II 

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. 

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


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1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

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

4 and Transparency Act of 2014’’. 

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

6 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 NONDEPARTMENT OF VETERANS AFFAIRS PROVIDERS 

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

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

and other health care from non-Department providers to the 

Chief Business Office of the Veterans Health Administration of 

the Department. 

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

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

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

Affairs. 

TITLE IV—HEALTH CARE ADMINISTRATIVE MATTERS 

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

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

Affairs. 

Sec. 403. Commission on Access to Care. 


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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. 


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1 TITLE I—IMPROVEMENT OF 

2 SCHEDULING SYSTEM FOR 

3 HEALTH CARE APPOINT4 MENTS 

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

7 HEALTH CARE MANAGEMENT PROCESSES OF 

8 THE DEPARTMENT OF VETERANS AFFAIRS. 

9 (a) INDEPENDENT ASSESSMENT.— 

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

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

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

15 (A) The process at each medical facility of 

16 the Department of Veterans Affairs for sched17 uling appointments for veterans to receive hos18 pital care, medical services, or other health care 

19 from the Department. 

20 (B) The staffing level and productivity of 

21 each medical facility of the Department, includ22 ing the following: 

23 (i) The case load of each health care 

24 provider of the Department. 


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1 (ii) The time spent by each health 

2 care provider of the Department on mat3 ters other than the case load of such 

4 health care provider, including time spent 

5 by such health care provider as follows: 

6 (I) At a medical facility that is 

7 affiliated with the Department. 

8 (II) Conducting research. 

9 (III) Training or overseeing other 

10 health care professionals of the De11 partment. 

12 (C) The organization, processes, and tools 

13 used by the Department to support clinical doc14 umentation and the subsequent coding of inpa15 tient services. 

16 (D) The purchasing, distribution, and use 

17 of pharmaceuticals, medical and surgical sup18 plies, and medical devices by the Department, 

19 including the following: 

20 (i) The prices paid for, standardiza21 tion of, and use by the Department of the 

22 following: 

23 (I) High-cost pharmaceuticals. 

24 (II) Medical and surgical sup25 plies. 


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1 (III) Medical devices. 

2 (ii) The use by the Department of 

3 group purchasing arrangements to pur4 chase pharmaceuticals, medical and sur5 gical supplies, medical devices, and health 

6 care related services. 

7 (iii) The strategy used by the Depart8 ment to distribute pharmaceuticals, med9 ical and surgical supplies, and medical de10 vices to Veterans Integrated Service Net11 works and medical facilities of the Depart12 ment. 

13 (E) The performance of the Department in 

14 paying amounts owed to third parties and col15 lecting amounts owed to the Department with 

16 respect to hospital care, medical services, and 

17 other health care, including any recommenda18 tions of the independent third party as follows: 

19 (i) To avoid the payment of penalties 

20 to vendors. 

21 (ii) To increase the collection of 

22 amounts owed to the Department for hos23 pital care, medical services, or other health 

24 care provided by the Department for which 


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1 reimbursement from a third party is au2 thorized. 

3 (iii) To increase the collection of any 

4 other amounts owed to the Department. 

5 (2) ELEMENTS OF SCHEDULING ASSESS6 MENT.—In carrying out the assessment required by 

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

8 do the following: 

9 (A) Review all training materials per10 taining to scheduling of appointments at each 

11 medical facility of the Department. 

12 (B) Assess whether all employees of the 

13 Department conducting tasks related to sched14 uling are properly trained for conducting such 

15 tasks. 

16 (C) Assess whether changes in the tech17 nology or system used in scheduling appoint18 ments are necessary to limit access to the sys19 tem to only those employees that have been 

20 properly trained in conducting such tasks. 

21 (D) Assess whether health care providers 

22 of the Department are making changes to their 

23 schedules that hinder the ability of employees 

24 conducting such tasks to perform such tasks. 


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1 (E) Assess whether the establishment of a 

2 centralized call center throughout the Depart3 ment for scheduling appointments at medical 

4 facilities of the Department would improve the 

5 process of scheduling such appointments. 

6 (F) Assess whether booking templates for 

7 each medical facility or clinic of the Depart8 ment would improve the process of scheduling 

9 such appointments. 

10 (G) Recommend any actions to be taken by 

11 the Department to improve the process for 

12 scheduling such appointments, including the fol13 lowing: 

14 (i) Changes in training materials pro15 vided to employees of the Department with 

16 respect to conducting tasks related to 

17 scheduling such appointments. 

18 (ii) Changes in monitoring and assess19 ment conducted by the Department of wait 

20 times of veterans for such appointments. 

21 (iii) Changes in the system used to 

22 schedule such appointments, including 

23 changes to improve how the Department— 

24 (I) measures wait times of vet25 erans for such appointments; 


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1 (II) monitors the availability of 

2 health care providers of the Depart3 ment; and 

4 (III) provides veterans the ability 

5 to schedule such appointments. 

6 (iv) Such other actions as the inde7 pendent third party considers appropriate. 

8 (3) TIMING.—The independent third party car9 rying out the assessment required by paragraph (1) 

10 shall complete such assessment not later than 180 

11 days after entering into the contract described in 

12 such paragraph. 

13 (b) REPORT.— 

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

15 the date on which the independent third party com16 pletes the assessment under this section, the Sec17 retary shall submit to the Committee on Veterans’ 

18 Affairs of the Senate and the Committee on Vet19 erans’ Affairs of the House of Representatives a re20 port on the results of such assessment. 

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

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

23 Secretary shall publish such report in the Federal 

24 Register and on an Internet website of the Depart25 ment accessible to the public. 


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1 SEC. 102. TECHNOLOGY TASK FORCE ON REVIEW OF 

2 SCHEDULING SYSTEM AND SOFTWARE OF 

3 THE DEPARTMENT OF VETERANS AFFAIRS. 

4 (a) TASK FORCE REVIEW.— 

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

6 Affairs shall, through the use of a technology task 

7 force, conduct a review of the needs of the Depart8 ment of Veterans Affairs with respect to the sched9 uling system and scheduling software of the Depart10 ment of Veterans Affairs that is used by the Depart11 ment to schedule appointments for veterans for hos12 pital care, medical services, and other health care 

13 from the Department. 

14 (2) AGREEMENT.— 

15 (A) IN GENERAL.—The Secretary shall 

16 seek to enter into an agreement with a tech17 nology organization or technology organizations 

18 to carry out the review required by paragraph 

19 (1). 

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

21 Federal funds may be used to assist the tech22 nology organization or technology organizations 

23 under subparagraph (A) in carrying out the re24 view required by paragraph (1). 

25 (b) REPORT.— 


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

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

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

4 submit to the Secretary, the Committee on Veterans’ 

5 Affairs of the Senate, and the Committee on Vet6 erans’ Affairs of the House of Representatives a re7 port setting forth the findings and recommendations 

8 of the technology task force regarding the needs of 

9 the Department with respect to the scheduling sys10 tem and scheduling software of the Department de11 scribed in such subsection. 

12 (2) ELEMENTS.—The report required by para13 graph (1) shall include the following: 

14 (A) Proposals for specific actions to be 

15 taken by the Department to improve the sched16 uling system and scheduling software of the De17 partment described in subsection (a)(1). 

18 (B) A determination as to whether an ex19 isting off-the-shelf system would— 

20 (i) meet the needs of the Department 

21 to schedule appointments for veterans for 

22 hospital care, medical services, and other 

23 health care from the Department; and 

24 (ii) improve the access of veterans to 

25 such care and services. 


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

2 after the receipt of the report required by paragraph 

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

4 Federal Register and on an Internet website of the 

5 Department accessible to the public. 

6 (c) IMPLEMENTATION OF TASK FORCE REC7 OMMENDATIONS.—Not later than one year after the re8 ceipt of the report required by subsection (b)(1), the Sec9 retary shall implement the recommendations set forth in 

10 such report that the Secretary considers are feasible, ad11 visable, and cost-effective. 

12 TITLE II—TRAINING AND HIRING 

13 OF HEALTH CARE STAFF 

14 SEC. 201. TREATMENT OF STAFFING SHORTAGE AND BIAN15 NUAL REPORT ON STAFFING OF MEDICAL FA16 CILITIES OF THE DEPARTMENT OF VET17 ERANS AFFAIRS. 

18 (a) STAFFING SHORTAGE.— 

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

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

21 later than September 30 each year thereafter, the 

22 Inspector General of the Department of Veterans 

23 Affairs shall determine, and the Secretary of Vet24 erans Affairs shall publish in the Federal Register, 

25 the five occupations of health care providers of the 


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1 Department of Veterans Affairs for which there is 

2 the largest staffing shortage throughout the Depart3 ment. 

4 (2) RECRUITMENT AND APPOINTMENT.—Not5 withstanding sections 3304 and 3309 through 3318 

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

7 upon a determination by the Inspector General 

8 under paragraph (1) that there is a staffing short9 age throughout the Department with respect to a 

10 particular occupation of health care provider, recruit 

11 and directly appoint highly qualified health care pro12 viders to serve as health care providers in that par13 ticular occupation for the Department. 

14 (3) PRIORITY IN HEALTH PROFESSIONALS EDU15 CATIONAL ASSISTANCE PROGRAM TO CERTAIN PRO16 VIDERS.—Section 7612(b)(5) of title 38, United 

17 States Code, is amended— 

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

19 ‘‘and’’ at the end; 

20 (B) by redesignating subparagraph (B) as 

21 subparagraph (C); and 

22 (C) by inserting after subparagraph (A) 

23 the following new subparagraph (B): 

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

25 a course of education or training towards a career 


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

2 most current determination published in the Federal 

3 Register pursuant to section 201(a)(1) of the Vet4 erans’ Access to Care through Choice, Account5 ability, and Transparency Act of 2014, determined 

6 that there is one of the largest staffing shortages 

7 throughout the Department with respect to such oc8 cupation; and’’. 

9 (b) REPORTS.— 

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

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

12 later than December 31 of each even numbered year 

13 thereafter until 2024, the Secretary of Veterans Af14 fairs shall submit to the Committee on Veterans’ Af15 fairs of the Senate and the Committee on Veterans’ 

16 Affairs of the House of Representatives a report as17 sessing the staffing of each medical facility of the 

18 Department of Veterans Affairs. 

19 (2) ELEMENTS.—Each report submitted under 

20 paragraph (1) shall include the following: 

21 (A) The results of a system-wide assess22 ment of all medical facilities of the Department 

23 to ensure the following: 

24 (i) Appropriate staffing levels for 

25 health care providers to meet the goals of 


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1 the Secretary for timely access to care for 

2 veterans. 

3 (ii) Appropriate staffing levels for 

4 support personnel, including clerks. 

5 (iii) Appropriate sizes for clinical pan6 els. 

7 (iv) Appropriate numbers of full-time 

8 staff, or full-time equivalents, dedicated to 

9 direct care of patients. 

10 (v) Appropriate physical plant space 

11 to meet the capacity needs of the Depart12 ment in that area. 

13 (vi) Such other factors as the Sec14 retary considers necessary. 

15 (B) A plan for addressing any issues iden16 tified in the assessment described in subpara17 graph (A), including a timeline for addressing 

18 such issues. 

