II Calendar No. 408 113th CONGRESS 2d Session S. 2422 IN THE SENATE OF THE UNITED STATES June 3, 2014 Mr. Sanders (for himself, Mr. Rockefeller , Mr. Begich , Mrs. Shaheen , Mr. Kaine , Mr. Reed , Mr. Merkley , Mr. Casey , Mr. Whitehouse , Mr. Blumenthal , Mr. Heinrich , Mr. Udall of New Mexico , Mr. Schatz , Ms. Baldwin , Mr. Wyden , Mr. Leahy , Mr. Brown , Ms. Heitkamp , Ms. Landrieu , Mr. Booker , Mr. Durbin , Mr. Schumer , Ms. Hirono , Mr. Harkin , Mr. Coons , Mr. Markey , Ms. Klobuchar , Mr. Walsh , Mr. Tester , and Mr. Menendez ) introduced the following bill; which was read the first time June 4, 2014 Read the second time and placed on the calendar A BILL To improve the access of veterans to medical services from the Department of Veterans Affairs, and for other purposes.

1. Short title; table of contents (a) Short title This Act may be cited as the Ensuring Veterans Access to Care Act of 2014 . (b) Table of contents The table of contents for this Act is as follows: Sec. 1. Short title; table of contents. TITLE I—Improvement of Scheduling System for Health Care Appointments Sec. 101. Implementation of upgraded Department of Veterans Affairs electronic scheduling system for appointments for receipt of health care from the Department. Sec. 102. Independent assessment of the scheduling process for medical appointments for care from Department of Veterans Affairs. TITLE II—Training and Hiring of Health Care Staff Sec. 201. Modification of liability for breach of period of obligated service under Health Professionals Educational Assistance Program for primary care physicians. Sec. 202. Program of education at Uniformed Services University of the Health Sciences with specialization in primary care. Sec. 203. Treatment of staffing shortage and biannual report on staffing of medical facilities of the Department of Veterans Affairs. Sec. 204. Clinic management training program of the Department of Veterans Affairs. Sec. 205. Inclusion of Department of Veterans Affairs facilities in National Health Service Corps Scholarship and loan repayment programs. Sec. 206. Authorization of emergency appropriations. TITLE III—Improvement of Access to Care from Non-Department of Veterans Affairs Providers Sec. 301. Improvement of access by veterans to health care from non-Department of Veterans Affairs providers. Sec. 302. Extension of and report on joint incentives program of Department of Veterans Affairs and Department of Defense. Sec. 303. 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. 304. Enhancement of collaboration between Department of Veterans Affairs and Indian Health Service. Sec. 305. Enhancement of collaboration between Department of Veterans Affairs and Native Hawaiian health care systems. Sec. 306. Authorization of emergency appropriations. TITLE IV—Health Care Administrative Matters Sec. 401. Improvement of access of veterans to mobile vet centers of the Department of Veterans Affairs. Sec. 402. Commission on Access to Care. Sec. 403. Commission on Capital Planning for Department of Veterans Affairs Medical Facilities. Sec. 404. Removal of Senior Executive Service employees of the Department of Veterans Affairs for performance. TITLE V—Major Medical Facility Leases Sec. 501. Authorization of major medical facility leases. Sec. 502. Budgetary treatment of Department of Veterans Affairs major medical facilities leases. I Improvement of Scheduling System for Health Care Appointments 101. Implementation of upgraded Department of Veterans Affairs electronic scheduling system for appointments for receipt of health care from the Department (a) Implementation (1) In general Not later than March 31, 2016, the Secretary of Veterans Affairs shall fully implement an upgraded and centralized electronic scheduling system described in subsection (b) for appointments by eligible individuals for health care from the Department of Veterans Affairs. (2) Agile software development methodologies In implementing the upgraded electronic scheduling system required by paragraph (1), the Secretary shall use agile software development methodologies to fully implement portions of such system every 180 days beginning on the date on which the Secretary begins the implementation of such system, or enters into a contract for the implementation of such system, and ending on the date on which such system is fully implemented. (b) Electronic scheduling system The upgraded electronic scheduling system described in this subsection shall include mechanisms to achieve the following: (1) An efficient and effective graphical user interface with a calendar view for use by employees of the Department in scheduling appointments that enables error-free scheduling of the health care resources of the Department. (2) A capability to assist employees of the Department to easily and consistently implement policies of the Department with respect to scheduling of appointments, including with respect to priority for appointments for certain eligible individuals. (3) A capability for employees of the Department to sort and view through a unified interface the availability for each health care provider of the Department or other health care resource of the Department. (4) A capability for employees of the Department to sort and view appointments for and appointment requests made by a particular eligible individual. (5) A capability for seamless coordination of appointments for primary care, specialty care, consultations, or any other health care matter among facilities of the Department. (6) A capability for eligible individuals to access the system remotely and schedule appointments directly through the system. (7) An electronic timestamp of each activity made by an eligible individual or on behalf of such individual with respect to an appointment or the scheduling of an appointment that shall be kept in the medical record of such individual. (8) A seamless connection to the Computerized Patient Record System of the Department so that employees of the Department, when scheduling an appointment for an eligible individual, have access to recommendations from the health care provider of such individual with respect to when such individual should receive an appointment. (9) A capability to provide automated reminders to eligible individuals on upcoming appointments through various electronic and voice media. (10) A capability to provide automated reminders to employees of the Department when an eligible individual who is on the wait-list for an appointment becomes eligible to schedule an appointment. (11) A dashboard capability to support efforts to track the following metrics in aggregate and by medical facility with respect to health care provided to eligible individuals under the laws administered by the Secretary: (A) The number of days into the future that the schedules of health care providers are available to schedule an appointment. (B) The number of providers available to see patients each day. (C) The number of support personnel working each day. (D) The types of appointments available. (E) The rate at which patients fail to appear for appointments. (F) The number of appointments canceled by a patient on a daily basis. (G) The number of appointments canceled by a health care provider on a daily basis. (H) The number of patients on the wait list at any given time. (I) The number of appointments scheduled on a daily basis; (J) The number of appointments available to be scheduled on a daily basis. (K) The number of patients seen on a daily, weekly, and monthly basis. (L) Wait-times for an appointment with a health care provider of the Department. (M) Wait-times for an appointment with a non-Department health care provider. (N) Wait-times for a referral to a specialist or consult. (12) A capability to provide data on the capacity of medical facilities of the Department for purposes of determining the resources needed by the Department to provide health care to eligible individuals. (13) Any other capabilities as specified by the Secretary for purposes of this section. (c) Plan (1) In general Not later than 90 days after the date of the enactment of this Act, the Secretary shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a plan for implementing the upgraded electronic scheduling system required by subsection (a). (2) Elements The plan required by paragraph (1) shall include the following: (A) A description of the priorities of the Secretary for implementing the requirements of the system under subsection (b). (B) A detailed description of the manner in which the Secretary will fully implement such system, including deadlines for completing each such requirement. (3) Update Not later than 90 days after the submittal of the plan required by paragraph (1), and not less frequently than every 90 days thereafter until such system is fully implemented, the Secretary shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives an update on the status of the implementation of such plan. (d) Use of amounts The Secretary may use amounts available to the Department of Veterans Affairs for the appropriations account under the heading Medical Services in implementing and carrying out the upgraded electronic scheduling system required by subsection (a). (e) Eligible individual defined In this section, the term eligible individual means an individual eligible for hospital, nursing home, domiciliary, medical care, or other health care under the laws administered by the Secretary of Veterans Affairs. 