In the Senate of the United States, 
June 11, 2014. 
Resolved, That the bill from the House of Representa-
tives (H.R. 3230) entitled ‘‘An Act making continuing appro-
priations during a Government shutdown to provide pay and 
allowances to members of the reserve components of the 
Armed Forces who perform inactive-duty training during 
such period.’’, do pass with the following 
AMENDMENTS: 
Strike all after the enacting clause, and insert in lieu 
thereof: 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the ‘‘Vet-
erans’ Access to Care through Choice, Accountability, and 
Transparency Act of 2014’’. 
(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
Sec. 1. Short title; table of contents.
† HR 3230 EAS 
TITLE I—IMPROVEMENT OF SCHEDULING SYSTEM FOR HEALTH 
CARE APPOINTMENTS 
Sec. 101. Independent assessment of the scheduling of appointments and other 
health care management processes of the Department of Veterans 
Affairs. 
Sec. 102. Technology task force on review of scheduling system and software of 
the Department of Veterans Affairs. 
TITLE II—TRAINING AND HIRING OF HEALTH CARE STAFF 
Sec. 201. Treatment of staffing shortage and biannual report on staffing of med-
ical facilities of the Department of Veterans Affairs. 
Sec. 202. Clinic management training for managers and health care providers of 
the Department of Veterans Affairs. 
Sec. 203. Use of unobligated amounts to hire additional health care providers for 
the Veterans Health Administration. 
TITLE III—IMPROVEMENT OF ACCESS TO CARE FROM NON- 
DEPARTMENT OF VETERANS AFFAIRS PROVIDERS 
Sec. 301. Expanded availability of hospital care and medical services for veterans 
through the use of contracts. 
Sec. 302. Transfer of authority for payments for hospital care, medical services, 
and other health care from non-Department providers to the 
Chief Business Office of the Veterans Health Administration of 
the Department. 
Sec. 303. Enhancement of collaboration between Department of Veterans Affairs 
and Indian Health Service. 
Sec. 304. Enhancement of collaboration between Department of Veterans Affairs 
and Native Hawaiian health care systems. 
Sec. 305. Sense of Congress on prompt payment by Department of Veterans Af-
fairs. 
TITLE IV—HEALTH CARE ADMINISTRATIVE MATTERS 
Sec. 401. Improvement of access of veterans to mobile vet centers of the Depart-
ment of Veterans Affairs. 
Sec. 402. Commission on construction projects of the Department of Veterans Af-
fairs. 
Sec. 403. Commission on Access to Care. 
Sec. 404. Improved performance metrics for health care provided by Department 
of Veterans Affairs. 
Sec. 405. Improved transparency concerning health care provided by Department 
of Veterans Affairs. 
Sec. 406. Information for veterans on the credentials of Department of Veterans 
Affairs physicians. 
Sec. 407. Information in annual budget of the President on hospital care and 
medical services furnished through expanded use of contracts for 
such care. 
Sec. 408. Prohibition on falsification of data concerning wait times and quality 
measures at Department of Veterans Affairs. 
Sec. 409. Removal of Senior Executive Service employees of the Department of 
Veterans Affairs for performance.
† HR 3230 EAS 
TITLE V—HEALTH CARE RELATED TO SEXUAL TRAUMA 
Sec. 501. Expansion of eligibility for sexual trauma counseling and treatment to 
veterans on inactive duty training. 
Sec. 502. Provision of counseling and treatment for sexual trauma by the Depart-
ment of Veterans Affairs to members of the Armed Forces. 
Sec. 503. Reports on military sexual trauma. 
TITLE VI—MAJOR MEDICAL FACILITY LEASES 
Sec. 601. Authorization of major medical facility leases. 
Sec. 602. Budgetary treatment of Department of Veterans Affairs major medical 
facilities leases. 
TITLE VII—VETERANS BENEFITS MATTERS 
Sec. 701. Expansion of Marine Gunnery Sergeant John David Fry Scholarship. 
Sec. 702. Approval of courses of education provided by public institutions of high-
er learning for purposes of All-Volunteer Force Educational As-
sistance Program and Post-9/11 Educational Assistance condi-
tional on in-State tuition rate for veterans. 
TITLE VIII—APPROPRIATION AND EMERGENCY DESIGNATIONS 
Sec. 801. Appropriation of emergency amounts. 
Sec. 802. Emergency designations. 
TITLE 
I—IMPROVEMENT 
OF 
SCHEDULING 
SYSTEM 
FOR 
HEALTH 
CARE 
APPOINT-
MENTS 
SEC. 101. INDEPENDENT ASSESSMENT OF THE SCHED-
ULING 
OF 
APPOINTMENTS 
AND 
OTHER 
HEALTH CARE MANAGEMENT PROCESSES OF 
THE DEPARTMENT OF VETERANS AFFAIRS. 
(a) INDEPENDENT ASSESSMENT.— 
(1) ASSESSMENT.—Not later than 30 days after 
the date of the enactment of this Act, the Secretary of 
Veterans Affairs shall enter into a contract with an 
independent third party to assess the following:
† HR 3230 EAS 
(A) The process at each medical facility of 
the Department of Veterans Affairs for sched-
uling appointments for veterans to receive hos-
pital care, medical services, or other health care 
from the Department. 
(B) The staffing level and productivity of 
each medical facility of the Department, includ-
ing the following: 
(i) The case load of each health care 
provider of the Department. 
(ii) The time spent by each health care 
provider of the Department on matters other 
than the case load of such health care pro-
vider, including time spent by such health 
care provider as follows: 
(I) At a medical facility that is 
affiliated with the Department. 
(II) Conducting research. 
(III) Training or overseeing other 
health care professionals of the Depart-
ment. 
(C) The organization, processes, and tools 
used by the Department to support clinical docu-
mentation and the subsequent coding of inpa-
tient services.
† HR 3230 EAS 
(D) The purchasing, distribution, and use 
of pharmaceuticals, medical and surgical sup-
plies, and medical devices by the Department, 
including the following: 
(i) The prices paid for, standardiza-
tion of, and use by the Department of the 
following: 
(I) High-cost pharmaceuticals. 
(II) Medical and surgical sup-
plies. 
(III) Medical devices. 
(ii) The use by the Department of 
group purchasing arrangements to purchase 
pharmaceuticals, medical and surgical sup-
plies, medical devices, and health care re-
lated services. 
(iii) The strategy used by the Depart-
ment to distribute pharmaceuticals, medical 
and surgical supplies, and medical devices 
to Veterans Integrated Service Networks and 
medical facilities of the Department. 
(E) The performance of the Department in 
paying amounts owed to third parties and col-
lecting amounts owed to the Department with re-
spect to hospital care, medical services, and other
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health care, including any recommendations of 
the independent third party as follows: 
(i) To avoid the payment of penalties 
to vendors. 
(ii) To increase the collection of 
amounts owed to the Department for hos-
pital care, medical services, or other health 
care provided by the Department for which 
reimbursement from a third party is au-
thorized. 
(iii) To increase the collection of any 
other amounts owed to the Department. 
(2) ELEMENTS OF SCHEDULING ASSESSMENT.— 
In carrying out the assessment required by paragraph 
(1)(A), the independent third party shall do the fol-
lowing: 
(A) Review all training materials per-
taining to scheduling of appointments at each 
medical facility of the Department. 
(B) Assess whether all employees of the De-
partment conducting tasks related to scheduling 
are properly trained for conducting such tasks. 
(C) Assess whether changes in the technology 
or system used in scheduling appointments are 
necessary to limit access to the system to only
† HR 3230 EAS 
those employees that have been properly trained 
in conducting such tasks. 
(D) Assess whether health care providers of 
the Department are making changes to their 
schedules that hinder the ability of employees 
conducting such tasks to perform such tasks. 
(E) Assess whether the establishment of a 
centralized call center throughout the Depart-
ment for scheduling appointments at medical fa-
cilities of the Department would improve the 
process of scheduling such appointments. 
(F) Assess whether booking templates for 
each medical facility or clinic of the Department 
would improve the process of scheduling such ap-
pointments. 
(G) Recommend any actions to be taken by 
the Department to improve the process for sched-
uling such appointments, including the fol-
lowing: 
(i) Changes in training materials pro-
vided to employees of the Department with 
respect to conducting tasks related to sched-
uling such appointments.
† HR 3230 EAS 
(ii) Changes in monitoring and assess-
ment conducted by the Department of wait 
times of veterans for such appointments. 
(iii) Changes in the system used to 
schedule 
such 
appointments, 
including 
changes to improve how the Department— 
(I) measures wait times of vet-
erans for such appointments; 
(II) monitors the availability of 
health care providers of the Depart-
ment; and 
(III) provides veterans the ability 
to schedule such appointments. 
(iv) Such other actions as the inde-
pendent third party considers appropriate. 
(3) TIMING.—The independent third party car-
rying out the assessment required by paragraph (1) 
shall complete such assessment not later than 180 
days after entering into the contract described in such 
paragraph. 
(b) REPORT.— 
(1) IN GENERAL.—Not later than 90 days after 
the date on which the independent third party com-
pletes the assessment under this section, the Secretary 
shall submit to the Committee on Veterans’ Affairs of
† HR 3230 EAS 
the Senate and the Committee on Veterans’ Affairs of 
the House of Representatives a report on the results 
of such assessment. 
(2) PUBLICATION.—Not later than 30 days after 
submitting the report under paragraph (1), the Sec-
retary shall publish such report in the Federal Reg-
ister and on an Internet website of the Department 
accessible to the public. 
SEC. 102. TECHNOLOGY TASK FORCE ON REVIEW OF SCHED-
ULING SYSTEM AND SOFTWARE OF THE DE-
PARTMENT OF VETERANS AFFAIRS. 
(a) TASK FORCE REVIEW.— 
(1) IN GENERAL.—The Secretary of Veterans Af-
fairs shall, through the use of a technology task force, 
conduct a review of the needs of the Department of 
Veterans Affairs with respect to the scheduling system 
and scheduling software of the Department of Vet-
erans Affairs that is used by the Department to sched-
ule appointments for veterans for hospital care, med-
ical services, and other health care from the Depart-
ment. 
(2) AGREEMENT.— 
(A) IN GENERAL.—The Secretary shall seek 
to enter into an agreement with a technology or-
† HR 3230 EAS 
ganization or technology organizations to carry 
out the review required by paragraph (1). 
(B) PROHIBITION ON USE OF FUNDS.—No 
Federal funds may be used to assist the tech-
nology organization or technology organizations 
under subparagraph (A) in carrying out the re-
view required by paragraph (1). 
(b) REPORT.— 
(1) IN GENERAL.—Not later than 45 days after 
the date of the enactment of this Act, the technology 
task force required under subsection (a)(1) shall sub-
mit to the Secretary, the Committee on Veterans’ Af-
fairs of the Senate, and the Committee on Veterans’ 
Affairs of the House of Representatives a report set-
ting forth the findings and recommendations of the 
technology task force regarding the needs of the De-
partment with respect to the scheduling system and 
scheduling software of the Department described in 
such subsection. 
(2) ELEMENTS.—The report required by para-
graph (1) shall include the following: 
(A) Proposals for specific actions to be 
taken by the Department to improve the sched-
uling system and scheduling software of the De-
partment described in subsection (a)(1).
† HR 3230 EAS 
(B) A determination as to whether an exist-
ing off-the-shelf system would— 
(i) meet the needs of the Department to 
schedule appointments for veterans for hos-
pital care, medical services, and other 
health care from the Department; and 
(ii) improve the access of veterans to 
such care and services. 
(3) PUBLICATION.—Not later than 30 days after 
the receipt of the report required by paragraph (1), 
the Secretary shall publish such report in the Federal 
Register and on an Internet website of the Depart-
ment accessible to the public. 
(c) IMPLEMENTATION OF TASK FORCE RECOMMENDA-
TIONS.—Not later than one year after the receipt of the re-
port required by subsection (b)(1), the Secretary shall im-
plement the recommendations set forth in such report that 
the Secretary considers are feasible, advisable, and cost-ef-
fective.
† HR 3230 EAS 
TITLE II—TRAINING AND HIRING 
OF HEALTH CARE STAFF 
SEC. 201. TREATMENT OF STAFFING SHORTAGE AND BIAN-
NUAL REPORT ON STAFFING OF MEDICAL FA-
CILITIES OF THE DEPARTMENT OF VETERANS 
AFFAIRS. 
(a) STAFFING SHORTAGE.— 
(1) IN GENERAL.—Not later than 180 days after 
the date of the enactment of this Act, and not later 
than September 30 each year thereafter, the Inspector 
General of the Department of Veterans Affairs shall 
determine, and the Secretary of Veterans Affairs shall 
publish in the Federal Register, the five occupations 
of health care providers of the Department of Veterans 
Affairs for which there is the largest staffing shortage 
throughout the Department. 