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

20 workload levels for the following clinics in each 

21 medical facility: 

22 (i) Mental health. 

23 (ii) Primary care. 

24 (iii) Gastroenterology. 

25 (iv) Women’s health. 


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1 (v) Such other clinics as the Secretary 

2 considers appropriate. 

3 (D) A description of the results of the 

4 most current determination of the Inspector 

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

6 and a plan to use direct appointment authority 

7 under paragraph (2) of such subsection to fill 

8 staffing shortages, including recommendations 

9 for improving the speed at which the 

10 credentialing and privileging process can be 

11 conducted. 

12 (E) The current staffing models of the De13 partment for the following clinics, including rec14 ommendations for changes to such models: 

15 (i) Mental health. 

16 (ii) Primary care. 

17 (iii) Gastroenterology. 

18 (iv) Women’s health. 

19 (v) Such other clinics as the Secretary 

20 considers appropriate. 

21 (F) A detailed analysis of succession plan22 ning at medical facilities of the Department, in23 cluding the following: 


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1 (i) The number of positions in medical 

2 facilities throughout the Department that 

3 are not filled by a permanent employee. 

4 (ii) The length of time each position 

5 described in clause (i) remained vacant or 

6 filled by a temporary or acting employee. 

7 (iii) A description of any barriers to 

8 filling the positions described in clause (i). 

9 (iv) A plan for filling any positions 

10 that are vacant or filled by a temporary or 

11 acting employee for more than 180 days. 

12 (v) A plan for handling emergency cir13 cumstances, such as administrative leave 

14 or sudden medical leave for senior officials. 

15 (G) The number of health care providers of 

16 the Department who have been removed from 

17 their positions, have retired, or have left their 

18 positions for another reason, disaggregated by 

19 provider type, during the two-year period pre20 ceding the submittal of the report. 

21 (H) Of the health care providers specified 

22 in subparagraph (G) who have been removed 

23 from their positions, the following: 


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1 (i) The number of such health care 

2 providers who were reassigned to other po3 sitions in the Department. 

4 (ii) The number of such health care 

5 providers who left the Department. 

6 (iii) The number of such health care 

7 providers who left the Department and 

8 were subsequently rehired by the Depart9 ment. 

10 SEC. 202. CLINIC MANAGEMENT TRAINING FOR MANAGERS 

11 AND HEALTH CARE PROVIDERS OF THE DE12 PARTMENT OF VETERANS AFFAIRS. 

13 (a) CLINIC MANAGEMENT TRAINING PROGRAM.— 

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

15 after the date of the enactment of this Act, the Sec16 retary of Veterans Affairs shall commence a clinic 

17 management training program to provide in-person, 

18 standardized education on health care management 

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

20 medical facilities of the Department of Veterans Af21 fairs. 

22 (2) ELEMENTS.—The clinic management train23 ing program required by paragraph (1) shall include 

24 the following: 


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1 (A) Training on how to manage the sched2 ules of health care providers of the Department, 

3 including the following: 

4 (i) Maintaining such schedules in a 

5 manner that allows appointments to be 

6 booked at least eight weeks in advance. 

7 (ii) Proper planning procedures for 

8 vacation, leave, and graduate medical edu9 cation training schedules. 

10 (B) Training on the appropriate number of 

11 appointments that a health care provider should 

12 conduct on a daily basis, based on specialty. 

13 (C) Training on how to determine whether 

14 there are enough available appointment slots to 

15 manage demand for different appointment types 

16 and mechanisms for alerting management of in17 sufficient slots. 

18 (D) Training on how to properly use the 

19 appointment scheduling system of the Depart20 ment, including any new scheduling system im21 plemented by the Department. 

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

23 technology, including the following: 

24 (i) Telemedicine. 

25 (ii) Electronic mail. 


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1 (iii) Text messaging. 

2 (iv) Such other technologies as speci3 fied by the Secretary. 

4 (F) Training on how to properly use phys5 ical plant space at medical facilities of the De6 partment to ensure efficient flow and privacy 

7 for patients and staff. 

8 (3) SUNSET.—The clinic management training 

9 program required by paragraph (1) shall terminate 

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

11 the Secretary commences such program. 

12 (b) TRAINING MATERIALS.— 

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

14 clinic management training program required by 

15 subsection (a), the Secretary shall provide training 

16 materials on health care management to each of the 

17 following employees of the Department upon the 

18 commencement of employment of such employee: 

19 (A) Any manager of a medical facility of 

20 the Department. 

21 (B) Any health care provider at a medical 

22 facility of the Department. 

23 (C) Such other employees of the Depart24 ment as the Secretary considers appropriate. 


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1 (2) UPDATE.—The Secretary shall regularly up2 date the training materials required under para3 graph (1). 

4 SEC. 203. USE OF UNOBLIGATED AMOUNTS TO HIRE ADDI5 TIONAL HEALTH CARE PROVIDERS FOR THE 

6 VETERANS HEALTH ADMINISTRATION. 

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

8 2014 and 2015, all covered amounts shall be made avail9 able to the Secretary of Veterans Affairs to hire additional 

10 health care providers for the Veterans Health Administra11 tion of the Department of Veterans Affairs, or to carry 

12 out any provision of this Act or the amendments made 

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

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

15 prioritize hiring additional health care providers under 

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

17 in geographic areas in which the Secretary identifies the 

18 greatest shortage of health care providers. 

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

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

21 (1) that are made available to the Veterans 

22 Health Administration of the Department for an ap23 propriations account— 

24 (A) under the heading ‘‘MEDICAL SERV25 ICES’’; 


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1 (B) under the heading ‘‘MEDICAL SUPPORT

2 AND COMPLIANCE’’; or 

3 (C) under the heading ‘‘MEDICAL FACILI4 TIES’’; and 

5 (2) that are unobligated at the end of the appli6 cable fiscal year. 

7 TITLE III—IMPROVEMENT OF 

8 ACCESS TO CARE FROM NON9 DEPARTMENT OF VETERANS 

10 AFFAIRS PROVIDERS 

11 SEC. 301. EXPANDED AVAILABILITY OF HOSPITAL CARE 

12 AND MEDICAL SERVICES FOR VETERANS 

13 THROUGH THE USE OF CONTRACTS. 

14 (a) EXPANSION OF AVAILABLE CARE AND SERV15 ICES.— 

16 (1) FURNISHING OF CARE.— 

17 (A) IN GENERAL.—Hospital care and med18 ical services under chapter 17 of title 38, 

19 United States Code, shall be furnished to an el20 igible veteran described in subsection (b), at the 

21 election of such veteran, through contracts au22 thorized under subsection (d), or any other law 

23 administered by the Secretary of Veterans Af24 fairs, with entities specified in subparagraph 


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

2 to veterans. 

3 (B) ENTITIES SPECIFIED.—The entities 

4 specified in this subparagraph are the following: 

5 (i) Any health care provider that is 

6 participating in the Medicare program 

7 under title XVIII of the Social Security 

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

9 (ii) Any Federally-qualified health 

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

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

12 1396d(l)(2)(B))). 

13 (iii) The Department of Defense. 

14 (iv) The Indian Health Service. 

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

16 who elects to receive care and services under this 

17 section may select the provider of such care and 

18 services from among any source of provider of such 

19 care and services through an entity specified in 

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

21 (3) COORDINATION OF CARE AND SERVICES.— 

22 The Secretary shall coordinate, through the Non-VA 

23 Care Coordination Program of the Department of 

24 Veterans Affairs, the furnishing of care and services 

25 under this section to eligible veterans, including by 


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1 ensuring that an eligible veteran receives an appoint2 ment for such care and services within the current 

3 wait-time goals of the Veterans Health Administra4 tion for the furnishing of hospital care and medical 

5 services. 

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

7 veteran for purposes of this section if— 

8 (1)(A) the veteran is enrolled in the patient en9 rollment system of the Department of Veterans Af10 fairs established and operated under section 1705 of 

11 title 38, United States Code; or 

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

13 not received hospital care or medical services from 

14 the Department, and has contacted the Department 

15 seeking an initial appointment from the Department 

16 for the receipt of such care or services; and 

17 (2) the veteran— 

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

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

20 for the receipt of hospital care or medical serv21 ices under chapter 17 of title 38, United States 

22 Code, but is unable to schedule an appointment 

23 within the current wait-time goals of the Vet24 erans Health Administration for the furnishing 

25 of such care or services; and 


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1 (ii) elects, and is authorized, to be fur2 nished such care or services pursuant to sub3 section (c)(2); 

4 (B) resides more than 40 miles from the 

5 nearest medical facility of the Department, in6 cluding a community-based outpatient clinic, 

7 that is closest to the residence of the veteran; 

8 or 

9 (C) resides— 

10 (i) in a State without a medical facil11 ity of the Department that provides— 

12 (I) hospital care; 

13 (II) emergency medical services; 

14 and 

15 (III) surgical care rated by the 

16 Secretary as having a surgical com17 plexity of standard; and 

18 (ii) more than 20 miles from a med19 ical facility of the Department described in 

20 clause (i). 

21 (c) ELECTION AND AUTHORIZATION.— 

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

23 that an appointment for an eligible veteran described 

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

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


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1 United States Code, is unavailable within the cur2 rent wait-time goals of the Department for the fur3 nishing of such care or services, the Secretary shall, 

4 at the election of the eligible veteran— 

5 (A) place such eligible veteran on an elec6 tronic waiting list described in paragraph (2) 

7 for such an appointment; or 

8 (B)(i) authorize that such care and serv9 ices be furnished to the eligible veteran under 

10 this section for a period of time specified by the 

11 Secretary; and 

12 (ii) send a letter to the eligible veteran de13 scribing the care and services the eligible vet14 eran is eligible to receive under this section. 

15 (2) ELECTRONIC WAITING LIST.—The elec16 tronic waiting list described in this paragraph shall 

17 be maintained by the Department and allow access 

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

19 any successor website for the following purposes: 

20 (A) To determine the place of such eligible 

21 veteran on the waiting list. 

22 (B) To determine the average length of 

23 time an individual spends on the waiting list, 

24 disaggregated by medical facility of the Depart25 ment and type of care or service needed, for 


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1 purposes of allowing such eligible veteran to 

2 make an informed election under paragraph 

3 (1). 

4 (d) CARE AND SERVICES THROUGH CONTRACTS.— 

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

6 into contracts with health care providers that are 

7 participating in the Medicare program under title 

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

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

10 under this section. 

11 (2) RATES AND REIMBURSEMENT.— 

12 (A) IN GENERAL.—In entering into a con13 tract under this subsection, the Secretary 

14 shall— 

15 (i) negotiate rates for the furnishing 

16 of care and services under this section; and 

17 (ii) reimburse the health care provider 

18 for such care and services at the rates ne19 gotiated pursuant to clause (i) as provided 

20 in such contract. 

21 (B) LIMIT ON RATES.— 

22 (i) IN GENERAL.—Except as provided 

23 in clause (ii), rates negotiated under sub24 paragraph (A)(i) shall not be more than 

25 the rates paid by the United States to a 


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1 provider of services (as defined in section 

2 1861(u) of the Social Security Act (42 

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

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

5 1395x(d))) under the Medicare program 

6 under title XVIII of the Social Security 

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

8 care and services. 

