‘‘(4) The Secretary shall publish in the Federal Reg-
ister, and shall take all reasonable steps to provide direct 
notice to covered veterans affected under this subsection, 
at least once each year stating the time period during 
which such care and services will be available, the location 
or locations where such care and services will be available, 
and the clinical services available at each location under 
this subsection in accordance with regulations the Sec-
retary shall prescribe. 
‘‘(5) When the Secretary exercises the authority 
under paragraph (1), the decision to receive care or serv-
ices under such paragraph from a health care provider 
specified in subsection (c) shall be at the election of the 
covered veteran. 
‘‘(f) REVIEW OF DECISIONS.—The review of any de-
cision under subsection (d) or (e) shall be subject to the 
Department’s clinical appeals process, and such decisions 
may not be appealed to the Board of Veterans’ Appeals. 
‘‘(g) TIERED NETWORK.—(1) To promote the provi-
sion of high-quality and high-value hospital care, medical 
services, and extended care services under this section, the 
Secretary may develop a tiered provider network of eligible 
providers based on criteria established by the Secretary 
for purposes of this section. 
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‘‘(2) In developing a tiered provider network of eligi-
ble providers under paragraph (1), the Secretary shall not 
prioritize providers in a tier over providers in any other 
tier in a manner that limits the choice of a covered veteran 
in selecting a health care provider specified in subsection 
(c) for receipt of hospital care, medical services, or ex-
tended care services under this section. 
‘‘(h) CONTRACTS TO ESTABLISH NETWORKS
OF 
HEALTH CARE PROVIDERS.—(1) The Secretary shall 
enter into consolidated, competitively bid contracts to es-
tablish networks of health care providers specified in para-
graphs (1) and (5) of subsection (c) for purposes of pro-
viding sufficient access to hospital care, medical services, 
or extended care services under this section. 
‘‘(2)(A) The Secretary shall, to the extent practicable, 
ensure that covered veterans are able to make their own 
appointments using advanced technology. 
‘‘(B) To the extent practicable, the Secretary shall 
be responsible for the scheduling of appointments for hos-
pital care, medical services, and extended care services 
under this section. 
‘‘(3)(A) The Secretary may terminate a contract with 
an entity entered into under paragraph (1) at such time 
and upon such notice to the entity as the Secretary may 
specify for purposes of this section, if the Secretary noti-
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fies the appropriate committees of Congress that, at a 
minimum— 
‘‘(i) the entity— 
‘‘(I) failed to comply substantially with the 
provisions of the contract or with the provisions 
of this section and the regulations prescribed 
under this section; 
‘‘(II) failed to comply with the access 
standards or the standards for quality estab-
lished by the Secretary; 
‘‘(III) is excluded from participation in a 
Federal health care program (as defined in sec-
tion 1128B(f) of the Social Security Act (42 
U.S.C. 1320a–7b(f))) under section 1128 or 
1128A of the Social Security Act (42 U.S.C. 
1320a–7 and 1320a–7a); 
‘‘(IV) is identified as an excluded source 
on the list maintained in the System for Award 
Management, or any successor system; or 
‘‘(V) has been convicted of a felony or 
other serious offense under Federal or State 
law and the continued participation of the enti-
ty would be detrimental to the best interests of 
veterans or the Department; 
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‘‘(ii) it is reasonable to terminate the contract 
based on the health care needs of veterans; or 
‘‘(iii) it is reasonable to terminate the contract 
based on coverage provided by contracts or sharing 
agreements entered into under authorities other 
than this section. 
‘‘(B) Nothing in subparagraph (A) may be construed 
to restrict the authority of the Secretary to terminate a 
contract entered into under paragraph (1) under any other 
provision of law. 
‘‘(4) Whenever the Secretary provides notice to an 
entity that the entity is failing to meet contractual obliga-
tions entered into under paragraph (1), the Secretary shall 
submit to the Committee on Veterans’ Affairs of the Sen-
ate and the Committee on Veterans’ Affairs of the House 
of Representatives a report on such failure. Such report 
shall include the following: 
‘‘(A) An explanation of the reasons for pro-
viding such notice. 
‘‘(B) A description of the effect of such failure, 
including with respect to cost, schedule, and require-
ments. 
‘‘(C) A description of the actions taken by the 
Secretary to mitigate such failure. 
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‘‘(D) A description of the actions taken by the 
contractor to address such failure. 
‘‘(E) A description of any effect on the commu-
nity provider market for veterans in the affected 
area. 
‘‘(5)(A) The Secretary shall instruct each entity 
awarded a contract under paragraph (1) to recognize and 
accept, on an interim basis, the credentials and qualifica-
tions of health care providers who are authorized to fur-
nish hospital care and medical services to veterans under 
a community care program of the Department in effect 
as of the day before the date of the enactment of the Car-
ing for Our Veterans Act of 2018, including under the 
Patient-Centered Community Care Program and the Vet-
erans Choice Program under section 101 of the Veterans 
Access, Choice, and Accountability Act of 2014 (Public 
Law 113–146; 38 U.S.C. 1701 note), as qualified pro-
viders under the program established under this section. 
‘‘(B) The interim acceptance period under subpara-
graph (A) shall be determined by the Secretary based on 
the following criteria: 
‘‘(i) With respect to a health care provider, 
when the current certification agreement for the 
health care provider expires. 
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‘‘(ii) Whether the Department has enacted cer-
tification and eligibility criteria and regulatory pro-
cedures by which non-Department providers will be 
authorized under this section. 
‘‘(6) The Secretary shall establish a system or sys-
tems for monitoring the quality of care provided to covered 
veterans through a network under this subsection and for 
assessing the quality of hospital care, medical services, 
and extended care services furnished through such net-
work before the renewal of the contract for such network. 
‘‘(i) PAYMENT RATES FOR CARE AND SERVICES.— 
(1) Except as provided in paragraph (2), and to the extent 
practicable, the rate paid for hospital care, medical serv-
ices, or extended care services under any provision in this 
title may not exceed the rate 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 sup-
plier (as defined in section 1861(d) of such Act (42 U.S.C. 
1395x(d))) under the Medicare program under title XI or 
title XVIII of the Social Security Act (42 U.S.C. 1301 
et seq.), including section 1834 of such Act (42 U.S.C. 
1395m), for the same care or services. 
‘‘(2)(A) A higher rate than the rate paid by the 
United States as described in paragraph (1) may be nego-
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tiated with respect to the furnishing of care or services 
to a covered veteran who resides in a highly rural area. 
‘‘(B) In this paragraph, 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. 
‘‘(3) With respect to furnishing care or services under 
this section in Alaska, the Alaska Fee Schedule of the De-
partment of Veterans Affairs shall be followed, except for 
when another payment agreement, including a contract or 
provider agreement, is in effect. 
‘‘(4) With respect to furnishing hospital care, medical 
services, or extended care services under this section in 
a State with an All-Payer Model Agreement under section 
1814(b)(3) of the Social Security Act (42 U.S.C. 
1395f(b)(3)) that became effective on or after January 1, 
2014, the Medicare payment rates under paragraph 
(2)(A) shall be calculated based on the payment rates 
under such agreement. 
‘‘(5) Notwithstanding paragraph (1), the Secretary 
may incorporate, to the extent practicable, the use of 
value-based reimbursement models to promote the provi-
sion of high-quality care. 
‘‘(6) With respect to hospital care, medical services, 
or extended care services for which there is not a rate paid 
under the Medicare program as described in paragraph 
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(1), the rate paid for such care or services shall be deter-
mined by the Secretary. 
‘‘(j) TREATMENT OF OTHER HEALTH PLAN CON-
TRACTS.—In any case in which a covered veteran is fur-
nished hospital care, medical services, or extended care 
services under this section for a non-service-connected dis-
ability described in subsection (a)(2) of section 1729 of 
this title, the Secretary shall recover or collect reasonable 
charges for such care or services from a health plan con-
tract described in section 1729 in accordance with such 
section. 
‘‘(k) PAYMENT
BY VETERAN.—A covered veteran 
shall not pay a greater amount for receiving care or serv-
ices under this section than the amount the veteran would 
pay for receiving the same or comparable care or services 
at a medical facility of the Department or from a health 
care provider of the Department. 
‘‘(l) TRANSPLANT AUTHORITY FOR IMPROVED AC-
CESS.—(1) In the case of a covered veteran described in 
paragraph (2), the Secretary shall determine whether to 
authorize an organ or bone marrow transplant for that 
covered veteran at a non-Department facility. 
‘‘(2) A covered veteran described in this paragraph— 
‘‘(A) requires an organ or bone marrow trans-
plant; and 
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‘‘(B) has, in the opinion of the primary care 
provider of the veteran, a medically compelling rea-
son to travel outside the region of the Organ Pro-
curement and Transplantation Network, established 
under section 372 of the National Organ Transplan-
tation Act (Public Law 98–507; 42 U.S.C. 274), in 
which the veteran resides, to receive such transplant. 
‘‘(m) MONITORING OF CARE PROVIDED.—(1)(A) Not 
later than 540 days after the date of the enactment of 
the Caring for Our Veterans Act of 2018, and not less 
frequently than annually thereafter, the Secretary shall 
submit to appropriate committees of Congress a review of 
the types and frequency of care sought under subsection 
(d). 
‘‘(B) The review submitted under subparagraph (A) 
shall include an assessment of the following: 
‘‘(i) The top 25 percent of types of care and 
services most frequently provided under subsection 
(d) due to the Department not offering such care 
and services. 
‘‘(ii) The frequency such care and services were 
sought by covered veterans under this section. 
‘‘(iii) An analysis of the reasons the Depart-
ment was unable to provide such care and services. 
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‘‘(iv) Any steps the Department took to provide 
such care and services at a medical facility of the 
Department. 
‘‘(v) The cost of such care and services. 
‘‘(2) In monitoring the hospital care, medical serv-
ices, and extended care services furnished under this sec-
tion, the Secretary shall do the following: 
‘‘(A) With respect to hospital care, medical 
services, and extended care services furnished 
through provider networks established under sub-
section (i)— 
‘‘(i) compile data on the types of hospital 
care, medical services, and extended care serv-
ices furnished through such networks and how 
many patients used each type of care and serv-
ice; 
‘‘(ii) identify gaps in hospital care, medical 
services, or extended care services furnished 
through such networks; 
‘‘(iii) identify how such gaps may be fixed 
through new contracts within such networks or 
changes in the manner in which hospital care, 
medical services, or extended care services are 
furnished through such networks; 
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‘‘(iv) assess the total amounts spent by the 
Department on hospital care, medical services, 
and extended care services furnished through 
such networks; 
‘‘(v) assess the timeliness of the Depart-
ment in referring hospital care, medical serv-
ices, and extended care services to such net-
works; and 
‘‘(vi) assess the timeliness of such net-
works in— 
‘‘(I) accepting referrals; and 
‘‘(II) scheduling and completing ap-
pointments. 
‘‘(B) Report the number of medical service lines 
the Secretary has determined under subsection 
(e)(1) not to be providing hospital care, medical 
services, or extended care services that comply with 
the standards for quality established by the Sec-
retary. 
‘‘(C) Assess the use of academic affiliates and 
centers of excellence of the Department to furnish 
hospital care, medical services, and extended care 
services to covered veterans under this section. 
‘‘(D) Assess the hospital care, medical services, 
and extended care services furnished to covered vet-
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erans under this section by medical facilities oper-
ated by Federal agencies other than the Depart-
ment. 
‘‘(3) Not later than 540 days after the date of the 
enactment of the Caring for Our Veterans Act of 2018 
and not less frequently than once each year thereafter, the 
Secretary shall submit to the Committee on Veterans’ Af-
fairs of the Senate and the Committee on Veterans’ Af-
fairs of the House of Representatives a report on the in-
formation gathered under paragraph (2). 
‘‘(n) PROHIBITION ON CERTAIN LIMITATIONS.—(1) 
The Secretary shall not limit the types of hospital care, 
medical services, or extended care services covered vet-
erans may receive under this section if it is in the best 
medical interest of the veteran to receive such hospital 
care, medical services, or extended care services, as deter-
mined by the veteran and the veteran’s health care pro-
vider. 
‘‘(2) No provision in this section may be construed 
to alter or modify any other provision of law establishing 
specific eligibility criteria for certain hospital care, medical 
services, or extended care services. 
‘‘(o) DEFINITIONS.—In this section: 
‘‘(1) The term ‘appropriate committees of Con-
gress’ means— 
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‘‘(A) the Committee on Veterans’ Affairs 
and the Committee on Appropriations of the 
Senate; and 
‘‘(B) the Committee on Veterans’ Affairs 
and the Committee on Appropriations of the 
House of Representatives. 
‘‘(2) The term ‘medical service line’ means a 
clinic within a Department medical center.’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions at the beginning of chapter 17 is amended by 
striking the item relating to section 1703 and insert-
ing the following new item: 
‘‘1703. Veterans Community Care Program.’’. 
(b) EFFECTIVE DATE.—Section 1703 of title 38, 
United States Code, as amended by subsection (a), shall 
take effect on the later of— 
(1) the date that is 30 days after the date on 
which the Secretary of Veterans Affairs submits the 
report required under section 101(q)(2) of the Vet-
erans Access, Choice, and Accountability Act of 
2014 (Public Law 113–146; 38 U.S.C. 1701 note); 
or 
(2) the date on which the Secretary promul-
gates regulations pursuant to subsection (c). 
(c) REGULATIONS.— 
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(1) IN
GENERAL.—Not later than one year 
after the date of the enactment of this Act, the Sec-
retary of Veterans Affairs shall promulgate regula-
tions to carry out section 1703 of title 38, United 
States Code, as amended by subsection (a) of this 
section. 
(2) UPDATES.— 
(A) PERIODIC.—Before promulgating the 
regulations required under paragraph (1), the 
Secretary shall provide to the appropriate com-
mittees of Congress periodic updates to confirm 
the progress of the Secretary toward developing 
such regulations. 
(B) FIRST
UPDATE.—The first update 
under subparagraph (A) shall occur no later 
than 120 days from the date of the enactment 
of this Act. 
(C) APPROPRIATE COMMITTEES OF CON-
GRESS DEFINED.—In this paragraph, the term 
‘‘appropriate committees of Congress’’ means— 
(i) the Committee on Veterans’ Af-
fairs and the Committee on Appropriations 
of the Senate; and 
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(ii) the Committee on Veterans’ Af-
fairs and the Committee on Appropriations 
of the House of Representatives. 
(d) CONTINUITY OF EXISTING AGREEMENTS.— 
(1) IN
GENERAL.—Notwithstanding section 
1703 of title 38, United States Code, as amended by 
subsection (a), the Secretary of Veterans Affairs 
shall continue all contracts, memorandums of under-
standing, memorandums of agreements, and other 
arrangements that were in effect on the day before 
the date of the enactment of this Act between the 
Department of Veterans Affairs and the American 
Indian and Alaska Native health care systems as es-
tablished under the terms of the Department of Vet-
erans Affairs and Indian Health Service Memo-
randum of Understanding, signed October 1, 2010, 
the National Reimbursement Agreement, signed De-
cember 5, 2012, arrangements under section 405 of 
the Indian Health Care Improvement Act (25 U.S.C. 
1645), and agreements entered into under sections 
102 and 103 of the Veterans Access, Choice, and 
Accountability Act of 2014 (Public Law 113–146). 
(2) MODIFICATIONS.—Paragraph (1) shall not 
be construed to prohibit the Secretary and the par-
ties to the contracts, memorandums of under-
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standing, memorandums of agreements, and other 
arrangements described in such paragraph from 
making such changes to such contracts, memoran-
dums of understanding, memorandums of agree-
ments, and other arrangements as may be otherwise 
authorized pursuant to other provisions of law or the 
terms of the contracts, memorandums of under-
standing, memorandums of agreements, and other 
arrangements. 
SEC. 102. AUTHORIZATION OF AGREEMENTS BETWEEN DE-
PARTMENT OF VETERANS AFFAIRS AND NON- 
DEPARTMENT PROVIDERS. 
(a) IN GENERAL.—Subchapter I of chapter 17 is 
amended by inserting after section 1703 the following new 
section: 
‘‘§ 1703A. Agreements with eligible entities or pro-
viders; certification processes 
‘‘(a) AGREEMENTS AUTHORIZED.—(1)(A) When hos-
pital care, a medical service, or an extended care service 
required by a veteran who is entitled to such care or serv-
ice under this chapter is not feasibly available to the vet-
eran from a facility of the Department or through a con-
tract or sharing agreement entered into pursuant to an-
other provision of law, the Secretary may furnish such 
care or service to such veteran through an agreement 
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under this section with an eligible entity or provider to 
provide such hospital care, medical service, or extended 
care service. 
‘‘(B) An agreement entered into under this section 
to provide hospital care, a medical service, or an extended 
care service shall be known as a ‘Veterans Care Agree-
ment’. 
‘‘(C) For purposes of subparagraph (A), hospital 
care, a medical service, or an extended care service may 
be considered not feasibly available to a veteran from a 
facility of the Department or through a contract or shar-
ing agreement described in such subparagraph when the 
Secretary determines the veteran’s medical condition, the 
travel involved, the nature of the care or services required, 
or a combination of these factors make the use of a facility 
of the Department or a contract or sharing agreement de-
scribed in such subparagraph impracticable or inadvisable. 
‘‘(D) A Veterans Care Agreement may be entered 
into by the Secretary or any Department official author-
ized by the Secretary. 
‘‘(2)(A) Subject to subparagraph (B), the Secretary 
shall review each Veterans Care Agreement of material 
size, as determined by the Secretary or set forth in para-
graph (3), for hospital care, a medical service, or an ex-
tended care service to determine whether it is feasible and 
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advisable to provide such care or service within a facility 
of the Department or by contract or sharing agreement 
entered into pursuant to another provision of law and, if 
so, take action to do so. 
‘‘(B)(i) The Secretary shall review each Veterans 
Care Agreement of material size that has been in effect 
for at least six months within the first two years of its 
taking effect, and not less frequently than once every four 
years thereafter. 
‘‘(ii) If a Veterans Care Agreement has not been in 
effect for at least six months by the date of the review 
required by subparagraph (A), the agreement shall be re-
viewed during the next cycle required by subparagraph 
(A), and such review shall serve as its review within the 
first two years of its taking effect for purposes of clause 
(i). 
‘‘(3)(A) In fiscal year 2019 and in each fiscal year 
thereafter, in addition to such other Veterans Care Agree-
ments as the Secretary may determine are of material size, 
a Veterans Care Agreement for the purchase of extended 
care services that exceeds $5,000,000 annually shall be 
considered of material size. 
‘‘(B) From time to time, the Secretary may publish 
a notice in the Federal Register to adjust the dollar 
amount specified in subparagraph (A) to account for 
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changes in the cost of health care based upon recognized 
health care market surveys and other available data. 
‘‘(b) ELIGIBLE ENTITIES
AND PROVIDERS.—For 
purposes of this section, an eligible entity or provider is— 
‘‘(1) any provider of services that has enrolled 
and entered into a provider agreement under section 
1866(a) of the Social Security Act (42 U.S.C. 
1395cc(a)) and any physician or other supplier who 
has enrolled and entered into a participation agree-
ment under section 1842(h) of such Act (42 U.S.C. 
1395u(h)); 
‘‘(2) any provider participating under a State 
plan under title XIX of such Act (42 U.S.C. 1396 
et seq.); 
‘‘(3) an Aging and Disability Resource Center, 
an area agency on aging, or a State agency (as de-
fined in section 102 of the Older Americans Act of 
1965 (42 U.S.C. 3002)); 
‘‘(4) a center for independent living (as defined 
in section 702 of the Rehabilitation Act of 1973 (29 
U.S.C. 796a)); or 
‘‘(5) any entity or provider not described in 
paragraph (1) or (2) of this subsection that the Sec-
retary determines to be eligible pursuant to the cer-
tification process described in subsection (c). 
