(b) CLERICAL AMENDMENT.—The table of sections 
at the beginning of chapter 17, as amended by section 
102, is further amended by inserting after the item relat-
ing to section 1703A the following new items: 
‘‘1703B. Access standards. 
‘‘1703C. Standards for quality.’’. 
SEC. 105. ACCESS TO WALK-IN CARE. 
(a) IN GENERAL.—Chapter 17 is amended by insert-
ing after section 1725 the following new section: 
‘‘§ 1725A. Access to walk-in care 
‘‘(a) PROCEDURES TO ENSURE ACCESS TO WALK- 
IN CARE.—The Secretary shall develop procedures to en-
sure that eligible veterans are able to access walk-in care 
from qualifying non-Department entities or providers. 
‘‘(b) ELIGIBLE VETERANS.—For purposes of this 
section, an eligible veteran is any individual who— 
‘‘(1) is enrolled in the health care system estab-
lished under section 1705(a) of this title; and 
‘‘(2) has received care under this chapter within 
the 24-month period preceding the furnishing of 
walk-in care under this section. 
‘‘(c) QUALIFYING NON-DEPARTMENT ENTITIES OR 
PROVIDERS.—For purposes of this section, a qualifying 
non-Department entity or provider is a non-Department 
entity or provider that has entered into a contract or other 
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agreement with the Secretary to furnish services under 
this section. 
‘‘(d) FEDERALLY-QUALIFIED HEALTH CENTERS.— 
Whenever practicable, the Secretary may use a Federally- 
qualified health center (as defined in section 1905(l)(2)(B) 
of the Social Security Act (42 U.S.C. 1396d(l)(2)(B))) to 
carry out this section. 
‘‘(e) CONTINUITY OF CARE.—The Secretary shall en-
sure continuity of care for those eligible veterans who re-
ceive walk-in care services under this section, including 
through the establishment of a mechanism to receive med-
ical records from walk-in care providers and provide perti-
nent patient medical records to providers of walk-in care. 
‘‘(f) COPAYMENTS.—(1)(A) The Secretary may re-
quire an eligible veteran to pay the United States a copay-
ment for each episode of hospital care or medical services 
provided under this section if the eligible veteran would 
be required to pay a copayment under this title. 
‘‘(B) An eligible veteran not required to pay a copay-
ment under this title may access walk-in care without a 
copayment for the first two visits in a calendar year. For 
any additional visits, a copayment at an amount deter-
mined by the Secretary may be required. 
‘‘(C) An eligible veteran required to pay a copayment 
under this title may be required to pay a regular copay-
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ment for the first two walk-in care visits in a calendar 
year. For any additional visits, a higher copayment at an 
amount determined by the Secretary may be required. 
‘‘(2) After the first two episodes of care furnished 
to an eligible veteran under this section, the Secretary may 
adjust the copayment required of the veteran under this 
subsection based upon the priority group of enrollment of 
the eligible veteran, the number of episodes of care fur-
nished to the eligible veteran during a year, and other fac-
tors the Secretary considers appropriate under this sec-
tion. 
‘‘(3) The amount or amounts of the copayments re-
quired under this subsection shall be prescribed by the 
Secretary by rule. 
‘‘(4) Section 8153(c) of this title shall not apply to 
this subsection. 
‘‘(g) REGULATIONS.—Not later than one year after 
the date of the enactment of the Caring for Our Veterans 
Act of 2018, the Secretary shall promulgate regulations 
to carry out this section. 
‘‘(h) WALK-IN CARE DEFINED.—In this section, the 
term ‘walk-in care’ means non-emergent care provided by 
a qualifying non-Department entity or provider that fur-
nishes episodic care and not longitudinal management of 
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conditions and is otherwise defined through regulations 
the Secretary shall promulgate.’’. 
(b) EFFECTIVE DATE.—Section 1725A of title 38, 
United States Code, as added by subsection (a) shall take 
effect on the date upon which final regulations imple-
menting such section take effect. 
(c) CLERICAL AMENDMENT.—The table of sections 
at the beginning of such chapter is amended by inserting 
after the item related to section 1725 the following new 
item: 
‘‘§1725A. Access to walk-in care.’’. 
SEC. 106. STRATEGY REGARDING THE DEPARTMENT OF 
VETERANS AFFAIRS HIGH-PERFORMING IN-
TEGRATED HEALTH CARE NETWORK. 
(a) IN GENERAL.—Subchapter II of chapter 73 is 
amended by inserting after section 7330B the following 
new section: 
‘‘§ 7330C. Quadrennial Veterans Health Administra-
tion review 
‘‘(a) MARKET AREA ASSESSMENTS.—(1) Not less 
frequently than every four years, the Secretary of Vet-
erans Affairs shall perform market area assessments re-
garding the health care services furnished under the laws 
administered by the Secretary. 
‘‘(2) Each market area assessment established under 
paragraph (1) shall include the following: 
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‘‘(A) An assessment of the demand for health 
care from the Department, disaggregated by geo-
graphic market areas as determined by the Sec-
retary, including the number of requests for health 
care services under the laws administered by the 
Secretary. 
‘‘(B) An inventory of the health care capacity 
of the Department of Veterans Affairs across the 
Department’s system of facilities. 
‘‘(C) An assessment of the health care capacity 
to be provided through contracted community care 
providers and providers who entered into a provider 
agreement with the Department under section 
1703A of title 38, as added by section 102, includ-
ing the number of providers, the geographic location 
of the providers, and categories or types of health 
care services provided by the providers. 
‘‘(D) An assessment obtained from other Fed-
eral direct delivery systems of their capacity to pro-
vide health care to veterans. 
‘‘(E) An assessment of the health care capacity 
of non-contracted providers where there is insuffi-
cient network supply. 
‘‘(F) An assessment of the health care capacity 
of academic affiliates and other collaborations of the 
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Department as it relates to providing health care to 
veterans. 
‘‘(G) An assessment of the effects on health 
care capacity of the access standards and standards 
for quality established under sections 1703B and 
1703C of this title. 
‘‘(H) The number of appointments for health 
care services under the laws administered by the 
Secretary, disaggregated by— 
‘‘(i) appointments at facilities of the De-
partment of Veterans Affairs; and 
‘‘(ii) appointments with non-Department 
health care providers. 
‘‘(3)(A) The Secretary shall submit to the appro-
priate committees of Congress the market area assess-
ments established in paragraph (1). 
‘‘(B) The Secretary also shall submit to the appro-
priate committees of Congress the market area assess-
ments completed by or being performed on the day before 
the date of the enactment of the Caring for Our Veterans 
Act of 2018. 
‘‘(4)(A) The Secretary shall use the market area as-
sessments established under paragraph (1) to— 
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‘‘(i) determine the capacity of the health care 
provider networks established under section 1703(h) 
of this title; 
‘‘(ii) inform the Department budget, in accord-
ance with subparagraph (B); and 
‘‘(iii) inform and assess the appropriateness of 
the access standards established under section 
1703B of this title and standards for quality under 
section 1703C and to make recommendations for 
any changes to such standards. 
‘‘(B) The Secretary shall ensure that the Department 
budget for any fiscal year (as submitted with the budget 
of the President under section 1105(a) of title 31) reflects 
the findings of the Secretary with respect to the most re-
cent market area assessments under paragraph (1) and 
health care utilization data from the Department and non- 
Department entities or providers furnishing care and serv-
ices to covered veterans as described in section 1703(b). 
