairs (or any successor office).
                            (iii) The Director of the Office of 
                        Integrated Veteran Care of the Department (or 
                        any successor office).
                            (iv) The Director of the Office of Rural 
                        Health of the Department (or any successor 
                        office).
                            (v) The Director of the Office of Connected 
                        Care of the Department (or any successor 
                        office).
                            (vi) The Assistant Secretary for the Office 
                        of Information Technology (or any successor 
                        office).
                            (vii) The Chief Officer of the Office of 
                        Healthcare Innovation and Learning of the 
                        Office of Discovery, Education, and Affiliate 
                        Networks of the Veterans Health Administration 
                        (or any successor office).
                            (viii) An individual designated by the 
                        Secretary from the Center for Innovation for 
                        Care and Payment of the Department under 
                        section 1703E of title 38, United States Code.
                            (ix) An individual designated by the 
                        Administrator of the Centers for Medicare & 
                        Medicaid Services from the Center for Medicare 
                        and Medicaid Innovation.
                            (x) An individual designated by the 
                        Secretary of Health and Human Services from the 
                        Federal Office of Rural Health Policy of the 
                        Health Resources and Services Administration.
                            (xi) The Chief of Human Capital Management 
                        for the Veterans Health Administration.
                            (xii) An individual designated by the 
                        Secretary of Defense that is a representative 
                        of the Defense Health Agency.
                            (xiii) An individual selected by the 
                        Secretary of Veterans Affairs from the special 
                        medical advisory group established under 
                        section 7312 of title 38, United States Code.
                    (B) Optional members.--The Secretary of Veterans 
                Affairs may appoint any of the following individuals as 
                members of the working group:
                            (i) An individual representing the Health 
                        and Medicine Division of the National Academies 
                        of Sciences, Engineering, and Medicine.
                            (ii) Three individuals representing a 
                        private health care system that has made the 
                        transition to value-based care.
                            (iii) Three individuals representing an 
                        organization recognized by the Secretary of 
                        Veterans Affairs under section 5902 of title 
                        38, United States Code.
            (3) Public availability.--All meetings deliberations, and 
        products of the working group shall be made publicly available 
        throughout the duration of the working group, including to 
        individuals representing organizations recognized by the 
        Secretary of Veterans Affairs under section 5902 of title 38, 
        United States Code.
            (4) Exemption from faca.--Chapter 10 of title 5, United 
        States Code, shall not apply to the working group established 
        under paragraph (1).
    (b) Development of Strategic Plan.--The working group shall develop 
a strategic plan to implement value-based care into the Veterans Health 
Administration that includes the following:
            (1) An identification of the state of the Veterans Health 
        Administration as of the date of the enactment of this Act, 
        including an assessment of the current model of health care 
        delivery used by the Veterans Health Administration in medical 
        facilities of the Department of Veterans Affairs.
            (2) An assessment of the capacity needs of the Veterans 
        Health Administration during the five-year period beginning on 
        the date of the enactment of this Act.
            (3) An analysis of the leadership of the Veterans Health 
        Administration, including an assessment of leadership acumen 
        and ability to implement a clear, shared vision and effective 
        change management and care coordination.
            (4) An identification of goals for the future of the 
        Veterans Health Administration.
            (5) An identification and classification of the current 
        capabilities, capacity, and gaps in access and quality of the 
        health care system of the Department of Veterans Affairs.
            (6) An analysis of value-based care models, including--
                    (A) a selection of potential models that would best 
                work for the Veterans Health Administration;
                    (B) the capacity and capabilities of each such 
                model; and
                    (C) a thorough justification of the selection of 
                each selected model, including a summary of the ability 
                of such model to improve the metrics described under 
                paragraph (9).
            (7) A definition of what quality means with respect to--
                    (A) access to health care under the laws 
                administered by the Secretary of Veterans Affairs; and
                    (B) delivery of such health care.
            (8) A definition of what value means with respect to care 
        furnished by the Veterans Health Administration,
            (9) A system for measuring value within the Veterans Health 
        Administration that includes metrics for--
                    (A) outcomes;
                    (B) safety;
                    (C) service;
                    (D) access;
                    (E) productivity;
                    (F) capacity; and
                    (G) total cost of patient care.
            (10) With respect to the system described in subparagraph 
        (H), an analysis of variable value with respect to patient 
        outcomes across different health care types and specialties.
            (11) An assessment of--
                    (A) previous or ongoing assessments of the current 
                information technology infrastructure of the Veterans 
                Health Administration, including--
                            (i) such assessments conducted pursuant to 
                        the Electronic Health Record Modernization 
                        program of the Department of Veterans Affairs; 
                        and
                            (ii) any other ongoing information 
                        technology modernization programs of such 
                        Department and any unimplemented relevant 
                        recommendations from such assessments;
                    (B) the information technology infrastructure of 
                the Veterans Health Administration in effect as of the 
                date of the enactment of this Act;
                    (C) the value-driven framework of the Department, 
                in effect as of the date of the enactment of this Act, 
                for evaluating health care innovations, and how 
                improvements in such framework could be used to 
                encourage innovation; and
                    (D) workforce challenges and needs of the Veterans 
                Health Administration based on--
                            (i) reviews of workforce assessment data 
                        available as of the date of the enactment of 
                        this Act; and
                            (ii) the findings of--
                                    (I) the report required by section 
                                301(d) of the Veterans Access, Choice, 
                                and Accountability Act of 2014 (Public 
                                Law 113-146);
                                    (II) the reports required by 
                                section 505 of the John S. McCain III, 
                                Daniel K. Akaka and Samuel R. Johnson 
                                VA Maintaining Internal Systems and 
                                Strengthening Integrated Outside 
                                Networks Act of 2018 (Public Law 115-
                                182);
                                    (III) the report required by 
                                section 301 of the VA Choice and 
                                Quality Employment Act of 2017 (Public 
                                Law 115-46); and
                                    (IV) any comprehensive health care 
                                inspection conducted by the Inspector 
                                General of the Department of Veterans 
                                Affairs as of the date of the enactment 
                                of this Act.
            (12) Any recommendations of the working group with respect 
        to improving the information technology infrastructure 
        described in clause (i) of subparagraph (J).
            (13) An analysis of how the value-driven framework 
        described in clause (iii) of such subparagraph could be used to 
        improve the model of care delivery by the Department.
            (14) A description of how a value-based care system would 
        apply to primary care, inpatient and outpatient mental health 
        care, and inpatient and outpatient substance use treatment, 
        spinal cord injury disorder care, and polytrauma care furnished 
        by the Veterans Health Administration.
            (15) With respect to legislative or administrative action 
        necessary to incorporate value-based care models into the 
        Veterans Health Administration, a description of the estimated 
        timelines, effect on workforce, and costs.
    (c) Pilot Program.--
            (1) In general.--Not later than 180 days after the 
        submission of the strategic plan pursuant to subsection (b), 
        the Secretary of Veterans Affairs, acting through the Center 
        for Innovation for Care and Payment established under section 
        1703E of title 38, United States Code, shall commence a three-
        year pilot program under which the Secretary shall implement 
        the elements of such strategic plan relating to the delivery, 
        by the Veterans Health Administration, of primary care, 
        inpatient and outpatient mental health treatment, inpatient and 
        outpatient substance abuse treatment, spinal cord injury 
        disorder care, and polytrauma care.
            (2) Locations.--The Secretary shall carry out such pilot 
        program in four Veterans Integrated Service Networks that are 
        geographically dispersed and shall include the following:
                    (A) A Veterans Integrated Service Network that 
                predominately serves veterans in rural and highly rural 
                areas.
                    (B) A Veterans Integrated Service Network that 
                predominately serves veterans in urban areas.
                    (C) A Veterans Integrated Service Network that has 
                a high rate of suicide among veterans.
                    (D) A Veterans Integrated Service Network that has 
                a high rate of substance use disorder among veterans.
                    (E) A Veterans Integrated Service Network that has 
                access or productivity challenges.
            (3) Reports to congress.--
                    (A) Annual report.--Not later than one year after 
                the commencement of the pilot program, and annually 
                thereafter during the duration of the pilot program, 
                the Secretary shall submit to Congress a report on the 
                pilot program.
                    (B) Final report.--Not later than 90 days before 
                the conclusion of the pilot program, the Secretary 
                shall submit to Congress a final report on the pilot 
                program that includes--
                            (i) lessons learned during the 
                        administration of such pilot program; and
                            (ii) specific health outcomes in veteran 
                        patient care compared to the Veterans Health 
                        Administration system of care in effect as of 
                        the date of the enactment of this Act.

SEC. 108. PLAN ON ADOPTION OF CERTAIN HEALTH INFORMATION STANDARDS FOR 
              DEPARTMENT OF VETERANS AFFAIRS AND CERTAIN HEALTH CARE 
              PROVIDERS.

    (a) Plan for Certain Health Information Standards.--
            (1) In general.--The Secretary of Veterans Affairs, in 
        consultation with the Secretary of Health and Human Services, 
        the Administrator of the Centers for Medicare & Medicaid 
        Services, and the National Coordinator for Health Information 
        Technology of the Department of Health and Human Services, 
        shall create and implement a plan to adopt, as rapidly and to 
        the most comprehensive extent feasible, national health 
        information interoperability standards for the Department of 
        Veterans Affairs and community care providers with respect to--
                    (A) coordination of--
                            (i) care; and
                            (ii) benefits;
                    (B) patient identity matching;
                    (C) measurement and reporting of quality;
                    (D) population health; and
                    (E) public health.
            (2) Consideration.--In developing the plan under paragraph 
        (1), the Secretary of Veterans Affairs shall consider 
        challenges faced by--
                    (A) small community care providers; and
                    (B) community care providers located in rural 
                areas.
    (b) Plan on Electronic Health Record Exchange.--
            (1) In general.--Not later than one year after the date of 
        enactment of this Act, the Secretary shall submit to the 
        Committees on Veterans' Affairs of the Senate and the House of 
        Representatives a plan to provide, at no cost, to community 
        care providers of the Department, through Third Party 
        Administrators, a capability to facilitate the electronic 
        direct exchange, between such providers and the Department, 
        of--
                    (A) the health records of veterans; and
                    (B) documents relating to health care of veterans, 
                clinical notes, and any other information the Secretary 
                determines necessary.
            (2) Prioritization.--In developing the plan required under 
        paragraph (1), the Secretary shall prioritize providing the 
        capability described in such paragraph to community care 
        providers that--
                    (A) provide care under the laws administered by the 
                Secretary to--
                            (i) a lower volume of veterans; and
                            (ii) veterans who are located in rural 
                        areas; and
                    (B) are unable or unwilling to exchange the records 
                and documents described in subparagraphs (A) and (B) of 
                such paragraph with the Department through standards-
                based or direct exchange mechanisms in effect as of the 
                date of the enactment of this Act.
    (c) Reports on Plan for Interoperability Standards.--
            (1) Initial report.--Not later than one year after the date 
        of the enactment of this Act, the Secretary of Veterans Affairs 
        shall submit to the Committees on Veterans' Affairs of the 
        Senate and the House of Representatives--
                    (A) the plan required by subsection (a); and
                    (B) a report that includes--
                            (i) an analysis of gaps, if any, between 
                        the use, by the Department and other agencies, 
                        health information exchanges, and technology 
                        companies, of national health information 
                        interoperability standards and the potential, 
                        or optimal, use of such national health 
                        information interoperability standards;
                            (ii) an analysis and description of the 
                        participation by the Department, community care 
                        providers, and other relevant entities in the 
                        Trusted Exchange Framework and Common Agreement 
                        program of the Department of Health and Human 
                        Services as of the date of the enactment of 
                        this Act;
                            (iii) recommendations of the Secretary with 
                        respect to development of health information 
                        interoperability standards;
                            (iv) timelines or schedules to implement 
                        the plan required by subsection (a); and
                            (v) an identification of any legislative 
                        authorities or resources the Secretary requires 
                        to implement such plan.
            (2) Recurring report requirement.--
                    (A) In general.--Not later than 18 months after the 
                date of the enactment of this Act, and every 180 days 
                thereafter for four years, the Secretary of Veterans 
                Affairs shall submit to Committees on Veterans' Affairs 
                of the Senate and the House of Representatives a report 
                on the status of implementation of the plan required 
                under subsection (a).
                    (B) Elements of subsequent reports.--Each report 
                under subparagraph (A) submitted after the date on 
                which the first report required by such subparagraph is 
                submitted shall include a description of any revisions 
                to--
                            (i) the plan required by subsection (a) 
                        made during the period covered by the report; 
                        and
                            (ii) the analysis, recommendations, 
                        timelines, and legislative authorities reported 
                        pursuant to paragraph (1).
    (d) Definitions.--In this section:
            (1) The term ``community care provider'' means a non-
        Department health care provider providing care (including 
        dental care)--
                    (A) under section 1703 of title 38, United States 
                Code;
                    (B) pursuant to a Veterans Care Agreement under 
                section 1703A of such title; or
                    (C) under any other law administered by the 
                Secretary of Veterans Affairs.
            (2) The term ``Third Party Administrator'' means an entity 
        that manages a provider network and performs administrative 
        services related to such network under section 1703 of title 
        38, United States Code.

SEC. 109. REPORT ON USE OF VALUE-BASED REIMBURSEMENT MODELS UNDER 
              VETERANS COMMUNITY CARE PROGRAM.

    (a) Report on Value-based Reimbursement Models.--Not later than one 
year after the date of the enactment of this Act, the Secretary of 
Veterans Affairs, in consultation with the Center for Innovation for 
Care and Payment of the Department of Veterans Affairs under section 
1703E of title 38 United States Code, the Office of Integrated Veteran 
Care of the Department, or successor office, and Third Party 
Administrators, shall submit to the Committees on Veterans' Affairs of 
the House of Representatives and the Senate a report containing--
            (1) an assessment of the efforts of the Department pursuant 
        to section 1703(i)(5) of such title, to incorporate value-based 
        reimbursement models under the Veterans Community Care Program 
        to promote the provision of high-quality care to veterans; and
            (2) such recommendations for legislative or administrative 
        action as the Secretary considers appropriate regarding the use 
        of value-based reimbursement models throughout the Veterans 
        Community Care Program under section 1703 of such title.
    (b) Rule of Construction.--This section shall not be construed to 
be a pilot program subject to the requirements of section 1703E of 
title 38, United States Code.
    (c) Third Party Administrator Defined.--In this section, the term 
``Third Party Administrator'' means an entity that manages a provider 
network and performs administrative services related to such network 
under section 1703 of title 38, United States Code.

SEC. 110. INSPECTOR GENERAL ASSESSMENT OF IMPLEMENTATION OF VETERANS 
              COMMUNITY CARE PROGRAM.

    (a) In General.--Not later than 18 months after the date of the 
enactment of this Act, and periodically thereafter, the Inspector 
General shall assess the performance of the Department of Veterans 
Affairs in--
            (1) appropriately identifying veterans eligible for care 
        and services under section 1703 of title 38, United States 
        Code;
            (2) informing veterans of their eligibility for such care 
        and services; and
            (3) delivering such care and services in a timely manner.
    (b) Briefing on Assessments.--Upon the submission of the assessment 
required by subsection (a), the Inspector General of the Department of 
Veterans Affairs shall provide to the Committees on Veterans Affairs of 
the House of Representatives and the Senate a briefing on the results 
of such assessment.

SEC. 111. COMPTROLLER GENERAL REPORT ON DENTISTRY UNDER VETERANS 
              COMMUNITY CARE PROGRAM.

    (a) In General.--Not later than one year after the date of the 
enactment of this Act, the Comptroller General of the United States 
shall submit to the Committees on Veterans' Affairs of the Senate and 
the House of Representatives a report on dental care furnished by the 
Secretary of Veterans Affairs under the Veterans Community Care Program 
under section 1703 of title 38, United States Code, that includes a 
review of--
            (1) the impact current reimbursement rates provided by the 
        Department of Veterans Affairs to dental providers under such 
        program have on--
                    (A) the availability of dental care for veterans; 
                and
                    (B) the ability of Third Party Administrators to 
                meet their contractual obligations for network 
                adequacy;
            (2) the satisfaction of dental providers providing dental 
        care under such program with the processes of the Department 
        for approving dental care under such program; and
            (3) the current processes of the Department for approving 
        emergent dental care under such program.
    (b) Third Party Administrator Defined.--In this section, the term 
``Third Party Administrator'' means an entity that manages a provider 
network and performs administrative services related to such network 
under section 1703 of title 38, United States Code.

 Subtitle B--Matters Relating to Nursing Home and Other Long Term Care 
                         and Family Caregivers

SEC. 120. INCREASE OF EXPENDITURE CAP FOR NONINSTITUTIONAL CARE 
              ALTERNATIVES TO NURSING HOME CARE.

    (a) Increase of Expenditure Cap.--Section 1720C(d) of title 38, 
United States Code, is amended--
            (1) by striking ``The total cost'' and inserting ``(1) 
        Except as provided in paragraph (2), the total cost'';
            (2) by striking ``65 percent'' and inserting ``100 
        percent''; and
            (3) by adding at the end the following new paragraph:
    ``(2)(A) The total cost of providing services or in-kind assistance 
in the case of any veteran described in subparagraph (B) for any fiscal 
year under the program may exceed 100 percent of the cost that would 
otherwise have been incurred as specified in paragraph (1) if the 
Secretary determines, based on a consideration of clinical need, 
geographic market factors, and such other matters as the Secretary may 
prescribe through regulation, that such higher total cost is in the 
best interest of the veteran.
    ``(B) A veteran described in this subparagraph is a veteran with 
amyotrophic lateral sclerosis, a spinal cord injury, or a condition the 
Secretary determines to be similar to such conditions.''.
    (b) Applicability.--The amendments made by subsection (a) shall 
apply with respect to fiscal years beginning on or after the date of 
the enactment of this Act.

SEC. 121. COORDINATION WITH PROGRAM OF ALL-INCLUSIVE CARE FOR THE 
              ELDERLY.

    Section 1720C of title 38, United States Code, as amended by 
section 120, is further amended by adding at the end the following new 
subsection:
    ``(f) In furnishing services to a veteran under the program 
conducted pursuant to subsection (a), if a medical center of the 
Department through which such program is administered is located in a 
geographic area in which services are available to the veteran under a 
PACE program (as such term is defined in sections 1894(a)(2) and 
1934(a)(2) of the Social Security Act (42 U.S.C. 1395eee(a)(2); 1396u-
4(a)(2))), the Secretary shall seek to enter into an agreement with the 
PACE program operating in that area for the furnishing of such 
services.''.

SEC. 122. AUTHORITY FOR SECRETARY OF VETERANS AFFAIRS TO AWARD GRANTS 
              OR CONTRACTS TO ENTITIES TO IMPROVE PROVISION OF MENTAL 
              HEALTH SUPPORT TO FAMILY CAREGIVERS OF VETERANS.

    Subchapter II of chapter 17 of title 38, United States Code, is 
amended by adding at the end the following new section (and conforming 
the table of sections at the beginning of such chapter accordingly):
``Sec. 1720K. Grants or contracts to provide mental health support to 
              family caregivers of veterans
    ``(a) Authority.--The Secretary may award grants or contracts to 
carry out, coordinate, improve, or otherwise enhance mental health 
counseling, treatment, or support to the family caregivers of veterans 
participating in the family caregiver program.
    ``(b) Application.--(1) To be eligible for a grant or contract 
under this section, an entity shall submit to the Secretary an 
application therefor at such time, in such manner, and containing such 
information as the Secretary may require.
    ``(2) Each application submitted under paragraph (1) shall include 
the following:
            ``(A) A detailed plan for the use of the grant or contract.
            ``(B) A description of the programs or efforts through 
        which the entity will meet the outcome measures developed by 
        the Secretary under subsection (f).
            ``(C) A description of how the entity will distribute grant 
        or contract amounts equitably among areas with varying levels 
        of urbanization.
            ``(D) A plan for how the grant or contract will be used to 
        meet the unique needs of veterans residing in rural areas, 
        Native American, Native Hawaiian, or Alaska Native veterans, 
        elderly veterans, women veterans, and veterans from other 
        underserved communities.
    ``(c) Distribution.--The Secretary shall seek to ensure that grants 
and contracts awarded under this section are equitably distributed 
among entities located in States with varying levels of urbanization.
    ``(d) Priority.--The Secretary shall prioritize awarding grants or 
contracts under this section that will serve the following areas:
            ``(1) Areas with high rates of veterans enrolled in the 
        family caregiver program.
            ``(2) Areas with high rates of--
                    ``(A) suicide among veterans; or
                    ``(B) referrals to the Veterans Crisis Line.
    ``(e) Required Activities.--Any grant or contract awarded under 
this section shall be used--
            ``(1) to expand existing programs, activities, and 
        services;
            ``(2) to establish new or additional programs, activities, 
        and services; or
            ``(3) for travel and transportation to facilitate carrying 
        out paragraph (1) or (2).
    ``(f) Outcome Measures.--(1) The Secretary shall develop and 
provide to each entity that receives a grant or contract under this 
section written guidance on the following:
            ``(A) Outcome measures.
            ``(B) Policies of the Department.
    ``(2) In developing outcome measures under paragraph (1), the 
Secretary shall consider the following goals:
            ``(A) Increasing the utilization of mental health services 
        among family caregivers of veterans participating in the family 
        caregiver program.
            ``(B) Reducing barriers to mental health services among 
        family caregivers of veterans participating in such program.
    ``(g) Tracking Requirements.--(1) The Secretary shall establish 
appropriate tracking requirements with respect to the entities 
receiving a grant or contract under this section.
    ``(2) Not less frequently than annually, the Secretary shall submit 
to Congress a report on such tracking requirements.
    ``(h) Performance Review.--The Secretary shall--
            ``(1) review the performance of each entity that receives a 
        grant or contract under this section; and
            ``(2) make information regarding such performance publicly 
        available.
    ``(i) Remediation Plan.--(1) In the case of an entity that receives 
a grant or contract under this section and does not meet the outcome 
measures developed by the Secretary under subsection (f), the Secretary 
shall require the entity to submit to the Secretary a remediation plan 
under which the entity shall describe how and when it plans to meet 
such outcome measures.
    ``(2) The Secretary may not award a subsequent grant or contract 
under this section to an entity described in paragraph (1) unless the 
Secretary approves the remediation plan submitted by the entity under 
such paragraph.
    ``(j) Maximum Amount.--The amount of a grant or contract awarded 
under this section may not exceed 10 percent of amounts made available 
for grants or contracts under this section for the fiscal year in which 
the grant or contract is awarded.
    ``(k) Supplement, Not Supplant.--Any grant or contract awarded 
under this section shall be used to supplement and not supplant funding 
that is otherwise available through the Department to provide mental 
health support among family caregivers of veterans participating in the 
family caregiver program.
    ``(l) Outreach to Family Caregivers.--The Secretary shall include, 
in the outreach materials regularly provided to a family caregiver who 
participates in the family caregiver program, notice of mental health 
support provided by recipients of grants or contracts under this 
section that are located in the relevant Veterans Integrated Service 
Network.
    ``(m) Funding.--(1) Amounts for the activities of the Department 
under this section shall be budgeted and appropriated through a 
separate appropriation account.
    ``(2) In the budget justification materials submitted to Congress 
in support of the budget of the Department for any fiscal year (as 
submitted with the budget of the President under section 1105(a) of 
title 31), the Secretary shall include a separate statement of the 
amount requested to be appropriated for that fiscal year for the 
account specified in paragraph (1).
    ``(n) Authorization of Appropriations.--There is authorized to be 
appropriated to the Secretary, for each of fiscal years 2025 and 2026, 
$10,000,000 to carry out this section.
    ``(o) Definitions.--In this section:
            ``(1) The terms `caregiver' and `family caregiver' have the 
        meanings given those terms in section 1720G of this title.
            ``(2) The term `family caregiver program' means the program 
        of comprehensive assistance for family caregivers under section 
        1720G of this title.
            ``(3) The term `Veterans Crisis Line' means the toll-free 
        hotline for veterans established under section 1720F of this 
        title.''.

SEC. 123. HOME- AND COMMUNITY-BASED SERVICES: PROGRAMS.

