H. R. 3230 
One Hundred Thirteenth Congress 
of the 
United States of America 
AT THE SECOND SESSION 
Begun and held at the City of Washington on Friday, 
the third day of January, two thousand and fourteen 
An Act 
To improve the access of veterans to medical services from the Department of 
Veterans Affairs, and for other purposes. 
Be it enacted by the Senate and House of Representatives 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 ‘‘Veterans 
Access, Choice, and Accountability Act of 2014’’. 
(b) TABLE OF CONTENTS.—The table of contents for this Act 
is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. Definitions. 
TITLE I—IMPROVEMENT OF ACCESS TO CARE FROM NON-DEPARTMENT 
OF VETERANS AFFAIRS PROVIDERS 
Sec. 101. Expanded availability of hospital care and medical services for veterans 
through the use of agreements with non-Department of Veterans Affairs 
entities. 
Sec. 102. Enhancement of collaboration between Department of Veterans Affairs 
and Indian Health Service. 
Sec. 103. Enhancement of collaboration between Department of Veterans Affairs 
and Native Hawaiian health care systems. 
Sec. 104. Reauthorization and modification of pilot program of enhanced contract 
care authority for health care needs of veterans. 
Sec. 105. Prompt payment by Department of Veterans Affairs. 
Sec. 106. Transfer of authority for payments for hospital care, medical services, and 
other health care from non-Department of Veterans Affairs providers to 
the chief business office of the Veterans Health Administration. 
TITLE II—HEALTH CARE ADMINISTRATIVE MATTERS 
Sec. 201. Independent assessment of the health care delivery systems and manage-
ment processes of the Department of Veterans Affairs. 
Sec. 202. Commission on Care. 
Sec. 203. Technology task force on review of scheduling system and software of the 
Department of Veterans Affairs. 
Sec. 204. Improvement of access of veterans to mobile vet centers and mobile med-
ical centers of the Department of Veterans Affairs. 
Sec. 205. Improved performance metrics for health care provided by Department of 
Veterans Affairs. 
Sec. 206. Improved transparency concerning health care provided by Department of 
Veterans Affairs. 
Sec. 207. Information for veterans on the credentials of Department of Veterans Af-
fairs physicians. 
Sec. 208. Information in annual budget of the President on hospital care and med-
ical services furnished through expanded use of contracts for such care. 
Sec. 209. Prohibition on falsification of data concerning wait times and quality 
measures at Department of Veterans Affairs. 
TITLE III—HEALTH CARE STAFFING, RECRUITMENT, AND TRAINING 
MATTERS 
Sec. 301. Treatment of staffing shortage and biennial report on staffing of medical 
facilities of the Department of Veterans Affairs.
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Sec. 302. Extension and modification of certain programs within the Department of 
Veterans Affairs Health Professionals Educational Assistance Program. 
Sec. 303. Clinic management training for employees at medical facilities of the De-
partment of Veterans Affairs. 
TITLE IV—HEALTH CARE RELATED TO SEXUAL TRAUMA 
Sec. 401. Expansion of eligibility for sexual trauma counseling and treatment to 
veterans on inactive duty training. 
Sec. 402. Provision of counseling and treatment for sexual trauma by the Depart-
ment of Veterans Affairs to members of the Armed Forces. 
Sec. 403. Reports on military sexual trauma. 
TITLE V—OTHER HEALTH CARE MATTERS 
Sec. 501. Extension of pilot program on assisted living services for veterans with 
traumatic brain injury. 
TITLE VI—MAJOR MEDICAL FACILITY LEASES 
Sec. 601. Authorization of major medical facility leases. 
Sec. 602. Budgetary treatment of Department of Veterans Affairs major medical fa-
cilities leases. 
TITLE VII—OTHER VETERANS MATTERS 
Sec. 701. Expansion of Marine Gunnery Sergeant John David Fry Scholarship. 
Sec. 702. Approval of courses of education provided by public institutions of higher 
learning for purposes of All-Volunteer Force Educational Assistance Pro-
gram and Post-9/11 Educational Assistance conditional on in-State tui-
tion rate for veterans. 
Sec. 703. Extension of reduction in amount of pension furnished by Department of 
Veterans Affairs for certain veterans covered by Medicaid plans for serv-
ices furnished by nursing facilities. 
Sec. 704. Extension of requirement for collection of fees for housing loans guaran-
teed by Secretary of Veterans Affairs. 
Sec. 705. Limitation on awards and bonuses paid to employees of Department of 
Veterans Affairs. 
Sec. 706. Extension of authority to use income information. 
Sec. 707. Removal of senior executives of the Department of Veterans Affairs for 
performance or misconduct. 
TITLE VIII—OTHER MATTERS 
Sec. 801. Appropriation of amounts. 
Sec. 802. Veterans Choice Fund. 
Sec. 803. Emergency designations. 
SEC. 2. DEFINITIONS. 
In this Act: 
(1) The term ‘‘facility of the Department’’ has the meaning 
given the term ‘‘facilities of the Department’’ in section 1701 
of title 38, United States Code. 
(2) The terms ‘‘hospital care’’ and ‘‘medical services’’ have 
the meanings given such terms in section 1701 of title 38, 
United States Code. 
TITLE I—IMPROVEMENT OF ACCESS TO 
CARE FROM NON-DEPARTMENT OF 
VETERANS AFFAIRS PROVIDERS 
SEC. 101. EXPANDED AVAILABILITY OF HOSPITAL CARE AND MEDICAL 
SERVICES FOR VETERANS THROUGH THE USE OF AGREE-
MENTS WITH NON-DEPARTMENT OF VETERANS AFFAIRS 
ENTITIES. 
(a) EXPANSION OF AVAILABLE CARE AND SERVICES.— 
(1) FURNISHING OF CARE.— 
(A) IN GENERAL.—Hospital care and medical services 
under chapter 17 of title 38, United States Code, shall
H. R. 3230—3 
be furnished to an eligible veteran described in subsection 
(b), at the election of such veteran, through agreements 
authorized under subsection (d), or any other law adminis-
tered by the Secretary of Veterans Affairs, with entities 
specified in subparagraph (B) for the furnishing of such 
care and services to veterans. 
(B) ENTITIES SPECIFIED.—The entities specified in this 
subparagraph are the following: 
(i) Any health care provider that is participating 
in the Medicare program under title XVIII of the Social 
Security Act (42 U.S.C. 1395 et seq.), including any 
physician furnishing services under such program. 
(ii) Any 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))). 
(iii) The Department of Defense. 
(iv) The Indian Health Service. 
(2) CHOICE OF PROVIDER.—An eligible veteran who makes 
an election under subsection (c) to receive hospital care or 
medical services under this section may select a provider of 
such care or services from among the entities specified in 
paragraph (1)(B) that are accessible to the veteran. 
(3) COORDINATION OF CARE AND SERVICES.—The Secretary 
shall coordinate, through the Non-VA Care Coordination Pro-
gram of the Department of Veterans Affairs, the furnishing 
of care and services under this section to eligible veterans, 
including by ensuring that an eligible veteran receives an 
appointment for such care and services within the wait-time 
goals of the Veterans Health Administration for the furnishing 
of hospital care and medical services. 
(b) ELIGIBLE VETERANS.—A veteran is an eligible veteran for 
purposes of this section if— 
(1)(A) as of August 1, 2014, the veteran is enrolled in 
the patient enrollment system of the Department of Veterans 
Affairs established and operated under section 1705 of title 
38, United States Code, including any such veteran who has 
not received hospital care or medical services from the Depart-
ment and has contacted the Department seeking an initial 
appointment from the Department for the receipt of such care 
or services; or 
(B) the veteran is eligible for hospital care and medical 
services under section 1710(e)(1)(D) of such title and is a vet-
eran described in section 1710(e)(3) of such title; and 
(2) the veteran— 
(A) attempts, or has attempted, to schedule an appoint-
ment for the receipt of hospital care or medical services 
under chapter 17 of title 38, United States Code, but is 
unable to schedule an appointment within the wait-time 
goals of the Veterans Health Administration for the fur-
nishing of such care or services; 
(B) resides more than 40 miles from the medical facility 
of the Department, including a community-based outpatient 
clinic, that is closest to the residence of the veteran; 
(C) resides— 
(i) in a State without a medical facility of the 
Department that provides— 
(I) hospital care;
H. R. 3230—4 
(II) emergency medical services; and 
(III) surgical care rated by the Secretary as 
having a surgical complexity of standard; and 
(ii) more than 20 miles from a medical facility 
of the Department described in clause (i); or 
(D)(i) resides in a location, other than a location in 
Guam, American Samoa, or the Republic of the Philippines, 
that is 40 miles or less from a medical facility of the 
Department, including a community-based outpatient 
clinic; and 
(ii)(I) is required to travel by air, boat, or ferry to 
reach each medical facility described in clause (i) that 
is 40 miles or less from the residence of the veteran; 
or 
(II) faces an unusual or excessive burden in accessing 
each medical facility described in clause (i) that is 40 
miles or less from the residence of the veteran due to 
geographical challenges, as determined by the Secretary. 
(c) ELECTION AND AUTHORIZATION.— 
(1) IN
GENERAL.—In the case of an eligible veteran 
described in subsection (b)(2)(A), the Secretary shall, at the 
election of the eligible veteran— 
(A) place such eligible veteran on an electronic waiting 
list described in paragraph (2) for an appointment for hos-
pital care or medical services the veteran has elected to 
receive under this section; or 
(B)(i) authorize that such care or services be furnished 
to the eligible veteran under this section for a period of 
time specified by the Secretary; and 
(ii) notify the eligible veteran by the most effective 
means available, including electronic communication or 
notification in writing, describing the care or services the 
eligible veteran is eligible to receive under this section. 
(2) ELECTRONIC WAITING LIST.—The electronic waiting list 
described in this paragraph shall be maintained by the Depart-
ment 
and 
allow 
access 
by 
each 
eligible 
veteran 
via 
www.myhealth.va.gov or any successor website for the following 
purposes: 
(A) To determine the place of such eligible veteran 
on the waiting list. 
(B) To determine the average length of time an indi-
vidual spends on the waiting list, disaggregated by medical 
facility of the Department and type of care or service 
needed, for purposes of allowing such eligible veteran to 
make an informed election under paragraph (1). 
(d) CARE AND SERVICES THROUGH AGREEMENTS.— 
(1) AGREEMENTS.— 
(A) IN GENERAL.—The Secretary shall enter into agree-
ments for furnishing care and services to eligible veterans 
under this section with entities specified in subsection 
(a)(1)(B). 
(B) AGREEMENT DEFINED.—In this paragraph, the term 
‘‘agreement’’ includes contracts, intergovernmental agree-
ments, and provider agreements, as appropriate. 
(2) RATES AND REIMBURSEMENT.—
H. R. 3230—5 
(A) IN GENERAL.—In entering into an agreement under 
paragraph (1) with an entity specified in subsection 
(a)(1)(B), the Secretary shall— 
(i) negotiate rates for the furnishing of care and 
services under this section; and 
(ii) reimburse the entity for such care and services 
at the rates negotiated pursuant to clause (i) as pro-
vided in such agreement. 
(B) LIMIT ON RATES.— 
(i) IN GENERAL.—Except as provided in clause (ii), 
rates negotiated under subparagraph (A)(i) shall not 
be more than the rates paid by the United States 
to a provider of services (as defined in section 1861(u) 
of the Social Security Act (42 U.S.C. 1395x(u))) or 
a supplier (as defined in section 1861(d) of such Act 
(42 U.S.C. 1395x(d))) under the Medicare program 
under title XVIII of the Social Security Act (42 U.S.C. 
1395 et seq.) for the same care or services. 
(ii) EXCEPTION.— 
(I) IN GENERAL.—The Secretary may negotiate 
a rate that is more than the rate paid by the 
United States as described in clause (i) with 
respect to the furnishing of care or services under 
this section to an eligible veteran who resides in 
a highly rural area. 
(II) HIGHLY
RURAL
AREA
DEFINED.—In this 
clause, the term ‘‘highly rural area’’ means an 
area located in a county that has fewer than seven 
individuals residing in that county per square mile. 
(C) LIMIT ON COLLECTION.—For the furnishing of care 
or services pursuant to an agreement under paragraph 
(1), an entity specified in subsection (a)(1)(B) may not col-
lect any amount that is greater than the rate negotiated 
pursuant to subparagraph (A)(i). 
(3) CERTAIN PROCEDURES.— 
(A) IN GENERAL.—In entering into an agreement under 
paragraph (1) with an entity described in subparagraph 
(B), the Secretary may use the procedures, including those 
procedures relating to reimbursement, available for 
entering into provider agreements under section 1866(a) 
of the Social Security Act (42 U.S.C. 1395cc(a)) and partici-
pation agreements under section 1842(h) of such Act (42 
U.S.C. 1395u(h)). During the period in which such entity 
furnishes care or services pursuant to this section, such 
entity may not be treated as a Federal contractor or subcon-
tractor by the Office of Federal Contract Compliance Pro-
grams of the Department of Labor by virtue of furnishing 
such care or services. 
(B) ENTITIES DESCRIBED.—The entities described in this 
subparagraph are the following: 
(i) In the case of the Medicare program, any pro-
vider of services that has entered into a provider agree-
ment under section 1866(a) of the Social Security Act 
(42 U.S.C. 1395cc(a)) and any physician or other sup-
plier who has entered into a participation agreement 
under section 1842(h) of such Act (42 U.S.C. 1395u(h)); 
and
H. R. 3230—6 
(ii) In the case of the Medicaid program, any pro-
vider participating under a State plan under title XIX 
of such Act (42 U.S.C. 1396 et seq.). 
(4) INFORMATION ON POLICIES AND PROCEDURES.—The Sec-
retary shall provide to any entity with which the Secretary 
has entered into an agreement under paragraph (1) the fol-
lowing: 
(A) Information on applicable policies and procedures 
for submitting bills or claims for authorized care or services 
furnished to eligible veterans under this section. 
(B) Access to a telephone hotline maintained by the 
Department that such entity may call for information on 
the following: 
(i) Procedures for furnishing care and services 
under this section. 
(ii) Procedures for submitting bills or claims for 
authorized care and services furnished to eligible vet-
erans under this section and being reimbursed for fur-
nishing such care and services. 
(iii) Whether particular care or services under this 
section are authorized, and the procedures for 
authorization of such care or services. 
(e) OTHER HEALTH-CARE PLAN.— 
(1) SUBMITTAL
OF
INFORMATION
TO
SECRETARY.—Before 
receiving hospital care or medical services under this section, 
an eligible veteran shall provide to the Secretary information 
on any health-care plan described in paragraph (4) under which 
the eligible veteran is covered. 
(2) DISCLOSURE
OF
INFORMATION
TO
NON-DEPARTMENT 
ENTITY.—Notwithstanding section 5701 of title 38, United 
States Code, for purposes of furnishing hospital care or medical 
services to an eligible veteran under this section, the Secretary 
shall disclose to the entity specified in paragraph (1)(B) of 
subsection (a) with which the Secretary has entered into an 
agreement described in such subsection— 
(A) whether the eligible veteran is covered under a 
health-care plan described in paragraph (4); and 
(B) whether the hospital care or medical services 
sought by the eligible veteran is for a medical condition 
that is related to a non-service-connected disability 
described in paragraph (3)(C). 
(3) CARE
FOR
WHICH
THE
DEPARTMENT
IS
SECONDARILY 
RESPONSIBLE.— 
(A) IN
GENERAL.—If an eligible veteran is covered 
under a health-care plan described in paragraph (4) and 
receives hospital care or medical services for a non-service- 
connected disability described in subparagraph (C), such 
health-care plan shall be primarily responsible for paying 
for such care or services, to the extent such care or services 
is covered by such health-care plan, and the Secretary 
shall be secondarily responsible for paying for such care 
or services in accordance with subparagraph (B)(ii). 
(B) RESPONSIBILITY FOR COSTS OF CARE.—In a case 
in which the Secretary is secondarily responsible for paying 
for hospital care or medical services as described in 
subparagraph (A)—
H. R. 3230—7 
(i) the health care provider that furnishes such 
care or services pursuant to an agreement described 
in subsection (a) shall be responsible for seeking 
reimbursement for the cost of such care or services 
from the health-care plan described in paragraph (4) 
under which the eligible veteran is covered; and 
(ii) the Secretary shall be responsible for promptly 
paying only the amount that is not covered by such 
health-care plan, except that such responsibility for 
payment may not exceed the rate determined for such 
care or services pursuant to subsection (d)(2). 
