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(6) The term ‘‘Vet Center’’ has the meaning 
given that term in section 1712A(h) of title 38, 
United States Code. 
(7) The term ‘‘veterans service organization’’ 
means any organization recognized by the Secretary 
under section 5902 of such title. 
Subtitle C—Medical Treatment and 
Other Matters 
SEC. 140. QUARTERLY REPORT ON REFERRALS FOR NON- 
DEPARTMENT 
OF 
VETERANS 
AFFAIRS 
HEALTH CARE. 
Subchapter I of chapter 5 of title 38, United States 
Code, is amended by adding at the end the following new 
section (and amending the table of sections at the begin-
ning of such chapter accordingly): 
‘‘§ 534. Quarterly report on referrals for non-Depart-
ment health care 
‘‘Not later than 180 days after the date of the enact-
ment of this section, and not less frequently than quarterly 
thereafter, the Secretary shall submit to the Committees 
on Veterans’ Affairs of the Senate and the House of Rep-
resentatives a report containing, with respect to referrals 
for non-Department health care originating from a med-
ical facility of the Department during the quarter pre-
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ceding the date of the submission of the report, a measure-
ment of, for each such medical facility— 
‘‘(1) the period of time between— 
‘‘(A) the date on which a clinician em-
ployed by the Department determines that a 
veteran requires care, or a veteran presents to 
the Department requesting care, and the date 
on which the referral for care is sent to a non- 
Department health care provider; 
‘‘(B) the date on which such referral is 
sent to a non-Department health care provider 
and the date on which such non-Department 
health care provider accepts such referral; 
‘‘(C) the date on which such non-Depart-
ment health care provider accepts such referral 
and the date on which such referral is com-
pleted; 
‘‘(D) the date on which such referral is 
completed and the date on which an appoint-
ment with a non-Department health care pro-
vider is made; and 
‘‘(E) the date on which such an appoint-
ment is made and the date on which such ap-
pointment occurs; and 
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‘‘(2) any other period of time that the Secretary 
determines necessary.’’. 
SEC. 141. ELIMINATION OF CERTAIN REQUIREMENTS FOR 
CERTAIN DEPARTMENT OF VETERANS AF-
FAIRS ASSISTANT UNDER SECRETARIES. 
Section 7306 of title 38, United States Code, is 
amended— 
(1) by striking subsection (b); 
(2) by redesignating subsections (c) through (g) 
as subsections (b) through (f), respectively; and 
(3) in subsection (c) (as so redesignated), by 
striking ‘‘subsection (e)’’ and inserting ‘‘subsection 
(f)’’. 
SEC. 142. MODIFICATION OF PAY LIMITATION FOR PHYSI-
CIANS, PODIATRISTS, OPTOMETRISTS, AND 
DENTISTS OF DEPARTMENT OF VETERANS 
AFFAIRS. 
(a) PAY.— 
(1) IN
GENERAL.—Section 7431 of title 38, 
United States Code, is amended— 
(A) by inserting ‘‘optometrists,’’ after ‘‘po-
diatrists,’’ each place it appears; 
(B) by inserting ‘‘optometrist’’ after ‘‘podi-
atrist,’’ each place it appears; 
(C) in subsection (c)— 
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(i) in paragraph (5), by adding at the 
end the following new sentence: ‘‘Such a 
notice shall include a statement of whether 
the market pay will increase, decrease, or 
remain unchanged following such evalua-
tion.’’; and 
(ii) by adding at the end the following 
new paragraphs: 
‘‘(7) The Secretary shall ensure that each phy-
sician, podiatrist, optometrist, and dentist in the 
Veterans Health Administration is— 
‘‘(A) advised, on an annual basis, of the 
criteria described in subparagraph (F) of para-
graph (4); 
‘‘(B) evaluated in accordance with such 
criteria; and 
‘‘(C) compensated in accordance with— 
‘‘(i) applicable assignment and pay 
levels, subject to relevant pay limitations; 
and 
‘‘(ii) the extent to which such criteria 
is met. 
‘‘(8) Not later than 120 days after the end of 
each fiscal year, the Secretary shall submit to the 
Committees on Veterans’ Affairs of the Senate and 
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the House of Representatives a report that includes 
the following: 
‘‘(A) A list of each facility and specialty 
that conducted an evaluation of pay during the 
period covered by the report. 