‘‘(b) STRATEGIC PLAN TO MEET HEALTH CARE DE-
MAND.—(1) Not later than one year after the date of the 
enactment of the Caring for Our Veterans Act of 2018 
and not less frequently than once every four years there-
after, the Secretary shall submit to the appropriate com-
mittees of Congress a strategic plan that specifies a four- 
year forecast of— 
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‘‘(A) the demand for health care from the De-
partment, disaggregated by geographic area as de-
termined by the Secretary; 
‘‘(B) the health care capacity to be provided at 
each medical center of the Department; and 
‘‘(C) the health care capacity to be provided 
through community care providers. 
‘‘(2) In preparing the strategic plan under paragraph 
(1), the Secretary shall— 
‘‘(A) assess the access standards and standards 
for quality established under sections 1703B and 
1703C of this title; 
‘‘(B) assess the market area assessments estab-
lished under subsection (a); 
‘‘(C) assess the needs of the Department based 
on identified services that provide management of 
conditions or disorders related to military service for 
which there is limited experience or access in the na-
tional market, the overall health of veterans 
throughout their lifespan, or other services as the 
Secretary determines appropriate; 
‘‘(D) consult with key stakeholders within the 
Department, the heads of other Federal agencies, 
and other relevant governmental and nongovern-
mental entities, including State, local, and tribal 
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government officials, members of Congress, veterans 
service organizations, private sector representatives, 
academics, and other policy experts; 
‘‘(E) identify emerging issues, trends, problems, 
and opportunities that could affect health care serv-
ices furnished under the laws administered by the 
Secretary; 
‘‘(F) develop recommendations regarding both 
short- and long-term priorities for health care serv-
ices furnished under the laws administered by the 
Secretary; 
‘‘(G) after consultation with veterans service or-
ganizations and other key stakeholders on survey de-
velopment or modification of an existing survey, con-
sider a survey of veterans who have used hospital 
care, medical services, or extended care services fur-
nished by the Veterans Health Administration dur-
ing the most recent two-year period to assess the 
satisfaction of the veterans with service and quality 
of care; 
‘‘(H) conduct a comprehensive examination of 
programs and policies of the Department regarding 
the delivery of health care services and the demand 
of health care services for veterans in future years; 
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‘‘(I) assess the remediation of medical service 
lines of the Department as described in section 
1706A in conjunction with the utilization of non-De-
partment entities or providers to offset remediation; 
and 
‘‘(J) consider such other matters as the Sec-
retary considers appropriate. 
‘‘(c) RESPONSIBILITIES.—The Secretary shall be re-
sponsible for— 
‘‘(1) overseeing the transformation and organi-
zational change across the Department to achieve 
such high performing integrated health care net-
work; 
‘‘(2) developing the capital infrastructure plan-
ning and procurement processes, whether minor or 
major construction projects or leases; and 
‘‘(3) developing a multi-year budget process 
that is capable of forecasting future year budget re-
quirements and projecting the cost of delivering 
health care services under a high-performing inte-
grated health care network. 
‘‘(d) APPROPRIATE COMMITTEES OF CONGRESS DE-
FINED.—In this section, the term ‘appropriate committees 
of Congress’ means— 
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‘‘(1) the Committee on Veterans’ Affairs and 
the Committee on Appropriations of the Senate; and 
‘‘(2) the Committee on Veterans’ Affairs and 
the Committee on Appropriations of the House of 
Representatives.’’. 
(b) CLERICAL AMENDMENT.—The table of sections 
at the beginning of such chapter is amended by inserting 
after the item related to section 7330B the following new 
item: 
‘‘7330C. Quadrennial Veterans Health Administration review.’’. 
SEC. 107. APPLICABILITY OF DIRECTIVE OF OFFICE OF 
FEDERAL 
CONTRACT 
COMPLIANCE 
PRO-
GRAMS. 
(a) IN GENERAL.—Notwithstanding the treatment of 
certain laws under subsection (i) of section 1703A of title 
38, United States Code, as added by section 102 of this 
title, Directive 2014–01 of the Office of Federal Contract 
Compliance Programs of the Department of Labor (effec-
tive as of May 7, 2014) shall apply to any entity entering 
into an agreement under such section 1703A or section 
1745 of such title, as amended by section 103, in the same 
manner as such directive applies to subcontractors under 
the TRICARE program for the duration of the morato-
rium provided under such directive. 
(b) APPLICABILITY PERIOD.—The directive described 
in subsection (a), and the moratorium provided under such 
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directive, shall not be altered or rescinded before May 7, 
2019. 
(c) TRICARE PROGRAM DEFINED.—In this section, 
the term ‘‘TRICARE program’’ has the meaning given 
that term in section 1072 of title 10, United States Code. 
SEC. 108. PREVENTION OF CERTAIN HEALTH CARE PRO-
VIDERS FROM PROVIDING NON-DEPARTMENT 
HEALTH CARE SERVICES TO VETERANS. 
(a) IN GENERAL.—On and after the date that is one 
year after the date of the enactment of this Act, the Sec-
retary of Veterans Affairs shall deny or revoke the eligi-
bility of a health care provider to provide non-Department 
health care services to veterans if the Secretary determines 
that the health care provider— 
(1) was removed from employment with the De-
partment of Veterans Affairs due to conduct that 
violated a policy of the Department relating to the 
delivery of safe and appropriate health care; or 
(2) violated the requirements of a medical li-
cense of the health care provider that resulted in the 
loss of such medical license. 
(b) PERMISSIVE ACTION.—On and after the date that 
is one year after the date of the enactment of this Act, 
the Secretary may deny, revoke, or suspend the eligibility 
of a health care provider to provide non-Department 
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health care services if the Secretary determines such ac-
tion is necessary to immediately protect the health, safety, 
or welfare of veterans and the health care provider is 
under investigation by the medical licensing board of a 
State in which the health care provider is licensed or prac-
tices. 
(c) SUSPENSION.—The Secretary shall suspend the 
eligibility of a health care provider to provide non-Depart-
ment health care services to veterans if the health care 
provider is suspended from serving as a health care pro-
vider of the Department. 
(d) COMPTROLLER GENERAL REPORT.—Not later 
than two years after the date of the enactment of this Act, 
the Comptroller General of the United States shall submit 
to Congress a report on the implementation by the Sec-
retary of this section, including the following: 
(1) The aggregate number of health care pro-
viders denied or suspended under this section from 
participation in providing non-Department health 
care services. 
(2) An evaluation of any impact on access to 
health care for patients or staffing shortages in pro-
grams of the Department providing non-Department 
health care services. 
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(3) An explanation of the coordination of the 
Department with the medical licensing boards of 
States in implementing this section, the amount of 
involvement of such boards in such implementation, 
and efforts by the Department to address any con-
cerns raised by such boards with respect to such im-
plementation. 
(4) Such recommendations as the Comptroller 
General considers appropriate regarding harmo-
nizing eligibility criteria between health care pro-
viders of the Department and health care providers 
eligible to provide non-Department health care serv-
ices. 