102. Independent assessment of the scheduling process for medical appointments for care from Department of Veterans Affairs (a) Independent assessment (1) Contract Not later than 30 days after the date of the enactment of this Act, the Secretary of Veteran Affairs shall enter into a contract with an independent third party to assess the process at each medical facility of the Department of Veterans Affairs for scheduling appointments for veterans to receive hospital care, medical services, or other health care from the Department. (2) Elements In carrying out the assessment required by paragraph (1), the independent third party shall do the following: (A) Review all training materials pertaining to scheduling of appointments at each medical facility of the Department. (B) Assess whether all employees of the Department 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 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 Department for scheduling appointments at medical facilities 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 appointments. (G) Recommend any actions to be taken by the Department to improve the process for scheduling such appointments, including the following: (i) Changes in training materials provided to employees of the Department with respect to conducting tasks related to scheduling such appointments. (ii) Changes in monitoring and assessment 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 veterans for such appointments; (II) monitors the availability of health care providers of the Department; and (III) provides veterans the ability to schedule such appointments. (iv) Such other actions as the independent third party considers appropriate. (3) Timing The independent third party carrying 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 Not later than 90 days after the date on which the independent third party completes the assessment under this section, 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 results of such assessment. II Training and Hiring of Health Care Staff 201. Modification of liability for breach of period of obligated service under Health Professionals Educational Assistance Program for primary care physicians Section 7617 of title 38, United States Code, is amended— (1) In subsection (c)(1), by striking If a participant and inserting Except as provided in subsection (d), if a participant ; and (2) by adding at the end the following new subsection: (d) Liability shall not arise under subsection (c) in the case of a participant otherwise covered by that subsection who has pursued a course of education or training in primary care if— (1) the participant— (A) does not obtain, or fails to maintain, employment as a Department employee due to staffing changes approved by the Under Secretary for Health; or (B) does not obtain, or fails to maintain, employment in a position of primary care physician in the Veterans Health Administration due, as determined by the Secretary, to a number of primary care physicians in the Administration that is excess to the needs of the Administration; and (2) the participant agrees to accept and maintain employment as a primary care physician with another department or agency of the Federal Government (with such employment to be under such terms and conditions as are jointly agreed upon by the participant, the Secretary, and the head of such department or agency, including terms and conditions relating to a period of obligated service as a primary care physician with such department or agency) if such employment is offered to the participant by the Secretary and the head of such department or agency. . 202. Program of education at Uniformed Services University of the Health Sciences with specialization in primary care (a) Program required under Health Professionals Educational Assistance Program (1) In general Chapter 76 of title 38, United States Code, is amended by adding after subchapter VII the following new subchapter: VIII Program of Education at Uniformed Services University of the Health Sciences With Specialization in Primary Care 7691. Authority for program As part of the Educational Assistance Program, the Secretary shall, in collaboration with the Secretary of Defense, carry out a program to permit individuals to enroll in the Uniformed Services University of the Health Sciences under chapter 104 of title 10 to pursue a medical education with a specialization in primary care. The program shall be known as the Department of Veterans Affairs Primary Care Educational Assistance Program (in this chapter referred to as the Primary Care Educational Assistance Program ). 7692. Selection; agreement; ineligibility for certain other educational assistance (a) Selection (1) Medical students at the Uniformed Services University of the Health Sciences pursuant to the Primary Care Educational Assistance Program shall be selected by the Secretary, in consultation with the Secretary of Defense, in accordance with procedures established by the Secretaries for purposes of the Program. (2) The procedures referred to in paragraph (1) shall emphasize the basic requirement that students demonstrate a motivation and dedication to a medical career in primary care. (3) The number of medical students selected each year for first-year enrollment in the University pursuant to this subsection shall be jointly determined by the Secretary and the Secretary of Defense. (b) Agreement An agreement between the Secretary and a participant in the Primary Care Educational Assistance Program shall (in addition to the requirements set forth in section 7604 of this title) include the following: (1) The Secretary's agreement to cover the costs of the participant's education and training at the Uniformed Services University of the Health Sciences under chapter 104 of title 10 as if the participant were a medical student enrolled in the University pursuant to section 2114 of title 10. (2) The participant's agreement to serve as a full-time employee in the Veterans Health Administration in a position as a primary care physician for a period of time (in this subchapter referred to as the period of obligated service ) of one calendar year for each school year or part thereof for which the participant was a medical student at the Uniformed Services University of the Health Sciences pursuant to the Primary Care Educational Assistance Program, but for not less than one year. (c) Ineligibility for other educational assistance An individual who receives education and training under the Primary Care Educational Assistance Program shall not be eligible for other assistance under this chapter in connection with such education and training. 7693. Obligated service (a) In general Each participant in the Primary Care Educational Assistance Program shall provide service as a full-time employee of the Department in the Veterans Health Administration in a primary care position for the period of obligated service provided in the agreement of the participant entered into for purposes of this subchapter. Such service shall be provided in a full-time primary care clinical practice in an assignment or location determined by the Secretary. (b) Service commencement date (1) Not later than 60 days before a participant's service commencement date, the Secretary shall notify the participant of that service commencement date. That date is the date for the beginning of the participant's period of obligated service. (2) As soon as possible after a participant's service commencement date, the Secretary shall— (A) in the case of a participant who is not a full-time employee in the Veterans Health Administration, appoint the participant as such an employee; and (B) in the case of a participant who is an employee in the Veterans Health Administration but is not serving in a position for which the participant's course of education or training prepared the participant, assign the participant to such a position. (3) A participant's service commencement for purposes of this subsection date is the date upon which the participant becomes licensed to practice medicine in a State. (c) Commencement of obligated service A participant in the Primary Care Educational Assistance Program shall be considered to have begun serving the participant's period of obligated service— (1) on the date on which the participant is appointed as a full-time employee in the Veterans Health Administration pursuant to subsection (b)(2)(A); or (2) if the participant is a full-time employee in the Veterans Health Administration and assigned to a position pursuant to subsection (b)(2)(B), on the date on which the participant is so assigned to such position. 