IB 

Union Calendar No. 516 

115TH CONGRESS 

2D SESSION H. R. 5674 

[Report No. 115–671, Part I] 

To establish a permanent community care program for veterans, to establish 

a commission for the purpose of making recommendations regarding 

the modernization or realignment of facilities of the Veterans Health 

Administration, to improve construction of the Department of Veterans 

Affairs, to make certain improvements in the laws administered by the 

Secretary of Veterans Affairs relating to the home loan program of 

the Department of Veterans Affairs, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 3, 2018 

Mr. ROE of Tennessee introduced the following bill; which was referred to the 

Committee on Veterans’ Affairs, and in addition to the Committee on 

Rules, for a period to be subsequently determined by the Speaker, in each 

case for consideration of such provisions as fall within the jurisdiction of 

the committee concerned 

MAY 11, 2018 

Additional sponsors: Mrs. RADEWAGEN, Mr. RUTHERFORD, Mr. BANKS of Indiana, Mr. WENSTRUP, Mr. HIGGINS of Louisiana, Mrs. WAGNER, Mr. 

POLIQUIN, Mr. CARTER of Texas, Mr. WEBSTER of Florida, Mr. SAM

JOHNSON of Texas, Ms. SINEMA, Ms. MCSALLY, Mr. BERGMAN, Mr. 

BILIRAKIS, Miss GONZA ́LEZ-COLO ́N of Puerto Rico, Mr. DUNN, Mr. 

ARRINGTON, Ms. KUSTER of New Hampshire, Mr. BOST, Mr. COFFMAN, 

and Mr. WALDEN

MAY 11, 2018 

Reported from the Committee on Veterans’ Affairs 

MAY 11, 2018 

The Committee on Rules discharged; committed to the Committee of the 

Whole House on the State of the Union and ordered to be printed 


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A BILL 

To establish a permanent community care program for veterans, to establish a commission for the purpose of making recommendations regarding the modernization or realignment of facilities of the Veterans Health Administration, to improve construction of the Department of 

Veterans Affairs, to make certain improvements in the 

laws administered by the Secretary of Veterans Affairs 

relating to the home loan program of the Department 

of Veterans Affairs, and for other purposes. 


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

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

5 ‘‘VA Maintaining Internal Systems and Strengthening In6 tegrated Outside Networks Act of 2018’’ or ‘‘VA MIS7 SION Act of 2018’’. 

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

9 this Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—CARING FOR OUR VETERANS 

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

Subtitle A—Developing an Integrated High-Performing Network 

CHAPTER 1—ESTABLISHING COMMUNITY CARE PROGRAMS

Sec. 101. Establishment of Veterans Community Care Program. 

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

and non-Department providers. 

Sec. 103. Conforming amendments for State veterans homes. 

Sec. 104. Access standards and standards for quality. 

Sec. 105. Access to walk-in care. 

Sec. 106. Strategy regarding the Department of Veterans Affairs High-Performing Integrated Health Care Network. 

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

Programs. 

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

Sec. 109. Remediation of medical service lines. 

CHAPTER 2—PAYING PROVIDERS AND IMPROVING COLLECTIONS

Sec. 111. Prompt payment to providers. 

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

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

non-service-connected disabilities. 

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

CHAPTER 3—EDUCATION AND TRAINING PROGRAMS

Sec. 121. Education program on health care options. 

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

Affairs health care. 


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

CHAPTER 4—OTHER MATTERS RELATING TO NON-DEPARTMENT OF

VETERANS AFFAIRS PROVIDERS

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

by non-Department of Veterans Affairs health care providers. 

Sec. 132. Improving information sharing with community providers. 

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

care providers. 

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

State-based prescription drug monitoring programs. 

CHAPTER 5—OTHER NON-DEPARTMENT HEALTH CARE MATTERS

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

Sec. 142. Veterans Choice Fund flexibility. 

Sec. 143. Sunset of Veterans Choice Program. 

Sec. 144. Conforming amendments. 

Subtitle B—Improving Department of Veterans Affairs Health Care Delivery 

Sec. 151. Licensure of health care professionals of the Department of Veterans 

Affairs providing treatment via telemedicine. 

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

for Care and Payment. 

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

of conducting transplant procedures for veterans. 

Subtitle C—Family Caregivers 

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

Affairs. 

Sec. 162. Implementation of information technology system of Department of 

Veterans Affairs to assess and improve the family caregiver 

program. 

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

Department of Veterans Affairs. 

TITLE II—VA ASSET AND INFRASTRUCTURE REVIEW 

Subtitle A—Asset and Infrastructure Review 

Sec. 201. Short title. 

Sec. 202. The Commission. 

Sec. 203. Procedure for making recommendations. 

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

Administration. 

Sec. 205. Implementation. 

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

Sec. 207. Congressional consideration of Commission report. 

Sec. 208. Other matters. 

Sec. 209. Definitions. 

Subtitle B—Other Infrastructure Matters 


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Sec. 211. Improvement to training of construction personnel. 

Sec. 212. Review of enhanced use leases. 

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

who live in the Pacific territories. 

TITLE III—IMPROVEMENTS TO RECRUITMENT OF HEALTH CARE 

PROFESSIONALS 

Sec. 301. Designated scholarships for physicians and dentists under Department of Veterans Affairs Health Professional Scholarship Program. 

Sec. 302. Increase in maximum amount of debt that may be reduced under 

Education Debt Reduction Program of Department of Veterans Affairs. 

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

Loan Repayment Program. 

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

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

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

TITLE IV—HEALTH CARE IN UNDERSERVED AREAS 

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

the Department of Veterans Affairs as underserved facilities 

and plan to address problem of underserved facilities. 

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

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

TITLE V—OTHER MATTERS 

Sec. 501. Annual report on performance awards and bonuses awarded to certain high-level employees of the department. 

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

Sec. 503. Definition of major medical facility project. 

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

Sec. 505. Department of Veterans Affairs personnel transparency. 

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

team settings within medical centers of Department of Veterans Affairs. 

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

Sec. 508. Loans guaranteed under home loan program of Department of Veterans Affairs. 

Sec. 509. Extension of reduction in amount of pension furnished by Department of Veterans Affairs for certain veterans covered by Medicaid plans for services furnished by nursing facilities. 

Sec. 510. Appropriation of amounts. 

Sec. 511. Technical correction. 


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1 TITLE I—CARING FOR OUR 

2 VETERANS 

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

4 STATES CODE. 

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

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

7 (b) REFERENCES TO TITLE 38, UNITED STATES

8 CODE.—Except as otherwise expressly provided, whenever 

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

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

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

13 Subtitle A—Developing an Inte14 grated High-Performing Net15 work 

16 CHAPTER 1—ESTABLISHING COMMUNITY 

17 CARE PROGRAMS 

18 SEC. 101. ESTABLISHMENT OF VETERANS COMMUNITY 

19 CARE PROGRAM. 

20 (a) ESTABLISHMENT OF PROGRAM.— 

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

22 read as follows: 

23 ‘‘§ 1703. Veterans Community Care Program 

24 ‘‘(a) IN GENERAL.—(1) There is established a pro25 gram to furnish hospital care, medical services, and exVerDate Sep 11 2014 21:33 May 11, 2018 Jkt 079200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H5674.RH H5674

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1 tended care services to covered veterans through health 

2 care providers specified in subsection (c). 

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

4 hospital care, medical services, and extended care services 

5 under this section to covered veterans, including coordina6 tion of, at a minimum, the following: 

7 ‘‘(A) Ensuring the scheduling of medical ap8 pointments in a timely manner and the establish9 ment of a mechanism to receive medical records 

10 from non-Department providers. 

11 ‘‘(B) Ensuring continuity of care and services. 

12 ‘‘(C) Ensuring coordination among regional 

13 networks if the covered veteran accesses care and 

14 services in a different network than the regional net15 work in which the covered veteran resides. 

16 ‘‘(D) Ensuring that covered veterans do not ex17 perience a lapse in care resulting from errors or 

18 delays by the Department or its contractors or an 

19 unusual or excessive burden in accessing hospital 

20 care, medical services, or extended care services. 

21 ‘‘(3) A covered veteran may only receive care or serv22 ices under this section upon the authorization of such care 

23 or services by the Secretary. 

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

25 section, a covered veteran is any veteran who— 


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

2 enrollment established and operated under section 

3 1705 of this title; or 

4 ‘‘(2) is not enrolled in such system but is other5 wise entitled to hospital care, medical services, or ex6 tended care services under subsection (c)(2) of such 

7 section. 

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

9 care providers specified in this subsection are the fol10 lowing: 

11 ‘‘(1) Any health care provider that is partici12 pating in the Medicare program under title XVIII of 

13 the Social Security Act (42 U.S.C. 1395 et seq.), in14 cluding any physician furnishing services under such 

15 a program. 

16 ‘‘(2) The Department of Defense. 

17 ‘‘(3) The Indian Health Service. 

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

19 defined in section 1905(l)(2)(B) of the Social Secu20 rity Act (42 U.S.C. 1396d(l)(2)(B))). 

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

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

23 that meets criteria established by the Secretary for 

24 purposes of this section. 


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1 ‘‘(d) CONDITIONS UNDER WHICH CARE IS RE2 QUIRED TO BE FURNISHED THROUGH NON-DEPART3 MENT PROVIDERS.—(1) The Secretary shall, subject to 

4 the availability of appropriations, furnish hospital care, 

5 medical services, and extended care services to a covered 

6 veteran through health care providers specified in sub7 section (c) if— 

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

9 services the veteran requires; 

10 ‘‘(B) the Department does not operate a full11 service medical facility in the State in which the cov12 ered veteran resides; 

13 ‘‘(C)(i) the covered veteran was an eligible vet14 eran under section 101(b)(2)(B) of the Veterans Ac15 cess, Choice, and Accountability Act of 2014 (Public 

16 Law 113–146; 38 U.S.C. 1701 note) as of the day 

17 before the date of the enactment of the Caring for 

18 Our Veterans Act of 2018; 

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

20 qualify the veteran for eligibility under such section; 

21 and 

22 ‘‘(iii) either— 

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

24 the lowest population density as determined by 

25 data from the 2010 decennial census; or 


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

2 subclause (I) and— 

3 ‘‘(aa) received care or services under 

4 this title in the year preceding the enact5 ment of the Caring for Our Veterans Act 

6 of 2018; and 

7 ‘‘(bb) is seeking care or services with8 in two years of the date of the enactment 

9 of the Caring for Our Veterans Act of 

10 2018; 

11 ‘‘(D) the covered veteran has contacted the De12 partment to request care or services and the Depart13 ment is not able to furnish such care or services in 

14 a manner that complies with designated access 

15 standards developed by the Secretary under section 

16 1703B of this title; or 

17 ‘‘(E) the covered veteran and the covered vet18 eran’s referring clinician agree that furnishing care 

19 and services through a non-Department entity or 

20 provider would be in the best medical interest of the 

21 covered veteran based upon criteria developed by the 

22 Secretary. 

23 ‘‘(2) The Secretary shall ensure that the criteria de24 veloped under paragraph (1)(E) include consideration of 

25 the following: 


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

2 and the facility that provides the hospital care, med3 ical services, or extended care services the veteran 

4 needs. 

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

6 services, or extended care services required. 

7 ‘‘(C) The frequency that the hospital care, med8 ical services, or extended care services needs to be 

9 furnished. 

10 ‘‘(D) The timeliness of available appointments 

11 for the hospital care, medical services, or extended 

12 care services the veteran needs. 

13 ‘‘(E) Whether the covered veteran faces an un14 usual or excessive burden to access hospital care, 

15 medical services, or extended care services from the 

16 Department medical facility where a covered veteran 

17 seeks hospital care, medical services, or extended 

18 care services, which shall include consideration of 

19 the following: 

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

21 excessive driving distance, geographical chal22 lenge, or environmental factor that impedes the 

23 access of the covered veteran. 

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

25 services, or extended care services sought by the 


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1 veteran is provided by a medical facility of the 

2 Department that is reasonably accessible to a 

3 covered veteran. 

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

5 covered veteran affects the ability of the covered 

6 veteran to travel. 

7 ‘‘(iv) Whether there is compelling reason, 

8 as determined by the Secretary, that the vet9 eran needs to receive hospital care, medical 

10 services, or extended care services from a med11 ical facility other than a medical facility of the 

12 Department. 

13 ‘‘(v) Such other considerations as the Sec14 retary considers appropriate. 

15 ‘‘(3) If the Secretary has determined that the Depart16 ment does not offer the care or services the covered vet17 eran requires under subparagraph (A) of paragraph (1), 

18 that the Department does not operate a full-service med19 ical facility in the State in which the covered veteran re20 sides under subparagraph (B) of such paragraph, that the 

21 covered veteran is described under subparagraph (C) of 

22 such paragraph, or that the Department is not able to fur23 nish care or services in a manner that complies with des24 ignated access standards developed by the Secretary under 

25 section 1703B of this title under subparagraph (D) of 


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1 such paragraph, the decision to receive hospital care, med2 ical services, or extended care services under such sub3 paragraphs from a health care provider specified in sub4 section (c) shall be at the election of the veteran. 

5 ‘‘(e) CONDITIONS UNDER WHICH CARE IS AUTHOR6 IZED TO BE FURNISHED THROUGH NON-DEPARTMENT

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

8 care, medical services, or extended care services through 

9 a health care provider specified in subsection (c) to a cov10 ered veteran served by a medical service line of the De11 partment that the Secretary has determined is not pro12 viding care that complies with the standards for quality 

13 the Secretary shall establish under section 1703C. 

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

15 shall— 

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

17 line at a facility of the Department when compared 

18 with the same medical service line at different De19 partment facilities; and 

20 ‘‘(ii) measure quality at a medical service line 

21 of a facility of the Department by comparing it with 

22 two or more distinct and appropriate quality meas23 ures at non-Department medical service lines. 

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

25 hospital care, medical services, or extended care services 


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

2 medical service lines described in such subparagraph at 

3 any one health care facility of the Department. 

4 ‘‘(ii) The Secretary may not concurrently furnish hos5 pital care, medical services, or extended care services 

6 under subparagraph (A) with respect to more than 36 

7 medical service lines nationally described in such subpara8 graph. 

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

10 care, medical services, or extended care services covered 

11 veterans may receive under paragraph (1) in terms of the 

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

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

14 and the clinical care and services that will be available. 

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

16 the hospital care, medical services, and extended care serv17 ices authorized under paragraph (1) with respect to a 

18 medical service line shall cease when the remediation de19 scribed in section 1706A with respect to such medical 

20 service line is complete. 

21 ‘‘(B) The Secretary shall ensure continuity and co22 ordination of care for any veteran who elects to receive 

23 care or services under paragraph (1) from a health care 

24 provider specified in subsection (c) through the completion 

25 of an episode of care. 


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1 ‘‘(4) The Secretary shall publish in the Federal Reg2 ister, and shall take all reasonable steps to provide direct 

3 notice to covered veterans affected under this subsection, 

4 at least once each year stating the time period during 

5 which such care and services will be available, the location 

6 or locations where such care and services will be available, 

7 and the clinical services available at each location under 

8 this subsection in accordance with regulations the Sec9 retary shall prescribe. 

10 ‘‘(5) When the Secretary exercises the authority 

11 under paragraph (1), the decision to receive care or serv12 ices under such paragraph from a health care provider 

13 specified in subsection (c) shall be at the election of the 

14 covered veteran. 

15 ‘‘(f) REVIEW OF DECISIONS.—The review of any de16 cision under subsection (d) or (e) shall be subject to the 

17 Department’s clinical appeals process, and such decisions 

18 may not be appealed to the Board of Veterans’ Appeals. 

19 ‘‘(g) TIERED NETWORK.—(1) To promote the provi20 sion of high-quality and high-value hospital care, medical 

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

22 Secretary may develop a tiered provider network of eligible 

23 providers based on criteria established by the Secretary 

24 for purposes of this section. 


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1 ‘‘(2) In developing a tiered provider network of eligi2 ble providers under paragraph (1), the Secretary shall not 

3 prioritize providers in a tier over providers in any other 

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

5 in selecting a health care provider specified in subsection 

6 (c) for receipt of hospital care, medical services, or ex7 tended care services under this section. 

8 ‘‘(h) CONTRACTS TO ESTABLISH NETWORKS OF

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

10 enter into consolidated, competitively bid contracts to es11 tablish networks of health care providers specified in para12 graphs (1) and (5) of subsection (c) for purposes of pro13 viding sufficient access to hospital care, medical services, 

14 or extended care services under this section. 

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

16 ensure that covered veterans are able to make their own 

17 appointments using advanced technology. 

18 ‘‘(B) To the extent practicable, the Secretary shall 

19 be responsible for the scheduling of appointments for hos20 pital care, medical services, and extended care services 

21 under this section. 

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

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

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

25 specify for purposes of this section, if the Secretary notiVerDate Sep 11 2014 21:33 May 11, 2018 Jkt 079200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\H5674.RH H5674

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1 fies the appropriate committees of Congress that, at a 

2 minimum— 

3 ‘‘(i) the entity— 

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

5 provisions of the contract or with the provisions 

6 of this section and the regulations prescribed 

7 under this section; 

8 ‘‘(II) failed to comply with the access 

9 standards or the standards for quality estab10 lished by the Secretary; 

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

12 Federal health care program (as defined in sec13 tion 1128B(f) of the Social Security Act (42 

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

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

16 1320a–7 and 1320a–7a); 

17 ‘‘(IV) is identified as an excluded source 

18 on the list maintained in the System for Award 

19 Management, or any successor system; or 

20 ‘‘(V) has been convicted of a felony or 

21 other serious offense under Federal or State 

22 law and the continued participation of the enti23 ty would be detrimental to the best interests of 

24 veterans or the Department; 


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

2 based on the health care needs of veterans; or 

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

4 based on coverage provided by contracts or sharing 

5 agreements entered into under authorities other 

6 than this section. 

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

8 to restrict the authority of the Secretary to terminate a 

9 contract entered into under paragraph (1) under any other 

10 provision of law. 

11 ‘‘(4) Whenever the Secretary provides notice to an 

12 entity that the entity is failing to meet contractual obliga13 tions entered into under paragraph (1), the Secretary shall 

14 submit to the Committee on Veterans’ Affairs of the Sen15 ate and the Committee on Veterans’ Affairs of the House 

16 of Representatives a report on such failure. Such report 

17 shall include the following: 

18 ‘‘(A) An explanation of the reasons for pro19 viding such notice. 

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

21 including with respect to cost, schedule, and require22 ments. 

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

24 Secretary to mitigate such failure. 


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

2 contractor to address such failure. 

3 ‘‘(E) A description of any effect on the commu4 nity provider market for veterans in the affected 

5 area. 

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

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

8 accept, on an interim basis, the credentials and qualifica9 tions of health care providers who are authorized to fur10 nish hospital care and medical services to veterans under 

11 a community care program of the Department in effect 

12 as of the day before the date of the enactment of the Car13 ing for Our Veterans Act of 2018, including under the 

14 Patient-Centered Community Care Program and the Vet15 erans Choice Program under section 101 of the Veterans 

16 Access, Choice, and Accountability Act of 2014 (Public 

17 Law 113–146; 38 U.S.C. 1701 note), as qualified pro18 viders under the program established under this section. 

19 ‘‘(B) The interim acceptance period under subpara20 graph (A) shall be determined by the Secretary based on 

21 the following criteria: 

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

23 when the current certification agreement for the 

24 health care provider expires. 


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1 ‘‘(ii) Whether the Department has enacted cer2 tification and eligibility criteria and regulatory pro3 cedures by which non-Department providers will be 

4 authorized under this section. 

5 ‘‘(6) The Secretary shall establish a system or sys6 tems for monitoring the quality of care provided to covered 

7 veterans through a network under this subsection and for 

8 assessing the quality of hospital care, medical services, 

9 and extended care services furnished through such net10 work before the renewal of the contract for such network. 

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

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

13 practicable, the rate paid for hospital care, medical serv14 ices, or extended care services under any provision in this 

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

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

17 of the Social Security Act (42 U.S.C. 1395x(u))) or a sup18 plier (as defined in section 1861(d) of such Act (42 U.S.C. 

19 1395x(d))) under the Medicare program under title XI or 

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

21 et seq.), including section 1834 of such Act (42 U.S.C. 

22 1395m), for the same care or services. 

23 ‘‘(2)(A) A higher rate than the rate paid by the 

24 United States as described in paragraph (1) may be negoVerDate Sep 11 2014 21:33 May 11, 2018 Jkt 079200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 E:\BILLS\H5674.RH H5674

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1 tiated with respect to the furnishing of care or services 

2 to a covered veteran who resides in a highly rural area. 

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

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

5 seven individuals residing in that county per square mile. 

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

7 this section in Alaska, the Alaska Fee Schedule of the De8 partment of Veterans Affairs shall be followed, except for 

9 when another payment agreement, including a contract or 

10 provider agreement, is in effect. 

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

12 services, or extended care services under this section in 

13 a State with an All-Payer Model Agreement under section 

14 1814(b)(3) of the Social Security Act (42 U.S.C. 

15 1395f(b)(3)) that became effective on or after January 1, 

16 2014, the Medicare payment rates under paragraph 

17 (2)(A) shall be calculated based on the payment rates 

18 under such agreement. 

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

20 may incorporate, to the extent practicable, the use of 

21 value-based reimbursement models to promote the provi22 sion of high-quality care. 

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

24 or extended care services for which there is not a rate paid 

25 under the Medicare program as described in paragraph 


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1 (1), the rate paid for such care or services shall be deter2 mined by the Secretary. 

3 ‘‘(j) TREATMENT OF OTHER HEALTH PLAN CON4 TRACTS.—In any case in which a covered veteran is fur5 nished hospital care, medical services, or extended care 

6 services under this section for a non-service-connected dis7 ability described in subsection (a)(2) of section 1729 of 

8 this title, the Secretary shall recover or collect reasonable 

9 charges for such care or services from a health plan con10 tract described in section 1729 in accordance with such 

11 section. 

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

13 shall not pay a greater amount for receiving care or serv14 ices under this section than the amount the veteran would 

15 pay for receiving the same or comparable care or services 

16 at a medical facility of the Department or from a health 

17 care provider of the Department. 

18 ‘‘(l) TRANSPLANT AUTHORITY FOR IMPROVED AC19 CESS.—(1) In the case of a covered veteran described in 

20 paragraph (2), the Secretary shall determine whether to 

21 authorize an organ or bone marrow transplant for that 

22 covered veteran at a non-Department facility. 

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

24 ‘‘(A) requires an organ or bone marrow trans25 plant; and 


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

2 provider of the veteran, a medically compelling rea3 son to travel outside the region of the Organ Pro4 curement and Transplantation Network, established 

5 under section 372 of the National Organ Transplan6 tation Act (Public Law 98–507; 42 U.S.C. 274), in 

7 which the veteran resides, to receive such transplant. 

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

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

10 the Caring for Our Veterans Act of 2018, and not less 

11 frequently than annually thereafter, the Secretary shall 

12 submit to appropriate committees of Congress a review of 

13 the types and frequency of care sought under subsection 

14 (d). 

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

16 shall include an assessment of the following: 

17 ‘‘(i) The top 25 percent of types of care and 

18 services most frequently provided under subsection 

19 (d) due to the Department not offering such care 

20 and services. 

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

22 sought by covered veterans under this section. 

23 ‘‘(iii) An analysis of the reasons the Depart24 ment was unable to provide such care and services. 


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

2 such care and services at a medical facility of the 

3 Department. 

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

5 ‘‘(2) In monitoring the hospital care, medical serv6 ices, and extended care services furnished under this sec7 tion, the Secretary shall do the following: 

8 ‘‘(A) With respect to hospital care, medical 

9 services, and extended care services furnished 

10 through provider networks established under sub11 section (i)— 

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

13 care, medical services, and extended care serv14 ices furnished through such networks and how 

15 many patients used each type of care and serv16 ice; 

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

18 services, or extended care services furnished 

19 through such networks; 

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

21 through new contracts within such networks or 

22 changes in the manner in which hospital care, 

23 medical services, or extended care services are 

24 furnished through such networks; 


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

2 Department on hospital care, medical services, 

3 and extended care services furnished through 

4 such networks; 

5 ‘‘(v) assess the timeliness of the Depart6 ment in referring hospital care, medical serv7 ices, and extended care services to such net8 works; and 

9 ‘‘(vi) assess the timeliness of such net10 works in— 

11 ‘‘(I) accepting referrals; and 

12 ‘‘(II) scheduling and completing ap13 pointments. 

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

15 the Secretary has determined under subsection 

16 (e)(1) not to be providing hospital care, medical 

17 services, or extended care services that comply with 

18 the standards for quality established by the Sec19 retary. 

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

21 centers of excellence of the Department to furnish 

22 hospital care, medical services, and extended care 

23 services to covered veterans under this section. 

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

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1 erans under this section by medical facilities oper2 ated by Federal agencies other than the Depart3 ment. 

4 ‘‘(3) Not later than 540 days after the date of the 

5 enactment of the Caring for Our Veterans Act of 2018 

6 and not less frequently than once each year thereafter, the 

7 Secretary shall submit to the Committee on Veterans’ Af8 fairs of the Senate and the Committee on Veterans’ Af9 fairs of the House of Representatives a report on the in10 formation gathered under paragraph (2). 

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

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

13 medical services, or extended care services covered vet14 erans may receive under this section if it is in the best 

15 medical interest of the veteran to receive such hospital 

16 care, medical services, or extended care services, as deter17 mined by the veteran and the veteran’s health care pro18 vider. 

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

20 to alter or modify any other provision of law establishing 

21 specific eligibility criteria for certain hospital care, medical 

22 services, or extended care services. 

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

24 ‘‘(1) The term ‘appropriate committees of Con25 gress’ means— 


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

2 and the Committee on Appropriations of the 

3 Senate; and 

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

5 and the Committee on Appropriations of the 

6 House of Representatives. 

7 ‘‘(2) The term ‘medical service line’ means a 

8 clinic within a Department medical center.’’. 

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

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

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

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

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

15 take effect on the later of— 

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

17 which the Secretary of Veterans Affairs submits the 

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

20 2014 (Public Law 113–146; 38 U.S.C. 1701 note); 

21 or 

22 (2) the date on which the Secretary promul23 gates regulations pursuant to subsection (c). 

24 (c) REGULATIONS.— 


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1 (1) IN GENERAL.—Not later than one year 

2 after the date of the enactment of this Act, the Sec3 retary of Veterans Affairs shall promulgate regula4 tions to carry out section 1703 of title 38, United 

5 States Code, as amended by subsection (a) of this 

6 section. 

7 (2) UPDATES.— 

8 (A) PERIODIC.—Before promulgating the 

9 regulations required under paragraph (1), the 

10 Secretary shall provide to the appropriate com11 mittees of Congress periodic updates to confirm 

12 the progress of the Secretary toward developing 

13 such regulations. 

14 (B) FIRST UPDATE.—The first update 

15 under subparagraph (A) shall occur no later 

16 than 120 days from the date of the enactment 

17 of this Act. 

18 (C) APPROPRIATE COMMITTEES OF CON19 GRESS DEFINED.—In this paragraph, the term 

20 ‘‘appropriate committees of Congress’’ means— 

21 (i) the Committee on Veterans’ Af22 fairs and the Committee on Appropriations 

23 of the Senate; and 


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1 (ii) the Committee on Veterans’ Af2 fairs and the Committee on Appropriations 

3 of the House of Representatives. 

4 (d) CONTINUITY OF EXISTING AGREEMENTS.— 

5 (1) IN GENERAL.—Notwithstanding section 

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

7 subsection (a), the Secretary of Veterans Affairs 

8 shall continue all contracts, memorandums of under9 standing, memorandums of agreements, and other 

10 arrangements that were in effect on the day before 

11 the date of the enactment of this Act between the 

12 Department of Veterans Affairs and the American 

13 Indian and Alaska Native health care systems as es14 tablished under the terms of the Department of Vet15 erans Affairs and Indian Health Service Memo16 randum of Understanding, signed October 1, 2010, 

17 the National Reimbursement Agreement, signed De18 cember 5, 2012, arrangements under section 405 of 

19 the Indian Health Care Improvement Act (25 U.S.C. 

20 1645), and agreements entered into under sections 

21 102 and 103 of the Veterans Access, Choice, and 

22 Accountability Act of 2014 (Public Law 113–146). 

23 (2) MODIFICATIONS.—Paragraph (1) shall not 

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1 standing, memorandums of agreements, and other 

2 arrangements described in such paragraph from 

3 making such changes to such contracts, memoran4 dums of understanding, memorandums of agree5 ments, and other arrangements as may be otherwise 

6 authorized pursuant to other provisions of law or the 

7 terms of the contracts, memorandums of under8 standing, memorandums of agreements, and other 

9 arrangements. 

10 SEC. 102. AUTHORIZATION OF AGREEMENTS BETWEEN DE11 PARTMENT OF VETERANS AFFAIRS AND NON12 DEPARTMENT PROVIDERS. 

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

14 amended by inserting after section 1703 the following new 

15 section: 

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

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

20 required by a veteran who is entitled to such care or serv21 ice under this chapter is not feasibly available to the vet22 eran from a facility of the Department or through a con23 tract or sharing agreement entered into pursuant to an24 other provision of law, the Secretary may furnish such 

25 care or service to such veteran through an agreement 


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1 under this section with an eligible entity or provider to 

2 provide such hospital care, medical service, or extended 

3 care service. 

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

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

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

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

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

10 be considered not feasibly available to a veteran from a 

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

13 Secretary determines the veteran’s medical condition, the 

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

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

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

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

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

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

22 shall review each Veterans Care Agreement of material 

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


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1 advisable to provide such care or service within a facility 

2 of the Department or by contract or sharing agreement 

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

4 so, take action to do so. 