‘‘(B) For each evaluation described in sub-
paragraph (A)— 
‘‘(i) a list of occupations for which 
pay was evaluated, disaggregated by med-
ical specialty, number of authorized full- 
time employees, and onsite full-time em-
ployees as of the date of the evaluation; 
‘‘(ii) the date such evaluation was 
completed; 
‘‘(iii) whether a market pay adjust-
ment was made following the evaluation 
per each occupation and specialty evalu-
ated; 
‘‘(iv) whether applicable employees 
were notified of such evaluation; 
‘‘(v) whether local labor partners were 
notified of such evaluation; and 
‘‘(vi) in the case of an evaluation that 
resulted in an adjustment of pay— 
‘‘(I) the date such adjustment— 
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‘‘(aa) was implemented; and 
‘‘(bb) became effective; and 
‘‘(II) the percentage of employees 
of each occupation and specialty for 
which pay was adjusted pursuant to 
such evaluation. 
‘‘(C) A list of facilities of the Department 
that have not conducted an evaluation of mar-
ket pay, pursuant to paragraph (5), during the 
18-month-period that precedes the date of the 
submission of such report.’’; 
(D) in subsection (e)— 
(i) in paragraph (1)(A), by inserting 
‘‘optometrists,’’ after ‘‘podiatrists,’’; and 
(ii) by adding at the end the following 
new paragraphs: 
‘‘(5) Notwithstanding any compensation or pay 
limitations under this title or title 5, the Secretary 
may authorize the Under Secretary for Health to 
pay physicians, podiatrists, optometrists and den-
tists— 
‘‘(A) awards authorized under this title; 
‘‘(B) advance payments, recruitment or re-
location bonuses, and retention allowances au-
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thorized under section 7410(a) of this title or 
as otherwise provided by law; 
‘‘(C) incentives or bonuses under section 
706 of this title or as otherwise provided by 
law; and 
‘‘(D) earnings from fee-basis appointments 
under section 7405(a)(2) of this title. 
‘‘(6)(A) The Secretary may waive any pay limi-
tation described in this section (including tier limita-
tions) that the Secretary determines necessary for 
the recruitment or retention of critical health care 
personnel whom the Secretary determines would pro-
vide direct patient care. 
‘‘(B) Priority for such waivers shall be given for 
positions, locations, and care provided through con-
tracts at a high cost to the Department. 
‘‘(C) The Chief Human Capital Officer of the 
Department, the Chief Financial Officer of the De-
partment, and the Office of the General Counsel of 
the Department shall review any waiver issued under 
subparagraph (A). 
‘‘(D) During the period the authority under 
subparagraph (A) is effective, the Secretary may not 
issue more than 300 waivers under such subpara-
graph. 
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‘‘(E) The Secretary may prescribe require-
ments, limitations, and other considerations for 
waivers under such subparagraph. 
‘‘(F) Not later than 180 days after the date of 
the enactment of the Senator Elizabeth Dole 21st 
Century Veterans Healthcare and Benefits Improve-
ment Act, and annually thereafter, the Secretary 
shall submit to the Committees on Veterans’ Affairs 
of the Senate and the House of Representatives a 
report that includes— 
‘‘(i) any updates to the requirements, limi-
tations, and considerations prescribed under 
subparagraph (B) during the period covered by 
the report; 
‘‘(ii) a description of the findings of each 
review, if any, conducted pursuant to subpara-
graph (C); 
‘‘(iii) a description of each waiver under 
subparagraph (A) in effect as of the date of the 
submission of the report, including the— 
‘‘(I) duty location, position, specialty, 
market and performance considerations for 
the waiver; and 
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‘‘(II) impact, if any, of the waiver on 
contracted care purchased by the Depart-
ment for the region; and 
‘‘(iv) a list of any separation actions dur-
ing the period covered by the report with re-
spect to a position for which a waiver under 
subparagraph (A) is in effect. 
‘‘(G) The authority of the Secretary under sub-
paragraph (A) shall terminate on the last day of the 
third full fiscal year following the date of the enact-
ment of the Senator Elizabeth Dole 21st Century 
Veterans Healthcare and Benefits Improvement 
Act.’’. 
(2) REPORT
ON
WAIVER
AUTHORITY.—Not 
later than 180 days after the date of the enactment 
of this Act, the Secretary of Veterans Affairs shall 
submit to the Committees on Veterans’ Affairs of 
the Senate and the House of Representatives a re-
port that includes a description of the requirements, 
limitations, and other considerations prescribed 
under section 7431(b)(6)(D) of title 38, United 
States Code, as added by paragraph (1). 
(3) CONFORMING AMENDMENTS.— 
(A) PAY
OF
UNDER
SECRETARY
FOR 
HEALTH.—Section 7432(b)(1) of such title is 
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amended by inserting ‘‘, podiatrist, optom-
etrist,’’ after ‘‘physician’’. 
