II 

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. 

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


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1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

3 ‘‘Ensuring Veterans Access to Care Act of 2014’’. 

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

5 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 NONDEPARTMENT 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 


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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. 

1 TITLE I—IMPROVEMENT OF 

2 SCHEDULING SYSTEM FOR 

3 HEALTH CARE APPOINT4 MENTS 

5 SEC. 101. IMPLEMENTATION OF UPGRADED DEPARTMENT 

6 OF VETERANS AFFAIRS ELECTRONIC SCHED7 ULING SYSTEM FOR APPOINTMENTS FOR RE8 CEIPT OF HEALTH CARE FROM THE DEPART9 MENT. 

10 (a) IMPLEMENTATION.— 

11 (1) IN GENERAL.—Not later than March 31, 

12 2016, the Secretary of Veterans Affairs shall fully 

13 implement an upgraded and centralized electronic 

14 scheduling system described in subsection (b) for ap15 pointments by eligible individuals for health care 

16 from the Department of Veterans Affairs. 

17 (2) AGILE SOFTWARE DEVELOPMENT METH18 ODOLOGIES.—In implementing the upgraded elec19 tronic scheduling system required by paragraph (1), 


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1 the Secretary shall use agile software development 

2 methodologies to fully implement portions of such 

3 system every 180 days beginning on the date on 

4 which the Secretary begins the implementation of 

5 such system, or enters into a contract for the imple6 mentation of such system, and ending on the date 

7 on which such system is fully implemented. 

8 (b) ELECTRONIC SCHEDULING SYSTEM.—The up9 graded electronic scheduling system described in this sub10 section shall include mechanisms to achieve the following: 

11 (1) An efficient and effective graphical user 

12 interface with a calendar view for use by employees 

13 of the Department in scheduling appointments that 

14 enables error-free scheduling of the health care re15 sources of the Department. 

16 (2) A capability to assist employees of the De17 partment to easily and consistently implement poli18 cies of the Department with respect to scheduling of 

19 appointments, including with respect to priority for 

20 appointments for certain eligible individuals. 

21 (3) A capability for employees of the Depart22 ment to sort and view through a unified interface 

23 the availability for each health care provider of the 

24 Department or other health care resource of the De25 partment. 


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1 (4) A capability for employees of the Depart2 ment to sort and view appointments for and appoint3 ment requests made by a particular eligible indi4 vidual. 

5 (5) A capability for seamless coordination of 

6 appointments for primary care, specialty care, con7 sultations, or any other health care matter among 

8 facilities of the Department. 

9 (6) A capability for eligible individuals to access 

10 the system remotely and schedule appointments di11 rectly through the system. 

12 (7) An electronic timestamp of each activity 

13 made by an eligible individual or on behalf of such 

14 individual with respect to an appointment or the 

15 scheduling of an appointment that shall be kept in 

16 the medical record of such individual. 

17 (8) A seamless connection to the Computerized 

18 Patient Record System of the Department so that 

19 employees of the Department, when scheduling an 

20 appointment for an eligible individual, have access to 

21 recommendations from the health care provider of 

22 such individual with respect to when such individual 

23 should receive an appointment. 


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1 (9) A capability to provide automated reminders 

2 to eligible individuals on upcoming appointments 

3 through various electronic and voice media. 

4 (10) A capability to provide automated remind5 ers to employees of the Department when an eligible 

6 individual who is on the wait-list for an appointment 

7 becomes eligible to schedule an appointment. 

8 (11) A dashboard capability to support efforts 

9 to track the following metrics in aggregate and by 

10 medical facility with respect to health care provided 

11 to eligible individuals under the laws administered 

12 by the Secretary: 

13 (A) The number of days into the future 

14 that the schedules of health care providers are 

15 available to schedule an appointment. 

16 (B) The number of providers available to 

17 see patients each day. 

18 (C) The number of support personnel 

19 working each day. 

20 (D) The types of appointments available. 

21 (E) The rate at which patients fail to ap22 pear for appointments. 

23 (F) The number of appointments canceled 

24 by a patient on a daily basis. 


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1 (G) The number of appointments canceled 

2 by a health care provider on a daily basis. 

3 (H) The number of patients on the wait 

4 list at any given time. 

5 (I) The number of appointments scheduled 

6 on a daily basis; 

7 (J) The number of appointments available 

8 to be scheduled on a daily basis. 

9 (K) The number of patients seen on a 

10 daily, weekly, and monthly basis. 

11 (L) Wait-times for an appointment with a 

12 health care provider of the Department. 

13 (M) Wait-times for an appointment with a 

14 non-Department health care provider. 

15 (N) Wait-times for a referral to a specialist 

16 or consult. 

17 (12) A capability to provide data on the capac18 ity of medical facilities of the Department for pur19 poses of determining the resources needed by the 

20 Department to provide health care to eligible individ21 uals. 

22 (13) Any other capabilities as specified by the 

23 Secretary for purposes of this section. 

24 (c) PLAN.— 


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

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

3 shall submit to the Committee on Veterans’ Affairs 

4 of the Senate and the Committee on Veterans’ Af5 fairs of the House of Representatives a plan for im6 plementing the upgraded electronic scheduling sys7 tem required by subsection (a). 

8 (2) ELEMENTS.—The plan required by para9 graph (1) shall include the following: 

10 (A) A description of the priorities of the 

11 Secretary for implementing the requirements of 

12 the system under subsection (b). 

13 (B) A detailed description of the manner 

14 in which the Secretary will fully implement such 

15 system, including deadlines for completing each 

16 such requirement. 

17 (3) UPDATE.—Not later than 90 days after the 

18 submittal of the plan required by paragraph (1), and 

19 not less frequently than every 90 days thereafter 

20 until such system is fully implemented, the Secretary 

21 shall submit to the Committee on Veterans’ Affairs 

22 of the Senate and the Committee on Veterans’ Af23 fairs of the House of Representatives an update on 

24 the status of the implementation of such plan. 


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1 (d) USE OF AMOUNTS.—The Secretary may use 

2 amounts available to the Department of Veterans Affairs 

3 for the appropriations account under the heading ‘‘MED4 ICAL SERVICES’’ in implementing and carrying out the up5 graded electronic scheduling system required by sub6 section (a). 

7 (e) ELIGIBLE INDIVIDUAL DEFINED.—In this sec8 tion, the term ‘‘eligible individual’’ means an individual 

9 eligible for hospital, nursing home, domiciliary, medical 

10 care, or other health care under the laws administered by 

11 the Secretary of Veterans Affairs. 

12 SEC. 102. INDEPENDENT ASSESSMENT OF THE SCHED13 ULING PROCESS FOR MEDICAL APPOINT14 MENTS FOR CARE FROM DEPARTMENT OF 

15 VETERANS AFFAIRS. 

16 (a) INDEPENDENT ASSESSMENT.— 

17 (1) CONTRACT.—Not later than 30 days after 

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

19 of Veteran Affairs shall enter into a contract with 

20 an independent third party to assess the process at 

21 each medical facility of the Department of Veterans 

22 Affairs for scheduling appointments for veterans to 

23 receive hospital care, medical services, or other 

24 health care from the Department. 


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1 (2) ELEMENTS.—In carrying out the assess2 ment required by paragraph (1), the independent 

3 third party shall do the following: 

4 (A) Review all training materials per5 taining to scheduling of appointments at each 

6 medical facility of the Department. 

7 (B) Assess whether all employees of the 

8 Department conducting tasks related to sched9 uling are properly trained for conducting such 

10 tasks. 

11 (C) Assess whether changes in the tech12 nology or system used in scheduling appoint13 ments are necessary to limit access to the sys14 tem to only those employees that have been 

15 properly trained in conducting such tasks. 

16 (D) Assess whether health care providers 

17 of the Department are making changes to their 

18 schedules that hinder the ability of employees 

19 conducting such tasks to perform such tasks. 

20 (E) Assess whether the establishment of a 

21 centralized call center throughout the Depart22 ment for scheduling appointments at medical 

23 facilities of the Department would improve the 

24 process of scheduling such appointments. 


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1 (F) Assess whether booking templates for 

2 each medical facility or clinic of the Depart3 ment would improve the process of scheduling 

4 such appointments. 

5 (G) Recommend any actions to be taken by 

6 the Department to improve the process for 

7 scheduling such appointments, including the fol8 lowing: 

9 (i) Changes in training materials pro10 vided to employees of the Department with 

11 respect to conducting tasks related to 

12 scheduling such appointments. 

13 (ii) Changes in monitoring and assess14 ment conducted by the Department of 

15 wait-times of veterans for such appoint16 ments. 

17 (iii) Changes in the system used to 

18 schedule such appointments, including 

19 changes to improve how the Department— 

20 (I) measures wait-times of vet21 erans for such appointments; 

22 (II) monitors the availability of 

23 health care providers of the Depart24 ment; and 


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1 (III) provides veterans the ability 

2 to schedule such appointments. 

3 (iv) Such other actions as the inde4 pendent third party considers appropriate. 

5 (3) TIMING.—The independent third party car6 rying out the assessment required by paragraph (1) 

7 shall complete such assessment not later than 180 

8 days after entering into the contract described in 

9 such paragraph. 

10 (b) REPORT.—Not later than 90 days after the date 

11 on which the independent third party completes the as12 sessment under this section, the Secretary shall submit to 

13 the Committee on Veterans’ Affairs of the Senate and the 

14 Committee on Veterans’ Affairs of the House of Rep15 resentatives a report on the results of such assessment. 

16 TITLE II—TRAINING AND HIRING 

17 OF HEALTH CARE STAFF 

18 SEC. 201. MODIFICATION OF LIABILITY FOR BREACH OF PE19 RIOD OF OBLIGATED SERVICE UNDER 

20 HEALTH PROFESSIONALS EDUCATIONAL AS21 SISTANCE PROGRAM FOR PRIMARY CARE 

22 PHYSICIANS. 

23 Section 7617 of title 38, United States Code, is 

24 amended— 


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1 (1) In subsection (c)(1), by striking ‘‘If a par2 ticipant’’ and inserting ‘‘Except as provided in sub3 section (d), if a participant’’; and 

4 (2) by adding at the end the following new sub5 section: 

6 ‘‘(d) Liability shall not arise under subsection (c) in 

7 the case of a participant otherwise covered by that sub8 section who has pursued a course of education or training 

9 in primary care if— 

10 ‘‘(1) the participant— 

11 ‘‘(A) does not obtain, or fails to maintain, 

12 employment as a Department employee due to 

13 staffing changes approved by the Under Sec14 retary for Health; or 

15 ‘‘(B) does not obtain, or fails to maintain, 

16 employment in a position of primary care physi17 cian in the Veterans Health Administration 

18 due, as determined by the Secretary, to a num19 ber of primary care physicians in the Adminis20 tration that is excess to the needs of the Ad21 ministration; and 

22 ‘‘(2) the participant agrees to accept and main23 tain employment as a primary care physician with 

24 another department or agency of the Federal Gov25 ernment (with such employment to be under such 


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1 terms and conditions as are jointly agreed upon by 

2 the participant, the Secretary, and the head of such 

3 department or agency, including terms and condi4 tions relating to a period of obligated service as a 

5 primary care physician with such department or 

6 agency) if such employment is offered to the partici7 pant by the Secretary and the head of such depart8 ment or agency.’’. 

