(b) CLERICAL AMENDMENT.—The table of sections at 
the beginning of such chapter is further amended by insert-
ing after the item relating to section 1705A the following 
new item: 
‘‘1705B. Management of health care: productivity.’’. 
(c) REPORT.—Not later than one year after the date 
of the enactment of this Act, the Secretary shall submit to 
Congress a report on the implementation of section 1705B 
of title 38, United States Code, as added by subsection (a). 
Such report shall include, for each professional category of 
Department providers, the relative value unit of such cat-
egory of providers at the national, Veterans Integrated 
Service Network, and facility levels. 
SEC. 206. LICENSURE OF HEALTH CARE PROFESSIONALS OF 
THE DEPARTMENT OF VETERANS AFFAIRS 
PROVIDING TREATMENT VIA TELEMEDICINE. 
(a) IN GENERAL.—Chapter 17 of title 38, United 
States Code, is further amended by inserting after section 
1730A the following new section: 
‘‘§ 1730B. 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 
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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) 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. 
‘‘(c) CONSTRUCTION.—Nothing in this section may be 
construed to remove, limit, or otherwise affect any obliga-
tion of a covered health care professional under the Con-
trolled Substances Act (21 U.S.C. 801 et seq.). 
‘‘(d) COVERED HEALTH CARE PROFESSIONAL DE-
FINED.—In this section, the term ‘covered health care pro-
fessional’ means a health care professional who— 
‘‘(1) is an employee of the Department appointed 
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 quality stand-
ards relating to the provision of telemedicine in ac-
cordance with applicable policies of the Department; 
and 
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‘‘(4) has an active, current, full, and unrestricted 
license, registration, or certification in a State to 
practice the health care profession of the health care 
professional.’’. 
(b) CLERICAL AMENDMENT.—The table of sections at 
the beginning of chapter 17 of such title is further amended 
by inserting after the item relating to section 1730A the 
following new item: 
‘‘1730B. Licensure of health care professionals providing treatment via telemedi-
cine.’’. 
(c) REPORT ON TELEMEDICINE.— 
(1) IN GENERAL.—Not later than one year after 
the date of the enactment of this Act, the Secretary of 
Veterans Affairs shall submit to the Committee on 
Veterans’ Affairs of the Senate and the Committee on 
Veterans’ Affairs of the House of Representatives a re-
port 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 following: 
(A) The satisfaction of veterans with tele-
medicine furnished by the Department. 
(B) The satisfaction of health care providers 
in providing telemedicine furnished by the De-
partment. 
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(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 Depart-
ment. 
(v) The reduction, if any, in the use by 
veterans of in-person services at Depart-
ment facilities and non-Department facili-
ties. 
(D) The types of appointments for the re-
ceipt of telemedicine furnished by the Depart-
ment that were provided during the one-year pe-
riod preceding the submittal of the report. 
(E) The number of appointments for the re-
ceipt of telemedicine furnished by the Depart-
ment that were requested during such period, 
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disaggregated by Veterans Integrated Service 
Network. 
(F) Savings by the Department, if any, in-
cluding travel costs, of furnishing health care 
through the use of telemedicine during such pe-
riod. 
SEC. 207. 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 Sec-
retary 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 Initiative 
of the Department of Veterans Affairs under sections 
911(a)(2) and 912(c) of the Jason Simcakoski Memorial 
and Promise Act (Public Law 114–198; 38 U.S.C. 1701 
note) before first providing care under the laws adminis-
tered by the Secretary and at any time when those guide-
lines are modified thereafter. 
(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 
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Secretary, the document authorizing such care includes the 
relevant medical history of the veteran and a list of all 
medications prescribed to the veteran. 
(c) SUBMITTAL OF PRESCRIPTIONS.— 
(1) IN GENERAL.—Except as provided in para-
graph (3), the Secretary shall require, to the max-
imum extent practicable, each covered health care 
provider to submit prescriptions for opioids— 
(A) to the Department for prior authoriza-
tion for the prescribing of a limited amount of 
opioids under contracts the Department has with 
retail pharmacies; or 
(B) directly to a pharmacy of the Depart-
ment for the dispensing of such prescription. 
(2) DEPARTMENT RESPONSIBILITY.—In carrying 
out paragraph (1), upon receipt by the Department of 
a prescription for opioids for a veteran under the 
laws administered by the Secretary, the Secretary 
shall— 
(A) record such prescription in the elec-
tronic health record of the veteran; and 
(B) monitor such prescription as outlined 
in the Opioid Safety Initiative of the Depart-
ment. 