(2) RECRUITMENT AND APPOINTMENT.—Notwith-
standing sections 3304 and 3309 through 3318 of title 
5, United States Code, the Secretary may, upon a de-
termination by the Inspector General under para-
graph (1) that there is a staffing shortage throughout 
the Department with respect to a particular occupa-
tion of health care provider, recruit and directly ap-
point highly qualified health care providers to serve
† HR 3230 EAS 
as health care providers in that particular occupation 
for the Department. 
(3) PRIORITY IN HEALTH PROFESSIONALS EDU-
CATIONAL
ASSISTANCE
PROGRAM
TO
CERTAIN
PRO-
VIDERS.—Section 7612(b)(5) of title 38, United 
States Code, is amended— 
(A) in subparagraph (A), by striking ‘‘and’’ 
at the end; 
(B) by redesignating subparagraph (B) as 
subparagraph (C); and 
(C) by inserting after subparagraph (A) the 
following new subparagraph (B): 
‘‘(B) shall give priority to applicants pursuing 
a course of education or training towards a career in 
an occupation for which the Secretary has, in the 
most current determination published in the Federal 
Register pursuant to section 201(a)(1) of the Vet-
erans’ Access to Care through Choice, Accountability, 
and Transparency Act of 2014, determined that there 
is one of the largest staffing shortages throughout the 
Department with respect to such occupation; and’’. 
(b) REPORTS.— 
(1) IN GENERAL.—Not later than 180 days after 
the date of the enactment of this Act, and not later 
than December 31 of each even numbered year there-
† HR 3230 EAS 
after until 2024, the Secretary of Veterans Affairs 
shall submit to the Committee on Veterans’ Affairs of 
the Senate and the Committee on Veterans’ Affairs of 
the House of Representatives a report assessing the 
staffing of each medical facility of the Department of 
Veterans Affairs. 
(2) ELEMENTS.—Each report submitted under 
paragraph (1) shall include the following: 
(A) The results of a system-wide assessment 
of all medical facilities of the Department to en-
sure the following: 
(i) Appropriate staffing levels for 
health care providers to meet the goals of the 
Secretary for timely access to care for vet-
erans. 
(ii) Appropriate staffing levels for sup-
port personnel, including clerks. 
(iii) Appropriate sizes for clinical pan-
els. 
(iv) Appropriate numbers of full-time 
staff, or full-time equivalents, dedicated to 
direct care of patients. 
(v) Appropriate physical plant space 
to meet the capacity needs of the Depart-
ment in that area.
† HR 3230 EAS 
(vi) Such other factors as the Secretary 
considers necessary. 
(B) A plan for addressing any issues identi-
fied in the assessment described in subparagraph 
(A), including a timeline for addressing such 
issues. 
(C) A list of the current wait times and 
workload levels for the following clinics in each 
medical facility: 
(i) Mental health. 
(ii) Primary care. 
(iii) Gastroenterology. 
(iv) Women’s health. 
(v) Such other clinics as the Secretary 
considers appropriate. 
(D) A description of the results of the most 
current determination of the Inspector General 
under paragraph (1) of subsection (a) and a 
plan to use direct appointment authority under 
paragraph (2) of such subsection to fill staffing 
shortages, including recommendations for im-
proving the speed at which the credentialing and 
privileging process can be conducted.
† HR 3230 EAS 
(E) The current staffing models of the De-
partment for the following clinics, including rec-
ommendations for changes to such models: 
(i) Mental health. 
(ii) Primary care. 
(iii) Gastroenterology. 
(iv) Women’s health. 
(v) Such other clinics as the Secretary 
considers appropriate. 
(F) A detailed analysis of succession plan-
ning at medical facilities of the Department, in-
cluding the following: 
(i) The number of positions in medical 
facilities throughout the Department that 
are not filled by a permanent employee. 
(ii) The length of time each position 
described in clause (i) remained vacant or 
filled by a temporary or acting employee. 
(iii) A description of any barriers to 
filling the positions described in clause (i). 
(iv) A plan for filling any positions 
that are vacant or filled by a temporary or 
acting employee for more than 180 days.
† HR 3230 EAS 
(v) A plan for handling emergency cir-
cumstances, such as administrative leave or 
sudden medical leave for senior officials. 
(G) The number of health care providers of 
the Department who have been removed from 
their positions, have retired, or have left their 
positions for another reason, disaggregated by 
provider type, during the two-year period pre-
ceding the submittal of the report. 
(H) Of the health care providers specified in 
subparagraph (G) who have been removed from 
their positions, the following: 
(i) The number of such health care pro-
viders who were reassigned to other posi-
tions in the Department. 
(ii) The number of such health care 
providers who left the Department. 
(iii) The number of such health care 
providers who left the Department and were 
subsequently rehired by the Department. 
SEC. 202. CLINIC MANAGEMENT TRAINING FOR MANAGERS 
AND HEALTH CARE PROVIDERS OF THE DE-
PARTMENT OF VETERANS AFFAIRS. 
(a) CLINIC MANAGEMENT TRAINING PROGRAM.—
† HR 3230 EAS 
(1) IN GENERAL.—Not later than 180 days after 
the date of the enactment of this Act, the Secretary of 
Veterans Affairs shall commence a clinic management 
training program to provide in-person, standardized 
education on health care management to all managers 
of, and health care providers at, medical facilities of 
the Department of Veterans Affairs. 
(2) ELEMENTS.—The clinic management train-
ing program required by paragraph (1) shall include 
the following: 
(A) Training on how to manage the sched-
ules of health care providers of the Department, 
including the following: 
(i) Maintaining such schedules in a 
manner that allows appointments to be 
booked at least eight weeks in advance. 
(ii) Proper planning procedures for va-
cation, leave, and graduate medical edu-
cation training schedules. 
(B) Training on the appropriate number of 
appointments that a health care provider should 
conduct on a daily basis, based on specialty. 
(C) Training on how to determine whether 
there are enough available appointment slots to 
manage demand for different appointment types
† HR 3230 EAS 
and mechanisms for alerting management of in-
sufficient slots. 
(D) Training on how to properly use the 
appointment scheduling system of the Depart-
ment, including any new scheduling system im-
plemented by the Department. 
(E) Training on how to optimize the use of 
technology, including the following: 
(i) Telemedicine. 
(ii) Electronic mail. 
(iii) Text messaging. 
(iv) Such other technologies as speci-
fied by the Secretary. 
(F) Training on how to properly use phys-
ical plant space at medical facilities of the De-
partment to ensure efficient flow and privacy for 
patients and staff. 
(3) SUNSET.—The clinic management training 
program required by paragraph (1) shall terminate 
on the date that is two years after the date on which 
the Secretary commences such program. 
(b) TRAINING MATERIALS.— 
(1) IN GENERAL.—After the termination of the 
clinic management training program required by 
subsection (a), the Secretary shall provide training
† HR 3230 EAS 
materials on health care management to each of the 
following employees of the Department upon the com-
mencement of employment of such employee: 
(A) Any manager of a medical facility of 
the Department. 
(B) Any health care provider at a medical 
facility of the Department. 
(C) Such other employees of the Department 
as the Secretary considers appropriate. 
(2) UPDATE.—The Secretary shall regularly up-
date the training materials required under paragraph 
(1). 
SEC. 203. USE OF UNOBLIGATED AMOUNTS TO HIRE ADDI-
TIONAL HEALTH CARE PROVIDERS FOR THE 
VETERANS HEALTH ADMINISTRATION. 
(a) IN GENERAL.—At the end of each of fiscal years 
2014 and 2015, all covered amounts shall be made available 
to the Secretary of Veterans Affairs to hire additional health 
care providers for the Veterans Health Administration of 
the Department of Veterans Affairs, or to carry out any 
provision of this Act or the amendments made by this Act, 
and shall remain available until expended. 
(b) PRIORITY
IN
HIRING.—The Secretary shall 
prioritize hiring additional health care providers under 
subsection (a) at medical facilities of the Department and
† HR 3230 EAS 
in geographic areas in which the Secretary identifies the 
greatest shortage of health care providers. 
(c) COVERED AMOUNTS DEFINED.—In this section, the 
term ‘‘covered amounts’’ means amounts— 
(1) that are made available to the Veterans 
Health Administration of the Department for an ap-
propriations account— 
(A) under the heading ‘‘MEDICAL
SERV-
ICES’’; 
(B) under the heading ‘‘MEDICAL SUPPORT 
AND COMPLIANCE’’; or 
(C) under the heading ‘‘MEDICAL FACILI-
TIES’’; and 
(2) that are unobligated at the end of the appli-
cable fiscal year. 
TITLE III—IMPROVEMENT OF AC-
CESS TO CARE FROM NON-DE-
PARTMENT OF VETERANS AF-
FAIRS PROVIDERS 
SEC. 301. EXPANDED AVAILABILITY OF HOSPITAL CARE 
AND 
MEDICAL 
SERVICES 
FOR 
VETERANS 
THROUGH THE USE OF CONTRACTS. 
(a) EXPANSION OF AVAILABLE CARE AND SERVICES.— 
(1) FURNISHING OF CARE.—
† HR 3230 EAS 
(A) IN GENERAL.—Hospital care and med-
ical services under chapter 17 of title 38, United 
States Code, shall be furnished to an eligible vet-
eran described in subsection (b), at the election 
of such veteran, through contracts authorized 
under subsection (d), or any other law adminis-
tered by the Secretary of Veterans Affairs, with 
entities specified in subparagraph (B) for the 
furnishing of such care and services to veterans. 
(B) ENTITIES
SPECIFIED.—The entities 
specified in this subparagraph are the following: 
(i) Any health care provider that is 
participating in the Medicare program 
under title XVIII of the Social Security Act 
(42 U.S.C. 1395 et seq.). 
(ii) Any Federally-qualified health cen-
ter (as defined in section 1905(l)(2)(B) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396d(l)(2)(B))). 
(iii) The Department of Defense. 
(iv) The Indian Health Service. 
(2) CHOICE OF PROVIDER.—An eligible veteran 
who elects to receive care and services under this sec-
tion may select the provider of such care and services 
from among any source of provider of such care and
† HR 3230 EAS 
services through an entity specified in paragraph 
(1)(B) that is accessible to the veteran. 
(3) COORDINATION OF CARE AND SERVICES.— 
The Secretary shall coordinate, through the Non-VA 
Care Coordination Program of the Department of Vet-
erans Affairs, the furnishing of care and services 
under this section to eligible veterans, including by 
ensuring that an eligible veteran receives an appoint-
ment for such care and services within the current 
wait-time goals of the Veterans Health Administra-
tion for the furnishing of hospital care and medical 
services. 
(b) ELIGIBLE VETERANS.—A veteran is an eligible vet-
eran for purposes of this section if— 
(1)(A) the veteran is enrolled in the patient en-
rollment system of the Department of Veterans Affairs 
established and operated under section 1705 of title 
38, United States Code; or 
(B) the veteran is enrolled in such system, has 
not received hospital care or medical services from the 
Department, and has contacted the Department seek-
ing an initial appointment from the Department for 
the receipt of such care or services; and 
(2) the veteran—
† HR 3230 EAS 
(A)(i) attempts, or has attempted under 
paragraph (1)(B), to schedule an appointment 
for the receipt of hospital care or medical serv-
ices under chapter 17 of title 38, United States 
Code, but is unable to schedule an appointment 
within the current wait-time goals of the Vet-
erans Health Administration for the furnishing 
of such care or services; and 
(ii) elects, and is authorized, to be furnished 
such care or services pursuant to subsection 
(c)(2); 
(B) resides more than 40 miles from the 
nearest medical facility of the Department, in-
cluding a community-based outpatient clinic, 
that is closest to the residence of the veteran; or 
(C) resides— 
(i) in a State without a medical facil-
ity of the Department that provides— 
(I) hospital care; 
(II) emergency medical services; 
and 
(III) surgical care rated by the 
Secretary as having a surgical com-
plexity of standard; and
† HR 3230 EAS 
(ii) more than 20 miles from a medical 
facility of the Department described in 
clause (i). 
(c) ELECTION AND AUTHORIZATION.— 
(1) IN GENERAL.—If the Secretary confirms that 
an appointment for an eligible veteran described in 
subsection (b)(2)(A) for the receipt of hospital care or 
medical services under chapter 17 of title 38, United 
States Code, is unavailable within the current wait- 
time goals of the Department for the furnishing of 
such care or services, the Secretary shall, at the elec-
tion of the eligible veteran— 
(A) place such eligible veteran on an elec-
tronic waiting list described in paragraph (2) 
for such an appointment; or 
(B)(i) authorize that such care and services 
be furnished to the eligible veteran under this 
section for a period of time specified by the Sec-
retary; and 
(ii) send a letter to the eligible veteran de-
scribing the care and services the eligible veteran 
is eligible to receive under this section. 