9 (ii) EXCEPTION.—The Secretary may 

10 negotiate a rate that is more than the rate 

11 paid by the United States as described in 

12 clause (i) with respect to the furnishing of 

13 care or services under this section to an el14 igible veteran if the Secretary determines 

15 that there is no health care provider that 

16 will provide such care or services to such 

17 eligible veteran at the rate required under 

18 such clause— 

19 (I) within the current wait-time 

20 goals of the Veterans Health Adminis21 tration for the furnishing of such care 

22 or services; and 

23 (II) at a location not more than 

24 40 miles from the residence of such 

25 eligible veteran. 


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1 (C) LIMIT ON COLLECTION.—For the fur2 nishing of care and services pursuant to a con3 tract under this section, a health care provider 

4 may not collect any amount that is greater than 

5 the rate negotiated pursuant to subparagraph 

6 (A)(i). 

7 (3) INFORMATION ON POLICIES AND PROCE8 DURES.—The Secretary shall provide to any health 

9 care provider with which the Secretary has entered 

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

11 (A) Information on applicable policies and 

12 procedures for submitting bills or claims for au13 thorized care and services furnished to eligible 

14 veterans under this section. 

15 (B) Access to a telephone hotline main16 tained by the Department that such health care 

17 provider may call for information on the fol18 lowing: 

19 (i) Procedures for furnishing care and 

20 services under this section. 

21 (ii) Procedures for submitting bills or 

22 claims for authorized care and services fur23 nished to eligible veterans under this sec24 tion and being reimbursed for furnishing 

25 such care and services. 


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1 (iii) Whether particular care or serv2 ices under this section are authorized, and 

3 the procedures for authorization of such 

4 care or services. 

5 (e) CHOICE CARD.— 

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

7 care and services under this section, the Secretary 

8 shall issue to each eligible veteran a card that the 

9 eligible veteran shall present to a health care pro10 vider that is eligible to furnish care and services 

11 under this section before receiving such care and 

12 services. 

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

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

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

16 issued to an eligible veteran under paragraph (1) 

17 shall include the following: 

18 (A) The name of the eligible veteran. 

19 (B) An identification number for the eligi20 ble veteran that is not the social security num21 ber of the eligible veteran. 

22 (C) The contact information of an appro23 priate office of the Department for health care 

24 providers to confirm that care and services 


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1 under this section are authorized for the eligible 

2 veteran. 

3 (D) Contact information and other rel4 evant information for the submittal of claims or 

5 bills for the furnishing of care and services 

6 under this section. 

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

8 for qualifying medical care outside the Depart9 ment of Veterans Affairs. Please call the De10 partment of Veterans Affairs phone number 

11 specified on this card to ensure that treatment 

12 has been authorized.’’. 

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

14 issuing a Choice Card to an eligible veteran, the Sec15 retary shall provide the eligible veteran with infor16 mation clearly stating the circumstances under 

17 which the veteran may be eligible for care and serv18 ices under this section. 

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

20 Secretary shall provide information to a veteran about the 

21 availability of care and services under this section in the 

22 following circumstances: 

23 (1) When the veteran enrolls in the patient en24 rollment system of the Department under section 

25 1705 of title 38, United States Code. 


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1 (2) When the veteran attempts to schedule an 

2 appointment for the receipt of hospital care or med3 ical services from the Department but is unable to 

4 schedule an appointment within the current wait5 time goals of the Veterans Health Administration 

6 for delivery of such care or services. 

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

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

9 (1) maintain at least the same or similar cre10 dentials and licenses as those credentials and li11 censes that are required of health care providers of 

12 the Department, as determined by the Secretary for 

13 purposes of this section; and 

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

15 year, verification of such licenses and credentials 

16 maintained by such health care provider. 

17 (h) COST-SHARING.— 

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

19 an eligible veteran to pay a copayment to the De20 partment for the receipt of care and services under 

21 this section only if such eligible veteran would be re22 quired to pay such copayment for the receipt of such 

23 care and services at a medical facility of the Depart24 ment. 


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1 (2) LIMITATION.—The copayment required 

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

3 copayment required of such eligible veteran by the 

4 Department for the receipt of such care and services 

5 at a medical facility of the Department. 

6 (i) CLAIMS PROCESSING SYSTEM.— 

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

8 for an efficient nationwide system for processing and 

9 paying bills or claims for authorized care and serv10 ices furnished to eligible veterans under this section. 

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

12 after the date of the enactment of this Act, the Sec13 retary of Veterans Affairs shall prescribe regulations 

14 for the implementation of such system. 

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

16 the Veterans Health Administration shall oversee the 

17 implementation and maintenance of such system. 

18 (4) ACCURACY OF PAYMENT.— 

19 (A) IN GENERAL.—The Secretary shall en20 sure that such system meets such goals for ac21 curacy of payment as the Secretary shall specify 

22 for purposes of this section. 

23 (B) ANNUAL REPORT.— 

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

25 year after the date of the enactment of this 


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1 Act, and annually thereafter until the ter2 mination date specified in subsection (n), 

3 the Secretary shall submit to the Com4 mittee on Veterans’ Affairs of the Senate 

5 and the Committee on Veterans’ Affairs of 

6 the House of Representatives a report on 

7 the goals for accuracy of such system. 

8 (ii) ELEMENTS.—Each report re9 quired by clause (i) shall include the fol10 lowing: 

11 (I) A description of the goals for 

12 accuracy for such system specified by 

13 the Secretary under subparagraph 

14 (A). 

15 (II) An assessment of the success 

16 of the Department in meeting such 

17 goals during the year preceding the 

18 submittal of the report. 

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

20 that any health care provider that furnishes care and serv21 ices under this section to an eligible veteran submits to 

22 the Department any medical record related to the care and 

23 services provided to such eligible veteran by such health 

24 care provider for inclusion in the electronic medical record 

25 of such eligible veteran maintained by the Department 


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1 upon the completion of the provision of such care and serv2 ices to such eligible veteran. 

3 (k) TRACKING OF MISSED APPOINTMENTS.—The 

4 Secretary shall implement a mechanism to track any 

5 missed appointments for care and services under this sec6 tion by eligible veterans to ensure that the Department 

7 does not pay for such care and services that were not fur8 nished to an eligible veteran. 

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

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

11 prescribe interim final regulations on the implementation 

12 of this section and publish such regulations in the Federal 

13 Register. 

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

15 540 days after the publication of the interim final regula16 tions under subsection (l), the Inspector General of the 

17 Department shall submit to the Secretary a report on the 

18 results of an audit of the care and services furnished 

19 under this section to ensure the accuracy and timeliness 

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

21 and services, including any findings and recommendations 

22 of the Inspector General. 

23 (n) TERMINATION.—The requirement of the Sec24 retary to furnish care and services under this section ter25 minates on the date that is two years after the date on 


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1 which the Secretary publishes the interim final regulations 

2 under subsection (l). 

3 (o) REPORTS.— 

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

5 after the publication of the interim final regulations 

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

7 the Committee on Veterans’ Affairs of the Senate 

8 and the Committee on Veterans’ Affairs of the 

9 House of Representatives a report on the furnishing 

10 of care and services under this section that includes 

11 the following: 

12 (A) The number of eligible veterans who 

13 have received care and services under this sec14 tion. 

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

16 services furnished to eligible veterans under this 

17 section. 

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

19 after the publication of the interim final regulations 

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

21 the Committee on Veterans’ Affairs of the Senate 

22 and the Committee on Veterans’ Affairs of the 

23 House of Representatives a report on the furnishing 

24 of care and services under this section that includes 

25 the following: 


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1 (A) The total number of eligible veterans 

2 who have received care and services under this 

3 section, disaggregated by— 

4 (i) eligible veterans described in sub5 section (b)(2)(A); and 

6 (ii) eligible veterans described in sub7 section (b)(2)(B). 

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

9 services furnished to eligible veterans under this 

10 section. 

11 (C) An accounting of the total cost of fur12 nishing care and services to eligible veterans 

13 under this section. 

14 (D) The results of a survey of eligible vet15 erans who have received care or services under 

16 this section on the satisfaction of such eligible 

17 veterans with the care or services received by 

18 such eligible veterans under this section. 

19 (E) An assessment of the effect of fur20 nishing care and services under this section on 

21 wait times for an appointment for the receipt of 

22 hospital care and medical services from the De23 partment. 

24 (F) An assessment of the feasibility and 

25 advisability of continuing furnishing care and 


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1 services under this section after the termination 

2 date specified in subsection (n). 

3 (p) RULES OF CONSTRUCTION.— 

4 (1) NO MODIFICATION OF CONTRACTS.—Noth5 ing in this section shall be construed to require the 

6 Secretary to renegotiate contracts for the furnishing 

7 of hospital care or medical services to veterans en8 tered into by the Department before the date of the 

9 enactment of this Act. 

10 (2) FILLING AND PAYING FOR PRESCRIPTION

11 MEDICATIONS.—Nothing in this section shall be con12 strued to alter the process of the Department for 

13 filling and paying for prescription medications. 

14 SEC. 302. TRANSFER OF AUTHORITY FOR PAYMENTS FOR 

15 HOSPITAL CARE, MEDICAL SERVICES, AND 

16 OTHER HEALTH CARE FROM NON-DEPART17 MENT PROVIDERS TO THE CHIEF BUSINESS 

18 OFFICE OF THE VETERANS HEALTH ADMINIS19 TRATION OF THE DEPARTMENT. 

20 (a) TRANSFER OF AUTHORITY.— 

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

22 2014, the Secretary of Veterans Affairs shall trans23 fer the authority to pay for hospital care, medical 

24 services, and other health care through non-Depart25 ment providers to the Chief Business Office of the 


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1 Veterans Health Administration of the Department 

2 of Veterans Affairs from the Veterans Integrated 

3 Service Networks and medical centers of the Depart4 ment of Veterans Affairs. 

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

6 Office shall work in consultation with the Office of 

7 Clinical Operations and Management of the Depart8 ment of Veterans Affairs to ensure that care and 

9 services described in paragraph (1) are provided in 

10 a manner that is clinically appropriate and effective. 

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

12 authority under paragraph (1) shall be carried out 

13 in a manner that does not delay or impede any pay14 ment by the Department for hospital care, medical 

15 services, or other health care provided through a 

16 non-Department provider under the laws adminis17 tered by the Secretary. 

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

19 each fiscal year that begins after the date of the enact20 ment of this Act— 

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

22 Office of the Veterans Health Administration 

23 amounts to pay for hospital care, medical services, 

24 and other health care provided through non-Depart25 ment providers, including any amounts necessary to 


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1 carry out the transfer of authority to pay for such 

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

3 increase in staff; and 

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

5 Integrated Service Network and medical center of 

6 the Department amounts to pay for such care and 

7 services. 

8 SEC. 303. ENHANCEMENT OF COLLABORATION BETWEEN 

9 DEPARTMENT OF VETERANS AFFAIRS AND 

10 INDIAN HEALTH SERVICE. 

11 (a) OUTREACH TO TRIBAL-RUN MEDICAL FACILI12 TIES.—The Secretary of Veterans Affairs shall, in con13 sultation with the Director of the Indian Health Service, 

14 conduct outreach to each medical facility operated by an 

15 Indian tribe or tribal organization through a contract or 

16 compact with the Indian Health Service under the Indian 

17 Self-Determination and Education Assistance Act (25 

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

19 such facilities, Indian tribes, and tribal organizations to 

20 enter into agreements with the Department of Veterans 

21 Affairs under which the Secretary reimburses such facili22 ties, Indian tribes, or tribal organizations, as the case may 

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

24 care at such facilities. 