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‘‘(c) ELIGIBLE ENTITY
OR PROVIDER CERTIFI-
CATION PROCESS.—The Secretary shall establish by regu-
lation a process for the certification of eligible entities or 
providers or recertification of eligible entities or providers 
under this section. Such a process shall, at a minimum— 
‘‘(1) establish deadlines for actions on applica-
tions for certification; 
‘‘(2) set forth standards for an approval or de-
nial of certification, duration of certification, revoca-
tion of an eligible entity or provider’s certification, 
and recertification of eligible entities or providers; 
‘‘(3) require the denial of certification if the 
Secretary determines the eligible entity or provider 
is excluded from participation in a Federal health 
care program under section 1128 or section 1128A 
of the Social Security Act (42 U.S.C. 1320a–7 or 
1320a–7a) or is currently identified as an excluded 
source on the System for Award Management Exclu-
sions list described in part 9 of title 48, Code of 
Federal Regulations, and part 180 of title 2 of such 
Code, or successor regulations; 
‘‘(4) establish procedures for screening eligible 
entities or providers according to the risk of fraud, 
waste, and abuse that are similar to the standards 
under section 1866(j)(2)(B) of the Social Security 
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Act (42 U.S.C. 1395cc(j)(2)(B)) and section 9.104 
of title 48, Code of Federal Regulations, or suc-
cessor regulations; and 
‘‘(5) incorporate and apply the restrictions and 
penalties set forth in chapter 21 of title 41 and treat 
this section as a procurement program only for pur-
poses of applying such provisions. 
‘‘(d) RATES.—To the extent practicable, the rates 
paid by the Secretary for hospital care, medical services, 
and extended care services provided under a Veterans 
Care Agreement shall be in accordance with the rates paid 
by the United States under section 1703(i) of this title. 
‘‘(e) TERMS OF VETERANS CARE AGREEMENTS.—(1) 
Pursuant to regulations promulgated under subsection 
(k), the Secretary may define the requirements for pro-
viders and entities entering into agreements under this 
section based upon such factors as the number of patients 
receiving care or services, the number of employees em-
ployed by the entity or provider furnishing such care or 
services, the amount paid by the Secretary to the provider 
or entity, or other factors as determined by the Secretary. 
‘‘(2) To furnish hospital care, medical services, or ex-
tended care services under this section, an eligible entity 
or provider shall agree— 
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‘‘(A) to accept payment at the rates established 
in regulations prescribed under this section; 
‘‘(B) that payment by the Secretary under this 
section on behalf of a veteran to a provider of serv-
ices or care shall, unless rejected and refunded by 
the provider within 30 days of receipt, constitute 
payment in full and extinguish any liability on the 
part of the veteran for the treatment or care pro-
vided, and no provision of a contract, agreement, or 
assignment to the contrary shall operate to modify, 
limit, or negate this requirement; 
‘‘(C) to provide only the care and services au-
thorized by the Department under this section and 
to obtain the prior written consent of the Depart-
ment to furnish care or services outside the scope of 
such authorization; 
‘‘(D) to bill the Department in accordance with 
the methodology outlined in regulations prescribed 
under this section; 
‘‘(E) to not seek to recover or collect from a 
health plan contract or third party, as those terms 
are defined in section 1729 of this title, for any care 
or service that is furnished or paid for by the De-
partment; 
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‘‘(F) to provide medical records to the Depart-
ment in the time frame and format specified by the 
Department; and 
‘‘(G) to meet such other terms and conditions, 
including quality of care assurance standards, as the 
Secretary may specify in regulation. 
‘‘(f) DISCONTINUATION OR NONRENEWAL OF A VET-
ERANS CARE AGREEMENT.—(1) An eligible entity or pro-
vider may discontinue a Veterans Care Agreement at such 
time and upon such notice to the Secretary as may be 
provided in regulations prescribed under this section. 
‘‘(2) The Secretary may discontinue a Veterans Care 
Agreement with an eligible entity or provider at such time 
and upon such reasonable notice to the eligible entity or 
provider as may be specified in regulations prescribed 
under this section, if an official designated by the Sec-
retary— 
‘‘(A) has determined that the eligible entity or 
provider failed to comply substantially with the pro-
visions of the Veterans Care Agreement, or with the 
provisions of this section or regulations prescribed 
under this section; 
‘‘(B) has determined the eligible entity or pro-
vider is excluded from participation in a Federal 
health care program under section 1128 or section 
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1128A of the Social Security Act (42 U.S.C. 1320a– 
7 or 1320a–7a) or is identified on the System for 
Award Management Exclusions list as provided in 
part 9 of title 48, Code of Federal Regulations, and 
part 180 of title 2 of such Code, or successor regula-
tions; 
‘‘(C) has ascertained that the eligible entity or 
provider has been convicted of a felony or other seri-
ous offense under Federal or State law and deter-
mines the eligible entity or provider’s continued par-
ticipation would be detrimental to the best interests 
of veterans or the Department; or 
‘‘(D) has determined that it is reasonable to 
terminate the agreement based on the health care 
needs of a veteran. 
‘‘(g) QUALITY OF CARE.—The Secretary shall estab-
lish a system or systems for monitoring the quality of care 
provided to veterans through Veterans Care Agreements 
and for assessing the quality of hospital care, medical 
services, and extended care services furnished by eligible 
entities and providers before the renewal of Veterans Care 
Agreements. 
‘‘(h) DISPUTES.—(1) The Secretary shall promulgate 
administrative procedures for eligible entities and pro-
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viders to present all disputes arising under or related to 
Veterans Care Agreements. 
‘‘(2) Such procedures constitute the eligible entities’ 
and providers’ exhaustive and exclusive administrative 
remedies. 
‘‘(3) Eligible entities or providers must first exhaust 
such administrative procedures before seeking any judicial 
review under section 1346 of title 28 (known as the ‘Tuck-
er Act’). 
‘‘(4) Disputes under this section must pertain to ei-
ther the scope of authorization under the Veterans Care 
Agreement or claims for payment subject to the Veterans 
Care Agreement and are not claims for the purposes of 
such laws that would otherwise require application of sec-
tions 7101 through 7109 of title 41, United States Code. 
‘‘(i) APPLICABILITY
OF
OTHER
PROVISIONS
OF 
LAW.—(1) A Veterans Care Agreement may be authorized 
by the Secretary or any Department official authorized by 
the Secretary, and such action shall not be treated as— 
‘‘(A) an award for the purposes of such laws 
that would otherwise require the use of competitive 
procedures for the furnishing of care and services; or 
‘‘(B) a Federal contract for the acquisition of 
goods or services for purposes of any provision of 
Federal law governing Federal contracts for the ac-
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quisition of goods or services except section 4706(d) 
of title 41. 
‘‘(2)(A) Except as provided in the agreement itself, 
in subparagraph (B), and unless otherwise provided in this 
section or regulations prescribed pursuant to this section, 
an eligible entity or provider that enters into an agreement 
under this section is not subject to, in the carrying out 
of the agreement, any law to which providers of services 
and suppliers under the Medicare program under title 
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) 
are not subject. 
‘‘(B) An eligible entity or provider that enters into 
an agreement under this section is subject to— 
‘‘(i) all laws regarding integrity, ethics, or 
fraud, or that subject a person to civil or criminal 
penalties; and 
‘‘(ii) all laws that protect against employment 
discrimination or that otherwise ensure equal em-
ployment opportunities. 
‘‘(3) Notwithstanding paragraph (2)(B)(i), an eligible 
entity or provider that enters into an agreement under this 
section shall not be treated as a Federal contractor or sub-
contractor for purposes of chapter 67 of title 41 (com-
monly known as the ‘McNamara-O’Hara Service Contract 
Act of 1965’). 
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‘‘(j) PARITY OF TREATMENT.—Eligibility for hospital 
care, medical services, and extended care services fur-
nished to any veteran pursuant to a Veterans Care Agree-
ment shall be subject to the same terms as though pro-
vided in a facility of the Department, and provisions of 
this chapter applicable to veterans receiving such care and 
services in a facility of the Department shall apply to vet-
erans treated under this section. 
‘‘(k) RULEMAKING.—The Secretary shall promulgate 
regulations to carry out this section.’’. 
(b) CLERICAL AMENDMENT.—The table of sections 
at the beginning of such chapter is amended by inserting 
after the item related to section 1703 the following new 
item: 
‘‘1703A. Agreements with eligible entities or providers; certification processes.’’. 
SEC. 103. CONFORMING AMENDMENTS FOR STATE VET-
ERANS HOMES. 
(a) IN GENERAL.—Section 1745(a) is amended— 
(1) in paragraph (1), by striking ‘‘(or agree-
ment under section 1720(c)(1) of this title)’’ and in-
serting ‘‘(or an agreement)’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(4)(A) An agreement under this section may be au-
thorized by the Secretary or any Department official au-
thorized by the Secretary, and any such action is not an 
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award for purposes of such laws that would otherwise re-
quire the use of competitive procedures for the furnishing 
of hospital care, medical services, and extended care serv-
ices. 
‘‘(B)(i) Except as provided in the agreement itself, 
in clause (ii), and unless otherwise provided in this section 
or regulations prescribed pursuant to this section, a State 
home that enters into an agreement under this section is 
not subject to, in the carrying out of the agreement, any 
provision of law to which providers of services and sup-
pliers under the Medicare program under title XVIII of 
the Social Security Act (42 U.S.C. 1395 et seq.) are not 
subject. 
‘‘(ii) A State home that enters into an agreement 
under this section is subject to— 
‘‘(I) all provisions of law regarding integrity, 
ethics, or fraud, or that subject a person to civil or 
criminal penalties; 
‘‘(II) all provisions of law that protect against 
employment discrimination or that otherwise ensure 
equal employment opportunities; and 
‘‘(III) all provisions in subchapter V of chapter 
17 of this title. 
‘‘(iii) Notwithstanding subparagraph (B)(ii)(I), a 
State home that enters into an agreement under this sec-
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tion may not be treated as a Federal contractor or subcon-
tractor for purposes of chapter 67 of title 41 (known as 
the ‘McNamara-O’Hara Service Contract Act of 1965’).’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply to care provided on or after the 
effective date of regulations issued by the Secretary of 
Veterans Affairs to carry out this section. 
SEC. 104. ACCESS STANDARDS AND STANDARDS FOR QUAL-
ITY. 
(a) IN GENERAL.—Subchapter I of chapter 17, as 
amended by section 102, is further amended by inserting 
after section 1703A the following new sections: 
‘‘§ 1703B. Access standards 
‘‘(a)(1) The Secretary shall establish access stand-
ards for furnishing hospital care, medical services, or ex-
tended care services to covered veterans for the purposes 
of section 1703(d). 
‘‘(2) The Secretary shall ensure that the access 
standards established under paragraph (1) define such 
categories of care to cover all care and services within the 
medical benefits package of the Department of Veterans 
Affairs. 
‘‘(b) The Secretary shall ensure that the access 
standards provide covered veterans, employees of the De-
partment, and health care providers in the network estab-
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lished under section 1703(h) with relevant comparative in-
formation that is clear, useful, and timely, so that covered 
veterans can make informed decisions regarding their 
health care. 
‘‘(c) The Secretary shall consult with all pertinent 
Federal entities (including the Department of Defense, the 
Department of Health and Human Services, and the Cen-
ters for Medicare & Medicaid Services), entities in the pri-
vate sector, and other nongovernmental entities in estab-
lishing access standards. 
‘‘(d)(1) Not later than 270 days after the date of the 
enactment of the Caring for Our Veterans Act of 2018, 
the Secretary shall submit to the appropriate committees 
of Congress a report detailing the access standards. 
‘‘(2)(A) Before submitting the report required under 
paragraph (1), the Secretary shall provide periodic up-
dates to the appropriate committees of Congress to con-
firm the Department’s progress towards developing the ac-
cess standards required by this section. 
‘‘(B) The first update under subparagraph (A) shall 
occur no later than 120 days from the date of the enact-
ment of the Caring for Our Veterans Act of 2018. 
‘‘(3) Not later than 540 days after the date on which 
the Secretary implements the access standards established 
under subsection (a), the Secretary shall submit to the ap-
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propriate committees of Congress a report detailing the 
implementation of and compliance with such access stand-
ards by Department and non-Department entities or pro-
viders. 
‘‘(e) Not later than three years after the date on 
which the Secretary establishes access standards under 
subsection (a) and not less frequently than once every 
three years thereafter, the Secretary shall— 
‘‘(1) conduct a review of such standards; and 
‘‘(2) submit to the appropriate committees of 
Congress a report on the findings and any modifica-
tion to the access standards with respect to the re-
view conducted under paragraph (1). 
‘‘(f) The Secretary shall ensure health care providers 
specified under section 1703(c) are able to comply with 
the applicable access standards established by the Sec-
retary. 
‘‘(g) The Secretary shall publish in the Federal Reg-
ister and on an internet website of the Department the 
designated access standards established under this section 
for purposes of section 1703(d)(1)(D). 
‘‘(h)(1) Consistent with paragraphs (1)(D) and (3) 
of section 1703(d), covered veterans may contact the De-
partment at any time to request a determination regarding 
whether they are eligible to receive care and services from 
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‘‘§ 1703C. Standards for quality 
‘‘(a) IN GENERAL.—(1) The Secretary shall establish 
standards for quality regarding hospital care, medical 
services, and extended care services furnished by the De-
partment pursuant to this title, including through non-De-
partment health care providers pursuant to section 1703 
of this title. 
‘‘(2) In establishing standards for quality under para-
graph (1), the Secretary shall consider existing health 
quality measures that are applied to public and privately 
sponsored health care systems with the purpose of pro-
viding covered veterans relevant comparative information 
to make informed decisions regarding their health care. 
‘‘(3) The Secretary shall collect and consider data for 
purposes of establishing the standards under paragraph 
(1). Such data collection shall include— 
‘‘(A) after consultation with veterans service or-
ganizations and other key stakeholders on survey de-
velopment or modification of an existing survey, a 
survey of veterans who have used hospital care, med-
ical services, or extended care services furnished by 
the Veterans Health Administration during the most 
recent two-year period to assess the satisfaction of 
the veterans with service and quality of care; and 
‘‘(B) datasets that include, at a minimum, ele-
ments relating to the following: 
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‘‘(i) Timely care. 
‘‘(ii) Effective care. 
‘‘(iii) Safety, including, at a minimum, 
complications, readmissions, and deaths. 
‘‘(iv) Efficiency. 
‘‘(4) The Secretary shall consult with all pertinent 
Federal entities (including the Department of Defense, the 
Department of Health and Human Services, and the Cen-
ters for Medicare & Medicaid Services), entities in the pri-
vate sector, and other nongovernmental entities in estab-
lishing standards for quality. 
‘‘(5)(A) Not later than 270 days after the date of 
the enactment of the Caring for Our Veterans Act of 
2018, the Secretary shall submit to the appropriate com-
mittees of Congress a report detailing the standards for 
quality. 
‘‘(B)(i) Before submitting the report required under 
subparagraph (A), the Secretary shall provide periodic up-
dates to the appropriate committees of Congress to con-
firm the Department’s progress towards developing the 
standards for quality required by this section. 
‘‘(ii) The first update under clause (i) shall occur no 
later than 120 days from the date of the enactment of 
the Caring for Our Veterans Act of 2018. 
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‘‘(b) PUBLICATION AND CONSIDERATION OF PUBLIC 
COMMENTS.—(1) Not later than one year after the date 
on which the Secretary establishes standards for quality 
under subsection (a), the Secretary shall publish the qual-
ity rating of medical facilities of the Department in the 
publicly available Hospital Compare website through the 
Centers for Medicare & Medicaid Services for the purpose 
of providing veterans with information that allows them 
to compare performance measure information among De-
partment and non-Department health care providers. 
‘‘(2) Not later than two years after the date on which 
the Secretary establishes standards for quality under sub-
section (a), the Secretary shall consider and solicit public 
comment on potential changes to the measures used in 
such standards to ensure that they include the most up- 
to-date and applicable industry measures for veterans. 
‘‘(c)(1) The term ‘appropriate committees of Con-
gress’ means— 
‘‘(A) the Committee on Veterans’ Affairs and 
the Committee on Appropriations of the Senate; and 
‘‘(B) the Committee on Veterans’ Affairs and 
the Committee on Appropriations of the House of 
Representatives. 
‘‘(2) The term ‘covered veterans’ refers to veterans 
described in section 1703(b) of this title.’’. 
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(b) CLERICAL AMENDMENT.—The table of sections 
at the beginning of chapter 17, as amended by section 
102, is further amended by inserting after the item relat-
ing to section 1703A the following new items: 
‘‘1703B. Access standards. 
‘‘1703C. Standards for quality.’’. 
SEC. 105. ACCESS TO WALK-IN CARE. 
(a) IN GENERAL.—Chapter 17 is amended by insert-
ing after section 1725 the following new section: 
‘‘§ 1725A. Access to walk-in care 
‘‘(a) PROCEDURES TO ENSURE ACCESS TO WALK- 
IN CARE.—The Secretary shall develop procedures to en-
sure that eligible veterans are able to access walk-in care 
from qualifying non-Department entities or providers. 
‘‘(b) ELIGIBLE VETERANS.—For purposes of this 
section, an eligible veteran is any individual who— 
‘‘(1) is enrolled in the health care system estab-
lished under section 1705(a) of this title; and 
‘‘(2) has received care under this chapter within 
the 24-month period preceding the furnishing of 
walk-in care under this section. 
‘‘(c) QUALIFYING NON-DEPARTMENT ENTITIES OR 
PROVIDERS.—For purposes of this section, a qualifying 
non-Department entity or provider is a non-Department 
entity or provider that has entered into a contract or other 
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agreement with the Secretary to furnish services under 
this section. 
‘‘(d) FEDERALLY-QUALIFIED HEALTH CENTERS.— 
Whenever practicable, the Secretary may use a Federally- 
qualified health center (as defined in section 1905(l)(2)(B) 
of the Social Security Act (42 U.S.C. 1396d(l)(2)(B))) to 
carry out this section. 
‘‘(e) CONTINUITY OF CARE.—The Secretary shall en-
sure continuity of care for those eligible veterans who re-
ceive walk-in care services under this section, including 
through the establishment of a mechanism to receive med-
ical records from walk-in care providers and provide perti-
nent patient medical records to providers of walk-in care. 
‘‘(f) COPAYMENTS.—(1)(A) The Secretary may re-
quire an eligible veteran to pay the United States a copay-
ment for each episode of hospital care or medical services 
provided under this section if the eligible veteran would 
be required to pay a copayment under this title. 
‘‘(B) An eligible veteran not required to pay a copay-
ment under this title may access walk-in care without a 
copayment for the first two visits in a calendar year. For 
any additional visits, a copayment at an amount deter-
mined by the Secretary may be required. 
‘‘(C) An eligible veteran required to pay a copayment 
under this title may be required to pay a regular copay-
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ment for the first two walk-in care visits in a calendar 
year. For any additional visits, a higher copayment at an 
amount determined by the Secretary may be required. 
‘‘(2) After the first two episodes of care furnished 
to an eligible veteran under this section, the Secretary may 
adjust the copayment required of the veteran under this 
subsection based upon the priority group of enrollment of 
the eligible veteran, the number of episodes of care fur-
nished to the eligible veteran during a year, and other fac-
tors the Secretary considers appropriate under this sec-
tion. 
‘‘(3) The amount or amounts of the copayments re-
quired under this subsection shall be prescribed by the 
Secretary by rule. 
‘‘(4) Section 8153(c) of this title shall not apply to 
this subsection. 
‘‘(g) REGULATIONS.—Not later than one year after 
the date of the enactment of the Caring for Our Veterans 
Act of 2018, the Secretary shall promulgate regulations 
to carry out this section. 
‘‘(h) WALK-IN CARE DEFINED.—In this section, the 
term ‘walk-in care’ means non-emergent care provided by 
a qualifying non-Department entity or provider that fur-
nishes episodic care and not longitudinal management of 
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conditions and is otherwise defined through regulations 
the Secretary shall promulgate.’’. 
(b) EFFECTIVE DATE.—Section 1725A of title 38, 
United States Code, as added by subsection (a) shall take 
effect on the date upon which final regulations imple-
menting such section take effect. 
(c) CLERICAL AMENDMENT.—The table of sections 
at the beginning of such chapter is amended by inserting 
after the item related to section 1725 the following new 
item: 
‘‘§1725A. Access to walk-in care.’’. 
SEC. 106. STRATEGY REGARDING THE DEPARTMENT OF 
VETERANS AFFAIRS HIGH-PERFORMING IN-
TEGRATED HEALTH CARE NETWORK. 
(a) IN GENERAL.—Subchapter II of chapter 73 is 
amended by inserting after section 7330B the following 
new section: 
‘‘§ 7330C. Quadrennial Veterans Health Administra-
tion review 
‘‘(a) MARKET AREA ASSESSMENTS.—(1) Not less 
frequently than every four years, the Secretary of Vet-
erans Affairs shall perform market area assessments re-
garding the health care services furnished under the laws 
administered by the Secretary. 