    (a) Programs.--Such subchapter is further amended by inserting 
after section 1720K (as added by section 122) the following new section 
(and conforming the table of sections at the beginning of such chapter 
accordingly):
``Sec. 1720L. Home- and community-based services: programs
    ``(a) In General.--In furnishing noninstitutional alternatives to 
nursing home care pursuant to the authority of section 1720C of this 
title (or any other authority under this chapter or other provision of 
law administered by the Secretary of Veterans Affairs), the Secretary 
shall carry out each of the programs specified in this section in 
accordance with such relevant authorities except as otherwise provided 
in this section.
    ``(b) Veteran-Directed Care Program.--(1) The Secretary of Veterans 
Affairs, in collaboration with the Secretary of Health and Human 
Services, shall carry out a program to be known as the `Veteran-
Directed Care program'. Under such program, the Secretary of Veterans 
Affairs may enter into agreements with the providers described in 
paragraph (2) to provide to eligible veterans funds, to the extent 
practicable, to obtain such in-home care services and related items 
that support clinical need and improve quality of life, as may be 
determined appropriate by the Secretary of Veterans Affairs and 
selected by the veteran, including through the veteran hiring 
individuals to provide such services and items or directly purchasing 
such services and items.
    ``(2) The providers described in this paragraph are the following:
            ``(A) An Aging and Disability Resource Center, an area 
        agency on aging, or a State agency.
            ``(B) A center for independent living.
            ``(C) An Indian tribe or tribal organization receiving 
        assistance under title VI of the Older Americans Act of 1965 
        (42 U.S.C. 3057 et seq.).
            ``(D) Any other entity that the Secretary, in consultation 
        with the Secretary of Health and Human Services, determines 
        appropriate.
    ``(3) In carrying out the Veteran-Directed Care program, the 
Secretary of Veterans Affairs shall--
            ``(A) administer such program through each medical center 
        of the Department of Veterans Affairs;
            ``(B) seek to ensure the availability of such program in 
        American Samoa, Guam, the Commonwealth of the Northern Mariana 
        Islands, the Commonwealth of Puerto Rico, the Virgin Islands of 
        the United States, and any other territory or possession of the 
        United States, to the extent practicable; and
            ``(C) seek to ensure the availability of such program for 
        eligible veterans who are Native American veterans receiving 
        care and services furnished by the Indian Health Service, a 
        tribal health program, an Urban Indian organization, or (in the 
        case of a Native Hawaiian veteran) a Native Hawaiian health 
        care system, to the extent practicable.
    ``(4) If a veteran participating in the Veteran-Directed Care 
program is hospitalized, the veteran may continue to use funds under 
the program during a period of hospitalization in the same manner that 
the veteran would be authorized to use such funds under the program if 
the veteran were not hospitalized.
    ``(c) Homemaker and Home Health Aide Program.--(1) The Secretary 
shall carry out a program to be known as the `Homemaker and Home Health 
Aide program' under which the Secretary may enter into agreements with 
home health agencies to provide to eligible veterans such home health 
aide services as may be determined appropriate by the Secretary.
    ``(2) In carrying out the Homemaker and Home Health Aide program, 
the Secretary shall--
            ``(A) administer such program in the locations specified in 
        subparagraph (A) of subsection (b)(3);
            ``(B) seek to ensure the availability of such program in 
        the locations specified in subparagraph (B) of subsection 
        (b)(3); and
            ``(C) seek to ensure the availability of such program for 
        the veteran populations specified in subparagraph (C) of 
        subsection (b)(3).
    ``(d) Home-Based Primary Care Program.--The Secretary shall carry 
out a program to be known as the `Home-Based Primary Care program' 
under which the Secretary may furnish to eligible veterans in-home 
health care, the provision of which is overseen by a provider of the 
Department.
    ``(e) Purchased Skilled Home Care Program.--The Secretary shall 
carry out a program to be known as the `Purchased Skilled Home Care 
program' under which the Secretary may furnish to eligible veterans 
such in-home care services as may be determined appropriate and 
selected by the Secretary for the veteran.
    ``(f) Caregiver Support.--(1) With respect to a resident eligible 
caregiver of a veteran participating in a program under this section, 
the Secretary shall--
            ``(A) if the veteran meets the requirements of a covered 
        veteran under section 1720G(b) of this title, provide to such 
        caregiver the option of enrolling in the program of general 
        caregiver support services under such section;
            ``(B) provide to such caregiver covered respite care of not 
        less than 30 days annually; and
            ``(C) conduct on an annual basis (and, to the extent 
        practicable, in connection with in-person services provided 
        under the program in which the veteran is participating), a 
        wellness contact of such caregiver.
    ``(2) Covered respite care provided to a resident eligible 
caregiver of a veteran under paragraph (1) may exceed 30 days annually 
if such extension is requested by the resident eligible caregiver or 
veteran and determined medically appropriate by the Secretary.
    ``(g) Rule of Construction.--Nothing in this section shall be 
construed to limit the authority of the Secretary to carry out programs 
providing home- and community-based services under any other provision 
of law.
    ``(h) Definitions.--In this section:
            ``(1) The terms `Aging and Disability Resource Center', 
        `area agency on aging', and `State agency' have the meanings 
        given those terms in section 102 of the Older Americans Act of 
        1965 (42 U.S.C. 3002).
            ``(2) The terms `caregiver' and `family caregiver', with 
        respect to a veteran, have the meanings given those terms, 
        respectively, under subsection (e) of section 1720G of this 
        title with respect to an eligible veteran under subsection (a) 
        of such section or a covered veteran under subsection (b) of 
        such section, as the case may be.
            ``(3) The term `center for independent living' has the 
        meaning given that term in section 702 of the Rehabilitation 
        Act of 1973 (29 U.S.C. 796a).
            ``(4) The term `covered respite care' has the meaning given 
        such term in section 1720G(d) of this title.
            ``(5) The term `eligible veteran' means any veteran--
                    ``(A) for whom the Secretary determines 
                participation in a specific program under this section 
                is medically necessary to promote, preserve, or restore 
                the health of the veteran; and
                    ``(B) who absent such participation would be at 
                increased risk for hospitalization, placement in a 
                nursing home, or emergency room care.
            ``(6) The term `home health aide' means an individual 
        employed by a home health agency to provide in-home care 
        services.
            ``(7) The term `in-home care service' means any service, 
        including a personal care service, provided to enable the 
        recipient of such service to live at home.
            ``(8) The terms `Indian tribe' and `tribal organization' 
        have the meanings given those terms in section 4 of the Indian 
        Self-Determination and Education Assistance Act (25 U.S.C. 
        5304).
            ``(9) The terms `Native American' and `Native American 
        veteran' have the meanings given those terms in section 3765 of 
        this title.
            ``(10) The terms `Native Hawaiian' and `Native Hawaiian 
        health care system' have the meanings given those terms in 
        section 12 of the Native Hawaiian Health Care Improvement Act 
        (42 U.S.C. 11711).
            ``(11) The terms `tribal health programs' and `Urban Indian 
        organizations' have the meanings given those terms in section 4 
        of the Indian Health Care Improvement Act (25 U.S.C. 1603).
            ``(12) The term `resident eligible caregiver' means an 
        individual who--
                    ``(A) is a caregiver, or a family caregiver, of a 
                veteran and resides with that veteran; and
                    ``(B) has not entered into a contract, agreement, 
                or other arrangement for such individual to act as a 
                caregiver for that veteran unless such individual is a 
                family member of the veteran or is furnishing caregiver 
                services through a medical foster home.''.
    (b) Deadline for Improved Administration.--The Secretary of 
Veterans Affairs shall ensure that the Veteran-Directed Care program 
and the Homemaker and Home Health Aide program are administered through 
each medical center of the Department of Veterans Affairs in accordance 
with section 1720L of title 38, United States Code (as added by 
subsection (a)), by not later than two years after the date of the 
enactment of this Act.
    (c) Administration of Veteran-Directed Care Program.--
            (1) Procedures.--
                    (A) The Secretary shall establish procedures to--
                            (i) identify the staffing needs for the 
                        Veteran-Directed Care program of the Department 
                        of Veterans Affairs under such section (as 
                        added by subsection (a)); and
                            (ii) define the roles and responsibilities 
                        for personnel of the Department responsible for 
                        the administration of such program, including 
                        such personnel employed at the national, 
                        Veterans Integrated Service Network, or medical 
                        facility level.
                    (B) The responsibilities described in clause (ii) 
                of subparagraph (A) shall include responsibilities for 
                engagement with--
                            (i) veterans participating in such program;
                            (ii) veterans interested in participating 
                        in such program; and
                            (iii) providers described in section 
                        1720L(b)(2) (as added by subsection (a)).
            (2) Staffing model; report.--Not later than two years after 
        enactment of this Act, the Secretary of Veterans Affairs 
        shall--
                    (A) establish a staffing model for the 
                administration of such program at each medical facility 
                of the Department of Veterans Affairs; and
                    (B) submit to the Committees on Veterans' Affairs 
                of the House of Representatives and the Senate a report 
                containing the following:
                            (i) A description of--
                                    (I) the staffing model described in 
                                subparagraph (A); and
                                    (II) the rationale for such 
                                staffing model.
                            (ii) An identification of the ratio of 
                        staff required to administer such program to 
                        the number of veterans served by such program, 
                        disaggregated by each medical facility of the 
                        Department of Veterans Affairs.
                            (iii) A description of budgetary resources 
                        or other support, if any, required to 
                        accommodate an increase in staffing at medical 
                        facilities of the Department of Veterans 
                        Affairs pursuant to the requirements of the 
                        staffing model described in subparagraph (A).
                            (iv) Such other matters as the Secretary of 
                        Veterans Affairs determines appropriate.

SEC. 124. COORDINATION WITH ASSISTANCE AND SUPPORT SERVICES FOR 
              CAREGIVERS.

    (a) Coordination With Program of Comprehensive Assistance for 
Family Caregivers.--
            (1) Coordination.--Section 1720G(a) of title 38, United 
        States Code, is amended by adding at the end the following new 
        paragraph:
    ``(14)(A) In the case of a veteran or caregiver who seeks services 
under this subsection and is denied such services, or a veteran or the 
family caregiver of a veteran who is discharged from the program under 
this subsection, the Secretary shall--
            ``(i) if the veteran meets the requirements of a covered 
        veteran under subsection (b), provide to such caregiver the 
        option of enrolling in the program of general caregiver support 
        services under such subsection;
            ``(ii) assess the veteran or caregiver for participation in 
        any other available program of the Department for home- and 
        community-based services (including the programs specified in 
        section 1720L of this title) for which the veteran or caregiver 
        may be eligible and, with respect to the veteran, store (and 
        make accessible to the veteran) the results of such assessment 
        in the electronic medical record of the veteran; and
            ``(iii) provide to the veteran or caregiver written 
        information on any such program identified pursuant to the 
        assessment under clause (ii), including information about 
        facilities, eligibility requirements, and relevant contact 
        information for each such program.
    ``(B) The Secretary shall, to the extent practicable, provide to a 
veteran or family caregiver the option of obtaining clinically 
appropriate services under any other available program of the 
Department for home- and community-based services (including the 
programs specified in section 1720L of this title) for which the 
veteran or family caregiver may be eligible prior to discharging the 
veteran or family caregiver from the program under this subsection.
    ``(C) For each veteran or family caregiver who is discharged from 
the program under this subsection, a caregiver support coordinator 
shall provide for a smooth and personalized transition from such 
program to an appropriate program of the Department for home- and 
community-based services (including the programs specified in section 
1720L of this title), including by integrating caregiver support across 
programs.''.
            (2) Applicability.--The amendments made by paragraph (1) 
        shall apply with respect to denials and discharges occurring on 
        or after the date that is 180 days after the date of the 
        enactment of this Act.
            (3) Technical and conforming amendments.--Section 1720G(d) 
        of such title is amended--
                    (A) by striking ``or a covered veteran'' each place 
                it appears and inserting ``, a veteran denied or 
                discharged as specified in paragraph (14) of such 
                subsection, or a covered veteran''; and
                    (B) by striking ``under subsection (a), means'' 
                each place it appears and inserting ``under subsection 
                (a) or a veteran denied or discharged as specified in 
                paragraph (14) of such subsection, means''.
    (b) Conformity of Respite Care Across Programs.--Section 1720G of 
title 38, United States Code, as amended by subsection (a)(3), is 
further amended--
            (1) in subsection (a)(3)--
                    (A) by amending subparagraph (A)(ii)(III) to read 
                as follows:
                    ``(III) covered respite care of not less than 30 
                days annually;''; and
                    (B) by striking subparagraph (B) and redesignating 
                subparagraphs (C) and (D) as subparagraphs (B) through 
                (C), respectively; and
            (2) by amending subsection (b)(3)(A)(iii) to read as 
        follows:
            ``(iii) Covered respite care of not less than 30 days 
        annually.''; and
            (3) in subsection (d)--
                    (A) by redesignating paragraphs (2) through (4) as 
                paragraphs (3) through (5), respectively; and
                    (B) by inserting after paragraph (1) the following 
                new paragraph:
            ``(2) The term `covered respite care' means, with respect 
        to a caregiver of a veteran, respite care under section 1720B 
        of this title that--
                    ``(A) is medically and age appropriate for the 
                veteran (including 24-hour per day care of the veteran 
                commensurate with the care provided by the caregiver); 
                and
                    ``(B) includes in-home care.''.
    (c) Review Relating to Caregiver Contact.--The Secretary shall 
conduct a review of the capacity of the Department to establish a 
streamlined system for contacting all caregivers enrolled in the 
program of general caregiver support services under section 1720G(b) of 
title 38, United States Code, to provide to such caregivers program 
updates and alerts relating to emerging services for which such 
caregivers or the veterans for which they provide care may be eligible.

SEC. 125. IMPROVEMENTS TO PROGRAM OF COMPREHENSIVE ASSISTANCE FOR 
              FAMILY CAREGIVERS.

    Section 1720G(a) of title 38, United States Code, as amended by 
section 124, is further amended--
            (1) in paragraph (12)--
                    (A) in subparagraph (A), by inserting ``, which 
                shall include all criteria used to determine 
                eligibility for such assistance and, in the case of a 
                completed evaluation, how such criteria were used to 
                evaluate information provided in assessments to 
                determine such eligibility'' before the period at the 
                end; and
                    (B) in subparagraph (C)(i), by striking ``who 
                submits'' and all that follows through the end of the 
                clause and inserting the following: ``who--
                    ``(I) submits an application for the program 
                established under paragraph (1); or
                    ``(II) is being reassessed for eligibility to 
                continue in such program.''; and
            (2) by adding at the end the following new paragraph:
    ``(15)(A) Not less frequently than annually, the Secretary shall 
submit to the Committees on Veterans' Affairs of the Senate and the 
House of Representatives a comprehensive report on the program required 
by paragraph (1) that includes, with respect to the one-year period 
preceding the date of the submission of such report, the following:
            ``(i) The number of applications received for such program.
            ``(ii) The number, disaggregated by race, sex, and era and 
        branch of service in the Armed Forces of the applicant, of--
                    ``(I) approvals of such applications; and
                    ``(II) denials of such applications.
            ``(iii) The number of reassessments conducted for such 
        program.
            ``(iv) An identification of each decision made with respect 
        to a reassessment conducted for such program, disaggregated by 
        decisions resulting in--
                    ``(I) disenrollment, including removal, discharge, 
                or voluntary withdrawal;
                    ``(II) tier reduction; and
                    ``(III) tier continuation.
            ``(v) The number of appeals of decisions made with respect 
        to such program, disaggregated by type of appeal.
            ``(vi) With respect to each appeal described in clause (v), 
        the decision rendered, if any.
            ``(vii) A description of all tools used in assessments 
        conducted for such program, including an explanation of how and 
        by whom such tools are administered.
            ``(viii) A description of procedures used under such 
        program for reviewing and integrating clinical records from 
        health care providers that includes an explanation of how such 
        records are used in determinations of eligibility for such 
        program.
            ``(ix) A description of procedures available under such 
        program for health care providers to communicate medical 
        opinions to the teams conducting assessments to determine 
        eligibility for such program, including health care providers 
        in the private sector and health care providers specified in 
        subsection (c) of section 1703 of this title.
            ``(x) A description of information technology systems and 
        processes used under such program to upload and integrate all 
        clinical records from all non-Department providers, including 
        providers in the private sector and providers under the 
        Veterans Community Care Program established under such section.
    ``(B) The Secretary shall ensure that all data included in a report 
under subparagraph (A)--
            ``(i) relating to a decision made under the program 
        required by paragraph (1), are disaggregated by the specific 
        reason for the decision;
            ``(ii) relating to a veteran, include comprehensive 
        demographic information of the veteran, including the time 
        period of the injuries, if any, of the veteran and the Veterans 
        Integrated Service Network in which the veteran is located; and
            ``(iii) with respect to eligibility determinations relating 
        to a serious injury of a veteran, specify--
                    ``(I) how many such determinations relate to the 
                ability of the veteran to perform activities of daily 
                living; and
                    ``(II) how many such determinations relate to the 
                need of a veteran for supervision and protection.
    ``(C) The Secretary shall provide the data under paragraph (B) 
pursuant to Federal laws and in a manner that is wholly consistent with 
applicable Federal privacy and confidentiality laws, including the 
Privacy Act (5 U.S.C. 552a), the Health Insurance Portability and 
Accountability Act (Public Law 104-191; 42 U.S.C. 201 note) and 
regulations (title 45, Code of Federal Regulations, parts 160 and 164, 
or successor regulations), and sections 5701, 5705, and 7332 of this 
title to ensure that the provided data, or some portion of the data, 
will not undermine the anonymity of a veteran.''.

SEC. 126. IMPROVEMENTS RELATING TO HOMEMAKER AND HOME HEALTH AIDE 
              PROGRAM.

    (a) Pilot Program for Communities With Shortage of Home Health 
Aides.--
            (1) Program.--Beginning not later than 18 months after the 
        date of the enactment of this Act, the Secretary shall carry 
        out a three-year pilot program under which the Secretary shall 
        provide homemaker and home health aide services to veterans who 
        reside in communities with a shortage of home health aides.
            (2) Locations.--The Secretary shall select not fewer than 
        five geographic locations in which the Secretary determines 
        there is a shortage of home health aides at which to carry out 
        the pilot program under paragraph (1).
            (3) Nursing assistants.--
                    (A) In general.--In carrying out the pilot program 
                under paragraph (1), the Secretary may hire nursing 
                assistants as new employees of the Department of 
                Veterans Affairs, or reassign nursing assistants who 
                are existing employees of the Department, to provide to 
                veterans in-home care services (including basic tasks 
                authorized by the State certification of the nursing 
                assistant) under the pilot program, in lieu of or in 
                addition to the provision of such services through non-
                Department home health aides.
                    (B) Relationship to home-based primary care 
                program.--Nursing assistants hired or reassigned under 
                subparagraph (A) may provide services to a veteran 
                under the pilot program under paragraph (1) while 
                serving as part of a health care team for the veteran 
                under the Home-Based Primary Care program.
            (4) Report to congress.--Not later than one year before the 
        date of the termination of the pilot program under paragraph 
        (1), the Secretary shall submit to the Committees on Veterans' 
        Affairs of the House of Representatives and the Senate a report 
        that includes--
                    (A) a statement of the results of such pilot 
                program; and
                    (B) an assessment of the feasibility and 
                advisability of--
                            (i) extending such pilot program; or
                            (ii) making such pilot program a permanent 
                        program of the Department of Veterans Affairs.
    (b) Report on Use of Funds.--Not later than one year after the date 
of the enactment of this Act, the Secretary of Veterans Affairs shall 
submit to the Committees on Veterans' Affairs of the House of 
Representatives and the Senate a report containing, with respect to the 
period beginning in fiscal year 2012 and ending in fiscal year 2024, 
the following:
            (1) An identification of the amount of funds that were 
        included in a budget of the Department of Veterans Affairs 
        during such period for the provision of in-home care to 
        veterans under the Homemaker and Home Health Aide program but 
        were not expended for such provision, disaggregated by medical 
        center of the Department for which such unexpended funds were 
        budgeted (if such disaggregation is possible).
            (2) To the extent practicable, an identification of the 
        number of veterans for whom, during such period, the hours 
        during which a home health aide was authorized to provide 
        services to the veteran under the Homemaker and Home Health 
        Aide program were reduced for a reason other than a change in 
        the health care needs of the veteran, and a detailed 
        description of the reasons why any such reductions may have 
        occurred.
    (c) Updated Guidance on Program.--Not later than one year after the 
date of the enactment of this Act, the Secretary shall issue updated 
guidance for the Homemaker and Home Health Aide program. Such updated 
guidance shall include the following:
            (1) A process for the transition of veterans from the 
        Homemaker and Home Health Aide program to other covered 
        programs.
            (2) A requirement for the directors of the medical 
        facilities of the Department to complete such process whenever 
        a veteran with care needs has been denied services from home 
        health agencies under the Homemaker and Home Health Aide 
        program as a result of the clinical needs or behavioral issues 
        of the veteran.

SEC. 127. PILOT PROGRAM TO FURNISH ASSISTED LIVING SERVICES TO CERTAIN 
              VETERANS.

    (a) Establishment.--Beginning not later than two years after the 
date of the enactment of this Act, the Secretary of Veterans Affairs 
shall carry out a pilot program to assess--
            (1) the effectiveness of providing assisted living services 
        to eligible veterans, at the election of such veterans; and
            (2) the satisfaction with the pilot program of veterans 
        participating in such pilot program.
    (b) Program Locations.--
            (1) Veterans integrated service networks.--The Secretary 
        shall select two Veterans Integrated Service Networks of the 
        Department of Veterans Affairs at which to carry out the pilot 
        program under subsection (a).
            (2) Facilities.--
                    (A) In general.--Within the Veterans Integrated 
                Service Networks selected under paragraph (1), the 
                Secretary shall select facilities at which to carry out 
                the pilot program under subsection (a)(1).
                    (B) Selection criteria.--In selecting facilities 
                under subparagraph (A) at which to carry out the pilot 
                program under subsection (a)(1), the Secretary shall 
                ensure that--
                            (i) the locations of such facilities are in 
                        geographically diverse areas;
                            (ii) not fewer than one such facility 
                        serves veterans in rural or highly rural areas 
                        (as determined through the use of the Rural-
                        Urban Commuting Areas coding system of the 
                        Department of Agriculture);
                            (iii) not fewer than one such facility is 
                        located in each Veterans Integrated Service 
                        Network selected under paragraph (1); and
                            (iv) not fewer than one such facility is a 
                        State home.
    (c) Program Participants.--Not more than 60 eligible veterans may 
participate in the pilot program under subsection (a)(1) in each 
Veterans Integrated Service Network selected under subsection (b)(1).
    (d) Provision of Assisted Living Services.--
            (1) Agreements.--In carrying out the pilot program under 
        subsection (a)(1), the Secretary may enter into agreements for 
        the provision of assisted living services on behalf of eligible 
        veterans with--
                    (A) a provider participating under a State plan or 
                waiver under title XIX of the Social Security Act (42 
                U.S.C. 1396 et seq.); or
                    (B) a State home recognized and certified under 
                subpart B of part 51 of title 38, Code of Federal 
                Regulations, or successor regulations.
            (2) Standards.--The Secretary may not place, transfer, or 
        admit a veteran to any facility for assisted living services 
        under the pilot program under subsection (a)(1) unless the 
        Secretary determines that--
                    (A) the facility meets the standards for community 
                residential care established under sections 17.61 
                through 17.72 of title 38, Code of Federal Regulations, 
                or successor regulations, and any additional standards 
                of care as the Secretary may specify; or
                    (B) in the case of a facility that is a State home, 
                the State home meets such standards of care as the 
                Secretary may specify.
            (3) Inspection.--The Secretary shall inspect facilities at 
        which veterans are placed under the pilot program under 
        subsection (a)(1)--
                    (A) with respect to a facility that is a State 
                home, not less frequently than annually and in the same 
                manner as the Secretary conducts inspection of State 
                homes under section 1742 of title 38, United States 
                Code; and
                    (B) with respect to any other facility, not less 
                frequently than annually and in the same manner as the 
                Secretary conducts inspection of facilities under 
                section 1730 of such title.
            (4) Payment to certain facilities.--
                    (A) State homes.--In the case of a facility 
                participating in the pilot program under subsection 
                (a)(1) that is a State home, the Secretary shall pay to 
                the State home a per diem for each veteran 
                participating in the pilot program at a rate agreed to 
                by the Secretary and the State home.
                    (B) Community assisted living facilities.--In the 
                case of a facility participating in the pilot program 
                under subsection (a)(1) that is a community assisted 
                living facility, the Secretary shall--
                            (i) pay to the facility an amount that is 
                        less than the average rate paid by the 
                        Department for placement in a community nursing 
                        home in the same Veterans Integrated Service 
                        Network; and
                            (ii) re-evaluate payment rates annually to 
                        account for current economic conditions and 
                        current costs of assisted living services.
    (e) Continuity of Care.--Upon the termination of the pilot program 
under subsection (a)(1), the Secretary shall--
            (1) provide to all veterans participating in the pilot 
        program at the time of such termination the option to continue 
        to receive assisted living services at the site they were 
        assigned to under the pilot program, at the expense of the 
        Department; and
            (2) for such veterans who do not opt to continue to receive 
        such services--
                    (A) ensure such veterans do not experience lapses 
                in care; and
                    (B) provide such veterans with information on, and 
                furnish such veterans with, other extended care 
                services based on their preferences and best medical 
                interest.
    (f) Determination of Quality.--The Secretary shall determine a 
method for assessment of quality of care provided to veterans 
participating in the pilot program under subsection (a)(1) and shall 
communicate that method to providers of services under the pilot 
program.
    (g) Annual Report.--Not later than one year after the initiation of 
the pilot program under subsection (a)(1), and annually thereafter for 
the duration of such pilot program, the Secretary shall submit to the 
Committees on Veterans' Affairs of the House of Representatives and the 
Senate a report on the pilot program that includes--
            (1) an identification of Veterans Integrated Services 
        Networks and facilities of the Department participating in the 
        pilot program and assisted living facilities and State homes at 
        which veterans are placed under the pilot program;
            (2) the number of participants in the pilot program, 
        disaggregated by facility;
            (3) general demographic information of participants in the 
        pilot program, including average age, sex, and race or 
        ethnicity;
            (4) disability status of participants in the pilot program;
            (5) an identification of any barriers or challenges to 
        furnishing care to veterans under the pilot program, conducting 
        oversight of the pilot program, or any other barriers or 
        challenges;
            (6) the cost of care at each assisted living facility and 
        State home participating in the pilot program, including an 
        analysis of any cost savings by the Department when comparing 
        that cost to the cost of nursing home care;
            (7) aggregated feedback from participants in the pilot 
        program, including from veteran resident surveys and 
        interviews; and
            (8) such other matters the Secretary considers appropriate.
    (h) Final Report.--Not later than one year after the pilot program 
terminates under subsection (j), the Secretary shall submit to the 
Committees on Veterans' Affairs of the House of Representatives and the 
Senate a report on the pilot program that--
            (1) includes the matters required under paragraphs (1) 
        through (8) of subsection (g);
            (2) includes recommendations on whether the model studied 
        in the pilot program should be continued or adopted throughout 
        the Department; and
            (3) indicates whether the Secretary requests action by 
        Congress to make the pilot program permanent.
    (i) Inspector General Report.--
            (1) In general.--Not later than three years after the 
        initiation of the pilot program under subsection (a)(1), the 
        Inspector General of the Department of Veterans Affairs shall 
        submit to the Secretary of Veterans Affairs and the Committees 
        on Veterans' Affairs of House of Representatives and the Senate 
        a report on the pilot program.
            (2) Elements.--The report required by paragraph (1) shall 
        include an assessment of--
                    (A) the quality of care provided to veterans at 
                facilities participating in the pilot program, measured 
                pursuant to the method determined under subsection (f);
                    (B) the oversight of such facilities, as conducted 
                by the Department, the Centers for Medicare & Medicaid 
                Services, State agencies, and other relevant entities; 
                and
                    (C) such other matters as the Inspector General 
                considers appropriate.
            (3) Plan required.--Not later than 90 days after the 
        submission of the report under paragraph (1), the Secretary 
        shall submit to the Committees on Veterans' Affairs of the 
        House of Representatives and the Senate a plan to address the 
        deficiencies identified in the report, if any.
    (j) Termination.--
            (1) In general.--Subject to paragraph (2), the pilot 
        program under subsection (a)(1) shall terminate on September 
        30, 2028.
            (2) Extension.--The Secretary may extend the duration of 
        the pilot program for an additional two-year period if the 
        Secretary, based on the results of the reports submitted under 
        subsection (g), determines such an extension is appropriate.
    (k) Definitions.--In this section:
            (1) The term ``assisted living services'' means services of 
        a facility in providing room, board, and personal care for and 
        supervision of residents for their health, safety, and welfare.
            (2) The term ``eligible veteran'' means a veteran who is--
                    (A) receiving nursing home care paid for by the 
                Department of Veterans Affairs, eligible to receive 
                such care pursuant to section 1710A of title 38, United 
                States Code, or requires a higher level of care than 
                the domiciliary care provided by the Department of 
                Veterans Affairs, but does not meet the requirements 
                for nursing home level care provided by the Department 
                pursuant to such section; and
                    (B) eligible for assisted living services, as 
                determined by the Secretary or meets such additional 
                criteria for eligibility for the pilot program under 
                subsection (a)(1) as the Secretary may establish.
            (3) The term ``State home'' has the meaning given that term 
        in section 101 of title 38, United States Code.

