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[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[S. 2422 Placed on Calendar Senate (PCS)]

                                                       Calendar No. 408
113th CONGRESS
  2d Session
                                S. 2422

    To improve the access of veterans to medical services from the 
        Department of Veterans Affairs, and for other purposes.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                              June 3, 2014

 Mr. Sanders (for himself, Mr. Rockefeller, Mr. Begich, Mrs. Shaheen, 
   Mr. Kaine, Mr. Reed, Mr. Merkley, Mr. Casey, Mr. Whitehouse, Mr. 
  Blumenthal, Mr. Heinrich, Mr. Udall of New Mexico, Mr. Schatz, Ms. 
 Baldwin, Mr. Wyden, Mr. Leahy, Mr. Brown, Ms. Heitkamp, Ms. Landrieu, 
Mr. Booker, Mr. Durbin, Mr. Schumer, Ms. Hirono, Mr. Harkin, Mr. Coons, 
  Mr. Markey, Ms. Klobuchar, Mr. Walsh, Mr. Tester, and Mr. Menendez) 
      introduced the following bill; which was read the first time

                              June 4, 2014

            Read the second time and placed on the calendar

_______________________________________________________________________

                                 A BILL

 
    To improve the access of veterans to medical services from the 
        Department of Veterans Affairs, and for other purposes.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Ensuring Veterans 
Access to Care Act of 2014''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
 TITLE I--IMPROVEMENT OF SCHEDULING SYSTEM FOR HEALTH CARE APPOINTMENTS

Sec. 101. Implementation of upgraded Department of Veterans Affairs 
                            electronic scheduling system for 
                            appointments for receipt of health care 
                            from the Department.
Sec. 102. Independent assessment of the scheduling process for medical 
                            appointments for care from Department of 
                            Veterans Affairs.
           TITLE II--TRAINING AND HIRING OF HEALTH CARE STAFF

Sec. 201. Modification of liability for breach of period of obligated 
                            service under Health Professionals 
                            Educational Assistance Program for primary 
                            care physicians.
Sec. 202. Program of education at Uniformed Services University of the 
                            Health Sciences with specialization in 
                            primary care.
Sec. 203. Treatment of staffing shortage and biannual report on 
                            staffing of medical facilities of the 
                            Department of Veterans Affairs.
Sec. 204. Clinic management training program of the Department of 
                            Veterans Affairs.
Sec. 205. Inclusion of Department of Veterans Affairs facilities in 
                            National Health Service Corps Scholarship 
                            and loan repayment programs.
Sec. 206. Authorization of emergency appropriations.
    TITLE III--IMPROVEMENT OF ACCESS TO CARE FROM NON-DEPARTMENT OF 
                       VETERANS AFFAIRS PROVIDERS

Sec. 301. Improvement of access by veterans to health care from non-
                            Department of Veterans Affairs providers.
Sec. 302. Extension of and report on joint incentives program of 
                            Department of Veterans Affairs and 
                            Department of Defense.
Sec. 303. 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. 304. Enhancement of collaboration between Department of Veterans 
                            Affairs and Indian Health Service.
Sec. 305. Enhancement of collaboration between Department of Veterans 
                            Affairs and Native Hawaiian health care 
                            systems.
Sec. 306. Authorization of emergency appropriations.
              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 Access to Care.
Sec. 403. Commission on Capital Planning for Department of Veterans 
                            Affairs Medical Facilities.
Sec. 404. Removal of Senior Executive Service employees of the 
                            Department of Veterans Affairs for 
                            performance.
                 TITLE V--MAJOR MEDICAL FACILITY LEASES

Sec. 501. Authorization of major medical facility leases.
Sec. 502. Budgetary treatment of Department of Veterans Affairs major 
                            medical facilities leases.

 TITLE I--IMPROVEMENT OF SCHEDULING SYSTEM FOR HEALTH CARE APPOINTMENTS

SEC. 101. IMPLEMENTATION OF UPGRADED DEPARTMENT OF VETERANS AFFAIRS 
              ELECTRONIC SCHEDULING SYSTEM FOR APPOINTMENTS FOR RECEIPT 
              OF HEALTH CARE FROM THE DEPARTMENT.

    (a) Implementation.--
            (1) In general.--Not later than March 31, 2016, the 
        Secretary of Veterans Affairs shall fully implement an upgraded 
        and centralized electronic scheduling system described in 
        subsection (b) for appointments by eligible individuals for 
        health care from the Department of Veterans Affairs.
            (2) Agile software development methodologies.--In 
        implementing the upgraded electronic scheduling system required 
        by paragraph (1), the Secretary shall use agile software 
        development methodologies to fully implement portions of such 
        system every 180 days beginning on the date on which the 
        Secretary begins the implementation of such system, or enters 
        into a contract for the implementation of such system, and 
        ending on the date on which such system is fully implemented.
    (b) Electronic Scheduling System.--The upgraded electronic 
scheduling system described in this subsection shall include mechanisms 
to achieve the following:
            (1) An efficient and effective graphical user interface 
        with a calendar view for use by employees of the Department in 
        scheduling appointments that enables error-free scheduling of 
        the health care resources of the Department.
            (2) A capability to assist employees of the Department to 
        easily and consistently implement policies of the Department 
        with respect to scheduling of appointments, including with 
        respect to priority for appointments for certain eligible 
        individuals.
            (3) A capability for employees of the Department to sort 
        and view through a unified interface the availability for each 
        health care provider of the Department or other health care 
        resource of the Department.
            (4) A capability for employees of the Department to sort 
        and view appointments for and appointment requests made by a 
        particular eligible individual.
            (5) A capability for seamless coordination of appointments 
        for primary care, specialty care, consultations, or any other 
        health care matter among facilities of the Department.
            (6) A capability for eligible individuals to access the 
        system remotely and schedule appointments directly through the 
        system.
            (7) An electronic timestamp of each activity made by an 
        eligible individual or on behalf of such individual with 
        respect to an appointment or the scheduling of an appointment 
        that shall be kept in the medical record of such individual.
            (8) A seamless connection to the Computerized Patient 
        Record System of the Department so that employees of the 
        Department, when scheduling an appointment for an eligible 
        individual, have access to recommendations from the health care 
        provider of such individual with respect to when such 
        individual should receive an appointment.
            (9) A capability to provide automated reminders to eligible 
        individuals on upcoming appointments through various electronic 
        and voice media.
            (10) A capability to provide automated reminders to 
        employees of the Department when an eligible individual who is 
        on the wait-list for an appointment becomes eligible to 
        schedule an appointment.
            (11) A dashboard capability to support efforts to track the 
        following metrics in aggregate and by medical facility with 
        respect to health care provided to eligible individuals under 
        the laws administered by the Secretary:
                    (A) The number of days into the future that the 
                schedules of health care providers are available to 
                schedule an appointment.
                    (B) The number of providers available to see 
                patients each day.
                    (C) The number of support personnel working each 
                day.
                    (D) The types of appointments available.
                    (E) The rate at which patients fail to appear for 
                appointments.
                    (F) The number of appointments canceled by a 
                patient on a daily basis.
                    (G) The number of appointments canceled by a health 
                care provider on a daily basis.
                    (H) The number of patients on the wait list at any 
                given time.
                    (I) The number of appointments scheduled on a daily 
                basis;
                    (J) The number of appointments available to be 
                scheduled on a daily basis.
                    (K) The number of patients seen on a daily, weekly, 
                and monthly basis.
                    (L) Wait-times for an appointment with a health 
                care provider of the Department.
                    (M) Wait-times for an appointment with a non-
                Department health care provider.
                    (N) Wait-times for a referral to a specialist or 
                consult.
            (12) A capability to provide data on the capacity of 
        medical facilities of the Department for purposes of 
        determining the resources needed by the Department to provide 
        health care to eligible individuals.
            (13) Any other capabilities as specified by the Secretary 
        for purposes of this section.
    (c) Plan.--
            (1) In general.--Not later than 90 days after the date of 
        the enactment of this Act, the Secretary shall submit to the 
        Committee on Veterans' Affairs of the Senate and the Committee 
        on Veterans' Affairs of the House of Representatives a plan for 
        implementing the upgraded electronic scheduling system required 
        by subsection (a).
            (2) Elements.--The plan required by paragraph (1) shall 
        include the following:
                    (A) A description of the priorities of the 
                Secretary for implementing the requirements of the 
                system under subsection (b).
                    (B) A detailed description of the manner in which 
                the Secretary will fully implement such system, 
                including deadlines for completing each such 
                requirement.
            (3) Update.--Not later than 90 days after the submittal of 
        the plan required by paragraph (1), and not less frequently 
        than every 90 days thereafter until such system is fully 
        implemented, the Secretary shall submit to the Committee on 
        Veterans' Affairs of the Senate and the Committee on Veterans' 
        Affairs of the House of Representatives an update on the status 
        of the implementation of such plan.
    (d) Use of Amounts.--The Secretary may use amounts available to the 
Department of Veterans Affairs for the appropriations account under the 
heading ``medical services'' in implementing and carrying out the 
upgraded electronic scheduling system required by subsection (a).
    (e) Eligible Individual Defined.--In this section, the term 
``eligible individual'' means an individual eligible for hospital, 
nursing home, domiciliary, medical care, or other health care under the 
laws administered by the Secretary of Veterans Affairs.

SEC. 102. INDEPENDENT ASSESSMENT OF THE SCHEDULING PROCESS FOR MEDICAL 
              APPOINTMENTS FOR CARE FROM DEPARTMENT OF VETERANS 
              AFFAIRS.