9 SEC. 202. PROGRAM OF EDUCATION AT UNIFORMED SERV10 ICES UNIVERSITY OF THE HEALTH SCIENCES 

11 WITH SPECIALIZATION IN PRIMARY CARE. 

12 (a) PROGRAM REQUIRED UNDER HEALTH PROFES13 SIONALS EDUCATIONAL ASSISTANCE PROGRAM.— 

14 (1) IN GENERAL.—Chapter 76 of title 38, 

15 United States Code, is amended by adding after sub16 chapter VII the following new subchapter: 

17 ‘‘SUBCHAPTER VIII—PROGRAM OF EDUCATION 

18 AT UNIFORMED SERVICES UNIVERSITY OF 

19 THE HEALTH SCIENCES WITH SPECIALIZA20 TION IN PRIMARY CARE 

21 ‘‘§ 7691. Authority for program 

22 ‘‘As part of the Educational Assistance Program, the 

23 Secretary shall, in collaboration with the Secretary of De24 fense, carry out a program to permit individuals to enroll 

25 in the Uniformed Services University of the Health 


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1 Sciences under chapter 104 of title 10 to pursue a medical 

2 education with a specialization in primary care. The pro3 gram shall be known as the Department of Veterans Af4 fairs Primary Care Educational Assistance Program (in 

5 this chapter referred to as the ‘Primary Care Educational 

6 Assistance Program’). 

7 ‘‘§ 7692. Selection; agreement; ineligibility for certain 

8 other educational assistance 

9 ‘‘(a) SELECTION.—(1) Medical students at the Uni10 formed Services University of the Health Sciences pursu11 ant to the Primary Care Educational Assistance Program 

12 shall be selected by the Secretary, in consultation with the 

13 Secretary of Defense, in accordance with procedures es14 tablished by the Secretaries for purposes of the Program. 

15 ‘‘(2) The procedures referred to in paragraph (1) 

16 shall emphasize the basic requirement that students dem17 onstrate a motivation and dedication to a medical career 

18 in primary care. 

19 ‘‘(3) The number of medical students selected each 

20 year for first-year enrollment in the University pursuant 

21 to this subsection shall be jointly determined by the Sec22 retary and the Secretary of Defense. 

23 ‘‘(b) AGREEMENT.—An agreement between the Sec24 retary and a participant in the Primary Care Educational 


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1 Assistance Program shall (in addition to the requirements 

2 set forth in section 7604 of this title) include the following: 

3 ‘‘(1) The Secretary’s agreement to cover the 

4 costs of the participant’s education and training at 

5 the Uniformed Services University of the Health 

6 Sciences under chapter 104 of title 10 as if the par7 ticipant were a medical student enrolled in the Uni8 versity pursuant to section 2114 of title 10. 

9 ‘‘(2) The participant’s agreement to serve as a 

10 full-time employee in the Veterans Health Adminis11 tration in a position as a primary care physician for 

12 a period of time (in this subchapter referred to as 

13 the ‘period of obligated service’) of one calendar year 

14 for each school year or part thereof for which the 

15 participant was a medical student at the Uniformed 

16 Services University of the Health Sciences pursuant 

17 to the Primary Care Educational Assistance Pro18 gram, but for not less than one year. 

19 ‘‘(c) INELIGIBILITY FOR OTHER EDUCATIONAL AS20 SISTANCE.—An individual who receives education and 

21 training under the Primary Care Educational Assistance 

22 Program shall not be eligible for other assistance under 

23 this chapter in connection with such education and train24 ing. 


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1 ‘‘§ 7693. Obligated service 

2 ‘‘(a) IN GENERAL.—Each participant in the Primary 

3 Care Educational Assistance Program shall provide serv4 ice as a full-time employee of the Department in the Vet5 erans Health Administration in a primary care position 

6 for the period of obligated service provided in the agree7 ment of the participant entered into for purposes of this 

8 subchapter. Such service shall be provided in a full-time 

9 primary care clinical practice in an assignment or location 

10 determined by the Secretary. 

11 ‘‘(b) SERVICE COMMENCEMENT DATE.—(1) Not 

12 later than 60 days before a participant’s service com13 mencement date, the Secretary shall notify the participant 

14 of that service commencement date. That date is the date 

15 for the beginning of the participant’s period of obligated 

16 service. 

17 ‘‘(2) As soon as possible after a participant’s service 

18 commencement date, the Secretary shall— 

19 ‘‘(A) in the case of a participant who is not a 

20 full-time employee in the Veterans Health Adminis21 tration, appoint the participant as such an employee; 

22 and 

23 ‘‘(B) in the case of a participant who is an em24 ployee in the Veterans Health Administration but is 

25 not serving in a position for which the participant’s 


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1 course of education or training prepared the partici2 pant, assign the participant to such a position. 

3 ‘‘(3) A participant’s service commencement for pur4 poses of this subsection date is the date upon which the 

5 participant becomes licensed to practice medicine in a 

6 State. 

7 ‘‘(c) COMMENCEMENT OF OBLIGATED SERVICE.—A 

8 participant in the Primary Care Educational Assistance 

9 Program shall be considered to have begun serving the 

10 participant’s period of obligated service— 

11 ‘‘(1) on the date on which the participant is ap12 pointed as a full-time employee in the Veterans 

13 Health Administration pursuant to subsection 

14 (b)(2)(A); or 

15 ‘‘(2) if the participant is a full-time employee in 

16 the Veterans Health Administration and assigned to 

17 a position pursuant to subsection (b)(2)(B), on the 

18 date on which the participant is so assigned to such 

19 position. 

20 ‘‘§ 7694. Breach of agreement: liability 

21 ‘‘(a) LIABILITY DURING COURSE OF EDUCATION OR

22 TRAINING.—(1) A participant in the Primary Care Edu23 cational Assistance Program shall be liable to the United 

24 States for the amount which has been paid on behalf of 


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1 the participant under the agreement entered into for pur2 poses of this subchapter if any of the following occurs: 

3 ‘‘(A) The participant fails to maintain an ac4 ceptable level of academic standing in the Uniformed 

5 Services University of the Health Sciences. 

6 ‘‘(B) The participant is dismissed from the 

7 Uniformed Services University of the Health 

8 Sciences for disciplinary reasons. 

9 ‘‘(C) The participant voluntarily terminates the 

10 course of medical education and training in the Uni11 formed Services University of the Health Sciences 

12 before the completion of such course of education 

13 and training. 

14 ‘‘(D) The participant fails to become licensed to 

15 practice medicine in a State during a period of time 

16 determined under regulations prescribed by the Sec17 retary. 

18 ‘‘(2) Liability under this subsection is in lieu of any 

19 service obligation arising under a participant’s agreement 

20 for purposes of this subchapter. 

21 ‘‘(b) LIABILITY DURING PERIOD OF OBLIGATED

22 SERVICE.—(1) Except as provided in subsection (c) and 

23 subject to paragraph (2), if a participant in the Primary 

24 Care Educational Assistance Program breaches the agree25 ment entered into for purposes of this subchapter by failVerDate Mar 15 2010 21:21 Jun 04, 2014 Jkt 039200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\S2422.PCS S2422

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1 ing for any reason to complete the participant’s period of 

2 obligated service, the United States shall be entitled to re3 cover from the participant an amount equal to— 

4 ‘‘(A) the total amount paid under this sub5 chapter on behalf of the participant; multiplied by 

6 ‘‘(B) a fraction— 

7 ‘‘(i) the numerator of which is— 

8 ‘‘(I) the total number of months in 

9 the participant’s period of obligated serv10 ice; minus 

11 ‘‘(II) the number of months served by 

12 the participant pursuant to the agreement; 

13 and 

14 ‘‘(ii) the denominator of which is the total 

15 number of months in the participant’s period of 

16 obligated service. 

17 ‘‘(2) Any period of internship or residency training 

18 of a participant shall not be treated as satisfying the par19 ticipant’s period of obligated service for purposes of this 

20 subsection. 

21 ‘‘(c) EXCEPTIONS.—Liability shall not arise under 

22 subsection (b) in the case of a participant otherwise cov23 ered by that subsection if— 

24 ‘‘(1) the participant— 


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1 ‘‘(A) does not obtain, or fails to maintain, 

2 employment as a Department employee due to 

3 staffing changes approved by the Under Sec4 retary for Health; or 

5 ‘‘(B) does not obtain, or fails to maintain, 

6 employment in a position of primary care physi7 cian in the Veterans Health Administration 

8 due, as determined by the Secretary, to a num9 ber of primary care physicians in the Adminis10 tration that is excess to the needs of the Ad11 ministration; and 

12 ‘‘(2) the participant agrees to accept and main13 tain employment as a primary care physician with 

14 another department or agency of the Federal Gov15 ernment (with such employment to be under such 

16 terms and conditions as are jointly agreed upon by 

17 the participant, the Secretary, and the head of such 

18 department or agency, including terms and condi19 tions relating to a period of obligated service as a 

20 primary care physician with such department or 

21 agency) if such employment is offered to the partici22 pant by the Secretary and the head of such depart23 ment or agency. 


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1 ‘‘§ 7695. Funding 

2 ‘‘(a) IN GENERAL.—Amounts for the Primary Care 

3 Educational Assistance Program shall be derived from 

4 amounts available to the Secretary for the Veterans 

5 Health Administration. 

6 ‘‘(b) TRANSFER.—(1) The Secretary shall transfer to 

7 the Secretary of Defense amounts required by the Sec8 retary of Defense to carry out the Primary Care Edu9 cational Assistance Program. 

10 ‘‘(2) Amounts transferred to the Secretary of Defense 

11 pursuant to paragraph (1) shall be credited to the appro12 priation or account providing funding for the Uniformed 

13 Services University of the Health Sciences. Amounts so 

14 credited shall be merged with amounts in the appropria15 tion or account to which credited and shall be available, 

16 subject to the terms and conditions applicable to such ap17 propriation or account, for the Uniformed Services Uni18 versity of the Health Sciences.’’. 

