II 

114TH CONGRESS 

2D SESSION S. 3401 

To amend title 38, United States Code, to consolidate and expand the provision of health care to veterans through non-Department of Veterans 

Affairs health care providers, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 27, 2016 

Mr. CRAPO introduced the following bill; which was read twice and referred 

to the Committee on Veterans’ Affairs 

A BILL 

To amend title 38, United States Code, to consolidate and 

expand the provision of health care to veterans through 

non-Department of Veterans Affairs health care providers, and for other purposes. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Improving Veterans 

5 Care in the Community Act of 2016’’. 

6 SEC. 2. SENSE OF CONGRESS. 

7 It is the sense of Congress that— 


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1 (1) the Department of Veterans Affairs should 

2 remain the primary means by which eligible veterans 

3 access health care; 

4 (2) the Veterans Health Administration needs a 

5 simple tool by which it can send veterans into the 

6 community to receive health care when appropriate; 

7 and 

8 (3) it is appropriate to send veterans into the 

9 community for health care when— 

10 (A) it is in the best medical interest of the 

11 veteran; 

12 (B) the veteran does not have access to a 

13 medical facility of the Department without an 

14 undue travel burden; 

15 (C) the nearest medical facility of the De16 partment does not provide the service the vet17 eran needs and the veteran faces an undue 

18 travel burden to receive the service from an19 other medical facility of the Department; or 

20 (D) the Secretary of Veterans Affairs de21 termines that it is appropriate. 


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1 SEC. 3. ESTABLISHMENT OF CARE IN THE COMMUNITY 

2 PROGRAM OF DEPARTMENT OF VETERANS 

3 AFFAIRS TO CONSOLIDATE AND EXPAND THE 

4 PROVISION OF HEALTH CARE TO VETERANS 

5 THROUGH NON-DEPARTMENT OF VETERANS 

6 AFFAIRS PROVIDERS. 

7 (a) ESTABLISHMENT OF PROGRAM.— 

8 (1) IN GENERAL.—Subchapter I of chapter 17 

9 of title 38, United States Code, is amended by in10 serting after section 1703 the following new section: 

11 ‘‘§ 1703A. Care in the Community Program 

12 ‘‘(a) IN GENERAL.—(1) There is established a con13 solidated program to furnish care and services specified 

14 in subsection (e) to veterans through individuals and enti15 ties specified in subsection (c), including through the use 

16 of contracts or agreements entered into under this section 

17 to furnish such care and services. Such program may be 

18 referred to as the ‘Care in the Community Program’. 

19 ‘‘(b) REQUIREMENT TO RECEIVE CARE.—To receive 

20 care or services under this section, a veteran must be en21 rolled in the patient enrollment system of the Department 

22 established and operated under section 1705 of this title. 

23 ‘‘(c) INDIVIDUALS AND ENTITIES SPECIFIED.—Indi24 viduals and entities specified in this paragraph are the fol25 lowing: 


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1 ‘‘(1) Any health care provider that is partici2 pating in the Medicare program under title XVIII of 

3 the Social Security Act (42 U.S.C. 1395 et seq.) or 

4 the Medicaid program under title XIX of such Act 

5 (42 U.S.C. 1396 et seq.), including any physician 

6 furnishing services under such a program. 

7 ‘‘(2) The Department of Defense, including 

8 pursuant to agreements entered into under section 

9 8111 of this title. 

10 ‘‘(3) The Indian Health Service. 

11 ‘‘(4) Institutions affiliated with the Department 

12 under section 7302 of this title. 

13 ‘‘(5) Providers of care under the Alaska Native 

14 Health Care System. 

15 ‘‘(6) Federally-qualified health centers (as de16 fined in section 1905(l)(2)(B) of the Social Security 

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

18 ‘‘(7) Any individual or entity with which the 

19 Secretary has entered into a contract or agreement 

20 under section 8153 of this title. 

21 ‘‘(8) Any other individual or entity that meets 

22 criteria established by the Secretary for purposes of 

23 this section. 


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1 ‘‘(d) ELIGIBILITY FOR CERTAIN SERVICES.—(1)(A) 

2 A veteran is eligible for hospital care and medical services 

3 under subsection (e)(9) if— 

4 ‘‘(i) the veteran does not live within 40 miles of 

5 a medical facility of the Department, including a 

6 community-based outpatient clinic; 

7 ‘‘(ii) the veteran requires care or services that 

8 are not available at any medical facility of the De9 partment, including a community-based outpatient 

10 clinic, within 40 miles from the residence of the vet11 eran; 

12 ‘‘(iii) the veteran resides— 

13 ‘‘(I) in a State without a medical facility of 

14 the Department that provides— 

15 ‘‘(aa) hospital care; 

16 ‘‘(bb) emergency medical services; and 

17 ‘‘(cc) surgical care rated by the Sec18 retary as having a surgical complexity of 

19 standard; and 

20 ‘‘(II) more than 20 miles from a medical 

21 facility of the Department described in sub22 clause (I); 

23 ‘‘(iv) the veteran— 

24 ‘‘(I) resides in a location, other than a lo25 cation in Guam, American Samoa, or the ReVerDate Sep 11 2014 23:08 Oct 03, 2016 Jkt 069002 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S3401.IS S3401

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1 public of the Philippines, that is within 40 miles 

2 of a medical facility of the Department, includ3 ing a community-based outpatient clinic; and 

4 ‘‘(II)(aa) is required to travel by air, boat, 

5 or ferry to reach each medical facility described 

6 in subclause (I) that is within 40 miles of the 

7 residence of the veteran; or 

8 ‘‘(bb) faces an unusual or excessive burden 

9 in traveling to such a medical facility of the De10 partment based on— 

11 ‘‘(AA) geographical challenges; 

12 ‘‘(BB) environmental factors, such as 

13 roads that are not accessible to the general 

14 public, traffic, or hazardous weather; 

15 ‘‘(CC) a medical condition that im16 pacts the ability to travel; or 

17 ‘‘(DD) other factors, as determined by 

18 the Secretary; 

19 ‘‘(v) the veteran would be required to wait 

20 longer than a period specified by the Secretary to re21 ceive hospital care or medical services from the De22 partment; or 

23 ‘‘(vi) a health care provider of the Department 

24 determines that it is in the medical interest of the 


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1 veteran to access hospital care or medical services 

2 outside of the Department. 

3 ‘‘(B) Any distance specified under subparagraph (A) 

4 shall be calculated based on distance traveled. 

5 ‘‘(C) The period specified by the Secretary under sub6 paragraph (A)(v) shall be 30 days unless the Secretary— 

7 ‘‘(i) prescribes regulations specifying a different 

8 period, which may include a different period for each 

9 area of specialty care; and 

10 ‘‘(ii) publishes such different period or periods 

11 in the Federal Register and on an Internet Web site 

12 of the Department. 