(e) NON-DEPARTMENT HEALTH CARE SERVICES 
DEFINED.—In this section, the term ‘‘non-Department 
health care services’’ means services— 
(1) provided under subchapter I of chapter 17 
of title 38, United States Code, at non-Department 
facilities (as defined in section 1701 of such title); 
(2) provided under section 101 of the Veterans 
Access, Choice, and Accountability Act of 2014 
(Public Law 113–146; 38 U.S.C. 1701 note); 
(3) purchased through the Medical Community 
Care account of the Department; or 
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(4) purchased with amounts deposited in the 
Veterans Choice Fund under section 802 of the Vet-
erans Access, Choice, and Accountability Act of 
2014. 
SEC. 109. REMEDIATION OF MEDICAL SERVICE LINES. 
(a) IN GENERAL.—Subchapter I of chapter 17 is 
amended by inserting after section 1706 the following new 
section: 
‘‘§ 1706A. Remediation of medical service lines 
‘‘(a) IN GENERAL.—Not later than 30 days after de-
termining under section 1703(e)(1) that a medical service 
line of the Department is providing hospital care, medical 
services, or extended care services that does not comply 
with the standards for quality established by the Sec-
retary, the Secretary shall submit to Congress an assess-
ment of the factors that led the Secretary to make such 
determination and a plan with specific actions, and the 
time to complete them, to be taken to comply with such 
standards for quality, including the following: 
‘‘(1) Increasing personnel or temporary per-
sonnel assistance, including mobile deployment 
teams. 
‘‘(2) Special hiring incentives, including the 
Education Debt Reduction Program under sub-
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chapter VII of chapter 76 of this title and recruit-
ment, relocation, and retention incentives. 
‘‘(3) Utilizing direct hiring authority. 
‘‘(4) Providing improved training opportunities 
for staff. 
‘‘(5) Acquiring improved equipment. 
‘‘(6) Making structural modifications to the fa-
cility used by the medical service line. 
‘‘(7) Such other actions as the Secretary con-
siders appropriate. 
‘‘(b) RESPONSIBLE PARTIES.—In each assessment 
submitted under subsection (a) with respect to a medical 
service line, the Secretary shall identify the individuals at 
the Central Office of the Veterans Health Administration, 
the facility used by the medical service line, and the cen-
tral office of the relevant Veterans Integrated Service Net-
work who are responsible for overseeing the progress of 
that medical service line in complying with the standards 
for quality established by the Secretary. 
‘‘(c) INTERIM REPORTS.—Not later than 180 days 
after submitting an assessment under subsection (a) with 
respect to a medical service line, the Secretary shall sub-
mit to Congress a report on the progress of that medical 
service line in complying with the standards for quality 
established by the Secretary and any other measures the 
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Secretary will take to assist the medical service line in 
complying with such standards for quality. 
‘‘(d) ANNUAL REPORTS.—Not less frequently than 
once each year, the Secretary shall— 
‘‘(1) submit to Congress an analysis of the re-
mediation actions and costs of such actions taken 
with respect to each medical service line with respect 
to which the Secretary submitted an assessment and 
plan under paragraph (1) in the preceding year, in-
cluding an update on the progress of each such med-
ical service line in complying with the standards for 
quality and timeliness established by the Secretary 
and any other actions the Secretary is undertaking 
to assist the medical service line in complying with 
standards for quality as established by the Sec-
retary; and 
‘‘(2) publish such analysis on the internet 
website of the Department.’’. 
(b) CLERICAL AMENDMENT.—The table of sections 
at the beginning of such chapter is amended by inserting 
after the item related to section 1706 the following new 
item: 
‘‘1706A. Remediation of medical service lines.’’. 
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CHAPTER 2—PAYING PROVIDERS AND 
IMPROVING COLLECTIONS 
SEC. 111. PROMPT PAYMENT TO PROVIDERS. 
(a) IN GENERAL.—Subchapter I of chapter 17 is 
amended by inserting after section 1703C, as added by 
section 104 of this title, the following new section: 
‘‘§ 1703D. Prompt payment standard 
‘‘(a) IN GENERAL.—(1) Notwithstanding any other 
provision of this title or of any other provision of law, the 
Secretary shall pay for hospital care, medical services, or 
extended care services furnished by health care entities or 
providers under this chapter within 45 calendar days upon 
receipt of a clean paper claim or 30 calendar days upon 
receipt of a clean electronic claim. 
‘‘(2) If a claim is denied, the Secretary shall, within 
45 calendar days of denial for a paper claim and 30 cal-
endar days of denial for an electronic claim, notify the 
health care entity or provider of the reason for denying 
the claim and what, if any, additional information is re-
quired to process the claim. 
‘‘(3) Upon the receipt of the additional information, 
the Secretary shall ensure that the claim is paid, denied, 
or otherwise adjudicated within 30 calendar days from the 
receipt of the requested information. 
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‘‘(4) This section shall only apply to payments made 
on an invoice basis and shall not apply to capitation or 
other forms of periodic payment to entities or providers. 
‘‘(b) SUBMITTAL OF CLAIMS BY HEALTH CARE EN-
TITIES AND PROVIDERS.—A health care entity or provider 
that furnishes hospital care, a medical service, or an ex-
tended care service under this chapter shall submit to the 
Secretary a claim for payment for furnishing the hospital 
care, medical service, or extended care service not later 
than 180 days after the date on which the entity or pro-
vider furnished the hospital care, medical service, or ex-
tended care service. 
‘‘(c) FRAUDULENT
CLAIMS.—(1) Sections 3729 
through 3733 of title 31 shall apply to fraudulent claims 
for payment submitted to the Secretary by a health care 
entity or provider under this chapter. 
‘‘(2) Pursuant to regulations prescribed by the Sec-
retary, the Secretary shall bar a health care entity or pro-
vider from furnishing hospital care, medical services, and 
extended care services under this chapter when the Sec-
retary determines the entity or provider has submitted to 
the Secretary fraudulent health care claims for payment 
by the Secretary. 
‘‘(d) OVERDUE CLAIMS.—(1) Any claim that has not 
been denied with notice, made pending with notice, or paid 
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to the health care entity or provider by the Secretary shall 
be overdue if the notice or payment is not received by the 
entity provider within the time periods specified in sub-
section (a). 
‘‘(2)(A) If a claim is overdue under this subsection, 
the Secretary may, under the requirements established by 
subsection (a) and consistent with the provisions of chap-
ter 39 of title 31 (commonly referred to as the ‘Prompt 
Payment Act’), require that interest be paid on clean 
claims. 
‘‘(B) Interest paid under subparagraph (A) shall be 
computed at the rate of interest established by the Sec-
retary of the Treasury under section 3902 of title 31 and 
published in the Federal Register. 
‘‘(3) Not less frequently than annually, the Secretary 
shall submit to Congress a report on payment of overdue 
claims under this subsection, disaggregated by paper and 
electronic claims, that includes the following: 
‘‘(A) The amount paid in overdue claims de-
scribed in this subsection, disaggregated by the 
amount of the overdue claim and the amount of in-
terest paid on such overdue claim. 
‘‘(B) The number of such overdue claims and 
the average number of days late each claim was 
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paid, disaggregated by facility of the Department 
and Veterans Integrated Service Network region. 
‘‘(e) OVERPAYMENT.—(1) The Secretary shall deduct 
the amount of any overpayment from payments due a 
health care entity or provider under this chapter. 
‘‘(2) Deductions may not be made under this sub-
section unless the Secretary has made reasonable efforts 
to notify a health care entity or provider of the right to 
dispute the existence or amount of such indebtedness and 
the right to request a compromise of such indebtedness. 