(3) EXCEPTION.— 
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provider shall, on the same day the prescription 
is written, submit to the Secretary for inclusion 
in the electronic health record of the veteran a 
notice, in such form as the Secretary may estab-
lish, providing information about the prescrip-
tion and describing the reason for the exception. 
(C) REPORT.— 
(i) IN GENERAL.—Not less frequently 
than quarterly, the Secretary shall submit 
to the Committee on Veterans’ Affairs of the 
Senate and the Committee on Veterans’ Af-
fairs of the House of Representatives a re-
port evaluating the compliance of covered 
health care providers with the requirements 
under this paragraph and setting forth data 
on the use by health care providers of excep-
tions under subparagraph (A) and notices 
under subparagraph (B). 
(ii) ELEMENTS.—Each report required 
by clause (i) shall include the following 
with respect to the quarter covered by the 
report: 
(I) The number of exceptions used 
under subparagraph (A) and notices 
received under subparagraph (B). 
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(II) The rate of compliance by the 
Department 
with 
the 
requirement 
under subparagraph (B) to include 
such notices in the health records of 
veterans. 
(III) The identification of any 
covered health care providers that, 
based on criteria prescribed the Sec-
retary, are determined by the Secretary 
to be statistical outliers regarding the 
use of exceptions under subparagraph 
(A). 
(d) USE
OF OPIOID SAFETY INITIATIVE GUIDE-
LINES.— 
(1) IN GENERAL.—If a director of a medical cen-
ter of the Department or a Veterans Integrated Serv-
ice Network determines that the opioid prescribing 
practices of a covered health care provider conflicts 
with or is otherwise inconsistent with the standards 
of appropriate and safe care, as that term is used in 
section 913(d) of the Jason Simcakoski Memorial and 
Promise Act (Public Law 114–198; 38 U.S.C. 1701 
note), the director shall take such action as the direc-
tor considers appropriate to ensure the safety of all 
veterans receiving care from that health care provider, 
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including removing or directing the removal of any 
such health care provider from provider networks or 
otherwise refusing to authorize care of veterans by 
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 entered into by the 
Secretary with third parties involved in admin-
istering programs that provide care in the community 
to veterans under the laws administered by the Sec-
retary specifically grant the authority set forth in 
paragraph (1) to such third parties and to the direc-
tors described in that paragraph, as the case may be. 
(e) DENIAL OR REVOCATION OF ELIGIBILITY OF NON- 
DEPARTMENT PROVIDERS.—The Secretary shall deny or re-
voke the eligibility of a non-Department health care pro-
vider to provide health care to veterans under the laws ad-
ministered by the Secretary if the Secretary determines that 
the opioid prescribing practices of the provider— 
(1) violate the requirements of a medical license 
of the health care provider; or 
(2) detract from the ability of the health care 
provider to deliver safe and appropriate health care. 
(f) 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. 
SEC. 208. ASSESSMENT OF HEALTH CARE FURNISHED BY 
THE DEPARTMENT TO VETERANS WHO LIVE 
IN THE TERRITORIES. 
(a) IN GENERAL.—Not later than 180 days after the 
date of the enactment of this Act, the Secretary of Veterans 
Affairs shall submit to the Committees on Veterans’ Affairs 
of the Senate and the House of Representatives a report re-
garding health care furnished by the Department of Vet-
erans Affairs to veterans who live in the territories. 
(b) ELEMENTS.—The report under subsection (a) shall 
include assessments of the following: 
(1) The ability of the Department to furnish to 
veterans who live in the territories the following: 
(A) Hospital care. 
(B) Medical services. 
(C) Mental health services. 
(D) Geriatric services. 
(2) The feasibility of establishing a medical facil-
ity of the Department in any territory that does not 
contain such a facility. 
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(c) DEFINITION.—In this section, the term ‘‘terri-
tories’’ means the Northern Mariana Islands, Puerto Rico, 
American Samoa, Guam, and the Virgin Islands. 
SEC. 209. OVERSIGHT AND ACCOUNTABILITY OF FINANCIAL 
PROCESSES OF DEPARTMENT OF VETERANS 
AFFAIRS. 
