IB 
Union Calendar No. 516 
115TH CONGRESS 
2D SESSION 
H. R. 5674 
[Report No. 115–671, Part I] 
To establish a permanent community care program for veterans, to establish 
a commission for the purpose of making recommendations regarding 
the modernization or realignment of facilities of the Veterans Health 
Administration, to improve construction of the Department of Veterans 
Affairs, to make certain improvements in the laws administered by the 
Secretary of Veterans Affairs relating to the home loan program of 
the Department of Veterans Affairs, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 3, 2018 
Mr. ROE of Tennessee introduced the following bill; which was referred to the 
Committee on Veterans’ Affairs, and in addition to the Committee on 
Rules, for a period to be subsequently determined by the Speaker, in each 
case for consideration of such provisions as fall within the jurisdiction of 
the committee concerned 
MAY 11, 2018 
Additional sponsors: Mrs. RADEWAGEN, Mr. RUTHERFORD, Mr. BANKS of In-
diana, Mr. WENSTRUP, Mr. HIGGINS of Louisiana, Mrs. WAGNER, Mr. 
POLIQUIN, Mr. CARTER of Texas, Mr. WEBSTER of Florida, Mr. SAM 
JOHNSON of Texas, Ms. SINEMA, Ms. MCSALLY, Mr. BERGMAN, Mr. 
BILIRAKIS, Miss GONZA´LEZ-COLO´N of Puerto Rico, Mr. DUNN, Mr. 
ARRINGTON, Ms. KUSTER of New Hampshire, Mr. BOST, Mr. COFFMAN, 
and Mr. WALDEN 
MAY 11, 2018 
Reported from the Committee on Veterans’ Affairs 
MAY 11, 2018 
The Committee on Rules discharged; committed to the Committee of the 
Whole House on the State of the Union and ordered to be printed 
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A BILL 
To establish a permanent community care program for vet-
erans, to establish a commission for the purpose of mak-
ing recommendations regarding the modernization or re-
alignment of facilities of the Veterans Health Adminis-
tration, to improve construction of the Department of 
Veterans Affairs, to make certain improvements in the 
laws administered by the Secretary of Veterans Affairs 
relating to the home loan program of the Department 
of Veterans Affairs, and for other purposes. 
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Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘VA Maintaining Internal Systems and Strengthening In-
tegrated Outside Networks Act of 2018’’ or ‘‘VA MIS-
SION Act of 2018’’. 
(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
TITLE I—CARING FOR OUR VETERANS 
Sec. 100. Short title; references to title 38, United States Code. 
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-Per-
forming 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-De-
partment 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. 
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Sec. 123. Continuing medical education for non-Department medical profes-
sionals. 
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. 
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—VA ASSET AND INFRASTRUCTURE REVIEW 
Subtitle A—Asset and Infrastructure Review 
Sec. 201. Short title. 
Sec. 202. The Commission. 
Sec. 203. Procedure for making recommendations. 
Sec. 204. Actions regarding infrastructure and facilities of the Veterans Health 
Administration. 
Sec. 205. Implementation. 
Sec. 206. Department of Veterans Affairs Asset and Infrastructure Review Ac-
count. 
Sec. 207. Congressional consideration of Commission report. 
Sec. 208. Other matters. 
Sec. 209. Definitions. 
Subtitle B—Other Infrastructure Matters 
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Sec. 211. Improvement to training of construction personnel. 
Sec. 212. Review of enhanced use leases. 
Sec. 213. Assessment of health care furnished by the Department to veterans 
who live in the Pacific territories. 
TITLE III—IMPROVEMENTS TO RECRUITMENT OF HEALTH CARE 
PROFESSIONALS 
Sec. 301. Designated scholarships for physicians and dentists under Depart-
ment of Veterans Affairs Health Professional Scholarship Pro-
gram. 
Sec. 302. Increase in maximum amount of debt that may be reduced under 
Education Debt Reduction Program of Department of Vet-
erans Affairs. 
Sec. 303. Establishing the Department of Veterans Affairs Specialty Education 
Loan Repayment Program. 
Sec. 304. Veterans healing veterans medical access and scholarship program. 
Sec. 305. Bonuses for recruitment, relocation, and retention. 