‘‘(3) The Secretary shall make a determination with 
respect to any such dispute or request prior to deducting 
any overpayment unless the time required to make such 
a determination before making any deductions would jeop-
ardize the Secretary’s ability to recover the full amount 
of such indebtedness. 
‘‘(f) INFORMATION
AND
DOCUMENTATION
RE-
QUIRED.—(1) The Secretary shall provide to all health 
care entities and providers participating in a program to 
furnish hospital care, medical services, or extended care 
services under this chapter a list of information and docu-
mentation that is required to establish a clean claim under 
this section. 
‘‘(2) The Secretary shall consult with entities in the 
health care industry, in the public and private sector, to 
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determine the information and documentation to include 
in the list under paragraph (1). 
‘‘(3) If the Secretary modifies the information and 
documentation included in the list under paragraph (1), 
the Secretary shall notify all health care entities and pro-
viders described in paragraph (1) not later than 30 days 
before such modifications take effect. 
‘‘(g) PROCESSING OF CLAIMS.—(1) In processing a 
claim for compensation for hospital care, medical services, 
or extended care services furnished by a non-Department 
health care entity or provider under this chapter, the Sec-
retary may act through— 
‘‘(A) a non-Department entity that is under 
contract or agreement for the program established 
under section 1703(a) of this title; or 
‘‘(B) a non-Department entity that specializes 
in such processing for other Federal agency health 
care systems. 
‘‘(2) The Secretary shall seek to contract with a third 
party to conduct a review of claims described in paragraph 
(3) that includes— 
‘‘(A) a feasibility assessment to determine the 
capacity of the Department to process such claims 
in a timely manner; and 
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‘‘(B) a cost benefit analysis comparing the ca-
pacity of the Department to a third party entity ca-
pable of processing such claims. 
‘‘(3) The review required under paragraph (2) shall 
apply to claims for hospital care, medical services, or ex-
tended care services furnished under section 1703 of this 
Act, as amended by the Caring for Our Veterans Act of 
2018, that are processed by the Department. 
‘‘(h) REPORT ON ENCOUNTER DATA SYSTEM.—(1) 
Not later than 90 days after the date of the enactment 
of the Caring for Our Veterans Act of 2018, the Secretary 
shall submit to the appropriate committees of Congress 
a report on the feasibility and advisability of adopting a 
funding mechanism similar to what is utilized by other 
Federal agencies to allow a contracted entity to act as a 
fiscal intermediary for the Federal Government to dis-
tribute, or pass through, Federal Government funds for 
certain non-underwritten hospital care, medical services, 
or extended care services. 
‘‘(2) The Secretary may coordinate with the Depart-
ment of Defense, the Department of Health and Human 
Services, and the Department of the Treasury in devel-
oping the report required by paragraph (1). 
‘‘(i) DEFINITIONS.—In this section: 
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‘‘(1) The term ‘appropriate committees of Con-
gress’ means— 
‘‘(A) the Committee on Veterans’ Affairs 
and the Committee on Appropriations of the 
Senate; and 
‘‘(B) the Committee on Veterans’ Affairs 
and the Committee on Appropriations of the 
House of Representatives. 
‘‘(2) The term ‘clean electronic claim’ means 
the transmission of data for purposes of payment of 
covered health care expenses that is submitted to the 
Secretary which contains substantially all of the re-
quired data elements necessary for accurate adju-
dication, without obtaining additional information 
from the entity or provider that furnished the care 
or service, submitted in such format as prescribed by 
the Secretary in regulations for the purpose of pay-
ing claims for care or services. 
‘‘(3) The term ‘clean paper claim’ means a 
paper claim for payment of covered health care ex-
penses that is submitted to the Secretary which con-
tains substantially all of the required data elements 
necessary for accurate adjudication, without obtain-
ing additional information from the entity or pro-
vider that furnished the care or service, submitted in 
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such format as prescribed by the Secretary in regu-
lations for the purpose of paying claims for care or 
services. 
‘‘(4) The term ‘fraudulent claims’ means the 
knowing misrepresentation of a material fact or 
facts by a health care entity or provider made to in-
duce the Secretary to pay a claim that was not le-
gally payable to that provider. 
‘‘(5) The term ‘health care entity or provider’ 
includes any non-Department health care entity or 
provider, but does not include any Federal health 
care entity or provider.’’. 
(b) CLERICAL AMENDMENT.—The table of sections 
at the beginning of such chapter is amended by inserting 
after the item related to section 1703C, as added by sec-
tion 104 of this title, the following new item: 
‘‘1703D. Prompt payment standard.’’. 
SEC. 112. AUTHORITY TO PAY FOR AUTHORIZED CARE NOT 
SUBJECT TO AN AGREEMENT. 
(a) IN GENERAL.—Subchapter IV of chapter 81 is 
amended by adding at the end the following new section: 
‘‘§ 8159. Authority to pay for services authorized but 
not subject to an agreement 
‘‘(a) IN GENERAL.—If, in the course of furnishing 
hospital care, a medical service, or an extended care serv-
ice authorized by the Secretary and pursuant to a con-
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tract, agreement, or other arrangement with the Sec-
retary, a provider who is not a party to the contract, 
agreement, or other arrangement furnishes hospital care, 
a medical service, or an extended care service that the Sec-
retary considers necessary, the Secretary may compensate 
the provider for the cost of such care or service. 
‘‘(b) NEW CONTRACTS
AND AGREEMENTS.—The 
Secretary shall take reasonable efforts to enter into a con-
tract, agreement, or other arrangement with a provider 
described in subsection (a) to ensure that future care and 
services authorized by the Secretary and furnished by the 
provider are subject to such a contract, agreement, or 
other arrangement.’’. 
(b) CLERICAL AMENDMENT.—The table of sections 
at the beginning of such chapter is amended by inserting 
after the item relating to section 8158 the following new 
item: 
‘‘8159. Authority to pay for services authorized but not subject to an agree-
ment.’’. 
SEC. 113. IMPROVEMENT OF AUTHORITY TO RECOVER THE 
COST OF SERVICES FURNISHED FOR NON- 
SERVICE-CONNECTED DISABILITIES. 