7694. Breach of agreement: liability (a) Liability during course of education or training (1) A participant in the Primary Care Educational Assistance Program shall be liable to the United States for the amount which has been paid on behalf of the participant under the agreement entered into for purposes of this subchapter if any of the following occurs: (A) The participant fails to maintain an acceptable level of academic standing in the Uniformed Services University of the Health Sciences. (B) The participant is dismissed from the Uniformed Services University of the Health Sciences for disciplinary reasons. (C) The participant voluntarily terminates the course of medical education and training in the Uniformed Services University of the Health Sciences before the completion of such course of education and training. (D) The participant fails to become licensed to practice medicine in a State during a period of time determined under regulations prescribed by the Secretary. (2) Liability under this subsection is in lieu of any service obligation arising under a participant's agreement for purposes of this subchapter. (b) Liability during period of obligated service (1) Except as provided in subsection (c) and subject to paragraph (2), if a participant in the Primary Care Educational Assistance Program breaches the agreement entered into for purposes of this subchapter by failing for any reason to complete the participant's period of obligated service, the United States shall be entitled to recover from the participant an amount equal to— (A) the total amount paid under this subchapter on behalf of the participant; multiplied by (B) a fraction— (i) the numerator of which is— (I) the total number of months in the participant's period of obligated service; minus (II) the number of months served by the participant pursuant to the agreement; and (ii) the denominator of which is the total number of months in the participant's period of obligated service. (2) Any period of internship or residency training of a participant shall not be treated as satisfying the participant's period of obligated service for purposes of this subsection. (c) Exceptions Liability shall not arise under subsection (b) in the case of a participant otherwise covered by that subsection if— (1) the participant— (A) does not obtain, or fails to maintain, employment as a Department employee due to staffing changes approved by the Under Secretary for Health; or (B) does not obtain, or fails to maintain, employment in a position of primary care physician in the Veterans Health Administration due, as determined by the Secretary, to a number of primary care physicians in the Administration that is excess to the needs of the Administration; and (2) the participant agrees to accept and maintain employment as a primary care physician with another department or agency of the Federal Government (with such employment to be under such terms and conditions as are jointly agreed upon by the participant, the Secretary, and the head of such department or agency, including terms and conditions relating to a period of obligated service as a primary care physician with such department or agency) if such employment is offered to the participant by the Secretary and the head of such department or agency. 7695. Funding (a) In general Amounts for the Primary Care Educational Assistance Program shall be derived from amounts available to the Secretary for the Veterans Health Administration. (b) Transfer (1) The Secretary shall transfer to the Secretary of Defense amounts required by the Secretary of Defense to carry out the Primary Care Educational Assistance Program. (2) Amounts transferred to the Secretary of Defense pursuant to paragraph (1) shall be credited to the appropriation or account providing funding for the Uniformed Services University of the Health Sciences. Amounts so credited shall be merged with amounts in the appropriation or account to which credited and shall be available, subject to the terms and conditions applicable to such appropriation or account, for the Uniformed Services University of the Health Sciences. . (2) Clerical amendment The table of sections at the beginning of chapter 76 of such title is amended by adding after the item relating to section 7684 the following: SUBCHAPTER VIII—Program of Education at Uniformed Services University of the Health Sciences With Specialization in Primary Care 7691. Authority for program. 7692. Selection; agreement; ineligibility for certain other educational assistance. 7693. Obligated service. 7694. Breach of agreement: liability. 7695. Funding. . (b) Inclusion of program in Health Professionals Educational Assistance Program Section 7601(a) of such title is amended— (1) in paragraph (4), by striking ; and and inserting a semicolon; (2) in paragraph (5), by striking the period at the end and inserting ; and ; and (3) by adding at the end the following new paragraph: (6) the enrollment of individuals in the Uniformed Services University of the Health Sciences for specialization in primary care provided for in subchapter VIII of this chapter. . (c) Application requirements (1) In general Subsection (a)(1) of section 7603 of such title is amended in the matter preceding subparagraph (A) by striking , or VI and inserting , VI, or VIII . (2) No priority for applications Subsection (d) of such section is amended— (A) by striking In selecting and inserting (1) Except as provided in paragraph (2), in selecting ; and (B) by adding at the end the following new paragraph: (2) Paragraph (1) shall not apply with respect to applicants for participation in the Program of Education at Uniformed Services University of the Health Sciences With Specialization in Primary Care pursuant to subchapter VIII of this chapter. . (d) Agreement requirements Section 7604 of such title is amended by striking , or VI each place it appears and inserting , VI, or VIII . 203. Treatment of staffing shortage and biannual report on staffing of medical facilities 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 Secretary of Veterans Affairs shall determine, and 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 Notwithstanding sections 3304 and 3309 through 3318 of title 5, United States Code, the Secretary may, upon a determination by the Secretary under paragraph (1) or a modification to such determination under paragraph (2), that there is a staffing shortage throughout the Department with respect to a particular occupation of health care provider, recruit and directly appoint highly qualified health care providers to a position to serve as a health care provider in that particular occupation for the Department. (3) Priority in Health Professionals Educational Assistance Program to certain providers 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 203(a)(1) of the Ensuring Veterans Access to Care Act of 2014 , determined that there is one of the largest staffing shortage 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 thereafter 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 ensure the following: (i) Appropriate staffing levels for health care providers to meet the goals of the Secretary for timely access to care for veterans. (ii) Appropriate staffing levels for support personnel, including clerks. (iii) Appropriate sizes for clinical panels. (iv) Appropriate numbers of full-time staff, or full-time equivalent, dedicated to direct care of patients. (v) Appropriate physical plant space to meet the capacity needs of the Department in that area. (vi) Such other factors as the Secretary considers necessary. (B) A plan for addressing any issues identified 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 determination of the Secretary 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 improving the speed at which the credentialing and privileging process can be conducted. (E) The current staffing models of the Department for the following clinics, including recommendations 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 planning at medical facilities of the Department, including 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 such 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. (v) A plan for handling emergency circumstances, such administrative leave or sudden medical leave for senior officials. (G) The number of health care providers who have been removed from their position or have retired, by provider type, during the two-year period preceding the submittal of the report. (H) Of the health care providers specified in subparagraph (G) that have been removed from their position, the following: (i) The number of such health care providers who were reassigned to another position in the Department. (ii) The number of such health care providers who left the Department. 