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1 (b) METRICS FOR MEMORANDUM OF UNDER2 STANDING PERFORMANCE.—The Secretary of Veterans 

3 Affairs shall implement performance metrics for assessing 

4 the performance by the Department of Veterans Affairs 

5 and the Indian Health Service under the memorandum of 

6 understanding entitled ‘‘Memorandum of Understanding 

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

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

9 health care, improving quality and coordination of health 

10 care, promoting effective patient-centered collaboration 

11 and partnerships between the Department and the Serv12 ice, and ensuring health-promotion and disease-prevention 

13 services are appropriately funded and available for bene14 ficiaries under both health care systems. 

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

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

17 Affairs and the Director of the Indian Health Service shall 

18 jointly submit to Congress a report on the feasibility and 

19 advisability of the following: 

20 (1) Entering into agreements for the reimburse21 ment by the Secretary of the costs of direct care 

22 services provided through organizations receiving 

23 amounts pursuant to grants made or contracts en24 tered into under section 503 of the Indian Health 

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


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1 who are otherwise eligible to receive health care from 

2 such organizations. 

3 (2) Including the reimbursement of the costs of 

4 direct care services provided to veterans who are not 

5 Indians in agreements between the Department and 

6 the following: 

7 (A) The Indian Health Service. 

8 (B) An Indian tribe or tribal organization 

9 operating a medical facility through a contract 

10 or compact with the Indian Health Service 

11 under the Indian Self-Determination and Edu12 cation Assistance Act (25 U.S.C. 450 et seq.). 

13 (C) A medical facility of the Indian Health 

14 Service. 

15 (d) DEFINITIONS.—In this section: 

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

17 tribe’’ have the meanings given those terms in sec18 tion 4 of the Indian Health Care Improvement Act 

19 (25 U.S.C. 1603). 

20 (2) MEDICAL FACILITY OF THE INDIAN

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

22 the Indian Health Service’’ includes a facility oper23 ated by an Indian tribe or tribal organization 

24 through a contract or compact with the Indian 

25 Health Service under the Indian Self-Determination 


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

2 seq.). 

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

4 organization’’ has the meaning given the term in 

5 section 4 of the Indian Self-Determination and Edu6 cation Assistance Act (25 U.S.C. 450b). 

7 SEC. 304. ENHANCEMENT OF COLLABORATION BETWEEN 

8 DEPARTMENT OF VETERANS AFFAIRS AND 

9 NATIVE HAWAIIAN HEALTH CARE SYSTEMS. 

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

11 shall, in consultation with Papa Ola Lokahi and such 

12 other organizations involved in the delivery of health care 

13 to Native Hawaiians as the Secretary considers appro14 priate, enter into contracts or agreements with Native Ha15 waiian health care systems that are in receipt of funds 

16 from the Secretary of Health and Human Services pursu17 ant to grants awarded or contracts entered into under sec18 tion 6(a) of the Native Hawaiian Health Care Improve19 ment Act (42 U.S.C. 11705(a)) for the reimbursement of 

20 direct care services provided to eligible veterans as speci21 fied in such contracts or agreements. 

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

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

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


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1 in section 12 of the Native Hawaiian Health Care Im2 provement Act (42 U.S.C. 11711). 

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

4 DEPARTMENT OF VETERANS AFFAIRS. 

5 It is the sense of Congress that the Secretary of Vet6 erans Affairs shall comply with section 1315 of title 5, 

7 Code of Federal Regulations (commonly known as the 

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

9 regulation or ruling, in paying for health care pursuant 

10 to contracts entered into with non-Department of Vet11 erans Affairs providers to provide health care under the 

12 laws administered by the Secretary. 

13 TITLE IV—HEALTH CARE 

14 ADMINISTRATIVE MATTERS 

15 SEC. 401. IMPROVEMENT OF ACCESS OF VETERANS TO MO16 BILE VET CENTERS OF THE DEPARTMENT OF 

17 VETERANS AFFAIRS. 

18 (a) IMPROVEMENT OF ACCESS.— 

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

20 Affairs shall improve the access of veterans to tele21 medicine and other health care through the use of 

22 mobile vet centers of the Department of Veterans 

23 Affairs by providing standardized requirements for 

24 the operation of such centers. 


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1 (2) REQUIREMENTS.—The standardized re2 quirements required by paragraph (1) shall include 

3 the following: 

4 (A) The number of days each mobile vet 

5 center of the Department is expected to travel 

6 per year. 

7 (B) The number of locations each center is 

8 expected to visit per year. 

9 (C) The number of appointments each cen10 ter is expected to conduct per year. 

11 (D) The method and timing of notifica12 tions given by each center to individuals in the 

13 area to which such center is traveling, including 

14 notifications informing veterans of the avail15 ability to schedule appointments at the center. 

16 (3) USE OF TELEMEDICINE.—The Secretary 

17 shall ensure that each mobile vet center of the De18 partment has the capability to provide telemedicine 

19 services. 

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

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

22 30 each year thereafter, the Secretary of Veterans Affairs 

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

24 Senate and the Committee on Veterans’ Affairs of the 

25 House of Representatives a report on the following: 


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

2 telemedicine services to veterans during the year 

3 preceding the submittal of the report, including the 

4 following: 

5 (A) The number of days each mobile vet 

6 center was open to provide such services. 

7 (B) The number of days each mobile vet 

8 center traveled to a location other than the 

9 headquarters of the mobile vet center to provide 

10 such services. 

11 (C) The number of appointments each cen12 ter conducted to provide such services on aver13 age per month and in total during such year. 

14 (2) An analysis of the effectiveness of using mo15 bile vet centers to provide health care services to vet16 erans through the use of telemedicine. 

17 (3) Any recommendations for an increase in the 

18 number of mobile vet centers of the Department. 

19 (4) Any recommendations for an increase in the 

20 telemedicine capabilities of each mobile vet center. 

21 (5) The feasibility and advisability of using 

22 temporary health care providers, including locum 

23 tenens, to provide direct health care services to vet24 erans at mobile vet centers. 


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1 (6) Such other recommendations on improve2 ment of the use of mobile vet centers by the Depart3 ment as the Secretary considers appropriate. 

4 SEC. 402. COMMISSION ON CONSTRUCTION PROJECTS OF 

5 THE DEPARTMENT OF VETERANS AFFAIRS. 

6 (a) ESTABLISHMENT OF COMMISSION.— 

7 (1) ESTABLISHMENT.—There is established an 

8 Independent Commission on Department of Vet9 erans Affairs Construction Projects (in this section 

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

11 (2) MEMBERSHIP.— 

12 (A) VOTING MEMBERS.—The Commission 

13 shall be composed of 10 voting members as fol14 lows: 

15 (i) Three members to be appointed by 

16 the President from among members of the 

17 National Academy of Engineering who are 

18 nominated under subparagraph (B). 

19 (ii) Three members to be appointed by 

20 the President from among members of the 

21 National Institute of Building Sciences 

22 who are nominated under subparagraph 

23 (B). 

24 (iii) Four members to be appointed by 

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1 rolled in the patient enrollment system of 

2 the Department of Veterans Affairs under 

3 section 1705 of title 38, United States 

4 Code, who are nominated under subpara5 graph (B). 

6 (B) NOMINATION OF VOTING MEMBERS.— 

7 The majority leader of the Senate, the minority 

8 leader of the Senate, the speaker of the House 

9 of Representatives, and the minority leader of 

10 the House of Representatives shall jointly nomi11 nate not less than 24 individuals to be consid12 ered by the President for appointment under 

13 subparagraph (A). 

14 (C) NONVOTING MEMBERS.—The Commis15 sion shall be composed of the following non16 voting members: 

17 (i) The Comptroller General of the 

18 United States, or designee. 

19 (ii) The Secretary of Veterans Affairs, 

20 or designee. 

21 (iii) The Inspector General of the De22 partment of Veterans Affairs, or designee. 

23 (D) DATE OF APPOINTMENT OF MEM24 BERS.—The appointments of the members of 

25 the Commission under subparagraph (A) shall 


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1 be made not later than 14 days after the date 

2 of the enactment of this Act. 

3 (3) PERIOD OF APPOINTMENT; VACANCIES.— 

4 Members shall be appointed for the life of the Com5 mission. Any vacancy in the Commission shall not 

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

7 manner as the original appointment. 

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

9 days after the date on which all members of the 

10 Commission have been appointed, the Commission 

11 shall hold its first meeting. 

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

13 the call of the Chairperson. 

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

15 the Commission shall constitute a quorum, but a 

16 lesser number of members may hold hearings. 

17 (7) CHAIRPERSON AND VICE CHAIRPERSON.— 

18 The Commission shall select a Chairperson and Vice 

19 Chairperson from among its members. 

20 (b) DUTIES OF COMMISSION.— 

21 (1) REVIEW.—The Commission shall review 

22 current construction and maintenance projects and 

23 the medical facility leasing program of the Depart24 ment of Veterans Affairs to identify any problems 


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1 experienced by the Department in carrying out such 

2 projects and program. 

3 (2) REPORTS.— 

4 (A) COMMISSION REPORT.—Not later than 

5 120 days after the date of the enactment of this 

6 Act, the Commission shall submit to the Sec7 retary of Veterans Affairs, the Committee on 

8 Veterans’ Affairs of the Senate, and the Com9 mittee on Veterans’ Affairs of the House of 

10 Representatives a report setting forth rec11 ommendations, if any, for improving the man12 ner in which the Secretary carries out the 

13 projects and program specified in paragraph 

14 (1). 

15 (B) DEPARTMENT REPORT.—Not later 

16 than 60 days after the submittal of the report 

17 under subparagraph (A), the Secretary of Vet18 erans Affairs shall submit to the Committee on 

19 Veterans’ Affairs of the Senate and the Com20 mittee on Veterans’ Affairs of the House of 

21 Representatives a report on the feasibility and 

22 advisability of implementing the recommenda23 tions of the Commission, if any, included in the 

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1 cluding a timeline for the implementation of 

2 such recommendations. 

3 (c) POWERS OF COMMISSION.— 

4 (1) HEARINGS.—The Commission may hold 

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

6 take such testimony, and receive such evidence as 

7 the Commission considers advisable to carry out this 

8 section. 

9 (2) INFORMATION FROM FEDERAL AGENCIES.— 

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

12 considers necessary to carry out this section. Upon 

13 request of the Chairperson of the Commission, the 

14 head of such agency shall furnish such information 

15 to the Commission. 

16 (d) COMMISSION PERSONNEL MATTERS.— 

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

21 the annual rate of basic pay prescribed for level IV 

22 of the Executive Schedule under section 5315 of title 

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

24 time) during which such member is engaged in the 

25 performance of the duties of the Commission. All 


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

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

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

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

10 away from their homes or regular places of business 

11 in the performance of services for the Commission. 