13 ‘‘(D) Veterans who meet eligibility criteria set forth 

14 under the pilot program under section 403 of the Vet15 erans’ Mental Health and Other Care Improvements Act 

16 of 2008 (Public Law 110–387; 38 U.S.C. 1703 note) 

17 (commonly known as ‘Project Arch’), as in effect on the 

18 day before the termination of such program, are eligible 

19 for care and services under subsection (e)(9). 

20 ‘‘(2)(A) A veteran is eligible for reimbursement for 

21 emergency treatment furnished under subsection (e)(15) 

22 at a non-Department facility— 

23 ‘‘(i) if the veteran is an active Department 

24 health-care participant who is personally liable for 

25 emergency treatment furnished the veteran in a nonVerDate Sep 11 2014 23:08 Oct 03, 2016 Jkt 069002 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S3401.IS S3401

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1 Department facility, for any emergency treatment 

2 furnished such veteran; or 

3 ‘‘(ii) if the treatment was for— 

4 ‘‘(I) an adjudicated service-connected dis5 ability; 

6 ‘‘(II) a non-service-connected disability as7 sociated with and held to be aggravating a serv8 ice-connected disability; 

9 ‘‘(III) any disability of a veteran if the vet10 eran has a total disability permanent in nature 

11 from a service-connected disability; or 

12 ‘‘(IV) any illness, injury, or dental condi13 tion of a veteran who— 

14 ‘‘(aa) is a participant in a vocational 

15 rehabilitation program (as defined in sec16 tion 3101(9) of this title); and 

17 ‘‘(bb) is medically determined to have 

18 been in need of care or treatment to make 

19 possible the veteran’s entrance into a 

20 course of training, or prevent interruption 

21 of a course of training, or hasten the re22 turn to a course of training which was in23 terrupted because of such illness, injury, or 

24 dental condition. 


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1 ‘‘(B) A veteran is an active Department health-care 

2 participant if the veteran received care under this chapter 

3 within the 24-month period preceding the furnishing of 

4 such emergency treatment. 

5 ‘‘(C) A veteran is personally liable for emergency 

6 treatment furnished the veteran in a non-Department fa7 cility if the veteran— 

8 ‘‘(i) is financially liable to the provider of emer9 gency treatment for that treatment; 

10 ‘‘(ii) has no entitlement to care or services 

11 under a health-plan contract (determined, in the 

12 case of a health-plan contract as defined in sub13 section (j)(2)(B) or (j)(2)(C), without regard to any 

14 requirement or limitation relating to eligibility for 

15 care or services from any department or agency of 

16 the United States); and 

17 ‘‘(iii) has no other contractual or legal recourse 

18 against a third party that would, in whole, extin19 guish such liability to the provider. 

20 ‘‘(e) CARE AND SERVICES.—Care and services speci21 fied in this subsection are the following: 

22 ‘‘(1) Hospital care or medical services furnished 

23 to a veteran for the treatment of— 

24 ‘‘(A) a service-connected disability; 


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1 ‘‘(B) a disability for which a veteran was 

2 discharged or released from the active military, 

3 naval, or air service; or 

4 ‘‘(C) a disability of a veteran who has a 

5 total disability permanent in nature from a 

6 service-connected disability. 

7 ‘‘(2) Medical services for the treatment of any 

8 disability of— 

9 ‘‘(A) a veteran described in section 

10 1710(a)(1)(B) of this title; 

11 ‘‘(B) a veteran who— 

12 ‘‘(i) has been furnished hospital care, 

13 nursing home care, domiciliary care, or 

14 medical services; and 

15 ‘‘(ii) requires medical services to com16 plete treatment incident to such care or 

17 services; or 

18 ‘‘(C) a veteran described in section 

19 1710(a)(2)(E) of this title, or a veteran who is 

20 in receipt of increased pension, or additional 

21 compensation or allowances based on the need 

22 of regular aid and attendance or by reason of 

23 being permanently housebound (or who, but for 

24 the receipt of retired pay, would be in receipt 

25 of such pension, compensation, or allowance), if 


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1 the Secretary has determined, based on an ex2 amination by a physician employed by the De3 partment (or, in areas where no such physician 

4 is available, by a physician carrying out such 

5 function under a contract or fee arrangement), 

6 that the medical condition of such veteran pre7 cludes appropriate treatment in Department fa8 cilities. 

9 ‘‘(3) Hospital care or medical services in a non10 Department facility for the treatment of medical 

11 emergencies which pose a serious threat to the life 

12 or health of a veteran receiving medical services in 

13 a Department facility or nursing home care under 

14 section 1720 of this title until such time following 

15 the furnishing of care in the non-Department facility 

16 as the veteran can be safely transferred to a Depart17 ment facility. 

18 ‘‘(4) Hospital care for women veterans. 

19 ‘‘(5) Hospital care, or medical services that will 

20 obviate the need for hospital admission, for veterans 

21 in a State (other than the Commonwealth of Puerto 

22 Rico) not contiguous to the contiguous States, ex23 cept that the annually determined hospital patient 

24 load and incidence of the furnishing of medical serv25 ices to veterans hospitalized or treated at the exVerDate Sep 11 2014 23:08 Oct 03, 2016 Jkt 069002 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S3401.IS S3401

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1 pense of the Department in Government and non2 Department facilities in each such noncontiguous 

3 State shall be consistent with the patient load or in4 cidence of the furnishing of medical services for vet5 erans hospitalized or treated by the Department 

6 within the 48 contiguous States and the Common7 wealth of Puerto Rico. 

8 ‘‘(6) Diagnostic services necessary for deter9 mination of eligibility for, or of the appropriate 

10 course of treatment in connection with, furnishing 

11 medical services at independent Department out12 patient clinics to obviate the need for hospital admis13 sion. 

14 ‘‘(7) Outpatient dental services and treatment, 

15 and related dental appliances, for a veteran de16 scribed in section 1712(a)(1)(F) of this title. 

17 ‘‘(8) Diagnostic services (on an inpatient or 

18 outpatient basis) for observation or examination of a 

19 person to determine eligibility for a benefit or service 

20 under laws administered by the Secretary. 

21 ‘‘(9) Hospital care and medical services for vet22 erans described in subsection (d)(1). 

23 ‘‘(10) Hospital care and medical services, in24 cluding counseling and related mental health services 

25 under section 1712A, for veterans meeting eligibility 


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1 criteria for such care and services under the Patient2 Centered Community Care program of the Depart3 ment, as in effect on the day before the effective 

4 date under section 3(j)(2) of the ‘Improving Vet5 erans Care in the Community Act of 2016’. 

