II 

115TH CONGRESS 

2D SESSION S. 2906 

To establish a permanent community care program for veterans, to improve 

the recruitment of health care providers of the Department of Veterans 

Affairs, to improve construction by the Department, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MAY 22, 2018 

Mr. MANCHIN (for himself, Mrs. MCCASKILL, Ms. STABENOW, Mr. KAINE, 

Mr. WARNER, Mr. MENENDEZ, Mr. DONNELLY, Ms. HARRIS, Ms. KLOBUCHAR, Mr. NELSON, Mr. VAN HOLLEN, Mrs. MURRAY, Mr. KING, Mr. 

JONES, Mr. SCHUMER, Mr. BROWN, Ms. BALDWIN, Mr. DURBIN, Ms. 

WARREN, Ms. SMITH, and Mr. MARKEY) introduced the following bill; 

which was read twice and referred to the Committee on Veterans’ Affairs 

A BILL 

To establish a permanent community care program for veterans, to improve the recruitment of health care providers of the Department of Veterans Affairs, to improve 

construction by the Department, and for other purposes. 

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

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

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1 tegrated Outside Networks Act of 2018’’ or the ‘‘VA MIS2 SION Act of 2018’’. 

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

4 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. References to title 38, United States Code. 

TITLE I—CARING FOR OUR VETERANS 

Sec. 100. Short title. 

Subtitle A—Developing an Integrated High-Performing Network 

CHAPTER 1—ESTABLISHING COMMUNITY CARE PROGRAMS

Sec. 101. Establishment of Veterans Community Care Program. 

Sec. 102. Authorization of agreements between Department of Veterans Affairs 

and non-Department providers. 

Sec. 103. Conforming amendments for State veterans homes. 

Sec. 104. Access standards and standards for quality. 

Sec. 105. Access to walk-in care. 

Sec. 106. Strategy regarding the Department of Veterans Affairs High-Performing Integrated Health Care Network. 

Sec. 107. Applicability of Directive of Office of Federal Contract Compliance 

Programs. 

Sec. 108. Prevention of certain health care providers from providing non-Department health care services to veterans. 

Sec. 109. Remediation of medical service lines. 

CHAPTER 2—PAYING PROVIDERS AND IMPROVING COLLECTIONS

Sec. 111. Prompt payment to providers. 

Sec. 112. Authority to pay for authorized care not subject to an agreement. 

Sec. 113. Improvement of authority to recover the cost of services furnished for 

non-service-connected disabilities. 

Sec. 114. Processing of claims for reimbursement through electronic interface. 

CHAPTER 3—EDUCATION AND TRAINING PROGRAMS

Sec. 121. Education program on health care options. 

Sec. 122. Training program for administration of non-Department of Veterans 

Affairs health care. 

Sec. 123. Continuing medical education for non-Department medical professionals. 

CHAPTER 4—OTHER MATTERS RELATING TO NON-DEPARTMENT OF

VETERANS AFFAIRS PROVIDERS

Sec. 131. Establishment of processes to ensure safe opioid prescribing practices 

by non-Department of Veterans Affairs health care providers. 

Sec. 132. Improving information sharing with community providers. 

Sec. 133. Competency standards for non-Department of Veterans Affairs health 

care providers. 


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Sec. 134. Department of Veterans Affairs participation in national network of 

State-based prescription drug monitoring programs. 

CHAPTER 5—OTHER NON-DEPARTMENT HEALTH CARE MATTERS

Sec. 141. Plans for Use of Supplemental Appropriations Required. 

Sec. 142. Veterans Choice Fund flexibility. 

Sec. 143. Sunset of Veterans Choice Program. 

Sec. 144. Conforming amendments. 

Subtitle B—Improving Department of Veterans Affairs Health Care Delivery 

Sec. 151. Licensure of health care professionals of the Department of Veterans 

Affairs providing treatment via telemedicine. 

Sec. 152. Authority for Department of Veterans Affairs Center for Innovation 

for Care and Payment. 

Sec. 153. Authorization to provide for operations on live donors for purposes 

of conducting transplant procedures for veterans. 

Subtitle C—Family Caregivers 

Sec. 161. Expansion of family caregiver program of Department of Veterans 

Affairs. 

Sec. 162. Implementation of information technology system of Department of 

Veterans Affairs to assess and improve the family caregiver 

program. 

Sec. 163. Modifications to annual evaluation report on caregiver program of 

Department of Veterans Affairs. 

TITLE II—IMPROVEMENTS TO RECRUITMENT OF HEALTH CARE 

PROFESSIONALS 

Sec. 201. Designated scholarships for physicians and dentists under Department of Veterans Affairs Health Professional Scholarship Program. 

Sec. 202. Increase in maximum amount of debt that may be reduced under 

Education Debt Reduction Program of Department of Veterans Affairs. 

Sec. 203. Establishing the Department of Veterans Affairs Specialty Education 

Loan Repayment Program. 

Sec. 204. Veterans healing veterans medical access and scholarship program. 

Sec. 205. Bonuses for recruitment, relocation, and retention. 

Sec. 206. Inclusion of Vet Center employees in Education Debt Reduction Program of Department of Veterans Affairs. 

TITLE III—HEALTH CARE IN UNDERSERVED AREAS 

Sec. 301. Development of criteria for designation of certain medical facilities of 

the Department of Veterans Affairs as underserved facilities 

and plan to address problem of underserved facilities. 

Sec. 302. Pilot program to furnish mobile deployment teams to underserved facilities. 

Sec. 303. Pilot program on graduate medical education and residency. 

TITLE IV—INFRASTRUCTURE MATTERS 

Sec. 401. Improvement to training of construction personnel. 

Sec. 402. Review of enhanced use leases. 


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Sec. 403. Assessment of health care furnished by the Department to veterans 

who live in the Pacific territories. 

TITLE V—OTHER MATTERS 

Sec. 501. Annual report on performance awards and bonuses awarded to certain high-level employees of the department. 

Sec. 502. Role of podiatrists in Department of Veterans Affairs. 

Sec. 503. Definition of major medical facility project. 

Sec. 504. Authorization of certain major medical facility projects of the Department of Veterans Affairs. 

Sec. 505. Department of Veterans Affairs personnel transparency. 

Sec. 506. Program on establishment of peer specialists in patient aligned care 

team settings within medical centers of Department of Veterans Affairs. 

Sec. 507. Department of Veterans Affairs medical scribe pilot program. 

Sec. 508. Extension of requirement to collect fees for housing loans guaranteed 

by Secretary of Veterans Affairs. 

Sec. 509. Extension of reduction in amount of pension furnished by Department of Veterans Affairs for certain veterans covered by Medicaid plans for services furnished by nursing facilities. 

Sec. 510. Appropriation of amounts. 

Sec. 511. Technical correction. 

1 SEC. 2. REFERENCES TO TITLE 38, UNITED STATES CODE. 

2 Except as otherwise expressly provided, whenever in 

3 this Act an amendment or repeal is expressed in terms 

4 of an amendment to, or repeal of, a section or other provi5 sion, the reference shall be considered to be made to a 

6 section or other provision of title 38, United States Code. 

7 TITLE I—CARING FOR OUR 

8 VETERANS 

9 SEC. 100. SHORT TITLE. 

10 This title may be cited as the ‘‘Caring for Our Vet11 erans Act of 2018’’. 


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1 Subtitle A—Developing an Inte2 grated High-Performing Net3 work 

4 CHAPTER 1—ESTABLISHING COMMUNITY 

5 CARE PROGRAMS 

6 SEC. 101. ESTABLISHMENT OF VETERANS COMMUNITY 

7 CARE PROGRAM. 

8 (a) ESTABLISHMENT OF PROGRAM.— 

9 (1) IN GENERAL.—Section 1703 is amended to 

10 read as follows: 

11 ‘‘§ 1703. Veterans Community Care Program 

12 ‘‘(a) IN GENERAL.—(1) There is established a pro13 gram to furnish hospital care, medical services, and ex14 tended care services to covered veterans through health 

15 care providers specified in subsection (c). 

16 ‘‘(2) The Secretary shall coordinate the furnishing of 

17 hospital care, medical services, and extended care services 

18 under this section to covered veterans, including coordina19 tion of, at a minimum, the following: 

20 ‘‘(A) Ensuring the scheduling of medical ap21 pointments in a timely manner and the establish22 ment of a mechanism to receive medical records 

23 from non-Department providers. 

24 ‘‘(B) Ensuring continuity of care and services. 


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1 ‘‘(C) Ensuring coordination among regional 

2 networks if the covered veteran accesses care and 

3 services in a different network than the regional net4 work in which the covered veteran resides. 

5 ‘‘(D) Ensuring that covered veterans do not ex6 perience a lapse in care resulting from errors or 

7 delays by the Department or its contractors or an 

8 unusual or excessive burden in accessing hospital 

9 care, medical services, or extended care services. 

10 ‘‘(3) A covered veteran may only receive care or serv11 ices under this section upon the authorization of such care 

12 or services by the Secretary. 

13 ‘‘(b) COVERED VETERANS.—For purposes of this 

14 section, a covered veteran is any veteran who— 

15 ‘‘(1) is enrolled in the system of annual patient 

16 enrollment established and operated under section 

17 1705 of this title; or 

18 ‘‘(2) is not enrolled in such system but is other19 wise entitled to hospital care, medical services, or ex20 tended care services under subsection (c)(2) of such 

21 section. 

22 ‘‘(c) HEALTH CARE PROVIDERS SPECIFIED.—Health 

23 care providers specified in this subsection are the fol24 lowing: 


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

3 the Social Security Act (42 U.S.C. 1395 et seq.), in4 cluding any physician furnishing services under such 

5 a program. 

6 ‘‘(2) The Department of Defense. 

7 ‘‘(3) The Indian Health Service. 

8 ‘‘(4) Any Federally-qualified health center (as 

9 defined in section 1905(l)(2)(B) of the Social Secu10 rity Act (42 U.S.C. 1396d(l)(2)(B))). 

11 ‘‘(5) Any health care provider not otherwise 

12 covered under any of paragraphs (1) through (4) 

13 that meets criteria established by the Secretary for 

14 purposes of this section. 

15 ‘‘(d) CONDITIONS UNDER WHICH CARE IS RE16 QUIRED TO BE FURNISHED THROUGH NON-DEPART17 MENT PROVIDERS.—(1) The Secretary shall, subject to 

18 the availability of appropriations, furnish hospital care, 

19 medical services, and extended care services to a covered 

20 veteran through health care providers specified in sub21 section (c) if— 

22 ‘‘(A) the Department does not offer the care or 

23 services the veteran requires; 


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1 ‘‘(B) the Department does not operate a full2 service medical facility in the State in which the cov3 ered veteran resides; 

4 ‘‘(C)(i) the covered veteran was an eligible vet5 eran under section 101(b)(2)(B) of the Veterans Ac6 cess, Choice, and Accountability Act of 2014 (Public 

7 Law 113–146; 38 U.S.C. 1701 note) as of the day 

8 before the date of the enactment of the Caring for 

9 Our Veterans Act of 2018; 

10 ‘‘(ii) continues to reside in a location that would 

11 qualify the veteran for eligibility under such section; 

12 and 

13 ‘‘(iii) either— 

14 ‘‘(I) resides in one of the five States with 

15 the lowest population density as determined by 

16 data from the 2010 decennial census; or 

17 ‘‘(II) resides in a State not described in 

18 subclause (I) and— 

19 ‘‘(aa) received care or services under 

20 this title in the year preceding the enact21 ment of the Caring for Our Veterans Act 

22 of 2018; and 

23 ‘‘(bb) is seeking care or services with24 in two years of the date of the enactment 


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1 of the Caring for Our Veterans Act of 

2 2018; 

3 ‘‘(D) the covered veteran has contacted the De4 partment to request care or services and the Depart5 ment is not able to furnish such care or services in 

6 a manner that complies with designated access 

7 standards developed by the Secretary under section 

8 1703B of this title; or 

9 ‘‘(E) the covered veteran and the covered vet10 eran’s referring clinician agree that furnishing care 

11 and services through a non-Department entity or 

12 provider would be in the best medical interest of the 

13 covered veteran based upon criteria developed by the 

14 Secretary. 

15 ‘‘(2) The Secretary shall ensure that the criteria de16 veloped under paragraph (1)(E) include consideration of 

17 the following: 

18 ‘‘(A) The distance between the covered veteran 

19 and the facility that provides the hospital care, med20 ical services, or extended care services the veteran 

21 needs. 

22 ‘‘(B) The nature of the hospital care, medical 

23 services, or extended care services required. 


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1 ‘‘(C) The frequency that the hospital care, med2 ical services, or extended care services needs to be 

3 furnished. 

4 ‘‘(D) The timeliness of available appointments 

5 for the hospital care, medical services, or extended 

6 care services the veteran needs. 

7 ‘‘(E) Whether the covered veteran faces an un8 usual or excessive burden to access hospital care, 

9 medical services, or extended care services from the 

10 Department medical facility where a covered veteran 

11 seeks hospital care, medical services, or extended 

12 care services, which shall include consideration of 

13 the following: 

14 ‘‘(i) Whether the covered veteran faces an 

15 excessive driving distance, geographical chal16 lenge, or environmental factor that impedes the 

17 access of the covered veteran. 

18 ‘‘(ii) Whether the hospital care, medical 

19 services, or extended care services sought by the 

20 veteran is provided by a medical facility of the 

21 Department that is reasonably accessible to a 

22 covered veteran. 

23 ‘‘(iii) Whether a medical condition of the 

24 covered veteran affects the ability of the covered 

25 veteran to travel. 


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1 ‘‘(iv) Whether there is compelling reason, 

2 as determined by the Secretary, that the vet3 eran needs to receive hospital care, medical 

4 services, or extended care services from a med5 ical facility other than a medical facility of the 

6 Department. 

7 ‘‘(v) Such other considerations as the Sec8 retary considers appropriate. 

9 ‘‘(3) If the Secretary has determined that the Depart10 ment does not offer the care or services the covered vet11 eran requires under subparagraph (A) of paragraph (1), 

12 that the Department does not operate a full-service med13 ical facility in the State in which the covered veteran re14 sides under subparagraph (B) of such paragraph, that the 

15 covered veteran is described under subparagraph (C) of 

16 such paragraph, or that the Department is not able to fur17 nish care or services in a manner that complies with des18 ignated access standards developed by the Secretary under 

19 section 1703B of this title under subparagraph (D) of 

20 such paragraph, the decision to receive hospital care, med21 ical services, or extended care services under such sub22 paragraphs from a health care provider specified in sub23 section (c) shall be at the election of the veteran. 

24 ‘‘(e) CONDITIONS UNDER WHICH CARE IS AUTHOR25 IZED TO BE FURNISHED THROUGH NON-DEPARTMENT


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1 PROVIDERS.—(1)(A) The Secretary may furnish hospital 

2 care, medical services, or extended care services through 

3 a health care provider specified in subsection (c) to a cov4 ered veteran served by a medical service line of the De5 partment that the Secretary has determined is not pro6 viding care that complies with the standards for quality 

7 the Secretary shall establish under section 1703C. 

8 ‘‘(B) In carrying out subparagraph (A), the Secretary 

9 shall— 

10 ‘‘(i) measure timeliness of the medical service 

11 line at a facility of the Department when compared 

12 with the same medical service line at different De13 partment facilities; and 

14 ‘‘(ii) measure quality at a medical service line 

15 of a facility of the Department by comparing it with 

16 two or more distinct and appropriate quality meas17 ures at non-Department medical service lines. 

18 ‘‘(C)(i) The Secretary may not concurrently furnish 

19 hospital care, medical services, or extended care services 

20 under subparagraph (A) with respect to more than three 

21 medical service lines described in such subparagraph at 

22 any one health care facility of the Department. 

23 ‘‘(ii) The Secretary may not concurrently furnish hos24 pital care, medical services, or extended care services 

25 under subparagraph (A) with respect to more than 36 


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1 medical service lines nationally described in such subpara2 graph. 

3 ‘‘(2) The Secretary may limit the types of hospital 

4 care, medical services, or extended care services covered 

5 veterans may receive under paragraph (1) in terms of the 

6 length of time such care and services will be available, the 

7 location at which such care and services will be available, 

8 and the clinical care and services that will be available. 

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

10 the hospital care, medical services, and extended care serv11 ices authorized under paragraph (1) with respect to a 

12 medical service line shall cease when the remediation de13 scribed in section 1706A of this title with respect to such 

14 medical service line is complete. 

15 ‘‘(B) The Secretary shall ensure continuity and co16 ordination of care for any veteran who elects to receive 

17 care or services under paragraph (1) from a health care 

18 provider specified in subsection (c) through the completion 

19 of an episode of care. 

20 ‘‘(4) The Secretary shall publish in the Federal Reg21 ister, and shall take all reasonable steps to provide direct 

22 notice to covered veterans affected under this subsection, 

23 at least once each year stating the time period during 

24 which such care and services will be available, the location 

25 or locations where such care and services will be available, 


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1 and the clinical services available at each location under 

2 this subsection in accordance with regulations the Sec3 retary shall prescribe. 

4 ‘‘(5) When the Secretary exercises the authority 

5 under paragraph (1), the decision to receive care or serv6 ices under such paragraph from a health care provider 

7 specified in subsection (c) shall be at the election of the 

8 covered veteran. 

9 ‘‘(f) APPEAL BY VETERANS OF DECISIONS OF SEC10 RETARY.—The review of any decision under subsection (d) 

11 or (e) shall be subject to the clinical appeals process of 

12 the Department, and such decisions may not be appealed 

13 to the Board of Veterans’ Appeals. 

14 ‘‘(g) REVIEW OF DETERMINATIONS BY SEC15 RETARY.—The Secretary shall review a determination of 

16 the Secretary to furnish hospital care, medical services, 

17 or extended care services to a covered veteran under this 

18 section not later than the day that is— 

19 ‘‘(1) one year after the date of such determina20 tion, in the case of a determination under subsection 

21 (d); or 

22 ‘‘(2) 180 days after the date of such determina23 tion, in the case of a determination under subsection 

24 (e). 


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1 ‘‘(h) TIERED NETWORK.—(1) To promote the provi2 sion of high-quality and high-value hospital care, medical 

3 services, and extended care services under this section, the 

4 Secretary may develop a tiered provider network of eligible 

5 providers based on criteria established by the Secretary 

6 for purposes of this section. 

7 ‘‘(2) In developing a tiered provider network of eligi8 ble providers under paragraph (1), the Secretary shall not 

9 prioritize providers in a tier over providers in any other 

10 tier in a manner that limits the choice of a covered veteran 

11 in selecting a health care provider specified in subsection 

12 (c) for receipt of hospital care, medical services, or ex13 tended care services under this section. 

14 ‘‘(i) CONTRACTS TO ESTABLISH NETWORKS OF

15 HEALTH CARE PROVIDERS.—(1) The Secretary shall 

16 enter into consolidated, competitively bid contracts to es17 tablish networks of health care providers specified in para18 graphs (1) and (5) of subsection (c) for purposes of pro19 viding sufficient access to hospital care, medical services, 

20 or extended care services under this section. 

21 ‘‘(2)(A) To the extent practicable, the Secretary shall 

22 ensure that covered veterans are able to make their own 

23 appointments using advanced technology. 

24 ‘‘(B) To the extent practicable, the Secretary shall 

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1 pital care, medical services, and extended care services 

2 under this section. 

3 ‘‘(3)(A) The Secretary may terminate a contract with 

4 an entity entered into under paragraph (1) at such time 

5 and upon such notice to the entity as the Secretary may 

6 specify for purposes of this section if the Secretary notifies 

7 the appropriate committees of Congress that, at a min8 imum— 

9 ‘‘(i) the entity— 

10 ‘‘(I) failed to comply substantially with the 

11 provisions of the contract or with the provisions 

12 of this section and the regulations prescribed 

13 under this section; 

14 ‘‘(II) failed to comply with the access 

15 standards or the standards for quality estab16 lished by the Secretary; 

17 ‘‘(III) is excluded from participation in a 

18 Federal health care program (as defined in sec19 tion 1128B(f) of the Social Security Act (42 

20 U.S.C. 1320a–7b(f))) under section 1128 or 

21 1128A of the Social Security Act (42 U.S.C. 

22 1320a–7 and 1320a–7a); 

23 ‘‘(IV) is identified as an excluded source 

24 on the list maintained in the System for Award 

25 Management, or any successor system; or 


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1 ‘‘(V) has been convicted of a felony or 

2 other serious offense under Federal or State 

3 law and the continued participation of the enti4 ty would be detrimental to the best interests of 

5 veterans or the Department; 

6 ‘‘(ii) it is reasonable to terminate the contract 

7 based on the health care needs of veterans; or 

8 ‘‘(iii) it is reasonable to terminate the contract 

9 based on coverage provided by contracts or sharing 

10 agreements entered into under authorities other 

11 than this section. 

12 ‘‘(B) Nothing in subparagraph (A) may be construed 

13 to restrict the authority of the Secretary to terminate a 

14 contract entered into under paragraph (1) under any other 

15 provision of law. 

16 ‘‘(4) Whenever the Secretary provides notice to an 

17 entity that the entity is failing to meet contractual obliga18 tions entered into under paragraph (1), the Secretary shall 

19 submit to the Committee on Veterans’ Affairs of the Sen20 ate and the Committee on Veterans’ Affairs of the House 

21 of Representatives a report on such failure. Such report 

22 shall include the following: 

23 ‘‘(A) An explanation of the reasons for pro24 viding such notice. 


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1 ‘‘(B) A description of the effect of such failure, 

2 including with respect to cost, schedule, and require3 ments. 

4 ‘‘(C) A description of the actions taken by the 

5 Secretary to mitigate such failure. 

6 ‘‘(D) A description of the actions taken by the 

7 contractor to address such failure. 

8 ‘‘(E) A description of any effect on the commu9 nity provider market for veterans in the affected 

10 area. 

11 ‘‘(5)(A) The Secretary shall instruct each entity 

12 awarded a contract under paragraph (1) to recognize and 

13 accept, on an interim basis, the credentials and qualifica14 tions of health care providers who are authorized to fur15 nish hospital care and medical services to veterans under 

16 a community care program of the Department in effect 

17 as of the day before the date of the enactment of the Car18 ing for Our Veterans Act of 2018, including under the 

19 Patient-Centered Community Care Program and the Vet20 erans Choice Program under section 101 of the Veterans 

21 Access, Choice, and Accountability Act of 2014 (Public 

22 Law 113–146; 38 U.S.C. 1701 note), as qualified pro23 viders under the program established under this section. 


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1 ‘‘(B) The interim acceptance period under subpara2 graph (A) shall be determined by the Secretary based on 

3 the following criteria: 

4 ‘‘(i) With respect to a health care provider, 

5 when the current certification agreement for the 

6 health care provider expires. 

7 ‘‘(ii) Whether the Department has enacted cer8 tification and eligibility criteria and regulatory pro9 cedures by which non-Department providers will be 

10 authorized under this section. 

11 ‘‘(6) The Secretary shall establish a system or sys12 tems for monitoring the quality of care provided to covered 

13 veterans through a network under this subsection and for 

14 assessing the quality of hospital care, medical services, 

15 and extended care services furnished through such net16 work before the renewal of the contract for such network. 

17 ‘‘(j) PAYMENT RATES FOR CARE AND SERVICES.— 

18 (1) Except as provided in paragraph (2), and to the extent 

19 practicable, the rate paid for hospital care, medical serv20 ices, or extended care services under any provision in this 

21 title may not exceed the rate paid by the United States 

22 to a provider of services (as defined in section 1861(u) 

23 of the Social Security Act (42 U.S.C. 1395x(u))) or a sup24 plier (as defined in section 1861(d) of such Act (42 U.S.C. 

25 1395x(d))) under the Medicare program under title XI or 


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1 title XVIII of the Social Security Act (42 U.S.C. 1301 

2 et seq.), including section 1834 of such Act (42 U.S.C. 

3 1395m), for the same care or services. 

4 ‘‘(2)(A) A higher rate than the rate paid by the 

5 United States as described in paragraph (1) may be nego6 tiated with respect to the furnishing of care or services 

7 to a covered veteran who resides in a highly rural area. 

8 ‘‘(B) In this paragraph, the term ‘highly rural area’ 

9 means an area located in a county that has fewer than 

10 seven individuals residing in that county per square mile. 

11 ‘‘(3) With respect to furnishing care or services under 

12 this section in Alaska, the Alaska Fee Schedule of the De13 partment of Veterans Affairs shall be followed, except for 

14 when another payment agreement, including a contract or 

15 provider agreement, is in effect. 

16 ‘‘(4) With respect to furnishing hospital care, medical 

17 services, or extended care services under this section in 

18 a State with an All-Payer Model Agreement under section 

19 1814(b)(3) of the Social Security Act (42 U.S.C. 

20 1395f(b)(3)) that became effective on or after January 1, 

21 2014, the Medicare payment rates under paragraph 

22 (2)(A) shall be calculated based on the payment rates 

23 under such agreement. 

24 ‘‘(5) Notwithstanding paragraph (1), the Secretary 

25 may incorporate, to the extent practicable, the use of 


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1 value-based reimbursement models to promote the provi2 sion of high-quality care. 

3 ‘‘(6) With respect to hospital care, medical services, 

4 or extended care services for which there is not a rate paid 

5 under the Medicare program as described in paragraph 

6 (1), the rate paid for such care or services shall be deter7 mined by the Secretary. 