19 (2) CLERICAL AMENDMENT.—The table of sec20 tions at the beginning of chapter 76 of such title is 

21 amended by adding after the item relating to section 

22 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. 


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‘‘7694. Breach of agreement: liability. 

‘‘7695. Funding.’’. 

1 (b) INCLUSION OF PROGRAM IN HEALTH PROFES2 SIONALS EDUCATIONAL ASSISTANCE PROGRAM.—Section 

3 7601(a) of such title is amended— 

4 (1) in paragraph (4), by striking ‘‘; and’’ and 

5 inserting a semicolon; 

6 (2) in paragraph (5), by striking the period at 

7 the end and inserting ‘‘; and’’; and 

8 (3) by adding at the end the following new 

9 paragraph: 

10 ‘‘(6) the enrollment of individuals in the Uni11 formed Services University of the Health Sciences 

12 for specialization in primary care provided for in 

13 subchapter VIII of this chapter.’’. 

14 (c) APPLICATION REQUIREMENTS.— 

15 (1) IN GENERAL.—Subsection (a)(1) of section 

16 7603 of such title is amended in the matter pre17 ceding subparagraph (A) by striking ‘‘, or VI’’ and 

18 inserting ‘‘, VI, or VIII’’. 

19 (2) NO PRIORITY FOR APPLICATIONS.—Sub20 section (d) of such section is amended— 

21 (A) by striking ‘‘In selecting’’ and insert22 ing ‘‘(1) Except as provided in paragraph (2), 

23 in selecting’’; and 


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1 (B) by adding at the end the following new 

2 paragraph: 

3 ‘‘(2) Paragraph (1) shall not apply with respect to 

4 applicants for participation in the Program of Education 

5 at Uniformed Services University of the Health Sciences 

6 With Specialization in Primary Care pursuant to sub7 chapter VIII of this chapter.’’. 

8 (d) AGREEMENT REQUIREMENTS.—Section 7604 of 

9 such title is amended by striking ‘‘, or VI’’ each place it 

10 appears and inserting ‘‘, VI, or VIII’’. 

11 SEC. 203. TREATMENT OF STAFFING SHORTAGE AND BIAN12 NUAL REPORT ON STAFFING OF MEDICAL FA13 CILITIES OF THE DEPARTMENT OF VET14 ERANS AFFAIRS. 

15 (a) STAFFING SHORTAGE.— 

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

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

18 later than September 30 each year thereafter, the 

19 Secretary of Veterans Affairs shall determine, and 

20 publish in the Federal Register, the five occupations 

21 of health care providers of the Department of Vet22 erans Affairs for which there is the largest staffing 

23 shortage throughout the Department. 

24 (2) RECRUITMENT AND APPOINTMENT.—Not25 withstanding sections 3304 and 3309 through 3318 


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

2 upon a determination by the Secretary under para3 graph (1) or a modification to such determination 

4 under paragraph (2), that there is a staffing short5 age throughout the Department with respect to a 

6 particular occupation of health care provider, recruit 

7 and directly appoint highly qualified health care pro8 viders to a position to serve as a health care pro9 vider in that particular occupation for the Depart10 ment. 

11 (3) PRIORITY IN HEALTH PROFESSIONALS EDU12 CATIONAL ASSISTANCE PROGRAM TO CERTAIN PRO13 VIDERS.—Section 7612(b)(5) of title 38, United 

14 States Code, is amended— 

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

16 ‘‘and’’ at the end; 

17 (B) by redesignating subparagraph (B) as 

18 subparagraph (C); and 

19 (C) by inserting after subparagraph (A) 

20 the following new subparagraph (B): 

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

22 a course of education or training towards a career 

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

24 most current determination published in the Federal 

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1 ing Veterans Access to Care Act of 2014, deter2 mined that there is one of the largest staffing short3 age throughout the Department with respect to such 

4 occupation; and’’. 

5 (b) REPORTS.— 

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

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

8 later than December 31 of each even numbered year 

9 thereafter until 2024, the Secretary of Veterans Af10 fairs shall submit to the Committee on Veterans’ Af11 fairs of the Senate and the Committee on Veterans’ 

12 Affairs of the House of Representatives a report as13 sessing the staffing of each medical facility of the 

14 Department of Veterans Affairs. 

15 (2) ELEMENTS.—Each report submitted under 

16 paragraph (1) shall include the following: 

17 (A) The results of a system-wide assess18 ment of all medical facilities of the Department 

19 to ensure the following: 

20 (i) Appropriate staffing levels for 

21 health care providers to meet the goals of 

22 the Secretary for timely access to care for 

23 veterans. 

24 (ii) Appropriate staffing levels for 

25 support personnel, including clerks. 


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1 (iii) Appropriate sizes for clinical pan2 els. 

3 (iv) Appropriate numbers of full-time 

4 staff, or full-time equivalent, dedicated to 

5 direct care of patients. 

6 (v) Appropriate physical plant space 

7 to meet the capacity needs of the Depart8 ment in that area. 

9 (vi) Such other factors as the Sec10 retary considers necessary. 

11 (B) A plan for addressing any issues iden12 tified in the assessment described in subpara13 graph (A), including a timeline for addressing 

14 such issues. 

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

16 workload levels for the following clinics in each 

17 medical facility: 

18 (i) Mental health. 

19 (ii) Primary care. 

20 (iii) Gastroenterology. 

21 (iv) Women’s health. 

22 (v) Such other clinics as the Secretary 

23 considers appropriate. 

24 (D) A description of the results of the de25 termination of the Secretary under paragraph 


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1 (1) of subsection (a) and a plan to use direct 

2 appointment authority under paragraph (2) of 

3 such subsection to fill staffing shortages, in4 cluding recommendations for improving the 

5 speed at which the credentialing and privileging 

6 process can be conducted. 

7 (E) The current staffing models of the De8 partment for the following clinics, including rec9 ommendations for changes to such models: 

10 (i) Mental health. 

11 (ii) Primary care. 

12 (iii) Gastroenterology. 

13 (iv) Women’s health. 

14 (v) Such other clinics as the Secretary 

15 considers appropriate. 

16 (F) A detailed analysis of succession plan17 ning at medical facilities of the Department, in18 cluding the following: 

19 (i) The number of positions in medical 

20 facilities throughout the Department that 

21 are not filled by a permanent employee. 

22 (ii) The length of time each such posi23 tion described in clause (i) remained va24 cant or filled by a temporary or acting em25 ployee. 


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1 (iii) A description of any barriers to 

2 filling the positions described in clause (i). 

3 (iv) A plan for filling any positions 

4 that are vacant or filled by a temporary or 

5 acting employee for more than 180 days. 

6 (v) A plan for handling emergency cir7 cumstances, such administrative leave or 

8 sudden medical leave for senior officials. 

9 (G) The number of health care providers 

10 who have been removed from their position or 

11 have retired, by provider type, during the two12 year period preceding the submittal of the re13 port. 

14 (H) Of the health care providers specified 

15 in subparagraph (G) that have been removed 

16 from their position, the following: 

17 (i) The number of such health care 

18 providers who were reassigned to another 

19 position in the Department. 

20 (ii) The number of such health care 

21 providers who left the Department. 

22 SEC. 204. CLINIC MANAGEMENT TRAINING PROGRAM OF 

23 THE DEPARTMENT OF VETERANS AFFAIRS. 

24 (a) IN GENERAL.—Not later than 180 days after the 

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1 erans Affairs shall implement a clinic management train2 ing program to provide in-person, standardized education 

3 on health care management to all managers of, and health 

4 care providers at, medical facilities of the Department of 

5 Veterans Affairs. 

6 (b) ELEMENTS.—The clinic management training 

7 program required by subsection (a) shall include the fol8 lowing: 

9 (1) Training on how to manage the schedules of 

10 health care providers of the Department, including 

11 the following: 

12 (A) Maintaining such schedules in a man13 ner that allows appointments to be booked at 

14 least eight weeks in advance. 

15 (B) Proper planning procedures for vaca16 tion, leave, and graduate medical education 

17 training schedules. 

18 (2) Training on the appropriate number of ap19 pointments that a health care provider should con20 duct on a daily basis, based on specialty. 

21 (3) Training on how to determine whether there 

22 are enough available appointment slots to manage 

23 demand for different appointment types and mecha24 nisms for alerting management of insufficient slots. 


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1 (4) Training on how to properly use the data 

2 produced by the scheduling dashboard required by 

3 section 101(b)(11) of this Act to meet demand for 

4 health care, including the following: 

5 (A) Training on determining the next 

6 available appointment for each health care pro7 vider at the medical facility. 

8 (B) Training on determining the number 

9 of health care providers needed to meet demand 

10 for health care at the medical facility. 

11 (C) Training on determining the number 

12 of exam rooms needed to meet demand for such 

13 health care in an efficient manner. 

14 (5) Training on how to properly use the ap15 pointment scheduling system of the Department, in16 cluding any new scheduling system implemented by 

17 the Department. 

18 (6) Training on how to optimize the use of 

19 technology, including the following: 

20 (A) Telemedicine. 

21 (B) Electronic mail. 

22 (C) Text messaging. 

23 (D) Such other technologies as specified by 

24 the Secretary. 


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1 (7) Training on how to properly use physical 

2 plant space at medical facilities of the Department 

3 to ensure efficient flow and privacy for patients and 

4 staff. 

5 SEC. 205. INCLUSION OF DEPARTMENT OF VETERANS AF6 FAIRS FACILITIES IN NATIONAL HEALTH 

7 SERVICE CORPS SCHOLARSHIP AND LOAN 

8 REPAYMENT PROGRAMS. 

9 (a) IN GENERAL.—The Secretary of Health and 

10 Human Services shall use the funds transferred under 

11 subsection (e) to award scholarship and loan repayment 

12 contracts under sections 338A and 338B of the Public 

13 Health Service Act (42 U.S.C. 254l, 254l–1) to eligible 

14 individuals who agree to a period of obligated service 

15 under section 338A(f)(1) or 338B(f)(1) of such Act, as 

16 applicable, at a health facility of the Department of Vet17 erans Affairs. 

18 (b) HEALTH PROFESSIONAL SHORTAGE AREAS.— 

19 For purposes of selecting individuals eligible for the schol20 arships and loan repayment contracts under subsection 

21 (a), all health facilities of the Department of Veterans Af22 fairs shall be deemed health professional shortage areas, 

23 as defined in section 332 of the Public Health Service Act 

24 (42 U.S.C. 254e). 


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1 (c) REQUIREMENT.—The Secretary of Health and 

2 Human Services shall ensure that a minimum of 5 schol3 arships or loan repayment contracts are awarded to indi4 viduals who agree to a period of obligated service at Vet5 erans Affairs facilities in each State. 

