II 

Calendar No. 716 

114TH CONGRESS 

2D SESSION S. 425 

[Report No. 114–395] 

To amend title 38, United States Code, to provide for a five-year extension 

to the homeless veterans reintegration programs and to provide clarification regarding eligibility for services under such programs. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 10, 2015 

Mr. BOOZMAN (for himself, Mr. TESTER, Mr. INHOFE, and Mr. SCHUMER) 

introduced the following bill; which was read twice and referred to the 

Committee on Veterans’ Affairs 

DECEMBER 7, 2016 

Reported by Mr. ISAKSON, with an amendment and an amendment to the title 

[Strike out all after the enacting clause and insert the part printed in italic] 

A BILL 

To amend title 38, United States Code, to provide for a 

five-year extension to the homeless veterans reintegration 

programs and to provide clarification regarding eligibility 

for services under such programs. 

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. 

2 This Act may be cited as the ‘‘Homeless Veterans’ 

3 Reintegration Programs Reauthorization Act of 2015’’. 

4 SEC. 2. REAUTHORIZATION OF DEPARTMENT OF VETERANS 

5 AFFAIRS HOMELESS VETERANS REINTEGRA6 TION PROGRAMS. 

7 (a) FIVE-YEAR EXTENSION OF HOMELESS VET8 ERANS REINTEGRATION PROGRAMS.—Section 2021(e)(F) 

9 of title 38, United States Code, is amended by striking 

10 ‘‘2015’’ and inserting ‘‘2020’’. 

11 (b) FIVE-YEAR EXTENSION OF HOMELESS WOMEN

12 VETERANS AND HOMELESS VETERANS WITH CHILDREN

13 REINTEGRATION GRANT PROGRAM.—Section 2021A(f)(1) 

14 of such title is amended by striking ‘‘2015’’ and inserting 

15 ‘‘2020’’. 

16 (c) CLARIFICATION OF ELIGIBILITY FOR SERVICES

17 UNDER HOMELESS VETERANS REINTEGRATION PRO18 GRAMS.—Section 2021(a) of such title is amended by 

19 striking ‘‘reintegration of homeless veterans into the labor 

20 force.’’ and inserting the following: ‘‘reintegration into the 

21 labor force of—’’ 

22 ‘‘(1) homeless veterans; 

23 ‘‘(2) veterans participating in the Department 

24 of Veterans Affairs supported housing program for 

25 which rental assistance is provided pursuant to secVerDate Sep 11 2014 01:42 Dec 08, 2016 Jkt 069200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6401 E:\BILLS\S425.RS S425

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1 tion 8(o)(19) of the United States Housing Act of 

2 1937 (42 U.S.C. 1437f(o)(19)); 

3 ‘‘(3) Indians who are veterans and receiving as4 sistance under the Native American Housing Assist5 ance and Self Determination Act of 1996 (25 U.S.C. 

6 4101 et seq.); and 

7 ‘‘(4) veterans who are transitioning from being 

8 incarcerated.’’. 

9 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

10 (a) SHORT TITLE.—This Act may be cited as the ‘‘Vet11 erans Homeless Programs, Caregiver Services, and Other 

12 Improvements Act of 2015’’. 

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

14 this Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—BENEFITS 

Sec. 101. Expedited payment of survivors benefits. 

Sec. 102. Increase in special pension for Medal of Honor recipients. 

TITLE II—EDUCATION MATTERS 

Sec. 201. Restoration of entitlement to Post-9/11 Educational Assistance for veterans affected by closures of educational institutions. 

Sec. 202. Modification and improvement of transfer of unused Post-9/11 Educational Assistance to family members. 

Sec. 203. Codification and improvement of election process for Post-9/11 Educational Assistance. 

Sec. 204. Centralized reporting of veteran enrollment by certain groups, districts, 

and consortiums of educational institutions. 

Sec. 205. Improved role of State approving agencies in administration of veterans 

educational benefits. 

Sec. 206. Modification of criteria used to approve courses for purposes of veterans 

educational benefits. 

Sec. 207. Surveys for compliance of educational institutions and training establishments with requirements relating to administration of veterans educational benefits. 


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Sec. 208. Modification of requirements for approval for purposes of educational 

assistance provided by Department of Veterans Affairs of programs designed to prepare individuals for licensure or certification. 

Sec. 209. Expansion of Yellow Ribbon G.I. Education Enhancement Program. 

Sec. 210. Consideration of certain time spent receiving medical care from Secretary of Defense as active duty for purposes of eligibility for 

Post-9/11 Educational Assistance. 

TITLE III—HOMELESS VETERANS MATTERS 

Sec. 301. Expansion of definition of homeless veteran for purposes of benefits 

under the laws administered by the Secretary of Veterans Affairs. 

Sec. 302. Increased per diem payments for transitional housing assistance that 

becomes permanent housing for homeless veterans. 

Sec. 303. Expansion of Department of Veterans Affairs authority to provide dental care to homeless veterans. 

Sec. 304. Clarification of eligibility for services under homeless veterans reintegration programs. 

Sec. 305. Program to improve retention of housing by formerly homeless veterans 

and veterans at risk of becoming homeless. 

Sec. 306. Pilot program on provision of intensive case management interventions 

to homeless veterans who receive the most health care from the 

Department of Veterans Affairs. 

Sec. 307. Establishment of National Center on Homelessness Among Veterans. 

Sec. 308. Partnerships with public and private entities to provide legal services 

to homeless veterans and veterans at risk of homelessness. 

Sec. 309. Administrative improvements to grant and per diem programs of Department of Veterans Affairs. 

Sec. 310. Repeal of requirement for annual reports on assistance to homeless veterans. 

Sec. 311. Comptroller General of the United States study on homeless veterans 

programs of Department of Veterans Affairs. 

Sec. 312. Requirement for Department of Veterans Affairs to assess comprehensive 

service programs for homeless veterans. 

Sec. 313. Report on outreach relating to increasing the amount of housing available to veterans. 

TITLE IV—HEALTH CARE MATTERS 

Sec. 401. Short title. 

Subtitle A—Employment of Directors and Health Care Providers 

Sec. 411. Extension of period for increase in graduate medical education residency positions at medical facilities of the Department of Veterans Affairs. 

Sec. 412. Modification of hours of employment for physicians and physician assistants employed by the Department of Veterans Affairs. 

Sec. 413. Requirement that physician assistants employed by the Department of 

Veterans Affairs receive competitive pay. 

Sec. 414. Establishment of positions of Directors of Veterans Integrated Service 

Networks in Office of Under Secretary for Health of Department 

of Veterans Affairs and modification of qualifications for Medical Directors. 


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Sec. 415. Pay for Medical Directors and Directors of Veterans Integrated Service 

Networks. 

Sec. 416. Additional requirements for hiring of health care providers by Department of Veterans Affairs. 

Sec. 417. Provision of information on health care providers of Department of Veterans Affairs to State medical boards. 

Sec. 418. Report on compliance by Department of Veterans Affairs with reviews 

of health care providers leaving the Department or transferring 

to other facilities. 

Subtitle B—Opioid Therapy and Pain Management 

Sec. 421. Guidelines on management of opioid therapy by Department of Veterans Affairs and Department of Defense and implementation of 

such guidelines by Department of Veterans Affairs. 

Sec. 422. Improvement of opioid safety measures by Department of Veterans Affairs. 

Sec. 423. Enhancement of joint working group on pain management of the Department of Veterans Affairs and the Department of Defense. 

Sec. 424. Establishment of pain management boards of Department of Veterans 

Affairs. 

Sec. 425. Review, investigation, and report on use of opioids in treatment by Department of Veterans Affairs. 

Subtitle C—Patient Advocacy 

Sec. 431. Establishment of Office of Patient Advocacy of the Department of Veterans Affairs. 

Sec. 432. Community meetings on improving care from Department of Veterans 

Affairs. 

Sec. 433. Improvement of awareness of patient advocacy program and patient bill 

of rights of Department of Veterans Affairs. 

Sec. 434. Comptroller General Report on Patient Advocacy Program of Department of Veterans Affairs. 

Subtitle D—Complementary and Integrative Health 

Sec. 441. Expansion of research and education on and delivery of complementary 

and integrative health to veterans. 

Sec. 442. Pilot program on integration of complementary and integrative health 

within Department of Veterans Affairs medical centers. 

Subtitle E—Family Caregivers 

Sec. 451. Expansion of family caregiver program of Department of Veterans Affairs. 

Sec. 452. Implementation of information technology system of Department of Veterans Affairs to assess and improve the family caregiver program. 

Sec. 453. Modifications to annual evaluation report on caregiver program of Department of Veterans Affairs. 

Sec. 454. Advisory committee on caregiver policy. 

Sec. 455. Comprehensive study on seriously injured veterans and their caregivers. 


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Subtitle F—Health Care Agreements 

Sec. 461. Authorization of agreements between the Department of Veterans Affairs 

and non-Department extended care providers. 

Sec. 462. Modification of authority to enter into agreements with State homes to 

provide nursing home care. 

TITLE V—OTHER MATTERS 

Sec. 501. Extension of temporary increase in number of judges on United States 

Court of Appeals for Veterans Claims. 

Sec. 502. Repeal inapplicability of modification of basic allowance for housing to 

benefits under laws administered by Secretary of Veterans Affairs. 

Sec. 503. Department of Veterans Affairs program of internal audits. 

Sec. 504. Improvement of training for managers. 

1 TITLE I—BENEFITS 

2 SEC. 101. EXPEDITED PAYMENT OF SURVIVORS BENEFITS. 

3 (a) IN GENERAL.—Section 5101(a)(1) of title 38, 

4 United States Code, is amended— 

5 (1) by striking ‘‘A specific’’ and inserting ‘‘(A) 

6 Except as provided in subparagraph (B), a specific’’; 

7 and 

8 (2) by adding at the end the following new sub9 paragraph: 

10 ‘‘(B)(i) The Secretary may pay benefits under chapters 

11 13 and 15 and sections 2302, 2307, and 5121 of this title 

12 to a survivor of a veteran who has not filed a formal claim 

13 if the Secretary determines that the record contains suffi14 cient evidence to establish the entitlement of the survivor 

15 to such benefits. 

16 ‘‘(ii) For purposes of this subparagraph and section 

17 5110 of this title, the date on which the Secretary is notified 

18 of the death of the veteran shall be treated as the date of 


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1 the receipt of the survivor’s application for benefits de2 scribed in clause (i).’’. 

3 (b) EFFECTIVE DATE.—The amendments made by sub4 section (a) shall apply with respect to claims for benefits 

5 based on a death occurring on or after the date of the enact6 ment of this Act. 

7 SEC. 102. INCREASE IN SPECIAL PENSION FOR MEDAL OF 

8 HONOR RECIPIENTS. 

9 (a) IN GENERAL.—Section 1562(a) of title 38, United 

10 States Code, is amended by striking ‘‘$1,000’’ and inserting 

11 ‘‘$3,000’’. 

12 (b) EFFECTIVE DATE.— 

13 (1) IN GENERAL.—The amendment made by sub14 section (a) shall take effect on the date that is— 

15 (A) except as provided in subparagraph 

16 (B), one year after the date of the enactment of 

17 this Act; and 

18 (B) in the case that the date that is one 

19 year after the date of the enactment of this Act 

20 is not the first day of a month, the first day of 

21 the first month beginning after the date that is 

22 one year after the date of the enactment of this 

23 Act. 

24 (2) DELAY OF ANNUAL COST OF LIVING ADJUST25 MENT.— 


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1 (A) IN GENERAL.—The Secretary shall not 

2 make an increase pursuant to section 1562(e) of 

3 such title effective December 1, 2016, if the 

4 amendment made by subsection (a) takes effect 

5 before such date. 

6 (B) RESUMPTION.—In the case that the Sec7 retary, pursuant to subparagraph (A), does not 

8 make an increase pursuant to section 1562(e) of 

9 such title effective December 1, 2016, the Sec10 retary shall resume making increases pursuant 

11 to such section with the first such increase effec12 tive December 1, 2017. 

13 TITLE II—EDUCATION MATTERS 

14 SEC. 201. RESTORATION OF ENTITLEMENT TO POST-9/11 

15 EDUCATIONAL ASSISTANCE FOR VETERANS 

16 AFFECTED BY CLOSURES OF EDUCATIONAL 

17 INSTITUTIONS. 

18 (a) EDUCATIONAL ASSISTANCE.— 

19 (1) IN GENERAL.—Section 3312 of title 38, 

20 United States Code, is amended by adding at the end 

21 the following new subsection: 

22 ‘‘(d) DISCONTINUATION OF EDUCATION DUE TO CLO23 SURE OF EDUCATIONAL INSTITUTION.— 

24 ‘‘(1) IN GENERAL.—Any payment of educational 

25 assistance described in paragraph (2) shall not— 


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1 ‘‘(A) be charged against any entitlement to 

2 educational assistance of the individual con3 cerned under this chapter; or 

4 ‘‘(B) be counted against the aggregate pe5 riod for which section 3695 of this title limits the 

6 individual’s receipt of educational assistance 

7 under this chapter. 

8 ‘‘(2) DESCRIPTION OF PAYMENT OF EDU9 CATIONAL ASSISTANCE.—Subject to paragraph (3), 

10 the payment of educational assistance described in 

11 this paragraph is the payment of such assistance to 

12 an individual for pursuit of a course or courses under 

13 this chapter if the Secretary finds that the indi14 vidual— 

15 ‘‘(A) was forced to discontinue such course 

16 pursuit as a result of a permanent closure of an 

17 educational institution; and 

18 ‘‘(B) did not receive credit, or lost training 

19 time, toward completion of the program of edu20 cation being pursued at the time of such closure. 

21 ‘‘(3) PERIOD FOR WHICH PAYMENT NOT

22 CHARGED.—The period for which, by reason of this 

23 subsection, educational assistance is not charged 

24 against entitlement or counted toward the applicable 


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1 aggregate period under section 3695 of this title shall 

2 not exceed the aggregate of— 

3 ‘‘(A) the portion of the period of enrollment 

4 in the course or courses from which the indi5 vidual failed to receive credit or with respect to 

6 which the individual lost training time, as deter7 mined under paragraph (2)(B), and 

8 ‘‘(B) the period by which a monthly stipend 

9 is extended under section 3680(a)(2)(B) of this 

10 title.’’. 

11 (2) APPLICABILITY.—Subsection (d) of such sec12 tion, as added by paragraph (1), shall apply with re13 spect to courses and programs of education discon14 tinued as described in paragraph (2) of such sub15 section in fiscal year 2015 or any fiscal year there16 after. 

17 (b) MONTHLY HOUSING STIPEND.— 

18 (1) IN GENERAL.—Section 3680(a) of such title 

19 is amended— 

20 (A) by striking the matter after paragraph 

21 (3)(B); 

22 (B) in paragraph (3), by redesignating sub23 paragraphs (A) and (B) as clauses (i) and (ii), 

24 respectively; 


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1 (C) by redesignating paragraphs (1) 

2 through (3) as subparagraphs (A) through (C), 

3 respectively; 

4 (D) in the matter before subparagraph (A), 

5 as redesignated, in the first sentence, by striking 

6 ‘‘Payment of’’ and inserting ‘‘(1) Except as pro7 vided in paragraph (2), payment of’’; and 

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

9 paragraph (2): 

10 ‘‘(2) Notwithstanding paragraph (1), the Secretary 

11 may, pursuant to such regulations as the Secretary shall 

12 prescribe, continue to pay allowances to eligible veterans 

13 and eligible persons enrolled in courses set forth in para14 graph (1)(A)— 

15 ‘‘(A) during periods when schools are tempo16 rarily closed under an established policy based on an 

17 Executive order of the President or due to an emer18 gency situation, except that the total number of weeks 

19 for which allowances may continue to be so payable 

20 in any 12-month period may not exceed four weeks; 

21 or 

22 ‘‘(B) solely for the purpose of awarding a month23 ly housing stipend described in section 3313 of this 

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1 sure, except that payment of such a stipend may only 

2 be continued until the earlier of— 

3 ‘‘(i) the date of the end of the term, quarter, 

4 or semester during which the school closure oc5 curred; and 

6 ‘‘(ii) the date that is 4 months after the date 

7 of the school closure.’’. 

8 (2) CONFORMING AMENDMENT.—Paragraph 

9 (1)(C)(ii) of such section, as redesignated, is amended 

10 by striking ‘‘described in subclause (A) of this clause’’ 

11 and inserting ‘‘described in clause (i)’’. 

12 SEC. 202. MODIFICATION AND IMPROVEMENT OF TRANSFER 

13 OF UNUSED POST-9/11 EDUCATIONAL ASSIST14 ANCE TO FAMILY MEMBERS. 

15 (a) ELIGIBILITY REQUIREMENTS.—Subsection (b)(1) 

16 of section 3319 of title 38, United States Code, is amend17 ed— 

18 (1) by striking ‘‘six years’’ and inserting ‘‘ten 

19 years’’; and 

20 (2) by striking ‘‘four more years’’ and inserting 

21 ‘‘two more years’’. 

22 (b) COMMENCEMENT OF USE.—Subsection (g)(1)(A) of 

23 such section is amended by striking ‘‘six years’’ and insert24 ing ‘‘ten years’’. 


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1 (c) RATE OF PAYMENT.—Subsection (h)(3)(B) of such 

2 section is amended by inserting before the period at the end 

3 the following: ‘‘, except that the amount of the monthly sti4 pend described in subsection (c)(1)(B) or (g)(3)(A)(ii) of 

5 section 3313, as the case may be, shall be payable in an 

6 amount equal to 50 percent of the amount of such stipend 

7 that would otherwise be payable under this chapter to the 

8 individual making the transfer’’. 

9 (d) TECHNICAL CORRECTION.—Such section is further 

10 amended by striking ‘‘armed forces’’ each place it appears 

11 and inserting ‘‘Armed Forces’’. 

12 (e) APPLICABILITY.—The amendments made by sub13 sections (a) through (c) shall apply with respect to an elec14 tion to transfer entitlement under section 3319 of title 38, 

15 United States Code, that is made on or after the date that 

16 is 180 days after the date of the enactment of this Act. 

17 SEC. 203. CODIFICATION AND IMPROVEMENT OF ELECTION 

18 PROCESS FOR POST-9/11 EDUCATIONAL AS19 SISTANCE. 

20 (a) IN GENERAL.—Subchapter III of chapter 33 of 

21 title 38, United States Code, is amended by adding at the 

22 end the following new section: 

23 ‘‘§ 3326. Election to receive educational assistance 

24 ‘‘(a) INDIVIDUALS ELIGIBLE TO ELECT PARTICIPA25 TION IN POST-9/11 EDUCATIONAL ASSISTANCE.—An indiVerDate Sep 11 2014 01:42 Dec 08, 2016 Jkt 069200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6203 E:\BILLS\S425.RS S425

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1 vidual may elect to receive educational assistance under 

2 this chapter if such individual— 

3 ‘‘(1) as of August 1, 2009— 

4 ‘‘(A) is entitled to basic educational assist5 ance under chapter 30 of this title and has used, 

6 but retains unused, entitlement under that chap7 ter; 

8 ‘‘(B) is entitled to educational assistance 

9 under chapter 107, 1606, or 1607 of title 10 and 

10 has used, but retains unused, entitlement under 

11 the applicable chapter; 

12 ‘‘(C) is entitled to basic educational assist13 ance under chapter 30 of this title but has not 

14 used any entitlement under that chapter; 

15 ‘‘(D) is entitled to educational assistance 

16 under chapter 107, 1606, or 1607 of title 10 but 

17 has not used any entitlement under such chapter; 

18 ‘‘(E) is a member of the Armed Forces who 

19 is eligible for receipt of basic educational assist20 ance under chapter 30 of this title and is making 

21 contributions toward such assistance under sec22 tion 3011(b) or 3012(c) of this title; or 

23 ‘‘(F) is a member of the Armed Forces who 

24 is not entitled to basic educational assistance 

25 under chapter 30 of this title by reason of an 


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1 election under section 3011(c)(1) or 3012(d)(1) of 

2 this title; and 

3 ‘‘(2) as of the date of the individual’s election 

4 under this paragraph, meets the requirements for en5 titlement to educational assistance under this chapter. 

6 ‘‘(b) CESSATION OF CONTRIBUTIONS TOWARD GI 

7 BILL.—Effective as of the first month beginning on or after 

8 the date of an election under subsection (a) of an individual 

9 described by paragraph (1)(E) of that subsection, the obliga10 tion of the individual to make contributions under section 

11 3011(b) or 3012(c) of this title, as applicable, shall cease, 

12 and the requirements of such section shall be deemed to be 

13 no longer applicable to the individual. 

14 ‘‘(c) REVOCATION OF REMAINING TRANSFERRED ENTI15 TLEMENT.— 

16 ‘‘(1) ELECTION TO REVOKE.—If, on the date an 

17 individual described in paragraph (1)(A) or (1)(C) of 

18 subsection (a) makes an election under that sub19 section, a transfer of the entitlement of the individual 

20 to basic educational assistance under section 3020 of 

21 this title is in effect and a number of months of the 

22 entitlement so transferred remain unutilized, the in23 dividual may elect to revoke all or a portion of the 

24 entitlement so transferred that remains unutilized. 


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1 ‘‘(2) AVAILABILITY OF REVOKED ENTITLE2 MENT.—Any entitlement revoked by an individual 

3 under this paragraph shall no longer be available to 

4 the dependent to whom transferred, but shall be avail5 able to the individual instead for educational assist6 ance under chapter 33 of this title in accordance with 

7 the provisions of this section. 

8 ‘‘(3) AVAILABILITY OF UNREVOKED ENTITLE9 MENT.—Any entitlement described in paragraph (1) 

10 that is not revoked by an individual in accordance 

11 with that paragraph shall remain available to the de12 pendent or dependents concerned in accordance with 

13 the current transfer of such entitlement under section 

14 3020 of this title. 

15 ‘‘(d) POST-9/11 EDUCATIONAL ASSISTANCE.— 

16 ‘‘(1) IN GENERAL.—Subject to paragraph (2) 

17 and except as provided in subsection (e), an indi18 vidual making an election under subsection (a) shall 

19 be entitled to educational assistance under this chap20 ter in accordance with the provisions of this chapter, 

21 instead of basic educational assistance under chapter 

22 30 of this title, or educational assistance under chap23 ter 107, 1606, or 1607 of title 10, as applicable. 

24 ‘‘(2) LIMITATION ON ENTITLEMENT FOR CERTAIN

25 INDIVIDUALS.—In the case of an individual making 


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1 an election under subsection (a) who is described by 

2 paragraph (1)(A) of that subsection, the number of 

3 months of entitlement of the individual to educational 

4 assistance under this chapter shall be the number of 

5 months equal to— 

6 ‘‘(A) the number of months of unused enti7 tlement of the individual under chapter 30 of 

8 this title, as of the date of the election, plus 

9 ‘‘(B) the number of months, if any, of enti10 tlement revoked by the individual under sub11 section (c)(1). 

