An act to establish a permanent community care program for veterans, to establish a commission for the purpose of making recommendations regarding the modernization or realignment of facilities of the Veterans Health Administration, to improve construction of the Department of Veterans Affairs, to make certain improvements in the laws administered by the Secretary of Veterans Affairs relating to the home loan program of the Department of Veterans Affairs, and for other purposes
PL 115-182 (S.2372), enacted 06/06/2018

132 STAT. 1393 
PUBLIC LAW 115–182—JUNE 6, 2018 
Public Law 115–182 
115th Congress 
An Act 
To establish a permanent community care program for veterans, to establish a 
commission for the purpose of making recommendations regarding the moderniza-
tion or realignment of facilities of the Veterans Health Administration, to improve 
construction of the Department of Veterans Affairs, to make certain improvements 
in the laws administered by the Secretary of Veterans Affairs relating to the 
home loan program of the Department of Veterans Affairs, and for other purposes. 
Be it enacted by the Senate and House of Representatives of 
the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the ‘‘John S. McCain 
III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining 
Internal Systems and Strengthening Integrated Outside Networks 
Act of 2018’’ or the ‘‘VA MISSION Act of 2018’’. 
(b) TABLE OF CONTENTS.—The table of contents for this Act 
is as follows: 
Sec. 1. Short title; table of contents. 
TITLE I—CARING FOR OUR VETERANS 
Sec. 100. Short title; references to title 38, United States Code. 
Subtitle A—Developing an Integrated High-Performing Network 
CHAPTER 1—ESTABLISHING COMMUNITY CARE PROGRAMS 
Sec. 101. Establishment of Veterans Community Care Program. 
Sec. 102. Authorization of agreements between Department of Veterans Affairs and 
non-Department providers. 
Sec. 103. Conforming amendments for State veterans homes. 
Sec. 104. Access standards and standards for quality. 
Sec. 105. Access to walk-in care. 
Sec. 106. Strategy regarding the Department of Veterans Affairs High-Performing 
Integrated Health Care Network. 
Sec. 107. Applicability of Directive of Office of Federal Contract Compliance Pro-
grams. 
Sec. 108. Prevention of certain health care providers from providing non-Depart-
ment health care services to veterans. 
Sec. 109. Remediation of medical service lines. 
CHAPTER 2—PAYING PROVIDERS AND IMPROVING COLLECTIONS 
Sec. 111. Prompt payment to providers. 
Sec. 112. Authority to pay for authorized care not subject to an agreement. 
Sec. 113. Improvement of authority to recover the cost of services furnished for 
non-service-connected disabilities. 
Sec. 114. Processing of claims for reimbursement through electronic interface. 
CHAPTER 3—EDUCATION AND TRAINING PROGRAMS 
Sec. 121. Education program on health care options. 
Sec. 122. Training program for administration of non-Department of Veterans Af-
fairs health care. 
38 USC 101 note. 
John S. McCain 
III, Daniel K. 
Akaka, and 
Samuel R. 
Johnson VA 
Maintaining 
Internal Systems 
and 
Strengthening 
Integrated 
Outside 
Networks Act 
of 2018. 
June 6, 2018 
[S. 2372] 
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132 STAT. 1394 
PUBLIC LAW 115–182—JUNE 6, 2018 
Sec. 123. Continuing medical education for non-Department medical professionals. 
CHAPTER 4—OTHER MATTERS RELATING TO NON-DEPARTMENT OF VETERANS AFFAIRS 
PROVIDERS 
Sec. 131. Establishment of processes to ensure safe opioid prescribing practices by 
non-Department of Veterans Affairs health care providers. 
Sec. 132. Improving information sharing with community providers. 
Sec. 133. Competency standards for non-Department of Veterans Affairs health 
care providers. 
Sec. 134. Department of Veterans Affairs participation in national network of 
State-based prescription drug monitoring programs. 
CHAPTER 5—OTHER NON-DEPARTMENT HEALTH CARE MATTERS 
Sec. 141. Plans for Use of Supplemental Appropriations Required. 
Sec. 142. Veterans Choice Fund flexibility. 
Sec. 143. Sunset of Veterans Choice Program. 
Sec. 144. Conforming amendments. 
Subtitle B—Improving Department of Veterans Affairs Health Care Delivery 
Sec. 151. Licensure of health care professionals of the Department of Veterans Af-
fairs providing treatment via telemedicine. 
Sec. 152. Authority for Department of Veterans Affairs Center for Innovation for 
Care and Payment. 
Sec. 153. Authorization to provide for operations on live donors for purposes of con-
ducting transplant procedures for veterans. 
Subtitle C—Family Caregivers 
Sec. 161. Expansion of family caregiver program of Department of Veterans Affairs. 
Sec. 162. Implementation of information technology system of Department of Vet-
erans Affairs to assess and improve the family caregiver program. 
Sec. 163. Modifications to annual evaluation report on caregiver program of De-
partment of Veterans Affairs. 
TITLE II—VA ASSET AND INFRASTRUCTURE REVIEW 
Subtitle A—Asset and Infrastructure Review 
Sec. 201. Short title. 
Sec. 202. The Commission. 
Sec. 203. Procedure for making recommendations. 
Sec. 204. Actions regarding infrastructure and facilities of the Veterans Health Ad-
ministration. 
Sec. 205. Implementation. 
Sec. 206. Department of Veterans Affairs Asset and Infrastructure Review Account. 
Sec. 207. Congressional consideration of Commission report. 
Sec. 208. Other matters. 
Sec. 209. Definitions. 
Subtitle B—Other Infrastructure Matters 
Sec. 211. Improvement to training of construction personnel. 
Sec. 212. Review of enhanced use leases. 
Sec. 213. Assessment of health care furnished by the Department to veterans who 
live in the Pacific territories. 
TITLE III—IMPROVEMENTS TO RECRUITMENT OF HEALTH CARE 
PROFESSIONALS 
Sec. 301. Designated scholarships for physicians and dentists under Department of 
Veterans Affairs Health Professional Scholarship Program. 
Sec. 302. Increase in maximum amount of debt that may be reduced under Edu-
cation Debt Reduction Program of Department of Veterans Affairs. 
Sec. 303. Establishing the Department of Veterans Affairs Specialty Education 
Loan Repayment Program. 
Sec. 304. Veterans healing veterans medical access and scholarship program. 
Sec. 305. Bonuses for recruitment, relocation, and retention. 
Sec. 306. Inclusion of Vet Center employees in Education Debt Reduction Program 
of Department of Veterans Affairs. 
TITLE IV—HEALTH CARE IN UNDERSERVED AREAS 
Sec. 401. Development of criteria for designation of certain medical facilities of the 
Department of Veterans Affairs as underserved facilities and plan to ad-
dress problem of underserved facilities. 
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132 STAT. 1395 
PUBLIC LAW 115–182—JUNE 6, 2018 
Sec. 402. Pilot program to furnish mobile deployment teams to underserved facili-
ties. 
Sec. 403. Pilot program on graduate medical education and residency. 
TITLE V—OTHER MATTERS 
Sec. 501. Annual report on performance awards and bonuses awarded to certain 
high-level employees of the department. 
Sec. 502. Role of podiatrists in Department of Veterans Affairs. 
Sec. 503. Definition of major medical facility project. 
Sec. 504. Authorization of certain major medical facility projects of the Department 
of Veterans Affairs. 
Sec. 505. Department of Veterans Affairs personnel transparency. 
Sec. 506. Program on establishment of peer specialists in patient aligned care team 
settings within medical centers of Department of Veterans Affairs. 
Sec. 507. Department of Veterans Affairs medical scribe pilot program. 
Sec. 508. Extension of requirement to collect fees for housing loans guaranteed by 
Secretary of Veterans Affairs. 
Sec. 509. Extension of reduction in amount of pension furnished by Department of 
Veterans Affairs for certain veterans covered by Medicaid plans for serv-
ices furnished by nursing facilities. 
Sec. 510. Appropriation of amounts. 
Sec. 511. Technical correction. 
Sec. 512. Budgetary effects. 
TITLE I—CARING FOR OUR VETERANS 
SEC. 100. SHORT TITLE; REFERENCES TO TITLE 38, UNITED STATES 
CODE. 
(a) SHORT TITLE.—This title may be cited as the ‘‘Caring for 
Our Veterans Act of 2018’’. 
(b) REFERENCES TO TITLE 38, UNITED STATES CODE.—Except 
as otherwise expressly provided, whenever in this title an amend-
ment or repeal is expressed in terms of an amendment to, or 
repeal of, a section or other provision, the reference shall be consid-
ered to be made to a section or other provision of title 38, United 
States Code. 
Subtitle A—Developing an Integrated 
High-Performing Network 
CHAPTER 1—ESTABLISHING COMMUNITY CARE 
PROGRAMS 
SEC. 101. ESTABLISHMENT OF VETERANS COMMUNITY CARE PRO-
GRAM. 
(a) ESTABLISHMENT OF PROGRAM.— 
(1) IN GENERAL.—Section 1703 is amended to read as fol-
lows: 
‘‘§ 1703. Veterans Community Care Program 
‘‘(a) IN GENERAL.—(1) There is established a program to furnish 
hospital care, medical services, and extended care services to cov-
ered veterans through health care providers specified in subsection 
(c). 
‘‘(2) The Secretary shall coordinate the furnishing of hospital 
care, medical services, and extended care services under this section 
to covered veterans, including coordination of, at a minimum, the 
following: 
Coordination. 
38 USC 101 note. 
Caring for Our 
Veterans Act 
of 2018. 
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132 STAT. 1396 
PUBLIC LAW 115–182—JUNE 6, 2018 
‘‘(A) Ensuring the scheduling of medical appointments in 
a timely manner and the establishment of a mechanism to 
receive medical records from non-Department providers. 
‘‘(B) Ensuring continuity of care and services. 
‘‘(C) Ensuring coordination among regional networks if the 
covered veteran accesses care and services in a different net-
work than the regional network in which the covered veteran 
resides. 
‘‘(D) Ensuring that covered veterans do not experience a 
lapse in care resulting from errors or delays by the Department 
or its contractors or an unusual or excessive burden in accessing 
hospital care, medical services, or extended care services. 
‘‘(3) A covered veteran may only receive care or services under 
this section upon the authorization of such care or services by 
the Secretary. 
‘‘(b) COVERED VETERANS.—For purposes of this section, a cov-
ered veteran is any veteran who— 
‘‘(1) is enrolled in the system of annual patient enrollment 
established and operated under section 1705 of this title; or 
‘‘(2) is not enrolled in such system but is otherwise entitled 
to hospital care, medical services, or extended care services 
under subsection (c)(2) of such section. 
‘‘(c) HEALTH CARE PROVIDERS SPECIFIED.—Health care pro-
viders specified in this subsection are the following: 
‘‘(1) Any health care provider that is participating in the 
Medicare program under title XVIII of the Social Security Act 
(42 U.S.C. 1395 et seq.), including any physician furnishing 
services under such a program. 
‘‘(2) The Department of Defense. 
‘‘(3) The Indian Health Service. 
‘‘(4) Any 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))). 
‘‘(5) Any health care provider not otherwise covered under 
any of paragraphs (1) through (4) that meets criteria established 
by the Secretary for purposes of this section. 
‘‘(d) CONDITIONS UNDER WHICH CARE IS REQUIRED TO BE FUR-
NISHED THROUGH NON-DEPARTMENT PROVIDERS.—(1) The Secretary 
shall, subject to the availability of appropriations, furnish hospital 
care, medical services, and extended care services to a covered 
veteran through health care providers specified in subsection (c) 
if— 
‘‘(A) the Department does not offer the care or services 
the veteran requires; 
‘‘(B) the Department does not operate a full-service medical 
facility in the State in which the covered veteran resides; 
‘‘(C)(i) the covered veteran was an eligible veteran under 
section 101(b)(2)(B) of the Veterans Access, Choice, and 
Accountability Act of 2014 (Public Law 113–146; 38 U.S.C. 
1701 note) as of the day before the date of the enactment 
of the Caring for Our Veterans Act of 2018; 
‘‘(ii) continues to reside in a location that would qualify 
the veteran for eligibility under such section; and 
‘‘(iii) either— 
‘‘(I) resides in one of the five States with the lowest 
population density as determined by data from the 2010 
decennial census; or 
Criteria. 
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132 STAT. 1397 
PUBLIC LAW 115–182—JUNE 6, 2018 
‘‘(II) resides in a State not described in subclause (I) 
and— 
‘‘(aa) received care or services under this title in 
the year preceding the enactment of the Caring for 
Our Veterans Act of 2018; and 
‘‘(bb) is seeking care or services within 2 years 
of the date of the enactment of the Caring for Our 
Veterans Act of 2018; 
‘‘(D) the covered veteran has contacted the Department 
to request care or services and the Department is not able 
to furnish such care or services in a manner that complies 
with designated access standards developed by the Secretary 
under section 1703B of this title; or 
‘‘(E) the covered veteran and the covered veteran’s referring 
clinician agree that furnishing care and services through a 
non-Department entity or provider would be in the best medical 
interest of the covered veteran based upon criteria developed 
by the Secretary. 
‘‘(2) The Secretary shall ensure that the criteria developed 
under paragraph (1)(E) include consideration of the following: 
‘‘(A) The distance between the covered veteran and the 
facility that provides the hospital care, medical services, or 
extended care services the veteran needs. 
‘‘(B) The nature of the hospital care, medical services, or 
extended care services required. 
‘‘(C) The frequency that the hospital care, medical services, 
or extended care services needs to be furnished. 
‘‘(D) The timeliness of available appointments for the hos-
pital care, medical services, or extended care services the vet-
eran needs. 
