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[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[S. 2450 Placed on Calendar Senate (PCS)]

                                                       Calendar No. 426
113th CONGRESS
  2d Session
                                S. 2450

    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 9, 2014

Mr. Sanders (for himself, Mr. McCain, Mr. Merkley, Mr. Kaine, Mr. Burr, 
 Mr. Booker, Mr. Rubio, Mr. Manchin, Ms. Collins, Mr. Blumenthal, Mr. 
Murphy, Mr. Begich, Mr. Udall of New Mexico, Mrs. Hagan, Mr. Casey, Ms. 
    Hirono, Mr. Johanns, Mr. Coons, Mr. Schatz, Mr. Whitehouse, Mr. 
Isakson, Mr. Pryor, and Mr. Walsh) introduced the following bill; which 
                        was read the first time

                             June 10, 2014

            Read the second time and placed on the calendar

_______________________________________________________________________

                                 A BILL

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

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

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

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

Sec. 101. Independent assessment of the scheduling of appointments and 
                            other health care management processes of 
                            the Department of Veterans Affairs.
Sec. 102. Technology task force on review of scheduling system and 
                            software of the Department of Veterans 
                            Affairs.
           TITLE II--TRAINING AND HIRING OF HEALTH CARE STAFF

Sec. 201. Treatment of staffing shortage and biannual report on 
                            staffing of medical facilities of the 
                            Department of Veterans Affairs.
Sec. 202. Clinic management training for managers and health care 
                            providers of the Department of Veterans 
                            Affairs.
Sec. 203. Use of unobligated amounts to hire additional health care 
                            providers for the Veterans Health 
                            Administration.
    TITLE III--IMPROVEMENT OF ACCESS TO CARE FROM NON-DEPARTMENT OF 
                       VETERANS AFFAIRS PROVIDERS

Sec. 301. Expanded availability of hospital care and medical services 
                            for veterans through the use of contracts.
Sec. 302. Transfer of authority for payments for hospital care, medical 
                            services, and other health care from non-
                            Department providers to the Chief Business 
                            Office of the Veterans Health 
                            Administration of the Department.
Sec. 303. Enhancement of collaboration between Department of Veterans 
                            Affairs and Indian Health Service.
Sec. 304. Enhancement of collaboration between Department of Veterans 
                            Affairs and Native Hawaiian health care 
                            systems.
Sec. 305. Sense of Congress on prompt payment by Department of Veterans 
                            Affairs.
              TITLE IV--HEALTH CARE ADMINISTRATIVE MATTERS

Sec. 401. Improvement of access of veterans to mobile vet centers of 
                            the Department of Veterans Affairs.
Sec. 402. Commission on construction projects of the Department of 
                            Veterans Affairs.
Sec. 403. Commission on Access to Care.
Sec. 404. Improved performance metrics for health care provided by 
                            Department of Veterans Affairs.
Sec. 405. Improved transparency concerning health care provided by 
                            Department of Veterans Affairs.
Sec. 406. Information for veterans on the credentials of Department of 
                            Veterans Affairs physicians.
Sec. 407. Information in annual budget of the President on hospital 
                            care and medical services furnished through 
                            expanded use of contracts for such care.
Sec. 408. Prohibition on falsification of data concerning wait times 
                            and quality measures at Department of 
                            Veterans Affairs.
Sec. 409. Removal of Senior Executive Service employees of the 
                            Department of Veterans Affairs for 
                            performance.
             TITLE V--HEALTH CARE RELATED TO SEXUAL TRAUMA

Sec. 501. Expansion of eligibility for sexual trauma counseling and 
                            treatment to veterans on inactive duty 
                            training.
Sec. 502. Provision of counseling and treatment for sexual trauma by 
                            the Department of Veterans Affairs to 
                            members of the Armed Forces.
Sec. 503. Reports on military sexual trauma.
                TITLE VI--MAJOR MEDICAL FACILITY LEASES

Sec. 601. Authorization of major medical facility leases.
Sec. 602. Budgetary treatment of Department of Veterans Affairs major 
                            medical facilities leases.
                  TITLE VII--VETERANS BENEFITS MATTERS

Sec. 701. Expansion of Marine Gunnery Sergeant John David Fry 
                            Scholarship.
Sec. 702. Approval of courses of education provided by public 
                            institutions of higher learning for 
                            purposes of All-Volunteer Force Educational 
                            Assistance Program and Post-9/11 
                            Educational Assistance conditional on in-
                            State tuition rate for veterans.
          TITLE VIII--APPROPRIATION AND EMERGENCY DESIGNATIONS

Sec. 801. Appropriation of emergency amounts.
Sec. 802. Emergency designations.

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

SEC. 101. INDEPENDENT ASSESSMENT OF THE SCHEDULING OF APPOINTMENTS AND 
              OTHER HEALTH CARE MANAGEMENT PROCESSES OF THE DEPARTMENT 
              OF VETERANS AFFAIRS.

    (a) Independent Assessment.--
            (1) Assessment.--Not later than 30 days after the date of 
        the enactment of this Act, the Secretary of Veterans Affairs 
        shall enter into a contract with an independent third party to 
        assess the following:
                    (A) The process at each medical facility of the 
                Department of Veterans Affairs for scheduling 
                appointments for veterans to receive hospital care, 
                medical services, or other health care from the 
                Department.
                    (B) The staffing level and productivity of each 
                medical facility of the Department, including the 
                following:
                            (i) The case load of each health care 
                        provider of the Department.
                            (ii) The time spent by each health care 
                        provider of the Department on matters other 
                        than the case load of such health care 
                        provider, including time spent by such health 
                        care provider as follows:
                                    (I) At a medical facility that is 
                                affiliated with the Department.
                                    (II) Conducting research.
                                    (III) Training or overseeing other 
                                health care professionals of the 
                                Department.
                    (C) The organization, processes, and tools used by 
                the Department to support clinical documentation and 
                the subsequent coding of inpatient services.
                    (D) The purchasing, distribution, and use of 
                pharmaceuticals, medical and surgical supplies, and 
                medical devices by the Department, including the 
                following:
                            (i) The prices paid for, standardization 
                        of, and use by the Department of the following:
                                    (I) High-cost pharmaceuticals.
                                    (II) Medical and surgical supplies.
                                    (III) Medical devices.
                            (ii) The use by the Department of group 
                        purchasing arrangements to purchase 
                        pharmaceuticals, medical and surgical supplies, 
                        medical devices, and health care related 
                        services.
                            (iii) The strategy used by the Department 
                        to distribute pharmaceuticals, medical and 
                        surgical supplies, and medical devices to 
                        Veterans Integrated Service Networks and 
                        medical facilities of the Department.
                    (E) The performance of the Department in paying 
                amounts owed to third parties and collecting amounts 
                owed to the Department with respect to hospital care, 
                medical services, and other health care, including any 
                recommendations of the independent third party as 
                follows:
                            (i) To avoid the payment of penalties to 
                        vendors.
                            (ii) To increase the collection of amounts 
                        owed to the Department for hospital care, 
                        medical services, or other health care provided 
                        by the Department for which reimbursement from 
                        a third party is authorized.
                            (iii) To increase the collection of any 
                        other amounts owed to the Department.
            (2) Elements of scheduling assessment.--In carrying out the 
        assessment required by paragraph (1)(A), the independent third 
        party shall do the following:
                    (A) Review all training materials pertaining to 
                scheduling of appointments at each medical facility of 
                the Department.
                    (B) Assess whether all employees of the Department 
                conducting tasks related to scheduling are properly 
                trained for conducting such tasks.
                    (C) Assess whether changes in the technology or 
                system used in scheduling appointments are necessary to 
                limit access to the system to only those employees that 
                have been properly trained in conducting such tasks.
                    (D) Assess whether health care providers of the 
                Department are making changes to their schedules that 
                hinder the ability of employees conducting such tasks 
                to perform such tasks.
                    (E) Assess whether the establishment of a 
                centralized call center throughout the Department for 
                scheduling appointments at medical facilities of the 
                Department would improve the process of scheduling such 
                appointments.
                    (F) Assess whether booking templates for each 
                medical facility or clinic of the Department would 
                improve the process of scheduling such appointments.
                    (G) Recommend any actions to be taken by the 
                Department to improve the process for scheduling such 
                appointments, including the following:
                            (i) Changes in training materials provided 
                        to employees of the Department with respect to 
                        conducting tasks related to scheduling such 
                        appointments.
                            (ii) Changes in monitoring and assessment 
                        conducted by the Department of wait times of 
                        veterans for such appointments.
                            (iii) Changes in the system used to 
                        schedule such appointments, including changes 
                        to improve how the Department--
                                    (I) measures wait times of veterans 
                                for such appointments;
                                    (II) monitors the availability of 
                                health care providers of the 
                                Department; and
                                    (III) provides veterans the ability 
                                to schedule such appointments.
                            (iv) Such other actions as the independent 
                        third party considers appropriate.
            (3) Timing.--The independent third party carrying out the 
        assessment required by paragraph (1) shall complete such 
        assessment not later than 180 days after entering into the 
        contract described in such paragraph.
    (b) Report.--
            (1) In general.--Not later than 90 days after the date on 
        which the independent third party completes the assessment 
        under this section, the Secretary shall submit to the Committee 
        on Veterans' Affairs of the Senate and the Committee on 
        Veterans' Affairs of the House of Representatives a report on 
        the results of such assessment.
            (2) Publication.--Not later than 30 days after submitting 
        the report under paragraph (1), the Secretary shall publish 
        such report in the Federal Register and on an Internet website 
        of the Department accessible to the public.

SEC. 102. TECHNOLOGY TASK FORCE ON REVIEW OF SCHEDULING SYSTEM AND 
              SOFTWARE OF THE DEPARTMENT OF VETERANS AFFAIRS.