    (a) Independent Assessment.--
            (1) Contract.--Not later than 30 days after the date of the 
        enactment of this Act, the Secretary of Veteran Affairs shall 
        enter into a contract with an independent third party to assess 
        the process at each medical facility of the Department of 
        Veterans Affairs for scheduling appointments for veterans to 
        receive hospital care, medical services, or other health care 
        from the Department.
            (2) Elements.--In carrying out the assessment required by 
        paragraph (1), the independent third party shall do the 
        following:
                    (A) Review all training materials pertaining to 
                scheduling of appointments at each medical facility of 
                the Department.
                    (B) Assess whether all employees of the Department 
                conducting tasks related to scheduling are properly 
                trained for conducting such tasks.
                    (C) Assess whether changes in the technology or 
                system used in scheduling appointments are necessary to 
                limit access to the system to only those employees that 
                have been properly trained in conducting such tasks.
                    (D) Assess whether health care providers of the 
                Department are making changes to their schedules that 
                hinder the ability of employees conducting such tasks 
                to perform such tasks.
                    (E) Assess whether the establishment of a 
                centralized call center throughout the Department for 
                scheduling appointments at medical facilities of the 
                Department would improve the process of scheduling such 
                appointments.
                    (F) Assess whether booking templates for each 
                medical facility or clinic of the Department would 
                improve the process of scheduling such appointments.
                    (G) Recommend any actions to be taken by the 
                Department to improve the process for scheduling such 
                appointments, including the following:
                            (i) Changes in training materials provided 
                        to employees of the Department with respect to 
                        conducting tasks related to scheduling such 
                        appointments.
                            (ii) Changes in monitoring and assessment 
                        conducted by the Department of wait-times of 
                        veterans for such appointments.
                            (iii) Changes in the system used to 
                        schedule such appointments, including changes 
                        to improve how the Department--
                                    (I) measures wait-times of veterans 
                                for such appointments;
                                    (II) monitors the availability of 
                                health care providers of the 
                                Department; and
                                    (III) provides veterans the ability 
                                to schedule such appointments.
                            (iv) Such other actions as the independent 
                        third party considers appropriate.
            (3) Timing.--The independent third party carrying out the 
        assessment required by paragraph (1) shall complete such 
        assessment not later than 180 days after entering into the 
        contract described in such paragraph.
    (b) Report.--Not later than 90 days after the date on which the 
independent third party completes the assessment under this section, 
the Secretary shall submit to the Committee on Veterans' Affairs of the 
Senate and the Committee on Veterans' Affairs of the House of 
Representatives a report on the results of such assessment.

           TITLE II--TRAINING AND HIRING OF HEALTH CARE STAFF

SEC. 201. MODIFICATION OF LIABILITY FOR BREACH OF PERIOD OF OBLIGATED 
              SERVICE UNDER HEALTH PROFESSIONALS EDUCATIONAL ASSISTANCE 
              PROGRAM FOR PRIMARY CARE PHYSICIANS.

    Section 7617 of title 38, United States Code, is amended--
            (1) In subsection (c)(1), by striking ``If a participant'' 
        and inserting ``Except as provided in subsection (d), if a 
        participant''; and
            (2) by adding at the end the following new subsection:
    ``(d) Liability shall not arise under subsection (c) in the case of 
a participant otherwise covered by that subsection who has pursued a 
course of education or training in primary care if--
            ``(1) the participant--
                    ``(A) does not obtain, or fails to maintain, 
                employment as a Department employee due to staffing 
                changes approved by the Under Secretary for Health; or
                    ``(B) does not obtain, or fails to maintain, 
                employment in a position of primary care physician in 
                the Veterans Health Administration due, as determined 
                by the Secretary, to a number of primary care 
                physicians in the Administration that is excess to the 
                needs of the Administration; and
            ``(2) the participant agrees to accept and maintain 
        employment as a primary care physician with another department 
        or agency of the Federal Government (with such employment to be 
        under such terms and conditions as are jointly agreed upon by 
        the participant, the Secretary, and the head of such department 
        or agency, including terms and conditions relating to a period 
        of obligated service as a primary care physician with such 
        department or agency) if such employment is offered to the 
        participant by the Secretary and the head of such department or 
        agency.''.

SEC. 202. PROGRAM OF EDUCATION AT UNIFORMED SERVICES UNIVERSITY OF THE 
              HEALTH SCIENCES WITH SPECIALIZATION IN PRIMARY CARE.

    (a) Program Required Under Health Professionals Educational 
Assistance Program.--
            (1) In general.--Chapter 76 of title 38, United States 
        Code, is amended by adding after subchapter VII the following 
        new subchapter:

     ``SUBCHAPTER VIII--PROGRAM OF EDUCATION AT UNIFORMED SERVICES 
 UNIVERSITY OF THE HEALTH SCIENCES WITH SPECIALIZATION IN PRIMARY CARE

``Sec. 7691. Authority for program
    ``As part of the Educational Assistance Program, the Secretary 
shall, in collaboration with the Secretary of Defense, carry out a 
program to permit individuals to enroll in the Uniformed Services 
University of the Health Sciences under chapter 104 of title 10 to 
pursue a medical education with a specialization in primary care. The 
program shall be known as the Department of Veterans Affairs Primary 
Care Educational Assistance Program (in this chapter referred to as the 
`Primary Care Educational Assistance Program').
``Sec. 7692. Selection; agreement; ineligibility for certain other 
              educational assistance
    ``(a) Selection.--(1) Medical students at the Uniformed Services 
University of the Health Sciences pursuant to the Primary Care 
Educational Assistance Program shall be selected by the Secretary, in 
consultation with the Secretary of Defense, in accordance with 
procedures established by the Secretaries for purposes of the Program.
    ``(2) The procedures referred to in paragraph (1) shall emphasize 
the basic requirement that students demonstrate a motivation and 
dedication to a medical career in primary care.
    ``(3) The number of medical students selected each year for first-
year enrollment in the University pursuant to this subsection shall be 
jointly determined by the Secretary and the Secretary of Defense.
    ``(b) Agreement.--An agreement between the Secretary and a 
participant in the Primary Care Educational Assistance Program shall 
(in addition to the requirements set forth in section 7604 of this 
title) include the following:
            ``(1) The Secretary's agreement to cover the costs of the 
        participant's education and training at the Uniformed Services 
        University of the Health Sciences under chapter 104 of title 10 
        as if the participant were a medical student enrolled in the 
        University pursuant to section 2114 of title 10.
            ``(2) The participant's agreement to serve as a full-time 
        employee in the Veterans Health Administration in a position as 
        a primary care physician for a period of time (in this 
        subchapter referred to as the `period of obligated service') of 
        one calendar year for each school year or part thereof for 
        which the participant was a medical student at the Uniformed 
        Services University of the Health Sciences pursuant to the 
        Primary Care Educational Assistance Program, but for not less 
        than one year.
    ``(c) Ineligibility for Other Educational Assistance.--An 
individual who receives education and training under the Primary Care 
Educational Assistance Program shall not be eligible for other 
assistance under this chapter in connection with such education and 
training.
``Sec. 7693. Obligated service
    ``(a) In General.--Each participant in the Primary Care Educational 
Assistance Program shall provide service as a full-time employee of the 
Department in the Veterans Health Administration in a primary care 
position for the period of obligated service provided in the agreement 
of the participant entered into for purposes of this subchapter. Such 
service shall be provided in a full-time primary care clinical practice 
in an assignment or location determined by the Secretary.
    ``(b) Service Commencement Date.--(1) Not later than 60 days before 
a participant's service commencement date, the Secretary shall notify 
the participant of that service commencement date. That date is the 
date for the beginning of the participant's period of obligated 
service.
    ``(2) As soon as possible after a participant's service 
commencement date, the Secretary shall--
            ``(A) in the case of a participant who is not a full-time 
        employee in the Veterans Health Administration, appoint the 
        participant as such an employee; and
            ``(B) in the case of a participant who is an employee in 
        the Veterans Health Administration but is not serving in a 
        position for which the participant's course of education or 
        training prepared the participant, assign the participant to 
        such a position.
    ``(3) A participant's service commencement for purposes of this 
subsection date is the date upon which the participant becomes licensed 
to practice medicine in a State.
    ``(c) Commencement of Obligated Service.--A participant in the 
Primary Care Educational Assistance Program shall be considered to have 
begun serving the participant's period of obligated service--
            ``(1) on the date on which the participant is appointed as 
        a full-time employee in the Veterans Health Administration 
        pursuant to subsection (b)(2)(A); or
            ``(2) if the participant is a full-time employee in the 
        Veterans Health Administration and assigned to a position 
        pursuant to subsection (b)(2)(B), on the date on which the 
        participant is so assigned to such position.
``Sec. 7694. Breach of agreement: liability
    ``(a) Liability During Course of Education or Training.--(1) A 
participant in the Primary Care Educational Assistance Program shall be 
liable to the United States for the amount which has been paid on 
behalf of the participant under the agreement entered into for purposes 
of this subchapter if any of the following occurs:
            ``(A) The participant fails to maintain an acceptable level 
        of academic standing in the Uniformed Services University of 
        the Health Sciences.
            ``(B) The participant is dismissed from the Uniformed 
        Services University of the Health Sciences for disciplinary 
        reasons.
            ``(C) The participant voluntarily terminates the course of 
        medical education and training in the Uniformed Services 
        University of the Health Sciences before the completion of such 
        course of education and training.
            ``(D) The participant fails to become licensed to practice 
        medicine in a State during a period of time determined under 
        regulations prescribed by the Secretary.
    ``(2) Liability under this subsection is in lieu of any service 
obligation arising under a participant's agreement for purposes of this 
subchapter.
    ``(b) Liability During Period of Obligated Service.--(1) Except as 
provided in subsection (c) and subject to paragraph (2), if a 
participant in the Primary Care Educational Assistance Program breaches 
the agreement entered into for purposes of this subchapter by failing 
for any reason to complete the participant's period of obligated 
service, the United States shall be entitled to recover from the 
participant an amount equal to--
            ``(A) the total amount paid under this subchapter on behalf 
        of the participant; multiplied by
            ``(B) a fraction--
                    ``(i) the numerator of which is--
                            ``(I) the total number of months in the 
                        participant's period of obligated service; 
                        minus
                            ``(II) the number of months served by the 
                        participant pursuant to the agreement; and
                    ``(ii) the denominator of which is the total number 
                of months in the participant's period of obligated 
                service.
    ``(2) Any period of internship or residency training of a 
participant shall not be treated as satisfying the participant's period 
of obligated service for purposes of this subsection.
    ``(c) Exceptions.--Liability shall not arise under subsection (b) 
in the case of a participant otherwise covered by that subsection if--
            ``(1) the participant--
                    ``(A) does not obtain, or fails to maintain, 
                employment as a Department employee due to staffing 
                changes approved by the Under Secretary for Health; or
                    ``(B) does not obtain, or fails to maintain, 
                employment in a position of primary care physician in 
                the Veterans Health Administration due, as determined 
                by the Secretary, to a number of primary care 
                physicians in the Administration that is excess to the 
                needs of the Administration; and
            ``(2) the participant agrees to accept and maintain 
        employment as a primary care physician with another department 
        or agency of the Federal Government (with such employment to be 
        under such terms and conditions as are jointly agreed upon by 
        the participant, the Secretary, and the head of such department 
        or agency, including terms and conditions relating to a period 
        of obligated service as a primary care physician with such 
        department or agency) if such employment is offered to the 
        participant by the Secretary and the head of such department or 
        agency.
``Sec. 7695. Funding
    ``(a) In General.--Amounts for the Primary Care Educational 
Assistance Program shall be derived from amounts available to the 
Secretary for the Veterans Health Administration.
    ``(b) Transfer.--(1) The Secretary shall transfer to the Secretary 
of Defense amounts required by the Secretary of Defense to carry out 
the Primary Care Educational Assistance Program.
    ``(2) Amounts transferred to the Secretary of Defense pursuant to 
paragraph (1) shall be credited to the appropriation or account 
providing funding for the Uniformed Services University of the Health 
Sciences. Amounts so credited shall be merged with amounts in the 
appropriation or account to which credited and shall be available, 
subject to the terms and conditions applicable to such appropriation or 
account, for the Uniformed Services University of the Health 
Sciences.''.
            (2) Clerical amendment.--The table of sections at the 
        beginning of chapter 76 of such title is amended by adding 
        after the item relating to section 7684 the following:

     ``subchapter viii--program of education at uniformed services 
 university of the health sciences with specialization in primary care

``7691. Authority for program.
``7692. Selection; agreement; ineligibility for certain other 
                            educational assistance.
``7693. Obligated service.
``7694. Breach of agreement: liability.
``7695. Funding.''.
    (b) Inclusion of Program in Health Professionals Educational 
Assistance Program.--Section 7601(a) of such title is amended--
            (1) in paragraph (4), by striking ``; and'' and inserting a 
        semicolon;
            (2) in paragraph (5), by striking the period at the end and 
        inserting ``; and''; and
            (3) by adding at the end the following new paragraph:
            ``(6) the enrollment of individuals in the Uniformed 
        Services University of the Health Sciences for specialization 
        in primary care provided for in subchapter VIII of this 
        chapter.''.
    (c) Application Requirements.--
            (1) In general.--Subsection (a)(1) of section 7603 of such 
        title is amended in the matter preceding subparagraph (A) by 
        striking ``, or VI'' and inserting ``, VI, or VIII''.
            (2) No priority for applications.--Subsection (d) of such 
        section is amended--
                    (A) by striking ``In selecting'' and inserting 
                ``(1) Except as provided in paragraph (2), in 
                selecting''; and
                    (B) by adding at the end the following new 
                paragraph:
    ``(2) Paragraph (1) shall not apply with respect to applicants for 
participation in the Program of Education at Uniformed Services 
University of the Health Sciences With Specialization in Primary Care 
pursuant to subchapter VIII of this chapter.''.
    (d) Agreement Requirements.--Section 7604 of such title is amended 
by striking ``, or VI'' each place it appears and inserting ``, VI, or 
VIII''.

SEC. 203. TREATMENT OF STAFFING SHORTAGE AND BIANNUAL REPORT ON 
              STAFFING OF MEDICAL FACILITIES OF THE DEPARTMENT OF 
              VETERANS AFFAIRS.

    (a) Staffing Shortage.--
            (1) In general.--Not later than 180 days after the date of 
        the enactment of this Act, and not later than September 30 each 
        year thereafter, the Secretary of Veterans Affairs shall 
        determine, and publish in the Federal Register, the five 
        occupations of health care providers of the Department of 
        Veterans Affairs for which there is the largest staffing 
        shortage throughout the Department.
            (2) Recruitment and appointment.--Notwithstanding sections 
        3304 and 3309 through 3318 of title 5, United States Code, the 
        Secretary may, upon a determination by the Secretary under 
        paragraph (1) or a modification to such determination under 
        paragraph (2), that there is a staffing shortage throughout the 
        Department with respect to a particular occupation of health 
        care provider, recruit and directly appoint highly qualified 
        health care providers to a position to serve as a health care 
        provider in that particular occupation for the Department.
            (3) Priority in health professionals educational assistance 
        program to certain providers.--Section 7612(b)(5) of title 38, 
        United States Code, is amended--
                    (A) in subparagraph (A), by striking ``and'' at the 
                end;
                    (B) by redesignating subparagraph (B) as 
                subparagraph (C); and
                    (C) by inserting after subparagraph (A) the 
                following new subparagraph (B):
            ``(B) shall give priority to applicants pursuing a course 
        of education or training towards a career in an occupation for 
        which the Secretary has, in the most current determination 
        published in the Federal Register pursuant to section 203(a)(1) 
        of the Ensuring Veterans Access to Care Act of 2014, determined 
        that there is one of the largest staffing shortage throughout 
        the Department with respect to such occupation; and''.
    (b) Reports.--
            (1) In general.--Not later than 180 days after the date of 
        the enactment of this Act, and not later than December 31 of 
        each even numbered year thereafter until 2024, the Secretary of 
        Veterans Affairs shall submit to the Committee on Veterans' 
        Affairs of the Senate and the Committee on Veterans' Affairs of 
        the House of Representatives a report assessing the staffing of 
        each medical facility of the Department of Veterans Affairs.
            (2) Elements.--Each report submitted under paragraph (1) 
        shall include the following:
                    (A) The results of a system-wide assessment of all 
                medical facilities of the Department to ensure the 
                following:
                            (i) Appropriate staffing levels for health 
                        care providers to meet the goals of the 
                        Secretary for timely access to care for 
                        veterans.
                            (ii) Appropriate staffing levels for 
                        support personnel, including clerks.
                            (iii) Appropriate sizes for clinical 
                        panels.
                            (iv) Appropriate numbers of full-time 
                        staff, or full-time equivalent, dedicated to 
                        direct care of patients.
                            (v) Appropriate physical plant space to 
                        meet the capacity needs of the Department in 
                        that area.
                            (vi) Such other factors as the Secretary 
                        considers necessary.
                    (B) A plan for addressing any issues identified in 
                the assessment described in subparagraph (A), including 
                a timeline for addressing such issues.
                    (C) A list of the current wait times and workload 
                levels for the following clinics in each medical 
                facility:
                            (i) Mental health.
                            (ii) Primary care.
                            (iii) Gastroenterology.
                            (iv) Women's health.
                            (v) Such other clinics as the Secretary 
                        considers appropriate.
                    (D) A description of the results of the 
                determination of the Secretary under paragraph (1) of 
                subsection (a) and a plan to use direct appointment 
                authority under paragraph (2) of such subsection to 
                fill staffing shortages, including recommendations for 
                improving the speed at which the credentialing and 
                privileging process can be conducted.
                    (E) The current staffing models of the Department 
                for the following clinics, including recommendations 
                for changes to such models:
                            (i) Mental health.
                            (ii) Primary care.
                            (iii) Gastroenterology.
                            (iv) Women's health.
                            (v) Such other clinics as the Secretary 
                        considers appropriate.
                    (F) A detailed analysis of succession planning at 
                medical facilities of the Department, including the 
                following:
                            (i) The number of positions in medical 
                        facilities throughout the Department that are 
                        not filled by a permanent employee.
                            (ii) The length of time each such position 
                        described in clause (i) remained vacant or 
                        filled by a temporary or acting employee.
                            (iii) A description of any barriers to 
                        filling the positions described in clause (i).
                            (iv) A plan for filling any positions that 
                        are vacant or filled by a temporary or acting 
                        employee for more than 180 days.
                            (v) A plan for handling emergency 
                        circumstances, such administrative leave or 
                        sudden medical leave for senior officials.
                    (G) The number of health care providers who have 
                been removed from their position or have retired, by 
                provider type, during the two-year period preceding the 
                submittal of the report.
                    (H) Of the health care providers specified in 
                subparagraph (G) that have been removed from their 
                position, the following:
                            (i) The number of such health care 
                        providers who were reassigned to another 
                        position in the Department.
                            (ii) The number of such health care 
                        providers who left the Department.

SEC. 204. CLINIC MANAGEMENT TRAINING PROGRAM OF THE DEPARTMENT OF 
              VETERANS AFFAIRS.

    (a) In General.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall 
implement a clinic management training program to provide in-person, 
standardized education on health care management to all managers of, 
and health care providers at, medical facilities of the Department of 
Veterans Affairs.
    (b) Elements.--The clinic management training program required by 
subsection (a) shall include the following:
            (1) Training on how to manage the schedules of health care 
        providers of the Department, including the following:
                    (A) Maintaining such schedules in a manner that 
                allows appointments to be booked at least eight weeks 
                in advance.
                    (B) Proper planning procedures for vacation, leave, 
                and graduate medical education training schedules.
            (2) Training on the appropriate number of appointments that 
        a health care provider should conduct on a daily basis, based 
        on specialty.
            (3) Training on how to determine whether there are enough 
        available appointment slots to manage demand for different 
        appointment types and mechanisms for alerting management of 
        insufficient slots.
            (4) Training on how to properly use the data produced by 
        the scheduling dashboard required by section 101(b)(11) of this 
        Act to meet demand for health care, including the following:
                    (A) Training on determining the next available 
                appointment for each health care provider at the 
                medical facility.
                    (B) Training on determining the number of health 
                care providers needed to meet demand for health care at 
                the medical facility.
                    (C) Training on determining the number of exam 
                rooms needed to meet demand for such health care in an 
                efficient manner.
            (5) Training on how to properly use the appointment 
        scheduling system of the Department, including any new 
        scheduling system implemented by the Department.
            (6) Training on how to optimize the use of technology, 
        including the following:
                    (A) Telemedicine.
                    (B) Electronic mail.
                    (C) Text messaging.
                    (D) Such other technologies as specified by the 
                Secretary.
            (7) Training on how to properly use physical plant space at 
        medical facilities of the Department to ensure efficient flow 
        and privacy for patients and staff.

SEC. 205. INCLUSION OF DEPARTMENT OF VETERANS AFFAIRS FACILITIES IN 
              NATIONAL HEALTH SERVICE CORPS SCHOLARSHIP AND LOAN 
              REPAYMENT PROGRAMS.