(2) ELECTRONIC WAITING LIST.—The electronic 
waiting list described in this paragraph shall be 
maintained by the Department and allow access by
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each eligible veteran via www.myhealth.va.gov or any 
successor website for the following purposes: 
(A) To determine the place of such eligible 
veteran on the waiting list. 
(B) To determine the average length of time 
an individual spends on the waiting list, 
disaggregated by medical facility of the Depart-
ment and type of care or service needed, for pur-
poses of allowing such eligible veteran to make 
an informed election under paragraph (1). 
(d) CARE AND SERVICES THROUGH CONTRACTS.— 
(1) IN GENERAL.—The Secretary shall enter into 
contracts with health care providers that are partici-
pating in the Medicare program under title XVIII of 
the Social Security Act (42 U.S.C. 1395 et seq.) to 
furnish care and services to eligible veterans under 
this section. 
(2) RATES AND REIMBURSEMENT.— 
(A) IN GENERAL.—In entering into a con-
tract under this subsection, the Secretary shall— 
(i) negotiate rates for the furnishing of 
care and services under this section; and 
(ii) reimburse the health care provider 
for such care and services at the rates nego-
† HR 3230 EAS 
tiated pursuant to clause (i) as provided in 
such contract. 
(B) LIMIT ON RATES.— 
(i) IN GENERAL.—Except as provided 
in clause (ii), rates negotiated under sub-
paragraph (A)(i) shall not be more than the 
rates paid by the United States to a pro-
vider of services (as defined in section 
1861(u) of the Social Security Act (42 
U.S.C. 1395x(u))) or a supplier (as defined 
in section 1861(d) of such Act (42 U.S.C. 
1395x(d))) under the Medicare program 
under title XVIII of the Social Security Act 
(42 U.S.C. 1395 et seq.) for the same care 
and services. 
(ii) EXCEPTION.—The Secretary may 
negotiate a rate that is more than the rate 
paid by the United States as described in 
clause (i) with respect to the furnishing of 
care or services under this section to an eli-
gible veteran if the Secretary determines 
that there is no health care provider that 
will provide such care or services to such el-
igible veteran at the rate required under 
such clause—
† HR 3230 EAS 
(I) within the current wait-time 
goals of the Veterans Health Adminis-
tration for the furnishing of such care 
or services; and 
(II) at a location not more than 
40 miles from the residence of such eli-
gible veteran. 
(C) LIMIT ON COLLECTION.—For the fur-
nishing of care and services pursuant to a con-
tract under this section, a health care provider 
may not collect any amount that is greater than 
the rate negotiated pursuant to subparagraph 
(A)(i). 
(3) INFORMATION
ON
POLICIES
AND
PROCE-
DURES.—The Secretary shall provide to any health 
care provider with which the Secretary has entered 
into a contract under paragraph (1) the following: 
(A) Information on applicable policies and 
procedures for submitting bills or claims for au-
thorized care and services furnished to eligible 
veterans under this section. 
(B) Access to a telephone hotline main-
tained by the Department that such health care 
provider may call for information on the fol-
lowing:
† HR 3230 EAS 
(i) Procedures for furnishing care and 
services under this section. 
(ii) Procedures for submitting bills or 
claims for authorized care and services fur-
nished to eligible veterans under this section 
and being reimbursed for furnishing such 
care and services. 
(iii) Whether particular care or serv-
ices under this section are authorized, and 
the procedures for authorization of such care 
or services. 
(e) CHOICE CARD.— 
(1) IN GENERAL.—For purposes of receiving care 
and services under this section, the Secretary shall 
issue to each eligible veteran a card that the eligible 
veteran shall present to a health care provider that is 
eligible to furnish care and services under this section 
before receiving such care and services. 
(2) NAME OF CARD.—Each card issued under 
paragraph (1) shall be known as a ‘‘Choice Card’’. 
(3) DETAILS
OF
CARD.—Each Choice Card 
issued to an eligible veteran under paragraph (1) 
shall include the following: 
(A) The name of the eligible veteran.
† HR 3230 EAS 
(B) An identification number for the eligi-
ble veteran that is not the social security number 
of the eligible veteran. 
(C) The contact information of an appro-
priate office of the Department for health care 
providers to confirm that care and services under 
this section are authorized for the eligible vet-
eran. 
(D) Contact information and other relevant 
information for the submittal of claims or bills 
for the furnishing of care and services under this 
section. 
(E) The following statement: ‘‘This card is 
for qualifying medical care outside the Depart-
ment of Veterans Affairs. Please call the Depart-
ment of Veterans Affairs phone number specified 
on this card to ensure that treatment has been 
authorized.’’. 
(4) INFORMATION
ON
USE
OF
CARD.—Upon 
issuing a Choice Card to an eligible veteran, the Sec-
retary shall provide the eligible veteran with informa-
tion clearly stating the circumstances under which the 
veteran may be eligible for care and services under 
this section.
† HR 3230 EAS 
(f) INFORMATION ON AVAILABILITY OF CARE.—The 
Secretary shall provide information to a veteran about the 
availability of care and services under this section in the 
following circumstances: 
(1) When the veteran enrolls in the patient en-
rollment system of the Department under section 1705 
of title 38, United States Code. 
(2) When the veteran attempts to schedule an ap-
pointment for the receipt of hospital care or medical 
services from the Department but is unable to sched-
ule an appointment within the current wait-time 
goals of the Veterans Health Administration for deliv-
ery of such care or services. 
(g) PROVIDERS.—To be eligible to furnish care and 
services under this section, a health care provider must— 
(1) maintain at least the same or similar creden-
tials and licenses as those credentials and licenses 
that are required of health care providers of the De-
partment, as determined by the Secretary for pur-
poses of this section; and 
(2) submit, not less frequently than once each 
year, verification of such licenses and credentials 
maintained by such health care provider. 
(h) COST-SHARING.—
† HR 3230 EAS 
(1) IN GENERAL.—The Secretary shall require 
an eligible veteran to pay a copayment to the Depart-
ment for the receipt of care and services under this 
section only if such eligible veteran would be required 
to pay such copayment for the receipt of such care 
and services at a medical facility of the Department. 
(2) LIMITATION.—The copayment required under 
paragraph (1) shall not be greater than the copay-
ment required of such eligible veteran by the Depart-
ment for the receipt of such care and services at a 
medical facility of the Department. 
(i) CLAIMS PROCESSING SYSTEM.— 
(1) IN GENERAL.—The Secretary shall provide 
for an efficient nationwide system for processing and 
paying bills or claims for authorized care and services 
furnished to eligible veterans under this section. 
(2) REGULATIONS.—Not later than 90 days after 
the date of the enactment of this Act, the Secretary of 
Veterans Affairs shall prescribe regulations for the 
implementation of such system. 
(3) OVERSIGHT.—The Chief Business Office of 
the Veterans Health Administration shall oversee the 
implementation and maintenance of such system. 
(4) ACCURACY OF PAYMENT.—
† HR 3230 EAS 
(A) IN GENERAL.—The Secretary shall en-
sure that such system meets such goals for accu-
racy of payment as the Secretary shall specify 
for purposes of this section. 
(B) ANNUAL REPORT.— 
(i) IN GENERAL.—Not later than one 
year after the date of the enactment of this 
Act, and annually thereafter until the ter-
mination date specified in subsection (n), 
the Secretary shall submit to the Committee 
on Veterans’ Affairs of the Senate and the 
Committee on Veterans’ Affairs of the House 
of Representatives a report on the goals for 
accuracy of such system. 
(ii) ELEMENTS.—Each report required 
by clause (i) shall include the following: 
(I) A description of the goals for 
accuracy for such system specified by 
the Secretary under subparagraph (A). 
(II) An assessment of the success 
of the Department in meeting such 
goals during the year preceding the 
submittal of the report. 
(j) MEDICAL RECORDS.—The Secretary shall ensure 
that any health care provider that furnishes care and serv-
† HR 3230 EAS 
ices under this section to an eligible veteran submits to the 
Department any medical record related to the care and 
services provided to such eligible veteran by such health care 
provider for inclusion in the electronic medical record of 
such eligible veteran maintained by the Department upon 
the completion of the provision of such care and services 
to such eligible veteran. 
(k) TRACKING OF MISSED APPOINTMENTS.—The Sec-
retary shall implement a mechanism to track any missed 
appointments for care and services under this section by 
eligible veterans to ensure that the Department does not pay 
for such care and services that were not furnished to an 
eligible veteran. 
(l) IMPLEMENTATION.—Not later than 90 days after 
the date of the enactment of this Act, the Secretary shall 
prescribe interim final regulations on the implementation 
of this section and publish such regulations in the Federal 
Register. 
(m) INSPECTOR GENERAL REPORT.—Not later than 
540 days after the publication of the interim final regula-
tions under subsection (l), the Inspector General of the De-
partment shall submit to the Secretary a report on the re-
sults of an audit of the care and services furnished under 
this section to ensure the accuracy and timeliness of pay-
ments by the Department for the cost of such care and serv-
† HR 3230 EAS 
ices, including any findings and recommendations of the 
Inspector General. 
(n) TERMINATION.—The requirement of the Secretary 
to furnish care and services under this section terminates 
on the date that is two years after the date on which the 
Secretary publishes the interim final regulations under sub-
section (l). 
(o) REPORTS.— 
(1) INITIAL REPORT.—Not later than 90 days 
after the publication of the interim final regulations 
under subsection (l), the Secretary shall submit to the 
Committee on Veterans’ Affairs of the Senate and the 
Committee on Veterans’ Affairs of the House of Rep-
resentatives a report on the furnishing of care and 
services under this section that includes the following: 
(A) The number of eligible veterans who 
have received care and services under this sec-
tion. 
(B) A description of the type of care and 
services furnished to eligible veterans under this 
section. 
(2) FINAL REPORT.—Not later than 540 days 
after the publication of the interim final regulations 
under subsection (l), the Secretary shall submit to the 
Committee on Veterans’ Affairs of the Senate and the
† HR 3230 EAS 
Committee on Veterans’ Affairs of the House of Rep-
resentatives a report on the furnishing of care and 
services under this section that includes the following: 
(A) The total number of eligible veterans 
who have received care and services under this 
section, disaggregated by— 
(i) eligible veterans described in sub-
section (b)(2)(A); and 
(ii) eligible veterans described in sub-
section (b)(2)(B). 
(B) A description of the type of care and 
services furnished to eligible veterans under this 
section. 
(C) An accounting of the total cost of fur-
nishing care and services to eligible veterans 
under this section. 
(D) The results of a survey of eligible vet-
erans who have received care or services under 
this section on the satisfaction of such eligible 
veterans with the care or services received by 
such eligible veterans under this section. 
(E) An assessment of the effect of furnishing 
care and services under this section on wait 
times for an appointment for the receipt of hos-
† HR 3230 EAS 
pital care and medical services from the Depart-
ment. 
(F) An assessment of the feasibility and ad-
visability of continuing furnishing care and 
services under this section after the termination 
date specified in subsection (n). 
(p) RULES OF CONSTRUCTION.— 
(1) NO MODIFICATION OF CONTRACTS.—Nothing 
in this section shall be construed to require the Sec-
retary to renegotiate contracts for the furnishing of 
hospital care or medical services to veterans entered 
into by the Department before the date of the enact-
ment of this Act. 
(2) FILLING
AND
PAYING
FOR
PRESCRIPTION 
MEDICATIONS.—Nothing in this section shall be con-
strued to alter the process of the Department for fill-
ing and paying for prescription medications. 
SEC. 302. TRANSFER OF AUTHORITY FOR PAYMENTS FOR 
HOSPITAL CARE, MEDICAL SERVICES, AND 
OTHER HEALTH CARE FROM NON-DEPART-
MENT PROVIDERS TO THE CHIEF BUSINESS 
OFFICE OF THE VETERANS HEALTH ADMINIS-
TRATION OF THE DEPARTMENT. 
(a) TRANSFER OF AUTHORITY.—
† HR 3230 EAS 
(1) IN GENERAL.—Effective on October 1, 2014, 
the Secretary of Veterans Affairs shall transfer the au-
thority to pay for hospital care, medical services, and 
other health care through non-Department providers 
to the Chief Business Office of the Veterans Health 
Administration of the Department of Veterans Affairs 
from the Veterans Integrated Service Networks and 
medical centers of the Department of Veterans Affairs. 
(2) MANNER OF CARE.—The Chief Business Of-
fice shall work in consultation with the Office of Clin-
ical Operations and Management of the Department 
of Veterans Affairs to ensure that care and services 
described in paragraph (1) are provided in a manner 
that is clinically appropriate and effective. 
(3) NO DELAY IN PAYMENT.—The transfer of au-
thority under paragraph (1) shall be carried out in 
a manner that does not delay or impede any payment 
by the Department for hospital care, medical services, 
or other health care provided through a non-Depart-
ment provider under the laws administered by the 
Secretary. 