    (a) Task Force Review.--
            (1) In general.--The Secretary of Veterans Affairs shall, 
        through the use of a technology task force, conduct a review of 
        the needs of the Department of Veterans Affairs with respect to 
        the scheduling system and scheduling software of the Department 
        of Veterans Affairs that is used by the Department to schedule 
        appointments for veterans for hospital care, medical services, 
        and other health care from the Department.
            (2) Agreement.--
                    (A) In general.--The Secretary shall seek to enter 
                into an agreement with a technology organization or 
                technology organizations to carry out the review 
                required by paragraph (1).
                    (B) Prohibition on use of funds.--No Federal funds 
                may be used to assist the technology organization or 
                technology organizations under subparagraph (A) in 
                carrying out the review required by paragraph (1).
    (b) Report.--
            (1) In general.--Not later than 45 days after the date of 
        the enactment of this Act, the technology task force required 
        under subsection (a)(1) shall submit to the Secretary, the 
        Committee on Veterans' Affairs of the Senate, and the Committee 
        on Veterans' Affairs of the House of Representatives a report 
        setting forth the findings and recommendations of the 
        technology task force regarding the needs of the Department 
        with respect to the scheduling system and scheduling software 
        of the Department described in such subsection.
            (2) Elements.--The report required by paragraph (1) shall 
        include the following:
                    (A) Proposals for specific actions to be taken by 
                the Department to improve the scheduling system and 
                scheduling software of the Department described in 
                subsection (a)(1).
                    (B) A determination as to whether an existing off-
                the-shelf system would--
                            (i) meet the needs of the Department to 
                        schedule appointments for veterans for hospital 
                        care, medical services, and other health care 
                        from the Department; and
                            (ii) improve the access of veterans to such 
                        care and services.
            (3) Publication.--Not later than 30 days after the receipt 
        of the report required by paragraph (1), the Secretary shall 
        publish such report in the Federal Register and on an Internet 
        website of the Department accessible to the public.
    (c) Implementation of Task Force Recommendations.--Not later than 
one year after the receipt of the report required by subsection (b)(1), 
the Secretary shall implement the recommendations set forth in such 
report that the Secretary considers are feasible, advisable, and cost-
effective.

           TITLE II--TRAINING AND HIRING OF HEALTH CARE STAFF

SEC. 201. TREATMENT OF STAFFING SHORTAGE AND BIANNUAL REPORT ON 
              STAFFING OF MEDICAL FACILITIES OF THE DEPARTMENT OF 
              VETERANS AFFAIRS.

    (a) Staffing Shortage.--
            (1) In general.--Not later than 180 days after the date of 
        the enactment of this Act, and not later than September 30 each 
        year thereafter, the Inspector General of the Department of 
        Veterans Affairs shall determine, and the Secretary of Veterans 
        Affairs shall publish in the Federal Register, the five 
        occupations of health care providers of the Department of 
        Veterans Affairs for which there is the largest staffing 
        shortage throughout the Department.
            (2) Recruitment and appointment.--Notwithstanding sections 
        3304 and 3309 through 3318 of title 5, United States Code, the 
        Secretary may, upon a determination by the Inspector General 
        under paragraph (1) that there is a staffing shortage 
        throughout the Department with respect to a particular 
        occupation of health care provider, recruit and directly 
        appoint highly qualified health care providers to serve as 
        health care providers in that particular occupation for the 
        Department.
            (3) Priority in health professionals educational assistance 
        program to certain providers.--Section 7612(b)(5) of title 38, 
        United States Code, is amended--
                    (A) in subparagraph (A), by striking ``and'' at the 
                end;
                    (B) by redesignating subparagraph (B) as 
                subparagraph (C); and
                    (C) by inserting after subparagraph (A) the 
                following new subparagraph (B):
            ``(B) shall give priority to applicants pursuing a course 
        of education or training towards a career in an occupation for 
        which the Secretary has, in the most current determination 
        published in the Federal Register pursuant to section 201(a)(1) 
        of the Veterans' Access to Care through Choice, Accountability, 
        and Transparency Act of 2014, determined that there is one of 
        the largest staffing shortages throughout the Department with 
        respect to such occupation; and''.
    (b) Reports.--
            (1) In general.--Not later than 180 days after the date of 
        the enactment of this Act, and not later than December 31 of 
        each even numbered year thereafter until 2024, the Secretary of 
        Veterans Affairs shall submit to the Committee on Veterans' 
        Affairs of the Senate and the Committee on Veterans' Affairs of 
        the House of Representatives a report assessing the staffing of 
        each medical facility of the Department of Veterans Affairs.
            (2) Elements.--Each report submitted under paragraph (1) 
        shall include the following:
                    (A) The results of a system-wide assessment of all 
                medical facilities of the Department to ensure the 
                following:
                            (i) Appropriate staffing levels for health 
                        care providers to meet the goals of the 
                        Secretary for timely access to care for 
                        veterans.
                            (ii) Appropriate staffing levels for 
                        support personnel, including clerks.
                            (iii) Appropriate sizes for clinical 
                        panels.
                            (iv) Appropriate numbers of full-time 
                        staff, or full-time equivalents, dedicated to 
                        direct care of patients.
                            (v) Appropriate physical plant space to 
                        meet the capacity needs of the Department in 
                        that area.
                            (vi) Such other factors as the Secretary 
                        considers necessary.
                    (B) A plan for addressing any issues identified in 
                the assessment described in subparagraph (A), including 
                a timeline for addressing such issues.
                    (C) A list of the current wait times and workload 
                levels for the following clinics in each medical 
                facility:
                            (i) Mental health.
                            (ii) Primary care.
                            (iii) Gastroenterology.
                            (iv) Women's health.
                            (v) Such other clinics as the Secretary 
                        considers appropriate.
                    (D) A description of the results of the most 
                current determination of the Inspector General under 
                paragraph (1) of subsection (a) and a plan to use 
                direct appointment authority under paragraph (2) of 
                such subsection to fill staffing shortages, including 
                recommendations for improving the speed at which the 
                credentialing and privileging process can be conducted.
                    (E) The current staffing models of the Department 
                for the following clinics, including recommendations 
                for changes to such models:
                            (i) Mental health.
                            (ii) Primary care.
                            (iii) Gastroenterology.
                            (iv) Women's health.
                            (v) Such other clinics as the Secretary 
                        considers appropriate.
                    (F) A detailed analysis of succession planning at 
                medical facilities of the Department, including the 
                following:
                            (i) The number of positions in medical 
                        facilities throughout the Department that are 
                        not filled by a permanent employee.
                            (ii) The length of time each position 
                        described in clause (i) remained vacant or 
                        filled by a temporary or acting employee.
                            (iii) A description of any barriers to 
                        filling the positions described in clause (i).
                            (iv) A plan for filling any positions that 
                        are vacant or filled by a temporary or acting 
                        employee for more than 180 days.
                            (v) A plan for handling emergency 
                        circumstances, such as administrative leave or 
                        sudden medical leave for senior officials.
                    (G) The number of health care providers of the 
                Department who have been removed from their positions, 
                have retired, or have left their positions for another 
                reason, disaggregated by provider type, during the two-
                year period preceding the submittal of the report.
                    (H) Of the health care providers specified in 
                subparagraph (G) who have been removed from their 
                positions, the following:
                            (i) The number of such health care 
                        providers who were reassigned to other 
                        positions in the Department.
                            (ii) The number of such health care 
                        providers who left the Department.
                            (iii) The number of such health care 
                        providers who left the Department and were 
                        subsequently rehired by the Department.

SEC. 202. CLINIC MANAGEMENT TRAINING FOR MANAGERS AND HEALTH CARE 
              PROVIDERS OF THE DEPARTMENT OF VETERANS AFFAIRS.

    (a) Clinic Management Training Program.--
            (1) In general.--Not later than 180 days after the date of 
        the enactment of this Act, the Secretary of Veterans Affairs 
        shall commence a clinic management training program to provide 
        in-person, standardized education on health care management to 
        all managers of, and health care providers at, medical 
        facilities of the Department of Veterans Affairs.
            (2) Elements.--The clinic management training program 
        required by paragraph (1) shall include the following:
                    (A) Training on how to manage the schedules of 
                health care providers of the Department, including the 
                following:
                            (i) Maintaining such schedules in a manner 
                        that allows appointments to be booked at least 
                        eight weeks in advance.
                            (ii) Proper planning procedures for 
                        vacation, leave, and graduate medical education 
                        training schedules.
                    (B) Training on the appropriate number of 
                appointments that a health care provider should conduct 
                on a daily basis, based on specialty.
                    (C) Training on how to determine whether there are 
                enough available appointment slots to manage demand for 
                different appointment types and mechanisms for alerting 
                management of insufficient slots.
                    (D) Training on how to properly use the appointment 
                scheduling system of the Department, including any new 
                scheduling system implemented by the Department.
                    (E) Training on how to optimize the use of 
                technology, including the following:
                            (i) Telemedicine.
                            (ii) Electronic mail.
                            (iii) Text messaging.
                            (iv) Such other technologies as specified 
                        by the Secretary.
                    (F) Training on how to properly use physical plant 
                space at medical facilities of the Department to ensure 
                efficient flow and privacy for patients and staff.
            (3) Sunset.--The clinic management training program 
        required by paragraph (1) shall terminate on the date that is 
        two years after the date on which the Secretary commences such 
        program.
    (b) Training Materials.--
            (1) In general.--After the termination of the clinic 
        management training program required by subsection (a), the 
        Secretary shall provide training materials on health care 
        management to each of the following employees of the Department 
        upon the commencement of employment of such employee:
                    (A) Any manager of a medical facility of the 
                Department.
                    (B) Any health care provider at a medical facility 
                of the Department.
                    (C) Such other employees of the Department as the 
                Secretary considers appropriate.
            (2) Update.--The Secretary shall regularly update the 
        training materials required under paragraph (1).

SEC. 203. USE OF UNOBLIGATED AMOUNTS TO HIRE ADDITIONAL HEALTH CARE 
              PROVIDERS FOR THE VETERANS HEALTH ADMINISTRATION.

    (a) In General.--At the end of each of fiscal years 2014 and 2015, 
all covered amounts shall be made available to the Secretary of 
Veterans Affairs to hire additional health care providers for the 
Veterans Health Administration of the Department of Veterans Affairs, 
or to carry out any provision of this Act or the amendments made by 
this Act, and shall remain available until expended.
    (b) Priority in Hiring.--The Secretary shall prioritize hiring 
additional health care providers under subsection (a) at medical 
facilities of the Department and in geographic areas in which the 
Secretary identifies the greatest shortage of health care providers.
    (c) Covered Amounts Defined.--In this section, the term ``covered 
amounts'' means amounts--
            (1) that are made available to the Veterans Health 
        Administration of the Department for an appropriations 
        account--
                    (A) under the heading ``medical services'';
                    (B) under the heading ``medical support and 
                compliance''; or
                    (C) under the heading ``medical facilities''; and
            (2) that are unobligated at the end of the applicable 
        fiscal year.

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

SEC. 301. EXPANDED AVAILABILITY OF HOSPITAL CARE AND MEDICAL SERVICES 
              FOR VETERANS THROUGH THE USE OF CONTRACTS.