SEC. 128. PROVISION OF MEDICINE, EQUIPMENT, AND SUPPLIES AVAILABLE TO 
              DEPARTMENT OF VETERANS AFFAIRS TO STATE HOMES.

    (a) Provision Authorized.--The Secretary of Veterans Affairs may 
provide to State homes medicine, personal protective equipment, medical 
supplies, and any other equipment, supplies, and assistance available 
to the Department of Veterans Affairs.
    (b) Definition.--In this section:
            (1) The term ``personal protective equipment'' means any 
        protective equipment required to prevent the wearer from 
        contracting an infectious disease, including gloves, N-95 
        respirator masks, gowns, goggles, face shields, or other 
        equipment required for safety.
            (2) The term ``State home'' has the meaning given such term 
        in section 101 of title 38, United States Code.

SEC. 129. RECOGNITION OF ORGANIZATIONS AND INDIVIDUALS TO ASSIST 
              VETERANS, FAMILY MEMBERS, AND CAREGIVERS NAVIGATING 
              PROGRAMS AND SERVICES OF VETERANS HEALTH ADMINISTRATION.

    (a) In General.--Not later than one year after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall 
establish a process through which the Department of Veterans Affairs 
may recognize organizations and individuals to assist a veteran, a 
family member of a veteran, or a caregiver of a veteran (as defined in 
section 1720G(d) of title 38, United States Code) in navigating the 
programs and services of the Veterans Health Administration.
    (b) Solicitation of Feedback.--The Secretary shall solicit feedback 
and recommendations in the creation of the process under subsection (a) 
from such organizations as the Secretary may consider relevant.
    (c) Limitation.--The Secretary may not recognize an organization or 
individual pursuant to the process established under subsection (a) 
unless the organization or individual has certified to the Secretary 
that no fee or compensation of any nature will be charged to any 
individual for services rendered in providing assistance pursuant to 
such subsection.

SEC. 130. REVIEWS AND OTHER IMPROVEMENTS RELATING TO HOME- AND 
              COMMUNITY-BASED SERVICES.

    (a) Office of Geriatric and Extended Care.--
            (1) Review of programs.--The Under Secretary for Health of 
        the Department of Veterans Affairs shall conduct a review of 
        each program administered through the Office of Geriatric and 
        Extended Care of the Department and the Caregiver Support 
        Program Office of the Department, or any successor offices, 
        to--
                    (A) eliminate service gaps at the medical center 
                level; and
                    (B) ensure--
                            (i) the clinical needs of veterans are met;
                            (ii) consistency in program management;
                            (iii) the availability of, and the access 
                        by veterans to, home- and community-based 
                        services, including for veterans living in 
                        rural areas; and
                            (iv) proper coordination between covered 
                        programs.
            (2) Assessment of staffing needs.--The Secretary of 
        Veterans Affairs shall conduct an assessment of the staffing 
        needs of the Office of Geriatric and Extended Care of the 
        Department and the Caregiver Support Program Office of the 
        Department, or any successor offices.
            (3) Goals for geographic alignment of care.--
                    (A) Establishment of goals.--The Director of the 
                Office of Geriatric and Extended Care, or successor 
                office, shall establish quantitative goals to enable 
                aging or disabled veterans who are not located near 
                medical centers of the Department to access extended 
                care services (including by improving access to home- 
                and community-based services for such veterans).
                    (B) Implementation timeline.--Each goal established 
                under subparagraph (A) shall include a timeline for the 
                implementation of the goal at each medical center of 
                the Department.
            (4) Goals for in-home specialty care.--The Director of the 
        Office of Geriatric and Extended Care, or successor office, 
        shall establish quantitative goals to address the specialty 
        care needs of veterans through in-home care, including by 
        ensuring the education of home health aides and caregivers of 
        veterans in the following areas:
                    (A) Dementia care.
                    (B) Care for spinal cord injuries and diseases.
                    (C) Ventilator care.
                    (D) Other speciality care areas as determined by 
                the Secretary.
            (5) Input on goals.--To the extent practicable, the head of 
        the Caregiver Support Program Office, or successor office, 
        shall provide to the Director of the Office of Geriatric and 
        Extended Care, or successor office, input with respect to the 
        establishment of the goals under paragraphs (3) and (4).
            (6) Report to congress.--Not later than one year after the 
        date of the enactment of this Act, the Secretary shall submit 
        to the Committees on Veterans' Affairs of the House of 
        Representatives and the Senate a report containing the findings 
        of the review under paragraph (1), the results of the 
        assessment under paragraph (2), and the goals established under 
        paragraphs (3) and (4).
    (b) Review of Incentives and Efforts Relating to Home- and 
Community-based Services.--
            (1) Review.--The Secretary of Veterans Affairs shall 
        conduct a review of the following:
                    (A) The financial and organizational incentives or 
                disincentives for the directors of medical centers of 
                the Department to establish or expand covered programs 
                at such medical centers.
                    (B) Any incentives or disincentives for such 
                directors to provide to veterans home- and community-
                based services in lieu of institutional care.
                    (C) The efforts taken by the Secretary to enhance 
                spending of the Department for extended care by 
                balancing spending between institutional care and home- 
                and community-based services consistent with the demand 
                for such services.
                    (D) The plan of the Under Secretary for Health of 
                the Department to accelerate efforts to enhance 
                spending as specified in subparagraph (C), to match the 
                progress of similar efforts taken by the Administrator 
                of the Centers for Medicare & Medicaid Services with 
                respect to spending of the Centers for Medicare & 
                Medicaid Services for extended care.
            (2) Report to congress.--Not later than one year after the 
        date of the enactment of this Act, the Secretary shall submit 
        to the Committees on Veterans' Affairs of the House of 
        Representatives and the Senate a report on the findings of the 
        review under paragraph (1).
    (c) Review of Respite Care Services.--Not later than two years 
after the date of the enactment of this Act, the Secretary of Veterans 
Affairs shall conduct a review of the use, availability, cost, and 
effectiveness, of the respite care services furnished by the Secretary 
under chapter 17 of title 38, United States Code, including--
            (1) the frequency at which the Department of Veterans 
        Affairs is unable to meet demand for such services;
            (2) a detailed description of--
                    (A) the reasons the Department of Veterans Affairs 
                is unable to meet the demand for such services; and
                    (B) any actions, or planned actions, of the 
                Secretary of Veterans Affairs to ensure such demand is 
                met.
    (d) Collaboration to Improve Home- and Community-based Services.--
            (1) Recommendations.--
                    (A) Development.--The Secretary of Veterans Affairs 
                shall develop recommendations as follows:
                            (i) With respect to home- and community-
                        based services for veterans, the Secretary of 
                        Veterans Affairs shall develop recommendations 
                        regarding new services (in addition to those 
                        furnished as of the date of enactment of this 
                        Act) in collaboration with the Secretary of 
                        Health and Human Services.
                            (ii) With respect to the national shortage 
                        of home health aides, the Secretary of Veterans 
                        Affairs shall develop recommendations regarding 
                        methods to address such shortage in 
                        collaboration with the Secretary of Health and 
                        Human Services and the Secretary of Labor.
                    (B) Submission to congress.--The Secretary of 
                Veterans Affairs shall submit to the Committees on 
                Veterans' Affairs of the House of Representatives and 
                the Senate a report containing the recommendations 
                developed under subparagraph (A) and an identification 
                of any changes in existing law or new statutory 
                authority necessary to implement the recommendations, 
                as determined by the Secretary.
                    (C) Consultation with secretary of labor.--In 
                carrying out this paragraph, the Secretary of Veterans 
                Affairs shall consult with the Secretary of Labor.
            (2) Feedback and recommendations on caregiver support.--
                    (A) Feedback and recommendations.--The Secretary of 
                Veterans Affairs shall solicit from the entities 
                described in subparagraph (B) feedback and 
                recommendations regarding opportunities for the 
                Secretary to enhance home- and community-based services 
                for veterans and the caregivers of veterans, including 
                through the potential provision by the entity of care 
                and respite services to veterans and caregivers who may 
                not be eligible for any program under section 1720G of 
                title 38, United States Code, or section 1720L of such 
                title (as added by section 123), but have a need for 
                assistance.
                    (B) Covered entities.--The entities described in 
                this subparagraph are veterans service organizations 
                and nonprofit organizations with a focus on caregiver 
                support or long term care (as determined by the 
                Secretary).
            (3) Collaboration for certain veterans.--The Secretary of 
        Veterans Affairs shall collaborate with the Director of the 
        Indian Health Service and representatives from tribal health 
        programs and Urban Indian organizations to ensure the 
        availability of home- and community-based services for--
                    (A) Native American veterans, including Native 
                American veterans receiving health care and medical 
                services under multiple health care systems; and
                    (B) Native Hawaiian veterans, including Native 
                Hawaiian veterans receiving health care and medical 
                services under the Native Hawaiian health care system.

SEC. 131. GAO REPORT ON MENTAL HEALTH SUPPORT FOR CAREGIVERS.

    (a) Report Required.--Not later than one year after the date of the 
enactment of this Act, the Comptroller General of the United States 
shall submit to the Committee on Veterans' Affairs of the Senate and 
the Committee on Veterans' Affairs of the House of Representatives a 
report on the provision of mental health support to caregivers of 
veterans.
    (b) Contents.--The report submitted under subsection (a) shall 
include the following:
            (1) An assessment of the need for mental health support 
        among caregivers participating in the caregiver programs.
            (2) An assessment of options for mental health support in 
        facilities of the Department of Veterans Affairs and in the 
        community for caregivers participating in the caregiver 
        programs.
            (3) An assessment of the availability and accessibility of 
        mental health support in facilities of the Department and in 
        the community for caregivers participating in the caregiver 
        programs.
            (4) An assessment of the awareness among caregivers of the 
        availability of mental health support in facilities of the 
        Department and in the community for caregivers participating in 
        the caregiver programs.
            (5) An assessment of barriers to mental health support in 
        facilities of the Department and in the community for 
        caregivers participating in the caregiver programs.
    (c) Definitions.--In this section:
            (1) The term ``caregiver'' has the meaning given that term 
        in section 1720G of title 38, United States Code.
            (2) The term ``caregiver programs'' means--
                    (A) the program of comprehensive assistance for 
                family caregivers under subsection (a) of section 1720G 
                of title 38, United States Code; and
                    (B) the program of support services for caregivers 
                under subsection (b) of such section.

SEC. 132. DEVELOPMENT OF CENTRALIZED WEBSITE FOR PROGRAM INFORMATION.

    (a) Centralized Website.--The Secretary shall develop and maintain 
a centralized and publically accessible internet website of the 
Department as a clearinghouse for information and resources relating to 
covered programs.
    (b) Contents.--The website under subsection (a) shall contain the 
following:
            (1) A description of each covered program.
            (2) An informational assessment tool that--
                    (A) explains the administrative eligibility, if 
                applicable, of a veteran, or a caregiver of a veteran, 
                for any covered program; and
                    (B) provides information, as a result of such 
                explanation, on any covered program for which the 
                veteran or caregiver (as the case may be) may be 
                eligible.
            (3) A list of required procedures for the directors of the 
        medical facilities of the Department to follow in determining 
        the eligibility and suitability of veterans for participation 
        in a covered program, including procedures applicable to 
        instances in which the resource constraints of a facility (or 
        of a community in which a facility is located) may result in 
        the inability to address the health needs of a veteran under a 
        covered program in a timely manner.
    (c) Updates.--The Secretary shall ensure the website under 
subsection (a) is updated on a periodic basis.

SEC. 133. DEFINITIONS.

    In this subtitle:
            (1) The terms ``caregiver'' and ``family caregiver'' have 
        the meanings given those terms under section 1720L(h) of title 
        38, United States Code (as added by section 123).
            (2) The term ``covered program''--
                    (A) means any program of the Department of Veterans 
                Affairs for home- and community-based services; and
                    (B) includes the programs specified in section 
                1720L of title 38, United States Code (as added by 
                section 123).
            (3) The term ``home- and community-based services''--
                    (A) means the services referred to in section 
                1701(6)(E) of title 38, United States Code; and
                    (B) includes services furnished under a program 
                specified in section 1720L of such title (as added by 
                section 123).
            (4) The terms ``Home-Based Primary Care program'', 
        ``Homemaker and Home Health Aide program'', and ``Veteran-
        Directed Care program'' mean the programs of the Department of 
        Veterans Affairs specified in subsection (d), (c), and (b) of 
        such section 1720L, respectively.
            (5) The terms ``home health aide'', ``Native American'', 
        ``Native American veteran'', ``tribal health programs'', and 
        ``Urban Indian organizations'' have the meanings given those 
        terms in subsection (h) of such section 1720L.
            (6) The term ``veterans service organization'' means any 
        organization recognized by the Secretary under section 5902 of 
        such title.

            Subtitle C--Medical Treatment and Other Matters

SEC. 140. QUARTERLY REPORT ON REFERRALS FOR NON-DEPARTMENT OF VETERANS 
              AFFAIRS HEALTH CARE.

    (a) In General.--Subchapter I of chapter 17 of title 38, United 
States Code, is amended by inserting after section 1703F the following 
new section (and amending the table of sections at the beginning of 
such chapter accordingly):
``Sec. 1703G. Quarterly report on referrals for non-Department health 
              care
    ``The Secretary shall submit to the Committees on Veterans' Affairs 
of the Senate and the House of Representatives a quarterly report 
containing, with respect to referrals for non-Department health care 
originating from a medical facility of the Department during the 
quarter preceding the date of the submission of the report, a 
measurement of, for each such medical facility--
            ``(1) the period of time between--
                    ``(A) the date on which a clinician employed by the 
                Department determines that a veteran requires care, or 
                a veteran presents to the Department requesting care, 
                and the date on which the referral for care is sent to 
                a non-Department health care provider;
                    ``(B) the date on which such referral is sent to a 
                non-Department health care provider and the date on 
                which such non-Department health care provider accepts 
                such referral;
                    ``(C) the date on which such non-Department health 
                care provider accepts such referral and the date on 
                which such referral is completed;
                    ``(D) the date on which such referral is completed 
                and the date on which an appointment with a non-
                Department health care provider is made; and
                    ``(E) the date on which such an appointment is made 
                and the date on which such appointment occurs; and
            ``(2) any other period of time that the Secretary 
        determines necessary.''.
    (b) Effective Date.--The first report under section 1703G, as added 
by this section, shall be due not later than 180 days after the date of 
the enactment of this section.

SEC. 141. ELIMINATION OF CERTAIN REQUIREMENTS FOR CERTAIN DEPARTMENT OF 
              VETERANS AFFAIRS ASSISTANT UNDER SECRETARIES.

    Section 7306 of title 38, United States Code, is amended--
            (1) by striking subsection (b);
            (2) by redesignating subsections (c) through (g) as 
        subsections (b) through (f), respectively; and
            (3) in subsection (c) (as so redesignated), by striking 
        ``subsection (e)'' and inserting ``subsection (d)''.

SEC. 142. MODIFICATION OF PAY LIMITATION FOR PHYSICIANS, PODIATRISTS, 
              OPTOMETRISTS, AND DENTISTS OF DEPARTMENT OF VETERANS 
              AFFAIRS.

    (a) Pay.--
            (1) In general.--Section 7431 of title 38, United States 
        Code, is amended--
                    (A) by inserting ``optometrists,'' after 
                ``podiatrists,'' each place it appears;
                    (B) by inserting ``optometrist'' after 
                ``podiatrist,'' each place it appears;
                    (C) in subsection (c)--
                            (i) in paragraph (5), by adding at the end 
                        the following new sentence: ``Such a notice 
                        shall include a statement of whether the market 
                        pay will increase, decrease, or remain 
                        unchanged following such evaluation.''; and
                            (ii) by adding at the end the following new 
                        paragraphs:
            ``(7) The Secretary shall ensure that each physician, 
        podiatrist, optometrist, and dentist in the Veterans Health 
        Administration is--
                    ``(A) advised, on an annual basis, of the criteria 
                described in subparagraph (F) of paragraph (4);
                    ``(B) evaluated in accordance with such criteria; 
                and
                    ``(C) compensated in accordance with--
                            ``(i) applicable assignment and pay levels, 
                        subject to relevant pay limitations; and
                            ``(ii) the extent to which such criteria 
                        are met.
            ``(8) Not later than 120 days after the end of each fiscal 
        year, the Secretary shall submit to the Committees on Veterans' 
        Affairs of the Senate and the House of Representatives a report 
        that includes the following:
                    ``(A) A list of each facility and specialty that 
                conducted an evaluation of pay during the period 
                covered by the report.
                    ``(B) For each evaluation described in subparagraph 
                (A)--
                            ``(i) a list of occupations for which pay 
                        was evaluated, disaggregated by medical 
                        specialty, number of authorized full-time 
                        employees, and onsite full-time employees as of 
                        the date of the evaluation;
                            ``(ii) the date such evaluation was 
                        completed;
                            ``(iii) whether a market pay adjustment was 
                        made following the evaluation per each 
                        occupation and specialty evaluated;
                            ``(iv) whether applicable employees were 
                        notified of such evaluation;
                            ``(v) whether local labor partners were 
                        notified of such evaluation; and
                            ``(vi) in the case of an evaluation that 
                        resulted in an adjustment of pay--
                                    ``(I) the date such adjustment--
                                            ``(aa) was implemented; and
                                            ``(bb) became effective; 
                                        and
                                    ``(II) the percentage of employees 
                                of each occupation and specialty for 
                                which pay was adjusted pursuant to such 
                                evaluation.
                    ``(C) A list of facilities of the Department that 
                have not conducted an evaluation of market pay, 
                pursuant to paragraph (5), during the 18-month-period 
                that precedes the date of the submission of such 
                report.''; and
                    (D) in subsection (e), by adding at the end the 
                following new paragraphs:
            ``(5) Notwithstanding any compensation or pay limitations 
        under this title or title 5, the Secretary may authorize the 
        Under Secretary for Health to pay physicians, podiatrists, 
        optometrists, and dentists--
                    ``(A) awards authorized under this title;
                    ``(B) advance payments, recruitment or relocation 
                bonuses, and retention allowances authorized under 
                section 7410(a) of this title or as otherwise provided 
                by law;
                    ``(C) incentives or bonuses under section 706 of 
                this title or as otherwise provided by law; and
                    ``(D) earnings from fee-basis appointments under 
                section 7405(a)(2) of this title.
            ``(6)(A) The Secretary may waive any pay limitation 
        described in this section (including tier limitations) that the 
        Secretary determines necessary for the recruitment or retention 
        of critical health care personnel whom the Secretary determines 
        would provide direct patient care.
            ``(B) Priority for such waivers shall be given for 
        positions, locations, and care provided through agreements that 
        are costly to the Department.
            ``(C) The Chief Human Capital Officer of the Department, 
        the Chief Financial Officer of the Department, and the Office 
        of the General Counsel of the Department shall review any 
        waiver issued under subparagraph (A).
            ``(D) During the period the authority under subparagraph 
        (A) is effective, the Secretary may not issue more than 300 
        waivers under such subparagraph.
            ``(E) The Secretary may prescribe requirements, 
        limitations, and other considerations for waivers under such 
        subparagraph.
            ``(F) Not later than 180 days after the date of the 
        enactment of the Senator Elizabeth Dole 21st Century Veterans 
        Healthcare and Benefits Improvement Act, and annually 
        thereafter, the Secretary shall submit to the Committees on 
        Veterans' Affairs of the Senate and the House of 
        Representatives a report that includes--
                    ``(i) any updates to the requirements, limitations, 
                and considerations prescribed under subparagraph (B) 
                during the period covered by the report;
                    ``(ii) a description of the findings of each 
                review, if any, conducted pursuant to subparagraph (C);
                    ``(iii) a description of each waiver under 
                subparagraph (A) in effect as of the date of the 
                submission of the report, including the--
                            ``(I) duty location, position, specialty, 
                        market and performance considerations for the 
                        waiver; and
                            ``(II) impact, if any, of the waiver on 
                        care furnished by the Department pursuant to an 
                        agreement regarding the geographic area; and
                    ``(iv) a list of any separation actions during the 
                period covered by the report with respect to a position 
                for which a waiver under subparagraph (A) is in effect.
            ``(G) The authority of the Secretary under subparagraph (A) 
        shall terminate on the last day of the third full fiscal year 
        following the date of the enactment of the Senator Elizabeth 
        Dole 21st Century Veterans Healthcare and Benefits Improvement 
        Act.''.
            (2) Report on waiver authority.--Not later than 180 days 
        after the date of the enactment of this Act, the Secretary of 
        Veterans Affairs shall submit to the Committees on Veterans' 
        Affairs of the Senate and the House of Representatives a report 
        that includes a description of the requirements, limitations, 
        and other considerations prescribed under section 7431(b)(6)(D) 
        of title 38, United States Code, as added by paragraph (1).
            (3) Conforming amendments.--
                    (A) Pay of under secretary for health.--Section 
                7432(b)(1) of such title is amended by inserting ``, 
                podiatrist, optometrist,'' after ``physician''.
                    (B) Administrative matters.--Section 7433 of such 
                title is amended by inserting ``optometrists,'' after 
                ``physicians,'' each place it appears.
                    (C) Competitive pay.--Section 7451(a)(2)(C) of such 
                title is amended by inserting ``optometrist,'' after 
                ``physician,''.
            (4) Clerical amendments.--
                    (A) Subchapter heading.--Subchapter III of chapter 
                74 of such title is amended in the heading by inserting 
                ``Optometrists,'' after ``PODIATRISTS,''.
                    (B) Table of sections.--The table of sections for 
                such chapter is amended by striking the item relating 
                to subchapter III and inserting the following:

       ``subchapter iii--pay for physicians and other health-care 
                              personnel''.

            (5) Applicability dates.--The amendments made by this 
        subsection shall apply to any pay period of the Department of 
        Veterans Affairs beginning on or after the date that is 180 
        days after the date of the enactment of this Act.
    (b) Modification and Clarification of Pay Grade for Optometrists.--
Section 7404 of title 38, United States Code, is amended--
            (1) in subsection (a)(2)(A), by striking ``podiatrists, and 
        dentists'' and inserting ``podiatrists, optometrists, and 
        dentists''; and
            (2) in subsection (b)--
                    (A) by striking ``podiatrist (dpm), and dentist'' 
                and inserting ``podiatrist (dpm), optometrist (od), and 
                dentist'';
                    (B) by striking ``clinical chiropractor and 
                optometrist schedule,'' and inserting ``clinical 
                chiropractor schedule''; and
                    (C) by inserting ``optometrist grade'' after 
                ``Podiatrist grade''.
    (c) Retroactive Authority for Compensation.--
            (1) In general.--The Secretary of Veterans Affairs may pay 
        retroactive compensation to a covered employee in an amount 
        that equals the amount of compensation that was authorized to 
        be paid to such covered employee during the period specified in 
        paragraph (2), but was deferred and paid to such employee in 
        the calendar year following the calender year in which such 
        compensation was authorized because the payment such 
        compensation would have exceeded an applicable cap on annual 
        compensation.
            (2) Period specified.--The period specified in this 
        paragraph is the period beginning on January 8, 2006, and 
        ending on December 31, 2017.
            (3) Exclusion.--Compensation authorized under this 
        subsection shall not be included in the calculation of any 
        aggregate limit on compensation for a covered employee for the 
        year in which it is paid.
            (4) Charging of compensation.--Compensation authorized 
        under this subsection shall be charged to the appropriate 
        medical care appropriation account of the Department of 
        Veterans Affairs for the fiscal year in which the work was 
        performed except as follows:
                    (A) In the case of an account that has closed 
                pursuant to section 1552 of title 31, United States 
                Code, the compensation shall be charged to a current 
                appropriation account in accordance with section 1553 
                of such title.
                    (B) In the case of an expired account that has not 
                closed, if charging the compensation to the expired 
                account would cause such account to have a negative 
                unliquidated or unexpended balance, the compensation 
                may be charged to a current appropriation account 
                available for the same purpose.
            (5) Definitions.--In this subsection:
                    (A) The term ``compensation'' means any pay, 
                including salary, awards, and incentives.
                    (B) The term ``covered employee'' means a 
                physician, podiatrist, or dentist subject to market pay 
                under section 7431 of title 38, United States Code.

SEC. 143. REIMBURSEMENT OF AMBULANCE COST FOR CARE FOR CERTAIN RURAL 
              VETERANS.

    (a) In General.--The Secretary of Veterans Affairs shall pay, or 
reimburse a covered veteran for, the cost of transporting the veteran 
by ambulance, including air ambulance, from a covered location to a 
provider of the Department of Veterans Affairs, a non-Department 
provider, or the nearest hospital that can meet the needs of the 
veteran (including a hospital that compacts with the Indian Health 
Service) for covered care.
    (b) Amount Covered.--The maximum cumulative amount covered under 
this section for a covered veteran is $46,000.
    (c) Sunset.--This section shall cease to be effective on September 
30, 2026.
    (d) Definitions.--In this section:
            (1) The term ``covered care'' means care for a veteran 
        eligible for care provided by the Department of Veterans 
        Affairs under title 38, United States Code, or any other law 
        administered by the Secretary of Veterans Affairs, even if the 
        care associated with the transport described in subsection (a) 
        is not authorized by the Department.
            (2) The term ``covered location'' means a location that 
        is--
                    (A) in a State that is 100 miles or more from the 
                nearest medical center of the Department of Veterans 
                Affairs; and
                    (B) in an area rated as a 10 or higher under the 
                rural-urban commuting areas coding system of the 
                Department of Agriculture.
            (3) The term ``covered veteran'' means a veteran who--
                    (A) has a service-connected disability rated by the 
                Secretary as between 0 and 30 percent disabling;
                    (B) is not eligible for payments or reimbursements 
                for beneficiary travel or other transportation under 
                the laws administered by the Secretary of Veterans 
                Affairs, other than under this section; and
                    (C) is not entitled to care or services under a 
                non-Department of Veterans Affairs health-plan 
                contract.
            (4) The term ``health-plan contract'' has the meaning given 
        that term in section 1725 of title 38, United States Code.
            (5) The term ``service-connected'' has the meaning given 
        that term in section 101 of such title.