(b) BUDGETARY EFFECT.—The Secretary shall, for 
each fiscal year that begins after the date of the enactment 
of this Act—
† HR 3230 EAS 
(1) include in the budget for the Chief Business 
Office of the Veterans Health Administration amounts 
to pay for hospital care, medical services, and other 
health care provided through non-Department pro-
viders, including any amounts necessary to carry out 
the transfer of authority to pay for such care and 
services under subsection (a), including any increase 
in staff; and 
(2) not include in the budget of each Veterans 
Integrated Service Network and medical center of the 
Department amounts to pay for such care and serv-
ices. 
SEC. 303. ENHANCEMENT OF COLLABORATION BETWEEN 
DEPARTMENT OF VETERANS AFFAIRS AND IN-
DIAN HEALTH SERVICE. 
(a) OUTREACH
TO TRIBAL-RUN MEDICAL FACILI-
TIES.—The Secretary of Veterans Affairs shall, in consulta-
tion with the Director of the Indian Health Service, conduct 
outreach to each medical facility operated by an Indian 
tribe or tribal organization through a contract or compact 
with the Indian Health Service under the Indian Self-De-
termination and Education Assistance Act (25 U.S.C. 450 
et seq.) to raise awareness of the ability of such facilities, 
Indian tribes, and tribal organizations to enter into agree-
ments with the Department of Veterans Affairs under which
† HR 3230 EAS 
the Secretary reimburses such facilities, Indian tribes, or 
tribal organizations, as the case may be, for health care pro-
vided to veterans eligible for health care at such facilities. 
(b) METRICS FOR MEMORANDUM OF UNDERSTANDING 
PERFORMANCE.—The Secretary of Veterans Affairs shall 
implement performance metrics for assessing the perform-
ance by the Department of Veterans Affairs and the Indian 
Health Service under the memorandum of understanding 
entitled ‘‘Memorandum of Understanding between the De-
partment of Veterans Affairs (VA) and the Indian Health 
Service (IHS)’’ in increasing access to health care, improv-
ing quality and coordination of health care, promoting ef-
fective patient-centered collaboration and partnerships be-
tween the Department and the Service, and ensuring health- 
promotion and disease-prevention services are appro-
priately funded and available for beneficiaries under both 
health care systems. 
(c) REPORT.—Not later than 180 days after the date 
of the enactment of this Act, the Secretary of Veterans Af-
fairs and the Director of the Indian Health Service shall 
jointly submit to Congress a report on the feasibility and 
advisability of the following: 
(1) Entering into agreements for the reimburse-
ment by the Secretary of the costs of direct care serv-
ices 
provided 
through 
organizations 
receiving
† HR 3230 EAS 
amounts pursuant to grants made or contracts en-
tered into under section 503 of the Indian Health 
Care Improvement Act (25 U.S.C. 1653) to veterans 
who are otherwise eligible to receive health care from 
such organizations. 
(2) Including the reimbursement of the costs of 
direct care services provided to veterans who are not 
Indians in agreements between the Department and 
the following: 
(A) The Indian Health Service. 
(B) An Indian tribe or tribal organization 
operating a medical facility through a contract 
or compact with the Indian Health Service 
under the Indian Self-Determination and Edu-
cation Assistance Act (25 U.S.C. 450 et seq.). 
(C) A medical facility of the Indian Health 
Service. 
(d) DEFINITIONS.—In this section: 
(1) INDIAN.—The terms ‘‘Indian’’ and ‘‘Indian 
tribe’’ have the meanings given those terms in section 
4 of the Indian Health Care Improvement Act (25 
U.S.C. 1603). 
(2) MEDICAL FACILITY OF THE INDIAN HEALTH 
SERVICE.—The term ‘‘medical facility of the Indian 
Health Service’’ includes a facility operated by an In-
† HR 3230 EAS 
dian tribe or tribal organization through a contract 
or compact with the Indian Health Service under the 
Indian Self-Determination and Education Assistance 
Act (25 U.S.C. 450 et seq.). 
(3) TRIBAL
ORGANIZATION.—The term ‘‘tribal 
organization’’ has the meaning given the term in sec-
tion 4 of the Indian Self-Determination and Edu-
cation Assistance Act (25 U.S.C. 450b). 
SEC. 304. ENHANCEMENT OF COLLABORATION BETWEEN 
DEPARTMENT OF VETERANS AFFAIRS AND 
NATIVE HAWAIIAN HEALTH CARE SYSTEMS. 
(a) IN GENERAL.—The Secretary of Veterans Affairs 
shall, in consultation with Papa Ola Lokahi and such other 
organizations involved in the delivery of health care to Na-
tive Hawaiians as the Secretary considers appropriate, 
enter into contracts or agreements with Native Hawaiian 
health care systems that are in receipt of funds from the 
Secretary of Health and Human Services pursuant to 
grants awarded or contracts entered into under section 6(a) 
of the Native Hawaiian Health Care Improvement Act (42 
U.S.C. 11705(a)) for the reimbursement of direct care serv-
ices provided to eligible veterans as specified in such con-
tracts or agreements. 
(b) DEFINITIONS.—In this section, the terms ‘‘Native 
Hawaiian’’, ‘‘Native Hawaiian health care system’’, and
† HR 3230 EAS 
‘‘Papa Ola Lokahi’’ have the meanings given those terms 
in section 12 of the Native Hawaiian Health Care Improve-
ment Act (42 U.S.C. 11711). 
SEC. 305. SENSE OF CONGRESS ON PROMPT PAYMENT BY 
DEPARTMENT OF VETERANS AFFAIRS. 
It is the sense of Congress that the Secretary of Vet-
erans Affairs shall comply with section 1315 of title 5, Code 
of Federal Regulations (commonly known as the ‘‘prompt 
payment rule’’), or any corresponding similar regulation 
or ruling, in paying for health care pursuant to contracts 
entered into with non-Department of Veterans Affairs pro-
viders to provide health care under the laws administered 
by the Secretary. 
TITLE IV—HEALTH CARE 
ADMINISTRATIVE MATTERS 
SEC. 401. IMPROVEMENT OF ACCESS OF VETERANS TO MO-
BILE VET CENTERS OF THE DEPARTMENT OF 
VETERANS AFFAIRS. 
(a) IMPROVEMENT OF ACCESS.— 
(1) IN GENERAL.—The Secretary of Veterans Af-
fairs shall improve the access of veterans to telemedi-
cine and other health care through the use of mobile 
vet centers of the Department of Veterans Affairs by 
providing standardized requirements for the operation 
of such centers.
† HR 3230 EAS 
(2) REQUIREMENTS.—The standardized require-
ments required by paragraph (1) shall include the fol-
lowing: 
(A) The number of days each mobile vet 
center of the Department is expected to travel per 
year. 
(B) The number of locations each center is 
expected to visit per year. 
(C) The number of appointments each cen-
ter is expected to conduct per year. 
(D) The method and timing of notifications 
given by each center to individuals in the area 
to which such center is traveling, including noti-
fications informing veterans of the availability 
to schedule appointments at the center. 
(3) USE
OF
TELEMEDICINE.—The Secretary 
shall ensure that each mobile vet center of the Depart-
ment has the capability to provide telemedicine serv-
ices. 
(b) REPORTS.—Not later than one year after the date 
of the enactment of this Act, and not later than September 
30 each year thereafter, the Secretary of Veterans Affairs 
shall submit to the Committee on Veterans’ Affairs of the 
Senate and the Committee on Veterans’ Affairs of the House 
of Representatives a report on the following:
† HR 3230 EAS 
(1) The use of mobile vet centers to provide tele-
medicine services to veterans during the year pre-
ceding the submittal of the report, including the fol-
lowing: 
(A) The number of days each mobile vet 
center was open to provide such services. 
(B) The number of days each mobile vet 
center traveled to a location other than the head-
quarters of the mobile vet center to provide such 
services. 
(C) The number of appointments each cen-
ter conducted to provide such services on average 
per month and in total during such year. 
(2) An analysis of the effectiveness of using mo-
bile vet centers to provide health care services to vet-
erans through the use of telemedicine. 
(3) Any recommendations for an increase in the 
number of mobile vet centers of the Department. 
(4) Any recommendations for an increase in the 
telemedicine capabilities of each mobile vet center. 
(5) The feasibility and advisability of using tem-
porary health care providers, including locum tenens, 
to provide direct health care services to veterans at 
mobile vet centers.
† HR 3230 EAS 
(6) Such other recommendations on improvement 
of the use of mobile vet centers by the Department as 
the Secretary considers appropriate. 
SEC. 402. COMMISSION ON CONSTRUCTION PROJECTS OF 
THE DEPARTMENT OF VETERANS AFFAIRS. 
(a) ESTABLISHMENT OF COMMISSION.— 
(1) ESTABLISHMENT.—There is established an 
Independent Commission on Department of Veterans 
Affairs Construction Projects (in this section referred 
to as the ‘‘Commission’’). 
(2) MEMBERSHIP.— 
(A) VOTING
MEMBERS.—The Commission 
shall be composed of 10 voting members as fol-
lows: 
(i) Three members to be appointed by 
the President from among members of the 
National Academy of Engineering who are 
nominated under subparagraph (B). 
(ii) Three members to be appointed by 
the President from among members of the 
National Institute of Building Sciences who 
are nominated under subparagraph (B). 
(iii) Four members to be appointed by 
the President from among veterans enrolled 
in the patient enrollment system of the De-
† HR 3230 EAS 
partment of Veterans Affairs under section 
1705 of title 38, United States Code, who 
are nominated under subparagraph (B). 
(B) NOMINATION OF VOTING MEMBERS.— 
The majority leader of the Senate, the minority 
leader of the Senate, the speaker of the House of 
Representatives, and the minority leader of the 
House of Representatives shall jointly nominate 
not less than 24 individuals to be considered by 
the President for appointment under subpara-
graph (A). 
(C) NONVOTING
MEMBERS.—The Commis-
sion shall be composed of the following nonvoting 
members: 
(i) The Comptroller General of the 
United States, or designee. 
(ii) The Secretary of Veterans Affairs, 
or designee. 
(iii) The Inspector General of the De-
partment of Veterans Affairs, or designee. 
(D) DATE
OF
APPOINTMENT
OF
MEM-
BERS.—The appointments of the members of the 
Commission under subparagraph (A) shall be 
made not later than 14 days after the date of the 
enactment of this Act.
† HR 3230 EAS 
(3) PERIOD
OF
APPOINTMENT; VACANCIES.— 
Members shall be appointed for the life of the Com-
mission. Any vacancy in the Commission shall not af-
fect its powers, but shall be filled in the same manner 
as the original appointment. 
(4) INITIAL MEETING.—Not later than five days 
after the date on which all members of the Commis-
sion have been appointed, the Commission shall hold 
its first meeting. 
(5) MEETINGS.—The Commission shall meet at 
the call of the Chairperson. 
(6) QUORUM.—A majority of the members of the 
Commission shall constitute a quorum, but a lesser 
number of members may hold hearings. 
(7) CHAIRPERSON AND VICE CHAIRPERSON.—The 
Commission shall select a Chairperson and Vice 
Chairperson from among its members. 
(b) DUTIES OF COMMISSION.— 
(1) REVIEW.—The Commission shall review cur-
rent construction and maintenance projects and the 
medical facility leasing program of the Department of 
Veterans Affairs to identify any problems experienced 
by the Department in carrying out such projects and 
program. 
(2) REPORTS.—
† HR 3230 EAS 
(A) COMMISSION REPORT.—Not later than 
120 days after the date of the enactment of this 
Act, the Commission shall submit to the Sec-
retary of Veterans Affairs, the Committee on Vet-
erans’ Affairs of the Senate, and the Committee 
on Veterans’ Affairs of the House of Representa-
tives a report setting forth recommendations, if 
any, for improving the manner in which the Sec-
retary carries out the projects and program spec-
ified in paragraph (1). 
(B) DEPARTMENT REPORT.—Not later than 
60 days after the submittal of the report under 
subparagraph (A), the Secretary of Veterans Af-
fairs shall submit to the Committee on Veterans’ 
Affairs of the Senate and the Committee on Vet-
erans’ Affairs of the House of Representatives a 
report on the feasibility and advisability of im-
plementing the recommendations of the Commis-
sion, if any, included in the report submitted 
under such subparagraph, including a timeline 
for the implementation of such recommendations. 
(c) POWERS OF COMMISSION.— 
(1) HEARINGS.—The Commission may hold such 
hearings, sit and act at such times and places, take
† HR 3230 EAS 
such testimony, and receive such evidence as the Com-
mission considers advisable to carry out this section. 