8 ‘‘(k) TREATMENT OF OTHER HEALTH PLAN CON9 TRACTS.—In any case in which a covered veteran is fur10 nished hospital care, medical services, or extended care 

11 services under this section for a non-service-connected dis12 ability described in subsection (a)(2) of section 1729 of 

13 this title, the Secretary shall recover or collect reasonable 

14 charges for such care or services from a health plan con15 tract described in section 1729 in accordance with such 

16 section. 

17 ‘‘(l) PAYMENT BY VETERAN.—A covered veteran 

18 shall not pay a greater amount for receiving care or serv19 ices under this section than the amount the veteran would 

20 pay for receiving the same or comparable care or services 

21 at a medical facility of the Department or from a health 

22 care provider of the Department. 

23 ‘‘(m) TRANSPLANT AUTHORITY FOR IMPROVED AC24 CESS.—(1) In the case of a covered veteran described in 

25 paragraph (2), the Secretary shall determine whether to 


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1 authorize an organ or bone marrow transplant for that 

2 covered veteran at a non-Department facility. 

3 ‘‘(2) A covered veteran described in this paragraph— 

4 ‘‘(A) requires an organ or bone marrow trans5 plant; and 

6 ‘‘(B) has, in the opinion of the primary care 

7 provider of the veteran, a medically compelling rea8 son to travel outside the region of the Organ Pro9 curement and Transplantation Network, established 

10 under section 372 of the National Organ Transplan11 tation Act (Public Law 98–507; 42 U.S.C. 274), in 

12 which the veteran resides, to receive such transplant. 

13 ‘‘(n) MONITORING OF CARE PROVIDED.—(1)(A) Not 

14 later than 540 days after the date of the enactment of 

15 the Caring for Our Veterans Act of 2018, and not less 

16 frequently than annually thereafter, the Secretary shall 

17 submit to the appropriate committees of Congress a review 

18 of the types and frequency of care sought under subsection 

19 (d). 

20 ‘‘(B) The review submitted under subparagraph (A) 

21 shall include an assessment of the following: 

22 ‘‘(i) The top 25 percent of types of care and 

23 services most frequently provided under subsection 

24 (d) due to the Department not offering such care 

25 and services. 


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1 ‘‘(ii) The frequency such care and services were 

2 sought by covered veterans under this section. 

3 ‘‘(iii) An analysis of the reasons the Depart4 ment was unable to provide such care and services. 

5 ‘‘(iv) Any steps the Department took to provide 

6 such care and services at a medical facility of the 

7 Department. 

8 ‘‘(v) The cost of such care and services. 

9 ‘‘(2) In monitoring the hospital care, medical serv10 ices, and extended care services furnished under this sec11 tion, the Secretary shall do the following: 

12 ‘‘(A) With respect to hospital care, medical 

13 services, and extended care services furnished 

14 through provider networks established under sub15 section (i)— 

16 ‘‘(i) compile data on the types of hospital 

17 care, medical services, and extended care serv18 ices furnished through such networks and how 

19 many patients used each type of care and serv20 ice; 

21 ‘‘(ii) identify gaps in hospital care, medical 

22 services, or extended care services furnished 

23 through such networks; 

24 ‘‘(iii) identify how such gaps may be fixed 

25 through new contracts within such networks or 


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1 changes in the manner in which hospital care, 

2 medical services, or extended care services are 

3 furnished through such networks; 

4 ‘‘(iv) assess the total amounts spent by the 

5 Department on hospital care, medical services, 

6 and extended care services furnished through 

7 such networks; 

8 ‘‘(v) assess the timeliness of the Depart9 ment in referring hospital care, medical serv10 ices, and extended care services to such net11 works; and 

12 ‘‘(vi) assess the timeliness of such net13 works in— 

14 ‘‘(I) accepting referrals; and 

15 ‘‘(II) scheduling and completing ap16 pointments. 

17 ‘‘(B) Report the number of medical service lines 

18 the Secretary has determined under subsection 

19 (e)(1) not to be providing hospital care, medical 

20 services, or extended care services that comply with 

21 the standards for quality established by the Sec22 retary. 

23 ‘‘(C) Assess the use of academic affiliates and 

24 centers of excellence of the Department to furnish 


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1 hospital care, medical services, and extended care 

2 services to covered veterans under this section. 

3 ‘‘(D) Assess the hospital care, medical services, 

4 and extended care services furnished to covered vet5 erans under this section by medical facilities oper6 ated by Federal agencies other than the Depart7 ment. 

8 ‘‘(3) Not later than 540 days after the date of the 

9 enactment of the Caring for Our Veterans Act of 2018, 

10 and not less frequently than annually thereafter, the Sec11 retary shall submit to the Committee on Veterans’ Affairs 

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

13 the House of Representatives a report on the information 

14 gathered under paragraph (2). 

15 ‘‘(o) PROHIBITION ON CERTAIN LIMITATIONS.—(1) 

16 The Secretary shall not limit the types of hospital care, 

17 medical services, or extended care services covered vet18 erans may receive under this section if it is in the best 

19 medical interest of the veteran to receive such hospital 

20 care, medical services, or extended care services, as deter21 mined by the veteran and the veteran’s health care pro22 vider. 

23 ‘‘(2) No provision in this section may be construed 

24 to alter or modify any other provision of law establishing 


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1 specific eligibility criteria for certain hospital care, medical 

2 services, or extended care services. 

3 ‘‘(p) DEFINITIONS.—In this section: 

4 ‘‘(1) The term ‘appropriate committees of Con5 gress’ means— 

6 ‘‘(A) the Committee on Veterans’ Affairs 

7 and the Committee on Appropriations of the 

8 Senate; and 

9 ‘‘(B) the Committee on Veterans’ Affairs 

10 and the Committee on Appropriations of the 

11 House of Representatives. 

12 ‘‘(2) The term ‘medical service line’ means a 

13 clinic within a Department medical center.’’. 

14 (2) CLERICAL AMENDMENT.—The table of sec15 tions at the beginning of chapter 17 is amended by 

16 striking the item relating to section 1703 and insert17 ing the following new item: 

‘‘1703. Veterans Community Care Program.’’. 

18 (b) EFFECTIVE DATE.—Section 1703 of title 38, 

19 United States Code, as amended by subsection (a), shall 

20 take effect on the later of— 

21 (1) the date that is 30 days after the date on 

22 which the Secretary of Veterans Affairs submits the 

23 report required under section 101(q)(2) of the Vet24 erans Access, Choice, and Accountability Act of 


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1 2014 (Public Law 113–146; 38 U.S.C. 1701 note); 

2 or 

3 (2) the date on which the Secretary promul4 gates regulations pursuant to subsection (c). 

5 (c) REGULATIONS.— 

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

7 after the date of the enactment of this Act, the Sec8 retary of Veterans Affairs shall promulgate regula9 tions to carry out section 1703 of title 38, United 

10 States Code, as amended by subsection (a). 

11 (2) UPDATES.— 

12 (A) PERIODIC.—Before promulgating the 

13 regulations required under paragraph (1), the 

14 Secretary shall provide to the appropriate com15 mittees of Congress periodic updates to confirm 

16 the progress of the Secretary toward developing 

17 such regulations. 

18 (B) FIRST UPDATE.—The first update 

19 under subparagraph (A) shall occur not later 

20 than 120 days after the date of the enactment 

21 of this Act. 

22 (C) APPROPRIATE COMMITTEES OF CON23 GRESS DEFINED.—In this paragraph, the term 

24 ‘‘appropriate committees of Congress’’ means— 


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1 (i) the Committee on Veterans’ Af2 fairs and the Committee on Appropriations 

3 of the Senate; and 

4 (ii) the Committee on Veterans’ Af5 fairs and the Committee on Appropriations 

6 of the House of Representatives. 

7 (d) CONTINUITY OF EXISTING AGREEMENTS.— 

8 (1) IN GENERAL.—Notwithstanding section 

9 1703 of title 38, United States Code, as amended by 

10 subsection (a), the Secretary of Veterans Affairs 

11 shall continue all contracts, memorandums of under12 standing, memorandums of agreements, and other 

13 arrangements that were in effect on the day before 

14 the date of the enactment of this Act between the 

15 Department of Veterans Affairs and the American 

16 Indian and Alaska Native health care systems as es17 tablished under the terms of the Department of Vet18 erans Affairs and Indian Health Service Memo19 randum of Understanding, signed October 1, 2010, 

20 the National Reimbursement Agreement, signed De21 cember 5, 2012, arrangements under section 405 of 

22 the Indian Health Care Improvement Act (25 U.S.C. 

23 1645), and agreements entered into under sections 

24 102 and 103 of the Veterans Access, Choice, and 


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1 Accountability Act of 2014 (Public Law 113–146; 

2 38 U.S.C. 1701 note). 

3 (2) MODIFICATIONS.—Paragraph (1) shall not 

4 be construed to prohibit the Secretary and the par5 ties to the contracts, memorandums of under6 standing, memorandums of agreements, and other 

7 arrangements described in such paragraph from 

8 making such changes to such contracts, memoran9 dums of understanding, memorandums of agree10 ments, and other arrangements as may be otherwise 

11 authorized pursuant to other provisions of law or the 

12 terms of the contracts, memorandums of under13 standing, memorandums of agreements, and other 

14 arrangements. 

15 SEC. 102. AUTHORIZATION OF AGREEMENTS BETWEEN DE16 PARTMENT OF VETERANS AFFAIRS AND NON17 DEPARTMENT PROVIDERS. 

18 (a) IN GENERAL.—Subchapter I of chapter 17 is 

19 amended by inserting after section 1703 the following new 

20 section: 

21 ‘‘§ 1703A. Agreements with eligible entities or pro22 viders; certification processes 

23 ‘‘(a) AGREEMENTS AUTHORIZED.—(1)(A) When hos24 pital care, a medical service, or an extended care service 

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1 ice under this chapter is not feasibly available to the vet2 eran from a facility of the Department or through a con3 tract or sharing agreement entered into pursuant to an4 other provision of law, the Secretary may furnish such 

5 care or service to such veteran through an agreement 

6 under this section with an eligible entity or provider to 

7 provide such hospital care, medical service, or extended 

8 care service. 

9 ‘‘(B) An agreement entered into under this section 

10 to provide hospital care, a medical service, or an extended 

11 care service shall be known as a ‘Veterans Care Agree12 ment’. 

13 ‘‘(C) For purposes of subparagraph (A), hospital 

14 care, a medical service, or an extended care service may 

15 be considered not feasibly available to a veteran from a 

16 facility of the Department or through a contract or shar17 ing agreement described in such subparagraph when the 

18 Secretary determines the veteran’s medical condition, the 

19 travel involved, the nature of the care or services required, 

20 or a combination of those factors make the use of a facility 

21 of the Department or a contract or sharing agreement de22 scribed in such subparagraph impracticable or inadvisable. 

23 ‘‘(D) A Veterans Care Agreement may be entered 

24 into by the Secretary or any Department official author25 ized by the Secretary. 


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1 ‘‘(2)(A) Subject to subparagraph (B), the Secretary 

2 shall review each Veterans Care Agreement of material 

3 size, as determined by the Secretary or set forth in para4 graph (3), for hospital care, a medical service, or an ex5 tended care service to determine whether it is feasible and 

6 advisable to provide such care or service within a facility 

7 of the Department or by contract or sharing agreement 

8 entered into pursuant to another provision of law and, if 

9 so, take action to do so. 

10 ‘‘(B)(i) The Secretary shall review each Veterans 

11 Care Agreement of material size that has been in effect 

12 for at least six months within the first two years of its 

13 taking effect, and not less frequently than once every four 

14 years thereafter. 

15 ‘‘(ii) If a Veterans Care Agreement has not been in 

16 effect for at least six months by the date of the review 

17 required by subparagraph (A), the agreement shall be re18 viewed during the next cycle required by subparagraph 

19 (A), and such review shall serve as its review within the 

20 first two years of its taking effect for purposes of clause 

21 (i). 

22 ‘‘(3)(A) In fiscal year 2019 and in each fiscal year 

23 thereafter, in addition to such other Veterans Care Agree24 ments as the Secretary may determine are of material size, 

25 a Veterans Care Agreement for the purchase of extended 


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1 care services that exceeds $5,000,000 annually shall be 

2 considered of material size. 

3 ‘‘(B) From time to time, the Secretary may publish 

4 a notice in the Federal Register to adjust the dollar 

5 amount specified in subparagraph (A) to account for 

6 changes in the cost of health care based upon recognized 

7 health care market surveys and other available data. 

8 ‘‘(b) ELIGIBLE ENTITIES AND PROVIDERS.—For 

9 purposes of this section, an eligible entity or provider is— 

10 ‘‘(1) any provider of services that has enrolled 

11 and entered into a provider agreement under section 

12 1866(a) of the Social Security Act (42 U.S.C. 

13 1395cc(a)) and any physician or other supplier who 

14 has enrolled and entered into a participation agree15 ment under section 1842(h) of such Act (42 U.S.C. 

16 1395u(h)); 

17 ‘‘(2) any provider participating under a State 

18 plan under title XIX of such Act (42 U.S.C. 1396 

19 et seq.); 

20 ‘‘(3) an Aging and Disability Resource Center, 

21 an area agency on aging, or a State agency (as de22 fined in section 102 of the Older Americans Act of 

23 1965 (42 U.S.C. 3002)); 


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1 ‘‘(4) a center for independent living (as defined 

2 in section 702 of the Rehabilitation Act of 1973 (29 

3 U.S.C. 796a)); or 

4 ‘‘(5) any entity or provider not described in 

5 paragraph (1) or (2) that the Secretary determines 

6 to be eligible pursuant to the certification process 

7 described in subsection (c). 

8 ‘‘(c) ELIGIBLE ENTITY OR PROVIDER CERTIFI9 CATION PROCESS.—The Secretary shall establish by regu10 lation a process for the certification of eligible entities or 

11 providers or recertification of eligible entities or providers 

12 under this section. Such a process shall, at a minimum— 

13 ‘‘(1) establish deadlines for actions on applica14 tions for certification; 

15 ‘‘(2) set forth standards for an approval or de16 nial of certification, duration of certification, revoca17 tion of an eligible entity or provider’s certification, 

18 and recertification of eligible entities or providers; 

19 ‘‘(3) require the denial of certification if the 

20 Secretary determines the eligible entity or provider 

21 is excluded from participation in a Federal health 

22 care program under section 1128 or section 1128A 

23 of the Social Security Act (42 U.S.C. 1320a–7 or 

24 1320a–7a) or is currently identified as an excluded 

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1 sions list described in part 9 of title 48, Code of 

2 Federal Regulations, and part 180 of title 2 of such 

3 Code, or successor regulations; 

4 ‘‘(4) establish procedures for screening eligible 

5 entities or providers according to the risk of fraud, 

6 waste, and abuse that are similar to the standards 

7 under section 1866(j)(2)(B) of the Social Security 

8 Act (42 U.S.C. 1395cc(j)(2)(B)) and section 9.104 

9 of title 48, Code of Federal Regulations, or suc10 cessor regulations; and 

11 ‘‘(5) incorporate and apply the restrictions and 

12 penalties set forth in chapter 21 of title 41 and treat 

13 this section as a procurement program only for pur14 poses of applying such provisions. 

15 ‘‘(d) RATES.—To the extent practicable, the rates 

16 paid by the Secretary for hospital care, medical services, 

17 and extended care services provided under a Veterans 

18 Care Agreement shall be in accordance with the rates paid 

19 by the United States under section 1703(j) of this title. 

20 ‘‘(e) TERMS OF VETERANS CARE AGREEMENTS.—(1) 

21 Pursuant to regulations promulgated under subsection 

22 (k), the Secretary may define the requirements for pro23 viders and entities entering into agreements under this 

24 section based upon such factors as the number of patients 

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1 ployed by the entity or provider furnishing such care or 

2 services, the amount paid by the Secretary to the provider 

3 or entity, or other factors as determined by the Secretary. 

4 ‘‘(2) To furnish hospital care, medical services, or ex5 tended care services under this section, an eligible entity 

6 or provider shall agree— 

7 ‘‘(A) to accept payment at the rates established 

8 in regulations prescribed under this section; 

9 ‘‘(B) that payment by the Secretary under this 

10 section on behalf of a veteran to a provider of serv11 ices or care shall, unless rejected and refunded by 

12 the provider within 30 days of receipt, constitute 

13 payment in full and extinguish any liability on the 

14 part of the veteran for the treatment or care pro15 vided, and no provision of a contract, agreement, or 

16 assignment to the contrary shall operate to modify, 

17 limit, or negate this requirement; 

18 ‘‘(C) to provide only the care and services au19 thorized by the Department under this section and 

20 to obtain the prior written consent of the Depart21 ment to furnish care or services outside the scope of 

22 such authorization; 

23 ‘‘(D) to bill the Department in accordance with 

24 the methodology outlined in regulations prescribed 

25 under this section; 


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1 ‘‘(E) to not seek to recover or collect from a 

2 health plan contract or third party, as those terms 

3 are defined in section 1729 of this title, for any care 

4 or service that is furnished or paid for by the De5 partment; 

6 ‘‘(F) to provide medical records to the Depart7 ment in the time frame and format specified by the 

8 Department; and 

9 ‘‘(G) to meet such other terms and conditions, 

10 including quality of care assurance standards, as the 

11 Secretary may specify in regulation. 

12 ‘‘(f) DISCONTINUATION OR NONRENEWAL OF A VET13 ERANS CARE AGREEMENT.—(1) An eligible entity or pro14 vider may discontinue a Veterans Care Agreement at such 

15 time and upon such notice to the Secretary as may be 

16 provided in regulations prescribed under this section. 

17 ‘‘(2) The Secretary may discontinue a Veterans Care 

18 Agreement with an eligible entity or provider at such time 

19 and upon such reasonable notice to the eligible entity or 

20 provider as may be specified in regulations prescribed 

21 under this section, if an official designated by the Sec22 retary— 

23 ‘‘(A) has determined that the eligible entity or 

24 provider failed to comply substantially with the pro25 visions of the Veterans Care Agreement, or with the 


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1 provisions of this section or regulations prescribed 

2 under this section; 

3 ‘‘(B) has determined the eligible entity or pro4 vider is excluded from participation in a Federal 

5 health care program under section 1128 or section 

6 1128A of the Social Security Act (42 U.S.C. 1320a– 

7 7 or 1320a–7a) or is identified on the System for 

8 Award Management Exclusions list as provided in 

9 part 9 of title 48, Code of Federal Regulations, and 

10 part 180 of title 2 of such Code, or successor regula11 tions; 

12 ‘‘(C) has ascertained that the eligible entity or 

13 provider has been convicted of a felony or other seri14 ous offense under Federal or State law and deter15 mines the eligible entity or provider’s continued par16 ticipation would be detrimental to the best interests 

17 of veterans or the Department; or 

18 ‘‘(D) has determined that it is reasonable to 

19 terminate the agreement based on the health care 

20 needs of a veteran. 

21 ‘‘(g) QUALITY OF CARE.—The Secretary shall estab22 lish a system or systems for monitoring the quality of care 

23 provided to veterans through Veterans Care Agreements 

24 and for assessing the quality of hospital care, medical 

25 services, and extended care services furnished by eligible 


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1 entities and providers before the renewal of Veterans Care 

2 Agreements. 

3 ‘‘(h) DISPUTES.—(1) The Secretary shall promulgate 

4 administrative procedures for eligible entities and pro5 viders to present all disputes arising under or related to 

6 Veterans Care Agreements. 

7 ‘‘(2) Such procedures constitute the eligible entities’ 

8 and providers’ exhaustive and exclusive administrative 

9 remedies. 

10 ‘‘(3) Eligible entities or providers must first exhaust 

11 such administrative procedures before seeking any judicial 

12 review under section 1346 of title 28 (known as the ‘Tuck13 er Act’). 

14 ‘‘(4) Disputes under this section must pertain to ei15 ther the scope of authorization under the Veterans Care 

16 Agreement or claims for payment subject to the Veterans 

17 Care Agreement and are not claims for the purposes of 

18 such laws that would otherwise require application of sec19 tions 7101 through 7109 of title 41. 

20 ‘‘(i) APPLICABILITY OF OTHER PROVISIONS OF

21 LAW.—(1) A Veterans Care Agreement may be authorized 

22 by the Secretary or any Department official authorized by 

23 the Secretary, and such action shall not be treated as— 


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1 ‘‘(A) an award for the purposes of such laws 

2 that would otherwise require the use of competitive 

3 procedures for the furnishing of care and services; or 

4 ‘‘(B) a Federal contract for the acquisition of 

5 goods or services for purposes of any provision of 

6 Federal law governing Federal contracts for the ac7 quisition of goods or services except section 4706(d) 

8 of title 41. 

9 ‘‘(2)(A) Except as provided in the agreement itself, 

10 in subparagraph (B), and unless otherwise provided in this 

11 section or regulations prescribed pursuant to this section, 

12 an eligible entity or provider that enters into an agreement 

13 under this section is not subject to, in the carrying out 

14 of the agreement, any law to which providers of services 

15 and suppliers under the Medicare program under title 

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

17 are not subject. 

18 ‘‘(B) An eligible entity or provider that enters into 

19 an agreement under this section is subject to— 

20 ‘‘(i) all laws regarding integrity, ethics, or 

21 fraud, or that subject a person to civil or criminal 

22 penalties; and 

23 ‘‘(ii) all laws that protect against employment 

24 discrimination or that otherwise ensure equal em25 ployment opportunities. 


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1 ‘‘(3) Notwithstanding paragraph (2)(B)(i), an eligible 

2 entity or provider that enters into an agreement under this 

3 section shall not be treated as a Federal contractor or sub4 contractor for purposes of chapter 67 of title 41 (com5 monly known as the ‘McNamara-O’Hara Service Contract 

6 Act of 1965’). 

7 ‘‘(j) PARITY OF TREATMENT.—Eligibility for hospital 

8 care, medical services, and extended care services fur9 nished to any veteran pursuant to a Veterans Care Agree10 ment shall be subject to the same terms as though pro11 vided in a facility of the Department, and provisions of 

12 this chapter applicable to veterans receiving such care and 

13 services in a facility of the Department shall apply to vet14 erans treated under this section. 

15 ‘‘(k) RULEMAKING.—The Secretary shall promulgate 

16 regulations to carry out this section.’’. 

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

18 at the beginning of such chapter is amended by inserting 

19 after the item related to section 1703 the following new 

20 item: 

‘‘1703A. Agreements with eligible entities or providers; certification processes.’’. 

21 SEC. 103. CONFORMING AMENDMENTS FOR STATE VET22 ERANS HOMES. 

23 (a) IN GENERAL.—Section 1745(a) is amended— 


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1 (1) in paragraph (1), by striking ‘‘(or agree2 ment under section 1720(c)(1) of this title)’’ and in3 serting ‘‘(or an agreement)’’; and 

4 (2) by adding at the end the following new 

5 paragraph: 

6 ‘‘(4)(A) An agreement under this section may be au7 thorized by the Secretary or any Department official au8 thorized by the Secretary, and any such action is not an 

9 award for purposes of such laws that would otherwise re10 quire the use of competitive procedures for the furnishing 

11 of hospital care, medical services, and extended care serv12 ices. 

13 ‘‘(B)(i) Except as provided in the agreement itself, 

14 in clause (ii), and unless otherwise provided in this section 

15 or regulations prescribed pursuant to this section, a State 

16 home that enters into an agreement under this section is 

17 not subject to, in the carrying out of the agreement, any 

18 provision of law to which providers of services and sup19 pliers under the Medicare program under title XVIII of 

20 the Social Security Act (42 U.S.C. 1395 et seq.) are not 

21 subject. 

22 ‘‘(ii) A State home that enters into an agreement 

23 under this section is subject to— 


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1 ‘‘(I) all provisions of law regarding integrity, 

2 ethics, or fraud, or that subject a person to civil or 

3 criminal penalties; 

4 ‘‘(II) all provisions of law that protect against 

5 employment discrimination or that otherwise ensure 

6 equal employment opportunities; and 

7 ‘‘(III) all provisions in this subchapter. 

8 ‘‘(iii) Notwithstanding subparagraph (B)(ii)(I), a 

9 State home that enters into an agreement under this sec10 tion may not be treated as a Federal contractor or subcon11 tractor for purposes of chapter 67 of title 41 (known as 

12 the ‘McNamara-O’Hara Service Contract Act of 1965’).’’. 

13 (b) EFFECTIVE DATE.—The amendment made by 

14 subsection (a) shall apply to care provided on or after the 

15 effective date of regulations issued by the Secretary of 

16 Veterans Affairs to carry out this section. 

17 SEC. 104. ACCESS STANDARDS AND STANDARDS FOR QUAL18 ITY. 

19 (a) IN GENERAL.—Subchapter I of chapter 17, as 

20 amended by section 102, is further amended by inserting 

21 after section 1703A the following new sections: 

22 ‘‘§ 1703B. Access standards 

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

24 access standards for furnishing hospital care, medical 


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1 services, or extended care services to covered veterans for 

2 the purposes of section 1703(d) of this title. 

3 ‘‘(2) The Secretary shall ensure that the access 

4 standards established under paragraph (1) define such 

5 categories of care to cover all care and services within the 

6 medical benefits package of the Department. 

7 ‘‘(b) COMPARATIVE INFORMATION.—The Secretary 

8 shall ensure that the access standards established under 

9 paragraph (1) provide covered veterans, employees of the 

10 Department, and health care providers in the network es11 tablished under section 1703(i) of this title with relevant 

12 comparative information that is clear, useful, and timely, 

13 so that covered veterans can make informed decisions re14 garding their health care. 