204. Clinic management training program of the Department of Veterans Affairs (a) In general Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall implement 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. (b) Elements The clinic management training program required by subsection (a) shall include the following: (1) Training on how to manage the schedules of health care providers of the Department, including the following: (A) Maintaining such schedules in a manner that allows appointments to be booked at least eight weeks in advance. (B) Proper planning procedures for vacation, leave, and graduate medical education training schedules. (2) Training on the appropriate number of appointments that a health care provider should conduct on a daily basis, based on specialty. (3) Training on how to determine whether there are enough available appointment slots to manage demand for different appointment types and mechanisms for alerting management of insufficient slots. (4) Training on how to properly use the data produced by the scheduling dashboard required by section 101(b)(11) of this Act to meet demand for health care, including the following: (A) Training on determining the next available appointment for each health care provider at the medical facility. (B) Training on determining the number of health care providers needed to meet demand for health care at the medical facility. (C) Training on determining the number of exam rooms needed to meet demand for such health care in an efficient manner. (5) Training on how to properly use the appointment scheduling system of the Department, including any new scheduling system implemented by the Department. (6) Training on how to optimize the use of technology, including the following: (A) Telemedicine. (B) Electronic mail. (C) Text messaging. (D) Such other technologies as specified by the Secretary. (7) Training on how to properly use physical plant space at medical facilities of the Department to ensure efficient flow and privacy for patients and staff. 205. Inclusion of Department of Veterans Affairs facilities in National Health Service Corps Scholarship and loan repayment programs (a) In general The Secretary of Health and Human Services shall use the funds transferred under subsection (e) to award scholarship and loan repayment contracts under sections 338A and 338B of the Public Health Service Act ( 42 U.S.C. 254l , 254l–1) to eligible individuals who agree to a period of obligated service under section 338A(f)(1) or 338B(f)(1) of such Act, as applicable, at a health facility of the Department of Veterans Affairs. (b) Health professional shortage areas For purposes of selecting individuals eligible for the scholarships and loan repayment contracts under subsection (a), all health facilities of the Department of Veterans Affairs shall be deemed health professional shortage areas, as defined in section 332 of the Public Health Service Act ( 42 U.S.C. 254e ). (c) Requirement The Secretary of Health and Human Services shall ensure that a minimum of 5 scholarships or loan repayment contracts are awarded to individuals who agree to a period of obligated service at Veterans Affairs facilities in each State. (d) Applicability of NHSC program requirements Except as otherwise provided in this section, the terms of the National Health Service Corps Scholarship Program and the National Health Service Corps Loan Repayment Program shall apply to participants awarded a grant or loan repayment contract under subsection (a) in the same manner that such terms apply to participants awarded a grant or loan repayment contract under section 338A or 338B of the Public Health Service Act. (e) Inclusion of geriatricians For purposes of awarding scholarships and loan repayments contracts to eligible individuals who agree to a period of obligated service at a health facility of the Department of Veterans Affairs pursuant to this section, in sections 338A and 338B of the Public Health Service Act ( 42 U.S.C. 254l , 254l–1), the term primary health services shall include geriatrics. (f) Funding The Secretary of Veterans Affairs shall transfer $20,000,000 for fiscal year 2014, and such sums as may be necessary for each fiscal year thereafter, from accounts of the Veterans Health Administration to the Secretary of Health and Human Services to award scholarships and loan repayment contracts, as described in subsection (a). All funds so transferred shall be used exclusively for the purposes described in such subsection. 206. Authorization of emergency appropriations There is authorized to be appropriated for the Department of Veterans Affairs such sums as may be necessary to carry out this title. III Improvement of Access to Care from Non-Department of Veterans Affairs Providers 301. Improvement of access by veterans to health care from non-Department of Veterans Affairs providers (a) Improvement of access (1) In general The Secretary of Veterans Affairs shall ensure timely access of all veterans to the hospital care, medical services, and other health care for which such veterans are eligible under the laws administered by the Secretary through the enhanced use of authorities specified in paragraph (2) on the provision of such care and services through non-Department of Veterans Affairs providers (commonly referred to as non-Department of Veterans Affairs medical care ). (2) Authorities on provision of care through non-Department providers The authorities specified in this paragraph are the following: (A) Section 1703 of title 38, United States Code, relating to contracts for the provision of hospital care and medical services through non-Department facilities. (B) Section 1725 of such title, relating to reimbursement of certain veterans for the reasonable value of emergency treatment at non-Department facilities. (C) Section 1728 of such title, relating to reimbursement of certain veterans for customary and usual charges of emergency treatment from sources other than the Department. (D) Section 1786 of such title, relating to health care services furnished to newborn children of women veterans who are receiving maternity care furnished by the Department at a non-Department facility. (E) Any other authority under the laws administered by the Secretary to provide hospital care, medical services, or other health care from a non-Department provider, including the following: (i) A Federally-qualified health center (as defined in section 1905(l)(2)(B) of the Social Security Act ( 42 U.S.C. 1396d(l)(2)(B) )). (ii) The Department of Defense. (iii) The Indian Health Service. (3) Requirements In ensuring timely access of all veterans to the care and services described in paragraph (1) through the enhanced use of authorities specified in paragraph (2), the Secretary shall require the following: (A) That each veteran who has not received hospital care, medical services, or other health care from the Department and is seeking an appointment for primary care under the laws administered by the Secretary receive an appointment for primary care at a time consistent with timeliness measures established by the Secretary for purposes of providing primary care to all veterans. (B) That the determination whether to refer a veteran for specialty care through a non-Department provider shall take into account the urgency and acuity of such veteran's need for such care, including— (i) the severity of the condition of such veteran requiring specialty care; and (ii) the wait-time for an appointment with a specialist with