(C) NON-SERVICE-CONNECTED DISABILITY DESCRIBED.— 
A non-service-connected disability described in this sub-
section is a non-service-connected disability (as defined in 
section 101 of title 38, United States Code)— 
(i) that is incurred incident to a veteran’s employ-
ment and that is covered under a workers’ compensa-
tion law or plan that provides for payment for the 
cost of health care and services provided to the veteran 
by reason of the disability; 
(ii) that is incurred as the result of a motor vehicle 
accident to which applies a State law that requires 
the owners or operators of motor vehicles registered 
in that State to have in force automobile accident 
reparations insurance; 
(iii) that is incurred as the result of a crime of 
personal violence that occurred in a State, or a political 
subdivision of a State, in which a person injured as 
the result of such a crime is entitled to receive health 
care and services at such State’s or subdivision’s 
expense for personal injuries suffered as the result 
of such crime; 
(iv) that is incurred by a veteran— 
(I) who does not have a service-connected dis-
ability; and 
(II) who is entitled to care (or payment of 
the expenses of care) under a health-care plan; 
or 
(v) for which care and services are furnished under 
this section to a veteran who— 
(I) has a service-connected disability; and 
(II) is entitled to care (or payment of the 
expenses of care) under a health-care plan. 
(4) HEALTH-CARE PLAN.—A health-care plan described in 
this paragraph— 
(A) is an insurance policy or contract, medical or hos-
pital service agreement, membership or subscription con-
tract, or similar arrangement not administered by the Sec-
retary of Veterans Affairs, under which health services 
for individuals are provided or the expenses of such services 
are paid; and 
(B) does not include any such policy, contract, agree-
ment, or similar arrangement pursuant to title XVIII or 
XIX of the Social Security Act (42 U.S.C. 1395 et seq.) 
or chapter 55 of title 10, United States Code. 
(f) VETERANS CHOICE CARD.—
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(1) IN GENERAL.—For purposes of receiving care and serv-
ices under this section, the Secretary shall, not later than 
90 days after the date of the enactment of this Act, issue 
to each veteran described in subsection (b)(1) a card that may 
be presented to a health care provider to facilitate the receipt 
of care or services under this section. 
(2) NAME OF CARD.—Each card issued under paragraph 
(1) shall be known as a ‘‘Veterans Choice Card’’. 
(3) DETAILS OF CARD.—Each Veterans Choice Card issued 
to a veteran under paragraph (1) shall include the following: 
(A) The name of the veteran. 
(B) An identification number for the veteran that is 
not the social security number of the veteran. 
(C) The contact information of an appropriate office 
of the Department for health care providers to confirm 
that care or services under this section are authorized 
for the veteran. 
(D) Contact information and other relevant information 
for the submittal of claims or bills for the furnishing of 
care or services under this section. 
(E) The following statement: ‘‘This card is for qualifying 
medical care outside the Department of Veterans Affairs. 
Please call the Department of Veterans Affairs phone 
number specified on this card to ensure that treatment 
has been authorized.’’. 
(4) INFORMATION ON USE OF CARD.—Upon issuing a Vet-
erans Choice Card to a veteran, the Secretary shall provide 
the veteran with information clearly stating the circumstances 
under which the veteran may be eligible for care or services 
under this section. 
(g) INFORMATION
ON AVAILABILITY
OF CARE.—The Secretary 
shall provide information to a veteran about the availability of 
care and services under this section in the following circumstances: 
(1) In the case of a veteran described in subsection (b)(1)(B), 
when the veteran enrolls in the patient enrollment system 
of the Department under section 1705 of title 38, United States 
Code. 
(2) When the veteran attempts to schedule an appointment 
for the receipt of hospital care or medical services from the 
Department but is unable to schedule an appointment within 
the wait-time goals of the Veterans Health Administration for 
the furnishing of such care or services. 
(3) When the veteran becomes eligible for hospital care 
or medical services under this section under subparagraph (B), 
(C), or (D) of subsection (b)(2). 
(h) FOLLOW-UP CARE.—In carrying out this section, the Sec-
retary shall ensure that, at the election of an eligible veteran 
who receives hospital care or medical services from a health care 
provider in an episode of care under this section, the veteran 
receives such hospital care and medical services from such health 
care provider through the completion of the episode of care (but 
for a period not exceeding 60 days), including all specialty and 
ancillary services deemed necessary as part of the treatment rec-
ommended in the course of such hospital care or medical services. 
(i) PROVIDERS.—To be eligible to furnish care or services under 
this section, a health care provider must—
H. R. 3230—9 
(1) maintain at least the same or similar credentials and 
licenses as those credentials and licenses that are required 
of health care providers of the Department, as determined 
by the Secretary for purposes of this section; and 
(2) submit, not less frequently than once each year during 
the period in which the Secretary is authorized to carry out 
this section pursuant to subsection (p), verification of such 
licenses and credentials maintained by such health care pro-
vider. 
(j) COST-SHARING.— 
(1) IN GENERAL.—The Secretary shall require an eligible 
veteran to pay a copayment for the receipt of care or services 
under this section only if such eligible veteran would be 
required to pay a copayment for the receipt of such care or 
services at a medical facility of the Department or from a 
health care provider of the Department pursuant to chapter 
17 of title 38, United States Code. 
(2) LIMITATION.—The amount of a copayment charged 
under paragraph (1) may not exceed the amount of the 
copayment that would be payable by such eligible veteran for 
the receipt of such care or services at a medical facility of 
the Department or from a health care provider of the Depart-
ment pursuant to chapter 17 of title 38, United States Code. 
(3) COLLECTION OF COPAYMENT.—A health care provider 
that furnishes care or services to an eligible veteran under 
this section shall collect the copayment required under para-
graph (1) from such eligible veteran at the time of furnishing 
such care or services. 
(k) CLAIMS PROCESSING SYSTEM.— 
(1) IN GENERAL.—The Secretary shall provide for an effi-
cient nationwide system for processing and paying bills or 
claims for authorized care and services furnished to eligible 
veterans under this section. 
(2) REGULATIONS.—Not later than 90 days after the date 
of the enactment of this Act, the Secretary of Veterans Affairs 
shall prescribe regulations for the implementation of such 
system. 
(3) OVERSIGHT.—The Chief Business Office of the Veterans 
Health Administration shall oversee the implementation and 
maintenance of such system. 
(4) ACCURACY OF PAYMENT.— 
(A) IN GENERAL.—The Secretary shall ensure that such 
system meets such goals for accuracy of payment as the 
Secretary shall specify for purposes of this section. 
(B) QUARTERLY REPORT.— 
(i) IN
GENERAL.—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 quarterly report on the accuracy 
of such system. 
(ii) ELEMENTS.—Each report required by clause 
(i) shall include the following: 
(I) A description of the goals for accuracy for 
such system specified by the Secretary under 
subparagraph (A).
H. R. 3230—10 
(II) An assessment of the success of the 
Department in meeting such goals during the 
quarter covered by the report. 
(iii) DEADLINE.—The Secretary shall submit each 
report required by clause (i) not later than 20 days 
after the end of the quarter covered by the report. 
(l) MEDICAL RECORDS.— 
(1) IN
GENERAL.—The Secretary shall ensure that any 
health care provider that furnishes care or services under this 
section to an eligible veteran submits to the Department any 
medical record related to the care or services provided to such 
eligible veteran by such health care provider for inclusion in 
the electronic medical record of such eligible veteran main-
tained by the Department upon the completion of the provision 
of such care or services to such eligible veteran. 
(2) ELECTRONIC FORMAT.—Any medical record submitted 
to the Department under paragraph (1) shall, to the extent 
possible, be in an electronic format. 
(m) TRACKING OF MISSED APPOINTMENTS.—The Secretary shall 
implement a mechanism to track any missed appointments for 
care or services under this section by eligible veterans to ensure 
that the Department does not pay for such care or services that 
were not furnished to an eligible veteran. 
(n) IMPLEMENTATION.—Not later than 90 days after the date 
of the enactment of this Act, the Secretary shall prescribe interim 
final regulations on the implementation of this section and publish 
such regulations in the Federal Register. 
(o) INSPECTOR GENERAL REPORT.—Not later than 30 days after 
the date on which the Secretary determines that 75 percent of 
the amounts deposited in the Veterans Choice Fund established 
by section 802 have been exhausted, the Inspector General of the 
Department shall submit to the Secretary a report on the results 
of an audit of the care and services furnished under this section 
to ensure the accuracy and timeliness of payments by the Depart-
ment for the cost of such care and services, including any findings 
and recommendations of the Inspector General. 
(p) AUTHORITY TO FURNISH CARE AND SERVICES.— 
(1) IN GENERAL.—The Secretary may not use the authority 
under this section to furnish care and services after the date 
specified in paragraph (2). 
(2) DATE SPECIFIED.—The date specified in this paragraph 
is the date on which the Secretary has exhausted all amounts 
deposited in the Veterans Choice Fund established by section 
802, or the date that is 3 years after the date of the enactment 
of this Act, whichever occurs first. 
(3) PUBLICATION.—The Secretary shall publish such date 
in the Federal Register and on an Internet website of the 
Department available to the public not later than 30 days 
before such date. 
(q) REPORTS.— 
(1) INITIAL
REPORT.—Not later than 90 days after the 
publication of the interim final regulations under subsection 
(n), 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 on the furnishing 
of care and services under this section that includes the fol-
lowing:
H. R. 3230—11 
(A) The number of eligible veterans who have received 
care or services under this section. 
(B) A description of the types of care and services 
furnished to eligible veterans under this section. 
(2) FINAL REPORT.—Not later than 30 days after the date 
on which the Secretary determines that 75 percent of the 
amounts deposited in the Veterans Choice Fund established 
by section 802 have been exhausted, 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 on the furnishing of care and services under this 
section that includes the following: 
(A) The total number of eligible veterans who have 
received care or services under this section, disaggregated 
by— 
(i) eligible veterans described in subsection 
(b)(2)(A); 
(ii) eligible veterans described in subsection 
(b)(2)(B); 
(iii) eligible veterans described in subsection 
(b)(2)(C); and 
(iv) eligible veterans described in subsection 
(b)(2)(D). 
(B) A description of the types of care and services 
furnished to eligible veterans under this section. 
(C) An accounting of the total cost of furnishing care 
and services to eligible veterans under this section. 
(D) The results of a survey of eligible veterans who 
have received care or services under this section on the 
satisfaction of such eligible veterans with the care or serv-
ices received by such eligible veterans under this section. 
(E) An assessment of the effect of furnishing care and 
services under this section on wait times for appointments 
for the receipt of hospital care and medical services from 
the Department. 
(F) An assessment of the feasibility and advisability 
of continuing furnishing care and services under this sec-
tion after the termination date specified in subsection (p). 
(r) RULE OF CONSTRUCTION.—Nothing in this section shall be 
construed to alter the process of the Department for filling and 
paying for prescription medications. 
(s) WAIT-TIME GOALS OF THE VETERANS HEALTH ADMINISTRA-
TION.— 
(1) IN GENERAL.—Except as provided in paragraph (2), in 
this section, the term ‘‘wait-time goals of the Veterans Health 
Administration’’ means not more than 30 days from the date 
on which a veteran requests an appointment for hospital care 
or medical services from the Department. 
(2) ALTERNATE GOALS.—If the Secretary submits to Con-
gress, not later than 60 days after the date of the enactment 
of this Act, a report stating that the actual wait-time goals 
of the Veterans Health Administration are different from the 
wait-time goals specified in paragraph (1)— 
(A) for purposes of this section, the wait-time goals 
of the Veterans Health Administration shall be the wait- 
time goals submitted by the Secretary under this para-
graph; and
H. R. 3230—12 
(B) the Secretary shall publish such wait-time goals 
in the Federal Register and on an Internet website of 
the Department available to the public. 
SEC. 102. ENHANCEMENT OF COLLABORATION BETWEEN DEPART-
MENT OF VETERANS AFFAIRS AND INDIAN HEALTH 
SERVICE. 
(a) OUTREACH TO TRIBAL-RUN MEDICAL FACILITIES.—The Sec-
retary of Veterans Affairs shall, in consultation with the Director 
of the Indian Health Service, conduct outreach to each medical 
facility operated by an Indian tribe or tribal organization through 
a contract or compact with the Indian Health Service under the 
Indian Self-Determination and Education Assistance Act (25 U.S.C. 
450 et seq.) to raise awareness of the ability of such facilities, 
Indian tribes, and tribal organizations to enter into agreements 
with the Department of Veterans Affairs under which the Secretary 
reimburses such facilities, Indian tribes, or tribal organizations, 
as the case may be, for health care provided to veterans who 
are— 
(1) eligible for health care at such facilities; and 
(2)(A) enrolled in the patient enrollment system of the 
Department established and operated under section 1705 of 
title 38, United States Code; or 
(B) eligible for hospital care and medical services pursuant 
to subsection (c)(2) of such section. 
(b) PERFORMANCE METRICS
FOR MEMORANDUM
OF UNDER-
STANDING.—The Secretary of Veterans Affairs shall establish 
performance metrics for assessing the performance by the Depart-
ment of Veterans Affairs and the Indian Health Service under 
the memorandum of understanding entitled ‘‘Memorandum of 
Understanding between the Department of Veterans Affairs (VA) 
and the Indian Health Service (IHS)’’ in increasing access to health 
care, improving quality and coordination of health care, promoting 
effective patient-centered collaboration and partnerships between 
the Department and the Service, and ensuring health-promotion 
and disease-prevention services are appropriately funded and avail-
able for beneficiaries under both health care systems. 
(c) REPORT.—Not later than 180 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs and the 
Director of the Indian Health Service shall jointly submit to Con-
gress a report on the feasibility and advisability of the following: 
(1) Entering into agreements for the reimbursement by 
the Secretary of the costs of direct care services provided 
through organizations receiving amounts pursuant to grants 
made or contracts entered into under section 503 of the Indian 
Health Care Improvement Act (25 U.S.C. 1653) to veterans 
who are otherwise eligible to receive health care from such 
organizations. 
(2) Including the reimbursement of the costs of direct care 
services provided to veterans who are not Indians in agreements 
between the Department and the following: 
(A) The Indian Health Service. 
(B) An Indian tribe or tribal organization operating 
a medical facility through a contract or compact with the 
Indian Health Service under the Indian Self-Determination 
and Education Assistance Act (25 U.S.C. 450 et seq.). 
(C) A medical facility of the Indian Health Service.
H. R. 3230—13 
(d) DEFINITIONS.—In this section: 
(1) INDIAN.—The terms ‘‘Indian’’ and ‘‘Indian tribe’’ have 
the meanings given those terms in section 4 of the Indian 
Health Care Improvement Act (25 U.S.C. 1603). 
(2) MEDICAL FACILITY OF THE INDIAN HEALTH SERVICE.— 
The term ‘‘medical facility of the Indian Health Service’’ 
includes a facility operated by an Indian tribe or tribal organiza-
tion through a contract or compact with the Indian Health 
Service under the Indian Self-Determination and Education 
Assistance Act (25 U.S.C. 450 et seq.). 
(3) TRIBAL ORGANIZATION.—The term ‘‘tribal organization’’ 
has the meaning given the term in section 4 of the Indian 
Self-Determination and Education Assistance Act (25 U.S.C. 
450b). 
SEC. 103. ENHANCEMENT OF COLLABORATION BETWEEN DEPART-
MENT OF VETERANS AFFAIRS AND NATIVE HAWAIIAN 
HEALTH CARE SYSTEMS. 
(a) IN GENERAL.—The Secretary of Veterans Affairs shall, in 
consultation with Papa Ola Lokahi and such other organizations 
involved in the delivery of health care to Native Hawaiians as 
the Secretary considers appropriate, enter into contracts or agree-
ments with Native Hawaiian health care systems that are in receipt 
of funds from the Secretary of Health and Human Services pursuant 
to grants awarded or contracts entered into under section 6(a) 
of the Native Hawaiian Health Care Improvement Act (42 U.S.C. 