    (a) In General.--The Secretary of Health and Human Services shall 
use the funds transferred under subsection (e) to award scholarship and 
loan repayment contracts under sections 338A and 338B of the Public 
Health Service Act (42 U.S.C. 254l, 254l-1) to eligible individuals who 
agree to a period of obligated service under section 338A(f)(1) or 
338B(f)(1) of such Act, as applicable, at a health facility of the 
Department of Veterans Affairs.
    (b) Health Professional Shortage Areas.--For purposes of selecting 
individuals eligible for the scholarships and loan repayment contracts 
under subsection (a), all health facilities of the Department of 
Veterans Affairs shall be deemed health professional shortage areas, as 
defined in section 332 of the Public Health Service Act (42 U.S.C. 
254e).
    (c) Requirement.--The Secretary of Health and Human Services shall 
ensure that a minimum of 5 scholarships or loan repayment contracts are 
awarded to individuals who agree to a period of obligated service at 
Veterans Affairs facilities in each State.
    (d) Applicability of NHSC Program Requirements.--Except as 
otherwise provided in this section, the terms of the National Health 
Service Corps Scholarship Program and the National Health Service Corps 
Loan Repayment Program shall apply to participants awarded a grant or 
loan repayment contract under subsection (a) in the same manner that 
such terms apply to participants awarded a grant or loan repayment 
contract under section 338A or 338B of the Public Health Service Act.
    (e) Inclusion of Geriatricians.--For purposes of awarding 
scholarships and loan repayments contracts to eligible individuals who 
agree to a period of obligated service at a health facility of the 
Department of Veterans Affairs pursuant to this section, in sections 
338A and 338B of the Public Health Service Act (42 U.S.C. 254l, 254l-
1), the term ``primary health services'' shall include geriatrics.
    (f) Funding.--The Secretary of Veterans Affairs shall transfer 
$20,000,000 for fiscal year 2014, and such sums as may be necessary for 
each fiscal year thereafter, from accounts of the Veterans Health 
Administration to the Secretary of Health and Human Services to award 
scholarships and loan repayment contracts, as described in subsection 
(a). All funds so transferred shall be used exclusively for the 
purposes described in such subsection.

SEC. 206. AUTHORIZATION OF EMERGENCY APPROPRIATIONS.

    There is authorized to be appropriated for the Department of 
Veterans Affairs such sums as may be necessary to carry out this title.

    TITLE III--IMPROVEMENT OF ACCESS TO CARE FROM NON-DEPARTMENT OF 
                       VETERANS AFFAIRS PROVIDERS

SEC. 301. IMPROVEMENT OF ACCESS BY VETERANS TO HEALTH CARE FROM NON-
              DEPARTMENT OF VETERANS AFFAIRS PROVIDERS.

    (a) Improvement of Access.--
            (1) In general.--The Secretary of Veterans Affairs shall 
        ensure timely access of all veterans to the hospital care, 
        medical services, and other health care for which such veterans 
        are eligible under the laws administered by the Secretary 
        through the enhanced use of authorities specified in paragraph 
        (2) on the provision of such care and services through non-
        Department of Veterans Affairs providers (commonly referred to 
        as ``non-Department of Veterans Affairs medical care'').
            (2) Authorities on provision of care through non-department 
        providers.--The authorities specified in this paragraph are the 
        following:
                    (A) Section 1703 of title 38, United States Code, 
                relating to contracts for the provision of hospital 
                care and medical services through non-Department 
                facilities.
                    (B) Section 1725 of such title, relating to 
                reimbursement of certain veterans for the reasonable 
                value of emergency treatment at non-Department 
                facilities.
                    (C) Section 1728 of such title, relating to 
                reimbursement of certain veterans for customary and 
                usual charges of emergency treatment from sources other 
                than the Department.
                    (D) Section 1786 of such title, relating to health 
                care services furnished to newborn children of women 
                veterans who are receiving maternity care furnished by 
                the Department at a non-Department facility.
                    (E) Any other authority under the laws administered 
                by the Secretary to provide hospital care, medical 
                services, or other health care from a non-Department 
                provider, including the following:
                            (i) A Federally-qualified health center (as 
                        defined in section 1905(l)(2)(B) of the Social 
                        Security Act (42 U.S.C. 1396d(l)(2)(B))).
                            (ii) The Department of Defense.
                            (iii) The Indian Health Service.
            (3) Requirements.--In ensuring timely access of all 
        veterans to the care and services described in paragraph (1) 
        through the enhanced use of authorities specified in paragraph 
        (2), the Secretary shall require the following:
                    (A) That each veteran who has not received hospital 
                care, medical services, or other health care from the 
                Department and is seeking an appointment for primary 
                care under the laws administered by the Secretary 
                receive an appointment for primary care at a time 
                consistent with timeliness measures established by the 
                Secretary for purposes of providing primary care to all 
                veterans.
                    (B) That the determination whether to refer a 
                veteran for specialty care through a non-Department 
                provider shall take into account the urgency and acuity 
                of such veteran's need for such care, including--
                            (i) the severity of the condition of such 
                        veteran requiring specialty care; and
                            (ii) the wait-time for an appointment with 
                        a specialist with respect to such condition at 
                        the nearest medical facility of the Department 
                        with the capacity to provide such care.
                    (C) That the determination whether a veteran shall 
                receive hospital care, medical services, or other 
                health care from the Department through facilities of 
                the Department or through non-Department providers 
                pursuant to the authorities specified in paragraph (2) 
                shall take into account, in the manner specified by the 
                Secretary, the following:
                            (i) The distance the veteran would be 
                        required to travel to receive care or services 
                        through a non-Department provider compared to 
                        the distance the veteran would be required to 
                        travel to receive care or services from a 
                        medical facility of the Department.
                            (ii) Any factors that might limit the 
                        ability of the veteran to travel, including 
                        age, access to transportation, and infirmity.
                            (iii) The wait-time for the provision of 
                        care or services through a non-Department 
                        provider compared to the wait-time for the 
                        provision of care or services from a medical 
                        facility of the Department.
                            (iv) Where the veteran would prefer to 
                        receive the care and services described in 
                        paragraph (1), unless the preference of the 
                        veteran conflicts with any of the other 
                        requirements of this paragraph.
                    (D) That the Department maximize the use of 
                hospital care, medical services, and other health care 
                available to the Department through non-Department 
                providers, including providers available to provide 
                such care and services as follows:
                            (i) Pursuant to contracts under the 
                        Patient-Centered Community Care Program of the 
                        Department.
                            (ii) Pursuant to contracts between a 
                        facility or facilities of the Department and a 
                        local facility or provider.
                            (iii) Pursuant to contracts with Federally-
                        qualified health centers (as defined in section 
                        1905(l)(2)(B) of the Social Security Act (42 
                        U.S.C. 1396d(l)(2)(B))), the Department of 
                        Defense, or the Indian Health Service.
                            (iv) On a fee-for-service basis.
    (b) Medical Records.--In providing hospital care, medical services, 
and other health care to veterans through non-Department providers 
pursuant to the authorities specified in paragraph (2), the Secretary 
shall ensure that any such provider submits to the Department any 
medical record related to the care and services provided to a veteran 
by that provider for inclusion in the electronic medical record of such 
veteran maintained by the Department upon the completion of the 
provision of such care and services to such veteran.
    (c) Reports.--
            (1) Initial report.--Not later than 45 days after the date 
        of the enactment of this Act, the Secretary shall submit to the 
        Committee on Veterans' Affairs of the Senate and the Committee 
        on Veterans' Affairs of the House of Representatives a report 
        on the implementation of the requirements under subsection (a) 
        and (b), including a plan to enforce the proper implementation 
        of such requirements systematically throughout the Department.
            (2) Periodic reports.--Not later than 90 days after the 
        submittal of the report required by paragraph (1), and every 90 
        days thereafter for one year, the Secretary shall submit to the 
        Committee on Veterans' Affairs of the Senate and the Committee 
        on Veterans' Affairs of the House of Representatives a report 
        that includes the following:
                    (A) The progress of the Secretary in carrying out 
                the plan under paragraph (1) to enforce the proper 
                implementation of the requirements under subsection (a) 
                and (b) systematically throughout the Department.
                    (B) The impact of the implementation of such 
                requirements on wait-times for veterans to receive 
                hospital care, medical services, and other health care, 
                disaggregated by--
                            (i) new patients;
                            (ii) existing patients;
                            (iii) primary care; and
                            (iv) specialty care.
                    (C) Any recommendations for changes or improvements 
                to such requirements.
                    (D) Any requests for additional funding necessary 
                to carry out such requirements.

SEC. 302. EXTENSION OF AND REPORT ON JOINT INCENTIVES PROGRAM OF 
              DEPARTMENT OF VETERANS AFFAIRS AND DEPARTMENT OF DEFENSE.

    (a) Extension.--Section 8111(d)(3) of title 38, United States Code, 
is amended by striking ``September 30, 2015'' and inserting ``September 
30, 2020''.
    (b) Reports.--
            (1) Report on implementation of recommendations.--Not later 
        than 60 days after the date of the enactment of this Act, the 
        Secretary of Veterans Affairs and the Secretary of Defense 
        shall jointly submit to Congress a report on the implementation 
        by the Department of Veterans Affairs and the Department of 
        Defense of the findings and recommendations of the Comptroller 
        General of the United States in the September 2012 report 
        entitled ``VA and DoD Health Care: Department-Level Actions 
        Needed to Assess Collaboration Performance, Address Barriers, 
        and Identify Opportunities'' (GAO-12-992).
            (2) Comptroller general report.--
                    (A) In general.--Not later than one year after the 
                date of the enactment of this Act, the Comptroller 
                General of the United States shall submit to Congress a 
                report assessing and providing recommendations for 
                improvement to the program to identify, provide 
                incentives to, implement, fund, and evaluate creative 
                coordination and sharing initiatives between the 
                Department of Veterans Affairs and the Department of 
                Defense required under section 8111(d) of such title.
                    (B) Elements.--The report required by subparagraph 
                (A) shall include the following:
                            (i) An assessment of the extent to which 
                        the program described in subparagraph (A) has 
                        accomplished the goal of such program to 
                        improve the access to, and quality and cost 
                        effectiveness of, the health care provided by 
                        the Veterans Health Administration and the 
                        Military Health System to the beneficiaries of 
                        both the Department of Veterans Affairs and the 
                        Department of Defense.
                            (ii) An assessment of whether 
                        administration of such program through the 
                        Health Executive Committee of the Department of 
                        Veterans Affairs-Department of Defense Joint 
                        Executive Committee established under section 
                        320 of such title provides sufficient 
                        leadership attention and oversight to ensure 
                        maximum benefits to the Department of Veterans 
                        Affairs and the Department of Defense through 
                        collaborative efforts.
                            (iii) An assessment of whether additional 
                        authorities to jointly construct, lease, or 
                        acquire facilities would facilitate additional 
                        collaborative efforts under such program.
                            (iv) An assessment of whether the funding 
                        for such program is sufficient to ensure 
                        consistent identification of potential 
                        opportunities for collaboration and oversight 
                        of existing collaborations to ensure a 
                        meaningful partnership between the Department 
                        of Veterans Affairs and the Department of 
                        Defense and remove any barriers to integration 
                        or collaboration.
                            (v) An assessment of whether existing 
                        processes for identifying opportunities for 
                        collaboration are sufficient to ensure maximum 
                        collaboration between the Veterans Health 
                        Administration and the Military Health System.
                            (vi) Such legislative or administrative 
                        recommendations for improvement to such program 
                        as the Comptroller General considers 
                        appropriate to enhance the use of such program 
                        to increase access to health care.