15 ‘‘(c) CONSULTATION.—The Secretary shall consult 

16 with all pertinent Federal entities (including the Depart17 ment of Defense, the Department of Health and Human 

18 Services, and the Centers for Medicare & Medicaid Serv19 ices), entities in the private sector, and other nongovern20 mental entities in establishing access standards under this 

21 section. 

22 ‘‘(d) REPORT.—(1) Not later than 270 days after the 

23 date of the enactment of the Caring for Our Veterans Act 

24 of 2018, the Secretary shall submit to the appropriate 


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1 committees of Congress a report detailing the access 

2 standards established under this section. 

3 ‘‘(2)(A) Before submitting the report required under 

4 paragraph (1), the Secretary shall provide periodic up5 dates to the appropriate committees of Congress to con6 firm the Department’s progress towards developing the ac7 cess standards required by this section. 

8 ‘‘(B) The first update under subparagraph (A) shall 

9 occur not later than 120 days after the date of the enact10 ment of the Caring for Our Veterans Act of 2018. 

11 ‘‘(3) Not later than 540 days after the date on which 

12 the Secretary implements the access standards established 

13 under subsection (a), the Secretary shall submit to the ap14 propriate committees of Congress a report detailing the 

15 implementation of and compliance with such access stand16 ards by Department and non-Department entities or pro17 viders. 

18 ‘‘(e) REVIEW OF STANDARDS.—Not later than three 

19 years after the date on which the Secretary establishes ac20 cess standards under subsection (a) and not less fre21 quently than once every three years thereafter, the Sec22 retary shall— 

23 ‘‘(1) conduct a review of such standards; and 

24 ‘‘(2) submit to the appropriate committees of 

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1 tion to the access standards with respect to the re2 view conducted under paragraph (1). 

3 ‘‘(f) COMPLIANCE WITH STANDARDS.—The Sec4 retary shall ensure health care providers specified under 

5 section 1703(c) of this title are able to comply with the 

6 applicable access standards established by the Secretary. 

7 ‘‘(g) PUBLICATION OF STANDARDS.—The Secretary 

8 shall publish in the Federal Register and on an internet 

9 website of the Department the designated access stand10 ards established under this section for purposes of section 

11 1703(d)(1)(D) of this title. 

12 ‘‘(h) REQUEST FOR DETERMINATION OF ELIGI13 BILITY.—(1) Consistent with paragraphs (1)(D) and (3) 

14 of section 1703(d) of this title, covered veterans may con15 tact the Department at any time to request a determina16 tion regarding whether they are eligible to receive care and 

17 services from a non-Department entity or provider based 

18 on the Department being unable to furnish such care and 

19 services in a manner that complies with the designated 

20 access standards established under this section. 

21 ‘‘(2) The Secretary shall establish a process to review 

22 such requests from covered veterans to determine wheth23 er— 

24 ‘‘(A) the requested care is clinically necessary; 

25 and 


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1 ‘‘(B) the Department is able to provide such 

2 care in a manner that complies with designated ac3 cess standards established under this section. 

4 ‘‘(3) The Secretary shall promptly respond to any 

5 such request by a covered veteran. 

6 ‘‘(i) DEFINITIONS.—In this section: 

7 ‘‘(1) The term ‘appropriate committees of Con8 gress’ means— 

9 ‘‘(A) the Committee on Veterans’ Affairs 

10 and the Committee on Appropriations of the 

11 Senate; and 

12 ‘‘(B) the Committee on Veterans’ Affairs 

13 and the Committee on Appropriations of the 

14 House of Representatives. 

15 ‘‘(2) The term ‘covered veterans’ means vet16 erans described in section 1703(b) of this title. 

17 ‘‘§ 1703C. Standards for quality 

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

19 standards for quality regarding hospital care, medical 

20 services, and extended care services furnished by the De21 partment pursuant to this title, including through non-De22 partment health care providers pursuant to section 1703 

23 of this title. 

24 ‘‘(2) In establishing standards for quality under para25 graph (1), the Secretary shall consider existing health 


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1 quality measures that are applied to public and privately 

2 sponsored health care systems with the purpose of pro3 viding covered veterans relevant comparative information 

4 to make informed decisions regarding their health care. 

5 ‘‘(3) The Secretary shall collect and consider data for 

6 purposes of establishing the standards under paragraph 

7 (1). Such data collection shall include— 

8 ‘‘(A) after consultation with veterans service or9 ganizations and other key stakeholders on survey de10 velopment or modification of an existing survey, a 

11 survey of veterans who have used hospital care, med12 ical services, or extended care services furnished by 

13 the Veterans Health Administration during the most 

14 recent two-year period to assess the satisfaction of 

15 the veterans with service and quality of care; and 

16 ‘‘(B) datasets that include, at a minimum, ele17 ments relating to the following: 

18 ‘‘(i) Timely care. 

19 ‘‘(ii) Effective care. 

20 ‘‘(iii) Safety, including, at a minimum, 

21 complications, readmissions, and deaths. 

22 ‘‘(iv) Efficiency. 

23 ‘‘(4) The Secretary shall consult with all pertinent 

24 Federal entities (including the Department of Defense, the 

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1 ters for Medicare & Medicaid Services), entities in the pri2 vate sector, and other nongovernmental entities in estab3 lishing standards for quality under this section. 

4 ‘‘(5)(A) Not later than 270 days after the date of 

5 the enactment of the Caring for Our Veterans Act of 

6 2018, the Secretary shall submit to the appropriate com7 mittees of Congress a report detailing the standards for 

8 quality established under this section. 

9 ‘‘(B)(i) Before submitting the report required under 

10 subparagraph (A), the Secretary shall provide periodic up11 dates to the appropriate committees of Congress to con12 firm the Department’s progress towards developing the 

13 standards for quality required by this section. 

14 ‘‘(ii) The first update under clause (i) shall occur not 

15 later than 120 days after the date of the enactment of 

16 the Caring for Our Veterans Act of 2018. 

17 ‘‘(b) PUBLICATION AND CONSIDERATION OF PUBLIC

18 COMMENTS.—(1) Not later than one year after the date 

19 on which the Secretary establishes standards for quality 

20 under subsection (a), the Secretary shall publish the qual21 ity rating of medical facilities of the Department in the 

22 publicly available Hospital Compare website through the 

23 Centers for Medicare & Medicaid Services for the purpose 

24 of providing veterans with information that allows them 


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1 to compare performance measure information among De2 partment and non-Department health care providers. 

3 ‘‘(2) Not later than two years after the date on which 

4 the Secretary establishes standards for quality under sub5 section (a), the Secretary shall consider and solicit public 

6 comment on potential changes to the measures used in 

7 such standards to ensure that they include the most up8 to-date and applicable industry measures for veterans. 

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

10 ‘‘(1) The term ‘appropriate committees of Con11 gress’ means— 

12 ‘‘(A) the Committee on Veterans’ Affairs 

13 and the Committee on Appropriations of the 

14 Senate; and 

15 ‘‘(B) the Committee on Veterans’ Affairs 

16 and the Committee on Appropriations of the 

17 House of Representatives. 

18 ‘‘(2) The term ‘covered veterans’ means vet19 erans described in section 1703(b) of this title.’’. 

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

21 at the beginning of chapter 17, as amended by section 

22 102, is further amended by inserting after the item relat23 ing to section 1703A the following new items: 

‘‘1703B. Access standards. 

‘‘1703C. Standards for quality.’’. 


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1 SEC. 105. ACCESS TO WALK-IN CARE. 

2 (a) IN GENERAL.—Chapter 17 is amended by insert3 ing after section 1725 the following new section: 

4 ‘‘§ 1725A. Access to walk-in care 

5 ‘‘(a) PROCEDURES TO ENSURE ACCESS TO WALK6 IN CARE.—The Secretary shall develop procedures to en7 sure that eligible veterans are able to access walk-in care 

8 from qualifying non-Department entities or providers. 

9 ‘‘(b) ELIGIBLE VETERANS.—For purposes of this 

10 section, an eligible veteran is any individual who— 

11 ‘‘(1) is enrolled in the health care system estab12 lished under section 1705(a) of this title; and 

13 ‘‘(2) has received care under this chapter within 

14 the 24-month period preceding the furnishing of 

15 walk-in care under this section. 

16 ‘‘(c) QUALIFYING NON-DEPARTMENT ENTITIES OR

17 PROVIDERS.—For purposes of this section, a qualifying 

18 non-Department entity or provider is a non-Department 

19 entity or provider that has entered into a contract or other 

20 agreement with the Secretary to furnish services under 

21 this section. 

22 ‘‘(d) FEDERALLY-QUALIFIED HEALTH CENTERS.— 

23 Whenever practicable, the Secretary may use a Federally24 qualified health center (as defined in section 1905(l)(2)(B) 

25 of the Social Security Act (42 U.S.C. 1396d(l)(2)(B))) to 

26 carry out this section. 


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1 ‘‘(e) CONTINUITY OF CARE.—The Secretary shall en2 sure continuity of care for those eligible veterans who re3 ceive walk-in care services under this section, including 

4 through the establishment of a mechanism to receive med5 ical records from walk-in care providers and provide perti6 nent patient medical records to providers of walk-in care. 

7 ‘‘(f) FREQUENCY; COPAYMENTS.—(1) An eligible vet8 eran may only access walk-in care under this section for 

9 not more than two episodes of hospital care or medical 

10 services per year. 

11 ‘‘(2)(A) The Secretary may require an eligible vet12 eran to pay the United States a copayment for each epi13 sode of hospital care or medical services provided under 

14 this section if the eligible veteran would be required to 

15 pay a copayment under this title. 

16 ‘‘(B) An eligible veteran not required to pay a copay17 ment under this title may access walk-in care without a 

18 copayment. 

19 ‘‘(C) The amount of the copayments required under 

20 this paragraph shall be prescribed by the Secretary by 

21 rule. 

22 ‘‘(3) Section 8153(c) of this title shall not apply to 

23 this subsection. 

24 ‘‘(g) REGULATIONS.—Not later than one year after 

25 the date of the enactment of the Caring for Our Veterans 


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1 Act of 2018, the Secretary shall promulgate regulations 

2 to carry out this section. 

3 ‘‘(h) WALK-IN CARE DEFINED.—In this section, the 

4 term ‘walk-in care’ means non-emergent care provided by 

5 a qualifying non-Department entity or provider that fur6 nishes episodic care and not longitudinal management of 

7 conditions and is otherwise defined through regulations 

8 the Secretary shall promulgate.’’. 

9 (b) EFFECTIVE DATE.—Section 1725A of title 38, 

10 United States Code, as added by subsection (a), shall take 

11 effect on the date upon which final regulations imple12 menting such section take effect. 

13 (c) CLERICAL AMENDMENT.—The table of sections 

14 at the beginning of such chapter is amended by inserting 

15 after the item related to section 1725 the following new 

16 item: 

‘‘§1725A. Access to walk-in care.’’. 

17 SEC. 106. STRATEGY REGARDING THE DEPARTMENT OF 

18 VETERANS AFFAIRS HIGH-PERFORMING IN19 TEGRATED HEALTH CARE NETWORK. 

20 (a) IN GENERAL.—Subchapter II of chapter 73 is 

21 amended by inserting after section 7330B the following 

22 new section: 


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1 ‘‘§ 7330C. Quadrennial Veterans Health Administra2 tion review 

3 ‘‘(a) MARKET AREA ASSESSMENTS.—(1) Not less 

4 frequently than every four years, the Secretary shall per5 form market area assessments regarding the health care 

6 services furnished under the laws administered by the Sec7 retary. 

8 ‘‘(2) Each market area assessment established under 

9 paragraph (1) shall include the following: 

10 ‘‘(A) An assessment of the demand for health 

11 care from the Department, disaggregated by geo12 graphic market areas as determined by the Sec13 retary, including the number of requests for health 

14 care services under the laws administered by the 

15 Secretary. 

16 ‘‘(B) An inventory of the health care capacity 

17 of the Department across the Department’s system 

18 of facilities. 

19 ‘‘(C) An assessment of the health care capacity 

20 to be provided through contracted community care 

21 providers and providers who entered into a provider 

22 agreement with the Department under section 

23 1703A of this title, including the number of pro24 viders, the geographic location of the providers, and 

25 categories or types of health care services provided 

26 by the providers. 


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1 ‘‘(D) An assessment obtained from other Fed2 eral direct delivery systems of their capacity to pro3 vide health care to veterans. 

4 ‘‘(E) An assessment of the health care capacity 

5 of non-contracted providers where there is insuffi6 cient network supply. 

7 ‘‘(F) An assessment of the health care capacity 

8 of academic affiliates and other collaborations of the 

9 Department as it relates to providing health care to 

10 veterans. 

11 ‘‘(G) An assessment of the effects on health 

12 care capacity of the access standards and standards 

13 for quality established under sections 1703B and 

14 1703C of this title. 

15 ‘‘(H) The number of appointments for health 

16 care services under the laws administered by the 

17 Secretary, disaggregated by— 

18 ‘‘(i) appointments at facilities of the De19 partment; and 

20 ‘‘(ii) appointments with non-Department 

21 health care providers. 

22 ‘‘(3)(A) The Secretary shall submit to the appro23 priate committees of Congress the market area assess24 ments established in paragraph (1). 


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1 ‘‘(B) The Secretary also shall submit to the appro2 priate committees of Congress the market area assess3 ments completed by or being performed on the day before 

4 the date of the enactment of the Caring for Our Veterans 

5 Act of 2018. 

6 ‘‘(4)(A) The Secretary shall use the market area as7 sessments established under paragraph (1) to— 

8 ‘‘(i) determine the capacity of the health care 

9 provider networks established under section 1703(i) 

10 of this title; 

11 ‘‘(ii) inform the Department budget, in accord12 ance with subparagraph (B); and 

13 ‘‘(iii) inform and assess the appropriateness of 

14 the access standards established under section 

15 1703B of this title and standards for quality under 

16 section 1703C and to make recommendations for 

17 any changes to such standards. 

18 ‘‘(B) The Secretary shall ensure that the Department 

19 budget for any fiscal year (as submitted with the budget 

20 of the President under section 1105(a) of title 31) reflects 

21 the findings of the Secretary with respect to the most re22 cent market area assessments under paragraph (1) and 

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1 ices to covered veterans as described in section 1703(b) 

2 of this title. 

3 ‘‘(b) STRATEGIC PLAN TO MEET HEALTH CARE DE4 MAND.—(1) Not later than one year after the date of the 

5 enactment of the Caring for Our Veterans Act of 2018, 

6 and not less frequently than once every four years there7 after, the Secretary shall submit to the appropriate com8 mittees of Congress a strategic plan that specifies a four9 year forecast of— 

10 ‘‘(A) the demand for health care from the De11 partment, disaggregated by geographic area as de12 termined by the Secretary; 

13 ‘‘(B) the health care capacity to be provided at 

14 each medical center of the Department; and 

15 ‘‘(C) the health care capacity to be provided 

16 through community care providers. 

17 ‘‘(2) In preparing the strategic plan under paragraph 

18 (1), the Secretary shall— 

19 ‘‘(A) assess the access standards and standards 

20 for quality established under sections 1703B and 

21 1703C of this title; 

22 ‘‘(B) assess the market area assessments estab23 lished under subsection (a); 

24 ‘‘(C) assess the needs of the Department based 

25 on identified services that provide management of 


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1 conditions or disorders related to military service for 

2 which there is limited experience or access in the na3 tional market, the overall health of veterans 

4 throughout their lifespan, or other services as the 

5 Secretary determines appropriate; 

6 ‘‘(D) consult with key stakeholders within the 

7 Department, the heads of other Federal agencies, 

8 and other relevant governmental and nongovern9 mental entities, including State, local, and tribal 

10 government officials, members of Congress, veterans 

11 service organizations, private sector representatives, 

12 academics, and other policy experts; 

13 ‘‘(E) identify emerging issues, trends, problems, 

14 and opportunities that could affect health care serv15 ices furnished under the laws administered by the 

16 Secretary; 

17 ‘‘(F) develop recommendations regarding both 

18 short- and long-term priorities for health care serv19 ices furnished under the laws administered by the 

20 Secretary; 

21 ‘‘(G) after consultation with veterans service or22 ganizations and other key stakeholders on survey de23 velopment or modification of an existing survey, con24 sider a survey of veterans who have used hospital 

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1 nished by the Veterans Health Administration dur2 ing the most recent two-year period to assess the 

3 satisfaction of the veterans with service and quality 

4 of care; 

5 ‘‘(H) conduct a comprehensive examination of 

6 programs and policies of the Department regarding 

7 the delivery of health care services and the demand 

8 of health care services for veterans in future years; 

9 ‘‘(I) assess the remediation of medical service 

10 lines of the Department as described in section 

11 1706A of this title in conjunction with the utilization 

12 of non-Department entities or providers to offset re13 mediation; and 

14 ‘‘(J) consider such other matters as the Sec15 retary considers appropriate. 

16 ‘‘(c) RESPONSIBILITIES.—The Secretary shall be re17 sponsible for— 

18 ‘‘(1) overseeing the transformation and organi19 zational change across the Department to achieve a 

20 high-performing integrated health care network; 

21 ‘‘(2) developing the capital infrastructure plan22 ning and procurement processes, whether minor or 

23 major construction projects or leases; and 

24 ‘‘(3) developing a multi-year budget process 

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1 quirements and projecting the cost of delivering 

2 health care services under such a high-performing 

3 integrated health care network. 

4 ‘‘(d) APPROPRIATE COMMITTEES OF CONGRESS DE5 FINED.—In this section, the term ‘appropriate committees 

6 of Congress’ means— 

7 ‘‘(1) the Committee on Veterans’ Affairs and 

8 the Committee on Appropriations of the Senate; and 

9 ‘‘(2) the Committee on Veterans’ Affairs and 

10 the Committee on Appropriations of the House of 

11 Representatives.’’. 

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

13 at the beginning of such chapter is amended by inserting 

14 after the item related to section 7330B the following new 

15 item: 

‘‘7330C. Quadrennial Veterans Health Administration review.’’. 

16 SEC. 107. APPLICABILITY OF DIRECTIVE OF OFFICE OF 

17 FEDERAL CONTRACT COMPLIANCE PRO18 GRAMS. 

19 (a) IN GENERAL.—Notwithstanding the treatment of 

20 certain laws under subsection (i) of section 1703A of title 

21 38, United States Code, as added by section 102 of this 

22 Act, Directive 2014–01 of the Office of Federal Contract 

23 Compliance Programs of the Department of Labor (effec24 tive as of May 7, 2014) shall apply to any entity entering 

25 into an agreement under such section 1703A or section 


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1 1745 of such title, as amended by section 103 of this Act, 

2 in the same manner as such directive applies to sub3 contractors under the TRICARE program for the dura4 tion of the moratorium provided under such directive. 

5 (b) APPLICABILITY PERIOD.—The directive described 

6 in subsection (a), and the moratorium provided under such 

7 directive, shall not be altered or rescinded before May 7, 

8 2019. 

9 (c) TRICARE PROGRAM DEFINED.—In this section, 

10 the term ‘‘TRICARE program’’ has the meaning given 

11 that term in section 1072 of title 10, United States Code. 

12 SEC. 108. PREVENTION OF CERTAIN HEALTH CARE PRO13 VIDERS FROM PROVIDING NON-DEPARTMENT 

14 HEALTH CARE SERVICES TO VETERANS. 

15 (a) IN GENERAL.—On and after the date that is one 

16 year after the date of the enactment of this Act, the Sec17 retary of Veterans Affairs shall deny or revoke the eligi18 bility of a health care provider to provide non-Department 

19 health care services to veterans if the Secretary determines 

20 that the health care provider— 

21 (1) was removed from employment with the De22 partment of Veterans Affairs due to conduct that 

23 violated a policy of the Department relating to the 

24 delivery of safe and appropriate health care; or 


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1 (2) violated the requirements of a medical li2 cense of the health care provider that resulted in the 

3 loss of such medical license. 

4 (b) PERMISSIVE ACTION.—On and after the date that 

5 is one year after the date of the enactment of this Act, 

6 the Secretary may deny, revoke, or suspend the eligibility 

7 of a health care provider to provide non-Department 

8 health care services if the Secretary determines such ac9 tion is necessary to immediately protect the health, safety, 

10 or welfare of veterans and the health care provider is 

11 under investigation by the medical licensing board of a 

12 State in which the health care provider is licensed or prac13 tices. 

14 (c) SUSPENSION.—The Secretary shall suspend the 

15 eligibility of a health care provider to provide non-Depart16 ment health care services to veterans if the health care 

17 provider is suspended from serving as a health care pro18 vider of the Department. 

19 (d) COMPTROLLER GENERAL REPORT.—Not later 

20 than two years after the date of the enactment of this Act, 

21 the Comptroller General of the United States shall submit 

22 to Congress a report on the implementation by the Sec23 retary of this section, including the following: 

24 (1) The aggregate number of health care pro25 viders denied or suspended under this section from 


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1 participation in providing non-Department health 

2 care services. 

3 (2) An evaluation of any impact on access to 

4 health care for patients or staffing shortages in pro5 grams of the Department providing non-Department 

6 health care services. 

7 (3) An explanation of the coordination of the 

8 Department with the medical licensing boards of 

9 States in implementing this section, the amount of 

10 involvement of such boards in such implementation, 

11 and efforts by the Department to address any con12 cerns raised by such boards with respect to such im13 plementation. 

14 (4) Such recommendations as the Comptroller 

15 General considers appropriate regarding harmo16 nizing eligibility criteria between health care pro17 viders of the Department and health care providers 

18 eligible to provide non-Department health care serv19 ices. 

20 (e) NON-DEPARTMENT HEALTH CARE SERVICES

21 DEFINED.—In this section, the term ‘‘non-Department 

22 health care services’’ means services— 

23 (1) provided under subchapter I of chapter 17 

24 of title 38, United States Code, at non-Department 

25 facilities (as defined in section 1701 of such title); 


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1 (2) provided under section 101 of the Veterans 

2 Access, Choice, and Accountability Act of 2014 

3 (Public Law 113–146; 38 U.S.C. 1701 note); 

4 (3) purchased through the Medical Community 

5 Care account of the Department; or 

6 (4) purchased with amounts deposited in the 

7 Veterans Choice Fund under section 802 of the Vet8 erans Access, Choice, and Accountability Act of 

9 2014. 

10 SEC. 109. REMEDIATION OF MEDICAL SERVICE LINES. 

11 (a) IN GENERAL.—Subchapter I of chapter 17 is 

12 amended by inserting after section 1706 the following new 

13 section: 

14 ‘‘§ 1706A. Remediation of medical service lines 

15 ‘‘(a) IN GENERAL.—Not later than 30 days after de16 termining under section 1703(e)(1) of this title that a 

17 medical service line of the Department is providing hos18 pital care, medical services, or extended care services that 

19 does not comply with the standards for quality established 

20 by the Secretary, the Secretary shall submit to Congress 

21 an assessment of the factors that led the Secretary to 

22 make such determination and a plan with specific actions, 

23 and the time to complete them, to be taken to comply with 

24 such standards for quality, including the following: 


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1 ‘‘(1) Increasing personnel or temporary per2 sonnel assistance, including mobile deployment 

3 teams. 

4 ‘‘(2) Special hiring incentives, including the 

5 Education Debt Reduction Program under sub6 chapter VII of chapter 76 of this title and recruit7 ment, relocation, and retention incentives. 

8 ‘‘(3) Utilizing direct hiring authority. 

9 ‘‘(4) Providing improved training opportunities 

10 for staff. 

11 ‘‘(5) Acquiring improved equipment. 

12 ‘‘(6) Making structural modifications to the fa13 cility used by the medical service line. 

14 ‘‘(7) Such other actions as the Secretary con15 siders appropriate. 

16 ‘‘(b) RESPONSIBLE PARTIES.—In each assessment 

17 submitted under subsection (a) with respect to a medical 

18 service line, the Secretary shall identify the individuals at 

19 the Central Office of the Veterans Health Administration, 

20 the facility used by the medical service line, and the cen21 tral office of the relevant Veterans Integrated Service Net22 work who are responsible for overseeing the progress of 

23 that medical service line in complying with the standards 

24 for quality established by the Secretary. 


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1 ‘‘(c) INTERIM REPORTS.—Not later than 180 days 

2 after submitting an assessment under subsection (a) with 

3 respect to a medical service line, the Secretary shall sub4 mit to Congress a report on the progress of that medical 

5 service line in complying with the standards for quality 

6 established by the Secretary and any other measures the 

7 Secretary will take to assist the medical service line in 

8 complying with such standards for quality. 

9 ‘‘(d) ANNUAL REPORTS.—Not less frequently than 

10 once each year, the Secretary shall— 

11 ‘‘(1) submit to Congress an analysis of the re12 mediation actions and costs of such actions taken 

13 with respect to each medical service line with respect 

14 to which the Secretary submitted an assessment and 

15 plan under subsection (a) in the preceding year, in16 cluding an update on the progress of each such med17 ical service line in complying with the standards for 

18 quality and timeliness established by the Secretary 

19 and any other actions the Secretary is undertaking 

20 to assist the medical service line in complying with 

21 standards for quality as established by the Sec22 retary; and 

23 ‘‘(2) publish such analysis on the internet 

24 website of the Department.’’. 


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

2 at the beginning of such chapter is amended by inserting 

3 after the item related to section 1706 the following new 

4 item: 

‘‘1706A. Remediation of medical service lines.’’. 