6 ‘‘(11) Hospital care and medical services for 

7 veterans at medical facilities of the Indian Health 

8 Service or under the Tribal Health Program pursu9 ant to sharing agreements entered into between the 

10 Department and the Indian Health Service, Indian 

11 tribes, or tribal organizations. 

12 ‘‘(12) Hospital care and medical services for 

13 veterans at medical facilities of the Department of 

14 Defense pursuant to sharing agreements entered 

15 into between the Department of Veterans Affairs 

16 and the Department of Defense. 

17 ‘‘(13) Hospital care and medical services for 

18 veterans at other non-Department facilities pursuant 

19 to sharing agreements entered into between the De20 partment of Veterans Affairs and such facilities. 

21 ‘‘(14) Hospital care and medical services for 

22 veterans at institutions affiliated with the Depart23 ment under section 7302 of this title pursuant to 

24 contracts entered into with such institutions. 


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1 ‘‘(15) Reimbursement for payment made by vet2 erans described in subsection (d)(2), or on behalf of 

3 such veterans, for emergency treatment furnished 

4 such veterans in non-Department facilities. 

5 ‘‘(f) REFERRAL FOR SERVICES.—(1) Except as pro6 vided in paragraph (2), a veteran is required to obtain 

7 a referral from a primary care provider of the Department 

8 to receive specialty care services under this section. Any 

9 such referral shall be reviewed by the director of the med10 ical facility at which the primary care physician is located. 

11 ‘‘(2)(A) A veteran described in any of clauses (i) 

12 through (v) of subsection (d)(1)(A) is not required to ob13 tain a referral for specialty care services furnished under 

14 subsection (e)(9). 

15 ‘‘(B) In the case of a veteran described in subpara16 graph (A), the Secretary, through the Non-VA Care Co17 ordination Program of the Department, shall notify the 

18 primary care provider of the veteran of the specialty care 

19 appointment and ensure that the primary care provider 

20 receives materials from the specialty care provider nec21 essary to update the medical record of the veteran as ap22 propriate. 

23 ‘‘(g) PAYMENT RATES.—(1) Subject to paragraph 

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1 ment or reimbursement for care and services under this 

2 section. 

3 ‘‘(2) In entering into contracts or agreements under 

4 this section with individuals and entities specified in sub5 section (c), the Secretary shall— 

6 ‘‘(A) negotiate rates for the furnishing of care 

7 and services under this section; and 

8 ‘‘(B) reimburse the individual or entity for such 

9 care and services at the rates negotiated pursuant to 

10 subparagraph (A) as provided in such contract or 

11 agreement. 

12 ‘‘(3)(A) Except as provided in subparagraph (B), 

13 rates negotiated under paragraph (2)(A) shall not be more 

14 than the rates paid by the United States to a provider 

15 of services (as defined in section 1861(u) of the Social Se16 curity Act (42 U.S.C. 1395x(u))) or a supplier (as defined 

17 in section 1861(d) of such Act (42 U.S.C. 1395x(d))) 

18 under the Medicare program under title XVIII of the So19 cial Security Act (42 U.S.C. 1395 et seq.) for the same 

20 care or services. 

21 ‘‘(B)(i) The Secretary may negotiate a rate that is 

22 more than the rate paid by the United States as described 

23 in subparagraph (A) with respect to the furnishing of care 

24 or services under this section to a veteran who resides in 

25 a highly rural area. 


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1 ‘‘(ii) With respect to furnishing care or services under 

2 this section in Alaska, the Alaska Fee Schedule of the De3 partment of Veterans Affairs shall be followed, except for 

4 when another payment agreement, including a contract or 

5 provider agreement, is in place. 

6 ‘‘(iii) With respect to furnishing care or services 

7 under this section in a State with an All-Payer Model 

8 Agreement under section 1814(b)(3) of the Social Security 

9 Act (42 U.S.C. 1395f(b)(3)) that became effective on Jan10 uary 1, 2014, the Medicare payment rates under subpara11 graph (A) shall be calculated based on the payment rates 

12 under such agreement. 

13 ‘‘(iv) In this subparagraph, the term ‘highly rural 

14 area’ means an area located in a county that has fewer 

15 than seven individuals residing in that county per square 

16 mile. 

17 ‘‘(h) ADMINISTRATION.—(1) Except as provided in 

18 paragraph (2), the Secretary shall be responsible for ad19 ministering the Care in the Community Program through 

20 the Non-VA Care Coordination Program of the Depart21 ment. 

22 ‘‘(2) The Non-VA Care Coordination Program, 

23 through each medical center of the Department, shall be 

24 responsible for handling the day-to-day administration of 

25 the Care in the Community Program, including finding 


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1 providers, scheduling appointments, paying providers, and 

2 disseminating information to providers. 

3 ‘‘(i) OUTREACH.—The Non-VA Care Coordination 

4 Program, through each medical center of the Department, 

5 shall be responsible for conducting outreach to health care 

6 providers and veterans located in the area covered by the 

7 medical center regarding care and services available under 

8 the Care in the Community Program. 

9 ‘‘(j) DEFINITIONS.—In this section: 

10 ‘‘(1) The term ‘emergency treatment’ means 

11 medical care or services furnished, in the judgment 

12 of the Secretary— 

13 ‘‘(A) when Department or other Federal 

14 facilities are not feasibly available and an at15 tempt to use them beforehand would not be rea16 sonable; 

17 ‘‘(B) when such care or services are ren18 dered in a medical emergency of such nature 

19 that a prudent layperson reasonably expects 

20 that delay in seeking immediate medical atten21 tion would be hazardous to life or health; and 

22 ‘‘(C) until— 

23 ‘‘(i) such time as the veteran can be 

24 transferred safely to a Department facility 


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1 or other Federal facility and such facility 

2 is capable of accepting such transfer; or 

3 ‘‘(ii) such time as a Department facil4 ity or other Federal facility accepts such 

5 transfer if— 

6 ‘‘(I) at the time the veteran could 

7 have been transferred safely to a De8 partment facility or other Federal fa9 cility, no Department facility or other 

10 Federal facility agreed to accept such 

11 transfer; and 

12 ‘‘(II) the non-Department facility 

13 in which such medical care or services 

14 was furnished made and documented 

15 reasonable attempts to transfer the 

16 veteran to a Department facility or 

17 other Federal facility. 

18 ‘‘(2) The term ‘health-plan contract’ includes 

19 any of the following: 

20 ‘‘(A) An insurance policy or contract, med21 ical or hospital service agreement, membership 

22 or subscription contract, or similar arrangement 

23 under which health services for individuals are 

24 provided or the expenses of such services are 

25 paid. 