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

6 Care Agreement of material size that has been in effect 

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

8 taking effect, and not less frequently than once every four 

9 years thereafter. 

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

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

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

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

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

16 (i). 

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

18 thereafter, in addition to such other Veterans Care Agree19 ments as the Secretary may determine are of material size, 

20 a Veterans Care Agreement for the purchase of extended 

21 care services that exceeds $5,000,000 annually shall be 

22 considered of material size. 

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

24 a notice in the Federal Register to adjust the dollar 

25 amount specified in subparagraph (A) to account for 


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1 changes in the cost of health care based upon recognized 

2 health care market surveys and other available data. 

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

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

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

6 and entered into a provider agreement under section 

7 1866(a) of the Social Security Act (42 U.S.C. 

8 1395cc(a)) and any physician or other supplier who 

9 has enrolled and entered into a participation agree10 ment under section 1842(h) of such Act (42 U.S.C. 

11 1395u(h)); 

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

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

14 et seq.); 

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

16 an area agency on aging, or a State agency (as de17 fined in section 102 of the Older Americans Act of 

18 1965 (42 U.S.C. 3002)); 

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

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

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

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

23 paragraph (1) or (2) of this subsection that the Sec24 retary determines to be eligible pursuant to the cer25 tification process described in subsection (c). 


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1 ‘‘(c) ELIGIBLE ENTITY OR PROVIDER CERTIFI2 CATION PROCESS.—The Secretary shall establish by regu3 lation a process for the certification of eligible entities or 

4 providers or recertification of eligible entities or providers 

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

6 ‘‘(1) establish deadlines for actions on applica7 tions for certification; 

8 ‘‘(2) set forth standards for an approval or de9 nial of certification, duration of certification, revoca10 tion of an eligible entity or provider’s certification, 

11 and recertification of eligible entities or providers; 

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

13 Secretary determines the eligible entity or provider 

14 is excluded from participation in a Federal health 

15 care program under section 1128 or section 1128A 

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

17 1320a–7a) or is currently identified as an excluded 

18 source on the System for Award Management Exclu19 sions list described in part 9 of title 48, Code of 

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

21 Code, or successor regulations; 

22 ‘‘(4) establish procedures for screening eligible 

23 entities or providers according to the risk of fraud, 

24 waste, and abuse that are similar to the standards 

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


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

2 of title 48, Code of Federal Regulations, or suc3 cessor regulations; and 

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

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

6 this section as a procurement program only for pur7 poses of applying such provisions. 

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

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

10 and extended care services provided under a Veterans 

11 Care Agreement shall be in accordance with the rates paid 

12 by the United States under section 1703(i) of this title. 

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

14 Pursuant to regulations promulgated under subsection 

15 (k), the Secretary may define the requirements for pro16 viders and entities entering into agreements under this 

17 section based upon such factors as the number of patients 

18 receiving care or services, the number of employees em19 ployed by the entity or provider furnishing such care or 

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

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

22 ‘‘(2) To furnish hospital care, medical services, or ex23 tended care services under this section, an eligible entity 

24 or provider shall agree— 


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

2 in regulations prescribed under this section; 

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

4 section on behalf of a veteran to a provider of serv5 ices or care shall, unless rejected and refunded by 

6 the provider within 30 days of receipt, constitute 

7 payment in full and extinguish any liability on the 

8 part of the veteran for the treatment or care pro9 vided, and no provision of a contract, agreement, or 

10 assignment to the contrary shall operate to modify, 

11 limit, or negate this requirement; 

12 ‘‘(C) to provide only the care and services au13 thorized by the Department under this section and 

14 to obtain the prior written consent of the Depart15 ment to furnish care or services outside the scope of 

16 such authorization; 

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

18 the methodology outlined in regulations prescribed 

19 under this section; 

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

21 health plan contract or third party, as those terms 

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

23 or service that is furnished or paid for by the De24 partment; 


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1 ‘‘(F) to provide medical records to the Depart2 ment in the time frame and format specified by the 

3 Department; and 

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

5 including quality of care assurance standards, as the 

6 Secretary may specify in regulation. 

7 ‘‘(f) DISCONTINUATION OR NONRENEWAL OF A VET8 ERANS CARE AGREEMENT.—(1) An eligible entity or pro9 vider may discontinue a Veterans Care Agreement at such 

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

11 provided in regulations prescribed under this section. 

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

13 Agreement with an eligible entity or provider at such time 

14 and upon such reasonable notice to the eligible entity or 

15 provider as may be specified in regulations prescribed 

16 under this section, if an official designated by the Sec17 retary— 

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

19 provider failed to comply substantially with the pro20 visions of the Veterans Care Agreement, or with the 

21 provisions of this section or regulations prescribed 

22 under this section; 

23 ‘‘(B) has determined the eligible entity or pro24 vider is excluded from participation in a Federal 

25 health care program under section 1128 or section 


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1 1128A of the Social Security Act (42 U.S.C. 1320a– 

2 7 or 1320a–7a) or is identified on the System for 

3 Award Management Exclusions list as provided in 

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

5 part 180 of title 2 of such Code, or successor regula6 tions; 

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

8 provider has been convicted of a felony or other seri9 ous offense under Federal or State law and deter10 mines the eligible entity or provider’s continued par11 ticipation would be detrimental to the best interests 

12 of veterans or the Department; or 

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

14 terminate the agreement based on the health care 

15 needs of a veteran. 

16 ‘‘(g) QUALITY OF CARE.—The Secretary shall estab17 lish a system or systems for monitoring the quality of care 

18 provided to veterans through Veterans Care Agreements 

19 and for assessing the quality of hospital care, medical 

20 services, and extended care services furnished by eligible 

21 entities and providers before the renewal of Veterans Care 

22 Agreements. 

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

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1 viders to present all disputes arising under or related to 

2 Veterans Care Agreements. 

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

4 and providers’ exhaustive and exclusive administrative 

5 remedies. 

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

7 such administrative procedures before seeking any judicial 

8 review under section 1346 of title 28 (known as the ‘Tuck9 er Act’). 

10 ‘‘(4) Disputes under this section must pertain to ei11 ther the scope of authorization under the Veterans Care 

12 Agreement or claims for payment subject to the Veterans 

13 Care Agreement and are not claims for the purposes of 

14 such laws that would otherwise require application of sec15 tions 7101 through 7109 of title 41, United States Code. 

16 ‘‘(i) APPLICABILITY OF OTHER PROVISIONS OF

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

18 by the Secretary or any Department official authorized by 

19 the Secretary, and such action shall not be treated as— 

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

21 that would otherwise require the use of competitive 

22 procedures for the furnishing of care and services; or 

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

24 goods or services for purposes of any provision of 

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1 quisition of goods or services except section 4706(d) 

2 of title 41. 

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

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

5 section or regulations prescribed pursuant to this section, 

6 an eligible entity or provider that enters into an agreement 

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

8 of the agreement, any law to which providers of services 

9 and suppliers under the Medicare program under title 

10 XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) 

11 are not subject. 

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

13 an agreement under this section is subject to— 

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

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

16 penalties; and 

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

18 discrimination or that otherwise ensure equal em19 ployment opportunities. 

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

21 entity or provider that enters into an agreement under this 

22 section shall not be treated as a Federal contractor or sub23 contractor for purposes of chapter 67 of title 41 (com24 monly known as the ‘McNamara-O’Hara Service Contract 

25 Act of 1965’). 


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

2 care, medical services, and extended care services fur3 nished to any veteran pursuant to a Veterans Care Agree4 ment shall be subject to the same terms as though pro5 vided in a facility of the Department, and provisions of 

6 this chapter applicable to veterans receiving such care and 

7 services in a facility of the Department shall apply to vet8 erans treated under this section. 

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

10 regulations to carry out this section.’’. 

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

12 at the beginning of such chapter is amended by inserting 

13 after the item related to section 1703 the following new 

14 item: 

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

15 SEC. 103. CONFORMING AMENDMENTS FOR STATE VET16 ERANS HOMES. 

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

18 (1) in paragraph (1), by striking ‘‘(or agree19 ment under section 1720(c)(1) of this title)’’ and in20 serting ‘‘(or an agreement)’’; and 

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

22 paragraph: 

23 ‘‘(4)(A) An agreement under this section may be au24 thorized by the Secretary or any Department official au25 thorized by the Secretary, and any such action is not an 


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1 award for purposes of such laws that would otherwise re2 quire the use of competitive procedures for the furnishing 

3 of hospital care, medical services, and extended care serv4 ices. 

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

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

7 or regulations prescribed pursuant to this section, a State 

8 home that enters into an agreement under this section is 

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

10 provision of law to which providers of services and sup11 pliers under the Medicare program under title XVIII of 

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

13 subject. 

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

15 under this section is subject to— 

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

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

18 criminal penalties; 

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

20 employment discrimination or that otherwise ensure 

21 equal employment opportunities; and 

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

23 17 of this title. 

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

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1 tion may not be treated as a Federal contractor or subcon2 tractor for purposes of chapter 67 of title 41 (known as 

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

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

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

6 effective date of regulations issued by the Secretary of 

7 Veterans Affairs to carry out this section. 

8 SEC. 104. ACCESS STANDARDS AND STANDARDS FOR QUAL9 ITY. 

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

11 amended by section 102, is further amended by inserting 

12 after section 1703A the following new sections: 

13 ‘‘§ 1703B. Access standards 

14 ‘‘(a)(1) The Secretary shall establish access stand15 ards for furnishing hospital care, medical services, or ex16 tended care services to covered veterans for the purposes 

17 of section 1703(d). 

18 ‘‘(2) The Secretary shall ensure that the access 

19 standards established under paragraph (1) define such 

20 categories of care to cover all care and services within the 

21 medical benefits package of the Department of Veterans 

22 Affairs. 

23 ‘‘(b) The Secretary shall ensure that the access 

24 standards provide covered veterans, employees of the De25 partment, and health care providers in the network estabVerDate Sep 11 2014 21:33 May 11, 2018 Jkt 079200 PO 00000 Frm 00043 Fmt 6652 Sfmt 6201 E:\BILLS\H5674.RH H5674

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1 lished under section 1703(h) with relevant comparative in2 formation that is clear, useful, and timely, so that covered 

3 veterans can make informed decisions regarding their 

4 health care. 

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

6 Federal entities (including the Department of Defense, the 

7 Department of Health and Human Services, and the Cen8 ters for Medicare & Medicaid Services), entities in the pri9 vate sector, and other nongovernmental entities in estab10 lishing access standards. 

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

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

13 the Secretary shall submit to the appropriate committees 

14 of Congress a report detailing the access standards. 

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

16 paragraph (1), the Secretary shall provide periodic up17 dates to the appropriate committees of Congress to con18 firm the Department’s progress towards developing the ac19 cess standards required by this section. 

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

21 occur no later than 120 days from the date of the enact22 ment of the Caring for Our Veterans Act of 2018. 

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

24 the Secretary implements the access standards established 

25 under subsection (a), the Secretary shall submit to the apVerDate Sep 11 2014 21:33 May 11, 2018 Jkt 079200 PO 00000 Frm 00044 Fmt 6652 Sfmt 6201 E:\BILLS\H5674.RH H5674

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1 propriate committees of Congress a report detailing the 

2 implementation of and compliance with such access stand3 ards by Department and non-Department entities or pro4 viders. 

5 ‘‘(e) Not later than three years after the date on 

6 which the Secretary establishes access standards under 

7 subsection (a) and not less frequently than once every 

8 three years thereafter, the Secretary shall— 

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

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

11 Congress a report on the findings and any modifica12 tion to the access standards with respect to the re13 view conducted under paragraph (1). 

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

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

16 the applicable access standards established by the Sec17 retary. 

18 ‘‘(g) The Secretary shall publish in the Federal Reg19 ister and on an internet website of the Department the 

20 designated access standards established under this section 

21 for purposes of section 1703(d)(1)(D). 

22 ‘‘(h)(1) Consistent with paragraphs (1)(D) and (3) 

23 of section 1703(d), covered veterans may contact the De24 partment at any time to request a determination regarding 

25 whether they are eligible to receive care and services from 


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1 a non-Department entity or provider based on the Depart2 ment being unable to furnish such care and services in 

3 a manner that complies with the designated access stand4 ards established under this section. 

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

6 such requests from covered veterans to determine wheth7 er— 

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

9 and 

10 ‘‘(B) the Department is able to provide such 

11 care in a manner that complies with designated ac12 cess standards established under this section. 

13 ‘‘(3) The Secretary shall promptly respond to any 

14 such request by a covered veteran. 

15 ‘‘(i)(1) The term ‘appropriate committees of Con16 gress’ means— 

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

18 the Committee on Appropriations of the Senate; and 

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

20 the Committee on Appropriations of the House of 

21 Representatives. 

22 ‘‘(2) The term ‘covered veterans’ refers to veterans 

23 described in section 1703(b) of this title. 


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1 ‘‘§ 1703C. Standards for quality 

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

3 standards for quality regarding hospital care, medical 

4 services, and extended care services furnished by the De5 partment pursuant to this title, including through non-De6 partment health care providers pursuant to section 1703 

7 of this title. 

8 ‘‘(2) In establishing standards for quality under para9 graph (1), the Secretary shall consider existing health 

10 quality measures that are applied to public and privately 

11 sponsored health care systems with the purpose of pro12 viding covered veterans relevant comparative information 

13 to make informed decisions regarding their health care. 

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

15 purposes of establishing the standards under paragraph 

16 (1). Such data collection shall include— 

17 ‘‘(A) after consultation with veterans service or18 ganizations and other key stakeholders on survey de19 velopment or modification of an existing survey, a 

20 survey of veterans who have used hospital care, med21 ical services, or extended care services furnished by 

22 the Veterans Health Administration during the most 

23 recent two-year period to assess the satisfaction of 

24 the veterans with service and quality of care; and 

25 ‘‘(B) datasets that include, at a minimum, ele26 ments relating to the following: 


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1 ‘‘(i) Timely care. 

2 ‘‘(ii) Effective care. 

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

4 complications, readmissions, and deaths. 

5 ‘‘(iv) Efficiency. 

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

7 Federal entities (including the Department of Defense, the 

8 Department of Health and Human Services, and the Cen9 ters for Medicare & Medicaid Services), entities in the pri10 vate sector, and other nongovernmental entities in estab11 lishing standards for quality. 

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

13 the enactment of the Caring for Our Veterans Act of 

14 2018, the Secretary shall submit to the appropriate com15 mittees of Congress a report detailing the standards for 

16 quality. 

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

18 subparagraph (A), the Secretary shall provide periodic up19 dates to the appropriate committees of Congress to con20 firm the Department’s progress towards developing the 

21 standards for quality required by this section. 

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

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

24 the Caring for Our Veterans Act of 2018. 


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1 ‘‘(b) PUBLICATION AND CONSIDERATION OF PUBLIC

2 COMMENTS.—(1) Not later than one year after the date 

3 on which the Secretary establishes standards for quality 

4 under subsection (a), the Secretary shall publish the qual5 ity rating of medical facilities of the Department in the 

6 publicly available Hospital Compare website through the 

7 Centers for Medicare & Medicaid Services for the purpose 

8 of providing veterans with information that allows them 

9 to compare performance measure information among De10 partment and non-Department health care providers. 

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

12 the Secretary establishes standards for quality under sub13 section (a), the Secretary shall consider and solicit public 

14 comment on potential changes to the measures used in 

15 such standards to ensure that they include the most up16 to-date and applicable industry measures for veterans. 

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

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

20 the Committee on Appropriations of the Senate; and 

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

22 the Committee on Appropriations of the House of 

23 Representatives. 

24 ‘‘(2) The term ‘covered veterans’ refers to veterans 

25 described in section 1703(b) of this title.’’. 


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

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

3 102, is further amended by inserting after the item relat4 ing to section 1703A the following new items: 

‘‘1703B. Access standards. 

‘‘1703C. Standards for quality.’’. 

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

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

8 ‘‘§ 1725A. Access to walk-in care 

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

12 from qualifying non-Department entities or providers. 

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

14 section, an eligible veteran is any individual who— 

15 ‘‘(1) is enrolled in the health care system estab16 lished under section 1705(a) of this title; and 

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

18 the 24-month period preceding the furnishing of 

19 walk-in care under this section. 

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

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

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

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


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1 agreement with the Secretary to furnish services under 

2 this section. 

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

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

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

7 carry out this section. 

8 ‘‘(e) CONTINUITY OF CARE.—The Secretary shall en9 sure continuity of care for those eligible veterans who re10 ceive walk-in care services under this section, including 

11 through the establishment of a mechanism to receive med12 ical records from walk-in care providers and provide perti13 nent patient medical records to providers of walk-in care. 

14 ‘‘(f) COPAYMENTS.—(1)(A) The Secretary may re15 quire an eligible veteran to pay the United States a copay16 ment for each episode of hospital care or medical services 

17 provided under this section if the eligible veteran would 

18 be required to pay a copayment under this title. 

19 ‘‘(B) An eligible veteran not required to pay a copay20 ment under this title may access walk-in care without a 

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

22 any additional visits, a copayment at an amount deter23 mined by the Secretary may be required. 

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

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1 ment for the first two walk-in care visits in a calendar 

2 year. For any additional visits, a higher copayment at an 

3 amount determined by the Secretary may be required. 

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

5 to an eligible veteran under this section, the Secretary may 

6 adjust the copayment required of the veteran under this 

7 subsection based upon the priority group of enrollment of 

8 the eligible veteran, the number of episodes of care fur9 nished to the eligible veteran during a year, and other fac10 tors the Secretary considers appropriate under this sec11 tion. 

12 ‘‘(3) The amount or amounts of the copayments re13 quired under this subsection shall be prescribed by the 

14 Secretary by rule. 

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

16 this subsection. 

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

18 the date of the enactment of the Caring for Our Veterans 

19 Act of 2018, the Secretary shall promulgate regulations 

20 to carry out this section. 

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

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

23 a qualifying non-Department entity or provider that fur24 nishes episodic care and not longitudinal management of 


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1 conditions and is otherwise defined through regulations 

2 the Secretary shall promulgate.’’. 

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

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

5 effect on the date upon which final regulations imple6 menting such section take effect. 

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

8 at the beginning of such chapter is amended by inserting 

9 after the item related to section 1725 the following new 

10 item: 

‘‘§1725A. Access to walk-in care.’’. 

11 SEC. 106. STRATEGY REGARDING THE DEPARTMENT OF 

12 VETERANS AFFAIRS HIGH-PERFORMING IN13 TEGRATED HEALTH CARE NETWORK. 

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

15 amended by inserting after section 7330B the following 

16 new section: 

17 ‘‘§ 7330C. Quadrennial Veterans Health Administra18 tion review 

19 ‘‘(a) MARKET AREA ASSESSMENTS.—(1) Not less 

20 frequently than every four years, the Secretary of Vet21 erans Affairs shall perform market area assessments re22 garding the health care services furnished under the laws 

23 administered by the Secretary. 

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

25 paragraph (1) shall include the following: 


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

2 care from the Department, disaggregated by geo3 graphic market areas as determined by the Sec4 retary, including the number of requests for health 

5 care services under the laws administered by the 

6 Secretary. 

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

8 of the Department of Veterans Affairs across the 

9 Department’s system of facilities. 

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

11 to be provided through contracted community care 

12 providers and providers who entered into a provider 

13 agreement with the Department under section 

14 1703A of title 38, as added by section 102, includ15 ing the number of providers, the geographic location 

16 of the providers, and categories or types of health 

17 care services provided by the providers. 

18 ‘‘(D) An assessment obtained from other Fed19 eral direct delivery systems of their capacity to pro20 vide health care to veterans. 

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

22 of non-contracted providers where there is insuffi23 cient network supply. 

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

25 of academic affiliates and other collaborations of the 


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1 Department as it relates to providing health care to 

2 veterans. 

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

4 care capacity of the access standards and standards 

5 for quality established under sections 1703B and 

6 1703C of this title. 

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

8 care services under the laws administered by the 

9 Secretary, disaggregated by— 

10 ‘‘(i) appointments at facilities of the De11 partment of Veterans Affairs; and 

12 ‘‘(ii) appointments with non-Department 

13 health care providers. 

14 ‘‘(3)(A) The Secretary shall submit to the appro15 priate committees of Congress the market area assess16 ments established in paragraph (1). 

17 ‘‘(B) The Secretary also shall submit to the appro18 priate committees of Congress the market area assess19 ments completed by or being performed on the day before 

20 the date of the enactment of the Caring for Our Veterans 

21 Act of 2018. 

22 ‘‘(4)(A) The Secretary shall use the market area as23 sessments established under paragraph (1) to— 


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

2 provider networks established under section 1703(h) 

3 of this title; 

4 ‘‘(ii) inform the Department budget, in accord5 ance with subparagraph (B); and 

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

7 the access standards established under section 

8 1703B of this title and standards for quality under 

9 section 1703C and to make recommendations for 

10 any changes to such standards. 

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

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

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

14 the findings of the Secretary with respect to the most re15 cent market area assessments under paragraph (1) and 

16 health care utilization data from the Department and non17 Department entities or providers furnishing care and serv18 ices to covered veterans as described in section 1703(b). 

19 ‘‘(b) STRATEGIC PLAN TO MEET HEALTH CARE DE20 MAND.—(1) Not later than one year after the date of the 

21 enactment of the Caring for Our Veterans Act of 2018 

22 and not less frequently than once every four years there23 after, the Secretary shall submit to the appropriate com24 mittees of Congress a strategic plan that specifies a four25 year forecast of— 


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1 ‘‘(A) the demand for health care from the De2 partment, disaggregated by geographic area as de3 termined by the Secretary; 

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

5 each medical center of the Department; and 

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

7 through community care providers. 

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

9 (1), the Secretary shall— 

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

11 for quality established under sections 1703B and 

12 1703C of this title; 

13 ‘‘(B) assess the market area assessments estab14 lished under subsection (a); 

15 ‘‘(C) assess the needs of the Department based 

16 on identified services that provide management of 

17 conditions or disorders related to military service for 

18 which there is limited experience or access in the na19 tional market, the overall health of veterans 

20 throughout their lifespan, or other services as the 

21 Secretary determines appropriate; 

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

23 Department, the heads of other Federal agencies, 

24 and other relevant governmental and nongovern25 mental entities, including State, local, and tribal 


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1 government officials, members of Congress, veterans 

2 service organizations, private sector representatives, 

3 academics, and other policy experts; 

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

5 and opportunities that could affect health care serv6 ices furnished under the laws administered by the 

7 Secretary; 

8 ‘‘(F) develop recommendations regarding both 

9 short- and long-term priorities for health care serv10 ices furnished under the laws administered by the 

11 Secretary; 

12 ‘‘(G) after consultation with veterans service or13 ganizations and other key stakeholders on survey de14 velopment or modification of an existing survey, con15 sider a survey of veterans who have used hospital 

16 care, medical services, or extended care services fur17 nished by the Veterans Health Administration dur18 ing the most recent two-year period to assess the 

19 satisfaction of the veterans with service and quality 

20 of care; 

21 ‘‘(H) conduct a comprehensive examination of 

22 programs and policies of the Department regarding 

23 the delivery of health care services and the demand 

24 of health care services for veterans in future years; 


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

2 lines of the Department as described in section 

3 1706A in conjunction with the utilization of non-De4 partment entities or providers to offset remediation; 

5 and 

6 ‘‘(J) consider such other matters as the Sec7 retary considers appropriate. 

8 ‘‘(c) RESPONSIBILITIES.—The Secretary shall be re9 sponsible for— 

10 ‘‘(1) overseeing the transformation and organi11 zational change across the Department to achieve 

12 such high performing integrated health care net13 work; 

14 ‘‘(2) developing the capital infrastructure plan15 ning and procurement processes, whether minor or 

16 major construction projects or leases; and 

17 ‘‘(3) developing a multi-year budget process 

18 that is capable of forecasting future year budget re19 quirements and projecting the cost of delivering 

20 health care services under a high-performing inte21 grated health care network. 

22 ‘‘(d) APPROPRIATE COMMITTEES OF CONGRESS DE23 FINED.—In this section, the term ‘appropriate committees 

24 of Congress’ means— 


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

2 the Committee on Appropriations of the Senate; and 

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

4 the Committee on Appropriations of the House of 

5 Representatives.’’. 

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

7 at the beginning of such chapter is amended by inserting 

8 after the item related to section 7330B the following new 

9 item: 

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

10 SEC. 107. APPLICABILITY OF DIRECTIVE OF OFFICE OF 

11 FEDERAL CONTRACT COMPLIANCE PRO12 GRAMS. 

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

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

15 38, United States Code, as added by section 102 of this 

16 title, Directive 2014–01 of the Office of Federal Contract 

17 Compliance Programs of the Department of Labor (effec18 tive as of May 7, 2014) shall apply to any entity entering 

19 into an agreement under such section 1703A or section 

20 1745 of such title, as amended by section 103, in the same 

21 manner as such directive applies to subcontractors under 

22 the TRICARE program for the duration of the morato23 rium provided under such directive. 

24 (b) APPLICABILITY PERIOD.—The directive described 

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


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

2 2019. 

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

4 the term ‘‘TRICARE program’’ has the meaning given 

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

6 SEC. 108. PREVENTION OF CERTAIN HEALTH CARE PRO7 VIDERS FROM PROVIDING NON-DEPARTMENT 

8 HEALTH CARE SERVICES TO VETERANS. 

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

10 year after the date of the enactment of this Act, the Sec11 retary of Veterans Affairs shall deny or revoke the eligi12 bility of a health care provider to provide non-Department 

13 health care services to veterans if the Secretary determines 

14 that the health care provider— 

15 (1) was removed from employment with the De16 partment of Veterans Affairs due to conduct that 

17 violated a policy of the Department relating to the 

18 delivery of safe and appropriate health care; or 

19 (2) violated the requirements of a medical li20 cense of the health care provider that resulted in the 

21 loss of such medical license. 

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

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

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

25 of a health care provider to provide non-Department 


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1 health care services if the Secretary determines such ac2 tion is necessary to immediately protect the health, safety, 

3 or welfare of veterans and the health care provider is 

4 under investigation by the medical licensing board of a 

5 State in which the health care provider is licensed or prac6 tices. 

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

8 eligibility of a health care provider to provide non-Depart9 ment health care services to veterans if the health care 

10 provider is suspended from serving as a health care pro11 vider of the Department. 

12 (d) COMPTROLLER GENERAL REPORT.—Not later 

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

14 the Comptroller General of the United States shall submit 

15 to Congress a report on the implementation by the Sec16 retary of this section, including the following: 

17 (1) The aggregate number of health care pro18 viders denied or suspended under this section from 

19 participation in providing non-Department health 

20 care services. 

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

22 health care for patients or staffing shortages in pro23 grams of the Department providing non-Department 

24 health care services. 


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1 (3) An explanation of the coordination of the 

2 Department with the medical licensing boards of 

3 States in implementing this section, the amount of 

4 involvement of such boards in such implementation, 

5 and efforts by the Department to address any con6 cerns raised by such boards with respect to such im7 plementation. 

8 (4) Such recommendations as the Comptroller 

9 General considers appropriate regarding harmo10 nizing eligibility criteria between health care pro11 viders of the Department and health care providers 

12 eligible to provide non-Department health care serv13 ices. 

14 (e) NON-DEPARTMENT HEALTH CARE SERVICES

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

16 health care services’’ means services— 

17 (1) provided under subchapter I of chapter 17 

18 of title 38, United States Code, at non-Department 

19 facilities (as defined in section 1701 of such title); 

20 (2) provided under section 101 of the Veterans 

21 Access, Choice, and Accountability Act of 2014 

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

23 (3) purchased through the Medical Community 

24 Care account of the Department; or 


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1 (4) purchased with amounts deposited in the 

2 Veterans Choice Fund under section 802 of the Vet3 erans Access, Choice, and Accountability Act of 

4 2014. 

5 SEC. 109. REMEDIATION OF MEDICAL SERVICE LINES. 

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

7 amended by inserting after section 1706 the following new 

8 section: 

9 ‘‘§ 1706A. Remediation of medical service lines 

10 ‘‘(a) IN GENERAL.—Not later than 30 days after de11 termining under section 1703(e)(1) that a medical service 

12 line of the Department is providing hospital care, medical 

13 services, or extended care services that does not comply 

14 with the standards for quality established by the Sec15 retary, the Secretary shall submit to Congress an assess16 ment of the factors that led the Secretary to make such 

17 determination and a plan with specific actions, and the 

18 time to complete them, to be taken to comply with such 

19 standards for quality, including the following: 

20 ‘‘(1) Increasing personnel or temporary per21 sonnel assistance, including mobile deployment 

22 teams. 

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

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1 chapter VII of chapter 76 of this title and recruit2 ment, relocation, and retention incentives. 

3 ‘‘(3) Utilizing direct hiring authority. 

4 ‘‘(4) Providing improved training opportunities 

5 for staff. 

6 ‘‘(5) Acquiring improved equipment. 

7 ‘‘(6) Making structural modifications to the fa8 cility used by the medical service line. 

9 ‘‘(7) Such other actions as the Secretary con10 siders appropriate. 

11 ‘‘(b) RESPONSIBLE PARTIES.—In each assessment 

12 submitted under subsection (a) with respect to a medical 

13 service line, the Secretary shall identify the individuals at 

14 the Central Office of the Veterans Health Administration, 

15 the facility used by the medical service line, and the cen16 tral office of the relevant Veterans Integrated Service Net17 work who are responsible for overseeing the progress of 

18 that medical service line in complying with the standards 

19 for quality established by the Secretary. 