    (a) Expansion of Available Care and Services.--
            (1) Furnishing of care.--
                    (A) In general.--Hospital care and medical services 
                under chapter 17 of title 38, United States Code, shall 
                be furnished to an eligible veteran described in 
                subsection (b), at the election of such veteran, 
                through contracts authorized under subsection (d), or 
                any other law administered by the Secretary of Veterans 
                Affairs, with entities specified in subparagraph (B) 
                for the furnishing of such care and services to 
                veterans.
                    (B) Entities specified.--The entities specified in 
                this subparagraph are the following:
                            (i) Any health care provider that is 
                        participating in the Medicare program under 
                        title XVIII of the Social Security Act (42 
                        U.S.C. 1395 et seq.).
                            (ii) Any Federally-qualified health center 
                        (as defined in section 1905(l)(2)(B) of the 
                        Social Security Act (42 U.S.C. 
                        1396d(l)(2)(B))).
                            (iii) The Department of Defense.
                            (iv) The Indian Health Service.
            (2) Choice of provider.--An eligible veteran who elects to 
        receive care and services under this section may select the 
        provider of such care and services from among any source of 
        provider of such care and services through an entity specified 
        in paragraph (1)(B) that is accessible to the veteran.
            (3) Coordination of care and services.--The Secretary shall 
        coordinate, through the Non-VA Care Coordination Program of the 
        Department of Veterans Affairs, the furnishing of care and 
        services under this section to eligible veterans, including by 
        ensuring that an eligible veteran receives an appointment for 
        such care and services within the current wait-time goals of 
        the Veterans Health Administration for the furnishing of 
        hospital care and medical services.
    (b) Eligible Veterans.--A veteran is an eligible veteran for 
purposes of this section if--
            (1)(A) the veteran is enrolled in the patient enrollment 
        system of the Department of Veterans Affairs established and 
        operated under section 1705 of title 38, United States Code; or
            (B) the veteran is enrolled in such system, has not 
        received hospital care or medical services from the Department, 
        and has contacted the Department seeking an initial appointment 
        from the Department for the receipt of such care or services; 
        and
            (2) the veteran--
                    (A)(i) attempts, or has attempted under paragraph 
                (1)(B), to schedule an appointment for the receipt of 
                hospital care or medical services under chapter 17 of 
                title 38, United States Code, but is unable to schedule 
                an appointment within the current wait-time goals of 
                the Veterans Health Administration for the furnishing 
                of such care or services; and
                    (ii) elects, and is authorized, to be furnished 
                such care or services pursuant to subsection (c)(2);
                    (B) resides more than 40 miles from the nearest 
                medical facility of the Department, including a 
                community-based outpatient clinic, that is closest to 
                the residence of the veteran; or
                    (C) resides--
                            (i) in a State without a medical facility 
                        of the Department that provides--
                                    (I) hospital care;
                                    (II) emergency medical services; 
                                and
                                    (III) surgical care rated by the 
                                Secretary as having a surgical 
                                complexity of standard; and
                            (ii) more than 20 miles from a medical 
                        facility of the Department described in clause 
                        (i).
    (c) Election and Authorization.--
            (1) In general.--If the Secretary confirms that an 
        appointment for an eligible veteran described in subsection 
        (b)(2)(A) for the receipt of hospital care or medical services 
        under chapter 17 of title 38, United States Code, is 
        unavailable within the current wait-time goals of the 
        Department for the furnishing of such care or services, the 
        Secretary shall, at the election of the eligible veteran--
                    (A) place such eligible veteran on an electronic 
                waiting list described in paragraph (2) for such an 
                appointment; or
                    (B)(i) authorize that such care and services be 
                furnished to the eligible veteran under this section 
                for a period of time specified by the Secretary; and
                    (ii) send a letter to the eligible veteran 
                describing the care and services the eligible veteran 
                is eligible to receive under this section.
            (2) Electronic waiting list.--The electronic waiting list 
        described in this paragraph shall be maintained by the 
        Department and allow access by each eligible veteran via 
        www.myhealth.va.gov or any successor website for the following 
        purposes:
                    (A) To determine the place of such eligible veteran 
                on the waiting list.
                    (B) To determine the average length of time an 
                individual spends on the waiting list, disaggregated by 
                medical facility of the Department and type of care or 
                service needed, for purposes of allowing such eligible 
                veteran to make an informed election under paragraph 
                (1).
    (d) Care and Services Through Contracts.--
            (1) In general.--The Secretary shall enter into contracts 
        with health care providers that are participating in the 
        Medicare program under title XVIII of the Social Security Act 
        (42 U.S.C. 1395 et seq.) to furnish care and services to 
        eligible veterans under this section.
            (2) Rates and reimbursement.--
                    (A) In general.--In entering into a contract under 
                this subsection, the Secretary shall--
                            (i) negotiate rates for the furnishing of 
                        care and services under this section; and
                            (ii) reimburse the health care provider for 
                        such care and services at the rates negotiated 
                        pursuant to clause (i) as provided in such 
                        contract.
                    (B) Limit on rates.--
                            (i) In general.--Except as provided in 
                        clause (ii), rates negotiated under 
                        subparagraph (A)(i) shall not be more than the 
                        rates paid by the United States to a provider 
                        of services (as defined in section 1861(u) of 
                        the Social Security Act (42 U.S.C. 1395x(u))) 
                        or a supplier (as defined in section 1861(d) of 
                        such Act (42 U.S.C. 1395x(d))) under the 
                        Medicare program under title XVIII of the 
                        Social Security Act (42 U.S.C. 1395 et seq.) 
                        for the same care and services.
                            (ii) Exception.--The Secretary may 
                        negotiate a rate that is more than the rate 
                        paid by the United States as described in 
                        clause (i) with respect to the furnishing of 
                        care or services under this section to an 
                        eligible veteran if the Secretary determines 
                        that there is no health care provider that will 
                        provide such care or services to such eligible 
                        veteran at the rate required under such 
                        clause--
                                    (I) within the current wait-time 
                                goals of the Veterans Health 
                                Administration for the furnishing of 
                                such care or services; and
                                    (II) at a location not more than 40 
                                miles from the residence of such 
                                eligible veteran.
                    (C) Limit on collection.--For the furnishing of 
                care and services pursuant to a contract under this 
                section, a health care provider may not collect any 
                amount that is greater than the rate negotiated 
                pursuant to subparagraph (A)(i).
            (3) Information on policies and procedures.--The Secretary 
        shall provide to any health care provider with which the 
        Secretary has entered into a contract under paragraph (1) the 
        following:
                    (A) Information on applicable policies and 
                procedures for submitting bills or claims for 
                authorized care and services furnished to eligible 
                veterans under this section.
                    (B) Access to a telephone hotline maintained by the 
                Department that such health care provider may call for 
                information on the following:
                            (i) Procedures for furnishing care and 
                        services under this section.
                            (ii) Procedures for submitting bills or 
                        claims for authorized care and services 
                        furnished to eligible veterans under this 
                        section and being reimbursed for furnishing 
                        such care and services.
                            (iii) Whether particular care or services 
                        under this section are authorized, and the 
                        procedures for authorization of such care or 
                        services.
    (e) Choice Card.--
            (1) In general.--For purposes of receiving care and 
        services under this section, the Secretary shall issue to each 
        eligible veteran a card that the eligible veteran shall present 
        to a health care provider that is eligible to furnish care and 
        services under this section before receiving such care and 
        services.
            (2) Name of card.--Each card issued under paragraph (1) 
        shall be known as a ``Choice Card''.
            (3) Details of card.--Each Choice Card issued to an 
        eligible veteran under paragraph (1) shall include the 
        following:
                    (A) The name of the eligible veteran.
                    (B) An identification number for the eligible 
                veteran that is not the social security number of the 
                eligible veteran.
                    (C) The contact information of an appropriate 
                office of the Department for health care providers to 
                confirm that care and services under this section are 
                authorized for the eligible veteran.
                    (D) Contact information and other relevant 
                information for the submittal of claims or bills for 
                the furnishing of care and services under this section.
                    (E) The following statement: ``This card is for 
                qualifying medical care outside the Department of 
                Veterans Affairs. Please call the Department of 
                Veterans Affairs phone number specified on this card to 
                ensure that treatment has been authorized.''.
            (4) Information on use of card.--Upon issuing a Choice Card 
        to an eligible veteran, the Secretary shall provide the 
        eligible veteran with information clearly stating the 
        circumstances under which the veteran may be eligible for care 
        and services under this section.
    (f) Information on Availability of Care.--The Secretary shall 
provide information to a veteran about the availability of care and 
services under this section in the following circumstances:
            (1) When the veteran enrolls in the patient enrollment 
        system of the Department under section 1705 of title 38, United 
        States Code.
            (2) When the veteran attempts to schedule an appointment 
        for the receipt of hospital care or medical services from the 
        Department but is unable to schedule an appointment within the 
        current wait-time goals of the Veterans Health Administration 
        for delivery of such care or services.
    (g) Providers.--To be eligible to furnish care and services under 
this section, a health care provider must--
            (1) maintain at least the same or similar credentials and 
        licenses as those credentials and licenses that are required of 
        health care providers of the Department, as determined by the 
        Secretary for purposes of this section; and
            (2) submit, not less frequently than once each year, 
        verification of such licenses and credentials maintained by 
        such health care provider.
    (h) Cost-sharing.--
            (1) In general.--The Secretary shall require an eligible 
        veteran to pay a copayment to the Department for the receipt of 
        care and services under this section only if such eligible 
        veteran would be required to pay such copayment for the receipt 
        of such care and services at a medical facility of the 
        Department.
            (2) Limitation.--The copayment required under paragraph (1) 
        shall not be greater than the copayment required of such 
        eligible veteran by the Department for the receipt of such care 
        and services at a medical facility of the Department.
    (i) Claims Processing System.--
            (1) In general.--The Secretary shall provide for an 
        efficient nationwide system for processing and paying bills or 
        claims for authorized care and services furnished to eligible 
        veterans under this section.
            (2) Regulations.--Not later than 90 days after the date of 
        the enactment of this Act, the Secretary of Veterans Affairs 
        shall prescribe regulations for the implementation of such 
        system.
            (3) Oversight.--The Chief Business Office of the Veterans 
        Health Administration shall oversee the implementation and 
        maintenance of such system.
            (4) Accuracy of payment.--
                    (A) In general.--The Secretary shall ensure that 
                such system meets such goals for accuracy of payment as 
                the Secretary shall specify for purposes of this 
                section.
                    (B) Annual report.--
                            (i) In general.--Not later than one year 
                        after the date of the enactment of this Act, 
                        and annually thereafter until the termination 
                        date specified in subsection (n), the Secretary 
                        shall submit to the Committee on Veterans' 
                        Affairs of the Senate and the Committee on 
                        Veterans' Affairs of the House of 
                        Representatives a report on the goals for 
                        accuracy of such system.
                            (ii) Elements.--Each report required by 
                        clause (i) shall include the following:
                                    (I) A description of the goals for 
                                accuracy for such system specified by 
                                the Secretary under subparagraph (A).
                                    (II) An assessment of the success 
                                of the Department in meeting such goals 
                                during the year preceding the submittal 
                                of the report.
    (j) Medical Records.--The Secretary shall ensure that any health 
care provider that furnishes care and services under this section to an 
eligible veteran submits to the Department any medical record related 
to the care and services provided to such eligible veteran by such 
health care provider for inclusion in the electronic medical record of 
such eligible veteran maintained by the Department upon the completion 
of the provision of such care and services to such eligible veteran.
    (k) Tracking of Missed Appointments.--The Secretary shall implement 
a mechanism to track any missed appointments for care and services 
under this section by eligible veterans to ensure that the Department 
does not pay for such care and services that were not furnished to an 
eligible veteran.
    (l) Implementation.--Not later than 90 days after the date of the 
enactment of this Act, the Secretary shall prescribe interim final 
regulations on the implementation of this section and publish such 
regulations in the Federal Register.
    (m) Inspector General Report.--Not later than 540 days after the 
publication of the interim final regulations under subsection (l), the 
Inspector General of the Department shall submit to the Secretary a 
report on the results of an audit of the care and services furnished 
under this section to ensure the accuracy and timeliness of payments by 
the Department for the cost of such care and services, including any 
findings and recommendations of the Inspector General.
    (n) Termination.--The requirement of the Secretary to furnish care 
and services under this section terminates on the date that is two 
years after the date on which the Secretary publishes the interim final 
regulations under subsection (l).
    (o) Reports.--
            (1) Initial report.--Not later than 90 days after the 
        publication of the interim final regulations under subsection 
        (l), the Secretary shall submit to the Committee on Veterans' 
        Affairs of the Senate and the Committee on Veterans' Affairs of 
        the House of Representatives a report on the furnishing of care 
        and services under this section that includes the following:
                    (A) The number of eligible veterans who have 
                received care and services under this section.
                    (B) A description of the type of care and services 
                furnished to eligible veterans under this section.
            (2) Final report.--Not later than 540 days after the 
        publication of the interim final regulations under subsection 
        (l), the Secretary shall submit to the Committee on Veterans' 
        Affairs of the Senate and the Committee on Veterans' Affairs of 
        the House of Representatives a report on the furnishing of care 
        and services under this section that includes the following:
                    (A) The total number of eligible veterans who have 
                received care and services under this section, 
                disaggregated by--
                            (i) eligible veterans described in 
                        subsection (b)(2)(A); and
                            (ii) eligible veterans described in 
                        subsection (b)(2)(B).
                    (B) A description of the type of care and services 
                furnished to eligible veterans under this section.
                    (C) An accounting of the total cost of furnishing 
                care and services to eligible veterans under this 
                section.
                    (D) The results of a survey of eligible veterans 
                who have received care or services under this section 
                on the satisfaction of such eligible veterans with the 
                care or services received by such eligible veterans 
                under this section.
                    (E) An assessment of the effect of furnishing care 
                and services under this section on wait times for an 
                appointment for the receipt of hospital care and 
                medical services from the Department.
                    (F) An assessment of the feasibility and 
                advisability of continuing furnishing care and services 
                under this section after the termination date specified 
                in subsection (n).
    (p) Rules of Construction.--
            (1) No modification of contracts.--Nothing in this section 
        shall be construed to require the Secretary to renegotiate 
        contracts for the furnishing of hospital care or medical 
        services to veterans entered into by the Department before the 
        date of the enactment of this Act.
            (2) Filling and paying for prescription medications.--
        Nothing in this section shall be construed to alter the process 
        of the Department for filling and paying for prescription 
        medications.