(B) ADMINISTRATIVE
MATTERS.—Section 
7433 of such title is amended by inserting ‘‘op-
tometrists,’’ after ‘‘physicians,’’ each place it 
appears. 
(C) 
COMPETITIVE
PAY.—Section 
7451(a)(2)(C) of such title is amended by in-
serting ‘‘optometrist,’’ after ‘‘physician,’’. 
(4) CLERICAL AMENDMENTS.— 
(A) SUBCHAPTER
HEADING.—Subchapter 
III of chapter 74 of such title is amended in the 
heading by inserting ‘‘Optometrists,’’ after 
‘‘PODIATRISTS,’’. 
(B) TABLE OF SECTIONS.—The table of 
sections for such chapter is amended by strik-
ing the item relating to subchapter III and in-
serting the following: 
‘‘SUBCHAPTER III—PAY FOR PHYSICIANS AND OTHER HEALTH-CARE 
PERSONNEL’’. 
(5) APPLICABILITY DATES.—The amendments 
made by this subsection shall apply to any pay pe-
riod of the Department of Veterans Affairs begin-
ning on or after the date that is 180 days after the 
date of the enactment of this Act. 
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(b) MODIFICATION
AND CLARIFICATION
OF PAY 
GRADE FOR OPTOMETRISTS.—Section 7404 of title 38, 
United States Code, is amended— 
(1) in subsection (a)(2)(A), by striking ‘‘podia-
trists, and dentists’’ and inserting ‘‘podiatrists, op-
tometrists, and dentists’’; and 
(2) in subsection (b)— 
(A) by striking ‘‘podiatrist (dpm), and den-
tist’’ and inserting ‘‘podiatrist (dpm), optom-
etrist (od), and dentist’’; 
(B) by striking ‘‘clinical chiropractor and 
optometrist schedule,’’ and inserting ‘‘clinical 
chiropractor schedule’’; and 
(C) by inserting ‘‘optometrist grade’’ after 
‘‘Podiatrist grade’’. 
(c) RETROACTIVE
AUTHORITY
FOR
COMPENSA-
TION.— 
(1) IN GENERAL.—The Secretary of Veterans 
Affairs may pay retroactive compensation to a cov-
ered employee in an amount that equals the amount 
of compensation that was authorized to be paid to 
such covered employee during the period specified in 
paragraph (2), but was deferred and paid to such 
employee in the calendar year following the calender 
year in which such compensation was authorized be-
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cause the payment such compensation would have 
exceeded an applicable cap on annual compensation. 
(2) PERIOD SPECIFIED.—The period specified 
in this paragraph is the period beginning on Janu-
ary 8, 2006, and ending on December 31, 2017. 
(3) 
EXCLUSION.—Compensation 
authorized 
under this subsection shall not be included in the 
calculation of any aggregate limit on compensation 
for a covered employee for the year in which it is 
paid. 
(4) CHARGING OF COMPENSATION.—Compensa-
tion authorized under this subsection shall be 
charged to the appropriate medical care appropria-
tion account of the Department of Veterans Affairs 
for the fiscal year in which the work was performed 
except as follows: 
(A) In the case of an account that has 
closed pursuant to section 1552 of title 31, 
United States Code, the compensation shall be 
charged to a current appropriation account in 
accordance with section 1553 of such title. 
(B) In the case of an expired account that 
has not closed, if charging the compensation to 
the expired account would cause such account 
to have a negative unliquidated or unexpended 
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balance, the compensation may be charged to a 
current appropriation account available for the 
same purpose. 
(5) DEFINITIONS.—In this subsection: 
(A) The term ‘‘compensation’’ means any 
pay, including salary, awards, and incentives. 
(B) The term ‘‘covered employee’’ means a 
physician, podiatrist, or dentist subject to mar-
ket pay under section 7431 of title 38, United 
States Code. 
SEC. 143. REIMBURSEMENT OF AMBULANCE COST FOR 
CARE FOR CERTAIN RURAL VETERANS. 
(a) IN GENERAL.—The Secretary of Veterans Affairs 
shall pay, or reimburse a covered veteran for, the cost of 
transporting the veteran by ambulance, including air am-
bulance, from a covered location to a provider of the De-
partment of Veterans Affairs, a non-Department provider, 
or the nearest hospital that can meet the needs of the vet-
eran (including a hospital that compacts with the Indian 
Health Service) for covered care. 
(b) AMOUNT COVERED.—The maximum cumulative 
amount covered under this section for a covered veteran 
is $46,000. 
(c) SUNSET.—This section shall cease to be effective 
on September 30, 2026. 
