I 
111TH CONGRESS 
1ST SESSION 
H. R. 568 
To amend title 38, United States Code, to improve the quality of care 
provided to veterans in Department of Veterans Affairs medical facilities, 
to encourage highly qualified doctors to serve in hard-to-fill positions 
in such medical facilities, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JANUARY 15, 2009 
Mr. COSTELLO
(for himself, Mr. SHIMKUS, Mr. MITCHELL, and Mr. 
WHITFIELD) introduced the following bill; which was referred to the Com-
mittee on Veterans’ Affairs, and in addition to the Committee on Over-
sight and Government Reform, for a period to be subsequently deter-
mined by the Speaker, in each case for consideration of such provisions 
as fall within the jurisdiction of the committee concerned 
A BILL 
To amend title 38, United States Code, to improve the 
quality of care provided to veterans in Department of 
Veterans Affairs medical facilities, to encourage highly 
qualified doctors to serve in hard-to-fill positions in such 
medical facilities, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Veterans Health Care 
Quality Improvement Act’’. 
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SEC. 2. STANDARDS FOR APPOINTMENT AND PRACTICE OF 
PHYSICIANS IN DEPARTMENT OF VETERANS 
AFFAIRS MEDICAL FACILITIES. 
(a) STANDARDS.— 
(1) IN GENERAL.—Subchapter I of chapter 74 
of title 38, United States Code, is amended by in-
serting after section 7402 the following new section: 
‘‘§ 7402A. Appointment and practice of physicians: 
standards 
‘‘(a) IN GENERAL.—The Secretary shall, acting 
through the Under Secretary for Health, prescribe stand-
ards to be met by individuals in order to qualify for ap-
pointment in the Veterans Health Administration in the 
position of physician and to practice as a physician in 
medical facilities of the Veterans Health Administration. 
The standards shall incorporate the requirements of this 
section. 
‘‘(b) DISCLOSURE OF CERTAIN INFORMATION BE-
FORE APPOINTMENT.—Each individual seeking appoint-
ment in the Veterans Health Administration in the posi-
tion of physician shall do the following: 
‘‘(1) Provide the Secretary a full and complete 
explanation of the following: 
‘‘(A) Each lawsuit, civil action, or other 
claim (whether open or closed) brought against 
the individual for medical malpractice or neg-
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ligence (other than a lawsuit, action, or claim 
closed without any judgment against or pay-
ment by or on behalf of the individual). 
‘‘(B) Each payment made by or on behalf 
of the individual to settle any lawsuit, action, or 
claim covered by subparagraph (A). 
‘‘(C) Each investigation or disciplinary ac-
tion taken against the individual relating to the 
individual’s performance as a physician. 
‘‘(2) Submit a written request and authoriza-
tion to the State licensing board of each State in 
which the individual holds or has held a license to 
practice medicine to disclose to the Secretary any in-
formation in the records of such State on the fol-
lowing: 
‘‘(A) Each lawsuit, civil action, or other 
claim brought against the individual for medical 
malpractice or negligence covered by paragraph 
(1)(A) that occurred in such State. 
‘‘(B) Each payment made by or on behalf 
of the individual to settle any lawsuit, action, or 
claim covered by subparagraph (A). 
‘‘(C) Each medical malpractice judgment 
against the individual by the courts or adminis-
trative agencies or bodies of such State. 
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‘‘(D) Each disciplinary action taken or 
under consideration against the individual by 
an administrative agency or body of such State. 
‘‘(E) Any change in the status of the li-
cense to practice medicine issued the individual 
by such State, including any voluntary or non-
disciplinary surrendering of such license by the 
individual. 
‘‘(F) Any open investigation of the indi-
vidual by an administrative agency or body of 
such State, or any outstanding allegation 
against the individual before such an adminis-
trative agency or body. 
‘‘(G) Any written notification by the State 
to the individual of potential termination of a li-
cense for cause or otherwise. 