‘‘(E) Whether the covered veteran faces an unusual or 
excessive burden to access hospital care, medical services, or 
extended care services from the Department medical facility 
where a covered veteran seeks hospital care, medical services, 
or extended care services, which shall include consideration 
of the following: 
‘‘(i) Whether the covered veteran faces an excessive 
driving distance, geographical challenge, or environmental 
factor that impedes the access of the covered veteran. 
‘‘(ii) Whether the hospital care, medical services, or 
extended care services sought by the veteran is provided 
by a medical facility of the Department that is reasonably 
accessible to a covered veteran. 
‘‘(iii) Whether a medical condition of the covered vet-
eran affects the ability of the covered veteran to travel. 
‘‘(iv) Whether there is compelling reason, as determined 
by the Secretary, that the veteran needs to receive hospital 
care, medical services, or extended care services from a 
medical facility other than a medical facility of the Depart-
ment. 
‘‘(v) Such other considerations as the Secretary con-
siders appropriate. 
‘‘(3) If the Secretary has determined that the Department does 
not offer the care or services the covered veteran requires under 
subparagraph (A) of paragraph (1), that the Department does not 
operate a full-service medical facility in the State in which the 
covered veteran resides under subparagraph (B) of such paragraph, 
Criteria. 
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132 STAT. 1398 
PUBLIC LAW 115–182—JUNE 6, 2018 
that the covered veteran is described under subparagraph (C) of 
such paragraph, or that the Department is not able to furnish 
care or services in a manner that complies with designated access 
standards developed by the Secretary under section 1703B of this 
title under subparagraph (D) of such paragraph, the decision to 
receive hospital care, medical services, or extended care services 
under such subparagraphs from a health care provider specified 
in subsection (c) shall be at the election of the veteran. 
‘‘(e) CONDITIONS UNDER WHICH CARE IS AUTHORIZED TO BE 
FURNISHED THROUGH NON-DEPARTMENT PROVIDERS.—(1)(A) The 
Secretary may furnish hospital care, medical services, or extended 
care services through a health care provider specified in subsection 
(c) to a covered veteran served by a medical service line of the 
Department that the Secretary has determined is not providing 
care that complies with the standards for quality the Secretary 
shall establish under section 1703C. 
‘‘(B) In carrying out subparagraph (A), the Secretary shall— 
‘‘(i) measure timeliness of the medical service line at a 
facility of the Department when compared with the same med-
ical service line at different Department facilities; and 
‘‘(ii) measure quality at a medical service line of a facility 
of the Department by comparing it with two or more distinct 
and appropriate quality measures at non-Department medical 
service lines. 
‘‘(C)(i) The Secretary may not concurrently furnish hospital 
care, medical services, or extended care services under subpara-
graph (A) with respect to more than three medical service lines 
described in such subparagraph at any one health care facility 
of the Department. 
‘‘(ii) The Secretary may not concurrently furnish hospital care, 
medical services, or extended care services under subparagraph 
(A) with respect to more than 36 medical service lines nationally 
described in such subparagraph. 
‘‘(2) The Secretary may limit the types of hospital care, medical 
services, or extended care services covered veterans may receive 
under paragraph (1) in terms of the length of time such care 
and services will be available, the location at which such care 
and services will be available, and the clinical care and services 
that will be available. 
‘‘(3)(A) Except as provided for in subparagraph (B), the hospital 
care, medical services, and extended care services authorized under 
paragraph (1) with respect to a medical service line shall cease 
when the remediation described in section 1706A with respect to 
such medical service line is complete. 
‘‘(B) The Secretary shall ensure continuity and coordination 
of care for any veteran who elects to receive care or services under 
paragraph (1) from a health care provider specified in subsection 
(c) through the completion of an episode of care. 
‘‘(4) The Secretary shall publish in the Federal Register, and 
shall take all reasonable steps to provide direct notice to covered 
veterans affected under this subsection, at least once each year 
stating the time period during which such care and services will 
be available, the location or locations where such care and services 
will be available, and the clinical services available at each location 
under this subsection in accordance with regulations the Secretary 
shall prescribe. 
Federal Register, 
publication. 
Notice. 
Time period. 
Regulations. 
Coordination. 
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132 STAT. 1399 
PUBLIC LAW 115–182—JUNE 6, 2018 
‘‘(5) When the Secretary exercises the authority under para-
graph (1), the decision to receive care or services under such para-
graph from a health care provider specified in subsection (c) shall 
be at the election of the covered veteran. 
‘‘(f) REVIEW OF DECISIONS.—The review of any decision under 
subsection (d) or (e) shall be subject to the Department’s clinical 
appeals process, and such decisions may not be appealed to the 
Board of Veterans’ Appeals. 
‘‘(g) TIERED NETWORK.—(1) To promote the provision of high- 
quality and high-value hospital care, medical services, and extended 
care services under this section, the Secretary may develop a tiered 
provider network of eligible providers based on criteria established 
by the Secretary for purposes of this section. 
‘‘(2) In developing a tiered provider network of eligible providers 
under paragraph (1), the Secretary shall not prioritize providers 
in a tier over providers in any other tier in a manner that limits 
the choice of a covered veteran in selecting a health care provider 
specified in subsection (c) for receipt of hospital care, medical serv-
ices, or extended care services under this section. 
‘‘(h) CONTRACTS TO ESTABLISH NETWORKS OF HEALTH CARE 
PROVIDERS.—(1) The Secretary shall enter into consolidated, 
competitively bid contracts to establish networks of health care 
providers specified in paragraphs (1) and (5) of subsection (c) for 
purposes of providing sufficient access to hospital care, medical 
services, or extended care services under this section. 
‘‘(2)(A) The Secretary shall, to the extent practicable, ensure 
that covered veterans are able to make their own appointments 
using advanced technology. 
‘‘(B) To the extent practicable, the Secretary shall be responsible 
for the scheduling of appointments for hospital care, medical serv-
ices, and extended care services under this section. 
‘‘(3)(A) The Secretary may terminate a contract with an entity 
entered into under paragraph (1) at such time and upon such 
notice to the entity as the Secretary may specify for purposes 
of this section, if the Secretary notifies the appropriate committees 
of Congress that, at a minimum— 
‘‘(i) the entity— 
‘‘(I) failed to comply substantially with the provisions 
of the contract or with the provisions of this section and 
the regulations prescribed under this section; 
‘‘(II) failed to comply with the access standards or 
the standards for quality established by the Secretary; 
‘‘(III) is excluded from participation in a Federal health 
care program (as defined in section 1128B(f) of the Social 
Security Act (42 U.S.C. 1320a–7b(f))) under section 1128 
or 1128A of the Social Security Act (42 U.S.C. 1320a– 
7 and 1320a–7a); 
‘‘(IV) is identified as an excluded source on the list 
maintained in the System for Award Management, or any 
successor system; or 
‘‘(V) has been convicted of a felony or other serious 
offense under Federal or State law and the continued 
participation of the entity would be detrimental to the 
best interests of veterans or the Department; 
‘‘(ii) it is reasonable to terminate the contract based on 
the health care needs of veterans; or 
Notification. 
Criteria. 
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132 STAT. 1400 
PUBLIC LAW 115–182—JUNE 6, 2018 
‘‘(iii) it is reasonable to terminate the contract based on 
coverage provided by contracts or sharing agreements entered 
into under authorities other than this section. 
‘‘(B) Nothing in subparagraph (A) may be construed to restrict 
the authority of the Secretary to terminate a contract entered 
into under paragraph (1) under any other provision of law. 
‘‘(4) Whenever the Secretary provides notice to an entity that 
the entity is failing to meet contractual obligations entered into 
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 failure. 
Such report shall include the following: 
‘‘(A) An explanation of the reasons for providing such notice. 
‘‘(B) A description of the effect of such failure, including 
with respect to cost, schedule, and requirements. 
‘‘(C) A description of the actions taken by the Secretary 
to mitigate such failure. 
‘‘(D) A description of the actions taken by the contractor 
to address such failure. 
‘‘(E) A description of any effect on the community provider 
market for veterans in the affected area. 
‘‘(5)(A) The Secretary shall instruct each entity awarded a 
contract under paragraph (1) to recognize and accept, on an interim 
basis, the credentials and qualifications of health care providers 
who are authorized to furnish hospital care and medical services 
to veterans under a community care program of the Department 
in effect as of the day before the date of the enactment of the 
Caring for Our Veterans Act of 2018, including under the Patient- 
Centered Community Care Program and the Veterans Choice Pro-
gram under section 101 of the Veterans Access, Choice, and Account-
ability Act of 2014 (Public Law 113–146; 38 U.S.C. 1701 note), 
as qualified providers under the program established under this 
section. 
‘‘(B) The interim acceptance period under subparagraph (A) 
shall be determined by the Secretary based on the following criteria: 
‘‘(i) With respect to a health care provider, when the current 
certification agreement for the health care provider expires. 
‘‘(ii) Whether the Department has enacted certification and 
eligibility criteria and regulatory procedures by which non- 
Department providers will be authorized under this section. 
‘‘(6) The Secretary shall establish a system or systems for 
monitoring the quality of care provided to covered veterans through 
a network under this subsection and for assessing the quality 
of hospital care, medical services, and extended care services fur-
nished through such network before the renewal of the contract 
for such network. 
‘‘(i) PAYMENT RATES FOR CARE AND SERVICES.—(1) Except as 
provided in paragraph (2), and to the extent practicable, the rate 
paid for hospital care, medical services, or extended care services 
under any provision in this title may not exceed the rate paid 
by the United States to a provider of services (as defined in section 
1861(u) of the Social Security Act (42 U.S.C. 1395x(u))) or a supplier 
(as defined in section 1861(d) of such Act (42 U.S.C. 1395x(d))) 
under the Medicare program under title XI or title XVIII of the 
Social Security Act (42 U.S.C. 1301 et seq.), including section 1834 
of such Act (42 U.S.C. 1395m), for the same care or services. 
Determination. 
Criteria. 
Effective date. 
Reports. 
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132 STAT. 1401 
PUBLIC LAW 115–182—JUNE 6, 2018 
‘‘(2)(A) A higher rate than the rate paid by the United States 
as described in paragraph (1) may be negotiated with respect to 
the furnishing of care or services to a covered veteran who resides 
in a highly rural area. 
‘‘(B) In this paragraph, the term ‘highly rural area’ means 
an area located in a county that has fewer than seven individuals 
residing in that county per square mile. 
‘‘(3) With respect to furnishing care or services under this 
section in Alaska, the Alaska Fee Schedule of the Department 
of Veterans Affairs shall be followed, except for when another 
payment agreement, including a contract or provider agreement, 
is in effect. 
‘‘(4) With respect to furnishing hospital care, medical services, 
or extended care services under this section in a State with an 
All-Payer Model Agreement under section 1814(b)(3) of the Social 
Security Act (42 U.S.C. 1395f(b)(3)) that became effective on or 
after January 1, 2014, the Medicare payment rates under paragraph 
(2)(A) shall be calculated based on the payment rates under such 
agreement. 
‘‘(5) Notwithstanding paragraph (1), the Secretary may incor-
porate, to the extent practicable, the use of value-based reimburse-
ment models to promote the provision of high-quality care. 
‘‘(6) With respect to hospital care, medical services, or extended 
care services for which there is not a rate paid under the Medicare 
program as described in paragraph (1), the rate paid for such 
care or services shall be determined by the Secretary. 
‘‘(j) TREATMENT OF OTHER HEALTH PLAN CONTRACTS.—In any 
case in which a covered veteran is furnished hospital care, medical 
services, or extended care services under this section for a non- 
service-connected disability described in subsection (a)(2) of section 
1729 of this title, the Secretary shall recover or collect reasonable 
charges for such care or services from a health plan contract 
described in section 1729 in accordance with such section. 
‘‘(k) PAYMENT BY VETERAN.—A covered veteran shall not pay 
a greater amount for receiving care or services under this section 
than the amount the veteran would pay for receiving the same 
or comparable care or services at a medical facility of the Depart-
ment or from a health care provider of the Department. 
‘‘(l) TRANSPLANT AUTHORITY FOR IMPROVED ACCESS.—(1) In the 
case of a covered veteran described in paragraph (2), the Secretary 
shall determine whether to authorize an organ or bone marrow 
transplant for that covered veteran at a non-Department facility. 
‘‘(2) A covered veteran described in this paragraph— 
‘‘(A) requires an organ or bone marrow transplant; and 
‘‘(B) has, in the opinion of the primary care provider of 
the veteran, a medically compelling reason to travel outside 
the region of the Organ Procurement and Transplantation Net-
work, established under section 372 of the National Organ 
Transplantation Act (Public Law 98–507; 42 U.S.C. 274), in 
which the veteran resides, to receive such transplant. 
‘‘(m) MONITORING OF CARE PROVIDED.—(1)(A) Not later than 
540 days after the date of the enactment of the Caring for Our 
Veterans Act of 2018, and not less frequently than annually there-
after, the Secretary shall submit to appropriate committees of Con-
gress a review of the types and frequency of care sought under 
subsection (d). 
Deadlines. 
Review. 
Alaska. 
Definition. 
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132 STAT. 1402 
PUBLIC LAW 115–182—JUNE 6, 2018 
‘‘(B) The review submitted under subparagraph (A) shall include 
an assessment of the following: 
‘‘(i) The top 25 percent of types of care and services most 
frequently provided under subsection (d) due to the Department 
not offering such care and services. 
‘‘(ii) The frequency such care and services were sought 
by covered veterans under this section. 
‘‘(iii) An analysis of the reasons the Department was unable 
to provide such care and services. 
‘‘(iv) Any steps the Department took to provide such care 
and services at a medical facility of the Department. 
‘‘(v) The cost of such care and services. 