(a) SENSE OF CONGRESS.—It is the sense of Congress 
that— 
(1) the normal budget process for the Department 
of Veterans Affairs should be grounded in sound actu-
arial analysis based on accurate demand forecasting; 
(2) the regular budget process for the Department 
should be the norm; 
(3) supplemental requests for appropriations 
should be used sparingly and for unforeseen demand 
or natural occurrences; and 
(4) upon receipt of the financial audit of the Of-
fice of Inspector General of the Department, the Com-
mittee on Veterans’ Affairs of the Senate and the 
Committee on Veterans’ Affairs of the House of Rep-
resentatives shall give due consideration to the report, 
including by holding hearings as appropriate 
(b) PLANS FOR USE OF SUPPLEMENTAL APPROPRIA-
TIONS REQUIRED.—Whenever the Secretary submits to ad-
dress a budgetary issue affecting the Department of Vet-
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erans Affairs to Congress a request for supplemental appro-
priations or any other appropriation when the request is 
submitted outside the standard budget process, the Secretary 
shall, not later than 45 days before the date on which such 
budgetary issue would start affecting a program or service, 
submit to Congress a justification for the request, including 
a plan that details how the Secretary intends to use the 
requested appropriation and how long the requested appro-
priation is expected to meet the needs of the Department 
and certification that the request was made using an up-
dated and sound actuarial analysis. 
(c) ANNUAL ATTESTATION REGARDING FINANCIAL 
PROJECTIONS.—Concurrent with the President’s annual 
budget request submitted to Congress under section 1105 of 
title 31, United States Code, for fiscal year 2019 and each 
fiscal year thereafter, the Chief Financial Officer of the De-
partment of Veterans Affairs shall submit to the Committee 
on Veterans’ Affairs of the Senate and the Committee on 
Veterans’ Affairs of the House of Representatives the fol-
lowing: 
(1) A statement of assurance that financial pro-
jections included in such budget or the supporting 
materials submitted along with such budget for the 
Department of Veterans Affairs are sufficient to pro-
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vide benefits and services under laws administered by 
the Secretary of Veterans Affairs. 
(2) A certification of the Chief Financial Offi-
cer’s responsibility for internal financial controls of 
the Department. 
(3) An attestation that the Chief Financial Offi-
cer has collaborated sufficiently with the financial of-
ficers of the facilities and components of the Depart-
ment to be confident in such financial projections. 
SEC. 210. 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 section 103, is further amended by inserting 
after section 1703C, as added by section 109, the following 
new section: 
‘‘§ 1703D. Center for Innovation for Care and Payment 
‘‘(a) IN GENERAL.—(1) There is established within the 
Department a Center for Innovation for Care and Payment 
(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 testing 
payment and service delivery models in order to reduce ex-
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penditures 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 address-
es deficits in care (including poor clinical outcomes or po-
tentially avoidable expenditures) for a defined population. 
‘‘(B) The Secretary shall focus on models the Secretary 
expects to reduce program costs while preserving or enhanc-
ing the quality of care received by individuals receiving 
benefits under this chapter. 
‘‘(C) The models selected may include those described 
in section 1115A(b)(2)(B) of the Social Security Act (42 
U.S.C. 1315a(b)(2)(B)). 
‘‘(5) In selecting a model for testing, the Secretary may 
consider, in addition to other factors identified in this sub-
section, the following factors: 
‘‘(A) Whether the model includes a regular proc-
ess for monitoring and updating patient care plans 
in a manner that is consistent with the needs and 
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preferences of individuals receiving benefits under this 
chapter. 
‘‘(B) Whether the model places the individual re-
ceiving benefits under this chapter at the center of the 
care team (including family members and other care-
givers) of such individual. 
‘‘(C) Whether the model uses technology or new 
systems to coordinate care over time and across set-
tings. 
‘‘(D) Whether the model demonstrates effective 
linkage with other public sector payers, private sector 
payers, or statewide payment models. 
‘‘(6)(A) Models tested under this section may not be 
designed in such a way that would allow the United States 
to recover or collect reasonable charges from a Federal 
health care program for care or services furnished by the 
Secretary to a veteran under pilot programs carried out 
under this section. 
‘‘(B) In this paragraph, the term ‘Federal health care 
program’ means— 
‘‘(i) an insurance program described in section 
1811 of the Social Security Act (42 U.S.C. 1395c) or 
established by section 1831 of such Act (42 U.S.C. 
1395j); or 
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‘‘(ii) a State plan for medical assistance ap-
proved under title XIX of such Act (42 U.S.C. 1396 
et seq.); or 
‘‘(iii) a TRICARE program operated under sec-
tions 1075, 1075a, 1076, 1076a, 1076c, 1076d, 1076e, 
or 1076f of title 10. 