6 (d) APPLICABILITY OF NHSC PROGRAM REQUIRE7 MENTS.—Except as otherwise provided in this section, the 

8 terms of the National Health Service Corps Scholarship 

9 Program and the National Health Service Corps Loan Re10 payment Program shall apply to participants awarded a 

11 grant or loan repayment contract under subsection (a) in 

12 the same manner that such terms apply to participants 

13 awarded a grant or loan repayment contract under section 

14 338A or 338B of the Public Health Service Act. 

15 (e) INCLUSION OF GERIATRICIANS.—For purposes of 

16 awarding scholarships and loan repayments contracts to 

17 eligible individuals who agree to a period of obligated serv18 ice at a health facility of the Department of Veterans Af19 fairs pursuant to this section, in sections 338A and 338B 

20 of the Public Health Service Act (42 U.S.C. 254l, 254l– 

21 1), the term ‘‘primary health services’’ shall include geri22 atrics. 

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

24 shall transfer $20,000,000 for fiscal year 2014, and such 

25 sums as may be necessary for each fiscal year thereafter, 


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1 from accounts of the Veterans Health Administration to 

2 the Secretary of Health and Human Services to award 

3 scholarships and loan repayment contracts, as described 

4 in subsection (a). All funds so transferred shall be used 

5 exclusively for the purposes described in such subsection. 

6 SEC. 206. AUTHORIZATION OF EMERGENCY APPROPRIA7 TIONS. 

8 There is authorized to be appropriated for the De9 partment of Veterans Affairs such sums as may be nec10 essary to carry out this title. 

11 TITLE III—IMPROVEMENT OF 

12 ACCESS TO CARE FROM NON13 DEPARTMENT OF VETERANS 

14 AFFAIRS PROVIDERS 

15 SEC. 301. IMPROVEMENT OF ACCESS BY VETERANS TO 

16 HEALTH CARE FROM NON-DEPARTMENT OF 

17 VETERANS AFFAIRS PROVIDERS. 

18 (a) IMPROVEMENT OF ACCESS.— 

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

20 Affairs shall ensure timely access of all veterans to 

21 the hospital care, medical services, and other health 

22 care for which such veterans are eligible under the 

23 laws administered by the Secretary through the en24 hanced use of authorities specified in paragraph (2) 

25 on the provision of such care and services through 


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1 non-Department of Veterans Affairs providers (com2 monly referred to as ‘‘non-Department of Veterans 

3 Affairs medical care’’). 

4 (2) AUTHORITIES ON PROVISION OF CARE

5 THROUGH NON-DEPARTMENT PROVIDERS.—The au6 thorities specified in this paragraph are the fol7 lowing: 

8 (A) Section 1703 of title 38, United States 

9 Code, relating to contracts for the provision of 

10 hospital care and medical services through non11 Department facilities. 

12 (B) Section 1725 of such title, relating to 

13 reimbursement of certain veterans for the rea14 sonable value of emergency treatment at non15 Department facilities. 

16 (C) Section 1728 of such title, relating to 

17 reimbursement of certain veterans for cus18 tomary and usual charges of emergency treat19 ment from sources other than the Department. 

20 (D) Section 1786 of such title, relating to 

21 health care services furnished to newborn chil22 dren of women veterans who are receiving ma23 ternity care furnished by the Department at a 

24 non-Department facility. 


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1 (E) Any other authority under the laws ad2 ministered by the Secretary to provide hospital 

3 care, medical services, or other health care from 

4 a non-Department provider, including the fol5 lowing: 

6 (i) A Federally-qualified health center 

7 (as defined in section 1905(l)(2)(B) of the 

8 Social Security Act (42 U.S.C. 

9 1396d(l)(2)(B))). 

10 (ii) The Department of Defense. 

11 (iii) The Indian Health Service. 

12 (3) REQUIREMENTS.—In ensuring timely access 

13 of all veterans to the care and services described in 

14 paragraph (1) through the enhanced use of authori15 ties specified in paragraph (2), the Secretary shall 

16 require the following: 

17 (A) That each veteran who has not re18 ceived hospital care, medical services, or other 

19 health care from the Department and is seeking 

20 an appointment for primary care under the laws 

21 administered by the Secretary receive an ap22 pointment for primary care at a time consistent 

23 with timeliness measures established by the 

24 Secretary for purposes of providing primary 

25 care to all veterans. 


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1 (B) That the determination whether to 

2 refer a veteran for specialty care through a 

3 non-Department provider shall take into ac4 count the urgency and acuity of such veteran’s 

5 need for such care, including— 

6 (i) the severity of the condition of 

7 such veteran requiring specialty care; and 

8 (ii) the wait-time for an appointment 

9 with a specialist with respect to such con10 dition at the nearest medical facility of the 

11 Department with the capacity to provide 

12 such care. 

13 (C) That the determination whether a vet14 eran shall receive hospital care, medical serv15 ices, or other health care from the Department 

16 through facilities of the Department or through 

17 non-Department providers pursuant to the au18 thorities specified in paragraph (2) shall take 

19 into account, in the manner specified by the 

20 Secretary, the following: 

21 (i) The distance the veteran would be 

22 required to travel to receive care or serv23 ices through a non-Department provider 

24 compared to the distance the veteran 

25 would be required to travel to receive care 


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1 or services from a medical facility of the 

2 Department. 

3 (ii) Any factors that might limit the 

4 ability of the veteran to travel, including 

5 age, access to transportation, and infir6 mity. 

7 (iii) The wait-time for the provision of 

8 care or services through a non-Department 

9 provider compared to the wait-time for the 

10 provision of care or services from a medical 

11 facility of the Department. 

12 (iv) Where the veteran would prefer to 

13 receive the care and services described in 

14 paragraph (1), unless the preference of the 

15 veteran conflicts with any of the other re16 quirements of this paragraph. 

17 (D) That the Department maximize the 

18 use of hospital care, medical services, and other 

19 health care available to the Department 

20 through non-Department providers, including 

21 providers available to provide such care and 

22 services as follows: 

23 (i) Pursuant to contracts under the 

24 Patient-Centered Community Care Pro25 gram of the Department. 


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1 (ii) Pursuant to contracts between a 

2 facility or facilities of the Department and 

3 a local facility or provider. 

4 (iii) Pursuant to contracts with Fed5 erally-qualified health centers (as defined 

6 in section 1905(l)(2)(B) of the Social Se7 curity Act (42 U.S.C. 1396d(l)(2)(B))), 

8 the Department of Defense, or the Indian 

9 Health Service. 

10 (iv) On a fee-for-service basis. 

11 (b) MEDICAL RECORDS.—In providing hospital care, 

12 medical services, and other health care to veterans 

13 through non-Department providers pursuant to the au14 thorities specified in paragraph (2), the Secretary shall en15 sure that any such provider submits to the Department 

16 any medical record related to the care and services pro17 vided to a veteran by that provider for inclusion in the 

18 electronic medical record of such veteran maintained by 

19 the Department upon the completion of the provision of 

20 such care and services to such veteran. 

21 (c) REPORTS.— 

22 (1) INITIAL REPORT.—Not later than 45 days 

23 after the date of the enactment of this Act, the Sec24 retary shall submit to the Committee on Veterans’ 

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1 erans’ Affairs of the House of Representatives a re2 port on the implementation of the requirements 

3 under subsection (a) and (b), including a plan to en4 force the proper implementation of such require5 ments systematically throughout the Department. 

6 (2) PERIODIC REPORTS.—Not later than 90 

7 days after the submittal of the report required by 

8 paragraph (1), and every 90 days thereafter for one 

9 year, the Secretary shall submit to the Committee 

10 on Veterans’ Affairs of the Senate and the Com11 mittee on Veterans’ Affairs of the House of Rep12 resentatives a report that includes the following: 

13 (A) The progress of the Secretary in car14 rying out the plan under paragraph (1) to en15 force the proper implementation of the require16 ments under subsection (a) and (b) systemati17 cally throughout the Department. 

18 (B) The impact of the implementation of 

19 such requirements on wait-times for veterans to 

20 receive hospital care, medical services, and 

21 other health care, disaggregated by— 

22 (i) new patients; 

23 (ii) existing patients; 

24 (iii) primary care; and 

25 (iv) specialty care. 


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1 (C) Any recommendations for changes or 

2 improvements to such requirements. 

3 (D) Any requests for additional funding 

4 necessary to carry out such requirements. 

5 SEC. 302. EXTENSION OF AND REPORT ON JOINT INCEN6 TIVES PROGRAM OF DEPARTMENT OF VET7 ERANS AFFAIRS AND DEPARTMENT OF DE8 FENSE. 

9 (a) EXTENSION.—Section 8111(d)(3) of title 38, 

10 United States Code, is amended by striking ‘‘September 

11 30, 2015’’ and inserting ‘‘September 30, 2020’’. 

12 (b) REPORTS.— 

13 (1) REPORT ON IMPLEMENTATION OF REC14 OMMENDATIONS.—Not later than 60 days after the 

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

16 Veterans Affairs and the Secretary of Defense shall 

17 jointly submit to Congress a report on the imple18 mentation by the Department of Veterans Affairs 

19 and the Department of Defense of the findings and 

20 recommendations of the Comptroller General of the 

21 United States in the September 2012 report entitled 

22 ‘‘VA and DoD Health Care: Department-Level Ac23 tions Needed to Assess Collaboration Performance, 

24 Address Barriers, and Identify Opportunities’’ 

25 (GAO–12–992). 


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1 (2) COMPTROLLER GENERAL REPORT.— 

2 (A) IN GENERAL.—Not later than one year 

3 after the date of the enactment of this Act, the 

4 Comptroller General of the United States shall 

5 submit to Congress a report assessing and pro6 viding recommendations for improvement to the 

7 program to identify, provide incentives to, im8 plement, fund, and evaluate creative coordina9 tion and sharing initiatives between the Depart10 ment of Veterans Affairs and the Department 

11 of Defense required under section 8111(d) of 

12 such title. 

13 (B) ELEMENTS.—The report required by 

14 subparagraph (A) shall include the following: 

15 (i) An assessment of the extent to 

16 which the program described in subpara17 graph (A) has accomplished the goal of 

18 such program to improve the access to, 

19 and quality and cost effectiveness of, the 

20 health care provided by the Veterans 

21 Health Administration and the Military 

22 Health System to the beneficiaries of both 

23 the Department of Veterans Affairs and 

24 the Department of Defense. 


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1 (ii) An assessment of whether admin2 istration of such program through the 

3 Health Executive Committee of the De4 partment of Veterans Affairs-Department 

5 of Defense Joint Executive Committee es6 tablished under section 320 of such title 

7 provides sufficient leadership attention and 

8 oversight to ensure maximum benefits to 

9 the Department of Veterans Affairs and 

10 the Department of Defense through col11 laborative efforts. 