‘‘(c) DISCLOSURE OF CERTAIN INFORMATION FOL-
LOWING APPOINTMENT.—(1) Each individual appointed 
in the Veterans Health Administration in the position of 
physician after the date of the enactment of the Veterans 
Health Care Quality Improvement Act shall, as a condi-
tion of service under the appointment, disclose to the Sec-
retary, not later than 30 days after the occurrence of such 
event, the following: 
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‘‘(A) A judgment against the individual for 
medical malpractice or negligence. 
‘‘(B) A payment made by or on behalf of the 
individual to settle any lawsuit, action, or claim dis-
closed under paragraph (1) or (2) of subsection (b). 
‘‘(C) Any disposition of or material change in a 
matter disclosed under paragraph (1) or (2) of sub-
section (b). 
‘‘(2) Each individual appointed in the Veterans 
Health Administration in the position of physician as of 
the date of the enactment of the Veterans Health Care 
Quality Improvement Act shall do the following: 
‘‘(A) Not later than the end of the 60-day pe-
riod beginning on the date of the enactment of that 
Act and as a condition of service under the appoint-
ment after the end of that period, submit the re-
quest and authorization described in subsection 
(b)(2). 
‘‘(B) Agree, as a condition of service under the 
appointment, to disclose to the Secretary, not later 
than 30 days after the occurrence of such event, the 
following: 
‘‘(I) A judgment against the individual for 
medical malpractice or negligence. 
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‘‘(ii) A payment made by or on behalf of 
the individual to settle any lawsuit, action, or 
claim disclosed pursuant to subparagraph (A) 
or under this subparagraph. 
‘‘(iii) Any disposition of or material change 
in a matter disclosed pursuant to subparagraph 
(A) or under this subparagraph. 
‘‘(3) Each individual appointed in the Veterans 
Health Administration in the position of physician shall, 
as part of the biennial review of the performance of the 
physician under the appointment, submit the request and 
authorization described in subsection (b)(2). The require-
ment of this paragraph is in addition to the requirements 
of paragraph (1) or (2), as applicable. 
‘‘(d) INVESTIGATION OF DISCLOSED MATTERS.—(1) 
The Director of the Veterans Integrated Services Network 
(VISN) in which an individual is seeking appointment in 
the Veterans Health Administration in the position of phy-
sician shall perform a comprehensive investigation (in 
such manner as the standards required by this section 
shall specify) of each matter disclosed under subsection 
(b) with respect to the individual. 
‘‘(2) The Director of the Veterans Integrated Serv-
ices Network in which an individual is appointed in the 
Veterans Health Administration in the position of physi-
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cian shall perform a comprehensive investigation (in a 
manner so specified) of each matter disclosed under sub-
section (c) with respect to the individual. 
‘‘(3) The results of each investigation performed 
under this subsection shall be fully documented. 
‘‘(e) APPROVAL OF APPOINTMENTS BY DIRECTORS 
OF VISNS.—(1) An individual may not be appointed in 
the Veterans Health Administration in the position of phy-
sician without the approval of the Director of the Veterans 
Integrated Services Network in which the individual will 
first serve under the appointment. 
‘‘(2) In approving the appointment under this sub-
section of an individual for whom any matters have been 
disclosed under subsection (b), a Director shall— 
‘‘(A) certify in writing the completion of the 
performance of the investigation under subsection 
(d)(1) of each such matter, including the results of 
such investigation; and 
‘‘(B) provide a written justification why any 
matters raised in the course of such investigation do 
not disqualify the individual from appointment. 
‘‘(f) ENROLLMENT OF PHYSICIANS WITH PRACTICE 
PRIVILEGES IN PROACTIVE DISCLOSURE SERVICE.—Each 
medical facility of the Department at which physicians are 
extended the privileges of practice shall enroll each physi-
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cian extended such privileges in the Proactive Disclosure 
Service of the National Practitioners Data Bank. 