‘‘(b) DURATION.—Each pilot program carried out by 
the Secretary under this section shall terminate no later 
than five years after the date of the commencement of the 
pilot program. 
‘‘(c) LOCATION.—The Secretary shall ensure that each 
pilot program carried out under this section occurs in an 
area or areas appropriate for the intended purposes of the 
pilot program. 
‘‘(d) BUDGET.—Funding for each pilot program car-
ried out by the Secretary under this section shall come from 
appropriations— 
‘‘(1) provided in advance in appropriations acts 
for the Veterans Health Administration; and 
‘‘(2) provided for information technology sys-
tems. 
‘‘(e) NOTICE.—The Secretary shall— 
‘‘(1) publish information about each pilot pro-
gram under this section in the Federal Register; and 
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‘‘(2) take reasonable actions to provide direct no-
tice to veterans eligible to participate in such pilot 
programs. 
‘‘(f) WAIVER OF AUTHORITIES.—(1) Subject to report-
ing under paragraph (2) and approval under paragraph 
(3), in implementing a pilot program under this section, 
the Secretary may waive such requirements in subchapters 
I, II, and III of this chapter as the Secretary determines 
necessary solely for the purposes of carrying out this section 
with respect to testing models described in subsection (a). 
‘‘(2) Before waiving any authority under paragraph 
(1), the Secretary shall submit a report to the Speaker of 
the House of Representatives, the minority leader of the 
House of Representatives, the majority leader of the Senate, 
the minority leader of the Senate, and each standing com-
mittee with jurisdiction under the rules of the Senate and 
of the House of Representatives to report a bill to amend 
the provision or provisions of law that would be waived 
by the Department describing in detail the following: 
‘‘(A) The specific authorities to be waived under 
the pilot program. 
‘‘(B) The standard or standards to be used in the 
pilot program in lieu of the waived authorities. 
‘‘(C) The reasons for such waiver or waivers. 
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‘‘(D) A description of the metric or metrics the 
Secretary will use to determine the effect of the waiver 
or waivers upon the access to and quality, timeliness, 
or patient satisfaction of care and services furnished 
through the pilot program. 
‘‘(E) The anticipated cost savings, if any, of the 
pilot program. 
‘‘(F) The schedule for interim reports on the 
pilot program describing the results of the pilot pro-
gram so far and the feasibility and advisability of 
continuing the pilot program. 
‘‘(G) The schedule for the termination of the pilot 
program and the submission of a final report on the 
pilot program describing the result of the pilot pro-
gram and the feasibility and advisability of making 
the pilot program permanent. 
‘‘(H) The estimated budget of the pilot program. 
‘‘(3)(A) Upon receipt of a report submitted under 
paragraph (2), each House of Congress shall provide copies 
of the report to the chairman and ranking member of each 
standing committee with jurisdiction under the rules of the 
House of Representatives or the Senate to report a bill to 
amend the provision or provisions of law that would be 
waived by the Department under this subsection. 
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‘‘(B)(i) The waiver requested by the Secretary under 
paragraph (2) shall be considered approved under this 
paragraph if there is enacted into law a bill or joint resolu-
tion approving such request in its entirety. Such bill or 
joint resolution shall be passed by recorded vote to reflect 
the vote of each member of Congress thereon. 
‘‘(ii) The provisions of this paragraph are enacted by 
Congress— 
‘‘(I) as an exercise of the rulemaking power of 
the Senate and the House of Representatives and as 
such shall be considered as part of the rules of each 
House of Congress, and shall supersede other rules 
only to the extent that they are inconsistent therewith; 
and 
‘‘(II) with full recognition of the constitutional 
right of either House of Congress to change the rules 
(so far as they relate to the procedures of that House) 
at any time, in the same manner, and to the same 
extent as in the case of any other rule of that House. 
‘‘(C) During the 60-calendar-day period beginning on 
the date on which the Secretary submits the report described 
in paragraph (2) to Congress, it shall be in order as a mat-
ter of highest privilege in each House of Congress to consider 
a bill or joint resolution, if offered by the majority leader 
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of such House (or a designee), approving such request in 
its entirety. 
‘‘(g) LIMITATIONS.—(1) The waiver provisions in sub-
section (f) shall not apply unless the Secretary, in accord-
ance with the requirements in subsection (f), submits the 
first proposal for a pilot program not later than 18 months 
after the date of the enactment of the VA Care in the Com-
munity Act. 