respect to such condition at the nearest medical facility of the Department with the capacity to provide such care. (C) That the determination whether a veteran shall receive hospital care, medical services, or other health care from the Department through facilities of the Department or through non-Department providers pursuant to the authorities specified in paragraph (2) shall take into account, in the manner specified by the Secretary, the following: (i) The distance the veteran would be required to travel to receive care or services through a non-Department provider compared to the distance the veteran would be required to travel to receive care or services from a medical facility of the Department. (ii) Any factors that might limit the ability of the veteran to travel, including age, access to transportation, and infirmity. (iii) The wait-time for the provision of care or services through a non-Department provider compared to the wait-time for the provision of care or services from a medical facility of the Department. (iv) Where the veteran would prefer to receive the care and services described in paragraph (1), unless the preference of the veteran conflicts with any of the other requirements of this paragraph. (D) That the Department maximize the use of hospital care, medical services, and other health care available to the Department through non-Department providers, including providers available to provide such care and services as follows: (i) Pursuant to contracts under the Patient-Centered Community Care Program of the Department. (ii) Pursuant to contracts between a facility or facilities of the Department and a local facility or provider. (iii) Pursuant to contracts with 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) )), the Department of Defense, or the Indian Health Service. (iv) On a fee-for-service basis. (b) Medical records In providing hospital care, medical services, and other health care to veterans through non-Department providers pursuant to the authorities specified in paragraph (2), the Secretary shall ensure that any such provider submits to the Department any medical record related to the care and services provided to a veteran by that provider for inclusion in the electronic medical record of such veteran maintained by the Department upon the completion of the provision of such care and services to such veteran. (c) Reports (1) Initial report Not later than 45 days after the date of the enactment of this Act, 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 implementation of the requirements under subsection (a) and (b), including a plan to enforce the proper implementation of such requirements systematically throughout the Department. (2) Periodic reports Not later than 90 days after the submittal of the report required by paragraph (1), and every 90 days thereafter for one year, 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 that includes the following: (A) The progress of the Secretary in carrying out the plan under paragraph (1) to enforce the proper implementation of the requirements under subsection (a) and (b) systematically throughout the Department. (B) The impact of the implementation of such requirements on wait-times for veterans to receive hospital care, medical services, and other health care, disaggregated by— (i) new patients; (ii) existing patients; (iii) primary care; and (iv) specialty care. (C) Any recommendations for changes or improvements to such requirements. (D) Any requests for additional funding necessary to carry out such requirements. 302. Extension of and report on joint incentives program of Department of Veterans Affairs and Department of Defense (a) Extension Section 8111(d)(3) of title 38, United States Code, is amended by striking September 30, 2015 and inserting September 30, 2020 . (b) Reports (1) Report on implementation of recommendations Not later than 60 days after the date of the enactment of this Act, the Secretary of Veterans Affairs and the Secretary of Defense shall jointly submit to Congress a report on the implementation by the Department of Veterans Affairs and the Department of Defense of the findings and recommendations of the Comptroller General of the United States in the September 2012 report entitled VA and DoD Health Care: Department-Level Actions Needed to Assess Collaboration Performance, Address Barriers, and Identify Opportunities (GAO–12–992). (2) Comptroller General report (A) In general Not later than one year after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress a report assessing and providing recommendations for improvement to the program to identify, provide incentives to, implement, fund, and evaluate creative coordination and sharing initiatives between the Department of Veterans Affairs and the Department of Defense required under section 8111(d) of such title. (B) Elements The report required by subparagraph (A) shall include the following: (i) An assessment of the extent to which the program described in subparagraph (A) has accomplished the goal of such program to improve the access to, and quality and cost effectiveness of, the health care provided by the Veterans Health Administration and the Military Health System to the beneficiaries of both the Department of Veterans Affairs and the Department of Defense. (ii) An assessment of whether administration of such program through the Health Executive Committee of the Department of Veterans Affairs-Department of Defense Joint Executive Committee established under section 320 of such title provides sufficient leadership attention and oversight to ensure maximum benefits to the Department of Veterans Affairs and the Department of Defense through collaborative efforts. (iii) An assessment of whether additional authorities to jointly construct, lease, or acquire facilities would facilitate additional collaborative efforts under such program. (iv) An assessment of whether the funding for such program is sufficient to ensure consistent identification of potential opportunities for collaboration and oversight of existing collaborations to ensure a meaningful partnership between the Department of Veterans Affairs and the Department of Defense and remove any barriers to integration or collaboration. (v) An assessment of whether existing processes for identifying opportunities for collaboration are sufficient to ensure maximum collaboration between the Veterans Health Administration and the Military Health System. (vi) Such legislative or administrative recommendations for improvement to such program as the Comptroller General considers appropriate to enhance the use of such program to increase access to health care. 303. 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 (a) Transfer of authority (1) In general Effective on October 1, 2014, the Secretary of Veterans Affairs shall transfer the authority 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 Office shall work in consultation with the Office of Clinical Operations and Management of the Department of Veterans Affairs to ensure that care and services described in paragraph (1) is provided in a manner that is clinically appropriate and effective. (3) No delay in payment The transfer of authority 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-Department 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— (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 providers, 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 services. (c) Removal from performance goals For each fiscal year that begins after the date of the enactment of this Act, the Secretary shall not include in the performance 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 services, or other health care through a non-Department provider. 304. Enhancement of collaboration between Department of Veterans Affairs and Indian Health Service (a) Outreach to tribal-run medical facilities The Secretary of Veterans Affairs shall, in consultation 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-Determination 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 agreements with the Department of Veterans Affairs under which the Secretary reimburses such facilities, Indian tribes, or tribal organizations, as the case may be, for health care provided 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 performance by the Department of Veterans Affairs and the Indian Health Service under the memorandum of understanding entitled Memorandum of Understanding between the Department of Veterans Affairs (VA) and the Indian Health Service (IHS) in increasing access to health care, improving quality and coordination of health care, promoting effective patient-centered collaboration and partnerships between the Department and the Service, and ensuring health-promotion and disease-prevention services are appropriately 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 Affairs 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 reimbursement by the Secretary of the costs of direct care services provided through organizations receiving amounts pursuant to grants made or contracts entered 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 Education 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 Indian 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 section 4 of the Indian Self-Determination and Education Assistance Act ( 25 U.S.C. 450b ). 