SEC. 144. PILOT PROGRAM TO FURNISH DENTAL CARE FROM THE DEPARTMENT OF 
              VETERANS AFFAIRS TO CERTAIN VETERANS DIAGNOSED WITH 
              ISCHEMIC HEART DISEASE.

    (a) In General.--Beginning not later than one year after the date 
of the enactment of this Act, the Secretary of Veterans Affairs shall 
carry out a two-year pilot program (in this section referred to as the 
``pilot program'') under which the Secretary shall furnish covered care 
to covered veterans through means that include the use of community 
care.
    (b) Locations.--
            (1) In general.--The Secretary shall select not more than 
        four States in which to carry out the pilot program.
            (2) Selection criteria.--In selecting States under 
        paragraph (1), the Secretary shall prioritize States in which--
                    (A) the Department of Veterans Affairs serves a 
                high proportion, as determined by the Secretary, of 
                veterans residing in rural or highly rural areas (as 
                determined through the use of the Rural-Urban Commuting 
                Areas coding system of the Department of Agriculture);
                    (B) dental clinics operated by the Department of 
                Veterans Affairs currently utilize teledentistry;
                    (C) the Department of Veterans Affairs does not 
                currently operate a dental clinic; or
                    (D) the Secretary determines a large percentage of 
                veterans enrolled in the system of annual patient 
                enrollment of the Department of Veterans Affairs 
                established and operated under paragraphs (1) or (2) of 
                section 1705(a) of title 38, United States Code, visit 
                emergency rooms for dental emergencies at high rates.
    (c) Participation Limitation.--Participation in a pilot program 
established pursuant to this section shall be limited to a covered 
veteran who receives health care in a facility of the Department 
located in a State selected under subsection (b).
    (d) Use of Certain Methods to Provide Care.--
            (1) Mobile dental clinics.--In carrying out the pilot 
        program, the Secretary shall test the efficacy of mobile dental 
        clinics to service rural areas that do not have a population 
        base to warrant a full-time clinic but where there are covered 
        veterans in need of dental care.
            (2) Home-based dental care.--In carrying out the pilot 
        program, the Secretary shall test the efficacy of portable 
        dental care units to service rural veterans in their homes, as 
        the Secretary considers medically appropriate.
    (e) Administration.--
            (1) Community care network review.--
                    (A) In general.--Before commencing the pilot 
                program, the Secretary shall work with third party 
                administrators to conduct a review of dental providers 
                who are part of the community care network of the 
                Department in each State selected under subsection 
                (b)(1) to ensure--
                            (i) dental providers who are no longer 
                        accepting patients from the Department--
                                    (I) are not still listed as 
                                providers accepting referrals from the 
                                Department; and
                                    (II) are not sent referrals from 
                                the Department; and
                            (ii) dental providers participating in each 
                        such network are capable of receiving an influx 
                        of patients from the Department under the pilot 
                        program.
                    (B) Expansion of network.--If, pursuant to a review 
                under subparagraph (A), the Secretary determines the 
                community care network in a State selected under 
                subsection (b)(1) is not capable of receiving an influx 
                of patients under the pilot program, the Secretary 
                shall coordinate with the Third Party Administrator for 
                such State to ensure the dental provider network of 
                such community care network is sufficiently expanded 
                before the initiation of the pilot program.
            (2) Notice to covered veterans.--In carrying out the pilot 
        program, the Secretary shall inform all covered veterans in 
        States selected under subsection (b)(1) of the covered care 
        available under the pilot program.
            (3) Loss of eligibility.--Any veteran participating in the 
        pilot program who ceases to be a covered veteran shall be 
        removed from the pilot program on the date that is 90 days 
        after the Secretary determines the participant is no longer a 
        covered veteran.
            (4) Continuity of care.--
                    (A) In general.--Upon the termination of the pilot 
                program, the Secretary shall provide to all veterans 
                participating in the pilot program at the time of such 
                termination--
                            (i) information on how to enroll in the 
                        dental insurance plan of the Department of 
                        Veterans Affairs under section 1712C of title 
                        38, United States Code;
                            (ii) if appropriate, information on the 
                        VETSmile program of the Department of Veterans 
                        Affairs, or any successor program; and
                            (iii) contact information for dental 
                        providers in the surrounding community who 
                        provide low- or no-cost dental care and whom 
                        the Secretary has confirmed are available to 
                        take on new patients.
                    (B) Continuation of treatment plan.--Any veteran 
                participating in the pilot program may continue to 
                receive services under the pilot program after the 
                termination of the pilot program to complete a 
                treatment plan commenced under the pilot program, as 
                determined necessary by the Secretary.
    (f) Reports.--
            (1) Annual report.--Not later than one year after the 
        commencement of the pilot program, and annually thereafter for 
        the duration of the pilot program, the Secretary of Veterans 
        Affairs shall submit to the Committees on Veterans' Affairs of 
        the House of Representatives and the Senate a report on the 
        pilot program that includes--
                    (A) an identification of the States participating 
                in the pilot program;
                    (B) a description of the implementation and 
                operation of the pilot program;
                    (C) the number of participants in the pilot 
                program, disaggregated by--
                            (i) State; and
                            (ii) disability rating;
                    (D) an identification of any barriers or challenges 
                to implementing the pilot program;
                    (E) aggregated feedback from participants in the 
                pilot program, including from interviews and surveys;
                    (F) the average annual cost of providing covered 
                care to a participant in the pilot program, 
                disaggregated by--
                            (i) State;
                            (ii) disability rating; and
                            (iii) whether the care was provided through 
                        the community care network or through a 
                        provider of the Department;
                    (G) an analysis of the communication and 
                collaboration of the Department with Third Party 
                Administrators and community care dental providers, 
                disaggregated by State;
                    (H) an analysis of any cost savings by the 
                Department with respect to the treatment of ischemic 
                heart disease;
                    (I) an assessment of the impact of the pilot 
                program on appointments for care, prescriptions, 
                hospitalizations, emergency room visits, wellness, 
                employability, satisfaction, and perceived quality of 
                life of covered veterans related to their diagnosis of 
                ischemic heart disease;
                    (J) an analysis and assessment of the efficacy of 
                mobile clinics and portable dental care units, to the 
                extent such modalities are used, to service the needs 
                of covered veterans under the pilot program;
                    (K) an analysis and assessment of the usage of 
                teledentistry to service the needs of covered veterans 
                under the pilot program, to include a cost benefit 
                analysis of such services; and
                    (L) such other matters as the Secretary considers 
                appropriate.
            (2) Final report.--Not later than 90 days before the 
        completion of the pilot program, the Secretary shall submit to 
        the Committees on Veterans' Affairs of the House of 
        Representatives and the Senate a report on the pilot program 
        that--
                    (A) includes the matters required under paragraph 
                (1);
                    (B) includes recommendations on whether the pilot 
                program should be continued, expanded, or adopted 
                throughout the Department; and
                    (C) indicates whether the Secretary requests action 
                by Congress to make the pilot program permanent.
    (g) Impact on Community Care.--Participants in the pilot program 
shall be able to access covered care in the community under section 
1703 of title 38, United States Code.
    (h) Definitions.--In this section:
            (1) The term ``covered care'' means dental care that is 
        consistent with the dental services and treatment furnished by 
        the Secretary of Veterans Affairs to veterans pursuant to 
        section 1712(a)(1)(G) of title 38, United States Code.
            (2) The term ``covered veteran'' means a veteran who--
                    (A) is enrolled in the system of annual patient 
                enrollment of the Department established and operated 
                under paragraphs (1) or (2) of section 1705(a) of title 
                38, United States Code;
                    (B) is not eligible for dental services and 
                treatment and related dental appliances under the laws 
                administered by the Secretary as of the date of the 
                enactment of this Act; and
                    (C) has a diagnosis of ischemic heart disease.
            (3) The term ``Third Party Administrator'' has the meaning 
        given such term in section 1703F of such title.

SEC. 145. DOCUMENTATION OF PREFERENCES OF VETERANS FOR SCHEDULING OF 
              APPOINTMENTS FOR HEALTH CARE UNDER LAWS ADMINISTERED BY 
              SECRETARY OF VETERANS AFFAIRS.

    (a) In General.--Not later than one year after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall develop 
a mechanism to solicit information regarding the preference of veterans 
enrolled in the system of annual patient enrollment of the Department 
of Veterans Affairs established and operated under section 1705(a) of 
title 38, United States Code, for scheduling of appointments for health 
care and related services under the laws administered by the Secretary, 
including through non-Department providers.
    (b) Documentation of Preference.--Preferences provided voluntarily 
by a veteran pursuant to subsection (a) shall be documented on My 
HealtheVet or another system designated by the Secretary that allows 
the veteran to view and change such preferences at any time.
    (c) Inclusion in Preference.--Preferences solicited under 
subsection (a) shall include the following:
            (1) How and when the veteran prefers to be contacted about 
        an appointment for health care.
            (2) Whether the veteran prefers to schedule appointments 
        without the assistance of the Department, if able.
            (3) Whether the veteran prefers to select a provider 
        without the assistance of the Department, if able.
            (4) Whether the veteran prefers appointments to be 
        scheduled during certain days or times.
    (d) Use of Preference.--The Secretary shall make the preferences 
provided under subsection (a) easily accessible to medical support 
assistants and other staff of the Department, or non-Department staff, 
as the Secretary determines appropriate, who assist in the appointment 
scheduling process.
    (e) Deployment of Mechanism.--
            (1) In general.--Beginning after the date on which the 
        Secretary develops the mechanism required under subsection (a), 
        the Secretary shall--
                    (A) test the mechanism in not fewer than three 
                geographically diverse Veterans Integrated Service 
                Networks; and
                    (B) gather feedback about the effectiveness of such 
                mechanism from veterans, medical support assistants, 
                staff and other stakeholders as the Secretary 
                determines appropriate.
            (2) Limitation.--The Secretary may not implement such 
        mechanism across the Veterans Health Administration of the 
        Department before the Secretary addresses the feedback 
        described in paragraph (1)(B).

SEC. 146. STAFFING MODEL AND PERFORMANCE METRICS FOR CERTAIN EMPLOYEES 
              OF THE DEPARTMENT OF VETERANS AFFAIRS.

    (a) Staffing Model.--
            (1) In general.--Not later than one year after the date of 
        the enactment of this Act, the Secretary of Veterans Affairs 
        shall--
                    (A) develop, validate, and implement a staffing 
                model for the Office of Integrated Veteran Care of the 
                Department of Veterans Affairs, or successor office, 
                Veterans Integrated Services Networks, and medical 
                centers of the Department that includes appropriate 
                target staffing levels nationally, regionally, and 
                locally to ensure timely access to care and effectively 
                oversee the provision of care by the Department, 
                whether at a facility of the Department or through a 
                non-Department provider; and
                    (B) provide to Congress a briefing on such staffing 
                model, which shall include--
                            (i) the metrics and measures used by the 
                        Secretary in developing such staffing model;
                            (ii) an analysis of how such staffing model 
                        compares to the staffing models of other 
                        relevant Government-owned and private sector 
                        health care systems; and
                            (iii) an estimate of the portion of the 
                        roles in such staffing model that will be 
                        filled by contracted staff at any given time.
            (2) Report on implementation of staffing model.--Not later 
        than one year after the date on which the Secretary implements 
        the staffing model required under paragraph (1), the Secretary 
        shall submit to Congress and the Comptroller General of the 
        United States a report containing--
                    (A) an update on such implementation; and
                    (B) information on the outcomes yielded by such 
                staffing model in terms of improved access to care for 
                veterans and improved compliance with relevant laws, 
                regulations, policy directives, and guidance governing 
                access to care.
    (b) Performance Metrics.--
            (1) In general.--Not later than one year after the date of 
        the enactment of this Act, the Secretary shall develop and 
        implement a plan, with an appropriate tracking system, to 
        incorporate appropriate standardized performance metrics and 
        oversight measures within the performance appraisal systems for 
        employees of the Department specified in paragraph (2).
            (2) Employees of the department specified.--Employees of 
        the Department specified in this paragraph are employees who 
        are responsible for ensuring timely access to care from the 
        Department, compliance with relevant statutes and regulations 
        relating to the provision of care, including section 1703 of 
        title 38, United States Code, and overseeing the provision of 
        care, whether at a facility of the Department or through a non-
        Department provider, including employees within the Office of 
        Integrated Veteran Care of the Department, or successor office, 
        employees of a Veterans Integrated Service Network, and 
        employees of a medical center of the Department.
            (3) Report on implementation of performance metrics.--Not 
        later than one year after implementing the performance metrics 
        required under paragraph (1), the Secretary shall submit to 
        Congress and the Comptroller General of the United States a 
        report containing--
                    (A) an update on such implementation; and
                    (B) information on the outcomes yielded by such 
                performance metrics in terms of improved access to care 
                for veterans and improved compliance with relevant 
                laws, policy directives, and guidance governing access 
                to care.
    (c) GAO Report.--Not later than two years after the later of the 
date on which the Comptroller General receives the report under 
subsection (a)(2) or the report under subsection (b)(3), the 
Comptroller General shall submit to Congress a report that includes--
            (1) an assessment of the performance of the Office of 
        Integrated Veteran Care of the Department, or successor office, 
        in improving access to care for veterans in facilities of the 
        Department and pursuant to section 1703 of title 38, United 
        States Code; and
            (2) such recommendations as the Comptroller General 
        considers appropriate with respect to improving access to the 
        care described in paragraph (1) for veterans.

SEC. 147. ONLINE HEALTH EDUCATION PORTAL FOR VETERANS ENROLLED IN 
              PATIENT ENROLLMENT SYSTEM OF DEPARTMENT OF VETERANS 
              AFFAIRS.

    Not later than one year after the date of the enactment of this 
Act, the Secretary of Veterans Affairs shall establish, on an Internet 
website of the Department, a health education portal that includes 
interactive educational modules to ensure veterans enrolled in the 
patient enrollment system of the Department of Veterans Affairs 
established and operated under section 1705(a) of title 38, United 
States Code, understand the basic health care eligibilities and 
entitlements of veterans under the laws administered by the Secretary, 
including under the Veterans Community Care Program under section 1703 
of such title.

SEC. 148. LIMITATION ON DETAIL OF DIRECTORS OF MEDICAL CENTERS OF 
              DEPARTMENT OF VETERANS AFFAIRS TO DIFFERENT POSITIONS.

    (a) Notification.--
            (1) In general.--Not later than 90 days after detailing a 
        director of a medical center of the Department of Veterans 
        Affairs to a different position within the Department, the 
        Secretary of Veterans Affairs shall notify the Committee on 
        Veterans' Affairs of the Senate and the Committee on Veterans' 
        Affairs of the House of Representatives of such detail.
            (2) Matters to be included.--The notification required by 
        paragraph (1) shall include, with respect to a director of a 
        medical center who is detailed to a different position within 
        the Department, the following information:
                    (A) The location at which the director is detailed.
                    (B) The position title of the detail.
                    (C) The estimated time the director is expected to 
                be absent from their duties at the medical center.
                    (D) Such other information as the Secretary may 
                determine appropriate.
    (b) Appointment of Acting Director.--Not later than 120 days after 
detailing a director of a medical center of the Department to a 
different position within the Department, the Secretary shall appoint 
an individual as acting director of such medical center with all of the 
authority and responsibilities of the detailed director.
    (c) Update on Detail.--Not later than 120 days after detailing a 
director of a medical center of the Department to a different position 
within the Department, and not less frequently than every 30 days 
thereafter while the detail is in effect or while the director position 
at the medical center is vacant, the Secretary shall submit to the 
Committee on Veterans' Affairs of the Senate and the Committee on 
Veterans' Affairs of the House of Representatives an update regarding 
the status of the detail.
    (d) Return to Position or Reassignment.--
            (1) In general.--Except as provided in paragraph (2), not 
        later than 180 days after detailing a director of a medical 
        center of the Department to a different position within the 
        Department, for a reason other than an ongoing investigation or 
        administrative action with respect to the director, the 
        Secretary shall--
                    (A) return the individual to the position as 
                director of the medical center; or
                    (B) reassign the individual from the position as 
                director of the medical center and begin the process of 
                hiring a new director for such position.
            (2) Waiver.--
                    (A) In general.--The Secretary may waive the 
                requirement under paragraph (1) with respect to an 
                individual for successive 90-day increments for a total 
                period of not more than 540 days from the original date 
                the individual was detailed away from their position as 
                director of a medical center.
                    (B) Notification.--Not later than 30 days after 
                exercising a waiver under subparagraph (A), the 
                Secretary shall notify Congress of the waiver and 
                provide to Congress information as to why the waiver is 
                necessary.

SEC. 149. NATIONAL VETERAN SUICIDE PREVENTION ANNUAL REPORT.

    (a) National Veteran Suicide Prevention Annual Report.--
            (1) In general.--Not later than 18 months after the date of 
        the enactment of this Act, and not later than September 30 of 
        each year thereafter, the Secretary of Veterans Affairs shall 
        submit to the appropriate congressional committees and publish 
        on a publicly available website of the Department of Veterans 
        Affairs a report to be known as the ``National Veteran Suicide 
        Prevention Annual Report''.
            (2) Extension.--
                    (A) In general.--If the Secretary requires an 
                extension of the deadline for a report under subsection 
                (a), the Secretary shall submit to the appropriate 
                congressional committees a written request for such an 
                extension.
                    (B) Elements.--Each written request under paragraph 
                (1) for an extension for a report shall include the 
                following:
                            (i) The rationale for the delay in the 
                        submission of the report.
                            (ii) An explanation of the need for an 
                        extension.
                            (iii) A proposed amended date for the 
                        submission and publication of the report.
            (3) Briefing.--With respect to each report required under 
        paragraph (1), the Secretary shall, before the date on which 
        the Secretary submits such report, provide to the appropriate 
        congressional committees a briefing on such report.
            (4) Elements.--
                    (A) In general.--Each report required under 
                paragraph (1) shall include--
                            (i) the findings of the national analysis 
                        of veteran suicide rates for the latest year 
                        for which data is available;
                            (ii) an identification of trends, if any, 
                        demonstrated by such data; and
                            (iii) a comparison of such data to data on 
                        veteran suicide rates during preceding years.
                    (B) Additional elements.--Each report under 
                paragraph (1) shall include, for the year covered by 
                the report, the following:
                            (i) Suicide rates of veterans disaggregated 
                        by age, gender, and race or ethnicity.
                            (ii) Trends in suicide rates of veterans 
                        compared to engagement of those veterans with 
                        health care from the Veterans Health 
                        Administration, including an examination of 
                        trends in suicide rates or deaths among--
                                    (I) veterans who have recently 
                                received health care from the Veterans 
                                Health Administration as compared to 
                                veterans who have never received health 
                                care from the Veterans Health 
                                Administration;
                                    (II) veterans who are enrolled in 
                                the patient enrollment system of the 
                                Department of Veterans Affairs under 
                                section 1705(a) of title 38, United 
                                States Code, as compared to veterans 
                                who have never enrolled in such system;
                                    (III) veterans who have recently 
                                used services from a Vet Center as 
                                compared to veterans who have never 
                                used such services;
                                    (IV) to the extent practicable, 
                                veterans who have a diagnosis of 
                                substance use disorder; and
                                    (V) other groups of veterans 
                                relating to engagement with health care 
                                from the Veterans Health 
                                Administration, as the Secretary 
                                considers practicable.
                            (iii) To the extent practicable, trends in 
                        suicide rates of veterans compared to 
                        engagement of those veterans with benefits from 
                        the Veterans Benefits Administration, including 
                        an examination of trends in suicide rates or 
                        deaths among--
                                    (I) veterans who are currently 
                                using, have previously used, or have 
                                never used educational assistance under 
                                the laws administered by the Secretary;
                                    (II) veterans who are currently 
                                receiving, have previously received, or 
                                have never received services or 
                                assistance under chapter 31 of title 
                                38, United States Code;
                                    (III) with respect to compensation 
                                under chapter 11 of such title--
                                            (aa) veterans who were 
                                        recipients of such compensation 
                                        as compared to veterans who 
                                        never applied for such 
                                        compensation prior to death;
                                            (bb) veterans who had a 
                                        claim denied for such 
                                        compensation prior to death;
                                            (cc) veterans who had a 
                                        pending claim for such 
                                        compensation at time of death; 
                                        and
                                            (dd) veterans who had an 
                                        entitlement for such 
                                        compensation reduced prior to 
                                        death;
                                    (IV) veterans who are currently 
                                receiving or have never received 
                                pension under chapter 15 of title 38, 
                                United States Code;
                                    (V) veterans who are currently 
                                using, have recently used, or have 
                                never used programs or services 
                                provided by the Homeless Programs 
                                Office of the Department, including an 
                                examination of trends in suicide rates 
                                or deaths among veterans who made 
                                contact with such office but were 
                                denied or deemed ineligible for any 
                                such program or service;
                                    (VI) with respect to housing loans 
                                guaranteed by the Secretary under 
                                chapter 37 of title 38, United States 
                                Code, veterans who are current 
                                recipients of, were recent recipients 
                                of, or have never received such a loan;
                                    (VII) veterans owing debts to the 
                                Department;
                                    (VIII) veterans who were involved 
                                in a veterans treatment court program, 
                                whether they graduated successfully or 
                                not; and
                                    (IX) veterans who were successfully 
                                contacted, unsuccessfully contacted, or 
                                never contacted by the Department 
                                through the Solid Start program under 
                                section 6320 of title 38, United States 
                                Code.
                    (C) Strategy and recommendations.--
                            (i) Initial report.--The initial report 
                        under paragraph (1) shall include a strategy 
                        and recommendations developed by the Secretary 
                        of Veterans Affairs, in collaboration with the 
                        Director of the Centers for Disease Control and 
                        Prevention, for--
                                    (I) improving data collection at 
                                the State and local levels to 
                                accurately capture suicide deaths of 
                                veterans;
                                    (II) improving the timeliness, 
                                efficacy, and standardization of data 
                                reporting on suicide deaths of veterans 
                                at the Federal level, including by the 
                                Centers for Disease Control and 
                                Prevention and the Department of 
                                Veterans Affairs;
                                    (III) improving the timeliness of 
                                identification and analysis of suicide 
                                deaths of veterans by Federal agencies, 
                                including the Centers for Disease 
                                Control and Prevention, and the 
                                Department of Veterans Affairs; and
                                    (IV) any other necessary process 
                                improvements for improving the 
                                timeliness, efficacy, and 
                                standardization of reporting of data 
                                relating to suicide deaths of veterans, 
                                particularly with respect to the annual 
                                report under this section.
                            (ii) Subsequent reports.--Each report after 
                        the initial report under paragraph (1) shall 
                        include updates on actions taken to meet the 
                        strategy and recommendations developed under 
                        subparagraph (A).
            (5) Definitions.--In this subsection:
                    (A) The term ``appropriate congressional 
                committees'' means the Committees on Veterans' Affairs 
                of the Senate and the House of Representatives.
                    (B) The term ``Vet Center'' means a center for 
                readjustment counseling and related mental health 
                services for veterans under section 1712A of title 38, 
                United States Code.
    (b) Independent Assessment of National Veteran Suicide Prevention 
Annual Report.--
            (1) In general.--Not later than 90 days after the date of 
        the enactment of this Act, the Secretary of Veterans Affairs 
        shall enter into one or more contracts with a private sector 
        entity described in paragraph (5) to conduct an independent 
        assessment of the National Veteran Suicide Prevention Annual 
        Report required under subsection (a).
            (2) Frequency.--The private sector entity or entities 
        carrying out the assessment required under paragraph (1) shall 
        complete such assessment not later than 240 days after entering 
        into the contract described in such subsection and not less 
        frequently than every five years thereafter.
            (3) Elements.--Each assessment required under paragraph (1) 
        shall analyze the following:
                    (A) The methodology used by the Department to 
                track, analyze, categorize, and report suicide deaths 
                and suicide rates among veterans.
                    (B) Whether data sources used by the Department to 
                compile data on suicide deaths and suicide rates among 
                veterans are accurately reflecting such data.
                    (C) Vulnerabilities in the methodology used by the 
                Department that could lead to inaccurate counting of 
                suicide deaths and suicide rates among veterans.
                    (D) The ability of the Department to cross 
                reference suicide deaths and suicide rates among 
                veterans with trends in usage of programs of the 
                Veterans Health Administration or the Veterans Benefits 
                Administration or other programs that could serve as 
                widespread protective factors against suicide.
                    (E) Improvements that could be made to ensure the 
                National Veteran Suicide Prevention Annual Report 
                required under subsection (a) is accurate and 
                comprehensive and provides insights for making 
                improvements to the suicide prevention efforts of the 
                Department.
            (4) Report on assessment.--
                    (A) Report on findings and recommendations.--Not 
                later than 60 days after completing an assessment 
                required by paragraph (1), the private sector entity or 
                entities carrying out the assessment shall submit to 
                the Secretary of Veterans Affairs and the Committees on 
                Veterans' Affairs of the Senate and the House of 
                Representatives a report on the findings and 
                recommendations of the private sector entity or 
                entities with respect to such assessment.
                    (B) Report on planned improvements.--Not later than 
                60 days after receiving a report under paragraph (1) 
                with respect to an assessment required by paragraph 
                (1), the Secretary shall submit to the Committees on 
                Veterans' Affairs of the Senate and the House of 
                Representatives a report on how the Department plans to 
                improve the National Veteran Suicide Prevention Annual 
                Report required under subsection (a) based on such 
                assessment.
            (5) Private sector entity described.--A private sector 
        entity described in this paragraph is a private entity that--
                    (A) specializes in analyzing large-scale 
                organizational data collection and analysis efforts, 
                especially with respect to the health care sector; and
                    (B) has experience and proven outcomes in 
                optimizing the accuracy and comprehensiveness of data 
                collection and analysis related to suicide.
    (c) Report on Additional Benefits and Services From Department of 
Veterans Affairs to Prevent Veteran Suicide.--
            (1) In general.--Not later than three years after the date 
        of the enactment of this Act, the Secretary of Veterans Affairs 
        shall submit to the Committees on Veterans' Affairs of the 
        Senate and the House of Representatives and publish on a 
        publicly available website of the Department of Veterans 
        Affairs a report that analyzes which benefits and services 
        under the laws administered by such Secretary, including such 
        benefits and services furnished by the Veterans Benefits 
        Administration, have the greatest impact on the prevention of 
        suicide among veterans, including recommendations for potential 
        expansion of services and benefits to reduce the number of 
        veteran suicides.
            (2) Assessment of solid start program.--The report required 
        by paragraph (1) shall include an analysis of the effectiveness 
        of the Solid Start program under section 6320 of title 38, 
        United States Code, on prevention of suicide among veterans.
    (d) Toolkit for State and Local Coroners and Medical Examiners on 
Best Practices for Identifying and Reporting on Suicide Deaths of 
Veterans.--
            (1) In general.--The Secretary of Veterans Affairs, in 
        collaboration with the Director of the Centers for Disease 
        Control and Prevention, shall develop a toolkit for State and 
        local coroners and medical examiners that contains best 
        practices for--
                    (A) accurately identifying and reporting suicide 
                deaths of veterans, including how to identify veteran 
                status; and
                    (B) reporting such deaths to the Centers for 
                Disease Control and Prevention and other applicable 
                entities.
            (2) Availability.--Not later than two years after the date 
        of the enactment of this Act, the Secretary shall make the 
        toolkit developed under paragraph (1) available on a publicly 
        available website of the Department of Veterans Affairs.
            (3) Outreach.--The Secretary, in collaboration with the 
        Director of the Centers for Disease Control and Prevention, 
        shall conduct outreach to appropriate State and local agencies 
        to promote the availability and use of the toolkit developed 
        under paragraph (1).

