S. 141 

One Hundred Eighteenth Congress 

of the 

United States of America 

AT THE SECOND SESSION 

Begun and held at the City of Washington on Wednesday, 

the third day of January, two thousand and twenty four 

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. 
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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. 
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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 
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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 SERV- ICES.—(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.’’. 
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(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. 
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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 
S. 141—7 

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 
S. 141—8 

(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— 
S. 141—9 

(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— 
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(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 
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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). 
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(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 valuebased 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. 
S. 141—13 

(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 
S. 141—14 

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 threeyear 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. 
S. 141—15 

(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— 
S. 141—16 

(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 standardsbased 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— 
S. 141—17 

(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 nonDepartment 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; 
S. 141—18 

(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 
S. 141—19 

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): 

‘‘§ 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. 
S. 141—20 

‘‘(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 
S. 141—21 

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): 

‘‘§ 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. 
S. 141—22 

‘‘(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. 
S. 141—23 

‘‘(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). 
S. 141—24 

‘‘(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 VeteranDirected 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— 
S. 141—25 

(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.’’. 
S. 141—26 

(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 
S. 141—27 

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)— 
S. 141—28 

‘‘(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 inhome 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 HomeBased Primary Care program. 
S. 141—29 

(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.— 
S. 141—30 

(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 
S. 141—31 

(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 
S. 141—32 

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— 
S. 141—33 

(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 HOMEAND COMMUNITY-BASED SERVICES. 

(a) OFFICE OF GERIATRIC AND EXTENDED CARE.— 
S. 141—34 

(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 communitybased 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 HOMEAND COMMUNITY-BASED SERVICES.— 
S. 141—35 

(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. 
S. 141—36 

(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 homeand 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. 
S. 141—37 

(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). 
S. 141—38 

(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 ‘‘VeteranDirected 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): 

‘‘§ 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 nonDepartment 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 
S. 141—39 

‘‘(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; 
S. 141—40 

‘‘(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— 
S. 141—41 

‘‘(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 
S. 141—42 

(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. 
S. 141—43 

(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 nonDepartment 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 
S. 141—44 

(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.— 
S. 141—45 

(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 nocost 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; 
S. 141—46 

(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. 
S. 141—47 

(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 nonDepartment 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; 
S. 141—48 

(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 
S. 141—49 

(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— 
S. 141—50 

(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: 
S. 141—51 

(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 
S. 141—52 

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.— 
S. 141—53 

(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 
S. 141—54 

(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 
S. 141—55 

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. 
S. 141—56 

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. 
S. 141—57 

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 
S. 141—58 

(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.’’. 
S. 141—59 

(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): 
S. 141—60 

‘‘(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 
S. 141—61 

‘‘(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): 

‘‘§ 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. 
S. 141—62 

‘‘(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: 

‘‘§ 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. 
S. 141—63 

‘‘(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. 
S. 141—64 

‘‘(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 fulltime 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 
S. 141—65 

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. 
S. 141—66 

‘‘(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; 
S. 141—67 

‘‘(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 parttime 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): 
S. 141—68 

‘‘(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 indemand 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; 
S. 141—69 

‘‘(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: 

‘‘§ 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 
S. 141—70 

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 
S. 141—71 

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: 
S. 141—72 

‘‘(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 
S. 141—73 

(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.— 
S. 141—74 

(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 
S. 141—75 

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; 
S. 141—76 

(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— 
S. 141—77 

(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. 
S. 141—78 

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 
S. 141—79 

‘‘(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). 
S. 141—80 

‘‘(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: 
S. 141—81 

‘‘(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).’’. 
S. 141—82 

(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: 

‘‘§ 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. 
S. 141—83 

‘‘(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. 
S. 141—84 

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: 

‘‘§ 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 
S. 141—85 

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); 
S. 141—86 

‘‘(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 
S. 141—87 

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. 
S. 141—88 

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. 
S. 141—89 

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: 
S. 141—90 

‘‘(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. 
S. 141—91 

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 
S. 141—92 

(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: 

‘‘§ 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 
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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). 
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(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 enhanceduse 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; 
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(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. 
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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’’. 

Speaker of the House of Representatives. 

Vice President of the United States and

President of the Senate.