5 CHAPTER 2—PAYING PROVIDERS AND 

6 IMPROVING COLLECTIONS 

7 SEC. 111. PROMPT PAYMENT TO PROVIDERS. 

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

9 amended by inserting after section 1703C, as added by 

10 section 104 of this Act, the following new section: 

11 ‘‘§ 1703D. Prompt payment standard 

12 ‘‘(a) IN GENERAL.—(1) Notwithstanding any other 

13 provision of this title or any other provision of law, the 

14 Secretary shall pay for hospital care, medical services, or 

15 extended care services furnished by health care entities or 

16 providers under this chapter within 45 calendar days upon 

17 receipt of a clean paper claim or 30 calendar days upon 

18 receipt of a clean electronic claim. 

19 ‘‘(2) If a claim is denied, the Secretary shall, within 

20 45 calendar days of denial for a paper claim and 30 cal21 endar days of denial for an electronic claim, notify the 

22 health care entity or provider of the reason for denying 

23 the claim and what, if any, additional information is re24 quired to process the claim. 


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1 ‘‘(3) Upon the receipt of the additional information, 

2 the Secretary shall ensure that the claim is paid, denied, 

3 or otherwise adjudicated within 30 calendar days from the 

4 receipt of the requested information. 

5 ‘‘(4) This section shall only apply to payments made 

6 on an invoice basis and shall not apply to capitation or 

7 other forms of periodic payment to entities or providers. 

8 ‘‘(b) SUBMITTAL OF CLAIMS BY HEALTH CARE EN9 TITIES AND PROVIDERS.—A health care entity or provider 

10 that furnishes hospital care, a medical service, or an ex11 tended care service under this chapter shall submit to the 

12 Secretary a claim for payment for furnishing the hospital 

13 care, medical service, or extended care service not later 

14 than 180 days after the date on which the entity or pro15 vider furnished the hospital care, medical service, or ex16 tended care service. 

17 ‘‘(c) FRAUDULENT CLAIMS.—(1) Sections 3729 

18 through 3733 of title 31 shall apply to fraudulent claims 

19 for payment submitted to the Secretary by a health care 

20 entity or provider under this chapter. 

21 ‘‘(2) Pursuant to regulations prescribed by the Sec22 retary, the Secretary shall bar a health care entity or pro23 vider from furnishing hospital care, medical services, and 

24 extended care services under this chapter when the Sec25 retary determines the entity or provider has submitted to 


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1 the Secretary fraudulent health care claims for payment 

2 by the Secretary. 

3 ‘‘(d) OVERDUE CLAIMS.—(1) Any claim that has not 

4 been denied with notice, made pending with notice, or paid 

5 to the health care entity or provider by the Secretary shall 

6 be overdue if the notice or payment is not received by the 

7 entity provider within the time periods specified in sub8 section (a). 

9 ‘‘(2)(A) If a claim is overdue under this subsection, 

10 the Secretary may, under the requirements established by 

11 subsection (a) and consistent with the provisions of chap12 ter 39 of title 31 (commonly referred to as the ‘Prompt 

13 Payment Act’), require that interest be paid on clean 

14 claims. 

15 ‘‘(B) Interest paid under subparagraph (A) shall be 

16 computed at the rate of interest established by the Sec17 retary of the Treasury under section 3902 of title 31 and 

18 published in the Federal Register. 

19 ‘‘(3) Not less frequently than annually, the Secretary 

20 shall submit to Congress a report on payment of overdue 

21 claims under this subsection, disaggregated by paper and 

22 electronic claims, that includes the following: 

23 ‘‘(A) The amount paid in overdue claims de24 scribed in this subsection, disaggregated by the 


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1 amount of the overdue claim and the amount of in2 terest paid on such overdue claim. 

3 ‘‘(B) The number of such overdue claims and 

4 the average number of days late each claim was 

5 paid, disaggregated by facility of the Department 

6 and Veterans Integrated Service Network region. 

7 ‘‘(e) OVERPAYMENT.—(1) The Secretary shall deduct 

8 the amount of any overpayment from payments due a 

9 health care entity or provider under this chapter. 

10 ‘‘(2) Deductions may not be made under this sub11 section unless the Secretary has made reasonable efforts 

12 to notify a health care entity or provider of the right to 

13 dispute the existence or amount of such indebtedness and 

14 the right to request a compromise of such indebtedness. 

15 ‘‘(3) The Secretary shall make a determination with 

16 respect to any such dispute or request prior to deducting 

17 any overpayment unless the time required to make such 

18 a determination before making any deductions would jeop19 ardize the Secretary’s ability to recover the full amount 

20 of such indebtedness. 

21 ‘‘(f) INFORMATION AND DOCUMENTATION RE22 QUIRED.—(1) The Secretary shall provide to all health 

23 care entities and providers participating in a program to 

24 furnish hospital care, medical services, or extended care 

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1 mentation that is required to establish a clean claim under 

2 this section. 

3 ‘‘(2) The Secretary shall consult with entities in the 

4 health care industry, in the public and private sector, to 

5 determine the information and documentation to include 

6 in the list under paragraph (1). 

7 ‘‘(3) If the Secretary modifies the information and 

8 documentation included in the list under paragraph (1), 

9 the Secretary shall notify all health care entities and pro10 viders described in paragraph (1) not later than 30 days 

11 before such modifications take effect. 

12 ‘‘(g) PROCESSING OF CLAIMS.—(1) In processing a 

13 claim for compensation for hospital care, medical services, 

14 or extended care services furnished by a non-Department 

15 health care entity or provider under this chapter, the Sec16 retary may act through— 

17 ‘‘(A) a non-Department entity that is under 

18 contract or agreement for the program established 

19 under section 1703(a) of this title; or 

20 ‘‘(B) a non-Department entity that specializes 

21 in such processing for other Federal agency health 

22 care systems. 

23 ‘‘(2) The Secretary shall seek to contract with a third 

24 party to conduct a review of claims described in paragraph 

25 (3) that includes— 


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1 ‘‘(A) a feasibility assessment to determine the 

2 capacity of the Department to process such claims 

3 in a timely manner; and 

4 ‘‘(B) a cost benefit analysis comparing the ca5 pacity of the Department to a third party entity ca6 pable of processing such claims. 

7 ‘‘(3) The review required under paragraph (2) shall 

8 apply to claims for hospital care, medical services, or ex9 tended care services furnished under section 1703 of this 

10 title that are processed by the Department. 

11 ‘‘(h) REPORT ON ENCOUNTER DATA SYSTEM.—(1) 

12 Not later than 90 days after the date of the enactment 

13 of the Caring for Our Veterans Act of 2018, the Secretary 

14 shall submit to the appropriate committees of Congress 

15 a report on the feasibility and advisability of adopting a 

16 funding mechanism similar to what is utilized by other 

17 Federal agencies to allow a contracted entity to act as a 

18 fiscal intermediary for the Federal Government to dis19 tribute, or pass through, Federal Government funds for 

20 certain non-underwritten hospital care, medical services, 

21 or extended care services. 

22 ‘‘(2) The Secretary may coordinate with the Depart23 ment of Defense, the Department of Health and Human 

24 Services, and the Department of the Treasury in devel25 oping the report required by paragraph (1). 


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1 ‘‘(i) DEFINITIONS.—In this section: 

2 ‘‘(1) The term ‘appropriate committees of Con3 gress’ means— 

4 ‘‘(A) the Committee on Veterans’ Affairs 

5 and the Committee on Appropriations of the 

6 Senate; and 

7 ‘‘(B) the Committee on Veterans’ Affairs 

8 and the Committee on Appropriations of the 

9 House of Representatives. 

10 ‘‘(2) The term ‘clean electronic claim’ means 

11 the transmission of data for purposes of payment of 

12 covered health care expenses that is submitted to the 

13 Secretary which contains substantially all of the re14 quired data elements necessary for accurate adju15 dication, without obtaining additional information 

16 from the entity or provider that furnished the care 

17 or service, submitted in such format as prescribed by 

18 the Secretary in regulations for the purpose of pay19 ing claims for care or services. 

20 ‘‘(3) The term ‘clean paper claim’ means a 

21 paper claim for payment of covered health care ex22 penses that is submitted to the Secretary which con23 tains substantially all of the required data elements 

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1 vider that furnished the care or service, submitted in 

2 such format as prescribed by the Secretary in regu3 lations for the purpose of paying claims for care or 

4 services. 

5 ‘‘(4) The term ‘fraudulent claims’ means the 

6 knowing misrepresentation of a material fact or 

7 facts by a health care entity or provider made to in8 duce the Secretary to pay a claim that was not le9 gally payable to that provider. 

10 ‘‘(5) The term ‘health care entity or provider’ 

11 includes any non-Department health care entity or 

12 provider, but does not include any Federal health 

13 care entity or provider.’’. 

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

15 at the beginning of such chapter is amended by inserting 

16 after the item related to section 1703C, as added by sec17 tion 104 of this title, the following new item: 

‘‘1703D. Prompt payment standard.’’. 

18 SEC. 112. AUTHORITY TO PAY FOR AUTHORIZED CARE NOT 

19 SUBJECT TO AN AGREEMENT. 

20 (a) IN GENERAL.—Subchapter IV of chapter 81 is 

21 amended by adding at the end the following new section: 

22 ‘‘§ 8159. Authority to pay for services authorized but 

23 not subject to an agreement 

24 ‘‘(a) IN GENERAL.—If, in the course of furnishing 

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1 ice authorized by the Secretary and pursuant to a con2 tract, agreement, or other arrangement with the Sec3 retary, a provider who is not a party to the contract, 

4 agreement, or other arrangement furnishes hospital care, 

5 a medical service, or an extended care service that the Sec6 retary considers necessary, the Secretary may compensate 

7 the provider for the cost of such care or service. 

8 ‘‘(b) NEW CONTRACTS AND AGREEMENTS.—The 

9 Secretary shall take reasonable efforts to enter into a con10 tract, agreement, or other arrangement with a provider 

11 described in subsection (a) to ensure that future care and 

12 services authorized by the Secretary and furnished by the 

13 provider are subject to such a contract, agreement, or 

14 other arrangement.’’. 

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

16 at the beginning of such chapter is amended by inserting 

17 after the item relating to section 8158 the following new 

18 item: 

‘‘8159. Authority to pay for services authorized but not subject to an agreement.’’. 

19 SEC. 113. IMPROVEMENT OF AUTHORITY TO RECOVER THE 

20 COST OF SERVICES FURNISHED FOR NON21 SERVICE-CONNECTED DISABILITIES. 

22 (a) BROADENING SCOPE OF APPLICABILITY.—Sec23 tion 1729 is amended— 

24 (1) in subsection (a)— 


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1 (A) in paragraph (2)(A)— 

2 (i) by striking ‘‘the veteran’s’’ and in3 serting ‘‘the individual’s’’; and 

4 (ii) by striking ‘‘the veteran’’ and in5 serting ‘‘the individual’’; and 

6 (B) in paragraph (3)— 

7 (i) in the matter preceding subpara8 graph (A), by striking ‘‘the veteran’’ and 

9 inserting ‘‘the individual’’; and 

10 (ii) in subparagraph (A), by striking 

11 ‘‘the veteran’s’’ and inserting ‘‘the individ12 ual’s’’; 

13 (2) in subsection (b)— 

14 (A) in paragraph (1)— 

15 (i) by striking ‘‘the veteran’’ and in16 serting ‘‘the individual’’; and 

17 (ii) by striking ‘‘the veteran’s’’ and in18 serting ‘‘the individual’s’’; and 

19 (B) in paragraph (2)— 

20 (i) in subparagraph (A)— 

21 (I) by striking ‘‘the veteran’’ and 

22 inserting ‘‘the individual’’; and 

23 (II) by striking ‘‘the veteran’s’’ 

24 and inserting ‘‘the individual’s’’; and 

25 (ii) in subparagraph (B)— 


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1 (I) in clause (i), by striking ‘‘the 

2 veteran’’ and inserting ‘‘the indi3 vidual’’; and 

4 (II) in clause (ii)— 

5 (aa) by striking ‘‘the vet6 eran’’ and inserting ‘‘the indi7 vidual’’; and 

8 (bb) by striking ‘‘the vet9 eran’s’’ each place it appears and 

10 inserting ‘‘the individual’s’’; 

11 (3) in subsection (e), by striking ‘‘A veteran’’ 

12 and inserting ‘‘An individual’’; and 

13 (4) in subsection (h)— 

14 (A) in paragraph (1)— 

15 (i) in the matter preceding subpara16 graph (A), by striking ‘‘a veteran’’ and in17 serting ‘‘an individual’’; 

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

19 ‘‘the veteran’’ and inserting ‘‘the indi20 vidual’’; and 

21 (iii) in subparagraph (B), by striking 

22 ‘‘the veteran’’ and inserting ‘‘the indi23 vidual’’; and 

24 (B) in paragraph (2)— 


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1 (i) by striking ‘‘A veteran’’ and insert2 ing ‘‘An individual’’; 

3 (ii) by striking ‘‘a veteran’’ and in4 serting ‘‘an individual’’; and 

5 (iii) by striking ‘‘the veteran’’ and in6 serting ‘‘the individual’’. 

7 (b) MODIFICATION OF AUTHORITY.—Subsection 

8 (a)(1) of such section is amended by striking ‘‘(1) Sub9 ject’’ and all that follows through the period and inserting 

10 the following: ‘‘(1) Subject to the provisions of this sec11 tion, in any case in which the United States is required 

12 by law to furnish or pay for care or services under this 

13 chapter for a non-service-connected disability described in 

14 paragraph (2) of this subsection, the United States has 

15 the right to recover or collect from a third party the rea16 sonable charges of care or services so furnished or paid 

17 for to the extent that the recipient or provider of the care 

18 or services would be eligible to receive payment for such 

19 care or services from such third party if the care or serv20 ices had not been furnished or paid for by a department 

21 or agency of the United States.’’ 

22 (c) MODIFICATION OF ELIGIBLE INDIVIDUALS.— 

23 Subparagraph (D) of subsection (a)(2) of such section is 

24 amended to read as follows: 


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1 ‘‘(D) that is incurred by an individual who is 

2 entitled to care (or payment of the expenses of care) 

3 under a health-plan contract.’’. 

4 SEC. 114. PROCESSING OF CLAIMS FOR REIMBURSEMENT 

5 THROUGH ELECTRONIC INTERFACE. 

6 The Secretary of Veterans Affairs may enter into an 

7 agreement with a third-party entity to process, through 

8 the use of an electronic interface, claims for reimburse9 ment for health care provided under the laws administered 

10 by the Secretary. 

11 CHAPTER 3—EDUCATION AND TRAINING 

12 PROGRAMS 

13 SEC. 121. EDUCATION PROGRAM ON HEALTH CARE OP14 TIONS. 

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

16 shall develop and administer an education program that 

17 teaches veterans about their health care options through 

18 the Department of Veterans Affairs. 

19 (b) ELEMENTS.—The program under subsection (a) 

20 shall— 

21 (1) teach veterans about— 

22 (A) eligibility criteria for care from the De23 partment set forth under sections 1703, as 

24 amended by section 101 of this Act, and 1710 

25 of title 38, United States Code; 


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1 (B) priority groups for enrollment in the 

2 system of annual patient enrollment under sec3 tion 1705(a) of such title; 

4 (C) the copayments and other financial ob5 ligations, if any, required of certain individuals 

6 for certain services; and 

7 (D) how to utilize the access standards 

8 and standards for quality established under sec9 tions 1703B and 1703C of such title, as added 

10 by section 104 of this Act; 

11 (2) teach veterans about the interaction be12 tween health insurance (including private insurance, 

13 Medicare, Medicaid, the TRICARE program, the In14 dian Health Service, tribal health programs, and 

15 other forms of insurance) and health care from the 

16 Department; and 

17 (3) provide veterans with information on what 

18 to do when they have a complaint about health care 

19 received from the Department (whether about the 

20 provider, the Department, or any other type of com21 plaint). 

22 (c) ACCESSIBILITY.—In developing the education 

23 program under this section, the Secretary shall ensure 

24 that materials under such program are accessible— 


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1 (1) to veterans who may not have access to the 

2 internet; and 

3 (2) to veterans in a manner that complies with 

4 the Americans with Disabilities Act of 1990 (42 

5 U.S.C. 12101 et seq.). 

6 (d) ANNUAL EVALUATION AND REPORT.— 

7 (1) EVALUATION.—The Secretary shall develop 

8 a method to evaluate the effectiveness of the edu9 cation program under this section and evaluate the 

10 program using the method not less frequently than 

11 once each year. 

12 (2) REPORT.—Not less frequently than once 

13 each year, the Secretary shall submit to Congress a 

14 report on the findings of the Secretary with respect 

15 to the most recent evaluation conducted by the Sec16 retary under paragraph (1). 

17 (e) DEFINITIONS.—In this section: 

18 (1) MEDICAID.—The term ‘‘Medicaid’’ means 

19 the Medicaid program under title XIX of the Social 

20 Security Act (42 U.S.C. 1396 et seq.). 

21 (2) MEDICARE.—The term ‘‘Medicare’’ means 

22 the Medicare program under title XVIII of such Act 

23 (42 U.S.C. 1395 et seq.). 


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1 (3) TRICARE PROGRAM.—The term ‘‘TRICARE 

2 program’’ has the meaning given that term in sec3 tion 1072 of title 10, United States Code. 

4 SEC. 122. TRAINING PROGRAM FOR ADMINISTRATION OF 

5 NON-DEPARTMENT OF VETERANS AFFAIRS 

6 HEALTH CARE. 

7 (a) ESTABLISHMENT OF PROGRAM.—The Secretary 

8 of Veterans Affairs shall develop and implement a training 

9 program to train employees and contractors of the Depart10 ment of Veterans Affairs on how to administer non-De11 partment health care programs, including the following: 

12 (1) Reimbursement for non-Department emer13 gency room care. 

14 (2) The Veterans Community Care Program 

15 under section 1703 of title 38, United States Code, 

16 as amended by section 101. 

17 (3) Management of prescriptions pursuant to 

18 improvements under section 131. 

19 (b) ANNUAL EVALUATION AND REPORT.—The Sec20 retary shall— 

21 (1) develop a method to evaluate the effective22 ness of the training program developed and imple23 mented under subsection (a); 

24 (2) evaluate such program not less frequently 

25 than once each year; and 


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1 (3) not less frequently than once each year, 

2 submit to Congress the findings of the Secretary 

3 with respect to the most recent evaluation carried 

4 out under paragraph (2). 

5 SEC. 123. CONTINUING MEDICAL EDUCATION FOR NON-DE6 PARTMENT MEDICAL PROFESSIONALS. 

7 (a) ESTABLISHMENT OF PROGRAM.— 

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

9 Affairs shall establish a program to provide con10 tinuing medical education material to non-Depart11 ment medical professionals. 

12 (2) EDUCATION PROVIDED.—The program es13 tablished under paragraph (1) shall include edu14 cation on the following: 

15 (A) Identifying and treating common men16 tal and physical conditions of veterans and fam17 ily members of veterans. 

18 (B) The health care system of the Depart19 ment of Veterans Affairs. 

20 (C) Such other matters as the Secretary 

21 considers appropriate. 

22 (b) MATERIAL PROVIDED.—The continuing medical 

23 education material provided to non-Department medical 

24 professionals under the program established under sub25 section (a) shall be the same material provided to medical 


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1 professionals of the Department to ensure that all medical 

2 professionals treating veterans have access to the same 

3 materials, which supports core competencies throughout 

4 the community. 

5 (c) ADMINISTRATION OF PROGRAM.— 

6 (1) IN GENERAL.—The Secretary shall admin7 ister the program established under subsection (a) to 

8 participating non-Department medical professionals 

9 through an internet website of the Department of 

10 Veterans Affairs. 

11 (2) CURRICULUM AND CREDIT PROVIDED.—The 

12 Secretary shall determine the curriculum of the pro13 gram and the number of hours of credit to provide 

14 to participating non-Department medical profes15 sionals for continuing medical education. 

16 (3) ACCREDITATION.—The Secretary shall en17 sure that the program is accredited in as many 

18 States as practicable. 

19 (4) CONSISTENCY WITH EXISTING RULES.—The 

20 Secretary shall ensure that the program is consistent 

21 with the rules and regulations of the following: 

22 (A) The medical licensing agency of each 

23 State in which the program is accredited. 

24 (B) Such medical credentialing organiza25 tions as the Secretary considers appropriate. 


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1 (5) USER COST.—The Secretary shall carry out 

2 the program at no cost to participating non-Depart3 ment medical professionals. 

4 (6) MONITORING, EVALUATION, AND REPORT.— 

5 The Secretary shall monitor the utilization of the 

6 program established under subsection (a), evaluate 

7 its effectiveness, and report to Congress on utiliza8 tion and effectiveness not less frequently than once 

9 each year. 

10 (d) NON-DEPARTMENT MEDICAL PROFESSIONAL

11 DEFINED.—In this section, the term ‘‘non-Department 

12 medical professional’’ means any individual who is licensed 

13 by an appropriate medical authority in the United States 

14 and is in good standing, is not an employee of the Depart15 ment of Veterans Affairs, and provides care to veterans 

16 or family members of veterans under the laws adminis17 tered by the Secretary of Veterans Affairs. 


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1 CHAPTER 4—OTHER MATTERS RELATING 

2 TO NON-DEPARTMENT OF VETERANS 

3 AFFAIRS PROVIDERS 

4 SEC. 131. ESTABLISHMENT OF PROCESSES TO ENSURE 

5 SAFE OPIOID PRESCRIBING PRACTICES BY 

6 NON-DEPARTMENT OF VETERANS AFFAIRS 

7 HEALTH CARE PROVIDERS. 

8 (a) RECEIPT AND REVIEW OF GUIDELINES.—The 

9 Secretary of Veterans Affairs shall ensure that all covered 

10 health care providers are provided a copy of and certify 

11 that they have reviewed the evidence-based guidelines for 

12 prescribing opioids set forth by the Opioid Safety Initia13 tive of the Department of Veterans Affairs. 

14 (b) INCLUSION OF MEDICAL HISTORY AND CURRENT

15 MEDICATIONS.—The Secretary shall implement a process 

16 to ensure that, if care of a veteran by a covered health 

17 care provider is authorized under the laws administered 

18 by the Secretary, the document authorizing such care in19 cludes the available and relevant medical history of the 

20 veteran and a list of all medications prescribed to the vet21 eran as known by the Department. 

22 (c) SUBMITTAL OF MEDICAL RECORDS AND PRE23 SCRIPTIONS.— 

24 (1) IN GENERAL.—The Secretary shall, con25 sistent with section 1703(a)(2)(A) of title 38, United 


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1 States Code, as amended by section 101 of this Act, 

2 and section 1703A(e)(2)(F) of such title, as added 

3 by section 102 of this Act, require each covered 

4 health care provider to submit medical records of 

5 any care or services furnished, including records of 

6 any prescriptions for opioids, to the Department in 

7 the timeframe and format specified by the Secretary. 

8 (2) RESPONSIBILITY OF DEPARTMENT FOR RE9 CORDING AND MONITORING.—In carrying out para10 graph (1) and upon the receipt by the Department 

11 of the medical records described in paragraph (1), 

12 the Secretary shall— 

13 (A) ensure the Department is responsible 

14 for the recording of the prescription in the elec15 tronic health record of the veteran; and 

16 (B) enable other monitoring of the pre17 scription as outlined in the Opioid Safety Initia18 tive of the Department. 

19 (3) REPORT.—Not less frequently than annu20 ally, the Secretary shall submit to the Committee on 

21 Veterans’ Affairs of the Senate and the Committee 

22 on Veterans’ Affairs of the House of Representatives 

23 a report evaluating the compliance of covered health 

24 care providers with the requirements under this sec25 tion. 


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1 (d) USE OF OPIOID SAFETY INITIATIVE GUIDE2 LINES.— 

3 (1) IN GENERAL.—If the Secretary determines 

4 that the opioid prescribing practices of a covered 

5 health care provider, when treating veterans, satisfy 

6 a condition described in paragraph (3), the Sec7 retary shall take such action as the Secretary con8 siders appropriate to ensure the safety of all vet9 erans receiving care from that health care provider, 

10 including removing or directing the removal of any 

11 such health care provider from provider networks or 

12 otherwise refusing to authorize care of veterans by 

13 such health care provider in any program authorized 

14 under the laws administered by the Secretary. 

15 (2) INCLUSION IN CONTRACTS.—The Secretary 

16 shall ensure that any contracts, agreements, or other 

17 arrangements entered into by the Secretary with 

18 third parties involved in administering programs 

19 that provide care in the community to veterans 

20 under the laws administered by the Secretary spe21 cifically grant the authority set forth in paragraph 

22 (1) to such third parties and to the Secretary, as the 

23 case may be. 

24 (3) CONDITIONS FOR EXCLUSION OR LIMITA25 TION.—The Secretary shall take such action as is 


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1 considered appropriate under paragraph (1) when 

2 the opioid prescribing practices of a covered health 

3 care provider when treating veterans— 

4 (A) conflict with or are otherwise incon5 sistent with the standards of appropriate and 

6 safe care; 

7 (B) violate the requirements of a medical 

8 license of the health care provider; or 

9 (C) may place at risk the veterans receiv10 ing health care from the provider. 

11 (e) COVERED HEALTH CARE PROVIDER DEFINED.— 

12 In this section, the term ‘‘covered health care provider’’ 

13 means a non-Department of Veterans Affairs health care 

14 provider who provides health care to veterans under the 

15 laws administered by the Secretary of Veterans Affairs, 

16 but does not include a health care provider employed by 

17 another agency of the Federal Government. 

18 SEC. 132. IMPROVING INFORMATION SHARING WITH COM19 MUNITY PROVIDERS. 

20 Section 7332(b)(2) is amended by striking subpara21 graph (H) and inserting the following new subparagraphs: 

22 ‘‘(H)(i) To a non-Department entity (including 

23 private entities and other Federal agencies) for pur24 poses of providing health care, including hospital 

25 care, medical services, and extended care services, to 


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1 patients or performing other health care-related ac2 tivities or functions. 