‘‘(2) In monitoring the hospital care, medical services, and 
extended care services furnished under this section, the Secretary 
shall do the following: 
‘‘(A) With respect to hospital care, medical services, and 
extended care services furnished through provider networks 
established under subsection (i)— 
‘‘(i) compile data on the types of hospital care, medical 
services, and extended care services furnished through such 
networks and how many patients used each type of care 
and service; 
‘‘(ii) identify gaps in hospital care, medical services, 
or extended care services furnished through such networks; 
‘‘(iii) identify how such gaps may be fixed through 
new contracts within such networks or changes in the 
manner in which hospital care, medical services, or 
extended care services are furnished through such net-
works; 
‘‘(iv) assess the total amounts spent by the Department 
on hospital care, medical services, and extended care serv-
ices furnished through such networks; 
‘‘(v) assess the timeliness of the Department in refer-
ring hospital care, medical services, and extended care 
services to such networks; and 
‘‘(vi) assess the timeliness of such networks in— 
‘‘(I) accepting referrals; and 
‘‘(II) scheduling and completing appointments. 
‘‘(B) Report the number of medical service lines the Sec-
retary has determined under subsection (e)(1) not to be pro-
viding hospital care, medical services, or extended care services 
that comply with the standards for quality established by the 
Secretary. 
‘‘(C) Assess the use of academic affiliates and centers of 
excellence of the Department to furnish hospital care, medical 
services, and extended care services to covered veterans under 
this section. 
‘‘(D) Assess the hospital care, medical services, and 
extended care services furnished to covered veterans under 
this section by medical facilities operated by Federal agencies 
other than the Department. 
‘‘(3) Not later than 540 days after the date of the enactment 
of the Caring for Our Veterans Act of 2018 and not less frequently 
than once each year thereafter, 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 information gathered under paragraph (2). 
Reports. 
Reports. 
Data. 
Assessments. 
Analysis. 
Assessment. 
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132 STAT. 1403 
PUBLIC LAW 115–182—JUNE 6, 2018 
‘‘(n) PROHIBITION ON CERTAIN LIMITATIONS.—(1) The Secretary 
shall not limit the types of hospital care, medical services, or 
extended care services covered veterans may receive under this 
section if it is in the best medical interest of the veteran to receive 
such hospital care, medical services, or extended care services, 
as determined by the veteran and the veteran’s health care provider. 
‘‘(2) No provision in this section may be construed to alter 
or modify any other provision of law establishing specific eligibility 
criteria for certain hospital care, medical services, or extended 
care services. 
‘‘(o) DEFINITIONS.—In this section: 
‘‘(1) The term ‘appropriate committees of Congress’ means— 
‘‘(A) the Committee on Veterans’ Affairs and the Com-
mittee on Appropriations of the Senate; and 
‘‘(B) the Committee on Veterans’ Affairs and the Com-
mittee on Appropriations of the House of Representatives. 
‘‘(2) The term ‘medical service line’ means a clinic within 
a Department medical center.’’. 
(2) CLERICAL AMENDMENT.—The table of sections at the 
beginning of chapter 17 is amended by striking the item relating 
to section 1703 and inserting the following new item: 
‘‘1703. Veterans Community Care Program.’’. 
(b) EFFECTIVE DATE.—Section 1703 of title 38, United States 
Code, as amended by subsection (a), shall take effect on the later 
of— 
(1) the date that is 30 days after the date on which the 
Secretary of Veterans Affairs submits the report required under 
section 101(q)(2) of the Veterans Access, Choice, and Account-
ability Act of 2014 (Public Law 113–146; 38 U.S.C. 1701 note); 
or 
(2) the date on which the Secretary promulgates regulations 
pursuant to subsection (c). 
(c) REGULATIONS.— 
(1) IN
GENERAL.—Not later than 1 year after the date 
of the enactment of this Act, the Secretary of Veterans Affairs 
shall promulgate regulations to carry out section 1703 of title 
38, United States Code, as amended by subsection (a) of this 
section. 
(2) UPDATES.— 
(A) PERIODIC.—Before promulgating the regulations 
required under paragraph (1), the Secretary shall provide 
to the appropriate committees of Congress periodic updates 
to confirm the progress of the Secretary toward developing 
such regulations. 
(B) FIRST UPDATE.—The first update under subpara-
graph (A) shall occur no later than 120 days from the 
date of the enactment of this Act. 
(C) APPROPRIATE COMMITTEES OF CONGRESS DEFINED.— 
In this paragraph, the term ‘‘appropriate committees of 
Congress’’ means— 
(i) the Committee on Veterans’ Affairs and the 
Committee on Appropriations of the Senate; and 
(ii) the Committee on Veterans’ Affairs and the 
Committee on Appropriations of the House of Rep-
resentatives. 
(d) CONTINUITY OF EXISTING AGREEMENTS.— 
Deadline. 
Deadline. 
38 USC 1703 
note. 
38 USC 
prec. 1701. 
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132 STAT. 1404 
PUBLIC LAW 115–182—JUNE 6, 2018 
(1) IN GENERAL.—Notwithstanding section 1703 of title 38, 
United States Code, as amended by subsection (a), the Secretary 
of Veterans Affairs shall continue all contracts, memorandums 
of understanding, memorandums of agreements, and other 
arrangements that were in effect on the day before the date 
of the enactment of this Act between the Department of Vet-
erans Affairs and the American Indian and Alaska Native 
health care systems as established under the terms of the 
Department of Veterans Affairs and Indian Health Service 
Memorandum of Understanding, signed October 1, 2010, the 
National Reimbursement Agreement, signed December 5, 2012, 
arrangements under section 405 of the Indian Health Care 
Improvement Act (25 U.S.C. 1645), and agreements entered 
into under sections 102 and 103 of the Veterans Access, Choice, 
and Accountability Act of 2014 (Public Law 113–146). 
(2) MODIFICATIONS.—Paragraph (1) shall not be construed 
to prohibit the Secretary and the parties to the contracts, 
memorandums of understanding, memorandums of agreements, 
and other arrangements described in such paragraph from 
making such changes to such contracts, memorandums of 
understanding, memorandums of agreements, and other 
arrangements as may be otherwise authorized pursuant to 
other provisions of law or the terms of the contracts, memoran-
dums of understanding, memorandums of agreements, and 
other arrangements. 
SEC. 102. AUTHORIZATION OF AGREEMENTS BETWEEN DEPARTMENT 
OF VETERANS AFFAIRS AND NON-DEPARTMENT PRO-
VIDERS. 
(a) IN GENERAL.—Subchapter I of chapter 17 is amended by 
inserting after section 1703 the following new section: 
‘‘§ 1703A. Agreements with eligible entities or providers; cer-
tification processes 
‘‘(a) AGREEMENTS AUTHORIZED.—(1)(A) When hospital care, a 
medical service, or an extended care service required by a veteran 
who is entitled to such care or service under this chapter is not 
feasibly available to the veteran from a facility of the Department 
or through a contract or sharing agreement entered into pursuant 
to another provision of law, the Secretary may furnish such care 
or service to such veteran through an agreement under this section 
with an eligible entity or provider to provide such hospital care, 
medical service, or extended care service. 
‘‘(B) An agreement entered into under this section to provide 
hospital care, a medical service, or an extended care service shall 
be known as a ‘Veterans Care Agreement’. 
‘‘(C) For purposes of subparagraph (A), hospital care, a medical 
service, or an extended care service may be considered not feasibly 
available to a veteran from a facility of the Department or through 
a contract or sharing agreement described in such subparagraph 
when the Secretary determines the veteran’s medical condition, 
the travel involved, the nature of the care or services required, 
or a combination of these factors make the use of a facility of 
the Department or a contract or sharing agreement described in 
such subparagraph impracticable or inadvisable. 
‘‘(D) A Veterans Care Agreement may be entered into by the 
Secretary or any Department official authorized by the Secretary. 
38 USC 1703A. 
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132 STAT. 1405 
PUBLIC LAW 115–182—JUNE 6, 2018 
‘‘(2)(A) Subject to subparagraph (B), the Secretary shall review 
each Veterans Care Agreement of material size, as determined 
by the Secretary or set forth in paragraph (3), for hospital care, 
a medical service, or an extended care service to determine whether 
it is feasible and advisable to provide such care or service within 
a facility of the Department or by contract or sharing agreement 
entered into pursuant to another provision of law and, if so, take 
action to do so. 
‘‘(B)(i) The Secretary shall review each Veterans Care Agree-
ment of material size that has been in effect for at least 6 months 
within the first 2 years of its taking effect, and not less frequently 
than once every 4 years thereafter. 
‘‘(ii) If a Veterans Care Agreement has not been in effect 
for at least 6 months by the date of the review required by subpara-
graph (A), the agreement shall be reviewed during the next cycle 
required by subparagraph (A), and such review shall serve as its 
review within the first 2 years of its taking effect for purposes 
of clause (i). 
‘‘(3)(A) In fiscal year 2019 and in each fiscal year thereafter, 
in addition to such other Veterans Care Agreements as the Sec-
retary may determine are of material size, a Veterans Care Agree-
ment for the purchase of extended care services that exceeds 
$5,000,000 annually shall be considered of material size. 
‘‘(B) From time to time, the Secretary may publish a notice 
in the Federal Register to adjust the dollar amount specified in 
subparagraph (A) to account for changes in the cost of health 
care based upon recognized health care market surveys and other 
available data. 
‘‘(b) ELIGIBLE ENTITIES AND PROVIDERS.—For purposes of this 
section, an eligible entity or provider is— 
‘‘(1) any provider of services that has enrolled and entered 
into a provider agreement under section 1866(a) of the Social 
Security Act (42 U.S.C. 1395cc(a)) and any physician or other 
supplier who has enrolled and entered into a participation 
agreement under section 1842(h) of such Act (42 U.S.C. 
1395u(h)); 
‘‘(2) any provider participating under a State plan under 
title XIX of such Act (42 U.S.C. 1396 et seq.); 
‘‘(3) an Aging and Disability Resource Center, an area 
agency on aging, or a State agency (as defined in section 102 
of the Older Americans Act of 1965 (42 U.S.C. 3002)); 
‘‘(4) a center for independent living (as defined in section 
702 of the Rehabilitation Act of 1973 (29 U.S.C. 796a)); or 
‘‘(5) any entity or provider not described in paragraph 
(1) or (2) of this subsection that the Secretary determines 
to be eligible pursuant to the certification process described 
in subsection (c). 
‘‘(c) ELIGIBLE ENTITY OR PROVIDER CERTIFICATION PROCESS.— 
The Secretary shall establish by regulation a process for the certifi-
cation of eligible entities or providers or recertification of eligible 
entities or providers under this section. Such a process shall, at 
a minimum— 
‘‘(1) establish deadlines for actions on applications for cer-
tification; 
‘‘(2) set forth standards for an approval or denial of certifi-
cation, duration of certification, revocation of an eligible entity 
Regulations. 
Time periods. 
Time periods. 
Reviews. 
Determination. 
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132 STAT. 1406 
PUBLIC LAW 115–182—JUNE 6, 2018 
or provider’s certification, and recertification of eligible entities 
or providers; 
‘‘(3) require the denial of certification if the Secretary deter-
mines the eligible entity or provider is excluded from participa-
tion in a Federal health care program under section 1128 
or section 1128A of the Social Security Act (42 U.S.C. 1320a– 
7 or 1320a–7a) or is currently identified as an excluded source 
on the System for Award Management Exclusions list described 
in part 9 of title 48, Code of Federal Regulations, and part 
180 of title 2 of such Code, or successor regulations; 
‘‘(4) establish procedures for screening eligible entities or 
providers according to the risk of fraud, waste, and abuse 
that are similar to the standards under section 1866(j)(2)(B) 
of the Social Security Act (42 U.S.C. 1395cc(j)(2)(B)) and section 
9.104 of title 48, Code of Federal Regulations, or successor 
regulations; and 
‘‘(5) incorporate and apply the restrictions and penalties 
set forth in chapter 21 of title 41 and treat this section as 
a procurement program only for purposes of applying such 
provisions. 
‘‘(d) RATES.—To the extent practicable, the rates paid by the 
Secretary for hospital care, medical services, and extended care 
services provided under a Veterans Care Agreement shall be in 
accordance with the rates paid by the United States under section 
1703(i) of this title. 
‘‘(e) TERMS
OF VETERANS CARE AGREEMENTS.—(1) Pursuant 
to regulations promulgated under subsection (k), the Secretary may 
define the requirements for providers and entities entering into 
agreements under this section based upon such factors as the 
number of patients receiving care or services, the number of 
employees employed by the entity or provider furnishing such care 
or services, the amount paid by the Secretary to the provider 
or entity, or other factors as determined by the Secretary. 
‘‘(2) To furnish hospital care, medical services, or extended 
care services under this section, an eligible entity or provider shall 
agree— 
‘‘(A) to accept payment at the rates established in regula-
tions prescribed under this section; 
‘‘(B) that payment by the Secretary under this section 
on behalf of a veteran to a provider of services or care shall, 
unless rejected and refunded by the provider within 30 days 
of receipt, constitute payment in full and extinguish any 
liability on the part of the veteran for the treatment or care 
provided, and no provision of a contract, agreement, or assign-
ment to the contrary shall operate to modify, limit, or negate 
this requirement; 
‘‘(C) to provide only the care and services authorized by 
the Department under this section and to obtain the prior 
written consent of the Department to furnish care or services 
outside the scope of such authorization; 
‘‘(D) to bill the Department in accordance with the method-
ology outlined in regulations prescribed under this section; 
‘‘(E) to not seek to recover or collect from a health plan 
contract or third party, as those terms are defined in section 
1729 of this title, for any care or service that is furnished 
or paid for by the Department; 
Deadline. 
Procedures. 