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1 ‘‘(B) An insurance program described in 

2 section 1811 of the Social Security Act (42 

3 U.S.C. 1395c) or established by section 1831 of 

4 that Act (42 U.S.C. 1395j). 

5 ‘‘(C) A State plan for medical assistance 

6 approved under title XIX of such Act (42 

7 U.S.C. 1396 et seq.). 

8 ‘‘(D) A workers’ compensation law or plan 

9 described in section 1729(a)(2)(A) of this title. 

10 ‘‘(3) The term ‘third party’ means any of the 

11 following: 

12 ‘‘(A) A Federal entity. 

13 ‘‘(B) A State or political subdivision of a 

14 State. 

15 ‘‘(C) An employer or an employer’s insur16 ance carrier. 

17 ‘‘(D) An automobile accident reparations 

18 insurance carrier. 

19 ‘‘(E) A person or entity obligated to pro20 vide, or to pay the expenses of, health services 

21 under a health-plan contract.’’. 

22 (2) CLERICAL AMENDMENT.—The table of sec23 tions at the beginning of chapter 17 of such title is 

24 amended by inserting after the item relating to sec25 tion 1703 the following new item: 

‘‘1703A. Care in the Community Program.’’. 


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1 (b) IMPLEMENTATION.— 

2 (1) INITIAL IMPLEMENTATION.— 

3 (A) IN GENERAL.—Except as provided in 

4 subparagraph (B), during the one-year period 

5 beginning on the effective date specified in sub6 section (j)(1), the Secretary of Veterans Affairs 

7 shall implement the Care in the Community 

8 Program under section 1703A of title 38, 

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

10 by prioritizing the use of such Program in areas 

11 where there are medical facilities of the Depart12 ment that are experiencing issues with quality 

13 of care or lack of capacity. 

14 (B) EXCEPTION FOR REIMBURSEMENT

15 FOR EMERGENCY CARE.—Reimbursement for 

16 payment made by veterans, or on behalf of such 

17 veterans, for emergency treatment furnished 

18 such veterans in non-Department facilities 

19 under section 1703A(e)(15) of such title, as so 

20 added, shall be implemented in all areas on and 

21 after the effective date specified in subsection 

22 (j)(1). 

23 (2) FULL IMPLEMENTATION.— 

24 (A) IN GENERAL.—On and after the end of 

25 the one-year period described in paragraph 


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1 (1)(A), the Secretary shall implement the Care 

2 in the Community Program under section 

3 1703A of such title, as so added, in all areas. 

4 (B) REPORT.—If the Secretary is unable 

5 to implement the Care in the Community Pro6 gram under section 1703A of such title, as so 

7 added, in all areas as of the date that is two 

8 years after the date of the enactment of this 

9 Act, the Secretary shall submit to Congress a 

10 report on why the Secretary is unable to imple11 ment such program in all areas. 

12 (c) FUNDING.—Amounts required to carry out the 

13 Care in the Community Program under section 1703A of 

14 title 38, United States Code, as added by subsection (a), 

15 shall be derived from the Medical Services account of the 

16 Department of Veterans Affairs or the Veterans Choice 

17 Fund under section 802 of the Veterans Access, Choice, 

18 and Accountability Act of 2014 (Public Law 113–146; 38 

19 U.S.C. 1701 note), as amended by section 4 of this Act. 

20 (d) TREATMENT OF OTHER PROGRAMS, CONTRACTS, 

21 AND AGREEMENTS.— 

22 (1) IN GENERAL.—Any contract, sharing agree23 ment, or other agreement entered into under any 

24 provision of law that authorizes individuals eligible 

25 for health care from the Department of Veterans AfVerDate Sep 11 2014 23:08 Oct 03, 2016 Jkt 069002 PO 00000 Frm 00021 Fmt 6652 Sfmt 6201 E:\BILLS\S3401.IS S3401

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1 fairs to receive such care at facilities that are not fa2 cilities of the Department of Veterans Affairs shall 

3 be administered under the Care in the Community 

4 Program under section 1703A of title 38, United 

5 States Code, as added by subsection (a), on and 

6 after the effective date specified in subsection (j)(2). 

7 (2) TREATMENT OF PATIENT-CENTERED COM8 MUNITY CARE PROGRAM.—On and after the effective 

9 date specified in subsection (j)(2), the Secretary of 

10 Veterans Affairs may not carry out the Patient-Cen11 tered Community Care program of the Department 

12 of Veterans Affairs (commonly known as ‘‘PC3’’) 

13 and shall ensure that beneficiaries under such pro14 gram are able to receive care under the Care in the 

15 Community Program under section 1703A of title 

16 38, United States Code, as added by subsection (a). 

17 (e) PATIENT ADVOCACY.—Section 7309A of title 38, 

18 United States Code, is amended— 

19 (1) by redesignating subsections (e) and (f) as 

20 subsections (f) and (g), respectively; 

21 (2) by inserting after subsection (d) the fol22 lowing new subsection (e): 

23 ‘‘(e) EDUCATION ON NON-DEPARTMENT CARE.—The 

24 Director shall develop and administer a program of edu25 cation on the Care in the Community Program under secVerDate Sep 11 2014 23:08 Oct 03, 2016 Jkt 069002 PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 E:\BILLS\S3401.IS S3401

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1 tion 1703A of this title that ensures veterans under2 stand— 

3 ‘‘(1) how the Care in the Community Program 

4 works; 

5 ‘‘(2) how veterans become eligible for the Care 

6 in the Community Program; and 

7 ‘‘(3) all issues regarding payment for care 

8 under the Care in the Community Program, includ9 ing when the Department is the primary payer and 

10 when the Department is not the primary payer and 

11 the veteran may have to pay out of pocket.’’. 

12 (f) EXTENSION OF EXISTING PROGRAM.—Subsection 

13 (p) of section 101 of the Veterans Access, Choice, and Ac14 countability Act of 2014 (Public Law 113–146; 38 U.S.C. 

15 1701 note) is amended to read as follows: 

16 ‘‘(p) AUTHORITY TO FURNISH CARE AND SERV17 ICES.—The Secretary may not use the authority under 

18 this section to furnish care and services after the date on 

19 which the Secretary submits to Congress the certification 

20 described in section 3(j)(2) of the Improving Veterans 

21 Care in the Community Act of 2016.’’. 

22 (g) REPORT ON ADMINISTRATORS OF CHOICE PRO23 GRAM.— 

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

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


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1 Comptroller General of the United States shall sub2 mit to Congress a report on administrators used by 

3 the Department of Veterans Affairs to administer 

4 section 101 of the Veterans Access, Choice, and Ac5 countability Act of 2014 (Public Law 113–146; 38 

6 U.S.C. 1701 note). 

7 (2) ELEMENTS.—The report required by para8 graph (1) shall include the following: 

9 (A) An assessment of the performance of 

10 administrators, including— 

11 (i) an examination of the ability of ad12 ministrators to schedule appointments, re13 imburse providers in a timely manner, and 

14 meet the performance standards estab15 lished by their contract with the Depart16 ment of Veterans Affairs; and 

17 (ii) an assessment of the satisfaction 

18 of veterans with the work of administra19 tors. 