SEC. 302. TRANSFER OF AUTHORITY FOR PAYMENTS FOR HOSPITAL CARE, MEDICAL 
              SERVICES, AND OTHER HEALTH CARE FROM NON-DEPARTMENT 
              PROVIDERS TO THE CHIEF BUSINESS OFFICE OF THE VETERANS 
              HEALTH ADMINISTRATION OF THE DEPARTMENT.

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

SEC. 303. ENHANCEMENT OF COLLABORATION BETWEEN DEPARTMENT OF VETERANS 
              AFFAIRS AND INDIAN HEALTH SERVICE.

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

SEC. 304. ENHANCEMENT OF COLLABORATION BETWEEN DEPARTMENT OF VETERANS 
              AFFAIRS AND NATIVE HAWAIIAN HEALTH CARE SYSTEMS.

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

SEC. 305. SENSE OF CONGRESS ON PROMPT PAYMENT BY DEPARTMENT OF VETERANS 
              AFFAIRS.

    It is the sense of Congress that the Secretary of Veterans Affairs 
shall comply with section 1315 of title 5, Code of Federal Regulations 
(commonly known as the ``prompt payment rule''), or any corresponding 
similar regulation or ruling, in paying for health care pursuant to 
contracts entered into with non-Department of Veterans Affairs 
providers to provide health care under the laws administered by the 
Secretary.

              TITLE IV--HEALTH CARE ADMINISTRATIVE MATTERS

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

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

SEC. 402. COMMISSION ON CONSTRUCTION PROJECTS OF THE DEPARTMENT OF 
              VETERANS AFFAIRS.

    (a) Establishment of Commission.--
            (1) Establishment.--There is established an Independent 
        Commission on Department of Veterans Affairs Construction 
        Projects (in this section referred to as the ``Commission'').
            (2) Membership.--
                    (A) Voting members.--The Commission shall be 
                composed of 10 voting members as follows:
                            (i) Three members to be appointed by the 
                        President from among members of the National 
                        Academy of Engineering who are nominated under 
                        subparagraph (B).
                            (ii) Three members to be appointed by the 
                        President from among members of the National 
                        Institute of Building Sciences who are 
                        nominated under subparagraph (B).
                            (iii) Four members to be appointed by the 
                        President from among veterans enrolled in the 
                        patient enrollment system of the Department of 
                        Veterans Affairs under section 1705 of title 
                        38, United States Code, who are nominated under 
                        subparagraph (B).
                    (B) Nomination of voting members.--The majority 
                leader of the Senate, the minority leader of the 
                Senate, the speaker of the House of Representatives, 
                and the minority leader of the House of Representatives 
                shall jointly nominate not less than 24 individuals to 
                be considered by the President for appointment under 
                subparagraph (A).
                    (C) Nonvoting members.--The Commission shall be 
                composed of the following nonvoting members:
                            (i) The Comptroller General of the United 
                        States, or designee.
                            (ii) The Secretary of Veterans Affairs, or 
                        designee.
                            (iii) The Inspector General of the 
                        Department of Veterans Affairs, or designee.
                    (D) Date of appointment of members.--The 
                appointments of the members of the Commission under 
                subparagraph (A) shall be made not later than 14 days 
                after the date of the enactment of this Act.
            (3) Period of appointment; vacancies.--Members shall be 
        appointed for the life of the Commission. Any vacancy in the 
        Commission shall not affect its powers, but shall be filled in 
        the same manner as the original appointment.
            (4) Initial meeting.--Not later than five days after the 
        date on which all members of the Commission have been 
        appointed, the Commission shall hold its first meeting.
            (5) Meetings.--The Commission shall meet at the call of the 
        Chairperson.
            (6) Quorum.--A majority of the members of the Commission 
        shall constitute a quorum, but a lesser number of members may 
        hold hearings.
            (7) Chairperson and vice chairperson.--The Commission shall 
        select a Chairperson and Vice Chairperson from among its 
        members.
    (b) Duties of Commission.--
            (1) Review.--The Commission shall review current 
        construction and maintenance projects and the medical facility 
        leasing program of the Department of Veterans Affairs to 
        identify any problems experienced by the Department in carrying 
        out such projects and program.
            (2) Reports.--
                    (A) Commission report.--Not later than 120 days 
                after the date of the enactment of this Act, the 
                Commission shall submit to the Secretary of Veterans 
                Affairs, the Committee on Veterans' Affairs of the 
                Senate, and the Committee on Veterans' Affairs of the 
                House of Representatives a report setting forth 
                recommendations, if any, for improving the manner in 
                which the Secretary carries out the projects and 
                program specified in paragraph (1).
                    (B) Department report.--Not later than 60 days 
                after the submittal of the report under subparagraph 
                (A), the Secretary of Veterans Affairs shall submit to 
                the Committee on Veterans' Affairs of the Senate and 
                the Committee on Veterans' Affairs of the House of 
                Representatives a report on the feasibility and 
                advisability of implementing the recommendations of the 
                Commission, if any, included in the report submitted 
                under such subparagraph, including a timeline for the 
                implementation of such recommendations.
    (c) Powers of Commission.--
            (1) Hearings.--The Commission may hold such hearings, sit 
        and act at such times and places, take such testimony, and 
        receive such evidence as the Commission considers advisable to 
        carry out this section.
            (2) Information from federal agencies.--The Commission may 
        secure directly from any Federal agency such information as the 
        Commission considers necessary to carry out this section. Upon 
        request of the Chairperson of the Commission, the head of such 
        agency shall furnish such information to the Commission.
    (d) Commission Personnel Matters.--
            (1) Compensation of members.--Each member of the Commission 
        who is not an officer or employee of the Federal Government 
        shall be compensated at a rate equal to the daily equivalent of 
        the annual rate of basic pay prescribed for level IV of the 
        Executive Schedule under section 5315 of title 5, United States 
        Code, for each day (including travel time) during which such 
        member is engaged in the performance of the duties of the 
        Commission. All members of the Commission who are officers or 
        employees of the United States shall serve without compensation 
        in addition to that received for their services as officers or 
        employees of the United States.
            (2) Travel expenses.--The members of the Commission shall 
        be allowed travel expenses, including per diem in lieu of 
        subsistence, at rates authorized for employees of agencies 
        under subchapter I of chapter 57 of title 5, United States 
        Code, while away from their homes or regular places of business 
        in the performance of services for the Commission.
            (3) Staff.--
                    (A) In general.--The Chairperson of the Commission 
                may, without regard to the civil service laws and 
                regulations, appoint and terminate an executive 
                director and such other additional personnel as may be 
                necessary to enable the Commission to perform its 
                duties. The employment of an executive director shall 
                be subject to confirmation by the Commission.
                    (B) Compensation.--The Chairperson of the 
                Commission may fix the compensation of the executive 
                director and other personnel without regard to chapter 
                51 and subchapter III of chapter 53 of title 5, United 
                States Code, relating to classification of positions 
                and General Schedule pay rates, except that the rate of 
                pay for the executive director and other personnel may 
                not exceed the rate payable for level V of the 
                Executive Schedule under section 5316 of such title.
            (4) Detail of government employees.--Any Federal Government 
        employee may be detailed to the Commission without 
        reimbursement, and such detail shall be without interruption or 
        loss of civil service status or privilege.
            (5) Procurement of temporary and intermittent services.--
        The Chairperson of the Commission may procure temporary and 
        intermittent services under section 3109(b) of title 5, United 
        States Code, at rates for individuals that do not exceed the 
        daily equivalent of the annual rate of basic pay prescribed for 
        level V of the Executive Schedule under section 5316 of such 
        title.
    (e) Termination of Commission.--The Commission shall terminate 30 
days after the date on which the Commission submits its report under 
subsection (b)(2)(A).