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(d) DEFINITIONS.—In this section: 
(1) The term ‘‘covered care’’ means care for a 
veteran eligible for care provided by the Department 
of Veterans Affairs under title 38, United States 
Code, or any other law administered by the Sec-
retary of Veterans Affairs, even if the care associ-
ated with the transport described in subsection (a) 
is not authorized by the Department. 
(2) The term ‘‘covered location’’ means a loca-
tion that is— 
(A) in a State that is 100 miles or more 
from the nearest medical center of the Depart-
ment of Veterans Affairs; and 
(B) in an area rated as a 10 or higher 
under the rural-urban commuting areas coding 
system of the Department of Agriculture. 
(3) The term ‘‘covered veteran’’ means a vet-
eran who— 
(A) has a service-connected disability rated 
by the Secretary as between 0 and 30 percent 
disabling; 
(B) is not eligible for payments or reim-
bursements for beneficiary travel or other 
transportation under the laws administered by 
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the Secretary of Veterans Affairs, other than 
under this section; and 
(C) is not entitled to care or services under 
a non-Department of Veterans Affairs health- 
plan contract. 
(4) The term ‘‘health-plan contract’’ has the 
meaning given that term in section 1725 of title 38, 
United States Code. 
(5) The term ‘‘service-connected’’ has the 
meaning given that term in section 101 of such title. 
SEC. 144. PILOT PROGRAM TO FURNISH DENTAL CARE 
FROM THE DEPARTMENT OF VETERANS AF-
FAIRS TO CERTAIN VETERANS DIAGNOSED 
WITH ISCHEMIC HEART DISEASE. 
(a) IN GENERAL.—Beginning not later than one year 
after the date of the enactment of this Act, the Secretary 
of Veterans Affairs shall carry out a two-year pilot pro-
gram (in this section referred to as the ‘‘pilot program’’) 
under which the Secretary shall furnish covered care to 
covered veterans through means that include the use of 
community care. 
(b) LOCATIONS.— 
(1) IN GENERAL.—The Secretary shall select 
not more than four States in which to carry out the 
pilot program. 
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(2) SELECTION CRITERIA.—In selecting States 
under paragraph (1), the Secretary shall prioritize 
States in which— 
(A) the Department of Veterans Affairs 
serves a high proportion, as determined by the 
Secretary, of veterans residing in rural or high-
ly rural areas (as determined through the use 
of the Rural-Urban Commuting Areas coding 
system of the Department of Agriculture); 
(B) dental clinics operated by the Depart-
ment of Veterans Affairs currently utilize tele-
dentistry; 
(C) the Department of Veterans Affairs 
does not currently operate a dental clinic; or 
(D) the Secretary determines a large per-
centage of veterans enrolled in the system of 
annual patient enrollment of the Department of 
Veterans Affairs established and operated under 
paragraphs (1) or (2) of section 1705(a) of title 
38, United States Code, visit emergency rooms 
for dental emergencies at high rates. 
(c) PARTICIPATION LIMITATION.—Participation in a 
pilot program established pursuant to this section shall be 
limited to a covered veteran who receives health care in 
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a facility of the Department located in a State selected 
under subsection (b). 
(d) USE
OF
CERTAIN
METHODS
TO
PROVIDE 
CARE.— 
(1) MOBILE DENTAL CLINICS.—In carrying out 
the pilot program, the Secretary shall test the effi-
cacy of mobile dental clinics to service rural areas 
that do not have a population base to warrant a full- 
time clinic but where there are covered veterans in 
need of dental care. 
(2) HOME-BASED DENTAL CARE.—In carrying 
out the pilot program, the Secretary shall test the 
efficacy of portable dental care units to service rural 
veterans in their homes, as the Secretary considers 
medically appropriate. 
(e) ADMINISTRATION.— 
(1) COMMUNITY CARE NETWORK REVIEW.— 
(A) IN GENERAL.—Before commencing the 
pilot program, the Secretary shall work with 
third party administrators to conduct a review 
of dental providers who are part of the commu-
nity care network of the Department in each 
State selected under subsection (b)(1) to en-
sure— 
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(i) dental providers who are no longer 
accepting patients from the Department— 
(I) are not still listed as pro-
viders accepting referrals from the 
Department; and 
(II) are not sent referrals from 
the Department; and 
(ii) dental providers participating in 
each such network are capable of receiving 
an influx of patients from the Department 
under the pilot program. 
(B) EXPANSION OF NETWORK.—If, pursu-
ant to a review under subparagraph (A), the 
Secretary determines the community care net-
work in a State selected under subsection (b)(1) 
is not capable of receiving an influx of patients 
under the pilot program, the Secretary shall co-
ordinate with the Third Party Administrator 
for such State to ensure the dental provider 
network of such community care network is suf-
ficiently expanded before the initiation of the 
pilot program. 