305. 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 Native 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 services provided to eligible veterans as specified in such contracts or agreements. (b) Definitions In this section, the terms Native Hawaiian , Native Hawaiian health care system , and Papa Ola Lokahi have the meanings given those terms in section 12 of the Native Hawaiian Health Care Improvement Act ( 42 U.S.C. 11711 ). 306. Authorization of emergency appropriations There is authorized to be appropriated for the Department of Veterans Affairs such sums as may be necessary to carry out this title. IV Health Care Administrative Matters 401. Improvement of access of veterans to mobile vet centers of the Department of Veterans Affairs (a) Improvement of access (1) In general The Secretary of Veterans Affairs shall improve the access of veterans to telemedicine 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. (2) Requirements The standardized requirements required by paragraph (1) shall include the following: (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 center 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 notifications 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 Department has the capability to provide telemedicine services. (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: (1) The use of mobile vet centers to provide telemedicine services to veterans during the year preceding the submittal of the report, including the following: (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 headquarters of the mobile vet center to provide such services. (C) The number of appointments each center conducted to provide such services on average per month and in total during such year. (2) An analysis of the effectiveness of using mobile vet centers to provide health care services to veterans 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 temporary health care providers, including locum tenens, to provide direct health care services to veterans at mobile vet centers. (6) Such other recommendations on improvement of the use of mobile vet centers by the Department as the Secretary considers appropriate. 402. Commission on Access to Care (a) Establishment of commission (1) In general There is established the Commission on Access to Care (in this section referred to as the Commission ) to examine the access of veterans 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 during the next 10 to 20 years. (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 are experts concerning a public or private hospital system. (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) )). (iv) At least two members from among persons who are familiar with the Veterans Health Administration. (B) Nonvoting members In addition to members appointed under subparagraph (A), the Commission shall be composed of 10 nonvoting 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 are experts in a public or private hospital system. (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) )). (iv) At least two members from among persons who are familiar with the Veterans Health Administration. (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 Commission. Any vacancy in the Commission shall not affect 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. (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 Commission shall undertake a comprehensive evaluation and assessment of access to health care at the Department 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 standards of the Department of Veterans Affairs concerning access to health care. (B) The measurement of such standards. (C) The appropriateness of performance standards and incentives in relation to standards described in subparagraph (A). (D) Staffing levels throughout the Veterans Health Administration and whether they are sufficient to meet current demand for health care from the Administration. (3) Reports The Commission shall submit to the President, through the Secretary of Veterans Affairs, reports as follows: (A) Not later than 90 days after the date of the initial meeting of the Commission, an interim report on— (i) the findings of the Commission with respect to the evaluation and assessment required by this subsection; and (ii) such recommendations as the Commission may have for legislative or administrative action to improve access to health care through the Veterans Health Administration. (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 required by this subsection; and (ii) such recommendations as the Commission may have for legislative or administrative action to improve access to health care through the Veterans Health Administration. (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 Commission considers advisable to carry out this section. (2) Information from Federal agencies The Commission may secure directly from any Federal department or agency such information as the Commission considers necessary to carry out this section. Upon request of the Chairperson of the Commission, the head of such department or agency shall furnish such information to the Commission. (d) Commission personnel matters (1) Compensation of members Each member of the Commission who is not an officer or employee of the Federal Government shall be compensated 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 employees of the United States shall serve without compensation in addition to that received for their services as officers or employees of the United States. (2) Travel expenses The members of the Commission shall be allowed travel expenses, including per diem in lieu of subsistence, at rates authorized 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 terminate an executive director and such other additional personnel as may be necessary to enable the Commission to perform its duties. The employment 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 chapter 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 executive director and other personnel may not exceed 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 intermittent services The Chairperson of the Commission may procure temporary and intermittent services under section 3109(b) of title 5, United States Code, at rates for individuals which do not exceed the daily equivalent of the annual rate of basic pay prescribed for level V of the Executive Schedule under section 5316 of such title. (e) Termination of the commission The Commission shall terminate 30 days after the date on which the Commission submits its report under subsection (b)(3)(B). (f) Funding The Secretary of Veterans Affairs shall make available to the Commission from amounts appropriated or otherwise made available to the Secretary such amounts as the Secretary and the Chairperson of the Commission jointly consider appropriate for the Commission to perform its duties under this section. (g) Executive action (1) Action on recommendations The President 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 Representatives and such other committees of Congress as the President considers appropriate a report setting forth the following: (A) An assessment of the feasibility and advisability 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 requires legislative action. (ii) If such recommendation requires legislative action, a recommendation concerning such legislative action. (iii) A description of any administrative action already taken to carry out such recommendation. (iv) A description of any administrative action the President intends to be taken to carry out such recommendation and by whom. 403. Commission on Capital Planning for Department of Veterans Affairs Medical Facilities (a) Establishment of commission (1) Establishment There is established the Commission on Capital Planning for Department of Veterans