SEC. 403. COMMISSION ON ACCESS TO CARE.

    (a) Establishment of Commission.--
            (1) In general.--There is established the Commission on 
        Access to Care (in this section referred to as the 
        ``Commission'') to examine the access of veterans to health 
        care from the Department of Veterans Affairs and strategically 
        examine how best to organize the Veterans Health 
        Administration, locate health care resources, and deliver 
        health care to veterans during the 10- to 20-year period 
        beginning on the date of the enactment of this Act.
            (2) Membership.--
                    (A) Voting members.--The Commission shall be 
                composed of 10 voting members who are appointed by the 
                President as follows:
                            (i) At least two members who represent an 
                        organization recognized by the Secretary of 
                        Veterans Affairs for the representation of 
                        veterans under section 5902 of title 38, United 
                        States Code.
                            (ii) At least one member from among persons 
                        who have experience as senior management for a 
                        private integrated health care system with an 
                        annual gross revenue of more than $50,000,000.
                            (iii) At least one member from among 
                        persons who are familiar with government health 
                        care systems, including those systems of the 
                        Department of Defense, the Indian Health 
                        Service, and Federally-qualified health centers 
                        (as defined in section 1905(l)(2)(B) of the 
                        Social Security Act (42 U.S.C. 
                        1396d(l)(2)(B))).
                            (iv) At least two members from among 
                        persons who are familiar with the Veterans 
                        Health Administration but are not current 
                        employees of the Veterans Health 
                        Administration.
                            (v) At least two members from among persons 
                        who are veterans or eligible for hospital care, 
                        medical services, or other health care under 
                        the laws administered by the Secretary of 
                        Veterans Affairs.
                    (B) Nonvoting members.--
                            (i) In general.--In addition to members 
                        appointed under subparagraph (A), the 
                        Commission shall be composed of 10 nonvoting 
                        members who are appointed by the President as 
                        follows:
                                    (I) At least two members who 
                                represent an organization recognized by 
                                the Secretary of Veterans Affairs for 
                                the representation of veterans under 
                                section 5902 of title 38, United States 
                                Code.
                                    (II) At least one member from among 
                                persons who have experience as senior 
                                management for a private integrated 
                                health care system with an annual gross 
                                revenue of more than $50,000,000.
                                    (III) At least one member from 
                                among persons who are familiar with 
                                government health care systems, 
                                including those systems of the 
                                Department of Defense, the Indian 
                                Health Service, and Federally-qualified 
                                health centers (as defined in section 
                                1905(l)(2)(B) of the Social Security 
                                Act (42 U.S.C. 1396d(l)(2)(B))).
                                    (IV) At least two members from 
                                among persons who are familiar with the 
                                Veterans Health Administration but are 
                                not current employees of the Veterans 
                                Health Administration.
                                    (V) At least two members from among 
                                persons who are veterans or eligible 
                                for hospital care, medical services, or 
                                other health care under the laws 
                                administered by the Secretary of 
                                Veterans Affairs.
                            (ii) Additional nonvoting members.--In 
                        addition to members appointed under 
                        subparagraph (A) and clause (i), the Commission 
                        shall be composed of the following nonvoting 
                        members:
                                    (I) The Comptroller General of the 
                                United States, or designee.
                                    (II) The Inspector General of the 
                                Department of Veterans Affairs, or 
                                designee.
                    (C) Date.--The appointments of members of the 
                Commission shall be made not later than 60 days after 
                the date of the enactment of this Act.
            (3) Period of appointment; vacancies.--Members shall be 
        appointed for the life of the Commission. Any vacancy in the 
        Commission shall not affect its powers, but shall be filled in 
        the same manner as the original appointment.
            (4) Initial meeting.--Not later than 15 days after the date 
        on which seven voting members of the Commission have been 
        appointed, the Commission shall hold its first meeting.
            (5) Meetings.--The Commission shall meet at the call of the 
        Chairperson.
            (6) Quorum.--A majority of the members of the Commission 
        shall constitute a quorum, but a lesser number of members may 
        hold hearings.
            (7) Chairperson and vice chairperson.--The Commission shall 
        select a Chairperson and Vice Chairperson from among its 
        members.
    (b) Duties of Commission.--
            (1) Evaluation and assessment.--The Commission shall 
        undertake a comprehensive evaluation and assessment of access 
        to health care at the Department of Veterans Affairs.
            (2) Matters evaluated and assessed.--The matters evaluated 
        and assessed by the Commission shall include the following:
                    (A) The appropriateness of current standards of the 
                Department of Veterans Affairs concerning access to 
                health care.
                    (B) The measurement of such standards.
                    (C) The appropriateness of performance standards 
                and incentives in relation to standards described in 
                subparagraph (A).
                    (D) Staffing levels throughout the Veterans Health 
                Administration and whether they are sufficient to meet 
                current demand for health care from the Administration.
                    (E) The results of the assessment conducted by an 
                independent third party under section 101(a), including 
                any data or recommendations included in such 
                assessment.
            (3) Reports.--The Commission shall submit to the President, 
        through the Secretary of Veterans Affairs, reports as follows:
                    (A) Not later than 90 days after the date of the 
                initial meeting of the Commission, an interim report 
                on--
                            (i) the findings of the Commission with 
                        respect to the evaluation and assessment 
                        required by this subsection; and
                            (ii) such recommendations as the Commission 
                        may have for legislative or administrative 
                        action to improve access to health care through 
                        the Veterans Health Administration.
                    (B) Not later than 180 days after the date of the 
                initial meeting of the Commission, a final report on--
                            (i) the findings of the Commission with 
                        respect to the evaluation and assessment 
                        required by this subsection; and
                            (ii) such recommendations as the Commission 
                        may have for legislative or administrative 
                        action to improve access to health care through 
                        the Veterans Health Administration.
    (c) Powers of the Commission.--
            (1) Hearings.--The Commission may hold such hearings, sit 
        and act at such times and places, take such testimony, and 
        receive such evidence as the Commission considers advisable to 
        carry out this section.
            (2) Information from federal agencies.--The Commission may 
        secure directly from any Federal department or agency such 
        information as the Commission considers necessary to carry out 
        this section. Upon request of the Chairperson of the 
        Commission, the head of such department or agency shall furnish 
        such information to the Commission.
    (d) Commission Personnel Matters.--
            (1) Compensation of members.--Each member of the Commission 
        who is not an officer or employee of the Federal Government 
        shall be compensated at a rate equal to the daily equivalent of 
        the annual rate of basic pay prescribed for level IV of the 
        Executive Schedule under section 5315 of title 5, United States 
        Code, for each day (including travel time) during which such 
        member is engaged in the performance of the duties of the 
        Commission. All members of the Commission who are officers or 
        employees of the United States shall serve without compensation 
        in addition to that received for their services as officers or 
        employees of the United States.
            (2) Travel expenses.--The members of the Commission shall 
        be allowed travel expenses, including per diem in lieu of 
        subsistence, at rates authorized for employees of agencies 
        under subchapter I of chapter 57 of title 5, United States 
        Code, while away from their homes or regular places of business 
        in the performance of services for the Commission.
            (3) Staff.--
                    (A) In general.--The Chairperson of the Commission 
                may, without regard to the civil service laws and 
                regulations, appoint and terminate an executive 
                director and such other additional personnel as may be 
                necessary to enable the Commission to perform its 
                duties. The employment of an executive director shall 
                be subject to confirmation by the Commission.
                    (B) Compensation.--The Chairperson of the 
                Commission may fix the compensation of the executive 
                director and other personnel without regard to chapter 
                51 and subchapter III of chapter 53 of title 5, United 
                States Code, relating to classification of positions 
                and General Schedule pay rates, except that the rate of 
                pay for the executive director and other personnel may 
                not exceed the rate payable for level V of the 
                Executive Schedule under section 5316 of such title.
            (4) Detail of government employees.--Any Federal Government 
        employee may be detailed to the Commission without 
        reimbursement, and such detail shall be without interruption or 
        loss of civil service status or privilege.
            (5) Procurement of temporary and intermittent services.--
        The Chairperson of the Commission may procure temporary and 
        intermittent services under section 3109(b) of title 5, United 
        States Code, at rates for individuals that do not exceed the 
        daily equivalent of the annual rate of basic pay prescribed for 
        level V of the Executive Schedule under section 5316 of such 
        title.
    (e) Termination of the Commission.--The Commission shall terminate 
30 days after the date on which the Commission submits its report under 
subsection (b)(3)(B).
    (f) Funding.--The Secretary of Veterans Affairs shall make 
available to the Commission from amounts appropriated or otherwise made 
available to the Secretary such amounts as the Secretary and the 
Chairperson of the Commission jointly consider appropriate for the 
Commission to perform its duties under this section.
    (g) Executive Action.--
            (1) Action on recommendations.--The President shall require 
        the Secretary of Veterans Affairs and such other heads of 
        relevant Federal departments and agencies to implement each 
        recommendation set forth in a report submitted under subsection 
        (b)(3) that the President--
                    (A) considers feasible and advisable; and
                    (B) determines can be implemented without further 
                legislative action.
            (2) Reports.--Not later than 60 days after the date on 
        which the President receives a report under subsection (b)(3), 
        the President shall submit to the Committee on Veterans' 
        Affairs of the Senate and the Committee on Veterans' Affairs of 
        the House of Representatives and such other committees of 
        Congress as the President considers appropriate a report 
        setting forth the following:
                    (A) An assessment of the feasibility and 
                advisability of each recommendation contained in the 
                report received by the President.
                    (B) For each recommendation assessed as feasible 
                and advisable under subparagraph (A) the following:
                            (i) Whether such recommendation requires 
                        legislative action.
                            (ii) If such recommendation requires 
                        legislative action, a recommendation concerning 
                        such legislative action.
                            (iii) A description of any administrative 
                        action already taken to carry out such 
                        recommendation.
                            (iv) A description of any administrative 
                        action the President intends to be taken to 
                        carry out such recommendation and by whom.