(2) NOTICE TO COVERED VETERANS.—In car-
rying out the pilot program, the Secretary shall in-
form all covered veterans in States selected under 
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subsection (b)(1) of the covered care available under 
the pilot program. 
(3) LOSS OF ELIGIBILITY.—Any veteran par-
ticipating in the pilot program who ceases to be a 
covered veteran shall be removed from the pilot pro-
gram on the date that is 90 days after the Secretary 
determines the participant is no longer a covered 
veteran. 
(4) CONTINUITY OF CARE.— 
(A) IN GENERAL.—Upon the termination 
of the pilot program, the Secretary shall provide 
to all veterans participating in the pilot pro-
gram at the time of such termination— 
(i) information on how to enroll in the 
dental insurance plan of the Department of 
Veterans Affairs under section 1712C of 
title 38, United States Code; 
(ii) if appropriate, information on the 
VETSmile program of the Department of 
Veterans Affairs, or any successor pro-
gram; or 
(iii) contact information for dental 
providers in the surrounding community 
who provide low- or no-cost dental care 
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and whom the Secretary has confirmed are 
available to take on new patients. 
(B) 
CONTINUATION
OF
TREATMENT 
PLAN.—Any veteran participating in the pilot 
program may continue to receive services under 
the pilot program after the termination of the 
pilot program to complete a treatment plan 
commenced under the pilot program, as deter-
mined necessary by the Secretary. 
(f) REPORTS.— 
(1) ANNUAL REPORT.—Not later than one year 
after the commencement of the pilot program, and 
annually thereafter for the duration of the pilot pro-
gram, the Secretary of Veterans Affairs shall submit 
to the Committees on Veterans’ Affairs of the House 
of Representatives and the Senate a report on the 
pilot program that includes— 
(A) an identification of the States partici-
pating in the pilot program; 
(B) a description of the implementation 
and operation of the pilot program; 
(C) the number of participants in the pilot 
program, disaggregated by— 
(i) State; and 
(ii) disability rating; 
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(D) an identification of any barriers or 
challenges to implementing the pilot program; 
(E) aggregated feedback from participants 
in the pilot program, including from interviews 
and surveys; 
(F) the average annual cost of providing 
covered care to a participant in the pilot pro-
gram, disaggregated by— 
(i) State; 
(ii) disability rating; and 
(iii) whether the care was provided 
through the community care network or 
through a provider of the Department; 
(G) an analysis of the communication and 
collaboration of the Department with Third 
Party Administrators and community care den-
tal providers, disaggregated by State; 
(H) an analysis of any cost savings by the 
Department with respect to the treatment of 
ischemic heart disease; 
(I) an assessment of the impact of the 
pilot program on appointments for care, pre-
scriptions, hospitalizations, emergency room vis-
its, wellness, employability, satisfaction, and 
perceived quality of life of covered veterans re-
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lated to their diagnosis of ischemic heart dis-
ease; 
(J) an analysis and assessment of the effi-
cacy of mobile clinics and portable dental care 
units, to the extent such modalities are used, to 
service the needs of covered veterans under the 
pilot program; 
(K) an analysis and assessment of the 
usage of teledentistry to service the needs of 
covered veterans under the pilot program, to in-
clude a cost benefit analysis of such services; 
and 
(L) such other matters as the Secretary 
considers appropriate. 
(2) FINAL REPORT.—Not later than 90 days 
before the completion of the pilot program, the Sec-
retary shall submit to the Committees on Veterans’ 
Affairs of the House of Representatives and the Sen-
ate a report on the pilot program that— 
(A) includes the matters required under 
paragraph (1); 
(B) includes recommendations on whether 
the pilot program should be continued, ex-
panded, or adopted throughout the Department; 
and 
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(C) indicates whether the Secretary re-
quests action by Congress to make the pilot 
program permanent. 
(g) IMPACT ON COMMUNITY CARE.—Participants in 
the pilot program shall be able to access covered care in 
the community under section 1703 of title 38, United 
States Code. 
(h) DEFINITIONS.—In this section: 
(1) The term ‘‘covered care’’ means dental care 
that is consistent with the dental services and treat-
ment furnished by the Secretary of Veterans Affairs 
to veterans pursuant to section 1712(a)(1)(G) of 
title 38, United States Code. 