12 ‘‘(e) CONTINUING ENTITLEMENT TO EDUCATIONAL AS13 SISTANCE NOT AVAILABLE UNDER 9/11 ASSISTANCE PRO14 GRAM.— 

15 ‘‘(1) IN GENERAL.—In the event educational as16 sistance to which an individual making an election 

17 under subsection (a) would be entitled under chapter 

18 30 of this title, or chapter 107, 1606, or 1607 of title 

19 10, as applicable, is not authorized to be available to 

20 the individual under the provisions of this chapter the 

21 individual shall remain entitled to such educational 

22 assistance in accordance with the provisions of the 

23 applicable chapter. 

24 ‘‘(2) CHARGE FOR USE OF ENTITLEMENT.—The 

25 utilization by an individual of entitlement under 


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1 paragraph (1) shall be chargeable against the entitle2 ment of the individual to educational assistance 

3 under this chapter at the rate of one month of entitle4 ment under this chapter for each month of entitlement 

5 utilized by the individual under paragraph (1) (as 

6 determined as if such entitlement were utilized under 

7 the provisions of chapter 30 of this title, or chapter 

8 107, 1606, or 1607 of title 10, as applicable). 

9 ‘‘(f) ADDITIONAL POST-9/11 ASSISTANCE FOR MEM10 BERS HAVING MADE CONTRIBUTIONS TOWARD GI BILL.— 

11 ‘‘(1) ADDITIONAL ASSISTANCE.—In the case of 

12 an individual making an election under subsection 

13 (a) who is described by subparagraph (A), (C), or (E) 

14 of paragraph (1) of that subsection, the amount of 

15 educational assistance payable to the individual 

16 under this chapter as a monthly stipend payable 

17 under paragraph (1)(B) of section 3313(c) of this 

18 title, or under paragraphs (2) through (7) of that sec19 tion (as applicable), shall be the amount otherwise 

20 payable as a monthly stipend under the applicable 

21 paragraph increased by the amount equal to— 

22 ‘‘(A) the total amount of contributions to23 ward basic educational assistance made by the 

24 individual under section 3011(b) or 3012(c) of 


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1 this title, as of the date of the election, multiplied 

2 by 

3 ‘‘(B) the fraction— 

4 ‘‘(i) the numerator of which is— 

5 ‘‘(I) the number of months of enti6 tlement to basic educational assistance 

7 under chapter 30 of this title remain8 ing to the individual at the time of the 

9 election; plus 

10 ‘‘(II) the number of months, if 

11 any, of entitlement under chapter 30 

12 revoked by the individual under sub13 section (c)(1); and 

14 ‘‘(ii) the denominator of which is 36 

15 months. 

16 ‘‘(2) MONTHS OF REMAINING ENTITLEMENT FOR

17 CERTAIN INDIVIDUALS.—In the case of an individual 

18 covered by paragraph (1) who is described by sub19 section (a)(1)(E), the number of months of entitlement 

20 to basic educational assistance remaining to the indi21 vidual for purposes of paragraph (1)(B)(i)(II) shall 

22 be 36 months. 

23 ‘‘(3) TIMING OF PAYMENT.—The amount payable 

24 with respect to an individual under paragraph (1) 

25 shall be paid to the individual together with the last 


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1 payment of the monthly stipend payable to the indi2 vidual under paragraph (1)(B) of section 3313(c) of 

3 this title, or under paragraphs (2) through (7) of that 

4 section (as applicable), before the exhaustion of the in5 dividual’s entitlement to educational assistance under 

6 this chapter. 

7 ‘‘(g) CONTINUING ENTITLEMENT TO ADDITIONAL AS8 SISTANCE FOR CRITICAL SKILLS OR SPECIALITY AND ADDI9 TIONAL SERVICE.—An individual making an election 

10 under subsection (a)(1) who, at the time of the election, is 

11 entitled to increased educational assistance under section 

12 3015(d) of this title, or section 16131(i) of title 10, or sup13 plemental educational assistance under subchapter III of 

14 chapter 30 of this title, shall remain entitled to such in15 creased educational assistance or supplemental educational 

16 assistance in the utilization of entitlement to educational 

17 assistance under this chapter, in an amount equal to the 

18 quarter, semester, or term, as applicable, equivalent of the 

19 monthly amount of such increased educational assistance 

20 or supplemental educational assistance payable with respect 

21 to the individual at the time of the election. 

22 ‘‘(h) ALTERNATIVE ELECTION BY SECRETARY.— 

23 ‘‘(1) IN GENERAL.—In the case of an individual 

24 who, on or after January 1, 2016, submits to the Sec25 retary an election under this section that the SecVerDate Sep 11 2014 01:42 Dec 08, 2016 Jkt 069200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6203 E:\BILLS\S425.RS S425

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1 retary determines is clearly against the interests of 

2 the individual, or who fails to make an election under 

3 this section, the Secretary may make an alternative 

4 election on behalf of the individual that the Secretary 

5 determines is in the best interests of the individual. 

6 ‘‘(2) NOTICE.—If the Secretary makes an elec7 tion on behalf of an individual under this subsection, 

8 the Secretary shall notify the individual by not later 

9 than seven days after making such election and shall 

10 provide the individual with a 30-day period, begin11 ning on the date of the individual’s receipt of such 

12 notice, during which the individual may modify or 

13 revoke the election made by the Secretary on the indi14 vidual’s behalf. The Secretary shall include, as part 

15 of such notice, a clear statement of why the alter16 native election made by the Secretary is in the best 

17 interests of the individual as compared to the election 

18 submitted by the individual. The Secretary shall pro19 vide the notice required under this paragraph by elec20 tronic means whenever possible. 

21 ‘‘(i) IRREVOCABILITY OF ELECTIONS.—An election 

22 under subsection (a) or (c)(1) is irrevocable.’’. 

23 (b) CLERICAL AMENDMENT.—The table of sections at 

24 the beginning of such chapter is amended by adding at the 

25 end the following new item: 

‘‘3326. Election to receive educational assistance.’’. 


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1 (c) CONFORMING REPEAL.—Subsection (c) of section 

2 5003 of the Post-9/11 Veterans Educational Assistance Act 

3 of 2008 (Public Law 110–252; 38 U.S.C. 3301 note) is here4 by repealed. 

5 SEC. 204. CENTRALIZED REPORTING OF VETERAN ENROLL6 MENT BY CERTAIN GROUPS, DISTRICTS, AND 

7 CONSORTIUMS OF EDUCATIONAL INSTITU8 TIONS. 

9 (a) IN GENERAL.—Section 3684(a) of title 38, United 

10 States Code, is amended— 

11 (1) in paragraph (1), by inserting ‘‘32, 33,’’ 

12 after ‘‘31,’’; and 

13 (2) by adding at the end the following new para14 graph: 

15 ‘‘(4) For purposes of this subsection, the term ‘edu16 cational institution’ may include a group, district, or con17 sortium of separately accredited educational institutions lo18 cated in the same State that are organized in a manner 

19 that facilitates the centralized reporting of the enrollments 

20 in such group, district, or consortium of institutions.’’. 

21 (b) EFFECTIVE DATE.—The amendments made by sub22 section (a) shall apply with respect to reports submitted on 

23 or after the date of the enactment of this Act. 


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1 SEC. 205. IMPROVED ROLE OF STATE APPROVING AGENCIES 

2 IN ADMINISTRATION OF VETERANS EDU3 CATIONAL BENEFITS. 

4 (a) APPROVAL OF CERTAIN COURSES.—Section 

5 3672(b)(2)(A) of title 38, United States Code, is amended 

6 by striking ‘‘the following’’ and all that follows through the 

7 colon and inserting the following: ‘‘a program of education 

8 is deemed to be approved for purposes of this chapter if a 

9 State approving agency determines that the program is one 

10 of the following programs:’’. 

11 (b) APPROVAL OF OTHER COURSES.—Section 3675 of 

12 such title amended— 

13 (1) in subsection (a)(1)— 

14 (A) by striking ‘‘The Secretary or a State 

15 approving agency’’ and inserting ‘‘A State ap16 proving agency, or the Secretary when acting in 

17 the role of a State approving agency,’’; and 

18 (B) by striking ‘‘offered by proprietary for19 profit educational institutions’’ and inserting 

20 ‘‘not covered by section 3672 of this title’’; and 

21 (2) in subsection (b)— 

22 (A) in the matter before paragraph (1), by 

23 striking ‘‘the Secretary or the State approving 

24 agency’’ and inserting ‘‘the State approving 

25 agency, or the Secretary when acting in the role 

26 of a State approving agency,’’; and 


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1 (B) in paragraph (1), by striking ‘‘the Sec2 retary or the State approving agency’’ and in3 serting ‘‘the State approving agency, or the Sec4 retary when acting in the role of a State approv5 ing agency’’. 

6 SEC. 206. MODIFICATION OF CRITERIA USED TO APPROVE 

7 COURSES FOR PURPOSES OF VETERANS EDU8 CATIONAL BENEFITS. 

9 (a) NONACCREDITED COURSES.—Section 3676(c)(14) 

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

11 before the period the following: ‘‘if the Secretary, in con12 sultation with the State approving agency and pursuant 

13 to regulations prescribed to carry out this paragraph, deter14 mines such criteria are necessary and treat public, private, 

15 and proprietary for-profit educational institutions equi16 tably’’. 

17 (b) ACCREDITED COURSES.—Section 3675(b)(3) of 

18 such title is amended by striking ‘‘and (3)’’ and inserting 

19 ‘‘(3), and (14)’’. 

20 (c) APPLICATION.—The amendment made by sub21 section (a) shall apply with respect to— 

22 (1) criteria developed pursuant to paragraph 

23 (14) of subsection (c) of section 3676 of title 38, 

24 United States Code, on or after January 1, 2013; and 


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1 (2) an investigation conducted under such sub2 section that is covered by a reimbursement of expenses 

3 paid by the Secretary of Veterans Affairs to a State 

4 pursuant to section 3674 of such title on or after Oc5 tober 1, 2015. 

6 SEC. 207. SURVEYS FOR COMPLIANCE OF EDUCATIONAL IN7 STITUTIONS AND TRAINING ESTABLISH8 MENTS WITH REQUIREMENTS RELATING TO 

9 ADMINISTRATION OF VETERANS EDU10 CATIONAL BENEFITS. 

11 (a) IN GENERAL.—Section 3693 of title 38, United 

12 States Code, is amended— 

13 (1) by striking subsection (a) and inserting the 

14 following new subsection (a): 

15 ‘‘(a)(1)(A) Except as provided in subsection (b), the 

16 Secretary shall conduct an annual compliance survey of 

17 educational institutions and training establishments offer18 ing one or more courses approved for the enrollment of eligi19 ble veterans or persons if at least 20 such veterans or per20 sons are enrolled in any such course. 

21 ‘‘(B) The Secretary shall— 

22 ‘‘(i) design the compliance surveys to ensure that 

23 such institutions or establishments, as the case may 

24 be, and approved courses are in compliance with all 


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1 applicable provisions of chapters 30 through 36 of 

2 this title; 

3 ‘‘(ii) survey each such educational institution 

4 and training establishment not less than once during 

5 every two-year period; and 

6 ‘‘(iii) assign not fewer than one education com7 pliance specialist to work on compliance surveys in 

8 any year for each 40 compliance surveys required to 

9 be made under this section for such year. 

10 ‘‘(2) The Secretary, in consultation with the State ap11 proving agencies, shall— 

12 ‘‘(A) annually determine the parameters of the 

13 surveys required under paragraph (1); and 

14 ‘‘(B) not later than September 1 of each year, 

15 make available to the State approving agencies a list 

16 of the educational institutions and training establish17 ments that will be surveyed during the fiscal year fol18 lowing the date of making such list available.’’; and 

19 (2) by adding at the end the following new sub20 section: 

21 ‘‘(c) In this section, the terms ‘educational institution’ 

22 and ‘training establishment’ have the meaning given such 

23 terms in section 3452 of this title.’’. 

24 (b) CONFORMING AMENDMENTS.—Subsection (b) of 

25 such section is amended— 


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1 (1) by striking ‘‘subsection (a) of this section for 

2 an annual compliance survey’’ and inserting ‘‘sub3 section (a)(1) for a compliance survey’’; 

4 (2) by striking ‘‘institution’’ and inserting ‘‘edu5 cational institution or training establishment’’; and 

6 (3) by striking ‘‘institution’s demonstrated 

7 record of compliance’’ and inserting ‘‘record of com8 pliance of such institution or establishment’’. 

9 SEC. 208. MODIFICATION OF REQUIREMENTS FOR AP10 PROVAL FOR PURPOSES OF EDUCATIONAL 

11 ASSISTANCE PROVIDED BY DEPARTMENT OF 

12 VETERANS AFFAIRS OF PROGRAMS DESIGNED 

13 TO PREPARE INDIVIDUALS FOR LICENSURE 

14 OR CERTIFICATION. 

15 (a) APPROVAL OF NON-ACCREDITED COURSES.—Sub16 section (c) of section 3676 of title 38, United States Code, 

17 as amended by section 206, is further amended— 

18 (1) by redesignating paragraph (14) as para19 graph (16); and 

20 (2) by inserting after paragraph (13) the fol21 lowing new paragraphs: 

22 ‘‘(14) In the case of a course designed to prepare 

23 an individual for licensure or certification in a State, 

24 the course— 


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1 ‘‘(A) meets any instructional curriculum li2 censure or certification requirements of such 

3 State; and 

4 ‘‘(B) in the case of a course designed to pre5 pare an individual for licensure to practice law 

6 in a State, is accredited by an accrediting agen7 cy or association recognized by the Secretary of 

8 Education under subpart 2 of part H of title IV 

9 of the Higher Education Act of 1965 (20 U.S.C. 

10 1099b). 

11 ‘‘(15) In the case of a course designed to prepare 

12 an individual for employment pursuant to standards 

13 developed by a board or agency of a State in an occu14 pation that requires approval, licensure, or certifi15 cation, the course— 

16 ‘‘(A) meets such standards; and 

17 ‘‘(B) in the case of a course designed to pre18 pare an individual for licensure to practice law 

19 in a State, is accredited by an accrediting agen20 cy or association recognized by the Secretary of 

21 Education under subpart 2 of part H of title IV 

22 of the Higher Education Act of 1965 (20 U.S.C. 

23 1099b).’’. 

24 (b) EXCEPTIONS.—Such section is further amended by 

25 adding at the end the following new subsection: 


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1 ‘‘(f)(1) The Secretary may waive the requirements of 

2 paragraph (14) or (15) of subsection (c) in the case of a 

3 course of education offered by an educational institution 

4 (either accredited or not accredited) if the Secretary deter5 mines all of the following: 

6 ‘‘(A) The course did not meet the requirements of 

7 such paragraph at any time during the two-year pe8 riod preceding the date of the waiver. 

9 ‘‘(B) The waiver furthers the purposes of the edu10 cational assistance programs administered by the Sec11 retary or would further the education interests of in12 dividuals eligible for assistance under such programs. 

13 ‘‘(C) The educational institution does not pro14 vide any commission, bonus, or other incentive pay15 ment based directly or indirectly on success in secur16 ing enrollments or financial aid to any persons or en17 tities engaged in any student recruiting or admission 

18 activities or in making decisions regarding the award 

19 of student financial assistance, except for the recruit20 ment of foreign students residing in foreign countries 

21 who are not eligible to receive Federal student assist22 ance. 

23 ‘‘(2) Not later than 30 days after the date on which 

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1 retary shall submit to Congress notice of such waiver and 

2 a justification for issuing such waiver.’’. 

3 (c) APPROVAL OF ACCREDITED COURSES.—Section 

4 3675(b)(3) of such title, as amended by section 206, is fur5 ther amended— 

6 (1) by striking ‘‘and (14)’’ and inserting ‘‘(14), 

7 (15), and (16)’’; and 

8 (2) by inserting before the period at the end the 

9 following: ‘‘(or, with respect to such paragraphs (14) 

10 and (15), the requirements under such paragraphs are 

11 waived pursuant to subsection (f)(1) of section 3676 

12 of this title)’’. 

13 (d) APPROVAL OF ACCREDITED STANDARD COLLEGE

14 DEGREE PROGRAMS OFFERED AT PUBLIC OR NOT-FOR15 PROFIT EDUCATIONAL INSTITUTIONS.—Section 3672(b)(2) 

16 of such title is amended— 

17 (1) in subparagraph (A)(i), by striking ‘‘An ac18 credited’’ and inserting ‘‘Except as provided in sub19 paragraph (C), an accredited’’; and 

20 (2) by adding at the end the following new sub21 paragraph: 

22 ‘‘(C) A course that is described in both subparagraph 

23 (A)(i) of this paragraph and in paragraph (14) or (15) of 

24 section 3676(c) of this title shall not be deemed to be ap25 proved for purposes of this chapter unless— 


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1 ‘‘(i) a State approving agency, or the Secretary 

2 when acting in the role of a State approving agency, 

3 determines that the course meets the applicable cri4 teria in such paragraphs; or 

5 ‘‘(ii) the Secretary issues a waiver for such 

6 course under section 3676(f)(1) of this title.’’. 

7 (e) DISAPPROVAL OF COURSES.—Section 3679 of such 

8 title is amended by adding at the end the following new 

9 subsection: 

10 ‘‘(d) Notwithstanding any other provision of this chap11 ter, the Secretary or the applicable State approving agency 

12 shall disapprove a course of education described in para13 graph (14) or (15) of section 3676(c) of this title unless the 

14 educational institution providing the course of education— 

15 ‘‘(1) publicly discloses any conditions or addi16 tional requirements, including training, experience, 

17 or examinations, required to obtain the license, cer18 tification, or approval for which the course of edu19 cation is designed to provide preparation; and 

20 ‘‘(2) makes each disclosure required by para21 graph (1) in a manner that the Secretary considers 

22 prominent.’’. 

23 (f) APPLICABILITY.—If after enrollment in a course of 

24 education that is subject to disapproval by reason of an 

25 amendment made by this Act, an individual pursues one 


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1 or more courses of education at the same educational insti2 tution while remaining continuously enrolled (other than 

3 during regularly scheduled breaks between courses, semes4 ters, or terms) at that institution, any course so pursued 

5 by the individual at that institution while so continuously 

6 enrolled shall not be subject to disapproval by reason of such 

7 amendment. 

8 SEC. 209. EXPANSION OF YELLOW RIBBON G.I. EDUCATION 

9 ENHANCEMENT PROGRAM. 

10 (a) IN GENERAL.—Section 3317(a) of title 38, United 

11 States Code, is amended by striking ‘‘in paragraphs (1) and 

12 (2)’’ and inserting ‘‘in paragraphs (1), (2), and (9)’’. 

13 (b) EFFECTIVE DATE.—The amendment made by sub14 section (a) shall apply with respect to academic years be15 ginning after the date that is one year after the date of 

16 the enactment of this Act. 

17 SEC. 210. CONSIDERATION OF CERTAIN TIME SPENT RE18 CEIVING MEDICAL CARE FROM SECRETARY 

19 OF DEFENSE AS ACTIVE DUTY FOR PURPOSES 

20 OF ELIGIBILITY FOR POST-9/11 EDUCATIONAL 

21 ASSISTANCE. 

22 (a) IN GENERAL.—Section 3301(1)(B) of title 38, 

23 United States Code, is amended by inserting ‘‘12301(h),’’ 

24 after ‘‘12301(g),’’. 


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1 (b) EFFECTIVE DATE.—The amendment made by sub2 section (a) shall take effect on the date that is one year after 

3 the date of the enactment of this Act and shall apply with 

4 respect to assistance provided under chapter 33 of such title 

5 on and after the date that is one year after the date of the 

6 enactment of this Act. 

7 TITLE III—HOMELESS VETERANS 

8 MATTERS 

9 SEC. 301. EXPANSION OF DEFINITION OF HOMELESS VET10 ERAN FOR PURPOSES OF BENEFITS UNDER 

11 THE LAWS ADMINISTERED BY THE SEC12 RETARY OF VETERANS AFFAIRS. 

13 Section 2002(1) of title 38, United States Code, is 

14 amended by striking ‘‘in section 103(a) of the McKinney15 Vento Homeless Assistance Act (42 U.S.C. 11302(a))’’ and 

16 inserting ‘‘in subsection (a) or (b) of section 103 of the 

17 McKinney-Vento Homeless Assistance Act (42 U.S.C. 

18 11302)’’. 

19 SEC. 302. INCREASED PER DIEM PAYMENTS FOR TRANSI20 TIONAL HOUSING ASSISTANCE THAT BE21 COMES PERMANENT HOUSING FOR HOME22 LESS VETERANS. 

23 Section 2012(a)(2) of title 38, United States Code, is 

24 amended— 


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1 (1) by redesignating subparagraphs (B) through 

2 (D) as subparagraphs (C) through (E), respectively; 

3 (2) in subparagraph (C), as redesignated, by 

4 striking ‘‘in subparagraph (D)’’ and inserting ‘‘in 

5 subparagraph (E)’’; 

6 (3) in subparagraph (D), as redesignated, by 

7 striking ‘‘under subparagraph (B)’’ and inserting 

8 ‘‘under subparagraph (C)’’; 

9 (4) in subparagraph (E), as redesignated, by 

10 striking ‘‘in subparagraphs (B) and (C)’’ and insert11 ing ‘‘in subparagraphs (C) and (D)’’; and 

12 (5) in subparagraph (A)— 

13 (A) by striking ‘‘The rate’’ and inserting 

14 ‘‘Except as otherwise provided in subparagraph 

15 (B), the rate’’; and 

16 (B) by striking ‘‘under subparagraph (B)’’ 

17 and all that follows through the end and insert18 ing the following: ‘‘under subparagraph (C). 

19 ‘‘(B)(i) Except as provided in clause (ii), in no case 

20 may the rate determined under this paragraph exceed the 

21 rate authorized for State homes for domiciliary care under 

22 subsection (a)(1)(A) of section 1741 of this title, as the Sec23 retary may increase from time to time under subsection (c) 

24 of that section. 


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1 ‘‘(ii) In the case of services furnished to a homeless 

2 veteran who is placed in housing that will become perma3 nent housing for the veteran upon termination of the fur4 nishing of such services to such veteran, the maximum rate 

5 of per diem authorized under this section is 150 percent 

6 of the rate described in clause (i).’’. 