SEC. 150. REPORT ON PHYSICAL INFRASTRUCTURE REQUIRED BY MEDICAL 
              FACILITIES OF DEPARTMENT OF VETERANS AFFAIRS TO PROVIDE 
              DENTAL CARE SERVICES.

    Not later than one year after the date of the enactment of this 
Act, the Secretary of Veterans Affairs shall submit to the Committees 
on Veterans' Affairs of the Senate and the House of Representatives a 
report, for each medical center or other relevant health care facility 
of the Department of Veterans Affairs, that includes--
            (1) an identification of the physical infrastructure, 
        including new facilities, renovations, remodels, leases, or 
        other infrastructure, such medical center or health care 
        facility requires to provide dental care services to veterans 
        eligible for such services under the laws administered by the 
        Secretary; and
            (2) an analysis of the physical infrastructure such medical 
        center or health care facility would require if a greater 
        number of veterans became eligible for such dental care 
        services pursuant to a modification of the laws administered by 
        the Secretary.

SEC. 151. COMPTROLLER GENERAL REPORT ON CERTAIN ORAL HEALTH CARE 
              PROGRAMS UNDER LAWS ADMINISTERED BY SECRETARY OF VETERANS 
              AFFAIRS.

    (a) In General.--Not later than one year after the date of the 
enactment of this Act, the Comptroller General of the United States 
shall submit to the Committees on Veterans' Affairs of the Senate and 
the House of Representatives a report on the status of the oral health 
care programs of the Department of Veterans Affairs, that includes an 
assessment of--
            (1) any issues with information technology programs, 
        including Dental Record Manager Plus, that affect dental care 
        staff of the Department;
            (2) the implementation of the dental insurance plan of the 
        Department under section 1712C of title 38, United States Code;
            (3) the implementation and expansion of the VETSmile 
        program of the Department;
            (4) barriers preventing the Department from expanding 
        dental care eligibility to all veterans with ischemic heart 
        disease, including such barriers relating to physical 
        infrastructure, workforce, and cost of such dental care;
            (5) barriers preventing dental clinics of the Department, 
        if any, from adopting teledentistry;
            (6) the demographic makeup of veterans eligible for dental 
        care paid for by the Department as of the commencement of the 
        pilot program under section 144 of this Act, including 
        information on--
                    (A) age;
                    (B) gender;
                    (C) race or ethnicity, disaggregated by--
                            (i) membership in an Indian Tribe; and
                            (ii) the major race groups used in the 
                        decennial census;
                    (D) employment status; and
                    (E) location of residence, disaggregated by rural, 
                highly rural, and urban locations; and
            (7) changes to such demographic makeup if any, that would 
        result from an expansion of eligibility for dental care under 
        the laws administered by the Secretary to all veterans with 
        ischemic heart disease including changes to demographics 
        specified in paragraph (6).
    (b) Third Party Administrator Defined.--In this section, the term 
``Third Party Administrator'' means an entity that manages a provider 
network and performs administrative services related to such network 
under section 1703 of title 38, United States Code.

SEC. 152. REVIEW OF WORKFLOWS ASSOCIATED WITH PROCESSING REFERRALS 
              BETWEEN FACILITIES OF THE VETERANS HEALTH ADMINISTRATION.

    (a) In General.--The Secretary of Veterans Affairs shall conduct a 
review of the workflows directly associated with processing referrals 
of patients between facilities of the Veterans Health Administration of 
the Department of Veterans Affairs to identify specific delays or 
bottlenecks in such referrals.
    (b) Elements of Review.--The review required under subsection (a) 
shall include a review of--
            (1) the interfacility consult management guidance of the 
        Veterans Health Administration that assists facilities 
        described in subsection (a) in constructing a workflow for 
        consults between such facilities; and
            (2) the roles and responsibilities of the individuals 
        involved in the consult management process in managing such 
        consults, including the role of the referral coordination team.
    (c) Report.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary shall submit to Congress a report 
on the results of the review required under subsection (a).

SEC. 153. PLAN FOR TIMELY SCHEDULING OF APPOINTMENTS AT MEDICAL 
              FACILITIES OF DEPARTMENT OF VETERANS AFFAIRS.

    (a) Plan Required.--To improve responsiveness in the provision of 
hospital care and medical services at medical facilities of the 
Department of Veterans Affairs, the Secretary of Veterans Affairs shall 
develop a plan to--
            (1) ensure that whenever a covered veteran contacts the 
        Department by telephone to request the scheduling of an 
        appointment for care or services for the covered veteran at 
        such a facility, the scheduling for the appointment occurs 
        during that telephone call (regardless of the prospective date 
        of the appointment being scheduled); and
            (2) provide timely and, where applicable, same-day 
        scheduling for an appointment described in paragraph (1).
    (b) Report.--Not later than one year after the date of the 
enactment of this Act, the Secretary shall submit to the Committees on 
Veterans' Affairs of the House of Representatives and the Senate a 
report on the plan under subsection (a).
    (c) Covered Veteran Defined.--In this section, the term ``covered 
veteran'' means a veteran who is enrolled in the system of patient 
enrollment of the Department under section 1705(a) of title 38, United 
States Code.

SEC. 154. AUTHORIZATION OF APPROPRIATIONS TO SUPPORT INITIATIVES FOR 
              MOBILE MAMMOGRAPHY SERVICES FOR VETERANS.

    There is authorized to be appropriated to the Secretary of Veterans 
Affairs $5,000,000 for fiscal year 2025 for the Office of Women's 
Health of the Department of Veterans Affairs under section 7310 of 
title 38, United States Code, to be used by the Secretary to expand 
access of women veterans to--
            (1) mobile mammography initiatives;
            (2) advanced mammography equipment; and
            (3) outreach activities to publicize those initiatives and 
        equipment.

                 TITLE II--ECONOMIC OPPORTUNITY MATTERS

                   Subtitle A--Educational Assistance

SEC. 201. TEMPORARY EXPANSION OF ELIGIBILITY FOR MARINE GUNNERY 
              SERGEANT JOHN DAVID FRY SCHOLARSHIP.

    (a) In General.--The Secretary of Veterans Affairs shall treat an 
individual described in subsection (b) as a covered individual 
described in section 3311(b) of title 38, United States Code.
    (b) Covered Individual Described.--An individual described in this 
subsection is an individual who is the child or spouse of a person--
            (1) who dies from a service-connected disability during the 
        120-day period immediately following the day on which the 
        person was discharged or released from duty as a member of the 
        Armed Forces (without regard to whether such duty was active 
        duty); and
            (2)(A) who received an honorable discharge; or
            (B) whose service in the Armed Forces is characterized by 
        the Secretary concerned as honorable service.
    (c) Applicability.--This section shall apply with respect to--
            (1) deaths that occur before, on, or after the date of the 
        enactment of this Act; and
            (2) a quarter, semester, or term, as applicable, 
        commencing--
                    (A) on or after August 1, 2025; and
                    (B) before October 1, 2027.

SEC. 202. REMOVAL OF EXPIRATION ON ENTITLEMENT TO MARINE GUNNERY 
              SERGEANT JOHN DAVID FRY SCHOLARSHIP FOR SURVIVING 
              SPOUSES.

    Section 3311(f) of title 38, United States Code, is amended--
            (1) by striking paragraph (2);
            (2) by redesignating paragraphs (3) through (5) as 
        paragraphs (2) through (4), respectively;
            (3) in paragraph (2), as redesignated by paragraph (2) of 
        this section, by striking ``in paragraph (4)'' and inserting 
        ``in paragraph (3)''; and
            (4) in paragraph (3)(A), as redesignated by paragraph (2) 
        of this section, by striking ``under paragraph (3)'' and 
        inserting ``under paragraph (2)''.

SEC. 203. SOLE LIABILITY FOR TRANSFERRED EDUCATIONAL ASSISTANCE BY AN 
              INDIVIDUAL WHO FAILS TO COMPLETE A SERVICE AGREEMENT.

    Subsection (i) of section 3319 of title 38, United States Code, is 
amended--
            (1) in paragraph (1)--
                    (A) by striking ``In the event'' and inserting 
                ``Subject to paragraph (2), in the event''; and
                    (B) by inserting ``of this title'' after ``section 
                3685'';
            (2) in subparagraph (A) of paragraph (2)--
                    (A) in the heading, by striking ``In general'' and 
                inserting ``Sole liability''; and
                    (B) by striking ``under paragraph (1)'' and 
                inserting ``for which the individual shall be solely 
                liable to the United States for the amount of the 
                overpayment for purposes of section 3685 of this 
                title''; and
            (3) in subparagraph (B) of paragraph (2)--
                    (A) in the matter preceding clause (i), by striking 
                ``Subparagraph (A) shall not apply'' and inserting 
                ``Neither the individual nor the dependent shall be 
                liable to the United States for the amount of the 
                overpayment for purposes of section 3685 of this 
                title''; and
                    (B) in clause (ii), by inserting ``of this title'' 
                after ``section 3311(c)(4)''.

SEC. 204. NOTICE TO EDUCATIONAL INSTITUTIONS OF RISK-BASED SURVEYS.

    Section 3673A(d) of title 38, United States Code, is amended by 
striking ``one business day'' and inserting ``two business days''.

SEC. 205. RELATIONSHIP OF PARTICIPATION BY AN EDUCATIONAL INSTITUTION 
              IN CERTAIN FEDERAL STUDENT FINANCIAL AID PROGRAMS TO 
              APPROVAL OF SUCH INSTITUTION FOR PURPOSES OF DEPARTMENT 
              OF VETERANS AFFAIRS EDUCATIONAL ASSISTANCE PROGRAMS.

    Paragraph (4) of section 3675(b) of title 38, United States Code, 
is amended to read as follows:
            ``(4) The educational institution--
                    ``(A) is approved and participates in a program 
                under title IV of the Higher Education Act of 1965 (20 
                U.S.C. 1070 et seq.); or
                    ``(B) does not participate in such a program and 
                the Secretary has waived the requirement under this 
                paragraph with respect to the educational institution, 
                and submits to the Committee on Veterans' Affairs of 
                the Senate and the Committee on Veterans' Affairs of 
                the House of Representatives notice of such waiver, 
                because the Secretary determines that the educational 
                institution--
                            ``(i) elects not to participate in such a 
                        program;
                            ``(ii) cannot participate in such a 
                        program; or
                            ``(iii) is in the process of making a good-
                        faith effort to submit an initial application 
                        for approval to participate in such a program, 
                        except that a waiver under this clause may not 
                        be provided for a period of longer than 36 
                        months.''.

SEC. 206. EXPANSION OF DEPARTMENT OF VETERANS AFFAIRS OVERSIGHT OF 
              CERTAIN EDUCATIONAL INSTITUTIONS.

    (a) Additional Requirement for Approval.--Section 3675(b) of title 
38, United States Code, as amended by section 205, is further amended 
by adding at the end the following new paragraph:
            ``(5) The educational institution agrees to, not later than 
        30 days after any date on which such educational institution 
        becomes subject to an action or event described in section 
        3673(e)(3) of this title, submit to the State approving agency, 
        or the Secretary when acting in the role of a State approving 
        agency, a notification of such action or event in such form and 
        containing such information as the Secretary determines 
        appropriate.''.
    (b) Additional Requirement for Approval of Nonaccredited Courses.--
            (1) In general.--Section 3676(c) of such title is amended--
                    (A) by redesignating paragraphs (14) through (16) 
                as paragraphs (15) through (17), respectively; and
                    (B) by inserting after paragraph (13) the following 
                new paragraph:
            ``(14) The institution agrees to, not later than 30 days 
        after any date on which such institution becomes subject to an 
        action or event described in section 3673(e)(3) of this title, 
        submit to the State approving agency, or the Secretary when 
        acting in the role of a State approving agency, a notification 
        of such action or event in such form and containing such 
        information as the Secretary determines appropriate.''.
            (2) Conforming amendments.--Such title is further amended--
                    (A) in section 3672(b)(2)(C), by striking 
                ``paragraph (14) or (15)'' and inserting ``paragraph 
                (15) or (16)'';
                    (B) in section 3675(b)(3), by striking ``(14), 
                (15), and (16)'' and inserting ``(15), (16), and 
                (17)'';
                    (C) in section 3679(d), by striking ``described in 
                paragraph (14) or (15)'' and inserting ``described in 
                paragraph (15) or (16)''; and
                    (D) in section 3680A(a)(4)(C)(iii), by striking 
                ``section 3676(c)(14) and (15)'' and inserting 
                ``section 3676(c)(15) and (16)''.
    (c) Additional Grounds for Suspension of Approval.--Section 
3679(f)(1) of such title is amended by adding at the end the following 
new subparagraph:
            ``(I) Comply with the notification requirements under 
        sections 3675(b)(5) and 3676(c)(14) of this title, when 
        applicable.''.
    (d) Deadline for Risk-based Surveys Database.--The Secretary of 
Veterans Affairs shall establish the database required under section 
3673A(c) of title 38, United States Code, by not later than 180 days 
after the date of the enactment of this Act.

SEC. 207. REQUIREMENT THAT EDUCATIONAL INSTITUTIONS APPROVED FOR 
              PURPOSES OF DEPARTMENT OF VETERANS AFFAIRS EDUCATIONAL 
              ASSISTANCE PROGRAMS PROVIDE DIGITAL OFFICIAL TRANSCRIPTS.

    (a) Requirement.--Section 3675(b) of title 38, United States Code, 
as amended by sections 205 and 206, is further amended by adding at the 
end the following new paragraph:
            ``(6) The educational institution makes available to each 
        eligible person or veteran a copy of the person or veteran's 
        official transcript in a digital format.''.
    (b) Conforming Amendments.--
            (1) Approval of courses.--Section 3672(b)(2)(A) of such 
        title is amended by striking ``(b)(1) and (b)(2)'' and 
        inserting ``paragraphs (1), (2), and (6) of section 3675(b)''.
            (2) Approval of nonaccredited courses.--Section 3676(c) of 
        such title is amended--
                    (A) by redesignating paragraph (17) as paragraph 
                (18); and
                    (B) by inserting after paragraph (16) the following 
                new paragraph (17):
            ``(17) In the case of a course that leads to a standard 
        college degree, the educational institution satisfies the 
        requirements of section 3675(b)(6) of this title.''.
            (3) Conforming amendments.--Section 3675(b)(3) of such 
        title is amended by striking ``(15), (16), and (17)'' and 
        inserting ``(15), (16), and (18)''.
    (c) Effective Date.--The amendments made by this section shall take 
effect on August 1, 2025, and apply with respect to a quarter, 
semester, or term, as applicable, commencing on or after such date.

SEC. 208. PAYMENT OF FULL MONTHLY HOUSING STIPEND FOR VETERANS ENROLLED 
              IN FINAL SEMESTER USING EDUCATIONAL ASSISTANCE UNDER 
              POST-9/11 EDUCATIONAL ASSISTANCE PROGRAM.

    (a) Housing Allowance.--Section 3680(a)(3) of title 38, United 
States Code, is amended--
            (1) by redesignating subparagraphs (A) and (B) as clauses 
        (i) and (ii), respectively (and by redesignating each 
        subordinate provision and the margins thereof accordingly);
            (2) by striking ``Notwithstanding paragraph (1)'' and 
        inserting ``(A) Notwithstanding paragraph (1)'';
            (3) by striking ``, including a monthly housing stipend 
        described in section 3313(c) of this title,''; and
            (4) by adding at the end the following new subparagraph 
        (B):
    ``(B) For purposes of providing a monthly housing stipend described 
in section 3313(c) to an eligible veteran or eligible person for whom 
the Secretary is providing educational assistance under chapter 33 of 
this title during a period that is the last semester, term, or academic 
period pursuant to subparagraph (A), the Secretary shall treat the 
veteran or person as pursuing a program of education on a full-time 
basis.''.
    (b) Application.--The amendments made by subsection (a) shall take 
effect on the date of the enactment of this Act and apply with respect 
to a quarter, semester, or term, as applicable, commencing on or after 
January 1, 2025.

SEC. 209. MODIFICATION OF RULES FOR APPROVAL OF COMMERCIAL DRIVER 
              EDUCATION PROGRAMS FOR PURPOSES OF EDUCATIONAL ASSISTANCE 
              PROGRAMS OF THE DEPARTMENT OF VETERANS AFFAIRS.

    (a) In General.--Subsection (a)(4) of section 2 of the Veteran 
Improvement Commercial Driver License Act of 2023 (Public Law 118-95) 
is amended, in the matter to be inserted as the new paragraph (2) of 
section 3680A(e) of title 38, United States Code--
            (1) in subparagraph (A)--
                    (A) in the matter preceding clause (i), by striking 
                ``the commercial driver education program offered at 
                the branch by the educational institution--'' and 
                inserting and em dash; and
                    (B) by striking clauses (i) and (ii) and inserting 
                the following:
            ``(i) the commercial driver education program offered at 
        the branch by the educational institution is approved for 
        purposes of this chapter by a State approving agency (or the 
        Secretary when acting in the role of a State approving agency); 
        and
            ``(ii)(I) such branch is located in a State in which such 
        educational institution offers such commercial driver education 
        program at another branch of such educational institution; or
                    ``(II) such branch--
                            ``(aa) has been operating for at least one 
                        year; and
                            ``(bb) offers such commercial driver 
                        education program, using the same curriculum as 
                        another branch of such educational 
                        institution.''; and
            (2) by adding at the end the following new subparagraph:
    ``(D) The Secretary shall submit to the Committees on Veterans' 
Affairs of the Senate and House of Representatives a notification not 
later than 30 days after the Secretary grants an exemption under 
subparagraph (A). Such notification shall identify the educational 
institution, and the branch thereof, granted such exemption.''.
    (b) Implementation.--Section 2(b) of such Act is amended--
            (1) in paragraph (2), by striking ``180 days'' and 
        inserting ``365 days''; and
            (2) by adding at the end the following new paragraphs:
            ``(3) Regulations.--In prescribing any regulation to carry 
        out the amendments made by subsection (a), the Secretary of 
        Veterans Affairs shall consult with State approving agencies 
        designated under section 3671 of such title.
            ``(4) GAO study.--Not later than 365 days after the 
        applicability date under paragraph (2), the Comptroller General 
        of the United States shall--
                    ``(A) conduct a study to--
                            ``(i) determine the effects of the 
                        amendments made by subsection (a); and
                            ``(ii) the feasibility and advisability of 
                        similarly amending the rules for approval of 
                        programs of education for other vocational 
                        programs of education; and
                    ``(B) submit to the Committees on Veterans' Affairs 
                of the Senate and House of Representatives a report on 
                the findings of the Comptroller General with respect to 
                such study.''.
    (c) Effective Date.--The amendments made by this section shall take 
effect as if included in such Act on the date of the enactment of such 
Act.

SEC. 210. PROVISION OF CERTIFICATES OF ELIGIBILITY AND AWARD LETTERS 
              USING ELECTRONIC MEANS.

    (a) In General.--Chapter 36 of title 38, United States Code, is 
amended by inserting after section 3698 the following new section (and 
conforming the table of sections at the beginning of such chapter 
accordingly):
``Sec. 3698A. Provision of certificates of eligibility and award 
              letters using electronic means
    ``(a) Requirement.--Except as provided by subsection (b), the 
Secretary shall provide to an individual the following documents using 
electronic means:
            ``(1) A certificate of eligibility for the entitlement of 
        the individual to covered educational assistance.
            ``(2) An award letter regarding the authorization of the 
        individual to receive covered educational assistance.
    ``(b) Election to Opt Out.--An individual may elect to receive the 
documents specified in subsection (a) by mail rather than through 
electronic means under subsection (a). An individual may revoke such an 
election at any time, by means prescribed by the Secretary.
    ``(c) Covered Educational Assistance.--In this section, the term 
`covered educational assistance' means educational assistance under 
chapter 30, 33, or 35 of this title, or section 3699C of this title.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by inserting after the item relating to section 
3698 the following new item:

``3698A. Provision of certificates of eligibility and award letters 
                            using electronic means.''.

SEC. 211. RETROACTIVE EFFECTIVE DATE OF LAW REGARDING CHARGE TO 
              ENTITLEMENT TO EDUCATIONAL ASSISTANCE FOR INDIVIDUALS WHO 
              DO NOT TRANSFER CREDITS FROM CERTAIN CLOSED OR 
              DISAPPROVED PROGRAMS OF EDUCATION.

    Section 3699(c)(2) of title 38, United States Code, is amended by 
striking subparagraph (C) and inserting the following new subparagraph 
(C):
    ``(C) This paragraph, including clauses (ii) and (iii) of 
subparagraph (A), shall apply with respect to the closure or 
discontinuation of a course or program of education, as described in 
subsection (b)(1), that occurs during the period beginning on August 1, 
2021, and ending on September 30, 2025.''.

SEC. 212. DEPARTMENT OF VETERANS AFFAIRS HIGH TECHNOLOGY PROGRAM.

