II 113th CONGRESS 1st Session S. 543 IN THE SENATE OF THE UNITED STATES March 13, 2013 Mr. Burr (for himself and Mr. Coburn ) introduced the following bill; which was read twice and referred to the Committee on Veterans' Affairs A BILL To require the Secretary of Veterans Affairs to reorganize the Veterans Integrated Service Networks of the Veterans Health Administration, and for other purposes.

1. Short title This Act may be cited as the VISN Reorganization Act of 2013 . 2. Administration of Veterans Integrated Service Networks (a) Veterans Integrated Service Networks (1) In general Subchapter I of chapter 73 of title 38, United States Code, is amended by adding at the end the following new section: 7310. Veterans Integrated Service Networks (a) Organization The Secretary shall organize the Veterans Health Administration in 12 geographically defined Veterans Integrated Service Networks. (b) Alignment with mission of Department The Secretary shall ensure that the staff, services, and programs of each Veterans Integrated Service Network are aligned with the mission of the Department and the specific health care requirements of each population of veterans in each Network. (c) Implementation of National goals The Secretary shall ensure that each Veterans Integrated Service Network takes appropriate measures to implement the national goals of the Department within their networks and associated medical centers. (d) Integrated health care system The Secretary shall ensure that each Veterans Integrated Service Network maintains a regional integrated healthcare system by— (1) implementing alliances with such other governmental, public, and private health care organizations and practitioners as the Secretary considers appropriate to meet the needs of veterans in the Network; (2) providing oversight and management of, and taking responsibility for, a regional budget for the activities of the Veterans Health Administration in the geographic area of the Network that— (A) is aligned with the budget guidelines of the Department and the Veterans Health Administration; and (B) is balanced at the end of each fiscal year; (3) using national metrics to develop systems to provide effective, efficient, and safe delivery of health care that is rated as highly satisfactory by patients and families of patients; and (4) ensuring high quality clinical programs and services are rendered in and through— (A) the medical centers and outpatient clinics of the Department that are located in the Network; and (B) other non-Department clinical or health care delivery settings located in the Network. (e) Reduction in duplicate functions The Secretary shall ensure that the Veterans Integrated Service Networks identify and reduce, whenever practicable, the duplication of functions in clinical, administrative, and operational processes and practices of the Veterans Health Administration. (f) Collaboration and cooperation The Secretary shall ensure that each Veteran Integrated Service Network— (1) works to achieve maximum effectiveness in patient care and safety, graduate medical education, and research; and (2) assesses the consolidation or realignment of institutional functions, including capital asset, safety, and operational support functions, in collaboration and cooperation with other Veterans Integrated Service Networks and the following offices or entities within the geographical area of the Network: (A) The offices of the Veterans Benefits Administration and the National Cemetery Administration. (B) The offices, installations, and facilities of the Department of Defense, including the offices, installations, and facilities of each branch of the Armed Forces and the reserve components of the Armed Forces. (C) The offices, installations, and facilities of the Coast Guard. (D) Offices of State and local agencies that have a mission to provide assistance to veterans. (E) Medical schools and other affiliates. (F) Offices of Congress, offices of State and local elected officials, and other government offices. (G) Federal, State and local emergency preparedness organizations. (H) Community and faith-based organizations. (I) Such other offices of the Federal Government as the Secretary considers appropriate. (g) Development and sharing of innovations and practices The Secretary shall ensure that the Veterans Integrated Service Networks develop and share innovations and best practices with each other at the local, regional, and national levels. (h) Headquarters (1) The Secretary shall ensure that each Veterans Integrated Service Network has only one headquarters office. (2) The location of a headquarters office for a Veterans Integrated Service Network shall be determined by the Secretary and co-located with a Department of Veterans Affairs medical center. (3) (A) The Secretary may employ or contract for the services of not more than 65 full time equivalent employees and contractors at the headquarters of each Veterans Integrated Service Network. (B) Not less frequently than once each 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 on employment at the headquarters of Veterans Integrated Service Networks during the most recently completed fiscal year. (C) Each report submitted under subparagraph (B) shall include the following for the year