7 SEC. 303. EXPANSION OF DEPARTMENT OF VETERANS AF8 FAIRS AUTHORITY TO PROVIDE DENTAL CARE 

9 TO HOMELESS VETERANS. 

10 (a) IN GENERAL.—Subsection (b) of section 2062 of 

11 title 38, United States Code, is amended to read as follows: 

12 ‘‘(b) ELIGIBLE VETERANS.—(1) Subsection (a) applies 

13 to a veteran who— 

14 ‘‘(A) is enrolled for care under section 1705(a) of 

15 this title; and 

16 ‘‘(B) for a period of 60 consecutive days, is re17 ceiving— 

18 ‘‘(i) assistance under section 8(o) of the 

19 United States Housing Act of 1937 (42 U.S.C. 

20 1437f(o)); or 

21 ‘‘(ii) care (directly or by contract) in any 

22 of the following settings: 

23 ‘‘(I) A domiciliary under section 1710 

24 of this title. 


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1 ‘‘(II) A therapeutic residence under 

2 section 2032 of this title. 

3 ‘‘(III) Community residential care co4 ordinated by the Secretary under section 

5 1730 of this title. 

6 ‘‘(IV) A setting for which the Secretary 

7 provides funds for a grant and per diem 

8 provider. 

9 ‘‘(2) For purposes of paragraph (1), in determining 

10 whether a veteran has received assistance or care for a pe11 riod of 60 consecutive days, the Secretary may disregard 

12 breaks in the continuity of assistance or care for which the 

13 veteran is not responsible.’’. 

14 (b) EFFECTIVE DATE.—Subsection (a) shall take effect 

15 on the date that is one year after the date of the enactment 

16 of this Act. 

17 SEC. 304. CLARIFICATION OF ELIGIBILITY FOR SERVICES 

18 UNDER HOMELESS VETERANS REINTEGRA19 TION PROGRAMS. 

20 Section 2021(a) of title 38, United States Code, is 

21 amended by striking ‘‘reintegration of homeless veterans 

22 into the labor force.’’ and inserting the following: ‘‘re23 integration into the labor force of—’’ 

24 ‘‘(1) homeless veterans; 


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1 ‘‘(2) veterans participating in the Department of 

2 Veterans Affairs supported housing program for 

3 which rental assistance is provided pursuant to sec4 tion 8(o)(19) of the United States Housing Act of 

5 1937 (42 U.S.C. 1437f(o)(19)); 

6 ‘‘(3) Indians who are veterans and receiving as7 sistance under the Native American Housing Assist8 ance and Self Determination Act of 1996 (25 U.S.C. 

9 4101 et seq.); and 

10 ‘‘(4) veterans who are transitioning from being 

11 incarcerated.’’. 

12 SEC. 305. PROGRAM TO IMPROVE RETENTION OF HOUSING 

13 BY FORMERLY HOMELESS VETERANS AND 

14 VETERANS AT RISK OF BECOMING HOME15 LESS. 

16 (a) PROGRAM REQUIRED.— 

17 (1) IN GENERAL.—Subchapter II of chapter 20 of 

18 title 38, United States Code, is amended— 

19 (A) by redesignating section 2013 as section 

20 2014; and 

21 (B) by inserting after section 2012 the fol22 lowing new section 2013: 


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1 ‘‘§ 2013. Program to improve retention of housing by 

2 formerly homeless veterans and veterans 

3 at risk of becoming homeless 

4 ‘‘(a) PROGRAM REQUIRED.—The Secretary shall carry 

5 out a program under which the Secretary shall provide case 

6 management services to improve the retention of housing 

7 by veterans who were previously homeless and are 

8 transitioning to permanent housing and veterans who are 

9 at risk of becoming homeless. 

10 ‘‘(b) GRANTS.—(1) The Secretary shall carry out the 

11 program through the award of grants. 

12 ‘‘(2)(A) In awarding grants under paragraph (1), the 

13 Secretary shall give priority to organizations that dem14 onstrate a capability to provide case management services 

15 as described in subsection (a), particularly organizations 

16 that are successfully providing or have successfully provided 

17 transitional housing services using amounts provided by the 

18 Secretary under sections 2012 and 2061 of this title. 

19 ‘‘(B) In giving priority under subparagraph (A), the 

20 Secretary shall give extra priority to an organization de21 scribed in such subparagraph that— 

22 ‘‘(i) voluntarily stops receiving amounts pro23 vided by the Secretary under sections 2012 and 2061 

24 of this title; and 

25 ‘‘(ii) converts a facility that the organization 

26 used to provide transitional housing services into a 


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1 facility that the organization uses to provide perma2 nent housing that meets housing quality standards es3 tablished under section 8(o)(8)(B) of the United 

4 States Housing Act of 1937 (42 U.S.C. 

5 1437f(o)(8)(B)). 

6 ‘‘(C) In any case in which a facility, with respect to 

7 which a person received a grant for construction, rehabilita8 tion, or acquisition under section 2011 of this title, is con9 verted as described in subparagraph (B)(ii), such conver10 sion shall be considered to have been carried out pursuant 

11 to the needs of the Department and such person shall not 

12 be considered in non-compliance with the terms of such 

13 grant by reason of such conversion.’’. 

14 (2) CLERICAL AMENDMENT.—The table of sec15 tions at the beginning of chapter 20 of such title is 

16 amended by striking the item relating to section 2013 

17 and inserting the following new items: 

‘‘2013. Program to improve retention of housing by formerly homeless veterans 

and veterans at risk of becoming homeless. 

‘‘2014. Authorization of appropriations.’’. 

18 (b) REGULATIONS.—Not later than one year after the 

19 date of the enactment of this Act, the Secretary of Veterans 

20 Affairs shall prescribe regulations to carry out section 2013 

21 of such title, as added by subsection (a)(1)(B). 

22 (c) REPORT.— 

23 (1) IN GENERAL.—Not later than June 1, 2019, 

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1 erans’ Affairs of the Senate and the Committee on 

2 Veterans’ Affairs of the House of Representatives a re3 port on the program required by section 2013 of such 

4 title, as added by subsection (a)(1)(B). 

5 (2) CONTENTS.—The report submitted under 

6 paragraph (1) shall include assessments of the fol7 lowing: 

8 (A) The percentage of veterans who received 

9 case management services under the program 

10 who were able to retain permanent housing by 

11 the end of the program, disaggregated by each re12 cipient of a grant under such section. 

13 (B) The percentage of veterans who received 

14 case management services under the program 

15 who were not in permanent housing at the end 

16 of the program, disaggregated by housing status 

17 and reason for failing to retain permanent hous18 ing under the program. 

19 (C) The use by veterans who received case 

20 management services under the program of hous21 ing assistance furnished by the Department of 

22 Veterans Affairs, including a comparison of the 

23 use of such assistance by such veterans before 

24 and after receiving such services. 


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1 (D) An assessment of the employment status 

2 of veterans who received case management serv3 ices under the program, including a comparison 

4 of the employment status of such veterans before 

5 and after receiving such services. 

6 SEC. 306. PILOT PROGRAM ON PROVISION OF INTENSIVE 

7 CASE MANAGEMENT INTERVENTIONS TO 

8 HOMELESS VETERANS WHO RECEIVE THE 

9 MOST HEALTH CARE FROM THE DEPARTMENT 

10 OF VETERANS AFFAIRS. 

11 (a) PILOT PROGRAM REQUIRED.—Not later than Sep12 tember 1, 2016, the Secretary of Veterans Affairs shall com13 mence a pilot program to assess the feasibility and advis14 ability of providing intensive case management interven15 tions to covered veterans. 

16 (b) COVERED VETERANS.—For purposes of the pilot 

17 program, a covered veteran is a veteran who is enrolled 

18 in— 

19 (1) the homeless registry of the Department; and 

20 (2) the system of annual patient enrollment es21 tablished and operated by the Secretary under section 

22 1705(a) of title 38, United States Code. 

23 (c) LOCATION.— 

24 (1) IN GENERAL.—The Secretary shall carry out 

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1 lected by the Secretary for purposes of the pilot pro2 gram as follows: 

3 (A) Not fewer than three locations in cities 

4 that have the largest populations of homeless vet5 erans in the United States. 

6 (B) Not fewer than three locations in subur7 ban or rural settings. 

8 (2) INTERACTION AND COORDINATION WITH COM9 MUNITY ORGANIZATIONS.—In selecting locations 

10 under paragraph (1), the Secretary shall only select 

11 locations in areas in which the Secretary determines 

12 that there is a high degree of interaction and coordi13 nation between the Department and community orga14 nizations that provide housing and social services for 

15 veterans, such as outreach, employment, and financial 

16 assistance for homeless veterans, veterans at risk of 

17 becoming homeless, and low-income veterans. 

18 (d) PROVISION OF INTENSIVE CASE MANAGEMENT

19 INTERVENTIONS.— 

20 (1) MINIMUM NUMBER OF VETERANS TO RECEIVE

21 INTERVENTIONS.—In carrying out the program at 

22 each location selected under subsection (c), the Sec23 retary shall provide intensive case management inter24 ventions to not fewer than 20 covered veterans at each 

25 such location who the Secretary determines are the 


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1 covered veterans at such location who receive the most 

2 health care and related services furnished by the De3 partment of Veterans Affairs. 

4 (2) NATURE OF INTERVENTIONS.—The intensive 

5 case management interventions provided to covered 

6 veterans under paragraph (1) shall include assistance 

7 with gaining and maintaining access to such housing 

8 and services, including benefits and services to which 

9 covered veterans may be entitled or eligible under the 

10 laws administered by the Secretary, as may be nec11 essary to improve the stability of their housing and 

12 the appropriateness of the health care that they re13 ceive. 

14 (e) REPORT.— 

15 (1) IN GENERAL.—Not later than December 1, 

16 2018, the Secretary shall submit to the Committee on 

17 Veterans’ Affairs of the Senate and the Committee on 

18 Veterans’ Affairs of the House of Representatives a re19 port on the pilot program carried out under this sec20 tion. 

21 (2) CONTENTS.—The report submitted under 

22 paragraph (1) shall include assessments of the fol23 lowing: 


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1 (A) The types and frequencies of intensive 

2 case management interventions provided under 

3 the pilot program. 

4 (B) The housing status of each veteran who 

5 received an intensive case management interven6 tion under the pilot program. 

7 (C) The employment status of each veteran 

8 who received an intensive case management 

9 intervention under the pilot program, including 

10 a comparison of the employment status of such 

11 veteran before and after receiving such interven12 tion. 

13 (D) The use by veterans who received inten14 sive case management interventions under the 

15 pilot program of health care and related services 

16 furnished by the Department of Veterans Affairs 

17 and the costs incurred by the Department in fur18 nishing such care and services, including a com19 parison of the use by such veterans of such care 

20 and services and the costs incurred from fur21 nishing such care and services before and after 

22 receiving such interventions. 

23 (E) The number of veterans who received 

24 intensive case management interventions under 

25 the pilot program, disaggregated by whether the 


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1 intensive case management intervention was pro2 vided in a location described in subparagraph 

3 (A) or (B) of subsection (c)(1). 

4 (F) The costs incurred by the Department 

5 in carrying out the pilot program, disaggregated 

6 by provision of intensive case management inter7 ventions in locations described in subparagraphs 

8 (A) and (B) of such subsection. 

9 (G) An estimate of the costs the Department 

10 would have incurred for the provision of health 

11 care and associated services to covered veterans 

12 but for the provision of intensive case manage13 ment interventions under the pilot program, 

14 disaggregated by provision of intensive case 

15 management interventions in locations described 

16 in subparagraphs (A) and (B) of subsection 

17 (c)(1). 

18 SEC. 307. ESTABLISHMENT OF NATIONAL CENTER ON 

19 HOMELESSNESS AMONG VETERANS. 

20 (a) IN GENERAL.—Subchapter VII of chapter 20 of 

21 title 38, United States Code, is amended by adding at the 

22 end the following new section: 


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1 ‘‘§ 2067. National Center on Homelessness Among Vet2 erans 

3 ‘‘(a) IN GENERAL.—(1) The Secretary shall establish 

4 and operate a center to carry out the functions described 

5 in subsection (b). 

6 ‘‘(2) The center established under paragraph (1) shall 

7 be known as the ‘National Center on Homelessness Among 

8 Veterans’. 

9 ‘‘(3) To the degree practicable, the Secretary shall op10 erate the center established under paragraph (1) independ11 ently of the other programs of the Department that address 

12 homelessness among veterans. 

13 ‘‘(b) FUNCTIONS.—The functions described in this sub14 section are as follows: 

15 ‘‘(1) To carry out and promote research into the 

16 causes and contributing factors to veteran homeless17 ness. 

18 ‘‘(2) To assess the effectiveness of programs of the 

19 Department to meet the needs of homeless veterans. 

20 ‘‘(3) To identify and disseminate best practices 

21 with regard to housing stabilization, income support, 

22 employment assistance, community partnerships, and 

23 such other matters as the Secretary considers appro24 priate with respect to addressing veteran homeless25 ness. 


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1 ‘‘(4) To integrate evidence-based and best prac2 tices, policies, and programs into programs of the De3 partment for homeless veterans and veterans at risk 

4 of homelessness and to ensure that the staff of the De5 partment and community partners can implement 

6 such practices, policies, and programs. 

7 ‘‘(5) To serve as a resource center for, and pro8 mote and seek to coordinate the exchange of informa9 tion regarding, all research and training activities 

10 carried out by the Department and by other Federal 

11 and non-Federal entities with respect to veteran 

12 homelessness.’’. 

13 (b) CLERICAL AMENDMENT.—The table of sections at 

14 the beginning of chapter 20 of such title is amended by in15 serting after the item relating to section 2066 the following 

16 new item: 

‘‘2067. National Center on Homelessness Among Veterans.’’. 

17 SEC. 308. PARTNERSHIPS WITH PUBLIC AND PRIVATE ENTI18 TIES TO PROVIDE LEGAL SERVICES TO HOME19 LESS VETERANS AND VETERANS AT RISK OF 

20 HOMELESSNESS. 

21 (a) IN GENERAL.—Chapter 20 of title 38, United 

22 States Code, is amended by inserting after section 2022 the 

23 following new section: 


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1 ‘‘§ 2022A. Partnerships with public and private enti2 ties to provide legal services to homeless 

3 veterans and veterans at risk of homeless4 ness 

5 ‘‘(a) PARTNERSHIPS AUTHORIZED.—Subject to the 

6 availability of funds for that purpose, the Secretary may 

7 enter into partnerships with public or private entities to 

8 fund a portion of the general legal services specified in sub9 section (c) that are provided by such entities to homeless 

10 veterans and veterans at risk of homelessness. 

11 ‘‘(b) LOCATIONS.—(1) The Secretary shall ensure that, 

12 to the extent practicable, partnerships under this section are 

13 made with entities equitably distributed across the geo14 graphic regions of the United States, including rural com15 munities, tribal lands of the United States, Native Ameri16 cans, and tribal organizations. 

17 ‘‘(2) In this subsection, the terms ‘Native American’ 

18 and ‘tribal organization’ have the meanings given such 

19 terms in section 3765 of this title. 

20 ‘‘(c) LEGAL SERVICES.—Legal services specified in 

21 this subsection include legal services provided by public or 

22 private entities that address the needs of homeless veterans 

23 and veterans at risk of homelessness, such as the following: 

24 ‘‘(1) Legal services related to housing, including 

25 eviction defense and representation in landlord-tenant 

26 cases. 


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1 ‘‘(2) Legal services related to family law, includ2 ing assistance in court proceedings for child support, 

3 divorce, and estate planning. 

4 ‘‘(3) Legal services related to income support, in5 cluding assistance in obtaining public benefits. 

6 ‘‘(4) Legal services related to criminal defense, 

7 including defense in matters symptomatic of home8 lessness, such as outstanding warrants, fines, and 

9 driver’s license revocation, to reduce recidivism and 

10 facilitate the overcoming of reentry obstacles in em11 ployment or housing. 

12 ‘‘(d) CONSULTATION.—In developing and carrying out 

13 partnerships under this section, the Secretary shall, to the 

14 extent practicable, consult with public and private enti15 ties— 

16 ‘‘(1) for assistance in identifying and contacting 

17 organizations described in subsection (c); and 

18 ‘‘(2) to coordinate appropriate outreach relation19 ships with such organizations. 

20 ‘‘(e) REPORTS.—The Secretary may require entities 

21 that have entered into partnerships under this section to 

22 submit to the Secretary periodic reports on legal services 

23 provided to homeless veterans and veterans at risk of home24 lessness pursuant to such partnerships.’’. 


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1 (b) CLERICAL AMENDMENT.—The table of sections at 

2 the beginning of chapter 20 of such title is amended by add3 ing after the item relating to section 2022 the following new 

4 item: 

‘‘2022A. Partnerships with public and private entities to provide legal services to 

homeless veterans and veterans at risk of homelessness.’’. 

5 SEC. 309. ADMINISTRATIVE IMPROVEMENTS TO GRANT AND 

6 PER DIEM PROGRAMS OF DEPARTMENT OF 

7 VETERANS AFFAIRS. 

8 Section 2012 of title 38, United States Code, is amend9 ed— 

10 (1) in subsection (a)(1), in the matter before sub11 paragraph (A), by inserting ‘‘and except as otherwise 

12 provided in this section’’ after ‘‘such purpose’’; and 

13 (2) by adding at the end the following new sub14 section: 

15 ‘‘(e) REVIEW AND CONDITIONAL RENEWAL.—(1) Each 

16 year, the Secretary shall review each grant recipient and 

17 eligible entity that received a per diem payment under this 

18 section for a service furnished to a veteran during the one19 year period preceding the review to evaluate the perform20 ance of the grant recipient or eligible entity during that 

21 period with respect to— 

22 ‘‘(A) the success of the grant recipient or eligible 

23 entity in assisting veterans to obtain, transition into, 

24 and retain permanent housing; and 


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1 ‘‘(B) increasing the income of veterans, whether 

2 by helping veterans obtain employment or by helping 

3 veterans obtain income-related benefits to which such 

4 veterans may be eligible or entitled. 

5 ‘‘(2) For any grant recipient or eligible entity whose 

6 performance was evaluated for a year under paragraph (1), 

7 the Secretary may only provide per diem under this section 

8 to that grant recipient or eligible entity in the following 

9 year if the Secretary determines that such performance mer10 its continued receipt of per diem under this section. 

11 ‘‘(3) The Secretary shall establish uniform perform12 ance targets throughout the United States for all grant re13 cipients and eligible entities that receive per diem payments 

14 under this section for purposes of evaluating the perform15 ance of each such grant recipient and eligible entity under 

16 this subsection.’’. 

17 SEC. 310. REPEAL OF REQUIREMENT FOR ANNUAL REPORTS 

18 ON ASSISTANCE TO HOMELESS VETERANS. 

19 (a) IN GENERAL.—Section 2065 of title 38, United 

20 States Code, is hereby repealed. 

21 (b) CLERICAL AMENDMENT.—The table of sections at 

22 the beginning of chapter 20 of such title is amended by 

23 striking the item relating to section 2065. 


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1 SEC. 311. COMPTROLLER GENERAL OF THE UNITED STATES 

2 STUDY ON HOMELESS VETERANS PROGRAMS 

3 OF DEPARTMENT OF VETERANS AFFAIRS. 

4 (a) IN GENERAL.—Not later than 270 days after the 

5 date of the enactment of this Act, the Comptroller General 

6 of the United States shall complete a study of programs of 

7 the Department of Veterans Affairs that provide assistance 

8 to homeless veterans. 

9 (b) ELEMENTS.—The study required by subsection (a) 

10 shall include the following: 

11 (1) An assessment of whether programs described 

12 in subsection (a) are meeting the needs of veterans 

13 who are eligible for assistance provided by such pro14 grams, including any gaps or duplication in the pro15 vision of services. 

16 (2) A review of recent efforts of the Secretary of 

17 Veterans Affairs to improve the privacy, safety, and 

18 security of female veterans receiving assistance from 

19 such programs. 

20 SEC. 312. REQUIREMENT FOR DEPARTMENT OF VETERANS 

21 AFFAIRS TO ASSESS COMPREHENSIVE SERV22 ICE PROGRAMS FOR HOMELESS VETERANS. 

23 (a) IN GENERAL.—Not later than one year after the 

24 date of the enactment of this Act, the Secretary of Veterans 

25 Affairs shall— 


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1 (1) assess and measure the capacity of programs 

2 for which entities receive grants under section 2011 of 

3 title 38, United States Code, or per diem payments 

4 under section 2012 or 2061 of such title; and 

5 (2) assess such programs with respect to— 

6 (A) how well they achieve their stated goals 

7 at a national level; 

8 (B) placements in permanent housing; 

9 (C) placements in employment; and 

10 (D) increases in the regular income of par11 ticipants in the programs. 

12 (b) ASSESSMENT AT NATIONAL AND LOCAL LEVELS.— 

13 In assessing and measuring under subsection (a)(1), the 

14 Secretary shall develop and use tools to examine the capac15 ity of programs described in such subsection at both the na16 tional and local level in order to assess the following: 

17 (1) Whether sufficient capacity exists to meet the 

18 needs of homeless veterans in each geographic area. 

19 (2) Whether existing capacity meets the needs of 

20 the subpopulations of homeless veterans located in 

21 each geographic area. 

22 (3) The amount of capacity that recipients of 

23 grants under sections 2011 and 2061 and per diem 

24 payments under section 2012 of such title have to 

25 provide services for which the recipients are eligible to 


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1 receive per diem under section 2012(a)(2)(B)(ii) of 

2 title 38, United States Code, as added by section 

3 302(5)(B). 

4 (c) CONSIDERATION OF OTHER RESOURCES.—In as5 sessing and measuring programs under subsection (a)(1), 

6 the Secretary shall consider the availability to such pro7 grams of resources made available to such programs and 

8 to homeless veterans, including resources provided by the 

9 Department of Veterans Affairs and by entities other than 

10 the Department. 

11 (d) USE OF INFORMATION.—The Secretary shall use 

12 the information collected under this section as follows: 

13 (1) To set specific goals to ensure that programs 

14 described in subsection (a) are effectively serving the 

15 needs of homeless veterans. 

16 (2) To assess whether programs described in sub17 section (a) are meeting goals set under paragraph (1). 

18 (3) To inform funding allocations for programs 

19 described in subsection (a). 

20 (4) To improve the referral of homeless veterans 

21 to programs described in subsection (a). 

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

23 on which the assessment required by subsection (a) is com24 pleted, the Secretary shall submit to the Committee on Vet25 erans’ Affairs of the Senate and the Committee on Veterans’ 


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1 Affairs of the House of Representatives a report on such 

2 assessment and such recommendations for legislative and 

3 administrative action as the Secretary may have to im4 prove the programs and per diem payments described in 

5 subsection (a). 

