I 

113TH CONGRESS 

2D SESSION H. R. 4841 

To improve the access of veterans to medical services from the Department 

of Veterans Affairs, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 11, 2014 

Mrs. KIRKPATRICK (for herself, Mr. MICHAUD, Mr. BARBER, Mr. GRIJALVA, 

and Mr. PASTOR of Arizona) introduced the following bill; which was referred to the Committee on Veterans’ Affairs, and in addition to the 

Committees on Oversight and Government Reform and the Budget, 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 

A BILL 

To improve the access of veterans to medical services from 

the Department of Veterans Affairs, and for other purposes. 

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

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

5 ‘‘Veterans’ Access to Care through Choice, Accountability, 

6 and Transparency Act of 2014’’. 

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

8 this Act is as follows: 


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Sec. 1. Short title; table of contents. 

TITLE I—IMPROVEMENT OF SCHEDULING SYSTEM FOR HEALTH 

CARE APPOINTMENTS 

Sec. 101. Independent assessment of the scheduling of appointments and other 

health care management processes of the Department of Veterans Affairs. 

Sec. 102. Technology task force on review of scheduling system and software 

of the Department of Veterans Affairs. 

TITLE II—TRAINING AND HIRING OF HEALTH CARE STAFF 

Sec. 201. Treatment of staffing shortage and biannual report on staffing of 

medical facilities of the Department of Veterans Affairs. 

Sec. 202. Clinic management training for managers and health care providers 

of the Department of Veterans Affairs. 

Sec. 203. Use of unobligated amounts to hire additional health care providers 

for the Veterans Health Administration. 

TITLE III—IMPROVEMENT OF ACCESS TO CARE FROM NONDEPARTMENT OF VETERANS AFFAIRS PROVIDERS 

Sec. 301. Expanded availability of hospital care and medical services for veterans through the use of contracts. 

Sec. 302. Transfer of authority for payments for hospital care, medical services, 

and other health care from non-Department providers to the 

Chief Business Office of the Veterans Health Administration of 

the Department. 

Sec. 303. Enhancement of collaboration between Department of Veterans Affairs and Indian Health Service. 

Sec. 304. Enhancement of collaboration between Department of Veterans Affairs and Native Hawaiian health care systems. 

Sec. 305. Sense of Congress on prompt payment by Department of Veterans 

Affairs. 

TITLE IV—HEALTH CARE ADMINISTRATIVE MATTERS 

Sec. 401. Improvement of access of veterans to mobile vet centers of the Department of Veterans Affairs. 

Sec. 402. Commission on construction projects of the Department of Veterans 

Affairs. 

Sec. 403. Commission on Access to Care. 

Sec. 404. Improved performance metrics for health care provided by Department of Veterans Affairs. 

Sec. 405. Improved transparency concerning health care provided by Department of Veterans Affairs. 

Sec. 406. Information for veterans on the credentials of Department of Veterans Affairs physicians. 

Sec. 407. Information in annual budget of the President on hospital care and 

medical services furnished through expanded use of contracts 

for such care. 

Sec. 408. Prohibition on falsification of data concerning wait times and quality 

measures at Department of Veterans Affairs. 

Sec. 409. Removal of Senior Executive Service employees of the Department of 

Veterans Affairs for performance. 


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TITLE V—HEALTH CARE RELATED TO SEXUAL TRAUMA 

Sec. 501. Expansion of eligibility for sexual trauma counseling and treatment 

to veterans on inactive duty training. 

Sec. 502. Provision of counseling and treatment for sexual trauma by the Department of Veterans Affairs to members of the Armed Forces. 

Sec. 503. Reports on military sexual trauma. 

TITLE VI—MAJOR MEDICAL FACILITY LEASES 

Sec. 601. Authorization of major medical facility leases. 

Sec. 602. Budgetary treatment of Department of Veterans Affairs major medical facilities leases. 

TITLE VII—VETERANS BENEFITS MATTERS 

Sec. 701. Expansion of Marine Gunnery Sergeant John David Fry Scholarship. 

Sec. 702. Approval of courses of education provided by public institutions of 

higher learning for purposes of All-Volunteer Force Educational Assistance Program and Post-9/11 Educational Assistance conditional on in-State tuition rate for veterans. 

TITLE VIII—APPROPRIATION AND EMERGENCY DESIGNATIONS 

Sec. 801. Appropriation of emergency amounts. 

Sec. 802. Emergency designations. 

1 TITLE I—IMPROVEMENT OF 

2 SCHEDULING SYSTEM FOR 

3 HEALTH CARE APPOINT4 MENTS 

5 SEC. 101. INDEPENDENT ASSESSMENT OF THE SCHED6 ULING OF APPOINTMENTS AND OTHER 

7 HEALTH CARE MANAGEMENT PROCESSES OF 

8 THE DEPARTMENT OF VETERANS AFFAIRS. 

9 (a) INDEPENDENT ASSESSMENT.— 

10 (1) ASSESSMENT.—Not later than 30 days 

11 after the date of the enactment of this Act, the Sec12 retary of Veterans Affairs shall enter into a contract 

13 with an independent third party to assess the fol14 lowing: 


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1 (A) The process at each medical facility of 

2 the Department of Veterans Affairs for sched3 uling appointments for veterans to receive hos4 pital care, medical services, or other health care 

5 from the Department. 

6 (B) The staffing level and productivity of 

7 each medical facility of the Department, includ8 ing the following: 

9 (i) The case load of each health care 

10 provider of the Department. 

11 (ii) The time spent by each health 

12 care provider of the Department on mat13 ters other than the case load of such 

14 health care provider, including time spent 

15 by such health care provider as follows: 

16 (I) At a medical facility that is 

17 affiliated with the Department. 

18 (II) Conducting research. 

19 (III) Training or overseeing other 

20 health care professionals of the De21 partment. 

22 (C) The organization, processes, and tools 

23 used by the Department to support clinical doc24 umentation and the subsequent coding of inpa25 tient services. 


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1 (D) The purchasing, distribution, and use 

2 of pharmaceuticals, medical and surgical sup3 plies, and medical devices by the Department, 

4 including the following: 

5 (i) The prices paid for, standardiza6 tion of, and use by the Department of the 

7 following: 

8 (I) High-cost pharmaceuticals. 

9 (II) Medical and surgical sup10 plies. 

11 (III) Medical devices. 

12 (ii) The use by the Department of 

13 group purchasing arrangements to pur14 chase pharmaceuticals, medical and sur15 gical supplies, medical devices, and health 

16 care related services. 

17 (iii) The strategy used by the Depart18 ment to distribute pharmaceuticals, med19 ical and surgical supplies, and medical de20 vices to Veterans Integrated Service Net21 works and medical facilities of the Depart22 ment. 

23 (E) The performance of the Department in 

24 paying amounts owed to third parties and col25 lecting amounts owed to the Department with 


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1 respect to hospital care, medical services, and 

2 other health care, including any recommenda3 tions of the independent third party as follows: 

4 (i) To avoid the payment of penalties 

5 to vendors. 

6 (ii) To increase the collection of 

7 amounts owed to the Department for hos8 pital care, medical services, or other health 

9 care provided by the Department for which 

10 reimbursement from a third party is au11 thorized. 

12 (iii) To increase the collection of any 

13 other amounts owed to the Department. 

14 (2) ELEMENTS OF SCHEDULING ASSESS15 MENT.—In carrying out the assessment required by 

16 paragraph (1)(A), the independent third party shall 

17 do the following: 

18 (A) Review all training materials per19 taining to scheduling of appointments at each 

20 medical facility of the Department. 

21 (B) Assess whether all employees of the 

22 Department conducting tasks related to sched23 uling are properly trained for conducting such 

24 tasks. 


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1 (C) Assess whether changes in the tech2 nology or system used in scheduling appoint3 ments are necessary to limit access to the sys4 tem to only those employees that have been 

5 properly trained in conducting such tasks. 

6 (D) Assess whether health care providers 

7 of the Department are making changes to their 

8 schedules that hinder the ability of employees 

9 conducting such tasks to perform such tasks. 

10 (E) Assess whether the establishment of a 

11 centralized call center throughout the Depart12 ment for scheduling appointments at medical 

13 facilities of the Department would improve the 

14 process of scheduling such appointments. 

15 (F) Assess whether booking templates for 

16 each medical facility or clinic of the Depart17 ment would improve the process of scheduling 

18 such appointments. 

19 (G) Recommend any actions to be taken by 

20 the Department to improve the process for 

21 scheduling such appointments, including the fol22 lowing: 

23 (i) Changes in training materials pro24 vided to employees of the Department with 


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1 respect to conducting tasks related to 

2 scheduling such appointments. 

3 (ii) Changes in monitoring and assess4 ment conducted by the Department of wait 

5 times of veterans for such appointments. 

6 (iii) Changes in the system used to 

7 schedule such appointments, including 

8 changes to improve how the Department— 

9 (I) measures wait times of vet10 erans for such appointments; 

11 (II) monitors the availability of 

12 health care providers of the Depart13 ment; and 

14 (III) provides veterans the ability 

15 to schedule such appointments. 

16 (iv) Such other actions as the inde17 pendent third party considers appropriate. 

18 (3) TIMING.—The independent third party car19 rying out the assessment required by paragraph (1) 

20 shall complete such assessment not later than 180 

21 days after entering into the contract described in 

22 such paragraph. 

23 (b) REPORT.— 

24 (1) IN GENERAL.—Not later than 90 days after 

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1 pletes the assessment under this section, the Sec2 retary shall submit to the Committee on Veterans’ 

3 Affairs of the Senate and the Committee on Vet4 erans’ Affairs of the House of Representatives a re5 port on the results of such assessment. 

6 (2) PUBLICATION.—Not later than 30 days 

7 after submitting the report under paragraph (1), the 

8 Secretary shall publish such report in the Federal 

9 Register and on an Internet website of the Depart10 ment accessible to the public. 

11 SEC. 102. TECHNOLOGY TASK FORCE ON REVIEW OF 

12 SCHEDULING SYSTEM AND SOFTWARE OF 

13 THE DEPARTMENT OF VETERANS AFFAIRS. 

14 (a) TASK FORCE REVIEW.— 

15 (1) IN GENERAL.—The Secretary of Veterans 

16 Affairs shall, through the use of a technology task 

17 force, conduct a review of the needs of the Depart18 ment of Veterans Affairs with respect to the sched19 uling system and scheduling software of the Depart20 ment of Veterans Affairs that is used by the Depart21 ment to schedule appointments for veterans for hos22 pital care, medical services, and other health care 

23 from the Department. 

24 (2) AGREEMENT.— 


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1 (A) IN GENERAL.—The Secretary shall 

2 seek to enter into an agreement with a tech3 nology organization or technology organizations 

4 to carry out the review required by paragraph 

5 (1). 

6 (B) PROHIBITION ON USE OF FUNDS.—No 

7 Federal funds may be used to assist the tech8 nology organization or technology organizations 

9 under subparagraph (A) in carrying out the re10 view required by paragraph (1). 

11 (b) REPORT.— 

12 (1) IN GENERAL.—Not later than 45 days after 

13 the date of the enactment of this Act, the technology 

14 task force required under subsection (a)(1) shall 

15 submit to the Secretary, the Committee on Veterans’ 

16 Affairs of the Senate, and the Committee on Vet17 erans’ Affairs of the House of Representatives a re18 port setting forth the findings and recommendations 

19 of the technology task force regarding the needs of 

20 the Department with respect to the scheduling sys21 tem and scheduling software of the Department de22 scribed in such subsection. 

23 (2) ELEMENTS.—The report required by para24 graph (1) shall include the following: 


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1 (A) Proposals for specific actions to be 

2 taken by the Department to improve the sched3 uling system and scheduling software of the De4 partment described in subsection (a)(1). 

5 (B) A determination as to whether an ex6 isting off-the-shelf system would— 

7 (i) meet the needs of the Department 

8 to schedule appointments for veterans for 

9 hospital care, medical services, and other 

10 health care from the Department; and 

11 (ii) improve the access of veterans to 

12 such care and services. 

13 (3) PUBLICATION.—Not later than 30 days 

14 after the receipt of the report required by paragraph 

15 (1), the Secretary shall publish such report in the 

16 Federal Register and on an Internet website of the 

17 Department accessible to the public. 

18 (c) IMPLEMENTATION OF TASK FORCE REC19 OMMENDATIONS.—Not later than one year after the re20 ceipt of the report required by subsection (b)(1), the Sec21 retary shall implement the recommendations set forth in 

22 such report that the Secretary considers are feasible, ad23 visable, and cost-effective. 


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1 TITLE II—TRAINING AND HIRING 

2 OF HEALTH CARE STAFF 

3 SEC. 201. TREATMENT OF STAFFING SHORTAGE AND BIAN4 NUAL REPORT ON STAFFING OF MEDICAL FA5 CILITIES OF THE DEPARTMENT OF VET6 ERANS AFFAIRS. 

7 (a) STAFFING SHORTAGE.— 

8 (1) IN GENERAL.—Not later than 180 days 

9 after the date of the enactment of this Act, and not 

10 later than September 30 each year thereafter, the 

11 Inspector General of the Department of Veterans 

12 Affairs shall determine, and the Secretary of Vet13 erans Affairs shall publish in the Federal Register, 

14 the five occupations of health care providers of the 

15 Department of Veterans Affairs for which there is 

16 the largest staffing shortage throughout the Depart17 ment. 

18 (2) RECRUITMENT AND APPOINTMENT.—Not19 withstanding sections 3304 and 3309 through 3318 

20 of title 5, United States Code, the Secretary may, 

21 upon a determination by the Inspector General 

22 under paragraph (1) that there is a staffing short23 age throughout the Department with respect to a 

24 particular occupation of health care provider, recruit 

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1 viders to serve as health care providers in that par2 ticular occupation for the Department. 