11705(a)) for the reimbursement of direct care services provided 
to eligible veterans as specified in such contracts or agreements. 
(b) DEFINITIONS.—In this section, the terms ‘‘Native Hawaiian’’, 
‘‘Native Hawaiian health care system’’, and ‘‘Papa Ola Lokahi’’ 
have the meanings given those terms in section 12 of the Native 
Hawaiian Health Care Improvement Act (42 U.S.C. 11711). 
SEC. 104. REAUTHORIZATION AND MODIFICATION OF PILOT PROGRAM 
OF ENHANCED CONTRACT CARE AUTHORITY FOR HEALTH 
CARE NEEDS OF VETERANS. 
Section 403 of the Veterans’ Mental Health and Other Care 
Improvements Act of 2008 (Public Law 110–387; 38 U.S.C. 1703 
note) is amended— 
(1) in subsection (a)— 
(A) in paragraph (3), by striking ‘‘only during the’’ 
and all that follows through the period at the end and 
inserting ‘‘only during the period beginning on the date 
of the commencement of the pilot program under paragraph 
(2) and ending on the date that is two years after the 
date of the enactment of the Veterans Access, Choice, and 
Accountability Act of 2014.’’; and 
(B) by amending paragraph (4) to read as follows: 
‘‘(4) PROGRAM LOCATIONS.—The Secretary shall carry out 
the pilot program at locations in the following Veterans 
Integrated Service Networks (and such other locations as the 
Secretary considers appropriate): 
‘‘(A) Veterans Integrated Service Network 1. 
‘‘(B) Veterans Integrated Service Network 6. 
‘‘(C) Veterans Integrated Service Network 15. 
‘‘(D) Veterans Integrated Service Network 18. 
‘‘(E) Veterans Integrated Service Network 19.’’;
H. R. 3230—14 
(2) in subsection (b)(1)(A), by striking ‘‘as of the date of 
the commencement of the pilot program under subsection (a)(2)’’ 
and inserting ‘‘as of August 1, 2014’’; 
(3) by redesignating subsection (h) as subsection (k); 
(4) by inserting after subsection (g) the following new sub-
sections: 
‘‘(h) APPOINTMENTS.—In carrying out the pilot program under 
this section, the Secretary shall ensure that medical appointments 
for covered veterans— 
‘‘(1) are scheduled not later than 5 days after the date 
on which the appointment is requested; and 
‘‘(2) occur not later than 30 days after such date. 
‘‘(i) OUTREACH.—The Secretary shall ensure that covered vet-
erans are informed about the pilot program under this section. 
‘‘(j) USE OF EXISTING CONTRACTS.—In carrying out the pilot 
program under this section after the date of the enactment of 
the Veterans Access, Choice, and Accountability Act of 2014, the 
Secretary shall make use of contracts entered into before such 
date or may enter into new contracts.’’; and 
(5) in paragraph (2)(B) of subsection (k), as redesignated 
by paragraph (3) of this section, by striking the semicolon 
at the end and inserting ‘‘; and’’. 
SEC. 105. PROMPT PAYMENT BY DEPARTMENT OF VETERANS AFFAIRS. 
(a) SENSE
OF CONGRESS
ON PROMPT PAYMENT
BY DEPART-
MENT.—It is the sense of Congress that the Secretary of Veterans 
Affairs shall comply with section 1315 of title 5, Code of Federal 
Regulations (commonly known as the ‘‘prompt payment rule’’), or 
any corresponding similar regulation or ruling, in paying for health 
care pursuant to contracts entered into with non-Department of 
Veterans Affairs providers to provide health care under the laws 
administered by the Secretary. 
(b) ESTABLISHMENT OF CLAIMS PROCESSING SYSTEM.— 
(1) CLAIMS PROCESSING SYSTEM.—The Secretary of Veterans 
Affairs shall establish and implement a system to process and 
pay claims for payment for hospital care, medical services, 
and other health care furnished by non-Department of Veterans 
Affairs health care providers under the laws administered by 
the Secretary. 
(2) COMPLIANCE WITH PROMPT PAYMENT ACT.—The system 
established and implemented under paragraph (1) shall comply 
with all requirements of chapter 39, United States Code (com-
monly referred to as the ‘‘Prompt Payment Act’’). 
(c) REPORT.—Not later than 1 year after the date of the enact-
ment of this Act, the Comptroller General of the United States 
shall submit to Congress a report on the timeliness of payments 
by the Secretary for hospital care, medical services, and other 
health care furnished by non-Department of Veterans Affairs health 
care providers under the laws administered by the Secretary. 
(d) ELEMENTS.—The report required by subsection (b) shall 
include the following: 
(1) The results of a survey of non-Department health care 
providers who have submitted claims to the Department for 
hospital care, medical services, or other health care furnished 
to veterans for which payment is authorized under the laws
H. R. 3230—15 
administered by the Secretary during the one-year period pre-
ceding the submittal of the report, which survey shall include 
the following: 
(A) The amount of time it took for such health care 
providers, after submitting such claims, to receive payment 
from the Department for such care or services. 
(B) A comparison of the amount of time under subpara-
graph (A) and the amount of time it takes such health 
care providers to receive payments from the United States 
for similar care or services provided to the following, if 
applicable: 
(i) Beneficiaries under the Medicare program 
under title XVIII of the Social Security Act (42 U.S.C. 
1395 et seq.). 
(ii) Covered beneficiaries under the TRICARE pro-
gram under chapter 55 of title 10, United States Code. 
(2) Such recommendations for legislative or administrative 
action as the Comptroller General considers appropriate. 
(e) SURVEY ELEMENTS.—In carrying out the survey, the Comp-
troller General shall seek responses from non-Department health 
care providers in a manner that ensures that the survey reflects 
the responses of such providers that— 
(1) are located in different geographic areas; 
(2) furnish a variety of different hospital care, medical 
services, and other health care; and 
(3) furnish such care and services in a variety of different 
types of medical facilities. 
SEC. 106. TRANSFER OF AUTHORITY FOR PAYMENTS FOR HOSPITAL 
CARE, MEDICAL SERVICES, AND OTHER HEALTH CARE 
FROM NON-DEPARTMENT OF VETERANS AFFAIRS PRO-
VIDERS TO THE CHIEF BUSINESS OFFICE OF THE VET-
ERANS HEALTH ADMINISTRATION. 
(a) TRANSFER OF AUTHORITY.— 
(1) IN GENERAL.—Effective as of October 1, 2014, the Sec-
retary of Veterans Affairs shall transfer the authority to pay 
for hospital care, medical services, and other health care fur-
nished through non-Department of Veterans Affairs providers 
from— 
(A) the Veterans Integrated Service Networks and med-
ical centers of the Department of Veterans Affairs, to 
(B) the Chief Business Office of the Veterans Health 
Administration of the Department of Veterans Affairs. 
(2) MANNER
OF
CARE.—The Chief Business Office shall 
work in consultation with the Office of Clinical Operations 
and Management of the Department to ensure that care and 
services described in paragraph (1) are provided in a manner 
that is clinically appropriate and in the best interest of the 
veterans receiving such care and services. 
(3) NO DELAY IN PAYMENT.—The transfer of authority under 
paragraph (1) shall be carried out in a manner that does 
not delay or impede any payment by the Department for hos-
pital care, medical services, or other health care furnished 
through a non-Department provider under the laws adminis-
tered by the Secretary. 
(b) BUDGET MATTERS.—The budget of the Department of Vet-
erans Affairs for any fiscal year beginning after the date of the
H. R. 3230—16 
enactment of this Act (as submitted to Congress pursuant to section 
1105(a) of title 31, United States Code) shall specify funds for 
the payment for hospital care, medical services, and other health 
care furnished through non-Department of Veterans Affairs pro-
viders, including any administrative costs associated with such 
payment, as funds for the Chief Business Office of the Veterans 
Health Administration rather than as funds for the Veterans 
Integrated Service Networks or medical centers of the Department. 
TITLE II—HEALTH CARE 
ADMINISTRATIVE MATTERS 
SEC. 
201. 
INDEPENDENT 
ASSESSMENT 
OF 
THE 
HEALTH 
CARE 
DELIVERY SYSTEMS AND MANAGEMENT PROCESSES OF 
THE DEPARTMENT OF VETERANS AFFAIRS. 
(a) INDEPENDENT ASSESSMENT.— 
(1) ASSESSMENT.—Not later than 90 days after the date 
of the enactment of this Act, the Secretary of Veterans Affairs 
shall enter into one or more contracts with a private sector 
entity or entities described in subsection (b) to conduct an 
independent assessment of the hospital care, medical services, 
and other health care furnished in medical facilities of the 
Department. Such assessment shall address each of the fol-
lowing: 
(A) Current and projected demographics and unique 
health care needs of the patient population served by the 
Department. 
(B) Current and projected health care capabilities and 
resources of the Department, including hospital care, med-
ical services, and other health care furnished by non- 
Department facilities under contract with the Department, 
to provide timely and accessible care to veterans. 
(C) The authorities and mechanisms under which the 
Secretary may furnish hospital care, medical services, and 
other health care at non-Department facilities, including 
whether the Secretary should have the authority to furnish 
such care and services at such facilities through the comple-
tion of episodes of care. 
(D) The appropriate system-wide access standard 
applicable to hospital care, medical services, and other 
health care furnished by and through the Department, 
including an identification of appropriate access standards 
for each individual specialty and post-care rehabilitation. 
(E) The workflow process at each medical facility of 
the Department for scheduling appointments for veterans 
to receive hospital care, medical services, or other health 
care from the Department. 
(F) The organization, workflow processes, and tools 
used by the Department to support clinical staffing, access 
to care, effective length-of-stay management and care 
transitions, positive patient experience, accurate docu-
mentation, and subsequent coding of inpatient services. 
(G) The staffing level at each medical facility of the 
Department and the productivity of each health care pro-
vider at such medical facility, compared with health care
H. R. 3230—17 
industry performance metrics, which may include an 
assessment of any of the following: 
(i) The case load of, and number of patients treated 
by, each health care provider at such medical facility 
during an average week. 
(ii) The time spent by such health care provider 
on matters other than the case load of such health 
care provider, including time spent by such health 
care provider as follows: 
(I) At a medical facility that is affiliated with 
the Department. 
(II) Conducting research. 
(III) Training or supervising other health care 
professionals of the Department. 
(H) The information technology strategies of the 
Department with respect to furnishing and managing 
health care, including an identification of any weaknesses 
and opportunities with respect to the technology used by 
the Department, especially those strategies with respect 
to clinical documentation of episodes of hospital care, med-
ical services, and other health care, including any clinical 
images and associated textual reports, furnished by the 
Department in Department or non-Department facilities. 
(I) Business processes of the Veterans Health Adminis-
tration, including processes relating to furnishing non- 
Department health care, insurance identification, third- 
party revenue collection, and vendor reimbursement, 
including an identification of mechanisms as follows: 
(i) To avoid the payment of penalties to vendors. 
(ii) To increase the collection of amounts owed 
to the Department for hospital care, medical services, 
or other health care provided by the Department for 
which reimbursement from a third party is authorized 
and to ensure that such amounts collected are accurate. 
(iii) To increase the collection of any other amounts 
owed to the Department with respect to hospital care, 
medical services, and other health care and to ensure 
that such amounts collected are accurate. 
(iv) To increase the accuracy and timeliness of 
Department payments to vendors and providers. 
(J) The purchasing, distribution, and use of pharma-
ceuticals, medical and surgical supplies, medical devices, 
and health care related services by the Department, 
including the following: 
(i) The prices paid for, standardization of, and 
use by the Department of the following: 
(I) Pharmaceuticals. 
(II) Medical and surgical supplies. 
(III) Medical devices. 
(ii) The use by the Department of group purchasing 
arrangements to purchase pharmaceuticals, medical 
and surgical supplies, medical devices, and health care 
related services. 
(iii) The strategy and systems used by the Depart-
ment to distribute pharmaceuticals, medical and sur-
gical supplies, medical devices, and health care related
H. R. 3230—18 
services to Veterans Integrated Service Networks and 
medical facilities of the Department. 
(K) The process of the Department for carrying out 
construction and maintenance projects at medical facilities 
of the Department and the medical facility leasing program 
of the Department. 
(L) The competency of leadership with respect to cul-
ture, accountability, reform readiness, leadership develop-
ment, physician alignment, employee engagement, succes-
sion planning, and performance management. 
(2) PARTICULAR ELEMENTS OF CERTAIN ASSESSMENTS.— 
(A) SCHEDULING
ASSESSMENT.—In carrying out the 
assessment required by paragraph (1)(E), the private sector 
entity or entities shall do the following: 
(i) Review all training materials pertaining to 
scheduling of appointments at each medical facility 
of the Department. 
(ii) Assess whether all employees of the Depart-
ment conducting tasks related to scheduling are prop-
erly trained for conducting such tasks. 
(iii) Assess whether changes in the technology or 
system used in scheduling appointments are necessary 
to limit access to the system to only those employees 
that have been properly trained in conducting such 
tasks. 
(iv) Assess whether health care providers of the 
Department are making changes to their schedules 
that hinder the ability of employees conducting such 
tasks to perform such tasks. 
(v) Assess whether the establishment of a central-
ized call center throughout the Department for sched-
uling appointments at medical facilities of the Depart-
ment would improve the process of scheduling such 
appointments. 
(vi) Assess whether booking templates for each 
medical facility or clinic of the Department would 
improve the process of scheduling such appointments. 
(vii) Assess any interim technology changes or 
attempts by Department to internally develop a long- 
term scheduling solutions with respect to the feasibility 
and cost effectiveness of such internally developed solu-
tions compared to commercially available solutions. 
(viii) Recommend actions, if any, to be taken by 
the Department to improve the process for scheduling 
such appointments, including the following: 
(I) Changes in training materials provided to 
employees of the Department with respect to con-
ducting tasks related to scheduling such appoint-
ments. 
(II) Changes in monitoring and assessment 
conducted by the Department of wait times of vet-
erans for such appointments. 
(III) Changes in the system used to schedule 
such appointments, including changes to improve 
how the Department— 
(aa) measures wait times of veterans for 
such appointments;
H. R. 3230—19 
(bb) monitors the availability of health 
care providers of the Department; and 
(cc) provides veterans the ability to 
schedule such appointments. 
(IV) Such other actions as the private sector 
entity or entities considers appropriate. 
(B) 
MEDICAL
CONSTRUCTION
AND
MAINTENANCE 
PROJECT AND LEASING PROGRAM ASSESSMENT.—In carrying 
out the assessment required by paragraph (1)(K), the pri-
vate sector entity or entities shall do the following: 
(i) Review the process of the Department for identi-
fying and designing proposals for construction and 
maintenance projects at medical facilities of the 
Department and leases for medical facilities of the 
Department. 
(ii) Assess the process through which the Depart-
ment determines the following: 
(I) That a construction or maintenance project 
or lease is necessary with respect to a medical 
facility or proposed medical facility of the Depart-
ment. 
(II) The proper size of such medical facility 
or proposed medical facility with respect to 
treating veterans in the catchment area of such 
medical facility or proposed medical facility. 
(iii) Assess the management processes of the 
Department with respect to the capital management 
programs of the Department, including processes 
relating to the methodology for construction and design 
of medical facilities of the Department, the manage-
ment of projects relating to the construction and design 
of such facilities, and the activation of such facilities. 
(iv) Assess the medical facility leasing program 
of the Department. 
(3) TIMING.—The private sector entity or entities carrying 
out the assessment required by paragraph (1) shall complete 
such assessment not later than 240 days after entering into 
the contract described in such paragraph. 
(b) PRIVATE SECTOR ENTITIES DESCRIBED.—A private entity 
described in this subsection is a private entity that— 
(1) has experience and proven outcomes in optimizing the 
performance of the health care delivery systems of the Veterans 
Health Administration and the private sector and in health 
care management; and 
(2) specializes in implementing large-scale organizational 
and cultural transformations, especially with respect to health 
care delivery systems. 
(c) PROGRAM INTEGRATOR.— 
(1) IN
GENERAL.—If the Secretary enters into contracts 
with more than one private sector entity under subsection 
(a), the Secretary shall designate one such entity that is 
predominately a health care organization as the program inte-
grator. 