(2) The term ‘‘covered veteran’’ means a vet-
eran who— 
(A) is enrolled in the system of annual pa-
tient enrollment of the Department established 
and operated under paragraphs (1) or (2) of 
section 1705(a) of title 38, United States Code; 
(B) is not eligible for dental services and 
treatment and related dental appliances under 
the laws administered by the Secretary as of 
the date of the enactment of this Act; and 
(C) has a diagnosis of ischemic heart dis-
ease. 
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(3) The term ‘‘Third Party Administrator’’ has 
the meaning given such term in section 1703F of 
such title. 
SEC. 145. DOCUMENTATION OF PREFERENCES OF VET-
ERANS FOR SCHEDULING OF APPOINTMENTS 
FOR HEALTH CARE UNDER LAWS ADMINIS-
TERED BY SECRETARY OF VETERANS AF-
FAIRS. 
(a) IN GENERAL.—Not later than one year after the 
date of the enactment of this Act, the Secretary of Vet-
erans Affairs shall develop a mechanism to solicit informa-
tion regarding the preference of veterans enrolled in the 
system of annual patient enrollment of the Department 
of Veterans Affairs established and operated under section 
1705(a) of title 38, United States Code, for scheduling 
of appointments for health care and related services under 
the laws administered by the Secretary, including through 
non-Department providers. 
(b) 
DOCUMENTATION
OF
PREFERENCE.—Pref-
erences provided voluntarily by a veteran pursuant to sub-
section (a) shall be documented on My HealtheVet or an-
other system designated by the Secretary that allows the 
veteran to view and change such preferences at any time. 
(c) INCLUSION IN PREFERENCE.—Preferences solic-
ited under subsection (a) shall include the following: 
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(1) How and when the veteran prefers to be 
contacted about an appointment for health care. 
(2) Whether the veteran prefers to schedule ap-
pointments without the assistance of the Depart-
ment, if able. 
(3) Whether the veteran prefers to select a pro-
vider without the assistance of the Department, if 
able. 
(4) Whether the veteran prefers appointments 
to be scheduled during certain days or times. 
(d) USE
OF PREFERENCE.—The Secretary shall 
make the preferences provided under subsection (a) easily 
accessible to medical support assistants and other staff of 
the Department, or non-Department staff, as the Sec-
retary determines appropriate, who assist in the appoint-
ment scheduling process. 
(e) DEPLOYMENT OF MECHANISM.— 
(1) IN GENERAL.—Beginning after the date on 
which the Secretary develops the mechanism re-
quired under subsection (a), the Secretary shall— 
(A) test the mechanism in not fewer than 
three geographically diverse Veterans Inte-
grated Service Networks; and 
(B) gather feedback about the effectiveness 
of such mechanism from veterans, medical sup-
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port assistants, staff and other stakeholders as 
the Secretary determines appropriate. 
(2) LIMITATION.—The Secretary may not im-
plement such mechanism across the Veterans Health 
Administration of the Department before the Sec-
retary addresses the feedback described in para-
graph (1)(B). 
SEC. 146. STAFFING MODEL AND PERFORMANCE METRICS 
FOR CERTAIN EMPLOYEES OF THE DEPART-
MENT OF VETERANS AFFAIRS. 
(a) STAFFING MODEL.— 
(1) IN
GENERAL.—Not later than one year 
after the date of the enactment of this Act, the Sec-
retary of Veterans Affairs shall— 
(A) develop, validate, and implement a 
staffing model for the Office of Integrated Vet-
eran Care of the Department of Veterans Af-
fairs, or successor office, Veterans Integrated 
Services Networks, and medical centers of the 
Department that includes appropriate target 
staffing levels nationally, regionally, and locally 
to ensure timely access to care and effectively 
oversee the provision of care by the Depart-
ment, whether at a facility of the Department 
or through a non-Department provider; and 
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(B) provide to Congress a briefing on such 
staffing model, which shall include— 
(i) the metrics and measures used by 
the Secretary in developing such staffing 
model; 
(ii) an analysis of how such staffing 
model compares to the staffing models of 
other relevant Government-owned and pri-
vate sector health care systems; and 
(iii) an estimate of the portion of the 
roles in such staffing model that will be 
filled by contracted staff at any given time. 
(2) REPORT ON IMPLEMENTATION OF STAFF-
ING MODEL.—Not later than one year after the date 
on which the Secretary implements the staffing 
model required under paragraph (1), the Secretary 
shall submit to Congress and the Comptroller Gen-
eral of the United States a report containing— 
(A) an update on such implementation; 
and 
(B) information on the outcomes yielded 
by such staffing model in terms of improved ac-
cess to care for veterans and improved compli-
ance with relevant laws, regulations, policy di-
rectives, and guidance governing access to care. 