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

21 after submitting an assessment under subsection (a) with 

22 respect to a medical service line, the Secretary shall sub23 mit to Congress a report on the progress of that medical 

24 service line in complying with the standards for quality 

25 established by the Secretary and any other measures the 


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1 Secretary will take to assist the medical service line in 

2 complying with such standards for quality. 

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

4 once each year, the Secretary shall— 

5 ‘‘(1) submit to Congress an analysis of the re6 mediation actions and costs of such actions taken 

7 with respect to each medical service line with respect 

8 to which the Secretary submitted an assessment and 

9 plan under paragraph (1) in the preceding year, in10 cluding an update on the progress of each such med11 ical service line in complying with the standards for 

12 quality and timeliness established by the Secretary 

13 and any other actions the Secretary is undertaking 

14 to assist the medical service line in complying with 

15 standards for quality as established by the Sec16 retary; and 

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

18 website of the Department.’’. 

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

20 at the beginning of such chapter is amended by inserting 

21 after the item related to section 1706 the following new 

22 item: 

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


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1 CHAPTER 2—PAYING PROVIDERS AND 

2 IMPROVING COLLECTIONS 

3 SEC. 111. PROMPT PAYMENT TO PROVIDERS. 

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

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

6 section 104 of this title, the following new section: 

7 ‘‘§ 1703D. Prompt payment standard 

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

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

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

11 extended care services furnished by health care entities or 

12 providers under this chapter within 45 calendar days upon 

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

14 receipt of a clean electronic claim. 

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

16 45 calendar days of denial for a paper claim and 30 cal17 endar days of denial for an electronic claim, notify the 

18 health care entity or provider of the reason for denying 

19 the claim and what, if any, additional information is re20 quired to process the claim. 

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

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

23 or otherwise adjudicated within 30 calendar days from the 

24 receipt of the requested information. 


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

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

3 other forms of periodic payment to entities or providers. 

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

6 that furnishes hospital care, a medical service, or an ex7 tended care service under this chapter shall submit to the 

8 Secretary a claim for payment for furnishing the hospital 

9 care, medical service, or extended care service not later 

10 than 180 days after the date on which the entity or pro11 vider furnished the hospital care, medical service, or ex12 tended care service. 

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

14 through 3733 of title 31 shall apply to fraudulent claims 

15 for payment submitted to the Secretary by a health care 

16 entity or provider under this chapter. 

17 ‘‘(2) Pursuant to regulations prescribed by the Sec18 retary, the Secretary shall bar a health care entity or pro19 vider from furnishing hospital care, medical services, and 

20 extended care services under this chapter when the Sec21 retary determines the entity or provider has submitted to 

22 the Secretary fraudulent health care claims for payment 

23 by the Secretary. 

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

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


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

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

3 entity provider within the time periods specified in sub4 section (a). 

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

6 the Secretary may, under the requirements established by 

7 subsection (a) and consistent with the provisions of chap8 ter 39 of title 31 (commonly referred to as the ‘Prompt 

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

10 claims. 

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

12 computed at the rate of interest established by the Sec13 retary of the Treasury under section 3902 of title 31 and 

14 published in the Federal Register. 

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

16 shall submit to Congress a report on payment of overdue 

17 claims under this subsection, disaggregated by paper and 

18 electronic claims, that includes the following: 

19 ‘‘(A) The amount paid in overdue claims de20 scribed in this subsection, disaggregated by the 

21 amount of the overdue claim and the amount of in22 terest paid on such overdue claim. 

23 ‘‘(B) The number of such overdue claims and 

24 the average number of days late each claim was 


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1 paid, disaggregated by facility of the Department 

2 and Veterans Integrated Service Network region. 

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

4 the amount of any overpayment from payments due a 

5 health care entity or provider under this chapter. 

6 ‘‘(2) Deductions may not be made under this sub7 section unless the Secretary has made reasonable efforts 

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

9 dispute the existence or amount of such indebtedness and 

10 the right to request a compromise of such indebtedness. 

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

12 respect to any such dispute or request prior to deducting 

13 any overpayment unless the time required to make such 

14 a determination before making any deductions would jeop15 ardize the Secretary’s ability to recover the full amount 

16 of such indebtedness. 

17 ‘‘(f) INFORMATION AND DOCUMENTATION RE18 QUIRED.—(1) The Secretary shall provide to all health 

19 care entities and providers participating in a program to 

20 furnish hospital care, medical services, or extended care 

21 services under this chapter a list of information and docu22 mentation that is required to establish a clean claim under 

23 this section. 

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

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


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1 determine the information and documentation to include 

2 in the list under paragraph (1). 

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

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

5 the Secretary shall notify all health care entities and pro6 viders described in paragraph (1) not later than 30 days 

7 before such modifications take effect. 

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

9 claim for compensation for hospital care, medical services, 

10 or extended care services furnished by a non-Department 

11 health care entity or provider under this chapter, the Sec12 retary may act through— 

13 ‘‘(A) a non-Department entity that is under 

14 contract or agreement for the program established 

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

16 ‘‘(B) a non-Department entity that specializes 

17 in such processing for other Federal agency health 

18 care systems. 

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

20 party to conduct a review of claims described in paragraph 

21 (3) that includes— 

22 ‘‘(A) a feasibility assessment to determine the 

23 capacity of the Department to process such claims 

24 in a timely manner; and 


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1 ‘‘(B) a cost benefit analysis comparing the ca2 pacity of the Department to a third party entity ca3 pable of processing such claims. 

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

5 apply to claims for hospital care, medical services, or ex6 tended care services furnished under section 1703 of this 

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

8 2018, that are processed by the Department. 

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

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

11 of the Caring for Our Veterans Act of 2018, the Secretary 

12 shall submit to the appropriate committees of Congress 

13 a report on the feasibility and advisability of adopting a 

14 funding mechanism similar to what is utilized by other 

15 Federal agencies to allow a contracted entity to act as a 

16 fiscal intermediary for the Federal Government to dis17 tribute, or pass through, Federal Government funds for 

18 certain non-underwritten hospital care, medical services, 

19 or extended care services. 

20 ‘‘(2) The Secretary may coordinate with the Depart21 ment of Defense, the Department of Health and Human 

22 Services, and the Department of the Treasury in devel23 oping the report required by paragraph (1). 

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


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1 ‘‘(1) The term ‘appropriate committees of Con2 gress’ means— 

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

4 and the Committee on Appropriations of the 

5 Senate; and 

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

7 and the Committee on Appropriations of the 

8 House of Representatives. 

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

10 the transmission of data for purposes of payment of 

11 covered health care expenses that is submitted to the 

12 Secretary which contains substantially all of the re13 quired data elements necessary for accurate adju14 dication, without obtaining additional information 

15 from the entity or provider that furnished the care 

16 or service, submitted in such format as prescribed by 

17 the Secretary in regulations for the purpose of pay18 ing claims for care or services. 

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

20 paper claim for payment of covered health care ex21 penses that is submitted to the Secretary which con22 tains substantially all of the required data elements 

23 necessary for accurate adjudication, without obtain24 ing additional information from the entity or pro25 vider that furnished the care or service, submitted in 


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1 such format as prescribed by the Secretary in regu2 lations for the purpose of paying claims for care or 

3 services. 

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

5 knowing misrepresentation of a material fact or 

6 facts by a health care entity or provider made to in7 duce the Secretary to pay a claim that was not le8 gally payable to that provider. 

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

10 includes any non-Department health care entity or 

11 provider, but does not include any Federal health 

12 care entity or provider.’’. 

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

14 at the beginning of such chapter is amended by inserting 

15 after the item related to section 1703C, as added by sec16 tion 104 of this title, the following new item: 

‘‘1703D. Prompt payment standard.’’. 

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

18 SUBJECT TO AN AGREEMENT. 

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

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

21 ‘‘§ 8159. Authority to pay for services authorized but 

22 not subject to an agreement 

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

24 hospital care, a medical service, or an extended care serv25 ice authorized by the Secretary and pursuant to a conVerDate Sep 11 2014 21:33 May 11, 2018 Jkt 079200 PO 00000 Frm 00074 Fmt 6652 Sfmt 6201 E:\BILLS\H5674.RH H5674

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1 tract, agreement, or other arrangement with the Sec2 retary, a provider who is not a party to the contract, 

3 agreement, or other arrangement furnishes hospital care, 

4 a medical service, or an extended care service that the Sec5 retary considers necessary, the Secretary may compensate 

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

7 ‘‘(b) NEW CONTRACTS AND AGREEMENTS.—The 

8 Secretary shall take reasonable efforts to enter into a con9 tract, agreement, or other arrangement with a provider 

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

11 services authorized by the Secretary and furnished by the 

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

13 other arrangement.’’. 

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

15 at the beginning of such chapter is amended by inserting 

16 after the item relating to section 8158 the following new 

17 item: 

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

18 SEC. 113. IMPROVEMENT OF AUTHORITY TO RECOVER THE 

19 COST OF SERVICES FURNISHED FOR NON20 SERVICE-CONNECTED DISABILITIES. 

21 (a) BROADENING SCOPE OF APPLICABILITY.—Sec22 tion 1729 is amended— 

23 (1) in subsection (a)— 

24 (A) in paragraph (2)(A)— 


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1 (i) by striking ‘‘the veteran’s’’ and in2 serting ‘‘the individual’s’’; and 

3 (ii) by striking ‘‘the veteran’’ and in4 serting ‘‘the individual’’; and 

5 (B) in paragraph (3)— 

6 (i) in the matter preceding subpara7 graph (A), by striking ‘‘the veteran’’ and 

8 inserting ‘‘the individual’’; and 

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

10 ‘‘the veteran’s’’ and inserting ‘‘the individ11 ual’s’’; 

12 (2) in subsection (b)— 

13 (A) in paragraph (1)— 

14 (i) by striking ‘‘the veteran’’ and in15 serting ‘‘the individual’’; and 

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

18 (B) in paragraph (2)— 

19 (i) in subparagraph (A)— 

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

21 inserting ‘‘the individual’’; and 

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

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

24 (ii) in subparagraph (B)— 


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

2 veteran’’ and inserting ‘‘the indi3 vidual’’; and 

4 (II) in clause (ii)— 

5 (aa) by striking ‘‘the vet6 eran’’ and inserting ‘‘the indi7 vidual’’; and 

8 (bb) by striking ‘‘the vet9 eran’s’’ each place it appears and 

10 inserting ‘‘the individual’s’’; 

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

12 and inserting ‘‘An individual’’; and 

13 (4) in subsection (h)— 

14 (A) in paragraph (1)— 

15 (i) in the matter preceding subpara16 graph (A), by striking ‘‘a veteran’’ and in17 serting ‘‘an individual’’; 

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

19 ‘‘the veteran’’ and inserting ‘‘the indi20 vidual’’; and 

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

22 ‘‘the veteran’’ and inserting ‘‘the indi23 vidual’’; and 

24 (B) in paragraph (2)— 


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1 (i) by striking ‘‘A veteran’’ and insert2 ing ‘‘An individual’’; 

3 (ii) by striking ‘‘a veteran’’ and in4 serting ‘‘an individual’’; and 

5 (iii) by striking ‘‘the veteran’’ and in6 serting ‘‘the individual’’. 

7 (b) MODIFICATION OF AUTHORITY.—Subsection 

8 (a)(1) of such section is amended by striking ‘‘(1) Sub9 ject’’ and all that follows through the period and inserting 

10 the following: ‘‘(1) Subject to the provisions of this sec11 tion, in any case in which the United States is required 

12 by law to furnish or pay for care or services under this 

13 chapter for a non-service-connected disability described in 

14 paragraph (2) of this subsection, the United States has 

15 the right to recover or collect from a third party the rea16 sonable charges of care or services so furnished or paid 

17 for to the extent that the recipient or provider of the care 

18 or services would be eligible to receive payment for such 

19 care or services from such third party if the care or serv20 ices had not been furnished or paid for by a department 

21 or agency of the United States.’’ 

22 (c) MODIFICATION OF ELIGIBLE INDIVIDUALS.— 

23 Subparagraph (D) of subsection (a)(2) of such section is 

24 amended to read as follows: 


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

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

3 under a health-plan contract.’’. 

4 SEC. 114. PROCESSING OF CLAIMS FOR REIMBURSEMENT 

5 THROUGH ELECTRONIC INTERFACE. 

6 The Secretary of Veterans Affairs may enter into an 

7 agreement with a third-party entity to process, through 

8 the use of an electronic interface, claims for reimburse9 ment for health care provided under the laws administered 

10 by the Secretary. 

11 CHAPTER 3—EDUCATION AND TRAINING 

12 PROGRAMS 

13 SEC. 121. EDUCATION PROGRAM ON HEALTH CARE OP14 TIONS. 

15 (a) IN GENERAL.—The Secretary of Veterans Affairs 

16 shall develop and administer an education program that 

17 teaches veterans about their health care options through 

18 the Department of Veterans Affairs. 

19 (b) ELEMENTS.—The program under subsection (a) 

20 shall— 

21 (1) teach veterans about— 

22 (A) eligibility criteria for care from the De23 partment set forth under sections 1703, as 

24 amended by section 101 of this title, and 1710 

25 of title 38, United States Code; 


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1 (B) priority groups for enrollment in the 

2 system of annual patient enrollment under sec3 tion 1705(a) of such title; 

4 (C) the copayments and other financial ob5 ligations, if any, required of certain individuals 

6 for certain services; and 

7 (D) how to utilize the access standards 

8 and standards for quality established under sec9 tions 1703B and 1703C of such title; 

10 (2) teach veterans about the interaction be11 tween health insurance (including private insurance, 

12 Medicare, Medicaid, the TRICARE program, the In13 dian Health Service, tribal health programs, and 

14 other forms of insurance) and health care from the 

15 Department; and 

16 (3) provide veterans with information on what 

17 to do when they have a complaint about health care 

18 received from the Department (whether about the 

19 provider, the Department, or any other type of com20 plaint). 

21 (c) ACCESSIBILITY.—In developing the education 

22 program under this section, the Secretary shall ensure 

23 that materials under such program are accessible— 

24 (1) to veterans who may not have access to the 

25 internet; and 


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1 (2) to veterans in a manner that complies with 

2 the Americans with Disabilities Act of 1990 (42 

3 U.S.C. 12101 et seq.). 

4 (d) ANNUAL EVALUATION AND REPORT.— 

5 (1) EVALUATION.—The Secretary shall develop 

6 a method to evaluate the effectiveness of the edu7 cation program under this section and evaluate the 

8 program using the method not less frequently than 

9 once each year. 

10 (2) REPORT.—Not less frequently than once 

11 each year, the Secretary shall submit to Congress a 

12 report on the findings of the Secretary with respect 

13 to the most recent evaluation conducted by the Sec14 retary under paragraph (1). 

15 (e) DEFINITIONS.—In this section: 

16 (1) MEDICAID.—The term ‘‘Medicaid’’ means 

17 the Medicaid program under title XIX of the Social 

18 Security Act (42 U.S.C. 1396 et seq.). 

19 (2) MEDICARE.—The term ‘‘Medicare’’ means 

20 the Medicare program under title XVIII of such Act 

21 (42 U.S.C. 1395 et seq.). 

22 (3) TRICARE PROGRAM.—The term ‘‘TRICARE 

23 program’’ has the meaning given that term in sec24 tion 1072 of title 10, United States Code. 


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1 SEC. 122. TRAINING PROGRAM FOR ADMINISTRATION OF 

2 NON-DEPARTMENT OF VETERANS AFFAIRS 

3 HEALTH CARE. 

4 (a) ESTABLISHMENT OF PROGRAM.—The Secretary 

5 of Veterans Affairs shall develop and implement a training 

6 program to train employees and contractors of the Depart7 ment of Veterans Affairs on how to administer non-De8 partment health care programs, including the following: 

9 (1) Reimbursement for non-Department emer10 gency room care. 

11 (2) The Veterans Community Care Program 

12 under section 1703 of such title, as amended by sec13 tion 101. 

14 (3) Management of prescriptions pursuant to 

15 improvements under section 131. 

16 (b) ANNUAL EVALUATION AND REPORT.—The Sec17 retary shall— 

18 (1) develop a method to evaluate the effective19 ness of the training program developed and imple20 mented under subsection (a); 

21 (2) evaluate such program not less frequently 

22 than once each year; and 

23 (3) not less frequently than once each year, 

24 submit to Congress the findings of the Secretary 

25 with respect to the most recent evaluation carried 

26 out under paragraph (2). 


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1 SEC. 123. CONTINUING MEDICAL EDUCATION FOR NON-DE2 PARTMENT MEDICAL PROFESSIONALS. 

3 (a) ESTABLISHMENT OF PROGRAM.— 

4 (1) IN GENERAL.—The Secretary of Veterans 

5 Affairs shall establish a program to provide con6 tinuing medical education material to non-Depart7 ment medical professionals. 

8 (2) EDUCATION PROVIDED.—The program es9 tablished under paragraph (1) shall include edu10 cation on the following: 

11 (A) Identifying and treating common men12 tal and physical conditions of veterans and fam13 ily members of veterans. 

14 (B) The health care system of the Depart15 ment of Veterans Affairs. 

16 (C) Such other matters as the Secretary 

17 considers appropriate. 

18 (b) MATERIAL PROVIDED.—The continuing medical 

19 education material provided to non-Department medical 

20 professionals under the program established under sub21 section (a) shall be the same material provided to medical 

22 professionals of the Department to ensure that all medical 

23 professionals treating veterans have access to the same 

24 materials, which supports core competencies throughout 

25 the community. 

26 (c) ADMINISTRATION OF PROGRAM.— 


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1 (1) IN GENERAL.—The Secretary shall admin2 ister the program established under subsection (a) to 

3 participating non-Department medical professionals 

4 through an internet website of the Department of 

5 Veterans Affairs. 

6 (2) CURRICULUM AND CREDIT PROVIDED.—The 

7 Secretary shall determine the curriculum of the pro8 gram and the number of hours of credit to provide 

9 to participating non-Department medical profes10 sionals for continuing medical education. 

11 (3) ACCREDITATION.—The Secretary shall en12 sure that the program is accredited in as many 

13 States as practicable. 

14 (4) CONSISTENCY WITH EXISTING RULES.—The 

15 Secretary shall ensure that the program is consistent 

16 with the rules and regulations of the following: 

17 (A) The medical licensing agency of each 

18 State in which the program is accredited. 

19 (B) Such medical credentialing organiza20 tions as the Secretary considers appropriate. 

21 (5) USER COST.—The Secretary shall carry out 

22 the program at no cost to participating non-Depart23 ment medical professionals. 

24 (6) MONITORING, EVALUATION, AND REPORT.— 

25 The Secretary shall monitor the utilization of the 


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1 program established under subsection (a), evaluate 

2 its effectiveness, and report to Congress on utiliza3 tion and effectiveness not less frequently than once 

4 each year. 

5 (d) NON-DEPARTMENT MEDICAL PROFESSIONAL

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

7 medical professional’’ means any individual who is licensed 

8 by an appropriate medical authority in the United States 

9 and is in good standing, is not an employee of the Depart10 ment of Veterans Affairs, and provides care to veterans 

11 or family members of veterans under the laws adminis12 tered by the Secretary of Veterans Affairs. 

13 CHAPTER 4—OTHER MATTERS RELATING 

14 TO NON-DEPARTMENT OF VETERANS 

15 AFFAIRS PROVIDERS 

16 SEC. 131. ESTABLISHMENT OF PROCESSES TO ENSURE 

17 SAFE OPIOID PRESCRIBING PRACTICES BY 

18 NON-DEPARTMENT OF VETERANS AFFAIRS 

19 HEALTH CARE PROVIDERS. 

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

21 Secretary of Veterans Affairs shall ensure that all covered 

22 health care providers are provided a copy of and certify 

23 that they have reviewed the evidence-based guidelines for 

24 prescribing opioids set forth by the Opioid Safety Initia25 tive of the Department of Veterans Affairs. 


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1 (b) INCLUSION OF MEDICAL HISTORY AND CURRENT

2 MEDICATIONS.—The Secretary shall implement a process 

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

4 care provider is authorized under the laws administered 

5 by the Secretary, the document authorizing such care in6 cludes the available and relevant medical history of the 

7 veteran and a list of all medications prescribed to the vet8 eran as known by the Department. 

9 (c) SUBMITTAL OF MEDICAL RECORDS AND PRE10 SCRIPTIONS.— 

11 (1) IN GENERAL.—The Secretary shall, con12 sistent with section 1703(a)(2)(A), as amended by 

13 section 101 of this title, and section 1703A(e)(2)(F), 

14 as added by section 102 of this title, require each 

15 covered health care provider to submit medical 

16 records of any care or services furnished, including 

17 records of any prescriptions for opioids, to the De18 partment in the timeframe and format specified by 

19 the Secretary. 

20 (2) RESPONSIBILITY OF DEPARTMENT FOR RE21 CORDING AND MONITORING.—In carrying out para22 graph (1) and upon the receipt by the Department 

23 of the medical records described in paragraph (1), 

24 the Secretary shall— 


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1 (A) ensure the Department is responsible 

2 for the recording of the prescription in the elec3 tronic health record of the veteran; and 

4 (B) enable other monitoring of the pre5 scription as outlined in the Opioid Safety Initia6 tive of the Department. 

7 (3) REPORT.—Not less frequently than annu8 ally, the Secretary shall submit to the Committee on 

9 Veterans’ Affairs of the Senate and the Committee 

10 on Veterans’ Affairs of the House of Representatives 

11 a report evaluating the compliance of covered health 

12 care providers with the requirements under this sec13 tion. 

14 (d) USE OF OPIOID SAFETY INITIATIVE GUIDE15 LINES.— 

16 (1) IN GENERAL.—If the Secretary determines 

17 that the opioid prescribing practices of a covered 

18 health care provider, when treating covered veterans, 

19 satisfy a condition described in paragraph (3), the 

20 Secretary shall take such action as the Secretary 

21 considers appropriate to ensure the safety of all vet22 erans receiving care from that health care provider, 

23 including removing or directing the removal of any 

24 such health care provider from provider networks or 

25 otherwise refusing to authorize care of veterans by 


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1 such health care provider in any program authorized 

2 under the laws administered by the Secretary. 

3 (2) INCLUSION IN CONTRACTS.—The Secretary 

4 shall ensure that any contracts, agreements, or other 

5 arrangements entered into by the Secretary with 

6 third parties involved in administering programs 

7 that provide care in the community to veterans 

8 under the laws administered by the Secretary spe9 cifically grant the authority set forth in paragraph 

10 (1) to such third parties and to the Secretary, as the 

11 case may be. 

12 (3) CONDITIONS FOR EXCLUSION OR LIMITA13 TION.—The Secretary shall take such action as is 

14 considered appropriate under paragraph (1) when 

15 the opioid prescribing practices of a covered health 

16 care provider when treating covered veterans— 

17 (A) conflict with or are otherwise incon18 sistent with the standards of appropriate and 

19 safe care; 

20 (B) violate the requirements of a medical 

21 license of the health care provider; or 

22 (C) may place at risk the veterans receiv23 ing health care from the provider. 

24 (e) COVERED HEALTH CARE PROVIDER DEFINED.— 

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


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1 means a non-Department of Veterans Affairs health care 

2 provider who provides health care to veterans under the 

3 laws administered by the Secretary of Veterans Affairs, 

4 but does not include a health care provider employed by 

5 another agency of the Federal Government. 

6 SEC. 132. IMPROVING INFORMATION SHARING WITH COM7 MUNITY PROVIDERS. 

8 Section 7332(b)(2) is amended by striking subpara9 graph (H) and inserting the following new subparagraphs: 

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

11 private entities and other Federal agencies) for pur12 poses of providing health care, including hospital 

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

14 patients or performing other health care-related ac15 tivities or functions. 

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

17 under this subparagraph may not disclose or use 

18 such record for a purpose other than that for which 

19 the disclosure was made or as permitted by law. 

20 ‘‘(I) To a third party in order to recover or col21 lect reasonable charges for care furnished to, or paid 

22 on behalf of, a patient in connection with a non-serv23 ice connected disability as permitted by section 1729 

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

25 authorized or with respect to which the United 


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1 States is deemed to be a third party beneficiary 

2 under the Act entitled ‘An Act to provide for the re3 covery from tortiously liable third persons of the cost 

4 of hospital and medical care and treatment fur5 nished by the United States’ (Public Law 87–693; 

6 42 U.S.C. 2651 et seq.; commonly known as the 

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

8 SEC. 133. COMPETENCY STANDARDS FOR NON-DEPART9 MENT OF VETERANS AFFAIRS HEALTH CARE 

10 PROVIDERS. 

11 (a) ESTABLISHMENT OF STANDARDS AND REQUIRE12 MENTS.—The Secretary of Veterans Affairs shall establish 

13 standards and requirements for the provision of care by 

14 non-Department of Veterans Affairs health care providers 

15 in clinical areas for which the Department of Veterans Af16 fairs has special expertise, including post-traumatic stress 

17 disorder, military sexual trauma-related conditions, and 

18 traumatic brain injuries. 

19 (b) CONDITION FOR ELIGIBILITY TO FURNISH

20 CARE.—(1) Each non-Department of Veterans Affairs 

21 health care provider shall, to the extent practicable as de22 termined by the Secretary or otherwise provided for in 

23 paragraph (2), meet the standards and requirements es24 tablished pursuant to subsection (a) before furnishing care 

25 pursuant to a contract, agreement, or other arrangement 


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1 with the Department of Veterans Affairs. Non-Depart2 ment of Veterans Affairs health care providers furnishing 

3 care pursuant to a contract, agreement, or other arrange4 ment shall, to the extent practicable as determined by the 

5 Secretary, fulfill training requirements established by the 

6 Secretary on how to deliver evidence-based treatments in 

7 the clinical areas for which the Department of Veterans 

8 Affairs has special expertise. 

9 (2) Each non-Department of Veterans Affairs health 

10 care provider who enters into a contract, agreement, or 

11 other arrangement after the effective date identified in 

12 subsection (c) shall, to the extent practicable, meet the 

13 standards and requirements established pursuant to sub14 section (a) within 6 months of the contract, agreement, 

15 or other arrangement taking effect. 

16 (c) EFFECTIVE DATE.—This section shall take effect 

17 on the day that is one year after the date of the enactment 

18 of this Act. 

19 SEC. 134. DEPARTMENT OF VETERANS AFFAIRS PARTICIPA20 TION IN NATIONAL NETWORK OF STATE21 BASED PRESCRIPTION DRUG MONITORING 

22 PROGRAMS. 

23 (a) IN GENERAL.—Chapter 17 is amended by insert24 ing after section 1730A the following new section: 


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1 ‘‘§ 1730B. Access to State prescription drug moni2 toring programs 

3 ‘‘(a) ACCESS TO PROGRAMS.—(1) Any licensed health 

4 care provider or delegate of such a provider shall be con5 sidered an authorized recipient or user for the purpose of 

6 querying and receiving data from the national network of 

7 State-based prescription drug monitoring programs to 

8 support the safe and effective prescribing of controlled 

9 substances to covered patients. 

10 ‘‘(2) Under the authority granted by paragraph (1)— 

11 ‘‘(A) licensed health care providers or delegates 

12 of such providers shall query such network in ac13 cordance with applicable regulations and policies of 

14 the Veterans Health Administration; and 

15 ‘‘(B) notwithstanding any general or specific 

16 provision of law, rule, or regulation of a State, no 

17 State may restrict the access of licensed health care 

18 providers or delegates of such providers from access19 ing that State’s prescription drug monitoring pro20 grams. 

21 ‘‘(3) No State shall deny or revoke the license, reg22 istration, or certification of a licensed health care provider 

23 or delegate who otherwise meets that State’s qualifications 

24 for holding the license, registration, or certification on the 

25 basis that the licensed health care provider or delegate 

26 queried or received data, or attempted to query or receive 


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1 data, from the national network of State-based prescrip2 tion drug monitoring programs under this section. 

3 ‘‘(b) COVERED PATIENTS.—For purposes of this sec4 tion, a covered patient is a patient who— 

5 ‘‘(1) receives a prescription for a controlled sub6 stance; and 

7 ‘‘(2) is not receiving palliative care or enrolled 

8 in hospice care. 

9 ‘‘(c) DEFINITIONS.—In this section: 

10 ‘‘(1) The term ‘controlled substance’ has the 

11 meaning given such term in section 102(6) of the 

12 Controlled Substances Act (21 U.S.C. 802(6)). 

13 ‘‘(2) The term ‘delegate’ means a person or 

14 automated system accessing the national network of 

15 State-based prescription monitoring programs at the 

16 direction or under the supervision of a licensed 

17 health care provider. 

18 ‘‘(3) The term ‘licensed health care provider’ 

19 means a health care provider employed by the De20 partment who is licensed, certified, or registered 

21 within any State to fill or prescribe medications 

22 within the scope of his or her practice as a Depart23 ment employee. 

24 ‘‘(4) The term ‘national network of State-based 

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1 connected nation-wide system that facilitates the 

2 transfer to State prescription drug monitoring pro3 gram data across State lines. 

4 ‘‘(5) The term ‘State’ means a State, as defined 

5 in section 101(20) of this title, or a political subdivi6 sion of a State.’’. 

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

8 at the beginning of chapter 17 of such title is amended 

9 by inserting after the item relating to section 1730A the 

10 following new item: 

‘‘1730B. Access to State prescription drug monitoring programs.’’. 