(a) BROADENING SCOPE OF APPLICABILITY.—Sec-
tion 1729 is amended— 
(1) in subsection (a)— 
(A) in paragraph (2)(A)— 
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(i) by striking ‘‘the veteran’s’’ and in-
serting ‘‘the individual’s’’; and 
(ii) by striking ‘‘the veteran’’ and in-
serting ‘‘the individual’’; and 
(B) in paragraph (3)— 
(i) in the matter preceding subpara-
graph (A), by striking ‘‘the veteran’’ and 
inserting ‘‘the individual’’; and 
(ii) in subparagraph (A), by striking 
‘‘the veteran’s’’ and inserting ‘‘the individ-
ual’s’’; 
(2) in subsection (b)— 
(A) in paragraph (1)— 
(i) by striking ‘‘the veteran’’ and in-
serting ‘‘the individual’’; and 
(ii) by striking ‘‘the veteran’s’’ and in-
serting ‘‘the individual’s’’; and 
(B) in paragraph (2)— 
(i) in subparagraph (A)— 
(I) by striking ‘‘the veteran’’ and 
inserting ‘‘the individual’’; and 
(II) by striking ‘‘the veteran’s’’ 
and inserting ‘‘the individual’s’’; and 
(ii) in subparagraph (B)— 
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(I) in clause (i), by striking ‘‘the 
veteran’’ and inserting ‘‘the indi-
vidual’’; and 
(II) in clause (ii)— 
(aa) by striking ‘‘the vet-
eran’’ and inserting ‘‘the indi-
vidual’’; and 
(bb) by striking ‘‘the vet-
eran’s’’ each place it appears and 
inserting ‘‘the individual’s’’; 
(3) in subsection (e), by striking ‘‘A veteran’’ 
and inserting ‘‘An individual’’; and 
(4) in subsection (h)— 
(A) in paragraph (1)— 
(i) in the matter preceding subpara-
graph (A), by striking ‘‘a veteran’’ and in-
serting ‘‘an individual’’; 
(ii) in subparagraph (A), by striking 
‘‘the veteran’’ and inserting ‘‘the indi-
vidual’’; and 
(iii) in subparagraph (B), by striking 
‘‘the veteran’’ and inserting ‘‘the indi-
vidual’’; and 
(B) in paragraph (2)— 
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(i) by striking ‘‘A veteran’’ and insert-
ing ‘‘An individual’’; 
(ii) by striking ‘‘a veteran’’ and in-
serting ‘‘an individual’’; and 
(iii) by striking ‘‘the veteran’’ and in-
serting ‘‘the individual’’. 
(b) MODIFICATION
OF
AUTHORITY.—Subsection 
(a)(1) of such section is amended by striking ‘‘(1) Sub-
ject’’ and all that follows through the period and inserting 
the following: ‘‘(1) Subject to the provisions of this sec-
tion, in any case in which the United States is required 
by law to furnish or pay for care or services under this 
chapter for a non-service-connected disability described in 
paragraph (2) of this subsection, the United States has 
the right to recover or collect from a third party the rea-
sonable charges of care or services so furnished or paid 
for to the extent that the recipient or provider of the care 
or services would be eligible to receive payment for such 
care or services from such third party if the care or serv-
ices had not been furnished or paid for by a department 
or agency of the United States.’’ 
(c) MODIFICATION
OF ELIGIBLE INDIVIDUALS.— 
Subparagraph (D) of subsection (a)(2) of such section is 
amended to read as follows: 
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‘‘(D) that is incurred by an individual who is 
entitled to care (or payment of the expenses of care) 
under a health-plan contract.’’. 
SEC. 114. PROCESSING OF CLAIMS FOR REIMBURSEMENT 
THROUGH ELECTRONIC INTERFACE. 
The Secretary of Veterans Affairs may enter into an 
agreement with a third-party entity to process, through 
the use of an electronic interface, claims for reimburse-
ment for health care provided under the laws administered 
by the Secretary. 
CHAPTER 3—EDUCATION AND TRAINING 
PROGRAMS 
SEC. 121. EDUCATION PROGRAM ON HEALTH CARE OP-
TIONS. 
(a) IN GENERAL.—The Secretary of Veterans Affairs 
shall develop and administer an education program that 
teaches veterans about their health care options through 
the Department of Veterans Affairs. 
(b) ELEMENTS.—The program under subsection (a) 
shall— 
(1) teach veterans about— 
(A) eligibility criteria for care from the De-
partment set forth under sections 1703, as 
amended by section 101 of this title, and 1710 
of title 38, United States Code; 
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(B) priority groups for enrollment in the 
system of annual patient enrollment under sec-
tion 1705(a) of such title; 
(C) the copayments and other financial ob-
ligations, if any, required of certain individuals 
for certain services; and 
(D) how to utilize the access standards 
and standards for quality established under sec-
tions 1703B and 1703C of such title; 
(2) teach veterans about the interaction be-
tween health insurance (including private insurance, 
Medicare, Medicaid, the TRICARE program, the In-
dian Health Service, tribal health programs, and 
other forms of insurance) and health care from the 
Department; and 
(3) provide veterans with information on what 
to do when they have a complaint about health care 
received from the Department (whether about the 
provider, the Department, or any other type of com-
plaint). 
(c) ACCESSIBILITY.—In developing the education 
program under this section, the Secretary shall ensure 
that materials under such program are accessible— 
(1) to veterans who may not have access to the 
internet; and 
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(2) to veterans in a manner that complies with 
the Americans with Disabilities Act of 1990 (42 
U.S.C. 12101 et seq.). 
(d) ANNUAL EVALUATION AND REPORT.— 
(1) EVALUATION.—The Secretary shall develop 
a method to evaluate the effectiveness of the edu-
cation program under this section and evaluate the 
program using the method not less frequently than 
once each year. 
(2) REPORT.—Not less frequently than once 
each year, the Secretary shall submit to Congress a 
report on the findings of the Secretary with respect 
to the most recent evaluation conducted by the Sec-
retary under paragraph (1). 
(e) DEFINITIONS.—In this section: 
(1) MEDICAID.—The term ‘‘Medicaid’’ means 
the Medicaid program under title XIX of the Social 
Security Act (42 U.S.C. 1396 et seq.). 
(2) MEDICARE.—The term ‘‘Medicare’’ means 
the Medicare program under title XVIII of such Act 
(42 U.S.C. 1395 et seq.). 
(3) TRICARE PROGRAM.—The term ‘‘TRICARE 
program’’ has the meaning given that term in sec-
tion 1072 of title 10, United States Code. 
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SEC. 122. TRAINING PROGRAM FOR ADMINISTRATION OF 
NON-DEPARTMENT OF VETERANS AFFAIRS 
HEALTH CARE. 
(a) ESTABLISHMENT OF PROGRAM.—The Secretary 
of Veterans Affairs shall develop and implement a training 
program to train employees and contractors of the Depart-
ment of Veterans Affairs on how to administer non-De-
partment health care programs, including the following: 
(1) Reimbursement for non-Department emer-
gency room care. 
(2) The Veterans Community Care Program 
under section 1703 of such title, as amended by sec-
tion 101. 
(3) Management of prescriptions pursuant to 
improvements under section 131. 
(b) ANNUAL EVALUATION AND REPORT.—The Sec-
retary shall— 
(1) develop a method to evaluate the effective-
ness of the training program developed and imple-
mented under subsection (a); 
(2) evaluate such program not less frequently 
than once each year; and 
(3) not less frequently than once each year, 
submit to Congress the findings of the Secretary 
with respect to the most recent evaluation carried 
out under paragraph (2). 
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SEC. 123. CONTINUING MEDICAL EDUCATION FOR NON-DE-
PARTMENT MEDICAL PROFESSIONALS. 
(a) ESTABLISHMENT OF PROGRAM.— 
(1) IN GENERAL.—The Secretary of Veterans 
Affairs shall establish a program to provide con-
tinuing medical education material to non-Depart-
ment medical professionals. 
(2) EDUCATION PROVIDED.—The program es-
tablished under paragraph (1) shall include edu-
cation on the following: 
(A) Identifying and treating common men-
tal and physical conditions of veterans and fam-
ily members of veterans. 
(B) The health care system of the Depart-
ment of Veterans Affairs. 
(C) Such other matters as the Secretary 
considers appropriate. 