6 SEC. 313. REPORT ON OUTREACH RELATING TO INCREAS7 ING THE AMOUNT OF HOUSING AVAILABLE 

8 TO VETERANS. 

9 Not later than one year after the date of the enactment 

10 of this Act, the Secretary of Veterans Affairs shall submit 

11 to the Committee on Veterans’ Affairs of the Senate and 

12 the Committee on Veterans’ Affairs of the House of Rep13 resentatives a report describing and assessing the outreach 

14 conducted by the Secretary to realtors, landlords, property 

15 management companies, and developers to educate them 

16 about the housing needs of veterans and the benefits of hav17 ing veterans as tenants. 

18 TITLE IV—HEALTH CARE 

19 MATTERS 

20 SEC. 401. SHORT TITLE. 

21 This title may be cited as the ‘‘Jason Simcakoski Me22 morial Act’’. 


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1 Subtitle A—Employment of Direc2 tors and Health Care Providers 

3 SEC. 411. EXTENSION OF PERIOD FOR INCREASE IN GRAD4 UATE MEDICAL EDUCATION RESIDENCY POSI5 TIONS AT MEDICAL FACILITIES OF THE DE6 PARTMENT OF VETERANS AFFAIRS. 

7 (a) IN GENERAL.—Paragraph (2) of section 301(b) of 

8 the Veterans Access, Choice, and Accountability Act of 2014 

9 (Public Law 113–146; 38 U.S.C. 7302 note) is amended— 

10 (1) in the paragraph heading, by striking ‘‘FIVE11 YEAR’’ and inserting ‘‘TEN-YEAR’’; and 

12 (2) in subparagraph (A), by striking ‘‘5-year pe13 riod’’ and inserting ‘‘10-year period’’. 

14 (b) REPORT.—Paragraph (3)(A) of such section is 

15 amended by striking ‘‘until 2019’’ and inserting ‘‘until 

16 2024’’. 

17 SEC. 412. MODIFICATION OF HOURS OF EMPLOYMENT FOR 

18 PHYSICIANS AND PHYSICIAN ASSISTANTS EM19 PLOYED BY THE DEPARTMENT OF VETERANS 

20 AFFAIRS. 

21 Section 7423(a) of title 38, United States Code, is 

22 amended— 

23 (1) by striking ‘‘(a) The hours’’ and inserting 

24 ‘‘(a)(1) Except as provided in paragraph (2), the 

25 hours’’; and 


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1 (2) by adding at the end the following new para2 graph: 

3 ‘‘(2) The Secretary may modify the hours of employ4 ment for a physician or physician assistant appointed in 

5 the Administration under any provision of this chapter on 

6 a full-time basis to be more than or less than 80 hours in 

7 a biweekly pay period if the total hours of employment for 

8 such employee in a calendar year does not exceed 2,080 

9 hours.’’. 

10 SEC. 413. REQUIREMENT THAT PHYSICIAN ASSISTANTS EM11 PLOYED BY THE DEPARTMENT OF VETERANS 

12 AFFAIRS RECEIVE COMPETITIVE PAY. 

13 (a) IN GENERAL.—Section 7451(a)(2) of title 38, 

14 United States Code, is amended— 

15 (1) by redesignating subparagraph (B) as sub16 paragraph (C); 

17 (2) by inserting after subparagraph (A) the fol18 lowing new subparagraph (B): 

19 ‘‘(B) Physician assistant.’’; and 

20 (3) in subparagraph (C), as redesignated by 

21 paragraph (1), by striking ‘‘and registered nurse’’ 

22 and inserting ‘‘registered nurse, and physician assist23 ant’’. 


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1 (b) EFFECTIVE DATE.—The amendments made by sub2 section (a) shall take effect on the date that is one year after 

3 the date of the enactment of this Act. 

4 SEC. 414. ESTABLISHMENT OF POSITIONS OF DIRECTORS 

5 OF VETERANS INTEGRATED SERVICE NET6 WORKS IN OFFICE OF UNDER SECRETARY 

7 FOR HEALTH OF DEPARTMENT OF VETERANS 

8 AFFAIRS AND MODIFICATION OF QUALIFICA9 TIONS FOR MEDICAL DIRECTORS. 

10 Section 7306(a)(4) of title 38, United States Code, is 

11 amended— 

12 (1) by inserting ‘‘and Directors of Veterans Inte13 grated Service Networks’’ after ‘‘Such Medical Direc14 tors’’; and 

15 (2) by striking ‘‘, who shall be either a qualified 

16 doctor of medicine or a qualified doctor of dental sur17 gery or dental medicine’’. 

18 SEC. 415. PAY FOR MEDICAL DIRECTORS AND DIRECTORS 

19 OF VETERANS INTEGRATED SERVICE NET20 WORKS. 

21 (a) IN GENERAL.—Chapter 74 of title 38, United 

22 States Code, is amended by adding at the end the following 

23 new subchapter: 


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1 ‘‘Subchapter VII—Pay for Medical Directors 

2 and Directors of Veterans Integrated 

3 Service Networks 

4 ‘‘§ 7481. Pay for Medical Directors and Directors of 

5 Veterans Integrated Service Networks 

6 ‘‘(a) ELEMENTS OF PAY.—Pay for a Medical Director 

7 or Director of a Veterans Integrated Service Network ap8 pointed under section 7306(a)(4) of this title (in this section 

9 referred to as a ‘Director’) shall consist of basic pay set 

10 forth under section 7404(a) of this title and market pay 

11 determined under subsection (b). 

12 ‘‘(b) MARKET PAY.—(1) Each Director is eligible for 

13 market pay determined under this subsection. 

14 ‘‘(2) The amount of market pay payable to a Director 

15 under this section shall be determined by the Secretary on 

16 a case-by-case basis and shall consist of pay intended to 

17 reflect needs of the Department with respect to the recruit18 ment and retention (as determined by the Secretary) of such 

19 Director. 

20 ‘‘(3) In determining the amount of market pay payable 

21 to a Director under this section, the Secretary shall— 

22 ‘‘(A) consult not less than two national surveys 

23 on pay for hospital directors, medical facility direc24 tors, or other similar positions, whether prepared by 

25 private, public, or quasi-public entities, to make a 


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1 general assessment of the range of potential pay for 

2 the Director; and 

3 ‘‘(B) take into account— 

4 ‘‘(i) the experience of the Director in man5 aging facilities or program offices of the Depart6 ment, including the complexity of such facilities 

7 or offices; 

8 ‘‘(ii) the complexity of the facility or facili9 ties to be managed by the Director; 

10 ‘‘(iii) the labor market, in such geographic 

11 area as the Secretary considers relevant, for hos12 pital directors, medical facility directors, and 

13 other similar positions; 

14 ‘‘(iv) the experience of the Director in man15 aging medical facilities for other Federal agen16 cies, private entities, or non-profit entities; and 

17 ‘‘(v) such other considerations as the Sec18 retary considers appropriate. 

19 ‘‘(4)(A) The Secretary shall evaluate the amount of 

20 market pay payable to a Director under this section not 

21 less frequently than once every two years and may adjust 

22 the market pay payable to such Director as a result of such 

23 evaluation. 


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1 ‘‘(B) A Director whose market pay is evaluated under 

2 subparagraph (A) shall receive written notice of the results 

3 of such evaluation. 

4 ‘‘(c) REQUIREMENTS AND LIMITATIONS ON TOTAL

5 PAY.—(1) Not less frequently than once every two years, 

6 the Secretary shall set forth a Department-wide minimum 

7 and maximum amount for total annual pay under sub8 section (a) that may be paid to a Director and shall publish 

9 each such amount in the Federal Register. 

10 ‘‘(2) The minimum and maximum amounts set forth 

11 under paragraph (1) shall take effect not earlier than the 

12 date that is 60 days after the publication of such amounts 

13 under such paragraph. 

14 ‘‘(3) The sum of the basic pay set forth under section 

15 7404(a) of this title and market pay determined under sub16 section (b) for a Director for a calendar year— 

17 ‘‘(A) may not be less than the most recent min18 imum amount set forth under paragraph (1) before 

19 the beginning of such calendar year; and 

20 ‘‘(B) may not be more than the most recent max21 imum amount set forth under such paragraph before 

22 the beginning of such calendar year. 

23 ‘‘(4) The total amount of compensation paid to a Di24 rector under this title in any calendar year may not exceed 


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1 the amount of annual compensation (excluding expenses) 

2 of the President under section 102 of title 3. 

3 ‘‘(5) The Secretary may not delegate to an officer or 

4 employee of the Department the requirement of the Sec5 retary to set forth a Department-wide minimum and max6 imum amount under paragraph (1). 

7 ‘‘(d) TREATMENT OF PAY.—Pay under this section 

8 shall be considered pay for all purposes, including retire9 ment benefits under chapters 83 and 84 of title 5 and other 

10 benefits. 

11 ‘‘(e) ANCILLARY EFFECTS OF DECREASES IN PAY.— 

12 (1) A decrease in pay of a Director resulting from an ad13 justment in the amount of market pay of the Director under 

14 subsection (b) shall not be treated as an adverse action. 

15 ‘‘(2) A decrease in the amount of pay of a Director 

16 resulting from an involuntary reassignment in connection 

17 with a disciplinary action taken against the Director is not 

18 subject to appeal or judicial review.’’. 

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

20 the beginning of chapter 74 of such title is amended by add21 ing at the end the following: 

‘‘SUBCHAPTER VII. PAY FOR MEDICAL DIRECTORS AND DIRECTORS OF VETERANS

INTEGRATED SERVICE NETWORKS

‘‘7481. Pay for Medical Directors and Directors of Veterans Integrated Service 

Networks.’’. 


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1 (c) EFFECTIVE DATE.—The amendments made by this 

2 section shall take effect on the date that is one year after 

3 the date of the enactment of this Act. 

4 SEC. 416. ADDITIONAL REQUIREMENTS FOR HIRING OF 

5 HEALTH CARE PROVIDERS BY DEPARTMENT 

6 OF VETERANS AFFAIRS. 

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

8 shall, as part of the hiring process for each health care pro9 vider considered for a position at the Department of Vet10 erans Affairs after the date of the enactment of this Act, 

11 require from the medical board of each State in which the 

12 health care provider holds or has held a medical license— 

13 (1) information on any violation of the require14 ments of the medical license of the health care pro15 vider; and 

16 (2) information on whether the health care pro17 vider has entered into any settlement agreement for a 

18 disciplinary charge relating to the practice of medi19 cine by the health care provider. 

20 (b) REGULATIONS.—The Secretary shall prescribe reg21 ulations to carry out this section. 


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1 SEC. 417. PROVISION OF INFORMATION ON HEALTH CARE 

2 PROVIDERS OF DEPARTMENT OF VETERANS 

3 AFFAIRS TO STATE MEDICAL BOARDS. 

4 (a) IN GENERAL.—Notwithstanding section 552a of 

5 title 5, United States Code, the Secretary of Veterans Affairs 

6 shall, with respect to each health care provider of the De7 partment of Veterans Affairs that has violated a require8 ment of their medical license, provide to the medical board 

9 of each State in which the health care provider is licensed 

10 or practices all relevant information contained in the State 

11 Licensing Board Reporting File or any successor file of the 

12 Department with respect to such violation. 

13 (b) NO REQUEST REQUIRED.—The Secretary shall 

14 provide the information required in subsection (a) to a 

15 medical board described in such subsection notwithstanding 

16 that such board may not have formally requested such infor17 mation from the Department. 

18 SEC. 418. REPORT ON COMPLIANCE BY DEPARTMENT OF 

19 VETERANS AFFAIRS WITH REVIEWS OF 

20 HEALTH CARE PROVIDERS LEAVING THE DE21 PARTMENT OR TRANSFERRING TO OTHER FA22 CILITIES. 

23 Not later than two years after the date of the enact24 ment of this Act, the Secretary of Veterans Affairs shall sub25 mit to the Committee on Veterans’ Affairs of the Senate and 

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1 resentatives a report on the compliance by the Department 

2 of Veterans Affairs with the policy of the Department— 

3 (1) to conduct a review of each health care pro4 vider of the Department who transfers to another 

5 medical facility of the Department or leaves the De6 partment to determine whether there are any con7 cerns, complaints, or allegations of violations relating 

8 to the medical practice of the health care provider; 

9 and 

10 (2) to take appropriate action with respect to 

11 any such concern, complaint, or allegation. 

12 Subtitle B—Opioid Therapy and 

13 Pain Management 

14 SEC. 421. GUIDELINES ON MANAGEMENT OF OPIOID THER15 APY BY DEPARTMENT OF VETERANS AFFAIRS 

16 AND DEPARTMENT OF DEFENSE AND IMPLE17 MENTATION OF SUCH GUIDELINES BY DE18 PARTMENT OF VETERANS AFFAIRS. 

19 (a) GUIDELINES.— 

20 (1) IN GENERAL.—Not later than one year after 

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

22 Veterans Affairs and the Secretary of Defense shall 

23 jointly update the VA/DOD Clinical Practice Guide24 line for Management of Opioid Therapy for Chronic 

25 Pain to include the following: 


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1 (A) Except as provided in paragraph (2), 

2 guidelines developed by the Centers for Disease 

3 Control and Prevention for safely prescribing 

4 opioids for the treatment of chronic, non-cancer 

5 pain in outpatient settings upon the release of 

6 such guidelines by the Centers for Disease Con7 trol and Prevention. 

8 (B) Enhanced guidance with respect to ab9 solute contraindications for opioid therapy, in10 cluding guidance with respect to the following: 

11 (i) The coadministration of drugs that 

12 are capable of inducing a life-limiting drug13 drug interaction, including benzodiazepines. 

14 (ii) The treatment of patients with 

15 current acute psychiatric instability or sub16 stance use disorder or patients at risk of 

17 suicide. 

18 (iii) The use of opioid therapy to treat 

19 patients without any pain, including to 

20 treat mental health disorders other than 

21 opioid use disorder. 

22 (C) Enhanced guidance with respect to the 

23 treatment of patients with behaviors or 

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1 stance abuse or addiction, that require consulta2 tion or comanagement of opioid therapy with 

3 one or more specialists in pain management, 

4 mental health, or addictions. 

5 (D) Enhanced guidance with respect to the 

6 conduct by health care providers of an effective7 ness assessment for patients receiving opioid 

8 therapy, including patients on long-term opioid 

9 therapy, to determine— 

10 (i) whether opioid therapy is meeting 

11 the expected goals of the patient and health 

12 care provider of relieving pain and improv13 ing function; and 

14 (ii) whether opioid therapy should be 

15 continued. 

16 (E) Requirements that each health care pro17 vider of the Department of Veterans Affairs, be18 fore initiating opioid therapy to treat a patient, 

19 use the Opioid Therapy Risk Report tool of the 

20 Department, including by accessing the most re21 cent patient information from the prescription 

22 drug monitoring program of each State, as re23 quired to be included in such tool under section 

24 422(d)(1), to assess the risk for adverse outcomes 

25 of opioid therapy for the patient, including the 


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1 concurrent use of controlled substances such as 

2 benzodiazepines, as part of the comprehensive as3 sessment conducted by the health care provider. 

4 (F) Guidelines to govern the methodologies 

5 used by health care providers of the Department 

6 of Veterans Affairs and the Department of De7 fense to safely titrate and taper opioid therapy 

8 when adjusting or discontinuing the use of 

9 opioid therapy, including— 

10 (i) prescription of the lowest effective 

11 dose based on patient need; 

12 (ii) use of opioids only for a limited 

13 period of time; and 

14 (iii) augmentation of opioid therapy 

15 with other pain management therapies and 

16 modalities. 

17 (G) Guidelines with respect to appropriate 

18 case management for patients receiving opioid 

19 therapy who transition between inpatient and 

20 outpatient health care settings, which may in21 clude the use of care transition plans. 

22 (H) Enhanced recommendations with re23 spect to the use of routine and random urine 

24 drug tests for all patients before and during 

25 opioid therapy to help prevent substance abuse, 


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1 dependence, and diversion, including require2 ments— 

3 (i) that such tests occur not less fre4 quently than once each year; and 

5 (ii) that health care providers appro6 priately interpret and respond to the results 

7 from such tests to tailor pain therapy, safe8 guards, and risk management strategies to 

9 each patient. 

10 (I) Guidance that health care providers dis11 cuss with patients, before initiating opioid ther12 apy, options for pain management therapies 

13 without the use of opioids and options to aug14 ment opioid therapy with other clinical and 

15 complementary and integrative health services to 

16 minimize opioid dependence. 

17 (2) TREATMENT OF CERTAIN GUIDELINES DE18 VELOPED AFTER DEADLINE.—If the Centers for Dis19 ease Control and Prevention release the guidelines de20 scribed in paragraph (1)(A) after the date on which 

21 the Secretary of Veterans Affairs and the Secretary of 

22 Defense jointly update the VA/DOD Clinical Practice 

23 Guideline for Management of Opioid Therapy for 

24 Chronic Pain, as required under paragraph (1), the 

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1 fense shall jointly modify such updated clinical prac2 tice guideline to include the guidelines described in 

3 paragraph (1)(A). 

4 (b) CONSULTATION BEFORE UPDATE.—Before updat5 ing the clinical practice guideline under subsection (a), the 

6 Secretary of Veterans Affairs and the Secretary of Defense 

7 shall jointly consult with the Pain Management Working 

8 Group of the Health Executive Committee of the Depart9 ment of Veterans Affairs-Department of Defense Joint Exec10 utive Committee established under section 320 of title 38, 

11 United States Code. 

12 (c) CONTROLLED SUBSTANCE DEFINED.—In this sec13 tion, the term ‘‘controlled substance’’ has the meaning given 

14 that term in section 102 of the Controlled Substances Act 

15 (21 U.S.C. 802). 

16 SEC. 422. IMPROVEMENT OF OPIOID SAFETY MEASURES BY 

17 DEPARTMENT OF VETERANS AFFAIRS. 

18 (a) EXPANSION OF OPIOID SAFETY INITIATIVE.—Not 

19 later than 180 days after the date of the enactment of this 

20 Act, the Secretary of Veterans Affairs shall expand the 

21 Opioid Safety Initiative of the Department of Veterans Af22 fairs to include all medical facilities of the Department. 

23 (b) PAIN MANAGEMENT EDUCATION AND TRAINING.— 

24 (1) IN GENERAL.—In carrying out the Opioid 

25 Safety Initiative of the Department, the Secretary 


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1 shall require all employees of the Department respon2 sible for prescribing opioids to receive education and 

3 training described in paragraph (2). 

4 (2) EDUCATION AND TRAINING.—Education and 

5 training described in this paragraph is education and 

6 training on pain management and safe opioid pre7 scribing practices for purposes of safely and effectively 

8 managing patients with chronic pain and includes 

9 education and training on the following: 

10 (A) The implementation of and full compli11 ance with the VA/DOD Clinical Practice Guide12 line for Management of Opioid Therapy for 

13 Chronic Pain, including any update to such 

14 guideline. 

15 (B) The use of evidence-based pain manage16 ment therapies, including cognitive-behavioral 

17 therapy, non-opioid alternatives, and non-drug 

18 approaches to managing pain and related health 

19 conditions including complementary and inte20 grative health services. 

21 (C) Screening and identification of patients 

22 with substance use disorder, including drug-seek23 ing behavior, before prescribing opioids, assess24 ment of the risk potential for patients developing 

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1 priate addiction treatment professionals if addic2 tion is identified or strongly suspected. 

3 (D) Communication with patients on the 

4 potential harm associated with the use of opioids 

5 and other controlled substances, including the 

6 need to safely store and dispose of supplies relat7 ing to the use of opioids and other controlled 

8 substances. 

9 (E) Such other education and training as 

10 the Secretary considers appropriate to ensure 

11 that veterans receive safe, high-quality pain 

12 management care from the Department. 

13 (3) USE OF EXISTING PROGRAM.—In providing 

14 education and training described in paragraph (2), 

15 the Secretary shall use the Interdisciplinary Chronic 

16 Pain Management Training Team Program of the 

17 Department. 

18 (c) PAIN MANAGEMENT TEAMS.— 

19 (1) IN GENERAL.—In carrying out the Opioid 

20 Safety Initiative of the Department, each medical fa21 cility of the Department shall identify and designate 

22 a pain management team of health care professionals, 

23 which may include board certified pain medicine spe24 cialists, responsible for coordinating and overseeing 


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1 therapy at such facility for patients experiencing 

2 acute and chronic pain that is non-cancer related. 

3 (2) ESTABLISHMENT OF PROTOCOLS.— 

4 (A) IN GENERAL.—The director of each Vet5 erans Integrated Service Network shall establish 

6 protocols for the designation of pain manage7 ment teams at each medical facility within that 

8 Veterans Integrated Service Network. 

9 (B) CONSULTATION ON PRESCRIPTION OF

10 OPIOIDS.—Each protocol established for a med11 ical facility under subparagraph (A) shall ensure 

12 that any health care provider without expertise 

13 in prescribing analgesics or who has not com14 pleted the education and training under sub15 section (b), such as a mental health care pro16 vider, does not prescribe opioids to a patient un17 less that health care provider— 

18 (i) consults with a health care provider 

19 with pain management expertise or who is 

20 on the pain management team of the med21 ical facility; and 

22 (ii) refers the patient to that pain 

23 management team for any subsequent pre24 scriptions and related therapy. 

25 (3) REPORT.— 


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

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

3 head of each medical facility of the Department 

4 shall submit to the director of the Veterans Inte5 grated Service Network in which the medical fa6 cility is located a report identifying the health 

7 care professionals that have been designated as 

8 members of the pain management team at the 

9 medical facility. 

10 (B) ELEMENTS.—Each report submitted 

11 under subparagraph (A) with respect to a med12 ical facility of the Department shall include— 

13 (i) a certification as to whether all 

14 members of the pain management team at 

15 the medical facility have completed the edu16 cation and training required under sub17 section (b); and 

18 (ii) a plan for the management and re19 ferral of patients to such pain management 

20 team if health care providers without exper21 tise in prescribing analgesics prescribe 

22 opioid medications to treat acute and 

23 chronic pain that is non-cancer related. 

24 (d) TRACKING AND MONITORING OF OPIOID USE.— 


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1 (1) PRESCRIPTION DRUG MONITORING PROGRAMS

2 OF STATES.—In carrying out the Opioid Safety Ini3 tiative and the Opioid Therapy Risk Report tool of 

4 the Department, the Secretary shall— 

5 (A) ensure access by health care providers of 

6 the Department to information on controlled sub7 stances, including opioids and benzodiazepines, 

8 prescribed to veterans who receive care outside 

9 the Department through the prescription drug 

10 monitoring program of each State, including by 

11 seeking to enter into memoranda of under12 standing with States to allow such access; 

13 (B) include such information in the Opioid 

14 Therapy Risk Report; and 

15 (C) require health care providers of the De16 partment to submit to the prescription drug 

17 monitoring program of each State information 

18 on prescriptions of controlled substances received 

19 by veterans in that State under the laws admin20 istered by the Secretary. 