SEC. 404. IMPROVED PERFORMANCE METRICS FOR HEALTH CARE PROVIDED BY 
              DEPARTMENT OF VETERANS AFFAIRS.

    (a) Prohibition on Use of Scheduling and Wait-time Metrics in 
Determination of Performance Awards.--The Secretary of Veterans Affairs 
shall ensure that scheduling and wait-time metrics or goals are not 
used as factors in determining the performance of the following 
employees for purposes of determining whether to pay performance awards 
to such employees:
            (1) Directors, associate directors, assistant directors, 
        deputy directors, chiefs of staff, and clinical leads of 
        medical centers of the Department of Veterans Affairs.
            (2) Directors, assistant directors, and quality management 
        officers of Veterans Integrated Service Networks of the 
        Department of Veterans Affairs.
    (b) Modification of Performance Plans.--
            (1) In general.--Not later than 30 days after the date of 
        the enactment of this Act, the Secretary shall modify the 
        performance plans of the directors of the medical centers of 
        the Department and the directors of the Veterans Integrated 
        Service Networks to ensure that such plans are based on the 
        quality of care received by veterans at the health care 
        facilities under the jurisdictions of such directors.
            (2) Factors.--In modifying performance plans under 
        paragraph (1), the Secretary shall ensure that assessment of 
        the quality of care provided at health care facilities under 
        the jurisdiction of a director described in paragraph (1) 
        includes consideration of the following:
                    (A) Recent reviews by the Joint Commission 
                (formerly known as the ``Joint Commission on 
                Accreditation of Healthcare Organizations'') of such 
                facilities.
                    (B) The number and nature of recommendations 
                concerning such facilities by the Inspector General of 
                the Department in reviews conducted through the 
                Combined Assessment Program (CAP), in the reviews by 
                the Inspector General of community based outpatient 
                clinics and primary care clinics, and in reviews 
                conducted through the Office of Healthcare Inspections 
                during the two most recently completed fiscal years.
                    (C) The number of recommendations described in 
                subparagraph (B) that the Inspector General of the 
                Department determines have not been carried out 
                satisfactorily with respect to such facilities.
                    (D) Reviews of such facilities by the Commission on 
                Accreditation of Rehabilitation Facilities.
                    (E) The number and outcomes of administrative 
                investigation boards, root cause analysis, and peer 
                reviews conducted at such facilities during the fiscal 
                year for which the assessment is being conducted.
                    (F) The effectiveness of any remedial actions or 
                plans resulting from any Inspector General 
                recommendations in the reviews and analyses described 
                in subparagraphs (A) through (E).
            (3) Additional leadership positions.--To the degree 
        practicable, the Secretary shall assess the performance of 
        other employees of the Department in leadership positions at 
        Department medical centers, including associate directors, 
        assistant directors, deputy directors, chiefs of staff, and 
        clinical leads, and in Veterans Integrated Service Networks, 
        including assistant directors and quality management officers, 
        using factors and criteria similar to those used in the 
        performance plans modified under paragraph (1).
    (c) Removal of Certain Performance Goals.--For each fiscal year 
that begins after the date of the enactment of this Act, the Secretary 
shall not include in the performance goals of any employee of a 
Veterans Integrated Service Network or medical center of the Department 
any performance goal that might disincentivize the payment of 
Department amounts to provide hospital care, medical services, or other 
health care through a non-Department provider.

SEC. 405. IMPROVED TRANSPARENCY CONCERNING HEALTH CARE PROVIDED BY 
              DEPARTMENT OF VETERANS AFFAIRS.

    (a) Publication of Wait Times.--
            (1) Goals.--
                    (A) Initial.--Not later than 90 days after the date 
                of the enactment of this Act, the Secretary of Veterans 
                Affairs shall publish in the Federal Register, and on 
                an Internet website accessible to the public of each 
                medical center of the Department of Veterans Affairs, 
                the wait-time goals of the Department for the 
                scheduling of an appointment by a veteran for the 
                receipt of health care from the Department.
                    (B) Subsequent changes.--
                            (i) In general.--If the Secretary modifies 
                        the wait-time goals described in subparagraph 
                        (A), the Secretary shall publish the new wait-
                        times goals--
                                    (I) on an Internet website 
                                accessible to the public of each 
                                medical center of the Department not 
                                later than 30 days after such 
                                modification; and
                                    (II) in the Federal Register not 
                                later than 90 days after such 
                                modification.
                            (ii) Effective date.--Any modification 
                        under clause (i) shall take effect on the date 
                        of publication in the Federal Register.
                    (C) Goals described.--Wait-time goals published 
                under this paragraph shall include goals for primary 
                care appointments, specialty care appointments, and 
                appointments based on the general severity of the 
                condition of the veteran.
            (2) Wait times at medical centers of the department.--Not 
        later than one year after the date of the enactment of this 
        Act, the Secretary of Veterans Affairs shall publish on an 
        Internet website accessible to the public of each medical 
        center of the Department the current wait time for an 
        appointment for primary care and specialty care at the medical 
        center.
    (b) Publicly Available Database of Patient Safety, Quality of Care, 
and Outcome Measures.--
            (1) In general.--Not later than 180 days after the date of 
        the enactment of this Act, the Secretary shall develop and make 
        available to the public a comprehensive database containing all 
        applicable patient safety, quality of care, and outcome 
        measures for health care provided by the Department that are 
        tracked by the Secretary.
            (2) Update frequency.--The Secretary shall update the 
        database required by paragraph (1) not less frequently than 
        once each year.
            (3) Unavailable measures.--For all measures that the 
        Secretary would otherwise publish in the database required by 
        paragraph (1) but has not done so because such measures are not 
        available, the Secretary shall publish notice in the database 
        of the reason for such unavailability and a timeline for making 
        such measures available in the database.
            (4) Accessibility.--The Secretary shall ensure that the 
        database required by paragraph (1) is accessible to the public 
        through the primary Internet website of the Department and 
        through each primary Internet website of a Department medical 
        center.
    (c) Hospital Compare Website of Department of Health and Human 
Services.--
            (1) Agreement required.--Not later than 180 days after the 
        date of the enactment of this Act, the Secretary of Veterans 
        Affairs shall enter into an agreement with the Secretary of 
        Health and Human Services for the provision by the Secretary of 
        Veterans Affairs of such information as the Secretary of Health 
        and Human Services may require to report and make publicly 
        available patient quality and outcome information concerning 
        Department of Veterans Affairs medical centers through the 
        Hospital Compare Internet website of the Department of Health 
        and Human Services or any successor Internet website.
            (2) Information provided.--The information provided by the 
        Secretary of Veterans Affairs to the Secretary of Health and 
        Human Services under paragraph (1) shall include the following:
                    (A) Measures of timely and effective health care.
                    (B) Measures of readmissions, complications of 
                death, including with respect to 30-day mortality rates 
                and 30-day readmission rates, surgical complication 
                measures, and health care related infection measures.
                    (C) Survey data of patient experiences, including 
                the Hospital Consumer Assessment of Healthcare 
                Providers and Systems or any similar successor survey 
                developed by the Department of Health and Human 
                Services.
                    (D) Any other measures required of or reported with 
                respect to hospitals participating in the Medicare 
                program under title XVIII of the Social Security Act 
                (42 U.S.C. 1395 et seq.).
            (3) Unavailable information.--For any applicable metric 
        collected by the Department of Veterans Affairs or required to 
        be provided under paragraph (2) and withheld from or 
        unavailable in the Hospital Compare Internet website, the 
        Secretary of Veterans Affairs shall publish a notice in the 
        Federal Register stating the reason why such metric was 
        withheld from public disclosure and a timeline for making such 
        metric available, if applicable.
    (d) Comptroller General Review of Publicly Available Safety and 
Quality Metrics.--Not later than three years after the date of the 
enactment of this Act, the Comptroller General of the United States 
shall conduct a review of the safety and quality metrics made publicly 
available by the Secretary of Veterans Affairs under this section to 
assess the degree to which the Secretary is complying with the 
provisions of this section.

SEC. 406. INFORMATION FOR VETERANS ON THE CREDENTIALS OF DEPARTMENT OF 
              VETERANS AFFAIRS PHYSICIANS.

    (a) Improvement of ``Our Providers'' Internet Website Links.--
            (1) Availability through department of veterans affairs 
        homepage.--A link to the ``Our Providers'' health care 
        providers database of the Department of Veterans Affairs, or 
        any successor database, shall be available on and through the 
        homepage of the Internet website of the Department that is 
        accessible to the public.
            (2) Information on location of residency training.--The 
        Internet website of the Department that is accessible to the 
        public shall include under the link to the ``Our Providers'' 
        health care providers database of the Department, or any 
        successor database, the location of residency training of each 
        licensed physician of the Department.
            (3) Information on physicians at particular facilities.--
        The ``Our Providers'' health care providers database of the 
        Department, or any successor database, shall identify whether 
        each licensed physician of the Department is a physician in 
        residency.
    (b) Information on Credentials of Physicians for Veterans 
Undergoing Surgical Procedures.--
            (1) In general.--Each veteran who is undergoing a surgical 
        procedure by or through the Department shall be provided 
        information on the credentials of the surgeon to be performing 
        such procedure at such time in advance of the procedure as is 
        appropriate to permit such veteran to evaluate such 
        information.
            (2) Other individuals.--If a veteran is unable to evaluate 
        the information provided under paragraph (1) due to the health 
        or mental competence of the veteran, such information shall be 
        provided to an individual acting on behalf of the veteran.
    (c) Comptroller General Report and Plan.--
            (1) Report.--Not later than two years after the date of the 
        enactment of this Act, the Comptroller General of the United 
        States shall submit to the Committee on Veterans' Affairs of 
        the Senate and the Committee on Veterans' Affairs of the House 
        of Representatives a report setting forth an assessment by the 
        Comptroller General of the following:
                    (A) The manner in which contractors under the 
                Patient-Centered Community Care initiative of the 
                Department perform oversight of the credentials of 
                physicians within the networks of such contractors 
                under the initiative.
                    (B) The oversight by the Department of the 
                contracts under the Patient-Centered Community Care 
                initiative.
                    (C) The verification by the Department of the 
                credentials and licenses of health care providers 
                furnishing hospital care and medical services under 
                section 301.
            (2) Plan.--
                    (A) In general.--Not later than 30 days after the 
                submittal of the report under paragraph (1), the 
                Secretary shall--
                            (i) submit to the Comptroller General, the 
                        Committee on Veterans' Affairs of the Senate, 
                        and the Committee on Veterans' Affairs of the 
                        House of Representatives a plan to address any 
                        findings and recommendations of the Comptroller 
                        General included in such report; and
                            (ii) submit to the Committee on Veterans' 
                        Affairs of the Senate and the Committee on 
                        Veterans' Affairs of the House of 
                        Representatives a request for additional 
                        amounts, if any, that may be necessary to carry 
                        out such plan.
                    (B) Implementation.--Not later than 90 days after 
                the submittal of the report under paragraph (1), the 
                Secretary shall carry out such plan.