3 (3) PRIORITY IN HEALTH PROFESSIONALS EDU4 CATIONAL ASSISTANCE PROGRAM TO CERTAIN PRO5 VIDERS.—Section 7612(b)(5) of title 38, United 

6 States Code, is amended— 

7 (A) in subparagraph (A), by striking 

8 ‘‘and’’ at the end; 

9 (B) by redesignating subparagraph (B) as 

10 subparagraph (C); and 

11 (C) by inserting after subparagraph (A) 

12 the following new subparagraph (B): 

13 ‘‘(B) shall give priority to applicants pursuing 

14 a course of education or training towards a career 

15 in an occupation for which the Secretary has, in the 

16 most current determination published in the Federal 

17 Register pursuant to section 201(a)(1) of the Vet18 erans’ Access to Care through Choice, Account19 ability, and Transparency Act of 2014, determined 

20 that there is one of the largest staffing shortages 

21 throughout the Department with respect to such oc22 cupation; and’’. 

23 (b) REPORTS.— 

24 (1) IN GENERAL.—Not later than 180 days 

25 after the date of the enactment of this Act, and not 


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1 later than December 31 of each even numbered year 

2 thereafter until 2024, the Secretary of Veterans Af3 fairs shall submit to the Committee on Veterans’ Af4 fairs of the Senate and the Committee on Veterans’ 

5 Affairs of the House of Representatives a report as6 sessing the staffing of each medical facility of the 

7 Department of Veterans Affairs. 

8 (2) ELEMENTS.—Each report submitted under 

9 paragraph (1) shall include the following: 

10 (A) The results of a system-wide assess11 ment of all medical facilities of the Department 

12 to ensure the following: 

13 (i) Appropriate staffing levels for 

14 health care providers to meet the goals of 

15 the Secretary for timely access to care for 

16 veterans. 

17 (ii) Appropriate staffing levels for 

18 support personnel, including clerks. 

19 (iii) Appropriate sizes for clinical pan20 els. 

21 (iv) Appropriate numbers of full-time 

22 staff, or full-time equivalents, dedicated to 

23 direct care of patients. 


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1 (v) Appropriate physical plant space 

2 to meet the capacity needs of the Depart3 ment in that area. 

4 (vi) Such other factors as the Sec5 retary considers necessary. 

6 (B) A plan for addressing any issues iden7 tified in the assessment described in subpara8 graph (A), including a timeline for addressing 

9 such issues. 

10 (C) A list of the current wait times and 

11 workload levels for the following clinics in each 

12 medical facility: 

13 (i) Mental health. 

14 (ii) Primary care. 

15 (iii) Gastroenterology. 

16 (iv) Women’s health. 

17 (v) Such other clinics as the Secretary 

18 considers appropriate. 

19 (D) A description of the results of the 

20 most current determination of the Inspector 

21 General under paragraph (1) of subsection (a) 

22 and a plan to use direct appointment authority 

23 under paragraph (2) of such subsection to fill 

24 staffing shortages, including recommendations 

25 for improving the speed at which the 


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1 credentialing and privileging process can be 

2 conducted. 

3 (E) The current staffing models of the De4 partment for the following clinics, including rec5 ommendations for changes to such models: 

6 (i) Mental health. 

7 (ii) Primary care. 

8 (iii) Gastroenterology. 

9 (iv) Women’s health. 

10 (v) Such other clinics as the Secretary 

11 considers appropriate. 

12 (F) A detailed analysis of succession plan13 ning at medical facilities of the Department, in14 cluding the following: 

15 (i) The number of positions in medical 

16 facilities throughout the Department that 

17 are not filled by a permanent employee. 

18 (ii) The length of time each position 

19 described in clause (i) remained vacant or 

20 filled by a temporary or acting employee. 

21 (iii) A description of any barriers to 

22 filling the positions described in clause (i). 

23 (iv) A plan for filling any positions 

24 that are vacant or filled by a temporary or 

25 acting employee for more than 180 days. 


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1 (v) A plan for handling emergency cir2 cumstances, such as administrative leave 

3 or sudden medical leave for senior officials. 

4 (G) The number of health care providers of 

5 the Department who have been removed from 

6 their positions, have retired, or have left their 

7 positions for another reason, disaggregated by 

8 provider type, during the two-year period pre9 ceding the submittal of the report. 

10 (H) Of the health care providers specified 

11 in subparagraph (G) who have been removed 

12 from their positions, the following: 

13 (i) The number of such health care 

14 providers who were reassigned to other po15 sitions in the Department. 

16 (ii) The number of such health care 

17 providers who left the Department. 

18 (iii) The number of such health care 

19 providers who left the Department and 

20 were subsequently rehired by the Depart21 ment. 

22 SEC. 202. CLINIC MANAGEMENT TRAINING FOR MANAGERS 

23 AND HEALTH CARE PROVIDERS OF THE DE24 PARTMENT OF VETERANS AFFAIRS. 

25 (a) CLINIC MANAGEMENT TRAINING PROGRAM.— 


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1 (1) IN GENERAL.—Not later than 180 days 

2 after the date of the enactment of this Act, the Sec3 retary of Veterans Affairs shall commence a clinic 

4 management training program to provide in-person, 

5 standardized education on health care management 

6 to all managers of, and health care providers at, 

7 medical facilities of the Department of Veterans Af8 fairs. 

9 (2) ELEMENTS.—The clinic management train10 ing program required by paragraph (1) shall include 

11 the following: 

12 (A) Training on how to manage the sched13 ules of health care providers of the Department, 

14 including the following: 

15 (i) Maintaining such schedules in a 

16 manner that allows appointments to be 

17 booked at least eight weeks in advance. 

18 (ii) Proper planning procedures for 

19 vacation, leave, and graduate medical edu20 cation training schedules. 

21 (B) Training on the appropriate number of 

22 appointments that a health care provider should 

23 conduct on a daily basis, based on specialty. 

24 (C) Training on how to determine whether 

25 there are enough available appointment slots to 


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1 manage demand for different appointment types 

2 and mechanisms for alerting management of in3 sufficient slots. 

4 (D) Training on how to properly use the 

5 appointment scheduling system of the Depart6 ment, including any new scheduling system im7 plemented by the Department. 

8 (E) Training on how to optimize the use of 

9 technology, including the following: 

10 (i) Telemedicine. 

11 (ii) Electronic mail. 

12 (iii) Text messaging. 

13 (iv) Such other technologies as speci14 fied by the Secretary. 

15 (F) Training on how to properly use phys16 ical plant space at medical facilities of the De17 partment to ensure efficient flow and privacy 

18 for patients and staff. 

19 (3) SUNSET.—The clinic management training 

20 program required by paragraph (1) shall terminate 

21 on the date that is two years after the date on which 

22 the Secretary commences such program. 

23 (b) TRAINING MATERIALS.— 

24 (1) IN GENERAL.—After the termination of the 

25 clinic management training program required by 


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1 subsection (a), the Secretary shall provide training 

2 materials on health care management to each of the 

3 following employees of the Department upon the 

4 commencement of employment of such employee: 

5 (A) Any manager of a medical facility of 

6 the Department. 

7 (B) Any health care provider at a medical 

8 facility of the Department. 

9 (C) Such other employees of the Depart10 ment as the Secretary considers appropriate. 

11 (2) UPDATE.—The Secretary shall regularly up12 date the training materials required under para13 graph (1). 

14 SEC. 203. USE OF UNOBLIGATED AMOUNTS TO HIRE ADDI15 TIONAL HEALTH CARE PROVIDERS FOR THE 

16 VETERANS HEALTH ADMINISTRATION. 

17 (a) IN GENERAL.—At the end of each of fiscal years 

18 2014 and 2015, all covered amounts shall be made avail19 able to the Secretary of Veterans Affairs to hire additional 

20 health care providers for the Veterans Health Administra21 tion of the Department of Veterans Affairs, or to carry 

22 out any provision of this Act or the amendments made 

23 by this Act, and shall remain available until expended. 

24 (b) PRIORITY IN HIRING.—The Secretary shall 

25 prioritize hiring additional health care providers under 


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1 subsection (a) at medical facilities of the Department and 

2 in geographic areas in which the Secretary identifies the 

3 greatest shortage of health care providers. 

4 (c) COVERED AMOUNTS DEFINED.—In this section, 

5 the term ‘‘covered amounts’’ means amounts— 

6 (1) that are made available to the Veterans 

7 Health Administration of the Department for an ap8 propriations account— 

9 (A) under the heading ‘‘MEDICAL SERV10 ICES’’; 

11 (B) under the heading ‘‘MEDICAL SUPPORT

12 AND COMPLIANCE’’; or 

13 (C) under the heading ‘‘MEDICAL FACILI14 TIES’’; and 

15 (2) that are unobligated at the end of the appli16 cable fiscal year. 

17 TITLE III—IMPROVEMENT OF 

18 ACCESS TO CARE FROM NON19 DEPARTMENT OF VETERANS 

20 AFFAIRS PROVIDERS 

21 SEC. 301. EXPANDED AVAILABILITY OF HOSPITAL CARE 

22 AND MEDICAL SERVICES FOR VETERANS 

23 THROUGH THE USE OF CONTRACTS. 

24 (a) EXPANSION OF AVAILABLE CARE AND SERV25 ICES.— 


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1 (1) FURNISHING OF CARE.— 

2 (A) IN GENERAL.—Hospital care and med3 ical services under chapter 17 of title 38, 

4 United States Code, shall be furnished to an el5 igible veteran described in subsection (b), at the 

6 election of such veteran, through contracts au7 thorized under subsection (d), or any other law 

8 administered by the Secretary of Veterans Af9 fairs, with entities specified in subparagraph 

10 (B) for the furnishing of such care and services 

11 to veterans. 

12 (B) ENTITIES SPECIFIED.—The entities 

13 specified in this subparagraph are the following: 

14 (i) Any health care provider that is 

15 participating in the Medicare program 

16 under title XVIII of the Social Security 

17 Act (42 U.S.C. 1395 et seq.). 

18 (ii) Any Federally-qualified health 

19 center (as defined in section 1905(l)(2)(B) 

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

21 1396d(l)(2)(B))). 

22 (iii) The Department of Defense. 

23 (iv) The Indian Health Service. 

24 (2) CHOICE OF PROVIDER.—An eligible veteran 

25 who elects to receive care and services under this 


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1 section may select the provider of such care and 

2 services from among any source of provider of such 

3 care and services through an entity specified in 

4 paragraph (1)(B) that is accessible to the veteran. 

5 (3) COORDINATION OF CARE AND SERVICES.— 

6 The Secretary shall coordinate, through the Non-VA 

7 Care Coordination Program of the Department of 

8 Veterans Affairs, the furnishing of care and services 

9 under this section to eligible veterans, including by 

10 ensuring that an eligible veteran receives an appoint11 ment for such care and services within the current 

12 wait-time goals of the Veterans Health Administra13 tion for the furnishing of hospital care and medical 

14 services. 

15 (b) ELIGIBLE VETERANS.—A veteran is an eligible 

16 veteran for purposes of this section if— 

17 (1)(A) the veteran is enrolled in the patient en18 rollment system of the Department of Veterans Af19 fairs established and operated under section 1705 of 

20 title 38, United States Code; or 

21 (B) the veteran is enrolled in such system, has 

22 not received hospital care or medical services from 

23 the Department, and has contacted the Department 

24 seeking an initial appointment from the Department 

25 for the receipt of such care or services; and 


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1 (2) the veteran— 

2 (A)(i) attempts, or has attempted under 

3 paragraph (1)(B), to schedule an appointment 

4 for the receipt of hospital care or medical serv5 ices under chapter 17 of title 38, United States 

6 Code, but is unable to schedule an appointment 

7 within the current wait-time goals of the Vet8 erans Health Administration for the furnishing 

9 of such care or services; and 

10 (ii) elects, and is authorized, to be fur11 nished such care or services pursuant to sub12 section (c)(2); 

13 (B) resides more than 40 miles from the 

14 nearest medical facility of the Department, in15 cluding a community-based outpatient clinic, 

16 that is closest to the residence of the veteran; 

17 or 

18 (C) resides— 

19 (i) in a State without a medical facil20 ity of the Department that provides— 

21 (I) hospital care; 

22 (II) emergency medical services; 

23 and 


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1 (III) surgical care rated by the 

2 Secretary as having a surgical com3 plexity of standard; and 

4 (ii) more than 20 miles from a med5 ical facility of the Department described in 

6 clause (i). 

7 (c) ELECTION AND AUTHORIZATION.— 

8 (1) IN GENERAL.—If the Secretary confirms 

9 that an appointment for an eligible veteran described 

10 in subsection (b)(2)(A) for the receipt of hospital 

11 care or medical services under chapter 17 of title 38, 

12 United States Code, is unavailable within the cur13 rent wait-time goals of the Department for the fur14 nishing of such care or services, the Secretary shall, 

15 at the election of the eligible veteran— 

16 (A) place such eligible veteran on an elec17 tronic waiting list described in paragraph (2) 

18 for such an appointment; or 

19 (B)(i) authorize that such care and serv20 ices be furnished to the eligible veteran under 

21 this section for a period of time specified by the 

22 Secretary; and 

23 (ii) send a letter to the eligible veteran de24 scribing the care and services the eligible vet25 eran is eligible to receive under this section. 


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1 (2) ELECTRONIC WAITING LIST.—The elec2 tronic waiting list described in this paragraph shall 

3 be maintained by the Department and allow access 

4 by each eligible veteran via www.myhealth.va.gov or 

5 any successor website for the following purposes: 

6 (A) To determine the place of such eligible 

7 veteran on the waiting list. 

8 (B) To determine the average length of 

9 time an individual spends on the waiting list, 

10 disaggregated by medical facility of the Depart11 ment and type of care or service needed, for 

12 purposes of allowing such eligible veteran to 

13 make an informed election under paragraph 

14 (1). 