3 ‘‘(ii) An entity to which a record is disclosed 

4 under this subparagraph may not disclose or use 

5 such record for a purpose other than that for which 

6 the disclosure was made or as permitted by law. 

7 ‘‘(I) To a third party in order to recover or col8 lect reasonable charges for care furnished to, or paid 

9 on behalf of, a patient in connection with a non-serv10 ice connected disability as permitted by section 1729 

11 of this title or for a condition for which recovery is 

12 authorized or with respect to which the United 

13 States is deemed to be a third party beneficiary 

14 under the Act entitled ‘An Act to provide for the re15 covery from tortiously liable third persons of the cost 

16 of hospital and medical care and treatment fur17 nished by the United States’ (Public Law 87–693; 

18 42 U.S.C. 2651 et seq.; commonly known as the 

19 ‘Federal Medical Care Recovery Act’).’’. 

20 SEC. 133. COMPETENCY STANDARDS FOR NON-DEPART21 MENT OF VETERANS AFFAIRS HEALTH CARE 

22 PROVIDERS. 

23 (a) ESTABLISHMENT OF STANDARDS AND REQUIRE24 MENTS.—The Secretary of Veterans Affairs shall establish 

25 standards and requirements for the provision of care by 


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1 non-Department of Veterans Affairs health care providers 

2 in clinical areas for which the Department of Veterans Af3 fairs has special expertise, including post-traumatic stress 

4 disorder, military sexual trauma-related conditions, and 

5 traumatic brain injuries. 

6 (b) CONDITION FOR ELIGIBILITY TO FURNISH

7 CARE.—(1) Each non-Department of Veterans Affairs 

8 health care provider shall, to the extent practicable as de9 termined by the Secretary or otherwise provided for in 

10 paragraph (2), meet the standards and requirements es11 tablished pursuant to subsection (a) before furnishing care 

12 pursuant to a contract, agreement, or other arrangement 

13 with the Department of Veterans Affairs. Non-Depart14 ment of Veterans Affairs health care providers furnishing 

15 care pursuant to a contract, agreement, or other arrange16 ment shall, to the extent practicable as determined by the 

17 Secretary, fulfill training requirements established by the 

18 Secretary on how to deliver evidence-based treatments in 

19 the clinical areas for which the Department of Veterans 

20 Affairs has special expertise. 

21 (2) Each non-Department of Veterans Affairs health 

22 care provider who enters into a contract, agreement, or 

23 other arrangement after the effective date identified in 

24 subsection (c) shall, to the extent practicable, meet the 

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1 section (a) within 6 months of the contract, agreement, 

2 or other arrangement taking effect. 

3 (c) EFFECTIVE DATE.—This section shall take effect 

4 on the day that is one year after the date of the enactment 

5 of this Act. 

6 SEC. 134. DEPARTMENT OF VETERANS AFFAIRS PARTICIPA7 TION IN NATIONAL NETWORK OF STATE8 BASED PRESCRIPTION DRUG MONITORING 

9 PROGRAMS. 

10 (a) IN GENERAL.—Chapter 17 is amended by insert11 ing after section 1730A the following new section: 

12 ‘‘§ 1730B. Access to State prescription drug moni13 toring programs 

14 ‘‘(a) ACCESS TO PROGRAMS.—(1) Any licensed health 

15 care provider or delegate of such a provider shall be con16 sidered an authorized recipient or user for the purpose of 

17 querying and receiving data from the national network of 

18 State-based prescription drug monitoring programs to 

19 support the safe and effective prescribing of controlled 

20 substances to covered patients. 

21 ‘‘(2) Under the authority granted by paragraph (1)— 

22 ‘‘(A) licensed health care providers or delegates 

23 of such providers shall query such network in ac24 cordance with applicable regulations and policies of 

25 the Veterans Health Administration; and 


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1 ‘‘(B) notwithstanding any general or specific 

2 provision of law, rule, or regulation of a State, no 

3 State may restrict the access of licensed health care 

4 providers or delegates of such providers from access5 ing that State’s prescription drug monitoring pro6 grams. 

7 ‘‘(3) No State shall deny or revoke the license, reg8 istration, or certification of a licensed health care provider 

9 or delegate who otherwise meets that State’s qualifications 

10 for holding the license, registration, or certification on the 

11 basis that the licensed health care provider or delegate 

12 queried or received data, or attempted to query or receive 

13 data, from the national network of State-based prescrip14 tion drug monitoring programs under this section. 

15 ‘‘(b) COVERED PATIENTS.—For purposes of this sec16 tion, a covered patient is a patient who— 

17 ‘‘(1) receives a prescription for a controlled sub18 stance; and 

19 ‘‘(2) is not receiving palliative care or enrolled 

20 in hospice care. 

21 ‘‘(c) DEFINITIONS.—In this section: 

22 ‘‘(1) The term ‘controlled substance’ has the 

23 meaning given such term in section 102(6) of the 

24 Controlled Substances Act (21 U.S.C. 802(6)). 


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1 ‘‘(2) The term ‘delegate’ means a person or 

2 automated system accessing the national network of 

3 State-based prescription monitoring programs at the 

4 direction or under the supervision of a licensed 

5 health care provider. 

6 ‘‘(3) The term ‘licensed health care provider’ 

7 means a health care provider employed by the De8 partment who is licensed, certified, or registered 

9 within any State to fill or prescribe medications 

10 within the scope of his or her practice as a Depart11 ment employee. 

12 ‘‘(4) The term ‘national network of State-based 

13 prescription monitoring programs’ means an inter14 connected nation-wide system that facilitates the 

15 transfer to State prescription drug monitoring pro16 gram data across State lines. 

17 ‘‘(5) The term ‘State’ means a State, as defined 

18 in section 101(20) of this title, or a political subdivi19 sion of a State.’’. 

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

21 at the beginning of such chapter is amended by inserting 

22 after the item relating to section 1730A the following new 

23 item: 

‘‘1730B. Access to State prescription drug monitoring programs.’’. 


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1 CHAPTER 5—OTHER NON-DEPARTMENT 

2 HEALTH CARE MATTERS 

3 SEC. 141. PLANS FOR USE OF SUPPLEMENTAL APPROPRIA4 TIONS REQUIRED. 

5 Whenever the Secretary of Veterans Affairs submits 

6 to Congress a request for supplemental appropriations or 

7 any other appropriation outside the standard budget proc8 ess to address a budgetary issue affecting the Department 

9 of Veterans Affairs, the Secretary shall, not later than 45 

10 days before the date on which such budgetary issue would 

11 start affecting a program or service, submit to Congress 

12 a justification for the request, including a plan that details 

13 how the Secretary intends to use the requested appropria14 tion and how long the requested appropriation is expected 

15 to meet the needs of the Department and certification that 

16 the request was made using an updated and sound actu17 arial analysis. 

18 SEC. 142. VETERANS CHOICE FUND FLEXIBILITY. 

19 Section 802 of the Veterans Access, Choice, and Ac20 countability Act of 2014 (Public Law 113–146; 38 U.S.C. 

21 1701 note) is amended— 

22 (1) in subsection (c)— 

23 (A) in paragraph (1), by striking ‘‘by para24 graph (3)’’ and inserting ‘‘in paragraphs (3) 

25 and (4)’’; and 


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

2 paragraph: 

3 ‘‘(4) PERMANENT AUTHORITY FOR OTHER

4 USES.—Beginning on March 1, 2019, amounts re5 maining in the Veterans Choice Fund may be used 

6 to furnish hospital care, medical services, and ex7 tended care services to individuals pursuant to chap8 ter 17 of title 38, United States Code, at non-De9 partment facilities, including pursuant to non-De10 partment provider programs other than the program 

11 established by section 101. Such amounts shall be 

12 available in addition to amounts available in other 

13 appropriations accounts for such purposes.’’; and 

14 (2) in subsection (d)(1), by striking ‘‘to sub15 section (c)(3)’’ and inserting ‘‘to paragraphs (3) and 

16 (4) of subsection (c)’’. 

17 SEC. 143. SUNSET OF VETERANS CHOICE PROGRAM. 

18 Subsection (p) of section 101 of the Veterans Access, 

19 Choice, and Accountability Act of 2014 (Public Law 113– 

20 146; 38 U.S.C. 1701 note) is amended to read as follows: 

21 ‘‘(p) AUTHORITY TO FURNISH CARE AND SERV22 ICES.—The Secretary may not use the authority under 

23 this section to furnish care and services after the date that 

24 is one year after the date of the enactment of the Caring 

25 for Our Veterans Act of 2018.’’. 


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1 SEC. 144. CONFORMING AMENDMENTS. 

2 (a) IN GENERAL.— 

3 (1) TITLE 38.—Title 38, United States Code, is 

4 amended— 

5 (A) in section 1712(a)— 

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

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

8 1703(a) of this title’’ and inserting ‘‘or en9 tered an agreement’’; and 

10 (ii) in paragraph (4)(A), by striking 

11 ‘‘under the provisions of this subsection 

12 and section 1703 of this title’’; 

13 (B) in section 1712A(e)(1)— 

14 (i) by inserting ‘‘or agreements’’ after 

15 ‘‘contracts’’; and 

16 (ii) by striking ‘‘(under sections 

17 1703(a)(2) and 1710(a)(1)(B) of this 

18 title)’’; and 

19 (C) in section 2303(a)(2)(B)(i), by striking 

20 ‘‘with section 1703’’ and inserting ‘‘with sec21 tions 1703A, 8111, and 8153’’. 

22 (2) SOCIAL SECURITY ACT.—Section 

23 1866(a)(1)(L) of the Social Security Act (42 U.S.C. 

24 1395cc(a)(1)(L)) is amended by striking ‘‘under sec25 tion 1703’’ and inserting ‘‘under chapter 17’’. 


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1 (3) VETERANS’ BENEFITS IMPROVEMENTS ACT

2 OF 1994.—Section 104(a)(4)(A) of the Veterans’ 

3 Benefits Improvements Act of 1994 (Public Law 

4 103–446; 38 U.S.C. 1117 note) is amended by strik5 ing ‘‘in section 1703’’ and inserting ‘‘in sections 

6 1703A, 8111, and 8153’’. 

7 (b) EFFECTIVE DATE.—The amendments made by 

8 subsection (a) shall take effect on the date described in 

9 section 101(b). 

10 Subtitle B—Improving Department 

11 of Veterans Affairs Health Care 

12 Delivery 

13 SEC. 151. LICENSURE OF HEALTH CARE PROFESSIONALS 

14 OF THE DEPARTMENT OF VETERANS AF15 FAIRS PROVIDING TREATMENT VIA TELE16 MEDICINE. 

17 (a) IN GENERAL.—Chapter 17 is amended by insert18 ing after section 1730B, as added by section 134, the fol19 lowing new section: 

20 ‘‘§ 1730C. Licensure of health care professionals pro21 viding treatment via telemedicine 

22 ‘‘(a) IN GENERAL.—Notwithstanding any provision 

23 of law regarding the licensure of health care professionals, 

24 a covered health care professional may practice the health 

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1 tion in any State, regardless of where the covered health 

2 care professional or the patient is located, if the covered 

3 health care professional is using telemedicine to provide 

4 treatment to an individual under this chapter. 

5 ‘‘(b) COVERED HEALTH CARE PROFESSIONALS.— 

6 For purposes of this section, a covered health care profes7 sional is any health care professional who— 

8 ‘‘(1) is an employee of the Department ap9 pointed under the authority under section 7306, 

10 7401, 7405, 7406, or 7408 of this title or title 5; 

11 ‘‘(2) is authorized by the Secretary to provide 

12 health care under this chapter; 

13 ‘‘(3) is required to adhere to all standards for 

14 quality relating to the provision of medicine in ac15 cordance with applicable policies of the Department; 

16 and 

17 ‘‘(4) has an active, current, full, and unre18 stricted license, registration, or certification in a 

19 State to practice the health care profession of the 

20 health care professional. 

21 ‘‘(c) PROPERTY OF FEDERAL GOVERNMENT.—Sub22 section (a) shall apply to a covered health care professional 

23 providing treatment to a patient regardless of whether the 

24 covered health care professional or patient is located in 


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1 a facility owned by the Federal Government during such 

2 treatment. 

3 ‘‘(d) RELATION TO STATE LAW.—(1) The provisions 

4 of this section shall supersede any provisions of the law 

5 of any State to the extent that such provision of State 

6 law are inconsistent with this section. 

7 ‘‘(2) No State shall deny or revoke the license, reg8 istration, or certification of a covered health care profes9 sional who otherwise meets the qualifications of the State 

10 for holding the license, registration, or certification on the 

11 basis that the covered health care professional has en12 gaged or intends to engage in activity covered by sub13 section (a). 

14 ‘‘(e) RULE OF CONSTRUCTION.—Nothing in this sec15 tion may be construed to remove, limit, or otherwise affect 

16 any obligation of a covered health care professional under 

17 the Controlled Substances Act (21 U.S.C. 801 et seq.). 

18 ‘‘(f) STATE DEFINED.—In this section, the term 

19 ‘State’ means a State, as defined in section 101(20) of 

20 this title, or a political subdivision of a State.’’. 

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

22 at the beginning of such chapter is amended by inserting 

23 after the item relating to section 1730B, as added by sec24 tion 134, the following new item: 

‘‘1730C. Licensure of health care professionals providing treatment via telemedicine.’’. 


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1 (c) REPORT ON TELEMEDICINE.— 

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

3 after the earlier of the date on which services pro4 vided under section 1730B of title 38, United States 

5 Code, as added by subsection (a), first occur or reg6 ulations are promulgated to carry out such section, 

7 the Secretary of Veterans Affairs shall submit to the 

8 Committee on Veterans’ Affairs of the Senate and 

9 the Committee on Veterans’ Affairs of the House of 

10 Representatives a report on the effectiveness of the 

11 use of telemedicine by the Department of Veterans 

12 Affairs. 

13 (2) ELEMENTS.—The report required by para14 graph (1) shall include an assessment of the fol15 lowing: 

16 (A) The satisfaction of veterans with tele17 medicine furnished by the Department. 

18 (B) The satisfaction of health care pro19 viders in providing telemedicine furnished by 

20 the Department. 

21 (C) The effect of telemedicine furnished by 

22 the Department on the following: 

23 (i) The ability of veterans to access 

24 health care, whether from the Department 


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1 or from non-Department health care pro2 viders. 

3 (ii) The frequency of use by veterans 

4 of telemedicine. 

5 (iii) The productivity of health care 

6 providers. 

7 (iv) Wait times for an appointment 

8 for the receipt of health care from the De9 partment. 

10 (v) The use by veterans of in-person 

11 services at Department facilities and non12 Department facilities. 

13 (D) The types of appointments for the re14 ceipt of telemedicine furnished by the Depart15 ment that were provided during the one-year 

16 period preceding the submittal of the report. 

17 (E) The number of appointments for the 

18 receipt of telemedicine furnished by the Depart19 ment that were requested during such period, 

20 disaggregated by medical facility. 

21 (F) Savings by the Department, if any, in22 cluding travel costs, from furnishing health care 

23 through the use of telemedicine during such pe24 riod. 


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1 SEC. 152. AUTHORITY FOR DEPARTMENT OF VETERANS AF2 FAIRS CENTER FOR INNOVATION FOR CARE 

3 AND PAYMENT. 

4 (a) IN GENERAL.—Subchapter I of chapter 17, as 

5 amended by this title, is further amended by inserting 

6 after section 1703D, as added by section 111, the fol7 lowing new section: 

8 ‘‘§ 1703E. Center for Innovation for Care and Pay9 ment 

10 ‘‘(a) IN GENERAL.—(1) There is established within 

11 the Department a Center for Innovation for Care and Pay12 ment (in this section referred to as the ‘Center’). 

13 ‘‘(2) The Secretary, acting through the Center, may 

14 carry out such pilot programs the Secretary determines 

15 to be appropriate to develop innovative approaches to test16 ing payment and service delivery models in order to reduce 

17 expenditures while preserving or enhancing the quality of 

18 care furnished by the Department. 

19 ‘‘(3) The Secretary, acting through the Center, shall 

20 test payment and service delivery models to determine 

21 whether such models— 

22 ‘‘(A) improve access to, and quality, timeliness, 

23 and patient satisfaction of care and services; and 

24 ‘‘(B) create cost savings for the Department. 

25 ‘‘(4)(A) The Secretary shall test a model in a location 

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1 dresses deficits in care (including poor clinical outcomes 

2 or potentially avoidable expenditures) for a defined popu3 lation. 

4 ‘‘(B) The Secretary shall focus on models the Sec5 retary expects to reduce program costs while preserving 

6 or enhancing the quality of care received by individuals 

7 receiving benefits under this chapter. 

8 ‘‘(C) The models selected may include those described 

9 in section 1115A(b)(2)(B) of the Social Security Act (42 

10 U.S.C. 1315a(b)(2)(B)). 

11 ‘‘(5) In selecting a model for testing, the Secretary 

12 may consider, in addition to other factors identified in this 

13 subsection, the following factors: 

14 ‘‘(A) Whether the model includes a regular 

15 process for monitoring and updating patient care 

16 plans in a manner that is consistent with the needs 

17 and preferences of individuals receiving benefits 

18 under this chapter. 

19 ‘‘(B) Whether the model places the individual 

20 receiving benefits under this chapter (including fam21 ily members and other caregivers of such individual) 

22 at the center of the care team of such individual. 

23 ‘‘(C) Whether the model uses technology or new 

24 systems to coordinate care over time and across set25 tings. 


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1 ‘‘(D) Whether the model demonstrates effective 

2 linkage with other public sector payers, private sec3 tor payers, or statewide payment models. 

4 ‘‘(6)(A) Models tested under this section may not be 

5 designed in such a way that would allow the United States 

6 to recover or collect reasonable charges from a Federal 

7 health care program for care or services furnished by the 

8 Secretary to a veteran under pilot programs carried out 

9 under this section. 

10 ‘‘(B) In this paragraph, the term ‘Federal health care 

11 program’ means— 

12 ‘‘(i) an insurance program described in section 

13 1811 of the Social Security Act (42 U.S.C. 1395c) 

14 or established by section 1831 of such Act (42 

15 U.S.C. 1395j); 

16 ‘‘(ii) a State plan for medical assistance ap17 proved under title XIX of such Act (42 U.S.C. 1396 

18 et seq.); or 

19 ‘‘(iii) a TRICARE program operated under sec20 tion 1075, 1075a, 1076, 1076a, 1076c, 1076d, 

21 1076e, or 1076f of title 10. 

22 ‘‘(b) DURATION.—Each pilot program carried out by 

23 the Secretary under this section shall terminate not later 

24 than five years after the date of the commencement of the 

25 pilot program. 


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1 ‘‘(c) LOCATION.—The Secretary shall ensure that 

2 each pilot program carried out under this section occurs 

3 in an area or areas appropriate for the intended purposes 

4 of the pilot program. To the extent practicable, the Sec5 retary shall ensure that the pilot programs are located in 

6 geographically diverse areas of the United States. 

7 ‘‘(d) BUDGET.—Funding for each pilot program car8 ried out by the Secretary under this section shall come 

9 from appropriations— 

10 ‘‘(1) provided in advance in appropriations acts 

11 for the Veterans Health Administration; and 

12 ‘‘(2) provided for information technology sys13 tems. 

14 ‘‘(e) NOTICE.—The Secretary shall— 

15 ‘‘(1) publish information about each pilot pro16 gram under this section in the Federal Register; and 

17 ‘‘(2) take reasonable actions to provide direct 

18 notice to veterans eligible to participate in such pilot 

19 programs. 

20 ‘‘(f) WAIVER OF AUTHORITIES.—(1) Subject to re21 porting under paragraph (2) and approval under para22 graph (3), in implementing a pilot program under this sec23 tion, the Secretary may waive such requirements in sub24 chapters I, II, and III of this chapter as the Secretary 

25 determines necessary solely for the purposes of carrying 


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1 out this section with respect to testing models described 

2 in subsection (a). 

3 ‘‘(2) Before waiving any authority under paragraph 

4 (1), the Secretary shall submit to the Speaker of the 

5 House of Representatives, the minority leader of the 

6 House of Representatives, the majority leader of the Sen7 ate, the minority leader of the Senate, and each standing 

8 committee with jurisdiction under the rules of the Senate 

9 and of the House of Representatives to report a bill to 

10 amend the provision or provisions of law that would be 

11 waived by the Department, a report describing in detail 

12 the following: 

13 ‘‘(A) The specific authorities to be waived 

14 under the pilot program. 

15 ‘‘(B) The standard or standards to be used in 

16 the pilot program in lieu of the waived authorities. 

17 ‘‘(C) The reasons for such waiver or waivers. 

18 ‘‘(D) A description of the metric or metrics the 

19 Secretary will use to determine the effect of the 

20 waiver or waivers upon the access to and quality, 

21 timeliness, or patient satisfaction of care and serv22 ices furnished through the pilot program. 

23 ‘‘(E) The anticipated cost savings, if any, of the 

24 pilot program. 


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1 ‘‘(F) The schedule for interim reports on the 

2 pilot program describing the results of the pilot pro3 gram so far and the feasibility and advisability of 

4 continuing the pilot program. 

5 ‘‘(G) The schedule for the termination of the 

6 pilot program and the submission of a final report 

7 on the pilot program describing the result of the 

8 pilot program and the feasibility and advisability of 

9 making the pilot program permanent. 

10 ‘‘(H) The estimated budget of the pilot pro11 gram. 

12 ‘‘(3)(A) Upon receipt of a report submitted under 

13 paragraph (2), each House of Congress shall provide cop14 ies of the report to the chairman and ranking member of 

15 each standing committee with jurisdiction under the rules 

16 of the House of Representatives or the Senate to report 

17 a bill to amend the provision or provisions of law that 

18 would be waived by the Department under this subsection. 

19 ‘‘(B)(i) The waiver requested by the Secretary under 

20 paragraph (2) shall be considered approved under this 

21 paragraph if there is enacted into law a bill or joint resolu22 tion approving such request in its entirety. Such bill or 

23 joint resolution shall be passed by recorded vote to reflect 

24 the vote of each member of Congress thereon. 


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1 ‘‘(ii) The provisions of this paragraph are enacted by 

2 Congress— 

3 ‘‘(I) as an exercise of the rulemaking power of 

4 the Senate and the House of Representatives and as 

5 such shall be considered as part of the rules of each 

6 House of Congress, and shall supersede other rules 

7 only to the extent that they are inconsistent there8 with; and 

9 ‘‘(II) with full recognition of the constitutional 

10 right of either House of Congress to change the 

11 rules (so far as they relate to the procedures of that 

12 House) at any time, in the same manner, and to the 

13 same extent as in the case of any other rule of that 

14 House. 

15 ‘‘(C) During the 60-calendar-day period beginning on 

16 the date on which the Secretary submits the report de17 scribed in paragraph (2) to Congress, it shall be in order 

18 as a matter of highest privilege in each House of Congress 

19 to consider a bill or joint resolution, if offered by the ma20 jority leader of such House (or a designee), approving 

21 such request in its entirety. 

22 ‘‘(g) LIMITATIONS.—(1) The Secretary may not carry 

23 out more than 10 pilot programs concurrently. 


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1 ‘‘(2)(A) Subject to subparagraph (B), the Secretary 

2 may not expend more than $50,000,000 in any fiscal year 

3 from amounts under subsection (d). 

4 ‘‘(B) The Secretary may expend more than the 

5 amount in subparagraph (A) if— 

6 ‘‘(i) the Secretary determines that the addi7 tional expenditure is necessary to carry out pilot 

8 programs under this section; 

9 ‘‘(ii) the Secretary submits to the Committees 

10 on Veterans’ Affairs of the Senate and the House of 

11 Representatives a report setting forth the amount of 

12 the additional expenditure and a justification for the 

13 additional expenditure; and 

14 ‘‘(iii) the Chairmen of the Committees on Vet15 erans’ Affairs of the Senate and the House of Rep16 resentatives transmit to the Secretary a letter ap17 proving of the additional expenditure. 

18 ‘‘(3) The waiver provisions in subsection (f) shall not 

19 apply unless the Secretary, in accordance with the require20 ments in subsection (f), submits the first proposal for a 

21 pilot program not later than 18 months after the date of 

22 the enactment of the Caring for Our Veterans Act of 

23 2018. 

24 ‘‘(4) Notwithstanding section 502 of this title, deci25 sions by the Secretary under this section shall, consistent 


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1 with section 511 of this title, be final and conclusive and 

2 may not be reviewed by any other official or by any court, 

3 whether by an action in the nature of mandamus or other4 wise. 

5 ‘‘(5)(A) If the Secretary determines that a pilot pro6 gram is not improving the quality of care or producing 

7 cost savings, the Secretary shall— 

8 ‘‘(i) propose a modification to the pilot program 

9 in the interim report that shall also be considered a 

10 report under subsection (f)(2) and shall be subject 

11 to the terms and conditions of subsection (f)(2); or 

12 ‘‘(ii) terminate such pilot program not later 

13 than 30 days after submitting the interim report to 

14 Congress. 

15 ‘‘(B) If the Secretary terminates a pilot program 

16 under subparagraph (A)(ii), for purposes of subpara17 graphs (F) and (G) of subsection (f)(2), such interim re18 port will also serve as the final report for that pilot pro19 gram. 