‘‘(g) ENCOURAGING HIRING OF PHYSICIANS WITH 
BOARD CERTIFICATION.—(1) The Secretary shall, for 
each performance contract with a Director of a Veterans 
Integrated Services Network (VISN), include in such con-
tract a provision that encourages the director to hire phy-
sicians who are board eligible or board certified in the spe-
cialty in which the physicians will practice. 
‘‘(2) The Secretary may determine the nature and 
manner of the provision described in paragraph (1).’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions at the beginning of chapter 74 of such title is 
amended by inserting after the item relating to sec-
tion 7402 the following new item: 
‘‘7402A. Appointment and practice of physicians: standards.’’. 
(b) EFFECTIVE DATE AND APPLICABILITY.— 
(1) EFFECTIVE DATE.—Except as provided in 
paragraphs (2) and (3), the amendments made by 
subsection (a) shall take effect on the date of the en-
actment of this Act. 
(2) APPLICABILITY
OF
CERTAIN
REQUIRE-
MENTS TO PHYSICIANS PRACTICING ON EFFECTIVE 
DATE.—In the case of an individual appointed to the 
Veterans Health Administration in the position of 
physician as of the date of the enactment of this 
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Act, the requirements of subsection (f) of section 
7402A, United States Code, as added by subsection 
(a) of this section, shall take effect on the date that 
is one year after the date of the enactment of this 
Act. 
(3) APPLICABILITY
OF
REQUIREMENTS
RE-
LATED TO HIRING OF PHYSICIANS WITH BOARD CER-
TIFICATION.—The requirements of subsection (g) of 
such section 7402A shall apply with respect to the 
first cycle of performance contracts for directors of 
Veterans Integrated Services Networks beginning 
after the date of the enactment of this Act and each 
subsequent cycle. 
SEC. 3. ENHANCEMENT OF QUALITY ASSURANCE BY THE 
VETERANS HEALTH ADMINISTRATION. 
(a) 
ENHANCEMENT
OF
QUALITY
ASSURANCE 
THROUGH QUALITY ASSURANCE OFFICERS.— 
(1) IN GENERAL.—Subchapter II of chapter 73 
of title 38, United States Code, is amended by in-
serting after section 7311 the following new section: 
‘‘§ 7311A. Quality assurance officers 
‘‘(a) NATIONAL QUALITY ASSURANCE OFFICER.—(1) 
The Under Secretary for Health shall designate an official 
of the Veterans Health Administration to act as the prin-
cipal quality assurance officer for the quality-assurance 
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program required by section 7311 of this title. The official 
so designated may be known as the ‘National Quality As-
surance Officer of the Veterans Health Administration’ (in 
this section referred to as the ‘National Quality Assurance 
Officer’). 
‘‘(2) The National Quality Assurance Officer shall re-
port directly to the Under Secretary for Health in the dis-
charge of responsibilities and duties of the Officer under 
this section. 
‘‘(3) The National Quality Assurance Officer shall be 
the official within the Veterans Health Administration 
who is principally responsible for the quality-assurance 
program referred to in paragraph (1). In carrying out that 
responsibility, the Officer shall be responsible for— 
‘‘(A) establishing and enforcing the require-
ments of that program; and 
‘‘(B) carrying out such other responsibilities 
and duties relating to quality assurance in the Vet-
erans Health Administration as the Under Secretary 
for Health shall specify. 
‘‘(4) The requirements under paragraph (3) shall in-
clude requirements regarding the following: 
‘‘(A) A confidential system for the submittal of 
reports by Veterans Health Administration per-
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sonnel regarding quality assurance at Department 
facilities. 
‘‘(B) Mechanisms for the peer review of the ac-
tions of individuals appointed in the Veterans Health 
Administration in the position of physician. 
‘‘(C) Mechanisms for the accountability of the 
facility director and chief medical officer of each 
Veterans Health Administration medical facility for 
the actions of physicians in such facility. 
‘‘(b) QUALITY ASSURANCE OFFICERS FOR VISNS.— 
(1) The Director of each Veterans Integrated Services 
Network (VISN) shall appoint an official of the Network 
to act as the quality assurance officer of the Network. 