15 (d) CARE AND SERVICES THROUGH CONTRACTS.— 

16 (1) IN GENERAL.—The Secretary shall enter 

17 into contracts with health care providers that are 

18 participating in the Medicare program under title 

19 XVIII of the Social Security Act (42 U.S.C. 1395 et 

20 seq.) to furnish care and services to eligible veterans 

21 under this section. 

22 (2) RATES AND REIMBURSEMENT.— 

23 (A) IN GENERAL.—In entering into a con24 tract under this subsection, the Secretary 

25 shall— 


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1 (i) negotiate rates for the furnishing 

2 of care and services under this section; and 

3 (ii) reimburse the health care provider 

4 for such care and services at the rates ne5 gotiated pursuant to clause (i) as provided 

6 in such contract. 

7 (B) LIMIT ON RATES.— 

8 (i) IN GENERAL.—Except as provided 

9 in clause (ii), rates negotiated under sub10 paragraph (A)(i) shall not be more than 

11 the rates paid by the United States to a 

12 provider of services (as defined in section 

13 1861(u) of the Social Security Act (42 

14 U.S.C. 1395x(u))) or a supplier (as defined 

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

16 1395x(d))) under the Medicare program 

17 under title XVIII of the Social Security 

18 Act (42 U.S.C. 1395 et seq.) for the same 

19 care and services. 

20 (ii) EXCEPTION.—The Secretary may 

21 negotiate a rate that is more than the rate 

22 paid by the United States as described in 

23 clause (i) with respect to the furnishing of 

24 care or services under this section to an el25 igible veteran if the Secretary determines 


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1 that there is no health care provider that 

2 will provide such care or services to such 

3 eligible veteran at the rate required under 

4 such clause— 

5 (I) within the current wait-time 

6 goals of the Veterans Health Adminis7 tration for the furnishing of such care 

8 or services; and 

9 (II) at a location not more than 

10 40 miles from the residence of such 

11 eligible veteran. 

12 (C) LIMIT ON COLLECTION.—For the fur13 nishing of care and services pursuant to a con14 tract under this section, a health care provider 

15 may not collect any amount that is greater than 

16 the rate negotiated pursuant to subparagraph 

17 (A)(i). 

18 (3) INFORMATION ON POLICIES AND PROCE19 DURES.—The Secretary shall provide to any health 

20 care provider with which the Secretary has entered 

21 into a contract under paragraph (1) the following: 

22 (A) Information on applicable policies and 

23 procedures for submitting bills or claims for au24 thorized care and services furnished to eligible 

25 veterans under this section. 


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1 (B) Access to a telephone hotline main2 tained by the Department that such health care 

3 provider may call for information on the fol4 lowing: 

5 (i) Procedures for furnishing care and 

6 services under this section. 

7 (ii) Procedures for submitting bills or 

8 claims for authorized care and services fur9 nished to eligible veterans under this sec10 tion and being reimbursed for furnishing 

11 such care and services. 

12 (iii) Whether particular care or serv13 ices under this section are authorized, and 

14 the procedures for authorization of such 

15 care or services. 

16 (e) CHOICE CARD.— 

17 (1) IN GENERAL.—For purposes of receiving 

18 care and services under this section, the Secretary 

19 shall issue to each eligible veteran a card that the 

20 eligible veteran shall present to a health care pro21 vider that is eligible to furnish care and services 

22 under this section before receiving such care and 

23 services. 

24 (2) NAME OF CARD.—Each card issued under 

25 paragraph (1) shall be known as a ‘‘Choice Card’’. 


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1 (3) DETAILS OF CARD.—Each Choice Card 

2 issued to an eligible veteran under paragraph (1) 

3 shall include the following: 

4 (A) The name of the eligible veteran. 

5 (B) An identification number for the eligi6 ble veteran that is not the social security num7 ber of the eligible veteran. 

8 (C) The contact information of an appro9 priate office of the Department for health care 

10 providers to confirm that care and services 

11 under this section are authorized for the eligible 

12 veteran. 

13 (D) Contact information and other rel14 evant information for the submittal of claims or 

15 bills for the furnishing of care and services 

16 under this section. 

17 (E) The following statement: ‘‘This card is 

18 for qualifying medical care outside the Depart19 ment of Veterans Affairs. Please call the De20 partment of Veterans Affairs phone number 

21 specified on this card to ensure that treatment 

22 has been authorized.’’. 

23 (4) INFORMATION ON USE OF CARD.—Upon 

24 issuing a Choice Card to an eligible veteran, the Sec25 retary shall provide the eligible veteran with inforVerDate Mar 15 2010 06:00 Jun 13, 2014 Jkt 039200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\H4841.IH H4841

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1 mation clearly stating the circumstances under 

2 which the veteran may be eligible for care and serv3 ices under this section. 

4 (f) INFORMATION ON AVAILABILITY OF CARE.—The 

5 Secretary shall provide information to a veteran about the 

6 availability of care and services under this section in the 

7 following circumstances: 

8 (1) When the veteran enrolls in the patient en9 rollment system of the Department under section 

10 1705 of title 38, United States Code. 

11 (2) When the veteran attempts to schedule an 

12 appointment for the receipt of hospital care or med13 ical services from the Department but is unable to 

14 schedule an appointment within the current wait15 time goals of the Veterans Health Administration 

16 for delivery of such care or services. 

17 (g) PROVIDERS.—To be eligible to furnish care and 

18 services under this section, a health care provider must— 

19 (1) maintain at least the same or similar cre20 dentials and licenses as those credentials and li21 censes that are required of health care providers of 

22 the Department, as determined by the Secretary for 

23 purposes of this section; and 


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1 (2) submit, not less frequently than once each 

2 year, verification of such licenses and credentials 

3 maintained by such health care provider. 

4 (h) COST-SHARING.— 

5 (1) IN GENERAL.—The Secretary shall require 

6 an eligible veteran to pay a copayment to the De7 partment for the receipt of care and services under 

8 this section only if such eligible veteran would be re9 quired to pay such copayment for the receipt of such 

10 care and services at a medical facility of the Depart11 ment. 

12 (2) LIMITATION.—The copayment required 

13 under paragraph (1) shall not be greater than the 

14 copayment required of such eligible veteran by the 

15 Department for the receipt of such care and services 

16 at a medical facility of the Department. 

17 (i) CLAIMS PROCESSING SYSTEM.— 

18 (1) IN GENERAL.—The Secretary shall provide 

19 for an efficient nationwide system for processing and 

20 paying bills or claims for authorized care and serv21 ices furnished to eligible veterans under this section. 

22 (2) REGULATIONS.—Not later than 90 days 

23 after the date of the enactment of this Act, the Sec24 retary of Veterans Affairs shall prescribe regulations 

25 for the implementation of such system. 


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1 (3) OVERSIGHT.—The Chief Business Office of 

2 the Veterans Health Administration shall oversee the 

3 implementation and maintenance of such system. 

4 (4) ACCURACY OF PAYMENT.— 

5 (A) IN GENERAL.—The Secretary shall en6 sure that such system meets such goals for ac7 curacy of payment as the Secretary shall specify 

8 for purposes of this section. 

9 (B) ANNUAL REPORT.— 

10 (i) IN GENERAL.—Not later than one 

11 year after the date of the enactment of this 

12 Act, and annually thereafter until the ter13 mination date specified in subsection (n), 

14 the Secretary shall submit to the Com15 mittee on Veterans’ Affairs of the Senate 

16 and the Committee on Veterans’ Affairs of 

17 the House of Representatives a report on 

18 the goals for accuracy of such system. 

19 (ii) ELEMENTS.—Each report re20 quired by clause (i) shall include the fol21 lowing: 

22 (I) A description of the goals for 

23 accuracy for such system specified by 

24 the Secretary under subparagraph 

25 (A). 


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1 (II) An assessment of the success 

2 of the Department in meeting such 

3 goals during the year preceding the 

4 submittal of the report. 

5 (j) MEDICAL RECORDS.—The Secretary shall ensure 

6 that any health care provider that furnishes care and serv7 ices under this section to an eligible veteran submits to 

8 the Department any medical record related to the care and 

9 services provided to such eligible veteran by such health 

10 care provider for inclusion in the electronic medical record 

11 of such eligible veteran maintained by the Department 

12 upon the completion of the provision of such care and serv13 ices to such eligible veteran. 

14 (k) TRACKING OF MISSED APPOINTMENTS.—The 

15 Secretary shall implement a mechanism to track any 

16 missed appointments for care and services under this sec17 tion by eligible veterans to ensure that the Department 

18 does not pay for such care and services that were not fur19 nished to an eligible veteran. 

20 (l) IMPLEMENTATION.—Not later than 90 days after 

21 the date of the enactment of this Act, the Secretary shall 

22 prescribe interim final regulations on the implementation 

23 of this section and publish such regulations in the Federal 

24 Register. 


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1 (m) INSPECTOR GENERAL REPORT.—Not later than 

2 540 days after the publication of the interim final regula3 tions under subsection (l), the Inspector General of the 

4 Department shall submit to the Secretary a report on the 

5 results of an audit of the care and services furnished 

6 under this section to ensure the accuracy and timeliness 

7 of payments by the Department for the cost of such care 

8 and services, including any findings and recommendations 

9 of the Inspector General. 

10 (n) TERMINATION.—The requirement of the Sec11 retary to furnish care and services under this section ter12 minates on the date that is two years after the date on 

13 which the Secretary publishes the interim final regulations 

14 under subsection (l). 

15 (o) REPORTS.— 

16 (1) INITIAL REPORT.—Not later than 90 days 

17 after the publication of the interim final regulations 

18 under subsection (l), the Secretary shall submit to 

19 the Committee on Veterans’ Affairs of the Senate 

20 and the Committee on Veterans’ Affairs of the 

21 House of Representatives a report on the furnishing 

22 of care and services under this section that includes 

23 the following: 


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1 (A) The number of eligible veterans who 

2 have received care and services under this sec3 tion. 

4 (B) A description of the type of care and 

5 services furnished to eligible veterans under this 

6 section. 

7 (2) FINAL REPORT.—Not later than 540 days 

8 after the publication of the interim final regulations 

9 under subsection (l), the Secretary shall submit to 

10 the Committee on Veterans’ Affairs of the Senate 

11 and the Committee on Veterans’ Affairs of the 

12 House of Representatives a report on the furnishing 

13 of care and services under this section that includes 

14 the following: 

15 (A) The total number of eligible veterans 

16 who have received care and services under this 

17 section, disaggregated by— 

18 (i) eligible veterans described in sub19 section (b)(2)(A); and 

20 (ii) eligible veterans described in sub21 section (b)(2)(B). 

22 (B) A description of the type of care and 

23 services furnished to eligible veterans under this 

24 section. 


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1 (C) An accounting of the total cost of fur2 nishing care and services to eligible veterans 

3 under this section. 

4 (D) The results of a survey of eligible vet5 erans who have received care or services under 

6 this section on the satisfaction of such eligible 

7 veterans with the care or services received by 

8 such eligible veterans under this section. 

9 (E) An assessment of the effect of fur10 nishing care and services under this section on 

11 wait times for an appointment for the receipt of 

12 hospital care and medical services from the De13 partment. 

14 (F) An assessment of the feasibility and 

15 advisability of continuing furnishing care and 

16 services under this section after the termination 

17 date specified in subsection (n). 

18 (p) RULES OF CONSTRUCTION.— 

19 (1) NO MODIFICATION OF CONTRACTS.—Noth20 ing in this section shall be construed to require the 

21 Secretary to renegotiate contracts for the furnishing 

22 of hospital care or medical services to veterans en23 tered into by the Department before the date of the 

24 enactment of this Act. 


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1 (2) FILLING AND PAYING FOR PRESCRIPTION

2 MEDICATIONS.—Nothing in this section shall be con3 strued to alter the process of the Department for 

4 filling and paying for prescription medications. 

5 SEC. 302. TRANSFER OF AUTHORITY FOR PAYMENTS FOR 

6 HOSPITAL CARE, MEDICAL SERVICES, AND 

7 OTHER HEALTH CARE FROM NON-DEPART8 MENT PROVIDERS TO THE CHIEF BUSINESS 

9 OFFICE OF THE VETERANS HEALTH ADMINIS10 TRATION OF THE DEPARTMENT. 

11 (a) TRANSFER OF AUTHORITY.— 

12 (1) IN GENERAL.—Effective on October 1, 

13 2014, the Secretary of Veterans Affairs shall trans14 fer the authority to pay for hospital care, medical 

15 services, and other health care through non-Depart16 ment providers to the Chief Business Office of the 

17 Veterans Health Administration of the Department 

18 of Veterans Affairs from the Veterans Integrated 

19 Service Networks and medical centers of the Depart20 ment of Veterans Affairs. 

21 (2) MANNER OF CARE.—The Chief Business 

22 Office shall work in consultation with the Office of 

23 Clinical Operations and Management of the Depart24 ment of Veterans Affairs to ensure that care and 


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1 services described in paragraph (1) are provided in 

2 a manner that is clinically appropriate and effective. 

3 (3) NO DELAY IN PAYMENT.—The transfer of 

4 authority under paragraph (1) shall be carried out 

5 in a manner that does not delay or impede any pay6 ment by the Department for hospital care, medical 

7 services, or other health care provided through a 

8 non-Department provider under the laws adminis9 tered by the Secretary. 

10 (b) BUDGETARY EFFECT.—The Secretary shall, for 

11 each fiscal year that begins after the date of the enact12 ment of this Act— 

13 (1) include in the budget for the Chief Business 

14 Office of the Veterans Health Administration 

15 amounts to pay for hospital care, medical services, 

16 and other health care provided through non-Depart17 ment providers, including any amounts necessary to 

18 carry out the transfer of authority to pay for such 

19 care and services under subsection (a), including any 

20 increase in staff; and 

21 (2) not include in the budget of each Veterans 

22 Integrated Service Network and medical center of 

23 the Department amounts to pay for such care and 

24 services. 