(2) INFORMATION FROM FEDERAL AGENCIES.— 
The Commission may secure directly from any Fed-
eral agency such information as the Commission con-
siders necessary to carry out this section. Upon re-
quest of the Chairperson of the Commission, the head 
of such agency shall furnish such information to the 
Commission. 
(d) COMMISSION PERSONNEL MATTERS.— 
(1) COMPENSATION OF MEMBERS.—Each mem-
ber of the Commission who is not an officer or em-
ployee of the Federal Government shall be com-
pensated at a rate equal to the daily equivalent of the 
annual rate of basic pay prescribed for level IV of the 
Executive Schedule under section 5315 of title 5, 
United States Code, for each day (including travel 
time) during which such member is engaged in the 
performance of the duties of the Commission. All 
members of the Commission who are officers or em-
ployees of the United States shall serve without com-
pensation in addition to that received for their serv-
ices as officers or employees of the United States. 
(2) TRAVEL
EXPENSES.—The members of the 
Commission shall be allowed travel expenses, includ-
† HR 3230 EAS 
ing per diem in lieu of subsistence, at rates author-
ized for employees of agencies under subchapter I of 
chapter 57 of title 5, United States Code, while away 
from their homes or regular places of business in the 
performance of services for the Commission. 
(3) STAFF.— 
(A) IN GENERAL.—The Chairperson of the 
Commission may, without regard to the civil 
service laws and regulations, appoint and termi-
nate an executive director and such other addi-
tional personnel as may be necessary to enable 
the Commission to perform its duties. The em-
ployment of an executive director shall be subject 
to confirmation by the Commission. 
(B) COMPENSATION.—The Chairperson of 
the Commission may fix the compensation of the 
executive director and other personnel without 
regard to chapter 51 and subchapter III of chap-
ter 53 of title 5, United States Code, relating to 
classification of positions and General Schedule 
pay rates, except that the rate of pay for the ex-
ecutive director and other personnel may not ex-
ceed the rate payable for level V of the Executive 
Schedule under section 5316 of such title.
† HR 3230 EAS 
(4) DETAIL OF GOVERNMENT EMPLOYEES.—Any 
Federal Government employee may be detailed to the 
Commission without reimbursement, and such detail 
shall be without interruption or loss of civil service 
status or privilege. 
(5) PROCUREMENT OF TEMPORARY AND INTER-
MITTENT SERVICES.—The Chairperson of the Com-
mission may procure temporary and intermittent 
services under section 3109(b) of title 5, United States 
Code, at rates for individuals that do not exceed the 
daily equivalent of the annual rate of basic pay pre-
scribed for level V of the Executive Schedule under 
section 5316 of such title. 
(e) TERMINATION OF COMMISSION.—The Commission 
shall terminate 30 days after the date on which the Com-
mission submits its report under subsection (b)(2)(A). 
SEC. 403. COMMISSION ON ACCESS TO CARE. 
(a) ESTABLISHMENT OF COMMISSION.— 
(1) IN GENERAL.—There is established the Com-
mission on Access to Care (in this section referred to 
as the ‘‘Commission’’) to examine the access of vet-
erans to health care from the Department of Veterans 
Affairs and strategically examine how best to organize 
the Veterans Health Administration, locate health 
care resources, and deliver health care to veterans
† HR 3230 EAS 
during the 10- to 20-year period beginning on the 
date of the enactment of this Act. 
(2) MEMBERSHIP.— 
(A) VOTING
MEMBERS.—The Commission 
shall be composed of 10 voting members who are 
appointed by the President as follows: 
(i) At least two members who represent 
an organization recognized by the Secretary 
of Veterans Affairs for the representation of 
veterans under section 5902 of title 38, 
United States Code. 
(ii) At least one member from among 
persons who have experience as senior man-
agement for a private integrated health care 
system with an annual gross revenue of 
more than $50,000,000. 
(iii) At least one member from among 
persons who are familiar with government 
health care systems, including those systems 
of the Department of Defense, the Indian 
Health Service, and Federally-qualified 
health 
centers 
(as 
defined 
in 
section 
1905(l)(2)(B) of the Social Security Act (42 
U.S.C. 1396d(l)(2)(B))).
† HR 3230 EAS 
(iv) At least two members from among 
persons who are familiar with the Veterans 
Health Administration but are not current 
employees of the Veterans Health Adminis-
tration. 
(v) At least two members from among 
persons who are veterans or eligible for hos-
pital care, medical services, or other health 
care under the laws administered by the 
Secretary of Veterans Affairs. 
(B) NONVOTING MEMBERS.— 
(i) IN GENERAL.—In addition to mem-
bers appointed under subparagraph (A), the 
Commission shall be composed of 10 non-
voting members who are appointed by the 
President as follows: 
(I) At least two members who rep-
resent an organization recognized by 
the Secretary of Veterans Affairs for 
the representation of veterans under 
section 5902 of title 38, United States 
Code. 
(II) At least one member from 
among persons who have experience as 
senior management for a private inte-
† HR 3230 EAS 
grated health care system with an an-
nual gross revenue of more than 
$50,000,000. 
(III) At least one member from 
among persons who are familiar with 
government health care systems, in-
cluding those systems of the Depart-
ment of Defense, the Indian Health 
Service, and Federally-qualified health 
centers 
(as 
defined 
in 
section 
1905(l)(2)(B) of the Social Security 
Act (42 U.S.C. 1396d(l)(2)(B))). 
(IV) At least two members from 
among persons who are familiar with 
the Veterans Health Administration 
but are not current employees of the 
Veterans Health Administration. 
(V) At least two members from 
among persons who are veterans or eli-
gible for hospital care, medical services, 
or other health care under the laws ad-
ministered by the Secretary of Veterans 
Affairs. 
(ii) ADDITIONAL
NONVOTING
MEM-
BERS.—In addition to members appointed
† HR 3230 EAS 
under subparagraph (A) and clause (i), the 
Commission shall be composed of the fol-
lowing nonvoting members: 
(I) The Comptroller General of the 
United States, or designee. 
(II) The Inspector General of the 
Department of Veterans Affairs, or des-
ignee. 
(C) DATE.—The appointments of members 
of the Commission shall be made not later than 
60 days after the date of the enactment of this 
Act. 
(3) PERIOD
OF
APPOINTMENT; VACANCIES.— 
Members shall be appointed for the life of the Com-
mission. Any vacancy in the Commission shall not af-
fect its powers, but shall be filled in the same manner 
as the original appointment. 
(4) INITIAL MEETING.—Not later than 15 days 
after the date on which seven voting members of the 
Commission have been appointed, the Commission 
shall hold its first meeting. 
(5) MEETINGS.—The Commission shall meet at 
the call of the Chairperson.
† HR 3230 EAS 
(6) QUORUM.—A majority of the members of the 
Commission shall constitute a quorum, but a lesser 
number of members may hold hearings. 
(7) CHAIRPERSON AND VICE CHAIRPERSON.—The 
Commission shall select a Chairperson and Vice 
Chairperson from among its members. 
(b) DUTIES OF COMMISSION.— 
(1) EVALUATION AND ASSESSMENT.—The Com-
mission shall undertake a comprehensive evaluation 
and assessment of access to health care at the Depart-
ment of Veterans Affairs. 
(2) MATTERS EVALUATED AND ASSESSED.—The 
matters evaluated and assessed by the Commission 
shall include the following: 
(A) The appropriateness of current stand-
ards of the Department of Veterans Affairs con-
cerning access to health care. 
(B) The measurement of such standards. 
(C) The appropriateness of performance 
standards and incentives in relation to stand-
ards described in subparagraph (A). 
(D) Staffing levels throughout the Veterans 
Health Administration and whether they are suf-
ficient to meet current demand for health care 
from the Administration.
† HR 3230 EAS 
(E) The results of the assessment conducted 
by an independent third party under section 
101(a), including any data or recommendations 
included in such assessment. 
(3) REPORTS.—The Commission shall submit to 
the President, through the Secretary of Veterans Af-
fairs, reports as follows: 
(A) Not later than 90 days after the date of 
the initial meeting of the Commission, an in-
terim report on— 
(i) the findings of the Commission with 
respect to the evaluation and assessment re-
quired by this subsection; and 
(ii) such recommendations as the Com-
mission may have for legislative or admin-
istrative action to improve access to health 
care through the Veterans Health Adminis-
tration. 
(B) Not later than 180 days after the date 
of the initial meeting of the Commission, a final 
report on— 
(i) the findings of the Commission with 
respect to the evaluation and assessment re-
quired by this subsection; and
† HR 3230 EAS 
(ii) such recommendations as the Com-
mission may have for legislative or admin-
istrative action to improve access to health 
care through the Veterans Health Adminis-
tration. 
(c) POWERS OF THE COMMISSION.— 
(1) HEARINGS.—The Commission may hold such 
hearings, sit and act at such times and places, take 
such testimony, and receive such evidence as the Com-
mission considers advisable to carry out this section. 
(2) INFORMATION FROM FEDERAL AGENCIES.— 
The Commission may secure directly from any Fed-
eral department or agency such information as the 
Commission considers necessary to carry out this sec-
tion. Upon request of the Chairperson of the Commis-
sion, the head of such department or agency shall fur-
nish such information to the Commission. 
(d) COMMISSION PERSONNEL MATTERS.— 
(1) COMPENSATION OF MEMBERS.—Each mem-
ber of the Commission who is not an officer or em-
ployee of the Federal Government shall be com-
pensated at a rate equal to the daily equivalent of the 
annual rate of basic pay prescribed for level IV of the 
Executive Schedule under section 5315 of title 5, 
United States Code, for each day (including travel
† HR 3230 EAS 
time) during which such member is engaged in the 
performance of the duties of the Commission. All 
members of the Commission who are officers or em-
ployees of the United States shall serve without com-
pensation in addition to that received for their serv-
ices as officers or employees of the United States. 
(2) TRAVEL
EXPENSES.—The members of the 
Commission shall be allowed travel expenses, includ-
ing per diem in lieu of subsistence, at rates author-
ized for employees of agencies under subchapter I of 
chapter 57 of title 5, United States Code, while away 
from their homes or regular places of business in the 
performance of services for the Commission. 
(3) STAFF.— 
(A) IN GENERAL.—The Chairperson of the 
Commission may, without regard to the civil 
service laws and regulations, appoint and termi-
nate an executive director and such other addi-
tional personnel as may be necessary to enable 
the Commission to perform its duties. The em-
ployment of an executive director shall be subject 
to confirmation by the Commission. 
(B) COMPENSATION.—The Chairperson of 
the Commission may fix the compensation of the 
executive director and other personnel without
† HR 3230 EAS 
regard to chapter 51 and subchapter III of chap-
ter 53 of title 5, United States Code, relating to 
classification of positions and General Schedule 
pay rates, except that the rate of pay for the ex-
ecutive director and other personnel may not ex-
ceed the rate payable for level V of the Executive 
Schedule under section 5316 of such title. 
(4) DETAIL OF GOVERNMENT EMPLOYEES.—Any 
Federal Government employee may be detailed to the 
Commission without reimbursement, and such detail 
shall be without interruption or loss of civil service 
status or privilege. 
(5) PROCUREMENT OF TEMPORARY AND INTER-
MITTENT SERVICES.—The Chairperson of the Com-
mission may procure temporary and intermittent 
services under section 3109(b) of title 5, United States 
Code, at rates for individuals that do not exceed the 
daily equivalent of the annual rate of basic pay pre-
scribed for level V of the Executive Schedule under 
section 5316 of such title. 
(e) TERMINATION OF THE COMMISSION.—The Com-
mission shall terminate 30 days after the date on which 
the Commission submits its report under subsection 
(b)(3)(B).
† HR 3230 EAS 
(f) FUNDING.—The Secretary of Veterans Affairs shall 
make available to the Commission from amounts appro-
priated or otherwise made available to the Secretary such 
amounts as the Secretary and the Chairperson of the Com-
mission jointly consider appropriate for the Commission to 
perform its duties under this section. 
(g) EXECUTIVE ACTION.— 
(1) ACTION ON RECOMMENDATIONS.—The Presi-
dent shall require the Secretary of Veterans Affairs 
and such other heads of relevant Federal departments 
and agencies to implement each recommendation set 
forth in a report submitted under subsection (b)(3) 
that the President— 
(A) considers feasible and advisable; and 
(B) determines can be implemented without 
further legislative action. 
(2) REPORTS.—Not later than 60 days after the 
date on which the President receives a report under 
subsection (b)(3), the President shall submit to the 
Committee on Veterans’ Affairs of the Senate and the 
Committee on Veterans’ Affairs of the House of Rep-
resentatives and such other committees of Congress as 
the President considers appropriate a report setting 
forth the following:
† HR 3230 EAS 
(A) An assessment of the feasibility and ad-
visability of each recommendation contained in 
the report received by the President. 