(b) MATERIAL PROVIDED.—The continuing medical 
education material provided to non-Department medical 
professionals under the program established under sub-
section (a) shall be the same material provided to medical 
professionals of the Department to ensure that all medical 
professionals treating veterans have access to the same 
materials, which supports core competencies throughout 
the community. 
(c) ADMINISTRATION OF PROGRAM.— 
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(1) IN GENERAL.—The Secretary shall admin-
ister the program established under subsection (a) to 
participating non-Department medical professionals 
through an internet website of the Department of 
Veterans Affairs. 
(2) CURRICULUM AND CREDIT PROVIDED.—The 
Secretary shall determine the curriculum of the pro-
gram and the number of hours of credit to provide 
to participating non-Department medical profes-
sionals for continuing medical education. 
(3) ACCREDITATION.—The Secretary shall en-
sure that the program is accredited in as many 
States as practicable. 
(4) CONSISTENCY WITH EXISTING RULES.—The 
Secretary shall ensure that the program is consistent 
with the rules and regulations of the following: 
(A) The medical licensing agency of each 
State in which the program is accredited. 
(B) Such medical credentialing organiza-
tions as the Secretary considers appropriate. 
(5) USER COST.—The Secretary shall carry out 
the program at no cost to participating non-Depart-
ment medical professionals. 
(6) MONITORING, EVALUATION, AND REPORT.— 
The Secretary shall monitor the utilization of the 
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program established under subsection (a), evaluate 
its effectiveness, and report to Congress on utiliza-
tion and effectiveness not less frequently than once 
each year. 
(d) NON-DEPARTMENT
MEDICAL
PROFESSIONAL 
DEFINED.—In this section, the term ‘‘non-Department 
medical professional’’ means any individual who is licensed 
by an appropriate medical authority in the United States 
and is in good standing, is not an employee of the Depart-
ment of Veterans Affairs, and provides care to veterans 
or family members of veterans under the laws adminis-
tered by the Secretary of Veterans Affairs. 
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. 
(a) RECEIPT AND REVIEW OF GUIDELINES.—The 
Secretary of Veterans Affairs shall ensure that all covered 
health care providers are provided a copy of and certify 
that they have reviewed the evidence-based guidelines for 
prescribing opioids set forth by the Opioid Safety Initia-
tive of the Department of Veterans Affairs. 
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(b) INCLUSION OF MEDICAL HISTORY AND CURRENT 
MEDICATIONS.—The Secretary shall implement a process 
to ensure that, if care of a veteran by a covered health 
care provider is authorized under the laws administered 
by the Secretary, the document authorizing such care in-
cludes the available and relevant medical history of the 
veteran and a list of all medications prescribed to the vet-
eran as known by the Department. 
(c) SUBMITTAL OF MEDICAL RECORDS AND PRE-
SCRIPTIONS.— 
(1) IN
GENERAL.—The Secretary shall, con-
sistent with section 1703(a)(2)(A), as amended by 
section 101 of this title, and section 1703A(e)(2)(F), 
as added by section 102 of this title, require each 
covered health care provider to submit medical 
records of any care or services furnished, including 
records of any prescriptions for opioids, to the De-
partment in the timeframe and format specified by 
the Secretary. 
(2) RESPONSIBILITY OF DEPARTMENT FOR RE-
CORDING AND MONITORING.—In carrying out para-
graph (1) and upon the receipt by the Department 
of the medical records described in paragraph (1), 
the Secretary shall— 
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(A) ensure the Department is responsible 
for the recording of the prescription in the elec-
tronic health record of the veteran; and 
(B) enable other monitoring of the pre-
scription as outlined in the Opioid Safety Initia-
tive of the Department. 
(3) REPORT.—Not less frequently than annu-
ally, the Secretary shall submit to the Committee on 
Veterans’ Affairs of the Senate and the Committee 
on Veterans’ Affairs of the House of Representatives 
a report evaluating the compliance of covered health 
care providers with the requirements under this sec-
tion. 
(d) USE
OF OPIOID SAFETY INITIATIVE GUIDE-
LINES.— 
(1) IN GENERAL.—If the Secretary determines 
that the opioid prescribing practices of a covered 
health care provider, when treating covered veterans, 
satisfy a condition described in paragraph (3), the 
Secretary shall take such action as the Secretary 
considers appropriate to ensure the safety of all vet-
erans receiving care from that health care provider, 
including removing or directing the removal of any 
such health care provider from provider networks or 
otherwise refusing to authorize care of veterans by 
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such health care provider in any program authorized 
under the laws administered by the Secretary. 
(2) INCLUSION IN CONTRACTS.—The Secretary 
shall ensure that any contracts, agreements, or other 
arrangements entered into by the Secretary with 
third parties involved in administering programs 
that provide care in the community to veterans 
under the laws administered by the Secretary spe-
cifically grant the authority set forth in paragraph 
(1) to such third parties and to the Secretary, as the 
case may be. 
(3) CONDITIONS FOR EXCLUSION OR LIMITA-
TION.—The Secretary shall take such action as is 
considered appropriate under paragraph (1) when 
the opioid prescribing practices of a covered health 
care provider when treating covered veterans— 
(A) conflict with or are otherwise incon-
sistent with the standards of appropriate and 
safe care; 
(B) violate the requirements of a medical 
license of the health care provider; or 
(C) may place at risk the veterans receiv-
ing health care from the provider. 
(e) COVERED HEALTH CARE PROVIDER DEFINED.— 
In this section, the term ‘‘covered health care provider’’ 
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means a non-Department of Veterans Affairs health care 
provider who provides health care to veterans under the 
laws administered by the Secretary of Veterans Affairs, 
but does not include a health care provider employed by 
another agency of the Federal Government. 
SEC. 132. IMPROVING INFORMATION SHARING WITH COM-
MUNITY PROVIDERS. 
Section 7332(b)(2) is amended by striking subpara-
graph (H) and inserting the following new subparagraphs: 
‘‘(H)(i) To a non-Department entity (including 
private entities and other Federal agencies) for pur-
poses of providing health care, including hospital 
care, medical services, and extended care services, to 
patients or performing other health care-related ac-
tivities or functions. 
‘‘(ii) An entity to which a record is disclosed 
under this subparagraph may not disclose or use 
such record for a purpose other than that for which 
the disclosure was made or as permitted by law. 
‘‘(I) To a third party in order to recover or col-
lect reasonable charges for care furnished to, or paid 
on behalf of, a patient in connection with a non-serv-
ice connected disability as permitted by section 1729 
of this title or for a condition for which recovery is 
authorized or with respect to which the United 
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States is deemed to be a third party beneficiary 
under the Act entitled ‘An Act to provide for the re-
covery from tortiously liable third persons of the cost 
of hospital and medical care and treatment fur-
nished by the United States’ (Public Law 87–693; 
42 U.S.C. 2651 et seq.; commonly known as the 
‘Federal Medical Care Recovery Act’).’’. 
SEC. 133. COMPETENCY STANDARDS FOR NON-DEPART-
MENT OF VETERANS AFFAIRS HEALTH CARE 
PROVIDERS. 
(a) ESTABLISHMENT OF STANDARDS AND REQUIRE-
MENTS.—The Secretary of Veterans Affairs shall establish 
standards and requirements for the provision of care by 
non-Department of Veterans Affairs health care providers 
in clinical areas for which the Department of Veterans Af-
fairs has special expertise, including post-traumatic stress 
disorder, military sexual trauma-related conditions, and 
traumatic brain injuries. 