11 CHAPTER 5—OTHER NON-DEPARTMENT 

12 HEALTH CARE MATTERS 

13 SEC. 141. PLANS FOR USE OF SUPPLEMENTAL APPROPRIA14 TIONS REQUIRED. 

15 Whenever the Secretary submits to Congress a re16 quest for supplemental appropriations or any other appro17 priation outside the standard budget process to address 

18 a budgetary issue affecting the Department of Veterans 

19 Affairs, the Secretary shall, not later than 45 days before 

20 the date on which such budgetary issue would start affect21 ing a program or service, submit to Congress a justifica22 tion for the request, including a plan that details how the 

23 Secretary intends to use the requested appropriation and 

24 how long the requested appropriation is expected to meet 

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1 quest was made using an updated and sound actuarial 

2 analysis. 

3 SEC. 142. VETERANS CHOICE FUND FLEXIBILITY. 

4 Section 802 of the Veterans Access, Choice, and Ac5 countability Act of 2014 (Public Law 113–146; 38 U.S.C. 

6 1701 note) is amended— 

7 (1) in subsection (c)— 

8 (A) in paragraph (1), by striking ‘‘by para9 graph (3)’’ and inserting ‘‘in paragraphs (3) 

10 and (4)’’; and 

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

12 paragraph: 

13 ‘‘(4) PERMANENT AUTHORITY FOR OTHER

14 USES.—Beginning on March 1, 2019, amounts re15 maining in the Veterans Choice Fund may be used 

16 to furnish hospital care, medical services, and ex17 tended care services to individuals pursuant to chap18 ter 17 of title 38, United States Code, at non-De19 partment facilities, including pursuant to non-De20 partment provider programs other than the program 

21 established by section 101. Such amounts shall be 

22 available in addition to amounts available in other 

23 appropriations accounts for such purposes.’’; and 


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1 (2) in subsection (d)(1), by striking ‘‘to sub2 section (c)(3)’’ and inserting ‘‘to paragraphs (3) and 

3 (4) of subsection (c)’’. 

4 SEC. 143. SUNSET OF VETERANS CHOICE PROGRAM. 

5 Subsection (p) of section 101 of the Veterans Access, 

6 Choice, and Accountability Act of 2014 (Public Law 113– 

7 146; 38 U.S.C. 1701 note) is amended to read as follows: 

8 ‘‘(p) AUTHORITY TO FURNISH CARE AND SERV9 ICES.—The Secretary may not use the authority under 

10 this section to furnish care and services after the date that 

11 is one year after the date of the enactment of the Caring 

12 for Our Veterans Act of 2018.’’. 

13 SEC. 144. CONFORMING AMENDMENTS. 

14 (a) IN GENERAL.— 

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

16 amended— 

17 (A) in section 1712(a)— 

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

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

20 1703(a) of this title’’ and inserting ‘‘or en21 tered an agreement’’; and 

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

23 ‘‘under the provisions of this subsection 

24 and section 1703 of this title’’; 

25 (B) in section 1712A(e)(1)— 


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

2 ‘‘contracts’’; and 

3 (ii) by striking ‘‘(under sections 

4 1703(a)(2) and 1710(a)(1)(B) of this 

5 title)’’; and 

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

7 ‘‘with section 1703’’ and inserting ‘‘with sec8 tions 1703A, 8111, and 8153’’. 

9 (2) SOCIAL SECURITY ACT.—Section 

10 1866(a)(1)(L) of the Social Security Act (42 U.S.C. 

11 1395cc(a)(1)(L)) is amended by striking ‘‘under sec12 tion 1703’’ and inserting ‘‘under chapter 17’’. 

13 (3) VETERANS’ BENEFITS IMPROVEMENTS ACT

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

15 Benefits Improvements Act of 1994 (Public Law 

16 103–446; 38 U.S.C. 1117 note) is amended by strik17 ing ‘‘in section 1703’’ and inserting ‘‘in sections 

18 1703A, 8111, and 8153’’. 

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

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

21 section 101(b). 


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1 Subtitle B—Improving Department 

2 of Veterans Affairs Health Care 

3 Delivery 

4 SEC. 151. LICENSURE OF HEALTH CARE PROFESSIONALS 

5 OF THE DEPARTMENT OF VETERANS AF6 FAIRS PROVIDING TREATMENT VIA TELE7 MEDICINE. 

8 (a) IN GENERAL.—Chapter 17 is amended by insert9 ing after section 1730B, as added by section 134, the fol10 lowing new section: 

11 ‘‘§ 1730C. Licensure of health care professionals pro12 viding treatment via telemedicine 

13 ‘‘(a) IN GENERAL.—Notwithstanding any provision 

14 of law regarding the licensure of health care professionals, 

15 a covered health care professional may practice the health 

16 care profession of the health care professional at any loca17 tion in any State, regardless of where the covered health 

18 care professional or the patient is located, if the covered 

19 health care professional is using telemedicine to provide 

20 treatment to an individual under this chapter. 

21 ‘‘(b) COVERED HEALTH CARE PROFESSIONALS.— 

22 For purposes of this section, a covered health care profes23 sional is any health care professional who— 


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1 ‘‘(1) is an employee of the Department ap2 pointed under the authority under section 7306, 

3 7401, 7405, 7406, or 7408 of this title or title 5; 

4 ‘‘(2) is authorized by the Secretary to provide 

5 health care under this chapter; 

6 ‘‘(3) is required to adhere to all standards for 

7 quality relating to the provision of medicine in ac8 cordance with applicable policies of the Department; 

9 and 

10 ‘‘(4) has an active, current, full, and unre11 stricted license, registration, or certification in a 

12 State to practice the health care profession of the 

13 health care professional. 

14 ‘‘(c) PROPERTY OF FEDERAL GOVERNMENT.—Sub15 section (a) shall apply to a covered health care professional 

16 providing treatment to a patient regardless of whether the 

17 covered health care professional or patient is located in 

18 a facility owned by the Federal Government during such 

19 treatment. 

20 ‘‘(d) RELATION TO STATE LAW.—(1) The provisions 

21 of this section shall supersede any provisions of the law 

22 of any State to the extent that such provision of State 

23 law are inconsistent with this section. 

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1 sional who otherwise meets the qualifications of the State 

2 for holding the license, registration, or certification on the 

3 basis that the covered health care professional has en4 gaged or intends to engage in activity covered by sub5 section (a). 

6 ‘‘(e) RULE OF CONSTRUCTION.—Nothing in this sec7 tion may be construed to remove, limit, or otherwise affect 

8 any obligation of a covered health care professional under 

9 the Controlled Substances Act (21 U.S.C. 801 et seq.). 

10 ‘‘(f) STATE DEFINED.—In this section, the term 

11 ‘State’ means a State, as defined in section 101(20) of 

12 this title, or a political subdivision of a State.’’. 

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

14 at the beginning of chapter 17 of such title is amended 

15 by inserting after the item relating to section 1730B, as 

16 added by section 134, the following new item: 

‘‘1730C. Licensure of health care professionals providing treatment via telemedicine.’’. 

17 (c) REPORT ON TELEMEDICINE.— 

18 (1) IN GENERAL.—Not later than one year 

19 after the earlier of the date on which services pro20 vided under section 1730B of title 38, United States 

21 Code, as added by subsection (a), first occur or reg22 ulations are promulgated to carry out such section, 

23 the Secretary of Veterans Affairs shall submit to the 

24 Committee on Veterans’ Affairs of the Senate and 


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1 the Committee on Veterans’ Affairs of the House of 

2 Representatives a report on the effectiveness of the 

3 use of telemedicine by the Department of Veterans 

4 Affairs. 

5 (2) ELEMENTS.—The report required by para6 graph (1) shall include an assessment of the fol7 lowing: 

8 (A) The satisfaction of veterans with tele9 medicine furnished by the Department. 

10 (B) The satisfaction of health care pro11 viders in providing telemedicine furnished by 

12 the Department. 

13 (C) The effect of telemedicine furnished by 

14 the Department on the following: 

15 (i) The ability of veterans to access 

16 health care, whether from the Department 

17 or from non-Department health care pro18 viders. 

19 (ii) The frequency of use by veterans 

20 of telemedicine. 

21 (iii) The productivity of health care 

22 providers. 

23 (iv) Wait times for an appointment 

24 for the receipt of health care from the De25 partment. 


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1 (v) The use by veterans of in-person 

2 services at Department facilities and non3 Department facilities. 

4 (D) The types of appointments for the re5 ceipt of telemedicine furnished by the Depart6 ment that were provided during the one-year 

7 period preceding the submittal of the report. 

8 (E) The number of appointments for the 

9 receipt of telemedicine furnished by the Depart10 ment that were requested during such period, 

11 disaggregated by medical facility. 

12 (F) Savings by the Department, if any, in13 cluding travel costs, from furnishing health care 

14 through the use of telemedicine during such pe15 riod. 

16 SEC. 152. AUTHORITY FOR DEPARTMENT OF VETERANS AF17 FAIRS CENTER FOR INNOVATION FOR CARE 

18 AND PAYMENT. 

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

20 amended by this title, is further amended by inserting 

21 after section 1703D, as added by section 111, the fol22 lowing new section: 


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1 ‘‘§ 1703E. Center for Innovation for Care and Pay2 ment 

3 ‘‘(a) IN GENERAL.—(1) There is established within 

4 the Department a Center for Innovation for Care and Pay5 ment (in this section referred to as the ‘Center’). 

6 ‘‘(2) The Secretary, acting through the Center, may 

7 carry out such pilot programs the Secretary determines 

8 to be appropriate to develop innovative approaches to test9 ing payment and service delivery models in order to reduce 

10 expenditures while preserving or enhancing the quality of 

11 care furnished by the Department. 

12 ‘‘(3) The Secretary, acting through the Center, shall 

13 test payment and service delivery models to determine 

14 whether such models— 

15 ‘‘(A) improve access to, and quality, timeliness, 

16 and patient satisfaction of care and services; and 

17 ‘‘(B) create cost savings for the Department. 

18 ‘‘(4)(A) The Secretary shall test a model in a location 

19 where the Secretary determines that the model will ad20 dresses deficits in care (including poor clinical outcomes 

21 or potentially avoidable expenditures) for a defined popu22 lation. 

23 ‘‘(B) The Secretary shall focus on models the Sec24 retary expects to reduce program costs while preserving 

25 or enhancing the quality of care received by individuals 

26 receiving benefits under this chapter. 


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1 ‘‘(C) The models selected may include those described 

2 in section 1115A(b)(2)(B) of the Social Security Act (42 

3 U.S.C. 1315a(b)(2)(B)). 

4 ‘‘(5) In selecting a model for testing, the Secretary 

5 may consider, in addition to other factors identified in this 

6 subsection, the following factors: 

7 ‘‘(A) Whether the model includes a regular 

8 process for monitoring and updating patient care 

9 plans in a manner that is consistent with the needs 

10 and preferences of individuals receiving benefits 

11 under this chapter. 

12 ‘‘(B) Whether the model places the individual 

13 receiving benefits under this chapter (including fam14 ily members and other caregivers of such individual) 

15 at the center of the care team of such individual. 

16 ‘‘(C) Whether the model uses technology or new 

17 systems to coordinate care over time and across set18 tings. 

19 ‘‘(D) Whether the model demonstrates effective 

20 linkage with other public sector payers, private sec21 tor payers, or statewide payment models. 

22 ‘‘(6)(A) Models tested under this section may not be 

23 designed in such a way that would allow the United States 

24 to recover or collect reasonable charges from a Federal 

25 health care program for care or services furnished by the 


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1 Secretary to a veteran under pilot programs carried out 

2 under this section. 

3 ‘‘(B) In this paragraph, the term ‘Federal health care 

4 program’ means— 

5 ‘‘(i) an insurance program described in section 

6 1811 of the Social Security Act (42 U.S.C. 1395c) 

7 or established by section 1831 of such Act (42 

8 U.S.C. 1395j); 

9 ‘‘(ii) a State plan for medical assistance ap10 proved under title XIX of such Act (42 U.S.C. 1396 

11 et seq.); or 

12 ‘‘(iii) a TRICARE program operated under sec13 tions 1075, 1075a, 1076, 1076a, 1076c, 1076d, 

14 1076e, or 1076f of title 10. 

15 ‘‘(b) DURATION.—Each pilot program carried out by 

16 the Secretary under this section shall terminate no later 

17 than five years after the date of the commencement of the 

18 pilot program. 

19 ‘‘(c) LOCATION.—The Secretary shall ensure that 

20 each pilot program carried out under this section occurs 

21 in an area or areas appropriate for the intended purposes 

22 of the pilot program. To the extent practicable, the Sec23 retary shall ensure that the pilot programs are located in 

24 geographically diverse areas of the United States. 


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1 ‘‘(d) BUDGET.—Funding for each pilot program car2 ried out by the Secretary under this section shall come 

3 from appropriations— 

4 ‘‘(1) provided in advance in appropriations acts 

5 for the Veterans Health Administration; and 

6 ‘‘(2) provided for information technology sys7 tems. 

8 ‘‘(e) NOTICE.—The Secretary shall— 

9 ‘‘(1) publish information about each pilot pro10 gram under this section in the Federal Register; and 

11 ‘‘(2) take reasonable actions to provide direct 

12 notice to veterans eligible to participate in such pilot 

13 programs. 

14 ‘‘(f) WAIVER OF AUTHORITIES.—(1) Subject to re15 porting under paragraph (2) and approval under para16 graph (3), in implementing a pilot program under this sec17 tion, the Secretary may waive such requirements in sub18 chapters I, II, and III of this chapter as the Secretary 

19 determines necessary solely for the purposes of carrying 

20 out this section with respect to testing models described 

21 in subsection (a). 

22 ‘‘(2) Before waiving any authority under paragraph 

23 (1), the Secretary shall submit to the Speaker of the 

24 House of Representatives, the minority leader of the 

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1 ate, the minority leader of the Senate, and each standing 

2 committee with jurisdiction under the rules of the Senate 

3 and of the House of Representatives to report a bill to 

4 amend the provision or provisions of law that would be 

5 waived by the Department, a report describing in detail 

6 the following: 

7 ‘‘(A) The specific authorities to be waived 

8 under the pilot program. 

9 ‘‘(B) The standard or standards to be used in 

10 the pilot program in lieu of the waived authorities. 

11 ‘‘(C) The reasons for such waiver or waivers. 

12 ‘‘(D) A description of the metric or metrics the 

13 Secretary will use to determine the effect of the 

14 waiver or waivers upon the access to and quality, 

15 timeliness, or patient satisfaction of care and serv16 ices furnished through the pilot program. 

17 ‘‘(E) The anticipated cost savings, if any, of the 

18 pilot program. 

19 ‘‘(F) The schedule for interim reports on the 

20 pilot program describing the results of the pilot pro21 gram so far and the feasibility and advisability of 

22 continuing the pilot program. 

23 ‘‘(G) The schedule for the termination of the 

24 pilot program and the submission of a final report 

25 on the pilot program describing the result of the 


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1 pilot program and the feasibility and advisability of 

2 making the pilot program permanent. 

3 ‘‘(H) The estimated budget of the pilot pro4 gram. 

5 ‘‘(3)(A) Upon receipt of a report submitted under 

6 paragraph (2), each House of Congress shall provide cop7 ies of the report to the chairman and ranking member of 

8 each standing committee with jurisdiction under the rules 

9 of the House of Representatives or the Senate to report 

10 a bill to amend the provision or provisions of law that 

11 would be waived by the Department under this subsection. 

12 ‘‘(B)(i) The waiver requested by the Secretary under 

13 paragraph (2) shall be considered approved under this 

14 paragraph if there is enacted into law a bill or joint resolu15 tion approving such request in its entirety. Such bill or 

16 joint resolution shall be passed by recorded vote to reflect 

17 the vote of each member of Congress thereon. 

18 ‘‘(ii) The provisions of this paragraph are enacted by 

19 Congress— 

20 ‘‘(I) as an exercise of the rulemaking power of 

21 the Senate and the House of Representatives and as 

22 such shall be considered as part of the rules of each 

23 House of Congress, and shall supersede other rules 

24 only to the extent that they are inconsistent there25 with; and 


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1 ‘‘(II) with full recognition of the constitutional 

2 right of either House of Congress to change the 

3 rules (so far as they relate to the procedures of that 

4 House) at any time, in the same manner, and to the 

5 same extent as in the case of any other rule of that 

6 House. 

7 ‘‘(C) During the 60-calendar-day period beginning on 

8 the date on which the Secretary submits the report de9 scribed in paragraph (2) to Congress, it shall be in order 

10 as a matter of highest privilege in each House of Congress 

11 to consider a bill or joint resolution, if offered by the ma12 jority leader of such House (or a designee), approving 

13 such request in its entirety. 

14 ‘‘(g) LIMITATIONS.—(1) The Secretary may not carry 

15 out more than 10 pilot programs concurrently. 

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

17 may not expend more than $50,000,000 in any fiscal year 

18 from amounts under subsection (d). 

19 ‘‘(B) The Secretary may expend more than the 

20 amount in subparagraph (A) if— 

21 ‘‘(i) the Secretary determines that the addi22 tional expenditure is necessary to carry out pilot 

23 programs under this section; 

24 ‘‘(ii) the Secretary submits to the Committees 

25 on Veterans’ Affairs of the Senate and the House of 


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1 Representatives a report setting forth the amount of 

2 the additional expenditure and a justification for the 

3 additional expenditure; and 

4 ‘‘(iii) the Chairmen of the Committees on Vet5 erans’ Affairs of the Senate and the House of Rep6 resentatives transmit to the Secretary a letter ap7 proving of the additional expenditure. 

8 ‘‘(3) The waiver provisions in subsection (f) shall not 

9 apply unless the Secretary, in accordance with the require10 ments in subsection (f), submits the first proposal for a 

11 pilot program not later than 18 months after the date of 

12 the enactment of the Caring for Our Veterans Act of 

13 2018. 

14 ‘‘(4) Notwithstanding section 502 of this title, deci15 sions by the Secretary under this section shall, consistent 

16 with section 511 of this title, be final and conclusive and 

17 may not be reviewed by any other official or by any court, 

18 whether by an action in the nature of mandamus or other19 wise. 

20 ‘‘(5)(A) If the Secretary determines that a pilot pro21 gram is not improving the quality of care or producing 

22 cost savings, the Secretary shall— 

23 ‘‘(i) propose a modification to the pilot program 

24 in the interim report that shall also be considered a 


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1 report under subsection (f)(2) and shall be subject 

2 to the terms and conditions of subsection (f)(2); or 

3 ‘‘(ii) terminate such pilot program not later 

4 than 30 days after submitting the interim report to 

5 Congress. 

6 ‘‘(B) If the Secretary terminates a pilot program 

7 under subparagraph (A)(ii), for purposes of subpara8 graphs (F) and (G) of subsection (f)(2), such interim re9 port will also serve as the final report for that pilot pro10 gram. 

11 ‘‘(h) EVALUATION AND REPORTING REQUIRE12 MENTS.—(1) The Secretary shall conduct an evaluation 

13 of each model tested, which shall include, at a minimum, 

14 an analysis of— 

15 ‘‘(A) the quality of care furnished under the 

16 model, including the measurement of patient-level 

17 outcomes and patient-centeredness criteria deter18 mined appropriate by the Secretary; and 

19 ‘‘(B) the changes in spending by reason of that 

20 model. 

21 ‘‘(2) The Secretary shall make the results of each 

22 evaluation under this subsection available to the public in 

23 a timely fashion and may establish requirements for other 

24 entities participating in the testing of models under this 

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1 retary determines is necessary to monitor and evaluate 

2 such models. 

3 ‘‘(i) COORDINATION AND ADVICE.—(1) The Sec4 retary shall obtain advice from the Under Secretary for 

5 Health and the Special Medical Advisory Group estab6 lished pursuant to section 7312 of this title in the develop7 ment and implementation of any pilot program operated 

8 under this section. 

9 ‘‘(2) In carrying out the duties under this section, 

10 the Secretary shall consult representatives of relevant 

11 Federal agencies, and clinical and analytical experts with 

12 expertise in medicine and health care management. The 

13 Secretary shall use appropriate mechanisms to seek input 

14 from interested parties. 

15 ‘‘(j) EXPANSION OF SUCCESSFUL PILOT PRO16 GRAMS.—Taking into account the evaluation under sub17 section (f), the Secretary may, through rulemaking, ex18 pand (including implementation on a nationwide basis) the 

19 duration and the scope of a model that is being tested 

20 under subsection (a) to the extent determined appropriate 

21 by the Secretary, if— 

22 ‘‘(1) the Secretary determines that such expan23 sion is expected to— 

24 ‘‘(A) reduce spending without reducing the 

25 quality of care; or 


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1 ‘‘(B) improve the quality of patient care 

2 without increasing spending; and 

3 ‘‘(2) the Secretary determines that such expan4 sion would not deny or limit the coverage or provi5 sion of benefits for individuals receiving benefits 

6 under this chapter.’’. 

7 (b) CONFORMING AMENDMENT.—The table of sec8 tions at the beginning of such chapter, as amended by this 

9 title, is further amended by inserting after the item relat10 ing to section 1703D the following new item: 

‘‘1703E. Center for Innovation for Care and Payment.’’. 

11 SEC. 153. AUTHORIZATION TO PROVIDE FOR OPERATIONS 

12 ON LIVE DONORS FOR PURPOSES OF CON13 DUCTING TRANSPLANT PROCEDURES FOR 

14 VETERANS. 

15 (a) IN GENERAL.—Subchapter VIII of chapter 17 is 

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

17 ‘‘§ 1788. Transplant procedures with live donors and 

18 related services 

19 ‘‘(a) IN GENERAL.—Subject to subsections (b) and 

20 (c), in a case in which a veteran is eligible for a transplant 

21 procedure from the Department, the Secretary may pro22 vide for an operation on a live donor to carry out such 

23 procedure for such veteran, notwithstanding that the live 

24 donor may not be eligible for health care from the Depart25 ment. 


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1 ‘‘(b) OTHER SERVICES.—Subject to the availability 

2 of appropriations for such purpose, the Secretary shall 

3 furnish to a live donor any care or services before and 

4 after conducting the transplant procedure under sub5 section (a) that may be required in connection with such 

6 procedure. 

7 ‘‘(c) USE OF NON-DEPARTMENT FACILITIES.—In 

8 carrying out this section, the Secretary may provide for 

9 the operation described in subsection (a) on a live donor 

10 and furnish to the live donor the care and services de11 scribed in subsection (b) at a non-Department facility pur12 suant to an agreement entered into by the Secretary under 

13 this chapter. The live donor shall be deemed to be an indi14 vidual eligible for hospital care and medical services at a 

15 non-Department facility pursuant to such an agreement 

16 solely for the purposes of receiving such operation, care, 

17 and services at the non-Department facility.’’. 

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

19 at the beginning of chapter 17 is amended by inserting 

20 after the item relating to section 1787 the following new 

21 item: 

‘‘1788. Transplant procedures with live donors and related services.’’. 

22 Subtitle C—Family Caregivers 

23 SEC. 161. EXPANSION OF FAMILY CAREGIVER PROGRAM OF 

24 DEPARTMENT OF VETERANS AFFAIRS. 

25 (a) FAMILY CAREGIVER PROGRAM.— 


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1 (1) EXPANSION OF ELIGIBILITY.— 

2 (A) IN GENERAL.—Subparagraph (B) of 

3 subsection (a)(2) of section 1720G is amended 

4 to read as follows: 

5 ‘‘(B) for assistance provided under this sub6 section— 

7 ‘‘(i) before the date on which the Secretary 

8 submits to Congress a certification that the De9 partment has fully implemented the information 

10 technology system required by section 162(a) of 

11 the Caring for Our Veterans Act of 2018, has 

12 a serious injury (including traumatic brain in13 jury, psychological trauma, or other mental dis14 order) incurred or aggravated in the line of 

15 duty in the active military, naval, or air service 

16 on or after September 11, 2001; 

17 ‘‘(ii) during the two-year period beginning 

18 on the date on which the Secretary submitted 

19 to Congress the certification described in clause 

20 (i), has a serious injury (including traumatic 

21 brain injury, psychological trauma, or other 

22 mental disorder) incurred or aggravated in the 

23 line of duty in the active military, naval, or air 

24 service— 

25 ‘‘(I) on or before May 7, 1975; or 


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1 ‘‘(II) on or after September 11, 2001; 

2 or 

3 ‘‘(iii) after the date that is two years after 

4 the date on which the Secretary submits to 

5 Congress the certification described in clause 

6 (i), has a serious injury (including traumatic 

7 brain injury, psychological trauma, or other 

8 mental disorder) incurred or aggravated in the 

9 line of duty in the active military, naval, or air 

10 service; and’’. 

11 (B) PUBLICATION IN FEDERAL REG12 ISTER.—Not later than 30 days after the date 

13 on which the Secretary of Veterans Affairs sub14 mits to Congress the certification described in 

15 subsection (a)(2)(B)(i) of section 1720G of 

16 such title, as amended by subparagraph (A) of 

17 this paragraph, the Secretary shall publish the 

18 date specified in such subsection in the Federal 

19 Register. 

20 (2) EXPANSION OF NEEDED SERVICES IN ELI21 GIBILITY CRITERIA.—Subsection (a)(2)(C) of such 

22 section is amended— 

23 (A) in clause (ii), by striking ‘‘; or’’ and in24 serting a semicolon; 


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1 (B) by redesignating clause (iii) as clause 

2 (iv); and 

3 (C) by inserting after clause (ii) the fol4 lowing new clause (iii): 

5 ‘‘(iii) a need for regular or extensive in6 struction or supervision without which the abil7 ity of the veteran to function in daily life would 

8 be seriously impaired; or’’. 

9 (3) EXPANSION OF SERVICES PROVIDED.—Sub10 section (a)(3)(A)(ii) of such section is amended— 

11 (A) in subclause (IV), by striking ‘‘; and’’ 

12 and inserting a semicolon; 

13 (B) in subclause (V), by striking the period 

14 at the end and inserting ‘‘; and’’; and 

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

16 subclause: 

17 ‘‘(VI) through the use of contracts with, or 

18 the provision of grants to, public or private en19 tities— 

20 ‘‘(aa) financial planning services relat21 ing to the needs of injured veterans and 

22 their caregivers; and 

23 ‘‘(bb) legal services, including legal 

24 advice and consultation, relating to the 


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1 needs of injured veterans and their care2 givers.’’. 

3 (4) MODIFICATION OF STIPEND CALCULA4 TION.—Subsection (a)(3)(C) of such section is 

5 amended— 

6 (A) by redesignating clause (iii) as clause 

7 (iv); and 

8 (B) by inserting after clause (ii) the fol9 lowing new clause (iii): 

10 ‘‘(iii) In determining the amount and degree of per11 sonal care services provided under clause (i) with respect 

12 to an eligible veteran whose need for personal care services 

13 is based in whole or in part on a need for supervision or 

14 protection under paragraph (2)(C)(ii) or regular instruc15 tion or supervision under paragraph (2)(C)(iii), the Sec16 retary shall take into account the following: 

17 ‘‘(I) The assessment by the family caregiver of 

18 the needs and limitations of the veteran. 

19 ‘‘(II) The extent to which the veteran can func20 tion safely and independently in the absence of such 

21 supervision, protection, or instruction. 

22 ‘‘(III) The amount of time required for the 

23 family caregiver to provide such supervision, protec24 tion, or instruction to the veteran.’’. 


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1 (5) PERIODIC EVALUATION OF NEED FOR CER2 TAIN SERVICES.—Subsection (a)(3) of such section 

3 is amended by adding at the end the following new 

4 subparagraph: 

5 ‘‘(D) In providing instruction, preparation, and train6 ing under subparagraph (A)(i)(I) and technical support 

7 under subparagraph (A)(i)(II) to each family caregiver 

8 who is approved as a provider of personal care services 

9 for an eligible veteran under paragraph (6), the Secretary 

10 shall periodically evaluate the needs of the eligible veteran 

11 and the skills of the family caregiver of such veteran to 

12 determine if additional instruction, preparation, training, 

13 or technical support under those subparagraphs is nec14 essary.’’. 

15 (6) USE OF PRIMARY CARE TEAMS.—Subsection 

16 (a)(5) of such section is amended, in the matter pre17 ceding subparagraph (A), by inserting ‘‘(in collabo18 ration with the primary care team for the eligible 

19 veteran to the maximum extent practicable)’’ after 

20 ‘‘evaluate’’. 

21 (7) ASSISTANCE FOR FAMILY CAREGIVERS.— 

22 Subsection (a) of such section is amended by adding 

23 at the end the following new paragraph: 

24 ‘‘(11)(A) In providing assistance under this sub25 section to family caregivers of eligible veterans, the SecVerDate Sep 11 2014 21:33 May 11, 2018 Jkt 079200 PO 00000 Frm 00119 Fmt 6652 Sfmt 6201 E:\BILLS\H5674.RH H5674

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1 retary may enter into contracts, provider agreements, and 

2 memoranda of understanding with Federal agencies, 

3 States, and private, nonprofit, and other entities to pro4 vide such assistance to such family caregivers. 

5 ‘‘(B) The Secretary may provide assistance under 

6 this paragraph only if such assistance is reasonably acces7 sible to the family caregiver and is substantially equivalent 

8 or better in quality to similar services provided by the De9 partment. 

10 ‘‘(C) The Secretary may provide fair compensation 

11 to Federal agencies, States, and other entities that provide 

12 assistance under this paragraph.’’. 

13 (b) MODIFICATION OF DEFINITION OF PERSONAL

14 CARE SERVICES.—Subsection (d)(4) of such section is 

15 amended— 

16 (1) in subparagraph (A), by striking ‘‘inde17 pendent’’; 

18 (2) by redesignating subparagraph (B) as sub19 paragraph (D); and 

20 (3) by inserting after subparagraph (A) the fol21 lowing new subparagraphs: 

22 ‘‘(B) Supervision or protection based on 

23 symptoms or residuals of neurological or other 

24 impairment or injury. 