21 (2) REPORT ON TRACKING OF DATA ON OPIOID

22 USE.—Not later than 180 days after the date of the 

23 enactment of this Act, the Secretary shall submit to 

24 Congress a report on the feasibility and advisability 

25 of improving the Opioid Therapy Risk Report tool of 


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1 the Department to allow for more advanced real-time 

2 tracking of and access to data on— 

3 (A) the key clinical indicators with respect 

4 to the totality of opioid use by veterans; 

5 (B) concurrent prescribing by health care 

6 providers of the Department of opioids in dif7 ferent health care settings, include data on con8 current prescribing of opioids to treat mental 

9 health disorders other than opioid use disorder; 

10 and 

11 (C) mail-order prescriptions of opioids pre12 scribed to veterans under the laws administered 

13 by the Secretary. 

14 (e) AVAILABILITY OF OPIOID RECEPTOR ANTAGO15 NISTS.— 

16 (1) INCREASED AVAILABILITY AND USE.— 

17 (A) IN GENERAL.—The Secretary shall in18 crease the availability of opioid receptor antago19 nists approved by the Food and Drug Adminis20 tration, such as naloxone, to veterans. 

21 (B) AVAILABILITY, TRAINING, AND DIS22 TRIBUTION.—In carrying out subparagraph (A), 

23 the Secretary shall, not later than 90 days after 

24 the date of the enactment of this Act— 


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1 (i) equip each pharmacy of the Depart2 ment with opioid receptor antagonists ap3 proved by the Food and Drug Administra4 tion to be dispensed to outpatients as need5 ed; and 

6 (ii) expand the Overdose Education 

7 and Naloxone Distribution program of the 

8 Department to ensure that all veterans in 

9 receipt of health care under the laws admin10 istered by the Secretary who are at risk of 

11 opioid overdose may access such opioid re12 ceptor antagonists and training on the 

13 proper administration of such opioid recep14 tor antagonists. 

15 (C) VETERANS WHO ARE AT RISK.—For 

16 purposes of subparagraph (B), veterans who are 

17 at risk of opioid overdose include— 

18 (i) veterans receiving long-term opioid 

19 therapy; 

20 (ii) veterans receiving opioid therapy 

21 who have a history of substance use disorder 

22 or prior instances of overdose; and 

23 (iii) veterans who are at risk as deter24 mined by a health care provider who is 

25 treating the veteran. 


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1 (2) REPORT.—Not later than 120 days after the 

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

3 submit to the Committee on Veterans’ Affairs of the 

4 Senate and the Committee on Veterans’ Affairs of the 

5 House of Representatives a report on compliance with 

6 paragraph (1) that includes an assessment of any re7 maining steps to be carried out by the Department to 

8 comply with such paragraph. 

9 (f) INCLUSION OF CERTAIN INFORMATION AND CAPA10 BILITIES IN OPIOID THERAPY RISK REPORT TOOL.— 

11 (1) INFORMATION.—The Secretary shall include 

12 in the Opioid Therapy Risk Report tool of the De13 partment— 

14 (A) information on the most recent time the 

15 tool was accessed by a health care provider of the 

16 Department with respect to each veteran; and 

17 (B) information on the results of the most 

18 recent urine drug test for each veteran. 

19 (2) CAPABILITIES.—The Secretary shall include 

20 in the Opioid Therapy Risk Report tool the ability of 

21 health care providers of the Department to determine 

22 whether a health care provider of the Department pre23 scribed opioids to a veteran without checking the in24 formation in the tool with respect to the veteran. 


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1 (g) NOTIFICATION OF RISK IN COMPUTERIZED

2 HEALTH RECORD.—The Secretary shall modify the Com3 puterized Patient Record System of the Department to en4 sure that any health care provider that accesses the record 

5 of a veteran, regardless of the reason the veteran seeks care 

6 from the health care provider, will be immediately notified 

7 whether the veteran— 

8 (1) is receiving opioid therapy and has a history 

9 of substance use disorder or prior instances of over10 dose; 

11 (2) has a history of opioid abuse; or 

12 (3) is at risk of becoming an opioid abuser as de13 termined by a health care provider who is treating 

14 the veteran. 

15 (h) CONTROLLED SUBSTANCE DEFINED.—In this sec16 tion, the term ‘‘controlled substance’’ has the meaning given 

17 that term in section 102 of the Controlled Substances Act 

18 (21 U.S.C. 802). 

19 SEC. 423. ENHANCEMENT OF JOINT WORKING GROUP ON 

20 PAIN MANAGEMENT OF THE DEPARTMENT OF 

21 VETERANS AFFAIRS AND THE DEPARTMENT 

22 OF DEFENSE. 

23 (a) IN GENERAL.—Not later than 90 days after the 

24 date of the enactment of this Act, the Secretary of Veterans 

25 Affairs and the Secretary of Defense shall ensure that the 


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1 Pain Management Working Group of the Health Executive 

2 Committee of the Department of Veterans Affairs-Depart3 ment of Defense Joint Executive Committee established 

4 under section 320 of title 38, United States Code, includes 

5 a focus on the following: 

6 (1) The opioid prescribing practices of health 

7 care providers of each Department. 

8 (2) The ability of each Department to manage 

9 acute and chronic pain among individuals receiving 

10 health care from that Department, including training 

11 health care providers with respect to pain manage12 ment. 

13 (3) The use by each Department of complemen14 tary and integrative health in treating such individ15 uals. 

16 (4) The concurrent use by health care providers 

17 of each Department of opioids and prescription drugs 

18 to treat mental health disorders, including 

19 benzodiazepines. 

20 (5) The practice by health care providers of each 

21 Department of prescribing opioids to treat mental 

22 health disorders. 

23 (6) The coordination in coverage of and con24 sistent access to medications prescribed for patients 

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1 partment of Defense to receiving health care from the 

2 Department of Veterans Affairs. 

3 (7) The ability of each Department to identify 

4 and treat substance use disorders among individuals 

5 receiving health care from that Department. 

6 (b) COORDINATION AND CONSULTATION.—The Sec7 retary of Veterans Affairs and the Secretary of Defense shall 

8 ensure that the working group described in subsection (a)— 

9 (1) coordinates the activities of the working 

10 group with other relevant working groups established 

11 under section 320 of title 38, United States Code, in12 cluding the working groups on evidence based prac13 tice, patient safety, pharmacy, and psychological 

14 health; 

15 (2) consults with other relevant Federal agencies, 

16 including the Centers for Disease Control and Preven17 tion, with respect to the activities of the working 

18 group; and 

19 (3) consults with the Department of Veterans Af20 fairs and the Department of Defense with respect to, 

21 reviews, and comments on the VA/DOD Clinical 

22 Practice Guideline for Management of Opioid Ther23 apy for Chronic Pain, or any successor guideline, be24 fore any update to the guideline is released. 


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1 (c) CONSULTATION.—The Secretary of Veterans Affairs 

2 and the Secretary of Defense shall ensure that the working 

3 group described in subsection (a) is able to meaningfully 

4 consult with respect to the updated guideline required under 

5 subsection (a) of section 421, as required by subsection (b) 

6 of such section, not later than one year after the date of 

7 the enactment of this Act. 

8 SEC. 424. ESTABLISHMENT OF PAIN MANAGEMENT BOARDS 

9 OF DEPARTMENT OF VETERANS AFFAIRS. 

10 (a) IN GENERAL.—Subchapter I of chapter 73 of title 

11 38, United States Code, is amended by adding at the end 

12 the following new section: 

13 ‘‘§ 7309A. Pain management boards 

14 ‘‘(a) ESTABLISHMENT.—The Secretary shall establish 

15 in each Veterans Integrated Service Network a Pain Man16 agement Board (in this section referred to as a ‘Board’). 

17 ‘‘(b) ACTIVITIES.—(1) Each Board may— 

18 ‘‘(A) consult with health care professionals and 

19 other employees of the Department located in the Vet20 erans Integrated Service Network covered by the 

21 Board, patients who are being treated at medical fa22 cilities of the Department located in such Veterans In23 tegrated Service Network, and family members of such 

24 patients with respect to the pain management re25 sources and best practices of the Department; 


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1 ‘‘(B) oversee compliance by the health care pro2 fessionals and other employees of the Department with 

3 the best practices of the Department, including by 

4 issuing recommendations to improve compliance with 

5 those best practices; 

6 ‘‘(C) provide oversight of the pain management 

7 practices of the pain management teams of each med8 ical facility of the Department and the health care 

9 professionals and other employees of the Department 

10 that are located in the Veterans Integrated Service 

11 Network covered by the Board; 

12 ‘‘(D) host educational events, as the Board con13 siders appropriate, for individuals specified in sub14 paragraph (A) on pain management and treatment 

15 that may include the sharing of updated research and 

16 best practices from medical experts, other health care 

17 systems, and such other Federal agencies as the Board 

18 considers necessary to carry out this subparagraph; 

19 and 

20 ‘‘(E) host public events, as the Board considers 

21 appropriate, during which health care professionals 

22 discuss and share best practices on pain management 

23 and complementary and integrative health. 

24 ‘‘(2)(A) Each Board may provide treatment rec25 ommendations for patients with complex clinical pain who 


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1 are being treated at a medical facility of the Department 

2 located in the Veterans Integrated Service Network covered 

3 by the Board, and assist in facilitating communication be4 tween such patients and their health care providers, regard5 less of whether such treatment is on an in-patient or out6 patient basis, and for whom a request for such recommenda7 tions, subject to subparagraph (C), has been made by an 

8 individual described in subparagraph (B). 

9 ‘‘(B) An individual described in this subparagraph is 

10 one of the following individuals: 

11 ‘‘(i) The patient. 

12 ‘‘(ii) The spouse of the patient. 

13 ‘‘(iii) A family member of the patient or another 

14 individual if such family member or individual has 

15 been designated by the patient to make health care de16 cisions for the patient or to receive health care infor17 mation with respect to the patient. 

18 ‘‘(iv) A physician of the patient. 

19 ‘‘(v) An employee of the medical facility of the 

20 Department described in subparagraph (A). 

21 ‘‘(C) An individual described in subparagraph (B) 

22 may not request treatment recommendations under sub23 paragraph (A) unless the individual— 

24 ‘‘(i) has requested treatment recommendations 

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1 ity of the Department at which the patient is receiv2 ing treatment; and 

3 ‘‘(ii) has received treatment recommendations 

4 from such team and is not satisfied with those treat5 ment recommendations. 

6 ‘‘(D) Treatment recommendations provided under sub7 paragraph (A) shall assist the patient and health care pro8 vider in determining the best treatment plan for the patient 

9 and shall not dictate the treatment plan used by the health 

10 care provider. 

11 ‘‘(3) Based on treatment recommendations developed 

12 under paragraph (2)(A), consultations conducted under 

13 paragraph (1)(A), and educational and public events hosted 

14 under subparagraphs (D) and (E) of paragraph (1), each 

15 Board may provide to health care professionals of the De16 partment located in the Veterans Integrated Service Net17 work covered by the Board recommendations on the best 

18 practices regarding pain management in cases of complex 

19 clinical pain. 

20 ‘‘(4)(A) Not later than January 31 of each year, the 

21 Secretary shall submit to the Committee on Veterans’ Af22 fairs of the Senate and the Committee on Veterans’ Affairs 

23 of the House of Representatives a report that contains com24 prehensive information from each Board (with all person25 ally identifiable information of patients redacted) on pain 


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1 management practices carried out in the Veterans Inte2 grated Service Network covered by the Board. 

3 ‘‘(B) Each report submitted by the Secretary under 

4 subparagraph (A) shall include, for the year preceding the 

5 submittal of the report— 

6 ‘‘(i) a summary and explanation of the treat7 ment recommendations provided under paragraph 

8 2(A) during such year; and 

9 ‘‘(ii) the recommendations for best practices pro10 vided to health care professionals under paragraph 

11 (3) during such year. 

12 ‘‘(5) The Federal Advisory Committee Act (5 U.S.C. 

13 App.) shall not apply to any Board. 

14 ‘‘(c) MEMBERSHIP.—(1) Each Board shall include the 

15 following individuals appointed by the Secretary: 

16 ‘‘(A) A board certified pain medicine specialist. 

17 ‘‘(B) A trained and qualified member of the pri18 mary care team of a medical facility of the Depart19 ment with experience in pain care, such as a nurse 

20 practitioner. 

21 ‘‘(C) A pain psychologist. 

22 ‘‘(D) A pain social worker. 

23 ‘‘(E) A clinical pharmacist. 

24 ‘‘(F) A pain point of contact for a Veterans Inte25 grated Service Network. 


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1 ‘‘(G) A physician with addiction and 

2 psychopharmacology expertise and experience. 

3 ‘‘(H) An allied health care professional. 

4 ‘‘(I) A clinician with expertise in complemen5 tary and integrative health. 

6 ‘‘(J) A clinical behavioral therapist. 

7 ‘‘(K) A patient advocate. 

8 ‘‘(L) A representative of the labor interests of 

9 employees of the Department who are responsible for 

10 prescribing drugs. 

11 ‘‘(M) Two current or former clinical patients 

12 who are representative of the demographic of patients 

13 served by the Veterans Integrated Service Network 

14 covered by the Board. 

15 ‘‘(N) A family member of a current or former 

16 clinical patient who is representative of the demo17 graphic of patients served by the Veterans Integrated 

18 Service Network covered by the Board. 

19 ‘‘(2) The Secretary shall determine the terms of service 

20 of the members of each Board, taking into consideration the 

21 clinical duties of members who are employees of the Depart22 ment. 

23 ‘‘(3)(A) Members of each Board shall serve without pay 

24 and, except as provided in subparagraph (B), members who 

25 are full-time officers or employees of the United States may 


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1 not receive additional pay, allowances, or benefits by reason 

2 of their service on the Board. 

3 ‘‘(B) Members may receive travel expenses, including 

4 per diem in lieu of subsistence, for travel in connection with 

5 their duties as members of the Board. 

6 ‘‘(C)(i) Except as provided in clause (ii), any member 

7 who has clinical duties as an officer or employee of the 

8 United States shall be relieved of such duties during periods 

9 in which such relief is necessary for the member to carry 

10 out the duties of the Board. 

11 ‘‘(ii) The Secretary shall ensure that carrying out the 

12 duties of the Board does not prevent any member who has 

13 clinical duties as an employee of the Department from fur14 nishing direct clinical care as appropriate to maintain 

15 quality patient care. 

16 ‘‘(d) PARTICIPATION OF CERTAIN MEMBERS.—(1) In 

17 carrying out the activities of a Board under subsection (b), 

18 any member appointed under subsection (c)(1) solely based 

19 on qualifications under subparagraph (K), (L), (M), or (N) 

20 of subsection (c)(1)— 

21 ‘‘(A) may not have access to specific information 

22 identifying a patient and other confidential informa23 tion relating to a patient; and 


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1 ‘‘(B) except as provided in paragraph (2), may 

2 not participate in providing treatment recommenda3 tions under subsection (b)(2)(A). 

4 ‘‘(2) In carrying out the activities of the Board under 

5 subsection (b), a member appointed under subsection (c)(1) 

6 solely based on qualifications under subparagraph (K) of 

7 subsection (c)(1) may be present during the provision of 

8 treatment recommendations under subsection (b)(2)(A) with 

9 the consent and upon the request of the patient for which 

10 such treatment recommendations are provided for purposes 

11 of representing the interests of the patient. 

12 ‘‘(e) EMPLOYMENT PROTECTIONS.—No adverse per13 sonnel action may be made against an employee of the De14 partment in connection with a communication by the em15 ployee with a member of a Board relating to the activities 

16 of the Board under subsection (b) and any such communica17 tion shall be covered by the employment and whistleblower 

18 protections otherwise applicable to communications by em19 ployees of the Department. 

20 ‘‘(f) RESOURCES OF DEPARTMENT.—The Secretary 

21 shall make available to each Board the resources and per22 sonnel of the Department necessary for the Board to carry 

23 out the activities of the Board under subsection (b), includ24 ing resources and personnel of the General Counsel of the 

25 Department.’’. 


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1 (b) CLERICAL AMENDMENT.—The table of sections at 

2 the beginning of chapter 73 of such title is amended by in3 serting after the item relating to section 7309 the following 

4 new item: 

‘‘7309A. Pain management boards.’’. 

5 (c) EFFECTIVE DATE.—The amendments made by this 

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

7 the date of the enactment of this Act. 

8 SEC. 425. REVIEW, INVESTIGATION, AND REPORT ON USE 

9 OF OPIOIDS IN TREATMENT BY DEPARTMENT 

10 OF VETERANS AFFAIRS. 

11 (a) INDEPENDENT REVIEW.— 

12 (1) IN GENERAL.—Not later than two years after 

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

14 Veterans Affairs shall enter into a contract with an 

15 independent entity with expertise in assessing clinical 

16 prescribing practices to conduct an independent re17 view of the Opioid Safety Initiative of the Depart18 ment of Veterans Affairs and the opioid prescribing 

19 practices of health care providers of the Department. 

20 (2) REPORT.— 

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

22 after completing the independent review under 

23 paragraph (1), the independent entity that car24 ried out such review shall submit to the Sec25 retary, the Committee on Veterans’ Affairs of the 


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1 Senate, and the Committee on Veterans’ Affairs 

2 of the House of Representatives a report on the 

3 findings and recommendations of the inde4 pendent entity with respect to such review. 

5 (B) ELEMENTS.—The report submitted 

6 under subparagraph (A) by the independent en7 tity described in such subparagraph— 

8 (i) shall include— 

9 (I) recommendations on such im10 provements to the Opioid Safety Ini11 tiative of the Department as the inde12 pendent entity considers appropriate; 

13 (II) information with respect to— 

14 (aa) deaths resulting from 

15 sentinel events involving veterans 

16 prescribed opioids by a health 

17 care provider of the Department; 

18 (bb) overall prescription 

19 rates and prescription indications 

20 of opioids at all medical facilities 

21 of the Department to treat non22 cancer, non-palliative, and non23 hospice care patients, including 

24 whether such prescription rates 

25 for each medical facility or health 


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1 care provider of the Department 

2 conflicts with or is otherwise in3 consistent with the standards of 

4 appropriate and safe care with re5 spect to such prescription rates; 

6 (cc) the prescription rates 

7 and prescription indications of 

8 benzodiazepines and opioids con9 comitantly by health care pro10 viders of the Department, includ11 ing whether such prescription 

12 rates for each medical facility or 

13 health care provider of the De14 partment conflicts with or is oth15 erwise inconsistent with the 

16 standards of appropriate and safe 

17 care with respect to such prescrip18 tion rates; 

19 (dd) the practice by health 

20 care providers of the Department 

21 of prescribing opioids to treat pa22 tients without any pain, includ23 ing to treat patients with mental 

24 health disorders other than opioid 

25 use disorder; and 


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1 (ee) the effectiveness of opioid 

2 therapy for patients receiving 

3 such therapy, including the effec4 tiveness of long-term opioid ther5 apy; and 

6 (III) an assessment of the compli7 ance of the Department with the VA/ 

8 DOD Clinical Practice Guideline for 

9 Management of Opioid Therapy for 

10 Chronic Pain, as updated under sec11 tion 421(a); and 

12 (ii) may include recommendations 

13 with respect to whether the Department 

14 should implement policies relating to per15 formance management, such as written 

16 warnings or performance improvement 

17 plans, for health care providers of the De18 partment that are— 

19 (I) not practicing at a level meet20 ing or exceeding the minimum level 

21 standard of care established by the De22 partment; and 

23 (II) not following the enhanced 

24 guidance with respect to absolute con25 traindications for opioid therapy set 


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1 forth in the VA/DOD Clinical Practice 

2 Guideline for Management of Opioid 

3 Therapy for Chronic Pain, as updated 

4 under section 421(a). 

5 (b) ANNUAL REVIEW, INVESTIGATION, AND REPORT ON

6 OPIOID THERAPY.— 

7 (1) ANNUAL REVIEW OF PRESCRIPTION RATES.— 

8 Not later than one year after the date of the enact9 ment of this Act, and not less frequently than annu10 ally thereafter, the Secretary of Veterans Affairs shall, 

11 with respect to each medical facility of the Depart12 ment of Veterans Affairs, collect and review informa13 tion on opioids prescribed by health care providers at 

14 the facility to treat non-cancer, non-palliative, and 

15 non-hospice care patients, including information 

16 on— 

17 (A) the prescription rate at which each 

18 health care provider at the facility prescribed 

19 benzodiazepines and opioids concurrently to such 

20 patients and the aggregate such prescription rate 

21 for all health care providers at the facility; 

22 (B) the prescription rate at which each 

23 health care provider at the facility prescribed 

24 benzodiazepines or opioids to such patients to 

25 treat conditions for which opioids or 


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1 benzodiazepines are not an approved treatment 

2 and the aggregate such prescription rate for all 

3 health care providers at the facility; 

4 (C) the prescription rate at which each 

5 health care provider at the facility prescribed or 

6 dispensed mail-order prescriptions of opioids to 

7 such patients while such patients were being 

8 treated with opioids on an inpatient-basis and 

9 the aggregate such prescription rate for all health 

10 care providers at the facility; and 

11 (D) the prescription rate at which each 

12 health care provider at the facility prescribed 

13 opioids to such patients who were also concur14 rently prescribed opioids by a health care pro15 vider that is not a health care provider of the 

16 Department and the aggregate such prescription 

17 rate for all health care providers at the facility. 

18 (2) INVESTIGATION OF PRESCRIPTION RATES.—If 

19 the Secretary determines that a prescription rate de20 scribed in paragraph (1) with respect to a health care 

21 provider or medical facility of the Department con22 flicts with or is otherwise inconsistent with the stand23 ards of appropriate and safe care, the Secretary 

24 shall— 


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1 (A) include information relating to such de2 termination, prescription rate, and health care 

3 provider or medical facility, as the case may be, 

4 in the report submitted under paragraph (3)(F); 

5 (B) through the Office of the Medical In6 spector of the Veterans Health Administration, 

7 conduct a full investigation of the health care 

8 provider or medical facility, as the case may be; 

9 and 

10 (C) immediately notify the Committee on 

11 Veterans’ Affairs of the Senate, the Committee on 

12 Veterans’ Affairs of the House of Representatives, 

13 and each Member of the Senate and the House 

14 of Representatives who represents the area in 

15 which the health care provider or medical facil16 ity, as the case may be, is located. 

17 (3) REPORT ON OPIOID THERAPY.—Not later 

18 than one year after the date of the enactment of this 

19 Act, and not less frequently than annually thereafter, 

20 the Secretary shall submit to the Committee on Vet21 erans’ Affairs of the Senate and the Committee on 

22 Veterans’ Affairs of the House of Representatives a re23 port that contains, for the one year period preceding 

24 the submittal of the report, the following: 


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1 (A) The number of patients and the percent2 age of the patient population of the Department 

3 of Veterans Affairs who were prescribed 

4 benzodiazepines and opioids concurrently by a 

5 health care provider of the Department. 