Determination. 
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132 STAT. 1407 
PUBLIC LAW 115–182—JUNE 6, 2018 
‘‘(F) to provide medical records to the Department in the 
time frame and format specified by the Department; and 
‘‘(G) to meet such other terms and conditions, including 
quality of care assurance standards, as the Secretary may 
specify in regulation. 
‘‘(f) DISCONTINUATION OR NONRENEWAL OF A VETERANS CARE 
AGREEMENT.—(1) An eligible entity or provider may discontinue 
a Veterans Care Agreement at such time and upon such notice 
to the Secretary as may be provided in regulations prescribed 
under this section. 
‘‘(2) The Secretary may discontinue a Veterans Care Agreement 
with an eligible entity or provider at such time and upon such 
reasonable notice to the eligible entity or provider as may be speci-
fied in regulations prescribed under this section, if an official des-
ignated by the Secretary— 
‘‘(A) has determined that the eligible entity or provider 
failed to comply substantially with the provisions of the Vet-
erans Care Agreement, or with the provisions of this section 
or regulations prescribed under this section; 
‘‘(B) has determined the eligible entity or provider is 
excluded from participation in a Federal health care program 
under section 1128 or section 1128A of the Social Security 
Act (42 U.S.C. 1320a–7 or 1320a–7a) or is identified on the 
System for Award Management Exclusions list as provided 
in part 9 of title 48, Code of Federal Regulations, and part 
180 of title 2 of such Code, or successor regulations; 
‘‘(C) has ascertained that the eligible entity or provider 
has been convicted of a felony or other serious offense under 
Federal or State law and determines the eligible entity or 
provider’s continued participation would be detrimental to the 
best interests of veterans or the Department; or 
‘‘(D) has determined that it is reasonable to terminate 
the agreement based on the health care needs of a veteran. 
‘‘(g) QUALITY OF CARE.—The Secretary shall establish a system 
or systems for monitoring the quality of care provided to veterans 
through Veterans Care Agreements and for assessing the quality 
of hospital care, medical services, and extended care services fur-
nished by eligible entities and providers before the renewal of 
Veterans Care Agreements. 
‘‘(h) DISPUTES.—(1) The Secretary shall promulgate administra-
tive procedures for eligible entities and providers to present all 
disputes arising under or related to Veterans Care Agreements. 
‘‘(2) Such procedures constitute the eligible entities’ and pro-
viders’ exhaustive and exclusive administrative remedies. 
‘‘(3) Eligible entities or providers must first exhaust such 
administrative procedures before seeking any judicial review under 
section 1346 of title 28 (known as the ‘Tucker Act’). 
‘‘(4) Disputes under this section must pertain to either the 
scope of authorization under the Veterans Care Agreement or claims 
for payment subject to the Veterans Care Agreement and are not 
claims for the purposes of such laws that would otherwise require 
application of sections 7101 through 7109 of title 41, United States 
Code. 
‘‘(i) APPLICABILITY OF OTHER PROVISIONS OF LAW.—(1) A Vet-
erans Care Agreement may be authorized by the Secretary or 
any Department official authorized by the Secretary, and such 
action shall not be treated as— 
Procedures. 
Assessments. 
Determinations. 
Notices. 
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132 STAT. 1408 
PUBLIC LAW 115–182—JUNE 6, 2018 
‘‘(A) an award for the purposes of such laws that would 
otherwise require the use of competitive procedures for the 
furnishing of care and services; or 
‘‘(B) a Federal contract for the acquisition of goods or 
services for purposes of any provision of Federal law governing 
Federal contracts for the acquisition of goods or services except 
section 4706(d) of title 41. 
‘‘(2)(A) Except as provided in the agreement itself, in subpara-
graph (B), and unless otherwise provided in this section or regula-
tions prescribed pursuant to this section, an eligible entity or pro-
vider that enters into an agreement under this section is not subject 
to, in the carrying out of the agreement, any law to which providers 
of services and suppliers under the Medicare program under title 
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) are not 
subject. 
‘‘(B) An eligible entity or provider that enters into an agreement 
under this section is subject to— 
‘‘(i) all laws regarding integrity, ethics, or fraud, or that 
subject a person to civil or criminal penalties; and 
‘‘(ii) all laws that protect against employment discrimina-
tion or that otherwise ensure equal employment opportunities. 
‘‘(3) Notwithstanding paragraph (2)(B)(i), an eligible entity or 
provider that enters into an agreement under this section shall 
not be treated as a Federal contractor or subcontractor for purposes 
of chapter 67 of title 41 (commonly known as the ‘McNamara- 
O’Hara Service Contract Act of 1965’). 
‘‘(j) PARITY OF TREATMENT.—Eligibility for hospital care, med-
ical services, and extended care services furnished to any veteran 
pursuant to a Veterans Care Agreement shall be subject to the 
same terms as though provided in a facility of the Department, 
and provisions of this chapter applicable to veterans receiving such 
care and services in a facility of the Department shall apply to 
veterans treated under this section. 
‘‘(k) RULEMAKING.—The Secretary shall promulgate regulations 
to carry out this section.’’. 
(b) CLERICAL AMENDMENT.—The table of sections at the begin-
ning of such chapter is amended by inserting after the item relating 
to section 1703 the following new item: 
‘‘1703A. Agreements with eligible entities or providers; certification processes.’’. 
SEC. 103. CONFORMING AMENDMENTS FOR STATE VETERANS HOMES. 
(a) IN GENERAL.—Section 1745(a) is amended— 
(1) in paragraph (1), by striking ‘‘(or agreement under 
section 1720(c)(1) of this title)’’ and inserting ‘‘(or an agree-
ment)’’; and 
(2) by adding at the end the following new paragraph: 
‘‘(4)(A) An agreement under this section may be authorized 
by the Secretary or any Department official authorized by the 
Secretary, and any such action is not an award for purposes of 
such laws that would otherwise require the use of competitive 
procedures for the furnishing of hospital care, medical services, 
and extended care services. 
‘‘(B)(i) Except as provided in the agreement itself, in clause 
(ii), and unless otherwise provided in this section or regulations 
prescribed pursuant to this section, a State home that enters into 
an agreement under this section is not subject to, in the carrying 
out of the agreement, any provision of law to which providers 
38 USC 
prec. 1701. 
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132 STAT. 1409 
PUBLIC LAW 115–182—JUNE 6, 2018 
of services and suppliers under the Medicare program under title 
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) are not 
subject. 
‘‘(ii) A State home that enters into an agreement under this 
section is subject to— 
‘‘(I) all provisions of law regarding integrity, ethics, or 
fraud, or that subject a person to civil or criminal penalties; 
‘‘(II) all provisions of law that protect against employment 
discrimination or that otherwise ensure equal employment 
opportunities; and 
‘‘(III) all provisions in subchapter V of chapter 17 of this 
title. 
‘‘(iii) Notwithstanding subparagraph (B)(ii)(I), a State home 
that enters into an agreement under this section may not be treated 
as a Federal contractor or subcontractor for purposes of chapter 
67 of title 41 (known as the ‘McNamara-O’Hara Service Contract 
Act of 1965’).’’. 
(b) EFFECTIVE DATE.—The amendment made by subsection (a) 
shall apply to care provided on or after the effective date of regula-
tions issued by the Secretary of Veterans Affairs to carry out 
this section. 
SEC. 104. ACCESS STANDARDS AND STANDARDS FOR QUALITY. 
(a) IN GENERAL.—Subchapter I of chapter 17, as amended by 
section 102, is further amended by inserting after section 1703A 
the following new sections: 
‘‘§ 1703B. Access standards 
‘‘(a)(1) The Secretary shall establish access standards for fur-
nishing hospital care, medical services, or extended care services 
to covered veterans for the purposes of section 1703(d). 
‘‘(2) The Secretary shall ensure that the access standards estab-
lished under paragraph (1) define such categories of care to cover 
all care and services within the medical benefits package of the 
Department of Veterans Affairs. 
‘‘(b) The Secretary shall ensure that the access standards pro-
vide covered veterans, employees of the Department, and health 
care providers in the network established under section 1703(h) 
with relevant comparative information that is clear, useful, and 
timely, so that covered veterans can make informed decisions 
regarding their health care. 
‘‘(c) The Secretary shall consult with all pertinent Federal enti-
ties (including the Department of Defense, the Department of 
Health and Human Services, and the Centers for Medicare & Med-
icaid Services), entities in the private sector, and other nongovern-
mental entities in establishing access standards. 
‘‘(d)(1) Not later than 270 days after the date of the enactment 
of the Caring for Our Veterans Act of 2018, the Secretary shall 
submit to the appropriate committees of Congress a report detailing 
the access standards. 
‘‘(2)(A) Before submitting the report required under paragraph 
(1), the Secretary shall provide periodic updates to the appropriate 
committees of Congress to confirm the Department’s progress 
towards developing the access standards required by this section. 
‘‘(B) The first update under subparagraph (A) shall occur no 
later than 120 days from the date of the enactment of the Caring 
for Our Veterans Act of 2018. 
Reports. 
Consultation. 
38 USC 1703B. 
38 USC 1745 
note. 
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132 STAT. 1410 
PUBLIC LAW 115–182—JUNE 6, 2018 
‘‘(3) Not later than 540 days after the date on which the 
Secretary implements the access standards established under sub-
section (a), the Secretary shall submit to the appropriate committees 
of Congress a report detailing the implementation of and compliance 
with such access standards by Department and non-Department 
entities or providers. 
‘‘(e) Not later than 3 years after the date on which the Secretary 
establishes access standards under subsection (a) and not less fre-
quently than once every 3 years thereafter, the Secretary shall— 
‘‘(1) conduct a review of such standards; and 
‘‘(2) submit to the appropriate committees of Congress a 
report on the findings and any modification to the access stand-
ards with respect to the review conducted under paragraph 
(1). 
‘‘(f) The Secretary shall ensure health care providers specified 
under section 1703(c) are able to comply with the applicable access 
standards established by the Secretary. 
‘‘(g) The Secretary shall publish in the Federal Register and 
on an internet website of the Department the designated access 
standards established under this section for purposes of section 
1703(d)(1)(D). 
‘‘(h)(1) Consistent with paragraphs (1)(D) and (3) of section 
1703(d), covered veterans may contact the Department at any time 
to request a determination regarding whether they are eligible 
to receive care and services from a non-Department entity or pro-
vider based on the Department being unable to furnish such care 
and services in a manner that complies with the designated access 
standards established under this section. 
‘‘(2) The Secretary shall establish a process to review such 
requests from covered veterans to determine whether— 
‘‘(A) the requested care is clinically necessary; and 
‘‘(B) the Department is able to provide such care in a 
manner that complies with designated access standards estab-
lished under this section. 
‘‘(3) The Secretary shall promptly respond to any such request 
by a covered veteran. 
‘‘(i)(1) The term ‘appropriate committees of Congress’ means— 
‘‘(A) the Committee on Veterans’ Affairs and the Committee 
on Appropriations of the Senate; and 
‘‘(B) the Committee on Veterans’ Affairs and the Committee 
on Appropriations of the House of Representatives. 
‘‘(2) The term ‘covered veterans’ refers to veterans described 
in section 1703(b) of this title. 
‘‘§ 1703C. Standards for quality 
‘‘(a) IN GENERAL.—(1) The Secretary shall establish standards 
for quality regarding hospital care, medical services, and extended 
care services furnished by the Department pursuant to this title, 
including through non-Department health care providers pursuant 
to section 1703 of this title. 
‘‘(2) In establishing standards for quality under paragraph (1), 
the Secretary shall consider existing health quality measures that 
are applied to public and privately sponsored health care systems 
with the purpose of providing covered veterans relevant comparative 
information to make informed decisions regarding their health care. 
38 USC 1703C. 
Definitions. 
Compliance. 
Review process. 
Compliance. 
Federal Register, 
publication. 
Web posting. 
Compliance. 
Reports. 
Review. 
Deadline. 
Time period. 
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132 STAT. 1411 
PUBLIC LAW 115–182—JUNE 6, 2018 
‘‘(3) The Secretary shall collect and consider data for purposes 
of establishing the standards under paragraph (1). Such data collec-
tion shall include— 
‘‘(A) after consultation with veterans service organizations 
and other key stakeholders on survey development or modifica-
tion of an existing survey, a survey of veterans who have 
used hospital care, medical services, or extended care services 
furnished by the Veterans Health Administration during the 
most recent 2-year period to assess the satisfaction of the 
veterans with service and quality of care; and 
‘‘(B) datasets that include, at a minimum, elements relating 
to the following: 
‘‘(i) Timely care. 
‘‘(ii) Effective care. 
‘‘(iii) Safety, including, at a minimum, complications, 
readmissions, and deaths. 
‘‘(iv) Efficiency. 
‘‘(4) The Secretary shall consult with all pertinent Federal 
entities (including the Department of Defense, the Department 
of Health and Human Services, and the Centers for Medicare & 
Medicaid Services), entities in the private sector, and other non-
governmental entities in establishing standards for quality. 
‘‘(5)(A) Not later than 270 days after the date of the enactment 
of the Caring for Our Veterans Act of 2018, the Secretary shall 
submit to the appropriate committees of Congress a report detailing 
the standards for quality. 
‘‘(B)(i) Before submitting the report required under subpara-
graph (A), the Secretary shall provide periodic updates to the appro-
priate committees of Congress to confirm the Department’s progress 
towards developing the standards for quality required by this sec-
tion. 
‘‘(ii) The first update under clause (i) shall occur no later 
than 120 days from the date of the enactment of the Caring for 
Our Veterans Act of 2018. 