(2) RESPONSIBILITIES.—The program integrator designated 
pursuant to paragraph (1) shall be responsible for coordinating 
the outcomes of the assessments conducted by the private enti-
ties pursuant to such contracts.
H. R. 3230—20 
(d) REPORT ON ASSESSMENT.— 
(1) IN GENERAL.—Not later than 60 days after completing 
the assessment required by subsection (a), the private sector 
entity or entities carrying out such assessment shall submit 
to the Secretary of Veterans Affairs, the Committee on Vet-
erans’ Affairs of the Senate, the Committee on Veterans’ Affairs 
of the House of Representatives, and the Commission on Care 
established under section 202 a report on the findings and 
recommendations of the private sector entity or entities with 
respect to such assessment. 
(2) PUBLICATION.—Not later than 30 days after receiving 
the report under paragraph (1), the Secretary shall publish 
such report in the Federal Register and on an Internet website 
of the Department of Veterans Affairs that is accessible to 
the public. 
(e) NON-DEPARTMENT FACILITIES DEFINED.—In this section, the 
term ‘‘non-Department facilities’’ has the meaning given that term 
in section 1701 of title 38, United States Code. 
SEC. 202. COMMISSION ON CARE. 
(a) ESTABLISHMENT OF COMMISSION.— 
(1) IN GENERAL.—There is established a commission, to 
be known as the ‘‘Commission on Care’’ (in this section referred 
to as the ‘‘Commission’’), to examine the access of veterans 
to health care from the Department of Veterans Affairs and 
strategically examine how best to organize the Veterans Health 
Administration, locate health care resources, and deliver health 
care to veterans during the 20-year period beginning on the 
date of the enactment of this Act. 
(2) MEMBERSHIP.— 
(A) VOTING MEMBERS.—The Commission shall be com-
posed of 15 voting members who are appointed as follows: 
(i) Three members appointed by the Speaker of 
the House of Representatives, at least one of whom 
shall be a veteran. 
(ii) Three members appointed by the Minority 
Leader of the House of Representatives, at least one 
of whom shall be a veteran. 
(iii) Three members appointed by the Majority 
Leader of the Senate, at least one of whom shall be 
a veteran. 
(iv) Three members appointed by the Minority 
Leader of the Senate, at least one of whom shall be 
a veteran. 
(v) Three members appointed by the President, 
at least two of whom shall be veterans. 
(B) QUALIFICATIONS.—Of the members appointed under 
subparagraph (A)— 
(i) at least one member shall represent an 
organization recognized by the Secretary of Veterans 
Affairs for the representation of veterans under section 
5902 of title 38, United States Code; 
(ii) at least one member shall have experience 
as senior management for a private integrated health 
care system with an annual gross revenue of more 
than $50,000,000;
H. R. 3230—21 
(iii) at least one member shall be familiar with 
government health care systems, including those sys-
tems of the Department of Defense, the Indian Health 
Service, and Federally-qualified health centers (as 
defined in section 1905(l)(2)(B) of the Social Security 
Act (42 U.S.C. 1396d(l)(2)(B))); 
(iv) at least one member shall be familiar with 
the Veterans Health Administration but shall not be 
currently employed by the Veterans Health Adminis-
tration; and 
(v) at least one member shall be familiar with 
medical facility construction and leasing projects car-
ried out by government entities and have experience 
in 
the 
building 
trades, 
including 
construction, 
engineering, and architecture. 
(C) DATE.—The appointments of members of the 
Commission shall be made not later than 1 year after 
the date of the enactment of this Act. 
(3) PERIOD OF APPOINTMENT.— 
(A) IN GENERAL.—Members shall be appointed for the 
life of the Commission. 
(B) VACANCIES.—Any vacancy in the Commission shall 
not affect its powers, but shall be filled in the same manner 
as the original appointment. 
(4) INITIAL MEETING.—Not later than 15 days after the 
date on which eight voting members of the Commission have 
been appointed, the Commission shall hold its first meeting. 
(5) MEETINGS.—The Commission shall meet at the call 
of the Chairperson. 
(6) QUORUM.—A majority of the members of the Commis-
sion shall constitute a quorum, but a lesser number of members 
may hold hearings. 
(7) CHAIRPERSON AND VICE CHAIRPERSON.—The President 
shall designate a member of the commission to serve as Chair-
person of the Commission. The Commission shall select a Vice 
Chairperson from among its members. 
(b) DUTIES OF COMMISSION.— 
(1) EVALUATION AND ASSESSMENT.—The Commission shall 
undertake a comprehensive evaluation and assessment of access 
to health care at the Department of Veterans Affairs. 
(2) MATTERS EVALUATED AND ASSESSED.—In undertaking 
the comprehensive evaluation and assessment required by para-
graph (1), the Commission shall evaluate and assess the results 
of the assessment conducted by the private sector entity or 
entities under section 201, including any findings, data, or 
recommendations included in such assessment. 
(3) REPORTS.—The Commission shall submit to the Presi-
dent, through the Secretary of Veterans Affairs, reports as 
follows: 
(A) Not later than 90 days after the date of the initial 
meeting of the Commission, an interim report on— 
(i) the findings of the Commission with respect 
to the evaluation and assessment required by this sub-
section; and 
(ii) such recommendations as the Commission may 
have for legislative or administrative action to improve
H. R. 3230—22 
access to health care through the Veterans Health 
Administration. 
(B) Not later than 180 days after the date of the 
initial meeting of the Commission, a final report on— 
(i) the findings of the Commission with respect 
to the evaluation and assessment required by this sub-
section; and 
(ii) such recommendations as the Commission may 
have for legislative or administrative action to improve 
access to health care through the Veterans Health 
Administration. 
(c) POWERS OF THE COMMISSION.— 
(1) HEARINGS.—The Commission may hold such hearings, 
sit and act at such times and places, take such testimony, 
and receive such evidence as the Commission considers advis-
able to carry out this section. 
(2) INFORMATION FROM FEDERAL AGENCIES.—The Commis-
sion may secure directly from any Federal agency such informa-
tion as the Commission considers necessary to carry out this 
section. Upon request of the Chairperson of the Commission, 
the head of such agency shall furnish such information to 
the Commission. 
(d) COMMISSION PERSONNEL MATTERS.— 
(1) COMPENSATION OF MEMBERS.— 
(A) IN
GENERAL.—Each member of the Commission 
who is not an officer or employee of the Federal Govern-
ment shall be compensated at a rate equal to the daily 
equivalent of the annual rate of basic pay prescribed for 
level IV of the Executive Schedule under section 5315 
of title 5, United States Code, for each day (including 
travel time) during which such member is engaged in the 
performance of the duties of the Commission. 
(B) OFFICERS OR EMPLOYEES OF THE UNITED STATES.— 
All members of the Commission who are officers or 
employees of the United States shall serve without com-
pensation in addition to that received for their services 
as officers or employees of the United States. 
(2) TRAVEL EXPENSES.—The members of the Commission 
shall be allowed travel expenses, including per diem in lieu 
of subsistence, at rates authorized for employees of agencies 
under subchapter I of chapter 57 of title 5, United States 
Code, while away from their homes or regular places of business 
in the performance of services for the Commission. 
(3) STAFF.— 
(A) IN GENERAL.—The Chairperson of the Commission 
may, without regard to the civil service laws and regula-
tions, appoint and terminate an executive director and 
such other additional personnel as may be necessary to 
enable the Commission to perform its duties. The employ-
ment of an executive director shall be subject to confirma-
tion by the Commission. 
(B) COMPENSATION.—The Chairperson of the Commis-
sion may fix the compensation of the executive director 
and other personnel without regard to chapter 51 and 
subchapter III of chapter 53 of title 5, United States Code, 
relating to classification of positions and General Schedule 
pay rates, except that the rate of pay for the executive
H. R. 3230—23 
director and other personnel may not exceed the rate pay-
able for level V of the Executive Schedule under section 
5316 of such title. 
(4) DETAIL
OF
GOVERNMENT
EMPLOYEES.—Any Federal 
Government employee may be detailed to the Commission with-
out reimbursement, and such detail shall be without interrup-
tion or loss of civil service status or privilege. 
(5) PROCUREMENT OF TEMPORARY AND INTERMITTENT SERV-
ICES.—The Chairperson of the Commission may procure tem-
porary and intermittent services under section 3109(b) of title 
5, United States Code, at rates for individuals that do not 
exceed the daily equivalent of the annual rate of basic pay 
prescribed for level V of the Executive Schedule under section 
5316 of such title. 
(e) TERMINATION OF THE COMMISSION.—The Commission shall 
terminate 30 days after the date on which the Commission submits 
the report under subsection (b)(3)(B). 
(f) FUNDING.—The Secretary of Veterans Affairs shall make 
available to the Commission from amounts appropriated or other-
wise made available to the Secretary such amounts as the Secretary 
and the Chairperson of the Commission jointly consider appropriate 
for the Commission to perform its duties under this section. 
(g) EXECUTIVE ACTION.— 
(1) ACTION
ON
RECOMMENDATIONS.—The President shall 
require the Secretary of Veterans Affairs and such other heads 
of relevant Federal departments and agencies to implement 
each recommendation set forth in a report submitted under 
subsection (b)(3) that the President— 
(A) considers feasible and advisable; and 
(B) determines can be implemented without further 
legislative action. 
(2) REPORTS.—Not later than 60 days after the date on 
which the President receives a report under subsection (b)(3), 
the President shall submit to the Committee on Veterans’ 
Affairs of the Senate and the Committee on Veterans’ Affairs 
of the House of Representatives and such other committees 
of Congress as the President considers appropriate a report 
setting forth the following: 
(A) An assessment of the feasibility and advisability 
of each recommendation contained in the report received 
by the President. 
(B) For each recommendation assessed as feasible and 
advisable under subparagraph (A) the following: 
(i) Whether such recommendation requires legisla-
tive action. 
(ii) If such recommendation requires legislative 
action, a recommendation concerning such legislative 
action. 
(iii) A description of any administrative action 
already taken to carry out such recommendation. 
(iv) A description of any administrative action the 
President intends to be taken to carry out such rec-
ommendation and by whom.
H. R. 3230—24 
SEC. 203. TECHNOLOGY TASK FORCE ON REVIEW OF SCHEDULING 
SYSTEM AND SOFTWARE OF THE DEPARTMENT OF VET-
ERANS AFFAIRS. 
(a) TASK FORCE REVIEW.— 
(1) IN GENERAL.—The Secretary of Veterans Affairs shall, 
through the use of a technology task force, conduct a review 
of the needs of the Department of Veterans Affairs with respect 
to the scheduling system and scheduling software of the Depart-
ment of Veterans Affairs that is used by the Department to 
schedule appointments for veterans for hospital care, medical 
services, and other health care from the Department. 
(2) AGREEMENT.— 
(A) IN GENERAL.—The Secretary shall seek to enter 
into an agreement with a technology organization or tech-
nology organizations to carry out the review required by 
paragraph (1). 
(B) PROHIBITION ON USE OF FUNDS.—Notwithstanding 
any other provision of law, no Federal funds may be used 
to assist the technology organization or technology 
organizations under subparagraph (A) in carrying out the 
review required by paragraph (1). 
(b) REPORT.— 
(1) IN GENERAL.—Not later than 45 days after the date 
of the enactment of this Act, the technology task force required 
under subsection (a)(1) shall submit to the Secretary, the Com-
mittee on Veterans’ Affairs of the Senate, and the Committee 
on Veterans’ Affairs of the House of Representatives a report 
setting forth the findings and recommendations of the tech-
nology task force regarding the needs of the Department with 
respect to the scheduling system and scheduling software of 
the Department described in such subsection. 
(2) ELEMENTS.—The report required by paragraph (1) shall 
include the following: 
(A) Proposals for specific actions to be taken by the 
Department to improve the scheduling system and sched-
uling software of the Department described in subsection 
(a)(1). 
(B) A determination as to whether one or more existing 
off-the-shelf systems would— 
(i) meet the needs of the Department to schedule 
appointments for veterans for hospital care, medical 
services, and other health care from the Department; 
and 
(ii) improve the access of veterans to such care 
and services. 
(3) PUBLICATION.—Not later than 30 days after the receipt 
of the report required by paragraph (1), the Secretary shall 
publish such report in the Federal Register and on an Internet 
website of the Department accessible to the public. 
(c) IMPLEMENTATION OF TASK FORCE RECOMMENDATIONS.—Not 
later than 1 year after the receipt of the report required by sub-
section (b)(1), the Secretary shall implement the recommendations 
set forth in such report that the Secretary considers are feasible, 
advisable, and cost effective.
H. R. 3230—25 
SEC. 204. IMPROVEMENT OF ACCESS OF VETERANS TO MOBILE VET 
CENTERS AND MOBILE MEDICAL CENTERS OF THE 
DEPARTMENT OF VETERANS AFFAIRS. 
(a) IMPROVEMENT OF ACCESS.— 
(1) IN GENERAL.—The Secretary of Veterans Affairs shall 
improve the access of veterans to telemedicine and other health 
care through the use of mobile vet centers and mobile medical 
centers of the Department of Veterans Affairs by providing 
standardized requirements for the operation of such centers. 
(2) 
REQUIREMENTS.—The 
standardized 
requirements 
required by paragraph (1) shall include the following: 
(A) The number of days each mobile vet center and 
mobile medical center of the Department is expected to 
travel per year. 
(B) The number of locations each center is expected 
to visit per year. 
(C) The number of appointments each center is 
expected to conduct per year. 
(D) The method and timing of notifications given by 
each center to individuals in the area to which the center 
is traveling, including notifications informing veterans of 
the availability to schedule appointments at the center. 
(3) USE OF TELEMEDICINE.—The Secretary shall ensure that 
each mobile vet center and mobile medical center of the Depart-
ment has the capability to provide telemedicine services. 
(b) REPORTS.— 
(1) IN
GENERAL.—Not later than 1 year after the date 
of the enactment of this Act, and not later than September 
30 each year thereafter, 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 Rep-
resentatives a report on access to health care through the 
use of mobile vet centers and mobile medical centers of the 
Department that includes statistics on each of the requirements 
set forth in subsection (a)(2) for the year covered by the report. 
(2) ELEMENTS.—Each report required by paragraph (1) 
shall include the following: 
(A) A description of the use of mobile vet centers and 
mobile medical centers to provide telemedicine services 
to veterans during the year preceding the submittal of 
the report, including the following: 
(i) The number of days each mobile vet center 
and mobile medical center was open to provide such 
services. 
(ii) The number of days each center traveled to 
a location other than the headquarters of the center 
to provide such services. 
(iii) The number of appointments each center con-
ducted to provide such services on average per month 
and in total during such year. 
(B) An analysis of the effectiveness of using mobile 
vet centers and mobile medical centers to provide health 
care services to veterans through the use of telemedicine. 
(C) Any recommendations for an increase in the 
number of mobile vet centers and mobile medical centers 
of the Department.
H. R. 3230—26 
(D) Any recommendations for an increase in the tele-
medicine capabilities of each mobile vet center and mobile 
medical center. 
(E) The feasibility and advisability of using temporary 
health care providers, including locum tenens, to provide 
direct health care services to veterans at mobile vet centers 
and mobile medical centers. 
(F) Such other recommendations on improvement of 
the use of mobile vet centers and mobile medical centers 
by the Department as the Secretary considers appropriate. 
SEC. 205. IMPROVED PERFORMANCE METRICS FOR HEALTH CARE 
PROVIDED BY DEPARTMENT OF VETERANS AFFAIRS. 
(a) PROHIBITION
ON USE
OF SCHEDULING
AND WAIT-TIME 
METRICS IN DETERMINATION OF PERFORMANCE AWARDS.—The Sec-
retary of Veterans Affairs shall ensure that scheduling and wait- 
time metrics or goals are not used as factors in determining the 
performance of the following employees for purposes of determining 
whether to pay performance awards to such employees: 
(1) Directors, associate directors, assistant directors, deputy 
directors, chiefs of staff, and clinical leads of medical centers 
of the Department of Veterans Affairs. 
(2) Directors, assistant directors, and quality management 
officers of Veterans Integrated Service Networks of the Depart-
ment of Veterans Affairs. 