‘‘(2) Each official appointed as a quality assurance 
officer under this subsection shall be a board-certified phy-
sician. 
‘‘(3) The quality assurance officer for a Veterans In-
tegrated Services Network shall report to the Director of 
the Veterans Integrated Services Network, and to the Na-
tional Quality Assurance Officer, regarding the discharge 
of the responsibilities and duties of the officer under this 
section. 
‘‘(4) The quality assurance officer for a Veterans In-
tegrated Services Network shall— 
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‘‘(A) direct the quality assurance office in the 
Network; and 
‘‘(B) coordinate, monitor, and oversee the qual-
ity assurance programs and activities of the Vet-
erans Health Administration medical facilities in the 
Network in order to ensure the thorough and uni-
form discharge of quality assurance requirements 
under such programs and activities throughout such 
facilities. 
‘‘(c) QUALITY ASSURANCE OFFICERS FOR MEDICAL 
FACILITIES.—(1) The director of each Veterans Health 
Administration medical facility shall appoint a quality as-
surance officer for that facility. 
‘‘(2) Each official appointed as a quality assurance 
officer under this subsection shall be a board-certified phy-
sician. 
‘‘(3) The official appointed as a quality assurance of-
ficer for a facility under this subsection shall be a prac-
ticing physician at the facility. If the official appointed as 
quality assurance officer for a facility has other clinical 
or administrative duties, the director of the facility shall 
ensure that those duties are sufficiently limited in scope 
so as to ensure that those duties do not prevent the officer 
from effectively discharging the responsibilities and duties 
of quality assurance officer at the facility. 
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‘‘(4) The quality assurance officer for a facility shall 
report directly to the director of the facility, and to the 
quality assurance officer of the Veterans Integrated Serv-
ices Network in which the facility is located, regarding the 
discharge of the responsibilities and duties of the quality 
assurance officer under this section. 
‘‘(5) The quality assurance officer for a facility shall 
be responsible for designing, disseminating, and imple-
menting quality assurance programs and activities for the 
facility that meet the requirements established by the Na-
tional Quality Assurance Officer under subsection (a).’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions at the beginning of chapter 73 of such title is 
amended by inserting after the item relating to sec-
tion 7311 the following new item: 
‘‘7311A. Quality assurance officers.’’. 
(b) BOARD-CERTIFIED PHYSICIAN REQUIREMENT 
FOR INDIVIDUALS APPOINTED
AS UNDER SECRETARY 
FOR HEALTH.—Section 305(a)(2) of title 38, United 
States Code, is amended by inserting ‘‘shall be a board- 
certified physician and’’ before ‘‘shall be’’. 
(c) REPORTS ON QUALITY CONCERNS UNDER QUAL-
ITY-ASSURANCE PROGRAM.—Section 7311(b) of such title 
is amended by adding at the end the following new para-
graph: 
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‘‘(4) As part of the quality-assurance program, the 
Under Secretary for Health shall establish mechanisms 
through which employees of Veterans Health Administra-
tion facilities may submit reports, on a confidential basis, 
on matters relating to quality of care in Veterans Health 
Administration facilities to the quality assurance officers 
of such facilities under section 7311A(c) of this title and 
to the quality assurance officers of the Veterans Inte-
grated Services Networks (VISNs) in which such facilities 
are located under section 7311A(b) of this title. The mech-
anisms shall provide for the prompt and thorough review 
of any reports so submitted by the receiving officials.’’. 
(d) REVIEW OF CURRENT HEALTH CARE QUALITY 
SAFEGUARDS.— 
(1) IN GENERAL.—The Secretary of Veterans 
Affairs shall conduct a comprehensive review of all 
current policies and protocols of the Department of 
Veterans Affairs for maintaining health care quality 
and patient safety at Department of Veterans Af-
fairs medical facilities. The review shall include a re-
view and assessment of the National Surgical Qual-
ity Improvement Program (NSQIP), including an 
assessment of— 
(A) the efficacy of the quality indicators 
under the program; 
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(B) the efficacy of the data collection 
methods under the program; 
(C) the efficacy of the frequency with 
which regular data analyses are performed 
under the program; and 
(D) the extent to which the resources allo-
cated to the program are adequate to fulfill the 
stated function of the program. 