12 (iii) An assessment of whether addi13 tional authorities to jointly construct, 

14 lease, or acquire facilities would facilitate 

15 additional collaborative efforts under such 

16 program. 

17 (iv) An assessment of whether the 

18 funding for such program is sufficient to 

19 ensure consistent identification of potential 

20 opportunities for collaboration and over21 sight of existing collaborations to ensure a 

22 meaningful partnership between the De23 partment of Veterans Affairs and the De24 partment of Defense and remove any bar25 riers to integration or collaboration. 


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1 (v) An assessment of whether existing 

2 processes for identifying opportunities for 

3 collaboration are sufficient to ensure max4 imum collaboration between the Veterans 

5 Health Administration and the Military 

6 Health System. 

7 (vi) Such legislative or administrative 

8 recommendations for improvement to such 

9 program as the Comptroller General con10 siders appropriate to enhance the use of 

11 such program to increase access to health 

12 care. 

13 SEC. 303. TRANSFER OF AUTHORITY FOR PAYMENTS FOR 

14 HOSPITAL CARE, MEDICAL SERVICES, AND 

15 OTHER HEALTH CARE FROM NON-DEPART16 MENT PROVIDERS TO THE CHIEF BUSINESS 

17 OFFICE OF THE VETERANS HEALTH ADMINIS18 TRATION OF THE DEPARTMENT. 

19 (a) TRANSFER OF AUTHORITY.— 

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

21 2014, the Secretary of Veterans Affairs shall trans22 fer the authority to pay for hospital care, medical 

23 services, and other health care through non-Depart24 ment providers to the Chief Business Office of the 

25 Veterans Health Administration of the Department 


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1 of Veterans Affairs from the Veterans Integrated 

2 Service Networks and medical centers of the Depart3 ment of Veterans Affairs. 

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

5 Office shall work in consultation with the Office of 

6 Clinical Operations and Management of the Depart7 ment of Veterans Affairs to ensure that care and 

8 services described in paragraph (1) is provided in a 

9 manner that is clinically appropriate and effective. 

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

11 authority under paragraph (1) shall be carried out 

12 in a manner that does not delay or impede any pay13 ment by the Department for hospital care, medical 

14 services, or other health care provided through a 

15 non-Department provider under the laws adminis16 tered by the Secretary. 

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

18 each fiscal year that begins after the date of the enact19 ment of this Act— 

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

21 Office of the Veterans Health Administration 

22 amounts to pay for hospital care, medical services, 

23 and other health care provided through non-Depart24 ment providers, including any amounts necessary to 

25 carry out the transfer of authority to pay for such 


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

2 increase in staff; and 

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

4 Integrated Service Network and medical center of 

5 the Department amounts to pay for such care and 

6 services. 

7 (c) REMOVAL FROM PERFORMANCE GOALS.—For 

8 each fiscal year that begins after the date of the enact9 ment of this Act, the Secretary shall not include in the 

10 performance goals of any employee of a Veterans Inte11 grated Service Network or medical center of the Depart12 ment any performance goal that might disincentivize the 

13 payment of Department amounts to provide hospital care, 

14 medical services, or other health care through a non-De15 partment provider. 

16 SEC. 304. ENHANCEMENT OF COLLABORATION BETWEEN 

17 DEPARTMENT OF VETERANS AFFAIRS AND 

18 INDIAN HEALTH SERVICE. 

19 (a) OUTREACH TO TRIBAL-RUN MEDICAL FACILI20 TIES.—The Secretary of Veterans Affairs shall, in con21 sultation with the Director of the Indian Health Service, 

22 conduct outreach to each medical facility operated by an 

23 Indian tribe or tribal organization through a contract or 

24 compact with the Indian Health Service under the Indian 

25 Self-Determination and Education Assistance Act (25 


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

2 such facilities, Indian tribes, and tribal organizations to 

3 enter into agreements with the Department of Veterans 

4 Affairs under which the Secretary reimburses such facili5 ties, Indian tribes, or tribal organizations, as the case may 

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

7 care at such facilities. 

8 (b) METRICS FOR MEMORANDUM OF UNDER9 STANDING PERFORMANCE.—The Secretary of Veterans 

10 Affairs shall implement performance metrics for assessing 

11 the performance by the Department of Veterans Affairs 

12 and the Indian Health Service under the memorandum of 

13 understanding entitled ‘‘Memorandum of Understanding 

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

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

16 health care, improving quality and coordination of health 

17 care, promoting effective patient-centered collaboration 

18 and partnerships between the Department and the Serv19 ice, and ensuring health-promotion and disease-prevention 

20 services are appropriately funded and available for bene21 ficiaries under both health care systems. 

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

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

24 Affairs and the Director of the Indian Health Service shall 


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1 jointly submit to Congress a report on the feasibility and 

2 advisability of the following: 

3 (1) Entering into agreements for the reimburse4 ment by the Secretary of the costs of direct care 

5 services provided through organizations receiving 

6 amounts pursuant to grants made or contracts en7 tered into under section 503 of the Indian Health 

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

9 who are otherwise eligible to receive health care from 

10 such organizations. 

11 (2) Including the reimbursement of the costs of 

12 direct care services provided to veterans who are not 

13 Indians in agreements between the Department and 

14 the following: 

15 (A) The Indian Health Service. 

16 (B) An Indian tribe or tribal organization 

17 operating a medical facility through a contract 

18 or compact with the Indian Health Service 

19 under the Indian Self-Determination and Edu20 cation Assistance Act (25 U.S.C. 450 et seq.). 

21 (C) A medical facility of the Indian Health 

22 Service. 

23 (d) DEFINITIONS.—In this section: 

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

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1 tion 4 of the Indian Health Care Improvement Act 

2 (25 U.S.C. 1603). 

3 (2) MEDICAL FACILITY OF THE INDIAN

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

5 the Indian Health Service’’ includes a facility oper6 ated by an Indian tribe or tribal organization 

7 through a contract or compact with the Indian 

8 Health Service under the Indian Self-Determination 

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

10 seq.). 

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

12 organization’’ has the meaning given the term in 

13 section 4 of the Indian Self-Determination and Edu14 cation Assistance Act (25 U.S.C. 450b). 

15 SEC. 305. ENHANCEMENT OF COLLABORATION BETWEEN 

16 DEPARTMENT OF VETERANS AFFAIRS AND 

17 NATIVE HAWAIIAN HEALTH CARE SYSTEMS. 

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

19 shall, in consultation with Papa Ola Lokahi and such 

20 other organizations involved in the delivery of health care 

21 to Native Hawaiians as the Secretary considers appro22 priate, enter into contracts or agreements with Native Ha23 waiian health care systems that are in receipt of funds 

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1 tion 6(a) of the Native Hawaiian Health Care Improve2 ment Act (42 U.S.C. 11705(a)) for the reimbursement of 

3 direct care services provided to eligible veterans as speci4 fied in such contracts or agreements. 

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

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

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

8 in section 12 of the Native Hawaiian Health Care Im9 provement Act (42 U.S.C. 11711). 

10 SEC. 306. AUTHORIZATION OF EMERGENCY APPROPRIA11 TIONS. 

12 There is authorized to be appropriated for the De13 partment of Veterans Affairs such sums as may be nec14 essary to carry out this title. 

15 TITLE IV—HEALTH CARE 

16 ADMINISTRATIVE MATTERS 

17 SEC. 401. IMPROVEMENT OF ACCESS OF VETERANS TO MO18 BILE VET CENTERS OF THE DEPARTMENT OF 

19 VETERANS AFFAIRS. 

20 (a) IMPROVEMENT OF ACCESS.— 

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

22 Affairs shall improve the access of veterans to tele23 medicine and other health care through the use of 

24 mobile vet centers of the Department of Veterans 


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1 Affairs by providing standardized requirements for 

2 the operation of such centers. 

3 (2) REQUIREMENTS.—The standardized re4 quirements required by paragraph (1) shall include 

5 the following: 

6 (A) The number of days each mobile vet 

7 center of the Department is expected to travel 

8 per year. 

9 (B) The number of locations each center is 

10 expected to visit per year. 

11 (C) The number of appointments each cen12 ter is expected to conduct per year. 

13 (D) The method and timing of notifica14 tions given by each center to individuals in the 

15 area to which such center is traveling, including 

16 notifications informing veterans of the avail17 ability to schedule appointments at the center. 

18 (3) USE OF TELEMEDICINE.—The Secretary 

19 shall ensure that each mobile vet center of the De20 partment has the capability to provide telemedicine 

21 services. 

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

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

24 30 each year thereafter, the Secretary of Veterans Affairs 

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


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1 Senate and the Committee on Veterans’ Affairs of the 

2 House of Representatives a report on the following: 

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

4 telemedicine services to veterans during the year 

5 preceding the submittal of the report, including the 

6 following: 

7 (A) The number of days each mobile vet 

8 center was open to provide such services. 

9 (B) The number of days each mobile vet 

10 center traveled to a location other than the 

11 headquarters of the mobile vet center to provide 

12 such services. 

13 (C) The number of appointments each cen14 ter conducted to provide such services on aver15 age per month and in total during such year. 

16 (2) An analysis of the effectiveness of using mo17 bile vet centers to provide health care services to vet18 erans through the use of telemedicine. 

19 (3) Any recommendations for an increase in the 

20 number of mobile vet centers of the Department. 

21 (4) Any recommendations for an increase in the 

22 telemedicine capabilities of each mobile vet center. 

23 (5) The feasibility and advisability of using 

24 temporary health care providers, including locum 


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1 tenens, to provide direct health care services to vet2 erans at mobile vet centers. 

3 (6) Such other recommendations on improve4 ment of the use of mobile vet centers by the Depart5 ment as the Secretary considers appropriate. 

6 SEC. 402. COMMISSION ON ACCESS TO CARE. 

7 (a) ESTABLISHMENT OF COMMISSION.— 

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

9 Commission on Access to Care (in this section re10 ferred to as the ‘‘Commission’’) to examine the ac11 cess of veterans to health care from the Department 

12 of Veterans Affairs and strategically examine how 

13 best to organize the Veterans Health Administra14 tion, locate health care resources, and deliver health 

15 care to veterans during the next 10 to 20 years. 

16 (2) MEMBERSHIP.— 

17 (A) VOTING MEMBERS.—The Commission 

18 shall be composed of 10 voting members who 

19 are appointed by the President as follows: 

20 (i) At least two members who rep21 resent an organization recognized by the 

22 Secretary of Veterans Affairs for the rep23 resentation of veterans under section 5902 

24 of title 38, United States Code. 