20 (B) An assessment of the overlap of the 

21 work of administrators with the work of em22 ployees of the Department, especially employees 

23 at medical centers and community-based out24 patient clinics and employees of the Non-VA 

25 Care Coordination Program. 


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1 (C) An assessment of the resources needed 

2 by the Department to function without adminis3 trators in implementing the Care in the Com4 munity Program under section 1703A of title 

5 38, United States Code, as added by subsection 

6 (a). 

7 (h) REPEAL OF SUPERSEDED AUTHORITY FOR CON8 TRACTS FOR CARE IN NON-DEPARTMENT FACILITIES.— 

9 (1) IN GENERAL.—Section 1703 of title 38, 

10 United States Code, is repealed. 

11 (2) CONFORMING AMENDMENTS.— 

12 (A) DENTAL CARE.—Section 1712(a) of 

13 such title is amended— 

14 (i) in paragraph (3), by striking 

15 ‘‘under clause (1), (2), or (5) of section 

16 1703(a) of this title’’ and inserting ‘‘under 

17 section 1703A of this title’’; and 

18 (ii) in paragraph (4)(A), in the first 

19 sentence, by striking ‘‘section 1703 of this 

20 title’’ each place it appears and inserting 

21 ‘‘section 1703A of this title’’. 

22 (B) READJUSTMENT COUNSELING.—Sec23 tion 1712A(e)(1) of such title is amended by 

24 striking ‘‘sections 1703(a)(2) and 


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1 1710(a)(1)(B)’’ and inserting ‘‘sections 1703A 

2 and 1710(a)(1)(B)’’. 

3 (C) DEATH IN DEPARTMENT FACILITY.— 

4 Section 2303(a)(2)(B)(i) of such title is amend5 ed by striking ‘‘in accordance with section 

6 1703’’ and inserting ‘‘under section 1703A’’. 

7 (D) MEDICARE PROVIDER AGREEMENTS.— 

8 Section 1866(a)(1)(L) of the Social Security 

9 Act (42 U.S.C. 1395cc(a)(1)(L)) is amended by 

10 striking ‘‘under section 1703 of title 38’’ and 

11 inserting ‘‘under section 1703A of title 38’’. 

12 (i) REPEAL OF SUPERSEDED AUTHORITY FOR EMER13 GENCY TREATMENT REIMBURSEMENT.— 

14 (1) NON-SERVICE CONNECTED.— 

15 (A) IN GENERAL.—Section 1725 of such 

16 title is repealed. 

17 (B) CONFORMING AMENDMENTS.— 

18 (i) MEDICAL CARE COLLECTIONS

19 FUND.—Section 1729A(b) of such title is 

20 amended— 

21 (I) by striking paragraph (5); 

22 and 

23 (II) by redesignating paragraphs 

24 (6) through (10) as paragraphs (5) 

25 through (9), respectively. 


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1 (ii) MEDICAL CARE FOR SURVIVORS

2 AND DEPENDENTS.—Section 1781(a)(4) of 

3 such title is amended by striking ‘‘section 

4 1725(f)’’ and inserting ‘‘section 1703(j)’’. 

5 (iii) HEALTH CARE FOR FAMILY MEM6 BERS OF VETERANS STATIONED AT CAMP

7 LEJEUNE, NORTH CAROLINA.—Section 

8 1787(b)(3) of such title is amended by 

9 striking ‘‘section 1725(f)’’ and inserting 

10 ‘‘section 1703(j)’’. 

11 (2) SERVICE CONNECTED.—Section 1728 of 

12 such title is repealed. 

13 (j) EFFECTIVE DATES.— 

14 (1) COMMUNITY CARE PROGRAM.—The amend15 ments made by subsections (a), (d), and (i) shall 

16 take effect on the date that is one year after the 

17 date of the enactment of this Act. 

18 (2) REPEAL OF SUPERSEDED AUTHORITY.— 

19 (A) IN GENERAL.—The amendments made 

20 by subsection (h) shall take effect on the date 

21 on which the Secretary of Veterans Affairs cer22 tifies to Congress that the Secretary is fully im23 plementing the Care in the Community Pro24 gram under section 1703A of title 38, United 

25 States Code, as added by subsection (a). 


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1 (B) PUBLICATION.—The Secretary shall 

2 publish the date specified in subparagraph (A) 

3 in the Federal Register not later than 90 days 

4 before such date. 

5 SEC. 4. AUTHORIZATION OF USE OF CERTAIN AMOUNTS AP6 PROPRIATED TO THE VETERANS CHOICE 

7 FUND FOR OTHER NON-DEPARTMENT OF 

8 VETERANS AFFAIRS CARE. 

9 Section 802 of the Veterans Access, Choice, and Ac10 countability Act of 2014 (Public Law 113–146; 128 Stat. 

11 1801) is amended— 

12 (1) in subsection (c)— 

13 (A) in paragraph (1)— 

14 (i) by striking ‘‘Except as provided by 

15 paragraph (3), any’’ and inserting ‘‘Any’’; 

16 and 

17 (ii) by striking ‘‘by the Secretary of 

18 Veterans Affairs’’ and all that following 

19 through the period at the end and insert20 ing ‘‘by the Secretary of Veterans Af21 fairs— 

22 ‘‘(A) to carry out section 101, including, 

23 subject to paragraph (2), any administrative re24 quirements of such section; 


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1 ‘‘(B) to furnish health care to individuals 

2 under chapter 17 of title 38, United States 

3 Code, at non-Department facilities, including 

4 pursuant to non-Department provider programs 

5 other than the program under section 101; and 

6 ‘‘(C) to furnish disability examinations 

7 conducted by health care providers that are not 

8 health care providers of the Department of Vet9 erans Affairs.’’; and 

10 (B) by striking paragraph (3) and insert11 ing the following new paragraphs: 

12 ‘‘(3) TREATMENT OF AMOUNTS.—Amounts 

13 made available to the Secretary under this section 

14 shall be in addition to amounts made available to 

15 the Secretary in the Medical Services account of the 

16 Department of Veterans Affairs. 

17 ‘‘(4) DEFINITIONS.—In this subsection: 

18 ‘‘(A) The term ‘non-Department facilities’ 

19 has the meaning given that term in section 

20 1701 of title 38, United States Code. 