(2) REPORT.—Not later than 60 days after the 
date of the enactment of this Act, the Secretary 
shall submit to Congress a report on the review con-
ducted under paragraph (1), including the findings 
of the Secretary as a result of the review and such 
recommendations as the Secretary considers appro-
priate in light of the review. 
SEC. 4. INCENTIVES TO ENCOURAGE HIGH-QUALITY PHYSI-
CIANS TO SERVE IN THE VETERANS HEALTH 
ADMINISTRATION. 
(a) INCENTIVES REQUIRED.— 
(1) IN GENERAL.—Subchapter III of chapter 
74 of title 38, United States Code, is amended by 
inserting after section 7431 the following new sec-
tion: 
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‘‘§ 7431A. Physicians: additional incentives for service 
in hard-to-fill positions 
‘‘(a) LOAN
REPAYMENT
FOR
PHYSICIANS
WHO 
SERVE IN HARD-TO-FILL POSITIONS.—(1) In order to re-
cruit and retain physicians in the Veterans Health Admin-
istration in hard-to-fill positions (as designated by the Sec-
retary for purposes of this subsection), the Secretary shall 
repay, for each individual who agrees to serve as a physi-
cian for a period of not less than three years in an Admin-
istration facility in such a position, any loan of such indi-
vidual as follows: 
‘‘(A) Any loan of the individual described in 
paragraphs (1) through (4) of section 16302(a) of 
title 10. 
‘‘(B) Any other loan of the individual des-
ignated by the Secretary for purposes of this sub-
section the proceeds of which were used by the indi-
vidual to finance education leading to the medical 
degree of the individual. 
‘‘(2) Each individual seeking repayment of loans 
under paragraph (1) shall enter into an agreement with 
the Secretary regarding the repayment of loans. Under the 
agreement, the individual shall agree— 
‘‘(A) to perform satisfactory service in a physi-
cian position specified in the agreement in an Ad-
ministration facility specified in the agreement for 
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such period of years as the agreement shall specify; 
and 
‘‘(B) to possess and retain for the period of the 
agreement such professional qualifications as are 
necessary for the service specified under subpara-
graph (A). 
‘‘(3) Repayment of loans under this subsection shall 
be made on the basis of complete years of service under 
the agreement under this subsection. The amount to be 
repaid under an agreement under this subsection for a 
complete year of service specified in the agreement shall 
be such amount, not to exceed $30,000, for each complete 
year of service as the agreement shall specify. 
‘‘(b) TUITION
REIMBURSEMENT
FOR
PHYSICIAN 
STUDENTS WHO AGREE TO SERVE IN HARD-TO-FILL 
POSITIONS.—(1) In order to recruit and retain physicians 
in the Veterans Health Administration in hard-to-fill posi-
tions (as designated by the Secretary for purposes of this 
subsection), the Secretary shall reimburse individuals who 
are enrolled in a course of education leading toward board 
certification as a physician for the tuition charged for pur-
suit of such course of education if such individuals agree 
to serve as a physician in an Administration facility in 
such a position. 
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‘‘(2) Each individual seeking tuition reimbursement 
under paragraph (1) shall enter into an agreement with 
the Secretary regarding such tuition reimbursement. 
Under the agreement, the individuals shall agree— 
‘‘(A) to satisfactorily complete the course of 
education of the individual described in paragraph 
(1); and 
‘‘(B) upon completion of the course of edu-
cation, to become board-certified as a physician; and 
‘‘(C) upon completion of the matters referred to 
in subparagraphs (A) and (B)— 
‘‘(I) to perform satisfactory service in a 
physician position specified in the agreement in 
an Administration facility specified in the 
agreement for such period of years as the 
agreement shall specify; and 
‘‘(ii) to possess and retain for the period of 
the agreement such professional qualifications 
as are necessary for the service specified under 
clause (I). 