‘‘(b) PUBLICATION AND CONSIDERATION OF PUBLIC COMMENTS.— 
(1) Not later than 1 year after the date on which the Secretary 
establishes standards for quality under subsection (a), the Secretary 
shall publish the quality rating of medical facilities of the Depart-
ment in the publicly available Hospital Compare website through 
the Centers for Medicare & Medicaid Services for the purpose 
of providing veterans with information that allows them to compare 
performance measure information among Department and non- 
Department health care providers. 
‘‘(2) Not later than 2 years after the date on which the Secretary 
establishes standards for quality under subsection (a), the Secretary 
shall consider and solicit public comment on potential changes 
to the measures used in such standards to ensure that they include 
the most up-to-date and applicable industry measures for veterans. 
‘‘(c)(1) The term ‘appropriate committees of Congress’ means— 
‘‘(A) the Committee on Veterans’ Affairs and the Committee 
on Appropriations of the Senate; and 
‘‘(B) the Committee on Veterans’ Affairs and the Committee 
on Appropriations of the House of Representatives. 
‘‘(2) The term ‘covered veterans’ refers to veterans described 
in section 1703(b) of this title.’’. 
(b) CLERICAL AMENDMENT.—The table of sections at the begin-
ning of chapter 17, as amended by section 102, is further amended 
38 USC 
prec. 1701. 
Definitions. 
Web posting. 
Deadlines. 
Reports. 
Consultation. 
Consultation. 
Survey. 
Time period. 
Data. 
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132 STAT. 1412 
PUBLIC LAW 115–182—JUNE 6, 2018 
by inserting after the item relating to section 1703A the following 
new items: 
‘‘1703B. Access standards. 
‘‘1703C. Standards for quality.’’. 
SEC. 105. ACCESS TO WALK-IN CARE. 
(a) IN GENERAL.—Chapter 17 is amended by inserting after 
section 1725 the following new section: 
‘‘§ 1725A. Access to walk-in care 
‘‘(a) PROCEDURES TO ENSURE ACCESS TO WALK-IN CARE.—The 
Secretary shall develop procedures to ensure that eligible veterans 
are able to access walk-in care from qualifying non-Department 
entities or providers. 
‘‘(b) ELIGIBLE VETERANS.—For purposes of this section, an 
eligible veteran is any individual who— 
‘‘(1) is enrolled in the health care system established under 
section 1705(a) of this title; and 
‘‘(2) has received care under this chapter within the 24- 
month period preceding the furnishing of walk-in care under 
this section. 
‘‘(c) QUALIFYING NON-DEPARTMENT ENTITIES OR PROVIDERS.— 
For purposes of this section, a qualifying non-Department entity 
or provider is a non-Department entity or provider that has entered 
into a contract or other agreement with the Secretary to furnish 
services under this section. 
‘‘(d) FEDERALLY-QUALIFIED HEALTH CENTERS.—Whenever prac-
ticable, the Secretary may use 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))) to carry out this section. 
‘‘(e) CONTINUITY OF CARE.—The Secretary shall ensure con-
tinuity of care for those eligible veterans who receive walk-in care 
services under this section, including through the establishment 
of a mechanism to receive medical records from walk-in care pro-
viders and provide pertinent patient medical records to providers 
of walk-in care. 
‘‘(f) COPAYMENTS.—(1)(A) The Secretary may require an eligible 
veteran to pay the United States a copayment for each episode 
of hospital care or medical services provided under this section 
if the eligible veteran would be required to pay a copayment under 
this title. 
‘‘(B) An eligible veteran not required to pay a copayment under 
this title may access walk-in care without a copayment for the 
first two visits in a calendar year. For any additional visits, a 
copayment at an amount determined by the Secretary may be 
required. 
‘‘(C) An eligible veteran required to pay a copayment under 
this title may be required to pay a regular copayment for the 
first two walk-in care visits in a calendar year. For any additional 
visits, a higher copayment at an amount determined by the Sec-
retary may be required. 
‘‘(2) After the first two episodes of care furnished to an eligible 
veteran under this section, the Secretary may adjust the copayment 
required of the veteran under this subsection based upon the pri-
ority group of enrollment of the eligible veteran, the number of 
episodes of care furnished to the eligible veteran during a year, 
38 USC 1725A. 
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132 STAT. 1413 
PUBLIC LAW 115–182—JUNE 6, 2018 
and other factors the Secretary considers appropriate under this 
section. 
‘‘(3) The amount or amounts of the copayments required under 
this subsection shall be prescribed by the Secretary by rule. 
‘‘(4) Section 8153(c) of this title shall not apply to this sub-
section. 
‘‘(g) REGULATIONS.—Not later than 1 year after the date of 
the enactment of the Caring for Our Veterans Act of 2018, the 
Secretary shall promulgate regulations to carry out this section. 
‘‘(h) WALK-IN CARE DEFINED.—In this section, the term ‘walk- 
in care’ means non-emergent care provided by a qualifying non- 
Department entity or provider that furnishes episodic care and 
not longitudinal management of conditions and is otherwise defined 
through regulations the Secretary shall promulgate.’’. 
(b) EFFECTIVE DATE.—Section 1725A of title 38, United States 
Code, as added by subsection (a) shall take effect on the date 
upon which final regulations implementing such section take effect. 
(c) CLERICAL AMENDMENT.—The table of sections at the begin-
ning of such chapter is amended by inserting after the item relating 
to section 1725 the following new item: 
‘‘1725A. Access to walk-in care.’’. 
SEC. 106. STRATEGY REGARDING THE DEPARTMENT OF VETERANS 
AFFAIRS HIGH-PERFORMING INTEGRATED HEALTH CARE 
NETWORK. 
(a) IN GENERAL.—Subchapter II of chapter 73 is amended by 
inserting after section 7330B the following new section: 
‘‘§ 7330C. 
Quadrennial 
Veterans 
Health 
Administration 
review 
‘‘(a) MARKET AREA ASSESSMENTS.—(1) Not less frequently than 
every 4 years, the Secretary of Veterans Affairs shall perform 
market area assessments regarding the health care services fur-
nished under the laws administered by the Secretary. 
‘‘(2) Each market area assessment established under paragraph 
(1) shall include the following: 
‘‘(A) An assessment of the demand for health care from 
the Department, disaggregated by geographic market areas 
as determined by the Secretary, including the number of 
requests for health care services under the laws administered 
by the Secretary. 
‘‘(B) An inventory of the health care capacity of the Depart-
ment of Veterans Affairs across the Department’s system of 
facilities. 
‘‘(C) An assessment of the health care capacity to be pro-
vided through contracted community care providers and pro-
viders who entered into a provider agreement with the Depart-
ment under section 1703A of title 38, as added by section 
102, including the number of providers, the geographic location 
of the providers, and categories or types of health care services 
provided by the providers. 
‘‘(D) An assessment obtained from other Federal direct 
delivery systems of their capacity to provide health care to 
veterans. 
‘‘(E) An assessment of the health care capacity of non- 
contracted providers where there is insufficient network supply. 
Inventory. 
Time period. 
38 USC 7330C. 
38 USC 
prec. 1701. 
38 USC 1725A 
note. 
Deadline. 
Regulations. 
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132 STAT. 1414 
PUBLIC LAW 115–182—JUNE 6, 2018 
‘‘(F) An assessment of the health care capacity of academic 
affiliates and other collaborations of the Department as it 
relates to providing health care to veterans. 
‘‘(G) An assessment of the effects on health care capacity 
of the access standards and standards for quality established 
under sections 1703B and 1703C of this title. 
‘‘(H) The number of appointments for health care services 
under the laws administered by the Secretary, disaggregated 
by— 
‘‘(i) appointments at facilities of the Department of 
Veterans Affairs; and 
‘‘(ii) appointments with non-Department health care 
providers. 
‘‘(3)(A) The Secretary shall submit to the appropriate commit-
tees of Congress the market area assessments established in para-
graph (1). 
‘‘(B) The Secretary also shall submit to the appropriate commit-
tees of Congress the market area assessments completed by or 
being performed on the day before the date of the enactment of 
the Caring for Our Veterans Act of 2018. 
‘‘(4)(A) The Secretary shall use the market area assessments 
established under paragraph (1) to— 
‘‘(i) determine the capacity of the health care provider 
networks established under section 1703(h) of this title; 
‘‘(ii) inform the Department budget, in accordance with 
subparagraph (B); and 
‘‘(iii) inform and assess the appropriateness of the access 
standards established under section 1703B of this title and 
standards for quality under section 1703C and to make rec-
ommendations for any changes to such standards. 
‘‘(B) The Secretary shall ensure that the Department budget 
for any fiscal year (as submitted with the budget of the President 
under section 1105(a) of title 31) reflects the findings of the Sec-
retary with respect to the most recent market area assessments 
under paragraph (1) and health care utilization data from the 
Department and non-Department entities or providers furnishing 
care and services to covered veterans as described in section 1703(b). 
‘‘(b) STRATEGIC PLAN TO MEET HEALTH CARE DEMAND.—(1) 
Not later than 1 year after the date of the enactment of the 
Caring for Our Veterans Act of 2018 and not less frequently than 
once every 4 years thereafter, the Secretary shall submit to the 
appropriate committees of Congress a strategic plan that specifies 
a 4-year forecast of— 
‘‘(A) the demand for health care from the Department, 
disaggregated by geographic area as determined by the Sec-
retary; 
‘‘(B) the health care capacity to be provided at each medical 
center of the Department; and 
‘‘(C) the health care capacity to be provided through 
community care providers. 
‘‘(2) In preparing the strategic plan under paragraph (1), the 
Secretary shall— 
‘‘(A) assess the access standards and standards for quality 
established under sections 1703B and 1703C of this title; 
‘‘(B) assess the market area assessments established under 
subsection (a); 
Assessment. 
Assessment. 
Deadlines. 
Time period. 
Recommenda- 
tions. 
Effective date. 
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132 STAT. 1415 
PUBLIC LAW 115–182—JUNE 6, 2018 
‘‘(C) assess the needs of the Department based on identified 
services that provide management of conditions or disorders 
related to military service for which there is limited experience 
or access in the national market, the overall health of veterans 
throughout their lifespan, or other services as the Secretary 
determines appropriate; 
‘‘(D) consult with key stakeholders within the Department, 
the heads of other Federal agencies, and other relevant govern-
mental and nongovernmental entities, including State, local, 
and tribal government officials, members of Congress, veterans 
service organizations, private sector representatives, academics, 
and other policy experts; 
‘‘(E) identify emerging issues, trends, problems, and 
opportunities that could affect health care services furnished 
under the laws administered by the Secretary; 
‘‘(F) develop recommendations regarding both short- and 
long-term priorities for health care services furnished under 
the laws administered by the Secretary; 
‘‘(G) after consultation with veterans service organizations 
and other key stakeholders on survey development or modifica-
tion of an existing survey, consider a survey of veterans who 
have used hospital care, medical services, or extended care 
services furnished by the Veterans Health Administration 
during the most recent 2-year period to assess the satisfaction 
of the veterans with service and quality of care; 
‘‘(H) conduct a comprehensive examination of programs 
and policies of the Department regarding the delivery of health 
care services and the demand of health care services for vet-
erans in future years; 
‘‘(I) assess the remediation of medical service lines of the 
Department as described in section 1706A in conjunction with 
the utilization of non-Department entities or providers to offset 
remediation; and 
‘‘(J) consider such other matters as the Secretary considers 
appropriate. 
‘‘(c) RESPONSIBILITIES.—The Secretary shall be responsible for— 
‘‘(1) overseeing the transformation and organizational 
change across the Department to achieve such high performing 
integrated health care network; 
‘‘(2) developing the capital infrastructure planning and 
procurement processes, whether minor or major construction 
projects or leases; and 
‘‘(3) developing a multi-year budget process that is capable 
of forecasting future year budget requirements and projecting 
the cost of delivering health care services under a high-per-
forming integrated health care network. 
‘‘(d) APPROPRIATE COMMITTEES OF CONGRESS DEFINED.—In this 
section, the term ‘appropriate committees of Congress’ means— 
‘‘(1) the Committee on Veterans’ Affairs and the Committee 
on Appropriations of the Senate; and 
‘‘(2) the Committee on Veterans’ Affairs and the Committee 
on Appropriations of the House of Representatives.’’. 
(b) CLERICAL AMENDMENT.—The table of sections at the begin-
ning of such chapter is amended by inserting after the item relating 
to section 7330B the following new item: 
‘‘7330C. Quadrennial Veterans Health Administration review.’’. 
38 USC 
prec. 7301. 
Assessment. 
Examination. 
Survey. 
Time period. 
Recommenda- 
tions. 
Consultation. 
Assessment. 
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132 STAT. 1416 
PUBLIC LAW 115–182—JUNE 6, 2018 
SEC. 107. APPLICABILITY OF DIRECTIVE OF OFFICE OF FEDERAL CON-
TRACT COMPLIANCE PROGRAMS. 
(a) IN GENERAL.—Notwithstanding the treatment of certain 
laws under subsection (i) of section 1703A of title 38, United States 
Code, as added by section 102 of this title, Directive 2014–01 
of the Office of Federal Contract Compliance Programs of the 
Department of Labor (effective as of May 7, 2014) shall apply 
to any entity entering into an agreement under such section 1703A 
or section 1745 of such title, as amended by section 103, in the 
same manner as such directive applies to subcontractors under 
the TRICARE program for the duration of the moratorium provided 
under such directive. 
(b) APPLICABILITY PERIOD.—The directive described in sub-
section (a), and the moratorium provided under such directive, 
shall not be altered or rescinded before May 7, 2019. 
(c) TRICARE PROGRAM DEFINED.—In this section, the term 
‘‘TRICARE program’’ has the meaning given that term in section 
1072 of title 10, United States Code. 