‘‘(2) Each market area assessment established under 
paragraph (1) shall include the following: 
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‘‘(A) An assessment of the demand for health 
care from the Department, disaggregated by geo-
graphic market areas as determined by the Sec-
retary, including the number of requests for health 
care services under the laws administered by the 
Secretary. 
‘‘(B) An inventory of the health care capacity 
of the Department of Veterans Affairs across the 
Department’s system of facilities. 
‘‘(C) An assessment of the health care capacity 
to be provided through contracted community care 
providers and providers who entered into a provider 
agreement with the Department under section 
1703A of title 38, as added by section 102, includ-
ing the number of providers, the geographic location 
of the providers, and categories or types of health 
care services provided by the providers. 
‘‘(D) An assessment obtained from other Fed-
eral direct delivery systems of their capacity to pro-
vide health care to veterans. 
‘‘(E) An assessment of the health care capacity 
of non-contracted providers where there is insuffi-
cient network supply. 
‘‘(F) An assessment of the health care capacity 
of academic affiliates and other collaborations of the 
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Department as it relates to providing health care to 
veterans. 
‘‘(G) An assessment of the effects on health 
care capacity of the access standards and standards 
for quality established under sections 1703B and 
1703C of this title. 
‘‘(H) The number of appointments for health 
care services under the laws administered by the 
Secretary, disaggregated by— 
‘‘(i) appointments at facilities of the De-
partment of Veterans Affairs; and 
‘‘(ii) appointments with non-Department 
health care providers. 
‘‘(3)(A) The Secretary shall submit to the appro-
priate committees of Congress the market area assess-
ments established in paragraph (1). 
‘‘(B) The Secretary also shall submit to the appro-
priate committees of Congress the market area assess-
ments completed by or being performed on the day before 
the date of the enactment of the Caring for Our Veterans 
Act of 2018. 
‘‘(4)(A) The Secretary shall use the market area as-
sessments established under paragraph (1) to— 
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‘‘(i) determine the capacity of the health care 
provider networks established under section 1703(h) 
of this title; 
‘‘(ii) inform the Department budget, in accord-
ance with subparagraph (B); and 
‘‘(iii) inform and assess the appropriateness of 
the access standards established under section 
1703B of this title and standards for quality under 
section 1703C and to make recommendations for 
any changes to such standards. 
‘‘(B) The Secretary shall ensure that the Department 
budget for any fiscal year (as submitted with the budget 
of the President under section 1105(a) of title 31) reflects 
the findings of the Secretary with respect to the most re-
cent market area assessments under paragraph (1) and 
health care utilization data from the Department and non- 
Department entities or providers furnishing care and serv-
ices to covered veterans as described in section 1703(b). 
‘‘(b) STRATEGIC PLAN TO MEET HEALTH CARE DE-
MAND.—(1) Not later than one year after the date of the 
enactment of the Caring for Our Veterans Act of 2018 
and not less frequently than once every four years there-
after, the Secretary shall submit to the appropriate com-
mittees of Congress a strategic plan that specifies a four- 
year forecast of— 
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‘‘(A) the demand for health care from the De-
partment, disaggregated by geographic area as de-
termined by the Secretary; 
‘‘(B) the health care capacity to be provided at 
each medical center of the Department; and 
‘‘(C) the health care capacity to be provided 
through community care providers. 
‘‘(2) In preparing the strategic plan under paragraph 
(1), the Secretary shall— 
‘‘(A) assess the access standards and standards 
for quality established under sections 1703B and 
1703C of this title; 
‘‘(B) assess the market area assessments estab-
lished under subsection (a); 
‘‘(C) assess the needs of the Department based 
on identified services that provide management of 
conditions or disorders related to military service for 
which there is limited experience or access in the na-
tional market, the overall health of veterans 
throughout their lifespan, or other services as the 
Secretary determines appropriate; 
‘‘(D) consult with key stakeholders within the 
Department, the heads of other Federal agencies, 
and other relevant governmental and nongovern-
mental entities, including State, local, and tribal 
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government officials, members of Congress, veterans 
service organizations, private sector representatives, 
academics, and other policy experts; 
‘‘(E) identify emerging issues, trends, problems, 
and opportunities that could affect health care serv-
ices furnished under the laws administered by the 
Secretary; 
‘‘(F) develop recommendations regarding both 
short- and long-term priorities for health care serv-
ices furnished under the laws administered by the 
Secretary; 
‘‘(G) after consultation with veterans service or-
ganizations and other key stakeholders on survey de-
velopment or modification of an existing survey, con-
sider a survey of veterans who have used hospital 
care, medical services, or extended care services fur-
nished by the Veterans Health Administration dur-
ing the most recent two-year period to assess the 
satisfaction of the veterans with service and quality 
of care; 
‘‘(H) conduct a comprehensive examination of 
programs and policies of the Department regarding 
the delivery of health care services and the demand 
of health care services for veterans in future years; 
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‘‘(I) assess the remediation of medical service 
lines of the Department as described in section 
1706A in conjunction with the utilization of non-De-
partment entities or providers to offset remediation; 
and 
‘‘(J) consider such other matters as the Sec-
retary considers appropriate. 
‘‘(c) RESPONSIBILITIES.—The Secretary shall be re-
sponsible for— 
‘‘(1) overseeing the transformation and organi-
zational change across the Department to achieve 
such high performing integrated health care net-
work; 
‘‘(2) developing the capital infrastructure plan-
ning and procurement processes, whether minor or 
major construction projects or leases; and 
‘‘(3) developing a multi-year budget process 
that is capable of forecasting future year budget re-
quirements and projecting the cost of delivering 
health care services under a high-performing inte-
grated health care network. 
‘‘(d) APPROPRIATE COMMITTEES OF CONGRESS DE-
FINED.—In this section, the term ‘appropriate committees 
of Congress’ means— 
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‘‘(1) the Committee on Veterans’ Affairs and 
the Committee on Appropriations of the Senate; and 
‘‘(2) the Committee on Veterans’ Affairs and 
the Committee on Appropriations of the House of 
Representatives.’’. 
(b) CLERICAL AMENDMENT.—The table of sections 
at the beginning of such chapter is amended by inserting 
after the item related to section 7330B the following new 
item: 
‘‘7330C. Quadrennial Veterans Health Administration review.’’. 
SEC. 107. APPLICABILITY OF DIRECTIVE OF OFFICE OF 
FEDERAL 
CONTRACT 
COMPLIANCE 
PRO-
GRAMS. 
(a) IN GENERAL.—Notwithstanding the treatment of 
certain laws under subsection (i) of section 1703A of title 
38, United States Code, as added by section 102 of this 
title, Directive 2014–01 of the Office of Federal Contract 
Compliance Programs of the Department of Labor (effec-
tive as of May 7, 2014) shall apply to any entity entering 
into an agreement under such section 1703A or section 
1745 of such title, as amended by section 103, in the same 
manner as such directive applies to subcontractors under 
the TRICARE program for the duration of the morato-
rium provided under such directive. 
(b) APPLICABILITY PERIOD.—The directive described 
in subsection (a), and the moratorium provided under such 
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directive, shall not be altered or rescinded before May 7, 
2019. 
(c) TRICARE PROGRAM DEFINED.—In this section, 
the term ‘‘TRICARE program’’ has the meaning given 
that term in section 1072 of title 10, United States Code. 
SEC. 108. PREVENTION OF CERTAIN HEALTH CARE PRO-
VIDERS FROM PROVIDING NON-DEPARTMENT 
HEALTH CARE SERVICES TO VETERANS. 
(a) IN GENERAL.—On and after the date that is one 
year after the date of the enactment of this Act, the Sec-
retary of Veterans Affairs shall deny or revoke the eligi-
bility of a health care provider to provide non-Department 
health care services to veterans if the Secretary determines 
that the health care provider— 
(1) was removed from employment with the De-
partment of Veterans Affairs due to conduct that 
violated a policy of the Department relating to the 
delivery of safe and appropriate health care; or 
(2) violated the requirements of a medical li-
cense of the health care provider that resulted in the 
loss of such medical license. 
(b) PERMISSIVE ACTION.—On and after the date that 
is one year after the date of the enactment of this Act, 
the Secretary may deny, revoke, or suspend the eligibility 
of a health care provider to provide non-Department 
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health care services if the Secretary determines such ac-
tion is necessary to immediately protect the health, safety, 
or welfare of veterans and the health care provider is 
under investigation by the medical licensing board of a 
State in which the health care provider is licensed or prac-
tices. 
(c) SUSPENSION.—The Secretary shall suspend the 
eligibility of a health care provider to provide non-Depart-
ment health care services to veterans if the health care 
provider is suspended from serving as a health care pro-
vider of the Department. 
(d) COMPTROLLER GENERAL REPORT.—Not later 
than two years after the date of the enactment of this Act, 
the Comptroller General of the United States shall submit 
to Congress a report on the implementation by the Sec-
retary of this section, including the following: 
(1) The aggregate number of health care pro-
viders denied or suspended under this section from 
participation in providing non-Department health 
care services. 
(2) An evaluation of any impact on access to 
health care for patients or staffing shortages in pro-
grams of the Department providing non-Department 
health care services. 
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(3) An explanation of the coordination of the 
Department with the medical licensing boards of 
States in implementing this section, the amount of 
involvement of such boards in such implementation, 
and efforts by the Department to address any con-
cerns raised by such boards with respect to such im-
plementation. 
(4) Such recommendations as the Comptroller 
General considers appropriate regarding harmo-
nizing eligibility criteria between health care pro-
viders of the Department and health care providers 
eligible to provide non-Department health care serv-
ices. 
(e) NON-DEPARTMENT HEALTH CARE SERVICES 
DEFINED.—In this section, the term ‘‘non-Department 
health care services’’ means services— 
(1) provided under subchapter I of chapter 17 
of title 38, United States Code, at non-Department 
facilities (as defined in section 1701 of such title); 
(2) provided under section 101 of the Veterans 
Access, Choice, and Accountability Act of 2014 
(Public Law 113–146; 38 U.S.C. 1701 note); 
(3) purchased through the Medical Community 
Care account of the Department; or 
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(4) purchased with amounts deposited in the 
Veterans Choice Fund under section 802 of the Vet-
erans Access, Choice, and Accountability Act of 
2014. 
SEC. 109. REMEDIATION OF MEDICAL SERVICE LINES. 
(a) IN GENERAL.—Subchapter I of chapter 17 is 
amended by inserting after section 1706 the following new 
section: 
‘‘§ 1706A. Remediation of medical service lines 
‘‘(a) IN GENERAL.—Not later than 30 days after de-
termining under section 1703(e)(1) that a medical service 
line of the Department is providing hospital care, medical 
services, or extended care services that does not comply 
with the standards for quality established by the Sec-
retary, the Secretary shall submit to Congress an assess-
ment of the factors that led the Secretary to make such 
determination and a plan with specific actions, and the 
time to complete them, to be taken to comply with such 
standards for quality, including the following: 
‘‘(1) Increasing personnel or temporary per-
sonnel assistance, including mobile deployment 
teams. 
‘‘(2) Special hiring incentives, including the 
Education Debt Reduction Program under sub-
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chapter VII of chapter 76 of this title and recruit-
ment, relocation, and retention incentives. 
‘‘(3) Utilizing direct hiring authority. 
‘‘(4) Providing improved training opportunities 
for staff. 
‘‘(5) Acquiring improved equipment. 
‘‘(6) Making structural modifications to the fa-
cility used by the medical service line. 
‘‘(7) Such other actions as the Secretary con-
siders appropriate. 
‘‘(b) RESPONSIBLE PARTIES.—In each assessment 
submitted under subsection (a) with respect to a medical 
service line, the Secretary shall identify the individuals at 
the Central Office of the Veterans Health Administration, 
the facility used by the medical service line, and the cen-
tral office of the relevant Veterans Integrated Service Net-
work who are responsible for overseeing the progress of 
that medical service line in complying with the standards 
for quality established by the Secretary. 
‘‘(c) INTERIM REPORTS.—Not later than 180 days 
after submitting an assessment under subsection (a) with 
respect to a medical service line, the Secretary shall sub-
mit to Congress a report on the progress of that medical 
service line in complying with the standards for quality 
established by the Secretary and any other measures the 
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Secretary will take to assist the medical service line in 
complying with such standards for quality. 
‘‘(d) ANNUAL REPORTS.—Not less frequently than 
once each year, the Secretary shall— 
‘‘(1) submit to Congress an analysis of the re-
mediation actions and costs of such actions taken 
with respect to each medical service line with respect 
to which the Secretary submitted an assessment and 
plan under paragraph (1) in the preceding year, in-
cluding an update on the progress of each such med-
ical service line in complying with the standards for 
quality and timeliness established by the Secretary 
and any other actions the Secretary is undertaking 
to assist the medical service line in complying with 
standards for quality as established by the Sec-
retary; and 
‘‘(2) publish such analysis on the internet 
website of the Department.’’. 
(b) CLERICAL AMENDMENT.—The table of sections 
at the beginning of such chapter is amended by inserting 
after the item related to section 1706 the following new 
item: 
‘‘1706A. Remediation of medical service lines.’’. 
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CHAPTER 2—PAYING PROVIDERS AND 
IMPROVING COLLECTIONS 
SEC. 111. PROMPT PAYMENT TO PROVIDERS. 
(a) IN GENERAL.—Subchapter I of chapter 17 is 
amended by inserting after section 1703C, as added by 
section 104 of this title, the following new section: 
‘‘§ 1703D. Prompt payment standard 
‘‘(a) IN GENERAL.—(1) Notwithstanding any other 
provision of this title or of any other provision of law, the 
Secretary shall pay for hospital care, medical services, or 
extended care services furnished by health care entities or 
providers under this chapter within 45 calendar days upon 
receipt of a clean paper claim or 30 calendar days upon 
receipt of a clean electronic claim. 
‘‘(2) If a claim is denied, the Secretary shall, within 
45 calendar days of denial for a paper claim and 30 cal-
endar days of denial for an electronic claim, notify the 
health care entity or provider of the reason for denying 
the claim and what, if any, additional information is re-
quired to process the claim. 
‘‘(3) Upon the receipt of the additional information, 
the Secretary shall ensure that the claim is paid, denied, 
or otherwise adjudicated within 30 calendar days from the 
receipt of the requested information. 
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‘‘(4) This section shall only apply to payments made 
on an invoice basis and shall not apply to capitation or 
other forms of periodic payment to entities or providers. 
‘‘(b) SUBMITTAL OF CLAIMS BY HEALTH CARE EN-
TITIES AND PROVIDERS.—A health care entity or provider 
that furnishes hospital care, a medical service, or an ex-
tended care service under this chapter shall submit to the 
Secretary a claim for payment for furnishing the hospital 
care, medical service, or extended care service not later 
than 180 days after the date on which the entity or pro-
vider furnished the hospital care, medical service, or ex-
tended care service. 
‘‘(c) FRAUDULENT
CLAIMS.—(1) Sections 3729 
through 3733 of title 31 shall apply to fraudulent claims 
for payment submitted to the Secretary by a health care 
entity or provider under this chapter. 
‘‘(2) Pursuant to regulations prescribed by the Sec-
retary, the Secretary shall bar a health care entity or pro-
vider from furnishing hospital care, medical services, and 
extended care services under this chapter when the Sec-
retary determines the entity or provider has submitted to 
the Secretary fraudulent health care claims for payment 
by the Secretary. 
‘‘(d) OVERDUE CLAIMS.—(1) Any claim that has not 
been denied with notice, made pending with notice, or paid 
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to the health care entity or provider by the Secretary shall 
be overdue if the notice or payment is not received by the 
entity provider within the time periods specified in sub-
section (a). 
‘‘(2)(A) If a claim is overdue under this subsection, 
the Secretary may, under the requirements established by 
subsection (a) and consistent with the provisions of chap-
ter 39 of title 31 (commonly referred to as the ‘Prompt 
Payment Act’), require that interest be paid on clean 
claims. 
‘‘(B) Interest paid under subparagraph (A) shall be 
computed at the rate of interest established by the Sec-
retary of the Treasury under section 3902 of title 31 and 
published in the Federal Register. 
‘‘(3) Not less frequently than annually, the Secretary 
shall submit to Congress a report on payment of overdue 
claims under this subsection, disaggregated by paper and 
electronic claims, that includes the following: 
‘‘(A) The amount paid in overdue claims de-
scribed in this subsection, disaggregated by the 
amount of the overdue claim and the amount of in-
terest paid on such overdue claim. 
‘‘(B) The number of such overdue claims and 
the average number of days late each claim was 
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paid, disaggregated by facility of the Department 
and Veterans Integrated Service Network region. 
‘‘(e) OVERPAYMENT.—(1) The Secretary shall deduct 
the amount of any overpayment from payments due a 
health care entity or provider under this chapter. 
‘‘(2) Deductions may not be made under this sub-
section unless the Secretary has made reasonable efforts 
to notify a health care entity or provider of the right to 
dispute the existence or amount of such indebtedness and 
the right to request a compromise of such indebtedness. 
‘‘(3) The Secretary shall make a determination with 
respect to any such dispute or request prior to deducting 
any overpayment unless the time required to make such 
a determination before making any deductions would jeop-
ardize the Secretary’s ability to recover the full amount 
of such indebtedness. 
‘‘(f) INFORMATION
AND
DOCUMENTATION
RE-
QUIRED.—(1) The Secretary shall provide to all health 
care entities and providers participating in a program to 
furnish hospital care, medical services, or extended care 
services under this chapter a list of information and docu-
mentation that is required to establish a clean claim under 
this section. 
‘‘(2) The Secretary shall consult with entities in the 
health care industry, in the public and private sector, to 
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determine the information and documentation to include 
in the list under paragraph (1). 
‘‘(3) If the Secretary modifies the information and 
documentation included in the list under paragraph (1), 
the Secretary shall notify all health care entities and pro-
viders described in paragraph (1) not later than 30 days 
before such modifications take effect. 
‘‘(g) PROCESSING OF CLAIMS.—(1) In processing a 
claim for compensation for hospital care, medical services, 
or extended care services furnished by a non-Department 
health care entity or provider under this chapter, the Sec-
retary may act through— 
‘‘(A) a non-Department entity that is under 
contract or agreement for the program established 
under section 1703(a) of this title; or 
‘‘(B) a non-Department entity that specializes 
in such processing for other Federal agency health 
care systems. 
‘‘(2) The Secretary shall seek to contract with a third 
party to conduct a review of claims described in paragraph 
(3) that includes— 
‘‘(A) a feasibility assessment to determine the 
capacity of the Department to process such claims 
in a timely manner; and 
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‘‘(B) a cost benefit analysis comparing the ca-
pacity of the Department to a third party entity ca-
pable of processing such claims. 
‘‘(3) The review required under paragraph (2) shall 
apply to claims for hospital care, medical services, or ex-
tended care services furnished under section 1703 of this 
Act, as amended by the Caring for Our Veterans Act of 
2018, that are processed by the Department. 
‘‘(h) REPORT ON ENCOUNTER DATA SYSTEM.—(1) 
Not later than 90 days after the date of the enactment 
of the Caring for Our Veterans Act of 2018, the Secretary 
shall submit to the appropriate committees of Congress 
a report on the feasibility and advisability of adopting a 
funding mechanism similar to what is utilized by other 
Federal agencies to allow a contracted entity to act as a 
fiscal intermediary for the Federal Government to dis-
tribute, or pass through, Federal Government funds for 
certain non-underwritten hospital care, medical services, 
or extended care services. 
‘‘(2) The Secretary may coordinate with the Depart-
ment of Defense, the Department of Health and Human 
Services, and the Department of the Treasury in devel-
oping the report required by paragraph (1). 
‘‘(i) DEFINITIONS.—In this section: 
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‘‘(1) The term ‘appropriate committees of Con-
gress’ means— 
‘‘(A) the Committee on Veterans’ Affairs 
and the Committee on Appropriations of the 
Senate; and 
‘‘(B) the Committee on Veterans’ Affairs 
and the Committee on Appropriations of the 
House of Representatives. 
‘‘(2) The term ‘clean electronic claim’ means 
the transmission of data for purposes of payment of 
covered health care expenses that is submitted to the 
Secretary which contains substantially all of the re-
quired data elements necessary for accurate adju-
dication, without obtaining additional information 
from the entity or provider that furnished the care 
or service, submitted in such format as prescribed by 
the Secretary in regulations for the purpose of pay-
ing claims for care or services. 