21 ‘‘(B) The term ‘non-Department provider 

22 programs’ has the meaning given that term in 

23 section 4002(d) of the VA Budget and Choice 

24 Improvement Act (Public Law 114–41; 129 

25 Stat. 462).’’; and 


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1 (2) in subsection (d)(1), by striking ‘‘only for 

2 the program’’ and all that follows through the period 

3 at the end and inserting ‘‘only for the purposes spec4 ified in subsection (c)(1).’’. 

5 SEC. 5. INTERDISCIPLINARY PANEL ON DEVELOPMENT OF 

6 CLINICAL APPEALS PROCESS FOR THE DE7 PARTMENT OF VETERANS AFFAIRS. 

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

9 shall establish an interdisciplinary panel to assist the Sec10 retary in developing a new clinical appeals process for re11 solving disputes regarding health care furnished under the 

12 laws administered by the Secretary of Veterans Affairs, 

13 including health care furnished under the Care in the 

14 Community Program under section 1703A of title 38, 

15 United States Code, as added by section 3(a). 

16 (b) DUTIES.—The duties of the interdisciplinary 

17 panel established under subsection (a) are the following: 

18 (1) To create one process throughout the Vet19 erans Health Administration for resolving clinical 

20 disputes. 

21 (2) To ensure that such process provides vet22 erans with the ability to have an external review at 

23 his or her discretion. 


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1 (3) To ensure that such process is as com2 prehensive and fair as processes provided by private 

3 health insurers and other Federal agencies. 

4 (c) REPORT.—Not later than one year after the date 

5 of the enactment of this Act, the Secretary shall submit 

6 to Congress a report on the activities of the interdiscipli7 nary panel under this section. 

8 SEC. 6. COMPTROLLER GENERAL REPORTS ON THE DE9 PARTMENT OF VETERANS AFFAIRS. 

10 (a) REPORT ON CLINICAL OPERATIONS OF VET11 ERANS HEALTH ADMINISTRATION.—Not later than one 

12 year after the date of the enactment of this Act, the Comp13 troller General of the United States shall submit to Con14 gress a report on the clinical operations of the Veterans 

15 Health Administration that includes an assessment of the 

16 following: 

17 (1) How such clinical operations can be en18 hanced. 

19 (2) What the Secretary of Veterans Affairs can 

20 do to ensure that highly trained clinical staff of the 

21 Department of Veterans Affairs are able to perform 

22 at the top of their license and are not performing 

23 tasks that should be done by support staff. 


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1 (3) What the Secretary can do to improve the 

2 hiring, retaining, and training of medical support as3 sistants of the Department. 

4 (b) REPORT ON TRAVEL BENEFITS PROGRAM OF

5 DEPARTMENT.—Not later than one year after the date of 

6 the enactment of this Act, the Comptroller General shall 

7 submit to Congress a report on the travel benefits pro8 gram of the Department under sections 111 and 111A of 

9 title 38, United States Code, that includes an assessment 

10 of the following: 

11 (1) How such program can be improved to en12 sure that veterans are reimbursed for travel in a 

13 timely manner. 

14 (2) What the Secretary can do to speed up the 

15 reimbursement process while protecting against 

16 fraud, waste, and abuse. 

17 (3) Whether there should be changes made to 

18 eligibility for such program. 

19 (c) REPORT ON OFFICE OF CONGRESSIONAL AND

20 LEGISLATIVE AFFAIRS OF DEPARTMENT.—Not later than 

21 one year after the date of the enactment of this Act, the 

22 Comptroller General shall submit to Congress a report on 

23 the structure and management of the Office of Congres24 sional and Legislative Affairs of the Department, includ25 ing an assessment of what the Secretary can do to enable 


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1 the Office to provide more timely, complete responses to 

2 requests from Congress. 

3 (d) REPORT ON PAYMENT FOR NON-DEPARTMENT

4 CARE.—Not later than one year after the date of the en5 actment of this Act, the Comptroller General shall submit 

6 to Congress a report on payment by the Department for 

7 health care furnished to veterans through non-Department 

8 health care providers, including an assessment of the fol9 lowing: 

10 (1) When the Department should be the pri11 mary payer for such care and when the Department 

12 should be the secondary payer for such care. 

13 (2) How payment by the Department for such 

14 care should function with coverage under private in15 surance, coverage under the Medicare program, and 

16 other health coverage options. 

17 SEC. 7. ESTABLISHMENT OF PAYMENT AND ACCESS COM18 MISSION FOR VETERANS HEALTH ADMINIS19 TRATION. 

20 (a) ESTABLISHMENT.—Subchapter II of chapter 73 

21 of title 38, United States Code, is amended by inserting 

22 after section 7330A the following new section: 

23 ‘‘§ 7330B. Payment and Access Commission 

24 ‘‘(a) ESTABLISHMENT.—There is established in the 

25 Veterans Health Administration a Payment and Access 


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1 Commission (in this section referred to as the 

2 ‘VHAPAC’). 

3 ‘‘(b) MEMBERSHIP.—(1) The VHAPAC shall be com4 posed of 17 members appointed by the Comptroller Gen5 eral of the United States. 

6 ‘‘(2)(A) The membership of VHAPAC shall include 

7 the following: 

8 ‘‘(i) Veterans who have received care from the 

9 Veterans Health Administration. 

10 ‘‘(ii) Individuals with national recognition for 

11 their expertise with respect to— 

12 ‘‘(I) Federal health programs; 

13 ‘‘(II) health finance and economics; 

14 ‘‘(III) actuarial science; 

15 ‘‘(IV) health plans and integrated delivery 

16 systems; 

17 ‘‘(V) reimbursement for health care; or 

18 ‘‘(VI) health information technology. 

19 ‘‘(iii) Providers of health services, public health, 

20 and other related fields. 

21 ‘‘(iv) Physicians and other health professionals. 

22 ‘‘(v) Individuals with expertise in the delivery of 

23 health services. 

24 ‘‘(B) Members of the VHAPAC shall be appointed 

25 in a manner to provide a mix of different professions, 


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1 broad geographic representation, and a balance between 

2 urban and rural representation. 

3 ‘‘(C) Members described in clauses (iv) and (v) of 

4 subparagraph (A) shall include representatives of vet5 erans, including veterans with disabilities, and caregivers. 

6 ‘‘(D) Individuals who are directly involved in the pro7 vision, or management of the delivery, of items and serv8 ices furnished by the Department shall not constitute a 

9 majority of the membership of the VHAPAC. 

10 ‘‘(E) The Comptroller General of the United States 

11 shall establish a system for public disclosure by members 

12 of the VHAPAC of financial and other potential conflicts 

13 of interest relating to such members. 

14 ‘‘(F) Members of the VHAPAC shall be treated as 

15 employees of Congress for purposes of applying title I of 

16 the Ethics in Government Act of 1978 (5 U.S.C. App.). 