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(b) PERFORMANCE METRICS.— 
(1) IN
GENERAL.—Not later than one year 
after the date of the enactment of this Act, the Sec-
retary shall develop and implement a plan, with an 
appropriate tracking system, to incorporate appro-
priate standardized performance metrics and over-
sight measures within the performance appraisal 
systems for employees of the Department specified 
in paragraph (2). 
(2) EMPLOYEES OF THE DEPARTMENT SPECI-
FIED.—Employees of the Department specified in 
this paragraph are employees who are responsible 
for ensuring timely access to care from the Depart-
ment, compliance with relevant statutes and regula-
tions relating to the provision of care, including sec-
tion 1703 of title 38, United States Code, and over-
seeing the provision of care, whether at a facility of 
the Department or through a non-Department pro-
vider, including employees within the Office of Inte-
grated Veteran Care of the Department, or suc-
cessor office, employees of a Veterans Integrated 
Service Network, and employees of a medical center 
of the Department. 
(3) REPORT
ON
IMPLEMENTATION
OF
PER-
FORMANCE METRICS.—Not later than one year after 
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implementing the performance metrics required 
under paragraph (1), the Secretary shall submit to 
Congress and the Comptroller General of the United 
States a report containing— 
(A) an update on such implementation; 
and 
(B) information on the outcomes yielded 
by such performance metrics in terms of im-
proved access to care for veterans and improved 
compliance with relevant laws, policy directives, 
and guidance governing access to care. 
(c) GAO REPORT.—Not later than two years after 
the later of the date on which the Comptroller General 
receives the report under subsection (a)(2) or the report 
under subsection (b)(3), the Comptroller General shall 
submit to Congress a report that includes— 
(1) an assessment of the performance of the Of-
fice of Integrated Veteran Care of the Department, 
or successor office, in improving access to care for 
veterans in facilities of the Department and pursu-
ant to section 1703 of title 38, United States Code; 
and 
(2) such recommendations as the Comptroller 
General considers appropriate with respect to im-
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proving access to the care described in paragraph 
(1) for veterans. 
SEC. 147. ONLINE HEALTH EDUCATION PORTAL FOR VET-
ERANS ENROLLED IN PATIENT ENROLLMENT 
SYSTEM OF DEPARTMENT OF VETERANS AF-
FAIRS. 
Not later than one year after the date of the enact-
ment of this Act, the Secretary of Veterans Affairs shall 
establish, on an Internet website of the Department, a 
health education portal that includes interactive edu-
cational modules to ensure veterans enrolled in the patient 
enrollment system of the Department of Veterans Affairs 
established and operated under section 1705(a) of title 38, 
United States Code, understand the basic health care eli-
gibilities and entitlements of veterans under the laws ad-
ministered by the Secretary, including under the Veterans 
Community Care Program under section 1703 of such 
title. 
SEC. 148. LIMITATION ON DETAIL OF DIRECTORS OF MED-
ICAL CENTERS OF DEPARTMENT OF VET-
ERANS AFFAIRS TO DIFFERENT POSITIONS. 
(a) NOTIFICATION.— 
(1) IN GENERAL.—Not later than 90 days after 
detailing a director of a medical center of the De-
partment of Veterans Affairs to a different position 
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within the Department, the Secretary of Veterans 
Affairs shall notify the Committee on Veterans’ Af-
fairs of the Senate and the Committee on Veterans’ 
Affairs of the House of Representatives of such de-
tail. 
(2) MATTERS TO BE INCLUDED.—The notifica-
tion required by paragraph (1) shall include, with re-
spect to a director of a medical center who is de-
tailed to a different position within the Department, 
the following information: 
(A) The location at which the director is 
detailed. 
(B) The position title of the detail. 
(C) The estimated time the director is ex-
pected to be absent from their duties at the 
medical center. 
(D) Such other information as the Sec-
retary may determine appropriate. 
(b) APPOINTMENT OF ACTING DIRECTOR.—Not later 
than 120 days after detailing a director of a medical cen-
ter of the Department to a different position within the 
Department, the Secretary shall appoint an individual as 
acting director of such medical center with all of the au-
thority and responsibilities of the detailed director. 
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(c) UPDATE ON DETAIL.—Not later than 120 days 
after detailing a director of a medical center of the De-
partment to a different position within the Department, 
and not less frequently than every 30 days thereafter while 
the detail is in effect or while the director position at the 
medical center is vacant, 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 an update regarding the status of the detail. 