‘‘(3) The term ‘clean paper claim’ means a 
paper claim for payment of covered health care ex-
penses that is submitted to the Secretary which con-
tains substantially all of the required data elements 
necessary for accurate adjudication, without obtain-
ing additional information from the entity or pro-
vider that furnished the care or service, submitted in 
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such format as prescribed by the Secretary in regu-
lations for the purpose of paying claims for care or 
services. 
‘‘(4) The term ‘fraudulent claims’ means the 
knowing misrepresentation of a material fact or 
facts by a health care entity or provider made to in-
duce the Secretary to pay a claim that was not le-
gally payable to that provider. 
‘‘(5) The term ‘health care entity or provider’ 
includes any non-Department health care entity or 
provider, but does not include any Federal health 
care entity or provider.’’. 
(b) CLERICAL AMENDMENT.—The table of sections 
at the beginning of such chapter is amended by inserting 
after the item related to section 1703C, as added by sec-
tion 104 of this title, the following new item: 
‘‘1703D. Prompt payment standard.’’. 
SEC. 112. AUTHORITY TO PAY FOR AUTHORIZED CARE NOT 
SUBJECT TO AN AGREEMENT. 
(a) IN GENERAL.—Subchapter IV of chapter 81 is 
amended by adding at the end the following new section: 
‘‘§ 8159. Authority to pay for services authorized but 
not subject to an agreement 
‘‘(a) IN GENERAL.—If, in the course of furnishing 
hospital care, a medical service, or an extended care serv-
ice authorized by the Secretary and pursuant to a con-
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tract, agreement, or other arrangement with the Sec-
retary, a provider who is not a party to the contract, 
agreement, or other arrangement furnishes hospital care, 
a medical service, or an extended care service that the Sec-
retary considers necessary, the Secretary may compensate 
the provider for the cost of such care or service. 
‘‘(b) NEW CONTRACTS
AND AGREEMENTS.—The 
Secretary shall take reasonable efforts to enter into a con-
tract, agreement, or other arrangement with a provider 
described in subsection (a) to ensure that future care and 
services authorized by the Secretary and furnished by the 
provider are subject to such a contract, agreement, or 
other arrangement.’’. 
(b) CLERICAL AMENDMENT.—The table of sections 
at the beginning of such chapter is amended by inserting 
after the item relating to section 8158 the following new 
item: 
‘‘8159. Authority to pay for services authorized but not subject to an agree-
ment.’’. 
SEC. 113. IMPROVEMENT OF AUTHORITY TO RECOVER THE 
COST OF SERVICES FURNISHED FOR NON- 
SERVICE-CONNECTED DISABILITIES. 
(a) BROADENING SCOPE OF APPLICABILITY.—Sec-
tion 1729 is amended— 
(1) in subsection (a)— 
(A) in paragraph (2)(A)— 
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(i) by striking ‘‘the veteran’s’’ and in-
serting ‘‘the individual’s’’; and 
(ii) by striking ‘‘the veteran’’ and in-
serting ‘‘the individual’’; and 
(B) in paragraph (3)— 
(i) in the matter preceding subpara-
graph (A), by striking ‘‘the veteran’’ and 
inserting ‘‘the individual’’; and 
(ii) in subparagraph (A), by striking 
‘‘the veteran’s’’ and inserting ‘‘the individ-
ual’s’’; 
(2) in subsection (b)— 
(A) in paragraph (1)— 
(i) by striking ‘‘the veteran’’ and in-
serting ‘‘the individual’’; and 
(ii) by striking ‘‘the veteran’s’’ and in-
serting ‘‘the individual’s’’; and 
(B) in paragraph (2)— 
(i) in subparagraph (A)— 
(I) by striking ‘‘the veteran’’ and 
inserting ‘‘the individual’’; and 
(II) by striking ‘‘the veteran’s’’ 
and inserting ‘‘the individual’s’’; and 
(ii) in subparagraph (B)— 
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(I) in clause (i), by striking ‘‘the 
veteran’’ and inserting ‘‘the indi-
vidual’’; and 
(II) in clause (ii)— 
(aa) by striking ‘‘the vet-
eran’’ and inserting ‘‘the indi-
vidual’’; and 
(bb) by striking ‘‘the vet-
eran’s’’ each place it appears and 
inserting ‘‘the individual’s’’; 
(3) in subsection (e), by striking ‘‘A veteran’’ 
and inserting ‘‘An individual’’; and 
(4) in subsection (h)— 
(A) in paragraph (1)— 
(i) in the matter preceding subpara-
graph (A), by striking ‘‘a veteran’’ and in-
serting ‘‘an individual’’; 
(ii) in subparagraph (A), by striking 
‘‘the veteran’’ and inserting ‘‘the indi-
vidual’’; and 
(iii) in subparagraph (B), by striking 
‘‘the veteran’’ and inserting ‘‘the indi-
vidual’’; and 
(B) in paragraph (2)— 
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(i) by striking ‘‘A veteran’’ and insert-
ing ‘‘An individual’’; 
(ii) by striking ‘‘a veteran’’ and in-
serting ‘‘an individual’’; and 
(iii) by striking ‘‘the veteran’’ and in-
serting ‘‘the individual’’. 
(b) MODIFICATION
OF
AUTHORITY.—Subsection 
(a)(1) of such section is amended by striking ‘‘(1) Sub-
ject’’ and all that follows through the period and inserting 
the following: ‘‘(1) Subject to the provisions of this sec-
tion, in any case in which the United States is required 
by law to furnish or pay for care or services under this 
chapter for a non-service-connected disability described in 
paragraph (2) of this subsection, the United States has 
the right to recover or collect from a third party the rea-
sonable charges of care or services so furnished or paid 
for to the extent that the recipient or provider of the care 
or services would be eligible to receive payment for such 
care or services from such third party if the care or serv-
ices had not been furnished or paid for by a department 
or agency of the United States.’’ 
(c) MODIFICATION
OF ELIGIBLE INDIVIDUALS.— 
Subparagraph (D) of subsection (a)(2) of such section is 
amended to read as follows: 
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‘‘(D) that is incurred by an individual who is 
entitled to care (or payment of the expenses of care) 
under a health-plan contract.’’. 
SEC. 114. PROCESSING OF CLAIMS FOR REIMBURSEMENT 
THROUGH ELECTRONIC INTERFACE. 
The Secretary of Veterans Affairs may enter into an 
agreement with a third-party entity to process, through 
the use of an electronic interface, claims for reimburse-
ment for health care provided under the laws administered 
by the Secretary. 
CHAPTER 3—EDUCATION AND TRAINING 
PROGRAMS 
SEC. 121. EDUCATION PROGRAM ON HEALTH CARE OP-
TIONS. 
(a) IN GENERAL.—The Secretary of Veterans Affairs 
shall develop and administer an education program that 
teaches veterans about their health care options through 
the Department of Veterans Affairs. 
(b) ELEMENTS.—The program under subsection (a) 
shall— 
(1) teach veterans about— 
(A) eligibility criteria for care from the De-
partment set forth under sections 1703, as 
amended by section 101 of this title, and 1710 
of title 38, United States Code; 
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(B) priority groups for enrollment in the 
system of annual patient enrollment under sec-
tion 1705(a) of such title; 
(C) the copayments and other financial ob-
ligations, if any, required of certain individuals 
for certain services; and 
(D) how to utilize the access standards 
and standards for quality established under sec-
tions 1703B and 1703C of such title; 
(2) teach veterans about the interaction be-
tween health insurance (including private insurance, 
Medicare, Medicaid, the TRICARE program, the In-
dian Health Service, tribal health programs, and 
other forms of insurance) and health care from the 
Department; and 
(3) provide veterans with information on what 
to do when they have a complaint about health care 
received from the Department (whether about the 
provider, the Department, or any other type of com-
plaint). 
(c) ACCESSIBILITY.—In developing the education 
program under this section, the Secretary shall ensure 
that materials under such program are accessible— 
(1) to veterans who may not have access to the 
internet; and 
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(2) to veterans in a manner that complies with 
the Americans with Disabilities Act of 1990 (42 
U.S.C. 12101 et seq.). 
(d) ANNUAL EVALUATION AND REPORT.— 
(1) EVALUATION.—The Secretary shall develop 
a method to evaluate the effectiveness of the edu-
cation program under this section and evaluate the 
program using the method not less frequently than 
once each year. 
(2) REPORT.—Not less frequently than once 
each year, the Secretary shall submit to Congress a 
report on the findings of the Secretary with respect 
to the most recent evaluation conducted by the Sec-
retary under paragraph (1). 
(e) DEFINITIONS.—In this section: 
(1) MEDICAID.—The term ‘‘Medicaid’’ means 
the Medicaid program under title XIX of the Social 
Security Act (42 U.S.C. 1396 et seq.). 
(2) MEDICARE.—The term ‘‘Medicare’’ means 
the Medicare program under title XVIII of such Act 
(42 U.S.C. 1395 et seq.). 
(3) TRICARE PROGRAM.—The term ‘‘TRICARE 
program’’ has the meaning given that term in sec-
tion 1072 of title 10, United States Code. 
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SEC. 122. TRAINING PROGRAM FOR ADMINISTRATION OF 
NON-DEPARTMENT OF VETERANS AFFAIRS 
HEALTH CARE. 
(a) ESTABLISHMENT OF PROGRAM.—The Secretary 
of Veterans Affairs shall develop and implement a training 
program to train employees and contractors of the Depart-
ment of Veterans Affairs on how to administer non-De-
partment health care programs, including the following: 
(1) Reimbursement for non-Department emer-
gency room care. 
(2) The Veterans Community Care Program 
under section 1703 of such title, as amended by sec-
tion 101. 
(3) Management of prescriptions pursuant to 
improvements under section 131. 
(b) ANNUAL EVALUATION AND REPORT.—The Sec-
retary shall— 
(1) develop a method to evaluate the effective-
ness of the training program developed and imple-
mented under subsection (a); 
(2) evaluate such program not less frequently 
than once each year; and 
(3) not less frequently than once each year, 
submit to Congress the findings of the Secretary 
with respect to the most recent evaluation carried 
out under paragraph (2). 
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SEC. 123. CONTINUING MEDICAL EDUCATION FOR NON-DE-
PARTMENT MEDICAL PROFESSIONALS. 
(a) ESTABLISHMENT OF PROGRAM.— 
(1) IN GENERAL.—The Secretary of Veterans 
Affairs shall establish a program to provide con-
tinuing medical education material to non-Depart-
ment medical professionals. 
(2) EDUCATION PROVIDED.—The program es-
tablished under paragraph (1) shall include edu-
cation on the following: 
(A) Identifying and treating common men-
tal and physical conditions of veterans and fam-
ily members of veterans. 
(B) The health care system of the Depart-
ment of Veterans Affairs. 
(C) Such other matters as the Secretary 
considers appropriate. 
(b) MATERIAL PROVIDED.—The continuing medical 
education material provided to non-Department medical 
professionals under the program established under sub-
section (a) shall be the same material provided to medical 
professionals of the Department to ensure that all medical 
professionals treating veterans have access to the same 
materials, which supports core competencies throughout 
the community. 
(c) ADMINISTRATION OF PROGRAM.— 
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(1) IN GENERAL.—The Secretary shall admin-
ister the program established under subsection (a) to 
participating non-Department medical professionals 
through an internet website of the Department of 
Veterans Affairs. 
(2) CURRICULUM AND CREDIT PROVIDED.—The 
Secretary shall determine the curriculum of the pro-
gram and the number of hours of credit to provide 
to participating non-Department medical profes-
sionals for continuing medical education. 
(3) ACCREDITATION.—The Secretary shall en-
sure that the program is accredited in as many 
States as practicable. 
(4) CONSISTENCY WITH EXISTING RULES.—The 
Secretary shall ensure that the program is consistent 
with the rules and regulations of the following: 
(A) The medical licensing agency of each 
State in which the program is accredited. 
(B) Such medical credentialing organiza-
tions as the Secretary considers appropriate. 
(5) USER COST.—The Secretary shall carry out 
the program at no cost to participating non-Depart-
ment medical professionals. 
(6) MONITORING, EVALUATION, AND REPORT.— 
The Secretary shall monitor the utilization of the 
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program established under subsection (a), evaluate 
its effectiveness, and report to Congress on utiliza-
tion and effectiveness not less frequently than once 
each year. 
(d) NON-DEPARTMENT
MEDICAL
PROFESSIONAL 
DEFINED.—In this section, the term ‘‘non-Department 
medical professional’’ means any individual who is licensed 
by an appropriate medical authority in the United States 
and is in good standing, is not an employee of the Depart-
ment of Veterans Affairs, and provides care to veterans 
or family members of veterans under the laws adminis-
tered by the Secretary of Veterans Affairs. 
CHAPTER 4—OTHER MATTERS RELATING 
TO NON-DEPARTMENT OF VETERANS 
AFFAIRS PROVIDERS 
SEC. 131. ESTABLISHMENT OF PROCESSES TO ENSURE 
SAFE OPIOID PRESCRIBING PRACTICES BY 
NON-DEPARTMENT OF VETERANS AFFAIRS 
HEALTH CARE PROVIDERS. 
(a) RECEIPT AND REVIEW OF GUIDELINES.—The 
Secretary of Veterans Affairs shall ensure that all covered 
health care providers are provided a copy of and certify 
that they have reviewed the evidence-based guidelines for 
prescribing opioids set forth by the Opioid Safety Initia-
tive of the Department of Veterans Affairs. 
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(b) INCLUSION OF MEDICAL HISTORY AND CURRENT 
MEDICATIONS.—The Secretary shall implement a process 
to ensure that, if care of a veteran by a covered health 
care provider is authorized under the laws administered 
by the Secretary, the document authorizing such care in-
cludes the available and relevant medical history of the 
veteran and a list of all medications prescribed to the vet-
eran as known by the Department. 
(c) SUBMITTAL OF MEDICAL RECORDS AND PRE-
SCRIPTIONS.— 
(1) IN
GENERAL.—The Secretary shall, con-
sistent with section 1703(a)(2)(A), as amended by 
section 101 of this title, and section 1703A(e)(2)(F), 
as added by section 102 of this title, require each 
covered health care provider to submit medical 
records of any care or services furnished, including 
records of any prescriptions for opioids, to the De-
partment in the timeframe and format specified by 
the Secretary. 
(2) RESPONSIBILITY OF DEPARTMENT FOR RE-
CORDING AND MONITORING.—In carrying out para-
graph (1) and upon the receipt by the Department 
of the medical records described in paragraph (1), 
the Secretary shall— 
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(A) ensure the Department is responsible 
for the recording of the prescription in the elec-
tronic health record of the veteran; and 
(B) enable other monitoring of the pre-
scription as outlined in the Opioid Safety Initia-
tive of the Department. 
(3) REPORT.—Not less frequently than annu-
ally, the Secretary shall submit to the Committee on 
Veterans’ Affairs of the Senate and the Committee 
on Veterans’ Affairs of the House of Representatives 
a report evaluating the compliance of covered health 
care providers with the requirements under this sec-
tion. 
(d) USE
OF OPIOID SAFETY INITIATIVE GUIDE-
LINES.— 
(1) IN GENERAL.—If the Secretary determines 
that the opioid prescribing practices of a covered 
health care provider, when treating covered veterans, 
satisfy a condition described in paragraph (3), the 
Secretary shall take such action as the Secretary 
considers appropriate to ensure the safety of all vet-
erans receiving care from that health care provider, 
including removing or directing the removal of any 
such health care provider from provider networks or 
otherwise refusing to authorize care of veterans by 
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such health care provider in any program authorized 
under the laws administered by the Secretary. 
(2) INCLUSION IN CONTRACTS.—The Secretary 
shall ensure that any contracts, agreements, or other 
arrangements entered into by the Secretary with 
third parties involved in administering programs 
that provide care in the community to veterans 
under the laws administered by the Secretary spe-
cifically grant the authority set forth in paragraph 
(1) to such third parties and to the Secretary, as the 
case may be. 
(3) CONDITIONS FOR EXCLUSION OR LIMITA-
TION.—The Secretary shall take such action as is 
considered appropriate under paragraph (1) when 
the opioid prescribing practices of a covered health 
care provider when treating covered veterans— 
(A) conflict with or are otherwise incon-
sistent with the standards of appropriate and 
safe care; 
(B) violate the requirements of a medical 
license of the health care provider; or 
(C) may place at risk the veterans receiv-
ing health care from the provider. 
(e) COVERED HEALTH CARE PROVIDER DEFINED.— 
In this section, the term ‘‘covered health care provider’’ 
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means a non-Department of Veterans Affairs health care 
provider who provides health care to veterans under the 
laws administered by the Secretary of Veterans Affairs, 
but does not include a health care provider employed by 
another agency of the Federal Government. 
SEC. 132. IMPROVING INFORMATION SHARING WITH COM-
MUNITY PROVIDERS. 
Section 7332(b)(2) is amended by striking subpara-
graph (H) and inserting the following new subparagraphs: 
‘‘(H)(i) To a non-Department entity (including 
private entities and other Federal agencies) for pur-
poses of providing health care, including hospital 
care, medical services, and extended care services, to 
patients or performing other health care-related ac-
tivities or functions. 
‘‘(ii) An entity to which a record is disclosed 
under this subparagraph may not disclose or use 
such record for a purpose other than that for which 
the disclosure was made or as permitted by law. 
‘‘(I) To a third party in order to recover or col-
lect reasonable charges for care furnished to, or paid 
on behalf of, a patient in connection with a non-serv-
ice connected disability as permitted by section 1729 
of this title or for a condition for which recovery is 
authorized or with respect to which the United 
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States is deemed to be a third party beneficiary 
under the Act entitled ‘An Act to provide for the re-
covery from tortiously liable third persons of the cost 
of hospital and medical care and treatment fur-
nished by the United States’ (Public Law 87–693; 
42 U.S.C. 2651 et seq.; commonly known as the 
‘Federal Medical Care Recovery Act’).’’. 
SEC. 133. COMPETENCY STANDARDS FOR NON-DEPART-
MENT OF VETERANS AFFAIRS HEALTH CARE 
PROVIDERS. 
(a) ESTABLISHMENT OF STANDARDS AND REQUIRE-
MENTS.—The Secretary of Veterans Affairs shall establish 
standards and requirements for the provision of care by 
non-Department of Veterans Affairs health care providers 
in clinical areas for which the Department of Veterans Af-
fairs has special expertise, including post-traumatic stress 
disorder, military sexual trauma-related conditions, and 
traumatic brain injuries. 
(b) CONDITION
FOR
ELIGIBILITY
TO
FURNISH 
CARE.—(1) Each non-Department of Veterans Affairs 
health care provider shall, to the extent practicable as de-
termined by the Secretary or otherwise provided for in 
paragraph (2), meet the standards and requirements es-
tablished pursuant to subsection (a) before furnishing care 
pursuant to a contract, agreement, or other arrangement 
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with the Department of Veterans Affairs. Non-Depart-
ment of Veterans Affairs health care providers furnishing 
care pursuant to a contract, agreement, or other arrange-
ment shall, to the extent practicable as determined by the 
Secretary, fulfill training requirements established by the 
Secretary on how to deliver evidence-based treatments in 
the clinical areas for which the Department of Veterans 
Affairs has special expertise. 
(2) Each non-Department of Veterans Affairs health 
care provider who enters into a contract, agreement, or 
other arrangement after the effective date identified in 
subsection (c) shall, to the extent practicable, meet the 
standards and requirements established pursuant to sub-
section (a) within 6 months of the contract, agreement, 
or other arrangement taking effect. 
(c) EFFECTIVE DATE.—This section shall take effect 
on the day that is one year after the date of the enactment 
of this Act. 
SEC. 134. DEPARTMENT OF VETERANS AFFAIRS PARTICIPA-
TION IN NATIONAL NETWORK OF STATE- 
BASED PRESCRIPTION DRUG MONITORING 
PROGRAMS. 
(a) IN GENERAL.—Chapter 17 is amended by insert-
ing after section 1730A the following new section: 
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‘‘§ 1730B. Access to State prescription drug moni-
toring programs 
‘‘(a) ACCESS TO PROGRAMS.—(1) Any licensed health 
care provider or delegate of such a provider shall be con-
sidered an authorized recipient or user for the purpose of 
querying and receiving data from the national network of 
State-based prescription drug monitoring programs to 
support the safe and effective prescribing of controlled 
substances to covered patients. 