6 (B) The number of patients and the per7 centage of the patient population of the Depart8 ment without any pain who were prescribed 

9 opioids by a health care provider of the Depart10 ment, including those who were prescribed 

11 benzodiazepines and opioids concurrently. 

12 (C) The number of non-cancer, non-pallia13 tive, and non-hospice care patients and the per14 centage of such patients who were treated with 

15 opioids by a health care provider of the Depart16 ment on an inpatient-basis and who also re17 ceived prescription opioids by mail from the De18 partment while being treated on an inpatient19 basis. 

20 (D) The number of non-cancer, non-pallia21 tive, and non-hospice care patients and the per22 centage of such patients who were prescribed 

23 opioids concurrently by a health care provider of 

24 the Department and a health care provider that 

25 is not a health care provider of the Department. 


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1 (E) With respect to each medical facility of 

2 the Department, the number of times a phar3 macist at the facility overrode a critical drug 

4 interaction warning with respect to an inter5 action between opioids and another medication 

6 before dispensing a medication to a veteran. 

7 (F) The results of the review conducted 

8 under paragraph (1) (including a summary of 

9 such review at the Veterans Integrated Service 

10 Network level) and the investigation conducted 

11 under paragraph (2) (including information de12 scribed in paragraph (2)(A)), compiled in such 

13 a manner as the Secretary determines appro14 priate to ensure that the information is easily 

15 accessible. 

16 (G) An assessment of the compliance of the 

17 Department with the VA/DOD Clinical Practice 

18 Guideline for Management of Opioid Therapy 

19 for Chronic Pain, including any update to such 

20 guideline. 

21 (c) PRESCRIPTION RATE DEFINED.—In this section, 

22 the term ‘‘prescription rate’’ means, with respect to a health 

23 care provider or medical facility of the Department, each 

24 of the following: 


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1 (1) The number of patients treated with opioids 

2 by the health care provider or at the medical facility, 

3 as the case may be, divided by the total number of 

4 pharmacy users of that health care provider or at that 

5 medical facility. 

6 (2) The average number of morphine equivalents 

7 per day prescribed by the health care provider or at 

8 the medical facility, as the case may be, to patients 

9 being treated with opioids. 

10 (3) Of the patients being treated with opioids by 

11 the health care provider or at the medical facility, as 

12 the case may be, the average number of prescriptions 

13 of opioids per patient. 

14 Subtitle C—Patient Advocacy 

15 SEC. 431. ESTABLISHMENT OF OFFICE OF PATIENT ADVO16 CACY OF THE DEPARTMENT OF VETERANS AF17 FAIRS. 

18 (a) IN GENERAL.—Subchapter I of chapter 73 of title 

19 38, United States Code, as amended by section 424(a), is 

20 further amended by adding at the end the following new 

21 section: 

22 ‘‘§ 7309B. Office of Patient Advocacy 

23 ‘‘(a) ESTABLISHMENT.—There is established in the De24 partment within the Office of the Under Secretary for 


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1 Health an office to be known as the ‘Office of Patient Advo2 cacy’ (in this section referred to as the ‘Office’). 

3 ‘‘(b) HEAD.—(1) The Director of the Office of Patient 

4 Advocacy shall be the head of the Office. 

5 ‘‘(2) The Director of the Office of Patient Advocacy 

6 shall be appointed by the Under Secretary for Health from 

7 among individuals qualified to perform the duties of the 

8 position and shall report directly to the Under Secretary 

9 for Health. 

10 ‘‘(c) FUNCTION.—(1) The function of the Office is to 

11 carry out the Patient Advocacy Program of the Department. 

12 ‘‘(2) In carrying out the Patient Advocacy Program 

13 of the Department, the Director shall ensure that patient 

14 advocates of the Department— 

15 ‘‘(A) advocate on behalf of veterans with respect 

16 to health care received and sought by veterans under 

17 the laws administered by the Secretary; 

18 ‘‘(B) carry out the responsibilities specified in 

19 subsection (d); and 

20 ‘‘(C) receive training in patient advocacy. 

21 ‘‘(d) PATIENT ADVOCACY RESPONSIBILITIES.—The re22 sponsibilities of each patient advocate at a medical facility 

23 of the Department are the following: 

24 ‘‘(1) To resolve complaints by veterans with re25 spect to health care furnished under the laws adminVerDate Sep 11 2014 01:42 Dec 08, 2016 Jkt 069200 PO 00000 Frm 00100 Fmt 6652 Sfmt 6203 E:\BILLS\S425.RS S425

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1 istered by the Secretary that cannot be resolved at the 

2 point of service or at a higher level easily accessible 

3 to the veteran. 

4 ‘‘(2) To present at various meetings and to var5 ious committees the issues experienced by veterans in 

6 receiving such health care at such medical facility. 

7 ‘‘(3) To express to veterans their rights and re8 sponsibilities as patients in receiving such health 

9 care. 

10 ‘‘(4) To manage the Patient Advocate Tracking 

11 System of the Department at such medical facility. 

12 ‘‘(5) To compile data at such medical facility of 

13 complaints made by veterans with respect to the re14 ceipt of such health care at such medical facility and 

15 the satisfaction of veterans with such health care at 

16 such medical facility to determine whether there are 

17 trends in such data. 

18 ‘‘(6) To ensure that a process is in place for the 

19 distribution of the data compiled under paragraph 

20 (5) to appropriate leaders, committees, services, and 

21 staff of the Department. 

22 ‘‘(7) To identify, not less frequently than quar23 terly, opportunities for improvements in the fur24 nishing of such health care to veterans at such med25 ical facility based on complaints by veterans. 


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1 ‘‘(8) To ensure that any significant complaint by 

2 a veteran with respect to such health care is brought 

3 to the attention of appropriate staff of the Depart4 ment to trigger an assessment of whether there needs 

5 to be a further analysis of the problem at the facility6 wide level. 

7 ‘‘(9) To support any patient advocacy programs 

8 carried out by the Department. 

9 ‘‘(10) To ensure that all appeals and final deci10 sions with respect to the receipt of such health care 

11 are entered into the Patient Advocate Tracking Sys12 tem of the Department. 

13 ‘‘(11) To understand all laws, directives, and 

14 other rules with respect to the rights and responsibil15 ities of veterans in receiving such health care, includ16 ing the appeals processes available to veterans. 

17 ‘‘(12) To ensure that veterans receiving mental 

18 health care, or the surrogate decision makers for such 

19 veterans, are aware of the rights of veterans to seek 

20 representation from systems established under section 

21 103 of the Protection and Advocacy for Mentally Ill 

22 Individuals Act of 1986 (42 U.S.C. 10803) to protect 

23 and advocate the rights of individuals with mental 

24 illness and to investigate incidents of abuse and ne25 glect of such individuals. 


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1 ‘‘(13) To fulfill requirements established by the 

2 Secretary with respect to the inspection of controlled 

3 substances. 

4 ‘‘(14) To document potentially threatening be5 havior and report such behavior to appropriate au6 thorities. 

7 ‘‘(e) TRAINING.—In providing training to patient ad8 vocates under subsection (c)(2)(C), the Director shall ensure 

9 that such training is consistent throughout the Department. 

10 ‘‘(f) CONTROLLED SUBSTANCE DEFINED.—In this sec11 tion, the term ‘controlled substance’ has the meaning given 

12 that term in section 102 of the Controlled Substances Act 

13 (21 U.S.C. 802).’’. 

14 (b) CLERICAL AMENDMENT.—The table of sections at 

15 the beginning of chapter 73 of such title, as amended by 

16 section 424(b), is further amended by adding after the item 

17 relating to section 7309A the following new item: 

‘‘7309B. Office of Patient Advocacy.’’. 

18 (c) DATE FULLY OPERATIONAL.—The Secretary of 

19 Veterans Affairs shall ensure that the Office of Patient Ad20 vocacy established in section 7309B of title 38, United 

21 States Code, as added by subsection (a), is fully operational 

22 not later than the date that is one year after the date of 

23 the enactment of this Act. 


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1 SEC. 432. COMMUNITY MEETINGS ON IMPROVING CARE 

2 FROM DEPARTMENT OF VETERANS AFFAIRS. 

3 (a) COMMUNITY MEETINGS.— 

4 (1) MEDICAL CENTERS.—Not later than 90 days 

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

6 less frequently than once every 90 days thereafter, 

7 each medical center of the Department of Veterans Af8 fairs shall host a community meeting open to the pub9 lic on improving health care from the Department. 

10 (2) COMMUNITY BASED OUTPATIENT CLINICS.— 

11 Not later than one year after the date of the enact12 ment of this Act, and not less frequently than annu13 ally thereafter, each community based outpatient clin14 ic of the Department shall host a community meeting 

15 open to the public on improving health care from the 

16 Department. 

17 (b) ATTENDANCE BY DIRECTOR OF VETERANS INTE18 GRATED SERVICE NETWORK OR DESIGNEE.— 

19 (1) IN GENERAL.—Subject to paragraph (2), 

20 each community meeting hosted by a medical center 

21 or community based outpatient clinic under sub22 section (a) shall be attended by the Director of the 

23 Veterans Integrated Service Network in which the 

24 medical center or community based outpatient clinic, 

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1 ignated by the Director who works in the office of the 

2 Director . 

3 (2) ATTENDANCE BY DIRECTOR.—Each Director 

4 of a Veterans Integrated Service Network shall attend 

5 not less than one community meeting under sub6 section (a) hosted by each medical center located in 

7 the Veterans Integrated Service Network each year. 

8 (c) NOTICE.—Each medical center or community 

9 based outpatient clinic hosting a community meeting shall 

10 send timely notice of the community meeting to the Com11 mittee on Veterans’ Affairs of the Senate, the Committee 

12 on Veterans’ Affairs of the House of Representatives, and 

13 each Member of the Senate and the House of Representatives 

14 who represents the area in which the medical facility is lo15 cated. 

16 SEC. 433. IMPROVEMENT OF AWARENESS OF PATIENT AD17 VOCACY PROGRAM AND PATIENT BILL OF 

18 RIGHTS OF DEPARTMENT OF VETERANS AF19 FAIRS. 

20 Not later than 90 days after the date of the enactment 

21 of this Act, the Secretary of Veterans Affairs shall, in as 

22 many prominent locations as appropriate to be seen by the 

23 largest percentage of patients and family members of pa24 tients at each medical facility of the Department of Vet25 erans Affairs— 


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1 (1) display the purposes of the Patient Advocacy 

2 Program of the Department and the contact informa3 tion for the patient advocate at such medical facility; 

4 and 

5 (2) display the rights and responsibilities of— 

6 (A) patients and family members of pa7 tients at such medical facility; and 

8 (B) with respect to community living cen9 ters and other residential facilities of the Depart10 ment, residents and family members of residents 

11 at such medical facility. 

12 SEC. 434. COMPTROLLER GENERAL REPORT ON PATIENT 

13 ADVOCACY PROGRAM OF DEPARTMENT OF 

14 VETERANS AFFAIRS. 

15 (a) IN GENERAL.—Not later than three years after the 

16 date of the enactment of this Act, the Comptroller General 

17 of the United States shall submit to the Committee on Vet18 erans’ Affairs of the Senate and the Committee on Veterans’ 

19 Affairs of the House of Representatives a report on the Pa20 tient Advocacy Program of the Department of Veterans Af21 fairs (in this section referred to as the ‘‘Program’’) as car22 ried out under the Office of Patient Advocacy of the Depart23 ment established in section 7309B of title 38, United States 

24 Code, as added by section 431(a). 


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1 (b) ELEMENTS.—The report required by subsection 

2 (a)— 

3 (1) shall include— 

4 (A) such recommendations and proposals 

5 for improving or modifying the Program as the 

6 Comptroller General considers appropriate; and 

7 (B) such other information with respect to 

8 the Program as the Comptroller General con9 siders appropriate; and 

10 (2) may include— 

11 (A) a description of the Program, includ12 ing— 

13 (i) the purposes of the Program; 

14 (ii) the activities carried out under the 

15 Program; and 

16 (iii) the sufficiency of the Program in 

17 achieving the purposes of the Program; 

18 (B) an assessment of the sufficiency of staff19 ing of employees of the Department responsible 

20 for carrying out the Program; 

21 (C) an assessment of the sufficiency of the 

22 training of such employees; and 

23 (D) an assessment of— 

24 (i) awareness of the Program among 

25 veterans and their family members; and 


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1 (ii) the use of the Program by veterans 

2 and their family members. 

3 Subtitle D—Complementary and 

4 Integrative Health 

5 SEC. 441. EXPANSION OF RESEARCH AND EDUCATION ON 

6 AND DELIVERY OF COMPLEMENTARY AND IN7 TEGRATIVE HEALTH TO VETERANS. 

8 (a) DEVELOPMENT OF PLAN TO EXPAND RESEARCH, 

9 EDUCATION, AND DELIVERY.—Not later than 180 days 

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

11 of Veterans Affairs shall develop a plan to expand materi12 ally and substantially the scope of the effectiveness of re13 search and education on, and delivery and integration of, 

14 complementary and integrative health services into the 

15 health care services provided to veterans. 

16 (b) ELEMENTS.—The plan required by subsection (a) 

17 shall provide for the following: 

18 (1) Research on the following: 

19 (A) The effectiveness of various complemen20 tary and integrative health services, including 

21 the effectiveness of such services integrated with 

22 clinical therapies. 

23 (B) Approaches to integrating complemen24 tary and integrative health services into other 

25 health care services provided by the Department. 


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1 (2) Education and training for health care pro2 fessionals of the Department on the following: 

3 (A) complementary and integrative health 

4 services selected by the Secretary for purposes of 

5 the plan. 

6 (B) Appropriate uses of such services. 

7 (C) Integration of such services into the de8 livery of health care to veterans. 

9 (3) Research, education, and clinical activities 

10 on complementary and integrative health at centers of 

11 innovation at medical centers of the Department. 

12 (4) Identification or development of metrics and 

13 outcome measures to evaluate the effectiveness of the 

14 provision and integration of complementary and inte15 grative health services into the delivery of health care 

16 to veterans. 

17 (5) Integration and delivery of complementary 

18 and integrative health services with other health care 

19 services provided by the Department. 

20 (c) CONSULTATION.— 

21 (1) IN GENERAL.—In carrying out subsection 

22 (a), the Secretary shall consult with the following: 

23 (A) The Director of the National Center for 

24 Complementary and Integrative Health of the 

25 National Institutes of Health. 


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1 (B) The Commissioner of Food and Drugs. 

2 (C) Institutions of higher education, private 

3 research institutes, and individual researchers 

4 with extensive experience in complementary and 

5 integrative health and the integration of com6 plementary and integrative health practices into 

7 the delivery of health care. 

8 (D) Nationally recognized providers of com9 plementary and integrative health. 

10 (E) Such other officials, entities, and indi11 viduals with expertise on complementary and in12 tegrative health as the Secretary considers appro13 priate. 

14 (2) SCOPE OF CONSULTATION.—The Secretary 

15 shall undertake consultation under paragraph (1) in 

16 carrying out subsection (a) with respect to the fol17 lowing: 

18 (A) To develop the plan. 

19 (B) To identify specific complementary and 

20 integrative health practices that, on the basis of 

21 research findings or promising clinical interven22 tions, are appropriate to include as services to 

23 veterans. 

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1 tegrative health services into the delivery of 

2 health care to veterans, and to identify mecha3 nisms for overcoming such barriers. 

4 (d) COMPLEMENTARY AND INTEGRATIVE HEALTH DE5 FINED.—In this section, the term ‘‘complementary and inte6 grative health’’ has the meaning given that term by the Na7 tional Institutes of Health. 

8 SEC. 442. PILOT PROGRAM ON INTEGRATION OF COM9 PLEMENTARY AND INTEGRATIVE HEALTH 

10 WITHIN DEPARTMENT OF VETERANS AFFAIRS 

11 MEDICAL CENTERS. 

12 (a) PILOT PROGRAM REQUIRED.—Not later than 180 

13 days after the completion of the development of the plan 

14 under section 441, the Secretary of Veterans Affairs shall— 

15 (1) carry out, through the Office of Patient Cen16 tered Care and Cultural Transformation of the De17 partment of Veterans Affairs, a pilot program to as18 sess the feasibility and advisability of integrating the 

19 delivery of complementary and integrative health 

20 services selected by the Secretary with other health 

21 care services provided by the Department for veterans 

22 with mental health conditions, chronic pain condi23 tions, other chronic conditions, and such other condi24 tions as the Secretary determines appropriate; and 

25 (2) in developing the pilot program— 


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1 (A) use the plan developed under section 

2 441; and 

3 (B) identify and, to the extent practicable, 

4 resolve barriers to the provision of complemen5 tary and integrative health services selected by 

6 the Secretary and the integration of those serv7 ices with other health care services provided by 

8 the Department. 

9 (b) DURATION OF PILOT PROGRAM.—The Secretary 

10 shall carry out the pilot program during the three-year pe11 riod beginning on the date that is 180 days after the com12 pletion of the development of the plan under section 441. 

13 (c) LOCATIONS.— 

14 (1) IN GENERAL.—The Secretary shall carry out 

15 the pilot program at not fewer than 15 medical cen16 ters of the Department. 

17 (2) POLYTRAUMA CENTERS.—Not less than two 

18 of the medical centers designated under paragraph (1) 

19 shall be located at polytrauma rehabilitation centers 

20 of the Department. 

21 (3) MEDICAL CENTERS WITH PRESCRIPTION

22 RATE OF OPIOIDS THAT CONFLICTS WITH CARE

23 STANDARDS.— 

24 (A) IN GENERAL.—In selecting medical cen25 ters under paragraph (1), the Secretary shall 


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1 give priority to medical centers of the Depart2 ment at which there is a prescription rate of 

3 opioids that conflicts with or is otherwise incon4 sistent with the standards of appropriate and 

5 safe care. 

6 (B) PRESCRIPTION RATE DEFINED.—In this 

7 paragraph, the term ‘‘prescription rate’’ means, 

8 with respect to a medical center of the Depart9 ment, each of the following: 

10 (i) The number of patients treated with 

11 opioids at the medical center divided by the 

12 total number of pharmacy users at the med13 ical center. 

14 (ii) The average number of morphine 

15 equivalents per day prescribed at the med16 ical center to patients being treated with 

17 opioids. 

18 (iii) Of the patients being treated with 

19 opioids at the medical center, the average 

20 number of prescriptions of opioids per pa21 tient. 

22 (4) SELECTION OF LOCATIONS.—In carrying out 

23 the pilot program, the Secretary shall select locations 

24 that include the following areas: 

25 (A) Rural areas. 


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1 (B) Areas that are not in close proximity to 

2 an active duty military installation. 

3 (C) Areas representing different geographic 

4 locations, such as census tracts established by the 

5 Bureau of the Census. 

6 (d) PROVISION OF SERVICES.—Under the pilot pro7 gram, the Secretary shall provide covered services to covered 

8 veterans by integrating complementary and integrative 

9 health services with other services provided by the Depart10 ment at the medical centers designated under subsection 

11 (c)(1). 

12 (e) COVERED VETERANS.—For purposes of the pilot 

13 program, a covered veteran is any veteran who— 

14 (1) has a mental health condition diagnosed by 

15 a clinician of the Department; 

16 (2) experiences chronic pain; 

17 (3) has a chronic condition being treated by a 

18 clinician of the Department; or 

19 (4) is not described in paragraph (1), (2), or (3) 

20 and requests to participate in the pilot program or is 

21 referred by a clinician of the Department who is 

22 treating the veteran. 

23 (f) COVERED SERVICES.— 

24 (1) IN GENERAL.—For purposes of the pilot pro25 gram, covered services are services consisting of comVerDate Sep 11 2014 01:42 Dec 08, 2016 Jkt 069200 PO 00000 Frm 00114 Fmt 6652 Sfmt 6203 E:\BILLS\S425.RS S425

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1 plementary and integrative health services as selected 

2 by the Secretary. 

3 (2) ADMINISTRATION OF SERVICES.—Covered 

4 services shall be administered under the pilot pro5 gram as follows: 

6 (A) Covered services shall be administered 

7 by professionals or other instructors with appro8 priate training and expertise in complementary 

9 and integrative health services who are employ10 ees of the Department or with whom the Depart11 ment enters into an agreement to provide such 

12 services. 

13 (B) Covered services shall be included as 

14 part of the Patient Aligned Care Teams initia15 tive of the Office of Patient Care Services, Pri16 mary Care Program Office, in coordination with 

17 the Office of Patient Centered Care and Cultural 

18 Transformation. 

19 (C) Covered services shall be made available 

20 to— 

21 (i) covered veterans who have received 

22 conventional treatments from the Depart23 ment for the conditions for which the cov24 ered veteran seeks complementary and inteVerDate Sep 11 2014 01:42 Dec 08, 2016 Jkt 069200 PO 00000 Frm 00115 Fmt 6652 Sfmt 6203 E:\BILLS\S425.RS S425

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1 grative health services under the pilot pro2 gram; and 

3 (ii) covered veterans who have not re4 ceived conventional treatments from the De5 partment for such conditions. 

6 (g) VOLUNTARY PARTICIPATION.—The participation of 

7 a veteran in the pilot program shall be at the election of 

8 the veteran and in consultation with a clinician of the De9 partment. 

10 (h) REPORT.— 

11 (1) IN GENERAL.—Not later than three years 

12 after the date of the commencement of the pilot pro13 gram, the Secretary shall submit to the Committee on 

14 Veterans’ Affairs of the Senate and the Committee on 

15 Veterans’ Affairs of the House of Representatives a re16 port on the pilot program. 

17 (2) ELEMENTS.—The report submitted under 

18 paragraph (1) shall include the following: 

19 (A) The findings and conclusions of the Sec20 retary with respect to the pilot program, includ21 ing with respect to— 

22 (i) the use and efficacy of the com23 plementary and integrative health services 

24 established under the pilot program; 


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1 (ii) the outreach conducted by the Sec2 retary to inform veterans and community 

3 organizations about the pilot program; and 

4 (iii) an assessment of the benefit of the 

5 pilot program to covered veterans in mental 

6 health diagnoses, pain management, and 

7 treatment of chronic illness. 

8 (B) Barriers identified under subsection 

9 (a)(2)(B) that were not resolved. 

10 (C) Such recommendations for the continu11 ation or expansion of the pilot program as the 

12 Secretary considers appropriate. 

13 (i) COMPLEMENTARY AND INTEGRATIVE HEALTH DE14 FINED.—In this section, the term ‘‘complementary and inte15 grative health’’ shall have the meaning given that term in 

16 section 441(d). 