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1 SEC. 303. ENHANCEMENT OF COLLABORATION BETWEEN 

2 DEPARTMENT OF VETERANS AFFAIRS AND 

3 INDIAN HEALTH SERVICE. 

4 (a) OUTREACH TO TRIBAL-RUN MEDICAL FACILI5 TIES.—The Secretary of Veterans Affairs shall, in con6 sultation with the Director of the Indian Health Service, 

7 conduct outreach to each medical facility operated by an 

8 Indian tribe or tribal organization through a contract or 

9 compact with the Indian Health Service under the Indian 

10 Self-Determination and Education Assistance Act (25 

11 U.S.C. 450 et seq.) to raise awareness of the ability of 

12 such facilities, Indian tribes, and tribal organizations to 

13 enter into agreements with the Department of Veterans 

14 Affairs under which the Secretary reimburses such facili15 ties, Indian tribes, or tribal organizations, as the case may 

16 be, for health care provided to veterans eligible for health 

17 care at such facilities. 

18 (b) METRICS FOR MEMORANDUM OF UNDER19 STANDING PERFORMANCE.—The Secretary of Veterans 

20 Affairs shall implement performance metrics for assessing 

21 the performance by the Department of Veterans Affairs 

22 and the Indian Health Service under the memorandum of 

23 understanding entitled ‘‘Memorandum of Understanding 

24 between the Department of Veterans Affairs (VA) and the 

25 Indian Health Service (IHS)’’ in increasing access to 

26 health care, improving quality and coordination of health 


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1 care, promoting effective patient-centered collaboration 

2 and partnerships between the Department and the Serv3 ice, and ensuring health-promotion and disease-prevention 

4 services are appropriately funded and available for bene5 ficiaries under both health care systems. 

6 (c) REPORT.—Not later than 180 days after the date 

7 of the enactment of this Act, the Secretary of Veterans 

8 Affairs and the Director of the Indian Health Service shall 

9 jointly submit to Congress a report on the feasibility and 

10 advisability of the following: 

11 (1) Entering into agreements for the reimburse12 ment by the Secretary of the costs of direct care 

13 services provided through organizations receiving 

14 amounts pursuant to grants made or contracts en15 tered into under section 503 of the Indian Health 

16 Care Improvement Act (25 U.S.C. 1653) to veterans 

17 who are otherwise eligible to receive health care from 

18 such organizations. 

19 (2) Including the reimbursement of the costs of 

20 direct care services provided to veterans who are not 

21 Indians in agreements between the Department and 

22 the following: 

23 (A) The Indian Health Service. 

24 (B) An Indian tribe or tribal organization 

25 operating a medical facility through a contract 


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1 or compact with the Indian Health Service 

2 under the Indian Self-Determination and Edu3 cation Assistance Act (25 U.S.C. 450 et seq.). 

4 (C) A medical facility of the Indian Health 

5 Service. 

6 (d) DEFINITIONS.—In this section: 

7 (1) INDIAN.—The terms ‘‘Indian’’ and ‘‘Indian 

8 tribe’’ have the meanings given those terms in sec9 tion 4 of the Indian Health Care Improvement Act 

10 (25 U.S.C. 1603). 

11 (2) MEDICAL FACILITY OF THE INDIAN

12 HEALTH SERVICE.—The term ‘‘medical facility of 

13 the Indian Health Service’’ includes a facility oper14 ated by an Indian tribe or tribal organization 

15 through a contract or compact with the Indian 

16 Health Service under the Indian Self-Determination 

17 and Education Assistance Act (25 U.S.C. 450 et 

18 seq.). 

19 (3) TRIBAL ORGANIZATION.—The term ‘‘tribal 

20 organization’’ has the meaning given the term in 

21 section 4 of the Indian Self-Determination and Edu22 cation Assistance Act (25 U.S.C. 450b). 


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1 SEC. 304. ENHANCEMENT OF COLLABORATION BETWEEN 

2 DEPARTMENT OF VETERANS AFFAIRS AND 

3 NATIVE HAWAIIAN HEALTH CARE SYSTEMS. 

4 (a) IN GENERAL.—The Secretary of Veterans Affairs 

5 shall, in consultation with Papa Ola Lokahi and such 

6 other organizations involved in the delivery of health care 

7 to Native Hawaiians as the Secretary considers appro8 priate, enter into contracts or agreements with Native Ha9 waiian health care systems that are in receipt of funds 

10 from the Secretary of Health and Human Services pursu11 ant to grants awarded or contracts entered into under sec12 tion 6(a) of the Native Hawaiian Health Care Improve13 ment Act (42 U.S.C. 11705(a)) for the reimbursement of 

14 direct care services provided to eligible veterans as speci15 fied in such contracts or agreements. 

16 (b) DEFINITIONS.—In this section, the terms ‘‘Native 

17 Hawaiian’’, ‘‘Native Hawaiian health care system’’, and 

18 ‘‘Papa Ola Lokahi’’ have the meanings given those terms 

19 in section 12 of the Native Hawaiian Health Care Im20 provement Act (42 U.S.C. 11711). 

21 SEC. 305. SENSE OF CONGRESS ON PROMPT PAYMENT BY 

22 DEPARTMENT OF VETERANS AFFAIRS. 

23 It is the sense of Congress that the Secretary of Vet24 erans Affairs shall comply with section 1315 of title 5, 

25 Code of Federal Regulations (commonly known as the 

26 ‘‘prompt payment rule’’), or any corresponding similar 


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1 regulation or ruling, in paying for health care pursuant 

2 to contracts entered into with non-Department of Vet3 erans Affairs providers to provide health care under the 

4 laws administered by the Secretary. 

5 TITLE IV—HEALTH CARE 

6 ADMINISTRATIVE MATTERS 

7 SEC. 401. IMPROVEMENT OF ACCESS OF VETERANS TO MO8 BILE VET CENTERS OF THE DEPARTMENT OF 

9 VETERANS AFFAIRS. 

10 (a) IMPROVEMENT OF ACCESS.— 

11 (1) IN GENERAL.—The Secretary of Veterans 

12 Affairs shall improve the access of veterans to tele13 medicine and other health care through the use of 

14 mobile vet centers of the Department of Veterans 

15 Affairs by providing standardized requirements for 

16 the operation of such centers. 

17 (2) REQUIREMENTS.—The standardized re18 quirements required by paragraph (1) shall include 

19 the following: 

20 (A) The number of days each mobile vet 

21 center of the Department is expected to travel 

22 per year. 

23 (B) The number of locations each center is 

24 expected to visit per year. 


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1 (C) The number of appointments each cen2 ter is expected to conduct per year. 

3 (D) The method and timing of notifica4 tions given by each center to individuals in the 

5 area to which such center is traveling, including 

6 notifications informing veterans of the avail7 ability to schedule appointments at the center. 

8 (3) USE OF TELEMEDICINE.—The Secretary 

9 shall ensure that each mobile vet center of the De10 partment has the capability to provide telemedicine 

11 services. 

12 (b) REPORTS.—Not later than one year after the date 

13 of the enactment of this Act, and not later than September 

14 30 each year thereafter, the Secretary of Veterans Affairs 

15 shall submit to the Committee on Veterans’ Affairs of the 

16 Senate and the Committee on Veterans’ Affairs of the 

17 House of Representatives a report on the following: 

18 (1) The use of mobile vet centers to provide 

19 telemedicine services to veterans during the year 

20 preceding the submittal of the report, including the 

21 following: 

22 (A) The number of days each mobile vet 

23 center was open to provide such services. 

24 (B) The number of days each mobile vet 

25 center traveled to a location other than the 


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1 headquarters of the mobile vet center to provide 

2 such services. 

3 (C) The number of appointments each cen4 ter conducted to provide such services on aver5 age per month and in total during such year. 

6 (2) An analysis of the effectiveness of using mo7 bile vet centers to provide health care services to vet8 erans through the use of telemedicine. 

9 (3) Any recommendations for an increase in the 

10 number of mobile vet centers of the Department. 

11 (4) Any recommendations for an increase in the 

12 telemedicine capabilities of each mobile vet center. 

13 (5) The feasibility and advisability of using 

14 temporary health care providers, including locum 

15 tenens, to provide direct health care services to vet16 erans at mobile vet centers. 

17 (6) Such other recommendations on improve18 ment of the use of mobile vet centers by the Depart19 ment as the Secretary considers appropriate. 

20 SEC. 402. COMMISSION ON CONSTRUCTION PROJECTS OF 

21 THE DEPARTMENT OF VETERANS AFFAIRS. 

22 (a) ESTABLISHMENT OF COMMISSION.— 

23 (1) ESTABLISHMENT.—There is established an 

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1 erans Affairs Construction Projects (in this section 

2 referred to as the ‘‘Commission’’). 

3 (2) MEMBERSHIP.— 

4 (A) VOTING MEMBERS.—The Commission 

5 shall be composed of 10 voting members as fol6 lows: 

7 (i) Three members to be appointed by 

8 the President from among members of the 

9 National Academy of Engineering who are 

10 nominated under subparagraph (B). 

11 (ii) Three members to be appointed by 

12 the President from among members of the 

13 National Institute of Building Sciences 

14 who are nominated under subparagraph 

15 (B). 

16 (iii) Four members to be appointed by 

17 the President from among veterans en18 rolled in the patient enrollment system of 

19 the Department of Veterans Affairs under 

20 section 1705 of title 38, United States 

21 Code, who are nominated under subpara22 graph (B). 

23 (B) NOMINATION OF VOTING MEMBERS.— 

24 The majority leader of the Senate, the minority 

25 leader of the Senate, the speaker of the House 


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1 of Representatives, and the minority leader of 

2 the House of Representatives shall jointly nomi3 nate not less than 24 individuals to be consid4 ered by the President for appointment under 

5 subparagraph (A). 

6 (C) NONVOTING MEMBERS.—The Commis7 sion shall be composed of the following non8 voting members: 

9 (i) The Comptroller General of the 

10 United States, or designee. 

11 (ii) The Secretary of Veterans Affairs, 

12 or designee. 

13 (iii) The Inspector General of the De14 partment of Veterans Affairs, or designee. 

15 (D) DATE OF APPOINTMENT OF MEM16 BERS.—The appointments of the members of 

17 the Commission under subparagraph (A) shall 

18 be made not later than 14 days after the date 

19 of the enactment of this Act. 

20 (3) PERIOD OF APPOINTMENT; VACANCIES.— 

21 Members shall be appointed for the life of the Com22 mission. Any vacancy in the Commission shall not 

23 affect its powers, but shall be filled in the same 

24 manner as the original appointment. 


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1 (4) INITIAL MEETING.—Not later than five 

2 days after the date on which all members of the 

3 Commission have been appointed, the Commission 

4 shall hold its first meeting. 

5 (5) MEETINGS.—The Commission shall meet at 

6 the call of the Chairperson. 

7 (6) QUORUM.—A majority of the members of 

8 the Commission shall constitute a quorum, but a 

9 lesser number of members may hold hearings. 

10 (7) CHAIRPERSON AND VICE CHAIRPERSON.— 

11 The Commission shall select a Chairperson and Vice 

12 Chairperson from among its members. 

13 (b) DUTIES OF COMMISSION.— 

14 (1) REVIEW.—The Commission shall review 

15 current construction and maintenance projects and 

16 the medical facility leasing program of the Depart17 ment of Veterans Affairs to identify any problems 

18 experienced by the Department in carrying out such 

19 projects and program. 

20 (2) REPORTS.— 

21 (A) COMMISSION REPORT.—Not later than 

22 120 days after the date of the enactment of this 

23 Act, the Commission shall submit to the Sec24 retary of Veterans Affairs, the Committee on 

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1 mittee on Veterans’ Affairs of the House of 

2 Representatives a report setting forth rec3 ommendations, if any, for improving the man4 ner in which the Secretary carries out the 

5 projects and program specified in paragraph 

6 (1). 

7 (B) DEPARTMENT REPORT.—Not later 

8 than 60 days after the submittal of the report 

9 under subparagraph (A), the Secretary of Vet10 erans Affairs shall submit to the Committee on 

11 Veterans’ Affairs of the Senate and the Com12 mittee on Veterans’ Affairs of the House of 

13 Representatives a report on the feasibility and 

14 advisability of implementing the recommenda15 tions of the Commission, if any, included in the 

16 report submitted under such subparagraph, in17 cluding a timeline for the implementation of 

18 such recommendations. 

19 (c) POWERS OF COMMISSION.— 

20 (1) HEARINGS.—The Commission may hold 

21 such hearings, sit and act at such times and places, 

22 take such testimony, and receive such evidence as 

23 the Commission considers advisable to carry out this 

24 section. 


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1 (2) INFORMATION FROM FEDERAL AGENCIES.— 

2 The Commission may secure directly from any Fed3 eral agency such information as the Commission 

4 considers necessary to carry out this section. Upon 

5 request of the Chairperson of the Commission, the 

6 head of such agency shall furnish such information 

7 to the Commission. 

8 (d) COMMISSION PERSONNEL MATTERS.— 

9 (1) COMPENSATION OF MEMBERS.—Each mem10 ber of the Commission who is not an officer or em11 ployee of the Federal Government shall be com12 pensated at a rate equal to the daily equivalent of 

13 the annual rate of basic pay prescribed for level IV 

14 of the Executive Schedule under section 5315 of title 

15 5, United States Code, for each day (including travel 

16 time) during which such member is engaged in the 

17 performance of the duties of the Commission. All 

18 members of the Commission who are officers or em19 ployees of the United States shall serve without com20 pensation in addition to that received for their serv21 ices as officers or employees of the United States. 

22 (2) TRAVEL EXPENSES.—The members of the 

23 Commission shall be allowed travel expenses, includ24 ing per diem in lieu of subsistence, at rates author25 ized for employees of agencies under subchapter I of 


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1 chapter 57 of title 5, United States Code, while 

2 away from their homes or regular places of business 

3 in the performance of services for the Commission. 