20 ‘‘(h) EVALUATION AND REPORTING REQUIRE21 MENTS.—(1) The Secretary shall conduct an evaluation 

22 of each model tested, which shall include, at a minimum, 

23 an analysis of— 

24 ‘‘(A) the quality of care furnished under the 

25 model, including the measurement of patient-level 


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1 outcomes and patient-centeredness criteria deter2 mined appropriate by the Secretary; and 

3 ‘‘(B) the changes in spending by reason of that 

4 model. 

5 ‘‘(2) The Secretary shall make the results of each 

6 evaluation under this subsection available to the public in 

7 a timely fashion and may establish requirements for other 

8 entities participating in the testing of models under this 

9 section to collect and report information that the Sec10 retary determines is necessary to monitor and evaluate 

11 such models. 

12 ‘‘(i) COORDINATION AND ADVICE.—(1) The Sec13 retary shall obtain advice from the Under Secretary for 

14 Health and the Special Medical Advisory Group estab15 lished pursuant to section 7312 of this title in the develop16 ment and implementation of any pilot program operated 

17 under this section. 

18 ‘‘(2) In carrying out the duties under this section, 

19 the Secretary shall consult representatives of relevant 

20 Federal agencies, and clinical and analytical experts with 

21 expertise in medicine and health care management. The 

22 Secretary shall use appropriate mechanisms to seek input 

23 from interested parties. 

24 ‘‘(j) EXPANSION OF SUCCESSFUL PILOT PRO25 GRAMS.—Taking into account the evaluation under subVerDate Sep 11 2014 00:46 May 30, 2018 Jkt 079200 PO 00000 Frm 00111 Fmt 6652 Sfmt 6201 E:\BILLS\S2906.IS S2906

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1 section (h), the Secretary may, through rulemaking, ex2 pand (including implementation on a nationwide basis) the 

3 duration and the scope of a model that is being tested 

4 under subsection (a) to the extent determined appropriate 

5 by the Secretary, if— 

6 ‘‘(1) the Secretary determines that such expan7 sion is expected to— 

8 ‘‘(A) reduce spending without reducing the 

9 quality of care; or 

10 ‘‘(B) improve the quality of patient care 

11 without increasing spending; and 

12 ‘‘(2) the Secretary determines that such expan13 sion would not deny or limit the coverage or provi14 sion of benefits for individuals receiving benefits 

15 under this chapter.’’. 

16 (b) CONFORMING AMENDMENT.—The table of sec17 tions at the beginning of such chapter, as amended by this 

18 title, is further amended by inserting after the item relat19 ing to section 1703D the following new item: 

‘‘1703E. Center for Innovation for Care and Payment.’’. 

20 SEC. 153. AUTHORIZATION TO PROVIDE FOR OPERATIONS 

21 ON LIVE DONORS FOR PURPOSES OF CON22 DUCTING TRANSPLANT PROCEDURES FOR 

23 VETERANS. 

24 (a) IN GENERAL.—Subchapter VIII of chapter 17 is 

25 amended by adding at the end the following new section: 


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1 ‘‘§ 1788. Transplant procedures with live donors and 

2 related services 

3 ‘‘(a) IN GENERAL.—Subject to subsections (b) and 

4 (c), in a case in which a veteran is eligible for a transplant 

5 procedure from the Department, the Secretary may pro6 vide for an operation on a live donor to carry out such 

7 procedure for such veteran, notwithstanding that the live 

8 donor may not be eligible for health care from the Depart9 ment. 

10 ‘‘(b) OTHER SERVICES.—Subject to the availability 

11 of appropriations for such purpose, the Secretary shall 

12 furnish to a live donor any care or services before and 

13 after conducting the transplant procedure under sub14 section (a) that may be required in connection with such 

15 procedure. 

16 ‘‘(c) USE OF NON-DEPARTMENT FACILITIES.—In 

17 carrying out this section, the Secretary may provide for 

18 the operation described in subsection (a) on a live donor 

19 and furnish to the live donor the care and services de20 scribed in subsection (b) at a non-Department facility pur21 suant to an agreement entered into by the Secretary under 

22 this chapter. The live donor shall be deemed to be an indi23 vidual eligible for hospital care and medical services at a 

24 non-Department facility pursuant to such an agreement 

25 solely for the purposes of receiving such operation, care, 

26 and services at the non-Department facility.’’. 


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

2 at the beginning of such chapter is amended by inserting 

3 after the item relating to section 1787 the following new 

4 item: 

‘‘1788. Transplant procedures with live donors and related services.’’. 

5 Subtitle C—Family Caregivers 

6 SEC. 161. EXPANSION OF FAMILY CAREGIVER PROGRAM OF 

7 DEPARTMENT OF VETERANS AFFAIRS. 

8 (a) FAMILY CAREGIVER PROGRAM.— 

9 (1) EXPANSION OF ELIGIBILITY.— 

10 (A) IN GENERAL.—Subparagraph (B) of 

11 subsection (a)(2) of section 1720G is amended 

12 to read as follows: 

13 ‘‘(B) for assistance provided under this sub14 section— 

15 ‘‘(i) before the date on which the Secretary 

16 submits to Congress a certification that the De17 partment has fully implemented the information 

18 technology system required by section 162(a) of 

19 the Caring for Our Veterans Act of 2018, has 

20 a serious injury (including traumatic brain in21 jury, psychological trauma, or other mental dis22 order) incurred or aggravated in the line of 

23 duty in the active military, naval, or air service 

24 on or after September 11, 2001; 


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1 ‘‘(ii) during the two-year period beginning 

2 on the date on which the Secretary submitted 

3 to Congress the certification described in clause 

4 (i), has a serious injury (including traumatic 

5 brain injury, psychological trauma, or other 

6 mental disorder) incurred or aggravated in the 

7 line of duty in the active military, naval, or air 

8 service— 

9 ‘‘(I) on or before May 7, 1975; or 

10 ‘‘(II) on or after September 11, 2001; 

11 or 

12 ‘‘(iii) after the date that is two years after 

13 the date on which the Secretary submits to 

14 Congress the certification described in clause 

15 (i), has a serious injury (including traumatic 

16 brain injury, psychological trauma, or other 

17 mental disorder) incurred or aggravated in the 

18 line of duty in the active military, naval, or air 

19 service; and’’. 

20 (B) PUBLICATION IN FEDERAL REG21 ISTER.—Not later than 30 days after the date 

22 on which the Secretary of Veterans Affairs sub23 mits to Congress the certification described in 

24 subsection (a)(2)(B)(i) of section 1720G of title 

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1 paragraph (A), the Secretary shall publish the 

2 date specified in such subsection in the Federal 

3 Register. 

4 (2) EXPANSION OF NEEDED SERVICES IN ELI5 GIBILITY CRITERIA.—Subsection (a)(2)(C) of such 

6 section is amended— 

7 (A) in clause (ii), by striking ‘‘; or’’ and in8 serting a semicolon; 

9 (B) by redesignating clause (iii) as clause 

10 (iv); and 

11 (C) by inserting after clause (ii) the fol12 lowing new clause (iii): 

13 ‘‘(iii) a need for regular or extensive in14 struction or supervision without which the abil15 ity of the veteran to function in daily life would 

16 be seriously impaired; or’’. 

17 (3) EXPANSION OF SERVICES PROVIDED.—Sub18 section (a)(3)(A)(ii) of such section is amended— 

19 (A) in subclause (IV), by striking ‘‘; and’’ 

20 and inserting a semicolon; 

21 (B) in subclause (V), by striking the period 

22 at the end and inserting ‘‘; and’’; and 

23 (C) by adding at the end the following new 

24 subclause: 


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1 ‘‘(VI) through the use of contracts with, or 

2 the provision of grants to, public or private en3 tities— 

4 ‘‘(aa) financial planning services relat5 ing to the needs of injured veterans and 

6 their caregivers; and 

7 ‘‘(bb) legal services, including legal 

8 advice and consultation, relating to the 

9 needs of injured veterans and their care10 givers.’’. 

11 (4) MODIFICATION OF STIPEND CALCULA12 TION.—Subsection (a)(3)(C) of such section is 

13 amended— 

14 (A) by redesignating clause (iii) as clause 

15 (iv); and 

16 (B) by inserting after clause (ii) the fol17 lowing new clause (iii): 

18 ‘‘(iii) In determining the amount and degree of per19 sonal care services provided under clause (i) with respect 

20 to an eligible veteran whose need for personal care services 

21 is based in whole or in part on a need for supervision or 

22 protection under paragraph (2)(C)(ii) or regular instruc23 tion or supervision under paragraph (2)(C)(iii), the Sec24 retary shall take into account the following: 


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1 ‘‘(I) The assessment by the family caregiver of 

2 the needs and limitations of the veteran. 

3 ‘‘(II) The extent to which the veteran can func4 tion safely and independently in the absence of such 

5 supervision, protection, or instruction. 

6 ‘‘(III) The amount of time required for the 

7 family caregiver to provide such supervision, protec8 tion, or instruction to the veteran.’’. 

9 (5) PERIODIC EVALUATION OF NEED FOR CER10 TAIN SERVICES.—Subsection (a)(3) of such section 

11 is amended by adding at the end the following new 

12 subparagraph: 

13 ‘‘(D) In providing instruction, preparation, and train14 ing under subparagraph (A)(i)(I) and technical support 

15 under subparagraph (A)(i)(II) to each family caregiver 

16 who is approved as a provider of personal care services 

17 for an eligible veteran under paragraph (6), the Secretary 

18 shall periodically evaluate the needs of the eligible veteran 

19 and the skills of the family caregiver of such veteran to 

20 determine if additional instruction, preparation, training, 

21 or technical support under those subparagraphs is nec22 essary.’’. 

23 (6) USE OF PRIMARY CARE TEAMS.—Subsection 

24 (a)(5) of such section is amended, in the matter pre25 ceding subparagraph (A), by inserting ‘‘(in collaboVerDate Sep 11 2014 00:46 May 30, 2018 Jkt 079200 PO 00000 Frm 00118 Fmt 6652 Sfmt 6201 E:\BILLS\S2906.IS S2906

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1 ration with the primary care team for the eligible 

2 veteran to the maximum extent practicable)’’ after 

3 ‘‘evaluate’’. 

4 (7) ASSISTANCE FOR FAMILY CAREGIVERS.— 

5 Subsection (a) of such section is amended by adding 

6 at the end the following new paragraph: 

7 ‘‘(11)(A) In providing assistance under this sub8 section to family caregivers of eligible veterans, the Sec9 retary may enter into contracts, provider agreements, and 

10 memoranda of understanding with Federal agencies, 

11 States, and private, nonprofit, and other entities to pro12 vide such assistance to such family caregivers. 

13 ‘‘(B) The Secretary may provide assistance under 

14 this paragraph only if such assistance is reasonably acces15 sible to the family caregiver and is substantially equivalent 

16 or better in quality to similar services provided by the De17 partment. 

18 ‘‘(C) The Secretary may provide fair compensation 

19 to Federal agencies, States, and other entities that provide 

20 assistance under this paragraph.’’. 

21 (b) MODIFICATION OF DEFINITION OF PERSONAL

22 CARE SERVICES.—Subsection (d)(4) of such section is 

23 amended— 

24 (1) in subparagraph (A), by striking ‘‘inde25 pendent’’; 


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1 (2) by redesignating subparagraph (B) as sub2 paragraph (D); and 

3 (3) by inserting after subparagraph (A) the fol4 lowing new subparagraphs: 

5 ‘‘(B) Supervision or protection based on 

6 symptoms or residuals of neurological or other 

7 impairment or injury. 

8 ‘‘(C) Regular or extensive instruction or 

9 supervision without which the ability of the vet10 eran to function in daily life would be seriously 

11 impaired.’’. 

12 SEC. 162. IMPLEMENTATION OF INFORMATION TECH13 NOLOGY SYSTEM OF DEPARTMENT OF VET14 ERANS AFFAIRS TO ASSESS AND IMPROVE 

15 THE FAMILY CAREGIVER PROGRAM. 

16 (a) IMPLEMENTATION OF NEW SYSTEM.— 

17 (1) IN GENERAL.—Not later than October 1, 

18 2018, the Secretary of Veterans Affairs shall imple19 ment an information technology system that fully 

20 supports the Program and allows for data assess21 ment and comprehensive monitoring of the Program. 

22 (2) ELEMENTS OF SYSTEM.—The information 

23 technology system required to be implemented under 

24 paragraph (1) shall include the following: 


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1 (A) The ability to easily retrieve data that 

2 will allow all aspects of the Program (at the 

3 medical center and aggregate levels) and the 

4 workload trends for the Program to be assessed 

5 and comprehensively monitored. 

6 (B) The ability to manage data with re7 spect to a number of caregivers that is more 

8 than the number of caregivers that the Sec9 retary expects to apply for the Program. 

10 (C) The ability to integrate the system 

11 with other relevant information technology sys12 tems of the Veterans Health Administration. 

13 (b) ASSESSMENT OF PROGRAM.—Not later than 180 

14 days after implementing the system described in sub15 section (a), the Secretary shall, through the Under Sec16 retary for Health, use data from the system and other rel17 evant data to conduct an assessment of how key aspects 

18 of the Program are structured and carried out. 

19 (c) ONGOING MONITORING OF AND MODIFICATIONS

20 TO PROGRAM.— 

21 (1) MONITORING.—The Secretary shall use the 

22 system implemented under subsection (a) to monitor 

23 and assess the workload of the Program, including 

24 monitoring and assessment of data on— 


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1 (A) the status of applications, appeals, and 

2 home visits in connection with the Program; 

3 and 

4 (B) the use by caregivers participating in 

5 the Program of other support services under 

6 the Program such as respite care. 

7 (2) MODIFICATIONS.—Based on the monitoring 

8 and assessment conducted under paragraph (1), the 

9 Secretary shall identify and implement such modi10 fications to the Program as the Secretary considers 

11 necessary to ensure the Program is functioning as 

12 intended and providing veterans and caregivers par13 ticipating in the Program with services in a timely 

14 manner. 

15 (d) REPORTS.— 

16 (1) INITIAL REPORT.— 

17 (A) IN GENERAL.—Not later than 90 days 

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

19 Secretary shall submit to the Committee on 

20 Veterans’ Affairs of the Senate, the Committee 

21 on Veterans’ Affairs of the House of Represent22 atives, and the Comptroller General of the 

23 United States a report that includes— 

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1 quired to be implemented under subsection 

2 (a), including any changes in the timeline 

3 for the implementation of the system; and 

4 (ii) an assessment of the needs of 

5 family caregivers of veterans described in 

6 subparagraph (B), the resources needed 

7 for the inclusion of such family caregivers 

8 in the Program, and such changes to the 

9 Program as the Secretary considers nec10 essary to ensure the successful expansion 

11 of the Program to include such family 

12 caregivers. 

13 (B) VETERANS DESCRIBED.—Veterans de14 scribed in this subparagraph are veterans who 

15 are eligible for the Program under clause (ii) or 

16 (iii) of section 1720G(a)(2)(B) of title 38, 

17 United States Code, as amended by section 

18 161(a)(1) of this Act, solely due to a serious in19 jury (including traumatic brain injury, psycho20 logical trauma, or other mental disorder) in21 curred or aggravated in the line of duty in the 

22 active military, naval, or air service before Sep23 tember 11, 2001. 

24 (2) NOTIFICATION BY COMPTROLLER GEN25 ERAL.—The Comptroller General shall review the reVerDate Sep 11 2014 00:46 May 30, 2018 Jkt 079200 PO 00000 Frm 00123 Fmt 6652 Sfmt 6201 E:\BILLS\S2906.IS S2906

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1 port submitted under paragraph (1) and notify the 

2 Committee on Veterans’ Affairs of the Senate and 

3 the Committee on Veterans’ Affairs of the House of 

4 Representatives with respect to the progress of the 

5 Secretary in— 

6 (A) fully implementing the system required 

7 under subsection (a); and 

8 (B) implementing a process for using such 

9 system to monitor and assess the Program 

10 under subsection (c)(1) and modify the Pro11 gram as considered necessary under subsection 

12 (c)(2). 

13 (3) FINAL REPORT.— 

14 (A) IN GENERAL.—Not later than October 

15 1, 2019, the Secretary shall submit to the Com16 mittee on Veterans’ Affairs of the Senate, the 

17 Committee on Veterans’ Affairs of the House of 

18 Representatives, and the Comptroller General a 

19 report on the implementation of subsections (a) 

20 through (c). 

21 (B) ELEMENTS.—The report required by 

22 subparagraph (A) shall include the following: 

23 (i) A certification by the Secretary 

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1 scribed in subsection (a) has been imple2 mented. 

3 (ii) A description of how the Secretary 

4 has implemented such system. 

5 (iii) A description of the modifications 

6 to the Program, if any, that were identified 

7 and implemented under subsection (c)(2). 

8 (iv) A description of how the Sec9 retary is using such system to monitor the 

10 workload of the Program. 

11 (e) DEFINITIONS.—In this section: 

12 (1) ACTIVE MILITARY, NAVAL, OR AIR SERV13 ICE.—The term ‘‘active military, naval, or air serv14 ice’’ has the meaning given that term in section 101 

15 of title 38, United States Code. 

16 (2) PROGRAM.—The term ‘‘Program’’ means 

17 the program of comprehensive assistance for family 

18 caregivers under section 1720G(a) of title 38, 

19 United States Code, as amended by section 161 of 

20 this Act. 

21 SEC. 163. MODIFICATIONS TO ANNUAL EVALUATION RE22 PORT ON CAREGIVER PROGRAM OF DEPART23 MENT OF VETERANS AFFAIRS. 

24 (a) BARRIERS TO CARE AND SERVICES.—Subpara25 graph (A)(iv) of section 101(c)(2) of the Caregivers and 


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1 Veterans Omnibus Health Services Act of 2010 (Public 

2 Law 111–163; 38 U.S.C. 1720G note) is amended by in3 serting ‘‘, including a description of any barriers to access4 ing and receiving care and services under such programs’’ 

5 before the semicolon. 

6 (b) SUFFICIENCY OF TRAINING FOR FAMILY CARE7 GIVER PROGRAM.—Subparagraph (B) of such section is 

8 amended— 

9 (1) in clause (i), by striking ‘‘; and’’ and insert10 ing a semicolon; 

11 (2) in clause (ii), by striking the period at the 

12 end and inserting ‘‘; and’’; and 

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

14 clause: 

15 ‘‘(iii) an evaluation of the sufficiency 

16 and consistency of the training provided to 

17 family caregivers under such program in 

18 preparing family caregivers to provide care 

19 to veterans under such program.’’. 


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1 TITLE II—IMPROVEMENTS TO 

2 RECRUITMENT OF HEALTH 

3 CARE PROFESSIONALS 

4 SEC. 201. DESIGNATED SCHOLARSHIPS FOR PHYSICIANS 

5 AND DENTISTS UNDER DEPARTMENT OF VET6 ERANS AFFAIRS HEALTH PROFESSIONAL 

7 SCHOLARSHIP PROGRAM. 

8 (a) SCHOLARSHIPS FOR PHYSICIANS AND DEN9 TISTS.—Section 7612(b) is amended by adding at the end 

10 the following new paragraph: 

11 ‘‘(6)(A) Of the scholarships awarded under this sub12 chapter, the Secretary shall ensure that not less than 50 

13 scholarships are awarded each year to individuals who are 

14 accepted for enrollment or enrolled (as described in section 

15 7602 of this title) in a program of education or training 

16 leading to employment as a physician or dentist until such 

17 date as the Secretary determines that the staffing short18 age of physicians and dentists in the Department is less 

19 than 500. 

20 ‘‘(B) After such date, the Secretary shall ensure that 

21 of the scholarships awarded under this subchapter, a num22 ber of scholarships is awarded each year to individuals re23 ferred to in subparagraph (A) in an amount equal to not 

24 less than ten percent of the staffing shortage of physicians 


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1 and dentists in the Department, as determined by the Sec2 retary. 

3 ‘‘(C) Notwithstanding subsection (c)(1), the agree4 ment between the Secretary and a participant in the 

5 Scholarship Program who receives a scholarship pursuant 

6 to this paragraph shall provide the following: 

7 ‘‘(i) The Secretary’s agreement to provide the 

8 participant with a scholarship under this subchapter 

9 for a specified number (from two to four) of school 

10 years during which the participant is pursuing a 

11 course of education or training leading to employ12 ment as a physician or dentist. 

13 ‘‘(ii) The participant’s agreement to serve as a 

14 full-time employee in the Veterans Health Adminis15 tration for a period of time (hereinafter in this sub16 chapter referred to as the ‘period of obligated serv17 ice’) of 18 months for each school year or part 

18 thereof for which the participant was provided a 

19 scholarship under the Scholarship Program. 

20 ‘‘(D) In providing scholarships pursuant to this para21 graph, the Secretary may provide a preference for appli22 cants who are veterans. 

23 ‘‘(E) On an annual basis, the Secretary shall provide 

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1 terial about the availability of scholarships under this 

2 paragraph.’’. 

3 (b) BREACH OF AGREEMENT.—Section 7617(b) is 

4 amended— 

5 (1) by redesignating paragraphs (4) and (5) as 

6 paragraphs (5) and (6), respectively; and 

7 (2) by inserting after paragraph (3) the fol8 lowing new paragraph (4): 

9 ‘‘(4) In the case of a participant who is enrolled 

10 in a program or education or training leading to em11 ployment as a physician, the participant fails to suc12 cessfully complete post-graduate training leading to 

13 eligibility for board certification in a specialty.’’. 

14 (c) EXTENSION OF PROGRAM.—Section 7619 is 

15 amended by striking ‘‘December 31, 2019’’ and inserting 

16 ‘‘December 31, 2033’’. 

17 SEC. 202. INCREASE IN MAXIMUM AMOUNT OF DEBT THAT 

18 MAY BE REDUCED UNDER EDUCATION DEBT 

19 REDUCTION PROGRAM OF DEPARTMENT OF 

20 VETERANS AFFAIRS. 

21 (a) INCREASE IN AMOUNT.—Section 7683(d)(1) is 

22 amended— 

23 (1) by striking ‘‘$120,000’’ and inserting 

24 ‘‘$200,000’’; and 


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1 (2) by striking ‘‘$24,000’’ and inserting 

2 ‘‘$40,000’’. 

3 (b) STUDY.— 

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

5 after the date of the enactment of this Act, the Sec6 retary of Veterans Affairs shall— 

7 (A) conduct a study on the demand for 

8 education debt reduction under subchapter VII 

9 of chapter 76 of title 38, United States Code; 

10 and 

11 (B) submit to the Committee on Veterans’ 

12 Affairs of the Senate and the Committee on 

13 Veterans’ Affairs of the House of Representa14 tives a report on the findings of the Secretary 

15 with respect to the study carried out under sub16 paragraph (A). 

17 (2) CONSIDERATIONS.—In carrying out the 

18 study required by paragraph (1)(A), the Secretary 

19 shall consider the following: 

20 (A) The total number of vacancies within 

21 the Veterans Health Administration whose ap22 plicants are eligible to participate in the Edu23 cation Debt Reduction Program pursuant to 

24 section 7682(a) of such title. 


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1 (B) The types of medical professionals in 

2 greatest demand in the United States. 

3 (C) Projections by the Secretary of the 

4 numbers and types of medical professions that 

5 meet the needs of veterans. 

6 SEC. 203. ESTABLISHING THE DEPARTMENT OF VETERANS 

7 AFFAIRS SPECIALTY EDUCATION LOAN RE8 PAYMENT PROGRAM. 

9 (a) IN GENERAL.—Chapter 76 is amended by insert10 ing after subchapter VII the following new subchapter: 

11 ‘‘SUBCHAPTER VIII—SPECIALTY EDUCATION 

12 LOAN REPAYMENT PROGRAM 

13 ‘‘§ 7691. Establishment 

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

15 Secretary may carry out a student loan repayment pro16 gram under section 5379 of title 5. The program shall be 

17 known as the Department of Veterans Affairs Specialty 

18 Education Loan Repayment Program (in this chapter re19 ferred to as the ‘Specialty Education Loan Repayment 

20 Program’). 

21 ‘‘§ 7692. Purpose 

22 ‘‘The purpose of the Specialty Education Loan Re23 payment Program is to assist, through the establishment 

24 of an incentive program for certain individuals employed 

25 in the Veterans Health Administration, in meeting the 


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1 staffing needs of the Veterans Health Administration for 

2 physicians in medical specialties for which the Secretary 

3 determines recruitment or retention of qualified personnel 

4 is difficult. 

5 ‘‘§ 7693. Eligibility; preferences; covered costs 

6 ‘‘(a) ELIGIBILITY.—An individual is eligible to par7 ticipate in the Specialty Education Loan Repayment Pro8 gram if the individual— 

9 ‘‘(1) is hired under section 7401 of this title to 

10 work in an occupation described in section 7692 of 

11 this title; 

12 ‘‘(2) owes any amount of principal or interest 

13 under a loan, the proceeds of which were used by or 

14 on behalf of that individual to pay costs relating to 

15 a course of education or training which led to a de16 gree that qualified the individual for the position re17 ferred to in paragraph (1); and 

18 ‘‘(3) is— 

19 ‘‘(A) recently graduated from an accredited 

20 medical or osteopathic school and matched to 

21 an accredited residency program in a medical 

22 specialty described in section 7692 of this title; 

23 or 

24 ‘‘(B) a physician in training in a medical 

25 specialty described in section 7692 of this title 


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1 with more than two years remaining in such 

2 training. 

3 ‘‘(b) PREFERENCES.—In selecting individuals for 

4 participation in the Specialty Education Loan Repayment 

5 Program under this subchapter, the Secretary may give 

6 preference to the following: 

7 ‘‘(1) Individuals who are, or will be, partici8 pating in residency programs in health care facili9 ties— 

10 ‘‘(A) located in rural areas; 

11 ‘‘(B) operated by Indian tribes, tribal orga12 nizations, or the Indian Health Service; or 

13 ‘‘(C) affiliated with underserved health 

14 care facilities of the Department. 