SEC. 303. 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.

    (a) Transfer of Authority.--
            (1) In general.--Effective on October 1, 2014, the 
        Secretary of Veterans Affairs shall transfer the authority to 
        pay for hospital care, medical services, and other health care 
        through non-Department providers to the Chief Business Office 
        of the Veterans Health Administration of the Department of 
        Veterans Affairs from the Veterans Integrated Service Networks 
        and medical centers of the Department of Veterans Affairs.
            (2) Manner of care.--The Chief Business Office shall work 
        in consultation with the Office of Clinical Operations and 
        Management of the Department of Veterans Affairs to ensure that 
        care and services described in paragraph (1) is provided in a 
        manner that is clinically appropriate and effective.
            (3) No delay in payment.--The transfer of authority under 
        paragraph (1) shall be carried out in a manner that does not 
        delay or impede any payment by the Department for hospital 
        care, medical services, or other health care provided through a 
        non-Department provider under the laws administered by the 
        Secretary.
    (b) Budgetary Effect.--The Secretary shall, for each fiscal year 
that begins after the date of the enactment of this Act--
            (1) include in the budget for the Chief Business Office of 
        the Veterans Health Administration amounts to pay for hospital 
        care, medical services, and other health care provided through 
        non-Department providers, including any amounts necessary to 
        carry out the transfer of authority to pay for such care and 
        services under subsection (a), including any increase in staff; 
        and
            (2) not include in the budget of each Veterans Integrated 
        Service Network and medical center of the Department amounts to 
        pay for such care and services.
    (c) Removal From Performance Goals.--For each fiscal year that 
begins after the date of the enactment of this Act, the Secretary shall 
not include in the performance goals of any employee of a Veterans 
Integrated Service Network or medical center of the Department any 
performance goal that might disincentivize the payment of Department 
amounts to provide hospital care, medical services, or other health 
care through a non-Department provider.

SEC. 304. ENHANCEMENT OF COLLABORATION BETWEEN DEPARTMENT OF VETERANS 
              AFFAIRS AND INDIAN HEALTH SERVICE.

    (a) Outreach to Tribal-run Medical Facilities.--The Secretary of 
Veterans Affairs shall, in consultation with the Director of the Indian 
Health Service, conduct outreach to each medical facility operated by 
an Indian tribe or tribal organization through a contract or compact 
with the Indian Health Service under the Indian Self-Determination and 
Education Assistance Act (25 U.S.C. 450 et seq.) to raise awareness of 
the ability of such facilities, Indian tribes, and tribal organizations 
to enter into agreements with the Department of Veterans Affairs under 
which the Secretary reimburses such facilities, Indian tribes, or 
tribal organizations, as the case may be, for health care provided to 
veterans eligible for health care at such facilities.
    (b) Metrics for Memorandum of Understanding Performance.--The 
Secretary of Veterans Affairs shall implement performance metrics for 
assessing the performance by the Department of Veterans Affairs and the 
Indian Health Service under the memorandum of understanding entitled 
``Memorandum of Understanding between the Department of Veterans 
Affairs (VA) and the Indian Health Service (IHS)'' in increasing access 
to health care, improving quality and coordination of health care, 
promoting effective patient-centered collaboration and partnerships 
between the Department and the Service, and ensuring health-promotion 
and disease-prevention services are appropriately funded and available 
for beneficiaries under both health care systems.
    (c) Report.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs and the 
Director of the Indian Health Service shall jointly submit to Congress 
a report on the feasibility and advisability of the following:
            (1) Entering into agreements for the reimbursement by the 
        Secretary of the costs of direct care services provided through 
        organizations receiving amounts pursuant to grants made or 
        contracts entered into under section 503 of the Indian Health 
        Care Improvement Act (25 U.S.C. 1653) to veterans who are 
        otherwise eligible to receive health care from such 
        organizations.
            (2) Including the reimbursement of the costs of direct care 
        services provided to veterans who are not Indians in agreements 
        between the Department and the following:
                    (A) The Indian Health Service.
                    (B) An Indian tribe or tribal organization 
                operating a medical facility through a contract or 
                compact with the Indian Health Service under the Indian 
                Self-Determination and Education Assistance Act (25 
                U.S.C. 450 et seq.).
                    (C) A medical facility of the Indian Health 
                Service.
    (d) Definitions.--In this section:
            (1) Indian.--The terms ``Indian'' and ``Indian tribe'' have 
        the meanings given those terms in section 4 of the Indian 
        Health Care Improvement Act (25 U.S.C. 1603).
            (2) Medical facility of the indian health service.--The 
        term ``medical facility of the Indian Health Service'' includes 
        a facility operated by an Indian tribe or tribal organization 
        through a contract or compact with the Indian Health Service 
        under the Indian Self-Determination and Education Assistance 
        Act (25 U.S.C. 450 et seq.).
            (3) Tribal organization.--The term ``tribal organization'' 
        has the meaning given the term in section 4 of the Indian Self-
        Determination and Education Assistance Act (25 U.S.C. 450b).

SEC. 305. ENHANCEMENT OF COLLABORATION BETWEEN DEPARTMENT OF VETERANS 
              AFFAIRS AND NATIVE HAWAIIAN HEALTH CARE SYSTEMS.

    (a) In General.--The Secretary of Veterans Affairs shall, in 
consultation with Papa Ola Lokahi and such other organizations involved 
in the delivery of health care to Native Hawaiians as the Secretary 
considers appropriate, enter into contracts or agreements with Native 
Hawaiian health care systems that are in receipt of funds from the 
Secretary of Health and Human Services pursuant to grants awarded or 
contracts entered into under section 6(a) of the Native Hawaiian Health 
Care Improvement Act (42 U.S.C. 11705(a)) for the reimbursement of 
direct care services provided to eligible veterans as specified in such 
contracts or agreements.
    (b) Definitions.--In this section, the terms ``Native Hawaiian'', 
``Native Hawaiian health care system'', and ``Papa Ola Lokahi'' have 
the meanings given those terms in section 12 of the Native Hawaiian 
Health Care Improvement Act (42 U.S.C. 11711).

SEC. 306. AUTHORIZATION OF EMERGENCY APPROPRIATIONS.

    There is authorized to be appropriated for the Department of 
Veterans Affairs such sums as may be necessary to carry out this title.

              TITLE IV--HEALTH CARE ADMINISTRATIVE MATTERS

SEC. 401. IMPROVEMENT OF ACCESS OF VETERANS TO MOBILE VET CENTERS OF 
              THE DEPARTMENT OF VETERANS AFFAIRS.

    (a) Improvement of Access.--
            (1) In general.--The Secretary of Veterans Affairs shall 
        improve the access of veterans to telemedicine and other health 
        care through the use of mobile vet centers of the Department of 
        Veterans Affairs by providing standardized requirements for the 
        operation of such centers.
            (2) Requirements.--The standardized requirements required 
        by paragraph (1) shall include the following:
                    (A) The number of days each mobile vet center of 
                the Department is expected to travel per year.
                    (B) The number of locations each center is expected 
                to visit per year.
                    (C) The number of appointments each center is 
                expected to conduct per year.
                    (D) The method and timing of notifications given by 
                each center to individuals in the area to which such 
                center is traveling, including notifications informing 
                veterans of the availability to schedule appointments 
                at the center.
            (3) Use of telemedicine.--The Secretary shall ensure that 
        each mobile vet center of the Department has the capability to 
        provide telemedicine services.
    (b) Reports.--Not later than one year after the date of the 
enactment of this Act, and not later than September 30 each year 
thereafter, the Secretary of Veterans Affairs shall submit to the 
Committee on Veterans' Affairs of the Senate and the Committee on 
Veterans' Affairs of the House of Representatives a report on the 
following:
            (1) The use of mobile vet centers to provide telemedicine 
        services to veterans during the year preceding the submittal of 
        the report, including the following:
                    (A) The number of days each mobile vet center was 
                open to provide such services.
                    (B) The number of days each mobile vet center 
                traveled to a location other than the headquarters of 
                the mobile vet center to provide such services.
                    (C) The number of appointments each center 
                conducted to provide such services on average per month 
                and in total during such year.
            (2) An analysis of the effectiveness of using mobile vet 
        centers to provide health care services to veterans through the 
        use of telemedicine.
            (3) Any recommendations for an increase in the number of 
        mobile vet centers of the Department.
            (4) Any recommendations for an increase in the telemedicine 
        capabilities of each mobile vet center.
            (5) The feasibility and advisability of using temporary 
        health care providers, including locum tenens, to provide 
        direct health care services to veterans at mobile vet centers.
            (6) Such other recommendations on improvement of the use of 
        mobile vet centers by the Department as the Secretary considers 
        appropriate.

SEC. 402. COMMISSION ON ACCESS TO CARE.