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1 ‘‘(C) Regular or extensive instruction or 

2 supervision without which the ability of the vet3 eran to function in daily life would be seriously 

4 impaired.’’. 

5 SEC. 162. IMPLEMENTATION OF INFORMATION TECH6 NOLOGY SYSTEM OF DEPARTMENT OF VET7 ERANS AFFAIRS TO ASSESS AND IMPROVE 

8 THE FAMILY CAREGIVER PROGRAM. 

9 (a) IMPLEMENTATION OF NEW SYSTEM.— 

10 (1) IN GENERAL.—Not later than October 1, 

11 2018, the Secretary of Veterans Affairs shall imple12 ment an information technology system that fully 

13 supports the Program and allows for data assess14 ment and comprehensive monitoring of the Program. 

15 (2) ELEMENTS OF SYSTEM.—The information 

16 technology system required to be implemented under 

17 paragraph (1) shall include the following: 

18 (A) The ability to easily retrieve data that 

19 will allow all aspects of the Program (at the 

20 medical center and aggregate levels) and the 

21 workload trends for the Program to be assessed 

22 and comprehensively monitored. 

23 (B) The ability to manage data with re24 spect to a number of caregivers that is more 


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1 than the number of caregivers that the Sec2 retary expects to apply for the Program. 

3 (C) The ability to integrate the system 

4 with other relevant information technology sys5 tems of the Veterans Health Administration. 

6 (b) ASSESSMENT OF PROGRAM.—Not later than 180 

7 days after implementing the system described in sub8 section (a), the Secretary shall, through the Under Sec9 retary for Health, use data from the system and other rel10 evant data to conduct an assessment of how key aspects 

11 of the Program are structured and carried out. 

12 (c) ONGOING MONITORING OF AND MODIFICATIONS

13 TO PROGRAM.— 

14 (1) MONITORING.—The Secretary shall use the 

15 system implemented under subsection (a) to monitor 

16 and assess the workload of the Program, including 

17 monitoring and assessment of data on— 

18 (A) the status of applications, appeals, and 

19 home visits in connection with the Program; 

20 and 

21 (B) the use by caregivers participating in 

22 the Program of other support services under 

23 the Program such as respite care. 

24 (2) MODIFICATIONS.—Based on the monitoring 

25 and assessment conducted under paragraph (1), the 


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1 Secretary shall identify and implement such modi2 fications to the Program as the Secretary considers 

3 necessary to ensure the Program is functioning as 

4 intended and providing veterans and caregivers par5 ticipating in the Program with services in a timely 

6 manner. 

7 (d) REPORTS.— 

8 (1) INITIAL REPORT.— 

9 (A) IN GENERAL.—Not later than 90 days 

10 after the date of the enactment of this Act, the 

11 Secretary shall submit to the Committee on 

12 Veterans’ Affairs of the Senate, the Committee 

13 on Veterans’ Affairs of the House of Represent14 atives, and the Comptroller General of the 

15 United States a report that includes— 

16 (i) the status of the planning, develop17 ment, and deployment of the system re18 quired to be implemented under subsection 

19 (a), including any changes in the timeline 

20 for the implementation of the system; and 

21 (ii) an assessment of the needs of 

22 family caregivers of veterans described in 

23 subparagraph (B), the resources needed 

24 for the inclusion of such family caregivers 

25 in the Program, and such changes to the 


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1 Program as the Secretary considers nec2 essary to ensure the successful expansion 

3 of the Program to include such family 

4 caregivers. 

5 (B) VETERANS DESCRIBED.—Veterans de6 scribed in this subparagraph are veterans who 

7 are eligible for the Program under clause (ii) or 

8 (iii) of section 1720G(a)(2)(B) of title 38, 

9 United States Code, as amended by section 

10 161(a)(1) of this title, solely due to a serious 

11 injury (including traumatic brain injury, psy12 chological trauma, or other mental disorder) in13 curred or aggravated in the line of duty in the 

14 active military, naval, or air service before Sep15 tember 11, 2001. 

16 (2) NOTIFICATION BY COMPTROLLER GEN17 ERAL.—The Comptroller General shall review the re18 port submitted under paragraph (1) and notify the 

19 Committee on Veterans’ Affairs of the Senate and 

20 the Committee on Veterans’ Affairs of the House of 

21 Representatives with respect to the progress of the 

22 Secretary in— 

23 (A) fully implementing the system required 

24 under subsection (a); and 


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1 (B) implementing a process for using such 

2 system to monitor and assess the Program 

3 under subsection (c)(1) and modify the Pro4 gram as considered necessary under subsection 

5 (c)(2). 

6 (3) FINAL REPORT.— 

7 (A) IN GENERAL.—Not later than October 

8 1, 2019, the Secretary shall submit to the Com9 mittee on Veterans’ Affairs of the Senate, the 

10 Committee on Veterans’ Affairs of the House of 

11 Representatives, and the Comptroller General a 

12 report on the implementation of subsections (a) 

13 through (c). 

14 (B) ELEMENTS.—The report required by 

15 subparagraph (A) shall include the following: 

16 (i) A certification by the Secretary 

17 that the information technology system de18 scribed in subsection (a) has been imple19 mented. 

20 (ii) A description of how the Secretary 

21 has implemented such system. 

22 (iii) A description of the modifications 

23 to the Program, if any, that were identified 

24 and implemented under subsection (c)(2). 


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1 (iv) A description of how the Sec2 retary is using such system to monitor the 

3 workload of the Program. 

4 (e) DEFINITIONS.—In this section: 

5 (1) ACTIVE MILITARY, NAVAL, OR AIR SERV6 ICE.—The term ‘‘active military, naval, or air serv7 ice’’ has the meaning given that term in section 101 

8 of title 38, United States Code. 

9 (2) PROGRAM.—The term ‘‘Program’’ means 

10 the program of comprehensive assistance for family 

11 caregivers under section 1720G(a) of title 38, 

12 United States Code, as amended by section 161 of 

13 this title. 

14 SEC. 163. MODIFICATIONS TO ANNUAL EVALUATION RE15 PORT ON CAREGIVER PROGRAM OF DEPART16 MENT OF VETERANS AFFAIRS. 

17 (a) BARRIERS TO CARE AND SERVICES.—Subpara18 graph (A)(iv) of section 101(c)(2) of the Caregivers and 

19 Veterans Omnibus Health Services Act of 2010 (Public 

20 Law 111–163; 38 U.S.C. 1720G note) is amended by in21 serting ‘‘, including a description of any barriers to access22 ing and receiving care and services under such programs’’ 

23 before the semicolon. 


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1 (b) SUFFICIENCY OF TRAINING FOR FAMILY CARE2 GIVER PROGRAM.—Subparagraph (B) of such section is 

3 amended— 

4 (1) in clause (i), by striking ‘‘; and’’ and insert5 ing a semicolon; 

6 (2) in clause (ii), by striking the period at the 

7 end and inserting ‘‘; and’’; and 

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

9 clause: 

10 ‘‘(iii) an evaluation of the sufficiency 

11 and consistency of the training provided to 

12 family caregivers under such program in 

13 preparing family caregivers to provide care 

14 to veterans under such program.’’. 

15 TITLE II—VA ASSET AND 

16 INFRASTRUCTURE REVIEW 

17 Subtitle A—Asset and 

18 Infrastructure Review 

19 SEC. 201. SHORT TITLE. 

20 This subtitle may be cited as the ‘‘VA Asset and In21 frastructure Review Act of 2018’’. 

22 SEC. 202. THE COMMISSION. 

23 (a) ESTABLISHMENT.—There is established an inde24 pendent commission to be known as the ‘‘Asset and InfraVerDate Sep 11 2014 21:33 May 11, 2018 Jkt 079200 PO 00000 Frm 00127 Fmt 6652 Sfmt 6201 E:\BILLS\H5674.RH H5674

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1 structure Review Commission’’ (in this subtitle referred 

2 to as the ‘‘Commission’’). 

3 (b) DUTIES.—The Commission shall carry out the 

4 duties specified for it in this subtitle. 

5 (c) APPOINTMENT.— 

6 (1) IN GENERAL.— 

7 (A) APPOINTMENT.—The Commission 

8 shall be composed of 9 members appointed by 

9 the President, by and with the advice and con10 sent of the Senate. 

11 (B) TRANSMISSION OF NOMINATIONS.— 

12 The President shall transmit to the Senate the 

13 nominations for appointment to the Commission 

14 not later than May 31, 2021. 

15 (2) CONSULTATION IN SELECTION PROCESS.— 

16 In selecting individuals for nominations for appoint17 ments to the Commission, the President shall con18 sult with— 

19 (A) the Speaker of the House of Rep20 resentatives; 

21 (B) the majority leader of the Senate; 

22 (C) the minority leader of the House of 

23 Representatives; 

24 (D) the minority leader of the Senate; and 


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1 (E) congressionally chartered, membership 

2 based veterans service organizations concerning 

3 the appointment of three members. 

4 (3) DESIGNATION OF CHAIR.—At the time the 

5 President nominates individuals for appointment to 

6 the Commission under paragraph (1)(B), the Presi7 dent shall designate one such individual who shall 

8 serve as Chair of the Commission and one such indi9 vidual who shall serve as Vice Chair of the Commis10 sion. 

11 (4) MEMBER REPRESENTATION.—In nomi12 nating individuals under this subsection, the Presi13 dent shall ensure that— 

14 (A) veterans, reflecting current demo15 graphics of veterans enrolled in the system of 

16 annual patient enrollment under section 1705 

17 of title 38, United States Code, are adequately 

18 represented in the membership of the Commis19 sion; 

20 (B) at least one member of the Commis21 sion has experience working for a private inte22 grated health care system that has annual gross 

23 revenues of more than $50,000,000; 

24 (C) at least one member has experience as 

25 a senior manager for an entity specified in 


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1 clause (ii), (iii), or (iv) of section 101(a)(1)(B) 

2 of the Veterans Access, Choice, and Account3 ability Act of 2014 (Public Law 113–146; 38 

4 U.S.C. 1701 note); 

5 (D) at least one member— 

6 (i) has experience with capital asset 

7 management for the Federal Government; 

8 and 

9 (ii) is familiar with trades related to 

10 building and real property, including con11 struction, engineering, architecture, leas12 ing, and strategic partnerships; and 

13 (E) at least three members represent con14 gressionally chartered, membership-based, vet15 erans service organizations. 

16 (d) MEETINGS.— 

17 (1) IN GENERAL.—The Commission shall meet 

18 only during calendar years 2022 and 2023. 

19 (2) PUBLIC NATURE OF MEETINGS AND PRO20 CEEDINGS.— 

21 (A) PUBLIC MEETINGS.—Each meeting of 

22 the Commission shall be open to the public. 

23 (B) OPEN PARTICIPATION.—All the pro24 ceedings, information, and deliberations of the 


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1 Commission shall be available for review by the 

2 public. 

3 (e) VACANCIES.—A vacancy in the Commission shall 

4 be filled in the same manner as the original appointment, 

5 but the individual appointed to fill the vacancy shall serve 

6 only for the unexpired portion of the term for which the 

7 individual’s predecessor was appointed. 

8 (f) PAY.— 

9 (1) IN GENERAL.—Members of the Commission 

10 shall serve without pay. 

11 (2) OFFICERS OR EMPLOYEES OF THE UNITED

12 STATES.—Each member of the Commission who is 

13 an officer or employee of the United States shall 

14 serve without compensation in addition to that re15 ceived for service as an officer or employee of the 

16 United States. 

17 (3) TRAVEL EXPENSES.—Members shall receive 

18 travel expenses, including per diem in lieu of subsist19 ence, in accordance with sections 5702 and 5703 of 

20 title 5, United States Code. 

21 (g) DIRECTOR OF STAFF.— 

22 (1) APPOINTMENT.—The Commission shall ap23 point a Director who— 

24 (A) has not served as an employee of the 

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1 year period preceding the date of such appoint2 ment; and 

3 (B) is not otherwise barred or prohibited 

4 from serving as Director under Federal ethics 

5 laws and regulations, by reason of post-employ6 ment conflict of interest. 

7 (2) RATE OF PAY.—The Director shall be paid 

8 at the rate of basic pay payable for level IV of the 

9 Executive Schedule under section 5315 of title 5, 

10 United States Code. 

11 (h) STAFF.— 

12 (1) PAY OF PERSONNEL.—Subject to para13 graphs (2) and (3), the Director, with the approval 

14 of the Commission, may appoint and fix the pay of 

15 additional personnel. 

16 (2) EXEMPTION FROM CERTAIN REQUIRE17 MENTS.—The Director may make such appoint18 ments without regard to the provisions of title 5, 

19 United States Code, governing appointments in the 

20 competitive service, and any personnel so appointed 

21 may be paid without regard to the provisions of 

22 chapter 51 and subchapter III of chapter 53 of that 

23 title relating to classification and General Schedule 

24 pay rates, except that an individual so appointed 

25 may not receive pay in excess of the annual rate of 


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1 basic pay payable for GS–15 of the General Sched2 ule. 

3 (3) DETAILEES.— 

4 (A) LIMITATION ON NUMBER.—Not more 

5 than two-thirds of the personnel employed by or 

6 detailed to the Commission may be on detail 

7 from the Department of Veterans Affairs. 

8 (B) PROFESSIONAL ANALYSTS.—Not more 

9 than half of the professional analysts of the 

10 Commission staff may be persons detailed from 

11 the Department of Veterans Affairs to the 

12 Commission. 

13 (C) PROHIBITION ON DETAIL OF CERTAIN

14 PERSONNEL.—A person may not be detailed 

15 from the Department of Veterans Affairs to the 

16 Commission if, within 6 months before the de17 tail is to begin, that person participated person18 ally and substantially in any matter within the 

19 Department of Veterans Affairs concerning the 

20 preparation of recommendations regarding fa21 cilities of the Veterans Health Administration. 

22 (4) AUTHORITY TO REQUEST DETAILED PER23 SONNEL.—Subject to paragraph (3), the head of any 

24 Federal department or agency, upon the request of 

25 the Director, may detail any of the personnel of that 


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1 department or agency to the Commission to assist 

2 the Commission in carrying out its duties under this 

3 subtitle. 

4 (5) INFORMATION FROM FEDERAL AGENCIES.— 

5 The Commission may secure directly from any Fed6 eral agency such information the Commission con7 siders necessary to carry out this subtitle. Upon re8 quest of the Chair, the head of such agency shall 

9 furnish such information to the Commission. 

10 (i) OTHER AUTHORITY.— 

11 (1) TEMPORARY AND INTERMITTENT SERV12 ICES.—The Commission may procure by contract, to 

13 the extent funds are available, the temporary or 

14 intermittent services of experts or consultants pursu15 ant to section 3109 of title 5, United States Code. 

16 (2) LEASING AND ACQUISITION OF PROP17 ERTY.—To the extent funds are available, the Com18 mission may lease real property and acquire personal 

19 property either of its own accord or in consultation 

20 with the General Services Administration. 

21 (j) TERMINATION.—The Commission shall terminate 

22 on December 31, 2023. 

23 (k) PROHIBITION AGAINST RESTRICTING COMMU24 NICATIONS.— 


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1 (1) IN GENERAL.—Except as provided in para2 graph (2), no person may restrict an employee of the 

3 Department of Veterans Affairs in communicating 

4 with the Commission. 

5 (2) UNLAWFUL COMMUNICATIONS.—Paragraph 

6 (1) does not apply to a communication that is un7 lawful. 

8 SEC. 203. PROCEDURE FOR MAKING RECOMMENDATIONS. 

9 (a) SELECTION CRITERIA.— 

10 (1) PUBLICATION.—The Secretary shall, not 

11 later than February 1, 2021, and after consulting 

12 with veterans service organizations, publish in the 

13 Federal Register and transmit to the Committees on 

14 Veterans’ Affairs of the Senate and the House of 

15 Representatives the criteria proposed to be used by 

16 the Department of Veterans Affairs in assessing and 

17 making recommendations regarding the moderniza18 tion or realignment of facilities of the Veterans 

19 Health Administration under this subtitle. Such cri20 teria shall include the preferences of veterans re21 garding health care furnished by the Department. 

22 (2) PUBLIC COMMENT.—The Secretary shall 

23 provide an opportunity for public comment on the 

24 proposed criteria under paragraph (1) for a period 

25 of at least 90 days and shall include notice of that 


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1 opportunity in the publication required under such 

2 paragraph. 

3 (3) PUBLICATION OF FINAL CRITERIA.—The 

4 Secretary shall, not later than May 31, 2021, pub5 lish in the Federal Register and transmit to the 

6 Committees on Veterans’ Affairs of the Senate and 

7 the House of Representatives the final criteria to be 

8 used in making recommendations regarding the clo9 sure, modernization, or realignment of facilities of 

10 the Veterans Health Administration under this sub11 title. 

12 (b) RECOMMENDATIONS OF THE SECRETARY.— 

13 (1) PUBLICATION IN FEDERAL REGISTER.—The 

14 Secretary shall, not later than January 31, 2022, 

15 and after consulting with veterans service organiza16 tions, publish in the Federal Register and transmit 

17 to the Committees on Veterans’ Affairs of the Sen18 ate and the House of Representatives and to the 

19 Commission a report detailing the recommendations 

20 regarding the modernization or realignment of facili21 ties of the Veterans Health Administration on the 

22 basis of the final criteria referred to in subsection 

23 (a)(2) that are applicable. 


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1 (2) FACTORS FOR CONSIDERATION.—In making 

2 recommendations under this subsection, the Sec3 retary shall consider each of the following factors: 

4 (A) The degree to which any health care 

5 delivery or other site for providing services to 

6 veterans reflect the metrics of the Department 

7 of Veterans Affairs regarding market area 

8 health system planning. 

9 (B) The provision of effective and efficient 

10 access to high-quality health care and services 

11 for veterans. 

12 (C) The extent to which the real property 

13 that no longer meets the needs of the Federal 

14 Government could be reconfigured, repurposed, 

15 consolidated, realigned, exchanged, outleased, 

16 replaced, sold, or disposed. 

17 (D) The need of the Veterans Health Ad18 ministration to acquire infrastructure or facili19 ties that will be used for the provision of health 

20 care and services to veterans. 

21 (E) The extent to which the operating and 

22 maintenance costs are reduced through consoli23 dating, colocating, and reconfiguring space, and 

24 through realizing other operational efficiencies. 


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1 (F) The extent and timing of potential 

2 costs and savings, including the number of 

3 years such costs or savings will be incurred, be4 ginning with the date of completion of the pro5 posed recommendation. 

6 (G) The extent to which the real property 

7 aligns with the mission of the Department of 

8 Veterans Affairs. 

9 (H) The extent to which any action would 

10 impact other missions of the Department (in11 cluding education, research, or emergency pre12 paredness). 

13 (I) Local stakeholder inputs and any fac14 tors identified through public field hearings. 

15 (J) The assessments under paragraph (3). 

16 (K) The extent to which the Veterans 

17 Health Administration has appropriately staffed 

18 the medical facility, including determinations 

19 whether there has been insufficient resource al20 location or deliberate understaffing. 

21 (L) Any other such factors the Secretary 

22 determines appropriate. 

23 (3) CAPACITY AND COMMERCIAL MARKET AS24 SESSMENTS.— 


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1 (A) ASSESSMENTS.—The Secretary shall 

2 assess the capacity of each Veterans Integrated 

3 Service Network and medical facility of the De4 partment to furnish hospital care or medical 

5 services to veterans under chapter 17 of title 

6 38, United States Code. Each such assessment 

7 shall— 

8 (i) identify gaps in furnishing such 

9 care or services at such Veterans Inte10 grated Service Network or medical facility; 

11 (ii) identify how such gaps can be 

12 filled by— 

13 (I) entering into contracts or 

14 agreements with network providers 

15 under this section or with entities 

16 under other provisions of law; 

17 (II) making changes in the way 

18 such care and services are furnished 

19 at such Veterans Integrated Service 

20 Network or medical facility, includ21 ing— 

22 (aa) extending hours of op23 eration; 

24 (bb) adding personnel; or 


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1 (cc) expanding space 

2 through the construction, leasing, 

3 or sharing of health care facili4 ties; and 

5 (III) the building or realignment 

6 of Department resources or personnel; 

7 (iii) forecast, based on future projec8 tions and historical trends, both the short9 and long-term demand in furnishing care 

10 or services at such Veterans Integrated 

11 Service Network or medical facility and as12 sess how such demand affects the needs to 

13 use such network providers; 

14 (iv) include a commercial health care 

15 market assessment of designated 

16 catchment areas in the United States con17 ducted by a non-governmental entity; and 

18 (v) consider the unique ability of the 

19 Federal Government to retain a presence 

20 in an area otherwise devoid of commercial 

21 health care providers or from which such 

22 providers are at risk of leaving. 

23 (B) CONSULTATION.—In carrying out the 

24 assessments under subparagraph (A), the Sec25 retary shall consult with veterans service orgaVerDate Sep 11 2014 21:33 May 11, 2018 Jkt 079200 PO 00000 Frm 00140 Fmt 6652 Sfmt 6201 E:\BILLS\H5674.RH H5674

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1 nizations and veterans served by each such Vet2 erans Integrated Service Network and medical 

3 facility. 

4 (C) SUBMITTAL.—The Secretary shall sub5 mit such assessments to the Committees on 

6 Veterans’ Affairs of the House of Representa7 tives and the Senate with the recommendations 

8 of the Secretary under this subsection and 

9 make the assessments publicly available. 

10 (4) SUMMARY OF SELECTION PROCESS.—The 

11 Secretary shall include, with the list of recommenda12 tions published and transmitted pursuant to para13 graph (1), a summary of the selection process that 

14 resulted in the recommendation for each facility of 

15 the Veterans Health Administration, including a jus16 tification for each recommendation. The Secretary 

17 shall transmit the matters referred to in the pre18 ceding sentence not later than 7 days after the date 

19 of the transmittal to the Committees on Veterans’ 

20 Affairs of the Senate and the House of Representa21 tives and the Commission of the report referred to 

22 in paragraph (1). 

23 (5) TREATMENT OF FACILITIES.—In assessing 

24 facilities of the Veterans Health Administration, the 

25 Secretary shall consider all such facilities equally 


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1 without regard to whether the facility has been pre2 viously considered or proposed for reuse, closure, 

3 modernization, or realignment by the Department of 

4 Veterans Affairs. 

5 (6) AVAILABILITY OF INFORMATION TO CON6 GRESS.—In addition to making all information used 

7 by the Secretary to prepare the recommendations 

8 under this subsection available to Congress (includ9 ing any committee or Member of Congress), the Sec10 retary shall also make such information available to 

11 the Commission and the Comptroller General of the 

12 United States. 

13 (7) CERTIFICATION OF ACCURACY.— 

14 (A) IN GENERAL.—Each person referred to 

15 in subparagraph (B), when submitting informa16 tion to the Secretary or the Commission con17 cerning the modernization or realignment of a 

18 facility of the Veterans Health Administration, 

19 shall certify that such information is accurate 

20 and complete to the best of that person’s knowl21 edge and belief. 

22 (B) COVERED PERSONS.—Subparagraph 

23 (A) applies to the following persons: 

24 (i) Each Under Secretary of the De25 partment of Veterans Affairs. 


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1 (ii) Each director of a Veterans Inte2 grated Service Network. 

3 (iii) Each director of a medical center 

4 of the Department of Veterans Affairs. 

5 (iv) Each director of a program office 

6 of the Department of Veterans Affairs. 

7 (v) Each person who is in a position 

8 the duties of which include personal and 

9 substantial involvement in the preparation 

10 and submission of information and rec11 ommendations concerning the moderniza12 tion or realignment of facilities of the Vet13 erans Health Administration. 

14 (c) REVIEW AND RECOMMENDATIONS BY THE COM15 MISSION.— 

16 (1) PUBLIC HEARINGS.— 

17 (A) IN GENERAL.—After receiving the rec18 ommendations from the Secretary pursuant to 

19 subsection (b), the Commission shall conduct 

20 public hearings on the recommendations. 

21 (B) LOCATIONS.—The Commission shall 

22 conduct public hearings in regions affected by a 

23 recommendation of the Secretary to close a fa24 cility of the Veterans Health Administration. 

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1 sion shall conduct public hearings in regions af2 fected by a recommendation of the Secretary to 

3 modernize or realign such a facility. 

4 (C) REQUIRED WITNESSES.—Witnesses at 

5 each public hearing shall include at a min6 imum— 

7 (i) a veteran— 

8 (I) enrolled under section 1705 

9 of title 38, United States Code; and 

10 (II) identified by a local veterans 

11 service organization; and 

12 (ii) a local elected official. 

13 (2) TRANSMITTAL TO PRESIDENT.— 

14 (A) IN GENERAL.—The Commission shall, 

15 not later than January 31, 2023, transmit to 

16 the President a report containing the Commis17 sion’s findings and conclusions based on a re18 view and analysis of the recommendations made 

19 by the Secretary, together with the Commis20 sion’s recommendations, for modernizations and 

21 realignments of facilities of the Veterans Health 

22 Administration. 

23 (B) AUTHORITY TO MAKE CHANGES TO

24 RECOMMENDATIONS.—Subject to subparagraph 

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1 mission may change any recommendation made 

2 by the Secretary if the Commission— 

3 (i) determines that the Secretary devi4 ated substantially from the final criteria 

5 referred to in subsection (a)(2) in making 

6 such recommendation; 

7 (ii) determines that the change is con8 sistent with the final criteria referred to in 

9 subsection (a)(2); 

10 (iii) publishes a notice of the proposed 

11 change in the Federal Register not less 

12 than 45 days before transmitting its rec13 ommendations to the President pursuant 

14 to subparagraph (A); and 

15 (iv) conducts public hearings on the 

16 proposed change. 

17 (3) JUSTIFICATION FOR CHANGES.—The Com18 mission shall explain and justify in its report sub19 mitted to the President pursuant to paragraph (2) 

20 any recommendation made by the Commission that 

21 is different from the recommendations made by the 

22 Secretary pursuant to subsection (b). The Commis23 sion shall transmit a copy of such report to the 

24 Committees on Veterans’ Affairs of the Senate and 

25 the House of Representatives on the same date on 


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1 which it transmits its recommendations to the Presi2 dent under paragraph (2). 

3 (4) PROVISION OF INFORMATION TO CON4 GRESS.—After the Commission transmits its report 

5 to the President, the Commission shall promptly 

6 provide, upon request, to any Member of Congress, 

7 information used by the Commission in making its 

8 recommendations. 

9 (d) REVIEW BY THE PRESIDENT.— 

10 (1) REPORT.—The President shall, not later 

11 than February 15, 2023, transmit to the Commis12 sion and to the Congress a report containing the 

13 President’s approval or disapproval of the Commis14 sion’s recommendations. 

15 (2) PRESIDENTIAL APPROVAL.—If the Presi16 dent approves all the recommendations of the Com17 mission, the President shall transmit a copy of such 

18 recommendations to the Congress, together with a 

19 certification of such approval. 

20 (3) PRESIDENTIAL DISAPPROVAL.—If the 

21 President disapproves the recommendations of the 

22 Commission, in whole or in part, the President shall 

23 transmit to the Commission and the Congress, not 

24 later than March 1, 2023, the reasons for that dis25 approval. The Commission, after consideration of the 


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1 President’s reasons for disapproval, shall then trans2 mit to the President, not later than March 15, 2023, 

3 a report containing— 

4 (A) the Commission’s findings and conclu5 sions based on a review and analysis of those 

6 reasons for disapproval provided by the Presi7 dent; and 

8 (B) recommendations that the Commission 

9 determines are appropriate for modernizations 

10 and realignments of facilities of the Veterans 

11 Health Administration. 

12 (4) TRANSMITTAL OF RECOMMENDATIONS TO

13 CONGRESS.—If the President approves all rec14 ommendations of the Commission transmitted to the 

15 President under paragraph (3), the President shall 

16 transmit a copy of such recommendations to the 

17 Congress, together with a certification of such ap18 proval. 

19 (5) FAILURE TO TRANSMIT.—If the President 

20 does not transmit to the Congress an approval and 

21 certification described in paragraph (2) or (4) by 

22 March 30, 2023, the process by which facilities of 

23 the Veterans Health Administration may be selected 

24 for modernization or realignment under this subtitle 

25 shall be terminated. 


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1 SEC. 204. ACTIONS REGARDING INFRASTRUCTURE AND FA2 CILITIES OF THE VETERANS HEALTH ADMIN3 ISTRATION. 

4 (a) IN GENERAL.—Subject to subsection (b), the Sec5 retary shall begin to implement the recommended mod6 ernizations and realignments in the report under section 

7 203(d) not later than three years after the date on which 

8 the President transmits such report to Congress. In any 

9 fiscal year, such implementation includes— 

10 (1) the planning of modernizations and realign11 ments of facilities of the Veterans Health Adminis12 tration as recommended in such report; and 

13 (2) providing detailed information on the budg14 et for such modernizations or realignments in docu15 ments submitted to Congress by the Secretary in 

16 support of the President’s budget for that fiscal 

17 year. 

18 (b) CONGRESSIONAL DISAPPROVAL.— 

19 (1) IN GENERAL.—The Secretary may not carry 

20 out any modernization or realignment recommended 

21 by the Commission in a report transmitted from the 

22 President pursuant to section 203(d) if a joint reso23 lution is enacted, in accordance with the provisions 

24 of section 207, disapproving such recommendations 

25 of the Commission before the earlier of— 


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1 (A) the end of the 45-day period beginning 

2 on the date on which the President transmits 

3 such report; or 

4 (B) the adjournment of Congress sine die 

5 for the session during which such report is 

6 transmitted. 