12 (3) STAFF.— 

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

14 Commission may, without regard to the civil 

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

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

21 (B) COMPENSATION.—The Chairperson of 

22 the Commission may fix the compensation of 

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

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1 ing to classification of positions and General 

2 Schedule pay rates, except that the rate of pay 

3 for the executive director and other personnel 

4 may not exceed the rate payable for level V of 

5 the Executive Schedule under section 5316 of 

6 such title. 

7 (4) DETAIL OF GOVERNMENT EMPLOYEES.— 

8 Any Federal Government employee may be detailed 

9 to the Commission without reimbursement, and such 

10 detail shall be without interruption or loss of civil 

11 service status or privilege. 

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

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

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

18 pay prescribed for level V of the Executive Schedule 

19 under section 5316 of such title. 

20 (e) TERMINATION OF COMMISSION.—The Commis21 sion shall terminate 30 days after the date on which the 

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

23 SEC. 403. COMMISSION ON ACCESS TO CARE. 

24 (a) ESTABLISHMENT OF COMMISSION.— 


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

2 Commission on Access to Care (in this section re3 ferred to as the ‘‘Commission’’) to examine the ac4 cess of veterans to health care from the Department 

5 of Veterans Affairs and strategically examine how 

6 best to organize the Veterans Health Administra7 tion, locate health care resources, and deliver health 

8 care to veterans during the 10- to 20-year period be9 ginning on the date of the enactment of this Act. 

10 (2) MEMBERSHIP.— 

11 (A) VOTING MEMBERS.—The Commission 

12 shall be composed of 10 voting members who 

13 are appointed by the President as follows: 

14 (i) At least two members who rep15 resent an organization recognized by the 

16 Secretary of Veterans Affairs for the rep17 resentation of veterans under section 5902 

18 of title 38, United States Code. 

19 (ii) At least one member from among 

20 persons who have experience as senior 

21 management for a private integrated 

22 health care system with an annual gross 

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

24 (iii) At least one member from among 

25 persons who are familiar with government 


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1 health care systems, including those sys2 tems of the Department of Defense, the 

3 Indian Health Service, and Federally-quali4 fied health centers (as defined in section 

5 1905(l)(2)(B) of the Social Security Act 

6 (42 U.S.C. 1396d(l)(2)(B))). 

7 (iv) At least two members from 

8 among persons who are familiar with the 

9 Veterans Health Administration but are 

10 not current employees of the Veterans 

11 Health Administration. 

12 (v) At least two members from among 

13 persons who are veterans or eligible for 

14 hospital care, medical services, or other 

15 health care under the laws administered by 

16 the Secretary of Veterans Affairs. 

17 (B) NONVOTING MEMBERS.— 

18 (i) IN GENERAL.—In addition to 

19 members appointed under subparagraph 

20 (A), the Commission shall be composed of 

21 10 nonvoting members who are appointed 

22 by the President as follows: 

23 (I) At least two members who 

24 represent an organization recognized 

25 by the Secretary of Veterans Affairs 


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1 for the representation of veterans 

2 under section 5902 of title 38, United 

3 States Code. 

4 (II) At least one member from 

5 among persons who have experience 

6 as senior management for a private 

7 integrated health care system with an 

8 annual gross revenue of more than 

9 $50,000,000. 

10 (III) At least one member from 

11 among persons who are familiar with 

12 government health care systems, in13 cluding those systems of the Depart14 ment of Defense, the Indian Health 

15 Service, and Federally-qualified health 

16 centers (as defined in section 

17 1905(l)(2)(B) of the Social Security 

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

19 (IV) At least two members from 

20 among persons who are familiar with 

21 the Veterans Health Administration 

22 but are not current employees of the 

23 Veterans Health Administration. 

24 (V) At least two members from 

25 among persons who are veterans or elVerDate Mar 15 2010 23:50 Jun 10, 2014 Jkt 039200 PO 00000 Frm 00056 Fmt 6652 Sfmt 6201 E:\BILLS\S2450.PCS S2450

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1 igible for hospital care, medical serv2 ices, or other health care under the 

3 laws administered by the Secretary of 

4 Veterans Affairs. 

5 (ii) ADDITIONAL NONVOTING MEM6 BERS.—In addition to members appointed 

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

8 Commission shall be composed of the fol9 lowing nonvoting members: 

10 (I) The Comptroller General of 

11 the United States, or designee. 

12 (II) The Inspector General of the 

13 Department of Veterans Affairs, or 

14 designee. 

15 (C) DATE.—The appointments of members 

16 of the Commission shall be made not later than 

17 60 days after the date of the enactment of this 

18 Act. 

19 (3) PERIOD OF APPOINTMENT; VACANCIES.— 

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

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

23 manner as the original appointment. 

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

25 after the date on which seven voting members of the 


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1 Commission have been appointed, the Commission 

2 shall hold its first meeting. 

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

4 the call of the Chairperson. 

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

6 the Commission shall constitute a quorum, but a 

7 lesser number of members may hold hearings. 

8 (7) CHAIRPERSON AND VICE CHAIRPERSON.— 

9 The Commission shall select a Chairperson and Vice 

10 Chairperson from among its members. 

11 (b) DUTIES OF COMMISSION.— 

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

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

16 (2) MATTERS EVALUATED AND ASSESSED.— 

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

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

21 concerning access to health care. 

22 (B) The measurement of such standards. 

23 (C) The appropriateness of performance 

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


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

3 are sufficient to meet current demand for 

4 health care from the Administration. 

5 (E) The results of the assessment con6 ducted by an independent third party under 

7 section 101(a), including any data or rec8 ommendations included in such assessment. 

9 (3) REPORTS.—The Commission shall submit 

10 to the President, through the Secretary of Veterans 

11 Affairs, reports as follows: 

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

13 of the initial meeting of the Commission, an in14 terim report on— 

15 (i) the findings of the Commission 

16 with respect to the evaluation and assess17 ment required by this subsection; and 

18 (ii) such recommendations as the 

19 Commission may have for legislative or ad20 ministrative action to improve access to 

21 health care through the Veterans Health 

22 Administration. 

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

24 of the initial meeting of the Commission, a final 

25 report on— 


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1 (i) the findings of the Commission 

2 with respect to the evaluation and assess3 ment required by this subsection; and 

4 (ii) such recommendations as the 

5 Commission may have for legislative or ad6 ministrative action to improve access to 

7 health care through the Veterans Health 

8 Administration. 

9 (c) POWERS OF THE COMMISSION.— 

10 (1) HEARINGS.—The Commission may hold 

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

12 take such testimony, and receive such evidence as 

13 the Commission considers advisable to carry out this 

14 section. 

15 (2) INFORMATION FROM FEDERAL AGENCIES.— 

16 The Commission may secure directly from any Fed17 eral department or agency such information as the 

18 Commission considers necessary to carry out this 

19 section. Upon request of the Chairperson of the 

20 Commission, the head of such department or agency 

21 shall furnish such information to the Commission. 

22 (d) COMMISSION PERSONNEL MATTERS.— 

23 (1) COMPENSATION OF MEMBERS.—Each mem24 ber of the Commission who is not an officer or em25 ployee of the Federal Government shall be comVerDate Mar 15 2010 23:50 Jun 10, 2014 Jkt 039200 PO 00000 Frm 00060 Fmt 6652 Sfmt 6201 E:\BILLS\S2450.PCS S2450

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1 pensated at a rate equal to the daily equivalent of 

2 the annual rate of basic pay prescribed for level IV 

3 of the Executive Schedule under section 5315 of title 

4 5, United States Code, for each day (including travel 

5 time) during which such member is engaged in the 

6 performance of the duties of the Commission. All 

7 members of the Commission who are officers or em8 ployees of the United States shall serve without com9 pensation in addition to that received for their serv10 ices as officers or employees of the United States. 

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

12 Commission shall be allowed travel expenses, includ13 ing per diem in lieu of subsistence, at rates author14 ized for employees of agencies under subchapter I of 

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

16 away from their homes or regular places of business 

17 in the performance of services for the Commission. 

18 (3) STAFF.— 

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

20 Commission may, without regard to the civil 

21 service laws and regulations, appoint and termi22 nate an executive director and such other addi23 tional personnel as may be necessary to enable 

24 the Commission to perform its duties. The emVerDate Mar 15 2010 23:50 Jun 10, 2014 Jkt 039200 PO 00000 Frm 00061 Fmt 6652 Sfmt 6201 E:\BILLS\S2450.PCS S2450

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1 ployment of an executive director shall be sub2 ject to confirmation by the Commission. 

3 (B) COMPENSATION.—The Chairperson of 

4 the Commission may fix the compensation of 

5 the executive director and other personnel with6 out regard to chapter 51 and subchapter III of 

7 chapter 53 of title 5, United States Code, relat8 ing to classification of positions and General 

9 Schedule pay rates, except that the rate of pay 

10 for the executive director and other personnel 

11 may not exceed the rate payable for level V of 

12 the Executive Schedule under section 5316 of 

13 such title. 

14 (4) DETAIL OF GOVERNMENT EMPLOYEES.— 

15 Any Federal Government employee may be detailed 

16 to the Commission without reimbursement, and such 

17 detail shall be without interruption or loss of civil 

18 service status or privilege. 

19 (5) PROCUREMENT OF TEMPORARY AND INTER20 MITTENT SERVICES.—The Chairperson of the Com21 mission may procure temporary and intermittent 

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

23 States Code, at rates for individuals that do not ex24 ceed the daily equivalent of the annual rate of basic 


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1 pay prescribed for level V of the Executive Schedule 

2 under section 5316 of such title. 

3 (e) TERMINATION OF THE COMMISSION.—The Com4 mission shall terminate 30 days after the date on which 

5 the Commission submits its report under subsection 

6 (b)(3)(B). 

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

8 shall make available to the Commission from amounts ap9 propriated or otherwise made available to the Secretary 

10 such amounts as the Secretary and the Chairperson of the 

11 Commission jointly consider appropriate for the Commis12 sion to perform its duties under this section. 

13 (g) EXECUTIVE ACTION.— 

14 (1) ACTION ON RECOMMENDATIONS.—The 

15 President shall require the Secretary of Veterans Af16 fairs and such other heads of relevant Federal de17 partments and agencies to implement each rec18 ommendation set forth in a report submitted under 

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

20 (A) considers feasible and advisable; and 

21 (B) determines can be implemented with22 out further legislative action. 

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

24 the date on which the President receives a report 

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


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1 to the Committee on Veterans’ Affairs of the Senate 

2 and the Committee on Veterans’ Affairs of the 

3 House of Representatives and such other committees 

4 of Congress as the President considers appropriate 

5 a report setting forth the following: 

6 (A) An assessment of the feasibility and 

7 advisability of each recommendation contained 

8 in the report received by the President. 

9 (B) For each recommendation assessed as 

10 feasible and advisable under subparagraph (A) 

11 the following: 

12 (i) Whether such recommendation re13 quires legislative action. 

14 (ii) If such recommendation requires 

15 legislative action, a recommendation con16 cerning such legislative action. 

17 (iii) A description of any administra18 tive action already taken to carry out such 

19 recommendation. 

20 (iv) A description of any administra21 tive action the President intends to be 

22 taken to carry out such recommendation 

23 and by whom. 