‘‘(2) Notwithstanding section 502 of this title, decisions 
by the Secretary under this section shall, consistent with 
section 511 of this title, be final and conclusive and may 
not be reviewed by any other official or by any court, wheth-
er by an action in the nature of mandamus or otherwise. 
‘‘(3)(A) If the Secretary determines that the pilot pro-
gram is not improving the quality of care or producing cost 
savings, the Secretary shall— 
‘‘(i) propose a modification to the pilot program 
in the interim report that shall also be considered a 
report under subsection (f)(2)(A) and shall be subject 
to the terms and conditions of subsection (f)(2); or 
‘‘(ii) terminate such pilot program not later 
than 30 days after submitting the interim report to 
Congress. 
‘‘(B) If the Secretary terminates the pilot program 
under subparagraph (A)(ii), for purposes of clauses (vi) and 
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(vii) of subsection (f)(2)(A), such interim report will also 
serve as the final report for that pilot program. 
‘‘(h) EVALUATION AND REPORTING REQUIREMENTS.— 
(1) The Secretary shall conduct an evaluation of each model 
tested, which shall include, at a minimum, an analysis of— 
‘‘(A) the quality of care furnished under the 
model, including the measurement of patient-level 
outcomes and patient-centeredness criteria determined 
appropriate by the Secretary; and 
‘‘(B) the changes in spending by reason of that 
model. 
‘‘(2) The Secretary shall make the results of each eval-
uation under this subsection available to the public in a 
timely fashion and may establish requirements for other en-
tities participating in the testing of models under this sec-
tion to collect and report information that the Secretary 
determines is necessary to monitor and evaluate such mod-
els. 
‘‘(i) COORDINATION
AND CONSULTATION.—(1) The 
Secretary shall consult with the Under Secretary for Health 
and the Special Medical Advisory Group established pursu-
ant to section 7312 of this title in the development and im-
plementation of any pilot program operated under this sec-
tion. 
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‘‘(2) In carrying out the duties under this section, the 
Secretary shall consult representatives of relevant Federal 
agencies, and clinical and analytical experts with expertise 
in medicine and health care management. The Secretary 
shall use appropriate mechanisms to seek input from inter-
ested parties. 
‘‘(j) EXPANSION OF SUCCESSFUL PILOT PROGRAMS.— 
Taking into account the evaluation under subsection (f), the 
Secretary may, through rulemaking, expand (including im-
plementation on a nationwide basis) the duration and the 
scope of a model that is being tested under subsection (a) 
to the extent determined appropriate by the Secretary, if— 
‘‘(1) the Secretary determines that such expan-
sion is expected to— 
‘‘(A) reduce spending without reducing the 
quality of care; or 
‘‘(B) improve the quality of patient care 
without increasing spending; and 
‘‘(2) the Secretary determines that such expan-
sion would not deny or limit the coverage or provi-
sion of benefits for individuals receiving benefits 
under this chapter.’’. 
(b) CONFORMING AMENDMENT.—The table of sections 
at the beginning of such chapter, as amended by section 
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109, is further amended by inserting after the item relating 
to section 1703C the following new item: 
‘‘1703D. Center for Innovation for Care and Payment.’’. 
TITLE III—IMPROVEMENTS TO 
RECRUITMENT OF PHYSICIANS 
SEC. 301. DESIGNATED SCHOLARSHIPS FOR PHYSICIANS 
AND DENTISTS UNDER DEPARTMENT OF VET-
ERANS 
AFFAIRS 
HEALTH 
PROFESSIONAL 
SCHOLARSHIP PROGRAM. 
(a) SCHOLARSHIPS
FOR
PHYSICIANS
AND
DEN-
TISTS.—Section 7612(b) of title 38, United States Code, is 
amended by adding at the end the following new paragraph: 
‘‘(6)(A) Of the scholarships awarded under this sub-
chapter, the Secretary shall ensure that not less than 50 
scholarships are awarded each year to individuals who are 
accepted for enrollment or enrolled (as described in section 
7602 of this title) in a program of education or training 
leading to employment as a physician or dentist until such 
date as the Secretary determines that the staffing shortage 
of physicians and dentists in the Department is less than 
500. 
‘‘(B) After such date, the Secretary shall ensure that 
of the scholarships awarded under this subchapter, a num-
ber of scholarships is awarded each year to individuals re-
ferred to in subparagraph (A) in an amount equal to not 
less than ten percent of the staffing shortage of physicians 
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