    (a) Establishment of Commission.--
            (1) In general.--There is established the Commission on 
        Access to Care (in this section referred to as the 
        ``Commission'') to examine the access of veterans to health 
        care from the Department of Veterans Affairs and strategically 
        examine how best to organize the Veterans Health 
        Administration, locate health care resources, and deliver 
        health care to veterans during the next 10 to 20 years.
            (2) Membership.--
                    (A) Voting members.--The Commission shall be 
                composed of 10 voting members who are appointed by the 
                President as follows:
                            (i) At least two members who represent an 
                        organization recognized by the Secretary of 
                        Veterans Affairs for the representation of 
                        veterans under section 5902 of title 38, United 
                        States Code.
                            (ii) At least one member from among persons 
                        who are experts concerning a public or private 
                        hospital system.
                            (iii) At least one member from among 
                        persons who are familiar with government health 
                        care systems, including those systems of the 
                        Department of Defense, the Indian Health 
                        Service, and Federally-qualified health centers 
                        (as defined in section 1905(l)(2)(B) of the 
                        Social Security Act (42 U.S.C. 
                        1396d(l)(2)(B))).
                            (iv) At least two members from among 
                        persons who are familiar with the Veterans 
                        Health Administration.
                    (B) Nonvoting members.--In addition to members 
                appointed under subparagraph (A), the Commission shall 
                be composed of 10 nonvoting members who are appointed 
                by the President as follows:
                            (i) At least two members who represent an 
                        organization recognized by the Secretary of 
                        Veterans Affairs for the representation of 
                        veterans under section 5902 of title 38, United 
                        States Code.
                            (ii) At least one member from among persons 
                        who are experts in a public or private hospital 
                        system.
                            (iii) At least one member from among 
                        persons who are familiar with government health 
                        care systems, including those systems of the 
                        Department of Defense, the Indian Health 
                        Service, and Federally-qualified health centers 
                        (as defined in section 1905(l)(2)(B) of the 
                        Social Security Act (42 U.S.C. 
                        1396d(l)(2)(B))).
                            (iv) At least two members from among 
                        persons who are familiar with the Veterans 
                        Health Administration.
                    (C) Date.--The appointments of members of the 
                Commission shall be made not later than 60 days after 
                the date of the enactment of this Act.
            (3) Period of appointment; vacancies.--Members shall be 
        appointed for the life of the Commission. Any vacancy in the 
        Commission shall not affect its powers, but shall be filled in 
        the same manner as the original appointment.
            (4) Initial meeting.--Not later than 15 days after the date 
        on which seven voting members of the Commission have been 
        appointed, the Commission shall hold its first meeting.
            (5) Meetings.--The Commission shall meet at the call of the 
        Chairperson.
            (6) Quorum.--A majority of the members of the Commission 
        shall constitute a quorum, but a lesser number of members may 
        hold hearings.
            (7) Chairperson and vice chairperson.--The Commission shall 
        select a Chairperson and Vice Chairperson from among its 
        members.
    (b) Duties of Commission.--
            (1) Evaluation and assessment.--The Commission shall 
        undertake a comprehensive evaluation and assessment of access 
        to health care at the Department of Veterans Affairs.
            (2) Matters evaluated and assessed.--The matters evaluated 
        and assessed by the Commission shall include the following:
                    (A) The appropriateness of current standards of the 
                Department of Veterans Affairs concerning access to 
                health care.
                    (B) The measurement of such standards.
                    (C) The appropriateness of performance standards 
                and incentives in relation to standards described in 
                subparagraph (A).
                    (D) Staffing levels throughout the Veterans Health 
                Administration and whether they are sufficient to meet 
                current demand for health care from the Administration.
            (3) Reports.--The Commission shall submit to the President, 
        through the Secretary of Veterans Affairs, reports as follows:
                    (A) Not later than 90 days after the date of the 
                initial meeting of the Commission, an interim report 
                on--
                            (i) the findings of the Commission with 
                        respect to the evaluation and assessment 
                        required by this subsection; and
                            (ii) such recommendations as the Commission 
                        may have for legislative or administrative 
                        action to improve access to health care through 
                        the Veterans Health Administration.
                    (B) Not later than 180 days after the date of the 
                initial meeting of the Commission, a final report on--
                            (i) the findings of the Commission with 
                        respect to the evaluation and assessment 
                        required by this subsection; and
                            (ii) such recommendations as the Commission 
                        may have for legislative or administrative 
                        action to improve access to health care through 
                        the Veterans Health Administration.
    (c) Powers of the Commission.--
            (1) Hearings.--The Commission may hold such hearings, sit 
        and act at such times and places, take such testimony, and 
        receive such evidence as the Commission considers advisable to 
        carry out this section.
            (2) Information from federal agencies.--The Commission may 
        secure directly from any Federal department or agency such 
        information as the Commission considers necessary to carry out 
        this section. Upon request of the Chairperson of the 
        Commission, the head of such department or agency shall furnish 
        such information to the Commission.
    (d) Commission Personnel Matters.--
            (1) Compensation of members.--Each member of the Commission 
        who is not an officer or employee of the Federal Government 
        shall be compensated at a rate equal to the daily equivalent of 
        the annual rate of basic pay prescribed for level IV of the 
        Executive Schedule under section 5315 of title 5, United States 
        Code, for each day (including travel time) during which such 
        member is engaged in the performance of the duties of the 
        Commission. All members of the Commission who are officers or 
        employees of the United States shall serve without compensation 
        in addition to that received for their services as officers or 
        employees of the United States.
            (2) Travel expenses.--The members of the Commission shall 
        be allowed travel expenses, including per diem in lieu of 
        subsistence, at rates authorized for employees of agencies 
        under subchapter I of chapter 57 of title 5, United States 
        Code, while away from their homes or regular places of business 
        in the performance of services for the Commission.
            (3) Staff.--
                    (A) In general.--The Chairperson of the Commission 
                may, without regard to the civil service laws and 
                regulations, appoint and terminate an executive 
                director and such other additional personnel as may be 
                necessary to enable the Commission to perform its 
                duties. The employment of an executive director shall 
                be subject to confirmation by the Commission.
                    (B) Compensation.--The Chairperson of the 
                Commission may fix the compensation of the executive 
                director and other personnel without regard to chapter 
                51 and subchapter III of chapter 53 of title 5, United 
                States Code, relating to classification of positions 
                and General Schedule pay rates, except that the rate of 
                pay for the executive director and other personnel may 
                not exceed the rate payable for level V of the 
                Executive Schedule under section 5316 of such title.
            (4) Detail of government employees.--Any Federal Government 
        employee may be detailed to the Commission without 
        reimbursement, and such detail shall be without interruption or 
        loss of civil service status or privilege.
            (5) Procurement of temporary and intermittent services.--
        The Chairperson of the Commission may procure temporary and 
        intermittent services under section 3109(b) of title 5, United 
        States Code, at rates for individuals which do not exceed the 
        daily equivalent of the annual rate of basic pay prescribed for 
        level V of the Executive Schedule under section 5316 of such 
        title.
    (e) Termination of the Commission.--The Commission shall terminate 
30 days after the date on which the Commission submits its report under 
subsection (b)(3)(B).
    (f) Funding.--The Secretary of Veterans Affairs shall make 
available to the Commission from amounts appropriated or otherwise made 
available to the Secretary such amounts as the Secretary and the 
Chairperson of the Commission jointly consider appropriate for the 
Commission to perform its duties under this section.
    (g) Executive Action.--
            (1) Action on recommendations.--The President shall require 
        the Secretary of Veterans Affairs and such other heads of 
        relevant Federal departments and agencies to implement each 
        recommendation set forth in a report submitted under subsection 
        (b)(3) that the President--
                    (A) considers feasible and advisable; and
                    (B) determines can be implemented without further 
                legislative action.
            (2) Reports.--Not later than 60 days after the date on 
        which the President receives a report under subsection (b)(3), 
        the President shall submit to the Committee on Veterans' 
        Affairs of the Senate and the Committee on Veterans' Affairs of 
        the House of Representatives and such other committees of 
        Congress as the President considers appropriate a report 
        setting forth the following:
                    (A) An assessment of the feasibility and 
                advisability of each recommendation contained in the 
                report received by the President.
                    (B) For each recommendation assessed as feasible 
                and advisable under subparagraph (A) the following:
                            (i) Whether such recommendation requires 
                        legislative action.
                            (ii) If such recommendation requires 
                        legislative action, a recommendation concerning 
                        such legislative action.
                            (iii) A description of any administrative 
                        action already taken to carry out such 
                        recommendation.
                            (iv) A description of any administrative 
                        action the President intends to be taken to 
                        carry out such recommendation and by whom.

SEC. 403. COMMISSION ON CAPITAL PLANNING FOR DEPARTMENT OF VETERANS 
              AFFAIRS MEDICAL FACILITIES.