‘‘(2) Under the authority granted by paragraph (1)— 
‘‘(A) licensed health care providers or delegates 
of such providers shall query such network in ac-
cordance with applicable regulations and policies of 
the Veterans Health Administration; and 
‘‘(B) notwithstanding any general or specific 
provision of law, rule, or regulation of a State, no 
State may restrict the access of licensed health care 
providers or delegates of such providers from access-
ing that State’s prescription drug monitoring pro-
grams. 
‘‘(3) No State shall deny or revoke the license, reg-
istration, or certification of a licensed health care provider 
or delegate who otherwise meets that State’s qualifications 
for holding the license, registration, or certification on the 
basis that the licensed health care provider or delegate 
queried or received data, or attempted to query or receive 
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data, from the national network of State-based prescrip-
tion drug monitoring programs under this section. 
‘‘(b) COVERED PATIENTS.—For purposes of this sec-
tion, a covered patient is a patient who— 
‘‘(1) receives a prescription for a controlled sub-
stance; and 
‘‘(2) is not receiving palliative care or enrolled 
in hospice care. 
‘‘(c) DEFINITIONS.—In this section: 
‘‘(1) The term ‘controlled substance’ has the 
meaning given such term in section 102(6) of the 
Controlled Substances Act (21 U.S.C. 802(6)). 
‘‘(2) The term ‘delegate’ means a person or 
automated system accessing the national network of 
State-based prescription monitoring programs at the 
direction or under the supervision of a licensed 
health care provider. 
‘‘(3) The term ‘licensed health care provider’ 
means a health care provider employed by the De-
partment who is licensed, certified, or registered 
within any State to fill or prescribe medications 
within the scope of his or her practice as a Depart-
ment employee. 
‘‘(4) The term ‘national network of State-based 
prescription monitoring programs’ means an inter-
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connected nation-wide system that facilitates the 
transfer to State prescription drug monitoring pro-
gram data across State lines. 
‘‘(5) The term ‘State’ means a State, as defined 
in section 101(20) of this title, or a political subdivi-
sion of a State.’’. 
(b) CLERICAL AMENDMENT.—The table of sections 
at the beginning of chapter 17 of such title is amended 
by inserting after the item relating to section 1730A the 
following new item: 
‘‘1730B. Access to State prescription drug monitoring programs.’’. 
CHAPTER 5—OTHER NON-DEPARTMENT 
HEALTH CARE MATTERS 
SEC. 141. PLANS FOR USE OF SUPPLEMENTAL APPROPRIA-
TIONS REQUIRED. 
Whenever the Secretary submits to Congress a re-
quest for supplemental appropriations or any other appro-
priation outside the standard budget process to address 
a budgetary issue affecting the Department of Veterans 
Affairs, the Secretary shall, not later than 45 days before 
the date on which such budgetary issue would start affect-
ing a program or service, submit to Congress a justifica-
tion for the request, including a plan that details how the 
Secretary intends to use the requested appropriation and 
how long the requested appropriation is expected to meet 
the needs of the Department and certification that the re-
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quest was made using an updated and sound actuarial 
analysis. 
SEC. 142. VETERANS CHOICE FUND FLEXIBILITY. 
Section 802 of the Veterans Access, Choice, and Ac-
countability Act of 2014 (Public Law 113–146; 38 U.S.C. 
1701 note) is amended— 
(1) in subsection (c)— 
(A) in paragraph (1), by striking ‘‘by para-
graph (3)’’ and inserting ‘‘in paragraphs (3) 
and (4)’’; and 
(B) by adding at the end the following new 
paragraph: 
‘‘(4) PERMANENT
AUTHORITY
FOR
OTHER 
USES.—Beginning on March 1, 2019, amounts re-
maining in the Veterans Choice Fund may be used 
to furnish hospital care, medical services, and ex-
tended care services to individuals pursuant to chap-
ter 17 of title 38, United States Code, at non-De-
partment facilities, including pursuant to non-De-
partment provider programs other than the program 
established by section 101. Such amounts shall be 
available in addition to amounts available in other 
appropriations accounts for such purposes.’’; and 
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(2) in subsection (d)(1), by striking ‘‘to sub-
section (c)(3)’’ and inserting ‘‘to paragraphs (3) and 
(4) of subsection (c)’’. 
SEC. 143. SUNSET OF VETERANS CHOICE PROGRAM. 
Subsection (p) of section 101 of the Veterans Access, 
Choice, and Accountability Act of 2014 (Public Law 113– 
146; 38 U.S.C. 1701 note) is amended to read as follows: 
‘‘(p) AUTHORITY TO FURNISH CARE
AND SERV-
ICES.—The Secretary may not use the authority under 
this section to furnish care and services after the date that 
is one year after the date of the enactment of the Caring 
for Our Veterans Act of 2018.’’. 
SEC. 144. CONFORMING AMENDMENTS. 
(a) IN GENERAL.— 
(1) TITLE 38.—Title 38, United States Code, is 
amended— 
(A) in section 1712(a)— 
(i) in paragraph (3), by striking 
‘‘under clause (1), (2), or (5) of section 
1703(a) of this title’’ and inserting ‘‘or en-
tered an agreement’’; and 
(ii) in paragraph (4)(A), by striking 
‘‘under the provisions of this subsection 
and section 1703 of this title’’; 
(B) in section 1712A(e)(1)— 
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(i) by inserting ‘‘or agreements’’ after 
‘‘contracts’’; and 
(ii) by striking ‘‘(under sections 
1703(a)(2) and 1710(a)(1)(B) of this 
title)’’; and 
(C) in section 2303(a)(2)(B)(i), by striking 
‘‘with section 1703’’ and inserting ‘‘with sec-
tions 1703A, 8111, and 8153’’. 
(2) 
SOCIAL
SECURITY
ACT.—Section 
1866(a)(1)(L) of the Social Security Act (42 U.S.C. 
1395cc(a)(1)(L)) is amended by striking ‘‘under sec-
tion 1703’’ and inserting ‘‘under chapter 17’’. 
(3) VETERANS’ BENEFITS IMPROVEMENTS ACT 
OF
1994.—Section 104(a)(4)(A) of the Veterans’ 
Benefits Improvements Act of 1994 (Public Law 
103–446; 38 U.S.C. 1117 note) is amended by strik-
ing ‘‘in section 1703’’ and inserting ‘‘in sections 
1703A, 8111, and 8153’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall take effect on the date described in 
section 101(b). 
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Subtitle B—Improving Department 
of Veterans Affairs Health Care 
Delivery 
SEC. 151. LICENSURE OF HEALTH CARE PROFESSIONALS 
OF THE DEPARTMENT OF VETERANS AF-
FAIRS PROVIDING TREATMENT VIA TELE-
MEDICINE. 
(a) IN GENERAL.—Chapter 17 is amended by insert-
ing after section 1730B, as added by section 134, the fol-
lowing new section: 
‘‘§ 1730C. Licensure of health care professionals pro-
viding treatment via telemedicine 
‘‘(a) IN GENERAL.—Notwithstanding any provision 
of law regarding the licensure of health care professionals, 
a covered health care professional may practice the health 
care profession of the health care professional at any loca-
tion in any State, regardless of where the covered health 
care professional or the patient is located, if the covered 
health care professional is using telemedicine to provide 
treatment to an individual under this chapter. 
‘‘(b) COVERED HEALTH CARE PROFESSIONALS.— 
For purposes of this section, a covered health care profes-
sional is any health care professional who— 
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‘‘(1) is an employee of the Department ap-
pointed under the authority under section 7306, 
7401, 7405, 7406, or 7408 of this title or title 5; 
‘‘(2) is authorized by the Secretary to provide 
health care under this chapter; 
‘‘(3) is required to adhere to all standards for 
quality relating to the provision of medicine in ac-
cordance with applicable policies of the Department; 
and 
‘‘(4) has an active, current, full, and unre-
stricted license, registration, or certification in a 
State to practice the health care profession of the 
health care professional. 
‘‘(c) PROPERTY OF FEDERAL GOVERNMENT.—Sub-
section (a) shall apply to a covered health care professional 
providing treatment to a patient regardless of whether the 
covered health care professional or patient is located in 
a facility owned by the Federal Government during such 
treatment. 
‘‘(d) RELATION TO STATE LAW.—(1) The provisions 
of this section shall supersede any provisions of the law 
of any State to the extent that such provision of State 
law are inconsistent with this section. 
‘‘(2) No State shall deny or revoke the license, reg-
istration, or certification of a covered health care profes-
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100 
sional who otherwise meets the qualifications of the State 
for holding the license, registration, or certification on the 
basis that the covered health care professional has en-
gaged or intends to engage in activity covered by sub-
section (a). 
‘‘(e) RULE OF CONSTRUCTION.—Nothing in this sec-
tion may be construed to remove, limit, or otherwise affect 
any obligation of a covered health care professional under 
the Controlled Substances Act (21 U.S.C. 801 et seq.). 
‘‘(f) STATE DEFINED.—In this section, the term 
‘State’ means a State, as defined in section 101(20) of 
this title, or a political subdivision of a State.’’. 
(b) CLERICAL AMENDMENT.—The table of sections 
at the beginning of chapter 17 of such title is amended 
by inserting after the item relating to section 1730B, as 
added by section 134, the following new item: 
‘‘1730C. Licensure of health care professionals providing treatment via telemedi-
cine.’’. 
(c) REPORT ON TELEMEDICINE.— 
(1) IN
GENERAL.—Not later than one year 
after the earlier of the date on which services pro-
vided under section 1730B of title 38, United States 
Code, as added by subsection (a), first occur or reg-
ulations are promulgated to carry out such section, 
the Secretary of Veterans Affairs shall submit to the 
Committee on Veterans’ Affairs of the Senate and 
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the Committee on Veterans’ Affairs of the House of 
Representatives a report on the effectiveness of the 
use of telemedicine by the Department of Veterans 
Affairs. 
(2) ELEMENTS.—The report required by para-
graph (1) shall include an assessment of the fol-
lowing: 
(A) The satisfaction of veterans with tele-
medicine furnished by the Department. 
(B) The satisfaction of health care pro-
viders in providing telemedicine furnished by 
the Department. 
(C) The effect of telemedicine furnished by 
the Department on the following: 
(i) The ability of veterans to access 
health care, whether from the Department 
or from non-Department health care pro-
viders. 
(ii) The frequency of use by veterans 
of telemedicine. 
(iii) The productivity of health care 
providers. 
(iv) Wait times for an appointment 
for the receipt of health care from the De-
partment. 
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(v) The use by veterans of in-person 
services at Department facilities and non- 
Department facilities. 
(D) The types of appointments for the re-
ceipt of telemedicine furnished by the Depart-
ment that were provided during the one-year 
period preceding the submittal of the report. 
(E) The number of appointments for the 
receipt of telemedicine furnished by the Depart-
ment that were requested during such period, 
disaggregated by medical facility. 
(F) Savings by the Department, if any, in-
cluding travel costs, from furnishing health care 
through the use of telemedicine during such pe-
riod. 
SEC. 152. AUTHORITY FOR DEPARTMENT OF VETERANS AF-
FAIRS CENTER FOR INNOVATION FOR CARE 
AND PAYMENT. 
(a) IN GENERAL.—Subchapter I of chapter 17, as 
amended by this title, is further amended by inserting 
after section 1703D, as added by section 111, the fol-
lowing new section: 
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‘‘§ 1703E. Center for Innovation for Care and Pay-
ment 
‘‘(a) IN GENERAL.—(1) There is established within 
the Department a Center for Innovation for Care and Pay-
ment (in this section referred to as the ‘Center’). 
‘‘(2) The Secretary, acting through the Center, may 
carry out such pilot programs the Secretary determines 
to be appropriate to develop innovative approaches to test-
ing payment and service delivery models in order to reduce 
expenditures while preserving or enhancing the quality of 
care furnished by the Department. 
‘‘(3) The Secretary, acting through the Center, shall 
test payment and service delivery models to determine 
whether such models— 
‘‘(A) improve access to, and quality, timeliness, 
and patient satisfaction of care and services; and 
‘‘(B) create cost savings for the Department. 
‘‘(4)(A) The Secretary shall test a model in a location 
where the Secretary determines that the model will ad-
dresses deficits in care (including poor clinical outcomes 
or potentially avoidable expenditures) for a defined popu-
lation. 
‘‘(B) The Secretary shall focus on models the Sec-
retary expects to reduce program costs while preserving 
or enhancing the quality of care received by individuals 
receiving benefits under this chapter. 
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‘‘(C) The models selected may include those described 
in section 1115A(b)(2)(B) of the Social Security Act (42 
U.S.C. 1315a(b)(2)(B)). 
‘‘(5) In selecting a model for testing, the Secretary 
may consider, in addition to other factors identified in this 
subsection, the following factors: 
‘‘(A) Whether the model includes a regular 
process for monitoring and updating patient care 
plans in a manner that is consistent with the needs 
and preferences of individuals receiving benefits 
under this chapter. 
‘‘(B) Whether the model places the individual 
receiving benefits under this chapter (including fam-
ily members and other caregivers of such individual) 
at the center of the care team of such individual. 
‘‘(C) Whether the model uses technology or new 
systems to coordinate care over time and across set-
tings. 
‘‘(D) Whether the model demonstrates effective 
linkage with other public sector payers, private sec-
tor payers, or statewide payment models. 
‘‘(6)(A) Models tested under this section may not be 
designed in such a way that would allow the United States 
to recover or collect reasonable charges from a Federal 
health care program for care or services furnished by the 
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Secretary to a veteran under pilot programs carried out 
under this section. 
‘‘(B) In this paragraph, the term ‘Federal health care 
program’ means— 
‘‘(i) an insurance program described in section 
1811 of the Social Security Act (42 U.S.C. 1395c) 
or established by section 1831 of such Act (42 
U.S.C. 1395j); 
‘‘(ii) a State plan for medical assistance ap-
proved under title XIX of such Act (42 U.S.C. 1396 
et seq.); or 
‘‘(iii) a TRICARE program operated under sec-
tions 1075, 1075a, 1076, 1076a, 1076c, 1076d, 
1076e, or 1076f of title 10. 
‘‘(b) DURATION.—Each pilot program carried out by 
the Secretary under this section shall terminate no later 
than five years after the date of the commencement of the 
pilot program. 
‘‘(c) LOCATION.—The Secretary shall ensure that 
each pilot program carried out under this section occurs 
in an area or areas appropriate for the intended purposes 
of the pilot program. To the extent practicable, the Sec-
retary shall ensure that the pilot programs are located in 
geographically diverse areas of the United States. 
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‘‘(d) BUDGET.—Funding for each pilot program car-
ried out by the Secretary under this section shall come 
from appropriations— 
‘‘(1) provided in advance in appropriations acts 
for the Veterans Health Administration; and 
‘‘(2) provided for information technology sys-
tems. 
‘‘(e) NOTICE.—The Secretary shall— 
‘‘(1) publish information about each pilot pro-
gram under this section in the Federal Register; and 
‘‘(2) take reasonable actions to provide direct 
notice to veterans eligible to participate in such pilot 
programs. 
‘‘(f) WAIVER OF AUTHORITIES.—(1) Subject to re-
porting under paragraph (2) and approval under para-
graph (3), in implementing a pilot program under this sec-
tion, the Secretary may waive such requirements in sub-
chapters I, II, and III of this chapter as the Secretary 
determines necessary solely for the purposes of carrying 
out this section with respect to testing models described 
in subsection (a). 
‘‘(2) Before waiving any authority under paragraph 
(1), the Secretary shall submit to the Speaker of the 
House of Representatives, the minority leader of the 
House of Representatives, the majority leader of the Sen-
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ate, the minority leader of the Senate, and each standing 
committee with jurisdiction under the rules of the Senate 
and of the House of Representatives to report a bill to 
amend the provision or provisions of law that would be 
waived by the Department, a report describing in detail 
the following: 
‘‘(A) The specific authorities to be waived 
under the pilot program. 
‘‘(B) The standard or standards to be used in 
the pilot program in lieu of the waived authorities. 
‘‘(C) The reasons for such waiver or waivers. 
‘‘(D) A description of the metric or metrics the 
Secretary will use to determine the effect of the 
waiver or waivers upon the access to and quality, 
timeliness, or patient satisfaction of care and serv-
ices furnished through the pilot program. 
‘‘(E) The anticipated cost savings, if any, of the 
pilot program. 
‘‘(F) The schedule for interim reports on the 
pilot program describing the results of the pilot pro-
gram so far and the feasibility and advisability of 
continuing the pilot program. 
‘‘(G) The schedule for the termination of the 
pilot program and the submission of a final report 
on the pilot program describing the result of the 
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108 
pilot program and the feasibility and advisability of 
making the pilot program permanent. 
‘‘(H) The estimated budget of the pilot pro-
gram. 
‘‘(3)(A) Upon receipt of a report submitted under 
paragraph (2), each House of Congress shall provide cop-
ies of the report to the chairman and ranking member of 
each standing committee with jurisdiction under the rules 
of the House of Representatives or the Senate to report 
a bill to amend the provision or provisions of law that 
would be waived by the Department under this subsection. 
‘‘(B)(i) The waiver requested by the Secretary under 
paragraph (2) shall be considered approved under this 
paragraph if there is enacted into law a bill or joint resolu-
tion approving such request in its entirety. Such bill or 
joint resolution shall be passed by recorded vote to reflect 
the vote of each member of Congress thereon. 
‘‘(ii) The provisions of this paragraph are enacted by 
Congress— 
‘‘(I) as an exercise of the rulemaking power of 
the Senate and the House of Representatives and as 
such shall be considered as part of the rules of each 
House of Congress, and shall supersede other rules 
only to the extent that they are inconsistent there-
with; and 
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‘‘(II) with full recognition of the constitutional 
right of either House of Congress to change the 
rules (so far as they relate to the procedures of that 
House) at any time, in the same manner, and to the 
same extent as in the case of any other rule of that 
House. 
‘‘(C) During the 60-calendar-day period beginning on 
the date on which the Secretary submits the report de-
scribed in paragraph (2) to Congress, it shall be in order 
as a matter of highest privilege in each House of Congress 
to consider a bill or joint resolution, if offered by the ma-
jority leader of such House (or a designee), approving 
such request in its entirety. 
‘‘(g) LIMITATIONS.—(1) The Secretary may not carry 
out more than 10 pilot programs concurrently. 
‘‘(2)(A) Subject to subparagraph (B), the Secretary 
may not expend more than $50,000,000 in any fiscal year 
from amounts under subsection (d). 
‘‘(B) The Secretary may expend more than the 
amount in subparagraph (A) if— 
‘‘(i) the Secretary determines that the addi-
tional expenditure is necessary to carry out pilot 
programs under this section; 
‘‘(ii) the Secretary submits to the Committees 
on Veterans’ Affairs of the Senate and the House of 
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110 
Representatives a report setting forth the amount of 
the additional expenditure and a justification for the 
additional expenditure; and 
‘‘(iii) the Chairmen of the Committees on Vet-
erans’ Affairs of the Senate and the House of Rep-
resentatives transmit to the Secretary a letter ap-
proving of the additional expenditure. 
‘‘(3) The waiver provisions in subsection (f) shall not 
apply unless the Secretary, in accordance with the require-
ments in subsection (f), submits the first proposal for a 
pilot program not later than 18 months after the date of 
the enactment of the Caring for Our Veterans Act of 
2018. 
‘‘(4) Notwithstanding section 502 of this title, deci-
sions by the Secretary under this section shall, consistent 
with section 511 of this title, be final and conclusive and 
may not be reviewed by any other official or by any court, 
whether by an action in the nature of mandamus or other-
wise. 
‘‘(5)(A) If the Secretary determines that a pilot pro-
gram is not improving the quality of care or producing 
cost savings, the Secretary shall— 
‘‘(i) propose a modification to the pilot program 
in the interim report that shall also be considered a 
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111 
report under subsection (f)(2) and shall be subject 
to the terms and conditions of subsection (f)(2); or 
‘‘(ii) terminate such pilot program not later 
than 30 days after submitting the interim report to 
Congress. 
‘‘(B) If the Secretary terminates a pilot program 
under subparagraph (A)(ii), for purposes of subpara-
graphs (F) and (G) of subsection (f)(2), such interim re-
port will also serve as the final report for that pilot pro-
gram. 
‘‘(h) EVALUATION
AND
REPORTING
REQUIRE-
MENTS.—(1) The Secretary shall conduct an evaluation 
of each model tested, which shall include, at a minimum, 
an analysis of— 
‘‘(A) the quality of care furnished under the 
model, including the measurement of patient-level 
outcomes and patient-centeredness criteria deter-
mined appropriate by the Secretary; and 
‘‘(B) the changes in spending by reason of that 
model. 