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1 (ii) At least one member from among 

2 persons who are experts concerning a pub3 lic or private hospital system. 

4 (iii) At least one member from among 

5 persons who are familiar with government 

6 health care systems, including those sys7 tems of the Department of Defense, the 

8 Indian Health Service, and Federally-quali9 fied health centers (as defined in section 

10 1905(l)(2)(B) of the Social Security Act 

11 (42 U.S.C. 1396d(l)(2)(B))). 

12 (iv) At least two members from 

13 among persons who are familiar with the 

14 Veterans Health Administration. 

15 (B) NONVOTING MEMBERS.—In addition 

16 to members appointed under subparagraph (A), 

17 the Commission shall be composed of 10 non18 voting members who are appointed by the 

19 President as follows: 

20 (i) At least two members who rep21 resent an organization recognized by the 

22 Secretary of Veterans Affairs for the rep23 resentation of veterans under section 5902 

24 of title 38, United States Code. 


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1 (ii) At least one member from among 

2 persons who are experts in a public or pri3 vate hospital system. 

4 (iii) At least one member from among 

5 persons who are familiar with government 

6 health care systems, including those sys7 tems of the Department of Defense, the 

8 Indian Health Service, and Federally-quali9 fied health centers (as defined in section 

10 1905(l)(2)(B) of the Social Security Act 

11 (42 U.S.C. 1396d(l)(2)(B))). 

12 (iv) At least two members from 

13 among persons who are familiar with the 

14 Veterans Health Administration. 

15 (C) DATE.—The appointments of members 

16 of the Commission shall be made not later than 

17 60 days after the date of the enactment of this 

18 Act. 

19 (3) PERIOD OF APPOINTMENT; VACANCIES.— 

20 Members shall be appointed for the life of the Com21 mission. Any vacancy in the Commission shall not 

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

23 manner as the original appointment. 

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

25 after the date on which seven voting members of the 


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1 Commission have been appointed, the Commission 

2 shall hold its first meeting. 

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

4 the call of the Chairperson. 

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

6 the Commission shall constitute a quorum, but a 

7 lesser number of members may hold hearings. 

8 (7) CHAIRPERSON AND VICE CHAIRPERSON.— 

9 The Commission shall select a Chairperson and Vice 

10 Chairperson from among its members. 

11 (b) DUTIES OF COMMISSION.— 

12 (1) EVALUATION AND ASSESSMENT.—The Com13 mission shall undertake a comprehensive evaluation 

14 and assessment of access to health care at the De15 partment of Veterans Affairs. 

16 (2) MATTERS EVALUATED AND ASSESSED.— 

17 The matters evaluated and assessed by the Commis18 sion shall include the following: 

19 (A) The appropriateness of current stand20 ards of the Department of Veterans Affairs 

21 concerning access to health care. 

22 (B) The measurement of such standards. 

23 (C) The appropriateness of performance 

24 standards and incentives in relation to stand25 ards described in subparagraph (A). 


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1 (D) Staffing levels throughout the Vet2 erans Health Administration and whether they 

3 are sufficient to meet current demand for 

4 health care from the Administration. 

5 (3) REPORTS.—The Commission shall submit 

6 to the President, through the Secretary of Veterans 

7 Affairs, reports as follows: 

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

9 of the initial meeting of the Commission, an in10 terim report on— 

11 (i) the findings of the Commission 

12 with respect to the evaluation and assess13 ment required by this subsection; and 

14 (ii) such recommendations as the 

15 Commission may have for legislative or ad16 ministrative action to improve access to 

17 health care through the Veterans Health 

18 Administration. 

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

20 of the initial meeting of the Commission, a final 

21 report on— 

22 (i) the findings of the Commission 

23 with respect to the evaluation and assess24 ment required by this subsection; and 


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1 (ii) such recommendations as the 

2 Commission may have for legislative or ad3 ministrative action to improve access to 

4 health care through the Veterans Health 

5 Administration. 

6 (c) POWERS OF THE COMMISSION.— 

7 (1) HEARINGS.—The Commission may hold 

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

9 take such testimony, and receive such evidence as 

10 the Commission considers advisable to carry out this 

11 section. 

12 (2) INFORMATION FROM FEDERAL AGENCIES.— 

13 The Commission may secure directly from any Fed14 eral department or agency such information as the 

15 Commission considers necessary to carry out this 

16 section. Upon request of the Chairperson of the 

17 Commission, the head of such department or agency 

18 shall furnish such information to the Commission. 

19 (d) COMMISSION PERSONNEL MATTERS.— 

20 (1) COMPENSATION OF MEMBERS.—Each mem21 ber of the Commission who is not an officer or em22 ployee of the Federal Government shall be com23 pensated at a rate equal to the daily equivalent of 

24 the annual rate of basic pay prescribed for level IV 

25 of the Executive Schedule under section 5315 of title 


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1 5, United States Code, for each day (including travel 

2 time) during which such member is engaged in the 

3 performance of the duties of the Commission. All 

4 members of the Commission who are officers or em5 ployees of the United States shall serve without com6 pensation in addition to that received for their serv7 ices as officers or employees of the United States. 

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

9 Commission shall be allowed travel expenses, includ10 ing per diem in lieu of subsistence, at rates author11 ized for employees of agencies under subchapter I of 

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

13 away from their homes or regular places of business 

14 in the performance of services for the Commission. 

15 (3) STAFF.— 

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

17 Commission may, without regard to the civil 

18 service laws and regulations, appoint and termi19 nate an executive director and such other addi20 tional personnel as may be necessary to enable 

21 the Commission to perform its duties. The em22 ployment of an executive director shall be sub23 ject to confirmation by the Commission. 

24 (B) COMPENSATION.—The Chairperson of 

25 the Commission may fix the compensation of 


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1 the executive director and other personnel with2 out regard to chapter 51 and subchapter III of 

3 chapter 53 of title 5, United States Code, relat4 ing to classification of positions and General 

5 Schedule pay rates, except that the rate of pay 

6 for the executive director and other personnel 

7 may not exceed the rate payable for level V of 

8 the Executive Schedule under section 5316 of 

9 such title. 

10 (4) DETAIL OF GOVERNMENT EMPLOYEES.— 

11 Any Federal Government employee may be detailed 

12 to the Commission without reimbursement, and such 

13 detail shall be without interruption or loss of civil 

14 service status or privilege. 

15 (5) PROCUREMENT OF TEMPORARY AND INTER16 MITTENT SERVICES.—The Chairperson of the Com17 mission may procure temporary and intermittent 

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

19 States Code, at rates for individuals which do not 

20 exceed the daily equivalent of the annual rate of 

21 basic pay prescribed for level V of the Executive 

22 Schedule under section 5316 of such title. 

23 (e) TERMINATION OF THE COMMISSION.—The Com24 mission shall terminate 30 days after the date on which 


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1 the Commission submits its report under subsection 

2 (b)(3)(B). 

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

4 shall make available to the Commission from amounts ap5 propriated or otherwise made available to the Secretary 

6 such amounts as the Secretary and the Chairperson of the 

7 Commission jointly consider appropriate for the Commis8 sion to perform its duties under this section. 

9 (g) EXECUTIVE ACTION.— 

10 (1) ACTION ON RECOMMENDATIONS.—The 

11 President shall require the Secretary of Veterans Af12 fairs and such other heads of relevant Federal de13 partments and agencies to implement each rec14 ommendation set forth in a report submitted under 

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

16 (A) considers feasible and advisable; and 

17 (B) determines can be implemented with18 out further legislative action. 

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

20 the date on which the President receives a report 

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

22 to the Committee on Veterans’ Affairs of the Senate 

23 and the Committee on Veterans’ Affairs of the 

24 House of Representatives and such other committees 


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1 of Congress as the President considers appropriate 

2 a report setting forth the following: 

3 (A) An assessment of the feasibility and 

4 advisability of each recommendation contained 

5 in the report received by the President. 

6 (B) For each recommendation assessed as 

7 feasible and advisable under subparagraph (A) 

8 the following: 

9 (i) Whether such recommendation re10 quires legislative action. 

11 (ii) If such recommendation requires 

12 legislative action, a recommendation con13 cerning such legislative action. 

14 (iii) A description of any administra15 tive action already taken to carry out such 

16 recommendation. 

17 (iv) A description of any administra18 tive action the President intends to be 

19 taken to carry out such recommendation 

20 and by whom. 

21 SEC. 403. COMMISSION ON CAPITAL PLANNING FOR DE22 PARTMENT OF VETERANS AFFAIRS MEDICAL 

23 FACILITIES. 

24 (a) ESTABLISHMENT OF COMMISSION.— 


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1 (1) ESTABLISHMENT.—There is established the 

2 Commission on Capital Planning for Department of 

3 Veterans Affairs Medical Facilities (in this section 

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

5 (2) MEMBERSHIP.— 

6 (A) VOTING MEMBERS.—The Commission 

7 shall, subject to subparagraph (B), be composed 

8 of 10 voting members as follows: 

9 (i) 1 shall be appointed by the Presi10 dent. 

11 (ii) 1 shall be appointed by the Ad12 ministrator of General Services. 

13 (iii) 3 shall be appointed by the Sec14 retary of Veterans Affairs, of whom— 

15 (I) 1 shall be an employee of the 

16 Veterans Health Administration; 

17 (II) 1 shall be an employee of the 

18 Office of Asset Enterprise Manage19 ment of the Department of Veterans 

20 Affairs; and 

21 (III) 1 shall be an employee of 

22 the Office of Construction and Facili23 ties Management of the Department 

24 of Veterans Affairs. 


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1 (iv) 1 shall be appointed by the Sec2 retary of Defense from among employees 

3 of the Army Corps of Engineers. 

4 (v) 1 shall be appointed by the major5 ity leader of the Senate. 

6 (vi) 1 shall be appointed by the minor7 ity leader of the Senate. 

8 (vii) 1 shall be appointed by the 

9 Speaker of the House of Representatives. 

10 (viii) 1 shall be appointed by the mi11 nority leader of the House of Representa12 tives. 

13 (B) REQUIREMENT RELATING TO CERTAIN

14 APPOINTMENTS OF VOTING MEMBERS.—Of the 

15 members appointed pursuant to clause (i), (ii), 

16 and (iv) through (viii) of subparagraph (A), all 

17 shall have expertise in capital leasing, construc18 tion, or health facility management planning. 