    (a) Establishment of Commission.--
            (1) Establishment.--There is established the Commission on 
        Capital Planning for Department of Veterans Affairs Medical 
        Facilities (in this section referred to as the ``Commission'').
            (2) Membership.--
                    (A) Voting members.--The Commission shall, subject 
                to subparagraph (B), be composed of 10 voting members 
                as follows:
                            (i) 1 shall be appointed by the President.
                            (ii) 1 shall be appointed by the 
                        Administrator of General Services.
                            (iii) 3 shall be appointed by the Secretary 
                        of Veterans Affairs, of whom--
                                    (I) 1 shall be an employee of the 
                                Veterans Health Administration;
                                    (II) 1 shall be an employee of the 
                                Office of Asset Enterprise Management 
                                of the Department of Veterans Affairs; 
                                and
                                    (III) 1 shall be an employee of the 
                                Office of Construction and Facilities 
                                Management of the Department of 
                                Veterans Affairs.
                            (iv) 1 shall be appointed by the Secretary 
                        of Defense from among employees of the Army 
                        Corps of Engineers.
                            (v) 1 shall be appointed by the majority 
                        leader of the Senate.
                            (vi) 1 shall be appointed by the minority 
                        leader of the Senate.
                            (vii) 1 shall be appointed by the Speaker 
                        of the House of Representatives.
                            (viii) 1 shall be appointed by the minority 
                        leader of the House of Representatives.
                    (B) Requirement relating to certain appointments of 
                voting members.--Of the members appointed pursuant to 
                clause (i), (ii), and (iv) through (viii) of 
                subparagraph (A), all shall have expertise in capital 
                leasing, construction, or health facility management 
                planning.
                    (C) Non-voting members.--The Commission shall be 
                assisted by 10 non-voting members, appointed by the 
                vote of a majority of members of the Commission under 
                subparagraph (A), of whom--
                            (i) 6 shall be representatives of veterans 
                        service organizations recognized by the 
                        Secretary of Veterans Affairs; and
                            (ii) 4 shall be individuals from outside 
                        the Department of Veterans Affairs with 
                        experience and expertise in matters relating to 
                        management, construction, and leasing of 
                        capital assets.
                    (D) Date of appointment of voting members.--The 
                appointments of the members of the Commission under 
                subparagraph (A) shall be made not later than 60 days 
                after the date of the enactment of this Act.
            (3) Period of appointment; vacancies.--Members shall be 
        appointed for the life of the Commission. Any vacancy in the 
        Commission shall not affect its powers, but shall be filled in 
        the same manner as the original appointment.
            (4) Initial meeting.--Not later than 15 days after the date 
        on which 7 members of the Commission have been appointed, the 
        Commission shall hold its first meeting.
            (5) Meetings.--The Commission shall meet at the call of the 
        Chair.
            (6) Quorum.--A majority of the members of the Commission 
        shall constitute a quorum, but a lesser number of members may 
        hold hearings.
            (7) Chair and vice chair.--The Commission shall select a 
        Chair and Vice Chair from among its members.
    (b) Duties of Commission.--
            (1) In general.--The Commission shall undertake a 
        comprehensive evaluation and assessment of various options for 
        capital planning for Department of Veterans Affairs medical 
        facilities, including an evaluation and assessment of the 
        mechanisms by which the Department currently selects means for 
        the delivery of health care, whether by major construction, 
        major medical facility leases, sharing agreements with the 
        Department of Defense, the Indian Health Service, and Federally 
        Qualified Health Clinics under section 330 of the Public Health 
        Service Act (42 U.S.C. 254b), contract care, multisite care, 
        telemedicine, extended hours for care, or other means.
            (2) Context of evaluation and assessment.--In undertaking 
        the evaluation and assessment, the Commission shall consider--
                    (A) the importance of access to health care through 
                the Department, including associated guidelines of the 
                Department on access to, and drive time for, health 
                care;
                    (B) limitations and requirements applicable to the 
                construction and leasing of medical facilities for the 
                Department, including applicable laws, regulations, and 
                costs as determined by both the Congressional Budget 
                Office and the Office of Management and Budget;
                    (C) the nature of capital planning for Department 
                medical facilities in an era of fiscal uncertainty;
                    (D) projected future fluctuations in the population 
                of veterans; and
                    (E) the extent to which the Department was able to 
                meet the mandates of the Capital Asset Realignment for 
                Enhanced Services Commission.
            (3) Particular considerations.--In undertaking the 
        evaluation and assessment, the Commission shall address, in 
        particular, the following:
                    (A) The Major Medical Facility Lease Program of the 
                Department, including an identification of potential 
                improvements to the lease authorization processes under 
                that Program.
                    (B) The management processes of the Department for 
                its Major Medical Facility Construction Program, 
                including processes relating to contract award and 
                management, project management, and processing of 
                change orders.
                    (C) The overall capital planning program of the 
                Department for medical facilities, including an 
                evaluation and assessment of--
                            (i) the manner in which the Department 
                        determines whether to use capital or non-
                        capital means to expand access to health care;
                            (ii) the manner in which the Department 
                        determines the disposition of under-utilized 
                        and un-utilized buildings on campuses of 
                        Department medical centers, and any barriers to 
                        disposition;
                            (iii) the effectiveness of the facility 
                        master planning initiative of the Department; 
                        and
                            (iv) the extent to which sustainable 
                        attributes are planned for to decrease 
                        operating costs for Department medical 
                        facilities.
                    (D) The current backlog of construction projects 
                for Department medical facilities, including an 
                identification of the most effective means to quickly 
                secure the most critical repairs required, including 
                repairs relating to facility condition deficiencies, 
                structural safety, and compliance with the Americans 
                With Disabilities Act of 1990.
            (4) Reports.--Subject to paragraph (5), the Commission 
        shall submit to the Secretary of Veterans Affairs, and to the 
        Committee Veterans' Affairs of the Senate and the Committee on 
        Veterans' Affairs of the House of Representatives, reports as 
        follows:
                    (A) Not later than six months after its initial 
                meeting under subsection (a)(4), a report on the Major 
                Medical Facility Lease Program and the Congressional 
                lease authorization process.
                    (B) Not later than one year after its initial 
                meeting, a report--
                            (i) on the management processes of the 
                        Department for the construction of Department 
                        medical facilities; and
                            (ii) setting forth an update of any matters 
                        covered in the report under subparagraph (A).
                    (C) Not later than 18 months after its initial 
                meeting, a report--
                            (i) on the overall capital planning program 
                        of the Department for medical facilities; and
                            (ii) setting forth an update of any matters 
                        covered in earlier reports under this 
                        paragraph.
                    (D) Not later than two years after its initial 
                meeting, a report--
                            (i) on the current backlog of construction 
                        projects for Department medical facilities;
                            (ii) setting forth an update of any matters 
                        covered in earlier reports under this 
                        paragraph; and
                            (iii) including such other matters relating 
                        to the duties of the Commission that the 
                        Commission considers appropriate.
                    (E) Not later than 27 months after its initial 
                meeting, a report on the implementation by the 
                Secretary of Veterans Affairs pursuant to subsection 
                (g) of the recommendations included pursuant to 
                paragraph (5) in the reports under this paragraph.
            (5) Recommendations.--Each report under paragraph (4) shall 
        include, for the aspect of the capital asset planning process 
        of the Department covered by such report, such recommendations 
        as the Commission considers appropriate for the improvement and 
        enhancement of such aspect of the capital asset planning 
        process.
    (c) Powers of Commission.--
            (1) Hearings.--The Commission may hold such hearings, sit 
        and act at such times and places, take such testimony, and 
        receive such evidence as the Commission considers advisable to 
        carry out this section.
            (2) Information from federal agencies.--The Commission may 
        secure directly from any Federal department or agency such 
        information as the Commission considers necessary to carry out 
        this section. Upon request of the Chair of the Commission, the 
        head of such department or agency shall furnish such 
        information to the Commission.
    (d) Commission Personnel Matters.--
            (1) Compensation of members.--Each member of the Commission 
        who is not an officer or employee of the Federal Government 
        shall be compensated at a rate equal to the daily equivalent of 
        the annual rate of basic pay prescribed for level IV of the 
        Executive Schedule under section 5315 of title 5, United States 
        Code, for each day (including travel time) during which such 
        member is engaged in the performance of the duties of the 
        Commission. All members of the Commission who are officers or 
        employees of the United States shall serve without compensation 
        in addition to that received for their services as officers or 
        employees of the United States.
            (2) Travel expenses.--The members of the Commission shall 
        be allowed travel expenses, including per diem in lieu of 
        subsistence, at rates authorized for employees of agencies 
        under subchapter I of chapter 57 of title 5, United States 
        Code, while away from their homes or regular places of business 
        in the performance of services for the Commission.
            (3) Staff.--
                    (A) In general.--The Chair of the Commission may, 
                without regard to the civil service laws and 
                regulations, appoint and terminate an executive 
                director and such other additional personnel as may be 
                necessary to enable the Commission to perform its 
                duties. The employment of an executive director shall 
                be subject to confirmation by the Commission.
                    (B) Compensation.--The Chair of the Commission may 
                fix the compensation of the executive director and 
                other personnel without regard to chapter 51 and 
                subchapter III of chapter 53 of title 5, United States 
                Code, relating to classification of positions and 
                General Schedule pay rates, except that the rate of pay 
                for the executive director and other personnel may not 
                exceed the rate payable for level V of the Executive 
                Schedule under section 5316 of such title.
            (4) Detail of government employees.--Any Federal Government 
        employee may be detailed to the Commission without 
        reimbursement, and such detail shall be without interruption or 
        loss of civil service status or privilege.
            (5) Procurement of temporary and intermittent services.--
        The Chair of the Commission may procure temporary and 
        intermittent services under section 3109(b) of title 5, United 
        States Code, at rates for individuals which do not exceed the 
        daily equivalent of the annual rate of basic pay prescribed for 
        level V of the Executive Schedule under section 5316 of such 
        title.
    (e) Termination of Commission.--The Commission shall terminate 60 
days after the date on which the Commission submits its report under 
subsection (b)(4)(E).
    (f) Funding.--The Secretary of Veterans Affairs shall make 
available to the Commission such amounts as the Secretary and the Chair 
of the Commission jointly consider appropriate for the Commission to 
perform its duties under this section.
    (g) Action on Recommendations.--
            (1) In general.--The Secretary of Veterans Affairs shall 
        implement each recommendation included in a report under 
        subsection (b)(4) that the Secretary considers feasible and 
        advisable and can be implemented without further legislative 
        action.
            (2) Reports.--Not later than 120 days after receipt of a 
        report under subparagraphs (A) through (D) of subsection 
        (b)(4), the Secretary shall submit to the Committee Veterans' 
        Affairs of the Senate and the Committee on Veterans' Affairs of 
        the House of Representatives a report setting forth the 
        following:
                    (A) An assessment of the feasibility and 
                advisability of each recommendation contained in such 
                report.
                    (B) For each recommendation assessed as feasible 
                and advisable--
                            (i) if such recommendation does not require 
                        further legislative action for implementation, 
                        a description of the actions taken, and to be 
                        taken, by the Secretary to implement such 
                        recommendation; and
                            (ii) if such recommendation requires 
                        further legislative action for implementation, 
                        recommendations for such legislative action.

SEC. 404. REMOVAL OF SENIOR EXECUTIVE SERVICE EMPLOYEES OF THE 
              DEPARTMENT OF VETERANS AFFAIRS FOR PERFORMANCE.

    (a) Removal or Transfer.--
            (1) In general.--Chapter 7 of title 38, United States Code, 
        is amended by adding at the end the following new section:
``Sec. 713. Senior Executive Service: removal based on performance
    ``(a) In General.--The Secretary may remove any individual from the 
Senior Executive Service if the Secretary determines the performance of 
the individual warrants such removal. If the Secretary so removes such 
an individual, the Secretary may--
            ``(1) remove the individual from the civil service (as 
        defined in section 2101 of title 5); or
            ``(2) transfer the individual to a General Schedule 
        position at any grade of the General Schedule for which the 
        individual is qualified and that the Secretary determines is 
        appropriate.
    ``(b) Notice to Congress.--Not later than 30 days after removing or 
transferring an individual from the Senior Executive Service under 
paragraph (1), the Secretary shall submit to the Committees on 
Veterans' Affairs of the Senate and House of Representatives notice in 
writing of such removal or transfer and the reason for such removal or 
transfer.
    ``(c) Appeal of Removal or Transfer.--Any removal or transfer under 
subsection (a) may be appealed to the Merit Systems Protection Board 
under section 7701 of title 5 not later than 7 days after such removal 
or transfer.
    ``(d) Expedited Review by Merit Systems Protection Board.--(1) The 
Merit Systems Protection Board shall expedite any appeal under section 
7701 of title 5 of a removal or transfer under subsection (a) and, in 
any such case, shall issue a decision not later than 21 days after the 
date of the appeal.
    ``(2) In any case in which the Merit Systems Protection Board 
determines that it cannot issue a decision in accordance with the 21-
day requirement under paragraph (1), the Merit Systems Protection Board 
shall submit to Congress a report that explains the reason why the 
Merit Systems Protection Board is unable to issue a decision in 
accordance with such requirement in such case.
    ``(3) There is authorized to be appropriated such sums as may be 
necessary for the Merit Systems Protection Board to expedite appeals 
under paragraph (1).
    ``(4) The Merit Systems Protection Board may not stay any personnel 
action taken under this section.''.
            (2) Clerical amendment.--The table of sections at the 
        beginning of such chapter is amended by adding at the end the 
        following new item:

``713. Senior Executive Service: removal based on performance.''.
    (b) Establishment of Expedited Review Process.--
            (1) In general.--Not later than 30 days after the date of 
        the enactment of this Act, the Merit Systems Protection Board 
        shall establish and put into effect a process to conduct 
        expedited reviews in accordance with section 713(d) of title 
        38, United States Code.
            (2) Inapplicability of certain regulations.--Section 
        1201.22 of title 5, Code of Federal Regulations, as in effect 
        on the day before the date of the enactment of this Act, shall 
        not apply to expedited reviews carried out under section 713(d) 
        of title 38, United States Code.
            (3) Report by merit systems protection board.--Not later 
        than 30 days after the date of the enactment of this Act, the 
        Merit Systems Protection Board shall submit to Congress a 
        report on the actions the Board plans to take to conduct 
        expedited reviews under section 713(d) of title 38, United 
        States Code, as added by subsection (a). Such report shall 
        include a description of the resources the Board determines 
        will be necessary to conduct such reviews and a description of 
        whether any resources will be necessary to conduct such reviews 
        that were not available to the Board on the day before the date 
        of the enactment of this Act.
    (c) Temporary Exemption From Certain Limitation on Initiation of 
Removal From Senior Executive Service.--During the 120-day period 
beginning on the date of the enactment of this Act, an action to remove 
an individual from the Senior Executive Service at the Department of 
Veterans Affairs pursuant to section 713 of title 38, United States 
Code, as added by subsection (a), or section 7543 of title 5, United 
States Code, may be initiated, notwithstanding section 3592(b) of title 
5, United States Code, or any other provision of law.
    (d) Construction.--Nothing in this section or section 713 of title 
38, United States Code, as added by subsection (a), shall be construed 
to apply to an appeal of a removal, transfer, or other personnel action 
that was pending before the date of the enactment of this Act.

                 TITLE V--MAJOR MEDICAL FACILITY LEASES

SEC. 501. AUTHORIZATION OF MAJOR MEDICAL FACILITY LEASES.

    The Secretary of Veterans Affairs may carry out the following major 
medical facility leases at the locations specified, and in an amount 
for each lease not to exceed the amount shown for such location (not 
including any estimated cancellation costs):
            (1) For a clinical research and pharmacy coordinating 
        center, Albuquerque, New Mexico, an amount not to exceed 
        $9,560,000.
            (2) For a community-based outpatient clinic, Brick, New 
        Jersey, an amount not to exceed $7,280,000.
            (3) For a new primary care and dental clinic annex, 
        Charleston, South Carolina, an amount not to exceed $7,070,250.
            (4) For the Cobb County community-based Outpatient Clinic, 
        Cobb County, Georgia, an amount not to exceed $6,409,000.
            (5) For the Leeward Outpatient Healthcare Access Center, 
        Honolulu, Hawaii, including a co-located clinic with the 
        Department of Defense and the co-location of the Honolulu 
        Regional Office of the Veterans Benefits Administration and the 
        Kapolei Vet Center of the Department of Veterans Affairs, an 
        amount not to exceed $15,887,370.
            (6) For a community-based outpatient clinic, Johnson 
        County, Kansas, an amount not to exceed $2,263,000.
            (7) For a replacement community-based outpatient clinic, 
        Lafayette, Louisiana, an amount not to exceed $2,996,000.
            (8) For a community-based outpatient clinic, Lake Charles, 
        Louisiana, an amount not to exceed $2,626,000.
            (9) For outpatient clinic consolidation, New Port Richey, 
        Florida, an amount not to exceed $11,927,000.
            (10) For an outpatient clinic, Ponce, Puerto Rico, an 
        amount not to exceed $11,535,000.
            (11) For lease consolidation, San Antonio, Texas, an amount 
        not to exceed $19,426,000.
            (12) For a community-based outpatient clinic, San Diego, 
        California, an amount not to exceed $11,946,100.
            (13) For an outpatient clinic, Tyler, Texas, an amount not 
        to exceed $4,327,000.
            (14) For the Errera Community Care Center, West Haven, 
        Connecticut, an amount not to exceed $4,883,000.
            (15) For the Worcester community-based Outpatient Clinic, 
        Worcester, Massachusetts, an amount not to exceed $4,855,000.
            (16) For the expansion of a community-based outpatient 
        clinic, Cape Girardeau, Missouri, an amount not to exceed 
        $4,232,060.
            (17) For a multispecialty clinic, Chattanooga, Tennessee, 
        an amount not to exceed $7,069,000.
            (18) For the expansion of a community-based outpatient 
        clinic, Chico, California, an amount not to exceed $4,534,000.
            (19) For a community-based outpatient clinic, Chula Vista, 
        California, an amount not to exceed $3,714,000.
            (20) For a new research lease, Hines, Illinois, an amount 
        not to exceed $22,032,000.
            (21) For a replacement research lease, Houston, Texas, an 
        amount not to exceed $6,142,000.
            (22) For a community-based outpatient clinic, Lincoln, 
        Nebraska, an amount not to exceed $7,178,400.
            (23) For a community-based outpatient clinic, Lubbock, 
        Texas, an amount not to exceed $8,554,000.
            (24) For a community-based outpatient clinic consolidation, 
        Myrtle Beach, South Carolina, an amount not to exceed 
        $8,022,000.
            (25) For a community-based outpatient clinic, Phoenix, 
        Arizona, an amount not to exceed $20,757,000.
            (26) For the expansion of a community-based outpatient 
        clinic, Redding, California, an amount not to exceed 
        $8,154,000.
            (27) For the expansion of a community-based outpatient 
        clinic, Tulsa, Oklahoma, an amount not to exceed $13,269,200.

SEC. 502. BUDGETARY TREATMENT OF DEPARTMENT OF VETERANS AFFAIRS MAJOR 
              MEDICAL FACILITIES LEASES.

    (a) Findings.--Congress finds the following:
            (1) Title 31, United States Code, requires the Department 
        of Veterans Affairs to record the full cost of its contractual 
        obligation against funds available at the time a contract is 
        executed.
            (2) Office of Management and Budget Circular A-11 provides 
        guidance to agencies in meeting the statutory requirements 
        under title 31, United States Code, with respect to leases.
            (3) For operating leases, Office of Management and Budget 
        Circular A-11 requires the Department of Veterans Affairs to 
        record up-front budget authority in an ``amount equal to total 
        payments under the full term of the lease or [an] amount 
        sufficient to cover first year lease payments plus cancellation 
        costs''.
    (b) Requirement for Obligation of Full Cost.--
            (1) In general.--Subject to the availability of 
        appropriations provided in advance, in exercising the authority 
        of the Secretary of Veterans Affairs to enter into leases 
        provided in this Act, the Secretary shall record, pursuant to 
        section 1501 of title 31, United States Code, as the full cost 
        of the contractual obligation at the time a contract is 
        executed either--
                    (A) an amount equal to total payments under the 
                full term of the lease; or
                    (B) if the lease specifies payments to be made in 
                the event the lease is terminated before its full term, 
                an amount sufficient to cover the first year lease 
                payments plus the specified cancellation costs.
            (2) Self-insuring authority.--The requirements of paragraph 
        (1) may be satisfied through the use of a self-insuring 
        authority consistent with Office of Management and Budget 
        Circular A-11.
    (c) Transparency.--
            (1) Compliance.--Subsection (b) of section 8104 of title 
        38, United States Code, is amended by adding at the end the 
        following new paragraph:
            ``(7) In the case of a prospectus proposing funding for a 
        major medical facility lease, a detailed analysis of how the 
        lease is expected to comply with Office of Management and 
        Budget Circular A-11 and section 1341 of title 31 (commonly 
        referred to as the `Anti-Deficiency Act'). Any such analysis 
        shall include--
                    ``(A) an analysis of the classification of the 
                lease as a `lease-purchase', `capital lease', or 
                `operating lease' as those terms are defined in Office 
                of Management and Budget Circular A-11;
                    ``(B) an analysis of the obligation of budgetary 
                resources associated with the lease; and
                    ``(C) an analysis of the methodology used in 
                determining the asset cost, fair market value, and 
                cancellation costs of the lease.''.
            (2) Submittal to congress.--Such section 8104 is further 
        amended by adding at the end the following new subsection:
    ``(h)(1) Not less than 30 days before entering into a major medical 
facility lease, the Secretary shall submit to the Committees on 
Veterans' Affairs of the Senate and the House of Representatives--
            ``(A) notice of the Secretary's intention to enter into the 
        lease;
            ``(B) a detailed summary of the proposed lease;
            ``(C) a description and analysis of any differences between 
        the prospectus submitted pursuant to subsection (b) and the 
        proposed lease; and
            ``(D) a scoring analysis demonstrating that the proposed 
        lease fully complies with Office of Management and Budget 
        Circular A-11.
    ``(2) Each committee described in paragraph (1) shall ensure that 
any information submitted to the committee under such paragraph is 
treated by the committee with the same level of confidentiality as is 
required by law of the Secretary and subject to the same statutory 
penalties for unauthorized disclosure or use as the Secretary.
    ``(3) Not more than 30 days after entering into a major medical 
facility lease, the Secretary shall submit to each committee described 
in paragraph (1) a report on any material differences between the lease 
that was entered into and the proposed lease described under such 
paragraph, including how the lease that was entered into changes the 
previously submitted scoring analysis described in subparagraph (D) of 
such paragraph.''.
    (d) Rule of Construction.--Nothing in this section, or the 
amendments made by this section, shall be construed to in any way 
relieve the Department of Veterans Affairs from any statutory or 
regulatory obligations or requirements existing prior to the enactment 
of this section and such amendments.
                                                       Calendar No. 408

113th CONGRESS

  2d Session

                                S. 2422

_______________________________________________________________________

                                 A BILL

    To improve the access of veterans to medical services from the 
        Department of Veterans Affairs, and for other purposes.

_______________________________________________________________________

                              June 4, 2014

            Read the second time and placed on the calendar
```