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1 SEC. 404. IMPROVED PERFORMANCE METRICS FOR 

2 HEALTH CARE PROVIDED BY DEPARTMENT 

3 OF VETERANS AFFAIRS. 

4 (a) PROHIBITION ON USE OF SCHEDULING AND

5 WAIT-TIME METRICS IN DETERMINATION OF PERFORM6 ANCE AWARDS.—The Secretary of Veterans Affairs shall 

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

8 not used as factors in determining the performance of the 

9 following employees for purposes of determining whether 

10 to pay performance awards to such employees: 

11 (1) Directors, associate directors, assistant di12 rectors, deputy directors, chiefs of staff, and clinical 

13 leads of medical centers of the Department of Vet14 erans Affairs. 

15 (2) Directors, assistant directors, and quality 

16 management officers of Veterans Integrated Service 

17 Networks of the Department of Veterans Affairs. 

18 (b) MODIFICATION OF PERFORMANCE PLANS.— 

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

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

21 shall modify the performance plans of the directors 

22 of the medical centers of the Department and the di23 rectors of the Veterans Integrated Service Networks 

24 to ensure that such plans are based on the quality 

25 of care received by veterans at the health care facili26 ties under the jurisdictions of such directors. 


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1 (2) FACTORS.—In modifying performance plans 

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

3 assessment of the quality of care provided at health 

4 care facilities under the jurisdiction of a director de5 scribed in paragraph (1) includes consideration of 

6 the following: 

7 (A) Recent reviews by the Joint Commis8 sion (formerly known as the ‘‘Joint Commission 

9 on Accreditation of Healthcare Organizations’’) 

10 of such facilities. 

11 (B) The number and nature of rec12 ommendations concerning such facilities by the 

13 Inspector General of the Department in reviews 

14 conducted through the Combined Assessment 

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

16 General of community based outpatient clinics 

17 and primary care clinics, and in reviews con18 ducted through the Office of Healthcare Inspec19 tions during the two most recently completed 

20 fiscal years. 

21 (C) The number of recommendations de22 scribed in subparagraph (B) that the Inspector 

23 General of the Department determines have not 

24 been carried out satisfactorily with respect to 

25 such facilities. 


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1 (D) Reviews of such facilities by the Com2 mission on Accreditation of Rehabilitation Fa3 cilities. 

4 (E) The number and outcomes of adminis5 trative investigation boards, root cause analysis, 

6 and peer reviews conducted at such facilities 

7 during the fiscal year for which the assessment 

8 is being conducted. 

9 (F) The effectiveness of any remedial ac10 tions or plans resulting from any Inspector 

11 General recommendations in the reviews and 

12 analyses described in subparagraphs (A) 

13 through (E). 

14 (3) ADDITIONAL LEADERSHIP POSITIONS.—To 

15 the degree practicable, the Secretary shall assess the 

16 performance of other employees of the Department 

17 in leadership positions at Department medical cen18 ters, including associate directors, assistant direc19 tors, deputy directors, chiefs of staff, and clinical 

20 leads, and in Veterans Integrated Service Networks, 

21 including assistant directors and quality manage22 ment officers, using factors and criteria similar to 

23 those used in the performance plans modified under 

24 paragraph (1). 


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1 (c) REMOVAL OF CERTAIN PERFORMANCE GOALS.— 

2 For each fiscal year that begins after the date of the en3 actment of this Act, the Secretary shall not include in the 

4 performance goals of any employee of a Veterans Inte5 grated Service Network or medical center of the Depart6 ment any performance goal that might disincentivize the 

7 payment of Department amounts to provide hospital care, 

8 medical services, or other health care through a non-De9 partment provider. 

10 SEC. 405. IMPROVED TRANSPARENCY CONCERNING 

11 HEALTH CARE PROVIDED BY DEPARTMENT 

12 OF VETERANS AFFAIRS. 

13 (a) PUBLICATION OF WAIT TIMES.— 

14 (1) GOALS.— 

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

16 the date of the enactment of this Act, the Sec17 retary of Veterans Affairs shall publish in the 

18 Federal Register, and on an Internet website 

19 accessible to the public of each medical center 

20 of the Department of Veterans Affairs, the 

21 wait-time goals of the Department for the 

22 scheduling of an appointment by a veteran for 

23 the receipt of health care from the Department. 

24 (B) SUBSEQUENT CHANGES.— 


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1 (i) IN GENERAL.—If the Secretary 

2 modifies the wait-time goals described in 

3 subparagraph (A), the Secretary shall pub4 lish the new wait-times goals— 

5 (I) on an Internet website acces6 sible to the public of each medical 

7 center of the Department not later 

8 than 30 days after such modification; 

9 and 

10 (II) in the Federal Register not 

11 later than 90 days after such modi12 fication. 

13 (ii) EFFECTIVE DATE.—Any modifica14 tion under clause (i) shall take effect on 

15 the date of publication in the Federal Reg16 ister. 

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

18 published under this paragraph shall include 

19 goals for primary care appointments, specialty 

20 care appointments, and appointments based on 

21 the general severity of the condition of the vet22 eran. 

23 (2) WAIT TIMES AT MEDICAL CENTERS OF THE

24 DEPARTMENT.—Not later than one year after the 

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


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1 Veterans Affairs shall publish on an Internet website 

2 accessible to the public of each medical center of the 

3 Department the current wait time for an appoint4 ment for primary care and specialty care at the 

5 medical center. 

6 (b) PUBLICLY AVAILABLE DATABASE OF PATIENT

7 SAFETY, QUALITY OF CARE, AND OUTCOME MEAS8 URES.— 

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

10 after the date of the enactment of this Act, the Sec11 retary shall develop and make available to the public 

12 a comprehensive database containing all applicable 

13 patient safety, quality of care, and outcome meas14 ures for health care provided by the Department 

15 that are tracked by the Secretary. 

16 (2) UPDATE FREQUENCY.—The Secretary shall 

17 update the database required by paragraph (1) not 

18 less frequently than once each year. 

19 (3) UNAVAILABLE MEASURES.—For all meas20 ures that the Secretary would otherwise publish in 

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

22 done so because such measures are not available, the 

23 Secretary shall publish notice in the database of the 

24 reason for such unavailability and a timeline for 

25 making such measures available in the database. 


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1 (4) ACCESSIBILITY.—The Secretary shall en2 sure that the database required by paragraph (1) is 

3 accessible to the public through the primary Internet 

4 website of the Department and through each pri5 mary Internet website of a Department medical cen6 ter. 

7 (c) HOSPITAL COMPARE WEBSITE OF DEPARTMENT

8 OF HEALTH AND HUMAN SERVICES.— 

9 (1) AGREEMENT REQUIRED.—Not later than 

10 180 days after the date of the enactment of this Act, 

11 the Secretary of Veterans Affairs shall enter into an 

12 agreement with the Secretary of Health and Human 

13 Services for the provision by the Secretary of Vet14 erans Affairs of such information as the Secretary of 

15 Health and Human Services may require to report 

16 and make publicly available patient quality and out17 come information concerning Department of Vet18 erans Affairs medical centers through the Hospital 

19 Compare Internet website of the Department of 

20 Health and Human Services or any successor Inter21 net website. 

22 (2) INFORMATION PROVIDED.—The information 

23 provided by the Secretary of Veterans Affairs to the 

24 Secretary of Health and Human Services under 

25 paragraph (1) shall include the following: 


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1 (A) Measures of timely and effective health 

2 care. 

3 (B) Measures of readmissions, complica4 tions of death, including with respect to 30-day 

5 mortality rates and 30-day readmission rates, 

6 surgical complication measures, and health care 

7 related infection measures. 

8 (C) Survey data of patient experiences, in9 cluding the Hospital Consumer Assessment of 

10 Healthcare Providers and Systems or any simi11 lar successor survey developed by the Depart12 ment of Health and Human Services. 

13 (D) Any other measures required of or re14 ported with respect to hospitals participating in 

15 the Medicare program under title XVIII of the 

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

17 (3) UNAVAILABLE INFORMATION.—For any ap18 plicable metric collected by the Department of Vet19 erans Affairs or required to be provided under para20 graph (2) and withheld from or unavailable in the 

21 Hospital Compare Internet website, the Secretary of 

22 Veterans Affairs shall publish a notice in the Fed23 eral Register stating the reason why such metric was 

24 withheld from public disclosure and a timeline for 

25 making such metric available, if applicable. 


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1 (d) COMPTROLLER GENERAL REVIEW OF PUBLICLY

2 AVAILABLE SAFETY AND QUALITY METRICS.—Not later 

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

4 Act, the Comptroller General of the United States shall 

5 conduct a review of the safety and quality metrics made 

6 publicly available by the Secretary of Veterans Affairs 

7 under this section to assess the degree to which the Sec8 retary is complying with the provisions of this section. 

9 SEC. 406. INFORMATION FOR VETERANS ON THE CREDEN10 TIALS OF DEPARTMENT OF VETERANS AF11 FAIRS PHYSICIANS. 

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

13 WEBSITE LINKS.— 

14 (1) AVAILABILITY THROUGH DEPARTMENT OF

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

16 Providers’’ health care providers database of the De17 partment of Veterans Affairs, or any successor data18 base, shall be available on and through the home19 page of the Internet website of the Department that 

20 is accessible to the public. 

21 (2) INFORMATION ON LOCATION OF RESIDENCY

22 TRAINING.—The Internet website of the Department 

23 that is accessible to the public shall include under 

24 the link to the ‘‘Our Providers’’ health care pro25 viders database of the Department, or any successor 


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1 database, the location of residency training of each 

2 licensed physician of the Department. 

3 (3) INFORMATION ON PHYSICIANS AT PAR4 TICULAR FACILITIES.—The ‘‘Our Providers’’ health 

5 care providers database of the Department, or any 

6 successor database, shall identify whether each li7 censed physician of the Department is a physician in 

8 residency. 

9 (b) INFORMATION ON CREDENTIALS OF PHYSICIANS

10 FOR VETERANS UNDERGOING SURGICAL PROCEDURES.— 

11 (1) IN GENERAL.—Each veteran who is under12 going a surgical procedure by or through the De13 partment shall be provided information on the cre14 dentials of the surgeon to be performing such proce15 dure at such time in advance of the procedure as is 

16 appropriate to permit such veteran to evaluate such 

17 information. 

18 (2) OTHER INDIVIDUALS.—If a veteran is un19 able to evaluate the information provided under 

20 paragraph (1) due to the health or mental com21 petence of the veteran, such information shall be 

22 provided to an individual acting on behalf of the vet23 eran. 

24 (c) COMPTROLLER GENERAL REPORT AND PLAN.— 


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

2 the date of the enactment of this Act, the Comp3 troller General of the United States shall submit to 

4 the Committee on Veterans’ Affairs of the Senate 

5 and the Committee on Veterans’ Affairs of the 

6 House of Representatives a report setting forth an 

7 assessment by the Comptroller General of the fol8 lowing: 

9 (A) The manner in which contractors 

10 under the Patient-Centered Community Care 

11 initiative of the Department perform oversight 

12 of the credentials of physicians within the net13 works of such contractors under the initiative. 

14 (B) The oversight by the Department of 

15 the contracts under the Patient-Centered Com16 munity Care initiative. 