(B) For each recommendation assessed as 
feasible and advisable under subparagraph (A) 
the following: 
(i) Whether such recommendation re-
quires legislative action. 
(ii) If such recommendation requires 
legislative action, a recommendation con-
cerning such legislative action. 
(iii) A description of any administra-
tive action already taken to carry out such 
recommendation. 
(iv) A description of any administra-
tive action the President intends to be taken 
to carry out such recommendation and by 
whom. 
SEC. 404. IMPROVED PERFORMANCE METRICS FOR HEALTH 
CARE PROVIDED BY DEPARTMENT OF VET-
ERANS AFFAIRS. 
(a) PROHIBITION ON USE OF SCHEDULING AND WAIT- 
TIME METRICS
IN DETERMINATION
OF PERFORMANCE 
AWARDS.—The Secretary of Veterans Affairs shall ensure 
that scheduling and wait-time metrics or goals are not used
† HR 3230 EAS 
as factors in determining the performance of the following 
employees for purposes of determining whether to pay per-
formance awards to such employees: 
(1) Directors, associate directors, assistant direc-
tors, deputy directors, chiefs of staff, and clinical 
leads of medical centers of the Department of Veterans 
Affairs. 
(2) Directors, assistant directors, and quality 
management officers of Veterans Integrated Service 
Networks of the Department of Veterans Affairs. 
(b) MODIFICATION OF PERFORMANCE PLANS.— 
(1) IN GENERAL.—Not later than 30 days after 
the date of the enactment of this Act, the Secretary 
shall modify the performance plans of the directors of 
the medical centers of the Department and the direc-
tors of the Veterans Integrated Service Networks to 
ensure that such plans are based on the quality of 
care received by veterans at the health care facilities 
under the jurisdictions of such directors. 
(2) FACTORS.—In modifying performance plans 
under paragraph (1), the Secretary shall ensure that 
assessment of the quality of care provided at health 
care facilities under the jurisdiction of a director de-
scribed in paragraph (1) includes consideration of the 
following:
† HR 3230 EAS 
during the fiscal year for which the assessment 
is being conducted. 
(F) The effectiveness of any remedial ac-
tions or plans resulting from any Inspector Gen-
eral recommendations in the reviews and anal-
yses described in subparagraphs (A) through (E). 
(3) ADDITIONAL
LEADERSHIP
POSITIONS.—To 
the degree practicable, the Secretary shall assess the 
performance of other employees of the Department in 
leadership positions at Department medical centers, 
including associate directors, assistant directors, dep-
uty directors, chiefs of staff, and clinical leads, and 
in Veterans Integrated Service Networks, including 
assistant directors and quality management officers, 
using factors and criteria similar to those used in the 
performance plans modified under paragraph (1). 
(c) REMOVAL OF CERTAIN PERFORMANCE GOALS.— 
For each fiscal year that begins after the date of the enact-
ment of this Act, the Secretary shall not include in the per-
formance goals of any employee of a Veterans Integrated 
Service Network or medical center of the Department any 
performance goal that might disincentivize the payment of 
Department amounts to provide hospital care, medical serv-
ices, or other health care through a non-Department pro-
vider.
† HR 3230 EAS 
SEC. 
405. 
IMPROVED 
TRANSPARENCY 
CONCERNING 
HEALTH CARE PROVIDED BY DEPARTMENT 
OF VETERANS AFFAIRS. 
(a) PUBLICATION OF WAIT TIMES.— 
(1) GOALS.— 
(A) INITIAL.—Not later than 90 days after 
the date of the enactment of this Act, the Sec-
retary of Veterans Affairs shall publish in the 
Federal Register, and on an Internet website ac-
cessible to the public of each medical center of the 
Department of Veterans Affairs, the wait-time 
goals of the Department for the scheduling of an 
appointment by a veteran for the receipt of 
health care from the Department. 
(B) SUBSEQUENT CHANGES.— 
(i) IN
GENERAL.—If the Secretary 
modifies the wait-time goals described in 
subparagraph (A), the Secretary shall pub-
lish the new wait-times goals— 
(I) on an Internet website acces-
sible to the public of each medical cen-
ter of the Department not later than 30 
days after such modification; and 
(II) in the Federal Register not 
later than 90 days after such modifica-
tion.
† HR 3230 EAS 
(ii) EFFECTIVE DATE.—Any modifica-
tion under clause (i) shall take effect on the 
date of publication in the Federal Register. 
(C) GOALS
DESCRIBED.—Wait-time goals 
published under this paragraph shall include 
goals for primary care appointments, specialty 
care appointments, and appointments based on 
the general severity of the condition of the vet-
eran. 
(2) WAIT TIMES AT MEDICAL CENTERS OF THE 
DEPARTMENT.—Not later than one year after the date 
of the enactment of this Act, the Secretary of Veterans 
Affairs shall publish on an Internet website accessible 
to the public of each medical center of the Department 
the current wait time for an appointment for pri-
mary care and specialty care at the medical center. 
(b) PUBLICLY AVAILABLE DATABASE
OF PATIENT 
SAFETY, QUALITY OF CARE, AND OUTCOME MEASURES.— 
(1) IN GENERAL.—Not later than 180 days after 
the date of the enactment of this Act, the Secretary 
shall develop and make available to the public a com-
prehensive database containing all applicable patient 
safety, quality of care, and outcome measures for 
health care provided by the Department that are 
tracked by the Secretary.
† HR 3230 EAS 
(2) UPDATE FREQUENCY.—The Secretary shall 
update the database required by paragraph (1) not 
less frequently than once each year. 
(3) UNAVAILABLE MEASURES.—For all measures 
that the Secretary would otherwise publish in the 
database required by paragraph (1) but has not done 
so because such measures are not available, the Sec-
retary shall publish notice in the database of the rea-
son for such unavailability and a timeline for making 
such measures available in the database. 
(4) ACCESSIBILITY.—The Secretary shall ensure 
that the database required by paragraph (1) is acces-
sible to the public through the primary Internet 
website of the Department and through each primary 
Internet website of a Department medical center. 
(c) HOSPITAL COMPARE WEBSITE OF DEPARTMENT 
OF HEALTH AND HUMAN SERVICES.— 
(1) AGREEMENT REQUIRED.—Not later than 180 
days after the date of the enactment of this Act, the 
Secretary of Veterans Affairs shall enter into an 
agreement with the Secretary of Health and Human 
Services for the provision by the Secretary of Veterans 
Affairs of such information as the Secretary of Health 
and Human Services may require to report and make 
publicly available patient quality and outcome infor-
† HR 3230 EAS 
mation concerning Department of Veterans Affairs 
medical centers through the Hospital Compare Inter-
net website of the Department of Health and Human 
Services or any successor Internet website. 
(2) INFORMATION PROVIDED.—The information 
provided by the Secretary of Veterans Affairs to the 
Secretary of Health and Human Services under para-
graph (1) shall include the following: 
(A) Measures of timely and effective health 
care. 
(B) Measures of readmissions, complications 
of death, including with respect to 30-day mor-
tality rates and 30-day readmission rates, sur-
gical complication measures, and health care re-
lated infection measures. 
(C) Survey data of patient experiences, in-
cluding the Hospital Consumer Assessment of 
Healthcare Providers and Systems or any simi-
lar successor survey developed by the Department 
of Health and Human Services. 
(D) Any other measures required of or re-
ported with respect to hospitals participating in 
the Medicare program under title XVIII of the 
Social Security Act (42 U.S.C. 1395 et seq.).
† HR 3230 EAS 
(3) UNAVAILABLE INFORMATION.—For any ap-
plicable metric collected by the Department of Vet-
erans Affairs or required to be provided under para-
graph (2) and withheld from or unavailable in the 
Hospital Compare Internet website, the Secretary of 
Veterans Affairs shall publish a notice in the Federal 
Register stating the reason why such metric was with-
held from public disclosure and a timeline for making 
such metric available, if applicable. 
(d) COMPTROLLER GENERAL REVIEW OF PUBLICLY 
AVAILABLE SAFETY AND QUALITY METRICS.—Not later 
than three years after the date of the enactment of this Act, 
the Comptroller General of the United States shall conduct 
a review of the safety and quality metrics made publicly 
available by the Secretary of Veterans Affairs under this 
section to assess the degree to which the Secretary is com-
plying with the provisions of this section. 
SEC. 406. INFORMATION FOR VETERANS ON THE CREDEN-
TIALS OF DEPARTMENT OF VETERANS AF-
FAIRS PHYSICIANS. 
(a) IMPROVEMENT OF ‘‘OUR PROVIDERS’’ INTERNET 
WEBSITE LINKS.— 
(1) AVAILABILITY
THROUGH
DEPARTMENT
OF 
VETERANS AFFAIRS HOMEPAGE.—A link to the ‘‘Our 
Providers’’ health care providers database of the De-
† HR 3230 EAS 
partment of Veterans Affairs, or any successor data-
base, shall be available on and through the homepage 
of the Internet website of the Department that is ac-
cessible to the public. 
(2) INFORMATION ON LOCATION OF RESIDENCY 
TRAINING.—The Internet website of the Department 
that is accessible to the public shall include under the 
link to the ‘‘Our Providers’’ health care providers 
database of the Department, or any successor data-
base, the location of residency training of each li-
censed physician of the Department. 
(3) INFORMATION
ON
PHYSICIANS
AT
PAR-
TICULAR
FACILITIES.—The ‘‘Our Providers’’ health 
care providers database of the Department, or any 
successor database, shall identify whether each li-
censed physician of the Department is a physician in 
residency. 
(b) INFORMATION ON CREDENTIALS OF PHYSICIANS 
FOR VETERANS UNDERGOING SURGICAL PROCEDURES.— 
(1) IN GENERAL.—Each veteran who is under-
going a surgical procedure by or through the Depart-
ment shall be provided information on the credentials 
of the surgeon to be performing such procedure at 
such time in advance of the procedure as is appro-
† HR 3230 EAS 
priate to permit such veteran to evaluate such infor-
mation. 
(2) OTHER INDIVIDUALS.—If a veteran is unable 
to evaluate the information provided under para-
graph (1) due to the health or mental competence of 
the veteran, such information shall be provided to an 
individual acting on behalf of the veteran. 
(c) COMPTROLLER GENERAL REPORT AND PLAN.— 
(1) REPORT.—Not later than two years after the 
date of the enactment of this Act, the Comptroller 
General of the United States shall submit to the Com-
mittee on Veterans’ Affairs of the Senate and the 
Committee on Veterans’ Affairs of the House of Rep-
resentatives a report setting forth an assessment by 
the Comptroller General of the following: 
(A) The manner in which contractors under 
the Patient-Centered Community Care initiative 
of the Department perform oversight of the cre-
dentials of physicians within the networks of 
such contractors under the initiative. 
(B) The oversight by the Department of the 
contracts under the Patient-Centered Community 
Care initiative. 
(C) The verification by the Department of 
the credentials and licenses of health care pro-
† HR 3230 EAS 
viders furnishing hospital care and medical serv-
ices under section 301. 
(2) PLAN.— 
(A) IN GENERAL.—Not later than 30 days 
after the submittal of the report under para-
graph (1), the Secretary shall— 
(i) submit to the Comptroller General, 
the Committee on Veterans’ Affairs of the 
Senate, and the Committee on Veterans’ Af-
fairs of the House of Representatives a plan 
to address any findings and recommenda-
tions of the Comptroller General included in 
such report; and 
(ii) submit to the Committee on Vet-
erans’ Affairs of the Senate and the Com-
mittee on Veterans’ Affairs of the House of 
Representatives a request for additional 
amounts, if any, that may be necessary to 
carry out such plan. 
(B) IMPLEMENTATION.—Not later than 90 
days after the submittal of the report under 
paragraph (1), the Secretary shall carry out such 
plan.
† HR 3230 EAS 
SEC. 407. INFORMATION IN ANNUAL BUDGET OF THE 
PRESIDENT ON HOSPITAL CARE AND MED-
ICAL SERVICES FURNISHED THROUGH EX-
PANDED USE OF CONTRACTS FOR SUCH 
CARE. 
The materials on the Department of Veterans Affairs 
in the budget of the President for a fiscal year, as submitted 
to Congress pursuant to section 1105(a) of title 31, United 
States Code, shall set forth the following: 
(1) The number of veterans who received hospital 
care and medical services under section 301 during 
the fiscal year preceding the fiscal year in which such 
budget is submitted. 
(2) The amount expended by the Department on 
furnishing care and services under such section dur-
ing the fiscal year preceding the fiscal year in which 
such budget is submitted. 
(3) The amount requested in such budget for the 
costs of furnishing care and services under such sec-
tion during the fiscal year covered by such budget, set 
forth in aggregate and by amounts for each account 
for which amounts are so requested. 
(4) The number of veterans that the Department 
estimates will receive hospital care and medical serv-
ices under such section during the fiscal years covered 
by the budget submission.