    (a) High Technology Program.--
            (1) In general.--Chapter 36 of title 38, United States 
        Code, as amended by section 210, is amended by adding at the 
        end the following new section:
``Sec. 3699C. High technology program
    ``(a) Establishment.--(1) The Secretary shall carry out a program 
under which the Secretary provides covered individuals with the 
opportunity to enroll in high technology programs of education that the 
Secretary determines provide training or skills sought by employers in 
a relevant field or industry.
    ``(2) Not more than 4,000 covered individuals may participate in 
the program under this section in any fiscal year.
    ``(b) Amount of Assistance.--(1) The Secretary shall provide, to 
each covered individual who pursues a high technology program of 
education under this section, educational assistance in amounts equal 
to the amounts provided under section 3313(c)(1) of this title, 
including, except as provided in paragraph (3), with respect to the 
housing stipend described in that section and in accordance with the 
treatment of programs that are distance learning and programs that are 
less than half-time.
    ``(2) Under paragraph (1), the Secretary shall provide such amounts 
of educational assistance to a covered individual for each of the 
following:
            ``(A) A high technology program of education.
            ``(B) A second such program if--
                    ``(i) the second such program begins at least 18 
                months after the covered individual graduates from the 
                first such program; and
                    ``(ii) the covered individual uses educational 
                assistance under chapter 33 of this title to pursue the 
                second such program.
    ``(3) No covered individual may receive a housing stipend under 
this subsection for any month if such individual is in receipt of a 
housing stipend under chapter 33 of this title for that month.
    ``(c) Contracts.--(1) For purposes of carrying out subsection (a), 
the Secretary shall seek to enter into contracts with any number of 
qualified providers of high technology programs of education for the 
provision of such programs to covered individuals. Each such contract 
shall provide for the conditions under which the Secretary may 
terminate the contract with the provider and the procedures for 
providing for the graduation of students who were enrolled in a program 
provided by such provider in the case of such a termination.
    ``(2) A contract under this subsection shall provide that the 
Secretary shall pay to a provider--
            ``(A) upon the enrollment of a covered individual in the 
        program, 25 percent of the cost of the tuition and other fees 
        for the program of education for the individual;
            ``(B) upon graduation of the individual from the program, 
        25 percent of such cost; and
            ``(C) 50 percent of such cost upon--
                    ``(i) the successful employment of the covered 
                individual for a period--
                            ``(I) of 180 days in the field of study of 
                        the program; and
                            ``(II) that begins not later than 180 days 
                        following graduation of the covered individual 
                        from the program;
                    ``(ii) the employment of the individual by the 
                provider for a period of one year; or
                    ``(iii) the enrollment of the individual in a 
                program of education to continue education in such 
                field of study.
    ``(3) For purposes of this section, a provider of a high technology 
program of education is qualified if--
            ``(A) the provider employs instructors whom the Secretary 
        determines are experts in their respective fields in accordance 
        with paragraph (5);
            ``(B) the provider has successfully provided the high 
        technology program for at least one year;
            ``(C) the provider does not charge tuition and fees to a 
        covered individual who receives assistance under this section 
        to pursue such program that are higher than the tuition and 
        fees charged by such provider to another individual; and
            ``(D) the provider meets the approval criteria developed by 
        the Secretary under paragraph (4).
    ``(4)(A) The Secretary shall prescribe criteria for approving 
providers of a high technology program of education under this section.
    ``(B) In developing such criteria, the Secretary may consult with 
State approving agencies.
    ``(C) Such criteria are not required to meet the requirements of 
section 3672 of this title.
    ``(D) Such criteria shall include the job placement rate, in the 
field of study of a program of education, of covered individuals who 
complete such program of education.
    ``(5) The Secretary shall determine whether instructors are experts 
under paragraph (3)(A) based on evidence furnished to the Secretary by 
the provider regarding the ability of the instructors to--
            ``(A) identify professions in need of new employees to 
        hire, tailor the programs to meet market needs, and identify 
        the employers likely to hire graduates;
            ``(B) effectively teach the skills offered to covered 
        individuals;
            ``(C) provide relevant industry experience in the fields of 
        programs offered to incoming covered individuals; and
            ``(D) demonstrate relevant industry experience in such 
        fields of programs.
    ``(6) In entering into contracts under this subsection, the 
Secretary shall give preference to a provider of a high technology 
program of education--
            ``(A) from which at least 70 percent of graduates find 
        full-time employment in the field of study of the program 
        during the 180-day period beginning on the date the student 
        graduates from the program; or
            ``(B) that offers tuition reimbursement for any student who 
        graduates from such a program and does not find employment 
        described in subparagraph (A).
    ``(d) Effect on Other Entitlement.--(1) If a covered individual 
enrolled in a high technology program of education under this section 
has remaining entitlement to educational assistance under chapter 30, 
32, 33, 34, or 35 of this title, such entitlement shall be charged at 
the rate of one month of such entitlement for each month of educational 
assistance provided under this section.
    ``(2) If a covered individual enrolled in a high technology program 
of education under this section does not have remaining entitlement to 
educational assistance under chapter 30, 32, 33, 34, or 35 of this 
title, any educational assistance provided to such individual under 
this section shall be provided in addition to the entitlement that the 
individual has used.
    ``(3) The Secretary may not consider enrollment in a high 
technology program of education under this section to be assistance 
under a provision of law referred to in section 3695 of this title.
    ``(4)(A) An application for enrollment in a high technology program 
of education under this section shall include notice of the 
requirements relating to use of entitlement under paragraphs (1) and 
(2), including--
            ``(i) in the case of the enrollment of an individual 
        referred to under paragraph (1), the amount of entitlement that 
        is typically charged for such enrollment;
            ``(ii) an identification of any methods that may be 
        available for minimizing the amount of entitlement required for 
        such enrollment; and
            ``(iii) an element requiring applicants to acknowledge 
        receipt of the notice under this subparagraph.
    ``(B) If the Secretary approves the enrollment of a covered 
individual in a high technology program of education under this 
section, the Secretary shall deliver electronically to the individual 
an award letter that provides notice of such approval and includes 
specific information describing how paragraphs (1) and (2) will be 
applied to the individual if the individual chooses to enroll in the 
program.
    ``(e) Requirements for Educational Institutions.--(1) The Secretary 
shall not approve the enrollment of any covered individual, not already 
enrolled, in any high technology programs of education under this 
section for any period during which the Secretary finds that more than 
85 percent of the students enrolled in the program are having all or 
part of their tuition, fees, or other charges paid to or for them by 
the educational institution or by the Department of Veterans Affairs 
under this title or under chapter 1606 or 1607 of title 10, except with 
respect to tuition, fees, or other charges that are paid under a 
payment plan at an educational institution that the Secretary 
determines has a history of offering payment plans that are completed 
not later than 180 days after the end of the applicable term, quarter, 
or semester.
    ``(2) The Secretary may waive a requirement of paragraph (1) if the 
Secretary determines, pursuant to regulations which the Secretary shall 
prescribe, such waiver to be in the interest of the covered individual 
and the Federal Government. Not later than 30 days after the Secretary 
waives such a requirement, the Secretary shall submit to the Committees 
on Veterans' Affairs of the Senate and House of Representatives a 
report regarding such waiver.
    ``(3)(A)(i) The Secretary shall establish and maintain a process by 
which an educational institution may request a review of a 
determination that the educational institution does not meet the 
requirements of paragraph (1).
    ``(ii) The Secretary may consult with a State approving agency 
regarding such process or such a review.
    ``(iii) Not later than 180 days after the Secretary establishes or 
revises a process under this subparagraph, the Secretary shall submit 
to the Committees on Veterans' Affairs of the Senate and House of 
Representatives a report regarding such process.
    ``(B) An educational institution that requests a review under 
subparagraph (A)--
            ``(i) shall request the review not later than 30 days after 
        the start of the term, quarter, or semester for which the 
        determination described in subparagraph (A) applies; and
            ``(ii) may include any information that the educational 
        institution believes the Department should have taken into 
        account when making the determination, including with respect 
        to any mitigating circumstances.
    ``(f) Annual Reports.--Not later than one year after the date of 
the enactment of this section, and annually thereafter until the 
termination date specified in subsection (i), the Secretary shall 
submit to the Committees on Veterans' Affairs of the Senate and House 
of Representatives a report on the operation of program under this 
section during the year covered by the report. Each such report shall 
include each of the following:
            ``(1) The number of covered individuals enrolled in the 
        program, disaggregated by type of educational institution, 
        during the year covered by the report.
            ``(2) The number of covered individuals who completed a 
        high technology program of education under the program during 
        the year covered by the report.
            ``(3) The average employment rate of covered individuals 
        who completed such a program of education during such year, as 
        of 180 days after the date of completion.
            ``(4) The average length of time between the completion of 
        such a program of education and employment.
            ``(5) The total number of covered individuals who completed 
        a program of education under the program and who, as of the 
        date of the submission of the report, are employed in a 
        position related to technology.
            ``(6) The average salary of a covered individual who 
        completed a program of education under the program and who is 
        employed in a position related to technology, in various 
        geographic areas determined by the Secretary.
            ``(7) The average salary of all individuals employed in 
        positions related to technology in the geographic areas 
        determined under subparagraph (F), and the difference, if any, 
        between such average salary and the average salary of a covered 
        individual who completed a program of education under the 
        program and who is employed in a position related to 
        technology.
            ``(8) The number of covered individuals who completed a 
        program of education under the program and who subsequently 
        enrolled in a second program of education under the program.
    ``(g) Collection of Information; Consultation.--(1) The Secretary 
shall develop practices to use to collect information about covered 
individuals and providers of high technology programs of education.
    ``(2) For the purpose of carrying out program under this section, 
the Secretary may consult with providers of high technology programs of 
education and may establish an advisory group made up of 
representatives of such providers, private employers in the technology 
field, and other relevant groups or entities, as the Secretary 
determines necessary.
    ``(h) Definitions.--In this section:
            ``(1) The term `covered individual' means any of the 
        following:
                    ``(A) A veteran whom the Secretary determines--
                            ``(i) served an aggregate of at least 36 
                        months on active duty in the Armed Forces 
                        (including service on active duty in entry 
                        level and skill training) and was discharged or 
                        released therefrom under conditions other than 
                        dishonorable; and
                            ``(ii) has not attained the age of 62.
                    ``(B) A member of the Armed Forces that the 
                Secretary determines will become a veteran described in 
                subparagraph (A) fewer than 180 days after the date of 
                such determination.
            ``(2) The term `high technology program of education' means 
        a program of education--
                    ``(A) offered by a public or private educational 
                institution;
                    ``(B) if offered by an institution of higher 
                learning, that is provided directly by such institution 
                rather than by an entity other than such institution 
                under a contract or other agreement;
                    ``(C) that does not lead to a degree;
                    ``(D) that has a term of not less than six and not 
                more than 28 weeks; and
                    ``(E) that provides instruction in computer 
                programming, computer software, media application, data 
                processing, or information sciences.
    ``(i) Termination.--The Secretary may not provide educational 
assistance under this section for a high technology program of 
education that begins after September 30, 2027.''.
            (2) Clerical amendment.--The table of sections at the 
        beginning of such chapter is amended by inserting after the 
        item relating to section 3699B the following new item:

``3699C. High technology program.''.
    (b) Effect on High Technology Pilot Program.--Section 116 of the 
Harry W. Colmery Veterans Educational Assistance Act of 2017 (Public 
Law 115-48; 38 U.S.C. 3001 note) is amended--
            (1) by amending subsection (d) to read as follows:
    ``(d) Housing Stipend.--
            ``(1) In general.--Except as provided under paragraph (2), 
        the Secretary shall pay to each eligible veteran (not including 
        an individual described in the second sentence of subsection 
        (b)) who is enrolled in a high technology program of education 
        under the pilot program on a full-time or part-time basis a 
        monthly housing stipend equal to the product--
                    ``(A) of--
                            ``(i) in the case of a veteran pursuing 
                        resident training, the monthly amount of the 
                        basic allowance for housing payable under 
                        section 403 of title 37, United States Code, 
                        for a member with dependents in pay grade E-5 
                        residing in the military housing area that 
                        encompasses all or the majority portion of the 
                        ZIP code area in which is located the campus of 
                        the institution where the individual physically 
                        participates in a majority of classes; or
                            ``(ii) in the case of a veteran pursuing a 
                        program of education through distance learning, 
                        a monthly amount equal to 50 percent of the 
                        national average of the monthly amount of the 
                        basic allowance for housing payable under 
                        section 403 of title 37, United States Code, 
                        for a member with dependents in pay grade E-5, 
                        multiplied by
                    ``(B) the lesser of--
                            ``(i) 1.0; or
                            ``(ii) the number of course hours borne by 
                        the individual in pursuit of the program of 
                        education involved, divided by the minimum 
                        number of course hours required for full-time 
                        pursuit of such program of education, rounded 
                        to the nearest multiple of 10.
            ``(2) Bar to dual eligibility.--No covered individual may 
        receive a housing stipend under this subsection for any month 
        if such individual is in receipt of a housing stipend under 
        chapter 33 of title 38, United States Code, for that month.'';
            (2) in subsection (g), by striking paragraph (6); and
            (3) by striking subsection (h) and inserting the following 
        new subsection (h):
    ``(h) Termination.--The Secretary may not, under this section, pay 
a provider for a high technology program of education that begins after 
September 30, 2024.''.
    (c) Approval of Certain High Technology Programs.--Section 3680A of 
title 38, United States Code, is amended--
            (1) in subsection (a), by striking paragraph (4) and 
        inserting the following:
            ``(4) Any independent study program except--
                    ``(A) an independent study program (including such 
                a program taken over open circuit television) that--
                            ``(i) is accredited by an accrediting 
                        agency or association recognized by the 
                        Secretary of Education under subpart 2 of part 
                        H of title IV of the Higher Education Act of 
                        1965 (20 U.S.C. 1099b);
                            ``(ii) leads to--
                                    ``(I) a standard college degree;
                                    ``(II) a certificate that reflects 
                                educational attainment offered by an 
                                institution of higher learning; or
                                    ``(III) a certificate that reflects 
                                graduation from a course of study 
                                offered by--
                                            ``(aa) an area career and 
                                        technical education school (as 
                                        defined in subparagraphs (C) 
                                        and (D) of section 3(3) of the 
                                        Carl D. Perkins Career and 
                                        Technical Education Act of 2006 
                                        (20 U.S.C. 2302(3))) that 
                                        provides education at the 
                                        postsecondary level; or
                                            ``(bb) a postsecondary 
                                        vocational institution (as 
                                        defined in section 102(c) of 
                                        the Higher Education Act of 
                                        1965 (20 U.S.C. 1002(c))) that 
                                        provides education at the 
                                        postsecondary level; and
                            ``(iii) in the case of a program described 
                        in clause (ii)(III)--
                                    ``(I) provides training aligned 
                                with the requirements of employers in 
                                the State or local area where the 
                                program is located, which may include 
                                in-demand industry sectors or 
                                occupations;
                                    ``(II) provides a student, upon 
                                graduation from the program, with a 
                                recognized postsecondary credential 
                                that is recognized by employers in the 
                                relevant industry, which may include a 
                                credential recognized by industry or 
                                sector partnerships in the State or 
                                local area where the industry is 
                                located; and
                                    ``(III) meets such content and 
                                instructional standards as may be 
                                required to comply with the criteria 
                                under section 3676(c)(14) and (15) of 
                                this title; or
                    ``(B) an online high technology program of 
                education (as defined in subsection (h)(2) of section 
                3699C of this title)--
                            ``(i) the provider of which has entered 
                        into a contract with the Secretary under 
                        subsection (c) of such section;
                            ``(ii) that has been provided to covered 
                        individuals (as defined in subsection (h)(1) of 
                        such section) under such contract for a period 
                        of at least five years;
                            ``(iii) regarding which the Secretary has 
                        determined that the average employment rate of 
                        covered individuals who graduated from such 
                        program of education is 65 percent or higher 
                        for the year preceding such determination; and
                            ``(iv) that satisfies the requirements of 
                        subsection (e) of such section.''; and
            (2) in subsection (d), by adding at the end the following:
    ``(8) Paragraph (1) shall not apply to the enrollment of a veteran 
in an online high technology program described in subsection 
(a)(4)(B).''.

SEC. 213. NOTICE OF CHANGES TO DEPARTMENT OF VETERANS AFFAIRS POLICIES 
              AND GUIDANCE AFFECTING THE EDUCATIONAL ASSISTANCE 
              PROGRAMS OF THE DEPARTMENT.

    (a) In General.--Subchapter III of chapter 36 of title 38, United 
States Code, as amended by sections 210 and 212, is further amended by 
adding at the end the following new section:
``Sec. 3699D. Notice of changes to policies and guidance relating to 
              educational assistance programs
    ``In the case of any change to any policy or guidance provided by 
the Secretary that relates to any educational assistance program of the 
Department, the Secretary may not implement the change before the date 
that is 90 days after the date on which the Secretary makes available 
to students, educational institutions, and the Committees on Veterans' 
Affairs of the Senate and House of Representatives notice of, and 
justification for, the change.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by inserting after the item relating to section 
3699B the following new item:

``3699D. Notice of changes to policies and guidance relating to 
                            educational assistance programs.''.

SEC. 214. PAYMENT OF VA EDUCATIONAL ASSISTANCE VIA ELECTRONIC FUND 
              TRANSFER TO A FOREIGN INSTITUTION OF HIGHER EDUCATION.

    Not later than 90 days after the date of the enactment of this Act, 
the Secretary of Veterans Affairs shall update the payment system of 
the Department of Veterans Affairs to allow for electronic fund 
transfer of educational assistance, administered by the Secretary, to a 
foreign institution of higher education that--
            (1) provides an approved course of education to an eligible 
        recipient of such assistance; and
            (2) does not have--
                    (A) an employer identification number; or
                    (B) an account with a domestic bank.

SEC. 215. IMPROVING TRANSPARENCY AND ACCOUNTABILITY OF EDUCATIONAL 
              INSTITUTIONS FOR PURPOSES OF VETERANS EDUCATIONAL 
              ASSISTANCE.

    (a) Requirement Relating to G.I. Bill Comparison Tool.--
            (1) Requirement to maintain tool.--The Secretary of 
        Veterans Affairs shall maintain the G.I. Bill Comparison Tool 
        that was established pursuant to Executive Order 13607 (77 Fed. 
        Reg. 25861; relating to establishing principles of excellence 
        for educational institutions serving service members, veterans, 
        spouses, and other family members) and in effect on the day 
        before the date of enactment of this Act, or a successor tool, 
        to provide relevant and timely information about programs of 
        education approved under chapter 36 of title 38, United States 
        Code, and the educational institutions that offer such 
        programs.
            (2) Data retention.--The Secretary shall ensure that 
        historical data that is reported via the tool maintained under 
        paragraph (1) remains easily and prominently accessible on the 
        benefits.va.gov website, or a successor website, for a period 
        of not less than six years from the date of initial 
        publication.
    (b) Providing Timely and Relevant Education Information to 
Veterans, Members of the Armed Forces, and Other Individuals.--
            (1) In general.--Not later than one year after the date of 
        the enactment of this Act, the Secretary of Veterans Affairs, 
        in consultation with the Secretary of Education, the Secretary 
        of the Treasury, and the heads of other relevant Federal 
        agencies, shall make such changes to the tool maintained under 
        subsection (a) as the Secretary of Veterans Affairs determines 
        appropriate to ensure that such tool is an effective and 
        efficient method for providing information pursuant to section 
        3698(b)(5) of title 38, United States Code.
            (2) Memorandum of understanding required.--Not later than 
        two years after the date of the enactment of this Act, the 
        Secretary of Veterans Affairs shall seek to enter into a 
        memorandum of understanding with the Secretary of Education and 
        the heads other relevant Federal agencies, as the Secretary of 
        Veterans Affairs determines appropriate, to obtain information 
        on outcomes with respect to individuals who are entitled to 
        educational assistance under the laws administered by the 
        Secretary of Veterans Affairs and who are attending educational 
        institutions. Such memorandum of understanding may include data 
        sharing or computer matching agreements.
            (3) Modification of scope of comprehensive policy on 
        providing education information.--Section 3698 of title 38, 
        United States Code, is amended--
                    (A) in subsection (a), by striking ``veterans and 
                members of the Armed Forces'' and inserting 
                ``individuals entitled to educational assistance under 
                laws administered by the Secretary of Veterans 
                Affairs''; and
                    (B) in subsection (b)(5)--
                            (i) by striking ``veterans and members of 
                        the Armed Forces'' and inserting ``individuals 
                        described in subsection (a)''; and
                            (ii) by striking ``the veteran or member'' 
                        and inserting ``the individual''.
            (4) G.I. bill comparison tool required disclosures.--
        Paragraph (1) of subsection (c) of such section is amended--
                    (A) by striking subparagraph (B) and inserting the 
                following:
            ``(B) for each individual described in subsection (a) 
        seeking information provided under subsection (b)(5), the name 
        of each Federal student aid program, and a description of each 
        such program, from which the individual may receive educational 
        assistance; and'';
                    (B) in subparagraph (C)--
                            (i) in clause (i), by inserting ``and a 
                        definition of each type of institution'' before 
                        the semicolon;
                            (ii) in clause (iv), by inserting ``and if 
                        so, which programs'' before the semicolon;
                            (iii) by striking clause (v) and inserting 
                        the following:
                    ``(v) the average annual cost and the total cost to 
                earn an associate's degree and a bachelor's degree, 
                with available cost information on any other degree or 
                credential the institution awards;'';
                            (iv) in clause (vi), by inserting before 
                        the semicolon the following: ``disaggregated 
                        by--
                            ``(I) the type of beneficiary of 
                        educational assistance;
                            ``(II) individuals who received a 
                        credential and individuals who did not; and
                            ``(III) individuals using educational 
                        assistance under laws administered by the 
                        Secretary and individuals who are not;'';
                            (v) in clause (xiv), by striking ``and'' at 
                        the end;
                            (vi) in clause (xv), by striking the period 
                        at the end and inserting a semicolon; and
                            (vii) by adding at the end the following 
                        new clauses:
                    ``(xvi) the number of veterans or members who 
                completed covered education at the institution leading 
                to--
                            ``(I) a degree, disaggregated by type of 
                        program, including--
                                    ``(aa) an associate degree;
                                    ``(bb) a bachelor's degree; and
                                    ``(cc) a postbaccalaureate degree; 
                                and
                            ``(II) a certificate or professional 
                        license, disaggregated by type of certificate 
                        or professional license;
                    ``(xvii) programs available and the average time 
                for completion of each program;
                    ``(xviii) employment rate and median income of 
                graduates of the institution in general two and five 
                years after graduation, disaggregated by--
                            ``(I) specific program; and
                            ``(II) individuals using educational 
                        assistance under laws administered by the 
                        Secretary and individuals who are not; and
                    ``(xix) the number of individuals using educational 
                assistance under laws administered by the Secretary who 
                are enrolled in the both the institution and specific 
                program per year.''.
            (5) Clarity and anonymity of information provided.--
        Paragraph (2) of such subsection is amended--
                    (A) by inserting ``(A)'' before ``To the extent''; 
                and
                    (B) by adding at the end the following new 
                subparagraph:
    ``(B) The Secretary shall ensure that information provided pursuant 
to subsection (b)(5) is provided in a manner that is easy for, and 
accessible to, individuals described in subsection (a).
    ``(C) In providing information pursuant to subsection (b)(5), the 
Secretary shall maintain the anonymity of individuals described in 
subsection (a) and, to the extent that a portion of any data would 
undermine such anonymity, ensure that such data is not made available 
pursuant to such subsection.''.
    (c) Improvements for Student Feedback.--
            (1) In general.--Subsection (b)(2) of such section is 
        amended--
                    (A) by amending subparagraph (A) to read as 
                follows:
                    ``(A) provides institutions of higher learning--
                            ``(i) up to 30 days to review and respond 
                        to feedback from individuals described in 
                        subsection (a) and address issues regarding the 
                        feedback before the feedback is published; and
                            ``(ii) if an institution of higher learning 
                        contests the accuracy of the feedback, the 
                        opportunity to challenge the inclusion of such 
                        data with an official appointed by the 
                        Secretary;'';
                    (B) in subparagraph (B), by striking ``and'' at the 
                end;
                    (C) in subparagraph (C), by striking ``that 
                conforms with criteria for relevancy that the Secretary 
                shall determine.'' and inserting ``, and responses from 
                institutions of higher learning to such feedback, that 
                conform with criteria for relevancy that the Secretary 
                shall determine;''; and
                    (D) by adding at the end the following new 
                subparagraphs:
                    ``(D) for each institution of higher learning that 
                is approved under this chapter, retains, maintains, and 
                publishes all of such feedback for not less than six 
                years; and
                    ``(E) is easily accessible to individuals described 
                in subsection (a) and to the general public.''.
            (2) Accessibility from g.i. bill comparison tool.--The 
        Secretary shall ensure that--
                    (A) the feedback tracked and published under 
                subsection (b)(2) of such section, as amended by 
                paragraph (1), is prominently displayed in the tool 
                maintained under subsection (a) of this section; and
                    (B) when such tool displays information for an 
                institution of higher learning, the applicable feedback 
                is also displayed for such institution of higher 
                learning.
    (d) Training for Provision of Education Counseling Services.--
            (1) In general.--Not less than one year after the date of 
        the enactment of this Act, the Secretary shall ensure that 
        personnel employed by the Department of Veteran Affairs, or a 
        contractor of the Department, to provide education benefits 
        counseling, vocational or transition assistance, or similar 
        functions, including employees or contractors of the Department 
        who provide such counseling or assistance as part of the 
        Transition Assistance Program, are trained on how--
                    (A) to use properly the tool maintained under 
                subsection (a); and
                    (B) to provide appropriate educational counseling 
                services to individuals described in section 3698(a) of 
                such title, as amended by subsection (b)(3)(A).
            (2) Transition assistance program defined.--In this 
        subsection, the term ``Transition Assistance Program'' means 
        the program of counseling, information, and services under 
        section 1142 of title 10, United States Code.

                  Subtitle B--Employment and Training

SEC. 221. IMPROVEMENTS TO REEMPLOYMENT RIGHTS OF MEMBERS OF THE ARMED 
              FORCES.

    (a) USERRA Purposes.--Section 4301(a)(1) of title 38, United States 
Code, is amended by striking ``encourage noncareer service in the 
uniformed services'' and inserting ``encourage service in the uniformed 
services''.
    (b) Prohibition of Retaliation.--Subsection (b) of section 4311 of 
title 38, United States Code, is amended by inserting ``or other 
retaliatory action'' after ``employment action''.
    (c) Expansion of Injunctive Relief.--Subsection (e) of section 4323 
of such title is amended--
            (1) by striking ``The court shall use'' and inserting ``(1) 
        The court shall use''; and
            (2) by adding at the end the following new paragraphs:
    ``(2) A person bringing an action to enforce a provision of this 
chapter pursuant to subsection (a) shall be entitled to an injunction 
under paragraph (1) if such person demonstrates--
            ``(A) a violation--
                    ``(i) of the provisions of this chapter; or
                    ``(ii) of the provisions of this chapter is 
                threatened or is imminent;
            ``(B) the harm to the person outweighs the injury to the 
        employer;
            ``(C) a likelihood of success on the merits of such action; 
        and
            ``(D) awarding such relief is in the public interest.
    ``(3) The court may not deny a motion for injunctive relief on the 
basis that a party bringing an action to enforce a provision of this 
chapter may be awarded wages unearned due to an unlawful termination or 
denial of employment at the conclusion of such action.''.
    (d) Damages Against a State or Private Employer.--Section 4323 of 
such title is further amended, in paragraph (1) of subsection (d), by 
striking subparagraph (C) and inserting the following new 
subparagraphs:
            ``(C) The court may require the employer to pay the person 
        the amount referred to in subparagraph (B) and interest on such 
        amount, calculated at a rate of 3 percent per year.
            ``(D) The court may require the employer to pay the person 
        the greater of $50,000 or the amount equal to the amounts 
        referred to in subparagraphs (B) and (C) as liquidated damages, 
        if the court determines that the employer knowingly failed to 
        comply with the provisions of this chapter.''.
    (e) Mandatory Attorney Fees Award in Successful Actions for 
Reemployment.--
            (1) MSPB actions.--Paragraph (4) of subsection (c) of 
        section 4324 of such title is amended--
                    (A) by striking ``may, in its discretion,'' and 
                inserting ``shall''; and
                    (B) by adding at the end the following new 
                sentence: ``The Board may, in its discretion, award 
                reasonable attorney fees in a case settled before the 
                issuance of an order if the person can demonstrate that 
                significant attorney fees were incurred and that 
                justice requires such an award.''.
            (2) Federal circuit actions.--Subsection (d) of such 
        section is amended by adding at the end the following new 
        paragraph:
    ``(3) In such Federal Circuit proceeding, the court shall award 
such person reasonable attorney fees, expert witness fees, and other 
litigation expenses if such person--
            ``(A) prevails in such Federal Circuit proceeding; and
            ``(B) is not represented by the Special Counsel in such 
        Federal Circuit proceeding.''.
            (3) Actions against a state or private employer.--Paragraph 
        (2) of section 4323(h) of such title is amended--
                    (A) by striking ``subsection (a)(2)'' and inserting 
                ``subsection (a)(3)''; and
                    (B) by striking ``the court may award any such 
                person who prevails in such action or proceeding 
                reasonable attorney fees'' and inserting ``the court 
                shall award any such person who prevails in such action 
                or proceeding reasonable attorney fees''.
    (f) GAO Review and Report on USERRA.--
            (1) Review.--The Comptroller General of the United States 
        shall review the methods through which the Secretary of Labor, 
        acting through the Veterans' Employment and Training Service, 
        processes actions for relief under chapter 43 of title 38, 
        United States Code.
            (2) Elements.--Not later than one year after the date of 
        the enactment of this Act, the Comptroller General shall submit 
        to the Committees on Veterans' Affairs of the House of 
        Representatives and the Senate a report that includes--
                    (A) the findings of the review required under 
                paragraph (1);
                    (B) an identification of the number of actions for 
                relief under chapter 43 of title 38, United States 
                Code, initiated during the period covered by the 
                report, disaggregated by size of employer and 
                geographic region;
                    (C) an identification of the number of such actions 
                for relief that were erroneously dismissed, as 
                determined by the Comptroller General;
                    (D) an identification of the number of such actions 
                for relief that were referred to the Department of 
                Justice; and
                    (E) an assessment of trends, if any, in such 
                actions for relief initiated during such period.
    (g) GAO Review of Protections for Members of the Uniformed Services 
by Federal Intelligence Agencies.--
            (1) In general.--Not later than one year after the date of 
        the enactment of this Act, the Comptroller General of the 
        United States shall submit to the appropriate congressional 
        committees a report on the processes and procedures adopted and 
        used by the intelligence community to provide the protections 
        for members of the uniformed services otherwise established 
        under chapter 43 of title 38, United States Code.
            (2) Definitions.--In this subsection:
                    (A) The term ``appropriate congressional 
                committees'' means the Committees on Veterans' Affairs 
                of the House of Representatives and Senate, the 
                Permanent Select Committee on Intelligence of the House 
                of Representatives, and the Select Committee on 
                Intelligence of the Senate.
                    (B) The term ``intelligence community'' has the 
                meaning given such term in section 3(4) of the National 
                Security Act of 1947 (50 U.S.C. 3003(4)).