(b) MODIFICATION OF PERFORMANCE PLANS.— 
(1) IN GENERAL.—Not later than 30 days after the date 
of the enactment of this Act, the Secretary shall modify the 
performance plans of the directors of the medical centers of 
the Department and the directors of the Veterans Integrated 
Service Networks to ensure that such plans are based on the 
quality of care received by veterans at the health care facilities 
under the jurisdictions of such directors. 
(2) FACTORS.—In modifying performance plans under para-
graph (1), the Secretary shall ensure that assessment of the 
quality of care provided at health care facilities under the 
jurisdiction of a director described in paragraph (1) includes 
consideration of the following: 
(A) Recent reviews by the Joint Commission (formerly 
known as the ‘‘Joint Commission on Accreditation of 
Healthcare Organizations’’) of such facilities. 
(B) The number and nature of recommendations con-
cerning such facilities by the Inspector General of the 
Department in reviews conducted through the Combined 
Assessment Program, in the reviews by the Inspector Gen-
eral of community-based outpatient clinics and primary 
care clinics, and in reviews conducted through the Office 
of Healthcare Inspections during the two most recently 
completed fiscal years. 
(C) The number of recommendations described in 
subparagraph (B) that the Inspector General of the Depart-
ment determines have not been carried out satisfactorily 
with respect to such facilities. 
(D) Reviews of such facilities by the Commission on 
Accreditation of Rehabilitation Facilities.
H. R. 3230—27 
(E) The number and outcomes of administrative inves-
tigation boards, root cause analyses, and peer reviews con-
ducted at such facilities during the fiscal year for which 
the assessment is being conducted. 
(F) The effectiveness of any remedial actions or plans 
resulting from any Inspector General recommendations in 
the reviews and analyses described in subparagraphs (A) 
through (E). 
(3) ADDITIONAL
LEADERSHIP
POSITIONS.—To the degree 
practicable, the Secretary shall assess the performance of other 
employees of the Department in leadership positions at Depart-
ment medical centers, including associate directors, assistant 
directors, deputy directors, chiefs of staff, and clinical leads, 
and in Veterans Integrated Service Networks, including assist-
ant directors and quality management officers, using factors 
and criteria similar to those used in the performance plans 
modified under paragraph (1). 
(c) REMOVAL OF CERTAIN PERFORMANCE GOALS.—For each fiscal 
year that begins after the date of the enactment of this Act, the 
Secretary shall not include in the performance goals of any employee 
of a Veterans Integrated Service Network or medical center of 
the Department any performance goal that might disincentivize 
the payment of Department amounts to provide hospital care, med-
ical services, or other health care through a non-Department pro-
vider. 
SEC. 206. IMPROVED TRANSPARENCY CONCERNING HEALTH CARE 
PROVIDED BY DEPARTMENT OF VETERANS AFFAIRS. 
(a) PUBLICATION OF WAIT TIMES.—Not later than 90 days after 
the date of the enactment of this Act, the Secretary of Veterans 
Affairs shall publish in the Federal Register, and on a publicly 
accessible Internet website of each medical center of the Department 
of Veterans Affairs, the wait-times for the scheduling of an appoint-
ment in each Department facility by a veteran for the receipt 
of primary care, specialty care, and hospital care and medical 
services based on the general severity of the condition of the vet-
eran. Whenever the wait-times for the scheduling of such an 
appointment changes, the Secretary shall publish the revised wait- 
times— 
(1) on a publicly accessible Internet website of each medical 
center of the Department by not later than 30 days after 
such change; and 
(2) in the Federal Register by not later than 90 days 
after such change. 
(b) PUBLICLY
AVAILABLE
DATABASE
OF
PATIENT
SAFETY, 
QUALITY OF CARE, AND OUTCOME MEASURES.— 
(1) IN GENERAL.—Not later than 180 days after the date 
of the enactment of this Act, the Secretary shall develop and 
make available to the public a comprehensive database con-
taining all applicable patient safety, quality of care, and out-
come measures for health care provided by the Department 
that are tracked by the Secretary. 
(2) UPDATE FREQUENCY.—The Secretary shall update the 
database required by paragraph (1) not less frequently than 
once each year. 
(3) UNAVAILABLE MEASURES.—For all measures that the 
Secretary would otherwise publish in the database required
H. R. 3230—28 
by paragraph (1) but has not done so because such measures 
are not available, the Secretary shall publish notice in the 
database of the reason for such unavailability and a timeline 
for making such measures available in the database. 
(4) ACCESSIBILITY.—The Secretary shall ensure that the 
database required by paragraph (1) is accessible to the public 
through the primary Internet website of the Department and 
through each primary Internet website of a Department medical 
center. 
(c) HOSPITAL COMPARE WEBSITE OF DEPARTMENT OF HEALTH 
AND HUMAN SERVICES.— 
(1) AGREEMENT REQUIRED.—Not later than 180 days after 
the date of the enactment of this Act, the Secretary of Veterans 
Affairs shall enter into an agreement with the Secretary of 
Health and Human Services for the provision by the Secretary 
of Veterans Affairs of such information as the Secretary of 
Health and Human Services may require to report and make 
publicly available patient quality and outcome information con-
cerning Department of Veterans Affairs medical centers 
through the Hospital Compare Internet website of the Depart-
ment of Health and Human Services or any successor Internet 
website. 
(2) INFORMATION PROVIDED.—The information provided by 
the Secretary of Veterans Affairs to the Secretary of Health 
and Human Services under paragraph (1) shall include the 
following: 
(A) Measures of timely and effective health care. 
(B) Measures of readmissions, complications of death, 
including with respect to 30-day mortality rates and 30- 
day readmission rates, surgical complication measures, and 
health care related infection measures. 
(C) Survey data of patient experiences, including the 
Hospital Consumer Assessment of Healthcare Providers 
and Systems or any similar successor survey developed 
by the Department of Health and Human Services. 
(D) Any other measures required of or reported with 
respect to hospitals participating in the Medicare program 
under title XVIII of the Social Security Act (42 U.S.C. 
1395 et seq.). 
(3) UNAVAILABLE INFORMATION.—For any applicable metric 
collected by the Department of Veterans Affairs or required 
to be provided under paragraph (2) and withheld from or 
unavailable in the Hospital Compare Internet website or any 
successor Internet website, the Secretary of Veterans Affairs 
shall publish a notice on such Internet website stating the 
reason why such metric was withheld from public disclosure 
and a timeline for making such metric available, if applicable. 
(d) COMPTROLLER GENERAL REVIEW OF PUBLICLY AVAILABLE 
SAFETY AND QUALITY METRICS.—Not later than 3 years after the 
date of the enactment of this Act, the Comptroller General of 
the United States shall conduct a review of the safety and quality 
metrics made publicly available by the Secretary of Veterans Affairs 
under this section to assess the degree to which the Secretary 
is complying with the provisions of this section.
H. R. 3230—29 
SEC. 207. INFORMATION FOR VETERANS ON THE CREDENTIALS OF 
DEPARTMENT OF VETERANS AFFAIRS PHYSICIANS. 
(a) IMPROVEMENT
OF
‘‘OUR
DOCTORS’’ INTERNET
WEBSITE 
LINKS.— 
(1) AVAILABILITY
THROUGH
DEPARTMENT
OF
VETERANS 
AFFAIRS HOMEPAGE.—A link to the ‘‘Our Doctors’’ health care 
providers database of the Department of Veterans Affairs, or 
any successor database, shall be available on and through 
the homepage of the Internet website of the Department that 
is accessible to the public. 
(2) INFORMATION ON LOCATION OF RESIDENCY TRAINING.— 
The Internet website of the Department that is accessible to 
the public shall include under the link to the ‘‘Our Doctors’’ 
health care providers database of the Department, or any suc-
cessor database, the name of the facility at which each licensed 
physician of the Department underwent residency training. 
(3) INFORMATION
ON
PHYSICIANS
AT
PARTICULAR
FACILI-
TIES.—The ‘‘Our Doctors’’ health care providers database of 
the Department, or any successor database, shall identify 
whether each licensed physician of the Department is a physi-
cian in residency. 
(b) INFORMATION
ON CREDENTIALS
OF PHYSICIANS
FOR VET-
ERANS UNDERGOING SURGICAL PROCEDURES.— 
(1) IN GENERAL.—Each veteran who is undergoing a sur-
gical procedure by or through the Department shall be provided 
information described in paragraph (2) with respect to the 
surgeon to be performing such procedure at such time in 
advance of the procedure as is appropriate to permit such 
veteran to evaluate such information. 
(2) INFORMATION DESCRIBED.—The information described 
in this paragraph with respect to a surgeon described in para-
graph (1) is as follows: 
(A) The education and training of the surgeon. 
(B) The licensure, registration, and certification of the 
surgeon by the State or national entity responsible for 
such licensure, registration, or certification. 
(3) OTHER INDIVIDUALS.—If a veteran is unable to evaluate 
the information provided under paragraph (1) due to the health 
or mental competence of the veteran, such information shall 
be provided to an individual acting on behalf of the veteran. 
(c) COMPTROLLER GENERAL REPORT AND PLAN.— 
(1) REPORT.—Not later than 2 years after the date of the 
enactment of this Act, the Comptroller General of the United 
States shall submit to the Committee on Veterans’ Affairs 
of the Senate and the Committee on Veterans’ Affairs of the 
House of Representatives a report setting forth an assessment 
by the Comptroller General of the following: 
(A) The manner in which contractors under the 
Patient-Centered Community Care initiative of the Depart-
ment perform oversight of the credentials of physicians 
within the networks of such contractors under the initia-
tive. 
(B) The oversight by the Department of the contracts 
under the Patient-Centered Community Care initiative. 
(C) The verification by the Department of the creden-
tials and licenses of health care providers furnishing hos-
pital care and medical services under section 101.
H. R. 3230—30 
(2) PLAN.— 
(A) IN GENERAL.—Not later than 30 days after the 
submittal of the report under paragraph (1), the Secretary 
shall submit to the Comptroller General, the Committee 
on Veterans’ Affairs of the Senate, and the Committee 
on Veterans’ Affairs of the House of Representatives a 
plan to address any findings and recommendations of the 
Comptroller General included in such report. 
(B) IMPLEMENTATION.—Not later than 90 days after 
the submittal of the report under paragraph (1), the Sec-
retary shall carry out such plan. 
SEC. 208. INFORMATION IN ANNUAL BUDGET OF THE PRESIDENT ON 
HOSPITAL CARE AND MEDICAL SERVICES FURNISHED 
THROUGH EXPANDED USE OF CONTRACTS FOR SUCH 
CARE. 
The materials on the Department of Veterans Affairs in the 
budget of the President for a fiscal year, as submitted to Congress 
pursuant to section 1105(a) of title 31, United States Code, shall 
set forth the following: 
(1) The number of veterans who received hospital care 
and medical services under section 101 during the fiscal year 
preceding the fiscal year in which such budget is submitted. 
(2) The amount expended by the Department on furnishing 
care and services under such section during the fiscal year 
preceding the fiscal year in which such budget is submitted. 
(3) The amount requested in such budget for the costs 
of furnishing care and services under such section during the 
fiscal year covered by such budget, set forth in aggregate and 
by amounts for each account for which amounts are so 
requested. 
(4) The number of veterans that the Department estimates 
will receive hospital care and medical services under such sec-
tion during the fiscal years covered by the budget submission. 
(5) The number of employees of the Department on paid 
administrative leave at any point during the fiscal year pre-
ceding the fiscal year in which such budget is submitted. 
SEC. 209. PROHIBITION ON FALSIFICATION OF DATA CONCERNING 
WAIT TIMES AND QUALITY MEASURES AT DEPARTMENT 
OF VETERANS AFFAIRS. 
Not later than 60 days after the date of the enactment of 
this Act, and in accordance with title 5, United States Code, the 
Secretary of Veterans Affairs shall establish policies whereby any 
employee of the Department of Veterans Affairs who knowingly 
submits false data concerning wait times for health care or quality 
measures with respect to health care to another employee of the 
Department or knowingly requires another employee of the Depart-
ment to submit false data concerning such wait times or quality 
measures to another employee of the Department is subject to 
a penalty the Secretary considers appropriate after notice and an 
opportunity for a hearing, including civil penalties, unpaid suspen-
sions, or termination.
H. R. 3230—31 
TITLE III—HEALTH CARE STAFFING, 
RECRUITMENT, AND TRAINING MAT-
TERS 
SEC. 301. TREATMENT OF STAFFING SHORTAGE AND BIENNIAL 
REPORT ON STAFFING OF MEDICAL FACILITIES OF THE 
DEPARTMENT OF VETERANS AFFAIRS. 
(a) STAFFING SHORTAGES.— 
(1) IN GENERAL.—Subchapter I of chapter 74 of title 38, 
United States Code, is amended by adding at the end the 
following new section: 
‘‘§ 7412. Annual determination of staffing shortages; recruit-
ment and appointment for needed occupations 
‘‘(a) IN GENERAL.—Not later than September 30 of each year, 
the Inspector General of the Department shall determine, and the 
Secretary shall publish in the Federal Register, the five occupations 
of personnel of this title of the Department covered under section 
7401 of this title for which there are the largest staffing shortages 
throughout the Department as calculated over the five-year period 
preceding the determination. 
‘‘(b) RECRUITMENT
AND APPOINTMENT.—Notwithstanding sec-
tions 3304 and 3309 through 3318 of title 5, the Secretary may, 
upon a determination by the Inspector General under paragraph 
(1) that there is a staffing shortage throughout the Department 
with respect to a particular occupation, recruit and directly appoint, 
during the fiscal year after the fiscal year during which such 
determination is made, qualified personnel to serve in that par-
ticular occupation for the Department.’’. 
(2) CLERICAL AMENDMENT.—The table of sections at the 
beginning of such chapter is amended by inserting after the 
item relating to section 7411 the following new item: 
‘‘7412. Annual determination of staffing shortages; recruitment and appointment for 
needed occupations.’’. 
(3) DEADLINE FOR FIRST DETERMINATION.—Notwithstanding 
the deadline under section 7412 of title 38, United States 
Code, as added by paragraph (1), for the annual determination 
of staffing shortages in the Veterans Health Administration, 
the Inspector General of the Department of Veterans Affairs 
shall make the first determination required under such section, 
and the Secretary of Veterans Affairs shall publish in the 
Federal Register such determination, by not later than the 
date that is 180 days after the date of the enactment of this 
Act. 
(b) INCREASE OF GRADUATE MEDICAL EDUCATION RESIDENCY 
POSITIONS.— 
(1) IN GENERAL.—Section 7302 of title 38, United States 
Code, is amended by adding at the end the following new 
subsection: 
‘‘(e)(1) In carrying out this section, the Secretary shall establish 
medical residency programs, or ensure that already established 
medical residency programs have a sufficient number of residency 
positions, at any medical facility of the Department that the Sec-
retary determines—
H. R. 3230—32 
‘‘(A) is experiencing a shortage of physicians; and 
‘‘(B) is located in a community that is designated as a 
health professional shortage area (as defined in section 332 
of the Public Health Service Act (42 U.S.C. 254e)). 
‘‘(2) In carrying out paragraph (1), the Secretary shall— 
‘‘(A) allocate the residency positions under such paragraph 
among occupations included in the most current determination 
published in the Federal Register pursuant to section 7412(a) 
of this title; and 
‘‘(B) give priority to residency positions and programs in 
primary care, mental health, and any other specialty the Sec-
retary determines appropriate.’’. 
(2) FIVE-YEAR INCREASE.— 
(A) IN GENERAL.—In carrying out section 7302(e) of 
title 38, United States Code, as added by paragraph (1), 
during the 5-year period beginning on the day that is 
1 year after the date of the enactment of this Act, the 
Secretary of Veterans Affairs shall increase the number 
of graduate medical education residency positions at med-
ical facilities of the Department by up to 1,500 positions. 
(B) PRIORITY.—In increasing the number of graduate 
medical education residency positions at medical facilities 
of the Department under subparagraph (A), the Secretary 
shall give priority to medical facilities that— 
(i) as of the date of the enactment of this Act, 
do not have a medical residency program; and 
(ii) are located in a community that has a high 
concentration of veterans. 
(3) REPORT.— 
(A) IN GENERAL.—Not later than 60 days after the 
date of the enactment of this Act, and not later than 
October 1 each year thereafter until 2019, 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 on graduate medical 
education residency positions at medical facilities of the 
Department. 