19 (C) NON-VOTING MEMBERS.—The Com20 mission shall be assisted by 10 non-voting mem21 bers, appointed by the vote of a majority of 

22 members of the Commission under subpara23 graph (A), of whom— 


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1 (i) 6 shall be representatives of vet2 erans service organizations recognized by 

3 the Secretary of Veterans Affairs; and 

4 (ii) 4 shall be individuals from outside 

5 the Department of Veterans Affairs with 

6 experience and expertise in matters relat7 ing to management, construction, and leas8 ing of capital assets. 

9 (D) DATE OF APPOINTMENT OF VOTING

10 MEMBERS.—The appointments of the members 

11 of the Commission under subparagraph (A) 

12 shall be made not later than 60 days after the 

13 date of the enactment of this Act. 

14 (3) PERIOD OF APPOINTMENT; VACANCIES.— 

15 Members shall be appointed for the life of the Com16 mission. Any vacancy in the Commission shall not 

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

18 manner as the original appointment. 

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

20 after the date on which 7 members of the Commis21 sion have been appointed, the Commission shall hold 

22 its first meeting. 

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

24 the call of the Chair. 


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

2 the Commission shall constitute a quorum, but a 

3 lesser number of members may hold hearings. 

4 (7) CHAIR AND VICE CHAIR.—The Commission 

5 shall select a Chair and Vice Chair from among its 

6 members. 

7 (b) DUTIES OF COMMISSION.— 

8 (1) IN GENERAL.—The Commission shall un9 dertake a comprehensive evaluation and assessment 

10 of various options for capital planning for Depart11 ment of Veterans Affairs medical facilities, including 

12 an evaluation and assessment of the mechanisms by 

13 which the Department currently selects means for 

14 the delivery of health care, whether by major con15 struction, major medical facility leases, sharing 

16 agreements with the Department of Defense, the In17 dian Health Service, and Federally Qualified Health 

18 Clinics under section 330 of the Public Health Serv19 ice Act (42 U.S.C. 254b), contract care, multisite 

20 care, telemedicine, extended hours for care, or other 

21 means. 

22 (2) CONTEXT OF EVALUATION AND ASSESS23 MENT.—In undertaking the evaluation and assess24 ment, the Commission shall consider— 


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1 (A) the importance of access to health care 

2 through the Department, including associated 

3 guidelines of the Department on access to, and 

4 drive time for, health care; 

5 (B) limitations and requirements applica6 ble to the construction and leasing of medical 

7 facilities for the Department, including applica8 ble laws, regulations, and costs as determined 

9 by both the Congressional Budget Office and 

10 the Office of Management and Budget; 

11 (C) the nature of capital planning for De12 partment medical facilities in an era of fiscal 

13 uncertainty; 

14 (D) projected future fluctuations in the 

15 population of veterans; and 

16 (E) the extent to which the Department 

17 was able to meet the mandates of the Capital 

18 Asset Realignment for Enhanced Services Com19 mission. 

20 (3) PARTICULAR CONSIDERATIONS.—In under21 taking the evaluation and assessment, the Commis22 sion shall address, in particular, the following: 

23 (A) The Major Medical Facility Lease Pro24 gram of the Department, including an identiVerDate Mar 15 2010 21:21 Jun 04, 2014 Jkt 039200 PO 00000 Frm 00067 Fmt 6652 Sfmt 6201 E:\BILLS\S2422.PCS S2422

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1 fication of potential improvements to the lease 

2 authorization processes under that Program. 

3 (B) The management processes of the De4 partment for its Major Medical Facility Con5 struction Program, including processes relating 

6 to contract award and management, project 

7 management, and processing of change orders. 

8 (C) The overall capital planning program 

9 of the Department for medical facilities, includ10 ing an evaluation and assessment of— 

11 (i) the manner in which the Depart12 ment determines whether to use capital or 

13 non-capital means to expand access to 

14 health care; 

15 (ii) the manner in which the Depart16 ment determines the disposition of under17 utilized and un-utilized buildings on cam18 puses of Department medical centers, and 

19 any barriers to disposition; 

20 (iii) the effectiveness of the facility 

21 master planning initiative of the Depart22 ment; and 

23 (iv) the extent to which sustainable 

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1 ating costs for Department medical facili2 ties. 

3 (D) The current backlog of construction 

4 projects for Department medical facilities, in5 cluding an identification of the most effective 

6 means to quickly secure the most critical re7 pairs required, including repairs relating to fa8 cility condition deficiencies, structural safety, 

9 and compliance with the Americans With Dis10 abilities Act of 1990. 

11 (4) REPORTS.—Subject to paragraph (5), the 

12 Commission shall submit to the Secretary of Vet13 erans Affairs, and to the Committee Veterans’ Af14 fairs of the Senate and the Committee on Veterans’ 

15 Affairs of the House of Representatives, reports as 

16 follows: 

17 (A) Not later than six months after its ini18 tial meeting under subsection (a)(4), a report 

19 on the Major Medical Facility Lease Program 

20 and the Congressional lease authorization proc21 ess. 

22 (B) Not later than one year after its initial 

23 meeting, a report— 


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1 (i) on the management processes of 

2 the Department for the construction of De3 partment medical facilities; and 

4 (ii) setting forth an update of any 

5 matters covered in the report under sub6 paragraph (A). 

7 (C) Not later than 18 months after its ini8 tial meeting, a report— 

9 (i) on the overall capital planning pro10 gram of the Department for medical facili11 ties; and 

12 (ii) setting forth an update of any 

13 matters covered in earlier reports under 

14 this paragraph. 

15 (D) Not later than two years after its ini16 tial meeting, a report— 

17 (i) on the current backlog of construc18 tion projects for Department medical facili19 ties; 

20 (ii) setting forth an update of any 

21 matters covered in earlier reports under 

22 this paragraph; and 

23 (iii) including such other matters re24 lating to the duties of the Commission that 

25 the Commission considers appropriate. 


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1 (E) Not later than 27 months after its ini2 tial meeting, a report on the implementation by 

3 the Secretary of Veterans Affairs pursuant to 

4 subsection (g) of the recommendations included 

5 pursuant to paragraph (5) in the reports under 

6 this paragraph. 

7 (5) RECOMMENDATIONS.—Each report under 

8 paragraph (4) shall include, for the aspect of the 

9 capital asset planning process of the Department 

10 covered by such report, such recommendations as 

11 the Commission considers appropriate for the im12 provement and enhancement of such aspect of the 

13 capital asset planning process. 

14 (c) POWERS OF COMMISSION.— 

15 (1) HEARINGS.—The Commission may hold 

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

17 take such testimony, and receive such evidence as 

18 the Commission considers advisable to carry out this 

19 section. 

20 (2) INFORMATION FROM FEDERAL AGENCIES.— 

21 The Commission may secure directly from any Fed22 eral department or agency such information as the 

23 Commission considers necessary to carry out this 

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1 sion, the head of such department or agency shall 

2 furnish such information to the Commission. 

3 (d) COMMISSION PERSONNEL MATTERS.— 

4 (1) COMPENSATION OF MEMBERS.—Each mem5 ber of the Commission who is not an officer or em6 ployee of the Federal Government shall be com7 pensated at a rate equal to the daily equivalent of 

8 the annual rate of basic pay prescribed for level IV 

9 of the Executive Schedule under section 5315 of title 

10 5, United States Code, for each day (including travel 

11 time) during which such member is engaged in the 

12 performance of the duties of the Commission. All 

13 members of the Commission who are officers or em14 ployees of the United States shall serve without com15 pensation in addition to that received for their serv16 ices as officers or employees of the United States. 

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

18 Commission shall be allowed travel expenses, includ19 ing per diem in lieu of subsistence, at rates author20 ized for employees of agencies under subchapter I of 

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

22 away from their homes or regular places of business 

23 in the performance of services for the Commission. 

24 (3) STAFF.— 


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1 (A) IN GENERAL.—The Chair of the Com2 mission may, without regard to the civil service 

3 laws and regulations, appoint and terminate an 

4 executive director and such other additional 

5 personnel as may be necessary to enable the 

6 Commission to perform its duties. The employ7 ment of an executive director shall be subject to 

8 confirmation by the Commission. 

9 (B) COMPENSATION.—The Chair of the 

10 Commission may fix the compensation of the 

11 executive director and other personnel without 

12 regard to chapter 51 and subchapter III of 

13 chapter 53 of title 5, United States Code, relat14 ing to classification of positions and General 

15 Schedule pay rates, except that the rate of pay 

16 for the executive director and other personnel 

17 may not exceed the rate payable for level V of 

18 the Executive Schedule under section 5316 of 

19 such title. 

20 (4) DETAIL OF GOVERNMENT EMPLOYEES.— 

21 Any Federal Government employee may be detailed 

22 to the Commission without reimbursement, and such 

23 detail shall be without interruption or loss of civil 

24 service status or privilege. 


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1 (5) PROCUREMENT OF TEMPORARY AND INTER2 MITTENT SERVICES.—The Chair of the Commission 

3 may procure temporary and intermittent services 

4 under section 3109(b) of title 5, United States Code, 

5 at rates for individuals which do not exceed the daily 

6 equivalent of the annual rate of basic pay prescribed 

7 for level V of the Executive Schedule under section 

8 5316 of such title. 

9 (e) TERMINATION OF COMMISSION.—The Commis10 sion shall terminate 60 days after the date on which the 

11 Commission submits its report under subsection 

12 (b)(4)(E). 

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

14 shall make available to the Commission such amounts as 

15 the Secretary and the Chair of the Commission jointly 

16 consider appropriate for the Commission to perform its 

17 duties under this section. 

18 (g) ACTION ON RECOMMENDATIONS.— 

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

20 Affairs shall implement each recommendation in21 cluded in a report under subsection (b)(4) that the 

22 Secretary considers feasible and advisable and can 

23 be implemented without further legislative action. 

24 (2) REPORTS.—Not later than 120 days after 

25 receipt of a report under subparagraphs (A) through 


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1 (D) of subsection (b)(4), the Secretary shall submit 

2 to the Committee Veterans’ Affairs of the Senate 

3 and the Committee on Veterans’ Affairs of the 

4 House of Representatives a report setting forth the 

5 following: 

6 (A) An assessment of the feasibility and 

7 advisability of each recommendation contained 

8 in such report. 

9 (B) For each recommendation assessed as 

10 feasible and advisable— 

11 (i) if such recommendation does not 

12 require further legislative action for imple13 mentation, a description of the actions 

14 taken, and to be taken, by the Secretary to 

15 implement such recommendation; and 

16 (ii) if such recommendation requires 

17 further legislative action for implementa18 tion, recommendations for such legislative 

19 action. 