4 (3) STAFF.— 

5 (A) IN GENERAL.—The Chairperson of the 

6 Commission may, without regard to the civil 

7 service laws and regulations, appoint and termi8 nate an executive director and such other addi9 tional personnel as may be necessary to enable 

10 the Commission to perform its duties. The em11 ployment of an executive director shall be sub12 ject to confirmation by the Commission. 

13 (B) COMPENSATION.—The Chairperson of 

14 the Commission may fix the compensation of 

15 the executive director and other personnel with16 out regard to chapter 51 and subchapter III of 

17 chapter 53 of title 5, United States Code, relat18 ing to classification of positions and General 

19 Schedule pay rates, except that the rate of pay 

20 for the executive director and other personnel 

21 may not exceed the rate payable for level V of 

22 the Executive Schedule under section 5316 of 

23 such title. 

24 (4) DETAIL OF GOVERNMENT EMPLOYEES.— 

25 Any Federal Government employee may be detailed 


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1 to the Commission without reimbursement, and such 

2 detail shall be without interruption or loss of civil 

3 service status or privilege. 

4 (5) PROCUREMENT OF TEMPORARY AND INTER5 MITTENT SERVICES.—The Chairperson of the Com6 mission may procure temporary and intermittent 

7 services under section 3109(b) of title 5, United 

8 States Code, at rates for individuals that do not ex9 ceed the daily equivalent of the annual rate of basic 

10 pay prescribed for level V of the Executive Schedule 

11 under section 5316 of such title. 

12 (e) TERMINATION OF COMMISSION.—The Commis13 sion shall terminate 30 days after the date on which the 

14 Commission submits its report under subsection (b)(2)(A). 

15 SEC. 403. COMMISSION ON ACCESS TO CARE. 

16 (a) ESTABLISHMENT OF COMMISSION.— 

17 (1) IN GENERAL.—There is established the 

18 Commission on Access to Care (in this section re19 ferred to as the ‘‘Commission’’) to examine the ac20 cess of veterans to health care from the Department 

21 of Veterans Affairs and strategically examine how 

22 best to organize the Veterans Health Administra23 tion, locate health care resources, and deliver health 

24 care to veterans during the 10- to 20-year period be25 ginning on the date of the enactment of this Act. 


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1 (2) MEMBERSHIP.— 

2 (A) VOTING MEMBERS.—The Commission 

3 shall be composed of 10 voting members who 

4 are appointed by the President as follows: 

5 (i) At least two members who rep6 resent an organization recognized by the 

7 Secretary of Veterans Affairs for the rep8 resentation of veterans under section 5902 

9 of title 38, United States Code. 

10 (ii) At least one member from among 

11 persons who have experience as senior 

12 management for a private integrated 

13 health care system with an annual gross 

14 revenue of more than $50,000,000. 

15 (iii) At least one member from among 

16 persons who are familiar with government 

17 health care systems, including those sys18 tems of the Department of Defense, the 

19 Indian Health Service, and Federally-quali20 fied health centers (as defined in section 

21 1905(l)(2)(B) of the Social Security Act 

22 (42 U.S.C. 1396d(l)(2)(B))). 

23 (iv) At least two members from 

24 among persons who are familiar with the 

25 Veterans Health Administration but are 


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1 not current employees of the Veterans 

2 Health Administration. 

3 (v) At least two members from among 

4 persons who are veterans or eligible for 

5 hospital care, medical services, or other 

6 health care under the laws administered by 

7 the Secretary of Veterans Affairs. 

8 (B) NONVOTING MEMBERS.— 

9 (i) IN GENERAL.—In addition to 

10 members appointed under subparagraph 

11 (A), the Commission shall be composed of 

12 10 nonvoting members who are appointed 

13 by the President as follows: 

14 (I) At least two members who 

15 represent an organization recognized 

16 by the Secretary of Veterans Affairs 

17 for the representation of veterans 

18 under section 5902 of title 38, United 

19 States Code. 

20 (II) At least one member from 

21 among persons who have experience 

22 as senior management for a private 

23 integrated health care system with an 

24 annual gross revenue of more than 

25 $50,000,000. 


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1 (III) At least one member from 

2 among persons who are familiar with 

3 government health care systems, in4 cluding those systems of the Depart5 ment of Defense, the Indian Health 

6 Service, and Federally-qualified health 

7 centers (as defined in section 

8 1905(l)(2)(B) of the Social Security 

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

10 (IV) At least two members from 

11 among persons who are familiar with 

12 the Veterans Health Administration 

13 but are not current employees of the 

14 Veterans Health Administration. 

15 (V) At least two members from 

16 among persons who are veterans or el17 igible for hospital care, medical serv18 ices, or other health care under the 

19 laws administered by the Secretary of 

20 Veterans Affairs. 

21 (ii) ADDITIONAL NONVOTING MEM22 BERS.—In addition to members appointed 

23 under subparagraph (A) and clause (i), the 

24 Commission shall be composed of the fol25 lowing nonvoting members: 


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1 (I) The Comptroller General of 

2 the United States, or designee. 

3 (II) The Inspector General of the 

4 Department of Veterans Affairs, or 

5 designee. 

6 (C) DATE.—The appointments of members 

7 of the Commission shall be made not later than 

8 60 days after the date of the enactment of this 

9 Act. 

10 (3) PERIOD OF APPOINTMENT; VACANCIES.— 

11 Members shall be appointed for the life of the Com12 mission. Any vacancy in the Commission shall not 

13 affect its powers, but shall be filled in the same 

14 manner as the original appointment. 

15 (4) INITIAL MEETING.—Not later than 15 days 

16 after the date on which seven voting members of the 

17 Commission have been appointed, the Commission 

18 shall hold its first meeting. 

19 (5) MEETINGS.—The Commission shall meet at 

20 the call of the Chairperson. 

21 (6) QUORUM.—A majority of the members of 

22 the Commission shall constitute a quorum, but a 

23 lesser number of members may hold hearings. 


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1 (7) CHAIRPERSON AND VICE CHAIRPERSON.— 

2 The Commission shall select a Chairperson and Vice 

3 Chairperson from among its members. 

4 (b) DUTIES OF COMMISSION.— 

5 (1) EVALUATION AND ASSESSMENT.—The Com6 mission shall undertake a comprehensive evaluation 

7 and assessment of access to health care at the De8 partment of Veterans Affairs. 

9 (2) MATTERS EVALUATED AND ASSESSED.— 

10 The matters evaluated and assessed by the Commis11 sion shall include the following: 

12 (A) The appropriateness of current stand13 ards of the Department of Veterans Affairs 

14 concerning access to health care. 

15 (B) The measurement of such standards. 

16 (C) The appropriateness of performance 

17 standards and incentives in relation to stand18 ards described in subparagraph (A). 

19 (D) Staffing levels throughout the Vet20 erans Health Administration and whether they 

21 are sufficient to meet current demand for 

22 health care from the Administration. 

23 (E) The results of the assessment con24 ducted by an independent third party under 


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1 section 101(a), including any data or rec2 ommendations included in such assessment. 

3 (3) REPORTS.—The Commission shall submit 

4 to the President, through the Secretary of Veterans 

5 Affairs, reports as follows: 

6 (A) Not later than 90 days after the date 

7 of the initial meeting of the Commission, an in8 terim report on— 

9 (i) the findings of the Commission 

10 with respect to the evaluation and assess11 ment required by this subsection; and 

12 (ii) such recommendations as the 

13 Commission may have for legislative or ad14 ministrative action to improve access to 

15 health care through the Veterans Health 

16 Administration. 

17 (B) Not later than 180 days after the date 

18 of the initial meeting of the Commission, a final 

19 report on— 

20 (i) the findings of the Commission 

21 with respect to the evaluation and assess22 ment required by this subsection; and 

23 (ii) such recommendations as the 

24 Commission may have for legislative or ad25 ministrative action to improve access to 


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1 health care through the Veterans Health 

2 Administration. 

3 (c) POWERS OF THE COMMISSION.— 

4 (1) HEARINGS.—The Commission may hold 

5 such hearings, sit and act at such times and places, 

6 take such testimony, and receive such evidence as 

7 the Commission considers advisable to carry out this 

8 section. 

9 (2) INFORMATION FROM FEDERAL AGENCIES.— 

10 The Commission may secure directly from any Fed11 eral department or agency such information as the 

12 Commission considers necessary to carry out this 

13 section. Upon request of the Chairperson of the 

14 Commission, the head of such department or agency 

15 shall furnish such information to the Commission. 

16 (d) COMMISSION PERSONNEL MATTERS.— 

17 (1) COMPENSATION OF MEMBERS.—Each mem18 ber of the Commission who is not an officer or em19 ployee of the Federal Government shall be com20 pensated at a rate equal to the daily equivalent of 

21 the annual rate of basic pay prescribed for level IV 

22 of the Executive Schedule under section 5315 of title 

23 5, United States Code, for each day (including travel 

24 time) during which such member is engaged in the 

25 performance of the duties of the Commission. All 


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1 members of the Commission who are officers or em2 ployees of the United States shall serve without com3 pensation in addition to that received for their serv4 ices as officers or employees of the United States. 

5 (2) TRAVEL EXPENSES.—The members of the 

6 Commission shall be allowed travel expenses, includ7 ing per diem in lieu of subsistence, at rates author8 ized for employees of agencies under subchapter I of 

9 chapter 57 of title 5, United States Code, while 

10 away from their homes or regular places of business 

11 in the performance of services for the Commission. 

12 (3) STAFF.— 

13 (A) IN GENERAL.—The Chairperson of the 

14 Commission may, without regard to the civil 

15 service laws and regulations, appoint and termi16 nate an executive director and such other addi17 tional personnel as may be necessary to enable 

18 the Commission to perform its duties. The em19 ployment of an executive director shall be sub20 ject to confirmation by the Commission. 

21 (B) COMPENSATION.—The Chairperson of 

22 the Commission may fix the compensation of 

23 the executive director and other personnel with24 out regard to chapter 51 and subchapter III of 

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1 ing to classification of positions and General 

2 Schedule pay rates, except that the rate of pay 

3 for the executive director and other personnel 

4 may not exceed the rate payable for level V of 

5 the Executive Schedule under section 5316 of 

6 such title. 

7 (4) DETAIL OF GOVERNMENT EMPLOYEES.— 

8 Any Federal Government employee may be detailed 

9 to the Commission without reimbursement, and such 

10 detail shall be without interruption or loss of civil 

11 service status or privilege. 

12 (5) PROCUREMENT OF TEMPORARY AND INTER13 MITTENT SERVICES.—The Chairperson of the Com14 mission may procure temporary and intermittent 

15 services under section 3109(b) of title 5, United 

16 States Code, at rates for individuals that do not ex17 ceed the daily equivalent of the annual rate of basic 

18 pay prescribed for level V of the Executive Schedule 

19 under section 5316 of such title. 

20 (e) TERMINATION OF THE COMMISSION.—The Com21 mission shall terminate 30 days after the date on which 

22 the Commission submits its report under subsection 

23 (b)(3)(B). 

24 (f) FUNDING.—The Secretary of Veterans Affairs 

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1 propriated or otherwise made available to the Secretary 

2 such amounts as the Secretary and the Chairperson of the 

3 Commission jointly consider appropriate for the Commis4 sion to perform its duties under this section. 

5 (g) EXECUTIVE ACTION.— 

6 (1) ACTION ON RECOMMENDATIONS.—The 

7 President shall require the Secretary of Veterans Af8 fairs and such other heads of relevant Federal de9 partments and agencies to implement each rec10 ommendation set forth in a report submitted under 

11 subsection (b)(3) that the President— 

12 (A) considers feasible and advisable; and 

13 (B) determines can be implemented with14 out further legislative action. 

15 (2) REPORTS.—Not later than 60 days after 

16 the date on which the President receives a report 

17 under subsection (b)(3), the President shall submit 

18 to the Committee on Veterans’ Affairs of the Senate 

19 and the Committee on Veterans’ Affairs of the 

20 House of Representatives and such other committees 

21 of Congress as the President considers appropriate 

22 a report setting forth the following: 

23 (A) An assessment of the feasibility and 

24 advisability of each recommendation contained 

25 in the report received by the President. 


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1 (B) For each recommendation assessed as 

2 feasible and advisable under subparagraph (A) 

3 the following: 

4 (i) Whether such recommendation re5 quires legislative action. 

6 (ii) If such recommendation requires 

7 legislative action, a recommendation con8 cerning such legislative action. 

9 (iii) A description of any administra10 tive action already taken to carry out such 

11 recommendation. 

12 (iv) A description of any administra13 tive action the President intends to be 

14 taken to carry out such recommendation 

15 and by whom. 

16 SEC. 404. IMPROVED PERFORMANCE METRICS FOR 

17 HEALTH CARE PROVIDED BY DEPARTMENT 

18 OF VETERANS AFFAIRS. 

19 (a) PROHIBITION ON USE OF SCHEDULING AND

20 WAIT-TIME METRICS IN DETERMINATION OF PERFORM21 ANCE AWARDS.—The Secretary of Veterans Affairs shall 

22 ensure that scheduling and wait-time metrics or goals are 

23 not used as factors in determining the performance of the 

24 following employees for purposes of determining whether 

25 to pay performance awards to such employees: 


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1 (1) Directors, associate directors, assistant di2 rectors, deputy directors, chiefs of staff, and clinical 

3 leads of medical centers of the Department of Vet4 erans Affairs. 

5 (2) Directors, assistant directors, and quality 

6 management officers of Veterans Integrated Service 

7 Networks of the Department of Veterans Affairs. 

8 (b) MODIFICATION OF PERFORMANCE PLANS.— 

9 (1) IN GENERAL.—Not later than 30 days after 

10 the date of the enactment of this Act, the Secretary 

11 shall modify the performance plans of the directors 

12 of the medical centers of the Department and the di13 rectors of the Veterans Integrated Service Networks 

14 to ensure that such plans are based on the quality 

15 of care received by veterans at the health care facili16 ties under the jurisdictions of such directors. 