(B) ELEMENTS.—Each report required by subparagraph 
(A) shall include the following: 
(i) For the year preceding the submittal of the 
report, the number of graduate medical education resi-
dency positions at medical facilities of the Department 
as follows: 
(I) That were filled. 
(II) That were not filled. 
(III) That the Department anticipated filling. 
(ii) With respect to each graduate medical edu-
cation residency position specified in clause (i)— 
(I) the geographic location of each such posi-
tion; and 
(II) if such position was filled, the academic 
affiliation of the medical resident that filled such 
position. 
(iii) The policy at each medical facility of the 
Department with respect to the ratio of medical resi-
dents to staff supervising medical residents.
H. R. 3230—33 
(iv) During the 1-year period preceding the sub-
mittal of the report, the number of individuals who 
declined an offer from the Department to serve as 
a medical resident at a medical facility of the Depart-
ment and the reason why each such individual declined 
such offer. 
(v) During the 1-year period preceding the sub-
mittal of the report, a description of— 
(I) challenges, if any, faced by the Department 
in filling graduate medical education residency 
positions at medical facilities of the Department; 
and 
(II) actions, if any, taken by the Department 
to address such challenges. 
(vi) A description of efforts of the Department, 
as of the date of the submittal of the report, to recruit 
and retain medical residents to work for the Veterans 
Health Administration as full-time employees. 
(c) PRIORITY IN SCHOLARSHIP PROGRAM OF HEALTH PROFES-
SIONALS EDUCATIONAL ASSISTANCE PROGRAM
TO CERTAIN PRO-
VIDERS.—Section 7612(b)(5) of title 38, United States Code, is 
amended— 
(1) in subparagraph (A), by striking ‘‘and’’ at the end; 
(2) by redesignating subparagraph (B) as subparagraph 
(C); and 
(3) by inserting after subparagraph (A) the following new 
subparagraph (B): 
‘‘(B) shall give priority to applicants pursuing a course 
of education or training toward a career in an occupation for 
which the Inspector General of the Department has, in the 
most current determination published in the Federal Register 
pursuant to section 7412(a) of this title, determined that there 
is one of the largest staffing shortages throughout the Depart-
ment with respect to such occupation; and’’. 
(d) REPORTS.— 
(1) IN GENERAL.—Not later than 180 days after the date 
of the enactment of this Act, and not later than December 
31 of each even-numbered year thereafter until 2024, the Sec-
retary of Veterans Affairs shall submit to the Committees on 
Veterans’ Affairs of the Senate and House of Representatives 
a report assessing the staffing of each medical facility of the 
Department. 
(2) ELEMENTS.—Each report submitted under paragraph 
(1) shall include the following: 
(A) The results of a system-wide assessment of all 
medical facilities of the Department to ensure the following: 
(i) Appropriate staffing levels for health care 
professionals to meet the goals of the Secretary for 
timely access to care for veterans. 
(ii) Appropriate staffing levels for support per-
sonnel, including clerks. 
(iii) Appropriate sizes for clinical panels. 
(iv) Appropriate numbers of full-time staff, or full- 
time equivalents, dedicated to direct care of patients. 
(v) Appropriate physical plant space to meet the 
capacity needs of the Department in that area.
H. R. 3230—34 
(vi) Such other factors as the Secretary considers 
necessary. 
(B) A plan for addressing any issues identified in the 
assessment described in subparagraph (A), including a 
timeline for addressing such issues. 
(C) A list of the current wait times and workload 
levels for the following clinics in each medical facility: 
(i) Mental health. 
(ii) Primary care. 
(iii) Gastroenterology. 
(iv) Women’s health. 
(v) Such other clinics as the Secretary considers 
appropriate. 
(D) A description of the results of the most current 
determination of the Inspector General under subsection 
(a) of section 7412 of title 38, United States Code, as 
added by subsection (a)(1) of this section, and a plan to 
use direct appointment authority under subsection (b) of 
such section 7412 to fill staffing shortages, including rec-
ommendations for improving the speed at which the 
credentialing and privileging process can be conducted. 
(E) The current staffing models of the Department 
for the following clinics, including recommendations for 
changes to such models: 
(i) Mental health. 
(ii) Primary care. 
(iii) Gastroenterology. 
(iv) Women’s health. 
(v) Such other clinics as the Secretary considers 
appropriate. 
(F) A detailed analysis of succession planning at med-
ical facilities of the Department, including the following: 
(i) The number of positions in medical facilities 
throughout the Department that are not filled by a 
permanent employee. 
(ii) The length of time each position described in 
clause (i) remained vacant or filled by a temporary 
or acting employee. 
(iii) A description of any barriers to filling the 
positions described in clause (i). 
(iv) A plan for filling any positions that are vacant 
or filled by a temporary or acting employee for more 
than 180 days. 
(v) A plan for handling emergency circumstances, 
such as administrative leave or sudden medical leave 
for senior officials. 
(G) The number of health care providers of the Depart-
ment who have been removed from their positions, have 
retired, or have left their positions for another reason, 
disaggregated by provider type, during the 2-year period 
preceding the submittal of the report. 
(H) Of the health care providers specified in subpara-
graph (G) who have been removed from their positions, 
the following: 
(i) The number of such health care providers who 
were reassigned to other positions in the Department.
H. R. 3230—35 
(ii) The number of such health care providers who 
left the Department. 
(iii) The number of such health care providers 
who left the Department and were subsequently 
rehired by the Department. 
SEC. 302. EXTENSION AND MODIFICATION OF CERTAIN PROGRAMS 
WITHIN 
THE 
DEPARTMENT 
OF 
VETERANS 
AFFAIRS 
HEALTH 
PROFESSIONALS 
EDUCATIONAL 
ASSISTANCE 
PROGRAM. 
(a) EXTENSION
OF SCHOLARSHIP PROGRAM.—Section 7619 of 
title 38, United States Code, is amended by striking ‘‘December 
31, 2014’’ and inserting ‘‘December 31, 2019’’. 
(b) MODIFICATION OF EDUCATION DEBT REDUCTION PROGRAM.— 
(1) MODIFICATION
OF
AMOUNT
AND
DURATION
OF
ELIGI-
BILITY.—Paragraph (1) of section 7683(d) of such title is 
amended— 
(A) by striking ‘‘$60,000’’ and inserting ‘‘$120,000’’; and 
(B) by striking ‘‘$12,000 of such payments’’ and all 
that follows through the period at the end and inserting 
‘‘$24,000 of such payments may be made in each year 
of participation in the Program’’. 
(2) ELIMINATION OF LIMITATION.— 
(A) IN GENERAL.—Such section is further amended— 
(i) by striking paragraph (2); 
(ii) by redesignating paragraph (3) as paragraph 
(2); and 
(iii) in paragraph (2), as redesignated by clause 
(ii), by striking ‘‘paragraphs (1) and (2)’’ and inserting 
‘‘paragraph (1)’’. 
(B) CONFORMING AMENDMENT.—Paragraph (1) of such 
section, as amended by paragraph (1), is further amended 
by striking ‘‘Subject to paragraph (2), the amount’’ and 
inserting ‘‘The amount’’. 
SEC. 303. CLINIC MANAGEMENT TRAINING FOR EMPLOYEES AT MED-
ICAL FACILITIES OF THE DEPARTMENT OF VETERANS 
AFFAIRS. 
(a) CLINIC MANAGEMENT TRAINING PROGRAM.— 
(1) IN GENERAL.—Not later than 180 days after the date 
of the enactment of this Act, the Secretary of Veterans Affairs 
shall commence a role-specific clinic management training pro-
gram to provide in-person, standardized education on systems 
and processes for health care practice management and sched-
uling to all appropriate employees, as determined by the Sec-
retary, at medical facilities of the Department. 
(2) ELEMENTS.— 
(A) IN GENERAL.—The clinic management training pro-
gram required by paragraph (1) shall include the following: 
(i) Training on how to manage the schedules of 
health care providers of the Department, including 
the following: 
(I) Maintaining such schedules in a manner 
that allows appointments to be booked at least 
eight weeks in advance. 
(II) Proper planning procedures for vacation, 
leave, and graduate medical education training 
schedules.
H. R. 3230—36 
(ii) Training on the appropriate number of appoint-
ments that a health care provider should conduct on 
a daily basis, based on specialty. 
(iii) Training on how to determine whether there 
are enough available appointment slots to manage 
demand for different appointment types and mecha-
nisms for alerting management of insufficient slots. 
(iv) Training on how to properly use the appoint-
ment scheduling system of the Department, including 
any new scheduling system implemented by the 
Department. 
(v) Training on how to optimize the use of tech-
nology, including the following: 
(I) Telemedicine. 
(II) Electronic mail. 
(III) Text messaging. 
(IV) Such other technologies as specified by 
the Secretary. 
(vi) Training on how to properly use physical plant 
space at medical facilities of the Department to ensure 
efficient flow and privacy for patients and staff. 
(B) ROLE-SPECIFIC.—The Secretary shall ensure that 
each employee of the Department included in the clinic 
management training program required by paragraph (1) 
receives education under such program that is relevant 
to the responsibilities of such employee. 
(3) SUNSET.—The clinic management training program 
required by paragraph (1) shall terminate on the date that 
is 2 years after the date on which the Secretary commences 
such program. 
(b) TRAINING MATERIALS.— 
(1) IN
GENERAL.—After the termination of the clinic 
management training program required by subsection (a), the 
Secretary shall provide training materials on health care 
management to each of the following employees of the Depart-
ment that are relevant to the position and responsibilities of 
such employee upon the commencement of employment of such 
employee: 
(A) Any manager of a medical facility of the Depart-
ment. 
(B) Any health care provider at a medical facility of 
the Department. 
(C) Such other employees of the Department as the 
Secretary considers appropriate. 
(2) UPDATE.—The Secretary shall regularly update the 
training materials required under paragraph (1). 
TITLE IV—HEALTH CARE RELATED TO 
SEXUAL TRAUMA 
SEC. 401. EXPANSION OF ELIGIBILITY FOR SEXUAL TRAUMA COUN-
SELING AND TREATMENT TO VETERANS ON INACTIVE 
DUTY TRAINING. 
Section 1720D(a)(1) of title 38, United States Code, is amended 
by striking ‘‘or active duty for training’’ and inserting ‘‘, active 
duty for training, or inactive duty training’’.
H. R. 3230—37 
SEC. 402. PROVISION OF COUNSELING AND TREATMENT FOR SEXUAL 
TRAUMA BY THE DEPARTMENT OF VETERANS AFFAIRS TO 
MEMBERS OF THE ARMED FORCES. 
(a) EXPANSION
OF COVERAGE
TO MEMBERS
OF
THE ARMED 
FORCES.—Subsection (a) of section 1720D of title 38, United States 
Code, is amended— 
(1) by redesignating paragraph (2) as paragraph (3); 
(2) by inserting after paragraph (1) the following new para-
graph (2): 
‘‘(2)(A) In operating the program required by paragraph (1), 
the Secretary may, in consultation with the Secretary of Defense, 
provide counseling and care and services to members of the Armed 
Forces (including members of the National Guard and Reserves) 
on active duty to overcome psychological trauma described in that 
paragraph. 
‘‘(B) A member described in subparagraph (A) shall not be 
required to obtain a referral before receiving counseling and care 
and services under this paragraph.’’; and 
(3) in paragraph (3), as redesignated by paragraph (1)— 
(A) by striking ‘‘a veteran’’ and inserting ‘‘an indi-
vidual’’; and 
(B) by striking ‘‘that veteran’’ each place it appears 
and inserting ‘‘that individual’’. 
(b) INFORMATION TO MEMBERS ON AVAILABILITY OF COUNSELING 
AND SERVICES.—Subsection (c) of such section is amended— 
(1) by striking ‘‘to veterans’’ each place it appears; and 
(2) in paragraph (3), by inserting ‘‘members of the Armed 
Forces and’’ before ‘‘individuals’’. 
(c) INCLUSION OF MEMBERS IN REPORTS ON COUNSELING AND 
SERVICES.—Subsection (e) of such section is amended— 
(1) in the matter preceding paragraph (1), by striking ‘‘to 
veterans’’; 
(2) in paragraph (2)— 
(A) by striking ‘‘women veterans’’ and inserting 
‘‘individuals’’; and 
(B) by striking ‘‘training under subsection (d).’’ and 
inserting ‘‘training under subsection (d), disaggregated by— 
‘‘(A) veterans; 
‘‘(B) members of the Armed Forces (including members 
of the National Guard and Reserves) on active duty; and 
‘‘(C) for each of subparagraphs (A) and (B)— 
‘‘(i) men; and 
‘‘(ii) women.’’; 
(3) in paragraph (4), by striking ‘‘veterans’’ and inserting 
‘‘individuals’’; and 
(4) in paragraph (5)— 
(A) by striking ‘‘women veterans’’ and inserting 
‘‘individuals’’; and 
(B) by inserting ‘‘, including specific recommendations 
for individuals specified in subparagraphs (A), (B), and 
(C) of paragraph (2)’’ before the period at the end. 
(d) EFFECTIVE DATE.—The amendments made by this section 
shall take effect on the date that is 1 year after the date of 
the enactment of this Act.
H. R. 3230—38 
SEC. 403. REPORTS ON MILITARY SEXUAL TRAUMA. 
(a) REPORT
ON SERVICES AVAILABLE
FOR MILITARY SEXUAL 
TRAUMA IN THE DEPARTMENT OF VETERANS AFFAIRS.—Not later 
than 630 days 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 report on the treatment 
and services available from the Department of Veterans Affairs 
for male veterans who experience military sexual trauma compared 
to such treatment and services available to female veterans who 
experience military sexual trauma. 
(b) REPORTS
ON TRANSITION
OF MILITARY SEXUAL TRAUMA 
TREATMENT FROM DEPARTMENT OF DEFENSE TO DEPARTMENT OF 
VETERANS AFFAIRS.—Not later than 630 days after the date of 
the enactment of this Act, and annually thereafter for 5 years, 
the Department of Veterans Affairs-Department of Defense Joint 
Executive Committee established by section 320(a) of title 38, 
United States Code, shall submit to the appropriate committees 
of Congress a report on military sexual trauma that includes the 
following: 
(1) The processes and procedures utilized by the Depart-
ment of Veterans Affairs and the Department of Defense to 
facilitate transition of treatment of individuals who have experi-
enced military sexual trauma from treatment provided by the 
Department of Defense to treatment provided by the Depart-
ment of Veterans Affairs. 
(2) A description and assessment of the collaboration 
between the Department of Veterans Affairs and the Depart-
ment of Defense in assisting veterans in filing claims for disabil-
ities related to military sexual trauma, including permitting 
veterans access to information and evidence necessary to 
develop or support such claims. 
(c) DEFINITIONS.—In this section: 
(1) APPROPRIATE
COMMITTEES
OF
CONGRESS.—The term 
‘‘appropriate committees of Congress’’ means— 
(A) the Committee on Veterans’ Affairs and the Com-
mittee on Armed Services of the Senate; and 
(B) the Committee on Veterans’ Affairs and the Com-
mittee on Armed Services of the House of Representatives. 
(2) MILITARY SEXUAL TRAUMA.—The term ‘‘military sexual 
trauma’’ means psychological trauma, which in the judgment 
of a mental health professional employed by the Department, 
resulted from a physical assault of a sexual nature, battery 
of a sexual nature, or sexual harassment which occurred while 
the veteran was serving on active duty, active duty for training, 
or inactive duty training. 
(3) SEXUAL HARASSMENT.—The term ‘‘sexual harassment’’ 
means repeated, unsolicited verbal or physical contact of a 
sexual nature which is threatening in character. 
(4) SEXUAL TRAUMA.—The term ‘‘sexual trauma’’ shall have 
the meaning given that term by the Secretary of Veterans 
Affairs for purposes of this section. 
(d) EFFECTIVE DATE.—This section shall take effect on the 
date that is 270 days after the date of the enactment of this 
Act.
H. R. 3230—39 
TITLE V—OTHER HEALTH CARE 
MATTERS 
SEC. 501. EXTENSION OF PILOT PROGRAM ON ASSISTED LIVING SERV-
ICES FOR VETERANS WITH TRAUMATIC BRAIN INJURY. 