‘‘(2) The Secretary shall make the results of each 
evaluation under this subsection available to the public in 
a timely fashion and may establish requirements for other 
entities participating in the testing of models under this 
section to collect and report information that the Sec-
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112 
retary determines is necessary to monitor and evaluate 
such models. 
‘‘(i) COORDINATION
AND ADVICE.—(1) The Sec-
retary shall obtain advice from the Under Secretary for 
Health and the Special Medical Advisory Group estab-
lished pursuant to section 7312 of this title in the develop-
ment and implementation of any pilot program operated 
under this section. 
‘‘(2) In carrying out the duties under this section, 
the Secretary shall consult representatives of relevant 
Federal agencies, and clinical and analytical experts with 
expertise in medicine and health care management. The 
Secretary shall use appropriate mechanisms to seek input 
from interested parties. 
‘‘(j) EXPANSION
OF
SUCCESSFUL
PILOT
PRO-
GRAMS.—Taking into account the evaluation under sub-
section (f), the Secretary may, through rulemaking, ex-
pand (including implementation on a nationwide basis) the 
duration and the scope of a model that is being tested 
under subsection (a) to the extent determined appropriate 
by the Secretary, if— 
‘‘(1) the Secretary determines that such expan-
sion is expected to— 
‘‘(A) reduce spending without reducing the 
quality of care; or 
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‘‘(B) improve the quality of patient care 
without increasing spending; and 
‘‘(2) the Secretary determines that such expan-
sion would not deny or limit the coverage or provi-
sion of benefits for individuals receiving benefits 
under this chapter.’’. 
(b) CONFORMING AMENDMENT.—The table of sec-
tions at the beginning of such chapter, as amended by this 
title, is further amended by inserting after the item relat-
ing to section 1703D the following new item: 
‘‘1703E. Center for Innovation for Care and Payment.’’. 
SEC. 153. AUTHORIZATION TO PROVIDE FOR OPERATIONS 
ON LIVE DONORS FOR PURPOSES OF CON-
DUCTING TRANSPLANT PROCEDURES FOR 
VETERANS. 
(a) IN GENERAL.—Subchapter VIII of chapter 17 is 
amended by adding at the end the following new section: 
‘‘§ 1788. Transplant procedures with live donors and 
related services 
‘‘(a) IN GENERAL.—Subject to subsections (b) and 
(c), in a case in which a veteran is eligible for a transplant 
procedure from the Department, the Secretary may pro-
vide for an operation on a live donor to carry out such 
procedure for such veteran, notwithstanding that the live 
donor may not be eligible for health care from the Depart-
ment. 
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114 
‘‘(b) OTHER SERVICES.—Subject to the availability 
of appropriations for such purpose, the Secretary shall 
furnish to a live donor any care or services before and 
after conducting the transplant procedure under sub-
section (a) that may be required in connection with such 
procedure. 
‘‘(c) USE
OF NON-DEPARTMENT FACILITIES.—In 
carrying out this section, the Secretary may provide for 
the operation described in subsection (a) on a live donor 
and furnish to the live donor the care and services de-
scribed in subsection (b) at a non-Department facility pur-
suant to an agreement entered into by the Secretary under 
this chapter. The live donor shall be deemed to be an indi-
vidual eligible for hospital care and medical services at a 
non-Department facility pursuant to such an agreement 
solely for the purposes of receiving such operation, care, 
and services at the non-Department facility.’’. 
(b) CLERICAL AMENDMENT.—The table of sections 
at the beginning of chapter 17 is amended by inserting 
after the item relating to section 1787 the following new 
item: 
‘‘1788. Transplant procedures with live donors and related services.’’. 
Subtitle C—Family Caregivers 
SEC. 161. EXPANSION OF FAMILY CAREGIVER PROGRAM OF 
DEPARTMENT OF VETERANS AFFAIRS. 
(a) FAMILY CAREGIVER PROGRAM.— 
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(1) EXPANSION OF ELIGIBILITY.— 
(A) IN GENERAL.—Subparagraph (B) of 
subsection (a)(2) of section 1720G is amended 
to read as follows: 
‘‘(B) for assistance provided under this sub-
section— 
‘‘(i) before the date on which the Secretary 
submits to Congress a certification that the De-
partment has fully implemented the information 
technology system required by section 162(a) of 
the Caring for Our Veterans Act of 2018, has 
a serious injury (including traumatic brain in-
jury, psychological trauma, or other mental dis-
order) incurred or aggravated in the line of 
duty in the active military, naval, or air service 
on or after September 11, 2001; 
‘‘(ii) during the two-year period beginning 
on the date on which the Secretary submitted 
to Congress the certification described in clause 
(i), has a serious injury (including traumatic 
brain injury, psychological trauma, or other 
mental disorder) incurred or aggravated in the 
line of duty in the active military, naval, or air 
service— 
‘‘(I) on or before May 7, 1975; or 
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‘‘(II) on or after September 11, 2001; 
or 
‘‘(iii) after the date that is two years after 
the date on which the Secretary submits to 
Congress the certification described in clause 
(i), has a serious injury (including traumatic 
brain injury, psychological trauma, or other 
mental disorder) incurred or aggravated in the 
line of duty in the active military, naval, or air 
service; and’’. 
(B) PUBLICATION
IN
FEDERAL
REG-
ISTER.—Not later than 30 days after the date 
on which the Secretary of Veterans Affairs sub-
mits to Congress the certification described in 
subsection (a)(2)(B)(i) of section 1720G of 
such title, as amended by subparagraph (A) of 
this paragraph, the Secretary shall publish the 
date specified in such subsection in the Federal 
Register. 
(2) EXPANSION OF NEEDED SERVICES IN ELI-
GIBILITY CRITERIA.—Subsection (a)(2)(C) of such 
section is amended— 
(A) in clause (ii), by striking ‘‘; or’’ and in-
serting a semicolon; 
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(B) by redesignating clause (iii) as clause 
(iv); and 
(C) by inserting after clause (ii) the fol-
lowing new clause (iii): 
‘‘(iii) a need for regular or extensive in-
struction or supervision without which the abil-
ity of the veteran to function in daily life would 
be seriously impaired; or’’. 
(3) EXPANSION OF SERVICES PROVIDED.—Sub-
section (a)(3)(A)(ii) of such section is amended— 
(A) in subclause (IV), by striking ‘‘; and’’ 
and inserting a semicolon; 
(B) in subclause (V), by striking the period 
at the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
subclause: 
‘‘(VI) through the use of contracts with, or 
the provision of grants to, public or private en-
tities— 
‘‘(aa) financial planning services relat-
ing to the needs of injured veterans and 
their caregivers; and 
‘‘(bb) legal services, including legal 
advice and consultation, relating to the 
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needs of injured veterans and their care-
givers.’’. 
(4) MODIFICATION
OF
STIPEND
CALCULA-
TION.—Subsection (a)(3)(C) of such section is 
amended— 
(A) by redesignating clause (iii) as clause 
(iv); and 
(B) by inserting after clause (ii) the fol-
lowing new clause (iii): 
‘‘(iii) In determining the amount and degree of per-
sonal care services provided under clause (i) with respect 
to an eligible veteran whose need for personal care services 
is based in whole or in part on a need for supervision or 
protection under paragraph (2)(C)(ii) or regular instruc-
tion or supervision under paragraph (2)(C)(iii), the Sec-
retary shall take into account the following: 
‘‘(I) The assessment by the family caregiver of 
the needs and limitations of the veteran. 
‘‘(II) The extent to which the veteran can func-
tion safely and independently in the absence of such 
supervision, protection, or instruction. 
‘‘(III) The amount of time required for the 
family caregiver to provide such supervision, protec-
tion, or instruction to the veteran.’’. 
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119 
(5) PERIODIC EVALUATION OF NEED FOR CER-
TAIN SERVICES.—Subsection (a)(3) of such section 
is amended by adding at the end the following new 
subparagraph: 
‘‘(D) In providing instruction, preparation, and train-
ing under subparagraph (A)(i)(I) and technical support 
under subparagraph (A)(i)(II) to each family caregiver 
who is approved as a provider of personal care services 
for an eligible veteran under paragraph (6), the Secretary 
shall periodically evaluate the needs of the eligible veteran 
and the skills of the family caregiver of such veteran to 
determine if additional instruction, preparation, training, 
or technical support under those subparagraphs is nec-
essary.’’. 
(6) USE OF PRIMARY CARE TEAMS.—Subsection 
(a)(5) of such section is amended, in the matter pre-
ceding subparagraph (A), by inserting ‘‘(in collabo-
ration with the primary care team for the eligible 
veteran to the maximum extent practicable)’’ after 
‘‘evaluate’’. 
(7) ASSISTANCE
FOR
FAMILY
CAREGIVERS.— 
Subsection (a) of such section is amended by adding 
at the end the following new paragraph: 
‘‘(11)(A) In providing assistance under this sub-
section to family caregivers of eligible veterans, the Sec-
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retary may enter into contracts, provider agreements, and 
memoranda of understanding with Federal agencies, 
States, and private, nonprofit, and other entities to pro-
vide such assistance to such family caregivers. 
‘‘(B) The Secretary may provide assistance under 
this paragraph only if such assistance is reasonably acces-
sible to the family caregiver and is substantially equivalent 
or better in quality to similar services provided by the De-
partment. 
‘‘(C) The Secretary may provide fair compensation 
to Federal agencies, States, and other entities that provide 
assistance under this paragraph.’’. 
(b) MODIFICATION OF DEFINITION OF PERSONAL 
CARE SERVICES.—Subsection (d)(4) of such section is 
amended— 
(1) in subparagraph (A), by striking ‘‘inde-
pendent’’; 
(2) by redesignating subparagraph (B) as sub-
paragraph (D); and 
(3) by inserting after subparagraph (A) the fol-
lowing new subparagraphs: 
‘‘(B) Supervision or protection based on 
symptoms or residuals of neurological or other 
impairment or injury. 
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‘‘(C) Regular or extensive instruction or 
supervision without which the ability of the vet-
eran to function in daily life would be seriously 
impaired.’’. 
SEC. 162. IMPLEMENTATION OF INFORMATION TECH-
NOLOGY SYSTEM OF DEPARTMENT OF VET-
ERANS AFFAIRS TO ASSESS AND IMPROVE 
THE FAMILY CAREGIVER PROGRAM. 
(a) IMPLEMENTATION OF NEW SYSTEM.— 
(1) IN GENERAL.—Not later than October 1, 
2018, the Secretary of Veterans Affairs shall imple-
ment an information technology system that fully 
supports the Program and allows for data assess-
ment and comprehensive monitoring of the Program. 
(2) ELEMENTS OF SYSTEM.—The information 
technology system required to be implemented under 
paragraph (1) shall include the following: 
(A) The ability to easily retrieve data that 
will allow all aspects of the Program (at the 
medical center and aggregate levels) and the 
workload trends for the Program to be assessed 
and comprehensively monitored. 
(B) The ability to manage data with re-
spect to a number of caregivers that is more 
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than the number of caregivers that the Sec-
retary expects to apply for the Program. 
(C) The ability to integrate the system 
with other relevant information technology sys-
tems of the Veterans Health Administration. 
(b) ASSESSMENT OF PROGRAM.—Not later than 180 
days after implementing the system described in sub-
section (a), the Secretary shall, through the Under Sec-
retary for Health, use data from the system and other rel-
evant data to conduct an assessment of how key aspects 
of the Program are structured and carried out. 
(c) ONGOING MONITORING OF AND MODIFICATIONS 
TO PROGRAM.— 
(1) MONITORING.—The Secretary shall use the 
system implemented under subsection (a) to monitor 
and assess the workload of the Program, including 
monitoring and assessment of data on— 
(A) the status of applications, appeals, and 
home visits in connection with the Program; 
and 
(B) the use by caregivers participating in 
the Program of other support services under 
the Program such as respite care. 
(2) MODIFICATIONS.—Based on the monitoring 
and assessment conducted under paragraph (1), the 
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Secretary shall identify and implement such modi-
fications to the Program as the Secretary considers 
necessary to ensure the Program is functioning as 
intended and providing veterans and caregivers par-
ticipating in the Program with services in a timely 
manner. 
(d) REPORTS.— 
(1) INITIAL REPORT.— 
(A) IN GENERAL.—Not later than 90 days 
after the date of the enactment of this Act, the 
Secretary shall submit to the Committee on 
Veterans’ Affairs of the Senate, the Committee 
on Veterans’ Affairs of the House of Represent-
atives, and the Comptroller General of the 
United States a report that includes— 
(i) the status of the planning, develop-
ment, and deployment of the system re-
quired to be implemented under subsection 
(a), including any changes in the timeline 
for the implementation of the system; and 
(ii) an assessment of the needs of 
family caregivers of veterans described in 
subparagraph (B), the resources needed 
for the inclusion of such family caregivers 
in the Program, and such changes to the 
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Program as the Secretary considers nec-
essary to ensure the successful expansion 
of the Program to include such family 
caregivers. 
(B) VETERANS DESCRIBED.—Veterans de-
scribed in this subparagraph are veterans who 
are eligible for the Program under clause (ii) or 
(iii) of section 1720G(a)(2)(B) of title 38, 
United States Code, as amended by section 
161(a)(1) of this title, solely due to a serious 
injury (including traumatic brain injury, psy-
chological trauma, or other mental disorder) in-
curred or aggravated in the line of duty in the 
active military, naval, or air service before Sep-
tember 11, 2001. 
(2) NOTIFICATION
BY
COMPTROLLER
GEN-
ERAL.—The Comptroller General shall review the re-
port submitted under paragraph (1) and notify the 
Committee on Veterans’ Affairs of the Senate and 
the Committee on Veterans’ Affairs of the House of 
Representatives with respect to the progress of the 
Secretary in— 
(A) fully implementing the system required 
under subsection (a); and 
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(B) implementing a process for using such 
system to monitor and assess the Program 
under subsection (c)(1) and modify the Pro-
gram as considered necessary under subsection 
(c)(2). 
(3) FINAL REPORT.— 
(A) IN GENERAL.—Not later than October 
1, 2019, the Secretary shall submit to the Com-
mittee on Veterans’ Affairs of the Senate, the 
Committee on Veterans’ Affairs of the House of 
Representatives, and the Comptroller General a 
report on the implementation of subsections (a) 
through (c). 
(B) ELEMENTS.—The report required by 
subparagraph (A) shall include the following: 
(i) A certification by the Secretary 
that the information technology system de-
scribed in subsection (a) has been imple-
mented. 
(ii) A description of how the Secretary 
has implemented such system. 
(iii) A description of the modifications 
to the Program, if any, that were identified 
and implemented under subsection (c)(2). 
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(iv) A description of how the Sec-
retary is using such system to monitor the 
workload of the Program. 
(e) DEFINITIONS.—In this section: 
(1) ACTIVE MILITARY, NAVAL, OR AIR SERV-
ICE.—The term ‘‘active military, naval, or air serv-
ice’’ has the meaning given that term in section 101 
of title 38, United States Code. 
(2) PROGRAM.—The term ‘‘Program’’ means 
the program of comprehensive assistance for family 
caregivers under section 1720G(a) of title 38, 
United States Code, as amended by section 161 of 
this title. 
SEC. 163. MODIFICATIONS TO ANNUAL EVALUATION RE-
PORT ON CAREGIVER PROGRAM OF DEPART-
MENT OF VETERANS AFFAIRS. 
(a) BARRIERS TO CARE AND SERVICES.—Subpara-
graph (A)(iv) of section 101(c)(2) of the Caregivers and 
Veterans Omnibus Health Services Act of 2010 (Public 
Law 111–163; 38 U.S.C. 1720G note) is amended by in-
serting ‘‘, including a description of any barriers to access-
ing and receiving care and services under such programs’’ 
before the semicolon. 
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(b) SUFFICIENCY OF TRAINING FOR FAMILY CARE-
GIVER PROGRAM.—Subparagraph (B) of such section is 
amended— 
(1) in clause (i), by striking ‘‘; and’’ and insert-
ing a semicolon; 
(2) in clause (ii), by striking the period at the 
end and inserting ‘‘; and’’; and 
(3) by adding at the end the following new 
clause: 
‘‘(iii) an evaluation of the sufficiency 
and consistency of the training provided to 
family caregivers under such program in 
preparing family caregivers to provide care 
to veterans under such program.’’. 
TITLE II—VA ASSET AND 
INFRASTRUCTURE REVIEW 
Subtitle A—Asset and 
Infrastructure Review 
SEC. 201. SHORT TITLE. 
This subtitle may be cited as the ‘‘VA Asset and In-
frastructure Review Act of 2018’’. 
SEC. 202. THE COMMISSION. 
(a) ESTABLISHMENT.—There is established an inde-
pendent commission to be known as the ‘‘Asset and Infra-
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structure Review Commission’’ (in this subtitle referred 
to as the ‘‘Commission’’). 
(b) DUTIES.—The Commission shall carry out the 
duties specified for it in this subtitle. 
(c) APPOINTMENT.— 
(1) IN GENERAL.— 
(A) 
APPOINTMENT.—The 
Commission 
shall be composed of 9 members appointed by 
the President, by and with the advice and con-
sent of the Senate. 
(B) TRANSMISSION
OF
NOMINATIONS.— 
The President shall transmit to the Senate the 
nominations for appointment to the Commission 
not later than May 31, 2021. 
(2) CONSULTATION IN SELECTION PROCESS.— 
In selecting individuals for nominations for appoint-
ments to the Commission, the President shall con-
sult with— 
(A) the Speaker of the House of Rep-
resentatives; 
(B) the majority leader of the Senate; 
(C) the minority leader of the House of 
Representatives; 
(D) the minority leader of the Senate; and 
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(E) congressionally chartered, membership 
based veterans service organizations concerning 
the appointment of three members. 
(3) DESIGNATION OF CHAIR.—At the time the 
President nominates individuals for appointment to 
the Commission under paragraph (1)(B), the Presi-
dent shall designate one such individual who shall 
serve as Chair of the Commission and one such indi-
vidual who shall serve as Vice Chair of the Commis-
sion. 
(4) MEMBER
REPRESENTATION.—In nomi-
nating individuals under this subsection, the Presi-
dent shall ensure that— 
(A) veterans, reflecting current demo-
graphics of veterans enrolled in the system of 
annual patient enrollment under section 1705 
of title 38, United States Code, are adequately 
represented in the membership of the Commis-
sion; 
(B) at least one member of the Commis-
sion has experience working for a private inte-
grated health care system that has annual gross 
revenues of more than $50,000,000; 
(C) at least one member has experience as 
a senior manager for an entity specified in 
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clause (ii), (iii), or (iv) of section 101(a)(1)(B) 
of the Veterans Access, Choice, and Account-
ability Act of 2014 (Public Law 113–146; 38 
U.S.C. 1701 note); 
(D) at least one member— 
(i) has experience with capital asset 
management for the Federal Government; 
and 
(ii) is familiar with trades related to 
building and real property, including con-
struction, engineering, architecture, leas-
ing, and strategic partnerships; and 
(E) at least three members represent con-
gressionally chartered, membership-based, vet-
erans service organizations. 
(d) MEETINGS.— 
(1) IN GENERAL.—The Commission shall meet 
only during calendar years 2022 and 2023. 
(2) PUBLIC NATURE OF MEETINGS AND PRO-
CEEDINGS.— 
(A) PUBLIC MEETINGS.—Each meeting of 
the Commission shall be open to the public. 
(B) OPEN
PARTICIPATION.—All the pro-
ceedings, information, and deliberations of the 
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Commission shall be available for review by the 
public. 
(e) VACANCIES.—A vacancy in the Commission shall 
be filled in the same manner as the original appointment, 
but the individual appointed to fill the vacancy shall serve 
only for the unexpired portion of the term for which the 
individual’s predecessor was appointed. 
(f) PAY.— 
(1) IN GENERAL.—Members of the Commission 
shall serve without pay. 
(2) OFFICERS OR EMPLOYEES OF THE UNITED 
STATES.—Each member of the Commission who is 
an officer or employee of the United States shall 
serve without compensation in addition to that re-
ceived for service as an officer or employee of the 
United States. 
(3) TRAVEL EXPENSES.—Members shall receive 
travel expenses, including per diem in lieu of subsist-
ence, in accordance with sections 5702 and 5703 of 
title 5, United States Code. 