SEC. 407. INFORMATION IN ANNUAL BUDGET OF THE PRESIDENT ON HOSPITAL 
              CARE AND MEDICAL SERVICES FURNISHED THROUGH EXPANDED USE 
              OF CONTRACTS FOR SUCH CARE.

    The materials on the Department of Veterans Affairs in the budget 
of the President for a fiscal year, as submitted to Congress pursuant 
to section 1105(a) of title 31, United States Code, shall set forth the 
following:
            (1) The number of veterans who received hospital care and 
        medical services under section 301 during the fiscal year 
        preceding the fiscal year in which such budget is submitted.
            (2) The amount expended by the Department on furnishing 
        care and services under such section during the fiscal year 
        preceding the fiscal year in which such budget is submitted.
            (3) The amount requested in such budget for the costs of 
        furnishing care and services under such section during the 
        fiscal year covered by such budget, set forth in aggregate and 
        by amounts for each account for which amounts are so requested.
            (4) The number of veterans that the Department estimates 
        will receive hospital care and medical services under such 
        section during the fiscal years covered by the budget 
        submission.
            (5) The number of employees of the Department on paid 
        administrative leave at any point during the fiscal year 
        preceding the fiscal year in which such budget is submitted.

SEC. 408. PROHIBITION ON FALSIFICATION OF DATA CONCERNING WAIT TIMES 
              AND QUALITY MEASURES AT DEPARTMENT OF VETERANS AFFAIRS.

    Not later than 60 days after the date of the enactment of this Act, 
and in accordance with title 5, United States Code, the Secretary of 
Veterans Affairs shall establish policies whereby any employee of the 
Department of Veterans Affairs who knowingly submits false data 
concerning wait times for health care or quality measures with respect 
to health care to another employee of the Department or knowingly 
requires another employee of the Department to submit false data 
concerning such wait times or quality measures to another employee of 
the Department is subject to a penalty the Secretary considers 
appropriate after notice and an opportunity for a hearing, including 
civil penalties, unpaid suspensions, or termination.

SEC. 409. REMOVAL OF SENIOR EXECUTIVE SERVICE EMPLOYEES OF THE 
              DEPARTMENT OF VETERANS AFFAIRS FOR PERFORMANCE.

    (a) Removal or Transfer.--
            (1) In general.--Chapter 7 of title 38, United States Code, 
        is amended by adding at the end the following new section:
``Sec. 713. Senior Executive Service: removal based on performance
    ``(a) In General.--The Secretary may remove any individual from the 
Senior Executive Service if the Secretary determines the performance of 
the individual warrants such removal. If the Secretary so removes such 
an individual, the Secretary may--
            ``(1) remove the individual from the civil service (as 
        defined in section 2101 of title 5); or
            ``(2) transfer the individual to a General Schedule 
        position at any grade of the General Schedule for which the 
        individual is qualified and that the Secretary determines is 
        appropriate.
    ``(b) Notice to Congress.--Not later than 30 days after removing or 
transferring an individual from the Senior Executive Service under 
subsection (a), the Secretary shall submit to the Committees on 
Veterans' Affairs of the Senate and House of Representatives notice in 
writing of such removal or transfer and the reason for such removal or 
transfer.
    ``(c) Procedure.--(1) The procedures under section 7543 of title 5 
shall not apply to a removal or transfer under this section.
    ``(2)(A) Subject to subparagraph (B), any removal or transfer under 
subsection (a) may be appealed to the Merit Systems Protection Board 
under section 7701 of title 5.
    ``(B) An appeal under subparagraph (A) of a removal or transfer may 
only be made if such appeal is made not later than 7 days after the 
date of such removal or transfer.
    ``(d) Expedited Review by Merit Systems Protection Board.--(1) The 
Merit Systems Protection Board shall expedite any appeal under section 
7701 of title 5 of a removal or transfer under subsection (a) and, in 
any such case, shall issue a decision not later than 21 days after the 
date of the appeal.
    ``(2) In any case in which the Merit Systems Protection Board 
determines that it cannot issue a decision in accordance with the 21-
day requirement under paragraph (1), the Merit Systems Protection Board 
shall submit to Congress a report that explains the reason why the 
Merit Systems Protection Board is unable to issue a decision in 
accordance with such requirement in such case.
    ``(3) There is authorized to be appropriated such sums as may be 
necessary for the Merit Systems Protection Board to expedite appeals 
under paragraph (1).
    ``(4) The Merit Systems Protection Board may not stay any personnel 
action taken under this section.
    ``(5) A person who appeals under section 7701 of title 5 a removal 
under subsection (a)(1) may not receive any pay, awards, bonuses, 
incentives, allowances, differentials, student loan repayments, special 
payments, or benefits from the Secretary until the Merit Systems 
Protection Board has made a final decision on such appeal.
    ``(6) A decision made by the Merit Systems Protection Board with 
respect to a removal or transfer under subsection (a) shall not be 
subject to any further appeal.''.
            (2) Clerical amendment.--The table of sections at the 
        beginning of such chapter is amended by adding at the end the 
        following new item:

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

             TITLE V--HEALTH CARE RELATED TO SEXUAL TRAUMA

SEC. 501. EXPANSION OF ELIGIBILITY FOR SEXUAL TRAUMA COUNSELING AND 
              TREATMENT TO VETERANS ON INACTIVE DUTY TRAINING.

    Section 1720D(a)(1) of title 38, United States Code, is amended by 
striking ``or active duty for training'' and inserting ``, active duty 
for training, or inactive duty training''.

SEC. 502. PROVISION OF COUNSELING AND TREATMENT FOR SEXUAL TRAUMA BY 
              THE DEPARTMENT OF VETERANS AFFAIRS TO MEMBERS OF THE 
              ARMED FORCES.

    (a) Expansion of Coverage to Members of the Armed Forces.--
Subsection (a) of section 1720D of title 38, United States Code, is 
amended--
            (1) by redesignating paragraph (2) as paragraph (3);
            (2) by inserting after paragraph (1) the following new 
        paragraph (2):
    ``(2)(A) In operating the program required by paragraph (1), the 
Secretary may, in consultation with the Secretary of Defense, provide 
counseling and care and services to members of the Armed Forces 
(including members of the National Guard and Reserves) on active duty 
to overcome psychological trauma described in that paragraph.
    ``(B) A member described in subparagraph (A) shall not be required 
to obtain a referral before receiving counseling and care and services 
under this paragraph.''; and
            (3) in paragraph (3), as redesignated by paragraph (1)--
                    (A) by striking ``a veteran'' and inserting ``an 
                individual''; and
                    (B) by striking ``that veteran'' each place it 
                appears and inserting ``that individual''.
    (b) Information to Members on Availability of Counseling and 
Services.--Subsection (c) of such section is amended--
            (1) by striking ``to veterans'' each place it appears; and
            (2) in paragraph (3), by inserting ``members of the Armed 
        Forces and'' before ``individuals''.
    (c) Inclusion of Members in Reports on Counseling and Services.--
Subsection (e) of such section is amended--
            (1) in the matter preceding paragraph (1), by striking ``to 
        veterans'';
            (2) in paragraph (2)--
                    (A) by striking ``women veterans'' and inserting 
                ``individuals''; and
                    (B) by striking ``training under subsection (d).'' 
                and inserting ``training under subsection (d), 
                disaggregated by--
                    ``(A) veterans;
                    ``(B) members of the Armed Forces (including 
                members of the National Guard and Reserves) on active 
                duty; and
                    ``(C) for each of subparagraphs (A) and (B)--
                            ``(i) men; and
                            ``(ii) women.'';
            (3) in paragraph (4), by striking ``veterans'' and 
        inserting ``individuals''; and
            (4) in paragraph (5)--
                    (A) by striking ``women veterans'' and inserting 
                ``individuals'' ; and
                    (B) by inserting ``, including specific 
                recommendations for individuals specified in 
                subparagraphs (A), (B), and (C) of paragraph (2)'' 
                before the period at the end.
    (d) Effective Date.--The amendments made by this section shall take 
effect on the date that is one year after the date of the enactment of 
this Act.

SEC. 503. REPORTS ON MILITARY SEXUAL TRAUMA.

    (a) Report on Services Available for Military Sexual Trauma in the 
Department of Veterans Affairs.--Not later than 630 days after the date 
of the enactment of this Act, the Secretary of Veterans Affairs shall 
submit to the Committee on Veterans' Affairs of the Senate and the 
Committee on Veterans' Affairs of the House of Representatives a report 
on the treatment and services available from the Department of Veterans 
Affairs for male veterans who experience military sexual trauma 
compared to such treatment and services available to female veterans 
who experience military sexual trauma.
    (b) Reports on Transition of Military Sexual Trauma Treatment From 
Department of Defense to Department of Veterans Affairs.--Not later 
than 630 days after the date of the enactment of this Act, and annually 
thereafter for five years, the Department of Veterans Affairs-
Department of Defense Joint Executive Committee established by section 
320(a) of title 38, United States Code, shall submit to the appropriate 
committees of Congress a report on military sexual trauma that includes 
the following:
            (1) The processes and procedures utilized by the Department 
        of Veterans Affairs and the Department of Defense to facilitate 
        transition of treatment of individuals who have experienced 
        military sexual trauma from treatment provided by the 
        Department of Defense to treatment provided by the Department 
        of Veterans Affairs.
            (2) A description and assessment of the collaboration 
        between the Department of Veterans Affairs and the Department 
        of Defense in assisting veterans in filing claims for 
        disabilities related to military sexual trauma, including 
        permitting veterans access to information and evidence 
        necessary to develop or support such claims.
    (c) Definitions.--In this section:
            (1) Appropriate committees of congress.--The term 
        ``appropriate committees of Congress'' means--
                    (A) the Committee on Veterans' Affairs and the 
                Committee on Armed Services of the Senate; and
                    (B) the Committee on Veterans' Affairs and the 
                Committee on Armed Services of the House of 
                Representatives.
            (2) Military sexual trauma.--The term ``military sexual 
        trauma'' means psychological trauma, which in the judgment of a 
        mental health professional employed by the Department, resulted 
        from a physical assault of a sexual nature, battery of a sexual 
        nature, or sexual harassment which occurred while the veteran 
        was serving on active duty or active duty for training.
            (3) Sexual harassment.--The term ``sexual harassment'' 
        means repeated, unsolicited verbal or physical contact of a 
        sexual nature which is threatening in character.
            (4) Sexual trauma.--The term ``sexual trauma'' shall have 
        the meaning given that term by the Secretary of Veterans 
        Affairs for purposes of this section.
    (d) Effective Date.--This section shall take effect on the date 
that is 270 days after the date of the enactment of this Act.