7 (2) COMPUTATION OF PERIOD.—For purposes 

8 of paragraph (1) and subsections (a) and (c) of sec9 tion 207, the days on which either House of Con10 gress is not in session because of an adjournment of 

11 more than three days to a day certain shall be ex12 cluded in the computation of a period. 

13 SEC. 205. IMPLEMENTATION. 

14 (a) IN GENERAL.— 

15 (1) MODERNIZING AND REALIGNING FACILI16 TIES.—In modernizing or realigning any facility of 

17 the Veterans Health Administration under this sub18 title, the Secretary may— 

19 (A) take such actions as may be necessary 

20 to modernize or realign any such facility, in21 cluding the alteration of such facilities, the ac22 quisition of such land, the leasing or construc23 tion of such replacement facilities, the disposi24 tion of such land or facilities, the performance 

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1 vance planning and design as may be required 

2 to transfer functions from a facility of the Vet3 erans Health Administration to another such 

4 facility, and may use for such purpose funds in 

5 the Account or funds appropriated to the De6 partment of Veterans Affairs for such purposes; 

7 (B) carry out activities for the purposes of 

8 environmental mitigation, abatement, or res9 toration at any such facility, and shall use for 

10 such purposes funds in the Account; 

11 (C) reimburse other Federal agencies for 

12 actions performed at the request of the Sec13 retary with respect to any such closure or re14 alignment, and may use for such purpose funds 

15 in the Account or funds appropriated to the De16 partment of Veterans Affairs and available for 

17 such purpose; and 

18 (D) exercise the authority of the Secretary 

19 under subchapter V of chapter 81 of title 38, 

20 United States Code. 

21 (2) ENVIRONMENTAL RESTORATION; HISTORIC

22 PRESERVATION.—In carrying out any closure or re23 alignment under this subtitle, the Secretary, with re24 gards to any property made excess to the needs of 

25 the Department of Veterans Affairs as a result of 


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1 such closure or realignment, shall carry out, as soon 

2 as possible with funds available for such purpose, 

3 any of the following for which the Secretary is re4 sponsible: 

5 (A) Environmental mitigation. 

6 (B) Environmental abatement. 

7 (C) Environmental restoration. 

8 (D) Compliance with historic preservation 

9 requirements. 

10 (b) MANAGEMENT AND DISPOSAL OF PROPERTY.— 

11 (1) EXISTING DISPOSAL AUTHORITIES.—To 

12 transfer or dispose of surplus real property or infra13 structure located at any facility of the Veterans 

14 Health Administration that is modernized or re15 aligned under this title, the Secretary may exercise 

16 the authorities of the Secretary under subchapters I 

17 and II of chapter 81 of title 38, United States Code, 

18 or the authorities delegated to the Secretary by the 

19 Administrator of General Services under subchapter 

20 III of chapter 5 of title 40, United States Code. 

21 (2) EFFECTS ON LOCAL COMMUNITIES.— 

22 (A) CONSULTATION WITH STATE AND

23 LOCAL GOVERNMENT.—Before any action may 

24 be taken with respect to the disposal of any 

25 surplus real property or infrastructure located 


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1 at any facility of the Veterans Health Adminis2 tration to be closed or realigned under this sub3 title, the Secretary of Veterans Affairs shall 

4 consult with the Governor of the State and the 

5 heads of the local governments concerned for 

6 the purpose of considering any plan for the use 

7 of such property by the local community con8 cerned. 

9 (B) TREATMENT OF ROADS.—If infra10 structure or a facility of the Veterans Health 

11 Administration to be closed or realigned under 

12 this subtitle includes a road used for public ac13 cess through, into, or around the facility, the 

14 Secretary— 

15 (i) shall consult with the Government 

16 of the State and the heads of the local gov17 ernments concerned for the purpose of con18 sidering the continued availability of the 

19 road for public use after the recommended 

20 action is complete; and 

21 (ii) may exercise the authority of the 

22 Secretary under section 8108 of title 38, 

23 United States Code. 

24 (3) LEASES; CERCLA.— 

25 (A) LEASE AUTHORITY.— 


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1 (i) TRANSFER TO REDEVELOPMENT

2 AUTHORITY FOR LEASE.—The Secretary 

3 may transfer title to a facility of the Vet4 erans Health Administration approved for 

5 closure or realignment under this subtitle 

6 (including property at a facility of the Vet7 erans Health Administration approved for 

8 realignment which will be retained by the 

9 Department of Veterans Affairs or another 

10 Federal agency after realignment) to the 

11 redevelopment authority for the facility if 

12 the redevelopment authority agrees to 

13 lease, directly upon transfer, one or more 

14 portions of the property transferred under 

15 this subparagraph to the Secretary or to 

16 the head of another department or agency 

17 of the Federal Government. 

18 (ii) TERM OF LEASE.—A lease under 

19 clause (i) shall be for a term of not to ex20 ceed 50 years, but may provide for options 

21 for renewal or extension of the term by the 

22 department or agency concerned. 

23 (iii) LIMITATION.—A lease under 

24 clause (i) may not require rental payments 

25 by the United States. 


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1 (iv) TREATMENT OF REMAINDERED

2 LEASE TERMS.—A lease under clause (i) 

3 shall include a provision specifying that if 

4 the department or agency concerned ceases 

5 requiring the use of the leased property be6 fore the expiration of the term of the lease, 

7 the remainder of the lease term may be 

8 satisfied by the same or another depart9 ment or agency of the Federal Government 

10 using the property for a use similar to the 

11 use under the lease. Exercise of the au12 thority provided by this clause shall be 

13 made in consultation with the redevelop14 ment authority concerned. 

15 (v) FACILITY SERVICES.—Notwith16 standing clause (iii), if a lease under clause 

17 (i) involves a substantial portion of the fa18 cility, the department or agency concerned 

19 may obtain facility services for the leased 

20 property and common area maintenance 

21 from the redevelopment authority or the 

22 redevelopment authority’s assignee as a 

23 provision of the lease. The facility services 

24 and common area maintenance shall be 

25 provided at a rate no higher than the rate 


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1 charged to non-Federal tenants of the 

2 transferred property. Facility services and 

3 common area maintenance covered by the 

4 lease shall not include— 

5 (I) municipal services that a 

6 State or local government is required 

7 by law to provide to all landowners in 

8 its jurisdiction without direct charge; 

9 or 

10 (II) firefighting or security-guard 

11 functions. 

12 (B) APPLICATION OF CERCLA.—The provi13 sions of section 120(h) of the Comprehensive 

14 Environmental Response, Compensation, and 

15 Liability Act of 1980 (42 U.S.C. 9620(h)) shall 

16 apply to any transfer of real property under 

17 this paragraph. 

18 (C) ADDITIONAL TERMS AND CONDI19 TIONS.—The Secretary may require any addi20 tional terms and conditions in connection with 

21 a transfer under this paragraph as such Sec22 retary considers appropriate to protect the in23 terests of the United States. 

24 (4) APPLICATION OF MCKINNEY-VENTO HOME25 LESS ASSISTANCE ACT.—Nothing in this subtitle 


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1 shall limit or otherwise affect the application of the 

2 provisions of the McKinney-Vento Homeless Assist3 ance Act (42 U.S.C. 11301 et seq.) to facilities of 

4 the Veterans Health Administration closed under 

5 this subtitle. 

6 (c) APPLICABILITY OF NATIONAL ENVIRONMENTAL

7 POLICY ACT OF 1969.— 

8 (1) IN GENERAL.—The provisions of the Na9 tional Environmental Policy Act of 1969 (42 U.S.C. 

10 4321 et seq.) shall not apply to the actions of the 

11 President, the Commission, and, except as provided 

12 in paragraph (2), the Department of Veterans Af13 fairs in carrying out this subtitle. 

14 (2) DEPARTMENT OF VETERANS AFFAIRS.— 

15 (A) COVERED ACTIVITIES.—The provisions 

16 of the National Environmental Policy Act of 

17 1969 shall apply to actions of the Department 

18 of Veterans Affairs under this subtitle— 

19 (i) during the process of property dis20 posal; and 

21 (ii) during the process of relocating 

22 functions from a facility of the Veterans 

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1 ing facility has been selected but before the 

2 functions are relocated. 

3 (B) OTHER ACTIVITIES.—In applying the 

4 provisions of the National Environmental Policy 

5 Act of 1969 to the processes referred to in sub6 paragraph (A), the Secretary shall not have to 

7 consider— 

8 (i) the need for closing or realigning 

9 the facility of the Veterans Health Admin10 istration as recommended by the Commis11 sion; 

12 (ii) the need for transferring functions 

13 to any facility of the Veterans Health Ad14 ministration which has been selected as the 

15 receiving facility; or 

16 (iii) facilities of the Veterans Health 

17 Administration alternative to those rec18 ommended or selected. 

19 (d) WAIVER.— 

20 (1) RESTRICTIONS ON USE OF FUNDS.—The 

21 Secretary may close or realign facilities of the Vet22 erans Health Administration under this subtitle 

23 without regard to any provision of law restricting 

24 the use of funds for closing or realigning facilities of 


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1 the Veterans Health Administration included in any 

2 appropriation or authorization Act. 

3 (2) RESTRICTIONS ON AUTHORITIES.—The Sec4 retary may close or realign facilities of the Veterans 

5 Health Administration under this subtitle without 

6 regard to the restrictions of section 8110 of title 38, 

7 United States Code. 

8 (e) TRANSFER AUTHORITY IN CONNECTION WITH

9 PAYMENT OF ENVIRONMENTAL REMEDIATION COSTS.— 

10 (1) IN GENERAL.— 

11 (A) TRANSFER BY DEED.—Subject to 

12 paragraph (2) of this subsection and section 

13 120(h) of the Comprehensive Environmental 

14 Response, Compensation, and Liability Act of 

15 1980 (42 U.S.C. 9620(h)), the Secretary may 

16 enter into an agreement to transfer by deed a 

17 facility of the Veterans Health Administration 

18 with any person who agrees to perform all envi19 ronmental restoration, waste management, and 

20 environmental compliance activities that are re21 quired for the property or facilities under Fed22 eral and State laws, administrative decisions, 

23 agreements (including schedules and mile24 stones), and concurrences. 


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1 (B) ADDITIONAL TERMS OR CONDI2 TIONS.—The Secretary may require any addi3 tional terms and conditions in connection with 

4 an agreement authorized by subparagraph (A) 

5 as the Secretary considers appropriate to pro6 tect the interests of the United States. 

7 (2) LIMITATION.—A transfer of a facility of the 

8 Veterans Health Administration may be made under 

9 paragraph (1) only if the Secretary certifies to Con10 gress that— 

11 (A) the costs of all environmental restora12 tion, waste management, and environmental 

13 compliance activities otherwise to be paid by the 

14 Secretary with respect to the facility of the Vet15 erans Health Administration are equal to or 

16 greater than the fair market value of the prop17 erty or facilities to be transferred, as deter18 mined by the Secretary; or 

19 (B) if such costs are lower than the fair 

20 market value of the facility of the Veterans 

21 Health Administration, the recipient of such 

22 transfer agrees to pay the difference between 

23 the fair market value and such costs. 

24 (3) PAYMENT BY THE SECRETARY FOR CER25 TAIN TRANSFERS.—In the case of a facility of the 


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1 Veterans Health Administration covered by a certifi2 cation under paragraph (2)(A), the Secretary may 

3 pay the recipient of such facility an amount equal to 

4 the lesser of— 

5 (A) the amount by which the costs in6 curred by the recipient of the facility of the 

7 Veterans Health Administration for all environ8 mental restoration, waste, management, and en9 vironmental compliance activities with respect 

10 to such facility exceed the fair market value of 

11 such property as specified in such certification; 

12 or 

13 (B) the amount by which the costs (as de14 termined by the Secretary) that would other15 wise have been incurred by the Secretary for 

16 such restoration, management, and activities 

17 with respect to such facility of the Veterans 

18 Health Administration exceed the fair market 

19 value of property as so specified. 

20 (4) DISCLOSURE.—As part of an agreement 

21 under paragraph (1), the Secretary shall disclose to 

22 the person to whom the facility of the Veterans 

23 Health Administration will be transferred any infor24 mation of the Secretary regarding the environmental 

25 restoration, waste management, and environmental 


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1 compliance activities described in paragraph (1) that 

2 relate to the facility of the Veterans Health Admin3 istration. The Secretary shall provide such informa4 tion before entering into the agreement. 

5 (5) APPLICABILITY OF CERTAIN ENVIRON6 MENTAL LAWS.—Nothing in this subsection shall be 

7 construed to modify, alter, or amend the Com8 prehensive Environmental Response, Compensation, 

9 and Liability Act of 1980 (42 U.S.C. 9601 et seq.) 

10 or the Solid Waste Disposal Act (42 U.S.C. 6901 et 

11 seq.). 

12 SEC. 206. DEPARTMENT OF VETERANS AFFAIRS ASSET AND 

13 INFRASTRUCTURE REVIEW ACCOUNT. 

14 (a) ESTABLISHMENT.—There is hereby established in 

15 the ledgers of the Treasury an account to be known as 

16 the ‘‘Department of Veterans Affairs Asset and Infra17 structure Review Account’’ which shall be administered by 

18 the Secretary as a single account. 

19 (b) CREDITS TO ACCOUNT.—There shall be credited 

20 to the Account the following: 

21 (1) Funds authorized for and appropriated to 

22 the Account. 

23 (2) Proceeds received from the lease, transfer, 

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1 erans Health Administration closed or realigned 

2 under this subtitle. 

3 (c) USE OF ACCOUNT.—The Secretary may use the 

4 funds in the Account only for the following purposes: 

5 (1) To carry out this subtitle. 

6 (2) To cover property management and disposal 

7 costs incurred at facilities of the Veterans Health 

8 Administration closed, modernized, or realigned 

9 under this subtitle. 

10 (3) To cover costs associated with supervision, 

11 inspection, overhead, engineering, and design of con12 struction projects undertaken under this subtitle, 

13 and subsequent claims, if any, related to such activi14 ties. 

15 (4) Other purposes that the Secretary deter16 mines support the mission and operations of the De17 partment of Veterans Affairs. 

18 (d) CONSOLIDATED BUDGET JUSTIFICATION DIS19 PLAY FOR ACCOUNT.— 

20 (1) CONSOLIDATED BUDGET INFORMATION RE21 QUIRED.—The Secretary shall establish a consoli22 dated budget justification display in support of the 

23 Account that for each fiscal year— 


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1 (A) details the amount and nature of cred2 its to, and expenditures from, the Account dur3 ing the preceding fiscal year; 

4 (B) separately details the environmental 

5 remediation costs associated with facility of the 

6 Veterans Health Administration for which a 

7 budget request is made; 

8 (C) specifies the transfers into the Account 

9 and the purposes for which these transferred 

10 funds will be further obligated, to include care11 taker and environment remediation costs associ12 ated with each facility of the Veterans Health 

13 Administration; and 

14 (D) details any intra-budget activity trans15 fers within the Account that exceeded 

16 $1,000,000 during the preceding fiscal year or 

17 that are proposed for the next fiscal year and 

18 will exceed $1,000,000. 

19 (2) SUBMISSION.—The Secretary shall include 

20 the information required by paragraph (1) in the 

21 materials that the Secretary submits to Congress in 

22 support of the budget for a fiscal year submitted by 

23 the President pursuant to section 1105 of title 31, 

24 United States Code. 


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1 (e) CLOSURE OF ACCOUNT; TREATMENT OF REMAIN2 ING FUNDS.— 

3 (1) CLOSURE.—The Account shall be closed at 

4 the time and in the manner provided for appropria5 tion accounts under section 1555 of title 31, United 

6 States Code, except that unobligated funds which re7 main in the Account upon closure shall be held by 

8 the Secretary of the Treasury until transferred to 

9 the Secretary of Veterans Affairs by law after the 

10 Committees on Veterans’ Affairs of the Senate and 

11 the House of Representatives receive the final report 

12 transmitted under paragraph (2). 

13 (2) FINAL REPORT.—No later than 60 days 

14 after the closure of the Account under paragraph 

15 (1), the Secretary shall transmit to the Committees 

16 on Veterans’ Affairs of the Senate and the House of 

17 Representatives and the Committees on Appropria18 tions of the House of Representatives and the Sen19 ate a report containing an accounting of— 

20 (A) all the funds credited to and expended 

21 from the Account or otherwise expended under 

22 this subtitle; and 

23 (B) any funds remaining in the Account. 


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1 SEC. 207. CONGRESSIONAL CONSIDERATION OF COMMIS2 SION REPORT. 

3 (a) DISAPPROVAL RESOLUTION.—For purposes of 

4 section 204(b), the term ‘‘joint resolution’’ means only a 

5 joint resolution which is introduced within the 5-day pe6 riod beginning on the date on which the President trans7 mits the report to the Congress under section 203(d), 

8 and— 

9 (1) which does not have a preamble; 

10 (2) the matter after the resolving clause of 

11 which is as follows: ‘‘that Congress disapproves the 

12 recommendations of the VHA Asset and Infrastruc13 ture Review Commission as submitted by the Presi14 dent on lll’’, the blank space being filled with 

15 the appropriate date; and 

16 (3) the title of which is as follows: ‘‘Joint reso17 lution disapproving the recommendations of the 

18 VHA Asset and Infrastructure Review Commis19 sion.’’. 

20 (b) CONSIDERATION IN THE HOUSE OF REPRESENT21 ATIVES.— 

22 (1) REPORTING AND DISCHARGE.—Any com23 mittee of the House of Representatives to which a 

24 joint resolution is referred shall report it to the 

25 House without amendment not later than 15 legisla26 tive days after the date of introduction thereof. If a 


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1 committee fails to report the joint resolution within 

2 that period, the committee shall be discharged from 

3 further consideration of the joint resolution. 

4 (2) PROCEEDING TO CONSIDERATION.—It shall 

5 be in order at any time after the third legislative day 

6 after each committee authorized to consider a joint 

7 resolution has reported or has been discharged from 

8 consideration of a joint resolution, to move to pro9 ceed to consider the joint resolution in the House. 

10 All points of order against the motion are waived. 

11 Such a motion shall not be in order after the House 

12 has disposed of a motion to proceed on a joint reso13 lution addressing a particular submission. The pre14 vious question shall be considered as ordered on the 

15 motion to its adoption without intervening motion. 

16 The motion shall not be debatable. A motion to re17 consider the vote by which the motion is disposed of 

18 shall not be in order. 

19 (3) CONSIDERATION.—The joint resolution 

20 shall be considered as read. All points of order 

21 against the joint resolution and against its consider22 ation are waived. The previous question shall be con23 sidered as ordered on the joint resolution to its pas24 sage without intervening motion except two hours of 

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1 ponent and an opponent. A motion to reconsider the 

2 vote on passage of the joint resolution shall not be 

3 in order. 

4 (c) CONSIDERATION IN THE SENATE.— 

5 (1) REFERRAL.—A joint resolution introduced 

6 in the Senate shall be referred to the Committee on 

7 Veterans’ Affairs. 

8 (2) REPORTING AND DISCHARGE.—Any com9 mittee of the Senate to which a joint resolution is 

10 referred shall report it to the Senate without amend11 ment not later than 15 session days after the date 

12 of introduction of a joint resolution described in sub13 section (a). If a committee fails to report the joint 

14 resolution within that period, the committee shall be 

15 discharged from further consideration of the joint 

16 resolution and the joint resolution shall be placed on 

17 the calendar. 

18 (3) FLOOR CONSIDERATION.— 

19 (A) IN GENERAL.—Notwithstanding Rule 

20 XXII of the Standing Rules of the Senate, it is 

21 in order at any time after the third session day 

22 on which the Committee on Veterans’ Affairs 

23 has reported or has been discharged from con24 sideration of a joint resolution described in sub25 section (a) (even though a previous motion to 


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1 the same effect has been disagreed to) to move 

2 to proceed to the consideration of the joint reso3 lution, and all points of order against the joint 

4 resolution (and against consideration of the 

5 joint resolution) are waived. The motion to pro6 ceed is not debatable. The motion is not subject 

7 to a motion to postpone. A motion to reconsider 

8 the vote by which the motion is agreed to or 

9 disagreed to shall not be in order. If a motion 

10 to proceed to the consideration of the resolution 

11 is agreed to, the joint resolution shall remain 

12 the unfinished business until disposed of. 

13 (B) CONSIDERATION.—Consideration of 

14 the joint resolution, and on all debatable mo15 tions and appeals in connection therewith, shall 

16 be limited to not more than 2 hours, which 

17 shall be divided equally between the majority 

18 and minority leaders or their designees. A mo19 tion further to limit debate is in order and not 

20 debatable. An amendment to, or a motion to 

21 postpone, or a motion to proceed to the consid22 eration of other business, or a motion to recom23 mit the joint resolution is not in order. 

24 (C) VOTE ON PASSAGE.—If the Senate has 

25 voted to proceed to a joint resolution, the vote 


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1 on passage of the joint resolution shall occur 

2 immediately following the conclusion of consid3 eration of the joint resolution, and a single 

4 quorum call at the conclusion of the debate if 

5 requested in accordance with the rules of the 

6 Senate. 

7 (D) RULINGS OF THE CHAIR ON PROCE8 DURE.—Appeals from the decisions of the Chair 

9 relating to the application of the rules of the 

10 Senate, as the case may be, to the procedure re11 lating to a joint resolution shall be decided 

12 without debate. 

13 (d) AMENDMENT NOT IN ORDER.—A joint resolution 

14 of disapproval considered pursuant to this section shall not 

15 be subject to amendment in either the House of Rep16 resentatives or the Senate. 

17 (e) COORDINATION WITH ACTION BY OTHER

18 HOUSE.— 

19 (1) IN GENERAL.—If, before passing the joint 

20 resolution, one House receives from the other a joint 

21 resolution— 

22 (A) the joint resolution of the other House 

23 shall not be referred to a committee; and 

24 (B) the procedure in the receiving House 

25 shall be the same as if no joint resolution had 


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1 been received from the other House until the 

2 vote on passage, when the joint resolution re3 ceived from the other House shall supplant the 

4 joint resolution of the receiving House. 

5 (2) TREATMENT OF JOINT RESOLUTION OF

6 OTHER HOUSE.—If the Senate fails to introduce or 

7 consider a joint resolution under this section, the 

8 joint resolution of the House shall be entitled to ex9 pedited floor procedures under this section. 

10 (3) TREATMENT OF COMPANION MEASURES.— 

11 If, following passage of the joint resolution in the 

12 Senate, the Senate then receives the companion 

13 measure from the House of Representatives, the 

14 companion measure shall not be debatable. 

15 (f) RULES OF THE HOUSE OF REPRESENTATIVES

16 AND SENATE.—This section is enacted by Congress— 

17 (1) as an exercise of the rulemaking power of 

18 the Senate and House of Representatives, respec19 tively, and as such it is deemed a part of the rules 

20 of each House, respectively, but applicable only with 

21 respect to the procedure to be followed in that 

22 House in the case of a joint resolution, and it super23 sedes other rules only to the extent that it is incon24 sistent with such rules; and 


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1 (2) with full recognition of the constitutional 

2 right of either House to change the rules (so far as 

3 relating to the procedure of that House) at any time, 

4 in the same manner, and to the same extent as in 

5 the case of any other rule of that House. 

6 SEC. 208. OTHER MATTERS. 

7 (a) ONLINE PUBLICATION OF COMMUNICATIONS.— 

8 (1) IN GENERAL.—Not later than 24 hours 

9 after the transmission or receipt of any communica10 tion under this subtitle that is transmitted or re11 ceived by a party specified in paragraph (2), the 

12 Secretary of Veterans Affairs shall publish such 

13 communication online. 

14 (2) PARTIES SPECIFIED.—The parties specified 

15 under this paragraph are the following: 

16 (A) The Secretary of Veterans Affairs. 

17 (B) The Commission. 

18 (C) The President. 

19 (b) CONTINUATION OF EXISTING CONSTRUCTION

20 PROJECTS AND PLANNING.—During activities that the 

21 Commission, President, or Congress carry out under this 

22 subtitle, the Secretary of Veterans Affairs may not stop, 

23 solely because of such activities— 

24 (1) a construction or leasing project of the Vet25 erans Health Administration; 


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1 (2) long term planning regarding infrastructure 

2 and assets of the Veterans Health Administration; 

3 or 

4 (3) budgetary processes for the Veterans 

5 Health Administration. 

6 (c) RECOMMENDATIONS FOR FUTURE ASSET RE7 VIEWS.—The Secretary of Veterans Affairs may, after 

8 consulting with veterans service organizations, include in 

9 budget submissions the Secretary submits after the termi10 nation of the Commission recommendations for future 

11 such commissions or other capital asset realignment and 

12 management processes. 

13 SEC. 209. DEFINITIONS. 

14 In this subtitle: 

15 (1) The term ‘‘Account’’ means the Department 

16 of Veterans Affairs Asset and Infrastructure Review 

17 Account established by section 206(a). 

18 (2) The term ‘‘Commission’’ means the Com19 mission established by section 202. 

20 (3) The term ‘‘date of approval’’, with respect 

21 to a modernization or realignment of a facility of the 

22 Veterans Health Administration, means the date on 

23 which the authority of Congress to disapprove a rec24 ommendation of modernization or realignment, as 


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1 the case may be, of such facility under this subtitle 

2 expires. 

3 (4) The term ‘‘facility of the Veterans Health 

4 Administration’’— 

5 (A) means any land, building, structure, or 

6 infrastructure (including any medical center, 

7 nursing home, domiciliary facility, outpatient 

8 clinic, center that provides readjustment coun9 seling, or leased facility) that is— 

10 (i) under the jurisdiction of the De11 partment of Veterans Affairs; 

12 (ii) under the control of the Veterans 

13 Health Administration; and 

14 (iii) not under the control of the Gen15 eral Services Administration; or 

16 (B) with respect to a colocated facility of 

17 the Department of Veterans Affairs, includes 

18 any land, building, or structure— 

19 (i) under the jurisdiction of the De20 partment of Veterans Affairs; 

21 (ii) under the control of another ad22 ministration of the Department of Vet23 erans Affairs; and 

24 (iii) not under the control of the Gen25 eral Services Administration. 


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1 (5) The term ‘‘infrastructure’’ means improve2 ments to land other than buildings or structures. 

3 (6) The term ‘‘modernization’’ includes— 

4 (A) any action, including closure, required 

5 to align the form and function of a facility of 

6 the Veterans Health Administration to the pro7 vision of modern day health care, including util8 ities and environmental control systems; 

9 (B) the construction, purchase, lease, or 

10 sharing of a facility of the Veterans Health Ad11 ministration; and 

12 (C) realignments, disposals, exchanges, col13 laborations between the Department of Vet14 erans Affairs and other Federal entities, and 

15 strategic collaborations between the Depart16 ment and non-Federal entities, including tribal 

17 organizations. 

18 (7) The term ‘‘realignment’’, with respect to a 

19 facility of the Veterans Health Administration, in20 cludes— 

21 (A) any action that changes the numbers 

22 of or relocates services, functions, and per23 sonnel positions; 

24 (B) disposals or exchanges between the 

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1 eral entities, including the Department of De2 fense; and 

3 (C) strategic collaborations between the 

4 Department of Veterans Affairs and non-Fed5 eral entities, including tribal organizations. 

6 (8) The term ‘‘redevelopment authority’’, in the 

7 case of a facility of the Veterans Health Administra8 tion closed or modernized under this subtitle, means 

9 any entity (including an entity established by a 

10 State or local government) recognized by the Sec11 retary of Veterans Affairs as the entity responsible 

12 for developing the redevelopment plan with respect 

13 to the facility or for directing the implementation of 

14 such plan. 

15 (9) The term ‘‘redevelopment plan’’ in the case 

16 of a facility of the Veterans Health Administration 

17 to be closed or realigned under this subtitle, means 

18 a plan that— 

19 (A) is agreed to by the local redevelopment 

20 authority with respect to the facility; and 

21 (B) provides for the reuse or redevelop22 ment of the real property and personal property 

23 of the facility that is available for such reuse 

24 and redevelopment as a result of the closure or 

25 realignment of the facility. 


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1 (10) The term ‘‘Secretary’’ means the Secretary 

2 of Veterans Affairs. 

3 (11) The term ‘‘tribal organization’’ has the 

4 meaning given such term in section 3765 of title 38, 

5 United States Code. 

6 Subtitle B—Other Infrastructure 

7 Matters 

8 SEC. 211. IMPROVEMENT TO TRAINING OF CONSTRUCTION 

9 PERSONNEL. 

10 Subsection (g) of section 8103 of title 38, United 

11 States Code, is amended to read as follows: 

12 ‘‘(g)(1)(A) Not later than September 30 of the fiscal 

13 year following the fiscal year during which the VA Asset 

14 and Infrastructure Review Act of 2018 is enacted, the Sec15 retary shall implement the covered training curriculum 

16 and the covered certification program. 

17 ‘‘(B) In designing and implementing the covered 

18 training curriculum and the covered certification program 

19 under paragraph (1), the Secretary shall use as models 

20 existing training curricula and certification programs that 

21 have been established under chapter 87 of title 10, United 

22 States Code, as determined relevant by the Secretary. 

23 ‘‘(2) The Secretary may develop the training cur24 riculum under paragraph (1)(A) in a manner that provides 

25 such training in any combination of— 


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1 ‘‘(A) training provided in person; 

2 ‘‘(B) training provided over an internet website; 

3 or 

4 ‘‘(C) training provided by another department 

5 or agency of the Federal Government. 

6 ‘‘(3) The Secretary may develop the certification pro7 gram under paragraph (1)(A) in a manner that uses— 

8 ‘‘(A) one level of certification; or 

9 ‘‘(B) more than one level of certification, as de10 termined appropriate by the Secretary with respect 

11 to the level of certification for different grades of the 

12 General Schedule. 

13 ‘‘(4) The Secretary may enter into a contract with 

14 an appropriate entity to provide the covered training cur15 riculum and the covered certification program under para16 graph (1)(A). 