covered by the report: (i) The number of individuals employed at each headquarters of a Veterans Integrated Service Network. (ii) The number of individuals employed by the Veterans Health Administration in each Veterans Integrated Service Network who are not employed at the same location as the headquarters of the Network. (iii) The title for each position of employment at a headquarters of a Veterans Integrated Service Network. (iv) The title for each position of employment with the Veterans Health Administration in each Veterans Integrated Service Network that is not at the same location as the headquarters of the Network. (v) An assessment of the impact on the budget of the Department by the employment of individuals at the headquarters of the Veterans Integrated Service Networks. (i) Triennial structure review, reassessment, and report (1) Beginning three years after the date of the enactment of this section and not less frequently than once every three years thereafter, the Secretary shall conduct a review and assessment of the structure and operations of the Veterans Integrated Service Networks. (2) Not later than 180 days after conducting a review and assessment under paragraph (1), 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 such review and assessment, which shall include such recommendations for legislative or regulatory action as the Secretary considers appropriate to improve the Veterans Integrated Service Networks. . (2) Clerical amendment The table of sections at the beginning of chapter 73 of such title is amended by inserting after the item relating to section 7309 the following new item: 7310. Veterans Integrated Service Networks. . (b) Consolidation of networks (1) In general In order to comply with section 7310(a) of title 38, United States Code, as added by subsection (a), not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall geographically realign and combine the 21 Veterans Integrated Service Networks in effect on the day before the date of the enactment of this Act into 12 geographically defined Veterans Integrated Service Networks as follows: (A) Veterans Integrated Service Network 1, Veterans Integrated Service Network 2, and Veterans Integrated Service Network 3 shall be combined into a single Veterans Integrated Service Network. (B) Veterans Integrated Service Network 4 and Veterans Integrated Service Network 5 shall be combined into a single Veterans Integrated Service Network. (C) Veterans Integrated Service Network 9 and Veterans Integrated Service Network 10 shall be combined into a single Veterans Integrated Service Network. (D) Veterans Integrated Service Network 11 and Veterans Integrated Service Network 12 shall be combined into a single Veterans Integrated Service Network. (E) Veterans Integrated Service Network 15 and Veterans Integrated Service Network 23 shall be combined into a single Veterans Integrated Service Network. (F) Veterans Integrated Service Network 17 and Veterans Integrated Service Network 18 shall be combined into a single Veterans Integrated Service Network. (G) Veterans Integrated Service Network 19 and Veterans Integrated Service Network 20 shall be combined into a single Veterans Integrated Service Network. (H) Veterans Integrated Service Network 21 and Veterans Integrated Service Network 22 shall be combined into a single Veterans Integrated Service Network. (2) Consolidation of headquarters (A) In general Except as provided in subsection (c), for each set of Veterans Integrated Service Networks consolidated under paragraph (1), the Secretary shall retain one of the headquarters of such set in effect on the day before the date of the enactment of this Act in the same location as in effect on the day before such date and eliminate any other headquarters of such set to meet the requirements of section 7310(h) of such title, as added by subsection (a). (B) Reemployment assistance For each individual whose position of employment is eliminated as a result of eliminating a headquarters under subparagraph (A), the Secretary shall take such measures as the Secretary considers practicable to find a new position of employment for such individual within the Department of Veterans Affairs. (3) Implementation plan Not later than 180 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 to carry out this subsection. (c) Relocation of headquarters (1) In general In the case of a headquarters office of a Veterans Integrated Service Network that on the day before the date of the enactment of this Act was in a location that was not co-located with a Department of Veterans Affairs medical center and the Secretary is engaged in a lease for such location, the Secretary may— (A) relocate such headquarters upon the expiration of such lease so that such headquarters is co-located as required by section 7310(h)(2) of such title, as added by subsection (a); or (B) notwithstanding section 7310(h)(2) of such title, as so added, renew such lease or enter into a new lease to keep such headquarters in such location. (2) Report If the Secretary renews a lease or engages in a new lease under paragraph (1)(B), the Secretary shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives, before renewing such lease or engaging in such lease, a report describing the reasons for such renewal or engagement. Such report shall include the following: (A) A list of Department of Veterans Affairs medical centers in the Veterans Integrated Service Network of the headquarters with underutilized buildings, the number of such buildings, and the total underutilized square footage for each such medical center. (B) The cost of the current lease (the annual amount of rent, the total cost over the life of the lease, and the total cost per square foot) and the current square footage being leased. (C) The cost of the new lease (the annual amount of rent, the total cost over the life of the lease, and the total cost per square foot) and the square footage to be leased. 