17 (2) FACTORS.—In modifying performance plans 

18 under paragraph (1), the Secretary shall ensure that 

19 assessment of the quality of care provided at health 

20 care facilities under the jurisdiction of a director de21 scribed in paragraph (1) includes consideration of 

22 the following: 

23 (A) Recent reviews by the Joint Commis24 sion (formerly known as the ‘‘Joint Commission 


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1 on Accreditation of Healthcare Organizations’’) 

2 of such facilities. 

3 (B) The number and nature of rec4 ommendations concerning such facilities by the 

5 Inspector General of the Department in reviews 

6 conducted through the Combined Assessment 

7 Program (CAP), in the reviews by the Inspector 

8 General of community based outpatient clinics 

9 and primary care clinics, and in reviews con10 ducted through the Office of Healthcare Inspec11 tions during the two most recently completed 

12 fiscal years. 

13 (C) The number of recommendations de14 scribed in subparagraph (B) that the Inspector 

15 General of the Department determines have not 

16 been carried out satisfactorily with respect to 

17 such facilities. 

18 (D) Reviews of such facilities by the Com19 mission on Accreditation of Rehabilitation Fa20 cilities. 

21 (E) The number and outcomes of adminis22 trative investigation boards, root cause analysis, 

23 and peer reviews conducted at such facilities 

24 during the fiscal year for which the assessment 

25 is being conducted. 


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1 (F) The effectiveness of any remedial ac2 tions or plans resulting from any Inspector 

3 General recommendations in the reviews and 

4 analyses described in subparagraphs (A) 

5 through (E). 

6 (3) ADDITIONAL LEADERSHIP POSITIONS.—To 

7 the degree practicable, the Secretary shall assess the 

8 performance of other employees of the Department 

9 in leadership positions at Department medical cen10 ters, including associate directors, assistant direc11 tors, deputy directors, chiefs of staff, and clinical 

12 leads, and in Veterans Integrated Service Networks, 

13 including assistant directors and quality manage14 ment officers, using factors and criteria similar to 

15 those used in the performance plans modified under 

16 paragraph (1). 

17 (c) REMOVAL OF CERTAIN PERFORMANCE GOALS.— 

18 For each fiscal year that begins after the date of the en19 actment of this Act, the Secretary shall not include in the 

20 performance goals of any employee of a Veterans Inte21 grated Service Network or medical center of the Depart22 ment any performance goal that might disincentivize the 

23 payment of Department amounts to provide hospital care, 

24 medical services, or other health care through a non-De25 partment provider. 


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1 SEC. 405. IMPROVED TRANSPARENCY CONCERNING 

2 HEALTH CARE PROVIDED BY DEPARTMENT 

3 OF VETERANS AFFAIRS. 

4 (a) PUBLICATION OF WAIT TIMES.— 

5 (1) GOALS.— 

6 (A) INITIAL.—Not later than 90 days after 

7 the date of the enactment of this Act, the Sec8 retary of Veterans Affairs shall publish in the 

9 Federal Register, and on an Internet website 

10 accessible to the public of each medical center 

11 of the Department of Veterans Affairs, the 

12 wait-time goals of the Department for the 

13 scheduling of an appointment by a veteran for 

14 the receipt of health care from the Department. 

15 (B) SUBSEQUENT CHANGES.— 

16 (i) IN GENERAL.—If the Secretary 

17 modifies the wait-time goals described in 

18 subparagraph (A), the Secretary shall pub19 lish the new wait-times goals— 

20 (I) on an Internet website acces21 sible to the public of each medical 

22 center of the Department not later 

23 than 30 days after such modification; 

24 and 


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1 (II) in the Federal Register not 

2 later than 90 days after such modi3 fication. 

4 (ii) EFFECTIVE DATE.—Any modifica5 tion under clause (i) shall take effect on 

6 the date of publication in the Federal Reg7 ister. 

8 (C) GOALS DESCRIBED.—Wait-time goals 

9 published under this paragraph shall include 

10 goals for primary care appointments, specialty 

11 care appointments, and appointments based on 

12 the general severity of the condition of the vet13 eran. 

14 (2) WAIT TIMES AT MEDICAL CENTERS OF THE

15 DEPARTMENT.—Not later than one year after the 

16 date of the enactment of this Act, the Secretary of 

17 Veterans Affairs shall publish on an Internet website 

18 accessible to the public of each medical center of the 

19 Department the current wait time for an appoint20 ment for primary care and specialty care at the 

21 medical center. 

22 (b) PUBLICLY AVAILABLE DATABASE OF PATIENT

23 SAFETY, QUALITY OF CARE, AND OUTCOME MEAS24 URES.— 


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1 (1) IN GENERAL.—Not later than 180 days 

2 after the date of the enactment of this Act, the Sec3 retary shall develop and make available to the public 

4 a comprehensive database containing all applicable 

5 patient safety, quality of care, and outcome meas6 ures for health care provided by the Department 

7 that are tracked by the Secretary. 

8 (2) UPDATE FREQUENCY.—The Secretary shall 

9 update the database required by paragraph (1) not 

10 less frequently than once each year. 

11 (3) UNAVAILABLE MEASURES.—For all meas12 ures that the Secretary would otherwise publish in 

13 the database required by paragraph (1) but has not 

14 done so because such measures are not available, the 

15 Secretary shall publish notice in the database of the 

16 reason for such unavailability and a timeline for 

17 making such measures available in the database. 

18 (4) ACCESSIBILITY.—The Secretary shall en19 sure that the database required by paragraph (1) is 

20 accessible to the public through the primary Internet 

21 website of the Department and through each pri22 mary Internet website of a Department medical cen23 ter. 

24 (c) HOSPITAL COMPARE WEBSITE OF DEPARTMENT

25 OF HEALTH AND HUMAN SERVICES.— 


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1 (1) AGREEMENT REQUIRED.—Not later than 

2 180 days after the date of the enactment of this Act, 

3 the Secretary of Veterans Affairs shall enter into an 

4 agreement with the Secretary of Health and Human 

5 Services for the provision by the Secretary of Vet6 erans Affairs of such information as the Secretary of 

7 Health and Human Services may require to report 

8 and make publicly available patient quality and out9 come information concerning Department of Vet10 erans Affairs medical centers through the Hospital 

11 Compare Internet website of the Department of 

12 Health and Human Services or any successor Inter13 net website. 

14 (2) INFORMATION PROVIDED.—The information 

15 provided by the Secretary of Veterans Affairs to the 

16 Secretary of Health and Human Services under 

17 paragraph (1) shall include the following: 

18 (A) Measures of timely and effective health 

19 care. 

20 (B) Measures of readmissions, complica21 tions of death, including with respect to 30-day 

22 mortality rates and 30-day readmission rates, 

23 surgical complication measures, and health care 

24 related infection measures. 


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1 (C) Survey data of patient experiences, in2 cluding the Hospital Consumer Assessment of 

3 Healthcare Providers and Systems or any simi4 lar successor survey developed by the Depart5 ment of Health and Human Services. 

6 (D) Any other measures required of or re7 ported with respect to hospitals participating in 

8 the Medicare program under title XVIII of the 

9 Social Security Act (42 U.S.C. 1395 et seq.). 

10 (3) UNAVAILABLE INFORMATION.—For any ap11 plicable metric collected by the Department of Vet12 erans Affairs or required to be provided under para13 graph (2) and withheld from or unavailable in the 

14 Hospital Compare Internet website, the Secretary of 

15 Veterans Affairs shall publish a notice in the Fed16 eral Register stating the reason why such metric was 

17 withheld from public disclosure and a timeline for 

18 making such metric available, if applicable. 

19 (d) COMPTROLLER GENERAL REVIEW OF PUBLICLY

20 AVAILABLE SAFETY AND QUALITY METRICS.—Not later 

21 than three years after the date of the enactment of this 

22 Act, the Comptroller General of the United States shall 

23 conduct a review of the safety and quality metrics made 

24 publicly available by the Secretary of Veterans Affairs 


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1 under this section to assess the degree to which the Sec2 retary is complying with the provisions of this section. 

3 SEC. 406. INFORMATION FOR VETERANS ON THE CREDEN4 TIALS OF DEPARTMENT OF VETERANS AF5 FAIRS PHYSICIANS. 

6 (a) IMPROVEMENT OF ‘‘OUR PROVIDERS’’ INTERNET

7 WEBSITE LINKS.— 

8 (1) AVAILABILITY THROUGH DEPARTMENT OF

9 VETERANS AFFAIRS HOMEPAGE.—A link to the ‘‘Our 

10 Providers’’ health care providers database of the De11 partment of Veterans Affairs, or any successor data12 base, shall be available on and through the home13 page of the Internet website of the Department that 

14 is accessible to the public. 

15 (2) INFORMATION ON LOCATION OF RESIDENCY

16 TRAINING.—The Internet website of the Department 

17 that is accessible to the public shall include under 

18 the link to the ‘‘Our Providers’’ health care pro19 viders database of the Department, or any successor 

20 database, the location of residency training of each 

21 licensed physician of the Department. 

22 (3) INFORMATION ON PHYSICIANS AT PAR23 TICULAR FACILITIES.—The ‘‘Our Providers’’ health 

24 care providers database of the Department, or any 

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1 censed physician of the Department is a physician in 

2 residency. 

3 (b) INFORMATION ON CREDENTIALS OF PHYSICIANS

4 FOR VETERANS UNDERGOING SURGICAL PROCEDURES.— 

5 (1) IN GENERAL.—Each veteran who is under6 going a surgical procedure by or through the De7 partment shall be provided information on the cre8 dentials of the surgeon to be performing such proce9 dure at such time in advance of the procedure as is 

10 appropriate to permit such veteran to evaluate such 

11 information. 

12 (2) OTHER INDIVIDUALS.—If a veteran is un13 able to evaluate the information provided under 

14 paragraph (1) due to the health or mental com15 petence of the veteran, such information shall be 

16 provided to an individual acting on behalf of the vet17 eran. 

18 (c) COMPTROLLER GENERAL REPORT AND PLAN.— 

19 (1) REPORT.—Not later than two years after 

20 the date of the enactment of this Act, the Comp21 troller General of the United States shall submit to 

22 the Committee on Veterans’ Affairs of the Senate 

23 and the Committee on Veterans’ Affairs of the 

24 House of Representatives a report setting forth an 


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1 assessment by the Comptroller General of the fol2 lowing: 

3 (A) The manner in which contractors 

4 under the Patient-Centered Community Care 

5 initiative of the Department perform oversight 

6 of the credentials of physicians within the net7 works of such contractors under the initiative. 

8 (B) The oversight by the Department of 

9 the contracts under the Patient-Centered Com10 munity Care initiative. 

11 (C) The verification by the Department of 

12 the credentials and licenses of health care pro13 viders furnishing hospital care and medical 

14 services under section 301. 

15 (2) PLAN.— 

16 (A) IN GENERAL.—Not later than 30 days 

17 after the submittal of the report under para18 graph (1), the Secretary shall— 

19 (i) submit to the Comptroller General, 

20 the Committee on Veterans’ Affairs of the 

21 Senate, and the Committee on Veterans’ 

22 Affairs of the House of Representatives a 

23 plan to address any findings and rec24 ommendations of the Comptroller General 

25 included in such report; and 


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1 (ii) submit to the Committee on Vet2 erans’ Affairs of the Senate and the Com3 mittee on Veterans’ Affairs of the House 

4 of Representatives a request for additional 

5 amounts, if any, that may be necessary to 

6 carry out such plan. 

7 (B) IMPLEMENTATION.—Not later than 90 

8 days after the submittal of the report under 

9 paragraph (1), the Secretary shall carry out 

10 such plan. 

11 SEC. 407. INFORMATION IN ANNUAL BUDGET OF THE 

12 PRESIDENT ON HOSPITAL CARE AND MED13 ICAL SERVICES FURNISHED THROUGH EX14 PANDED USE OF CONTRACTS FOR SUCH 

15 CARE. 

16 The materials on the Department of Veterans Affairs 

17 in the budget of the President for a fiscal year, as sub18 mitted to Congress pursuant to section 1105(a) of title 

19 31, United States Code, shall set forth the following: 

20 (1) The number of veterans who received hos21 pital care and medical services under section 301 

22 during the fiscal year preceding the fiscal year in 

23 which such budget is submitted. 

24 (2) The amount expended by the Department 

25 on furnishing care and services under such section 


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1 during the fiscal year preceding the fiscal year in 

2 which such budget is submitted. 

3 (3) The amount requested in such budget for 

4 the costs of furnishing care and services under such 

5 section during the fiscal year covered by such budg6 et, set forth in aggregate and by amounts for each 

7 account for which amounts are so requested. 

8 (4) The number of veterans that the Depart9 ment estimates will receive hospital care and medical 

10 services under such section during the fiscal years 

11 covered by the budget submission. 

12 (5) The number of employees of the Depart13 ment on paid administrative leave at any point dur14 ing the fiscal year preceding the fiscal year in which 

15 such budget is submitted. 

16 SEC. 408. PROHIBITION ON FALSIFICATION OF DATA CON17 CERNING WAIT TIMES AND QUALITY MEAS18 URES AT DEPARTMENT OF VETERANS AF19 FAIRS. 

20 Not later than 60 days after the date of the enact21 ment of this Act, and in accordance with title 5, United 

22 States Code, the Secretary of Veterans Affairs shall estab23 lish policies whereby any employee of the Department of 

24 Veterans Affairs who knowingly submits false data con25 cerning wait times for health care or quality measures 


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1 with respect to health care to another employee of the De2 partment or knowingly requires another employee of the 

3 Department to submit false data concerning such wait 

4 times or quality measures to another employee of the De5 partment is subject to a penalty the Secretary considers 

6 appropriate after notice and an opportunity for a hearing, 

7 including civil penalties, unpaid suspensions, or termi8 nation. 