† HR 3230 EAS 
(5) The number of employees of the Department 
on paid administrative leave at any point during the 
fiscal year preceding the fiscal year in which such 
budget is submitted. 
SEC. 408. PROHIBITION ON FALSIFICATION OF DATA CON-
CERNING WAIT TIMES AND QUALITY MEAS-
URES AT DEPARTMENT OF VETERANS AF-
FAIRS. 
Not later than 60 days after the date of the enactment 
of this Act, and in accordance with title 5, United States 
Code, the Secretary of Veterans Affairs shall establish poli-
cies whereby any employee of the Department of Veterans 
Affairs who knowingly submits false data concerning wait 
times for health care or quality measures with respect to 
health care to another employee of the Department or know-
ingly requires another employee of the Department to sub-
mit false data concerning such wait times or quality meas-
ures to another employee of the Department is subject to 
a penalty the Secretary considers appropriate after notice 
and an opportunity for a hearing, including civil penalties, 
unpaid suspensions, or termination. 
SEC. 409. REMOVAL OF SENIOR EXECUTIVE SERVICE EM-
PLOYEES OF THE DEPARTMENT OF VET-
ERANS AFFAIRS FOR PERFORMANCE. 
(a) REMOVAL OR TRANSFER.—
† HR 3230 EAS 
(1) IN GENERAL.—Chapter 7 of title 38, United 
States Code, is amended by adding at the end the fol-
lowing new section: 
‘‘§ 713. Senior Executive Service: removal based on 
performance 
‘‘(a) IN GENERAL.—The Secretary may remove any 
individual from the Senior Executive Service if the Sec-
retary determines the performance of the individual war-
rants such removal. If the Secretary so removes such an 
individual, the Secretary may— 
‘‘(1) remove the individual from the civil service 
(as defined in section 2101 of title 5); or 
‘‘(2) transfer the individual to a General Sched-
ule position at any grade of the General Schedule for 
which the individual is qualified and that the Sec-
retary determines is appropriate. 
‘‘(b) NOTICE TO CONGRESS.—Not later than 30 days 
after removing or transferring an individual from the Sen-
ior Executive Service under subsection (a), the Secretary 
shall submit to the Committees on Veterans’ Affairs of the 
Senate and House of Representatives notice in writing of 
such removal or transfer and the reason for such removal 
or transfer.
† HR 3230 EAS 
‘‘(4) The Merit Systems Protection Board may not 
stay any personnel action taken under this section. 
‘‘(5) A person who appeals under section 7701 of title 
5 a removal under subsection (a)(1) may not receive any 
pay, awards, bonuses, incentives, allowances, differentials, 
student loan repayments, special payments, or benefits from 
the Secretary until the Merit Systems Protection Board has 
made a final decision on such appeal. 
‘‘(6) A decision made by the Merit Systems Protection 
Board with respect to a removal or transfer under sub-
section (a) shall not be subject to any further appeal.’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions at the beginning of such chapter is amended by 
adding at the end the following new item: 
‘‘713. Senior Executive Service: removal based on performance.’’. 
(b) ESTABLISHMENT OF EXPEDITED REVIEW PROC-
ESS.— 
(1) IN GENERAL.—Not later than 30 days after 
the date of the enactment of this Act, the Merit Sys-
tems Protection Board shall establish and put into ef-
fect a process to conduct expedited reviews in accord-
ance with section 713(d) of title 38, United States 
Code. 
(2) INAPPLICABILITY
OF
CERTAIN
REGULA-
TIONS.—Section 1201.22 of title 5, Code of Federal 
Regulations, as in effect on the day before the date of
† HR 3230 EAS 
the enactment of this Act, shall not apply to expedited 
reviews carried out under section 713(d) of title 38, 
United States Code. 
(3) REPORT
BY
MERIT
SYSTEMS
PROTECTION 
BOARD.—Not later than 30 days after the date of the 
enactment of this Act, the Merit Systems Protection 
Board shall submit to Congress a report on the ac-
tions the Board plans to take to conduct expedited re-
views under section 713(d) of title 38, United States 
Code, as added by subsection (a). Such report shall 
include a description of the resources the Board deter-
mines will be necessary to conduct such reviews and 
a description of whether any resources will be nec-
essary to conduct such reviews that were not available 
to the Board on the day before the date of the enact-
ment of this Act. 
(c) TEMPORARY EXEMPTION FROM CERTAIN LIMITA-
TION ON INITIATION OF REMOVAL FROM SENIOR EXECU-
TIVE SERVICE.—During the 120-day period beginning on 
the date of the enactment of this Act, an action to remove 
an individual from the Senior Executive Service at the De-
partment of Veterans Affairs pursuant to section 713 of title 
38, United States Code, as added by subsection (a), or sec-
tion 7543 of title 5, United States Code, may be initiated,
† HR 3230 EAS 
notwithstanding section 3592(b) of title 5, United States 
Code, or any other provision of law. 
(d) CONSTRUCTION.—Nothing in this section or section 
713 of title 38, United States Code, as added by subsection 
(a), shall be construed to apply to an appeal of a removal, 
transfer, or other personnel action that was pending before 
the date of the enactment of this Act. 
TITLE V—HEALTH CARE 
RELATED TO SEXUAL TRAUMA 
SEC. 501. EXPANSION OF ELIGIBILITY FOR SEXUAL TRAUMA 
COUNSELING AND TREATMENT TO VETERANS 
ON INACTIVE DUTY TRAINING. 
Section 1720D(a)(1) of title 38, United States Code, 
is amended by striking ‘‘or active duty for training’’ and 
inserting ‘‘, active duty for training, or inactive duty train-
ing’’. 
SEC. 502. PROVISION OF COUNSELING AND TREATMENT 
FOR SEXUAL TRAUMA BY THE DEPARTMENT 
OF VETERANS AFFAIRS TO MEMBERS OF THE 
ARMED FORCES. 
(a) EXPANSION OF COVERAGE TO MEMBERS OF THE 
ARMED FORCES.—Subsection (a) of section 1720D of title 
38, United States Code, is amended— 
(1) by redesignating paragraph (2) as para-
graph (3);
† HR 3230 EAS 
(2) by inserting after paragraph (1) the fol-
lowing new paragraph (2): 
‘‘(2)(A) In operating the program required by para-
graph (1), the Secretary may, in consultation with the Sec-
retary of Defense, provide counseling and care and services 
to members of the Armed Forces (including members of the 
National Guard and Reserves) on active duty to overcome 
psychological trauma described in that paragraph. 
‘‘(B) A member described in subparagraph (A) shall 
not be required to obtain a referral before receiving coun-
seling and care and services under this paragraph.’’; and 
(3) in paragraph (3), as predesignated by para-
graph (1)— 
(A) by striking ‘‘a veteran’’ and inserting 
‘‘an individual’’; and 
(B) by striking ‘‘that veteran’’ each place it 
appears and inserting ‘‘that individual’’. 
(b) INFORMATION TO MEMBERS ON AVAILABILITY OF 
COUNSELING AND SERVICES.—Subsection (c) of such sec-
tion is amended— 
(1) by striking ‘‘to veterans’’ each place it ap-
pears; and 
(2) in paragraph (3), by inserting ‘‘members of 
the Armed Forces and’’ before ‘‘individuals’’.
† HR 3230 EAS 
(c) INCLUSION OF MEMBERS IN REPORTS ON COUN-
SELING AND SERVICES.—Subsection (e) of such section is 
amended— 
(1) in the matter preceding paragraph (1), by 
striking ‘‘to veterans’’; 
(2) in paragraph (2)— 
(A) by striking ‘‘women veterans’’ and in-
serting ‘‘individuals’’; and 
(B) by striking ‘‘training under subsection 
(d).’’ and inserting ‘‘training under subsection 
(d), desegregated by— 
‘‘(A) veterans; 
‘‘(B) members of the Armed Forces (includ-
ing members of the National Guard and Re-
serves) on active duty; and 
‘‘(C) for each of subparagraphs (A) and 
(B)— 
‘‘(i) men; and 
‘‘(ii) women.’’; 
(3) in paragraph (4), by striking ‘‘veterans’’ and 
inserting ‘‘individuals’’; and 
(4) in paragraph (5)— 
(A) by striking ‘‘women veterans’’ and in-
serting ‘‘individuals’’ ; and
† HR 3230 EAS 
(B) by inserting ‘‘, including specific rec-
ommendations for individuals specified in sub-
paragraphs (A), (B), and (C) of paragraph (2)’’ 
before the period at the end. 
(d) EFFECTIVE DATE.—The amendments made by this 
section shall take effect on the date that is one year after 
the date of the enactment of this Act. 
SEC. 503. REPORTS ON MILITARY SEXUAL TRAUMA. 
(a) REPORT ON SERVICES AVAILABLE FOR MILITARY 
SEXUAL TRAUMA IN THE DEPARTMENT OF VETERANS AF-
FAIRS.—Not later than 630 days after the date of the enact-
ment of this Act, the Secretary of Veterans Affairs shall sub-
mit to the Committee on Veterans’ Affairs of the Senate and 
the Committee on Veterans’ Affairs of the House of Rep-
resentatives a report on the treatment and services available 
from the Department of Veterans Affairs for male veterans 
who experience military sexual trauma compared to such 
treatment and services available to female veterans who ex-
perience military sexual trauma. 
(b) REPORTS ON TRANSITION OF MILITARY SEXUAL 
TRAUMA TREATMENT FROM DEPARTMENT OF DEFENSE TO 
DEPARTMENT OF VETERANS AFFAIRS.—Not later than 630 
days after the date of the enactment of this Act, and annu-
ally thereafter for five years, the Department of Veterans 
Affairs-Department of Defense Joint Executive Committee
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established by section 320(a) of title 38, United States Code, 
shall submit to the appropriate committees of Congress a 
report on military sexual trauma that includes the fol-
lowing: 
(1) The processes and procedures utilized by the 
Department of Veterans Affairs and the Department 
of Defense to facilitate transition of treatment of indi-
viduals who have experienced military sexual trauma 
from treatment provided by the Department of De-
fense to treatment provided by the Department of Vet-
erans Affairs. 
(2) A description and assessment of the collabo-
ration between the Department of Veterans Affairs 
and the Department of Defense in assisting veterans 
in filing claims for disabilities related to military 
sexual trauma, including permitting veterans access 
to information and evidence necessary to develop or 
support such claims. 
(c) DEFINITIONS.—In this section: 
(1) APPROPRIATE COMMITTEES OF CONGRESS.— 
The term ‘‘appropriate committees of Congress’’ 
means— 
(A) the Committee on Veterans’ Affairs and 
the Committee on Armed Services of the Senate; 
and
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(B) the Committee on Veterans’ Affairs and 
the Committee on Armed Services of the House 
of Representatives. 
(2) MILITARY
SEXUAL
TRAUMA.—The term 
‘‘military sexual trauma’’ means psychological trau-
ma, which in the judgment of a mental health profes-
sional employed by the Department, resulted from a 
physical assault of a sexual nature, battery of a sex-
ual nature, or sexual harassment which occurred 
while the veteran was serving on active duty or active 
duty for training. 
(3) SEXUAL
HARASSMENT.—The term ‘‘sexual 
harassment’’ means repeated, unsolicited verbal or 
physical contact of a sexual nature which is threat-
ening in character. 
(4) SEXUAL TRAUMA.—The term ‘‘sexual trau-
ma’’ shall have the meaning given that term by the 
Secretary of Veterans Affairs for purposes of this sec-
tion. 
(d) EFFECTIVE DATE.—This section shall take effect 
on the date that is 270 days after the date of the enactment 
of this Act.
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TITLE VI—MAJOR MEDICAL 
FACILITY LEASES 
SEC. 601. AUTHORIZATION OF MAJOR MEDICAL FACILITY 
LEASES. 
The Secretary of Veterans Affairs may carry out the 
following major medical facility leases at the locations spec-
ified, and in an amount for each lease not to exceed the 
amount shown for such location (not including any esti-
mated cancellation costs): 
(1) For a clinical research and pharmacy coordi-
nating center, Albuquerque, New Mexico, an amount 
not to exceed $9,560,000. 
(2) For a community-based outpatient clinic, 
Brick, New Jersey, an amount not to exceed 
$7,280,000. 
(3) For a new primary care and dental clinic 
annex, Charleston, South Carolina, an amount not to 
exceed $7,070,250. 
(4) For the Cobb County community-based Out-
patient Clinic, Cobb County, Georgia, an amount not 
to exceed $6,409,000. 
(5) For the Leeward Outpatient Healthcare Ac-
cess Center, Honolulu, Hawaii, including a co-located 
clinic with the Department of Defense and the co-loca-
tion of the Honolulu Regional Office of the Veterans
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Benefits Administration and the Capel Vet Center of 
the Department of Veterans Affairs, an amount not to 
exceed $15,887,370. 