SEC. 222. REVIEW OF INVESTIGATIONS MANUAL OF VETERANS' EMPLOYMENT AND 
              TRAINING SERVICE.

    (a) In General.--Not later than one year after the date of the 
enactment of this Act, and once every two years thereafter for the 
period of five years beginning on such date, the Secretary of Labor, 
shall review the manual of the Department of Labor titled ``Veterans' 
Employment and Training Service Investigations Manual: USERRA, VEOA, 
and VP'' (or a successor manual) and make such revisions to such manual 
as the Secretary determines appropriate.
    (b) Report.--Not later than 90 days after any date on which the 
Secretary completes a review required under subsection (a), the 
Secretary shall submit to the Committees on Veterans' Affairs of the 
House of Representatives and the Senate--
            (1) a report that includes a description of any revision to 
        such manual made pursuant to such review; and
            (2) a copy of the entire such manual which--
                    (A) shall be provided to the Chairman and Ranking 
                Member of each such committee; and
                    (B) may contain a separate addendum for portions of 
                the manual that contain law enforcement sensitive 
                materials.

SEC. 223. WARRIOR TRAINING ADVANCEMENT COURSE.

    (a) Reports Required.--
            (1) Initial report.--Not later than six months after the 
        date of the enactment of this Act, the Secretary of Veterans 
        Affairs shall submit to the Committees on Veterans' Affairs of 
        the Senate and House of Representatives a report on WARTAC.
            (2) Annual report.--One year after the submission of the 
        report required under paragraph (1) and annually thereafter, 
        the Secretary shall submit to such Committees a report that 
        contains the elements under paragraphs (1) and (3) of 
        subsection (b) with regards to the preceding year.
            (3) Elements.--Except as provided in subsection (a)(2), the 
        reports under this subsection shall include the following 
        elements:
                    (A) Best practices.--With regards to best practices 
                of WARTAC--
                            (i) how many covered members have applied 
                        to participate in WARTAC;
                            (ii) how many covered members have 
                        participated in WARTAC;
                            (iii) how the Secretary provides training 
                        to covered members during TAP;
                            (iv) how many covered members have 
                        completed WARTAC; and
                            (v) any other information the Secretary 
                        determines appropriate.
                    (B) Cost savings.--With regards to cost savings of 
                WARTAC--
                            (i) how much money the Secretary determines 
                        WARTAC saves the United States each fiscal 
                        year;
                            (ii) how much money the Secretary 
                        determines WARTAC has saved the United States 
                        since its establishment; and
                            (iii) the determination of the Secretary 
                        whether other Federal agencies may save money 
                        by establishing a program similar to WARTAC.
                    (C) Hiring.--With regards to hiring covered members 
                who complete WARTAC--
                            (i) how the Secretary identifies positions 
                        in the Department of Veterans Affairs for which 
                        such covered members may qualify;
                            (ii) the grades of such positions on the 
                        General Schedule under section 5332 of title 5, 
                        United States Code; and
                            (iii) how many such covered members the 
                        Secretary has hired to such positions.
            (4) Distribution.--Not later than 30 days after submitting 
        the report under paragraph (1), the Secretary of Veterans 
        Affairs shall transmit a copy of such report to the head of 
        each Federal agency.
            (5) Definitions.--In this subsection:
                    (A) The term ``covered member'' means members of 
                the Armed Forces participating in TAP.
                    (B) The term ``TAP'' means the Transition 
                Assistance Program under sections 1142 and 1144 of 
                title 10, United States Code.
                    (C) The term ``WARTAC'' means the Warrior Training 
                Advancement Course of the Veterans Benefit 
                Administration, in which the Secretary provides 
                training to covered members so such covered members may 
                qualify for certain employment in the Veterans Benefit 
                Administration.
    (b) Best Practices for Other Departments.--The Assistant Secretary 
of Labor for Veterans' Employment and Training shall, in consultation 
with the Secretary of Veterans Affairs, establish guidelines containing 
best practices for departments and agencies of the Federal Government 
that carry out programs to employ veterans who are transitioning from 
service in the Armed Forces. Such guidelines shall include the findings 
of the initial report required under subsection (a)(1).
    (c) Pilot Program.--
            (1) Establishment.--The Secretary of the Interior shall, in 
        consultation with the Secretary of Labor and the Secretary of 
        Veterans Affairs, establish a pilot program to proactively 
        inform veterans of available employment positions that relate 
        to the conservation and resource management activities of the 
        Department of the Interior.
            (2) Positions.--The Secretary of the Interior shall--
                    (A) identify vacant positions in the Department of 
                the Interior that are appropriate to fill using the 
                pilot program; and
                    (B) to the maximum extent practicable, provide 
                assistance to veterans in selecting one or more vacant 
                positions to apply to, for which that veteran may be 
                best qualified.
            (3) Reports.--
                    (A) Implementation report.--Not later than one year 
                after the date on which the pilot program under 
                paragraph (1) commences, the Secretary of the Interior, 
                the Secretary of Veterans Affairs, and the Secretary of 
                Labor shall jointly provide to the appropriate 
                congressional committees a report on the implementation 
                of the pilot program.
                    (B) Final report.--Not later than 30 days after the 
                date on which the pilot program under paragraph (1) 
                terminates under paragraph (4), the Secretary of the 
                Interior, the Secretary of Veterans Affairs, and the 
                Secretary of Labor shall jointly submit to the 
                appropriate congressional committees a report on the 
                pilot program that includes the following:
                            (i) The number of veterans who applied to 
                        participate in the pilot program.
                            (ii) The number of such veterans employed 
                        under the pilot program.
                            (iii) The number of veterans identified in 
                        clause (ii) who transitioned to full-time 
                        positions with the Federal Government after 
                        participating in the pilot program.
                            (iv) Any other information the Secretary of 
                        the Interior, the Secretary of Veterans 
                        Affairs, and the Secretary of Labor determine 
                        appropriate with respect to measuring the 
                        effectiveness of the pilot program.
            (4) Termination.--The authority to carry out the pilot 
        program under this subsection shall terminate on the date that 
        is two years after the date on which the pilot program 
        commences.
            (5) Appropriate congressional committees defined.--In this 
        subsection, the term ``appropriate congressional committees'' 
        means--
                    (A) the Committee on Veterans' Affairs and the 
                Committee on Energy and Natural Resources of the 
                Senate; and
                    (B) the Committee on Veterans' Affairs and the 
                Committee on Natural Resources of the House of 
                Representatives.
    (d) Outdoor Recreation Program Attendance.--The Secretary of the 
Interior and the Secretary of Agriculture are encouraged to work with 
the Secretary of Defense and the Secretary of Veterans Affairs to 
ensure members of the Armed Forces and veterans have access to outdoor 
recreation and outdoor-related volunteer and wellness programs as part 
of the basic services provided to such members and veterans.

                         Subtitle C--Home Loans

SEC. 231. IMPROVEMENTS TO PROGRAM FOR DIRECT HOUSING LOANS MADE TO 
              NATIVE AMERICAN VETERANS BY THE SECRETARY OF VETERANS 
              AFFAIRS.

    (a) General Authorities and Requirements.--
            (1) Direct housing loans to native american veterans.--
        Section 3762(a) of title 38, United States Code, is amended to 
        read as follows:
    ``(a) The Secretary may make a direct housing loan to a Native 
American veteran under this subchapter if the Secretary ensures the 
following:
            ``(1) That each Native American veteran to whom the 
        Secretary makes a direct housing loan under this subchapter--
                    ``(A) holds, possesses, or purchases using the 
                proceeds of the loan a meaningful interest in a lot or 
                dwelling (or both) that is located on trust land; and
                    ``(B) will purchase, construct, or improve (as the 
                case may be) a dwelling on the lot using the proceeds 
                of the loan.
            ``(2) That each such Native American veteran will convey to 
        the Secretary by an appropriate instrument the interest 
        referred to in paragraph (1)(A) as security for a direct 
        housing loan under this subchapter.
            ``(3) That the Secretary, including the Secretary's 
        employees or agents, may enter upon the trust land for the 
        purposes of carrying out such actions as the Secretary 
        determines are necessary, including--
                    ``(A) to evaluate the advisability of the loan;
                    ``(B) to monitor any purchase, construction, or 
                improvements carried out using the proceeds of the 
                loan; and
                    ``(C) to manage any servicing or post-foreclosure 
                activities, including acquisition, property 
                inspections, and property management.
            ``(4) That there are established standards and procedures 
        that apply to the foreclosure of the interest conveyed by a 
        Native American veteran pursuant to paragraph (2), including--
                    ``(A) procedures for foreclosing the interest; and
                    ``(B) procedures for the resale of the lot or 
                dwelling (or both) purchased, constructed, or improved 
                using the proceeds of the loan.
            ``(5) That the loan is made in a responsible and prudent 
        manner, subject to standards and procedures as are necessary 
        for the reasonable protection of the financial interests of the 
        United States.''.
            (2) Memorandums of understanding, agreements, and 
        determinations.--Section 3762(b) of such title is amended to 
        read as follows:
    ``(b)(1) To carry out the purpose of subsection (a), the Secretary 
may--
            ``(A) enter into a memorandum of understanding with a 
        tribal organization, other entity, or individual;
            ``(B) rely on agreements or determinations of other Federal 
        agencies to guarantee, insure, or make loans on trust land; and
            ``(C) enter into other agreements or take such other 
        actions as the Secretary determines necessary.
    ``(2) If the Secretary determines that the requirements under 
subsection (a) are not being enforced by a tribal organization, other 
entity, or individual that is a party to any memorandum of 
understanding, agreement, or determination described in paragraph (1), 
the Secretary may cease making new direct housing loans to Native 
American veterans under this subchapter within the area of the 
authority of the tribal organization, other entity, or individual (as 
the case may be).''.
    (b) Direct Loans to Native American Veterans To Refinance Existing 
Mortgage Loans.--Section 3762(h) of such title is amended to read as 
follows:
    ``(h) The Secretary may make direct loans to Native American 
veterans in order to enable such veterans to refinance existing 
mortgage loans for any of the following purposes:
            ``(1) To refinance an existing loan made under this 
        section, if the loan--
                    ``(A) meets the requirements set forth in 
                subparagraphs (B), (C), and (E) of paragraph (1) of 
                section 3710(e) of this title;
                    ``(B) will bear an interest rate at least one 
                percentage point less than the interest rate borne by 
                the loan being refinanced; and
                    ``(C) complies with paragraphs (2) and (3) of 
                section 3710(e) of this title, except that for the 
                purposes of this subsection the reference to subsection 
                (a)(8) of section 3710 of this title in such paragraphs 
                (2) and (3) shall be deemed to be a reference to this 
                subsection.
            ``(2) To refinance an existing mortgage loan not made under 
        this section on a dwelling owned and occupied by the veteran as 
        the veteran's home, if all of the following requirements are 
        met:
                    ``(A) The loan will be secured by the same dwelling 
                as was the loan being refinanced.
                    ``(B) The loan will provide the veteran with a net 
                tangible benefit.
                    ``(C) The nature and condition of the property is 
                such as to be suitable for dwelling purposes.
                    ``(D) The amount of the loan does not exceed either 
                of the following:
                            ``(i) 100 percent of the reasonable value 
                        of the dwelling, with such reasonable value 
                        determined under the procedures established by 
                        the Secretary under subsection (d)(2).
                            ``(ii) An amount equal to the sum of the 
                        balance of the loan being refinanced and such 
                        closing costs (including any discount points) 
                        as may be authorized by the Secretary to be 
                        included in the loan.
                    ``(E) Notwithstanding subparagraph (D), if a loan 
                is made for both the purpose of this paragraph and to 
                make energy efficiency improvements, the loan must not 
                exceed either of the following:
                            ``(i) 100 percent of the reasonable value 
                        of the dwelling as improved for energy 
                        efficiency, with such reasonable value 
                        determined under the procedures established by 
                        the Secretary under subsection (d)(2).
                            ``(ii) The amount referred to under 
                        subparagraph (D)(ii), plus the applicable 
                        amount specified under section 3710(d)(2) of 
                        this title.
                    ``(F) The loan meets all other requirements the 
                Secretary may establish under this subchapter.
                    ``(G) The existing mortgage being refinanced is a 
                first lien on the property and secured of record.
            ``(3) To refinance an existing mortgage loan to repair, 
        alter, or improve a dwelling owned by the veteran and occupied 
        by the veteran as the veteran's home, if all of the following 
        requirements are met:
                    ``(A) The loan will be secured by the same dwelling 
                as was the loan being refinanced.
                    ``(B) The nature and condition of the property is 
                such as to be suitable for dwelling purposes, and the 
                repair, alteration, or improvement substantially 
                protects or improves the basic livability or utility of 
                such property.
                    ``(C) The amount of the loan, including the costs 
                of repairs, alterations, and improvements, does not 
                exceed either of the following:
                            ``(i) 100 percent of the reasonable value 
                        of the dwelling as repaired, altered, or 
                        improved, with such reasonable value determined 
                        under the procedures established by the 
                        Secretary under subsection (d)(2).
                            ``(ii) An amount equal to the sum of--
                                    ``(I) the balance of the loan being 
                                refinanced;
                                    ``(II) the actual cost of repairs, 
                                alterations, or improvements; and
                                    ``(III) such closing costs 
                                (including any discount points) as may 
                                be authorized by the Secretary to be 
                                included in the loan.
                    ``(D) The loan meets all other requirements the 
                Secretary may establish under this subchapter.
                    ``(E) The existing mortgage loan being refinanced 
                is a first lien on the property and secured of 
                record.''.
    (c) Expansion of Outreach Program on Availability of Direct Housing 
Loans for Native American Veterans.--Section 3762(i)(2) of such title 
is amended by adding at the end the following new subparagraph:
            ``(G) Pursuant to subsection (g)(4), assisting Native 
        American veterans in qualifying for mortgage financing by--
                    ``(i) partnering with local service providers, such 
                as tribal organizations, tribally designated housing 
                entities, Native community development financial 
                institutions, and nonprofit organizations, for 
                conducting outreach, homebuyer education, housing 
                counseling, and post-purchase education; and
                    ``(ii) providing other technical assistance as 
                needed.
            ``(H) Attending conferences and conventions conducted by 
        the network of Native community development financial 
        institutions and other Native American homeownership 
        organizations to provide information and training to Native 
        community development financial institutions about the 
        availability of the relending program under section 3762A of 
        this title.''.
    (d) Adequate Personnel.--Section 3762 of such title is amended by 
adding at the end the following new subsection:
    ``(k) The Secretary shall assign a sufficient number of personnel 
of the Department dedicated to carrying out the authority of the 
Secretary under this subchapter, including construction and valuation 
specialists to assist with issues unique to new construction and 
renovations on trust land.''.
    (e) Definitions.--Section 3765 of such title is amended--
            (1) in paragraph (1)--
                    (A) by amending subparagraph (C) to read as 
                follows:
                    ``(C) is located in the State of Alaska within a 
                region established under section 7(a) of the Alaska 
                Native Claims Settlement Act (43 U.S.C. 1606(a));'';
                    (B) in subparagraph (D), by striking the period at 
                the end and inserting a semicolon; and
                    (C) by adding at the end the following new 
                subparagraphs:
                    ``(E) is defined by the Secretary of the Interior 
                and recognized by the United States as land over which 
                an Indian Tribe has governmental dominion; or
                    ``(F) is on any land that the Secretary determines 
                is provided to Native American veterans because of 
                their status as Native Americans.''; and
            (2) by adding at the end the following new paragraphs:
            ``(6) The term `community development financial 
        institution' has the meaning given that term in section 103 of 
        the Community Development Banking and Financial Institutions 
        Act of 1994 (12 U.S.C. 4702).
            ``(7) The term `Indian Tribe' means any Indian tribe, band, 
        nation, or other organized group or community, including any 
        Alaska Native village or regional or village corporation as 
        defined in or established pursuant to the Alaska Native Claims 
        Settlement Act (43 U.S.C. 1601 et seq.), which is recognized as 
        eligible for the special programs and services provided by the 
        United States to Indians because of their status as Indians.
            ``(8) The term `Native community development financial 
        institution' means any entity--
                    ``(A) that has been certified as a community 
                development financial institution by the Secretary of 
                the Treasury;
                    ``(B) that is not less than 51 percent owned or 
                controlled by Native Americans; and
                    ``(C) for which not less than 51 percent of the 
                activities of the entity serve Native Americans.
            ``(9) The term `net tangible benefit' shall have such 
        meaning as the Secretary determines appropriate, but shall 
        include the refinance of an interim construction loan.
            ``(10) The term `other technical assistance' means services 
        to assist a Native American veteran to navigate the steps 
        necessary for securing a mortgage loan on trust land, including 
        pre-development activities related to utilities, identifying 
        appropriate residential construction services, and obtaining 
        lease clearances and title status reports from the applicable 
        tribal organization or the Bureau of Indian Affairs.
            ``(11) The term `tribally designated housing entity' has 
        the meaning given that term in section 4 of the Native American 
        Housing Assistance and Self-Determination Act of 1996 (25 
        U.S.C. 4103).''.
    (f) Interest Rate Reduction Financing Loan.--Section 3729(b)(4)(F) 
of such title is amended by striking ``3762(h)'' and inserting 
``3762(h)(1)''.
    (g) Regulations.--Section 3761 of such title is amended by adding 
at the end the following new subsection:
    ``(c) The Secretary shall prescribe such regulations as may be 
necessary to carry out this subchapter.''.

SEC. 232. NATIVE COMMUNITY DEVELOPMENT FINANCIAL INSTITUTION RELENDING 
              PROGRAM.

    (a) In General.--Subchapter V of chapter 37 of title 38, United 
States Code, is amended by inserting after section 3762 the following 
new section:
``Sec. 3762A. Native community development financial institution 
              relending program
    ``(a) Purpose.--The Secretary may make a loan to a Native community 
development financial institution for the purpose of allowing the 
institution to relend loan amounts to qualified Native American 
veterans, subject to the requirements of this section.
    ``(b) Standards.--(1) The Secretary shall establish standards to be 
used in evaluating whether to make a loan to a Native community 
development financial institution under this section.
    ``(2) In establishing standards under paragraph (1), the Secretary 
shall ensure that a Native community development financial 
institution--
            ``(A) is able to originate and service loans for single-
        family homes;
            ``(B) is able to operate the relending program in a manner 
        consistent with the mission of the Department to serve 
        veterans; and
            ``(C) uses loan amounts received under this section only 
        for the purpose of relending, as described in subsection (c), 
        to Native American veterans.
    ``(c) Relending Requirements.--(1) A Native community development 
financial institution that receives a loan under this section shall use 
the loan amounts to make loans to Native American veterans residing on 
trust land.
    ``(2) A loan to a Native American veteran made by a Native 
community development financial institution under paragraph (1) shall--
            ``(A) be limited either to the purpose of purchase, 
        construction, or improvement of a dwelling located on trust 
        land or to the refinance of an existing mortgage loan for a 
        dwelling on trust land, consistent with the requirements of 
        section 3762(h) of this title; and
            ``(B) comply with such terms and conditions as the 
        Secretary determines are necessary to protect against predatory 
        lending, including the interest rate charged on a loan to a 
        Native American veteran.
    ``(d) Repayment.--A loan made to a Native community development 
financial institution under this section shall--
            ``(1) be payable to the Secretary upon such terms and 
        conditions as are prescribed in regulations pursuant to this 
        subchapter; and
            ``(2) bear interest at a rate of one percent.
    ``(e) Oversight.--Subject to notice and opportunity for a hearing, 
whenever the Secretary finds with respect to loans made under 
subsection (a) or (c) that any Native community development financial 
institution has failed to maintain adequate loan accounting records, to 
demonstrate proper ability to service loans adequately, or to exercise 
proper credit judgment, or that such Native community development 
financial institution has willfully or negligently engaged in practices 
otherwise detrimental to the interest of veterans or of the Government, 
the Secretary may take such actions as the Secretary determines 
necessary to protect veterans or the Government, such as requiring 
immediate repayment of any loans made under subsection (a) and the 
assignment to the Secretary of loans made under subsection (c).
    ``(f) Sunset.--The Secretary may not make a loan under this section 
after September 30, 2027.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 37 of such title is amended by inserting after the item 
relating to section 3762 the following new item:

``3762A. Native community development financial institution relending 
                            program.''.
    (c) Native American Veteran Housing Loan Program Account.--Section 
3763 of such title is amended by adding at the end the following new 
subsection:
    ``(c) Of amounts available in the Account, the Secretary may use 
for loans made under section 3762A of this title--
            ``(1) in fiscal year 2025, not more than $5,000,000; and
            ``(2) in any fiscal year after fiscal year 2025, an amount 
        determined necessary by the Secretary to meet the demand for 
        such loans.''.

           TITLE III--DISABILITY AND MEMORIAL AFFAIRS MATTERS

SEC. 301. BURIAL ALLOWANCE FOR CERTAIN VETERANS WHO DIE AT HOME WHILE 
              IN RECEIPT OF HOSPICE CARE FURNISHED BY DEPARTMENT OF 
              VETERANS AFFAIRS.

    (a) In General.--The Secretary of Veterans Affairs shall treat a 
veteran described in subsection (b) as a veteran described in 
subparagraph (A) of section 2303(a)(2) of title 38, United States Code.
    (b) Veteran Described.--A veteran described in this subsection is a 
veteran who dies in a home or other setting at which the deceased 
veteran was, at the time of death, receiving hospice care pursuant to 
section 1717(a) of such title if such care was directly preceded by the 
Secretary furnishing to the veteran hospital care or nursing home care 
described in clause (ii) of such subparagraph.
    (c) Effective Date; Applicability.--This section shall apply with 
respect to deaths that occur--
            (1) on or after the date that is 180 days after the date of 
        the enactment of this Act; and
            (2) before October 1, 2026.

SEC. 302. AUTHORITY FOR SECRETARY OF VETERANS AFFAIRS TO AWARD GRANTS 
              TO STATES AND INDIAN TRIBES TO IMPROVE OUTREACH TO 
              VETERANS.

    (a) In General.--Chapter 63 of title 38, United States Code, is 
amended--
            (1) by redesignating sections 6307 and 6308 as sections 
        6308 and 6309, respectively; and
            (2) by inserting after section 6306 the following new 
        section 6307:
``Sec. 6307. Grants to States and Indian Tribes to improve outreach to 
              veterans
    ``(a) Purpose.--It is the purpose of this section to provide for 
assistance by the Secretary to States and Indian Tribes to carry out 
programs that improve covered outreach and assistance to veterans and 
the spouses, children, and parents of veterans, to ensure that such 
individuals are fully informed about, and assisted in applying for, any 
veterans and veterans-related benefits and programs (including veterans 
programs of a State or Indian Tribe) for which they may be eligible and 
facilitate opportunities for such individuals to receive competent, 
qualified services in the preparation, presentation and prosecution of 
veterans benefits claims.
    ``(b) Authority.--The Secretary may award grants to States and 
Indian Tribes--
            ``(1) to carry out, coordinate, improve, or otherwise 
        enhance--
                    ``(A) covered outreach activities; or
                    ``(B) activities to assist in the development and 
                submittal of claims for veterans and veterans-related 
                benefits; or
            ``(2) to increase the number of county or Tribal veterans 
        service officers serving in the State by hiring new, additional 
        such officers.
    ``(c) Application.--(1) To be eligible for a grant under this 
section, a State or Indian Tribe shall submit to the Secretary an 
application therefor at such time, in such manner, and containing such 
information as the Secretary may require.
    ``(2) Each application submitted under paragraph (1) shall include 
the following:
            ``(A) A detailed plan for the use of the grant.
            ``(B) A description of the programs through which the State 
        or Indian Tribe will meet the outcome measures developed by the 
        Secretary under subsection (j).
            ``(C) A description of how the State or Indian Tribe will 
        distribute grant amounts equitably among counties or Tribal 
        lands with varying levels of urbanization.
            ``(D) A plan for how the grant will be used to meet the 
        unique needs of American Indian veterans, Alaska Native 
        veterans, or Native Hawaiian veterans, elderly veterans, and 
        veterans from other underserved communities.
    ``(d) Distribution.--The Secretary shall seek to ensure that grants 
awarded under this section are equitably distributed among States and 
Indian Tribes with varying levels of urbanization.
    ``(e) Set-aside.--Of the amounts authorized to be appropriated or 
otherwise made available for grants under this section for any fiscal 
year, the Secretary shall ensure that not less than five percent is 
used to make grants to Indian Tribes.
    ``(f) Priority.--The Secretary shall prioritize awarding grants 
under this section that will serve the following areas:
            ``(1) Areas with a critical shortage of county or Tribal 
        veterans service officers.
            ``(2) Areas with high rates of--
                    ``(A) suicide among veterans; or
                    ``(B) referrals to the Veterans Crisis Line.
    ``(g) Use of County or Tribal Veterans Service Officers.--A State 
or Indian Tribe that receives a grant under this section to carry out 
an activity described in subsection (b)(1) shall carry out the activity 
through--
            ``(1) a county or Tribal veterans service officer of the 
        State; or
            ``(2) if the State or Indian Tribe does not have a county 
        or Tribal veterans service officer, or if the county or Tribal 
        veterans service officers of the State or Indian Tribe cover 
        only a portion of that State or Indian Tribe, an appropriate 
        entity of a State, local, or Tribal government, as determined 
        by the Secretary.
    ``(h) Required Activities.--Any grant awarded under this section 
shall be used--
            ``(1) to expand existing programs, activities, and 
        services;
            ``(2) to hire new, additional county or Tribal veterans 
        service officers; or
            ``(3) for travel and transportation to facilitate carrying 
        out paragraph (1) or (2).
    ``(i) Authorized Activities.--A grant under this section may be 
used to provide education and training, including on-the-job training, 
for State, county, local, and Tribal government employees who provide 
(or when trained will provide) covered outreach services in order for 
those employees to obtain accreditation in accordance with procedures 
approved by the Secretary.
    ``(j) Outcome Measures.--(1) The Secretary shall develop and 
provide to each State or Indian Tribe that receives a grant under this 
section written guidance on the following:
            ``(A) Outcome measures.
            ``(B) Policies of the Department.
    ``(2) In developing outcome measures under paragraph (1), the 
Secretary shall consider the following goals:
            ``(A) Increasing the use of veterans and veterans-related 
        benefits, particularly among vulnerable populations.
            ``(B) Increasing the number of county and Tribal veterans 
        service officers recognized by the Secretary for the 
        representation of veterans under chapter 59 of this title.
    ``(k) Tracking Requirements.--(1) With respect to each grant 
awarded under this section, the Secretary shall track the use of 
veterans and veterans-related benefits among the population served by 
the grant, including the average period of time between the date on 
which a veteran applies for such a benefit and the date on which the 
veteran receives the benefit, disaggregated by type of benefit.
    ``(2) Not less frequently than annually during the life of the 
grant program established under this section, the Secretary shall 
submit to Congress a report on--
            ``(A) the information tracked under paragraph (1);
            ``(B) how the grants awarded under this section serve the 
        unique needs of American Indian veterans, Alaska Native 
        veterans, or Native Hawaiian veterans, elderly veterans, and 
        veterans from other underserved communities; and
            ``(C) other information provided by States and Indian 
        Tribes pursuant to the grant reporting requirements.
    ``(l) Performance Review.--The Secretary shall--
            ``(1) review the performance of each State or Indian Tribe 
        that receives a grant under this section; and
            ``(2) make information regarding such performance publicly 
        available.
    ``(m) Remediation Plan.--(1) In the case of a State or Indian Tribe 
that receives a grant under this section and does not meet the outcome 
measures developed by the Secretary under subsection (j), the Secretary 
shall require the State or Indian Tribe to submit a remediation plan 
under which the State shall describe how and when it plans to meet such 
outcome measures.
    ``(2) The Secretary may not award a subsequent grant under this 
section to a State or Indian Tribe described in paragraph (1) unless 
the Secretary approves the remediation plan submitted by the State or 
Indian Tribe.
    ``(n) Definitions.--In this section:
            ``(1) The term `county or Tribal veterans service officer' 
        includes a local equivalent veterans service officer.
            ``(2) The term `covered outreach' means outreach with 
        respect to--
                    ``(A) benefits administered by the Under Secretary 
                for Benefits; or
                    ``(B) similar benefits administered by a State or 
                Indian Tribe.
            ``(3) The term `Indian Tribe' has the meaning given such 
        term in section 4 of the Indian Self-Determination and 
        Education Assistance Act (25 U.S.C. 5304).
            ``(4) The term `State' includes the District of Columbia, 
        the Commonwealth of Puerto Rico, the Commonwealth of the 
        Northern Mariana Islands, and any territory or possession of 
        the United States.
            ``(5) The term `Veterans Crisis Line' means the toll-free 
        hotline for veterans established under section 1720F(h) of this 
        title.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 63 of such title is amended by striking the items relating to 
sections 6307 and 6308 and inserting the following new items:

``6307. Grants to States and Indian Tribes to improve outreach to 
                            veterans.
``6308. Outreach for eligible dependents.
``6309. Biennial report to Congress.''.
    (c) Authorization of Appropriations.--There is authorized to be 
appropriated to the Secretary of Veterans Affairs for each of fiscal 
years 2026 and 2027, $10,000,000 to carry out section 6307 of title 38, 
United States Code, as added by subsection (a).