                TITLE VI--MAJOR MEDICAL FACILITY LEASES

SEC. 601. AUTHORIZATION OF MAJOR MEDICAL FACILITY LEASES.

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

SEC. 602. BUDGETARY TREATMENT OF DEPARTMENT OF VETERANS AFFAIRS MAJOR 
              MEDICAL FACILITIES LEASES.

    (a) Findings.--Congress finds the following:
            (1) Title 31, United States Code, requires the Department 
        of Veterans Affairs to record the full cost of its contractual 
        obligation against funds available at the time a contract is 
        executed.
            (2) Office of Management and Budget Circular A-11 provides 
        guidance to agencies in meeting the statutory requirements 
        under title 31, United States Code, with respect to leases.
            (3) For operating leases, Office of Management and Budget 
        Circular A-11 requires the Department of Veterans Affairs to 
        record up-front budget authority in an ``amount equal to total 
        payments under the full term of the lease or [an] amount 
        sufficient to cover first year lease payments plus cancellation 
        costs''.
    (b) Requirement for Obligation of Full Cost.--
            (1) In general.--Subject to the availability of 
        appropriations provided in advance, in exercising the authority 
        of the Secretary of Veterans Affairs to enter into leases 
        provided in this Act, the Secretary shall record, pursuant to 
        section 1501 of title 31, United States Code, as the full cost 
        of the contractual obligation at the time a contract is 
        executed either--
                    (A) an amount equal to total payments under the 
                full term of the lease; or
                    (B) if the lease specifies payments to be made in 
                the event the lease is terminated before its full term, 
                an amount sufficient to cover the first year lease 
                payments plus the specified cancellation costs.
            (2) Self-insuring authority.--The requirements of paragraph 
        (1) may be satisfied through the use of a self-insuring 
        authority consistent with Office of Management and Budget 
        Circular A-11.
    (c) Transparency.--
            (1) Compliance.--Subsection (b) of section 8104 of title 
        38, United States Code, is amended by adding at the end the 
        following new paragraph:
            ``(7) In the case of a prospectus proposing funding for a 
        major medical facility lease, a detailed analysis of how the 
        lease is expected to comply with Office of Management and 
        Budget Circular A-11 and section 1341 of title 31 (commonly 
        referred to as the `Anti-Deficiency Act'). Any such analysis 
        shall include--
                    ``(A) an analysis of the classification of the 
                lease as a `lease-purchase', `capital lease', or 
                `operating lease' as those terms are defined in Office 
                of Management and Budget Circular A-11;
                    ``(B) an analysis of the obligation of budgetary 
                resources associated with the lease; and
                    ``(C) an analysis of the methodology used in 
                determining the asset cost, fair market value, and 
                cancellation costs of the lease.''.
            (2) Submittal to congress.--Such section 8104 is further 
        amended by adding at the end the following new subsection:
    ``(h)(1) Not less than 30 days before entering into a major medical 
facility lease, the Secretary shall submit to the Committees on 
Veterans' Affairs of the Senate and the House of Representatives--
            ``(A) notice of the Secretary's intention to enter into the 
        lease;
            ``(B) a detailed summary of the proposed lease;
            ``(C) a description and analysis of any differences between 
        the prospectus submitted pursuant to subsection (b) and the 
        proposed lease; and
            ``(D) a scoring analysis demonstrating that the proposed 
        lease fully complies with Office of Management and Budget 
        Circular A-11.
    ``(2) Each committee described in paragraph (1) shall ensure that 
any information submitted to the committee under such paragraph is 
treated by the committee with the same level of confidentiality as is 
required by law of the Secretary and subject to the same statutory 
penalties for unauthorized disclosure or use as the Secretary.
    ``(3) Not more than 30 days after entering into a major medical 
facility lease, the Secretary shall submit to each committee described 
in paragraph (1) a report on any material differences between the lease 
that was entered into and the proposed lease described under such 
paragraph, including how the lease that was entered into changes the 
previously submitted scoring analysis described in subparagraph (D) of 
such paragraph.''.
    (d) Rule of Construction.--Nothing in this section, or the 
amendments made by this section, shall be construed to in any way 
relieve the Department of Veterans Affairs from any statutory or 
regulatory obligations or requirements existing prior to the enactment 
of this section and such amendments.

                  TITLE VII--VETERANS BENEFITS MATTERS

SEC. 701. EXPANSION OF MARINE GUNNERY SERGEANT JOHN DAVID FRY 
              SCHOLARSHIP.

    (a) Expansion of Entitlement.--Subsection (b)(9) of section 3311 of 
title 38, United States Code, is amended by inserting ``or spouse'' 
after ``child''.
    (b) Limitation and Election on Certain Benefits.--Subsection (f) of 
such section is amended--
            (1) by redesignating paragraph (2) as paragraph (4); and
            (2) by inserting after paragraph (1) the following new 
        paragraphs:
            ``(2) Limitation.--The entitlement of an individual to 
        assistance under subsection (a) pursuant to paragraph (9) of 
        subsection (b) because the individual was a spouse of a person 
        described in such paragraph shall expire on the earlier of--
                    ``(A) the date that is 15 years after the date on 
                which the person died; and
                    ``(B) the date on which the individual remarries.
            ``(3) Election on receipt of certain benefits.--A surviving 
        spouse entitled to assistance under subsection (a) pursuant to 
        paragraph (9) of subsection (b) who is also entitled to 
        educational assistance under chapter 35 of this title may not 
        receive assistance under both this section and such chapter, 
        but shall make an irrevocable election (in such form and manner 
        as the Secretary may prescribe) under which section or chapter 
        to receive educational assistance.''.
    (c) Conforming Amendment.--Section 3321(b)(4) of such title is 
amended--
            (1) by striking ``an individual'' and inserting ``a 
        child''; and
            (2) by striking ``such individual's'' each time it appears 
        and inserting ``such child's''.

SEC. 702. APPROVAL OF COURSES OF EDUCATION PROVIDED BY PUBLIC 
              INSTITUTIONS OF HIGHER LEARNING FOR PURPOSES OF ALL-
              VOLUNTEER FORCE EDUCATIONAL ASSISTANCE PROGRAM AND POST-
              9/11 EDUCATIONAL ASSISTANCE CONDITIONAL ON IN-STATE 
              TUITION RATE FOR VETERANS.

    (a) In General.--Section 3679 of title 38, United States Code, is 
amended by adding at the end the following new subsection:
    ``(c)(1) Notwithstanding any other provision of this chapter and 
subject to paragraphs (3) through (6), the Secretary shall disapprove a 
course of education provided by a public institution of higher learning 
to a covered individual pursuing a course of education with educational 
assistance under chapter 30 or 33 of this title while living in the 
State in which the public institution of higher learning is located if 
the institution charges tuition and fees for that course for the 
covered individual at a rate that is higher than the rate the 
institution charges for tuition and fees for that course for residents 
of the State in which the institution is located, regardless of the 
covered individual's State of residence.
    ``(2) For purposes of this subsection, a covered individual is any 
individual as follows:
            ``(A) A veteran who was discharged or released from a 
        period of not fewer than 90 days of service in the active 
        military, naval, or air service less than three years before 
        the date of enrollment in the course concerned.
            ``(B) An individual who is entitled to assistance under 
        section 3311(b)(9) or 3319 of this title by virtue of such 
        individual's relationship to a veteran described in 
        subparagraph (A).
    ``(3) If after enrollment in a course of education that is subject 
to disapproval under paragraph (1) by reason of paragraph (2)(A) or 
(2)(B) a covered individual pursues one or more courses of education at 
the same public institution of higher learning while remaining 
continuously enrolled (other than during regularly scheduled breaks 
between courses, semesters or terms) at that institution of higher 
learning, any course so pursued by the covered individual at that 
institution of higher learning while so continuously enrolled shall 
also be subject to disapproval under paragraph (1).
    ``(4) It shall not be grounds to disapprove a course of education 
under paragraph (1) if a public institution of higher learning requires 
a covered individual pursuing a course of education at the institution 
to demonstrate an intent, by means other than satisfying a physical 
presence requirement, to establish residency in the State in which the 
institution is located, or to satisfy other requirements not relating 
to the establishment of residency, in order to be charged tuition and 
fees for that course at a rate that is equal to or less than the rate 
the institution charges for tuition and fees for that course for 
residents of the State.
    ``(5) The Secretary may waive such requirements of paragraph (1) as 
the Secretary considers appropriate.
    ``(6) Disapproval under paragraph (1) shall apply only with respect 
to educational assistance under chapters 30 and 33 of this title.''.
    (b) Effective Date.--Subsection (c) of section 3679 of title 38, 
United States Code (as added by subsection (a) of this section), shall 
apply with respect to educational assistance provided for pursuit of 
programs of education during academic terms that begin after July 1, 
2015, through courses of education that commence on or after that date.

          TITLE VIII--APPROPRIATION AND EMERGENCY DESIGNATIONS

SEC. 801. APPROPRIATION OF EMERGENCY AMOUNTS.

    There is authorized to be appropriated, and is appropriated, to the 
Secretary of Veterans Affairs, out of any funds in the Treasury not 
otherwise appropriated, for fiscal years 2014, 2015, and 2016, such 
sums as may be necessary to carry out this Act.

SEC. 802. EMERGENCY DESIGNATIONS.

    (a) In General.--This Act is designated as an emergency requirement 
pursuant to section 4(g) of the Statutory Pay-As-You-Go Act of 2010 (2 
U.S.C. 933(g)).
    (b) Designation in Senate.--In the Senate, this Act is designated 
as an emergency requirement pursuant to section 403(a) of S. Con. Res. 
13 (111th Congress), the concurrent resolution on the budget for fiscal 
year 2010.
                                                       Calendar No. 426

113th CONGRESS

  2d Session

                                S. 2450

_______________________________________________________________________

                                 A BILL

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

_______________________________________________________________________

                             June 10, 2014

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