222 
(A) Rural areas and other areas that are 
underserved by the Department. 
(B) Areas that are not in close proximity 
to an active duty military installation. 
(C) Areas representing different geo-
graphic locations, such as census tracts estab-
lished by the Bureau of the Census. 
(d) GENDER-SPECIFIC SERVICES.—In carrying out 
the program at each location selected under subsection (c), 
the Secretary shall ensure that— 
(1) the needs of female veterans are specifically 
considered and addressed; and 
(2) female peer specialists are made available to 
female veterans who are treated at each location. 
(e) ENGAGEMENT WITH COMMUNITY PROVIDERS.— 
At each location selected under subsection (c), the Sec-
retary shall consider ways in which peer specialists can 
conduct outreach to health care providers in the commu-
nity who are known to be serving veterans to engage with 
those providers and veterans served by those providers. 
(f) REPORTS.— 
(1) PERIODIC REPORTS.— 
(A) IN
GENERAL.—Not later than 180 
days after the date of the enactment of this 
Act, and not less frequently than once every 
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180 days thereafter until the Secretary deter-
mines that the program is being carried out at 
the last location to be selected under subsection 
(c), the Secretary shall submit to Congress a 
report on the program. 
(B) ELEMENTS.—Each report required by 
subparagraph (A) shall, with respect to the 
180-day period preceding the submittal of the 
report, include the following: 
(i) The findings and conclusions of 
the Secretary with respect to the program. 
(ii) An assessment of the benefits of 
the program to veterans and family mem-
bers of veterans. 
(iii) An assessment of the effective-
ness of peer specialists in engaging under 
subsection (e) with health care providers in 
the community and veterans served by 
those providers. 
(2) FINAL REPORT.—Not later than 180 days 
after the Secretary determines that the program is 
being carried out at the last location to be selected 
under subsection (c), the Secretary shall submit to 
Congress a report detailing the recommendations of 
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the Secretary as to the feasibility and advisability of 
expanding the program to additional locations. 
SEC. 507. DEPARTMENT OF VETERANS AFFAIRS MEDICAL 
SCRIBE PILOT PROGRAM. 
(a) IN GENERAL.—The Secretary of Veterans Affairs 
shall carry out a two-year pilot program under which the 
Secretary shall increase the use of medical scribes at De-
partment of Veterans Affairs medical centers. 
(b) LOCATIONS.—The Secretary shall carry out the 
pilot program at the 10 medical centers of the Department 
as follows: 
(1) At least four such medical centers located 
in rural areas. 
(2) At least four such medical centers located 
in urban areas. 
(3) Two such medical centers located in areas 
with need for increased access or increased effi-
ciency, as determine by the Secretary. 
(c) MEDICAL SCRIBES.— 
(1) HIRING.—Under the pilot program the Sec-
retary shall— 
(A) hire 20 new Department of Veterans 
Affairs term employees as medical scribes; and 
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(B) seek to enter into contracts with ap-
propriate entities for the employment of 20 ad-
ditional medical scribes. 
(2) DISTRIBUTION.—The Secretary shall assign 
four medical scribes to each of the 10 medical cen-
ters of the Department where the Secretary carries 
out the pilot program as follows: 
(A) Two scribes shall be assigned to each 
of two physicians. 
(B) Thirty percent of the scribes shall be 
employed in the provision of emergency care. 
(C) Seventy percent of the scribes shall be 
employed in the provision of speciality care in 
specialties with the longest patient wait times 
or lowest efficiency ratings, as determined by 
the Secretary. 
(d) REPORTS.— 
(1) REPORTS TO CONGRESS.—Not later than 
180 days after the commencement of the pilot pro-
gram required under this section, and every 180 
days thereafter for the duration of the pilot pro-
gram, the Secretary of Veterans Affairs shall submit 
to Congress a report on the pilot program. Each 
such report shall include each of the following: 
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(A) A separate analysis of each the fol-
lowing with respect to medical scribes employed 
by the Department of Veterans Affairs and 
medical scribes performing Department of Vet-
erans Affairs functions under a contract: 
(i) Provider efficiency. 
(ii) Patient satisfaction. 
(iii) Average wait time. 