(6) For a community-based outpatient clinic, 
Johnson County, Kansas, an amount not to exceed 
$2,263,000. 
(7) For a replacement community-based out-
patient clinic, Lafayette, Louisiana, an amount not 
to exceed $2,996,000. 
(8) For a community-based outpatient clinic, 
Lake Charles, Louisiana, an amount not to exceed 
$2,626,000. 
(9) For outpatient clinic consolidation, New Port 
Riche, Florida, an amount not to exceed $11,927,000. 
(10) For an outpatient clinic, Pence, Puerto 
Rico, an amount not to exceed $11,535,000. 
(11) For lease consolidation, San Antonio, 
Texas, an amount not to exceed $19,426,000. 
(12) For a community-based outpatient clinic, 
San Diego, California, an amount not to exceed 
$11,946,100. 
(13) For an outpatient clinic, Tyler, Texas, an 
amount not to exceed $4,327,000.
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(14) For the Arere Community Care Center, 
West Haven, Connecticut, an amount not to exceed 
$4,883,000. 
(15) For the Worcester community-based Out-
patient Clinic, Worcester, Massachusetts, an amount 
not to exceed $4,855,000. 
(16) For the expansion of a community-based 
outpatient clinic, Cape Girardeau, Missouri, an 
amount not to exceed $4,232,060. 
(17) For a multi specialty clinic, Chattanooga, 
Tennessee, an amount not to exceed $7,069,000. 
(18) For the expansion of a community-based 
outpatient clinic, Chico, California, an amount not to 
exceed $4,534,000. 
(19) For a community-based outpatient clinic, 
Chula Vista, California, an amount not to exceed 
$3,714,000. 
(20) For a new research lease, Haines, Illinois, 
an amount not to exceed $22,032,000. 
(21) For a replacement research lease, Houston, 
Texas, an amount not to exceed $6,142,000. 
(22) For a community-based outpatient clinic, 
Lincoln, Nebraska, an amount not to exceed 
$7,178,400.
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(23) For a community-based outpatient clinic, 
Lubbock, Texas, an amount not to exceed $8,554,000. 
(24) For a community-based outpatient clinic 
consolidation, Myrtle Beach, South Carolina, an 
amount not to exceed $8,022,000. 
(25) For a community-based outpatient clinic, 
Phoenix, 
Arizona, 
an 
amount 
not 
to 
exceed 
$20,757,000. 
(26) For the expansion of a community-based 
outpatient clinic, Redding, California, an amount not 
to exceed $8,154,000. 
SEC. 602. BUDGETARY TREATMENT OF DEPARTMENT OF 
VETERANS AFFAIRS MAJOR MEDICAL FACILI-
TIES LEASES. 
(a) FINDINGS.—Congress finds the following: 
(1) Title 31, United States Code, requires the De-
partment of Veterans Affairs to record the full cost of 
its contractual obligation against funds available at 
the time a contract is executed. 
(2) Office of Management and Budget Circular 
A–11 provides guidance to agencies in meeting the 
statutory requirements under title 31, United States 
Code, with respect to leases. 
(3) For operating leases, Office of Management 
and Budget Circular A–11 requires the Department of
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Veterans Affairs to record up-front budget authority 
in an ‘‘amount equal to total payments under the full 
term of the lease or [an] amount sufficient to cover 
first year lease payments plus cancellation costs’’. 
(b) REQUIREMENT FOR OBLIGATION OF FULL COST.— 
(1) IN GENERAL.—Subject to the availability of 
appropriations provided in advance, in exercising the 
authority of the Secretary of Veterans Affairs to enter 
into leases provided in this Act, the Secretary shall 
record, pursuant to section 1501 of title 31, United 
States Code, as the full cost of the contractual obliga-
tion at the time a contract is executed either— 
(A) an amount equal to total payments 
under the full term of the lease; or 
(B) if the lease specifies payments to be 
made in the event the lease is terminated before 
its full term, an amount sufficient to cover the 
first year lease payments plus the specified can-
cellation costs. 
(2) SELF-INSURING
AUTHORITY.—The require-
ments of paragraph (1) may be satisfied through the 
use of a self-insuring authority consistent with Office 
of Management and Budget Circular A–11. 
(c) TRANSPARENCY.—
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(1) COMPLIANCE.—Subsection (b) of section 8104 
of title 38, United States Code, is amended by adding 
at the end the following new paragraph: 
‘‘(7) In the case of a prospectus proposing fund-
ing for a major medical facility lease, a detailed 
analysis of how the lease is expected to comply with 
Office of Management and Budget Circular A–11 and 
section 1341 of title 31 (commonly referred to as the 
‘Anti-Deficiency Act’). Any such analysis shall in-
clude— 
‘‘(A) an analysis of the classification of the 
lease as a ‘lease-purchase’, ‘capital lease’, or ‘op-
erating lease’ as those terms are defined in Office 
of Management and Budget Circular A–11; 
‘‘(B) an analysis of the obligation of budg-
etary resources associated with the lease; and 
‘‘(C) an analysis of the methodology used in 
determining the asset cost, fair market value, 
and cancellation costs of the lease.’’. 
(2) SUBMITTAL
TO
CONGRESS.—Such section 
8104 is further amended by adding at the end the fol-
lowing new subsection: 
‘‘(h)(1) Not less than 30 days before entering into a 
major medical facility lease, the Secretary shall submit to
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the Committees on Veterans’ Affairs of the Senate and the 
House of Representatives— 
‘‘(A) notice of the Secretary’s intention to enter 
into the lease; 
‘‘(B) a detailed summary of the proposed lease; 
‘‘(C) a description and analysis of any dif-
ferences between the prospectus submitted pursuant to 
subsection (b) and the proposed lease; and 
‘‘(D) a scoring analysis demonstrating that the 
proposed lease fully complies with Office of Manage-
ment and Budget Circular A–11. 
‘‘(2) Each committee described in paragraph (1) shall 
ensure that any information submitted to the committee 
under such paragraph is treated by the committee with the 
same level of confidentiality as is required by law of the 
Secretary and subject to the same statutory penalties for 
unauthorized disclosure or use as the Secretary. 
‘‘(3) Not more than 30 days after entering into a major 
medical facility lease, the Secretary shall submit to each 
committee described in paragraph (1) a report on any ma-
terial differences between the lease that was entered into and 
the proposed lease described under such paragraph, includ-
ing how the lease that was entered into changes the pre-
viously submitted scoring analysis described in subpara-
graph (D) of such paragraph.’’.
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(d) RULE OF CONSTRUCTION.—Nothing in this sec-
tion, or the amendments made by this section, shall be con-
strued to in any way relieve the Department of Veterans 
Affairs from any statutory or regulatory obligations or re-
quirements existing prior to the enactment of this section 
and such amendments. 
TITLE VII—VETERANS BENEFITS 
MATTERS 
SEC. 701. EXPANSION OF MARINE GUNNERY SERGEANT 
JOHN DAVID FRY SCHOLARSHIP. 
(a) EXPANSION OF ENTITLEMENT.—Subsection (b)(9) 
of section 3311 of title 38, United States Code, is amended 
by inserting ‘‘or spouse’’ after ‘‘child’’. 
(b) LIMITATION AND ELECTION ON CERTAIN BENE-
FITS.—Subsection (f) of such section is amended— 
(1) by redesignating paragraph (2) as para-
graph (4); and 
(2) by inserting after paragraph (1) the fol-
lowing new paragraphs: 
‘‘(2) LIMITATION.—The entitlement of an indi-
vidual to assistance under subsection (a) pursuant to 
paragraph (9) of subsection (b) because the individual 
was a spouse of a person described in such paragraph 
shall expire on the earlier of—
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‘‘(A) the date that is 15 years after the date 
on which the person died; and 
‘‘(B) the date on which the individual re-
marries. 
‘‘(3) ELECTION ON RECEIPT OF CERTAIN BENE-
FITS.—A surviving spouse entitled to assistance under 
subsection (a) pursuant to paragraph (9) of sub-
section (b) who is also entitled to educational assist-
ance under chapter 35 of this title may not receive as-
sistance under both this section and such chapter, but 
shall make an irrevocable election (in such form and 
manner as the Secretary may prescribe) under which 
section or chapter to receive educational assistance.’’. 
(c) CONFORMING AMENDMENT.—Section 3321(b)(4) of 
such title is amended— 
(1) by striking ‘‘an individual’’ and inserting ‘‘a 
child’’; and 
(2) by striking ‘‘such individual’s’’ each time it 
appears and inserting ‘‘such child’s’’.
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SEC. 702. APPROVAL OF COURSES OF EDUCATION PRO-
VIDED BY PUBLIC INSTITUTIONS OF HIGHER 
LEARNING FOR PURPOSES OF ALL-VOLUN-
TEER 
FORCE 
EDUCATIONAL 
ASSISTANCE 
PROGRAM AND POST-9/11 EDUCATIONAL AS-
SISTANCE CONDITIONAL ON IN-STATE TUI-
TION RATE FOR VETERANS. 
(a) IN GENERAL.—Section 3679 of title 38, United 
States Code, is amended by adding at the end the following 
new subsection: 
‘‘(c)(1) Notwithstanding any other provision of this 
chapter and subject to paragraphs (3) through (6), the Sec-
retary shall disapprove a course of education provided by 
a public institution of higher learning to a covered indi-
vidual pursuing a course of education with educational as-
sistance under chapter 30 or 33 of this title while living 
in the State in which the public institution of higher learn-
ing is located if the institution charges tuition and fees for 
that course for the covered individual at a rate that is high-
er than the rate the institution charges for tuition and fees 
for that course for residents of the State in which the insti-
tution is located, regardless of the covered individual’s State 
of residence. 
‘‘(2) For purposes of this subsection, a covered indi-
vidual is any individual as follows:
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‘‘(A) A veteran who was discharged or released 
from a period of not fewer than 90 days of service in 
the active military, naval, or air service less than 
three years before the date of enrollment in the course 
concerned. 
‘‘(B) An individual who is entitled to assistance 
under section 3311(b)(9) or 3319 of this title by vir-
tue of such individual’s relationship to a veteran de-
scribed in subparagraph (A). 
‘‘(3) If after enrollment in a course of education that 
is subject to disapproval under paragraph (1) by reason 
of paragraph (2)(A) or (2)(B) a covered individual pursues 
one or more courses of education at the same public institu-
tion of higher learning while remaining continuously en-
rolled (other than during regularly scheduled breaks between 
courses, semesters or terms) at that institution of higher 
learning, any course so pursued by the covered individual 
at that institution of higher learning while so continuously 
enrolled shall also be subject to disapproval under para-
graph (1). 
‘‘(4) It shall not be grounds to disapprove a course of 
education under paragraph (1) if a public institution of 
higher learning requires a covered individual pursuing a 
course of education at the institution to demonstrate an in-
tent, by means other than satisfying a physical presence
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requirement, to establish residency in the State in which 
the institution is located, or to satisfy other requirements 
not relating to the establishment of residency, in order to 
be charged tuition and fees for that course at a rate that 
is equal to or less than the rate the institution charges for 
tuition and fees for that course for residents of the State. 
‘‘(5) The Secretary may waive such requirements of 
paragraph (1) as the Secretary considers appropriate. 
‘‘(6) Disapproval under paragraph (1) shall apply 
only with respect to educational assistance under chapters 
30 and 33 of this title.’’. 
(b) EFFECTIVE DATE.—Subsection (c) of section 3679 
of title 38, United States Code (as added by subsection (a) 
of this section), shall apply with respect to educational as-
sistance provided for pursuit of programs of education dur-
ing academic terms that begin after July 1, 2015, through 
courses of education that commence on or after that date. 
TITLE 
VIII—APPROPRIATION 
AND EMERGENCY DESIGNA-
TIONS 
SEC. 801. APPROPRIATION OF EMERGENCY AMOUNTS. 
There is authorized to be appropriated, and is appro-
priated, to the Secretary of Veterans Affairs, out of any 
funds in the Treasury not otherwise appropriated, for fiscal
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years 2014, 2015, and 2016, such sums as may be necessary 
to carry out this Act. 
SEC. 802. EMERGENCY DESIGNATIONS. 
(a) IN GENERAL.—This Act is designated as an emer-
gency requirement pursuant to section 4(g) of the Statutory 
Pay-As-You-Go Act of 2010 (2 U.S.C. 933(g)). 
(b) DESIGNATION IN SENATE.—In the Senate, this Act 
is designated as an emergency requirement pursuant to sec-
tion 403(a) of S. Con. Res. 13 (111th Congress), the concur-
rent resolution on the budget for fiscal year 2010. 
Amend the title so as to read: ‘‘To improve the ac-
cess of veterans to medical services from the Department 
of Veterans Affairs, and for other purposes.’’ 
Attest: 
Secretary.