9 SEC. 409. REMOVAL OF SENIOR EXECUTIVE SERVICE EM10 PLOYEES OF THE DEPARTMENT OF VET11 ERANS AFFAIRS FOR PERFORMANCE. 

12 (a) REMOVAL OR TRANSFER.— 

13 (1) IN GENERAL.—Chapter 7 of title 38, United 

14 States Code, is amended by adding at the end the 

15 following new section: 

16 ‘‘§ 713. Senior Executive Service: removal based on 

17 performance 

18 ‘‘(a) IN GENERAL.—The Secretary may remove any 

19 individual from the Senior Executive Service if the Sec20 retary determines the performance of the individual war21 rants such removal. If the Secretary so removes such an 

22 individual, the Secretary may— 

23 ‘‘(1) remove the individual from the civil service 

24 (as defined in section 2101 of title 5); or 


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1 ‘‘(2) transfer the individual to a General Sched2 ule position at any grade of the General Schedule for 

3 which the individual is qualified and that the Sec4 retary determines is appropriate. 

5 ‘‘(b) NOTICE TO CONGRESS.—Not later than 30 days 

6 after removing or transferring an individual from the Sen7 ior Executive Service under subsection (a), the Secretary 

8 shall submit to the Committees on Veterans’ Affairs of 

9 the Senate and the House of Representatives notice in 

10 writing of such removal or transfer and the reason for 

11 such removal or transfer. 

12 ‘‘(c) PROCEDURE.—(1) The procedures under section 

13 7543 of title 5 shall not apply to a removal or transfer 

14 under this section. 

15 ‘‘(2)(A) Subject to subparagraph (B), any removal or 

16 transfer under subsection (a) may be appealed to the 

17 Merit Systems Protection Board under section 7701 of 

18 title 5. 

19 ‘‘(B) An appeal under subparagraph (A) of a removal 

20 or transfer may only be made if such appeal is made not 

21 later than 7 days after the date of such removal or trans22 fer. 

23 ‘‘(d) EXPEDITED REVIEW BY MERIT SYSTEMS PRO24 TECTION BOARD.—(1) The Merit Systems Protection 

25 Board shall expedite any appeal under section 7701 of 


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1 title 5 of a removal or transfer under subsection (a) and, 

2 in any such case, shall issue a decision not later than 21 

3 days after the date of the appeal. 

4 ‘‘(2) In any case in which the Merit Systems Protec5 tion Board determines that it cannot issue a decision in 

6 accordance with the 21-day requirement under paragraph 

7 (1), the Merit Systems Protection Board shall submit to 

8 Congress a report that explains the reason why the Merit 

9 Systems Protection Board is unable to issue a decision in 

10 accordance with such requirement in such case. 

11 ‘‘(3) There is authorized to be appropriated such 

12 sums as may be necessary for the Merit Systems Protec13 tion Board to expedite appeals under paragraph (1). 

14 ‘‘(4) The Merit Systems Protection Board may not 

15 stay any personnel action taken under this section. 

16 ‘‘(5) A person who appeals under section 7701 of title 

17 5 a removal under subsection (a)(1) may not receive any 

18 pay, awards, bonuses, incentives, allowances, differentials, 

19 student loan repayments, special payments, or benefits 

20 from the Secretary until the Merit Systems Protection 

21 Board has made a final decision on such appeal. 

22 ‘‘(6) A decision made by the Merit Systems Protec23 tion Board with respect to a removal or transfer under 

24 subsection (a) shall not be subject to any further appeal.’’. 


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1 (2) CLERICAL AMENDMENT.—The table of sec2 tions at the beginning of such chapter is amended 

3 by adding at the end the following new item: 

‘‘713. Senior Executive Service: removal based on performance.’’. 

4 (b) ESTABLISHMENT OF EXPEDITED REVIEW PROC5 ESS.— 

6 (1) IN GENERAL.—Not later than 30 days after 

7 the date of the enactment of this Act, the Merit Sys8 tems Protection Board shall establish and put into 

9 effect a process to conduct expedited reviews in ac10 cordance with section 713(d) of title 38, United 

11 States Code. 

12 (2) INAPPLICABILITY OF CERTAIN REGULA13 TIONS.—Section 1201.22 of title 5, Code of Federal 

14 Regulations, as in effect on the day before the date 

15 of the enactment of this Act, shall not apply to expe16 dited reviews carried out under section 713(d) of 

17 title 38, United States Code. 

18 (3) REPORT BY MERIT SYSTEMS PROTECTION

19 BOARD.—Not later than 30 days after the date of 

20 the enactment of this Act, the Merit Systems Pro21 tection Board shall submit to Congress a report on 

22 the actions the Board plans to take to conduct expe23 dited reviews under section 713(d) of title 38, 

24 United States Code, as added by subsection (a). 

25 Such report shall include a description of the reVerDate Mar 15 2010 06:00 Jun 13, 2014 Jkt 039200 PO 00000 Frm 00081 Fmt 6652 Sfmt 6201 E:\BILLS\H4841.IH H4841

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1 sources the Board determines will be necessary to 

2 conduct such reviews and a description of whether 

3 any resources will be necessary to conduct such re4 views that were not available to the Board on the 

5 day before the date of the enactment of this Act. 

6 (c) TEMPORARY EXEMPTION FROM CERTAIN LIMI7 TATION ON INITIATION OF REMOVAL FROM SENIOR EX8 ECUTIVE SERVICE.—During the 120-day period beginning 

9 on the date of the enactment of this Act, an action to re10 move an individual from the Senior Executive Service at 

11 the Department of Veterans Affairs pursuant to section 

12 713 of title 38, United States Code, as added by sub13 section (a), or section 7543 of title 5, United States Code, 

14 may be initiated, notwithstanding section 3592(b) of title 

15 5, United States Code, or any other provision of law. 

16 (d) CONSTRUCTION.—Nothing in this section or sec17 tion 713 of title 38, United States Code, as added by sub18 section (a), shall be construed to apply to an appeal of 

19 a removal, transfer, or other personnel action that was 

20 pending before the date of the enactment of this Act. 


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1 TITLE V—HEALTH CARE 

2 RELATED TO SEXUAL TRAUMA 

3 SEC. 501. EXPANSION OF ELIGIBILITY FOR SEXUAL TRAU4 MA COUNSELING AND TREATMENT TO VET5 ERANS ON INACTIVE DUTY TRAINING. 

6 Section 1720D(a)(1) of title 38, United States Code, 

7 is amended by striking ‘‘or active duty for training’’ and 

8 inserting ‘‘, active duty for training, or inactive duty train9 ing’’. 

10 SEC. 502. PROVISION OF COUNSELING AND TREATMENT 

11 FOR SEXUAL TRAUMA BY THE DEPARTMENT 

12 OF VETERANS AFFAIRS TO MEMBERS OF THE 

13 ARMED FORCES. 

14 (a) EXPANSION OF COVERAGE TO MEMBERS OF THE

15 ARMED FORCES.—Subsection (a) of section 1720D of title 

16 38, United States Code, is amended— 

17 (1) by redesignating paragraph (2) as para18 graph (3); 

19 (2) by inserting after paragraph (1) the fol20 lowing new paragraph (2): 

21 ‘‘(2)(A) In operating the program required by para22 graph (1), the Secretary may, in consultation with the 

23 Secretary of Defense, provide counseling and care and 

24 services to members of the Armed Forces (including mem25 bers of the National Guard and Reserves) on active duty 


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1 to overcome psychological trauma described in that para2 graph. 

3 ‘‘(B) A member described in subparagraph (A) shall 

4 not be required to obtain a referral before receiving coun5 seling and care and services under this paragraph.’’; and 

6 (3) in paragraph (3), as redesignated by para7 graph (1)— 

8 (A) by striking ‘‘a veteran’’ and inserting 

9 ‘‘an individual’’; and 

10 (B) by striking ‘‘that veteran’’ each place 

11 it appears and inserting ‘‘that individual’’. 

12 (b) INFORMATION TO MEMBERS ON AVAILABILITY OF

13 COUNSELING AND SERVICES.—Subsection (c) of such sec14 tion is amended— 

15 (1) by striking ‘‘to veterans’’ each place it ap16 pears; and 

17 (2) in paragraph (3), by inserting ‘‘members of 

18 the Armed Forces and’’ before ‘‘individuals’’. 

19 (c) INCLUSION OF MEMBERS IN REPORTS ON COUN20 SELING AND SERVICES.—Subsection (e) of such section 

21 is amended— 

22 (1) in the matter preceding paragraph (1), by 

23 striking ‘‘to veterans’’; 

24 (2) in paragraph (2)— 


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1 (A) by striking ‘‘women veterans’’ and in2 serting ‘‘individuals’’; and 

3 (B) by striking ‘‘training under subsection 

4 (d).’’ and inserting ‘‘training under subsection 

5 (d), disaggregated by— 

6 ‘‘(A) veterans; 

7 ‘‘(B) members of the Armed Forces (in8 cluding members of the National Guard and 

9 Reserves) on active duty; and 

10 ‘‘(C) for each of subparagraphs (A) and 

11 (B)— 

12 ‘‘(i) men; and 

13 ‘‘(ii) women.’’; 

14 (3) in paragraph (4), by striking ‘‘veterans’’ 

15 and inserting ‘‘individuals’’; and 

16 (4) in paragraph (5)— 

17 (A) by striking ‘‘women veterans’’ and in18 serting ‘‘individuals’’; and 

19 (B) by inserting ‘‘, including specific rec20 ommendations for individuals specified in sub21 paragraphs (A), (B), and (C) of paragraph (2)’’ 

22 before the period at the end. 

23 (d) EFFECTIVE DATE.—The amendments made by 

24 this section shall take effect on the date that is one year 

25 after the date of the enactment of this Act. 


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1 SEC. 503. REPORTS ON MILITARY SEXUAL TRAUMA. 

2 (a) REPORT ON SERVICES AVAILABLE FOR MILITARY

3 SEXUAL TRAUMA IN THE DEPARTMENT OF VETERANS

4 AFFAIRS.—Not later than 630 days after the date of the 

5 enactment of this Act, the Secretary of Veterans Affairs 

6 shall submit to the Committee on Veterans’ Affairs of the 

7 Senate and the Committee on Veterans’ Affairs of the 

8 House of Representatives a report on the treatment and 

9 services available from the Department of Veterans Af10 fairs for male veterans who experience military sexual 

11 trauma compared to such treatment and services available 

12 to female veterans who experience military sexual trauma. 

13 (b) REPORTS ON TRANSITION OF MILITARY SEXUAL

14 TRAUMA TREATMENT FROM DEPARTMENT OF DEFENSE

15 TO DEPARTMENT OF VETERANS AFFAIRS.—Not later 

16 than 630 days after the date of the enactment of this Act, 

17 and annually thereafter for five years, the Department of 

18 Veterans Affairs-Department of Defense Joint Executive 

19 Committee established by section 320(a) of title 38, 

20 United States Code, shall submit to the appropriate com21 mittees of Congress a report on military sexual trauma 

22 that includes the following: 

23 (1) The processes and procedures utilized by 

24 the Department of Veterans Affairs and the Depart25 ment of Defense to facilitate transition of treatment 

26 of individuals who have experienced military sexual 


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1 trauma from treatment provided by the Department 

2 of Defense to treatment provided by the Department 

3 of Veterans Affairs. 

4 (2) A description and assessment of the collabo5 ration between the Department of Veterans Affairs 

6 and the Department of Defense in assisting veterans 

7 in filing claims for disabilities related to military 

8 sexual trauma, including permitting veterans access 

9 to information and evidence necessary to develop or 

10 support such claims. 

11 (c) DEFINITIONS.—In this section: 

12 (1) APPROPRIATE COMMITTEES OF CON13 GRESS.—The term ‘‘appropriate committees of Con14 gress’’ means— 

15 (A) the Committee on Veterans’ Affairs 

16 and the Committee on Armed Services of the 

17 Senate; and 

18 (B) the Committee on Veterans’ Affairs 

19 and the Committee on Armed Services of the 

20 House of Representatives. 

21 (2) MILITARY SEXUAL TRAUMA.—The term 

22 ‘‘military sexual trauma’’ means psychological trau23 ma, which in the judgment of a mental health pro24 fessional employed by the Department, resulted from 

25 a physical assault of a sexual nature, battery of a 


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1 sexual nature, or sexual harassment which occurred 

2 while the veteran was serving on active duty or ac3 tive duty for training. 

4 (3) SEXUAL HARASSMENT.—The term ‘‘sexual 

5 harassment’’ means repeated, unsolicited verbal or 

6 physical contact of a sexual nature which is threat7 ening in character. 

8 (4) SEXUAL TRAUMA.—The term ‘‘sexual trau9 ma’’ shall have the meaning given that term by the 

10 Secretary of Veterans Affairs for purposes of this 

11 section. 

12 (d) EFFECTIVE DATE.—This section shall take effect 

13 on the date that is 270 days after the date of the enact14 ment of this Act. 

15 TITLE VI—MAJOR MEDICAL 

16 FACILITY LEASES 

17 SEC. 601. AUTHORIZATION OF MAJOR MEDICAL FACILITY 

18 LEASES. 

19 The Secretary of Veterans Affairs may carry out the 

20 following major medical facility leases at the locations 

21 specified, and in an amount for each lease not to exceed 

22 the amount shown for such location (not including any es23 timated cancellation costs): 


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1 (1) For a clinical research and pharmacy co2 ordinating center, Albuquerque, New Mexico, an 

3 amount not to exceed $9,560,000. 

4 (2) For a community-based outpatient clinic, 

5 Brick, New Jersey, an amount not to exceed 

6 $7,280,000. 

7 (3) For a new primary care and dental clinic 

8 annex, Charleston, South Carolina, an amount not 

9 to exceed $7,070,250. 

10 (4) For the Cobb County community-based 

11 Outpatient Clinic, Cobb County, Georgia, an amount 

12 not to exceed $6,409,000. 