(b) CONDITION
FOR
ELIGIBILITY
TO
FURNISH 
CARE.—(1) Each non-Department of Veterans Affairs 
health care provider shall, to the extent practicable as de-
termined by the Secretary or otherwise provided for in 
paragraph (2), meet the standards and requirements es-
tablished pursuant to subsection (a) before furnishing care 
pursuant to a contract, agreement, or other arrangement 
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with the Department of Veterans Affairs. Non-Depart-
ment of Veterans Affairs health care providers furnishing 
care pursuant to a contract, agreement, or other arrange-
ment shall, to the extent practicable as determined by the 
Secretary, fulfill training requirements established by the 
Secretary on how to deliver evidence-based treatments in 
the clinical areas for which the Department of Veterans 
Affairs has special expertise. 
(2) Each non-Department of Veterans Affairs health 
care provider who enters into a contract, agreement, or 
other arrangement after the effective date identified in 
subsection (c) shall, to the extent practicable, meet the 
standards and requirements established pursuant to sub-
section (a) within 6 months of the contract, agreement, 
or other arrangement taking effect. 
(c) EFFECTIVE DATE.—This section shall take effect 
on the day that is one year after the date of the enactment 
of this Act. 
SEC. 134. DEPARTMENT OF VETERANS AFFAIRS PARTICIPA-
TION IN NATIONAL NETWORK OF STATE- 
BASED PRESCRIPTION DRUG MONITORING 
PROGRAMS. 
(a) IN GENERAL.—Chapter 17 is amended by insert-
ing after section 1730A the following new section: 
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‘‘§ 1730B. Access to State prescription drug moni-
toring programs 
‘‘(a) ACCESS TO PROGRAMS.—(1) Any licensed health 
care provider or delegate of such a provider shall be con-
sidered an authorized recipient or user for the purpose of 
querying and receiving data from the national network of 
State-based prescription drug monitoring programs to 
support the safe and effective prescribing of controlled 
substances to covered patients. 
‘‘(2) Under the authority granted by paragraph (1)— 
‘‘(A) licensed health care providers or delegates 
of such providers shall query such network in ac-
cordance with applicable regulations and policies of 
the Veterans Health Administration; and 
‘‘(B) notwithstanding any general or specific 
provision of law, rule, or regulation of a State, no 
State may restrict the access of licensed health care 
providers or delegates of such providers from access-
ing that State’s prescription drug monitoring pro-
grams. 
‘‘(3) No State shall deny or revoke the license, reg-
istration, or certification of a licensed health care provider 
or delegate who otherwise meets that State’s qualifications 
for holding the license, registration, or certification on the 
basis that the licensed health care provider or delegate 
queried or received data, or attempted to query or receive 
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data, from the national network of State-based prescrip-
tion drug monitoring programs under this section. 
‘‘(b) COVERED PATIENTS.—For purposes of this sec-
tion, a covered patient is a patient who— 
‘‘(1) receives a prescription for a controlled sub-
stance; and 
‘‘(2) is not receiving palliative care or enrolled 
in hospice care. 
‘‘(c) DEFINITIONS.—In this section: 
‘‘(1) The term ‘controlled substance’ has the 
meaning given such term in section 102(6) of the 
Controlled Substances Act (21 U.S.C. 802(6)). 
‘‘(2) The term ‘delegate’ means a person or 
automated system accessing the national network of 
State-based prescription monitoring programs at the 
direction or under the supervision of a licensed 
health care provider. 
‘‘(3) The term ‘licensed health care provider’ 
means a health care provider employed by the De-
partment who is licensed, certified, or registered 
within any State to fill or prescribe medications 
within the scope of his or her practice as a Depart-
ment employee. 
‘‘(4) The term ‘national network of State-based 
prescription monitoring programs’ means an inter-
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connected nation-wide system that facilitates the 
transfer to State prescription drug monitoring pro-
gram data across State lines. 
‘‘(5) The term ‘State’ means a State, as defined 
in section 101(20) of this title, or a political subdivi-
sion of a State.’’. 
(b) CLERICAL AMENDMENT.—The table of sections 
at the beginning of chapter 17 of such title is amended 
by inserting after the item relating to section 1730A the 
following new item: 
‘‘1730B. Access to State prescription drug monitoring programs.’’. 
CHAPTER 5—OTHER NON-DEPARTMENT 
HEALTH CARE MATTERS 
SEC. 141. PLANS FOR USE OF SUPPLEMENTAL APPROPRIA-
TIONS REQUIRED. 
Whenever the Secretary submits to Congress a re-
quest for supplemental appropriations or any other appro-
priation outside the standard budget process to address 
a budgetary issue affecting the Department of Veterans 
Affairs, the Secretary shall, not later than 45 days before 
the date on which such budgetary issue would start affect-
ing a program or service, submit to Congress a justifica-
tion for the request, including a plan that details how the 
Secretary intends to use the requested appropriation and 
how long the requested appropriation is expected to meet 
the needs of the Department and certification that the re-
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quest was made using an updated and sound actuarial 
analysis. 
SEC. 142. VETERANS CHOICE FUND FLEXIBILITY. 
Section 802 of the Veterans Access, Choice, and Ac-
countability Act of 2014 (Public Law 113–146; 38 U.S.C. 
1701 note) is amended— 
(1) in subsection (c)— 
(A) in paragraph (1), by striking ‘‘by para-
graph (3)’’ and inserting ‘‘in paragraphs (3) 
and (4)’’; and 
(B) by adding at the end the following new 
paragraph: 
‘‘(4) PERMANENT
AUTHORITY
FOR
OTHER 
USES.—Beginning on March 1, 2019, amounts re-
maining in the Veterans Choice Fund may be used 
to furnish hospital care, medical services, and ex-
tended care services to individuals pursuant to chap-
ter 17 of title 38, United States Code, at non-De-
partment facilities, including pursuant to non-De-
partment provider programs other than the program 
established by section 101. Such amounts shall be 
available in addition to amounts available in other 
appropriations accounts for such purposes.’’; and 
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(2) in subsection (d)(1), by striking ‘‘to sub-
section (c)(3)’’ and inserting ‘‘to paragraphs (3) and 
(4) of subsection (c)’’. 
SEC. 143. SUNSET OF VETERANS CHOICE PROGRAM. 
Subsection (p) of section 101 of the Veterans Access, 
Choice, and Accountability Act of 2014 (Public Law 113– 
146; 38 U.S.C. 1701 note) is amended to read as follows: 
‘‘(p) AUTHORITY TO FURNISH CARE
AND SERV-
ICES.—The Secretary may not use the authority under 
this section to furnish care and services after the date that 
is one year after the date of the enactment of the Caring 
for Our Veterans Act of 2018.’’. 
SEC. 144. CONFORMING AMENDMENTS. 
(a) IN GENERAL.— 
(1) TITLE 38.—Title 38, United States Code, is 
amended— 
(A) in section 1712(a)— 
(i) in paragraph (3), by striking 
‘‘under clause (1), (2), or (5) of section 
1703(a) of this title’’ and inserting ‘‘or en-
tered an agreement’’; and 
(ii) in paragraph (4)(A), by striking 
‘‘under the provisions of this subsection 
and section 1703 of this title’’; 
(B) in section 1712A(e)(1)— 
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(i) by inserting ‘‘or agreements’’ after 
‘‘contracts’’; and 
(ii) by striking ‘‘(under sections 
1703(a)(2) and 1710(a)(1)(B) of this 
title)’’; and 
(C) in section 2303(a)(2)(B)(i), by striking 
‘‘with section 1703’’ and inserting ‘‘with sec-
tions 1703A, 8111, and 8153’’. 