15 ‘‘(2) Veterans. 

16 ‘‘(c) COVERED COSTS.—For purposes of subsection 

17 (a)(2), costs relating to a course of education or training 

18 include— 

19 ‘‘(1) tuition expenses; 

20 ‘‘(2) all other reasonable educational expenses, 

21 including expenses for fees, books, equipment, and 

22 laboratory expenses; and 

23 ‘‘(3) reasonable living expenses. 


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1 ‘‘§ 7694. Specialty education loan repayment 

2 ‘‘(a) IN GENERAL.—Payments under the Specialty 

3 Education Loan Repayment Program shall consist of pay4 ments for the principal and interest on loans described in 

5 section 7682(a)(2) of this title for individuals selected to 

6 participate in the Program to the holders of such loans. 

7 ‘‘(b) FREQUENCY OF PAYMENT.—The Secretary 

8 shall make payments for any given participant in the Spe9 cialty Education Loan Repayment Program on a schedule 

10 determined appropriate by the Secretary. 

11 ‘‘(c) MAXIMUM AMOUNT; WAIVER.—(1) The amount 

12 of payments made for a participant under the Specialty 

13 Education Loan Repayment Program may not exceed 

14 $160,000 over a total of four years of participation in the 

15 Program, of which not more than $40,000 of such pay16 ments may be made in each year of participation in the 

17 Program. 

18 ‘‘(2)(A) The Secretary may waive the limitations 

19 under paragraph (1) in the case of a participant described 

20 in subparagraph (B). In the case of such a waiver, the 

21 total amount of payments payable to or for that partici22 pant is the total amount of the principal and the interest 

23 on the participant’s loans referred to in subsection (a). 

24 ‘‘(B) A participant described in this subparagraph is 

25 a participant in the Program who the Secretary deter26 mines serves in a position for which there is a shortage 


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1 of qualified employees by reason of either the location or 

2 the requirements of the position. 

3 ‘‘§ 7695. Choice of location 

4 ‘‘Each participant in the Specialty Education Loan 

5 Repayment Program who completes residency may select, 

6 from a list of medical facilities of the Veterans Health Ad7 ministration provided by the Secretary, at which such fa8 cility the participant will work in a medical specialty de9 scribed in section 7692 of this title. 

10 ‘‘§ 7696. Term of obligated service 

11 ‘‘(a) IN GENERAL.—In addition to any requirements 

12 under section 5379(c) of title 5, a participant in the Spe13 cialty Education Loan Repayment Program must agree, 

14 in writing and before the Secretary may make any pay15 ment to or for the participant, to— 

16 ‘‘(1) obtain a license to practice medicine in a 

17 State; 

18 ‘‘(2) successfully complete post-graduate train19 ing leading to eligibility for board certification in a 

20 specialty; 

21 ‘‘(3) serve as a full-time clinical practice em22 ployee of the Veterans Health Administration for 12 

23 months for every $40,000 in such benefits that the 

24 employee receives, but in no case for fewer than 24 

25 months; and 


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1 ‘‘(4) except as provided in subsection (b), to 

2 begin such service as a full-time practice employee 

3 by not later than 60 days after completing a resi4 dency. 

5 ‘‘(b) FELLOWSHIP.—In the case of a participant who 

6 receives an accredited fellowship in a medical specialty 

7 other than a medical specialty described in section 7692 

8 of this title, the Secretary, on written request of the par9 ticipant, may delay the term of obligated service under 

10 subsection (a) for the participant until after the partici11 pant completes the fellowship, but in no case later than 

12 60 days after completion of such fellowship. 

13 ‘‘(c) PENALTY.—(1) An employee who does not com14 plete a period of obligated service under this section shall 

15 owe the Federal Government an amount determined in ac16 cordance with the following formula: A = B × ((T ¥ S) 

17 ÷ T)). 

18 ‘‘(2) In the formula in paragraph (1): 

19 ‘‘(A) ‘A’ is the amount the employee owes the 

20 Federal Government. 

21 ‘‘(B) ‘B’ is the sum of all payments to or for 

22 the participant under the Specialty Education Loan 

23 Repayment Program. 

24 ‘‘(C) ‘T’ is the number of months in the period 

25 of obligated service of the employee. 


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1 ‘‘(D) ‘S’ is the number of whole months of such 

2 period of obligated service served by the employee. 

3 ‘‘§ 7697. Relationship to Educational Assistance Pro4 gram 

5 ‘‘Assistance under the Specialty Education Loan Re6 payment Program may be in addition to other assistance 

7 available to individuals under the Educational Assistance 

8 Program.’’. 

9 (b) CONFORMING AND TECHNICAL AMENDMENTS.— 

10 (1) CONFORMING AMENDMENTS.— 

11 (A) Section 7601(a) is amended— 

12 (i) in paragraph (4), by striking 

13 ‘‘and’’; 

14 (ii) in paragraph (5), by striking the 

15 period and inserting ‘‘; and’’; and 

16 (iii) by adding at the end the fol17 lowing new paragraph: 

18 ‘‘(6) the specialty education loan repayment 

19 program provided for in subchapter VIII of this 

20 chapter.’’. 

21 (B) Section 7603(a)(1) is amended by 

22 striking ‘‘or VI’’ and inserting ‘‘VI, or VIII’’. 

23 (C) Section 7604 is amended by striking 

24 ‘‘or VI’’ each place it appears and inserting 

25 ‘‘VI, or VIII’’. 


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1 (D) Section 7631 is amended— 

2 (i) in subsection (a)(1)— 

3 (I) by striking ‘‘and’’ after 

4 ‘‘scholarship amount,’’; and 

5 (II) by inserting ‘‘, and the max6 imum specialty education loan repay7 ment amount’’ after ‘‘reduction pay8 ments amount’’; and 

9 (ii) in subsection (b) by adding at the 

10 end the following new paragraph: 

11 ‘‘(7) The term ‘specialty education loan repay12 ment amount’ means the maximum amount of spe13 cialty education loan repayment payments payable to 

14 or for a participant in the Department of Veterans 

15 Affairs Specialty Education Loan Repayment Pro16 gram under subchapter VIII of this chapter, as spec17 ified in section 7694(c)(1) of this title and as pre18 viously adjusted (if at all) in accordance with this 

19 section.’’. 

20 (E) Section 7632 is amended— 

21 (i) in paragraph (1), by striking ‘‘and 

22 the Education Debt Reduction Program’’ 

23 and inserting ‘‘the Education Debt Reduc24 tion Program, and the Specialty Education 

25 Loan Repayment Program’’; and 


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1 (ii) in paragraph (4), by striking ‘‘and 

2 per participant in the Education Debt Re3 duction Program’’ and inserting ‘‘per par4 ticipant in the Education Debt Reduction 

5 Program, and per participant in the Spe6 cialty Education Loan Repayment Pro7 gram’’. 

8 (2) TABLE OF SECTIONS.—The table of sections 

9 at the beginning of chapter 76 is amended by insert10 ing after the items relating to subchapter VII the 

11 following: 

‘‘SUBCHAPTER VIII—SPECIALTY EDUCATION LOAN REPAYMENT PROGRAM

‘‘Sec. 

‘‘7691. Establishment. 

‘‘7692. Purpose. 

‘‘7693. Eligibility; preferences; covered costs. 

‘‘7694. Specialty education loan repayment. 

‘‘7695. Choice of location. 

‘‘7696. Term of obligated service. 

‘‘7697. Relationship to Educational Assistance Program.’’. 

12 (c) NEEDS OF THE VHA.—In making determinations 

13 each year under section 7692 of title 38, United States 

14 Code, as added by subsection (a), the Secretary of Vet15 erans Affairs shall consider the anticipated needs of the 

16 Veterans Health Administration during the period two to 

17 six years in the future. 

18 (d) PREFERENCE.—In granting preference under 

19 section 7693 of title 38, United States Code, as added by 

20 subsection (a), the Secretary of Veterans Affairs shall de21 termine whether a facility of the Department of Veterans 


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1 Affairs is underserved based on the criteria developed 

2 under section 301 of this Act. 

3 (e) OFFER DEADLINE.—In the case of an applicant 

4 who applies before receiving a residency match and whom 

5 the Secretary of Veterans Affairs selects for participation 

6 in the Specialty Education Loan Repayment Program 

7 under subchapter VIII of title 38, United States Code, as 

8 added by subsection (a), the Secretary shall offer partici9 pation to the applicant not later than 28 days after— 

10 (1) the applicant matches with a residency in a 

11 medical specialty described in section 7692 of title 

12 38, United States Code, as added by subsection (a); 

13 and 

14 (2) such match is published. 

15 (f) PUBLICITY.—The Secretary of Veterans Affairs 

16 shall take such steps as the Secretary determines are ap17 propriate to publicize the Specialty Education Loan Re18 payment Program established under subchapter VIII of 

19 chapter 76 of title 38, United States Code, as added by 

20 subsection (a). 

21 SEC. 204. VETERANS HEALING VETERANS MEDICAL ACCESS 

22 AND SCHOLARSHIP PROGRAM. 

23 (a) ESTABLISHMENT.—The Secretary of Veterans 

24 Affairs, acting through the Office of Academic Affiliations 

25 of the Department of Veterans Affairs, shall carry out a 


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1 pilot program under which the Secretary shall provide 

2 funding for the medical education of a total of 18 eligible 

3 veterans. Such funding shall be provided for two veterans 

4 enrolled in each covered medical school in accordance with 

5 this section. 

6 (b) ELIGIBLE VETERANS.—To be eligible to receive 

7 funding for medical education under this section, a vet8 eran shall— 

9 (1) have been discharged from the Armed 

10 Forces not more than ten years before the date of 

11 application for admission to a covered medical 

12 school; 

13 (2) not be entitled to educational assistance 

14 under chapter 30, 31, 32, 33, 34, or 35 of title 38, 

15 United States Code, or chapter 1606 or 1607 of title 

16 10, United States Code; 

17 (3) apply for admission to a covered medical 

18 school for the entering class of 2019; 

19 (4) indicate on such application for admission 

20 that the veteran would like to be considered for an 

21 award of funding under this section; 

22 (5) meet the minimum admissions criteria for 

23 the covered medical school to which the veteran ap24 plies; and 


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1 (6) enter into an agreement described in sub2 section (d). 

3 (c) AWARD OF FUNDING.— 

4 (1) IN GENERAL.—Each covered medical school 

5 that opts to participate in the program under this 

6 section shall reserve two seats in the entering class 

7 of 2019 for eligible veterans who receive funding 

8 under such program. Such funding shall be awarded 

9 to the two eligible veterans with the highest admis10 sions rankings for such class at such school. 

11 (2) AMOUNT OF FUNDING.—Each eligible vet12 eran who receives funding under this section shall 

13 receive an amount equal to the actual cost of— 

14 (A) tuition at the covered medical school at 

15 which the veteran enrolls for four years; 

16 (B) books, fees, and technical equipment; 

17 (C) fees associated with the National Resi18 dency Match Program; 

19 (D) two away rotations performed during 

20 the fourth year at a Department of Veterans 

21 Affairs medical facility; and 

22 (E) a monthly stipend for the four-year pe23 riod during which the veteran is enrolled in 

24 medical school in an amount to be determined 

25 by the Secretary. 


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1 (3) DISTRIBUTION OF FUNDING.—In the event 

2 that two or more eligible veterans do not apply for 

3 admission at one of the covered medical schools for 

4 the entering class of 2019, the Secretary shall dis5 tribute the available funding to eligible veterans who 

6 applied for admission at other covered medical 

7 schools. 

8 (d) AGREEMENT.— 

9 (1) TERMS OF AGREEMENT.—Each eligible vet10 eran who accepts funding for medical education 

11 under this section shall enter into an agreement with 

12 the Secretary that provides that the veteran 

13 agrees— 

14 (A) to maintain enrollment and attendance 

15 in the medical school; 

16 (B) while enrolled in such medical school, 

17 to maintain an acceptable level of academic 

18 standing (as determined by the medical school 

19 under regulations prescribed by the Secretary); 

20 (C) to complete post-graduate training 

21 leading to eligibility for board certification in a 

22 speciality applicable to the Department of Vet23 erans Affairs, as determined by the Secretary; 


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1 (D) after completion of medical school, to 

2 obtain a license to practice medicine in a State; 

3 and 

4 (E) after completion of medical school and 

5 post-graduate training, to serve as a full-time 

6 clinical practice employee in the Veterans 

7 Health Administration for a period of four 

8 years. 

9 (2) BREACH OF AGREEMENT.—If an eligible 

10 veteran who accepts funding under this section 

11 breaches the terms of the agreement described in 

12 paragraph (1), the United States shall be entitled to 

13 recover damages in an amount equal to the total 

14 amount of such funding received by the veteran. 

15 (e) RULE OF CONSTRUCTION.—Nothing in this sec16 tion shall be construed to prevent any covered medical 

17 school from accepting more than two eligible veterans for 

18 the entering class of 2019. 

19 (f) REPORT TO CONGRESS.—Not later than Decem20 ber 31, 2020, and annually thereafter for the subsequent 

21 three years, the Secretary shall submit to Congress a re22 port on the pilot program under this section. Such report 

23 shall include the evaluation of the Secretary of the success 

24 of the pilot program, including the number of veterans 

25 who received funding under the program who matriculated 


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1 and an evaluation of the academic progress of such vet2 erans. 

3 (g) COVERED MEDICAL SCHOOLS.—In this section, 

4 the term ‘‘covered medical school’’ means any of the fol5 lowing. 

6 (1) The Teague-Cranston medical schools, con7 sisting of— 

8 (A) Texas A&M College of Medicine; 

9 (B) Quillen College of Medicine at East 

10 Tennessee State University; 

11 (C) Boonshoft School of Medicine at 

12 Wright State University; 

13 (D) Joan C. Edwards School of Medicine 

14 at Marshall University; and 

15 (E) University of South Carolina School of 

16 Medicine. 

17 (2) Charles R Drew University of Medicine and 

18 Science. 

19 (3) Howard University College of Medicine. 

20 (4) Meharry Medical College. 

21 (5) Morehouse School of Medicine. 


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1 SEC. 205. BONUSES FOR RECRUITMENT, RELOCATION, AND 

2 RETENTION. 

3 Section 705(a) of the Veterans Access, Choice, and 

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

5 U.S.C. 703 note) is amended— 

6 (1) in paragraph (1), by striking 

7 ‘‘$230,000,000’’ and inserting ‘‘$250,000,000, of 

8 which not less than $20,000,000 shall be for recruit9 ment, relocation, and retention bonuses’’; and 

10 (2) in paragraph (2), by striking 

11 ‘‘$225,000,000’’ and inserting ‘‘$290,000,000, of 

12 which not less than $20,000,000 shall be for recruit13 ment, relocation, and retention bonuses’’. 

14 SEC. 206. INCLUSION OF VET CENTER EMPLOYEES IN EDU15 CATION DEBT REDUCTION PROGRAM OF DE16 PARTMENT OF VETERANS AFFAIRS. 

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

18 shall ensure that clinical staff working at Vet Centers are 

19 eligible to participate in the Education Debt Reduction 

20 Program of the Department of Veterans Affairs under 

21 subchapter VII of chapter 76 of title 38, United States 

22 Code. 

23 (b) REPORT.—Not later than one year after the date 

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

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

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1 resentatives a report on the number of participants in the 

2 Education Debt Reduction Program of the Department 

3 under such subchapter who work at Vet Centers. 

4 (c) VET CENTER DEFINED.—In this section, the 

5 term ‘‘Vet Center’’ has the meaning given that term in 

6 section 1712A(h) of title 38, United States Code. 

7 TITLE III—HEALTH CARE IN 

8 UNDERSERVED AREAS 

9 SEC. 301. DEVELOPMENT OF CRITERIA FOR DESIGNATION 

10 OF CERTAIN MEDICAL FACILITIES OF THE 

11 DEPARTMENT OF VETERANS AFFAIRS AS UN12 DERSERVED FACILITIES AND PLAN TO AD13 DRESS PROBLEM OF UNDERSERVED FACILI14 TIES. 

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

16 date of the enactment of this Act, the Secretary of Vet17 erans Affairs shall develop criteria to designate medical 

18 centers, ambulatory care facilities, and community based 

19 outpatient clinics of the Department of Veterans Affairs 

20 as underserved facilities. 

21 (b) CONSIDERATION.—Criteria developed under sub22 section (a) shall include consideration of the following with 

23 respect to a facility: 

24 (1) The ratio of veterans to health care pro25 viders of the Department of Veterans Affairs for a 


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1 standardized geographic area surrounding the facil2 ity, including a separate ratio for general practi3 tioners and specialists. 

4 (2) The range of clinical specialties covered by 

5 such providers in such area. 

6 (3) Whether the local community is medically 

7 underserved. 

8 (4) The type, number, and age of open consults. 

9 (5) Whether the facility is meeting the wait10 time goals of the Department. 

11 (6) Such other criteria as the Secretary con12 siders important in determining which facilities are 

13 not adequately serving area veterans. 

14 (c) ANALYSIS OF FACILITIES.—Not less frequently 

15 than annually, directors of Veterans Integrated Service 

16 Networks of the Department shall perform an analysis to 

17 determine which facilities within that Veterans Integrated 

18 Service Network qualify as underserved facilities pursuant 

19 to criteria developed under subsection (a). 

20 (d) ANNUAL PLAN TO ADDRESS UNDERSERVED FA21 CILITIES.— 

22 (1) PLAN REQUIRED.—Not later than one year 

23 after the date of the enactment of this Act and not 

24 less frequently than once each year thereafter, the 

25 Secretary shall submit to Congress a plan to address 


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1 the problem of underserved facilities of the Depart2 ment, as designated pursuant to criteria developed 

3 under subsection (a). 

4 (2) CONTENTS.—Each plan submitted under 

5 paragraph (1) shall address the following: 

6 (A) Increasing personnel or temporary per7 sonnel assistance, including mobile deployment 

8 teams furnished under section 302. 

9 (B) Providing special hiring incentives, in10 cluding under the Education Debt Reduction 

11 Program under subchapter VII of chapter 76 of 

12 title 38, United States Code, and recruitment, 

13 relocation, and retention incentives. 

14 (C) Using direct hiring authority. 

15 (D) Improving training opportunities for 

16 staff. 

17 (E) Such other actions as the Secretary 

18 considers appropriate. 

19 SEC. 302. PILOT PROGRAM TO FURNISH MOBILE DEPLOY20 MENT TEAMS TO UNDERSERVED FACILITIES. 

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

22 shall carry out a pilot program to furnish mobile deploy23 ment teams of medical personnel to underserved facilities. 


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1 (b) ELEMENTS.—In furnishing mobile deployment 

2 teams under subsection (a), the Secretary shall consider 

3 the following elements: 

4 (1) The medical positions of greatest need at 

5 underserved facilities. 

6 (2) The size and composition of teams to be de7 ployed. 

8 (3) Such other elements as the Secretary con9 siders necessary for effective oversight of the pro10 gram established under subsection (a). 

11 (c) USE OF ANNUAL ANALYSIS.—The Secretary shall 

12 use the results of the annual analysis conducted under sec13 tion 301(c) to form mobile deployment teams under sub14 section (a) that are composed of the most needed medical 

15 personnel for underserved facilities. 

16 (d) REPORTING.— 

17 (1) PROGRESS REPORT.—Not later than one 

18 year after the date of the enactment of this Act, the 

19 Secretary shall submit a report to Congress on the 

20 implementation of the pilot program under this sec21 tion. 

22 (2) FINAL REPORT.—Not later than the termi23 nation of the pilot program under this section, the 

24 Secretary shall submit a final report to Congress 


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1 that contains the recommendations of the Secretary 

2 regarding the feasibility and advisability of— 

3 (A) extending or expanding the pilot pro4 gram; and 

5 (B) making the pilot program (or any as6 pect thereof) permanent. 

7 (e) DURATION.—The pilot program under this sec8 tion shall terminate three years after the date of the enact9 ment of this Act. 

10 (f) UNDERSERVED FACILITY DEFINED.—In this sec11 tion, the term ‘‘underserved facility’’ means a medical cen12 ter, ambulatory care facility, or community based out13 patient clinic of the Department of Veterans Affairs des14 ignated by the Secretary of Veterans Affairs as under15 served pursuant to criteria developed under section 301. 

16 SEC. 303. PILOT PROGRAM ON GRADUATE MEDICAL EDU17 CATION AND RESIDENCY. 

18 (a) ESTABLISHMENT.— 

19 (1) IN GENERAL.—Subject to paragraph (5), 

20 the Secretary of Veterans Affairs shall establish a 

21 pilot program to establish medical residency posi22 tions authorized under section 301(b)(2) of the Vet23 erans Access, Choice, and Accountability Act of 

24 2014 (Public Law 113–146; 38 U.S.C. 7302 note) 

25 at covered facilities. 


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1 (2) COVERED FACILITIES.—For purposes of 

2 this section, a covered facility is any of the following: 

3 (A) A health care facility of the Depart4 ment of Veterans Affairs. 

5 (B) A health care facility operated by an 

6 Indian tribe or a tribal organization, as those 

7 terms are defined in section 4 of the Indian 

8 Self-Determination and Education Assistance 

9 Act (25 U.S.C. 5304). 

10 (C) A health care facility operated by the 

11 Indian Health Service. 

12 (D) A Federally-qualified health center, as 

13 defined in section 1905(l)(2)(B) of the Social 

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

15 (E) A health care facility operated by the 

16 Department of Defense. 

17 (F) Such other health care facility as the 

18 Secretary considers appropriate for purposes of 

19 this section. 

20 (3) AGREEMENTS.—To carry out the pilot pro21 gram under this section, the Secretary may enter 

22 into agreements with entities that operate covered 

23 facilities in which the Secretary places residents 

24 under paragraph (1). 


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1 (4) PARAMETERS FOR LOCATION, AFFILIATE

2 SPONSOR, AND DURATION.—When determining in 

3 which covered facilities to place residents under 

4 paragraph (1), the Secretary shall consider the ex5 tent to which there is a clinical need for providers 

6 in an area, as determined by the following: 

7 (A) The ratio of veterans to health care 

8 providers of the Department for a standardized 

9 geographic area surrounding a facility, includ10 ing a separate ratio for general practitioners 

11 and specialists. 

12 (B) The range of clinical specialties of pro13 viders in standardized geographic areas sur14 rounding a facility. 

15 (C) Whether the specialty of a provider is 

16 included in the most recent staffing shortage 

17 determination of the Department under section 

18 7412 of title 38, United States Code. 

19 (D) Whether the local community is des20 ignated by the Secretary of Veterans Affairs as 

21 underserved pursuant to criteria developed 

22 under section 301. 

23 (E) Whether the facility is located in a 

24 community that is designated by the Secretary 

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1 fessional shortage area under section 332 of the 

2 Public Health Service Act (42 U.S.C. 254e). 

3 (F) Whether the facility is located in a 

4 rural or remote area. 

5 (G) Such other criteria as the Secretary 

6 considers important in determining which facili7 ties are not adequately serving area veterans. 

8 (5) PRIORITY IN PLACEMENTS.—During the 

9 pilot program under this section, the Secretary shall 

10 place not fewer than 100 residents in covered facili11 ties— 

12 (A) operated by the Indian Health Service; 

13 (B) operated by an Indian tribe; 

14 (C) operated by a tribal organization; or 

15 (D) located in communities designated by 

16 the Secretary as underserved pursuant to cri17 teria developed under section 301. 

18 (6) STIPENDS AND BENEFITS.—The Secretary 

19 may pay stipends and provide benefits for residents 

20 in positions under paragraph (1), regardless of 

21 whether they have been assigned in a Department 

22 facility. 

23 (b) REIMBURSEMENT.—If a covered facility estab24 lishes a new residency program in which the Secretary 

25 places a resident under the pilot program, the Secretary 


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1 shall reimburse that covered facility for costs of the fol2 lowing: 

3 (1) Curriculum development. 

4 (2) Recruitment and retention of faculty. 

5 (3) Accreditation of the program by the Accred6 itation Council for Graduate Medical Education. 

7 (4) The portion of faculty salaries attributable 

8 to duties under an agreement under subsection 

9 (a)(3). 

10 (5) Expenses relating to educating a resident 

11 under the pilot program. 

12 (c) REPORTING.— 

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

14 after the date of the enactment of this Act and not 

15 less frequently than once each year thereafter until 

16 the termination of the pilot program, the Secretary 

17 shall submit to Congress a report on the implemen18 tation of the pilot program. 

19 (2) ELEMENTS.—Each report submitted under 

20 paragraph (1) shall include the following with regard 

21 to the immediately preceding year, and in compari22 son to the year immediately preceding that year: 

23 (A) The number of veterans who received 

24 care from residents under the pilot program. 


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1 (B) The number of veterans who received 

2 care from each resident per position described 

3 in subsection (a)(1) under the pilot program. 

4 (C) The number of veterans who received 

5 care from residents under the pilot program ex6 pressed as a percentage of all individuals who 

7 received care from such residents. 

8 (D) The number of clinical appointments 

9 for veterans conducted by each resident under 

10 the pilot program. 

11 (E) The number of clinical appointments 

12 for veterans conducted by residents per position 

13 described in subsection (a)(1) under the pilot 

14 program. 

15 (F) The number of clinical appointments 

16 for veterans expressed as a percentage of all 

17 clinical appointments conducted by residents 

18 under the pilot program. 