SEC. 108. PREVENTION OF CERTAIN HEALTH CARE PROVIDERS FROM 
PROVIDING NON-DEPARTMENT HEALTH CARE SERVICES 
TO VETERANS. 
(a) IN GENERAL.—On and after the date that is 1 year after 
the date of the enactment of this Act, the Secretary of Veterans 
Affairs shall deny or revoke the eligibility of a health care provider 
to provide non-Department health care services to veterans if the 
Secretary determines that the health care provider— 
(1) was removed from employment with the Department 
of Veterans Affairs due to conduct that violated a policy of 
the Department relating to the delivery of safe and appropriate 
health care; or 
(2) violated the requirements of a medical license of the 
health care provider that resulted in the loss of such medical 
license. 
(b) PERMISSIVE ACTION.—On and after the date that is 1 year 
after the date of the enactment of this Act, the Secretary may 
deny, revoke, or suspend the eligibility of a health care provider 
to provide non-Department health care services if the Secretary 
determines such action is necessary to immediately protect the 
health, safety, or welfare of veterans and the health care provider 
is under investigation by the medical licensing board of a State 
in which the health care provider is licensed or practices. 
(c) SUSPENSION.—The Secretary shall suspend the eligibility 
of a health care provider to provide non-Department health care 
services to veterans if the health care provider is suspended from 
serving as a health care provider of the Department. 
(d) COMPTROLLER GENERAL REPORT.—Not later than 2 years 
after the date of the enactment of this Act, the Comptroller General 
of the United States shall submit to Congress a report on the 
implementation by the Secretary of this section, including the fol-
lowing: 
(1) The aggregate number of health care providers denied 
or suspended under this section from participation in providing 
non-Department health care services. 
(2) An evaluation of any impact on access to health care 
for patients or staffing shortages in programs of the Department 
providing non-Department health care services. 
Evaluation. 
Effective date. 
Effective date. 
Determinations. 
38 USC 1701 
note. 
38 USC 1703A 
note. 
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132 STAT. 1417 
PUBLIC LAW 115–182—JUNE 6, 2018 
(3) An explanation of the coordination of the Department 
with the medical licensing boards of States in implementing 
this section, the amount of involvement of such boards in such 
implementation, and efforts by the Department to address any 
concerns raised by such boards with respect to such 
implementation. 
(4) Such recommendations as the Comptroller General con-
siders appropriate regarding harmonizing eligibility criteria 
between health care providers of the Department and health 
care providers eligible to provide non-Department health care 
services. 
(e) NON-DEPARTMENT HEALTH CARE SERVICES DEFINED.—In 
this section, the term ‘‘non-Department health care services’’ means 
services— 
(1) provided under subchapter I of chapter 17 of title 38, 
United States Code, at non-Department facilities (as defined 
in section 1701 of such title); 
(2) provided under section 101 of the Veterans Access, 
Choice, and Accountability Act of 2014 (Public Law 113–146; 
38 U.S.C. 1701 note); 
(3) purchased through the Medical Community Care 
account of the Department; or 
(4) purchased with amounts deposited in the Veterans 
Choice Fund under section 802 of the Veterans Access, Choice, 
and Accountability Act of 2014. 
SEC. 109. REMEDIATION OF MEDICAL SERVICE LINES. 
(a) IN GENERAL.—Subchapter I of chapter 17 is amended by 
inserting after section 1706 the following new section: 
‘‘§ 1706A. Remediation of medical service lines 
‘‘(a) IN GENERAL.—Not later than 30 days after determining 
under section 1703(e)(1) that a medical service line of the Depart-
ment is providing hospital care, medical services, or extended care 
services that does not comply with the standards for quality estab-
lished by the Secretary, the Secretary shall submit to Congress 
an assessment of the factors that led the Secretary to make such 
determination and a plan with specific actions, and the time to 
complete them, to be taken to comply with such standards for 
quality, including the following: 
‘‘(1) Increasing personnel or temporary personnel assist-
ance, including mobile deployment teams. 
‘‘(2) Special hiring incentives, including the Education Debt 
Reduction Program under subchapter VII of chapter 76 of this 
title and recruitment, relocation, and retention incentives. 
‘‘(3) Utilizing direct hiring authority. 
‘‘(4) Providing improved training opportunities for staff. 
‘‘(5) Acquiring improved equipment. 
‘‘(6) Making structural modifications to the facility used 
by the medical service line. 
‘‘(7) Such other actions as the Secretary considers appro-
priate. 
‘‘(b) RESPONSIBLE PARTIES.—In each assessment submitted 
under subsection (a) with respect to a medical service line, the 
Secretary shall identify the individuals at the Central Office of 
the Veterans Health Administration, the facility used by the medical 
service line, and the central office of the relevant Veterans 
Deadline. 
Assessment. 
Determination. 
Plan. 
38 USC 1706A. 
Recommenda- 
tions. 
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132 STAT. 1418 
PUBLIC LAW 115–182—JUNE 6, 2018 
Integrated Service Network who are responsible for overseeing the 
progress of that medical service line in complying with the stand-
ards for quality established by the Secretary. 
‘‘(c) INTERIM REPORTS.—Not later than 180 days after submit-
ting an assessment under subsection (a) with respect to a medical 
service line, the Secretary shall submit to Congress a report on 
the progress of that medical service line in complying with the 
standards for quality established by the Secretary and any other 
measures the Secretary will take to assist the medical service 
line in complying with such standards for quality. 
‘‘(d) ANNUAL REPORTS.—Not less frequently than once each 
year, the Secretary shall— 
‘‘(1) submit to Congress an analysis of the remediation 
actions and costs of such actions taken with respect to each 
medical service line with respect to which the Secretary sub-
mitted an assessment and plan under paragraph (1) in the 
preceding year, including an update on the progress of each 
such medical service line in complying with the standards 
for quality and timeliness established by the Secretary and 
any other actions the Secretary is undertaking to assist the 
medical service line in complying with standards for quality 
as established by the Secretary; and 
‘‘(2) publish such analysis on the internet website of the 
Department.’’. 
(b) CLERICAL AMENDMENT.—The table of sections at the begin-
ning of such chapter is amended by inserting after the item relating 
to section 1706 the following new item: 
‘‘1706A. Remediation of medical service lines.’’. 
CHAPTER 2—PAYING PROVIDERS AND IMPROVING 
COLLECTIONS 
SEC. 111. PROMPT PAYMENT TO PROVIDERS. 
(a) IN GENERAL.—Subchapter I of chapter 17 is amended by 
inserting after section 1703C, as added by section 104 of this 
title, the following new section: 
‘‘§ 1703D. Prompt payment standard 
‘‘(a) IN GENERAL.—(1) Notwithstanding any other provision of 
this title or of any other provision of law, the Secretary shall 
pay for hospital care, medical services, or extended care services 
furnished by health care entities or providers under this chapter 
within 45 calendar days upon receipt of a clean paper claim or 
30 calendar days upon receipt of a clean electronic claim. 
‘‘(2) If a claim is denied, the Secretary shall, within 45 calendar 
days of denial for a paper claim and 30 calendar days of denial 
for an electronic claim, notify the health care entity or provider 
of the reason for denying the claim and what, if any, additional 
information is required to process the claim. 
‘‘(3) Upon the receipt of the additional information, the Sec-
retary shall ensure that the claim is paid, denied, or otherwise 
adjudicated within 30 calendar days from the receipt of the 
requested information. 
‘‘(4) This section shall only apply to payments made on an 
invoice basis and shall not apply to capitation or other forms of 
periodic payment to entities or providers. 
Notification. 
Deadlines. 
38 USC 1703D. 
38 USC 
prec. 1701. 
Web posting. 
Analysis. 
Compliance. 
Compliance. 
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132 STAT. 1419 
PUBLIC LAW 115–182—JUNE 6, 2018 
‘‘(b) SUBMITTAL
OF CLAIMS
BY HEALTH CARE ENTITIES
AND 
PROVIDERS.—A health care entity or provider that furnishes hospital 
care, a medical service, or an extended care service under this 
chapter shall submit to the Secretary a claim for payment for 
furnishing the hospital care, medical service, or extended care 
service not later than 180 days after the date on which the entity 
or provider furnished the hospital care, medical service, or extended 
care service. 
‘‘(c) FRAUDULENT CLAIMS.—(1) Sections 3729 through 3733 of 
title 31 shall apply to fraudulent claims for payment submitted 
to the Secretary by a health care entity or provider under this 
chapter. 
‘‘(2) Pursuant to regulations prescribed by the Secretary, the 
Secretary shall bar a health care entity or provider from furnishing 
hospital care, medical services, and extended care services under 
this chapter when the Secretary determines the entity or provider 
has submitted to the Secretary fraudulent health care claims for 
payment by the Secretary. 
‘‘(d) OVERDUE CLAIMS.—(1) Any claim that has not been denied 
with notice, made pending with notice, or paid to the health care 
entity or provider by the Secretary shall be overdue if the notice 
or payment is not received by the entity provider within the time 
periods specified in subsection (a). 
‘‘(2)(A) If a claim is overdue under this subsection, the Secretary 
may, under the requirements established by subsection (a) and 
consistent with the provisions of chapter 39 of title 31 (commonly 
referred to as the ‘Prompt Payment Act’), require that interest 
be paid on clean claims. 
‘‘(B) Interest paid under subparagraph (A) shall be computed 
at the rate of interest established by the Secretary of the Treasury 
under section 3902 of title 31 and published in the Federal Register. 
‘‘(3) Not less frequently than annually, the Secretary shall 
submit to Congress a report on payment of overdue claims under 
this subsection, disaggregated by paper and electronic claims, that 
includes the following: 
‘‘(A) The amount paid in overdue claims described in this 
subsection, disaggregated by the amount of the overdue claim 
and the amount of interest paid on such overdue claim. 
‘‘(B) The number of such overdue claims and the average 
number of days late each claim was paid, disaggregated by 
facility of the Department and Veterans Integrated Service 
Network region. 
‘‘(e) OVERPAYMENT.—(1) The Secretary shall deduct the amount 
of any overpayment from payments due a health care entity or 
provider under this chapter. 
‘‘(2) Deductions may not be made under this subsection unless 
the Secretary has made reasonable efforts to notify a health care 
entity or provider of the right to dispute the existence or amount 
of such indebtedness and the right to request a compromise of 
such indebtedness. 
‘‘(3) The Secretary shall make a determination with respect 
to any such dispute or request prior to deducting any overpayment 
unless the time required to make such a determination before 
making any deductions would jeopardize the Secretary’s ability 
to recover the full amount of such indebtedness. 
‘‘(f) INFORMATION
AND DOCUMENTATION REQUIRED.—(1) The 
Secretary shall provide to all health care entities and providers 
Determination. 
Notification. 
Time period. 
Reports. 
Federal Register, 
publication. 
Regulations. 
Applicability. 
Deadline. 
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132 STAT. 1420 
PUBLIC LAW 115–182—JUNE 6, 2018 
participating in a program to furnish hospital care, medical services, 
or extended care services under this chapter a list of information 
and documentation that is required to establish a clean claim under 
this section. 
‘‘(2) The Secretary shall consult with entities in the health 
care industry, in the public and private sector, to determine the 
information and documentation to include in the list under para-
graph (1). 
‘‘(3) If the Secretary modifies the information and documenta-
tion included in the list under paragraph (1), the Secretary shall 
notify all health care entities and providers described in paragraph 
(1) not later than 30 days before such modifications take effect. 
‘‘(g) PROCESSING
OF CLAIMS.—(1) In processing a claim for 
compensation for hospital care, medical services, or extended care 
services furnished by a non-Department health care entity or pro-
vider under this chapter, the Secretary may act through— 
‘‘(A) a non-Department entity that is under contract or 
agreement for the program established under section 1703(a) 
of this title; or 
‘‘(B) a non-Department entity that specializes in such proc-
essing for other Federal agency health care systems. 
‘‘(2) The Secretary shall seek to contract with a third party 
to conduct a review of claims described in paragraph (3) that 
includes— 
‘‘(A) a feasibility assessment to determine the capacity of 
the Department to process such claims in a timely manner; 
and 
‘‘(B) a cost benefit analysis comparing the capacity of the 
Department to a third party entity capable of processing such 
claims. 
‘‘(3) The review required under paragraph (2) shall apply to 
claims for hospital care, medical services, or extended care services 
furnished under section 1703 of this Act, as amended by the Caring 
for Our Veterans Act of 2018, that are processed by the Department. 
‘‘(h) REPORT ON ENCOUNTER DATA SYSTEM.—(1) Not later than 
90 days after the date of the enactment of the Caring for Our 
Veterans Act of 2018, the Secretary shall submit to the appropriate 
committees of Congress a report on the feasibility and advisability 
of adopting a funding mechanism similar to what is utilized by 
other Federal agencies to allow a contracted entity to act as a 
fiscal intermediary for the Federal Government to distribute, or 
pass through, Federal Government funds for certain non-under-
written hospital care, medical services, or extended care services. 
‘‘(2) The Secretary may coordinate with the Department of 
Defense, the Department of Health and Human Services, and the 
Department of the Treasury in developing the report required by 
paragraph (1). 
‘‘(i) DEFINITIONS.—In this section: 
‘‘(1) The term ‘appropriate committees of Congress’ means— 
‘‘(A) the Committee on Veterans’ Affairs and the Com-
mittee on Appropriations of the Senate; and 
‘‘(B) the Committee on Veterans’ Affairs and the Com-
mittee on Appropriations of the House of Representatives. 
‘‘(2) The term ‘clean electronic claim’ means the trans-
mission of data for purposes of payment of covered health 
care expenses that is submitted to the Secretary which contains 
substantially all of the required data elements necessary for 
Applicability. 
Analysis. 
Assessment. 
Contracts. 
Review. 
Notification. 
Deadline. 