17 (C) The verification by the Department of 

18 the credentials and licenses of health care pro19 viders furnishing hospital care and medical 

20 services under section 301. 

21 (2) PLAN.— 

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

23 after the submittal of the report under para24 graph (1), the Secretary shall— 


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1 (i) submit to the Comptroller General, 

2 the Committee on Veterans’ Affairs of the 

3 Senate, and the Committee on Veterans’ 

4 Affairs of the House of Representatives a 

5 plan to address any findings and rec6 ommendations of the Comptroller General 

7 included in such report; and 

8 (ii) submit to the Committee on Vet9 erans’ Affairs of the Senate and the Com10 mittee on Veterans’ Affairs of the House 

11 of Representatives a request for additional 

12 amounts, if any, that may be necessary to 

13 carry out such plan. 

14 (B) IMPLEMENTATION.—Not later than 90 

15 days after the submittal of the report under 

16 paragraph (1), the Secretary shall carry out 

17 such plan. 

18 SEC. 407. INFORMATION IN ANNUAL BUDGET OF THE 

19 PRESIDENT ON HOSPITAL CARE AND MED20 ICAL SERVICES FURNISHED THROUGH EX21 PANDED USE OF CONTRACTS FOR SUCH 

22 CARE. 

23 The materials on the Department of Veterans Affairs 

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1 mitted to Congress pursuant to section 1105(a) of title 

2 31, United States Code, shall set forth the following: 

3 (1) The number of veterans who received hos4 pital care and medical services under section 301 

5 during the fiscal year preceding the fiscal year in 

6 which such budget is submitted. 

7 (2) The amount expended by the Department 

8 on furnishing care and services under such section 

9 during the fiscal year preceding the fiscal year in 

10 which such budget is submitted. 

11 (3) The amount requested in such budget for 

12 the costs of furnishing care and services under such 

13 section during the fiscal year covered by such budg14 et, set forth in aggregate and by amounts for each 

15 account for which amounts are so requested. 

16 (4) The number of veterans that the Depart17 ment estimates will receive hospital care and medical 

18 services under such section during the fiscal years 

19 covered by the budget submission. 

20 (5) The number of employees of the Depart21 ment on paid administrative leave at any point dur22 ing the fiscal year preceding the fiscal year in which 

23 such budget is submitted. 


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1 SEC. 408. PROHIBITION ON FALSIFICATION OF DATA CON2 CERNING WAIT TIMES AND QUALITY MEAS3 URES AT DEPARTMENT OF VETERANS AF4 FAIRS. 

5 Not later than 60 days after the date of the enact6 ment of this Act, and in accordance with title 5, United 

7 States Code, the Secretary of Veterans Affairs shall estab8 lish policies whereby any employee of the Department of 

9 Veterans Affairs who knowingly submits false data con10 cerning wait times for health care or quality measures 

11 with respect to health care to another employee of the De12 partment or knowingly requires another employee of the 

13 Department to submit false data concerning such wait 

14 times or quality measures to another employee of the De15 partment is subject to a penalty the Secretary considers 

16 appropriate after notice and an opportunity for a hearing, 

17 including civil penalties, unpaid suspensions, or termi18 nation. 

19 SEC. 409. REMOVAL OF SENIOR EXECUTIVE SERVICE EM20 PLOYEES OF THE DEPARTMENT OF VET21 ERANS AFFAIRS FOR PERFORMANCE. 

22 (a) REMOVAL OR TRANSFER.— 

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

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

25 following new section: 


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

2 performance 

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

4 individual from the Senior Executive Service if the Sec5 retary determines the performance of the individual war6 rants such removal. If the Secretary so removes such an 

7 individual, the Secretary may— 

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

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

10 ‘‘(2) transfer the individual to a General Sched11 ule position at any grade of the General Schedule for 

12 which the individual is qualified and that the Sec13 retary determines is appropriate. 

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

15 after removing or transferring an individual from the Sen16 ior Executive Service under subsection (a), the Secretary 

17 shall submit to the Committees on Veterans’ Affairs of 

18 the Senate and House of Representatives notice in writing 

19 of such removal or transfer and the reason for such re20 moval or transfer. 

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

22 7543 of title 5 shall not apply to a removal or transfer 

23 under this section. 

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

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


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1 Merit Systems Protection Board under section 7701 of 

2 title 5. 

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

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

5 later than 7 days after the date of such removal or trans6 fer. 

7 ‘‘(d) EXPEDITED REVIEW BY MERIT SYSTEMS PRO8 TECTION BOARD.—(1) The Merit Systems Protection 

9 Board shall expedite any appeal under section 7701 of 

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

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

12 days after the date of the appeal. 

13 ‘‘(2) In any case in which the Merit Systems Protec14 tion Board determines that it cannot issue a decision in 

15 accordance with the 21-day requirement under paragraph 

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

17 Congress a report that explains the reason why the Merit 

18 Systems Protection Board is unable to issue a decision in 

19 accordance with such requirement in such case. 

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

21 sums as may be necessary for the Merit Systems Protec22 tion Board to expedite appeals under paragraph (1). 

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

24 stay any personnel action taken under this section. 


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

2 5 a removal under subsection (a)(1) may not receive any 

3 pay, awards, bonuses, incentives, allowances, differentials, 

4 student loan repayments, special payments, or benefits 

5 from the Secretary until the Merit Systems Protection 

6 Board has made a final decision on such appeal. 

7 ‘‘(6) A decision made by the Merit Systems Protec8 tion Board with respect to a removal or transfer under 

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

10 (2) CLERICAL AMENDMENT.—The table of sec11 tions at the beginning of such chapter is amended 

12 by adding at the end the following new item: 

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

13 (b) ESTABLISHMENT OF EXPEDITED REVIEW PROC14 ESS.— 

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

16 the date of the enactment of this Act, the Merit Sys17 tems Protection Board shall establish and put into 

18 effect a process to conduct expedited reviews in ac19 cordance with section 713(d) of title 38, United 

20 States Code. 

21 (2) INAPPLICABILITY OF CERTAIN REGULA22 TIONS.—Section 1201.22 of title 5, Code of Federal 

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

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1 dited reviews carried out under section 713(d) of 

2 title 38, United States Code. 

3 (3) REPORT BY MERIT SYSTEMS PROTECTION

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

5 the enactment of this Act, the Merit Systems Pro6 tection Board shall submit to Congress a report on 

7 the actions the Board plans to take to conduct expe8 dited reviews under section 713(d) of title 38, 

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

10 Such report shall include a description of the re11 sources the Board determines will be necessary to 

12 conduct such reviews and a description of whether 

13 any resources will be necessary to conduct such re14 views that were not available to the Board on the 

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

16 (c) TEMPORARY EXEMPTION FROM CERTAIN LIMI17 TATION ON INITIATION OF REMOVAL FROM SENIOR EX18 ECUTIVE SERVICE.—During the 120-day period beginning 

19 on the date of the enactment of this Act, an action to re20 move an individual from the Senior Executive Service at 

21 the Department of Veterans Affairs pursuant to section 

22 713 of title 38, United States Code, as added by sub23 section (a), or section 7543 of title 5, United States Code, 

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

25 5, United States Code, or any other provision of law. 


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1 (d) CONSTRUCTION.—Nothing in this section or sec2 tion 713 of title 38, United States Code, as added by sub3 section (a), shall be construed to apply to an appeal of 

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

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

6 TITLE V—HEALTH CARE 

7 RELATED TO SEXUAL TRAUMA 

8 SEC. 501. EXPANSION OF ELIGIBILITY FOR SEXUAL TRAU9 MA COUNSELING AND TREATMENT TO VET10 ERANS ON INACTIVE DUTY TRAINING. 

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

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

13 inserting ‘‘, active duty for training, or inactive duty train14 ing’’. 

15 SEC. 502. PROVISION OF COUNSELING AND TREATMENT 

16 FOR SEXUAL TRAUMA BY THE DEPARTMENT 

17 OF VETERANS AFFAIRS TO MEMBERS OF THE 

18 ARMED FORCES. 

19 (a) EXPANSION OF COVERAGE TO MEMBERS OF THE

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

21 38, United States Code, is amended— 

22 (1) by redesignating paragraph (2) as para23 graph (3); 

24 (2) by inserting after paragraph (1) the fol25 lowing new paragraph (2): 


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1 ‘‘(2)(A) In operating the program required by para2 graph (1), the Secretary may, in consultation with the 

3 Secretary of Defense, provide counseling and care and 

4 services to members of the Armed Forces (including mem5 bers of the National Guard and Reserves) on active duty 

6 to overcome psychological trauma described in that para7 graph. 

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

9 not be required to obtain a referral before receiving coun10 seling and care and services under this paragraph.’’; and 

11 (3) in paragraph (3), as redesignated by para12 graph (1)— 

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

14 ‘‘an individual’’; and 

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

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

17 (b) INFORMATION TO MEMBERS ON AVAILABILITY OF

18 COUNSELING AND SERVICES.—Subsection (c) of such sec19 tion is amended— 

20 (1) by striking ‘‘to veterans’’ each place it ap21 pears; and 

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

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


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1 (c) INCLUSION OF MEMBERS IN REPORTS ON COUN2 SELING AND SERVICES.—Subsection (e) of such section 

3 is amended— 

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

5 striking ‘‘to veterans’’; 

6 (2) in paragraph (2)— 

7 (A) by striking ‘‘women veterans’’ and in8 serting ‘‘individuals’’; and 

9 (B) by striking ‘‘training under subsection 

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

11 (d), disaggregated by— 

12 ‘‘(A) veterans; 

13 ‘‘(B) members of the Armed Forces (in14 cluding members of the National Guard and 

15 Reserves) on active duty; and 

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

17 (B)— 

18 ‘‘(i) men; and 

19 ‘‘(ii) women.’’; 

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

21 and inserting ‘‘individuals’’; and 

22 (4) in paragraph (5)— 

23 (A) by striking ‘‘women veterans’’ and in24 serting ‘‘individuals’’ ; and 


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1 (B) by inserting ‘‘, including specific rec2 ommendations for individuals specified in sub3 paragraphs (A), (B), and (C) of paragraph (2)’’ 

4 before the period at the end. 

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

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

7 after the date of the enactment of this Act. 

8 SEC. 503. REPORTS ON MILITARY SEXUAL TRAUMA. 

9 (a) REPORT ON SERVICES AVAILABLE FOR MILITARY

10 SEXUAL TRAUMA IN THE DEPARTMENT OF VETERANS

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

12 enactment of this Act, the Secretary of Veterans Affairs 

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

14 Senate and the Committee on Veterans’ Affairs of the 

15 House of Representatives a report on the treatment and 

16 services available from the Department of Veterans Af17 fairs for male veterans who experience military sexual 

18 trauma compared to such treatment and services available 

19 to female veterans who experience military sexual trauma. 

20 (b) REPORTS ON TRANSITION OF MILITARY SEXUAL

21 TRAUMA TREATMENT FROM DEPARTMENT OF DEFENSE

22 TO DEPARTMENT OF VETERANS AFFAIRS.—Not later 

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

24 and annually thereafter for five years, the Department of 

25 Veterans Affairs-Department of Defense Joint Executive 


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

2 United States Code, shall submit to the appropriate com3 mittees of Congress a report on military sexual trauma 

4 that includes the following: 

5 (1) The processes and procedures utilized by 

6 the Department of Veterans Affairs and the Depart7 ment of Defense to facilitate transition of treatment 

8 of individuals who have experienced military sexual 

9 trauma from treatment provided by the Department 

10 of Defense to treatment provided by the Department 

11 of Veterans Affairs. 