(a) IN
GENERAL.—Section 1705 of the National Defense 
Authorization Act for Fiscal Year 2008 (Public Law 110–181; 38 
U.S.C. 1710C note) is amended by adding at the end the following: 
‘‘(g) TERMINATION.—The pilot program shall terminate on 
October 6, 2017.’’. 
(b) CONFORMING AMENDMENT.—Subsection (a) of such section 
is amended by striking ‘‘five-year’’. 
TITLE VI—MAJOR MEDICAL FACILITY 
LEASES 
SEC. 601. AUTHORIZATION OF MAJOR MEDICAL FACILITY LEASES. 
(a) IN GENERAL.—The Secretary of Veterans Affairs may carry 
out the following major medical facility leases at the locations 
specified, and in an amount for each lease not to exceed the amount 
shown for such location (not including any estimated cancellation 
costs): 
(1) For a clinical research and pharmacy coordinating 
center, Albuquerque, New Mexico, an amount not to exceed 
$9,560,000. 
(2) For a community-based outpatient clinic, Brick, New 
Jersey, an amount not to exceed $7,280,000. 
(3) For a new primary care and dental clinic annex, 
Charleston, South Carolina, an amount not to exceed 
$7,070,250. 
(4) For a community-based outpatient clinic, Cobb County, 
Georgia, an amount not to exceed $6,409,000. 
(5) For the Leeward Outpatient Healthcare Access Center, 
Honolulu, Hawaii, including a co-located clinic with the Depart-
ment of Defense and the co-location of the Honolulu Regional 
Office of the Veterans Benefits Administration and the Kapolei 
Vet Center of the Department of Veterans Affairs, an amount 
not to exceed $15,887,370. 
(6) For a community-based outpatient clinic, Johnson 
County, Kansas, an amount not to exceed $2,263,000. 
(7) For a replacement community-based outpatient clinic, 
Lafayette, Louisiana, an amount not to exceed $2,996,000. 
(8) For a community-based outpatient clinic, Lake Charles, 
Louisiana, an amount not to exceed $2,626,000. 
(9) For outpatient clinic consolidation, New Port Richey, 
Florida, an amount not to exceed $11,927,000. 
(10) For an outpatient clinic, Ponce, Puerto Rico, an amount 
not to exceed $11,535,000. 
(11) For lease consolidation, San Antonio, Texas, an amount 
not to exceed $19,426,000. 
(12) For a community-based outpatient clinic, San Diego, 
California, an amount not to exceed $11,946,100. 
(13) For an outpatient clinic, Tyler, Texas, an amount 
not to exceed $4,327,000.
H. R. 3230—40 
(14) For the Errera Community Care Center, West Haven, 
Connecticut, an amount not to exceed $4,883,000. 
(15) For the Worcester Community-Based Outpatient 
Clinic, Worcester, Massachusetts, an amount not to exceed 
$4,855,000. 
(16) For the expansion of a community-based outpatient 
clinic, Cape Girardeau, Missouri, an amount not to exceed 
$4,232,060. 
(17) For a multispecialty clinic, Chattanooga, Tennessee, 
an amount not to exceed $7,069,000. 
(18) For the expansion of a community-based outpatient 
clinic, Chico, California, an amount not to exceed $4,534,000. 
(19) For a community-based outpatient clinic, Chula Vista, 
California, an amount not to exceed $3,714,000. 
(20) For a new research lease, Hines, Illinois, an amount 
not to exceed $22,032,000. 
(21) For a replacement research lease, Houston, Texas, 
an amount not to exceed $6,142,000. 
(22) For a community-based outpatient clinic, Lincoln, 
Nebraska, an amount not to exceed $7,178,400. 
(23) For a community-based outpatient clinic, Lubbock, 
Texas, an amount not to exceed $8,554,000. 
(24) For a community-based outpatient clinic consolidation, 
Myrtle Beach, South Carolina, an amount not to exceed 
$8,022,000. 
(25) For a community-based outpatient clinic, Phoenix, 
Arizona, an amount not to exceed $20,757,000. 
(26) For the expansion of a community-based outpatient 
clinic, Redding, California, an amount not to exceed $8,154,000. 
(27) For the expansion of a community-based outpatient 
clinic, Tulsa, Oklahoma, an amount not to exceed $13,269,200. 
(b) REQUIREMENTS FOR CLINIC IN TULSA.— 
(1) IN
GENERAL.—In carrying out the expansion of the 
community-based outpatient clinic in Tulsa, Oklahoma, author-
ized by subsection (a)(27), the Secretary of Veterans Affairs 
shall ensure that such clinic satisfies the following require-
ments: 
(A) Consist of not more than 140,000 gross square 
feet. 
(B) Have an annual cost per square foot of not more 
than the average market rate in Tulsa, Oklahoma, for 
an equivalent medical facility plus 20 percent. 
(C) Satisfy the mandate of the Department of Veterans 
Affairs to provide veterans in Oklahoma with access to 
quality and efficient care. 
(D) Expand clinical capacity in the region in which 
the clinic is located in a cost efficient manner based upon 
regional cost comparisons, taking into account the needs 
of current veterans and the potential demand by veterans 
for care in the future. 
(E) Be the most cost effective option for the Department 
as predicted over a 30-year life cycle for such clinic. 
(2) COST EFFECTIVE DETERMINATION.— 
(A) IN GENERAL.—If the Secretary determines that the 
most cost effective option over a 30-year life cycle would 
be to purchase or construct a facility in Tulsa, Oklahoma, 
instead of entering into a major medical facility lease in
H. R. 3230—41 
such location as authorized by subsection (a)(27), the Sec-
retary shall not enter into such lease. 
(B) MAJOR
MEDICAL
FACILITY
PROJECT.—If the Sec-
retary makes the determination described in subparagraph 
(A), the Secretary may request authority for a major med-
ical facility project in Tulsa, Oklahoma, from Congress 
pursuant to section 8104(b) of title 38, United States Code. 
(C) COST-BENEFIT ANALYSIS.—If the Secretary requests 
authority for the major medical facility project described 
in subparagraph (B), not later than 90 days after making 
the determination described in subparagraph (A), the Sec-
retary shall submit to Congress a detailed cost-benefit anal-
ysis of such major medical facility project. 
SEC. 602. BUDGETARY TREATMENT OF DEPARTMENT OF VETERANS 
AFFAIRS MAJOR MEDICAL FACILITIES LEASES. 
(a) FINDINGS.—Congress finds the following: 
(1) Title 31, United States Code, requires the Department 
of Veterans Affairs to record the full cost of its contractual 
obligation against funds available at the time a contract is 
executed. 
(2) Office of Management and Budget Circular A–11 pro-
vides guidance to agencies in meeting the statutory require-
ments under title 31, United States Code, with respect to 
leases. 
(3) For operating leases, Office of Management and Budget 
Circular A–11 requires the Department of Veterans Affairs 
to record up-front budget authority in an ‘‘amount equal to 
total payments under the full term of the lease or [an] amount 
sufficient to cover first year lease payments plus cancellation 
costs’’. 
(b) REQUIREMENT FOR OBLIGATION OF FULL COST.— 
(1) IN GENERAL.—Subject to the availability of appropria-
tions provided in advance, in exercising the authority of the 
Secretary of Veterans Affairs to enter into leases provided 
in this Act, the Secretary shall record, pursuant to section 
1501 of title 31, United States Code, as the full cost of the 
contractual obligation at the time a contract is executed either— 
(A) an amount equal to total payments under the full 
term of the lease; or 
(B) if the lease specifies payments to be made in the 
event the lease is terminated before its full term, an 
amount sufficient to cover the first year lease payments 
plus the specified cancellation costs. 
(2) SELF-INSURING AUTHORITY.—The requirements of para-
graph (1) may be satisfied through the use of the self-insuring 
authority identified in title 40, United States Code, consistent 
with Office of Management and Budget Circular A–11. 
(c) TRANSPARENCY.— 
(1) COMPLIANCE.—Subsection (b) of section 8104 of title 
38, United States Code, is amended by adding at the end 
the following new paragraph: 
‘‘(7) In the case of a prospectus proposing funding for a 
major medical facility lease, a detailed analysis of how the 
lease is expected to comply with Office of Management and 
Budget Circular A–11 and section 1341 of title 31 (commonly
H. R. 3230—42 
referred to as the ‘Anti-Deficiency Act’). Any such analysis 
shall include— 
‘‘(A) an analysis of the classification of the lease as 
a ‘lease-purchase’, ‘capital lease’, or ‘operating lease’ as 
those terms are defined in Office of Management and 
Budget Circular A–11; 
‘‘(B) an analysis of the obligation of budgetary resources 
associated with the lease; and 
‘‘(C) an analysis of the methodology used in deter-
mining the asset cost, fair market value, and cancellation 
costs of the lease.’’. 
(2) SUBMITTAL TO CONGRESS.—Such section 8104 is further 
amended by adding at the end the following new subsection: 
‘‘(h)(1) Not less than 30 days before entering into a major 
medical facility lease, the Secretary shall submit to the Committees 
on Veterans’ Affairs of the Senate and the House of Representa-
tives— 
‘‘(A) notice of the Secretary’s intention to enter into the 
lease; 
‘‘(B) a detailed summary of the proposed lease; 
‘‘(C) a description and analysis of any differences between 
the prospectus submitted pursuant to subsection (b) and the 
proposed lease; and 
‘‘(D) a scoring analysis demonstrating that the proposed 
lease fully complies with Office of Management and Budget 
Circular A–11. 
‘‘(2) Each committee described in paragraph (1) shall ensure 
that any information submitted to the committee under such para-
graph is treated by the committee with the same level of confiden-
tiality as is required by law of the Secretary and subject to the 
same statutory penalties for unauthorized disclosure or use as 
the Secretary. 
‘‘(3) Not more than 30 days after entering into a major medical 
facility lease, the Secretary shall submit to each committee 
described in paragraph (1) a report on any material differences 
between the lease that was entered into and the proposed lease 
described under such paragraph, including how the lease that was 
entered into changes the previously submitted scoring analysis 
described in subparagraph (D) of such paragraph.’’. 
(d) RULE OF CONSTRUCTION.—Nothing in this section, or the 
amendments made by this section, shall be construed to in any 
way relieve the Department of Veterans Affairs from any statutory 
or regulatory obligations or requirements existing prior to the enact-
ment of this section and such amendments. 
TITLE VII—OTHER VETERANS MATTERS 
SEC. 701. EXPANSION OF MARINE GUNNERY SERGEANT JOHN DAVID 
FRY SCHOLARSHIP. 
(a) EXPANSION OF ENTITLEMENT.—Subsection (b)(9) of section 
3311 of title 38, United States Code, is amended by inserting 
‘‘or spouse’’ after ‘‘child’’. 
(b) LIMITATION
AND ELECTION
ON CERTAIN BENEFITS.—Sub-
section (f) of such section is amended— 
(1) by redesignating paragraph (2) as paragraph (4); and
H. R. 3230—43 
(2) by inserting after paragraph (1) the following new para-
graphs: 
‘‘(2) LIMITATION.—The entitlement of an individual to 
assistance under subsection (a) pursuant to paragraph (9) of 
subsection (b) because the individual was a spouse of a person 
described in such paragraph shall expire on the earlier of— 
‘‘(A) the date that is 15 years after the date on which 
the person died; or 
‘‘(B) the date on which the individual remarries. 
‘‘(3) ELECTION ON RECEIPT OF CERTAIN BENEFITS.—A sur-
viving spouse entitled to assistance under subsection (a) pursu-
ant to paragraph (9) of subsection (b) who is also entitled 
to educational assistance under chapter 35 of this title may 
not receive assistance under both this section and such chapter, 
but shall make an irrevocable election (in such form and 
manner as the Secretary may prescribe) under which section 
or chapter to receive educational assistance.’’. 
(c) CONFORMING AMENDMENT.—Section 3321(b)(4) of such title 
is amended— 
(1) by striking ‘‘an individual’’ and inserting ‘‘a child’’; and 
(2) by striking ‘‘such individual’s’’ each time it appears 
and inserting ‘‘such child’s’’. 
(d) EFFECTIVE DATE.—The amendments made by this section 
shall apply with respect to a quarter, semester, or term, as 
applicable, commencing on or after January 1, 2015. 
SEC. 702. APPROVAL OF COURSES OF EDUCATION PROVIDED BY 
PUBLIC INSTITUTIONS OF HIGHER LEARNING FOR PUR-
POSES OF ALL-VOLUNTEER FORCE EDUCATIONAL ASSIST-
ANCE PROGRAM AND POST-9/11 EDUCATIONAL ASSIST-
ANCE CONDITIONAL ON IN-STATE TUITION RATE FOR VET-
ERANS. 
(a) IN GENERAL.—Section 3679 of title 38, United States Code, 
is amended by adding at the end the following new subsection: 
‘‘(c)(1) Notwithstanding any other provision of this chapter and 
subject to paragraphs (3) through (6), the Secretary shall disapprove 
a course of education provided by a public institution of higher 
learning to a covered individual pursuing a course of education 
with educational assistance under chapter 30 or 33 of this title 
while living in the State in which the public institution of higher 
learning is located if the institution charges tuition and fees for 
that course for the covered individual at a rate that is higher 
than the rate the institution charges for tuition and fees for that 
course for residents of the State in which the institution is located, 
regardless of the covered individual’s State of residence. 
‘‘(2) For purposes of this subsection, a covered individual is 
any individual as follows: 
‘‘(A) A veteran who was discharged or released from a 
period of not fewer than 90 days of service in the active military, 
naval, or air service less than three years before the date 
of enrollment in the course concerned. 
‘‘(B) An individual who is entitled to assistance under sec-
tion 3311(b)(9) or 3319 of this title by virtue of such individual’s 
relationship to a veteran described in subparagraph (A). 
‘‘(3) If after enrollment in a course of education that is subject 
to disapproval under paragraph (1) by reason of paragraph (2)(A)
H. R. 3230—44 
or (2)(B) a covered individual pursues one or more courses of edu-
cation at the same public institution of higher learning while 
remaining continuously enrolled (other than during regularly sched-
uled breaks between courses, semesters or terms) at that institution 
of higher learning, any course so pursued by the covered individual 
at that institution of higher learning while so continuously enrolled 
shall also be subject to disapproval under paragraph (1). 
‘‘(4) It shall not be grounds to disapprove a course of education 
under paragraph (1) if a public institution of higher learning 
requires a covered individual pursuing a course of education at 
the institution to demonstrate an intent, by means other than 
satisfying a physical presence requirement, to establish residency 
in the State in which the institution is located, or to satisfy other 
requirements not relating to the establishment of residency, in 
order to be charged tuition and fees for that course at a rate 
that is equal to or less than the rate the institution charges for 
tuition and fees for that course for residents of the State. 
‘‘(5) The Secretary may waive such requirements of paragraph 
(1) as the Secretary considers appropriate. 
‘‘(6) Disapproval under paragraph (1) shall apply only with 
respect to educational assistance under chapters 30 and 33 of this 
title.’’. 
(b) EFFECTIVE DATE.—Subsection (c) of section 3679 of title 
38, United States Code (as added by subsection (a) of this section), 
shall apply with respect to educational assistance provided for 
pursuit of a program of education during a quarter, semester, 
or term, as applicable, that begins after July 1, 2015. 
SEC. 703. EXTENSION OF REDUCTION IN AMOUNT OF PENSION FUR-
NISHED BY DEPARTMENT OF VETERANS AFFAIRS FOR 
CERTAIN VETERANS COVERED BY MEDICAID PLANS FOR 
SERVICES FURNISHED BY NURSING FACILITIES. 
Section 5503(d)(7) of title 38, United States Code, is amended 
by striking ‘‘November 30, 2016’’ and inserting ‘‘September 30, 
2024’’. 
SEC. 704. EXTENSION OF REQUIREMENT FOR COLLECTION OF FEES 
FOR HOUSING LOANS GUARANTEED BY SECRETARY OF 
VETERANS AFFAIRS. 