(iv) The number of patients seen per 
day by each physician or practitioner. 
(v) The amount of time required to 
hire and train an employee to perform 
medical scribe functions under the pilot 
program. 
(B) Metrics and data for analyzing the ef-
fects of the pilot program, including an evalua-
tion of the each of the elements under clauses 
(i) through (iv) of subparagraph (A) at medical 
centers who employed scribes under the pilot 
program for an appropriate period preceding 
the hiring of such scribes. 
(2) COMPTROLLER
GENERAL
REPORT.—Not 
later than 90 days after the termination of the pilot 
program under this section, the Comptroller General 
of the United States shall submit to Congress a re-
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227 
port on the pilot program. Such report shall include 
a comparison of the pilot program with similar pro-
grams carried out in the private sector. 
(e) DEFINITIONS.—In this section: 
(1) The term ‘‘medical scribe’’ means an unli-
censed individual hired to enter information into the 
electronic health record or chart at the direction of 
a physician or licensed independent practitioner 
whose responsibilities include the following: 
(A) Assisting the physician or practitioner 
in navigating the electronic health record. 
(B) Responding to various messages as di-
rected by the physician or practitioner. 
(C) Entering information into the elec-
tronic health record, as directed by the physi-
cian or practitioner. 
(2) The terms ‘‘urban’’ and ‘‘rural’’ have the 
meanings given such terms under the rural-urban 
commuting codes developed by the Secretary of Agri-
culture and the Secretary of Health and Human 
Services. 
(f) FUNDING.—The pilot program under this section 
shall be carried out using amounts otherwise authorized 
to be appropriated for the Department of Veterans Af-
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228 
fairs. No additional amounts are authorized to be appro-
priated to carry out such program. 
SEC. 508. EXTENSION OF REQUIREMENT TO COLLECT FEES 
FOR HOUSING LOANS GUARANTEED BY SEC-
RETARY OF VETERANS AFFAIRS. 
Section 3729(b)(2) of title 38, United States Code, 
is amended by striking ‘‘2027’’ each place it appears and 
inserting ‘‘2028’’. 
SEC. 509. EXTENSION OF REDUCTION IN AMOUNT OF PEN-
SION FURNISHED BY DEPARTMENT OF VET-
ERANS AFFAIRS FOR CERTAIN VETERANS 
COVERED BY MEDICAID PLANS FOR SERV-
ICES FURNISHED BY NURSING FACILITIES. 
Section 5503(d)(7) of title 38, United States Code, 
is amended by striking ‘‘September 30, 2027’’ and insert-
ing ‘‘September 30, 2028’’. 
SEC. 510. APPROPRIATION OF AMOUNTS. 
(a) VETERANS CHOICE PROGRAM.—There is author-
ized to be appropriated, and is appropriated, to the Sec-
retary of Veterans Affairs, out of any funds in the Treas-
ury not otherwise appropriated, $5,200,000,000 to be de-
posited in the Veterans Choice Fund under section 802 
of the Veterans Access, Choice, and Accountability Act of 
2014 (Public Law 113–146; 38 U.S.C. 1701 note). 
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(b) AVAILABILITY OF AMOUNTS.—The amounts ap-
propriated under subsection (a) shall be available for obli-
gation or expenditure without fiscal year limitation. 
SEC. 511. TECHNICAL CORRECTION. 
Section 1712I of title 38, United States Code, is re-
designated as section 1720I of such title. 
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Union Calendar No. 516 
115TH CONGRESS 
2D SESSION 
H. R. 5674 
[Report No. 115–671, Part I] 
A BILL 
To establish a permanent community care program 
for veterans, to establish a commission for the 
purpose of making recommendations regarding 
the modernization or realignment of facilities of 
the Veterans Health Administration, to improve 
construction of the Department of Veterans Af-
fairs, to make certain improvements in the laws 
administered by the Secretary of Veterans Af-
fairs relating to the home loan program of the 
Department of Veterans Affairs, and for other 
purposes. 
MAY 11, 2018 
Reported from the Committee on Veterans’ Affairs 
MAY 11, 2018 
The Committee on Rules discharged; committed to the 
Committee of the Whole House on the State of the 
Union and ordered to be printed 
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