12 (2) A description and assessment of the collabo13 ration between the Department of Veterans Affairs 

14 and the Department of Defense in assisting veterans 

15 in filing claims for disabilities related to military 

16 sexual trauma, including permitting veterans access 

17 to information and evidence necessary to develop or 

18 support such claims. 

19 (c) DEFINITIONS.—In this section: 

20 (1) APPROPRIATE COMMITTEES OF CON21 GRESS.—The term ‘‘appropriate committees of Con22 gress’’ means— 

23 (A) the Committee on Veterans’ Affairs 

24 and the Committee on Armed Services of the 

25 Senate; and 


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1 (B) the Committee on Veterans’ Affairs 

2 and the Committee on Armed Services of the 

3 House of Representatives. 

4 (2) MILITARY SEXUAL TRAUMA.—The term 

5 ‘‘military sexual trauma’’ means psychological trau6 ma, which in the judgment of a mental health pro7 fessional employed by the Department, resulted from 

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

9 sexual nature, or sexual harassment which occurred 

10 while the veteran was serving on active duty or ac11 tive duty for training. 

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

13 harassment’’ means repeated, unsolicited verbal or 

14 physical contact of a sexual nature which is threat15 ening in character. 

16 (4) SEXUAL TRAUMA.—The term ‘‘sexual trau17 ma’’ shall have the meaning given that term by the 

18 Secretary of Veterans Affairs for purposes of this 

19 section. 

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

21 on the date that is 270 days after the date of the enact22 ment of this Act. 


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1 TITLE VI—MAJOR MEDICAL 

2 FACILITY LEASES 

3 SEC. 601. AUTHORIZATION OF MAJOR MEDICAL FACILITY 

4 LEASES. 

5 The Secretary of Veterans Affairs may carry out the 

6 following major medical facility leases at the locations 

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

8 the amount shown for such location (not including any es9 timated cancellation costs): 

10 (1) For a clinical research and pharmacy co11 ordinating center, Albuquerque, New Mexico, an 

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

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

14 Brick, New Jersey, an amount not to exceed 

15 $7,280,000. 

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

17 annex, Charleston, South Carolina, an amount not 

18 to exceed $7,070,250. 

19 (4) For the Cobb County community-based 

20 Outpatient Clinic, Cobb County, Georgia, an amount 

21 not to exceed $6,409,000. 

22 (5) For the Leeward Outpatient Healthcare Ac23 cess Center, Honolulu, Hawaii, including a co-lo24 cated clinic with the Department of Defense and the 

25 co-location of the Honolulu Regional Office of the 


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1 Veterans Benefits Administration and the Kapolei 

2 Vet Center of the Department of Veterans Affairs, 

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

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

5 Johnson County, Kansas, an amount not to exceed 

6 $2,263,000. 

7 (7) For a replacement community-based out8 patient clinic, Lafayette, Louisiana, an amount not 

9 to exceed $2,996,000. 

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

11 Lake Charles, Louisiana, an amount not to exceed 

12 $2,626,000. 

13 (9) For outpatient clinic consolidation, New 

14 Port Richey, Florida, an amount not to exceed 

15 $11,927,000. 

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

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

18 (11) For lease consolidation, San Antonio, 

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

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

21 San Diego, California, an amount not to exceed 

22 $11,946,100. 

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

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


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1 (14) For the Errera Community Care Center, 

2 West Haven, Connecticut, an amount not to exceed 

3 $4,883,000. 

4 (15) For the Worcester community-based Out5 patient Clinic, Worcester, Massachusetts, an amount 

6 not to exceed $4,855,000. 

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

8 outpatient clinic, Cape Girardeau, Missouri, an 

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

10 (17) For a multispecialty clinic, Chattanooga, 

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

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

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

14 exceed $4,534,000. 

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

16 Chula Vista, California, an amount not to exceed 

17 $3,714,000. 

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

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

20 (21) For a replacement research lease, Hous21 ton, Texas, an amount not to exceed $6,142,000. 

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

23 Lincoln, Nebraska, an amount not to exceed 

24 $7,178,400. 


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

2 Lubbock, Texas, an amount not to exceed 

3 $8,554,000. 

4 (24) For a community-based outpatient clinic 

5 consolidation, Myrtle Beach, South Carolina, an 

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

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

8 Phoenix, Arizona, an amount not to exceed 

9 $20,757,000. 

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

11 outpatient clinic, Redding, California, an amount not 

12 to exceed $8,154,000. 

13 SEC. 602. BUDGETARY TREATMENT OF DEPARTMENT OF 

14 VETERANS AFFAIRS MAJOR MEDICAL FACILI15 TIES LEASES. 

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

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

18 Department of Veterans Affairs to record the full 

19 cost of its contractual obligation against funds avail20 able at the time a contract is executed. 

21 (2) Office of Management and Budget Circular 

22 A–11 provides guidance to agencies in meeting the 

23 statutory requirements under title 31, United States 

24 Code, with respect to leases. 


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1 (3) For operating leases, Office of Management 

2 and Budget Circular A–11 requires the Department 

3 of Veterans Affairs to record up-front budget au4 thority in an ‘‘amount equal to total payments under 

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

6 to cover first year lease payments plus cancellation 

7 costs’’. 

8 (b) REQUIREMENT FOR OBLIGATION OF FULL

9 COST.— 

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

11 appropriations provided in advance, in exercising the 

12 authority of the Secretary of Veterans Affairs to 

13 enter into leases provided in this Act, the Secretary 

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

15 United States Code, as the full cost of the contrac16 tual obligation at the time a contract is executed ei17 ther— 

18 (A) an amount equal to total payments 

19 under the full term of the lease; or 

20 (B) if the lease specifies payments to be 

21 made in the event the lease is terminated before 

22 its full term, an amount sufficient to cover the 

23 first year lease payments plus the specified can24 cellation costs. 


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1 (2) SELF-INSURING AUTHORITY.—The require2 ments of paragraph (1) may be satisfied through the 

3 use of a self-insuring authority consistent with Of4 fice of Management and Budget Circular A–11. 

5 (c) TRANSPARENCY.— 

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

7 8104 of title 38, United States Code, is amended by 

8 adding at the end the following new paragraph: 

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

10 funding for a major medical facility lease, a detailed 

11 analysis of how the lease is expected to comply with 

12 Office of Management and Budget Circular A–11 

13 and section 1341 of title 31 (commonly referred to 

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

15 include— 

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

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

18 ‘operating lease’ as those terms are defined in 

19 Office of Management and Budget Circular A– 

20 11; 

21 ‘‘(B) an analysis of the obligation of budg22 etary resources associated with the lease; and 

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

24 in determining the asset cost, fair market value, 

25 and cancellation costs of the lease.’’. 


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1 (2) SUBMITTAL TO CONGRESS.—Such section 

2 8104 is further amended by adding at the end the 

3 following new subsection: 

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

5 a major medical facility lease, the Secretary shall submit 

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

7 the House of Representatives— 

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

9 into the lease; 

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

11 ‘‘(C) a description and analysis of any dif12 ferences between the prospectus submitted pursuant 

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

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

15 proposed lease fully complies with Office of Manage16 ment and Budget Circular A–11. 

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

18 ensure that any information submitted to the committee 

19 under such paragraph is treated by the committee with 

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

21 the Secretary and subject to the same statutory penalties 

22 for unauthorized disclosure or use as the Secretary. 

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

24 major medical facility lease, the Secretary shall submit to 

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


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1 any material differences between the lease that was en2 tered into and the proposed lease described under such 

3 paragraph, including how the lease that was entered into 

4 changes the previously submitted scoring analysis de5 scribed in subparagraph (D) of such paragraph.’’. 

6 (d) RULE OF CONSTRUCTION.—Nothing in this sec7 tion, or the amendments made by this section, shall be 

8 construed to in any way relieve the Department of Vet9 erans Affairs from any statutory or regulatory obligations 

10 or requirements existing prior to the enactment of this 

11 section and such amendments. 

12 TITLE VII—VETERANS BENEFITS 

13 MATTERS 

14 SEC. 701. EXPANSION OF MARINE GUNNERY SERGEANT 

15 JOHN DAVID FRY SCHOLARSHIP. 

16 (a) EXPANSION OF ENTITLEMENT.—Subsection 

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

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

19 (b) LIMITATION AND ELECTION ON CERTAIN BENE20 FITS.—Subsection (f) of such section is amended— 

21 (1) by redesignating paragraph (2) as para22 graph (4); and 

23 (2) by inserting after paragraph (1) the fol24 lowing new paragraphs: 


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1 ‘‘(2) LIMITATION.—The entitlement of an indi2 vidual to assistance under subsection (a) pursuant to 

3 paragraph (9) of subsection (b) because the indi4 vidual was a spouse of a person described in such 

5 paragraph shall expire on the earlier of— 

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

7 date on which the person died; and 

8 ‘‘(B) the date on which the individual re9 marries. 

10 ‘‘(3) ELECTION ON RECEIPT OF CERTAIN BENE11 FITS.—A surviving spouse entitled to assistance 

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

13 subsection (b) who is also entitled to educational as14 sistance under chapter 35 of this title may not re15 ceive assistance under both this section and such 

16 chapter, but shall make an irrevocable election (in 

17 such form and manner as the Secretary may pre18 scribe) under which section or chapter to receive 

19 educational assistance.’’. 

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

21 of such title is amended— 

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

23 child’’; and 

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

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


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

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

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

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

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

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

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

13 Secretary shall disapprove a course of education provided 

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

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

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

20 is higher than the rate the institution charges for tuition 

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

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

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


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

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

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

4 three years before the date of enrollment in the 

5 course concerned. 

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

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

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

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

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

14 institution of higher learning while remaining continuously 

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

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

20 under paragraph (1). 

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

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

23 of higher learning requires a covered individual pursuing 

24 a course of education at the institution to demonstrate an 

25 intent, by means other than satisfying a physical presence 


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1 requirement, to establish residency in the State in which 

2 the institution is located, or to satisfy other requirements 

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

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

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

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

7 State. 

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

9 paragraph (1) as the Secretary considers appropriate. 

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

11 only with respect to educational assistance under chapters 

12 30 and 33 of this title.’’. 

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

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

17 education during academic terms that begin after July 1, 

18 2015, through courses of education that commence on or 

19 after that date. 

20 TITLE VIII—APPROPRIATION 

21 AND EMERGENCY DESIGNA22 TIONS 

23 SEC. 801. APPROPRIATION OF EMERGENCY AMOUNTS. 

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


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

3 necessary to carry out this Act. 

4 SEC. 802. EMERGENCY DESIGNATIONS. 

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

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

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

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

9 Act is designated as an emergency requirement pursuant 

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

11 the concurrent resolution on the budget for fiscal year 

12 2010. 


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Calendar No. 426 

113TH CONGRESS 

2D SESSION S. 2450 

A BILL 

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

JUNE 10, 2014 

Read the second time and placed on the calendar 


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