17 ‘‘(5)(A) Not later than September 30 of the second 

18 fiscal year following the fiscal year during which the VA 

19 Asset and Infrastructure Review Act of 2018 is enacted, 

20 the Secretary shall ensure that the majority of employees 

21 subject to the covered certification program achieve the 

22 certification or the appropriate level of certification pursu23 ant to paragraph (3), as the case may be. 

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1 ered certification program achieves the certification or the 

2 appropriate level of certification pursuant to paragraph 

3 (3), as the case may be, as quickly as practicable. 

4 ‘‘(6) In this subsection: 

5 ‘‘(A) The term ‘covered certification program’ 

6 means, with respect to employees of the Department 

7 of Veterans Affairs who are members of occupational 

8 series relating to construction or facilities manage9 ment, or employees of the Department who award or 

10 administer contracts for major construction, minor 

11 construction, or nonrecurring maintenance, including 

12 as contract specialists or contracting officers’ rep13 resentatives, a program to certify knowledge and 

14 skills relating to construction or facilities manage15 ment and to ensure that such employees maintain 

16 adequate expertise relating to industry standards 

17 and best practices for the acquisition of design and 

18 construction services. 

19 ‘‘(B) The term ‘covered training curriculum’ 

20 means, with respect to employees specified in sub21 paragraph (A), a training curriculum relating to 

22 construction or facilities management.’’. 

23 SEC. 212. REVIEW OF ENHANCED USE LEASES. 

24 Section 8162(b)(6) is amended to read as follows: 


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1 ‘‘(6) The Office of Management and Budget shall re2 view each enhanced-use lease before the lease goes into 

3 effect to determine whether the lease is in compliance with 

4 paragraph (5).’’. 

5 SEC. 213. ASSESSMENT OF HEALTH CARE FURNISHED BY 

6 THE DEPARTMENT TO VETERANS WHO LIVE 

7 IN THE PACIFIC TERRITORIES. 

8 (a) IN GENERAL.—Not later than 180 days after the 

9 date of the enactment of this Act, the Secretary of Vet10 erans Affairs shall submit to the Committees on Veterans’ 

11 Affairs of the Senate and the House of Representatives 

12 a report regarding health care furnished by the Depart13 ment of Veterans Affairs to veterans who live in the Pa14 cific territories. 

15 (b) ELEMENTS.—The report under subsection (a) 

16 shall include assessments of the following: 

17 (1) The ability of the Department to furnish to 

18 veterans who live in the Pacific territories the fol19 lowing: 

20 (A) Hospital care. 

21 (B) Medical services. 

22 (C) Mental health services. 

23 (D) Geriatric services. 


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1 (2) The feasibility of establishing a community2 based outpatient clinic of the Department in any Pa3 cific territory that does not contain such a facility. 

4 (c) DEFINITION.—In this section, the term ‘‘Pacific 

5 territories’’ means American Samoa, Guam, and the 

6 Northern Mariana Islands. 

7 TITLE III—IMPROVEMENTS TO 

8 RECRUITMENT OF HEALTH 

9 CARE PROFESSIONALS 

10 SEC. 301. DESIGNATED SCHOLARSHIPS FOR PHYSICIANS 

11 AND DENTISTS UNDER DEPARTMENT OF VET12 ERANS AFFAIRS HEALTH PROFESSIONAL 

13 SCHOLARSHIP PROGRAM. 

14 (a) SCHOLARSHIPS FOR PHYSICIANS AND DEN15 TISTS.—Section 7612(b) of title 38, United States Code, 

16 is amended by adding at the end the following new para17 graph: 

18 ‘‘(6)(A) Of the scholarships awarded under this sub19 chapter, the Secretary shall ensure that not less than 50 

20 scholarships are awarded each year to individuals who are 

21 accepted for enrollment or enrolled (as described in section 

22 7602 of this title) in a program of education or training 

23 leading to employment as a physician or dentist until such 

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1 age of physicians and dentists in the Department is less 

2 than 500. 

3 ‘‘(B) After such date, the Secretary shall ensure that 

4 of the scholarships awarded under this subchapter, a num5 ber of scholarships is awarded each year to individuals re6 ferred to in subparagraph (A) in an amount equal to not 

7 less than ten percent of the staffing shortage of physicians 

8 and dentists in the Department, as determined by the Sec9 retary. 

10 ‘‘(C) Notwithstanding subsection (c)(1), the agree11 ment between the Secretary and a participant in the 

12 Scholarship Program who receives a scholarship pursuant 

13 to this paragraph shall provide the following: 

14 ‘‘(i) The Secretary’s agreement to provide the 

15 participant with a scholarship under this subchapter 

16 for a specified number (from two to four) of school 

17 years during which the participant is pursuing a 

18 course of education or training leading to employ19 ment as a physician or dentist. 

20 ‘‘(ii) The participant’s agreement to serve as a 

21 full-time employee in the Veterans Health Adminis22 tration for a period of time (hereinafter in this sub23 chapter referred to as the ‘period of obligated serv24 ice’) of 18 months for each school year or part 


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1 thereof for which the participant was provided a 

2 scholarship under the Scholarship Program. 

3 ‘‘(D) In providing scholarships pursuant to this para4 graph, the Secretary may provide a preference for appli5 cants who are veterans. 

6 ‘‘(E) On an annual basis, the Secretary shall provide 

7 to appropriate educational institutions informational ma8 terial about the availability of scholarships under this 

9 paragraph.’’. 

10 (b) BREACH OF AGREEMENT.—Section 7617 of such 

11 title is amended— 

12 (1) by redesignating paragraphs (4) and (5) as 

13 paragraphs (5) and (6), respectively; and 

14 (2) by inserting after paragraph (3) the fol15 lowing new paragraph (4): 

16 ‘‘(4) In the case of a participant who is enrolled 

17 in a program or education or training leading to em18 ployment as a physician, the participant fails to suc19 cessfully complete post-graduate training leading to 

20 eligibility for board certification in a specialty.’’. 

21 (c) EXTENSION OF PROGRAM.—Section 7619 of such 

22 title is amended by striking ‘‘December 31, 2019’’ and in23 serting ‘‘December 31, 2033’’. 


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1 SEC. 302. INCREASE IN MAXIMUM AMOUNT OF DEBT THAT 

2 MAY BE REDUCED UNDER EDUCATION DEBT 

3 REDUCTION PROGRAM OF DEPARTMENT OF 

4 VETERANS AFFAIRS. 

5 (a) INCREASE IN AMOUNT.—Section 7683(d)(1) is 

6 amended— 

7 (1) by striking ‘‘$120,000’’ and inserting 

8 ‘‘$200,000’’; and 

9 (2) by striking ‘‘$24,000’’ and inserting 

10 ‘‘$40,000’’. 

11 (b) STUDY.— 

12 (1) IN GENERAL.—Not later than one year 

13 after the date of the enactment of this Act, the Sec14 retary of Veterans Affairs shall— 

15 (A) conduct a study on the demand for 

16 education debt reduction under subchapter VII 

17 of chapter 76 of title 38, United States Code; 

18 and 

19 (B) submit to the Committee on Veterans’ 

20 Affairs of the Senate and the Committee on 

21 Veterans’ Affairs of the House of Representa22 tives a report on the findings of the Secretary 

23 with respect to the study carried out under sub24 paragraph (A). 


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1 (2) CONSIDERATIONS.—In carrying out the 

2 study required by paragraph (1)(A), the Secretary 

3 shall consider the following: 

4 (A) The total number of vacancies within 

5 the Veterans Health Administration whose ap6 plicants are eligible to participate in the Edu7 cation Debt Reduction Program pursuant to 

8 section 7682(a) of such title. 

9 (B) The types of medical professionals in 

10 greatest demand in the United States. 

11 (C) Projections by the Secretary of the 

12 numbers and types of medical professions that 

13 meet the needs of veterans. 

14 SEC. 303. ESTABLISHING THE DEPARTMENT OF VETERANS 

15 AFFAIRS SPECIALTY EDUCATION LOAN RE16 PAYMENT PROGRAM. 

17 (a) IN GENERAL.—Chapter 76 of title 38, United 

18 States Code, is amended by inserting after subchapter VII 

19 the following new subchapter: 

20 ‘‘SUBCHAPTER VIII—SPECIALTY EDUCATION 

21 LOAN REPAYMENT PROGRAM 

22 ‘‘§ 7691. Establishment 

23 ‘‘As part of the Educational Assistance Program, the 

24 Secretary may carry out a student loan repayment pro25 gram under section 5379 of title 5. The program shall be 


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1 known as the Department of Veterans Affairs Specialty 

2 Education Loan Repayment Program (in this chapter re3 ferred to as the ‘Specialty Education Loan Repayment 

4 Program’). 

5 ‘‘§ 7692. Purpose 

6 ‘‘The purpose of the Specialty Education Loan Re7 payment Program is to assist, through the establishment 

8 of an incentive program for certain individuals employed 

9 in the Veterans Health Administration, in meeting the 

10 staffing needs of the Veterans Health Administration for 

11 physicians in medical specialties for which the Secretary 

12 determines recruitment or retention of qualified personnel 

13 is difficult. 

14 ‘‘§ 7693. Eligibility; preferences; covered costs 

15 ‘‘(a) ELIGIBILITY.—An individual is eligible to par16 ticipate in the Specialty Education Loan Repayment Pro17 gram if the individual— 

18 ‘‘(1) is hired under section 7401 of this title to 

19 work in an occupation described in section 7692 of 

20 this title; 

21 ‘‘(2) owes any amount of principal or interest 

22 under a loan, the proceeds of which were used by or 

23 on behalf of that individual to pay costs relating to 

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1 gree that qualified the individual for the position re2 ferred to in paragraph (1); and 

3 ‘‘(3) is— 

4 ‘‘(A) recently graduated from an accredited 

5 medical or osteopathic school and matched to 

6 an accredited residency program in a medical 

7 specialty described in section 7692 of this title; 

8 or 

9 ‘‘(B) a physician in training in a medical 

10 specialty described in section 7692 of this title 

11 with more than two years remaining in such 

12 training. 

13 ‘‘(b) PREFERENCES.—In selecting individuals for 

14 participation in the Specialty Education Loan Repayment 

15 Program under this subchapter, the Secretary may give 

16 preference to the following: 

17 ‘‘(1) Individuals who are, or will be, partici18 pating in residency programs in health care facili19 ties— 

20 ‘‘(A) located in rural areas; 

21 ‘‘(B) operated by Indian tribes, tribal orga22 nizations, or the Indian Health Service; or 

23 ‘‘(C) affiliated with underserved health 

24 care facilities of the Department. 

25 ‘‘(2) Veterans. 


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1 ‘‘(c) COVERED COSTS.—For purposes of subsection 

2 (a)(2), costs relating to a course of education or training 

3 include— 

4 ‘‘(1) tuition expenses; 

5 ‘‘(2) all other reasonable educational expenses, 

6 including expenses for fees, books, equipment, and 

7 laboratory expenses; and 

8 ‘‘(3) reasonable living expenses. 

9 ‘‘§ 7694. Specialty education loan repayment 

10 ‘‘(a) IN GENERAL.—Payments under the Specialty 

11 Education Loan Repayment Program shall consist of pay12 ments for the principal and interest on loans described in 

13 section 7682(a)(2) of this title for individuals selected to 

14 participate in the Program to the holders of such loans. 

15 ‘‘(b) FREQUENCY OF PAYMENT.—The Secretary 

16 shall make payments for any given participant in the Spe17 cialty Education Loan Repayment Program on a schedule 

18 determined appropriate by the Secretary. 

19 ‘‘(c) MAXIMUM AMOUNT; WAIVER.—(1) The amount 

20 of payments made for a participant under the Specialty 

21 Education Loan Repayment Program may not exceed 

22 $160,000 over a total of four years of participation in the 

23 Program, of which not more than $40,000 of such pay24 ments may be made in each year of participation in the 

25 Program. 


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1 ‘‘(2)(A) The Secretary may waive the limitations 

2 under paragraph (1) in the case of a participant described 

3 in subparagraph (B). In the case of such a waiver, the 

4 total amount of payments payable to or for that partici5 pant is the total amount of the principal and the interest 

6 on the participant’s loans referred to in subsection (a). 

7 ‘‘(B) A participant described in this subparagraph is 

8 a participant in the Program who the Secretary deter9 mines serves in a position for which there is a shortage 

10 of qualified employees by reason of either the location or 

11 the requirements of the position. 

12 ‘‘§ 7695. Choice of location 

13 ‘‘Each participant in the Specialty Education Loan 

14 Repayment Program who completes residency may select, 

15 from a list of medical facilities of the Veterans Health Ad16 ministration provided by the Secretary, at which such fa17 cility the participant will work in a medical specialty de18 scribed in section 7692 of this title. 

19 ‘‘§ 7696. Term of obligated service 

20 ‘‘(a) IN GENERAL.—In addition to any requirements 

21 under section 5379(c) of title 5, a participant in the Spe22 cialty Education Loan Repayment Program must agree, 

23 in writing and before the Secretary may make any pay24 ment to or for the participant, to— 


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1 ‘‘(1) obtain a license to practice medicine in a 

2 State; 

3 ‘‘(2) successfully complete post-graduate train4 ing leading to eligibility for board certification in a 

5 specialty; 

6 ‘‘(3) serve as a full-time clinical practice em7 ployee of the Veterans Health Administration for 12 

8 months for every $40,000 in such benefits that the 

9 employee receives, but in no case for fewer than 24 

10 months; and 

11 ‘‘(4) except as provided in subsection (b), to 

12 begin such service as a full-time practice employee 

13 by not later than 60 days after completing a resi14 dency. 

15 ‘‘(b) FELLOWSHIP.—In the case of a participant who 

16 receives an accredited fellowship in a medical specialty 

17 other than a medical specialty described in section 7692 

18 of this title, the Secretary, on written request of the par19 ticipant, may delay the term of obligated service under 

20 subsection (a) for the participant until after the partici21 pant completes the fellowship, but in no case later than 

22 60 days after completion of such fellowship. 

23 ‘‘(c) PENALTY.—(1) An employee who does not com24 plete a period of obligated service under this section shall 

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1 cordance with the following formula: A = B × ((T ¥ S) 

2 ÷ T)). 

3 ‘‘(2) In the formula in paragraph (1): 

4 ‘‘(A) ‘A’ is the amount the employee owes the 

5 Federal Government. 

6 ‘‘(B) ‘B’ is the sum of all payments to or for 

7 the participant under the Specialty Education Loan 

8 Repayment Program. 

9 ‘‘(C) ‘T’ is the number of months in the period 

10 of obligated service of the employee. 

11 ‘‘(D) ‘S’ is the number of whole months of such 

12 period of obligated service served by the employee. 

13 ‘‘§ 7697. Relationship to Educational Assistance Pro14 gram 

15 ‘‘Assistance under the Specialty Education Loan Re16 payment Program may be in addition to other assistance 

17 available to individuals under the Educational Assistance 

18 Program.’’. 

19 (b) CONFORMING AND TECHNICAL AMENDMENTS.— 

20 (1) CONFORMING AMENDMENTS.— 

21 (A) Section 7601(a) of title 38, United 

22 States Code, is amended— 

23 (i) in paragraph (4), by striking 

24 ‘‘and’’; 


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1 (ii) in paragraph (5), by striking the 

2 period and inserting ‘‘; and’’; and 

3 (iii) by adding at the end the fol4 lowing new paragraph: 

5 ‘‘(6) the specialty education loan repayment 

6 program provided for in subchapter VIII of this 

7 chapter.’’. 

8 (B) Section 7603(a)(1) of title 38, United 

9 States Code, is amended by striking ‘‘or VI’’ 

10 and inserting ‘‘VI, or VIII’’. 

11 (C) Section 7604 of title 38, United States 

12 Code, is amended by striking ‘‘or VI’’ each 

13 place it appears and inserting ‘‘VI, or VIII’’. 

14 (D) Section 7631 of title 38, United States 

15 Code, is amended— 

16 (i) in subsection (a)(1)— 

17 (I) by striking ‘‘and’’ after 

18 ‘‘scholarship amount’’; and 

19 (II) by inserting ‘‘, and the max20 imum specialty education loan repay21 ment amount’’ after ‘‘reduction pay22 ments amount’’; and 

23 (ii) in subsection (b) by adding at the 

24 end the following new paragraph: 


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1 ‘‘(7) The term ‘specialty education loan repayment 

2 amount’ means the maximum amount of specialty edu3 cation loan repayment payments payable to or for a partic4 ipant in the Department of Veterans Affairs Specialty 

5 Education Loan Repayment Program under subchapter 

6 VIII of this chapter, as specified in section 7694(c)(1) of 

7 this title and as previously adjusted (if at all) in accord8 ance with this section.’’. 

9 (E) Section 7632 of title 38, United States 

10 Code, is amended— 

11 (i) in paragraph (1), by striking ‘‘and 

12 the Education Debt Reduction Program’’ 

13 and inserting ‘‘the Education Debt Reduc14 tion Program, and the Specialty Education 

15 Loan Repayment Program’’; and 

16 (ii) in paragraph (4), by striking ‘‘and 

17 per participant in the Education Debt Re18 duction Program’’ and inserting ‘‘per par19 ticipant in the Education Debt Reduction 

20 Program, and per participant in the Spe21 cialty Education Loan Repayment Pro22 gram’’. 

23 (2) TABLE OF SECTIONS.—The table of sections 

24 at the beginning of chapter 76 of such title is 


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1 amended by inserting after the items relating to sub2 chapter VII the following: 

‘‘SUBCHAPTER VIII—SPECIALTY EDUCATION LOAN REPAYMENT PROGRAM

‘‘Sec. 

‘‘7691. Establishment. 

‘‘7692. Purpose. 

‘‘7693. Eligibility; preferences; covered costs. 

‘‘7694. Specialty education loan repayment. 

‘‘7695. Choice of location. 

‘‘7696. Term of obligated service. 

‘‘7697. Relationship to Educational Assistance Program.’’. 

3 (c) NEEDS OF THE VHA.—In making determinations 

4 each year under section 7692 of title 38, United States 

5 Code, as enacted by subsection (a), the Secretary of Vet6 erans Affairs shall consider the anticipated needs of the 

7 Veterans Health Administration during the period two to 

8 six years in the future. 

9 (d) PREFERENCE.—In granting preference under 

10 section 7693 of title 38, United States Code, as enacted 

11 by subsection (a), the Secretary of Veterans Affairs shall 

12 determine whether a facility of the Department is under13 served based on the criteria developed under section 401 

14 of this Act. 

15 (e) OFFER DEADLINE.—In the case of an applicant 

16 who applies before receiving a residency match and whom 

17 the Secretary of Veterans Affairs selects for participation 

18 in the Specialty Education Loan Repayment Program es19 tablished by subsection (a), the Secretary shall offer par20 ticipation to the applicant not later than 28 days after— 


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1 (1) the applicant matches with a residency in a 

2 medical specialty described in section 7692 of title 

3 38, United States Code, as enacted by subsection 

4 (a); and 

5 (2) such match is published. 

6 (f) PUBLICITY.—The Secretary of Veterans Affairs 

7 shall take such steps as the Secretary determines are ap8 propriate to publicize the Specialty Education Loan Re9 payment Program established under subchapter VIII of 

10 chapter 76 of title 38, United States Code, as enacted by 

11 subsection (a). 

12 SEC. 304. VETERANS HEALING VETERANS MEDICAL ACCESS 

13 AND SCHOLARSHIP PROGRAM. 

14 (a) ESTABLISHMENT.—The Secretary of Veterans 

15 Affairs, acting through the Office of Academic Affiliations 

16 of the Department of Veterans Affairs, shall carry out a 

17 pilot program under which the Secretary shall provide 

18 funding for the medical education of a total of 18 eligible 

19 veterans. Such funding shall be provided for two veterans 

20 enrolled in each covered medical schools in accordance 

21 with this section. 

22 (b) ELIGIBLE VETERANS.—To be eligible to receive 

23 funding for medical education under this section, a vet24 eran shall— 


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1 (1) have been discharged from the Armed 

2 Forces not more than ten years before the date of 

3 application for admission to a covered medical 

4 school; 

5 (2) not be entitled to educational assistance 

6 under chapter 30, 31, 32, 33, 34, or 35 of title 38, 

7 United States Code, or chapter 1606 or 1607 of title 

8 10, United States Code; 

9 (3) apply for admission to a covered medical 

10 school for the entering class of 2019; 

11 (4) indicate on such application for admission 

12 that the veteran would like to be considered for an 

13 award of funding under this section; 

14 (5) meet the minimum admissions criteria for 

15 the covered medical school to which the veteran ap16 plies; and 

17 (6) enter into an agreement described in sub18 section (e). 

19 (c) AWARD OF FUNDING.— 

20 (1) IN GENERAL.—Each covered medical school 

21 that opts to participate in the program under this 

22 section shall reserve two seats in the entering class 

23 of 2019 for eligible veterans who receive funding 

24 under such program. Such funding shall be awarded 


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1 to the two eligible veterans with the highest admis2 sions rankings for such class at such school. 

3 (2) AMOUNT OF FUNDING.—Each eligible vet4 eran who receives funding under this section shall 

5 receive an amount equal to the actual cost of— 

6 (A) tuition at the covered medical school at 

7 which the veteran enrolls for four years; 

8 (B) books, fees, and technical equipment; 

9 (C) fees associated with the National Resi10 dency Match Program; 

11 (D) two away rotations performed during 

12 the fourth year at a Department of Veterans 

13 Affairs medical facility; and 

14 (E) a monthly stipend for the four-year pe15 riod during which the veteran is enrolled in 

16 medical school in an amount to be determined 

17 by the Secretary. 

18 (3) DISTRIBUTION OF FUNDING.—In the event 

19 that two or more eligible veterans do not apply for 

20 admission at one of the covered medical schools for 

21 the entering class of 2019, the Secretary shall dis22 tribute the available funding to eligible veterans who 

23 applied for admission at other covered medical 

24 schools. 

25 (d) AGREEMENT.— 


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1 (1) TERMS OF AGREEMENT.—Each eligible vet2 eran who accepts funding for medical education 

3 under this section shall enter into an agreement with 

4 the Secretary that provides that the veteran 

5 agrees— 

6 (A) to maintain enrollment and attendance 

7 in the medical school; 

8 (B) while enrolled in such medical school, 

9 to maintain an acceptable level of academic 

10 standing (as determined by the medical school 

11 under regulations prescribed by the Secretary); 

12 (C) to complete post-graduate training 

13 leading to eligibility for board certification in a 

14 speciality applicable to the Department of Vet15 erans Affairs, as determined by the Secretary; 

16 (D) after completion of medical school, to 

17 obtain a license to practice medicine in a State; 

18 and 

19 (E) after completion of medical school and 

20 post-graduate training, to serve as a full-time 

21 clinical practice employee in the Veterans 

22 Health Administration for a period of four 

23 years. 

24 (2) BREACH OF AGREEMENT.—If an eligible 

25 veteran who accepts funding under this section 


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1 breaches the terms of the agreement described in 

2 paragraph (1), the United States shall be entitled to 

3 recover damages in an amount equal to the total 

4 amount of such funding received by the veteran. 

5 (e) RULE OF CONSTRUCTION.—Nothing in this sec6 tion shall be construed to prevent any covered medical 

7 school from accepting more than two eligible veterans for 

8 the entering class of 2019. 

9 (f) REPORT TO CONGRESS.—Not later than Decem10 ber 31, 2020, and annually thereafter for the subsequent 

11 three years, the Secretary shall submit to Congress a re12 port on the pilot program under this section. Such report 

13 shall include the evaluation of the Secretary of the success 

14 of the pilot program, including the number of veterans 

15 who received funding under the program who matriculated 

16 and an evaluation of the academic progress of such vet17 erans. 

18 (g) COVERED MEDICAL SCHOOLS.—In this section, 

19 the term ‘‘covered medical school’’ means any of the fol20 lowing. 

21 (1) The Teague-Cranston medical schools, con22 sisting of— 

23 (A) Texas A&M College of Medicine; 

24 (B) Quillen College of Medicine at East 

25 Tennessee State University; 


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1 (C) Boonshoft School of Medicine at 

2 Wright State University; 

3 (D) Joan C. Edwards School of Medicine 

4 at Marshall University; and 

5 (E) University of South Carolina School of 

6 Medicine. 

7 (2) Charles R Drew University of Medicine and 

8 Science. 

9 (3) Howard University College of Medicine. 

10 (4) Meharry Medical College. 

11 (5) Morehouse School of Medicine. 

12 SEC. 305. BONUSES FOR RECRUITMENT, RELOCATION, AND 

13 RETENTION. 

14 Section 705(a) of the Veterans Access, Choice, and 

15 Accountability Act of 2014 (Public Law 113–146; 38 

16 U.S.C. 703 note) is amended— 

17 (1) in paragraph (1), by striking 

18 ‘‘$230,000,000’’ and inserting ‘‘$250,000,000, of 

19 which not less than $20,000,000 shall be for recruit20 ment, relocation, and retention bonuses’’; and 

21 (2) in paragraph (2), by striking 

22 ‘‘$225,000,000’’ and inserting ‘‘$290,000,000, of 

23 which not less than $20,000,000 shall be for recruit24 ment, relocation, and retention bonuses’’. 


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1 SEC. 306. INCLUSION OF VET CENTER EMPLOYEES IN EDU2 CATION DEBT REDUCTION PROGRAM OF DE3 PARTMENT OF VETERANS AFFAIRS. 

4 (a) IN GENERAL.—The Secretary of Veterans Affairs 

5 shall ensure that clinical staff working at Vet Centers are 

6 eligible to participate in the Education Debt Reduction 

7 Program of the Department of Veterans Affairs under 

8 subchapter VII of chapter 76 of title 38, United States 

9 Code. 

10 (b) REPORT.—Not later than one year after the date 

11 of the enactment of this Act, the Secretary shall submit 

12 to the Committee on Veterans’ Affairs of the Senate and 

13 the Committee on Veterans’ Affairs of the House of Rep14 resentatives a report on the number of participants in the 

15 Education Debt Reduction Program of the Department 

16 under such subchapter who work at Vet Centers. 

17 (c) VET CENTER DEFINED.—In this section, the 

18 term ‘‘Vet Center’’ has the meaning given that term in 

19 section 1712A(h) of title 38, United States Code. 


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1 TITLE IV—HEALTH CARE IN 

2 UNDERSERVED AREAS 

3 SEC. 401. DEVELOPMENT OF CRITERIA FOR DESIGNATION 

4 OF CERTAIN MEDICAL FACILITIES OF THE 

5 DEPARTMENT OF VETERANS AFFAIRS AS UN6 DERSERVED FACILITIES AND PLAN TO AD7 DRESS PROBLEM OF UNDERSERVED FACILI8 TIES. 

9 (a) IN GENERAL.—Not later than 180 days after the 

10 date of the enactment of this Act, the Secretary of Vet11 erans Affairs shall develop criteria to designate medical 

12 centers, ambulatory care facilities, and community based 

13 outpatient clinics of the Department of Veterans Affairs 

14 as underserved facilities. 

15 (b) CONSIDERATION.—Criteria developed under sub16 section (a) shall include consideration of the following with 

17 respect to a facility: 

18 (1) The ratio of veterans to health care pro19 viders of the Department of Veterans Affairs for a 

20 standardized geographic area surrounding the facil21 ity, including a separate ratio for general practi22 tioners and specialists. 

23 (2) The range of clinical specialties covered by 

24 such providers in such area. 


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1 (3) Whether the local community is medically 

2 underserved. 

3 (4) The type, number, and age of open consults. 

4 (5) Whether the facility is meeting the wait5 time goals of the Department. 

6 (6) Such other criteria as the Secretary con7 siders important in determining which facilities are 

8 not adequately serving area veterans. 

9 (c) ANALYSIS OF FACILITIES.—Not less frequently 

10 than annually, directors of Veterans Integrated Service 

11 Networks of the Department shall perform an analysis to 

12 determine which facilities within that Veterans Integrated 

13 Service Network qualify as underserved facilities pursuant 

14 to criteria developed under subsection (a). 

15 (d) ANNUAL PLAN TO ADDRESS UNDERSERVED FA16 CILITIES.— 

17 (1) PLAN REQUIRED.—Not later than one year 

18 after the date of the enactment of this Act and not 

19 less frequently than once each year, the Secretary 

20 shall submit to Congress a plan to address the prob21 lem of underserved facilities of the Department, as 

22 designated pursuant to criteria developed under sub23 section (a). 

24 (2) CONTENTS.—Each plan submitted under 

25 paragraph (1) shall address the following: 


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1 (A) Increasing personnel or temporary per2 sonnel assistance, including mobile deployment 

3 teams furnished under section 407 of this Act. 

4 (B) Providing special hiring incentives, in5 cluding under the Education Debt Reduction 

6 Program under subchapter VII of chapter 76 of 

7 title 38, United States Code, and recruitment, 

8 relocation, and retention incentives. 

9 (C) Using direct hiring authority. 

10 (D) Improving training opportunities for 

11 staff. 

12 (E) Such other actions as the Secretary 

13 considers appropriate. 

14 SEC. 402. PILOT PROGRAM TO FURNISH MOBILE DEPLOY15 MENT TEAMS TO UNDERSERVED FACILITIES. 

16 (a) IN GENERAL.—The Secretary of Veterans Affairs 

17 shall carry out a pilot program to furnish mobile deploy18 ment teams of medical personnel to underserved facilities. 