19 (G) The number of positions described in 

20 subsection (a)(1) at each covered facility under 

21 the pilot program. 

22 (H) For each position described in sub23 section (a)(1) in a residency program affiliated 

24 with a health care facility of the Department, 

25 the time a resident under the pilot program 


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1 spent training at that facility of the Depart2 ment, expressed as a percentage of the total 

3 training time for that resident position. 

4 (I) For each residency program affiliated 

5 with a health care facility of the Department, 

6 the time all residents under the pilot program 

7 spent training at that facility of the Depart8 ment, expressed as a percentage of the total 

9 training time for those residents. 

10 (J) The time that all residents under the 

11 pilot program who are assigned to programs af12 filiated with health care facilities of the Depart13 ment spent training at facilities of the Depart14 ment, expressed as a percentage of the total 

15 training time for those residents. 

16 (K) The cost to the Department of Vet17 erans Affairs under the pilot program in the 

18 year immediately preceding the report and since 

19 the beginning of the pilot program. 

20 (L) The cost to the Department of Vet21 erans Affairs per resident placed under the pilot 

22 program at each covered facility. 

23 (M) The number of residents under the 

24 pilot program hired by the Secretary to work in 

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1 pletion of residency in the year immediately 

2 preceding the report and since the beginning of 

3 the pilot program. 

4 (N) The medical specialties pursued by 

5 residents under the pilot program. 

6 (d) DURATION.—The pilot program under this sec7 tion shall terminate on August 7, 2024. 

8 TITLE IV—INFRASTRUCTURE 

9 MATTERS 

10 SEC. 401. IMPROVEMENT TO TRAINING OF CONSTRUCTION 

11 PERSONNEL. 

12 Subsection (g) of section 8103 is amended to read 

13 as follows: 

14 ‘‘(g)(1)(A) Not later than September 30, 2019, the 

15 Secretary shall implement the covered training curriculum 

16 and the covered certification program. 

17 ‘‘(B) In designing and implementing the covered 

18 training curriculum and the covered certification program 

19 under subparagraph (A), the Secretary shall use as models 

20 existing training curricula and certification programs that 

21 have been established under chapter 87 of title 10, as de22 termined relevant by the Secretary. 

23 ‘‘(2) The Secretary may develop the training cur24 riculum under paragraph (1)(A) in a manner that provides 

25 such training in any combination of— 


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1 ‘‘(A) training provided in person; 

2 ‘‘(B) training provided over an internet website; 

3 or 

4 ‘‘(C) training provided by another department 

5 or agency of the Federal Government. 

6 ‘‘(3) The Secretary may develop the certification pro7 gram under paragraph (1)(A) in a manner that uses— 

8 ‘‘(A) one level of certification; or 

9 ‘‘(B) more than one level of certification, as de10 termined appropriate by the Secretary with respect 

11 to the level of certification for different grades of the 

12 General Schedule. 

13 ‘‘(4) The Secretary may enter into a contract with 

14 an appropriate entity to provide the covered training cur15 riculum and the covered certification program under para16 graph (1)(A). 

17 ‘‘(5)(A) Not later than September 30, 2020, the Sec18 retary shall ensure that the majority of employees subject 

19 to the covered certification program achieve the certifi20 cation or the appropriate level of certification pursuant to 

21 paragraph (3), as the case may be. 

22 ‘‘(B) After carrying out subparagraph (A), the Sec23 retary shall ensure that each employee subject to the cov24 ered certification program achieves the certification or the 


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1 appropriate level of certification pursuant to paragraph 

2 (3), as the case may be, as quickly as practicable. 

3 ‘‘(6) In this subsection: 

4 ‘‘(A) The term ‘covered certification program’ 

5 means, with respect to employees of the Department 

6 who are members of occupational series relating to 

7 construction or facilities management, or employees 

8 of the Department who award or administer con9 tracts for major construction, minor construction, or 

10 nonrecurring maintenance, including as contract 

11 specialists or contracting officers’ representatives, a 

12 program to certify knowledge and skills relating to 

13 construction or facilities management and to ensure 

14 that such employees maintain adequate expertise re15 lating to industry standards and best practices for 

16 the acquisition of design and construction services. 

17 ‘‘(B) The term ‘covered training curriculum’ 

18 means, with respect to employees specified in sub19 paragraph (A), a training curriculum relating to 

20 construction or facilities management.’’. 

21 SEC. 402. REVIEW OF ENHANCED USE LEASES. 

22 Paragraph (6) of section 8162(b) is amended to read 

23 as follows: 

24 ‘‘(6) The Director of the Office of Management and 

25 Budget shall review each enhanced-use lease before the 


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1 lease goes into effect to determine whether the lease is 

2 in compliance with paragraph (5).’’. 

3 SEC. 403. ASSESSMENT OF HEALTH CARE FURNISHED BY 

4 THE DEPARTMENT TO VETERANS WHO LIVE 

5 IN THE PACIFIC TERRITORIES. 

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

7 date of the enactment of this Act, the Secretary of Vet8 erans Affairs shall submit to the Committee on Veterans’ 

9 Affairs of the Senate and the Committee on Veterans’ Af10 fairs of the House of Representatives a report regarding 

11 health care furnished by the Department of Veterans Af12 fairs to veterans who live in the Pacific territories. 

13 (b) ELEMENTS.—The report under subsection (a) 

14 shall include assessments of the following: 

15 (1) The ability of the Department to furnish to 

16 veterans who live in the Pacific territories the fol17 lowing: 

18 (A) Hospital care. 

19 (B) Medical services. 

20 (C) Mental health services. 

21 (D) Geriatric services. 

22 (2) The feasibility of establishing a community23 based outpatient clinic of the Department in any Pa24 cific territory that does not contain such a clinic. 


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1 (c) DEFINITION.—In this section, the term ‘‘Pacific 

2 territories’’ means American Samoa, Guam, and the 

3 Northern Mariana Islands. 

4 TITLE V—OTHER MATTERS 

5 SEC. 501. ANNUAL REPORT ON PERFORMANCE AWARDS 

6 AND BONUSES AWARDED TO CERTAIN HIGH7 LEVEL EMPLOYEES OF THE DEPARTMENT. 

8 (a) IN GENERAL.—Chapter 7 is amended by adding 

9 at the end the following new section: 

10 ‘‘§ 726. Annual report on performance awards and bo11 nuses awarded to certain high-level em12 ployees 

13 ‘‘(a) IN GENERAL.—Not later than 100 days after 

14 the end of each fiscal year, the Secretary shall submit to 

15 the appropriate committees of Congress a report that con16 tains, for the most recent fiscal year ending before the 

17 submittal of the report, a description of all performance 

18 awards or bonuses awarded to each of the following: 

19 ‘‘(1) Regional Office Director of the Depart20 ment. 

21 ‘‘(2) Director of a Medical Center of the De22 partment. 

23 ‘‘(3) Director of a Veterans Integrated Service 

24 Network. 

25 ‘‘(4) Senior executive of the Department. 


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1 ‘‘(b) ELEMENTS.—Each report submitted under sub2 section (a) shall include the following with respect to each 

3 performance award or bonus awarded to an individual de4 scribed in such subsection: 

5 ‘‘(1) The amount of each award or bonus. 

6 ‘‘(2) The job title of the individual awarded the 

7 award or bonus. 

8 ‘‘(3) The location where the individual awarded 

9 the award or bonus works. 

10 ‘‘(c) DEFINITIONS.—In this section: 

11 ‘‘(1) The term ‘appropriate committees of Con12 gress’ means the Committees on Veterans’ Affairs 

13 and Appropriations of the Senate and House of Rep14 resentatives. 

15 ‘‘(2) The term ‘senior executive’ means— 

16 ‘‘(A) a career appointee; or 

17 ‘‘(B) an individual— 

18 ‘‘(i) in an administrative or executive 

19 position; and 

20 ‘‘(ii) appointed under section 7306(a) 

21 or section 7401(1) of this title. 

22 ‘‘(3) The term ‘career appointee’ has the mean23 ing given that term in section 3132(a) of title 5.’’. 

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

25 at the beginning of such chapter is amended by inserting 


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1 after the item relating to section 725 the following new 

2 item: 

‘‘726. Annual report on performance awards and bonuses awarded to certain 

high-level employees.’’. 

3 SEC. 502. ROLE OF PODIATRISTS IN DEPARTMENT OF VET4 ERANS AFFAIRS. 

5 (a) INCLUSION AS PHYSICIAN.— 

6 (1) IN GENERAL.—Subchapter I of chapter 74 

7 is amended by adding at the end the following new 

8 section: 

9 ‘‘§ 7413. Treatment of podiatrists; clinical oversight 

10 standards 

11 ‘‘(a) PODIATRISTS.—Except as provided by sub12 section (b), a doctor of podiatric medicine who is ap13 pointed as a podiatrist under section 7401(1) of this title 

14 is eligible for any supervisory position in the Veterans 

15 Health Administration to the same degree that a physician 

16 appointed under such section is eligible for the position. 

17 ‘‘(b) ESTABLISHMENT OF CLINICAL OVERSIGHT

18 STANDARDS.—The Secretary, in consultation with appro19 priate stakeholders, shall establish standards to ensure 

20 that specialists appointed in the Veterans Health Adminis21 tration to supervisory positions do not provide direct clin22 ical oversight for purposes of peer review or practice eval23 uation for providers of other clinical specialties.’’. 


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1 (2) CLERICAL AMENDMENT.—The table of sec2 tions at the beginning of chapter 74 is amended by 

3 inserting after the item relating to section 7412 the 

4 following new item: 

‘‘7413. Treatment of podiatrists; clinical oversight standards.’’. 

5 (b) MODIFICATION AND CLARIFICATION OF PAY

6 GRADE.— 

7 (1) GRADE.—The list in section 7404(b) is 

8 amended— 

9 (A) by striking ‘‘PHYSICIAN AND DEN10 TIST SCHEDULE’’ and inserting ‘‘PHYSI11 CIAN AND SURGEON (MD/DO), 

12 PODIATRIC SURGEON (DPM), AND DEN13 TIST AND ORAL SURGEON (DDS, DMD) 

14 SCHEDULE’’; 

15 (B) by striking, ‘‘Physician grade’’ and in16 serting ‘‘Physician and surgeon grade’’; and 

17 (C) by striking ‘‘PODIATRIST, CHIRO18 PRACTOR, AND’’ and inserting ‘‘CHIRO19 PRACTOR AND’’. 

20 (2) APPLICATION.—The amendments made by 

21 paragraph (1) shall apply with respect to a pay pe22 riod of the Department of Veterans Affairs begin23 ning on or after the date that is 30 days after the 

24 date of the enactment of this Act. 


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1 SEC. 503. DEFINITION OF MAJOR MEDICAL FACILITY 

2 PROJECT. 

3 (a) MODIFICATION OF DEFINITION OF MEDICAL FA4 CILITY.—Section 8101(3) is amended by striking ‘‘Sec5 retary’’ and all that follows through ‘‘nursing home,’’ and 

6 inserting ‘‘Secretary, or as otherwise authorized by law, 

7 for the provision of health-care services (including hos8 pital, outpatient clinic, nursing home,’’. 

9 (b) MODIFICATION OF DEFINITION OF MAJOR MED10 ICAL FACILITY PROJECT.—Paragraph (3) of section 

11 8104(a) is amended to read as follows: 

12 ‘‘(3) For purposes of this subsection, the term ‘major 

13 medical facility project’ means a project for the construc14 tion, alteration, or acquisition of a medical facility involv15 ing a total expenditure of more than $20,000,000, but 

16 such term does not include an acquisition by exchange, 

17 nonrecurring maintenance projects of the Department, or 

18 the construction, alteration, or acquisition of a shared 

19 Federal medical facility for which the Department’s esti20 mated share of the project costs does not exceed 

21 $20,000,000.’’. 

22 SEC. 504. AUTHORIZATION OF CERTAIN MAJOR MEDICAL 

23 FACILITY PROJECTS OF THE DEPARTMENT 

24 OF VETERANS AFFAIRS. 

25 (a) AUTHORIZATION.—The Secretary of Veterans Af26 fairs may carry out the following major medical facility 


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1 project, to be carried out in an amount not to exceed the 

2 amount specified for that project: Construction of the new 

3 East Bay Community Based Outpatient Clinic and all as4 sociated site work, utilities, parking, and landscaping, con5 struction of the Central Valley Engineering and Logistics 

6 support facility, and enhanced flood plain mitigation at the 

7 Central Valley and East Bay Community Based Out8 patient Clinics as part of the realignment of medical facili9 ties in Livermore, California, in an amount not to exceed 

10 $117,300,000. 

11 (b) AUTHORIZATION OF APPROPRIATIONS FOR CON12 STRUCTION.—There is authorized to be appropriated to 

13 the Secretary of Veterans Affairs for fiscal year 2018 or 

14 the year in which funds are appropriated for the Construc15 tion, Major Projects account, $117,300,000 for the project 

16 authorized in subsection (a). 

17 (c) SUBMITTAL OF INFORMATION.—Not later than 

18 90 days after the date of the enactment of this Act, for 

19 the project authorized in subsection (a), the Secretary of 

20 Veterans Affairs shall submit to the Committee on Vet21 erans’ Affairs of the Senate and the Committee on Vet22 erans’ Affairs of the House of Representatives the fol23 lowing information: 


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1 (1) A line item accounting of expenditures re2 lating to construction management carried out by 

3 the Department of Veterans Affairs for such project. 

4 (2) The future amounts that are budgeted to be 

5 obligated for construction management carried out 

6 by the Department for such project. 

7 (3) A justification for the expenditures de8 scribed in paragraph (1) and the future amounts de9 scribed in paragraph (2). 

10 (4) Any agreement entered into by the Sec11 retary regarding a non-Department of Veterans Af12 fairs Federal entity providing management services 

13 relating to such project, including reimbursement 

14 agreements and the costs to the Department for 

15 such services. 

16 SEC. 505. DEPARTMENT OF VETERANS AFFAIRS PER17 SONNEL TRANSPARENCY. 

18 (a) PUBLICATION OF STAFFING AND VACANCIES.— 

19 (1) WEBSITE REQUIRED.—Subject to para20 graph (2) and not later than 90 days after the date 

21 of the enactment of this Act, the Secretary of Vet22 erans Affairs shall make publicly available on an 

23 Internet website of the Department of Veterans Af24 fairs the following information, which shall, subject 

25 to subparagraph (D), be displayed by departmental 


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1 component or, in the case of information relating to 

2 Veterans Health Administration positions, by med3 ical facility: 

4 (A) The number of personnel encumbering 

5 positions. 

6 (B) The number of accessions and separa7 tion actions processed during the quarter pre8 ceding the date of the publication of the infor9 mation. 

10 (C) The number of vacancies, by occupa11 tion. 

12 (D) The percentage of new hires for the 

13 Department who were hired within the time-to14 hire target of the Office of Personnel Manage15 ment, disaggregated by administration. 

16 (2) EXCEPTIONS.—The Secretary may withhold 

17 from publication under paragraph (1) information 

18 relating to law enforcement, information security, or 

19 such positions in the Department that the Secretary 

20 determines to be sensitive. 

21 (3) UPDATE OF INFORMATION.—The Secretary 

22 shall update the information on the website required 

23 under paragraph (1) on a quarterly basis. 

24 (4) TREATMENT OF CONTRACTOR POSITIONS.— 

25 Any Department of Veterans Affairs position that is 


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1 filled with a contractor may not be treated as a De2 partment position for purposes of the information 

3 required to be published under paragraph (1). 

4 (5) INSPECTOR GENERAL REVIEW.—On a semi5 annual basis, the Inspector General of the Depart6 ment shall review the administration of the website 

7 required under paragraph (1) and make rec8 ommendations relating to the improvement of such 

9 administration. 

10 (b) REPORT TO CONGRESS.—The Secretary of Vet11 erans Affairs shall submit to Congress an annual report 

12 on the steps the Department is taking to achieve full staff13 ing capacity. Each such report shall include the amount 

14 of additional funds necessary to enable the Department 

15 to reach full staffing capacity. 

16 SEC. 506. PROGRAM ON ESTABLISHMENT OF PEER SPE17 CIALISTS IN PATIENT ALIGNED CARE TEAM 

18 SETTINGS WITHIN MEDICAL CENTERS OF DE19 PARTMENT OF VETERANS AFFAIRS. 

20 (a) PROGRAM REQUIRED.—The Secretary of Vet21 erans Affairs shall carry out a program to establish not 

22 fewer than two peer specialists in patient aligned care 

23 teams at medical centers of the Department of Veterans 

24 Affairs to promote the use and integration of services for 


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1 mental health, substance use disorder, and behavioral 

2 health in a primary care setting. 

3 (b) TIMEFRAME FOR ESTABLISHMENT OF PRO4 GRAM.—The Secretary shall carry out the program at 

5 medical centers of the Department as follows: 

6 (1) Not later than May 31, 2019, at not fewer 

7 than 15 medical centers of the Department. 

8 (2) Not later than May 31, 2020, at not fewer 

9 than 30 medical centers of the Department. 

10 (c) SELECTION OF LOCATIONS.— 

11 (1) IN GENERAL.—The Secretary shall select 

12 medical centers for the program as follows: 

13 (A) Not fewer than five shall be medical 

14 centers of the Department that are designated 

15 by the Secretary as polytrauma centers. 

16 (B) Not fewer than ten shall be medical 

17 centers of the Department that are not des18 ignated by the Secretary as polytrauma centers. 

19 (2) CONSIDERATIONS.—In selecting medical 

20 centers for the program under paragraph (1), the 

21 Secretary shall consider the feasibility and advis22 ability of selecting medical centers in the following 

23 areas: 

24 (A) Rural areas and other areas that are 

25 underserved by the Department. 


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1 (B) Areas that are not in close proximity 

2 to an active duty military installation. 

3 (C) Areas representing different geo4 graphic locations, such as census tracts estab5 lished by the Bureau of the Census. 

6 (d) GENDER-SPECIFIC SERVICES.—In carrying out 

7 the program at each location selected under subsection (c), 

8 the Secretary shall ensure that— 

9 (1) the needs of female veterans are specifically 

10 considered and addressed; and 

11 (2) female peer specialists are made available to 

12 female veterans who are treated at each location. 

13 (e) ENGAGEMENT WITH COMMUNITY PROVIDERS.— 

14 At each location selected under subsection (c), the Sec15 retary shall consider ways in which peer specialists can 

16 conduct outreach to health care providers in the commu17 nity who are known to be serving veterans to engage with 

18 those providers and veterans served by those providers. 

19 (f) REPORTS.— 

20 (1) PERIODIC REPORTS.— 

21 (A) IN GENERAL.—Not later than 180 

22 days after the date of the enactment of this 

23 Act, and not less frequently than once every 

24 180 days thereafter until the Secretary deter25 mines that the program is being carried out at 


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1 the last location to be selected under subsection 

2 (c), the Secretary shall submit to Congress a 

3 report on the program. 

4 (B) ELEMENTS.—Each report required by 

5 subparagraph (A) shall, with respect to the 

6 180-day period preceding the submittal of the 

7 report, include the following: 

8 (i) The findings and conclusions of 

9 the Secretary with respect to the program. 

10 (ii) An assessment of the benefits of 

11 the program to veterans and family mem12 bers of veterans. 

13 (iii) An assessment of the effective14 ness of peer specialists in engaging under 

15 subsection (e) with health care providers in 

16 the community and veterans served by 

17 those providers. 

18 (2) FINAL REPORT.—Not later than 180 days 

19 after the Secretary determines that the program is 

20 being carried out at the last location to be selected 

21 under subsection (c), the Secretary shall submit to 

22 Congress a report detailing the recommendations of 

23 the Secretary as to the feasibility and advisability of 

24 expanding the program to additional locations. 


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1 SEC. 507. DEPARTMENT OF VETERANS AFFAIRS MEDICAL 

2 SCRIBE PILOT PROGRAM. 

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

4 shall carry out a two-year pilot program under which the 

5 Secretary shall increase the use of medical scribes at De6 partment of Veterans Affairs medical centers. 

7 (b) LOCATIONS.—The Secretary shall carry out the 

8 pilot program at ten medical centers of the Department 

9 as follows: 

10 (1) At least four such medical centers located 

11 in rural areas. 

12 (2) At least four such medical centers located 

13 in urban areas. 

14 (3) Two such medical centers located in areas 

15 with need for increased access or increased effi16 ciency, as determine by the Secretary. 

17 (c) MEDICAL SCRIBES.— 

18 (1) HIRING.—Under the pilot program the Sec19 retary shall— 

20 (A) hire 20 new Department of Veterans 

21 Affairs term employees as medical scribes; and 

22 (B) seek to enter into contracts with ap23 propriate entities for the employment of 20 ad24 ditional medical scribes. 

25 (2) DISTRIBUTION.—The Secretary shall assign 

26 four medical scribes to each of the ten medical cenVerDate Sep 11 2014 00:46 May 30, 2018 Jkt 079200 PO 00000 Frm 00174 Fmt 6652 Sfmt 6201 E:\BILLS\S2906.IS S2906

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1 ters of the Department where the Secretary carries 

2 out the pilot program as follows: 

3 (A) Two scribes shall be assigned to each 

4 of two physicians. 

5 (B) Thirty percent of the scribes shall be 

6 employed in the provision of emergency care. 

7 (C) Seventy percent of the scribes shall be 

8 employed in the provision of speciality care in 

9 specialties with the longest patient wait times 

10 or lowest efficiency ratings, as determined by 

11 the Secretary. 

12 (d) REPORTS.— 

13 (1) REPORTS TO CONGRESS.—Not later than 

14 180 days after the commencement of the pilot pro15 gram required under this section, and every 180 

16 days thereafter for the duration of the pilot pro17 gram, the Secretary of Veterans Affairs shall submit 

18 to Congress a report on the pilot program. Each 

19 such report shall include each of the following: 

20 (A) A separate analysis of each the fol21 lowing with respect to medical scribes employed 

22 by the Department of Veterans Affairs and 

23 medical scribes performing Department of Vet24 erans Affairs functions under a contract: 

25 (i) Provider efficiency. 


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1 (ii) Patient satisfaction. 

2 (iii) Average wait time. 

3 (iv) The number of patients seen per 

4 day by each physician or practitioner. 

5 (v) The amount of time required to 

6 hire and train an employee to perform 

7 medical scribe functions under the pilot 

8 program. 

9 (B) Metrics and data for analyzing the ef10 fects of the pilot program, including an evalua11 tion of each of the elements under clauses (i) 

12 through (iv) of subparagraph (A) at medical 

13 centers who employed scribes under the pilot 

14 program for an appropriate period preceding 

15 the hiring of such scribes. 

16 (2) COMPTROLLER GENERAL REPORT.—Not 

17 later than 90 days after the termination of the pilot 

18 program under this section, the Comptroller General 

19 of the United States shall submit to Congress a re20 port on the pilot program. Such report shall include 

21 a comparison of the pilot program with similar pro22 grams carried out in the private sector. 

23 (e) DEFINITIONS.—In this section: 

24 (1) The term ‘‘medical scribe’’ means an unli25 censed individual hired to enter information into the 


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1 electronic health record or chart at the direction of 

2 a physician or licensed independent practitioner 

3 whose responsibilities include the following: 

4 (A) Assisting the physician or practitioner 

5 in navigating the electronic health record. 

6 (B) Responding to various messages as di7 rected by the physician or practitioner. 

8 (C) Entering information into the elec9 tronic health record, as directed by the physi10 cian or practitioner. 

11 (2) The terms ‘‘urban’’ and ‘‘rural’’ have the 

12 meanings given such terms under the rural-urban 

13 commuting codes developed by the Secretary of Agri14 culture and the Secretary of Health and Human 

15 Services. 

16 (f) FUNDING.—The pilot program under this section 

17 shall be carried out using amounts otherwise authorized 

18 to be appropriated for the Department of Veterans Af19 fairs. No additional amounts are authorized to be appro20 priated to carry out such program. 

21 SEC. 508. EXTENSION OF REQUIREMENT TO COLLECT FEES 

22 FOR HOUSING LOANS GUARANTEED BY SEC23 RETARY OF VETERANS AFFAIRS. 

24 Section 3729(b)(2) is amended by striking ‘‘2027’’ 

25 each place it appears and inserting ‘‘2028’’. 


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1 SEC. 509. EXTENSION OF REDUCTION IN AMOUNT OF PEN2 SION FURNISHED BY DEPARTMENT OF VET3 ERANS AFFAIRS FOR CERTAIN VETERANS 

4 COVERED BY MEDICAID PLANS FOR SERV5 ICES FURNISHED BY NURSING FACILITIES. 

6 Section 5503(d)(7) is amended by striking ‘‘Sep7 tember 30, 2027’’ and inserting ‘‘September 30, 2028’’. 

8 SEC. 510. APPROPRIATION OF AMOUNTS. 

9 (a) VETERANS CHOICE PROGRAM.—There is author10 ized to be appropriated, and is appropriated, to the Sec11 retary of Veterans Affairs, out of any funds in the Treas12 ury not otherwise appropriated, $5,200,000,000 to be de13 posited in the Veterans Choice Fund under section 802 

14 of the Veterans Access, Choice, and Accountability Act of 

15 2014 (Public Law 113–146; 38 U.S.C. 1701 note). 

16 (b) AVAILABILITY OF AMOUNTS.—The amounts ap17 propriated under subsection (a) shall be available for obli18 gation or expenditure without fiscal year limitation. 

19 SEC. 511. TECHNICAL CORRECTION. 

20 Section 1712I of title 38, United States Code, is re21 designated as section 1720I of such title. 

Æ 


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