17 ‘‘(3)(A) The terms of members of the VHAPAC shall 

18 be for three years except that the Comptroller General of 

19 the United States shall designate staggered terms for the 

20 members first appointed. 

21 ‘‘(B) Any member appointed to fill a vacancy occur22 ring before the expiration of the term for which the mem23 ber’s predecessor was appointed shall be appointed only 

24 for the remainder of that term. A member may serve after 

25 the expiration of that member’s term until a successor has 


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1 taken office. A vacancy in the VHAPAC shall be filled in 

2 the manner in which the original appointment was made. 

3 ‘‘(4)(A) While serving on the business of the 

4 VHAPAC (including travel time), a member of the 

5 VHAPAC shall be entitled to compensation at the per 

6 diem equivalent of the rate provided for level IV of the 

7 Executive Schedule under section 5315 of title 5. 

8 ‘‘(B) While serving on the business of the VHAPAC 

9 (including travel time) away from home and the member’s 

10 regular place of business, a member may be allowed travel 

11 expenses, as authorized by the Chairman of the VHAPAC. 

12 ‘‘(5) The Comptroller General of the United States 

13 shall designate a Chairman and Vice Chairman of the 

14 VHAPAC, at the time of appointment of each such indi15 vidual as a member of the VHAPAC, for the term of ap16 pointment of such individual, except that in the case of 

17 vacancy of the Chairmanship or Vice Chairmanship, the 

18 Comptroller General may designate another member for 

19 the remainder of the term of the Chairman or Vice Chair20 man, as the case may be. 

21 ‘‘(6) The VHAPAC shall meet at the call of the 

22 Chairman. 

23 ‘‘(c) DUTIES.—(1) The VHAPAC shall— 

24 ‘‘(A) review policies of the Veterans Health Ad25 ministration affecting access of veterans to health 


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1 care, including topics affected by the Care in the 

2 Community Program under section 1703A of this 

3 title; 

4 ‘‘(B) make recommendations to Congress, the 

5 Secretary, and States concerning such access poli6 cies; and 

7 ‘‘(C) by not later than March 15 of each year 

8 (beginning with 2018), submit to Congress a report 

9 containing— 

10 ‘‘(i) the results of reviews conducted under 

11 subparagraph (A); 

12 ‘‘(ii) recommendations made under sub13 paragraph (B); and 

14 ‘‘(iii) an examination of the implications of 

15 changes in health care delivery in the United 

16 States and in the market for health care serv17 ices on health care furnished under the laws ad18 ministered by the Secretary. 

19 ‘‘(2) Specifically, the VHAPAC shall review and as20 sess the following: 

21 ‘‘(A) Payment policies regarding payment by 

22 the Secretary for health care furnished under the 

23 laws administered by the Secretary by non-Depart24 ment providers, including— 


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1 ‘‘(i) the factors affecting expenditures for 

2 the efficient provision of items and services in 

3 different sectors, including the process for up4 dating payments to medical, dental, and health 

5 professionals, hospitals, residential and long6 term care providers, providers of home and 

7 community based services, Federally-qualified 

8 health centers and rural health clinics (as de9 fined in section 1905(l) of the Social Security 

10 Act (42 U.S.C. 1396d(l))), managed care enti11 ties, and providers of other covered items and 

12 services; 

13 ‘‘(ii) payment methodologies; and 

14 ‘‘(iii) the relationship of such factors and 

15 methodologies to access and quality of care for 

16 veterans receiving care under the laws adminis17 tered by the Secretary (including how such fac18 tors and methodologies enable such veterans to 

19 obtain the services for which they are eligible, 

20 affect provider supply, and affect providers that 

21 serve a disproportionate share of low-income 

22 and other vulnerable populations). 

23 ‘‘(B) Eligibility policies for receiving care under 

24 the laws administered by the Secretary, including 


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1 the Care in the Community Program under section 

2 1703A of this title. 

3 ‘‘(C) Enrollment and retention processes for re4 ceiving care under the laws administered by the Sec5 retary. 

6 ‘‘(D) Policies of the Department relating to the 

7 quality of care furnished under the laws adminis8 tered by the Secretary. 

9 ‘‘(E) The effect of payment policies described in 

10 subparagraph (A), especially under the Care in the 

11 Community Program under section 1703A of this 

12 title, on access to items and services for veterans 

13 and the implications of changes in health care deliv14 ery in the United States and in the general market 

15 for health care items and services on such payment 

16 policies. 

17 ‘‘(F) The interaction of policies of the Depart18 ment, including under the Care in the Community 

19 Program, with the Medicaid and Medicare programs, 

20 private insurance, and other forms of health care 

21 coverage such as the TRICARE program (as defined 

22 in section 1072 of title 10), including with respect 

23 to how such interactions affect access to services, 

24 payments, and dual eligible individuals. 


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1 ‘‘(G) The effect of policies of the Department 

2 on access to covered items and services, including 

3 policies relating to transportation and preventive, 

4 acute, and long-term services and supports. 

5 ‘‘(3) The VHAPAC shall— 

6 ‘‘(A) review national data regarding health care 

7 furnished under the laws administered by the Sec8 retary; and 

9 ‘‘(B) submit reports and recommendations to 

10 Congress and the Secretary, including recommenda11 tions that do not require changes in law. 

12 ‘‘(4)(A) The VHAPAC shall create an early-warning 

13 system to identify provider shortage areas, as well as other 

14 factors that adversely affect, or have the potential to ad15 versely affect, access to care by, or the health care status 

16 of, veterans eligible for health care under the laws admin17 istered by the Secretary. 

18 ‘‘(B) The VHAPAC shall include in the annual report 

19 required under paragraph (1)(C) a description of all areas 

20 and factors identified under subparagraph (A) with re21 spect to the period addressed in the report. 

22 ‘‘(5)(A) If the Secretary submits to Congress (or a 

23 committee of Congress) a report that is required by law 

24 and that relates to policies relating to access to health care 

25 under the laws administered by the Secretary, including 


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1 with respect to payment policies for non-Department pro2 viders, the Secretary shall transmit a copy of the report 

3 to the VHAPAC. The VHAPAC shall review the report 

4 and, not later than 180 days after the date of submittal 

5 by the Secretary of the report to Congress, shall submit 

6 to the appropriate committees of Congress and the Sec7 retary written comments on such report. Such comments 

8 may include such recommendations as the VHAPAC de9 termines appropriate. 