Affairs Medical Facilities (in this section referred to as the Commission ). (2) Membership (A) Voting members The Commission shall, subject to subparagraph (B), be composed of 10 voting members as follows: (i) 1 shall be appointed by the President. (ii) 1 shall be appointed by the Administrator of General Services. (iii) 3 shall be appointed by the Secretary of Veterans Affairs, of whom— (I) 1 shall be an employee of the Veterans Health Administration; (II) 1 shall be an employee of the Office of Asset Enterprise Management of the Department of Veterans Affairs; and (III) 1 shall be an employee of the Office of Construction and Facilities Management of the Department of Veterans Affairs. (iv) 1 shall be appointed by the Secretary of Defense from among employees of the Army Corps of Engineers. (v) 1 shall be appointed by the majority leader of the Senate. (vi) 1 shall be appointed by the minority leader of the Senate. (vii) 1 shall be appointed by the Speaker of the House of Representatives. (viii) 1 shall be appointed by the minority leader of the House of Representatives. (B) Requirement relating to certain appointments of voting members Of the members appointed pursuant to clause (i), (ii), and (iv) through (viii) of subparagraph (A), all shall have expertise in capital leasing, construction, or health facility management planning. (C) Non-voting members The Commission shall be assisted by 10 non-voting members, appointed by the vote of a majority of members of the Commission under subparagraph (A), of whom— (i) 6 shall be representatives of veterans service organizations recognized by the Secretary of Veterans Affairs; and (ii) 4 shall be individuals from outside the Department of Veterans Affairs with experience and expertise in matters relating to management, construction, and leasing of capital assets. (D) Date of appointment of voting members The appointments of the members of the Commission under subparagraph (A) 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 Commission. Any vacancy in the Commission shall not affect 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 7 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 Chair. (6) Quorum A majority of the members of the Commission shall constitute a quorum, but a lesser number of members may hold hearings. (7) Chair and vice chair The Commission shall select a Chair and Vice Chair from among its members. (b) Duties of commission (1) In general The Commission shall undertake a comprehensive evaluation and assessment of various options for capital planning for Department of Veterans Affairs medical facilities, including an evaluation and assessment of the mechanisms by which the Department currently selects means for the delivery of health care, whether by major construction, major medical facility leases, sharing agreements with the Department of Defense, the Indian Health Service, and Federally Qualified Health Clinics under section 330 of the Public Health Service Act ( 42 U.S.C. 254b ), contract care, multisite care, telemedicine, extended hours for care, or other means. (2) Context of evaluation and assessment In undertaking the evaluation and assessment, the Commission shall consider— (A) the importance of access to health care through the Department, including associated guidelines of the Department on access to, and drive time for, health care; (B) limitations and requirements applicable to the construction and leasing of medical facilities for the Department, including applicable laws, regulations, and costs as determined by both the Congressional Budget Office and the Office of Management and Budget; (C) the nature of capital planning for Department medical facilities in an era of fiscal uncertainty; (D) projected future fluctuations in the population of veterans; and (E) the extent to which the Department was able to meet the mandates of the Capital Asset Realignment for Enhanced Services Commission. (3) Particular considerations In undertaking the evaluation and assessment, the Commission shall address, in particular, the following: (A) The Major Medical Facility Lease Program of the Department, including an identification of potential improvements to the lease authorization processes under that Program. (B) The management processes of the Department for its Major Medical Facility Construction Program, including processes relating to contract award and management, project management, and processing of change orders. (C) The overall capital planning program of the Department for medical facilities, including an evaluation and assessment of— (i) the manner in which the Department determines whether to use capital or non-capital means to expand access to health care; (ii) the manner in which the Department determines the disposition of under-utilized and un-utilized buildings on campuses of Department medical centers, and any barriers to disposition; (iii) the effectiveness of the facility master planning initiative of the Department; and (iv) the extent to which sustainable attributes are planned for to decrease operating costs for Department medical facilities. (D) The current backlog of construction projects for Department medical facilities, including an identification of the most effective means to quickly secure the most critical repairs required, including repairs relating to facility condition deficiencies, structural safety, and compliance with the Americans With Disabilities Act of 1990. (4) Reports Subject to paragraph (5), the Commission shall submit to the Secretary of Veterans Affairs, and to the Committee Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives, reports as follows: (A) Not later than six months after its initial meeting under subsection (a)(4), a report on the Major Medical Facility Lease Program and the Congressional lease authorization process. (B) Not later than one year after its initial meeting, a report— (i) on the management processes of the Department for the construction of Department medical facilities; and (ii) setting forth an update of any matters covered in the report under subparagraph (A). (C) Not later than 18 months after its initial meeting, a report— (i) on the overall capital planning program of the Department for medical facilities; and (ii) setting forth an update of any matters covered in earlier reports under this paragraph. (D) Not later than two years after its initial meeting, a report— (i) on the current backlog of construction projects for Department medical facilities; (ii) setting forth an update of any matters covered in earlier reports under this paragraph; and (iii) including such other matters relating to the duties of the Commission that the Commission considers appropriate. (E) Not later than 27 months after its initial meeting, a report on the implementation by the Secretary of Veterans Affairs pursuant to subsection (g) of the recommendations included pursuant to paragraph (5) in the reports under this paragraph. (5) Recommendations Each report under paragraph (4) shall include, for the aspect of the capital asset planning process of the Department covered by such report, such recommendations as the Commission considers appropriate for the improvement and enhancement of such aspect of the capital asset planning process. (c) Powers of 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 Commission considers advisable to carry out this section. (2) Information from Federal agencies The Commission may secure directly from any Federal department or agency such information as the Commission considers necessary to carry out this section. Upon request of the Chair of the Commission, the head of such department or agency shall furnish such information to the Commission. (d) Commission personnel matters (1) Compensation of members Each member of the Commission who is not an officer or employee of the Federal Government shall be compensated 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 employees of the United States shall serve without compensation in addition to that received for their services as officers or employees of the United States. (2) Travel expenses The members of the Commission shall be allowed travel expenses, including per diem in lieu of subsistence, at rates authorized 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 Chair of the Commission may, without regard to the civil service laws and regulations, appoint and terminate an executive director and such other additional personnel as may be necessary to enable the Commission to perform its duties. The employment of an executive director shall be subject to confirmation by the