‘‘(3) The amount of reimbursement payable to an in-
dividual under paragraph (1) for a year may not exceed 
$30,000. 
‘‘(4) Any individual receiving tuition reimbursement 
under paragraph (1) who does not satisfy the require-
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ments of the agreement under paragraph (2) shall be sub-
ject to such repayment requirements as the Secretary shall 
specify in the agreement. 
‘‘(5) An individual receiving tuition reimbursement 
under paragraph (1) for pursuit of a course of education 
shall also be paid a stipend in the amount of $5,000 for 
each academic year of pursuit of such course of education 
after entry into an agreement under paragraph (2). 
‘‘(c) PARTICIPATION
IN FEHBP OF PHYSICIANS 
WHO SERVE PART-TIME IN HARD-TO-FILL POSITIONS.— 
(1) In order to recruit and retain physicians in the Vet-
erans Health Administration in hard-to-fill positions (as 
designated by the Secretary for purposes of this sub-
section), an individual not otherwise eligible for health in-
surance under chapter 89 of title 5 who agrees to serve 
as a physician in an Administration facility in such a posi-
tion for not less than five days per month (of which two 
days must occur in each 14-day period) shall be eligible 
for enrollment in the health benefit plans under chapter 
89 of title 5 on a self only or self and family basis (as 
applicable). 
‘‘(2) The Secretary shall administer this subsection 
in consultation with the Director of the Office of Per-
sonnel Management. 
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‘‘(d) ADDITIONAL PROGRAMS.—It is the sense of 
Congress that the Secretary should undertake active and 
on-going efforts to establish additional incentive programs 
to encourage individuals to serve in the position of physi-
cian in the Veterans Health Administration, or otherwise 
practice in the Administration, in hard-to-fill positions, in-
cluding, in particular, incentive programs to encourage 
more experienced physicians to serve or practice in such 
positions. 
‘‘(e) CONSTRUCTION.—The incentives required under 
this section are in addition to any other special pays or 
benefits to which the individuals covered by this section 
are eligible or entitled under law.’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions at the beginning of chapter 74 of such title is 
amended by inserting after the item relating to sec-
tion 731 the following new item: 
‘‘7431A. Physicians: additional incentives for service in hard-to-fill positions.’’. 
(b) AFFILIATION OF DEPARTMENT OF VETERANS 
AFFAIRS
MEDICAL
FACILITIES
WITH
MEDICAL 
SCHOOLS.—The Secretary of Veterans Affairs shall, to the 
extent practicable, require each medical facility of the De-
partment of Veterans Affairs to seek to establish an affili-
ation with a medical school within reasonable proximity 
of such medical facility. 
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SEC. 5. REPORTS TO CONGRESS. 
(a) REPORT.—Not later than December 15, 2009, 
and each year thereafter through 2012, the Secretary of 
Veterans Affairs shall submit to the congressional vet-
erans affairs committees a report on the implementation 
of this Act and the amendments made by this Act during 
the preceding fiscal year. Each report shall include, for 
the fiscal year covered by such report, the following: 
(1) A comprehensive description of the imple-
mentation of this Act and the amendments made by 
this Act. 
(2) Such recommendations as the Secretary 
considers appropriate for legislative or administra-
tive action to improve the authorities and require-
ments in this Act and the amendments made by this 
Act or to otherwise improve the quality of health 
care and the quality of the physicians in the Vet-
erans Health Administration. 
(b) CONGRESSIONAL VETERANS AFFAIRS COMMIT-
TEES DEFINED.—In this section, the term ‘‘congressional 
veterans affairs committees’’ means— 
(1) the Committees on Veterans’ Affairs and 
Appropriations of the Senate; and 
(2) the Committees on Veterans’ Affairs and 
Appropriations of the House of Representatives. 
Æ 
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E:\BILLS\H568.IH
H568
jlentini on PROD1PC65 with BILLS