10 ‘‘(B) The VHAPAC shall review regulations of the 

11 Department relating to the provision of health care and 

12 may comment through submission of a report to the ap13 propriate committees of Congress and the Secretary on 

14 any such regulations that affect access, quality, or effi15 ciency of health care under the laws administered by the 

16 Secretary. 

17 ‘‘(6)(A) The VHAPAC shall consult periodically with 

18 the chairmen and ranking minority members of the appro19 priate committees of Congress regarding the agenda of the 

20 VHAPAC and progress towards achieving that agenda. 

21 ‘‘(B) The VHAPAC may conduct additional reviews 

22 and submit additional reports to the appropriate commit23 tees of Congress from time to time on such topics relating 

24 to the policies and programs of the Veterans Health Ad25 ministration as may be requested by the chairmen and 


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1 ranking minority members of such committees and as the 

2 VHAPAC determines appropriate. 

3 ‘‘(7) The VHAPAC shall transmit to the Secretary 

4 a copy of each report submitted under this subsection and 

5 shall make such reports available to the public. 

6 ‘‘(8) With respect to each recommendation contained 

7 in a report submitted under paragraph (1)(C), each mem8 ber of the VHAPAC shall vote on the recommendation, 

9 and the VHAPAC shall include, by member, the results 

10 of that vote in the report containing the recommendation. 

11 ‘‘(9) Before making any recommendations under this 

12 section, the VHAPAC shall examine the budget con13 sequences of such recommendations, directly or through 

14 consultation with appropriate expert entities, and shall 

15 submit with any recommendations a report on the con16 sequences to the Federal Government of the recommenda17 tions. 

18 ‘‘(10)(A) The VHAPAC shall consult with the Medi19 care Payment Advisory Commission established under sec20 tion 1805 of the Social Security Act (42 U.S.C. 1395b– 

21 6) in carrying out its duties under this section, as the 

22 VHAPAC determines appropriate. 

23 ‘‘(B) The VHAPAC and the Medicare Payment Advi24 sory Commission shall have access to deliberations and 


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1 records of the other such entity, respectively, upon the re2 quest of the other such entity. 

3 ‘‘(11) The VHAPAC shall regularly consult with vet4 erans service organizations in carrying out its duties under 

5 this section, including with respect to developing processes 

6 for carrying out such duties, and shall ensure that input 

7 from veterans service organizations is taken into account 

8 and represented in recommendations and reports prepared 

9 by the VHAPAC. 

10 ‘‘(12) The authority of the VHAPAC to make rec11 ommendations under this section shall not affect, or be 

12 considered to duplicate, the authority of the Secretary to 

13 carry out Federal responsibilities with respect to programs 

14 of the Veterans Health Administration. 

15 ‘‘(13) In this subsection: 

16 ‘‘(A) The term ‘appropriate committees of Con17 gress’ means the Committee on Veterans’ Affairs of 

18 the Senate and the Committee on Veterans’ Affairs 

19 of the House of Representatives. 

20 ‘‘(B) The term ‘veterans service organization’ 

21 means an organization recognized by the Secretary 

22 for the representation of veterans under section 

23 5902 of this title. 

24 ‘‘(d) PERSONNEL.—(1) Subject to such review as the 

25 Comptroller General of the United States determines necVerDate Sep 11 2014 23:08 Oct 03, 2016 Jkt 069002 PO 00000 Frm 00043 Fmt 6652 Sfmt 6201 E:\BILLS\S3401.IS S3401

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1 essary to assure the efficient administration of the 

2 VHAPAC, the VHAPAC may— 

3 ‘‘(A) employ and fix the compensation of an 

4 Executive Director (subject to the approval of the 

5 Comptroller General) and such other personnel as 

6 may be necessary to carry out the duties of the 

7 VHAPAC (without regard to the provisions of title 

8 5 governing appointments in the competitive serv9 ice); 

10 ‘‘(B) seek such assistance and support as may 

11 be required in the performance of the duties of the 

12 VHAPAC from appropriate Federal and State de13 partments and agencies; 

14 ‘‘(C) enter into contracts or make other ar15 rangements as may be necessary for the conduct of 

16 the work of the VHAPAC (without regard to section 

17 6101 of title 41); 

18 ‘‘(D) make advance, progress, and other pay19 ments which relate to the work of the VHAPAC; 

20 ‘‘(E) provide transportation and subsistence for 

21 persons serving without compensation; and 

22 ‘‘(F) prescribe such rules and regulations as the 

23 VHAPAC determines necessary with respect to the 

24 internal organization and operation of the VHAPAC. 


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•S 3401 IS

1 ‘‘(2)(A) For purposes of pay (other than pay of 

2 members of the VHAPAC) and employment benefits, 

3 rights, and privileges, all personnel of the VHAPAC 

4 shall be treated as if they were employees of the 

5 United States Senate. 

6 ‘‘(B) Physicians serving as personnel of the 

7 VHAPAC may be provided a physician comparability 

8 allowance by the VHAPAC in the same manner as 

9 Government physicians may be provided such an al10 lowance by an agency under section 5948 of title 5, 

11 and for such purpose subsection (i) of such section 

12 shall apply to the VHAPAC in the same manner as 

13 it applies to the Tennessee Valley Authority. 

14 ‘‘(e) POWERS.—(1) The VHAPAC may secure di15 rectly from any Federal agency information in the posses16 sion of that agency necessary to enable the VHAPAC to 

17 carry out this section. Upon request of the Chairman, the 

18 head of that agency shall furnish that information to the 

19 VHAPAC on an agreed upon schedule. 

20 ‘‘(2) In order to carry out its functions, the VHAPAC 

21 shall— 

22 ‘‘(A) if possible, use existing information, both 

23 published and unpublished, collected and assessed ei24 ther by personnel of the VHAPAC or under other 

25 arrangements made in accordance with this section; 


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1 ‘‘(B) carry out, or award grants or contracts 

2 for, original research and experimentation if existing 

3 information is inadequate; and 

4 ‘‘(C) adopt procedures allowing any interested 

5 party to submit information for use by the VHAPAC 

6 in making reports and recommendations. 

7 ‘‘(3) The Comptroller General of the United States 

8 shall have unrestricted access to all deliberations, records, 

9 and nonproprietary data of the VHAPAC, immediately 

10 upon request. 

11 ‘‘(4) The VHAPAC shall be subject to periodic audit 

12 by the Comptroller General. 

13 ‘‘(f) FUNDING.—The VHAPAC shall submit requests 

14 for appropriations in the same manner as the Comptroller 

15 General of the United States submits requests for appro16 priations, but amounts appropriated for the VHAPAC 

17 shall be separate from amounts appropriated for the 

18 Comptroller General.’’. 

19 (b) CLERICAL AMENDMENT.—The table of sections 

20 at the beginning of chapter 73 of such title is amended 

21 by inserting after the item relating to section 7330A the 

22 following new item: 

‘‘7330B. Payment and Access Commission.’’. 

Æ 


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