Consultation. 
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132 STAT. 1421 
PUBLIC LAW 115–182—JUNE 6, 2018 
accurate adjudication, without obtaining additional information 
from the entity or provider that furnished the care or service, 
submitted in such format as prescribed by the Secretary in 
regulations for the purpose of paying claims for care or services. 
‘‘(3) The term ‘clean paper claim’ means a paper claim 
for payment of covered health care expenses that is submitted 
to the Secretary which contains substantially all of the required 
data elements necessary for accurate adjudication, without 
obtaining additional information from the entity or provider 
that furnished the care or service, submitted in such format 
as prescribed by the Secretary in regulations for the purpose 
of paying claims for care or services. 
‘‘(4) The term ‘fraudulent claims’ means the knowing mis-
representation of a material fact or facts by a health care 
entity or provider made to induce the Secretary to pay a claim 
that was not legally payable to that provider. 
‘‘(5) The term ‘health care entity or provider’ includes any 
non-Department health care entity or provider, but does not 
include any Federal health care entity or provider.’’. 
(b) CLERICAL AMENDMENT.—The table of sections at the begin-
ning of such chapter is amended by inserting after the item relating 
to section 1703C, as added by section 104 of this title, the following 
new item: 
‘‘1703D. Prompt payment standard.’’. 
SEC. 112. AUTHORITY TO PAY FOR AUTHORIZED CARE NOT SUBJECT 
TO AN AGREEMENT. 
(a) IN GENERAL.—Subchapter IV of chapter 81 is amended 
by adding at the end the following new section: 
‘‘§ 8159. Authority to pay for services authorized but not 
subject to an agreement 
‘‘(a) IN GENERAL.—If, in the course of furnishing hospital care, 
a medical service, or an extended care service authorized by the 
Secretary and pursuant to a contract, agreement, or other arrange-
ment with the Secretary, a provider who is not a party to the 
contract, agreement, or other arrangement furnishes hospital care, 
a medical service, or an extended care service that the Secretary 
considers necessary, the Secretary may compensate the provider 
for the cost of such care or service. 
‘‘(b) NEW CONTRACTS AND AGREEMENTS.—The Secretary shall 
take reasonable efforts to enter into a contract, agreement, or 
other arrangement with a provider described in subsection (a) to 
ensure that future care and services authorized by the Secretary 
and furnished by the provider are subject to such a contract, agree-
ment, or other arrangement.’’. 
(b) CLERICAL AMENDMENT.—The table of sections at the begin-
ning of such chapter is amended by inserting after the item relating 
to section 8158 the following new item: 
‘‘8159. Authority to pay for services authorized but not subject to an agreement.’’. 
SEC. 113. IMPROVEMENT OF AUTHORITY TO RECOVER THE COST OF 
SERVICES FURNISHED FOR NON-SERVICE-CONNECTED 
DISABILITIES. 
(a) BROADENING SCOPE
OF APPLICABILITY.—Section 1729 is 
amended— 
(1) in subsection (a)— 
38 USC 
prec. 8101. 
38 USC 8159. 
38 USC 
prec. 1701. 
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132 STAT. 1422 
PUBLIC LAW 115–182—JUNE 6, 2018 
(A) in paragraph (2)(A)— 
(i) by striking ‘‘the veteran’s’’ and inserting ‘‘the 
individual’s’’; and 
(ii) by striking ‘‘the veteran’’ and inserting ‘‘the 
individual’’; and 
(B) in paragraph (3)— 
(i) in the matter preceding subparagraph (A), by 
striking ‘‘the veteran’’ and inserting ‘‘the individual’’; 
and 
(ii) in subparagraph (A), by striking ‘‘the veteran’s’’ 
and inserting ‘‘the individual’s’’; 
(2) in subsection (b)— 
(A) in paragraph (1)— 
(i) by striking ‘‘the veteran’’ and inserting ‘‘the 
individual’’; and 
(ii) by striking ‘‘the veteran’s’’ and inserting ‘‘the 
individual’s’’; and 
(B) in paragraph (2)— 
(i) in subparagraph (A)— 
(I) by striking ‘‘the veteran’’ and inserting ‘‘the 
individual’’; and 
(II) by striking ‘‘the veteran’s’’ and inserting 
‘‘the individual’s’’; and 
(ii) in subparagraph (B)— 
(I) in clause (i), by striking ‘‘the veteran’’ and 
inserting ‘‘the individual’’; and 
(II) in clause (ii)— 
(aa) 
by 
striking 
‘‘the 
veteran’’ 
and 
inserting ‘‘the individual’’; and 
(bb) by striking ‘‘the veteran’s’’ each place 
it appears and inserting ‘‘the individual’s’’; 
(3) in subsection (e), by striking ‘‘A veteran’’ and inserting 
‘‘An individual’’; and 
(4) in subsection (h)— 
(A) in paragraph (1)— 
(i) in the matter preceding subparagraph (A), by 
striking ‘‘a veteran’’ and inserting ‘‘an individual’’; 
(ii) in subparagraph (A), by striking ‘‘the veteran’’ 
and inserting ‘‘the individual’’; and 
(iii) in subparagraph (B), by striking ‘‘the veteran’’ 
and inserting ‘‘the individual’’; and 
(B) in paragraph (2)— 
(i) by striking ‘‘A veteran’’ and inserting ‘‘An indi-
vidual’’; 
(ii) by striking ‘‘a veteran’’ and inserting ‘‘an indi-
vidual’’; and 
(iii) by striking ‘‘the veteran’’ and inserting ‘‘the 
individual’’. 
(b) MODIFICATION
OF AUTHORITY.—Subsection (a)(1) of such 
section is amended by striking ‘‘(1) Subject’’ and all that follows 
through the period and inserting the following: ‘‘(1) Subject to 
the provisions of this section, in any case in which the United 
States is required by law to furnish or pay for care or services 
under this chapter for a non-service-connected disability described 
in paragraph (2) of this subsection, the United States has the 
right to recover or collect from a third party the reasonable charges 
of care or services so furnished or paid for to the extent that 
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132 STAT. 1423 
PUBLIC LAW 115–182—JUNE 6, 2018 
the recipient or provider of the care or services would be eligible 
to receive payment for such care or services from such third party 
if the care or services had not been furnished or paid for by 
a department or agency of the United States.’’. 
(c) MODIFICATION OF ELIGIBLE INDIVIDUALS.—Subparagraph (D) 
of subsection (a)(2) of such section is amended to read as follows: 
‘‘(D) that is incurred by an individual who is entitled to 
care (or payment of the expenses of care) under a health- 
plan contract.’’. 
SEC. 114. PROCESSING OF CLAIMS FOR REIMBURSEMENT THROUGH 
ELECTRONIC INTERFACE. 
The Secretary of Veterans Affairs may enter into an agreement 
with a third-party entity to process, through the use of an electronic 
interface, claims for reimbursement for health care provided under 
the laws administered by the Secretary. 
CHAPTER 3—EDUCATION AND TRAINING PROGRAMS 
SEC. 121. EDUCATION PROGRAM ON HEALTH CARE OPTIONS. 
(a) IN GENERAL.—The Secretary of Veterans Affairs shall 
develop and administer an education program that teaches veterans 
about their health care options through the Department of Veterans 
Affairs. 
(b) ELEMENTS.—The program under subsection (a) shall— 
(1) teach veterans about— 
(A) eligibility criteria for care from the Department 
set forth under sections 1703, as amended by section 101 
of this title, and 1710 of title 38, United States Code; 
(B) priority groups for enrollment in the system of 
annual patient enrollment under section 1705(a) of such 
title; 
(C) the copayments and other financial obligations, 
if any, required of certain individuals for certain services; 
and 
(D) how to utilize the access standards and standards 
for quality established under sections 1703B and 1703C 
of such title; 
(2) teach veterans about the interaction between health 
insurance (including private insurance, Medicare, Medicaid, the 
TRICARE program, the Indian Health Service, tribal health 
programs, and other forms of insurance) and health care from 
the Department; and 
(3) provide veterans with information on what to do when 
they have a complaint about health care received from the 
Department (whether about the provider, the Department, or 
any other type of complaint). 
(c) ACCESSIBILITY.—In developing the education program under 
this section, the Secretary shall ensure that materials under such 
program are accessible— 
(1) to veterans who may not have access to the internet; 
and 
(2) to veterans in a manner that complies with the Ameri-
cans with Disabilities Act of 1990 (42 U.S.C. 12101 et seq.). 
(d) ANNUAL EVALUATION AND REPORT.— 
(1) EVALUATION.—The Secretary shall develop a method 
to evaluate the effectiveness of the education program under 
Compliance. 
38 USC 1701 
note. 
38 USC 1703D 
note. 
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132 STAT. 1424 
PUBLIC LAW 115–182—JUNE 6, 2018 
this section and evaluate the program using the method not 
less frequently than once each year. 
(2) REPORT.—Not less frequently than once each year, the 
Secretary shall submit to Congress a report on the findings 
of the Secretary with respect to the most recent evaluation 
conducted by the Secretary under paragraph (1). 
(e) DEFINITIONS.—In this section: 
(1) MEDICAID.—The term ‘‘Medicaid’’ means the Medicaid 
program under title XIX of the Social Security Act (42 U.S.C. 
1396 et seq.). 
(2) MEDICARE.—The term ‘‘Medicare’’ means the Medicare 
program under title XVIII of such Act (42 U.S.C. 1395 et 
seq.). 
(3) TRICARE PROGRAM.—The term ‘‘TRICARE program’’ has 
the meaning given that term in section 1072 of title 10, United 
States Code. 
SEC. 122. TRAINING PROGRAM FOR ADMINISTRATION OF NON-DEPART-
MENT OF VETERANS AFFAIRS HEALTH CARE. 
(a) ESTABLISHMENT OF PROGRAM.—The Secretary of Veterans 
Affairs shall develop and implement a training program to train 
employees and contractors of the Department of Veterans Affairs 
on how to administer non-Department health care programs, 
including the following: 
(1) Reimbursement for non-Department emergency room 
care. 
(2) The Veterans Community Care Program under section 
1703 of such title, as amended by section 101. 
(3) Management of prescriptions pursuant to improvements 
under section 131. 
(b) ANNUAL EVALUATION AND REPORT.—The Secretary shall— 
(1) develop a method to evaluate the effectiveness of the 
training program developed and implemented under subsection 
(a); 
(2) evaluate such program not less frequently than once 
each year; and 
(3) not less frequently than once each year, submit to 
Congress the findings of the Secretary with respect to the 
most recent evaluation carried out under paragraph (2). 
SEC. 123. CONTINUING MEDICAL EDUCATION FOR NON-DEPARTMENT 
MEDICAL PROFESSIONALS. 
(a) ESTABLISHMENT OF PROGRAM.— 
(1) IN GENERAL.—The Secretary of Veterans Affairs shall 
establish a program to provide continuing medical education 
material to non-Department medical professionals. 
(2) EDUCATION PROVIDED.—The program established under 
paragraph (1) shall include education on the following: 
(A) Identifying and treating common mental and phys-
ical conditions of veterans and family members of veterans. 
(B) The health care system of the Department of Vet-
erans Affairs. 
(C) Such other matters as the Secretary considers 
appropriate. 
(b) MATERIAL PROVIDED.—The continuing medical education 
material provided to non-Department medical professionals under 
the program established under subsection (a) shall be the same 
material provided to medical professionals of the Department to 
38 USC 1701 
note. 
38 USC 1701 
note. 
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132 STAT. 1425 
PUBLIC LAW 115–182—JUNE 6, 2018 
ensure that all medical professionals treating veterans have access 
to the same materials, which supports core competencies throughout 
the community. 
(c) ADMINISTRATION OF PROGRAM.— 
(1) IN GENERAL.—The Secretary shall administer the pro-
gram established under subsection (a) to participating non- 
Department medical professionals through an internet website 
of the Department of Veterans Affairs. 
(2) CURRICULUM
AND
CREDIT
PROVIDED.—The Secretary 
shall determine the curriculum of the program and the number 
of hours of credit to provide to participating non-Department 
medical professionals for continuing medical education. 
(3) ACCREDITATION.—The Secretary shall ensure that the 
program is accredited in as many States as practicable. 
(4) CONSISTENCY
WITH
EXISTING
RULES.—The Secretary 
shall ensure that the program is consistent with the rules 
and regulations of the following: 
(A) The medical licensing agency of each State in which 
the program is accredited. 
(B) Such medical credentialing organizations as the 
Secretary considers appropriate. 
(5) USER COST.—The Secretary shall carry out the program 
at no cost to participating non-Department medical profes-
sionals. 
(6) MONITORING, EVALUATION, AND REPORT.—The Secretary 
shall monitor the utilization of the program established under 
subsection (a), evaluate its effectiveness, and report to Congress 
on utilization and effectiveness not less frequently than once 
each year. 
(d) NON-DEPARTMENT MEDICAL PROFESSIONAL DEFINED.—In 
this section, the term ‘‘non-Department medical professional’’ means 
any individual who is licensed by an appropriate medical authority 
in the United States and is in good standing, is not an employee 
of the Department of Veterans Affairs, and provides care to veterans 
or family members of veterans under the laws administered by 
the Secretary of Veterans Affairs. 
CHAPTER 4—OTHER MATTERS RELATING TO NON- 
DEPARTMENT OF VETERANS AFFAIRS PROVIDERS 
SEC. 131. ESTABLISHMENT OF PROCESSES TO ENSURE SAFE OPIOID 
PRESCRIBING PRACTICES BY NON-DEPARTMENT OF VET-
ERANS AFFAIRS HEALTH CARE PROVIDERS. 