17 Subtitle E—Family Caregivers 

18 SEC. 451. EXPANSION OF FAMILY CAREGIVER PROGRAM OF 

19 DEPARTMENT OF VETERANS AFFAIRS. 

20 (a) FAMILY CAREGIVER PROGRAM.— 

21 (1) EXPANSION OF ELIGIBILITY.— 

22 (A) IN GENERAL.—Subsection (a)(2)(B) of 

23 section 1720G of title 38, United States Code, is 

24 amended to read as follows: 


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1 ‘‘(B) for assistance provided under this sub2 section— 

3 ‘‘(i) before the date on which the Secretary 

4 submits to Congress a certification that the De5 partment has fully implemented the information 

6 technology system required by section 452(a) of 

7 the Jason Simcakoski Memorial Act, has a seri8 ous injury (including traumatic brain injury, 

9 psychological trauma, or other mental disorder) 

10 incurred or aggravated in the line of duty in the 

11 active military, naval, or air service on or after 

12 September 11, 2001; 

13 ‘‘(ii) during the two-year period beginning 

14 on the date specified in clause (i), has a serious 

15 injury (including traumatic brain injury, psy16 chological trauma, or other mental disorder) in17 curred or aggravated in the line of duty in the 

18 active military, naval, or air service— 

19 ‘‘(I) on or before May 7, 1975; or 

20 ‘‘(II) on or after September 11, 2001; 

21 or 

22 ‘‘(iii) after the date that is two years after 

23 the date specified in clause (i), has a serious in24 jury (including traumatic brain injury, psycho25 logical trauma, or other mental disorder) inVerDate Sep 11 2014 01:42 Dec 08, 2016 Jkt 069200 PO 00000 Frm 00118 Fmt 6652 Sfmt 6203 E:\BILLS\S425.RS S425

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1 curred or aggravated in the line of duty in the 

2 active military, naval, or air service; and’’. 

3 (B) PUBLICATION IN FEDERAL REGISTER.— 

4 Not later than 30 days after the date on which 

5 the Secretary of Veterans Affairs submits to Con6 gress the certification described in subsection 

7 (a)(2)(B)(i) of section 1720G of such title, as 

8 amended by subparagraph (A) of this paragraph, 

9 the Secretary shall publish the date specified in 

10 such subsection in the Federal Register. 

11 (2) EXPANSION OF NEEDED SERVICES IN ELIGI12 BILITY CRITERIA.—Subsection (a)(2)(C) of such sec13 tion is amended— 

14 (A) in clause (ii), by striking ‘‘; or’’ and in15 serting a semicolon; 

16 (B) by redesignating clause (iii) as clause 

17 (iv); and 

18 (C) by inserting after clause (ii) the fol19 lowing new clause (iii): 

20 ‘‘(iii) a need for regular or extensive in21 struction or supervision without which the abil22 ity of the veteran to function in daily life would 

23 be seriously impaired; or’’. 

24 (3) EXPANSION OF SERVICES PROVIDED.—Sub25 section (a)(3)(A)(ii) of such section is amended— 


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1 (A) in subclause (IV), by striking ‘‘; and’’ 

2 and inserting a semicolon; 

3 (B) in subclause (V), by striking the period 

4 at the end and inserting ‘‘; and’’; and 

5 (C) by adding at the end the following new 

6 subclause: 

7 ‘‘(VI) through the use of contracts with, or 

8 the provision of grants to, public or private enti9 ties— 

10 ‘‘(aa) financial planning services relat11 ing to the needs of injured veterans and 

12 their caregivers; and 

13 ‘‘(bb) legal services, including legal ad14 vice and consultation, relating to the needs 

15 of injured veterans and their caregivers.’’. 

16 (4) MODIFICATION OF STIPEND CALCULATION.— 

17 Subsection (a)(3)(C) of such section is amended— 

18 (A) by redesignating clause (iii) as clause 

19 (iv); and 

20 (B) by inserting after clause (ii) the fol21 lowing new clause (iii): 

22 ‘‘(iii) In determining the amount and degree of per23 sonal care services provided under clause (i) with respect 

24 to an eligible veteran whose need for personal care services 

25 is based in whole or in part on a need for supervision or 


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1 protection under paragraph (2)(C)(ii) or regular instruc2 tion or supervision under paragraph (2)(C)(iii), the Sec3 retary shall take into account the following: 

4 ‘‘(I) The assessment by the family caregiver of 

5 the needs and limitations of the veteran. 

6 ‘‘(II) The extent to which the veteran can func7 tion safely and independently in the absence of such 

8 supervision, protection, or instruction. 

9 ‘‘(III) The amount of time required for the fam10 ily caregiver to provide such supervision, protection, 

11 or instruction to the veteran.’’. 

12 (5) PERIODIC EVALUATION OF NEED FOR CER13 TAIN SERVICES.—Subsection (a)(3) of such section is 

14 amended by adding at the end the following new sub15 paragraph: 

16 ‘‘(D) In providing instruction, preparation, and 

17 training under subparagraph (A)(i)(I) and technical sup18 port under subparagraph (A)(i)(II) to each family care19 giver who is approved as a provider of personal care serv20 ices for an eligible veteran under paragraph (6), the Sec21 retary shall periodically evaluate the needs of the eligible 

22 veteran and the skills of the family caregiver of such veteran 

23 to determine if additional instruction, preparation, train24 ing, or technical support under those subparagraphs is nec25 essary.’’. 


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1 (6) USE OF PRIMARY CARE TEAMS.—Subsection 

2 (a)(5) of such section is amended, in the matter pre3 ceding subparagraph (A), by inserting ‘‘(in collabora4 tion with the primary care team for the eligible vet5 eran to the maximum extent practicable)’’ after 

6 ‘‘evaluate’’. 

7 (7) ASSISTANCE FOR FAMILY CAREGIVERS.—Sub8 section (a) of such section is amended by adding at 

9 the end the following new paragraph: 

10 ‘‘(11)(A) In providing assistance under this subsection 

11 to family caregivers of eligible veterans, the Secretary may 

12 enter into contracts, provider agreements, and memoranda 

13 of understanding with Federal agencies, States, and pri14 vate, nonprofit, and other entities to provide such assistance 

15 to such family caregivers. 

16 ‘‘(B) The Secretary may provide assistance under this 

17 paragraph only if such assistance is reasonably accessible 

18 to the family caregiver and is substantially equivalent or 

19 better in quality to similar services provided by the Depart20 ment. 

21 ‘‘(C) The Secretary may provide fair compensation to 

22 Federal agencies, States, and other entities that provide as23 sistance under this paragraph.’’. 

24 (b) MODIFICATION OF DEFINITION OF PERSONAL CARE

25 SERVICES.—Subsection (d)(4) of such section is amended— 


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1 (1) in subparagraph (A), by striking ‘‘inde2 pendent’’; 

3 (2) by redesignating subparagraph (B) as sub4 paragraph (D); and 

5 (3) by inserting after subparagraph (A) the fol6 lowing new subparagraphs: 

7 ‘‘(B) Supervision or protection based on 

8 symptoms or residuals of neurological or other 

9 impairment or injury. 

10 ‘‘(C) Regular or extensive instruction or su11 pervision without which the ability of the vet12 eran to function in daily life would be seriously 

13 impaired.’’. 

14 SEC. 452. IMPLEMENTATION OF INFORMATION TECH15 NOLOGY SYSTEM OF DEPARTMENT OF VET16 ERANS AFFAIRS TO ASSESS AND IMPROVE 

17 THE FAMILY CAREGIVER PROGRAM. 

18 (a) IMPLEMENTATION OF NEW SYSTEM.— 

19 (1) IN GENERAL.—Not later than December 31, 

20 2016, the Secretary of Veterans Affairs shall imple21 ment an information technology system that fully 

22 supports the Program and allows for data assessment 

23 and comprehensive monitoring of the Program. 


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1 (2) ELEMENTS OF SYSTEM.—The information 

2 technology system required to be implemented under 

3 paragraph (1) shall include the following: 

4 (A) The ability to easily retrieve data that 

5 will allow all aspects of the Program (at the 

6 medical center and aggregate levels) and the 

7 workload trends for the Program to be assessed 

8 and comprehensively monitored. 

9 (B) The ability to manage data with respect 

10 to a number of caregivers that is more than the 

11 number of caregivers that the Secretary expects 

12 to apply for the Program. 

13 (C) The ability to integrate the system with 

14 other relevant information technology systems of 

15 the Veterans Health Administration. 

16 (b) ASSESSMENT OF PROGRAM.—Not later than 180 

17 days after implementing the system described in subsection 

18 (a), the Secretary shall, through the Under Secretary for 

19 Health, use data from the system and other relevant data 

20 to conduct an assessment of how key aspects of the Program 

21 are structured and carried out. 

22 (c) ONGOING MONITORING OF AND MODIFICATIONS TO

23 PROGRAM.— 

24 (1) MONITORING.—The Secretary shall use the 

25 system implemented under subsection (a) to monitor 


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1 and assess the workload of the Program, including 

2 monitoring and assessment of data on— 

3 (A) the status of applications, appeals, and 

4 home visits in connection with the Program; and 

5 (B) the use by caregivers participating in 

6 the Program of other support services under the 

7 Program such as respite care. 

8 (2) MODIFICATIONS.—Based on the monitoring 

9 and assessment conducted under paragraph (1), the 

10 Secretary shall identify and implement such modi11 fications to the Program as the Secretary considers 

12 necessary to ensure the Program is functioning as in13 tended and providing veterans and caregivers partici14 pating in the Program with services in a timely man15 ner. 

16 (d) REPORTS.— 

17 (1) INITIAL REPORT.— 

18 (A) IN GENERAL.—Not later than 90 days 

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

20 Secretary shall submit to the Committee on Vet21 erans’ Affairs of the Senate, the Committee on 

22 Veterans’ Affairs of the House of Representatives, 

23 and the Comptroller General of the United States 

24 a report that includes— 


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1 (i) the status of the planning, develop2 ment, and deployment of the system re3 quired to be implemented under subsection 

4 (a), including any changes in the timeline 

5 for the implementation of the system; and 

6 (ii) an assessment of the needs of fam7 ily caregivers of veterans described in sub8 paragraph (B), the resources needed for the 

9 inclusion of such family caregivers in the 

10 Program, and such changes to the Program 

11 as the Secretary considers necessary to en12 sure the successful expansion of the Program 

13 to include such family caregivers. 

14 (B) VETERANS DESCRIBED.—Veterans de15 scribed in this subparagraph are veterans who 

16 are eligible for the Program under clause (ii) or 

17 (iii) of section 1720G(a)(2)(B) of title 38, United 

18 States Code, as amended by section 451(a)(1) of 

19 this Act, solely due to a serious injury (including 

20 traumatic brain injury, psychological trauma, or 

21 other mental disorder) incurred or aggravated in 

22 the line of duty in the active military, naval, or 

23 air service before September 11, 2001. 

24 (2) NOTIFICATION BY COMPTROLLER GENERAL.— 

25 The Comptroller General shall review the report subVerDate Sep 11 2014 01:42 Dec 08, 2016 Jkt 069200 PO 00000 Frm 00126 Fmt 6652 Sfmt 6203 E:\BILLS\S425.RS S425

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1 mitted under paragraph (1) and notify the Committee 

2 on Veterans’ Affairs of the Senate and the Committee 

3 on Veterans’ Affairs of the House of Representatives 

4 with respect to the progress of the Secretary in— 

5 (A) fully implementing the system required 

6 under subsection (a); and 

7 (B) implementing a process for using such 

8 system to monitor and assess the Program under 

9 subsection (c)(1) and modify the Program as 

10 considered necessary under subsection (c)(2). 

11 (3) FINAL REPORT.— 

12 (A) IN GENERAL.—Not later than December 

13 31, 2017, the Secretary shall submit to the Com14 mittee on Veterans’ Affairs of the Senate, the 

15 Committee on Veterans’ Affairs of the House of 

16 Representatives, and the Comptroller General a 

17 report on the implementation of subsections (a) 

18 through (c). 

19 (B) ELEMENTS.—The report required by 

20 subparagraph (A) shall include the following: 

21 (i) A certification by the Secretary 

22 with respect to whether the information 

23 technology system described in subsection 

24 (a) has been implemented. 


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1 (ii) A description of how the Secretary 

2 has implemented such system. 

3 (iii) A description of the modifications 

4 to the Program, if any, that were identified 

5 and implemented under subsection (c)(2). 

6 (iv) A description of how the Secretary 

7 is using such system to monitor the work8 load of the Program. 

9 (e) DEFINITIONS.—In this section: 

10 (1) ACTIVE MILITARY, NAVAL, OR AIR SERVICE.— 

11 The term ‘‘active military, naval, or air service’’ has 

12 the meaning given that term in section 101 of title 

13 38, United States Code. 

14 (2) PROGRAM.—The term ‘‘Program’’ means the 

15 program of comprehensive assistance for family care16 givers under section 1720G(a) of title 38, United 

17 States Code, as amended by section 451 of this Act. 

18 SEC. 453. MODIFICATIONS TO ANNUAL EVALUATION RE19 PORT ON CAREGIVER PROGRAM OF DEPART20 MENT OF VETERANS AFFAIRS. 

21 (a) BARRIERS TO CARE AND SERVICES.—Subpara22 graph (A)(iv) of section 101(c)(2) of the Caregivers and Vet23 erans Omnibus Health Services Act of 2010 (Public Law 

24 111–163; 38 U.S.C. 1720G note) is amended by inserting 

25 ‘‘, including a description of any barriers to accessing and 


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1 receiving care and services under such programs’’ before the 

2 semicolon. 

3 (b) SUFFICIENCY OF TRAINING FOR FAMILY CARE4 GIVER PROGRAM.—Subparagraph (B) of such section is 

5 amended— 

6 (1) in clause (i), by striking ‘‘; and’’ and insert7 ing a semicolon; 

8 (2) in clause (ii), by striking the period at the 

9 end and inserting ‘‘; and’’; and 

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

11 clause: 

12 ‘‘(iii) an evaluation of the sufficiency 

13 and consistency of the training provided to 

14 family caregivers under such program in 

15 preparing family caregivers to provide care 

16 to veterans under such program.’’. 

17 SEC. 454. ADVISORY COMMITTEE ON CAREGIVER POLICY. 

18 (a) ESTABLISHMENT.—There is established in the De19 partment of Veterans Affairs an advisory committee on 

20 policies relating to caregivers of veterans (in this section 

21 referred to as the ‘‘Committee’’). 

22 (b) COMPOSITION.—The Committee shall be composed 

23 of the following: 

24 (1) A chair selected by the Secretary of Veterans 

25 Affairs. 


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1 (2) A representative from each of the following 

2 agencies or organizations selected by the head of such 

3 agency or organization: 

4 (A) The Department of Veterans Affairs. 

5 (B) The Department of Defense. 

6 (C) The Department of Health and Human 

7 Services. 

8 (D) The Department of Labor. 

9 (E) The Centers for Medicare and Medicaid 

10 Services. 

11 (3) Not less than seven individuals who are not 

12 employees of the Federal Government selected by the 

13 Secretary from among the following individuals: 

14 (A) Academic experts in fields relating to 

15 caregivers. 

16 (B) Clinicians. 

17 (C) Caregivers. 

18 (D) Individuals in receipt of caregiver serv19 ices. 

20 (E) Such other individuals with expertise 

21 that is relevant to the duties of the Committee as 

22 the Secretary considers appropriate. 

23 (c) DUTIES.—The duties of the Committee are as fol24 lows: 


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1 (1) To regularly review and recommend policies 

2 of the Department of Veterans Affairs relating to 

3 caregivers of veterans. 

4 (2) To examine and advise the implementation 

5 of such policies. 

6 (3) To evaluate the effectiveness of such policies. 

7 (4) To recommend standards of care for care8 giver services and respite care services provided to a 

9 caregiver or veteran by a non-profit or private sector 

10 entity. 

11 (5) To develop recommendations for legislative or 

12 administrative action to enhance the provision of 

13 services to caregivers and veterans, including elimi14 nating gaps in such services and eliminating dispari15 ties in eligibility for such services. 

16 (6) To make recommendations on coordination 

17 with State and local agencies and relevant non-profit 

18 organizations on maximizing the use and effectiveness 

19 of resources for caregivers of veterans. 

20 (d) REPORTS.— 

21 (1) ANNUAL REPORT TO SECRETARY.— 

22 (A) IN GENERAL.—Not later than December 

23 31, 2016, and not less frequently than annually 

24 thereafter until the termination date specified in 

25 subsection (e), the chair of the Committee shall 


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1 submit to the Secretary a report on policies and 

2 services of the Department of Veterans Affairs re3 lating to caregivers of veterans. 

4 (B) ELEMENTS.—Each report required by 

5 subparagraph (A) shall include the following: 

6 (i) An assessment of the policies of the 

7 Department relating to caregivers of vet8 erans and services provided pursuant to 

9 such policies as of the date of submittal of 

10 the report. 

11 (ii) A description of any recommenda12 tions made by the Committee to improve the 

13 coordination of services for caregivers of vet14 erans between the Department and the enti15 ties specified in subparagraphs (B) through 

16 (E) of subsection (b)(2) and to eliminate 

17 barriers to the effective use of such services, 

18 including with respect to eligibility criteria. 

19 (iii) An evaluation of the effectiveness 

20 of the Department in providing services for 

21 caregivers of veterans. 

22 (iv) An evaluation of the quality and 

23 sufficiency of services for caregivers of vet24 erans available from non-governmental or25 ganizations. 


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1 (v) A description of any gaps identi2 fied by the Committee in care or services 

3 provided by caregivers to veterans and rec4 ommendations for legislative or administra5 tive action to address such gaps. 

6 (vi) Such other matters or rec7 ommendations as the chair considers appro8 priate. 

9 (2) TRANSMITTAL TO CONGRESS.—Not later than 

10 90 days after the receipt of a report under paragraph 

11 (1), the Secretary shall transmit to the Committee on 

12 Veterans’ Affairs of the Senate and the Committee on 

13 Veterans’ Affairs of the House of Representatives a 

14 copy of such report, together with such comments and 

15 recommendations concerning such report as the Sec16 retary considers appropriate. 

17 (e) TERMINATION.—The Committee shall terminate on 

18 December 31, 2021. 

19 SEC. 455. COMPREHENSIVE STUDY ON SERIOUSLY INJURED 

20 VETERANS AND THEIR CAREGIVERS. 

21 (a) STUDY REQUIRED.—During the period specified in 

22 subsection (d), the Secretary of Veterans Affairs shall pro23 vide for the conduct by an independent entity of a com24 prehensive study on the following: 


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1 (1) Veterans who have incurred a serious injury 

2 or illness, including a mental health injury or illness. 

3 (2) Individuals who are acting as caregivers for 

4 veterans. 

5 (b) ELEMENTS.—The comprehensive study required by 

6 subsection (a) shall include the following with respect to 

7 each veteran included in such study: 

8 (1) The health of the veteran and, if applicable, 

9 the impact of the caregiver of such veteran on the 

10 health of such veteran. 

11 (2) The employment status of the veteran and, if 

12 applicable, the impact of the caregiver of such veteran 

13 on the employment status of such veteran. 

14 (3) The financial status and needs of the veteran. 

15 (4) The use by the veteran of benefits available 

16 to such veteran from the Department of Veterans Af17 fairs. 

18 (5) Such other information as the Secretary con19 siders appropriate. 

20 (c) CONTRACT.—The Secretary shall enter into a con21 tract with an appropriate independent entity to conduct 

22 the study required by subsection (a). 

23 (d) PERIOD SPECIFIED.—The period specified in this 

24 subsection is the one-year period beginning on the date that 

25 is four years after the date specified in section 


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1 1720G(a)(2)(B)(i) of title 38, United States Code, as 

2 amended by section 451(a)(1) of this Act. 

3 (e) REPORT.—Not later than 30 days after the end of 

4 the period specified in subsection (d), the Secretary shall 

5 submit to the Committee on Veterans’ Affairs of the Senate 

6 and the Committee on Veterans’ Affairs of the House of Rep7 resentatives a report on the results of the study required 

8 by subsection (a). 

9 Subtitle F—Health Care 

10 Agreements 

11 SEC. 461. AUTHORIZATION OF AGREEMENTS BETWEEN THE 

12 DEPARTMENT OF VETERANS AFFAIRS AND 

13 NON-DEPARTMENT EXTENDED CARE PRO14 VIDERS. 

15 (a) IN GENERAL.—Subchapter I of chapter 17 of title 

16 38, United States Code, is amended by adding after section 

17 1703 the following new section: 

18 ‘‘§ 1703A. Veterans Extended Care Agreements with 

19 certain health care providers 

20 ‘‘(a) AGREEMENTS TO FURNISH EXTENDED CARE.— 

21 (1) In addition to the authority of the Secretary under this 

22 chapter to furnish extended care at facilities of the Depart23 ment and under contracts or sharing agreements entered 

24 into under authorities other than this section, the Secretary 

25 may furnish extended care through the use of agreements 


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1 entered into under this section. An agreement entered into 

2 under this section may be referred to as a ‘Veterans Ex3 tended Care Agreement’. 

4 ‘‘(2) The Secretary may enter into agreements to fur5 nish extended care under this section with eligible providers 

6 that are certified under subsection (d) if the Secretary is 

7 not feasibly able to furnish extended care at facilities of the 

8 Department. 

9 ‘‘(3) An eligible provider, at its discretion, may opt 

10 to enter into an agreement under this section instead of a 

11 contract or sharing agreement under authorities other than 

12 this section. 

13 ‘‘(b) RECEIPT OF EXTENDED CARE.—(1) Eligibility of 

14 a veteran for extended care under this section shall be deter15 mined as if such care were furnished in a facility of the 

16 Department and provisions of this title applicable to vet17 erans receiving extended care in a facility of the Depart18 ment shall apply to veterans receiving such care under this 

19 section. 

20 ‘‘(2) In carrying out this section, the Secretary— 

21 ‘‘(A) may not direct veterans seeking extended 

22 care to health care providers that have entered into 

23 contracts or sharing agreements under authorities 

24 other than this section; and 


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1 ‘‘(B) shall ensure that veterans have the option 

2 to determine whether to receive extended care from a 

3 health care provider described in subparagraph (A) or 

4 an eligible provider that has entered into an agree5 ment under this section. 

6 ‘‘(c) ELIGIBLE PROVIDERS.—For purposes of this sec7 tion, an eligible provider is one of the following: 

8 ‘‘(1) A provider of services that has enrolled and 

9 entered into a provider agreement under section 

10 1866(a) of the Social Security Act (42 U.S.C. 

11 1395cc(a)). 

12 ‘‘(2) A physician or supplier that has enrolled 

13 and entered into a participation agreement under sec14 tion 1842(h) of such Act (42 U.S.C. 1395u(h)). 