Commission. (B) Compensation The Chair of the Commission may fix the compensation of the executive director and other personnel without regard to chapter 51 and subchapter III of chapter 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 executive director and other personnel may not exceed 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 intermittent services The Chair of the Commission may procure temporary and intermittent services under section 3109(b) of title 5, United States Code, at rates for individuals which do not exceed the daily equivalent of the annual rate of basic pay prescribed for level V of the Executive Schedule under section 5316 of such title. (e) Termination of commission The Commission shall terminate 60 days after the date on which the Commission submits its report under subsection (b)(4)(E). (f) Funding The Secretary of Veterans Affairs shall make available to the Commission such amounts as the Secretary and the Chair of the Commission jointly consider appropriate for the Commission to perform its duties under this section. (g) Action on recommendations (1) In general The Secretary of Veterans Affairs shall implement each recommendation included in a report under subsection (b)(4) that the Secretary considers feasible and advisable and can be implemented without further legislative action. (2) Reports Not later than 120 days after receipt of a report under subparagraphs (A) through (D) of subsection (b)(4), the Secretary shall submit to the Committee Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report setting forth the following: (A) An assessment of the feasibility and advisability of each recommendation contained in such report. (B) For each recommendation assessed as feasible and advisable— (i) if such recommendation does not require further legislative action for implementation, a description of the actions taken, and to be taken, by the Secretary to implement such recommendation; and (ii) if such recommendation requires further legislative action for implementation, recommendations for such legislative action. 404. Removal of Senior Executive Service employees of the Department of Veterans Affairs for performance (a) Removal or transfer (1) In general Chapter 7 of title 38, United States Code, is amended by adding at the end the following 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 Secretary determines the performance of the individual warrants 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 Schedule position at any grade of the General Schedule for which the individual is qualified and that the Secretary determines is appropriate. (b) Notice to Congress Not later than 30 days after removing or transferring an individual from the Senior Executive Service under paragraph (1), 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. (c) Appeal of removal or transfer Any removal or transfer under subsection (a) may be appealed to the Merit Systems Protection Board under section 7701 of title 5 not later than 7 days after such removal or transfer. (d) Expedited review by Merit Systems Protection Board (1) The Merit Systems Protection Board shall expedite any appeal under section 7701 of title 5 of a removal or transfer under subsection (a) and, in any such case, shall issue a decision not later than 21 days after the date of the appeal. (2) In any case in which the Merit Systems Protection Board determines that it cannot issue a decision in accordance with the 21-day requirement under paragraph (1), the Merit Systems Protection Board shall submit to Congress a report that explains the reason why the Merit Systems Protection Board is unable to issue a decision in accordance with such requirement in such case. (3) There is authorized to be appropriated such sums as may be necessary for the Merit Systems Protection Board to expedite appeals under paragraph (1). (4) The Merit Systems Protection Board may not stay any personnel action taken under this section. . (2) Clerical amendment The table of sections 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 process (1) In general Not later than 30 days after the date of the enactment of this Act, the Merit Systems Protection Board shall establish and put into effect a process to conduct expedited reviews in accordance with section 713(d) of title 38, United States Code. (2) Inapplicability of certain regulations Section 1201.22 of title 5, Code of Federal Regulations, as in effect on the day before the date of 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 actions the Board plans to take to conduct expedited reviews 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 determines will be necessary to conduct such reviews and a description of whether any resources will be necessary to conduct such reviews that were not available to the Board on the day before the date of the enactment of this Act. (c) Temporary exemption from certain limitation on initiation of removal from Senior Executive 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 Department of Veterans Affairs pursuant to section 713 of title 38, United States Code, as added by subsection (a), or section 7543 of title 5, United States Code, may be initiated, 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. V Major Medical Facility Leases 501. Authorization of major medical facility leases The Secretary of Veterans Affairs may carry out the following major medical facility leases at the locations specified, and in an amount for each lease not to exceed the amount shown for such location (not including any estimated cancellation costs): (1) For a clinical research and pharmacy coordinating 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 Outpatient Clinic, Cobb County, Georgia, an amount not to exceed $6,409,000. (5) For the Leeward Outpatient Healthcare Access Center, Honolulu, Hawaii, including a co-located clinic with the Department of Defense and the co-location of the Honolulu Regional Office of the Veterans Benefits Administration and the Kapolei 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 outpatient 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 Richey, Florida, an amount not to exceed $11,927,000. (10) For an outpatient clinic, Ponce, 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. (14) For the Errera Community Care Center, West Haven, Connecticut, an amount not to exceed $4,883,000. (15) For the Worcester community-based Outpatient 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 multispecialty 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, Hines, 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. (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. (27) For the expansion of a community-based outpatient clinic, Tulsa, Oklahoma, an amount not to exceed $13,269,200. 502. Budgetary treatment of Department of Veterans Affairs major medical facilities leases (a) Findings Congress finds the following: (1) Title 31, United States Code, requires the Department 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 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 obligation 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 cancellation costs. (2) Self-insuring authority The requirements 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 (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 funding 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 include— (A) an analysis of the classification of the lease as a lease-purchase , capital lease , or operating lease as those terms are defined in Office of Management and Budget Circular A–11; (B) an analysis of the obligation of budgetary 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 following new subsection: (h) (1) Not less than 30 days before entering into a major medical facility lease, the Secretary shall submit to 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 differences 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 Management 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 material differences between the lease that was entered into and the proposed lease described under such paragraph, including how the lease that was entered into changes the previously submitted scoring analysis described in subparagraph (D) of such paragraph. . (d) Rule of construction Nothing in this section, or the amendments made by this section, shall be construed to in any way relieve the Department of Veterans Affairs from any statutory or regulatory obligations or requirements existing prior to the enactment of this section and such amendments.

June 4, 2014 Read the second time and placed on the calendar