SEC. 303. DEFINITION OF SURVIVING SPOUSE.

    Paragraph (3) of section 101 of title 38, United States Code, is 
amended to read as follows:
            ``(3) The term `surviving spouse' means (except for 
        purposes of chapter 19 of this title) a person who was the 
        spouse of a veteran at the time of the veteran's death, and who 
        lived with the veteran continuously from the date of marriage 
        to the date of the veteran's death (except where there was a 
        separation which was due to the misconduct of, or procured by, 
        the veteran without the fault of the spouse) and who has not 
        remarried.''.

SEC. 304. ENSURING ONLY LICENSED HEALTH CARE PROFESSIONALS PERFORM 
              MEDICAL DISABILITY EXAMINATIONS UNDER CERTAIN DEPARTMENT 
              OF VETERANS AFFAIRS PILOT PROGRAM.

    (a) Prohibition on Use of Certain Health Care Professionals.--
Section 504(c)(1) of the Veterans' Benefits Improvements Act of 1996 
(Public Law 104-275; 38 U.S.C. 5101 note) is amended by inserting 
``only'' before ``a health care professional''.
    (b) Remedies.--The Secretary of Veterans Affairs shall take such 
actions as the Secretary considers appropriate to ensure compliance 
with section 504(c) of the Veterans' Benefits Improvements Act of 1996 
(Public Law 104-275; 38 U.S.C. 5101 note), as amended by subsection 
(a).
    (c) Annual Report.--Not later than one year after the date of the 
enactment of this Act and not less frequently than once each year 
thereafter, the Secretary shall submit to the Committee on Veterans' 
Affairs of the Senate and the Committee on Veterans' Affairs of the 
House of Representatives a report on--
            (1) the conduct of the pilot program established under 
        section 504 of the Veterans' Benefits Improvements Act of 1996 
        (Public Law 104-275; 38 U.S.C. 5101 note); and
            (2) the actions of the Secretary under subsection (b).
    (d) Technical Corrections.--Section 504 of the Veterans' Benefits 
Improvements Act of 1996 (Public Law 104-275; 38 U.S.C. 5101 note) is 
amended, in the section heading, by striking ``physicians'' and 
inserting ``health care professionals''.

SEC. 305. PROVISION OF INFORMATION REGARDING AN AGENT OR ATTORNEY TO A 
              LICENSED HEALTH CARE PROFESSIONAL WHO PERFORMS A MEDICAL 
              DISABILITY EXAMINATION UNDER CERTAIN DEPARTMENT OF 
              VETERANS AFFAIRS PILOT PROGRAM.

    (a) In General.--Section 504 of the Veterans' Benefits Improvements 
Act of 1996 (Public Law 104-275; 38 U.S.C. 5101 note), as amended by 
section 304, is further amended by adding at the end the following new 
subsection:
    ``(f) Certain Information Provided to Health Care Professional.--
The Secretary shall provide to a health care professional who performs 
an examination under subsection (a), or a contractor performing a 
contract under such subsection, the contact information of any agent or 
attorney recognized by the Secretary under chapter 59 of title 38, 
United States Code, with regards to a claim for benefits that gives 
rise to such examination.''.
    (b) Applicability.--The amendment made by this section shall apply 
to an examination described in subsection (a) of such section that is 
performed on or after the date of the enactment of this Act.

SEC. 306. MODERNIZATION OF DEPARTMENT OF VETERANS AFFAIRS DISABILITY 
              BENEFIT QUESTIONNAIRES.

    (a) Requirement for Transmission of Certain Information in Machine-
readable Format.--
            (1) Requirement.--Not later than 180 days after enactment 
        of this Act, the Secretary of Veterans Affairs shall require 
        all disability benefit questionnaire data collected in the 
        course of medical disability examinations made by covered non-
        Department providers to be transmitted to the Department in a 
        machine-readable format.
            (2) Issuance of standards.--Not later than 90 days after 
        the date of the enactment of this Act, the Secretary shall 
        issue standards for the transmission of disability benefit 
        questionnaire data in a machine-readable format as required 
        under paragraph (1).
            (3) Updates.--In making updates to disability benefit 
        questionnaires after the date specified in paragraph (1), the 
        Secretary shall--
                    (A) ensure that the updates are made in a manner 
                that allows for the data collected under the 
                questionnaires to be in a machine-readable format as of 
                the date on which the update goes into effect; and
                    (B) not later than 30 days before an update goes 
                into effect, notify the covered non-Department 
                providers (or the contractor performing a contract 
                under section 504 of the Veterans Benefits Improvement 
                Act of 1996 (Public Law 104-275; 38 U.S.C. 5101 note)) 
                described in such paragraph of such updates.
    (b) Plan for Information Technology System Modification.--Not later 
than 180 days after the date of the enactment of this Act, the 
Secretary shall submit to the Committees on Veterans' Affairs of the 
Senate and House of Representatives a plan to modify the information 
technology systems and processes of the Department to enable a non-
Department health care professional, assigned to or selected by a 
claimant, to transmit to the Department, in a machine-readable format, 
disability benefit questionnaire data, including complete disability 
benefit questionnaires rather than partial questionnaires or elements 
of medical evidence.
    (c) Public Availability of Information.--The Secretary shall make 
publicly available on the internet website of the Department referred 
to in section 5101(d) of title 38, United States Code--
            (1) a description of the standards issued under subsection 
        (a)(2); and
            (2) the plan required under subsection (b).
    (d) Definitions.--In this section:
            (1) The term ``claimant'' has the meaning given such term 
        in section 5100 of title 38, United States Code.
            (2) The term ``covered non-Department provider'' means a 
        health care provider who--
                    (A) is not an employee of the Department of 
                Veterans Affairs; and
                    (B) pursuant to a contract under section 504 of the 
                Veterans Benefits Improvement Act of 1996 (Public Law 
                104-275; 38 U.S.C. 5101 note), as amended by sections 
                304 and 305, examines a claimant for a medical 
                disability.

SEC. 307. DEPARTMENT OF VETERANS AFFAIRS AUTOMATIC PROCESSING OF 
              CERTAIN CLAIMS FOR TEMPORARY DISABILITY RATINGS.

    (a) In General.--Not later than one year after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall modify 
the information technology systems of the Department of Veterans 
Affairs to use automation technology for claims for temporary 
disability ratings for veterans described in section 1156(a)(1)(C) of 
title 38, United States Code.
    (b) Additional Requirements.--In carrying out subsection (a), the 
Secretary shall ensure that--
            (1) medical evidence is obtained from the corporate data 
        warehouse of the Department or other sources of data, the 
        Secretary determines appropriate;
            (2) employees of the Department continue to determine 
        whether a veteran is entitled to a temporary disability rating 
        under section 1156(a)(1)(C) of title 38, United States Code; 
        and
            (3) claims may be processed manually if the evidence of 
        record is not sufficient to decide the claim or if the medical 
        evidence is provided in a format that is not compatible with 
        the system developed under subsection (a).

                     TITLE IV--HOMELESSNESS MATTERS

SEC. 401. SHORT TITLE.

    This title may be cited as the ``Housing our Military Veterans 
Effectively Act of 2024'' or the ``HOME Act of 2024''.

SEC. 402. PER DIEM PAYMENTS PROVIDED BY THE SECRETARY OF VETERANS 
              AFFAIRS FOR SERVICES FURNISHED TO HOMELESS VETERANS.

    (a) In General.--Section 2012 of title 38, United States Code, is 
amended--
            (1) in subsection (a)--
                    (A) in paragraph (2)(B)--
                            (i) in clause (i)(II)(aa)(BB), by striking 
                        ``115 percent'' and inserting ``115 percent 
                        (or, during the period beginning on the date of 
                        the enactment of the Housing our Military 
                        Veterans Effectively Act of 2024 and ending on 
                        September 30, 2027, 133 percent)''; and
                            (ii) by adding at the end the following:
    ``(iii) For each of fiscal years 2025 through 2027, the Secretary 
may waive the maximum rate for per diem payments under clause 
(i)(II)(aa)(BB) or (ii) and, subject to the availability of 
appropriations, provide such payments at a rate that does not exceed 
200 percent of the rate authorized for State homes for domiciliary care 
under subsection (a)(1)(A) of section 1741 of this title, as the 
Secretary may increase from time to time under subsection (c) of that 
section, if the Secretary notifies Congress of such waiver.
    ``(iv) The Secretary may not, pursuant to clause (iii), waive the 
maximum rate described in such clause for more than 50 percent of all 
grant recipients and eligible entities for a fiscal year.''; and
                    (B) by adding at the end the following new 
                paragraph:
    ``(4) The Secretary may not provide more than 12,000 per diem 
payments under this section for a fiscal year.''; and
            (2) by adding at the end the following new subsection:
    ``(f) Reports Required.--Not later than 90 days after the date of 
the enactment of the HOME Act of 2024, and not less frequently than 
twice each year thereafter, the Secretary shall submit to the Committee 
on Veterans' Affairs of the Senate and the Committee on Veterans' 
Affairs of the House of Representatives a report on the rate for per 
diem payments under this section that includes, for each Veterans 
Integrated Service Network of the Department, the following data:
            ``(1) The average rate for such a payment.
            ``(2) A list of locations where the rate for such a payment 
        is within 10 percent of the maximum rate for such a payment 
        authorized under this section.
            ``(3) The average length of stay by a veteran participating 
        in a program described in section 2012(a) of this title.''.
    (b) Regulatory Authority.--The Secretary of Veterans Affairs may 
carry out the amendments made by subsection (a) through interim 
guidance in advance of the issuance of regulations for such purpose.
    (c) Strategic Plan.--
            (1) In general.--Not later than September 30, 2025, the 
        Secretary of Veterans Affairs shall submit to the Committee on 
        Veterans' Affairs of the Senate and the Committee on Veterans' 
        Affairs of the House of Representatives a strategic plan for 
        the provision of grants and per diem payments for services 
        furnished to homeless veterans under sections 2011 and 2012 of 
        title 38, United States Code.
            (2) Elements.--The plan required by paragraph (1) shall 
        include the following:
                    (A) A method for administering grant funding 
                equitably without using the rate authorized for State 
                homes for domiciliary care under subsection (a)(1)(A) 
                of section 1741 of title 38, United States Code, as the 
                Secretary may increase from time to time under 
                subsection (c) of that section, that takes into 
                account--
                            (i) the wide variety of services furnished 
                        by grant recipients and eligible entities under 
                        sections 2011 and 2012 of title 38, United 
                        States Code;
                            (ii) varying costs of living across 
                        different geographic locations;
                            (iii) varying availability of affordable 
                        housing in different geographic locations;
                            (iv) circumstances of housing insecurity in 
                        rural and Tribal communities;
                            (v) veterans with significant medical care 
                        needs; and
                            (vi) the changing dynamic of the veteran 
                        population nationwide.
                    (B) A plan and timeline for implementation of the 
                method included under subparagraph (A).
                    (C) An estimate of increased costs or savings per 
                year under the plan.
                    (D) An overview of the different grants that will 
                be available once the plan is implemented.

SEC. 403. AUTHORIZATION FOR SECRETARY OF VETERANS AFFAIRS TO USE 
              CERTAIN FUNDS FOR IMPROVED FLEXIBILITY IN ASSISTANCE TO 
              HOMELESS VETERANS.

    (a) Use of Funds.--During the period beginning on the date of the 
enactment of this Act and ending on the termination date specified in 
subsection (d), the Secretary of Veterans Affairs may provide to a 
covered veteran, as the Secretary determines necessary--
            (1) food, shelter, clothing, blankets, and hygiene items 
        required for the safety and survival of the veteran;
            (2) transportation required to support the stability and 
        health of the veteran for appointments with service providers, 
        the conduct of housing and employment searches, and the 
        obtainment of food and supplies; and
            (3) tablets, smartphones, disposable phones and other 
        technology, and related service plans required to support the 
        stability and health of the veteran through the maintenance of 
        contact with service providers, prospective landlords, and 
        family members.
    (b) Homeless Veterans on Department of Veterans Affairs Land.--
            (1) In general.--The Secretary may collaborate, to the 
        extent practicable, with one or more organizations to manage 
        the use of land of the Department of Veterans Affairs for 
        homeless veterans for living and sleeping.
            (2) Forms of collaboration.--Collaboration under paragraph 
        (1) may include the provision by either the Secretary or the 
        head of the organization concerned of food services and 
        security for property, buildings, and other facilities owned or 
        controlled by the Department of Veterans Affairs.
    (c) Report Required.--Not later than six months after the date of 
the enactment of this Act, and annually thereafter until the date 
specified in subsection (d), the Secretary shall submit to Congress a 
report that includes, with respect to the period covered by such 
report--
            (1) a statement, disaggregated by each medical center of 
        the Department of Veterans Affairs, of the amount of funds 
        under this section--
                    (A) each such medical center requested from the 
                Secretary; and
                    (B) to which the Secretary provided each such 
                medical center;
            (2) data, disaggregated by each such medical center, 
        relating to how each such medical center used amounts provided 
        by the Secretary under this section;
            (3) the number of covered veterans to which the Secretary 
        provided assistance under this section;
            (4) the total amount of assistance the Secretary provided 
        to covered veterans pursuant to subsection (a)(3) for 
        communications equipment, broken down by the type of equipment 
        provided;
            (5) the total amount of assistance the Secretary provided 
        covered veterans pursuant to subsection (a)(2) for ridesharing;
            (6) the number of covered veterans who received such 
        assistance; and
            (7) a description, for each rideshare used by a covered 
        veteran with such assistance, of the reasons such covered 
        veteran used such rideshare.
            (8) the number of covered veterans who lived or slept on 
        Department land;
            (9) the amount of funds used to make available Department 
        land for covered veterans to live and sleep;
            (10) the number of Department employees whose primary 
        responsibilities involved providing services for covered 
        veterans living or sleeping on Department land;
            (11) the average length of time a covered veteran lived or 
        slept on Department land, and
            (12) the period of time the Secretary expects Department 
        land will be made available for covered veterans to live and 
        sleep.
    (d) Termination Date.--The termination date specified in this 
subsection is September 30, 2027.
    (e) Definitions.--In this section, the term ``covered veteran'' 
means--
            (1) a homeless veteran, as such term is defined in section 
        2002 of title 38, United States Code; and
            (2) a veteran participating in the program carried out 
        under section 8(o)(19) of the United States Housing Act of 1937 
        (42 U.S.C. 1437f(o)(19)).

SEC. 404. ACCESS TO DEPARTMENT OF VETERANS AFFAIRS TELEHEALTH SERVICES.

    (a) In General.--Subtitle VII of chapter 20 of title 38, United 
States Code is amended by adding at the end the following new section:
``Sec. 2069. Access to telehealth services
    ``To the extent practicable, the Secretary shall ensure that 
veterans participating in or receiving services from a program under 
this chapter have access to telehealth services to which such veterans 
are eligible under the laws administered by the Secretary, including by 
ensuring that telehealth capabilities are available to--
            ``(1) such veterans;
            ``(2) case managers of the Department of programs for 
        homeless veterans authorized under this chapter; and
            ``(3) community-based service providers for homeless 
        veterans receiving funds from the Department through grants or 
        contracts.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 20 of title 38, United States Code, is amended by adding at the 
end the following new item:

``2069. Access to telehealth services.''.

             TITLE V--OVERSIGHT AND INVESTIGATIONS MATTERS

SEC. 501. DEPARTMENT OF VETERANS AFFAIRS EMPLOYEE TRAINING REGARDING 
              OFFICE OF INSPECTOR GENERAL.

    (a) Training.--The Secretary of Veterans Affairs shall require each 
employee of the Department of Veterans Affairs who begins employment 
with the Department on or after the date of the enactment of this Act 
to receive training that the Inspector General of the Department shall 
develop on the reporting of wrongdoing to, responding to requests from, 
and the duty of cooperating with the Office of Inspector General of the 
Department.
    (b) Timing of Training.--In carrying out subsection (a), the 
Secretary shall require each employee of the Department covered under 
such subsection to undergo the training required by such subsection not 
later than one year after the date on which the employee begins 
employment with the Department.
    (c) Elements.--Training developed and required under subsection (a) 
shall include the following:
            (1) Definition of the role, responsibilities, and legal 
        authority of the Inspector General of the Department and the 
        duties of employees of the Department for engaging with the 
        Office of Inspector General.
            (2) Identification of Federal whistleblower protection 
        rights, including the right to report fraud, waste, abuse, and 
        other wrongdoing to Congress.
            (3) Identification of the circumstances and mechanisms for 
        reporting fraud, waste, abuse, and other wrongdoing to the 
        Inspector General, including making confidential complaints to 
        the Inspector General.
            (4) Identification of the prohibitions and remedies that 
        help to protect employees of the Department from retaliation 
        when reporting wrongdoing to the Inspector General.
            (5) Recognition of opportunities to engage with staff of 
        the Office of Inspector General to improve programs, 
        operations, and services of the Department.
            (6) Notification of the authority of the Inspector General 
        to subpoena the attendance and testimony of witnesses, 
        including former employees of the Department, as necessary to 
        carry out the duties of the Office of Inspector General under 
        section 312 of title 38, United States Code.
    (d) Design and Update.--The Inspector General of the Department 
shall design, and update as the Inspector General considers 
appropriate, the training developed and required by subsection (a).
    (e) System.--The Secretary shall provide, via the talent management 
system of the Department, or successor system, the training developed 
and required under subsection (a).
    (f) Relation to Certain Training.--The Secretary shall ensure that 
training developed and required under subsection (a) is separate and 
distinct from training provided under section 733 of title 38, United 
States Code.
    (g) Notice to Employees.--The Secretary shall ensure that the 
Inspector General is afforded the opportunity, not less frequently than 
twice each year and more frequently if the Inspector General considers 
appropriate under extraordinary circumstances, to use the electronic 
mail system of the Department to notify all authorized users of such 
system of the following:
            (1) The roles and responsibilities of the employees of the 
        Department when engaging with the Office of Inspector General.
            (2) The availability of training provided under subsection 
        (a).
            (3) How to access training provided under subsection (a).
            (4) Information about how to contact the Office of 
        Inspector General, including a link to any website-based 
        reporting form of the Office.

SEC. 502. ANNUAL REVIEW OF SECURITY AT COVERED FACILITIES OF THE 
              DEPARTMENT OF VETERANS AFFAIRS.

    (a) Annual Survey.--Not later than one year after the date of the 
enactment of this Act, and annually thereafter for each of the 
following five fiscal years, the Secretary of Veterans Affairs, in 
coordination with the Director of the Office of Security and Law 
Enforcement of the Department of Veterans Affairs, shall conduct a 
survey of the covered employees at each covered facility to collect 
information regarding security. Each annual survey shall include 
questions about--
            (1) the type and frequency of criminal activity experienced 
        at the covered facility during the fiscal year which most 
        recently concluded including whether or not the criminal 
        activity was related to residents at the facility or campus 
        such as those in a residential rehabilitation treatment program 
        or enhanced-use lease facility;
            (2) the number of vacancies and number of days vacant for 
        Department police officers at the covered facility at the time 
        of the survey delineated by recruitment status and stage;
            (3) the availability and adequacy of covered equipment;
            (4) the availability and adequacy of resources, classes, or 
        other time set aside for training Department police officers 
        who work at each covered facility about any skill or tactic 
        related to law enforcement, including the proper use of force, 
        firearms qualifications and training, procedures for responding 
        to an active threat, and any other training required for 
        Department police officers;
            (5) any security weakness at covered facilities;
            (6) the relationship between the covered facility 
        (including the Department police officers who work at the 
        covered facility) and local, state, and federal law enforcement 
        agencies including what agreements or memorandums of 
        understanding exist between each covered facility and external 
        law enforcement agencies;
            (7) efforts by the personnel of the covered facility to 
        address and reduce criminal activity at, or in close proximity 
        to, the covered facility; and
            (8) recommendations for the Secretary to better address and 
        reduce criminal activity at, or in close proximity to, covered 
        facilities so as to improve the safety of veterans, employees, 
        visitors, other authorized personnel, and the surrounding 
        community.
    (b) Report.--Not later than 30 days after the end of the next full 
Fiscal Year after the enactment of this Act and for each of the 
following five fiscal years, the Secretary shall submit to each of the 
Committees on Veterans' Affairs of the Senate and the House of 
Representatives a report regarding the results of the surveys conducted 
under subsection (a) during the previous fiscal year. The report shall 
include--
            (1) the results of the annual survey described under 
        subsection (a) for the year covered by the report;
            (2) an analysis, made in coordination with the Director of 
        the Office of Security and Law Enforcement of such Department, 
        each director and police chief of a Veterans Integrated Service 
        Network, and the directors and police chiefs of the medical 
        centers within the Veterans Integrated Service Network of the 
        results of the triannual security inspections conducted in 
        prior fiscal year, to include a plan of action that describes 
        how the Secretary plans to address any security weakness 
        identified in the results of the triannual security inspections 
        and includes clearly-stated goals with measurable benchmarks 
        for each goal and deadlines for each benchmark; and
            (3) a list of all vacant positions for police chief or 
        deputy police chief at each covered facility during the prior 
        fiscal year, the number of individuals who filled those 
        positions over the two years prior to the date of the survey, 
        the number of days the positions were vacant without someone 
        serving in an acting capacity, and the number of days the 
        positions were filled by individuals serving in an acting 
        capacity.
    (c) Definitions.--In this section:
            (1) The term ``covered equipment'' means any item issued by 
        the Secretary of Veterans Affairs to a Department police 
        officer (including firearms, weapons detecting technology, 
        ballistic vests, body-worn cameras, and radios) for use in the 
        provision of services under section 902 of title 38, United 
        States Code.
            (2) The term ``covered employee'' means an employee of the 
        Department of Veterans Affairs who is employed and responsible 
        for security operations at a covered facility including a 
        covered facility's police chief, facility emergency management 
        leader, facility director, or person carrying out the 
        responsibilities of one of these positions in an acting 
        capacity.
            (3) The term ``covered facility'' means any facility of the 
        Department of Veterans Affairs where Department police officers 
        have jurisdiction.
            (4) The term ``Department police officer'' is used as such 
        term as used in section 902 of title 38, United States Code.
            (5) The term ``security weakness'' means a deficiency in 
        the facilities, staffing, or covered equipment at a covered 
        facility that a covered employee of the covered facility 
        determines presents a risk to the safety of visitors or staff, 
        including an unsecured door, inoperable security camera, 
        unsecured police operations room, a lack of security presence 
        at an entrance to the covered facility, and a lack of security 
        presence in an area of the covered facility or the grounds of 
        the covered facility that the director of the covered facility 
        determines requires an increased security presence.

SEC. 503. MODIFICATION OF CERTAIN HOUSING LOAN FEES.

    The loan fee table in section 3729(b)(2) of title 38, United States 
Code, is amended by striking ``November 29, 2031'' each place it 
appears and inserting ``June 9, 2034''.

            Passed the Senate December 12, 2024.

            Attest:

                                                             Secretary.
118th CONGRESS

  2d Session

                                 S. 141

_______________________________________________________________________

                                 AN ACT

 To amend title 38, United States Code, to improve certain programs of 
    the Department of Veterans Affairs for home and community based 
             services for veterans, and for other purposes.
```