Sec. 306. Inclusion of Vet Center employees in Education Debt Reduction Pro-
gram of Department of Veterans Affairs. 
TITLE IV—HEALTH CARE IN UNDERSERVED AREAS 
Sec. 401. 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. 402. Pilot program to furnish mobile deployment teams to underserved fa-
cilities. 
Sec. 403. Pilot program on graduate medical education and residency. 
TITLE V—OTHER MATTERS 
Sec. 501. Annual report on performance awards and bonuses awarded to cer-
tain 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 Depart-
ment 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 Vet-
erans Affairs. 
Sec. 507. Department of Veterans Affairs medical scribe pilot program. 
Sec. 508. Loans guaranteed under home loan program of Department of Vet-
erans Affairs. 
Sec. 509. Extension of reduction in amount of pension furnished by Depart-
ment of Veterans Affairs for certain veterans covered by Med-
icaid plans for services furnished by nursing facilities. 
Sec. 510. Appropriation of amounts. 
Sec. 511. Technical correction. 
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TITLE I—CARING FOR OUR 
VETERANS 
SEC. 100. SHORT TITLE; REFERENCES TO TITLE 38, UNITED 
STATES CODE. 
(a) SHORT TITLE.—This title may be cited as the 
‘‘Caring for Our Veterans Act of 2018’’. 
(b) REFERENCES TO TITLE 38, UNITED STATES 
CODE.—Except as otherwise expressly provided, whenever 
in this title an amendment or repeal is expressed in terms 
of an amendment to, or repeal of, a section or other provi-
sion, the reference shall be considered to be made to a 
section or other provision of title 38, United States Code. 
Subtitle A—Developing an Inte-
grated 
High-Performing 
Net-
work 
CHAPTER 1—ESTABLISHING COMMUNITY 
CARE PROGRAMS 
SEC. 101. ESTABLISHMENT OF VETERANS COMMUNITY 
CARE PROGRAM. 
(a) ESTABLISHMENT OF PROGRAM.— 
(1) IN GENERAL.—Section 1703 is amended to 
read as follows: 
‘‘§ 1703. Veterans Community Care Program 
‘‘(a) IN GENERAL.—(1) There is established a pro-
gram to furnish hospital care, medical services, and ex-
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tended care services to covered veterans through health 
care providers specified in subsection (c). 
‘‘(2) The Secretary shall coordinate the furnishing of 
hospital care, medical services, and extended care services 
under this section to covered veterans, including coordina-
tion of, at a minimum, the following: 
‘‘(A) Ensuring the scheduling of medical ap-
pointments in a timely manner and the establish-
ment of a mechanism to receive medical records 
from non-Department providers. 
‘‘(B) Ensuring continuity of care and services. 
‘‘(C) Ensuring coordination among regional 
networks if the covered veteran accesses care and 
services in a different network than the regional net-
work in which the covered veteran resides. 
‘‘(D) Ensuring that covered veterans do not ex-
perience a lapse in care resulting from errors or 
delays by the Department or its contractors or an 
unusual or excessive burden in accessing hospital 
care, medical services, or extended care services. 
‘‘(3) A covered veteran may only receive care or serv-
ices under this section upon the authorization of such care 
or services by the Secretary. 
‘‘(b) COVERED VETERANS.—For purposes of this 
section, a covered veteran is any veteran who— 
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‘‘(1) is enrolled in the system of annual patient 
enrollment established and operated under section 
1705 of this title; or 
‘‘(2) is not enrolled in such system but is other-
wise entitled to hospital care, medical services, or ex-
tended care services under subsection (c)(2) of such 
section. 
‘‘(c) HEALTH CARE PROVIDERS SPECIFIED.—Health 
care providers specified in this subsection are the fol-
lowing: 
‘‘(1) Any health care provider that is partici-
pating in the Medicare program under title XVIII of 
the Social Security Act (42 U.S.C. 1395 et seq.), in-
cluding any physician furnishing services under such 
a program. 
‘‘(2) The Department of Defense. 
‘‘(3) The Indian Health Service. 
‘‘(4) Any Federally-qualified health center (as 
defined in section 1905(l)(2)(B) of the Social Secu-
rity Act (42 U.S.C. 1396d(l)(2)(B))). 