(d) RETURN TO POSITION OR REASSIGNMENT.— 
(1) IN GENERAL.—Except as provided in para-
graph (2), not later than 180 days after detailing a 
director of a medical center of the Department to a 
different position within the Department, for a rea-
son other than an ongoing investigation or adminis-
trative action with respect to the director, the Sec-
retary shall— 
(A) return the individual to the position as 
director of the medical center; or 
(B) reassign the individual from the posi-
tion as director of the medical center and begin 
the process of hiring a new director for such po-
sition. 
(2) WAIVER.— 
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(A) IN
GENERAL.—The Secretary may 
waive the requirement under paragraph (1) 
with respect to an individual for successive 90- 
day increments for a total period of not more 
than 540 days from the original date the indi-
vidual was detailed away from their position as 
director of a medical center. 
(B) NOTIFICATION.—Not later than 30 
days after exercising a waiver under subpara-
graph (A), the Secretary shall notify Congress 
of the waiver and provide to Congress informa-
tion as to why the waiver is necessary. 
SEC. 149. NATIONAL VETERAN SUICIDE PREVENTION AN-
NUAL REPORT. 
(a) NATIONAL VETERAN SUICIDE PREVENTION AN-
NUAL REPORT.— 
(1) IN GENERAL.—Not later than 18 months 
after the date of the enactment of this Act, and not 
later than September 30 of each year thereafter, the 
Secretary of Veterans Affairs shall submit to the ap-
propriate congressional committees and publish on a 
publicly available website of the Department of Vet-
erans Affairs a report to be known as the ‘‘National 
Veteran Suicide Prevention Annual Report’’. 
(2) EXTENSION.— 
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(A) IN
GENERAL.—If the Secretary re-
quires an extension of the deadline for a report 
under subsection (a), the Secretary shall submit 
to the appropriate congressional committees a 
written request for such an extension. 
(B) ELEMENTS.—Each written request 
under paragraph (1) for an extension for a re-
port shall include the following: 
(i) The rationale for the delay in the 
submission of the report. 
(ii) An explanation of the need for an 
extension. 
(iii) A proposed amended date for the 
submission and publication of the report. 
(3) BRIEFING.—With respect to each report re-
quired under paragraph (1), the Secretary shall, be-
fore the date on which the Secretary submits such 
report, provide to the appropriate congressional com-
mittees a briefing on such report. 
(4) ELEMENTS.— 
(A) IN
GENERAL.—Each report required 
under paragraph (1) shall include— 
(i) the findings of the national anal-
ysis of veteran suicide rates for the latest 
year for which data is available; 
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(ii) an identification of trends, if any, 
demonstrated by such data; and 
(iii) a comparison of such data to data 
on veteran suicide rates during preceding 
years. 
(B) ADDITIONAL ELEMENTS.—Each report 
under paragraph (1) shall include, for the year 
covered by the report, the following: 
(i) 
Suicide 
rates 
of 
veterans 
disaggregated by age, gender, and race or 
ethnicity. 
(ii) Trends in suicide rates of veterans 
compared to engagement of those veterans 
with health care from the Veterans Health 
Administration, including an examination 
of trends in suicide rates or deaths 
among— 
(I) veterans who have recently re-
ceived health care from the Veterans 
Health Administration as compared to 
veterans who have never received 
health care from the Veterans Health 
Administration; 
(II) veterans who are enrolled in 
the patient enrollment system of the 
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Department of Veterans Affairs under 
section 1705(a) of title 38, United 
States Code, as compared to veterans 
who have never enrolled in such sys-
tem; 
(III) veterans who have recently 
used services from a Vet Center as 
compared to veterans who have never 
used such services; 
(IV) to the extent practicable, 
veterans who have a diagnosis of sub-
stance use disorder; and 
(V) other groups of veterans re-
lating to engagement with health care 
from the Veterans Health Administra-
tion, as the Secretary considers prac-
ticable. 
(iii) To the extent practicable, trends 
in suicide rates of veterans compared to 
engagement of those veterans with benefits 
from the Veterans Benefits Administra-
tion, including an examination of trends in 
suicide rates or deaths among— 
(I) veterans who are currently 
using, have previously used, or have 
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never 
used 
educational 
assistance 
under the laws administered by the 
Secretary; 
(II) veterans who are currently 
receiving, have previously received, or 
have never received services or assist-
ance under chapter 31 of title 38, 
United States Code; 
(III) with respect to compensa-
tion under chapter 11 of such title— 
(aa) veterans who were re-
cipients of such compensation as 
compared to veterans who never 
applied for such compensation 
prior to death; 
(bb) veterans who had a 
claim denied for such compensa-
tion prior to death; 
(cc) veterans who had a 
pending claim for such com-
pensation at time of death; and 
(dd) veterans who had an 
entitlement for such compensa-
tion reduced prior to death; 
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