3. Regional support centers for Veterans Integrated Service Networks (a) Regional support centers (1) In general Subchapter I of chapter 73 of title 38, United States Code, as amended by section 2(a), is further amended by adding at the end the following new section: 7310A. Regional support centers for Veterans Integrated Service Networks (a) Establishment The Secretary shall establish not more than four regional support centers within the Veterans Health Administration to assess the effectiveness and efficiency of the Veterans Integrated Service Networks. The head of each regional support center shall report to the Under Secretary of Health. (b) Functions The functions of the regional support centers established under subsection (a) are as follows: (1) To assess the quality of work performed within finance operations and other compliance related activities of the Veterans Integrated Service Networks. (2) To assess how effectively and efficiently each Veterans Integrated Service Network conducts outreach to veterans who served in Operation Enduring Freedom, Operation Iraqi Freedom, Operation New Dawn, or another contingency operation (as defined in section 101 of title 10). (3) To assess how effectively and efficiently each Veterans Integrated Service Network conducts programs for the benefit of women veterans. (4) To assess how effectively and efficiently each Veterans Integrated Service Network conducts programs that address homelessness among veterans. (5) To assess how effectively and efficiently each Veterans Integrated Service Network consumes energy. (6) To assess such other matters concerning the operations and activities of the Veterans Integrated Service Networks as the Secretary considers appropriate. (c) Staff The Secretary may hire such employees and contractors as the Secretary considers appropriate to carry out the functions of the regional support centers. (d) Location of regional support centers (1) Except as provided in paragraph (2), the location of each regional support center established under subsection (a) shall be determined by the Secretary and co-located with a Department of Veterans Affairs medical center. (2) The Secretary may choose a location for a regional support center established under subsection (a) that is not co-located with a Department of Veterans Affairs medical center if the Secretary submits to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives, before engaging in a lease for such location, a report explaining the reasons for the choice of the Secretary of a location for the regional support center that is not co-located with a Department of Veterans Affairs medical center. Such report shall include the following: (A) A list of Department of Veterans Affairs medical centers in the Veterans Integrated Service Network of the regional support center with underutilized buildings, the number of all Veterans Health Administration buildings in such Network, and the total underutilized square footage for each medical center in such Network. (B) In the case that the Secretary engages in a lease for the location of the regional support center, the cost of such lease (the annual amount of rent, the total cost over the life of the lease, and the total cost per square foot) and the square footage to be leased. . (2) Clerical amendment The table of sections at the beginning of chapter 73 of such title, as amended by section 2(a)(2), is further amended by inserting after the item relating to section 7310 the following new item: 7310A. Regional support centers for Veterans Integrated Service Networks. . (b) Initial staffing In providing for the initial staff of each regional support center established under section 7310A(a) of title 38, United States Code, as added by subsection (a), the Secretary of Veterans Affairs shall, to the extent practicable, transfer employees who were employed in positions at headquarters of Veterans Integrated Service Networks that covered functions similar to those described in section 7310A(b) of such title, as so added, from such headquarters to regional support centers. 4. Construction Nothing in this Act shall be construed to require any change in the location or type of medical care or service provided by a Department of Veterans Affairs medical center, a Department community-based outpatient clinic, a center for readjustment counseling and related mental health services for veterans under section 1712A of title 38, United States Code (known as a vet center ), or another facility that provides direct care or services under a law administered by the Secretary of Veterans Affairs.