(2) 
SOCIAL
SECURITY
ACT.—Section 
1866(a)(1)(L) of the Social Security Act (42 U.S.C. 
1395cc(a)(1)(L)) is amended by striking ‘‘under sec-
tion 1703’’ and inserting ‘‘under chapter 17’’. 
(3) VETERANS’ BENEFITS IMPROVEMENTS ACT 
OF
1994.—Section 104(a)(4)(A) of the Veterans’ 
Benefits Improvements Act of 1994 (Public Law 
103–446; 38 U.S.C. 1117 note) is amended by strik-
ing ‘‘in section 1703’’ and inserting ‘‘in sections 
1703A, 8111, and 8153’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall take effect on the date described in 
section 101(b). 
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Subtitle B—Improving Department 
of Veterans Affairs Health Care 
Delivery 
SEC. 151. LICENSURE OF HEALTH CARE PROFESSIONALS 
OF THE DEPARTMENT OF VETERANS AF-
FAIRS PROVIDING TREATMENT VIA TELE-
MEDICINE. 
(a) IN GENERAL.—Chapter 17 is amended by insert-
ing after section 1730B, as added by section 134, the fol-
lowing new section: 
‘‘§ 1730C. Licensure of health care professionals pro-
viding treatment via telemedicine 
‘‘(a) IN GENERAL.—Notwithstanding any provision 
of law regarding the licensure of health care professionals, 
a covered health care professional may practice the health 
care profession of the health care professional at any loca-
tion in any State, regardless of where the covered health 
care professional or the patient is located, if the covered 
health care professional is using telemedicine to provide 
treatment to an individual under this chapter. 
‘‘(b) COVERED HEALTH CARE PROFESSIONALS.— 
For purposes of this section, a covered health care profes-
sional is any health care professional who— 
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‘‘(1) is an employee of the Department ap-
pointed under the authority under section 7306, 
7401, 7405, 7406, or 7408 of this title or title 5; 
‘‘(2) is authorized by the Secretary to provide 
health care under this chapter; 
‘‘(3) is required to adhere to all standards for 
quality relating to the provision of medicine in ac-
cordance with applicable policies of the Department; 
and 
‘‘(4) has an active, current, full, and unre-
stricted license, registration, or certification in a 
State to practice the health care profession of the 
health care professional. 
‘‘(c) PROPERTY OF FEDERAL GOVERNMENT.—Sub-
section (a) shall apply to a covered health care professional 
providing treatment to a patient regardless of whether the 
covered health care professional or patient is located in 
a facility owned by the Federal Government during such 
treatment. 
‘‘(d) RELATION TO STATE LAW.—(1) The provisions 
of this section shall supersede any provisions of the law 
of any State to the extent that such provision of State 
law are inconsistent with this section. 
‘‘(2) No State shall deny or revoke the license, reg-
istration, or certification of a covered health care profes-
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sional who otherwise meets the qualifications of the State 
for holding the license, registration, or certification on the 
basis that the covered health care professional has en-
gaged or intends to engage in activity covered by sub-
section (a). 
‘‘(e) RULE OF CONSTRUCTION.—Nothing in this sec-
tion may be construed to remove, limit, or otherwise affect 
any obligation of a covered health care professional under 
the Controlled Substances Act (21 U.S.C. 801 et seq.). 
‘‘(f) STATE DEFINED.—In this section, the term 
‘State’ means a State, as defined in section 101(20) of 
this title, or a political subdivision of a State.’’. 
(b) CLERICAL AMENDMENT.—The table of sections 
at the beginning of chapter 17 of such title is amended 
by inserting after the item relating to section 1730B, as 
added by section 134, the following new item: 
‘‘1730C. Licensure of health care professionals providing treatment via telemedi-
cine.’’. 
(c) REPORT ON TELEMEDICINE.— 
(1) IN
GENERAL.—Not later than one year 
after the earlier of the date on which services pro-
vided under section 1730B of title 38, United States 
Code, as added by subsection (a), first occur or reg-
ulations are promulgated to carry out such section, 
the Secretary of Veterans Affairs shall submit to the 
Committee on Veterans’ Affairs of the Senate and 
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100 
the Committee on Veterans’ Affairs of the House of 
Representatives a report on the effectiveness of the 
use of telemedicine by the Department of Veterans 
Affairs. 
(2) ELEMENTS.—The report required by para-
graph (1) shall include an assessment of the fol-
lowing: 
(A) The satisfaction of veterans with tele-
medicine furnished by the Department. 
(B) The satisfaction of health care pro-
viders in providing telemedicine furnished by 
the Department. 
(C) The effect of telemedicine furnished by 
the Department on the following: 
(i) The ability of veterans to access 
health care, whether from the Department 
or from non-Department health care pro-
viders. 
(ii) The frequency of use by veterans 
of telemedicine. 
(iii) The productivity of health care 
providers. 
(iv) Wait times for an appointment 
for the receipt of health care from the De-
partment. 
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101 
(v) The use by veterans of in-person 
services at Department facilities and non- 
Department facilities. 
(D) The types of appointments for the re-
ceipt of telemedicine furnished by the Depart-
ment that were provided during the one-year 
period preceding the submittal of the report. 
(E) The number of appointments for the 
receipt of telemedicine furnished by the Depart-
ment that were requested during such period, 
disaggregated by medical facility. 
(F) Savings by the Department, if any, in-
cluding travel costs, from furnishing health care 
through the use of telemedicine during such pe-
riod. 
SEC. 152. AUTHORITY FOR DEPARTMENT OF VETERANS AF-
FAIRS CENTER FOR INNOVATION FOR CARE 
AND PAYMENT. 
(a) IN GENERAL.—Subchapter I of chapter 17, as 
amended by this title, is further amended by inserting 
after section 1703D, as added by section 111, the fol-
lowing new section: 
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102 
‘‘§ 1703E. Center for Innovation for Care and Pay-
ment 
‘‘(a) IN GENERAL.—(1) There is established within 
the Department a Center for Innovation for Care and Pay-
ment (in this section referred to as the ‘Center’). 
‘‘(2) The Secretary, acting through the Center, may 
carry out such pilot programs the Secretary determines 
to be appropriate to develop innovative approaches to test-
ing payment and service delivery models in order to reduce 
expenditures while preserving or enhancing the quality of 
care furnished by the Department. 
‘‘(3) The Secretary, acting through the Center, shall 
test payment and service delivery models to determine 
whether such models— 
‘‘(A) improve access to, and quality, timeliness, 
and patient satisfaction of care and services; and 
‘‘(B) create cost savings for the Department. 
‘‘(4)(A) The Secretary shall test a model in a location 
where the Secretary determines that the model will ad-
dresses deficits in care (including poor clinical outcomes 
or potentially avoidable expenditures) for a defined popu-
lation. 
‘‘(B) The Secretary shall focus on models the Sec-
retary expects to reduce program costs while preserving 
or enhancing the quality of care received by individuals 
receiving benefits under this chapter. 
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