15 ‘‘(3) A provider of items and services receiving 

16 payment under a State plan under title XIX of such 

17 Act (42 U.S.C. 1396 et seq.) or a waiver of such a 

18 plan. 

19 ‘‘(4) A provider that is— 

20 ‘‘(A) an Aging and Disability Resource 

21 Center, an area agency on aging, or a State 

22 agency (as defined in section 102 of the Older 

23 Americans Act of 1965 (42 U.S.C. 3002)); or 


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1 ‘‘(B) a center for independent living (as de2 fined in section 702 of the Rehabilitation Act of 

3 1973 (29 U.S.C. 796a)). 

4 ‘‘(5) Such other health care providers as the Sec5 retary considers appropriate for purposes of this sec6 tion. 

7 ‘‘(d) CERTIFICATION OF ELIGIBLE PROVIDERS.—(1) 

8 The Secretary shall establish a process for the certification 

9 of eligible providers under this section that shall, at a min10 imum, set forth the following. 

11 ‘‘(A) Procedures for the submittal of applications 

12 for certification and deadlines for actions taken by 

13 the Secretary with respect to such applications. 

14 ‘‘(B) Standards and procedures for approval and 

15 denial of certification, duration of certification, rev16 ocation of certification, and recertification. 

17 ‘‘(C) Procedures for assessing eligible providers 

18 based on the risk of fraud, waste, and abuse of such 

19 providers similar to the level of screening under sec20 tion 1866(j)(2)(B) of the Social Security Act (42 

21 U.S.C. 1395cc(j)(2)(B)) and the standards set forth 

22 under section 9.104 of title 48, Code of Federal Regu23 lations, or any successor regulation. 


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1 ‘‘(2) The Secretary shall deny or revoke certification 

2 to an eligible provider under this subsection if the Secretary 

3 determines that the eligible provider is currently— 

4 ‘‘(A) excluded from participation in a Federal 

5 health care program (as defined in section 1128B(f) 

6 of the Social Security Act (42 U.S.C. 1320a–7b(f))) 

7 under section 1128 or 1128A of the Social Security 

8 Act (42 U.S.C. 1320a–7 and 1320a–7a); or 

9 ‘‘(B) identified as an excluded source on the list 

10 maintained in the System for Award Management, or 

11 any successor system. 

12 ‘‘(e) TERMS OF AGREEMENTS.—Each agreement en13 tered into with an eligible provider under this section shall 

14 include provisions requiring the eligible provider to do the 

15 following: 

16 ‘‘(1) To accept payment for extended care fur17 nished under this section at rates established by the 

18 Secretary for purposes of this section, which shall be, 

19 to the extent practicable, the rates paid by the United 

20 States for such care to providers of services and sup21 pliers under the Medicare program under title XVIII 

22 of the Social Security Act (42 U.S.C. 1395 et seq.). 

23 ‘‘(2) To accept payment under paragraph (1) as 

24 payment in full for extended care furnished under 


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1 this section and to not seek any payment for such 

2 care from the recipient of such care. 

3 ‘‘(3) To furnish under this section only the ex4 tended care authorized by the Department under this 

5 section unless the eligible provider receives prior writ6 ten consent from the Department to furnish extended 

7 care outside the scope of such authorization. 

8 ‘‘(4) To bill the Department for extended care 

9 furnished under this section in accordance with a 

10 methodology established by the Secretary for purposes 

11 of this section. 

12 ‘‘(5) Not to seek to recover or collect from a 

13 health-plan contract or third party, as those terms 

14 are defined in section 1729 of this title, for any ex15 tended care for which payment is made by the De16 partment under this section. 

17 ‘‘(6) To provide medical records for veterans fur18 nished extended care under this section to the Depart19 ment in a time frame and format specified by the 

20 Secretary for purposes of this section. 

21 ‘‘(7) To meet such other terms and conditions, 

22 including quality of care assurance standards, as the 

23 Secretary may specify for purposes of this section. 

24 ‘‘(f) TERMINATION OF AGREEMENTS.—(1) An eligible 

25 provider may terminate an agreement with the Secretary 


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1 under this section at such time and upon such notice to 

2 the Secretary as the Secretary may specify for purposes of 

3 this section. 

4 ‘‘(2) The Secretary may terminate an agreement with 

5 an eligible provider under this section at such time and 

6 upon such notice to the eligible provider as the Secretary 

7 may specify for purposes of this section, if the Secretary— 

8 ‘‘(A) determines that the eligible provider failed 

9 to comply substantially with the provisions of the 

10 agreement or with the provisions of this section and 

11 the regulations prescribed thereunder; 

12 ‘‘(B) determines that the eligible provider is— 

13 ‘‘(i) excluded from participation in a Fed14 eral health care program (as defined in section 

15 1128B(f) of the Social Security Act (42 U.S.C. 

16 1320a–7b(f))) under section 1128 or 1128A of the 

17 Social Security Act (42 U.S.C. 1320a–7 and 

18 1320a–7a); or 

19 ‘‘(ii) identified as an excluded source on the 

20 list maintained in the System for Award Man21 agement, or any successor system; 

22 ‘‘(C) ascertains that the eligible provider has 

23 been convicted of a felony or other serious offense 

24 under Federal or State law and determines that the 

25 continued participation of the eligible provider would 


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1 be detrimental to the best interests of veterans or the 

2 Department; or 

3 ‘‘(D) determines that it is reasonable to termi4 nate the agreement based on the health care needs of 

5 a veteran or veterans. 

6 ‘‘(g) PERIODIC REVIEW OF CERTAIN AGREEMENTS.— 

7 (1) Not less frequently than once every two years, the Sec8 retary shall review each Veterans Extended Care Agreement 

9 of material size entered into during the two-year period pre10 ceding the review to determine whether it is feasible and 

11 advisable to furnish the extended care furnished under such 

12 agreement at facilities of the Department or through con13 tracts or sharing agreements entered into under authorities 

14 other than this section. 

15 ‘‘(2)(A) Subject to subparagraph (B), a Veterans Ex16 tended Care Agreement is of material size as determined 

17 by the Secretary for purposes of this section. 

18 ‘‘(B) A Veterans Extended Care Agreement entered 

19 into after September 30, 2016, is of material size if the pur20 chase of extended care under the agreement exceeds 

21 $1,000,000 annually. The Secretary may adjust such 

22 amount to account for changes in the cost of health care 

23 based upon recognized health care market surveys and other 

24 available data and shall publish any such adjustments in 

25 the Federal Register. 


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1 ‘‘(h) EXCLUSION OF CERTAIN FEDERAL CONTRACTING

2 PROVISIONS.—(1) An agreement under this section may be 

3 entered into without regard to any law that would require 

4 the Secretary to use competitive procedures in selecting the 

5 party with which to enter into the agreement. 

6 ‘‘(2)(A) Except as provided in subparagraph (B) and 

7 unless otherwise provided in this section or regulations pre8 scribed pursuant to this section, an eligible provider that 

9 enters into an agreement under this section is not subject 

10 to, in the carrying out of the agreement, any law that pro11 viders of services and suppliers under the Medicare program 

12 under title XVIII of the Social Security Act (42 U.S.C. 

13 1395 et seq.) are not subject to. 

14 ‘‘(B) Notwithstanding subparagraph (A), an eligible 

15 provider that enters into an agreement under this section 

16 shall be subject to all laws regarding integrity, ethics, fraud, 

17 or that subject a person to civil or criminal penalties as 

18 if such laws were incorporated into its provider agreements. 

19 ‘‘(i) QUALITY OF CARE.—The Secretary shall establish 

20 through regulation a system or systems for— 

21 ‘‘(1) monitoring the quality of extended care fur22 nished to veterans under this section; and 

23 ‘‘(2) assessing the quality of extended care fur24 nished by an eligible provider under this section prior 


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1 to the renewal of a Veterans Extended Care Agree2 ment with the eligible provider. 

3 ‘‘(j) DISPUTE RESOLUTION.—(1) The Secretary shall 

4 establish administrative procedures for eligible providers 

5 with which the Secretary has entered an agreement under 

6 this section to present any dispute arising under or related 

7 to the agreement. 

8 ‘‘(2) Before using any dispute resolution mechanism 

9 under chapter 71 of title 41 with respect to a dispute aris10 ing under an agreement under this section, an eligible pro11 vider must first exhaust the administrative procedures es12 tablished by the Secretary under paragraph (1). 

13 ‘‘(k) SUNSET.—The Secretary may not furnish ex14 tended care through the use of an agreement entered into 

15 under this section after the date that is two years after the 

16 date of the enactment of the Jason Simcakoski Memorial 

17 Act.’’. 

18 (b) REGULATIONS.—The Secretary of Veterans Affairs 

19 shall prescribe an interim final rule to carry out section 

20 1703A of such title, as added by subsection (a), not later 

21 than one year after the date of the enactment of this Act. 

22 (c) CLERICAL AMENDMENT.—The table of sections at 

23 the beginning of chapter 17 of such title is amended by in24 serting after the item related to section 1703 the following 

25 new item: 

‘‘1703A. Veterans Extended Care Agreements with certain health care providers.’’. 


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1 SEC. 462. MODIFICATION OF AUTHORITY TO ENTER INTO 

2 AGREEMENTS WITH STATE HOMES TO PRO3 VIDE NURSING HOME CARE. 

4 (a) USE OF AGREEMENTS.— 

5 (1) IN GENERAL.—Paragraph (1) of section 

6 1745(a) of title 38, United States Code, is amended, 

7 in the matter preceding subparagraph (A), by strik8 ing ‘‘a contract (or agreement under section 

9 1720(c)(1) of this title)’’ and inserting ‘‘an agree10 ment’’. 

11 (2) PAYMENT.—Paragraph (2) of such section is 

12 amended by striking ‘‘contract (or agreement)’’ each 

13 place it appears and inserting ‘‘agreement’’. 

14 (b) EXCLUSION OF CERTAIN FEDERAL CONTRACTING

15 PROVISIONS.—Such section is amended by adding at the 

16 end the following new paragraphs: 

17 ‘‘(4)(A) An agreement under paragraph (1) may be en18 tered into without regard to any law that would require 

19 the Secretary to use competitive procedures in selecting the 

20 party with which to enter into the agreement. 

21 ‘‘(B)(i) Except as provided in clause (ii) and unless 

22 otherwise provided in this section or regulations prescribed 

23 pursuant to this section, a State home that enters into an 

24 agreement under paragraph (1) is not subject to, in the car25 rying out of the agreement, any law that a provider de26 scribed in subparagraph (C) is not subject to under the 


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1 original Medicare fee-for-service program under parts A 

2 and B of title XVIII of the Social Security Act (42 U.S.C. 

3 1395 et seq.) or the Medicaid program under title XIX of 

4 such Act (42 U.S.C. 1396 et seq.). 

5 ‘‘(ii) Notwithstanding clause (i), a State home that en6 ters into an agreement under paragraph (1) shall be subject 

7 to all laws regarding integrity, ethics, fraud, or that subject 

8 a person to civil or criminal penalties as if such laws were 

9 incorporated into its provider agreements. 

10 ‘‘(C) A provider described in this subparagraph is one 

11 of the following: 

12 ‘‘(i) A provider of services that has enrolled and 

13 entered into a provider agreement under section 

14 1866(a) of the Social Security Act (42 U.S.C. 

15 1395cc(a)). 

16 ‘‘(ii) A physician or supplier that has enrolled 

17 and entered into a participation agreement under sec18 tion 1842(h) of such Act (42 U.S.C. 1395u(h)). 

19 ‘‘(iii) A provider of items and services receiving 

20 payment under a State plan under title XIX of such 

21 Act (42 U.S.C. 1396 et seq.) or a waiver of such a 

22 plan. 

23 ‘‘(5) The Secretary may not furnish nursing home care 

24 under an agreement entered into under paragraph (1) after 


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1 the date that is two years after the date of the enactment 

2 of the Jason Simcakoski Memorial Act.’’. 

3 (c) EFFECTIVE DATE.—The amendments made by this 

4 section shall apply to agreements entered into under section 

5 1745(a) of such title on and after the date that is 30 days 

6 after the date of the enactment of this Act. 

7 TITLE V—OTHER MATTERS 

8 SEC. 501. EXTENSION OF TEMPORARY INCREASE IN NUM9 BER OF JUDGES ON UNITED STATES COURT 

10 OF APPEALS FOR VETERANS CLAIMS. 

11 (a) IN GENERAL.—Subsection (i)(2) of section 7253 of 

12 title 38, United States Code, is amended by striking ‘‘Janu13 ary 1, 2013’’ and inserting ‘‘January 1, 2021’’. 

14 (b) REPORT.— 

15 (1) IN GENERAL.—Not later than June 30, 2020, 

16 the chief judge of the United States Court of Appeals 

17 for Veterans Claims shall submit to the Committee on 

18 Veterans’ Affairs of the Senate and the Committee on 

19 Veterans’ Affairs of the House of Representatives a re20 port on the temporary expansions of the Court under 

21 section 7253 of title 38, United States Code. 

22 (2) CONTENTS.—The report required by para23 graph (1) shall include the following: 


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1 (A) An assessment of the effect of the expan2 sions on ensuring appeals are handled in a time3 ly manner. 

4 (B) A description of the ways in which the 

5 complexity levels of the appeals acted on by the 

6 Court may have changed based on service during 

7 recent conflicts compared to those based on serv8 ice from previous eras. 

9 (C) A recommendation on whether the num10 ber of judges should be adjusted at the end of the 

11 temporary expansion period, including statistics, 

12 projections, trend analyses, and other informa13 tion to support the recommendation. 

14 SEC. 502. REPEAL INAPPLICABILITY OF MODIFICATION OF 

15 BASIC ALLOWANCE FOR HOUSING TO BENE16 FITS UNDER LAWS ADMINISTERED BY SEC17 RETARY OF VETERANS AFFAIRS. 

18 (a) REPEAL.—Subsection (b) of section 604 of the Carl 

19 Levin and Howard P. ‘‘Buck’’ McKeon National Defense 

20 Authorization Act for Fiscal Year 2015 (Public Law 113– 

21 291; 37 U.S.C. 403 note) is repealed. 

22 (b) EFFECTIVE DATE.—The amendment made by sub23 section (a) shall take effect on January 1, 2016. 


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1 SEC. 503. DEPARTMENT OF VETERANS AFFAIRS PROGRAM 

2 OF INTERNAL AUDITS. 

3 (a) IN GENERAL.—Subchapter II of chapter 5 of title 

4 38, United States Code, is amended by inserting after sec5 tion 527 the following new section: 

6 ‘‘§ 527A. Program of internal audits 

7 ‘‘(a) PROGRAM REQUIRED.—(1) The Secretary shall 

8 carry out a program of internal audits and self-analysis 

9 to improve the furnishing of benefits and health care to vet10 erans and their families. 

11 ‘‘(2) The Secretary shall carry out the program re12 quired by paragraph (1) through an office the Secretary 

13 shall establish for purposes of the program within the office 

14 of the Secretary that is interdisciplinary and independent 

15 of— 

16 ‘‘(A) the other offices within the office of the Sec17 retary; and 

18 ‘‘(B) the covered administrations (or functions of 

19 such administrations), staff organizations, and staff 

20 offices identified under subsection (b)(1)(A). 

21 ‘‘(b) PROGRAM REQUIREMENTS.—(1) In carrying out 

22 the program required by subsection (a), the Secretary 

23 shall— 

24 ‘‘(A) conduct periodic risk assessments of the De25 partment to identify those covered administrations 

26 (or functions of such administrations), staff organizaVerDate Sep 11 2014 01:42 Dec 08, 2016 Jkt 069200 PO 00000 Frm 00149 Fmt 6652 Sfmt 6203 E:\BILLS\S425.RS S425

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1 tions, and staff offices of the Department the audit of 

2 which would lead towards the greatest improvement 

3 in the furnishing of benefits and health care to vet4 erans and their families; 

5 ‘‘(B) develop plans that are informed by the risk 

6 assessments conducted under paragraph (1) to con7 duct internal audits of the covered administrations 

8 (or functions of such administrations), staff organiza9 tions, and staff offices identified under subparagraph 

10 (A); and 

11 ‘‘(C) conduct internal audits in accordance with 

12 the plans developed pursuant to subparagraph (B). 

13 ‘‘(2) The Secretary shall carry out under the program 

14 required by subsection (a) an audit of not fewer than five 

15 covered administrations (or functions of such administra16 tions), staff organizations, or staff offices of the Department 

17 each year. 

18 ‘‘(3) In identifying covered administrations (or func19 tions of such administrations), staff organizations, and staff 

20 offices of the Department under paragraph (1)(A), the Sec21 retary shall accord priority to the covered administrations 

22 and functions of such administrations. 

23 ‘‘(4)(A) For purposes of this subsection, the covered ad24 ministrations of the Department are the following: 

25 ‘‘(i) The National Cemetery Administration. 


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1 ‘‘(ii) The Veterans Benefits Administration. 

2 ‘‘(iii) The Veterans Health Administration. 

3 ‘‘(B) For purposes this subsection, the covered staff or4 ganizations of the Department are the following: 

5 ‘‘(i) The Office of Acquisition, Logistics, and 

6 Construction. 

7 ‘‘(ii) The Advisory Committee Management Of8 fice. 

9 ‘‘(iii) The Board of Veterans’ Appeals. 

10 ‘‘(iv) The Center for Faith-Based and Neighbor11 hood Partnerships. 

12 ‘‘(v) The Center for Minority Veterans. 

13 ‘‘(vi) The Center for Women Veterans. 

14 ‘‘(vii) The Office of General Counsel. 

15 ‘‘(viii) The Office of Regulation Policy and Man16 agement. 

17 ‘‘(ix) The Office of Employment Discrimination 

18 Complaint Adjudication. 

19 ‘‘(x) The Office of Interagency Care and Benefits 

20 Coordination. 

21 ‘‘(xi) The Office of Small and Disadvantaged 

22 Business Utilization. 

23 ‘‘(xii) The Office of Survivors Assistance. 

24 ‘‘(xiii) The Veterans’ Service Organizations Li25 aison. 


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1 ‘‘(C) For purposes of this subsection, the covered staff 

2 offices of the Department are the following: 

3 ‘‘(i) The office of the Assistant Secretary for Con4 gressional and Legislative Affairs. 

5 ‘‘(ii) The office of the Assistant Secretary for 

6 Human Resources and Administration. 

7 ‘‘(iii) The office of the Assistant Secretary for In8 formation and Technology. 

9 ‘‘(iv) The Office of Management. 

10 ‘‘(v) The office of the Assistant Secretary for Op11 erations, Security, and Preparedness. 

12 ‘‘(vi) The office of the Assistant Secretary for 

13 Policy and Planning. 

14 ‘‘(vii) The office of the Assistant Secretary for 

15 Public and Intergovernmental Affairs. 

16 ‘‘(c) REPORTS.—(1)(A) Not later than 90 days after 

17 completing an audit under the program required by sub18 section (a), the Secretary shall submit to the appropriate 

19 committees of Congress a report on the audit. 

20 ‘‘(B) Each report submitted under subparagraph (A) 

21 with respect to an audit shall include the following: 

22 ‘‘(i) A summary of the audit. 

23 ‘‘(ii) The findings of the Secretary with respect 

24 to the audit. 


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1 ‘‘(iii) Such recommendations as the Secretary 

2 may have for legislative or administrative action to 

3 improve the furnishing of benefits and health care to 

4 veterans and their families. 

5 ‘‘(iv) Plans to carry out the recommendations 

6 submitted under clause (iii), including timelines for 

7 completion of such plans. 

8 ‘‘(2)(A) Not later than September 1 of each year, the 

9 Secretary shall submit to the appropriate committees of 

10 Congress a report on the administration of this section. 

11 ‘‘(B) Each report submitted under subparagraph (A) 

12 shall include the following: 

13 ‘‘(i) A detailed description of each matter for 

14 which a recommendation was submitted under clause 

15 (iii) of paragraph (1)(B) and with respect to which 

16 plans that were submitted under clause (iv) of such 

17 paragraph have not been completed. 

18 ‘‘(ii) A plan for the conduct of audits under this 

19 section during the first fiscal year beginning after the 

20 fiscal year in which the report is submitted, which 

21 shall include the following: 

22 ‘‘(I) A description of any risk assessments 

23 the Secretary plans to conduct in such fiscal 

24 year. 


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1 ‘‘(II) A summary of each audit the Sec2 retary plans to conduct in such fiscal year, in3 cluding a description of the subject matter of the 

4 audit and identification of the administration, 

5 office, or function to be audited. 

6 ‘‘(3) In this subsection, the term ‘appropriate commit7 tees of Congress’ includes— 

8 ‘‘(A) the Committee on Veterans’ Affairs, the 

9 Committee on Appropriations, and the Committee on 

10 Homeland Security and Governmental Affairs of the 

11 Senate; and 

12 ‘‘(B) the Committee on Veterans’ Affairs, the 

13 Committee on Appropriations, and the Committee on 

14 Oversight and Government Reform of the House of 

15 Representatives.’’. 

16 (b) FIRST RISK ASSESSMENT.—The Secretary of Vet17 erans Affairs shall complete the first risk assessment re18 quired by section 527A(b)(1)(A) of such title, as added by 

19 subsection (a), by not later than 180 days after the date 

20 of the enactment of this Act. 

21 (c) CLERICAL AMENDMENT.—The table of sections at 

22 the beginning of chapter 5 of such title is amended by in23 serting after the item relating to section 527 the following 

24 new item: 

‘‘527A. Program of internal audits.’’. 


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1 SEC. 504. IMPROVEMENT OF TRAINING FOR MANAGERS. 

2 The Secretary of Veterans Affairs shall provide to each 

3 employee of the Department of Veterans Affairs who is em4 ployed by the Department in a managerial position peri5 odic training on the following: 

6 (1) The rights of whistleblowers and how to ad7 dress a report by an employee of a hostile work envi8 ronment, reprisal, or harassment. 

9 (2) How to effectively motivate, manage, and re10 ward the employees who report to the manager. 

11 (3) How to effectively manage employees who are 

12 performing at an unacceptable level and access assist13 ance from the human resources office of the Depart14 ment and the Office of the General Counsel of the De15 partment with respect to those employees. 

Amend the title so as to read: ‘‘A bill to amend title 

38, United States Code, to improve the benefits and 

health care provided by the Department of Veterans Affairs, and for other purposes.’’. 


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Calendar No. 716 

114TH CONGRESS 

2D SESSION S. 425 

[Report No. 114–395] 

A BILL 

To amend title 38, United States Code, to provide 

programs. tion regarding eligibility for services under such reintegration programs and to provide clarificafor a five-year extension to the homeless veterans 

DECEMBER 7, 2016 

Reported with an amendment and an amendment to the 

title 


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