19 (b) ELEMENTS.—In furnishing mobile deployment 

20 teams under subsection (a), the Secretary shall consider 

21 the following elements: 

22 (1) The medical positions of greatest need at 

23 underserved facilities. 

24 (2) The size and composition of teams to be de25 ployed. 


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1 (3) Such other elements as the Secretary con2 siders necessary for effective oversight of the pro3 gram established under subsection (a). 

4 (c) USE OF ANNUAL ANALYSIS.—The Secretary shall 

5 use the results of the annual analysis conducted under sec6 tion 401(c) of this Act to form mobile deployment teams 

7 under subsection (a) that are composed of the most needed 

8 medical personnel for underserved facilities. 

9 (d) REPORTING.— 

10 (1) PROGRESS REPORT.—Not later than one 

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

12 Secretary shall submit a report to Congress on the 

13 implementation of the pilot program under this sec14 tion. 

15 (2) FINAL REPORT.—Not later than the termi16 nation of the pilot program under this section, the 

17 Secretary shall submit a final report to Congress 

18 that contains the recommendations of the Secretary 

19 regarding the feasibility and advisability of— 

20 (A) extending or expanding the pilot pro21 gram; and 

22 (B) making the pilot program (or any as23 pect thereof) permanent. 


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1 (e) DURATION.—The pilot program under this sec2 tion shall terminate three years after the date of the enact3 ment of this Act. 

4 (f) UNDERSERVED FACILITY DEFINED.—In this sec5 tion, the term ‘‘underserved facility’’ means a medical cen6 ter, ambulatory care facility, or community based out7 patient clinic of the Department of Veterans Affairs des8 ignated by the Secretary of Veterans Affairs as under9 served pursuant to criteria developed under section 401 

10 of this Act. 

11 SEC. 403. PILOT PROGRAM ON GRADUATE MEDICAL EDU12 CATION AND RESIDENCY. 

13 (a) ESTABLISHMENT.— 

14 (1) IN GENERAL.—Subject to paragraph (5), 

15 the Secretary of Veterans Affairs shall establish a 

16 pilot program to establish medical residency posi17 tions authorized under section 301(b)(2) of the Vet18 erans Access, Choice, and Accountability Act of 

19 2014 (Public Law 113–146; 38 U.S.C. 7302 note) 

20 at covered facilities. 

21 (2) COVERED FACILITIES.—For purposes of 

22 this section, a covered facility is any of the following: 

23 (A) A health care facility of the Depart24 ment of Veterans Affairs. 


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1 (B) A health care facility operated by an 

2 Indian tribe or a tribal organization, as those 

3 terms are defined in section 4 of the Indian 

4 Self-Determination and Education Assistance 

5 Act (25 U.S.C. 5304). 

6 (C) A health care facility operated by the 

7 Indian Health Service. 

8 (D) A Federally-qualified health center, as 

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

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

11 (E) A health care facility operated by the 

12 Department of Defense. 

13 (F) Such other health care facility as the 

14 Secretary considers appropriate for purposes of 

15 this section. 

16 (3) AGREEMENTS.—To carry out the pilot pro17 gram under this section, the Secretary may enter 

18 into agreements with entities that operate covered 

19 facilities in which the Secretary places residents 

20 under paragraph (1). 

21 (4) PARAMETERS FOR LOCATION, AFFILIATE

22 SPONSOR, AND DURATION.—When determining in 

23 which covered facilities to place residents under 

24 paragraph (1), the Secretary shall consider the exVerDate Sep 11 2014 21:33 May 11, 2018 Jkt 079200 PO 00000 Frm 00206 Fmt 6652 Sfmt 6201 E:\BILLS\H5674.RH H5674

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1 tent to which there is a clinical need for providers 

2 in an area, as determined by the following: 

3 (A) The ratio of veterans to health care 

4 providers of the Department for a standardized 

5 geographic area surrounding a facility, includ6 ing a separate ratio for general practitioners 

7 and specialists. 

8 (B) The range of clinical specialties of pro9 viders in standardized geographic areas sur10 rounding a facility. 

11 (C) Whether the specialty of a provider is 

12 included in the most recent staffing shortage 

13 determination of the Department under section 

14 7412 of title 38, United States Code. 

15 (D) Whether the local community is des16 ignated by the Secretary of Veterans Affairs as 

17 underserved pursuant to criteria developed 

18 under section 401 of this Act. 

19 (E) Whether the facility is located in a 

20 community that is designated by the Secretary 

21 of Health and Human Services as a health pro22 fessional shortage area under section 332 of the 

23 Public Health Service Act (42 U.S.C. 254e). 

24 (F) Whether the facility is located in a 

25 rural or remote area. 


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1 (G) Such other criteria as the Secretary 

2 considers important in determining which facili3 ties are not adequately serving area veterans. 

4 (5) PRIORITY IN PLACEMENTS.—During the 

5 pilot program under this section, the Secretary shall 

6 place no fewer than 100 residents in covered facili7 ties— 

8 (A) operated by the Indian Health Service; 

9 (B) operated by an Indian tribe; 

10 (C) operated by a tribal organization; or 

11 (D) located in communities designated by 

12 the Secretary as underserved pursuant to cri13 teria developed under section 401 of this Act. 

14 (6) STIPENDS AND BENEFITS.—The Secretary 

15 may pay stipends and provide benefits for residents 

16 in positions under paragraph (1), regardless of 

17 whether they have been assigned in a Department 

18 facility. 

19 (b) REIMBURSEMENT.—If a covered facility estab20 lishes a new residency program in which the Secretary 

21 places a resident under the pilot program, the Secretary 

22 shall reimburse that covered facility for costs of the fol23 lowing: 

24 (1) Curriculum development. 

25 (2) Recruitment and retention of faculty. 


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1 (3) Accreditation of the program by the Accred2 itation Council for Graduate Medical Education. 

3 (4) The portion of faculty salaries attributable 

4 to duties under an agreement subsection (a)(3). 

5 (5) Expenses relating to educating a resident 

6 under the pilot program. 

7 (c) REPORTING.— 

8 (1) IN GENERAL.—Not later than one year 

9 after the date of the enactment of this Act and not 

10 less frequently than once each year thereafter until 

11 the termination of the pilot program, the Secretary 

12 shall submit to Congress a report on the implemen13 tation of the pilot program. 

14 (2) ELEMENTS.—Each report submitted under 

15 paragraph (1) shall include the following with regard 

16 to the immediately preceding year, and in compari17 son to the year immediately preceding that year: 

18 (A) The number of veterans who received 

19 care from residents under the pilot program. 

20 (B) The number of veterans who received 

21 care from each resident per position described 

22 in subsection (a)(1) under the pilot program. 

23 (C) The number of veterans who received 

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1 pressed as a percentage of all individuals who 

2 received care from such residents. 

3 (D) The number of clinical appointments 

4 for veterans conducted by each resident under 

5 the pilot program. 

6 (E) The number of clinical appointments 

7 for veterans conducted by residents per position 

8 described in subsection (a)(1) under the pilot 

9 program. 

10 (F) The number of clinical appointments 

11 for veterans expressed as a percentage of all 

12 clinical appointments conducted by residents 

13 under the pilot program. 

14 (G) The number of positions described in 

15 subsection (a)(1) at each covered facility under 

16 the pilot program. 

17 (H) For each position described in sub18 section (a)(1) in a residency program affiliated 

19 with a health care facility of the Department, 

20 the time a resident under the pilot program 

21 spent training at that facility of the Depart22 ment, expressed as a percentage of the total 

23 training time for that resident position. 

24 (I) For each residency program affiliated 

25 with a health care facility of the Department, 


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1 the time all residents under the pilot program 

2 spent training at that facility of the Depart3 ment, expressed as a percentage of the total 

4 training time for those residents. 

5 (J) The time that all residents under the 

6 pilot program who are assigned to programs af7 filiated with health care facilities of the Depart8 ment spent training at facilities of the Depart9 ment, expressed as a percentage of the total 

10 training time for those residents. 

11 (K) The cost to the Department of Vet12 erans Affairs under the pilot program in the 

13 year immediately preceding the report and since 

14 the beginning of the pilot program. 

15 (L) The cost to the Department of Vet16 erans Affairs per resident placed under the pilot 

17 program at each covered facility. 

18 (M) The number of residents under the 

19 pilot program hired by the Secretary to work in 

20 the Veterans Health Administration after com21 pletion of residency in the year immediately 

22 preceding the report and since the beginning of 

23 the pilot program. 

24 (N) The medical specialties pursued by 

25 residents under the pilot program. 


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1 (d) DURATION.—The pilot program under this sec2 tion shall terminate on August 7, 2024. 

3 TITLE V—OTHER MATTERS 

4 SEC. 501. ANNUAL REPORT ON PERFORMANCE AWARDS 

5 AND BONUSES AWARDED TO CERTAIN HIGH6 LEVEL EMPLOYEES OF THE DEPARTMENT. 

7 (a) IN GENERAL.—Chapter 7 of title 38, United 

8 States Code, is amended by adding at the end the fol9 lowing new section: 

10 ‘‘§ 726. Annual report on performance awards and bo11 nuses awarded to certain high-level em12 ployees 

13 ‘‘(a) IN GENERAL.—Not later than 100 days after 

14 the end of each fiscal year, the Secretary shall submit to 

15 the appropriate committees of Congress a report that con16 tains, for the most recent fiscal year ending before the 

17 submittal of the report, a description of all performance 

18 awards or bonuses awarded to each of the following: 

19 ‘‘(1) Regional Office Director of the Depart20 ment. 

21 ‘‘(2) Director of a Medical Center of the De22 partment. 

23 ‘‘(3) Director of a Veterans Integrated Service 

24 Network. 

25 ‘‘(4) Senior executive of the Department. 


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1 ‘‘(b) ELEMENTS.—Each report submitted under sub2 section (a) shall include the following with respect to each 

3 performance award or bonus awarded to an individual de4 scribed in such subsection: 

5 ‘‘(1) The amount of each award or bonus. 

6 ‘‘(2) The job title of the individual awarded the 

7 award or bonus. 

8 ‘‘(3) The location where the individual awarded 

9 the award or bonus works. 

10 ‘‘(c) DEFINITIONS.—In this section: 

11 ‘‘(1) The term ‘appropriate committees of Con12 gress’ means the Committees on Veterans’ Affairs 

13 and Appropriations of the Senate and House of Rep14 resentatives. 

15 ‘‘(2) The term ‘senior executive’ means— 

16 ‘‘(A) a career appointee; or 

17 ‘‘(B) an individual— 

18 ‘‘(i) in an administrative or executive 

19 position; and 

20 ‘‘(ii) appointed under section 7306(a) 

21 or section 7401(1) of this title. 

22 ‘‘(3) The term ‘career appointee’ has the mean23 ing given that term in section 3132(a) of title 5, 

24 United States Code.’’. 


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

2 at the beginning of such chapter is amended by inserting 

3 after the item relating to section 725 the following new 

4 item: 

‘‘726. Annual report on performance awards and bonuses awarded to certain 

high-level employees.’’. 

5 SEC. 502. ROLE OF PODIATRISTS IN DEPARTMENT OF VET6 ERANS AFFAIRS. 

7 (a) INCLUSION AS PHYSICIAN.— 

8 (1) IN GENERAL.—Subchapter I of chapter 74 

9 is amended by adding at the end the following new 

10 section: 

11 ‘‘§ 7413. Treatment of podiatrists; clinical oversight 

12 standards 

13 ‘‘(a) PODIATRISTS.—Except as provided by sub14 section (b), a doctor of podiatric medicine who is ap15 pointed as a podiatrist under section 7401(1) of this title 

16 is eligible for any supervisory position in the Veterans 

17 Health Administration to the same degree that a physician 

18 appointed under such section is eligible for the position. 

19 ‘‘(b) ESTABLISHMENT OF CLINICAL OVERSIGHT

20 STANDARDS.—The Secretary, in consultation with appro21 priate stakeholders, shall establish standards to ensure 

22 that specialists appointed in the Veterans Health Adminis23 tration to supervisory positions do not provide direct clinVerDate Sep 11 2014 21:33 May 11, 2018 Jkt 079200 PO 00000 Frm 00214 Fmt 6652 Sfmt 6201 E:\BILLS\H5674.RH H5674

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1 ical oversight for purposes of peer review or practice eval2 uation for providers of other clinical specialties.’’. 

3 (2) CLERICAL AMENDMENT.—The table of sec4 tions at the beginning of chapter 74 is amended by 

5 inserting after the item relating to section 7412 the 

6 following new item: 

‘‘7413. Treatment of podiatrists; clinical oversight standards.’’. 

7 (b) MODIFICATION AND CLARIFICATION OF PAY

8 GRADE.— 

9 (1) GRADE.—The list in section 7404(b) of 

10 such title is amended— 

11 (A) by striking ‘‘PHYSICIAN AND DEN12 TIST SCHEDULE’’ and inserting ‘‘PHYSI13 CIAN AND SURGEON (MD/DO), 

14 PODIATRIC SURGEON (DPM), AND DEN15 TIST AND ORAL SURGEON (DDS, DMD) 

16 SCHEDULE’’; 

17 (B) by striking, ‘‘Physician grade’’ and in18 serting ‘‘Physician and surgeon grade’’; and 

19 (C) by striking ‘‘PODIATRIST, CHIRO20 PRACTOR, AND’’ and inserting ‘‘CHIRO21 PRACTOR AND’’. 

22 (2) APPLICATION.—The amendments made by 

23 paragraph (1) shall apply with respect to a pay pe24 riod of the Department of Veterans Affairs beginVerDate Sep 11 2014 21:33 May 11, 2018 Jkt 079200 PO 00000 Frm 00215 Fmt 6652 Sfmt 6201 E:\BILLS\H5674.RH H5674

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1 ning on or after the date that is 30 days after the 

2 date of the enactment of this Act. 

3 SEC. 503. DEFINITION OF MAJOR MEDICAL FACILITY 

4 PROJECT. 

5 (a) MODIFICATION OF DEFINITION OF MEDICAL FA6 CILITY.—Section 8101(3) is amended by striking ‘‘Sec7 retary’’ and all that follows through ‘‘nursing home,’’ and 

8 inserting ‘‘Secretary, or as otherwise authorized by law, 

9 for the provision of health-care services (including hos10 pital, outpatient clinic, nursing home,’’. 

11 (b) MODIFICATION OF DEFINITION OF MAJOR MED12 ICAL FACILITY PROJECT.—Paragraph (3) of section 

13 8104(a) is amended to read as follows: 

14 ‘‘(3) For purposes of this subsection, the term ‘major 

15 medical facility project’ means a project for the construc16 tion, alteration, or acquisition of a medical facility involv17 ing a total expenditure of more than $20,000,000, but 

18 such term does not include an acquisition by exchange, 

19 nonrecurring maintenance projects of the Department, or 

20 the construction, alteration, or acquisition of a shared 

21 Federal medical facility for which the Department’s esti22 mated share of the project costs does not exceed 

23 $20,000,000.’’. 


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1 SEC. 504. AUTHORIZATION OF CERTAIN MAJOR MEDICAL 

2 FACILITY PROJECTS OF THE DEPARTMENT 

3 OF VETERANS AFFAIRS. 

4 (a) AUTHORIZATION.—The Secretary of Veterans Af5 fairs may carry out the following major medical facility 

6 project, to be carried out in an amount not to exceed the 

7 amount specified for that project: Construction of the new 

8 East Bay Community Based Outpatient Clinic and all as9 sociated site work, utilities, parking, and landscaping, con10 struction of the Central Valley Engineering and Logistics 

11 support facility, and enhanced flood plain mitigation at the 

12 Central Valley and East Bay Community Based Out13 patient Clinics as part of the realignment of medical facili14 ties in Livermore, California, in an amount not to exceed 

15 $117,300,000. 

16 (b) AUTHORIZATION OF APPROPRIATIONS FOR CON17 STRUCTION.—There is authorized to be appropriated to 

18 the Secretary of Veterans Affairs for fiscal year 2018 or 

19 the year in which funds are appropriated for the Construc20 tion, Major Projects account, $117,300,000 for the project 

21 authorized in subsection (a). 

22 (c) SUBMITTAL OF INFORMATION.—Not later than 

23 90 days after the date of the enactment of this Act, for 

24 the project authorized in subsection (a), the Secretary of 

25 Veterans Affairs shall submit to the Committee on Vet26 erans’ Affairs of the Senate and the Committee on VetVerDate Sep 11 2014 21:33 May 11, 2018 Jkt 079200 PO 00000 Frm 00217 Fmt 6652 Sfmt 6201 E:\BILLS\H5674.RH H5674

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1 erans’ Affairs of the House of Representatives the fol2 lowing information: 

3 (1) A line item accounting of expenditures re4 lating to construction management carried out by 

5 the Department of Veterans Affairs for such project. 

6 (2) The future amounts that are budgeted to be 

7 obligated for construction management carried out 

8 by the Department for such project. 

9 (3) A justification for the expenditures de10 scribed in paragraph (1) and the future amounts de11 scribed in paragraph (2). 

12 (4) Any agreement entered into by the Sec13 retary regarding a non-Department of Veterans Af14 fairs Federal entity providing management services 

15 relating to such project, including reimbursement 

16 agreements and the costs to the Department for 

17 such services. 

18 SEC. 505. DEPARTMENT OF VETERANS AFFAIRS PER19 SONNEL TRANSPARENCY. 

20 (a) PUBLICATION OF STAFFING AND VACANCIES.— 

21 (1) WEBSITE REQUIRED.—Subject to para22 graph (2) and not later than 90 days after the date 

23 of the enactment of this Act, the Secretary of Vet24 erans Affairs shall make publicly available on an 

25 Internet website of the Department of Veterans AfVerDate Sep 11 2014 21:33 May 11, 2018 Jkt 079200 PO 00000 Frm 00218 Fmt 6652 Sfmt 6201 E:\BILLS\H5674.RH H5674

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1 fairs the following information, which shall, subject 

2 to subparagraph (D), be displayed by departmental 

3 component or, in the case of information relating to 

4 Veterans Health Administration positions, by med5 ical facility: 

6 (A) The number of personnel encumbering 

7 positions. 

8 (B) The number of accessions and separa9 tion actions processed during the quarter pre10 ceding the date of the publication of the infor11 mation. 

12 (C) The number of vacancies, by occupa13 tion. 

14 (D) The percentage of new hires for the 

15 Department who were hired within the time-to16 hire target of the Office of Personnel Manage17 ment, disaggregated by administration. 

18 (2) EXCEPTIONS.—The Secretary may withhold 

19 from publication under paragraph (1) information 

20 relating to law enforcement, information security, or 

21 such positions in the Department that the Secretary 

22 determines to be sensitive. 

23 (3) UPDATE OF INFORMATION.—The Secretary 

24 shall update the information on the website required 

25 under paragraph (1) on a quarterly basis. 


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1 (4) TREATMENT OF CONTRACTOR POSITIONS.— 

2 Any Department of Veterans Affairs position that is 

3 filled with a contractor may not be treated as a De4 partment position for purposes of the information 

5 required to be published under paragraph (1). 

6 (5) INSPECTOR GENERAL REVIEW.—On a semi7 annual basis, the Inspector General of the Depart8 ment shall review the administration of the website 

9 required under paragraph (1) and make rec10 ommendations relating to the improvement of such 

11 administration. 

12 (b) REPORT TO CONGRESS.—The Secretary of Vet13 erans Affairs shall submit to Congress an annual report 

14 on the steps the Department is taking to achieve full staff15 ing capacity. Each such report shall include the amount 

16 of additional funds necessary to enable the Department 

17 to reach full staffing capacity. 

18 SEC. 506. PROGRAM ON ESTABLISHMENT OF PEER SPE19 CIALISTS IN PATIENT ALIGNED CARE TEAM 

20 SETTINGS WITHIN MEDICAL CENTERS OF DE21 PARTMENT OF VETERANS AFFAIRS. 

22 (a) PROGRAM REQUIRED.—The Secretary of Vet23 erans Affairs shall carry out a program to establish not 

24 fewer than two peer specialists in patient aligned care 

25 teams at medical centers of the Department of Veterans 


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1 Affairs to promote the use and integration of services for 

2 mental health, substance use disorder, and behavioral 

3 health in a primary care setting. 

4 (b) TIMEFRAME FOR ESTABLISHMENT OF PRO5 GRAM.—The Secretary shall carry out the program at 

6 medical centers of the Department as follows: 

7 (1) Not later than May 31, 2019, at not fewer 

8 than 15 medical centers of the Department. 

9 (2) Not later than May 31, 2020, at not fewer 

10 than 30 medical centers of the Department. 

11 (c) SELECTION OF LOCATIONS.— 

12 (1) IN GENERAL.—The Secretary shall select 

13 medical centers for the program as follows: 

14 (A) Not fewer than five shall be medical 

15 centers of the Department that are designated 

16 by the Secretary as polytrauma centers. 

17 (B) Not fewer than ten shall be medical 

18 centers of the Department that are not des19 ignated by the Secretary as polytrauma centers. 

20 (2) CONSIDERATIONS.—In selecting medical 

21 centers for the program under paragraph (1), the 

22 Secretary shall consider the feasibility and advis23 ability of selecting medical centers in the following 

24 areas: 


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1 (A) Rural areas and other areas that are 

2 underserved by the Department. 

3 (B) Areas that are not in close proximity 

4 to an active duty military installation. 

5 (C) Areas representing different geo6 graphic locations, such as census tracts estab7 lished by the Bureau of the Census. 

8 (d) GENDER-SPECIFIC SERVICES.—In carrying out 

9 the program at each location selected under subsection (c), 

10 the Secretary shall ensure that— 

11 (1) the needs of female veterans are specifically 

12 considered and addressed; and 

13 (2) female peer specialists are made available to 

14 female veterans who are treated at each location. 

15 (e) ENGAGEMENT WITH COMMUNITY PROVIDERS.— 

16 At each location selected under subsection (c), the Sec17 retary shall consider ways in which peer specialists can 

18 conduct outreach to health care providers in the commu19 nity who are known to be serving veterans to engage with 

20 those providers and veterans served by those providers. 

21 (f) REPORTS.— 

22 (1) PERIODIC REPORTS.— 

23 (A) IN GENERAL.—Not later than 180 

24 days after the date of the enactment of this 

25 Act, and not less frequently than once every 


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1 180 days thereafter until the Secretary deter2 mines that the program is being carried out at 

3 the last location to be selected under subsection 

4 (c), the Secretary shall submit to Congress a 

5 report on the program. 

6 (B) ELEMENTS.—Each report required by 

7 subparagraph (A) shall, with respect to the 

8 180-day period preceding the submittal of the 

9 report, include the following: 

10 (i) The findings and conclusions of 

11 the Secretary with respect to the program. 

12 (ii) An assessment of the benefits of 

13 the program to veterans and family mem14 bers of veterans. 

15 (iii) An assessment of the effective16 ness of peer specialists in engaging under 

17 subsection (e) with health care providers in 

18 the community and veterans served by 

19 those providers. 

20 (2) FINAL REPORT.—Not later than 180 days 

21 after the Secretary determines that the program is 

22 being carried out at the last location to be selected 

23 under subsection (c), the Secretary shall submit to 

24 Congress a report detailing the recommendations of 


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1 the Secretary as to the feasibility and advisability of 

2 expanding the program to additional locations. 

3 SEC. 507. DEPARTMENT OF VETERANS AFFAIRS MEDICAL 

4 SCRIBE PILOT PROGRAM. 

5 (a) IN GENERAL.—The Secretary of Veterans Affairs 

6 shall carry out a two-year pilot program under which the 

7 Secretary shall increase the use of medical scribes at De8 partment of Veterans Affairs medical centers. 

9 (b) LOCATIONS.—The Secretary shall carry out the 

10 pilot program at the 10 medical centers of the Department 

11 as follows: 

12 (1) At least four such medical centers located 

13 in rural areas. 

14 (2) At least four such medical centers located 

15 in urban areas. 

16 (3) Two such medical centers located in areas 

17 with need for increased access or increased effi18 ciency, as determine by the Secretary. 

19 (c) MEDICAL SCRIBES.— 

20 (1) HIRING.—Under the pilot program the Sec21 retary shall— 

22 (A) hire 20 new Department of Veterans 

23 Affairs term employees as medical scribes; and 


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1 (B) seek to enter into contracts with ap2 propriate entities for the employment of 20 ad3 ditional medical scribes. 

4 (2) DISTRIBUTION.—The Secretary shall assign 

5 four medical scribes to each of the 10 medical cen6 ters of the Department where the Secretary carries 

7 out the pilot program as follows: 

8 (A) Two scribes shall be assigned to each 

9 of two physicians. 

10 (B) Thirty percent of the scribes shall be 

11 employed in the provision of emergency care. 

12 (C) Seventy percent of the scribes shall be 

13 employed in the provision of speciality care in 

14 specialties with the longest patient wait times 

15 or lowest efficiency ratings, as determined by 

16 the Secretary. 

17 (d) REPORTS.— 

18 (1) REPORTS TO CONGRESS.—Not later than 

19 180 days after the commencement of the pilot pro20 gram required under this section, and every 180 

21 days thereafter for the duration of the pilot pro22 gram, the Secretary of Veterans Affairs shall submit 

23 to Congress a report on the pilot program. Each 

24 such report shall include each of the following: 


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1 (A) A separate analysis of each the fol2 lowing with respect to medical scribes employed 

3 by the Department of Veterans Affairs and 

4 medical scribes performing Department of Vet5 erans Affairs functions under a contract: 

6 (i) Provider efficiency. 

7 (ii) Patient satisfaction. 

8 (iii) Average wait time. 

9 (iv) The number of patients seen per 

10 day by each physician or practitioner. 

11 (v) The amount of time required to 

12 hire and train an employee to perform 

13 medical scribe functions under the pilot 

14 program. 

15 (B) Metrics and data for analyzing the ef16 fects of the pilot program, including an evalua17 tion of the each of the elements under clauses 

18 (i) through (iv) of subparagraph (A) at medical 

19 centers who employed scribes under the pilot 

20 program for an appropriate period preceding 

21 the hiring of such scribes. 

22 (2) COMPTROLLER GENERAL REPORT.—Not 

23 later than 90 days after the termination of the pilot 

24 program under this section, the Comptroller General 

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1 port on the pilot program. Such report shall include 

2 a comparison of the pilot program with similar pro3 grams carried out in the private sector. 

4 (e) DEFINITIONS.—In this section: 

5 (1) The term ‘‘medical scribe’’ means an unli6 censed individual hired to enter information into the 

7 electronic health record or chart at the direction of 

8 a physician or licensed independent practitioner 

9 whose responsibilities include the following: 

10 (A) Assisting the physician or practitioner 

11 in navigating the electronic health record. 

12 (B) Responding to various messages as di13 rected by the physician or practitioner. 

14 (C) Entering information into the elec15 tronic health record, as directed by the physi16 cian or practitioner. 

17 (2) The terms ‘‘urban’’ and ‘‘rural’’ have the 

18 meanings given such terms under the rural-urban 

19 commuting codes developed by the Secretary of Agri20 culture and the Secretary of Health and Human 

21 Services. 

22 (f) FUNDING.—The pilot program under this section 

23 shall be carried out using amounts otherwise authorized 

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1 fairs. No additional amounts are authorized to be appro2 priated to carry out such program. 

3 SEC. 508. EXTENSION OF REQUIREMENT TO COLLECT FEES 

4 FOR HOUSING LOANS GUARANTEED BY SEC5 RETARY OF VETERANS AFFAIRS. 

6 Section 3729(b)(2) of title 38, United States Code, 

7 is amended by striking ‘‘2027’’ each place it appears and 

8 inserting ‘‘2028’’. 

9 SEC. 509. EXTENSION OF REDUCTION IN AMOUNT OF PEN10 SION FURNISHED BY DEPARTMENT OF VET11 ERANS AFFAIRS FOR CERTAIN VETERANS 

12 COVERED BY MEDICAID PLANS FOR SERV13 ICES FURNISHED BY NURSING FACILITIES. 

14 Section 5503(d)(7) of title 38, United States Code, 

15 is amended by striking ‘‘September 30, 2027’’ and insert16 ing ‘‘September 30, 2028’’. 

17 SEC. 510. APPROPRIATION OF AMOUNTS. 

18 (a) VETERANS CHOICE PROGRAM.—There is author19 ized to be appropriated, and is appropriated, to the Sec20 retary of Veterans Affairs, out of any funds in the Treas21 ury not otherwise appropriated, $5,200,000,000 to be de22 posited in the Veterans Choice Fund under section 802 

23 of the Veterans Access, Choice, and Accountability Act of 

24 2014 (Public Law 113–146; 38 U.S.C. 1701 note). 


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1 (b) AVAILABILITY OF AMOUNTS.—The amounts ap2 propriated under subsection (a) shall be available for obli3 gation or expenditure without fiscal year limitation. 

4 SEC. 511. TECHNICAL CORRECTION. 

5 Section 1712I of title 38, United States Code, is re6 designated as section 1720I of such title. 


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Union Calendar No. 516 

115TH CONGRESS 

2D SESSION H. R. 5674 

[Report No. 115–671, Part I] 

A BILL 

To establish a permanent community care program 

purposes. Department of Veterans Affairs, and for other fairs relating to the home loan program of the administered by the Secretary of Veterans Affairs, to make certain improvements in the laws construction of the Department of Veterans Afthe Veterans Health Administration, to improve the modernization or realignment of facilities of purpose of making recommendations regarding for veterans, to establish a commission for the 

MAY 11, 2018 

Reported from the Committee on Veterans’ Affairs 

MAY 11, 2018 

The Committee on Rules discharged; committed to the 

Union and ordered to be printed Committee of the Whole House on the State of the 


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