‘‘(5) Any health care provider not otherwise 
covered under any of paragraphs (1) through (4) 
that meets criteria established by the Secretary for 
purposes of this section. 
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‘‘(d) CONDITIONS UNDER WHICH CARE IS RE-
QUIRED TO BE FURNISHED THROUGH NON-DEPART-
MENT PROVIDERS.—(1) The Secretary shall, subject to 
the availability of appropriations, furnish hospital care, 
medical services, and extended care services to a covered 
veteran through health care providers specified in sub-
section (c) if— 
‘‘(A) the Department does not offer the care or 
services the veteran requires; 
‘‘(B) the Department does not operate a full- 
service medical facility in the State in which the cov-
ered veteran resides; 
‘‘(C)(i) the covered veteran was an eligible vet-
eran under section 101(b)(2)(B) of the Veterans Ac-
cess, Choice, and Accountability Act of 2014 (Public 
Law 113–146; 38 U.S.C. 1701 note) as of the day 
before the date of the enactment of the Caring for 
Our Veterans Act of 2018; 
‘‘(ii) continues to reside in a location that would 
qualify the veteran for eligibility under such section; 
and 
‘‘(iii) either— 
‘‘(I) resides in one of the five States with 
the lowest population density as determined by 
data from the 2010 decennial census; or 
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‘‘(II) resides in a State not described in 
subclause (I) and— 
‘‘(aa) received care or services under 
this title in the year preceding the enact-
ment of the Caring for Our Veterans Act 
of 2018; and 
‘‘(bb) is seeking care or services with-
in two years of the date of the enactment 
of the Caring for Our Veterans Act of 
2018; 
‘‘(D) the covered veteran has contacted the De-
partment to request care or services and the Depart-
ment is not able to furnish such care or services in 
a manner that complies with designated access 
standards developed by the Secretary under section 
1703B of this title; or 
‘‘(E) the covered veteran and the covered vet-
eran’s referring clinician agree that furnishing care 
and services through a non-Department entity or 
provider would be in the best medical interest of the 
covered veteran based upon criteria developed by the 
Secretary. 
‘‘(2) The Secretary shall ensure that the criteria de-
veloped under paragraph (1)(E) include consideration of 
the following: 
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‘‘(A) The distance between the covered veteran 
and the facility that provides the hospital care, med-
ical services, or extended care services the veteran 
needs. 
‘‘(B) The nature of the hospital care, medical 
services, or extended care services required. 
‘‘(C) The frequency that the hospital care, med-
ical services, or extended care services needs to be 
furnished. 
‘‘(D) The timeliness of available appointments 
for the hospital care, medical services, or extended 
care services the veteran needs. 
‘‘(E) Whether the covered veteran faces an un-
usual or excessive burden to access hospital care, 
medical services, or extended care services from the 
Department medical facility where a covered veteran 
seeks hospital care, medical services, or extended 
care services, which shall include consideration of 
the following: 
‘‘(i) Whether the covered veteran faces an 
excessive driving distance, geographical chal-
lenge, or environmental factor that impedes the 
access of the covered veteran. 
‘‘(ii) Whether the hospital care, medical 
services, or extended care services sought by the 
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such paragraph, the decision to receive hospital care, med-
ical services, or extended care services under such sub-
paragraphs from a health care provider specified in sub-
section (c) shall be at the election of the veteran. 
‘‘(e) CONDITIONS UNDER WHICH CARE IS AUTHOR-
IZED TO BE FURNISHED THROUGH NON-DEPARTMENT 
PROVIDERS.—(1)(A) The Secretary may furnish hospital 
care, medical services, or extended care services through 
a health care provider specified in subsection (c) to a cov-
ered veteran served by a medical service line of the De-
partment that the Secretary has determined is not pro-
viding care that complies with the standards for quality 
the Secretary shall establish under section 1703C. 
‘‘(B) In carrying out subparagraph (A), the Secretary 
shall— 
‘‘(i) measure timeliness of the medical service 
line at a facility of the Department when compared 
with the same medical service line at different De-
partment facilities; and 
‘‘(ii) measure quality at a medical service line 
of a facility of the Department by comparing it with 
two or more distinct and appropriate quality meas-
ures at non-Department medical service lines. 
‘‘(C)(i) The Secretary may not concurrently furnish 
hospital care, medical services, or extended care services 
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