Section 3729(b)(2) of title 38, United States Code, is amended— 
(1) in subparagraph (A)— 
(A) in clause (iii), by striking ‘‘October 1, 2017’’ and 
inserting ‘‘September 30, 2024’’; and 
(B) in clause (iv), by striking ‘‘October 1, 2017’’ and 
inserting ‘‘September 30, 2024’’; 
(2) in subparagraph (B)— 
(A) in clause (i), by striking ‘‘October 1, 2017’’ and 
inserting ‘‘September 30, 2024’’; and 
(B) in clause (ii), by striking ‘‘October 1, 2017’’ and 
inserting ‘‘September 30, 2024’’; 
(3) in subparagraph (C)— 
(A) in clause (i), by striking ‘‘October 1, 2017’’ and 
inserting ‘‘September 30, 2024’’; and 
(B) in clause (ii), by striking ‘‘October 1, 2017’’ and 
inserting ‘‘September 30, 2024’’; and 
(4) in subparagraph (D)— 
(A) in clause (i), by striking ‘‘October 1, 2017’’ and 
inserting ‘‘September 30, 2024’’; and
H. R. 3230—45 
(B) in clause (ii), by striking ‘‘October 1, 2017’’ and 
inserting ‘‘September 30, 2024’’. 
SEC. 705. LIMITATION ON AWARDS AND BONUSES PAID TO EMPLOYEES 
OF DEPARTMENT OF VETERANS AFFAIRS. 
In each of fiscal years 2015 through 2024, the Secretary of 
Veterans Affairs shall ensure that the aggregate amount of awards 
and bonuses paid by the Secretary in a fiscal year under chapter 
45 or 53 of title 5, United States Code, or any other awards 
or 
bonuses 
authorized 
under 
such 
title 
does 
not 
exceed 
$360,000,000. 
SEC. 706. EXTENSION OF AUTHORITY TO USE INCOME INFORMATION. 
Section 5317(g) of title 38, United States Code, is amended 
by striking ‘‘September 30, 2016’’ and inserting ‘‘September 30, 
2024’’. 
SEC. 707. REMOVAL OF SENIOR EXECUTIVES OF THE DEPARTMENT 
OF VETERANS AFFAIRS FOR PERFORMANCE OR MIS-
CONDUCT. 
(a) REMOVAL OR TRANSFER.— 
(1) IN GENERAL.—Chapter 7 of title 38, United States Code, 
is amended by adding at the end the following new section: 
‘‘§ 713. Senior executives: removal based on performance or 
misconduct 
‘‘(a) IN GENERAL.—(1) The Secretary may remove an individual 
employed in a senior executive position at the Department of Vet-
erans Affairs from the senior executive position if the Secretary 
determines the performance or misconduct of the individual war-
rants such removal. If the Secretary so removes such an individual, 
the Secretary may— 
‘‘(A) remove the individual from the civil service (as defined 
in section 2101 of title 5); or 
‘‘(B) in the case of an individual described in paragraph 
(2), transfer the individual from the senior executive position 
to a General Schedule position at any grade of the General 
Schedule for which the individual is qualified and that the 
Secretary determines is appropriate. 
‘‘(2) An individual described in this paragraph is an individual 
who— 
‘‘(A) previously occupied a permanent position within the 
competitive service (as that term is defined in section 2102 
of title 5); 
‘‘(B) previously occupied a permanent position within the 
excepted service (as that term is defined in section 2103 of 
title 5); or 
‘‘(C) prior to employment in a senior executive position 
at the Department of Veterans Affairs, did not occupy any 
position within the Federal Government. 
‘‘(b) PAY OF TRANSFERRED INDIVIDUAL.—(1) Notwithstanding 
any other provision of law, including the requirements of section 
3594 of title 5, any individual transferred to a General Schedule 
position under subsection (a)(2) shall, beginning on the date of 
such transfer, receive the annual rate of pay applicable to such 
position. 
‘‘(2) An individual so transferred may not be placed on adminis-
trative leave or any other category of paid leave during the period
H. R. 3230—46 
during which an appeal (if any) under this section is ongoing, 
and may only receive pay if the individual reports for duty. If 
an individual so transferred does not report for duty, such individual 
shall not receive pay or other benefits pursuant to subsection (e)(5). 
‘‘(c) NOTICE
TO CONGRESS.—Not later than 30 days after 
removing or transferring an individual from a senior executive 
position under subsection (a), the Secretary shall submit to the 
Committees on Veterans’ Affairs of the Senate and House of Rep-
resentatives notice in writing of such removal or transfer and 
the reason for such removal or transfer. 
‘‘(d) PROCEDURE.—(1) The procedures under section 7543(b) 
of title 5 shall not apply to a removal or transfer under this 
section. 
‘‘(2)(A) Subject to subparagraph (B) and subsection (e), any 
removal or transfer under subsection (a) may be appealed to the 
Merit Systems Protection Board under section 7701 of title 5. 
‘‘(B) An appeal under subparagraph (A) of a removal or transfer 
may only be made if such appeal is made not later than seven 
days after the date of such removal or transfer. 
‘‘(e) EXPEDITED REVIEW BY ADMINISTRATIVE JUDGE.—(1) Upon 
receipt of an appeal under subsection (d)(2)(A), the Merit Systems 
Protection Board shall refer such appeal to an administrative judge 
pursuant to section 7701(b)(1) of title 5. The administrative judge 
shall expedite any such appeal under such section and, in any 
such case, shall issue a decision not later than 21 days after 
the date of the appeal. 
‘‘(2) Notwithstanding any other provision of law, including sec-
tion 7703 of title 5, the decision of an administrative judge under 
paragraph (1) shall be final and shall not be subject to any further 
appeal. 
‘‘(3) In any case in which the administrative judge cannot 
issue a decision in accordance with the 21-day requirement under 
paragraph (1), the removal or transfer is final. In such a case, 
the Merit Systems Protection Board shall, within 14 days after 
the date that such removal or transfer is final, submit to Congress 
and the Committees on Veterans’ Affairs of the Senate and House 
of Representatives a report that explains the reasons why a decision 
was not issued in accordance with such requirement. 
‘‘(4) The Merit Systems Protection Board or administrative 
judge may not stay any removal or transfer under this section. 
‘‘(5) During the period beginning on the date on which an 
individual appeals a removal from the civil service under subsection 
(d) and ending on the date that the administrative judge issues 
a final decision on such appeal, such individual may not receive 
any pay, awards, bonuses, incentives, allowances, differentials, stu-
dent loan repayments, special payments, or benefits. 
‘‘(6) To the maximum extent practicable, the Secretary shall 
provide to the Merit Systems Protection Board, and to any adminis-
trative judge to whom an appeal under this section is referred, 
such information and assistance as may be necessary to ensure 
an appeal under this subsection is expedited. 
‘‘(f) RELATION TO TITLE 5.—(1) The authority provided by this 
section is in addition to the authority provided by section 3592 
or subchapter V of chapter 75 of title 5. 
‘‘(2) Section 3592(b)(1) of title 5 does not apply to an action 
to remove or transfer an individual under this section. 
‘‘(g) DEFINITIONS.—In this section:
H. R. 3230—47 
‘‘(1) The term ‘individual’ means— 
‘‘(A) a career appointee (as that term is defined in 
section 3132(a)(4) of title 5); or 
‘‘(B) any individual who occupies an administrative 
or executive position and who was appointed under section 
7306(a) or section 7401(1) of this title. 
‘‘(2) The term ‘misconduct’ includes neglect of duty, malfea-
sance, or failure to accept a directed reassignment or to accom-
pany a position in a transfer of function. 
‘‘(3) The term ‘senior executive position’ means— 
‘‘(A) with respect to a career appointee (as that term 
is defined in section 3132(a)(4) of title 5), a Senior Executive 
Service position (as such term is defined in section 
3132(a)(2) of title 5); and 
‘‘(B) with respect to an individual appointed under 
section 7306(a) or section 7401(1) of this title, an adminis-
trative or executive position.’’. 
(2) CLERICAL AMENDMENT.—The table of sections at the 
beginning of such chapter is amended by adding at the end 
the following new item: 
‘‘713. Senior executives: removal based on performance or misconduct.’’. 
(b) ESTABLISHMENT OF EXPEDITED REVIEW PROCESS.— 
(1) IN GENERAL.—Not later than 14 days after the date 
of the enactment of this Act, the Merit Systems Protection 
Board shall establish and put into effect a process to conduct 
expedited reviews in accordance with section 713(d) of title 
38, United States Code. 
(2) INAPPLICABILITY
OF
CERTAIN
REGULATIONS.—Section 
1201.22 of title 5, Code of Federal Regulations, as in effect 
on the day before the date of the enactment of this Act, shall 
not apply to expedited reviews carried out under section 713(d) 
of title 38, United States Code. 
(3) WAIVER.—The Merit Systems Protection Board may 
waive any other regulation in order to provide for the expedited 
review required under section 713(d) of title 38, United States 
Code. 
(4) REPORT BY MERIT SYSTEMS PROTECTION BOARD.—Not 
later than 14 days after the date of the enactment of this 
Act, the Merit Systems Protection Board shall submit to the 
Committees on Veterans’ Affairs of the Senate and House of 
Representatives a report on the actions the Board plans to 
take to conduct expedited reviews under section 713(d) of title 
38, United States Code, as added by subsection (a). Such report 
shall include a description of the resources the Board deter-
mines will be necessary to conduct such reviews and a descrip-
tion of whether any resources will be necessary to conduct 
such reviews that were not available to the Board on the 
day before the date of the enactment of this Act. 
(c) TEMPORARY EXEMPTION FROM CERTAIN LIMITATION ON INITI-
ATION OF REMOVAL FROM SENIOR EXECUTIVE SERVICE.—During the 
120-day period beginning on the date of the enactment of this 
Act, an action to remove an individual from the Senior Executive 
Service at the Department of Veterans Affairs pursuant to section 
7543 of title 5, United States Code, may be initiated, notwith-
standing section 3592(b) of such title, or any other provision of 
law.
H. R. 3230—48 
(d) CONSTRUCTION.— 
(1) IN GENERAL.—Nothing in this section or section 713 
of title 38, United States Code, as added by subsection (a), 
shall be construed to apply to an appeal of a removal, transfer, 
or other personnel action that was pending before the date 
of the enactment of this Act. 
(2) RELATION TO TITLE 5.—With respect to the removal 
or transfer of an individual (as that term is defined in such 
section 713) employed at the Department of Veterans Affairs, 
the authority provided by such section 713 is in addition to 
the authority provided by section 3592 or subchapter V of 
chapter 75 of title 5, United States Code. 
TITLE VIII—OTHER MATTERS 
SEC. 801. APPROPRIATION OF AMOUNTS. 
(a) IN GENERAL.—There is authorized to be appropriated, and 
is appropriated, to the Secretary of Veterans Affairs, out of any 
funds in the Treasury not otherwise appropriated $5,000,000,000 
to carry out subsection (b). Such funds shall be available for obliga-
tion or expenditure without fiscal year limitation. 
(b) USE OF AMOUNTS.—The amount appropriated under sub-
section (a) shall be used by the Secretary as follows: 
(1) To increase the access of veterans to care as follows: 
(A) To hire primary care and specialty care physicians 
for employment in the Department of Veterans Affairs. 
(B) To hire other medical staff, including the following: 
(i) Physicians. 
(ii) Nurses. 
(iii) Social workers. 
(iv) Mental health professionals. 
(v) Other health care professionals as the Secretary 
considers appropriate. 
(C) To carry out sections 301 and 302, including the 
amendments made by such sections. 
(D) To pay for expenses, equipment, and other costs 
associated with the hiring of primary care, specialty care 
physicians, and other medical staff under subparagraphs 
(A), (B), and (C). 
(2) To improve the physical infrastructure of the Depart-
ment as follows: 
(A) To maintain and operate hospitals, nursing homes, 
domiciliary facilities, and other facilities of the Veterans 
Health Administration. 
(B) To enter into contracts or hire temporary employees 
to repair, alter, or improve facilities under the jurisdiction 
of the Department that are not otherwise provided for 
under this paragraph. 
(C) To carry out leases for facilities of the Department. 
(D) To carry out minor construction projects of the 
Department. 
(c) AVAILABILITY.—The amount appropriated under subsection 
(a) shall remain available until expended. 
(d) REPORT.— 
(1) IN
GENERAL.—Not later than 1 year after the date 
of the enactment of this Act, the Secretary of Veterans Affairs
H. R. 3230—49 
shall submit to the appropriate committees of Congress a report 
on how the Secretary has obligated the amounts appropriated 
under subsection (a) as of the date of the submittal of the 
report. 
(2) APPROPRIATE COMMITTEES OF CONGRESS DEFINED.—In 
this subsection, the term ‘‘appropriate committees of Congress’’ 
means— 
(A) the Committee on Veterans’ Affairs and the Com-
mittee on Appropriations of the Senate; and 
(B) the Committee on Veterans’ Affairs and the Com-
mittee on Appropriations of the House of Representatives. 
(e) FUNDING PLAN.—The Secretary shall submit to Congress 
a funding plan describing how the Secretary intends to use the 
amounts provided under subsection (a). 
SEC. 802. VETERANS CHOICE FUND. 
(a) IN GENERAL.—There is established in the Treasury of the 
United States a fund to be known as the Veterans Choice Fund. 
(b) ADMINISTRATION
OF FUND.—The Secretary of Veterans 
Affairs shall administer the Veterans Choice Fund established by 
subsection (a). 
(c) USE OF AMOUNTS.— 
(1) IN GENERAL.—Any amounts deposited in the Veteran 
Choice Fund shall be used by the Secretary of Veterans Affairs 
to carry out section 101, including, subject to paragraph (2), 
any administrative requirements of such section. 
(2) AMOUNT FOR ADMINISTRATIVE REQUIREMENTS.— 
(A) LIMITATION.—Except as provided by subparagraph 
(B), of the amounts deposited in the Veterans Choice Fund, 
not more than $300,000,000 may be used for administrative 
requirements to carry out section 101. 
(B) INCREASE.—The Secretary may increase the 
amount set forth in subparagraph (A) with respect to the 
amounts used for administrative requirements if— 
(i) the Secretary determines that the amount of 
such increase is necessary to carry out section 101; 
(ii) the Secretary submits to the Committees on 
Veterans’ Affairs and Appropriations of the House of 
Representatives and the Committees on Veterans’ 
Affairs and Appropriations of the Senate a report 
described in subparagraph (C); and 
(iii) a period of 60 days has elapsed following the 
date on which the Secretary submits the report under 
clause (ii). 
(C) REPORT.—A report described in this subparagraph 
is a report that contains the following: 
(i) A notification of the amount of the increase 
that 
the 
Secretary 
determines 
necessary 
under 
subparagraph (B)(i). 
(ii) The justifications for such increased amount. 
(iii) The administrative requirements that the Sec-
retary will carry out using such increased amount. 
(d) APPROPRIATION AND DEPOSIT OF AMOUNTS.— 
(1) IN GENERAL.—There is authorized to be appropriated, 
and is appropriated, to the Secretary of Veterans Affairs, out 
of any funds in the Treasury not otherwise appropriated 
$10,000,000,000 to be deposited in the Veterans Choice Fund
H. R. 3230—50 
established by subsection (a). Such funds shall be available 
for obligation or expenditure without fiscal year limitation, 
and only for the program created under section 101. 
(2) AVAILABILITY.—The amount appropriated under para-
graph (1) shall remain available until expended. 
(e) SENSE
OF CONGRESS.—It is the sense of Congress that 
the Veterans Choice Fund is a supplement to but distinct from 
the Department of Veterans Affairs’ current and expected level 
of non-Department care currently part of Department’s medical 
care budget. Congress expects that the Department will maintain 
at least its existing obligations of non-Department care programs 
in addition to but distinct from the Veterans Choice Fund for 
each of fiscal years 2015 through 2017. 
SEC. 803. EMERGENCY DESIGNATIONS. 
(a) IN GENERAL.—This Act is designated as an emergency 
requirement pursuant to section 4(g) of the Statutory Pay-As-You- 
Go Act of 2010 (2 U.S.C. 933(g)). 
(b) DESIGNATION IN SENATE.—In the Senate, this Act is des-
ignated as an emergency requirement pursuant to section 403(a) 
of S. Con. Res. 13 (111th Congress), the concurrent resolution 
on the budget for fiscal year 2010. 
Speaker of the House of Representatives. 
Vice President of the United States and
President of the Senate.