(g) DIRECTOR OF STAFF.— 
(1) APPOINTMENT.—The Commission shall ap-
point a Director who— 
(A) has not served as an employee of the 
Department of Veterans Affairs during the one- 
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year period preceding the date of such appoint-
ment; and 
(B) is not otherwise barred or prohibited 
from serving as Director under Federal ethics 
laws and regulations, by reason of post-employ-
ment conflict of interest. 
(2) RATE OF PAY.—The Director shall be paid 
at the rate of basic pay payable for level IV of the 
Executive Schedule under section 5315 of title 5, 
United States Code. 
(h) STAFF.— 
(1) PAY
OF
PERSONNEL.—Subject to para-
graphs (2) and (3), the Director, with the approval 
of the Commission, may appoint and fix the pay of 
additional personnel. 
(2) EXEMPTION
FROM
CERTAIN
REQUIRE-
MENTS.—The Director may make such appoint-
ments without regard to the provisions of title 5, 
United States Code, governing appointments in the 
competitive service, and any personnel so appointed 
may be paid without regard to the provisions of 
chapter 51 and subchapter III of chapter 53 of that 
title relating to classification and General Schedule 
pay rates, except that an individual so appointed 
may not receive pay in excess of the annual rate of 
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basic pay payable for GS–15 of the General Sched-
ule. 
(3) DETAILEES.— 
(A) LIMITATION ON NUMBER.—Not more 
than two-thirds of the personnel employed by or 
detailed to the Commission may be on detail 
from the Department of Veterans Affairs. 
(B) PROFESSIONAL ANALYSTS.—Not more 
than half of the professional analysts of the 
Commission staff may be persons detailed from 
the Department of Veterans Affairs to the 
Commission. 
(C) PROHIBITION ON DETAIL OF CERTAIN 
PERSONNEL.—A person may not be detailed 
from the Department of Veterans Affairs to the 
Commission if, within 6 months before the de-
tail is to begin, that person participated person-
ally and substantially in any matter within the 
Department of Veterans Affairs concerning the 
preparation of recommendations regarding fa-
cilities of the Veterans Health Administration. 
(4) AUTHORITY TO REQUEST DETAILED PER-
SONNEL.—Subject to paragraph (3), the head of any 
Federal department or agency, upon the request of 
the Director, may detail any of the personnel of that 
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department or agency to the Commission to assist 
the Commission in carrying out its duties under this 
subtitle. 
(5) INFORMATION FROM FEDERAL AGENCIES.— 
The Commission may secure directly from any Fed-
eral agency such information the Commission con-
siders necessary to carry out this subtitle. Upon re-
quest of the Chair, the head of such agency shall 
furnish such information to the Commission. 
(i) OTHER AUTHORITY.— 
(1) TEMPORARY
AND
INTERMITTENT
SERV-
ICES.—The Commission may procure by contract, to 
the extent funds are available, the temporary or 
intermittent services of experts or consultants pursu-
ant to section 3109 of title 5, United States Code. 
(2) LEASING
AND
ACQUISITION
OF
PROP-
ERTY.—To the extent funds are available, the Com-
mission may lease real property and acquire personal 
property either of its own accord or in consultation 
with the General Services Administration. 
(j) TERMINATION.—The Commission shall terminate 
on December 31, 2023. 
(k) PROHIBITION AGAINST RESTRICTING COMMU-
NICATIONS.— 
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(1) IN GENERAL.—Except as provided in para-
graph (2), no person may restrict an employee of the 
Department of Veterans Affairs in communicating 
with the Commission. 
(2) UNLAWFUL COMMUNICATIONS.—Paragraph 
(1) does not apply to a communication that is un-
lawful. 
SEC. 203. PROCEDURE FOR MAKING RECOMMENDATIONS. 
(a) SELECTION CRITERIA.— 
(1) PUBLICATION.—The Secretary shall, not 
later than February 1, 2021, and after consulting 
with veterans service organizations, publish in the 
Federal Register and transmit to the Committees on 
Veterans’ Affairs of the Senate and the House of 
Representatives the criteria proposed to be used by 
the Department of Veterans Affairs in assessing and 
making recommendations regarding the moderniza-
tion or realignment of facilities of the Veterans 
Health Administration under this subtitle. Such cri-
teria shall include the preferences of veterans re-
garding health care furnished by the Department. 
(2) PUBLIC
COMMENT.—The Secretary shall 
provide an opportunity for public comment on the 
proposed criteria under paragraph (1) for a period 
of at least 90 days and shall include notice of that 
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136 
opportunity in the publication required under such 
paragraph. 
(3) PUBLICATION
OF
FINAL
CRITERIA.—The 
Secretary shall, not later than May 31, 2021, pub-
lish in the Federal Register and transmit to the 
Committees on Veterans’ Affairs of the Senate and 
the House of Representatives the final criteria to be 
used in making recommendations regarding the clo-
sure, modernization, or realignment of facilities of 
the Veterans Health Administration under this sub-
title. 
(b) RECOMMENDATIONS OF THE SECRETARY.— 
(1) PUBLICATION IN FEDERAL REGISTER.—The 
Secretary shall, not later than January 31, 2022, 
and after consulting with veterans service organiza-
tions, publish in the Federal Register and transmit 
to the Committees on Veterans’ Affairs of the Sen-
ate and the House of Representatives and to the 
Commission a report detailing the recommendations 
regarding the modernization or realignment of facili-
ties of the Veterans Health Administration on the 
basis of the final criteria referred to in subsection 
(a)(2) that are applicable. 
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(2) FACTORS FOR CONSIDERATION.—In making 
recommendations under this subsection, the Sec-
retary shall consider each of the following factors: 
(A) The degree to which any health care 
delivery or other site for providing services to 
veterans reflect the metrics of the Department 
of Veterans Affairs regarding market area 
health system planning. 
(B) The provision of effective and efficient 
access to high-quality health care and services 
for veterans. 
(C) The extent to which the real property 
that no longer meets the needs of the Federal 
Government could be reconfigured, repurposed, 
consolidated, realigned, exchanged, outleased, 
replaced, sold, or disposed. 
(D) The need of the Veterans Health Ad-
ministration to acquire infrastructure or facili-
ties that will be used for the provision of health 
care and services to veterans. 
(E) The extent to which the operating and 
maintenance costs are reduced through consoli-
dating, colocating, and reconfiguring space, and 
through realizing other operational efficiencies. 
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(F) The extent and timing of potential 
costs and savings, including the number of 
years such costs or savings will be incurred, be-
ginning with the date of completion of the pro-
posed recommendation. 
(G) The extent to which the real property 
aligns with the mission of the Department of 
Veterans Affairs. 
(H) The extent to which any action would 
impact other missions of the Department (in-
cluding education, research, or emergency pre-
paredness). 
(I) Local stakeholder inputs and any fac-
tors identified through public field hearings. 
(J) The assessments under paragraph (3). 
(K) The extent to which the Veterans 
Health Administration has appropriately staffed 
the medical facility, including determinations 
whether there has been insufficient resource al-
location or deliberate understaffing. 
(L) Any other such factors the Secretary 
determines appropriate. 
(3) CAPACITY AND COMMERCIAL MARKET AS-
SESSMENTS.— 
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(A) ASSESSMENTS.—The Secretary shall 
assess the capacity of each Veterans Integrated 
Service Network and medical facility of the De-
partment to furnish hospital care or medical 
services to veterans under chapter 17 of title 
38, United States Code. Each such assessment 
shall— 
(i) identify gaps in furnishing such 
care or services at such Veterans Inte-
grated Service Network or medical facility; 
(ii) identify how such gaps can be 
filled by— 
(I) entering into contracts or 
agreements with network providers 
under this section or with entities 
under other provisions of law; 
(II) making changes in the way 
such care and services are furnished 
at such Veterans Integrated Service 
Network or medical facility, includ-
ing— 
(aa) extending hours of op-
eration; 
(bb) adding personnel; or 
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140 
(cc) 
expanding 
space 
through the construction, leasing, 
or sharing of health care facili-
ties; and 
(III) the building or realignment 
of Department resources or personnel; 
(iii) forecast, based on future projec-
tions and historical trends, both the short- 
and long-term demand in furnishing care 
or services at such Veterans Integrated 
Service Network or medical facility and as-
sess how such demand affects the needs to 
use such network providers; 
(iv) include a commercial health care 
market 
assessment 
of 
designated 
catchment areas in the United States con-
ducted by a non-governmental entity; and 
(v) consider the unique ability of the 
Federal Government to retain a presence 
in an area otherwise devoid of commercial 
health care providers or from which such 
providers are at risk of leaving. 
(B) CONSULTATION.—In carrying out the 
assessments under subparagraph (A), the Sec-
retary shall consult with veterans service orga-
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141 
nizations and veterans served by each such Vet-
erans Integrated Service Network and medical 
facility. 
(C) SUBMITTAL.—The Secretary shall sub-
mit such assessments to the Committees on 
Veterans’ Affairs of the House of Representa-
tives and the Senate with the recommendations 
of the Secretary under this subsection and 
make the assessments publicly available. 
(4) SUMMARY
OF
SELECTION
PROCESS.—The 
Secretary shall include, with the list of recommenda-
tions published and transmitted pursuant to para-
graph (1), a summary of the selection process that 
resulted in the recommendation for each facility of 
the Veterans Health Administration, including a jus-
tification for each recommendation. The Secretary 
shall transmit the matters referred to in the pre-
ceding sentence not later than 7 days after the date 
of the transmittal to the Committees on Veterans’ 
Affairs of the Senate and the House of Representa-
tives and the Commission of the report referred to 
in paragraph (1). 
(5) TREATMENT OF FACILITIES.—In assessing 
facilities of the Veterans Health Administration, the 
Secretary shall consider all such facilities equally 
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without regard to whether the facility has been pre-
viously considered or proposed for reuse, closure, 
modernization, or realignment by the Department of 
Veterans Affairs. 
(6) AVAILABILITY OF INFORMATION TO CON-
GRESS.—In addition to making all information used 
by the Secretary to prepare the recommendations 
under this subsection available to Congress (includ-
ing any committee or Member of Congress), the Sec-
retary shall also make such information available to 
the Commission and the Comptroller General of the 
United States. 
(7) CERTIFICATION OF ACCURACY.— 
(A) IN GENERAL.—Each person referred to 
in subparagraph (B), when submitting informa-
tion to the Secretary or the Commission con-
cerning the modernization or realignment of a 
facility of the Veterans Health Administration, 
shall certify that such information is accurate 
and complete to the best of that person’s knowl-
edge and belief. 
(B) COVERED
PERSONS.—Subparagraph 
(A) applies to the following persons: 
(i) Each Under Secretary of the De-
partment of Veterans Affairs. 
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(ii) Each director of a Veterans Inte-
grated Service Network. 
(iii) Each director of a medical center 
of the Department of Veterans Affairs. 
(iv) Each director of a program office 
of the Department of Veterans Affairs. 
(v) Each person who is in a position 
the duties of which include personal and 
substantial involvement in the preparation 
and submission of information and rec-
ommendations concerning the moderniza-
tion or realignment of facilities of the Vet-
erans Health Administration. 
(c) REVIEW AND RECOMMENDATIONS BY THE COM-
MISSION.— 
(1) PUBLIC HEARINGS.— 
(A) IN GENERAL.—After receiving the rec-
ommendations from the Secretary pursuant to 
subsection (b), the Commission shall conduct 
public hearings on the recommendations. 
(B) LOCATIONS.—The Commission shall 
conduct public hearings in regions affected by a 
recommendation of the Secretary to close a fa-
cility of the Veterans Health Administration. 
To the greatest extent practicable, the Commis-
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144 
sion shall conduct public hearings in regions af-
fected by a recommendation of the Secretary to 
modernize or realign such a facility. 
(C) REQUIRED WITNESSES.—Witnesses at 
each public hearing shall include at a min-
imum— 
(i) a veteran— 
(I) enrolled under section 1705 
of title 38, United States Code; and 
(II) identified by a local veterans 
service organization; and 
(ii) a local elected official. 
(2) TRANSMITTAL TO PRESIDENT.— 
(A) IN GENERAL.—The Commission shall, 
not later than January 31, 2023, transmit to 
the President a report containing the Commis-
sion’s findings and conclusions based on a re-
view and analysis of the recommendations made 
by the Secretary, together with the Commis-
sion’s recommendations, for modernizations and 
realignments of facilities of the Veterans Health 
Administration. 
(B) AUTHORITY
TO
MAKE
CHANGES
TO 
RECOMMENDATIONS.—Subject to subparagraph 
(C), in making its recommendations, the Com-
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mission may change any recommendation made 
by the Secretary if the Commission— 
(i) determines that the Secretary devi-
ated substantially from the final criteria 
referred to in subsection (a)(2) in making 
such recommendation; 
(ii) determines that the change is con-
sistent with the final criteria referred to in 
subsection (a)(2); 
(iii) publishes a notice of the proposed 
change in the Federal Register not less 
than 45 days before transmitting its rec-
ommendations to the President pursuant 
to subparagraph (A); and 
(iv) conducts public hearings on the 
proposed change. 
(3) JUSTIFICATION FOR CHANGES.—The Com-
mission shall explain and justify in its report sub-
mitted to the President pursuant to paragraph (2) 
any recommendation made by the Commission that 
is different from the recommendations made by the 
Secretary pursuant to subsection (b). The Commis-
sion shall transmit a copy of such report to the 
Committees on Veterans’ Affairs of the Senate and 
the House of Representatives on the same date on 
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146 
which it transmits its recommendations to the Presi-
dent under paragraph (2). 
(4) PROVISION
OF
INFORMATION
TO
CON-
GRESS.—After the Commission transmits its report 
to the President, the Commission shall promptly 
provide, upon request, to any Member of Congress, 
information used by the Commission in making its 
recommendations. 
(d) REVIEW BY THE PRESIDENT.— 
(1) REPORT.—The President shall, not later 
than February 15, 2023, transmit to the Commis-
sion and to the Congress a report containing the 
President’s approval or disapproval of the Commis-
sion’s recommendations. 
(2) PRESIDENTIAL
APPROVAL.—If the Presi-
dent approves all the recommendations of the Com-
mission, the President shall transmit a copy of such 
recommendations to the Congress, together with a 
certification of such approval. 
(3) 
PRESIDENTIAL
DISAPPROVAL.—If 
the 
President disapproves the recommendations of the 
Commission, in whole or in part, the President shall 
transmit to the Commission and the Congress, not 
later than March 1, 2023, the reasons for that dis-
approval. The Commission, after consideration of the 
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President’s reasons for disapproval, shall then trans-
mit to the President, not later than March 15, 2023, 
a report containing— 
(A) the Commission’s findings and conclu-
sions based on a review and analysis of those 
reasons for disapproval provided by the Presi-
dent; and 
(B) recommendations that the Commission 
determines are appropriate for modernizations 
and realignments of facilities of the Veterans 
Health Administration. 
(4) TRANSMITTAL OF RECOMMENDATIONS TO 
CONGRESS.—If the President approves all rec-
ommendations of the Commission transmitted to the 
President under paragraph (3), the President shall 
transmit a copy of such recommendations to the 
Congress, together with a certification of such ap-
proval. 
(5) FAILURE TO TRANSMIT.—If the President 
does not transmit to the Congress an approval and 
certification described in paragraph (2) or (4) by 
March 30, 2023, the process by which facilities of 
the Veterans Health Administration may be selected 
for modernization or realignment under this subtitle 
shall be terminated. 
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SEC. 204. ACTIONS REGARDING INFRASTRUCTURE AND FA-
CILITIES OF THE VETERANS HEALTH ADMIN-
ISTRATION. 
(a) IN GENERAL.—Subject to subsection (b), the Sec-
retary shall begin to implement the recommended mod-
ernizations and realignments in the report under section 
203(d) not later than three years after the date on which 
the President transmits such report to Congress. In any 
fiscal year, such implementation includes— 
(1) the planning of modernizations and realign-
ments of facilities of the Veterans Health Adminis-
tration as recommended in such report; and 
(2) providing detailed information on the budg-
et for such modernizations or realignments in docu-
ments submitted to Congress by the Secretary in 
support of the President’s budget for that fiscal 
year. 
(b) CONGRESSIONAL DISAPPROVAL.— 
(1) IN GENERAL.—The Secretary may not carry 
out any modernization or realignment recommended 
by the Commission in a report transmitted from the 
President pursuant to section 203(d) if a joint reso-
lution is enacted, in accordance with the provisions 
of section 207, disapproving such recommendations 
of the Commission before the earlier of— 
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(A) the end of the 45-day period beginning 
on the date on which the President transmits 
such report; or 
(B) the adjournment of Congress sine die 
for the session during which such report is 
transmitted. 
(2) COMPUTATION OF PERIOD.—For purposes 
of paragraph (1) and subsections (a) and (c) of sec-
tion 207, the days on which either House of Con-
gress is not in session because of an adjournment of 
more than three days to a day certain shall be ex-
cluded in the computation of a period. 
SEC. 205. IMPLEMENTATION. 
(a) IN GENERAL.— 
(1) MODERNIZING
AND
REALIGNING
FACILI-
TIES.—In modernizing or realigning any facility of 
the Veterans Health Administration under this sub-
title, the Secretary may— 
(A) take such actions as may be necessary 
to modernize or realign any such facility, in-
cluding the alteration of such facilities, the ac-
quisition of such land, the leasing or construc-
tion of such replacement facilities, the disposi-
tion of such land or facilities, the performance 
of such activities, and the conduct of such ad-
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vance planning and design as may be required 
to transfer functions from a facility of the Vet-
erans Health Administration to another such 
facility, and may use for such purpose funds in 
the Account or funds appropriated to the De-
partment of Veterans Affairs for such purposes; 
(B) carry out activities for the purposes of 
environmental mitigation, abatement, or res-
toration at any such facility, and shall use for 
such purposes funds in the Account; 
(C) reimburse other Federal agencies for 
actions performed at the request of the Sec-
retary with respect to any such closure or re-
alignment, and may use for such purpose funds 
in the Account or funds appropriated to the De-
partment of Veterans Affairs and available for 
such purpose; and 
(D) exercise the authority of the Secretary 
under subchapter V of chapter 81 of title 38, 
United States Code. 
(2) ENVIRONMENTAL RESTORATION; HISTORIC 
PRESERVATION.—In carrying out any closure or re-
alignment under this subtitle, the Secretary, with re-
gards to any property made excess to the needs of 
the Department of Veterans Affairs as a result of 
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such closure or realignment, shall carry out, as soon 
as possible with funds available for such purpose, 
any of the following for which the Secretary is re-
sponsible: 
(A) Environmental mitigation. 
(B) Environmental abatement. 
(C) Environmental restoration. 
(D) Compliance with historic preservation 
requirements. 
(b) MANAGEMENT AND DISPOSAL OF PROPERTY.— 
(1) EXISTING
DISPOSAL
AUTHORITIES.—To 
transfer or dispose of surplus real property or infra-
structure located at any facility of the Veterans 
Health Administration that is modernized or re-
aligned under this title, the Secretary may exercise 
the authorities of the Secretary under subchapters I 
and II of chapter 81 of title 38, United States Code, 
or the authorities delegated to the Secretary by the 
Administrator of General Services under subchapter 
III of chapter 5 of title 40, United States Code. 
(2) EFFECTS ON LOCAL COMMUNITIES.— 
(A) CONSULTATION
WITH
STATE
AND 
LOCAL GOVERNMENT.—Before any action may 
be taken with respect to the disposal of any 
surplus real property or infrastructure located 
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at any facility of the Veterans Health Adminis-
tration to be closed or realigned under this sub-
title, the Secretary of Veterans Affairs shall 
consult with the Governor of the State and the 
heads of the local governments concerned for 
the purpose of considering any plan for the use 
of such property by the local community con-
cerned. 
(B) TREATMENT
OF
ROADS.—If infra-
structure or a facility of the Veterans Health 
Administration to be closed or realigned under 
this subtitle includes a road used for public ac-
cess through, into, or around the facility, the 
Secretary— 
(i) shall consult with the Government 
of the State and the heads of the local gov-
ernments concerned for the purpose of con-
sidering the continued availability of the 
road for public use after the recommended 
action is complete; and 
(ii) may exercise the authority of the 
Secretary under section 8108 of title 38, 
United States Code. 
(3) LEASES; CERCLA.— 
(A) LEASE AUTHORITY.— 
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(i) TRANSFER
TO
REDEVELOPMENT 
AUTHORITY
FOR
LEASE.—The Secretary 
may transfer title to a facility of the Vet-
erans Health Administration approved for 
closure or realignment under this subtitle 
(including property at a facility of the Vet-
erans Health Administration approved for 
realignment which will be retained by the 
Department of Veterans Affairs or another 
Federal agency after realignment) to the 
redevelopment authority for the facility if 
the redevelopment authority agrees to 
lease, directly upon transfer, one or more 
portions of the property transferred under 
this subparagraph to the Secretary or to 
the head of another department or agency 
of the Federal Government. 