20 SEC. 404. REMOVAL OF SENIOR EXECUTIVE SERVICE EM21 PLOYEES OF THE DEPARTMENT OF VET22 ERANS AFFAIRS FOR PERFORMANCE. 

23 (a) REMOVAL OR TRANSFER.— 


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

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

3 following new section: 

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

5 performance 

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

7 individual from the Senior Executive Service if the Sec8 retary determines the performance of the individual war9 rants such removal. If the Secretary so removes such an 

10 individual, the Secretary may— 

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

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

13 ‘‘(2) transfer the individual to a General Sched14 ule position at any grade of the General Schedule for 

15 which the individual is qualified and that the Sec16 retary determines is appropriate. 

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

18 after removing or transferring an individual from the Sen19 ior Executive Service under paragraph (1), the Secretary 

20 shall submit to the Committees on Veterans’ Affairs of 

21 the Senate and House of Representatives notice in writing 

22 of such removal or transfer and the reason for such re23 moval or transfer. 

24 ‘‘(c) APPEAL OF REMOVAL OR TRANSFER.—Any re25 moval or transfer under subsection (a) may be appealed 


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1 to the Merit Systems Protection Board under section 7701 

2 of title 5 not later than 7 days after such removal or trans3 fer. 

4 ‘‘(d) EXPEDITED REVIEW BY MERIT SYSTEMS PRO5 TECTION BOARD.—(1) The Merit Systems Protection 

6 Board shall expedite any appeal under section 7701 of 

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

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

9 days after the date of the appeal. 

10 ‘‘(2) In any case in which the Merit Systems Protec11 tion Board determines that it cannot issue a decision in 

12 accordance with the 21-day requirement under paragraph 

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

14 Congress a report that explains the reason why the Merit 

15 Systems Protection Board is unable to issue a decision in 

16 accordance with such requirement in such case. 

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

18 sums as may be necessary for the Merit Systems Protec19 tion Board to expedite appeals under paragraph (1). 

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

21 stay any personnel action taken under this section.’’. 

22 (2) CLERICAL AMENDMENT.—The table of sec23 tions at the beginning of such chapter is amended 

24 by adding at the end the following new item: 

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


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1 (b) ESTABLISHMENT OF EXPEDITED REVIEW PROC2 ESS.— 

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

4 the date of the enactment of this Act, the Merit Sys5 tems Protection Board shall establish and put into 

6 effect a process to conduct expedited reviews in ac7 cordance with section 713(d) of title 38, United 

8 States Code. 

9 (2) INAPPLICABILITY OF CERTAIN REGULA10 TIONS.—Section 1201.22 of title 5, Code of Federal 

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

12 of the enactment of this Act, shall not apply to expe13 dited reviews carried out under section 713(d) of 

14 title 38, United States Code. 

15 (3) REPORT BY MERIT SYSTEMS PROTECTION

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

17 the enactment of this Act, the Merit Systems Pro18 tection Board shall submit to Congress a report on 

19 the actions the Board plans to take to conduct expe20 dited reviews under section 713(d) of title 38, 

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

22 Such report shall include a description of the re23 sources the Board determines will be necessary to 

24 conduct such reviews and a description of whether 

25 any resources will be necessary to conduct such reVerDate Mar 15 2010 21:21 Jun 04, 2014 Jkt 039200 PO 00000 Frm 00078 Fmt 6652 Sfmt 6201 E:\BILLS\S2422.PCS S2422

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1 views that were not available to the Board on the 

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

3 (c) TEMPORARY EXEMPTION FROM CERTAIN LIMI4 TATION ON INITIATION OF REMOVAL FROM SENIOR EX5 ECUTIVE SERVICE.—During the 120-day period beginning 

6 on the date of the enactment of this Act, an action to re7 move an individual from the Senior Executive Service at 

8 the Department of Veterans Affairs pursuant to section 

9 713 of title 38, United States Code, as added by sub10 section (a), or section 7543 of title 5, United States Code, 

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

12 5, United States Code, or any other provision of law. 

13 (d) CONSTRUCTION.—Nothing in this section or sec14 tion 713 of title 38, United States Code, as added by sub15 section (a), shall be construed to apply to an appeal of 

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

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

18 TITLE V—MAJOR MEDICAL 

19 FACILITY LEASES 

20 SEC. 501. AUTHORIZATION OF MAJOR MEDICAL FACILITY 

21 LEASES. 

22 The Secretary of Veterans Affairs may carry out the 

23 following major medical facility leases at the locations 

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


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1 the amount shown for such location (not including any es2 timated cancellation costs): 

3 (1) For a clinical research and pharmacy co4 ordinating center, Albuquerque, New Mexico, an 

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

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

7 Brick, New Jersey, an amount not to exceed 

8 $7,280,000. 

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

10 annex, Charleston, South Carolina, an amount not 

11 to exceed $7,070,250. 

12 (4) For the Cobb County community-based 

13 Outpatient Clinic, Cobb County, Georgia, an amount 

14 not to exceed $6,409,000. 

15 (5) For the Leeward Outpatient Healthcare Ac16 cess Center, Honolulu, Hawaii, including a co-lo17 cated clinic with the Department of Defense and the 

18 co-location of the Honolulu Regional Office of the 

19 Veterans Benefits Administration and the Kapolei 

20 Vet Center of the Department of Veterans Affairs, 

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

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

23 Johnson County, Kansas, an amount not to exceed 

24 $2,263,000. 


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1 (7) For a replacement community-based out2 patient clinic, Lafayette, Louisiana, an amount not 

3 to exceed $2,996,000. 

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

5 Lake Charles, Louisiana, an amount not to exceed 

6 $2,626,000. 

7 (9) For outpatient clinic consolidation, New 

8 Port Richey, Florida, an amount not to exceed 

9 $11,927,000. 

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

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

12 (11) For lease consolidation, San Antonio, 

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

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

15 San Diego, California, an amount not to exceed 

16 $11,946,100. 

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

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

19 (14) For the Errera Community Care Center, 

20 West Haven, Connecticut, an amount not to exceed 

21 $4,883,000. 

22 (15) For the Worcester community-based Out23 patient Clinic, Worcester, Massachusetts, an amount 

24 not to exceed $4,855,000. 


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

2 outpatient clinic, Cape Girardeau, Missouri, an 

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

4 (17) For a multispecialty clinic, Chattanooga, 

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

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

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

8 exceed $4,534,000. 

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

10 Chula Vista, California, an amount not to exceed 

11 $3,714,000. 

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

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

14 (21) For a replacement research lease, Hous15 ton, Texas, an amount not to exceed $6,142,000. 

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

17 Lincoln, Nebraska, an amount not to exceed 

18 $7,178,400. 

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

20 Lubbock, Texas, an amount not to exceed 

21 $8,554,000. 

22 (24) For a community-based outpatient clinic 

23 consolidation, Myrtle Beach, South Carolina, an 

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


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

2 Phoenix, Arizona, an amount not to exceed 

3 $20,757,000. 

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

5 outpatient clinic, Redding, California, an amount not 

6 to exceed $8,154,000. 

7 (27) For the expansion of a community-based 

8 outpatient clinic, Tulsa, Oklahoma, an amount not 

9 to exceed $13,269,200. 

10 SEC. 502. BUDGETARY TREATMENT OF DEPARTMENT OF 

11 VETERANS AFFAIRS MAJOR MEDICAL FACILI12 TIES LEASES. 

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

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

15 Department of Veterans Affairs to record the full 

16 cost of its contractual obligation against funds avail17 able at the time a contract is executed. 

18 (2) Office of Management and Budget Circular 

19 A–11 provides guidance to agencies in meeting the 

20 statutory requirements under title 31, United States 

21 Code, with respect to leases. 

22 (3) For operating leases, Office of Management 

23 and Budget Circular A–11 requires the Department 

24 of Veterans Affairs to record up-front budget au25 thority in an ‘‘amount equal to total payments under 


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

2 to cover first year lease payments plus cancellation 

3 costs’’. 

4 (b) REQUIREMENT FOR OBLIGATION OF FULL

5 COST.— 

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

7 appropriations provided in advance, in exercising the 

8 authority of the Secretary of Veterans Affairs to 

9 enter into leases provided in this Act, the Secretary 

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

11 United States Code, as the full cost of the contrac12 tual obligation at the time a contract is executed ei13 ther— 

14 (A) an amount equal to total payments 

15 under the full term of the lease; or 

16 (B) if the lease specifies payments to be 

17 made in the event the lease is terminated before 

18 its full term, an amount sufficient to cover the 

19 first year lease payments plus the specified can20 cellation costs. 

21 (2) SELF-INSURING AUTHORITY.—The require22 ments of paragraph (1) may be satisfied through the 

23 use of a self-insuring authority consistent with Of24 fice of Management and Budget Circular A–11. 

25 (c) TRANSPARENCY.— 


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

2 8104 of title 38, United States Code, is amended by 

3 adding at the end the following new paragraph: 

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

5 funding for a major medical facility lease, a detailed 

6 analysis of how the lease is expected to comply with 

7 Office of Management and Budget Circular A–11 

8 and section 1341 of title 31 (commonly referred to 

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

10 include— 

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

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

13 ‘operating lease’ as those terms are defined in 

14 Office of Management and Budget Circular A– 

15 11; 

16 ‘‘(B) an analysis of the obligation of budg17 etary resources associated with the lease; and 

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

19 in determining the asset cost, fair market value, 

20 and cancellation costs of the lease.’’. 

21 (2) SUBMITTAL TO CONGRESS.—Such section 

22 8104 is further amended by adding at the end the 

23 following new subsection: 

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

25 a major medical facility lease, the Secretary shall submit 


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

2 the House of Representatives— 

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

4 into the lease; 

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

6 ‘‘(C) a description and analysis of any dif7 ferences between the prospectus submitted pursuant 

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

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

10 proposed lease fully complies with Office of Manage11 ment and Budget Circular A–11. 

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

13 ensure that any information submitted to the committee 

14 under such paragraph is treated by the committee with 

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

16 the Secretary and subject to the same statutory penalties 

17 for unauthorized disclosure or use as the Secretary. 

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

19 major medical facility lease, the Secretary shall submit to 

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

21 any material differences between the lease that was en22 tered into and the proposed lease described under such 

23 paragraph, including how the lease that was entered into 

24 changes the previously submitted scoring analysis de25 scribed in subparagraph (D) of such paragraph.’’. 


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1 (d) RULE OF CONSTRUCTION.—Nothing in this sec2 tion, or the amendments made by this section, shall be 

3 construed to in any way relieve the Department of Vet4 erans Affairs from any statutory or regulatory obligations 

5 or requirements existing prior to the enactment of this 

6 section and such amendments. 


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Calendar No. 408 

113TH CONGRESS 

2D SESSION S. 2422 

A BILL 

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

JUNE 4, 2014 

Read the second time and placed on the calendar 


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