13 (5) For the Leeward Outpatient Healthcare Ac14 cess Center, Honolulu, Hawaii, including a co-lo15 cated clinic with the Department of Defense and the 

16 co-location of the Honolulu Regional Office of the 

17 Veterans Benefits Administration and the Kapolei 

18 Vet Center of the Department of Veterans Affairs, 

19 an amount not to exceed $15,887,370. 

20 (6) For a community-based outpatient clinic, 

21 Johnson County, Kansas, an amount not to exceed 

22 $2,263,000. 

23 (7) For a replacement community-based out24 patient clinic, Lafayette, Louisiana, an amount not 

25 to exceed $2,996,000. 


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1 (8) For a community-based outpatient clinic, 

2 Lake Charles, Louisiana, an amount not to exceed 

3 $2,626,000. 

4 (9) For outpatient clinic consolidation, New 

5 Port Richey, Florida, an amount not to exceed 

6 $11,927,000. 

7 (10) For an outpatient clinic, Ponce, Puerto 

8 Rico, an amount not to exceed $11,535,000. 

9 (11) For lease consolidation, San Antonio, 

10 Texas, an amount not to exceed $19,426,000. 

11 (12) For a community-based outpatient clinic, 

12 San Diego, California, an amount not to exceed 

13 $11,946,100. 

14 (13) For an outpatient clinic, Tyler, Texas, an 

15 amount not to exceed $4,327,000. 

16 (14) For the Errera Community Care Center, 

17 West Haven, Connecticut, an amount not to exceed 

18 $4,883,000. 

19 (15) For the Worcester community-based Out20 patient Clinic, Worcester, Massachusetts, an amount 

21 not to exceed $4,855,000. 

22 (16) For the expansion of a community-based 

23 outpatient clinic, Cape Girardeau, Missouri, an 

24 amount not to exceed $4,232,060. 


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1 (17) For a multispecialty clinic, Chattanooga, 

2 Tennessee, an amount not to exceed $7,069,000. 

3 (18) For the expansion of a community-based 

4 outpatient clinic, Chico, California, an amount not to 

5 exceed $4,534,000. 

6 (19) For a community-based outpatient clinic, 

7 Chula Vista, California, an amount not to exceed 

8 $3,714,000. 

9 (20) For a new research lease, Hines, Illinois, 

10 an amount not to exceed $22,032,000. 

11 (21) For a replacement research lease, Hous12 ton, Texas, an amount not to exceed $6,142,000. 

13 (22) For a community-based outpatient clinic, 

14 Lincoln, Nebraska, an amount not to exceed 

15 $7,178,400. 

16 (23) For a community-based outpatient clinic, 

17 Lubbock, Texas, an amount not to exceed 

18 $8,554,000. 

19 (24) For a community-based outpatient clinic 

20 consolidation, Myrtle Beach, South Carolina, an 

21 amount not to exceed $8,022,000. 

22 (25) For a community-based outpatient clinic, 

23 Phoenix, Arizona, an amount not to exceed 

24 $20,757,000. 


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1 (26) For the expansion of a community-based 

2 outpatient clinic, Redding, California, an amount not 

3 to exceed $8,154,000. 

4 SEC. 602. BUDGETARY TREATMENT OF DEPARTMENT OF 

5 VETERANS AFFAIRS MAJOR MEDICAL FACILI6 TIES LEASES. 

7 (a) FINDINGS.—Congress finds the following: 

8 (1) Title 31, United States Code, requires the 

9 Department of Veterans Affairs to record the full 

10 cost of its contractual obligation against funds avail11 able at the time a contract is executed. 

12 (2) Office of Management and Budget Circular 

13 A–11 provides guidance to agencies in meeting the 

14 statutory requirements under title 31, United States 

15 Code, with respect to leases. 

16 (3) For operating leases, Office of Management 

17 and Budget Circular A–11 requires the Department 

18 of Veterans Affairs to record up-front budget au19 thority in an ‘‘amount equal to total payments under 

20 the full term of the lease or [an] amount sufficient 

21 to cover first year lease payments plus cancellation 

22 costs’’. 

23 (b) REQUIREMENT FOR OBLIGATION OF FULL

24 COST.— 


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

2 appropriations provided in advance, in exercising the 

3 authority of the Secretary of Veterans Affairs to 

4 enter into leases provided in this Act, the Secretary 

5 shall record, pursuant to section 1501 of title 31, 

6 United States Code, as the full cost of the contrac7 tual obligation at the time a contract is executed ei8 ther— 

9 (A) an amount equal to total payments 

10 under the full term of the lease; or 

11 (B) if the lease specifies payments to be 

12 made in the event the lease is terminated before 

13 its full term, an amount sufficient to cover the 

14 first year lease payments plus the specified can15 cellation costs. 

16 (2) SELF-INSURING AUTHORITY.—The require17 ments of paragraph (1) may be satisfied through the 

18 use of a self-insuring authority consistent with Of19 fice of Management and Budget Circular A–11. 

20 (c) TRANSPARENCY.— 

21 (1) COMPLIANCE.—Subsection (b) of section 

22 8104 of title 38, United States Code, is amended by 

23 adding at the end the following new paragraph: 

24 ‘‘(7) In the case of a prospectus proposing 

25 funding for a major medical facility lease, a detailed 


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1 analysis of how the lease is expected to comply with 

2 Office of Management and Budget Circular A–11 

3 and section 1341 of title 31 (commonly referred to 

4 as the ‘Anti-Deficiency Act’). Any such analysis shall 

5 include— 

6 ‘‘(A) an analysis of the classification of the 

7 lease as a ‘lease-purchase’, ‘capital lease’, or 

8 ‘operating lease’ as those terms are defined in 

9 Office of Management and Budget Circular A– 

10 11; 

11 ‘‘(B) an analysis of the obligation of budg12 etary resources associated with the lease; and 

13 ‘‘(C) an analysis of the methodology used 

14 in determining the asset cost, fair market value, 

15 and cancellation costs of the lease.’’. 

16 (2) SUBMITTAL TO CONGRESS.—Such section 

17 8104 is further amended by adding at the end the 

18 following new subsection: 

19 ‘‘(h)(1) Not less than 30 days before entering into 

20 a major medical facility lease, the Secretary shall submit 

21 to the Committees on Veterans’ Affairs of the Senate and 

22 the House of Representatives— 

23 ‘‘(A) notice of the Secretary’s intention to enter 

24 into the lease; 

25 ‘‘(B) a detailed summary of the proposed lease; 


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1 ‘‘(C) a description and analysis of any dif2 ferences between the prospectus submitted pursuant 

3 to subsection (b) and the proposed lease; and 

4 ‘‘(D) a scoring analysis demonstrating that the 

5 proposed lease fully complies with Office of Manage6 ment and Budget Circular A–11. 

7 ‘‘(2) Each committee described in paragraph (1) shall 

8 ensure that any information submitted to the committee 

9 under such paragraph is treated by the committee with 

10 the same level of confidentiality as is required by law of 

11 the Secretary and subject to the same statutory penalties 

12 for unauthorized disclosure or use as the Secretary. 

13 ‘‘(3) Not more than 30 days after entering into a 

14 major medical facility lease, the Secretary shall submit to 

15 each committee described in paragraph (1) a report on 

16 any material differences between the lease that was en17 tered into and the proposed lease described under such 

18 paragraph, including how the lease that was entered into 

19 changes the previously submitted scoring analysis de20 scribed in subparagraph (D) of such paragraph.’’. 

21 (d) RULE OF CONSTRUCTION.—Nothing in this sec22 tion, or the amendments made by this section, shall be 

23 construed to in any way relieve the Department of Vet24 erans Affairs from any statutory or regulatory obligations 


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1 or requirements existing prior to the enactment of this 

2 section and such amendments. 

3 TITLE VII—VETERANS BENEFITS 

4 MATTERS 

5 SEC. 701. EXPANSION OF MARINE GUNNERY SERGEANT 

6 JOHN DAVID FRY SCHOLARSHIP. 

7 (a) EXPANSION OF ENTITLEMENT.—Subsection 

8 (b)(9) of section 3311 of title 38, United States Code, is 

9 amended by inserting ‘‘or spouse’’ after ‘‘child’’. 

10 (b) LIMITATION AND ELECTION ON CERTAIN BENE11 FITS.—Subsection (f) of such section is amended— 

12 (1) by redesignating paragraph (2) as para13 graph (4); and 

14 (2) by inserting after paragraph (1) the fol15 lowing new paragraphs: 

16 ‘‘(2) LIMITATION.—The entitlement of an indi17 vidual to assistance under subsection (a) pursuant to 

18 paragraph (9) of subsection (b) because the indi19 vidual was a spouse of a person described in such 

20 paragraph shall expire on the earlier of— 

21 ‘‘(A) the date that is 15 years after the 

22 date on which the person died; and 

23 ‘‘(B) the date on which the individual re24 marries. 


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1 ‘‘(3) ELECTION ON RECEIPT OF CERTAIN BENE2 FITS.—A surviving spouse entitled to assistance 

3 under subsection (a) pursuant to paragraph (9) of 

4 subsection (b) who is also entitled to educational as5 sistance under chapter 35 of this title may not re6 ceive assistance under both this section and such 

7 chapter, but shall make an irrevocable election (in 

8 such form and manner as the Secretary may pre9 scribe) under which section or chapter to receive 

10 educational assistance.’’. 

11 (c) CONFORMING AMENDMENT.—Section 3321(b)(4) 

12 of such title is amended— 

13 (1) by striking ‘‘an individual’’ and inserting ‘‘a 

14 child’’; and 

15 (2) by striking ‘‘such individual’s’’ each time it 

16 appears and inserting ‘‘such child’s’’. 


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1 SEC. 702. APPROVAL OF COURSES OF EDUCATION PRO2 VIDED BY PUBLIC INSTITUTIONS OF HIGHER 

3 LEARNING FOR PURPOSES OF ALL-VOLUN4 TEER FORCE EDUCATIONAL ASSISTANCE 

5 PROGRAM AND POST-9/11 EDUCATIONAL AS6 SISTANCE CONDITIONAL ON IN-STATE TUI7 TION RATE FOR VETERANS. 

8 (a) IN GENERAL.—Section 3679 of title 38, United 

9 States Code, is amended by adding at the end the fol10 lowing new subsection: 

11 ‘‘(c)(1) Notwithstanding any other provision of this 

12 chapter and subject to paragraphs (3) through (6), the 

13 Secretary shall disapprove a course of education provided 

14 by a public institution of higher learning to a covered indi15 vidual pursuing a course of education with educational as16 sistance under chapter 30 or 33 of this title while living 

17 in the State in which the public institution of higher learn18 ing is located if the institution charges tuition and fees 

19 for that course for the covered individual at a rate that 

20 is higher than the rate the institution charges for tuition 

21 and fees for that course for residents of the State in which 

22 the institution is located, regardless of the covered individ23 ual’s State of residence. 

24 ‘‘(2) For purposes of this subsection, a covered indi25 vidual is any individual as follows: 


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1 ‘‘(A) A veteran who was discharged or released 

2 from a period of not fewer than 90 days of service 

3 in the active military, naval, or air service less than 

4 three years before the date of enrollment in the 

5 course concerned. 

6 ‘‘(B) An individual who is entitled to assistance 

7 under section 3311(b)(9) or 3319 of this title by vir8 tue of such individual’s relationship to a veteran de9 scribed in subparagraph (A). 

10 ‘‘(3) If after enrollment in a course of education that 

11 is subject to disapproval under paragraph (1) by reason 

12 of paragraph (2)(A) or (2)(B) a covered individual pur13 sues one or more courses of education at the same public 

14 institution of higher learning while remaining continuously 

15 enrolled (other than during regularly scheduled breaks be16 tween courses, semesters or terms) at that institution of 

17 higher learning, any course so pursued by the covered indi18 vidual at that institution of higher learning while so con19 tinuously enrolled shall also be subject to disapproval 

20 under paragraph (1). 

21 ‘‘(4) It shall not be grounds to disapprove a course 

22 of education under paragraph (1) if a public institution 

23 of higher learning requires a covered individual pursuing 

24 a course of education at the institution to demonstrate an 

25 intent, by means other than satisfying a physical presence 


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1 requirement, to establish residency in the State in which 

2 the institution is located, or to satisfy other requirements 

3 not relating to the establishment of residency, in order to 

4 be charged tuition and fees for that course at a rate that 

5 is equal to or less than the rate the institution charges 

6 for tuition and fees for that course for residents of the 

7 State. 

8 ‘‘(5) The Secretary may waive such requirements of 

9 paragraph (1) as the Secretary considers appropriate. 

10 ‘‘(6) Disapproval under paragraph (1) shall apply 

11 only with respect to educational assistance under chapters 

12 30 and 33 of this title.’’. 

13 (b) EFFECTIVE DATE.—Subsection (c) of section 

14 3679 of title 38, United States Code (as added by sub15 section (a) of this section), shall apply with respect to edu16 cational assistance provided for pursuit of programs of 

17 education during academic terms that begin after July 1, 

18 2015, through courses of education that commence on or 

19 after that date. 

20 TITLE VIII—APPROPRIATION 

21 AND EMERGENCY DESIGNA22 TIONS 

23 SEC. 801. APPROPRIATION OF EMERGENCY AMOUNTS. 

24 There is authorized to be appropriated, and is appro25 priated, to the Secretary of Veterans Affairs, out of any 


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1 funds in the Treasury not otherwise appropriated, for fis2 cal years 2014, 2015, and 2016, such sums as may be 

3 necessary to carry out this Act. 

4 SEC. 802. EMERGENCY DESIGNATIONS. 

5 (a) IN GENERAL.—This Act is designated as an 

6 emergency requirement pursuant to section 4(g) of the 

7 Statutory Pay-As-You-Go Act of 2010 (2 U.S.C. 933(g)). 

8 (b) DESIGNATION IN SENATE.—In the Senate, this 

9 Act is designated as an emergency requirement pursuant 

10 to section 403(a) of S. Con. Res. 13 (111th Congress), 

11 the concurrent resolution on the budget for fiscal year 

12 2010. 

Æ 


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