(ii) TERM OF LEASE.—A lease under 
clause (i) shall be for a term of not to ex-
ceed 50 years, but may provide for options 
for renewal or extension of the term by the 
department or agency concerned. 
(iii) 
LIMITATION.—A 
lease 
under 
clause (i) may not require rental payments 
by the United States. 
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(iv) TREATMENT
OF
REMAINDERED 
LEASE TERMS.—A lease under clause (i) 
shall include a provision specifying that if 
the department or agency concerned ceases 
requiring the use of the leased property be-
fore the expiration of the term of the lease, 
the remainder of the lease term may be 
satisfied by the same or another depart-
ment or agency of the Federal Government 
using the property for a use similar to the 
use under the lease. Exercise of the au-
thority provided by this clause shall be 
made in consultation with the redevelop-
ment authority concerned. 
(v) 
FACILITY
SERVICES.—Notwith-
standing clause (iii), if a lease under clause 
(i) involves a substantial portion of the fa-
cility, the department or agency concerned 
may obtain facility services for the leased 
property and common area maintenance 
from the redevelopment authority or the 
redevelopment authority’s assignee as a 
provision of the lease. The facility services 
and common area maintenance shall be 
provided at a rate no higher than the rate 
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charged to non-Federal tenants of the 
transferred property. Facility services and 
common area maintenance covered by the 
lease shall not include— 
(I) municipal services that a 
State or local government is required 
by law to provide to all landowners in 
its jurisdiction without direct charge; 
or 
(II) firefighting or security-guard 
functions. 
(B) APPLICATION OF CERCLA.—The provi-
sions of section 120(h) of the Comprehensive 
Environmental Response, Compensation, and 
Liability Act of 1980 (42 U.S.C. 9620(h)) shall 
apply to any transfer of real property under 
this paragraph. 
(C) ADDITIONAL
TERMS
AND
CONDI-
TIONS.—The Secretary may require any addi-
tional terms and conditions in connection with 
a transfer under this paragraph as such Sec-
retary considers appropriate to protect the in-
terests of the United States. 
(4) APPLICATION OF MCKINNEY-VENTO HOME-
LESS
ASSISTANCE
ACT.—Nothing in this subtitle 
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shall limit or otherwise affect the application of the 
provisions of the McKinney-Vento Homeless Assist-
ance Act (42 U.S.C. 11301 et seq.) to facilities of 
the Veterans Health Administration closed under 
this subtitle. 
(c) APPLICABILITY OF NATIONAL ENVIRONMENTAL 
POLICY ACT OF 1969.— 
(1) IN GENERAL.—The provisions of the Na-
tional Environmental Policy Act of 1969 (42 U.S.C. 
4321 et seq.) shall not apply to the actions of the 
President, the Commission, and, except as provided 
in paragraph (2), the Department of Veterans Af-
fairs in carrying out this subtitle. 
(2) DEPARTMENT OF VETERANS AFFAIRS.— 
(A) COVERED ACTIVITIES.—The provisions 
of the National Environmental Policy Act of 
1969 shall apply to actions of the Department 
of Veterans Affairs under this subtitle— 
(i) during the process of property dis-
posal; and 
(ii) during the process of relocating 
functions from a facility of the Veterans 
Health Administration being closed or re-
aligned to another facility after the receiv-
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157 
ing facility has been selected but before the 
functions are relocated. 
(B) OTHER ACTIVITIES.—In applying the 
provisions of the National Environmental Policy 
Act of 1969 to the processes referred to in sub-
paragraph (A), the Secretary shall not have to 
consider— 
(i) the need for closing or realigning 
the facility of the Veterans Health Admin-
istration as recommended by the Commis-
sion; 
(ii) the need for transferring functions 
to any facility of the Veterans Health Ad-
ministration which has been selected as the 
receiving facility; or 
(iii) facilities of the Veterans Health 
Administration alternative to those rec-
ommended or selected. 
(d) WAIVER.— 
(1) RESTRICTIONS
ON
USE
OF
FUNDS.—The 
Secretary may close or realign facilities of the Vet-
erans Health Administration under this subtitle 
without regard to any provision of law restricting 
the use of funds for closing or realigning facilities of 
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the Veterans Health Administration included in any 
appropriation or authorization Act. 
(2) RESTRICTIONS ON AUTHORITIES.—The Sec-
retary may close or realign facilities of the Veterans 
Health Administration under this subtitle without 
regard to the restrictions of section 8110 of title 38, 
United States Code. 
(e) TRANSFER AUTHORITY IN CONNECTION WITH 
PAYMENT OF ENVIRONMENTAL REMEDIATION COSTS.— 
(1) IN GENERAL.— 
(A) TRANSFER
BY
DEED.—Subject to 
paragraph (2) of this subsection and section 
120(h) of the Comprehensive Environmental 
Response, Compensation, and Liability Act of 
1980 (42 U.S.C. 9620(h)), the Secretary may 
enter into an agreement to transfer by deed a 
facility of the Veterans Health Administration 
with any person who agrees to perform all envi-
ronmental restoration, waste management, and 
environmental compliance activities that are re-
quired for the property or facilities under Fed-
eral and State laws, administrative decisions, 
agreements (including schedules and mile-
stones), and concurrences. 
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(B) 
ADDITIONAL
TERMS
OR
CONDI-
TIONS.—The Secretary may require any addi-
tional terms and conditions in connection with 
an agreement authorized by subparagraph (A) 
as the Secretary considers appropriate to pro-
tect the interests of the United States. 
(2) LIMITATION.—A transfer of a facility of the 
Veterans Health Administration may be made under 
paragraph (1) only if the Secretary certifies to Con-
gress that— 
(A) the costs of all environmental restora-
tion, waste management, and environmental 
compliance activities otherwise to be paid by the 
Secretary with respect to the facility of the Vet-
erans Health Administration are equal to or 
greater than the fair market value of the prop-
erty or facilities to be transferred, as deter-
mined by the Secretary; or 
(B) if such costs are lower than the fair 
market value of the facility of the Veterans 
Health Administration, the recipient of such 
transfer agrees to pay the difference between 
the fair market value and such costs. 
(3) PAYMENT BY THE SECRETARY FOR CER-
TAIN TRANSFERS.—In the case of a facility of the 
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160 
Veterans Health Administration covered by a certifi-
cation under paragraph (2)(A), the Secretary may 
pay the recipient of such facility an amount equal to 
the lesser of— 
(A) the amount by which the costs in-
curred by the recipient of the facility of the 
Veterans Health Administration for all environ-
mental restoration, waste, management, and en-
vironmental compliance activities with respect 
to such facility exceed the fair market value of 
such property as specified in such certification; 
or 
(B) the amount by which the costs (as de-
termined by the Secretary) that would other-
wise have been incurred by the Secretary for 
such restoration, management, and activities 
with respect to such facility of the Veterans 
Health Administration exceed the fair market 
value of property as so specified. 
(4) DISCLOSURE.—As part of an agreement 
under paragraph (1), the Secretary shall disclose to 
the person to whom the facility of the Veterans 
Health Administration will be transferred any infor-
mation of the Secretary regarding the environmental 
restoration, waste management, and environmental 
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161 
compliance activities described in paragraph (1) that 
relate to the facility of the Veterans Health Admin-
istration. The Secretary shall provide such informa-
tion before entering into the agreement. 
(5) APPLICABILITY
OF
CERTAIN
ENVIRON-
MENTAL LAWS.—Nothing in this subsection shall be 
construed to modify, alter, or amend the Com-
prehensive Environmental Response, Compensation, 
and Liability Act of 1980 (42 U.S.C. 9601 et seq.) 
or the Solid Waste Disposal Act (42 U.S.C. 6901 et 
seq.). 
SEC. 206. DEPARTMENT OF VETERANS AFFAIRS ASSET AND 
INFRASTRUCTURE REVIEW ACCOUNT. 
(a) ESTABLISHMENT.—There is hereby established in 
the ledgers of the Treasury an account to be known as 
the ‘‘Department of Veterans Affairs Asset and Infra-
structure Review Account’’ which shall be administered by 
the Secretary as a single account. 
(b) CREDITS TO ACCOUNT.—There shall be credited 
to the Account the following: 
(1) Funds authorized for and appropriated to 
the Account. 
(2) Proceeds received from the lease, transfer, 
or disposal of any property at a facility of the Vet-
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erans Health Administration closed or realigned 
under this subtitle. 
(c) USE OF ACCOUNT.—The Secretary may use the 
funds in the Account only for the following purposes: 
(1) To carry out this subtitle. 
(2) To cover property management and disposal 
costs incurred at facilities of the Veterans Health 
Administration closed, modernized, or realigned 
under this subtitle. 
(3) To cover costs associated with supervision, 
inspection, overhead, engineering, and design of con-
struction projects undertaken under this subtitle, 
and subsequent claims, if any, related to such activi-
ties. 
(4) Other purposes that the Secretary deter-
mines support the mission and operations of the De-
partment of Veterans Affairs. 
(d) CONSOLIDATED BUDGET JUSTIFICATION DIS-
PLAY FOR ACCOUNT.— 
(1) CONSOLIDATED BUDGET INFORMATION RE-
QUIRED.—The Secretary shall establish a consoli-
dated budget justification display in support of the 
Account that for each fiscal year— 
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(A) details the amount and nature of cred-
its to, and expenditures from, the Account dur-
ing the preceding fiscal year; 
(B) separately details the environmental 
remediation costs associated with facility of the 
Veterans Health Administration for which a 
budget request is made; 
(C) specifies the transfers into the Account 
and the purposes for which these transferred 
funds will be further obligated, to include care-
taker and environment remediation costs associ-
ated with each facility of the Veterans Health 
Administration; and 
(D) details any intra-budget activity trans-
fers 
within 
the 
Account 
that 
exceeded 
$1,000,000 during the preceding fiscal year or 
that are proposed for the next fiscal year and 
will exceed $1,000,000. 
(2) SUBMISSION.—The Secretary shall include 
the information required by paragraph (1) in the 
materials that the Secretary submits to Congress in 
support of the budget for a fiscal year submitted by 
the President pursuant to section 1105 of title 31, 
United States Code. 
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(e) CLOSURE OF ACCOUNT; TREATMENT OF REMAIN-
ING FUNDS.— 
(1) CLOSURE.—The Account shall be closed at 
the time and in the manner provided for appropria-
tion accounts under section 1555 of title 31, United 
States Code, except that unobligated funds which re-
main in the Account upon closure shall be held by 
the Secretary of the Treasury until transferred to 
the Secretary of Veterans Affairs by law after the 
Committees on Veterans’ Affairs of the Senate and 
the House of Representatives receive the final report 
transmitted under paragraph (2). 
(2) FINAL
REPORT.—No later than 60 days 
after the closure of the Account under paragraph 
(1), the Secretary shall transmit to the Committees 
on Veterans’ Affairs of the Senate and the House of 
Representatives and the Committees on Appropria-
tions of the House of Representatives and the Sen-
ate a report containing an accounting of— 
(A) all the funds credited to and expended 
from the Account or otherwise expended under 
this subtitle; and 
(B) any funds remaining in the Account. 
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165 
SEC. 207. CONGRESSIONAL CONSIDERATION OF COMMIS-
SION REPORT. 
(a) DISAPPROVAL RESOLUTION.—For purposes of 
section 204(b), the term ‘‘joint resolution’’ means only a 
joint resolution which is introduced within the 5-day pe-
riod beginning on the date on which the President trans-
mits the report to the Congress under section 203(d), 
and— 
(1) which does not have a preamble; 
(2) the matter after the resolving clause of 
which is as follows: ‘‘that Congress disapproves the 
recommendations of the VHA Asset and Infrastruc-
ture Review Commission as submitted by the Presi-
dent on lll’’, the blank space being filled with 
the appropriate date; and 
(3) the title of which is as follows: ‘‘Joint reso-
lution disapproving the recommendations of the 
VHA Asset and Infrastructure Review Commis-
sion.’’. 
(b) CONSIDERATION IN THE HOUSE OF REPRESENT-
ATIVES.— 
(1) REPORTING
AND
DISCHARGE.—Any com-
mittee of the House of Representatives to which a 
joint resolution is referred shall report it to the 
House without amendment not later than 15 legisla-
tive days after the date of introduction thereof. If a 
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166 
committee fails to report the joint resolution within 
that period, the committee shall be discharged from 
further consideration of the joint resolution. 
(2) PROCEEDING TO CONSIDERATION.—It shall 
be in order at any time after the third legislative day 
after each committee authorized to consider a joint 
resolution has reported or has been discharged from 
consideration of a joint resolution, to move to pro-
ceed to consider the joint resolution in the House. 
All points of order against the motion are waived. 
Such a motion shall not be in order after the House 
has disposed of a motion to proceed on a joint reso-
lution addressing a particular submission. The pre-
vious question shall be considered as ordered on the 
motion to its adoption without intervening motion. 
The motion shall not be debatable. A motion to re-
consider the vote by which the motion is disposed of 
shall not be in order. 
(3) 
CONSIDERATION.—The 
joint 
resolution 
shall be considered as read. All points of order 
against the joint resolution and against its consider-
ation are waived. The previous question shall be con-
sidered as ordered on the joint resolution to its pas-
sage without intervening motion except two hours of 
debate equally divided and controlled by the pro-
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ponent and an opponent. A motion to reconsider the 
vote on passage of the joint resolution shall not be 
in order. 
(c) CONSIDERATION IN THE SENATE.— 
(1) REFERRAL.—A joint resolution introduced 
in the Senate shall be referred to the Committee on 
Veterans’ Affairs. 
(2) REPORTING
AND
DISCHARGE.—Any com-
mittee of the Senate to which a joint resolution is 
referred shall report it to the Senate without amend-
ment not later than 15 session days after the date 
of introduction of a joint resolution described in sub-
section (a). If a committee fails to report the joint 
resolution within that period, the committee shall be 
discharged from further consideration of the joint 
resolution and the joint resolution shall be placed on 
the calendar. 
(3) FLOOR CONSIDERATION.— 
(A) IN GENERAL.—Notwithstanding Rule 
XXII of the Standing Rules of the Senate, it is 
in order at any time after the third session day 
on which the Committee on Veterans’ Affairs 
has reported or has been discharged from con-
sideration of a joint resolution described in sub-
section (a) (even though a previous motion to 
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the same effect has been disagreed to) to move 
to proceed to the consideration of the joint reso-
lution, and all points of order against the joint 
resolution (and against consideration of the 
joint resolution) are waived. The motion to pro-
ceed is not debatable. The motion is not subject 
to a motion to postpone. A motion to reconsider 
the vote by which the motion is agreed to or 
disagreed to shall not be in order. If a motion 
to proceed to the consideration of the resolution 
is agreed to, the joint resolution shall remain 
the unfinished business until disposed of. 
(B) CONSIDERATION.—Consideration of 
the joint resolution, and on all debatable mo-
tions and appeals in connection therewith, shall 
be limited to not more than 2 hours, which 
shall be divided equally between the majority 
and minority leaders or their designees. A mo-
tion further to limit debate is in order and not 
debatable. An amendment to, or a motion to 
postpone, or a motion to proceed to the consid-
eration of other business, or a motion to recom-
mit the joint resolution is not in order. 
(C) VOTE ON PASSAGE.—If the Senate has 
voted to proceed to a joint resolution, the vote 
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on passage of the joint resolution shall occur 
immediately following the conclusion of consid-
eration of the joint resolution, and a single 
quorum call at the conclusion of the debate if 
requested in accordance with the rules of the 
Senate. 
(D) RULINGS OF THE CHAIR ON PROCE-
DURE.—Appeals from the decisions of the Chair 
relating to the application of the rules of the 
Senate, as the case may be, to the procedure re-
lating to a joint resolution shall be decided 
without debate. 
(d) AMENDMENT NOT IN ORDER.—A joint resolution 
of disapproval considered pursuant to this section shall not 
be subject to amendment in either the House of Rep-
resentatives or the Senate. 
(e) COORDINATION
WITH
ACTION
BY
OTHER 
HOUSE.— 
(1) IN GENERAL.—If, before passing the joint 
resolution, one House receives from the other a joint 
resolution— 
(A) the joint resolution of the other House 
shall not be referred to a committee; and 
(B) the procedure in the receiving House 
shall be the same as if no joint resolution had 
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been received from the other House until the 
vote on passage, when the joint resolution re-
ceived from the other House shall supplant the 
joint resolution of the receiving House. 
(2) TREATMENT
OF
JOINT
RESOLUTION
OF 
OTHER HOUSE.—If the Senate fails to introduce or 
consider a joint resolution under this section, the 
joint resolution of the House shall be entitled to ex-
pedited floor procedures under this section. 
(3) TREATMENT OF COMPANION MEASURES.— 
If, following passage of the joint resolution in the 
Senate, the Senate then receives the companion 
measure from the House of Representatives, the 
companion measure shall not be debatable. 
(f) RULES OF THE HOUSE OF REPRESENTATIVES 
AND SENATE.—This section is enacted by Congress— 
(1) as an exercise of the rulemaking power of 
the Senate and House of Representatives, respec-
tively, and as such it is deemed a part of the rules 
of each House, respectively, but applicable only with 
respect to the procedure to be followed in that 
House in the case of a joint resolution, and it super-
sedes other rules only to the extent that it is incon-
sistent with such rules; and 
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(2) with full recognition of the constitutional 
right of either House to change the rules (so far as 
relating to the procedure of that House) at any time, 
in the same manner, and to the same extent as in 
the case of any other rule of that House. 
SEC. 208. OTHER MATTERS. 
(a) ONLINE PUBLICATION OF COMMUNICATIONS.— 
(1) IN
GENERAL.—Not later than 24 hours 
after the transmission or receipt of any communica-
tion under this subtitle that is transmitted or re-
ceived by a party specified in paragraph (2), the 
Secretary of Veterans Affairs shall publish such 
communication online. 
(2) PARTIES SPECIFIED.—The parties specified 
under this paragraph are the following: 
(A) The Secretary of Veterans Affairs. 
(B) The Commission. 
(C) The President. 
(b) CONTINUATION
OF EXISTING CONSTRUCTION 
PROJECTS AND PLANNING.—During activities that the 
Commission, President, or Congress carry out under this 
subtitle, the Secretary of Veterans Affairs may not stop, 
solely because of such activities— 
(1) a construction or leasing project of the Vet-
erans Health Administration; 
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(2) long term planning regarding infrastructure 
and assets of the Veterans Health Administration; 
or 
(3) budgetary processes for the Veterans 
Health Administration. 
(c) RECOMMENDATIONS
FOR FUTURE ASSET RE-
VIEWS.—The Secretary of Veterans Affairs may, after 
consulting with veterans service organizations, include in 
budget submissions the Secretary submits after the termi-
nation of the Commission recommendations for future 
such commissions or other capital asset realignment and 
management processes. 
SEC. 209. DEFINITIONS. 
In this subtitle: 
(1) The term ‘‘Account’’ means the Department 
of Veterans Affairs Asset and Infrastructure Review 
Account established by section 206(a). 
(2) The term ‘‘Commission’’ means the Com-
mission established by section 202. 
(3) The term ‘‘date of approval’’, with respect 
to a modernization or realignment of a facility of the 
Veterans Health Administration, means the date on 
which the authority of Congress to disapprove a rec-
ommendation of modernization or realignment, as 
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the case may be, of such facility under this subtitle 
expires. 
(4) The term ‘‘facility of the Veterans Health 
Administration’’— 
(A) means any land, building, structure, or 
infrastructure (including any medical center, 
nursing home, domiciliary facility, outpatient 
clinic, center that provides readjustment coun-
seling, or leased facility) that is— 
(i) under the jurisdiction of the De-
partment of Veterans Affairs; 
(ii) under the control of the Veterans 
Health Administration; and 
(iii) not under the control of the Gen-
eral Services Administration; or 
(B) with respect to a colocated facility of 
the Department of Veterans Affairs, includes 
any land, building, or structure— 
(i) under the jurisdiction of the De-
partment of Veterans Affairs; 
(ii) under the control of another ad-
ministration of the Department of Vet-
erans Affairs; and 
(iii) not under the control of the Gen-
eral Services Administration. 
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