(a) RECEIPT AND REVIEW OF GUIDELINES.—The Secretary of 
Veterans Affairs shall ensure that all covered health care providers 
are provided a copy of and certify that they have reviewed the 
evidence-based guidelines for prescribing opioids set forth by the 
Opioid Safety Initiative of the Department of Veterans Affairs. 
(b) INCLUSION OF MEDICAL HISTORY AND CURRENT MEDICA-
TIONS.—The Secretary shall implement a process to ensure that, 
if care of a veteran by a covered health care provider is authorized 
under the laws administered by the Secretary, the document author-
izing such care includes the available and relevant medical history 
of the veteran and a list of all medications prescribed to the veteran 
as known by the Department. 
(c) SUBMITTAL
OF MEDICAL RECORDS
AND PRESCRIPTIONS.— 
Certification. 
38 USC 1701 
note. 
Website. 
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132 STAT. 1426 
PUBLIC LAW 115–182—JUNE 6, 2018 
(1) IN GENERAL.—The Secretary shall, consistent with sec-
tion 1703(a)(2)(A), as amended by section 101 of this title, 
and section 1703A(e)(2)(F), as added by section 102 of this 
title, require each covered health care provider to submit med-
ical records of any care or services furnished, including records 
of any prescriptions for opioids, to the Department in the time-
frame and format specified by the Secretary. 
(2) RESPONSIBILITY OF DEPARTMENT FOR RECORDING AND 
MONITORING.—In carrying out paragraph (1) and upon the 
receipt by the Department of the medical records described 
in paragraph (1), the Secretary shall— 
(A) ensure the Department is responsible for the 
recording of the prescription in the electronic health record 
of the veteran; and 
(B) enable other monitoring of the prescription as out-
lined in the Opioid Safety Initiative of the Department. 
(3) REPORT.—Not less frequently than annually, the Sec-
retary shall submit to the Committee on Veterans’ Affairs of 
the Senate and the Committee on Veterans’ Affairs of the 
House of Representatives a report evaluating the compliance 
of covered health care providers with the requirements under 
this section. 
(d) USE OF OPIOID SAFETY INITIATIVE GUIDELINES.— 
(1) IN
GENERAL.—If the Secretary determines that the 
opioid prescribing practices of a covered health care provider, 
when treating covered veterans, satisfy a condition described 
in paragraph (3), the Secretary shall take such action as the 
Secretary considers appropriate to ensure the safety of all vet-
erans receiving care from that health care provider, including 
removing or directing the removal of any such health care 
provider from provider networks or otherwise refusing to 
authorize care of veterans by such health care provider in 
any program authorized under the laws administered by the 
Secretary. 
(2) INCLUSION IN CONTRACTS.—The Secretary shall ensure 
that any contracts, agreements, or other arrangements entered 
into by the Secretary with third parties involved in admin-
istering programs that provide care in the community to vet-
erans under the laws administered by the Secretary specifically 
grant the authority set forth in paragraph (1) to such third 
parties and to the Secretary, as the case may be. 
(3) CONDITIONS FOR EXCLUSION OR LIMITATION.—The Sec-
retary shall take such action as is considered appropriate under 
paragraph (1) when the opioid prescribing practices of a covered 
health care provider when treating covered veterans— 
(A) conflict with or are otherwise inconsistent with 
the standards of appropriate and safe care; 
(B) violate the requirements of a medical license of 
the health care provider; or 
(C) may place at risk the veterans receiving health 
care from the provider. 
(e) COVERED HEALTH CARE PROVIDER DEFINED.—In this section, 
the term ‘‘covered health care provider’’ means a non-Department 
of Veterans Affairs health care provider who provides health care 
to veterans under the laws administered by the Secretary of Vet-
erans Affairs, but does not include a health care provider employed 
by another agency of the Federal Government. 
Determination. 
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132 STAT. 1427 
PUBLIC LAW 115–182—JUNE 6, 2018 
SEC. 132. IMPROVING INFORMATION SHARING WITH COMMUNITY PRO-
VIDERS. 
Section 7332(b)(2) is amended by striking subparagraph (H) 
and inserting the following new subparagraphs: 
‘‘(H)(i) To a non-Department entity (including private enti-
ties and other Federal agencies) for purposes of providing health 
care, including hospital care, medical services, and extended 
care services, to patients or performing other health care- 
related activities or functions. 
‘‘(ii) An entity to which a record is disclosed under this 
subparagraph may not disclose or use such record for a purpose 
other than that for which the disclosure was made or as per-
mitted by law. 
‘‘(I) To a third party in order to recover or collect reasonable 
charges for care furnished to, or paid on behalf of, a patient 
in connection with a non-service connected disability as per-
mitted by section 1729 of this title or for a condition for which 
recovery is authorized or with respect to which the United 
States is deemed to be a third party beneficiary under the 
Act entitled ‘An Act to provide for the recovery from tortiously 
liable third persons of the cost of hospital and medical care 
and treatment furnished by the United States’ (Public Law 
87–693; 42 U.S.C. 2651 et seq.; commonly known as the ‘Federal 
Medical Care Recovery Act’).’’. 
SEC. 133. COMPETENCY STANDARDS FOR NON-DEPARTMENT OF VET-
ERANS AFFAIRS HEALTH CARE PROVIDERS. 
(a) ESTABLISHMENT OF STANDARDS AND REQUIREMENTS.—The 
Secretary of Veterans Affairs shall establish standards and require-
ments for the provision of care by non-Department of Veterans 
Affairs health care providers in clinical areas for which the Depart-
ment of Veterans Affairs has special expertise, including post-trau-
matic stress disorder, military sexual trauma-related conditions, 
and traumatic brain injuries. 
(b) CONDITION FOR ELIGIBILITY TO FURNISH CARE.—(1) Each 
non-Department of Veterans Affairs health care provider shall, 
to the extent practicable as determined by the Secretary or other-
wise provided for in paragraph (2), meet the standards and require-
ments established pursuant to subsection (a) before furnishing care 
pursuant to a contract, agreement, or other arrangement with the 
Department of Veterans Affairs. Non-Department of Veterans 
Affairs health care providers furnishing care pursuant to a contract, 
agreement, or other arrangement shall, to the extent practicable 
as determined by the Secretary, fulfill training requirements estab-
lished by the Secretary on how to deliver evidence-based treatments 
in the clinical areas for which the Department of Veterans Affairs 
has special expertise. 
(2) Each non-Department of Veterans Affairs health care pro-
vider who enters into a contract, agreement, or other arrangement 
after the effective date identified in subsection (c) shall, to the 
extent practicable, meet the standards and requirements estab-
lished pursuant to subsection (a) within 6 months of the contract, 
agreement, or other arrangement taking effect. 
(c) EFFECTIVE DATE.—This section shall take effect on the day 
that is 1 year after the date of the enactment of this Act. 
Contracts. 
Deadline. 
38 USC 1701 
note. 
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132 STAT. 1428 
PUBLIC LAW 115–182—JUNE 6, 2018 
SEC. 134. DEPARTMENT OF VETERANS AFFAIRS PARTICIPATION IN 
NATIONAL NETWORK OF STATE-BASED PRESCRIPTION 
DRUG MONITORING PROGRAMS. 
(a) IN GENERAL.—Chapter 17 is amended by inserting after 
section 1730A the following new section: 
‘‘§ 1730B. Access to State prescription drug monitoring pro-
grams 
‘‘(a) ACCESS TO PROGRAMS.—(1) Any licensed health care pro-
vider or delegate of such a provider shall be considered an author-
ized recipient or user for the purpose of querying and receiving 
data from the national network of State-based prescription drug 
monitoring programs to support the safe and effective prescribing 
of controlled substances to covered patients. 
‘‘(2) Under the authority granted by paragraph (1)— 
‘‘(A) licensed health care providers or delegates of such 
providers shall query such network in accordance with 
applicable regulations and policies of the Veterans Health 
Administration; and 
‘‘(B) notwithstanding any general or specific provision of 
law, rule, or regulation of a State, no State may restrict the 
access of licensed health care providers or delegates of such 
providers from accessing that State’s prescription drug moni-
toring programs. 
‘‘(3) No State shall deny or revoke the license, registration, 
or certification of a licensed health care provider or delegate who 
otherwise meets that State’s qualifications for holding the license, 
registration, or certification on the basis that the licensed health 
care provider or delegate queried or received data, or attempted 
to query or receive data, from the national network of State-based 
prescription drug monitoring programs under this section. 
‘‘(b) COVERED PATIENTS.—For purposes of this section, a covered 
patient is a patient who— 
‘‘(1) receives a prescription for a controlled substance; and 
‘‘(2) is not receiving palliative care or enrolled in hospice 
care. 
‘‘(c) DEFINITIONS.—In this section: 
‘‘(1) The term ‘controlled substance’ has the meaning given 
such term in section 102(6) of the Controlled Substances Act 
(21 U.S.C. 802(6)). 
‘‘(2) The term ‘delegate’ means a person or automated 
system accessing the national network of State-based prescrip-
tion monitoring programs at the direction or under the super-
vision of a licensed health care provider. 
‘‘(3) The term ‘licensed health care provider’ means a health 
care provider employed by the Department who is licensed, 
certified, or registered within any State to fill or prescribe 
medications within the scope of his or her practice as a Depart-
ment employee. 
‘‘(4) The term ‘national network of State-based prescription 
monitoring programs’ means an interconnected nation-wide 
system that facilitates the transfer to State prescription drug 
monitoring program data across State lines. 
‘‘(5) The term ‘State’ means a State, as defined in section 
101(20) of this title, or a political subdivision of a State.’’. 
38 USC 1730B. 
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PUBLIC LAW 115–182—JUNE 6, 2018 
(b) CLERICAL AMENDMENT.—The table of sections at the begin-
ning of chapter 17 of such title is amended by inserting after 
the item relating to section 1730A the following new item: 
‘‘1730B. Access to State prescription drug monitoring programs.’’. 
CHAPTER 5—OTHER NON-DEPARTMENT HEALTH CARE 
MATTERS 
SEC. 141. PLANS FOR USE OF SUPPLEMENTAL APPROPRIATIONS 
REQUIRED. 
Whenever the Secretary submits to Congress a request for 
supplemental appropriations or any other appropriation outside 
the standard budget process to address a budgetary issue affecting 
the Department of Veterans Affairs, the Secretary shall, not later 
than 45 days before the date on which such budgetary issue would 
start affecting a program or service, submit to Congress a justifica-
tion for the request, including a plan that details how the Secretary 
intends to use the requested appropriation and how long the 
requested appropriation is expected to meet the needs of the Depart-
ment and certification that the request was made using an updated 
and sound actuarial analysis. 
SEC. 142. VETERANS CHOICE FUND FLEXIBILITY. 
Section 802 of the Veterans Access, Choice, and Accountability 
Act of 2014 (Public Law 113–146; 38 U.S.C. 1701 note) is amended— 
(1) in subsection (c)— 
(A) in paragraph (1), by striking ‘‘by paragraph (3)’’ 
and inserting ‘‘in paragraphs (3) and (4)’’; and 
(B) by adding at the end the following new paragraph: 
‘‘(4) PERMANENT AUTHORITY FOR OTHER USES.—Beginning 
on March 1, 2019, amounts remaining in the Veterans Choice 
Fund may be used to furnish hospital care, medical services, 
and extended care services to individuals pursuant to chapter 
17 of title 38, United States Code, at non-Department facilities, 
including pursuant to non-Department provider programs other 
than the program established by section 101. Such amounts 
shall be available in addition to amounts available in other 
appropriations accounts for such purposes.’’; and 
(2) in subsection (d)(1), by striking ‘‘to subsection (c)(3)’’ 
and inserting ‘‘to paragraphs (3) and (4) of subsection (c)’’. 
SEC. 143. SUNSET OF VETERANS CHOICE PROGRAM. 
Subsection (p) of section 101 of the Veterans Access, Choice, 
and Accountability Act of 2014 (Public Law 113–146; 38 U.S.C. 
1701 note) is amended to read as follows: 
‘‘(p) AUTHORITY TO FURNISH CARE AND SERVICES.—The Sec-
retary may not use the authority under this section to furnish 
care and services after the date that is 1 year after the date 
of the enactment of the Caring for Our Veterans Act of 2018.’’. 
SEC. 144. CONFORMING AMENDMENTS. 
(a) IN GENERAL.— 
(1) TITLE 38.—Title 38, United States Code, is amended— 
(A) in section 1712(a)— 
(i) in paragraph (3), by striking ‘‘under clause (1), 
(2), or (5) of section 1703(a) of this title’’ and inserting 
‘‘or entered an agreement’’; and 
38 USC 1701 
note. 
Effective date. 
38 USC 1701 
note. 
Deadline. 
Certification. 
38 USC 303 note. 
38 USC 
prec. 1701. 
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132 STAT. 1430 
PUBLIC LAW 115–182—JUNE 6, 2018 
(ii) in paragraph (4)(A), by striking ‘‘under the 
provisions of this subsection and section 1703 of this 
title’’; 
(B) in section 1712A(e)(1)— 
(i) by inserting ‘‘or agreements’’ after ‘‘contracts’’; 
and 
(ii) by striking ‘‘(under sections 1703(a)(2) and 
1710(a)(1)(B) of this title)’’; and 
(C) in section 2303(a)(2)(B)(i), by striking ‘‘with section 
1703’’ and inserting ‘‘with sections 1703A, 8111, and 8153’’. 
(2) SOCIAL
SECURITY
ACT.—Section 1866(a)(1)(L) of the 
Social Security Act (42 U.S.C. 1395cc(a)(1)(L)) is amended by 
striking ‘‘under section 603’’ and inserting ‘‘under chapter 17’’. 
(3) VETERANS’ BENEFITS IMPROVEMENTS ACT OF 1994.—Sec-
tion 104(a)(4)(A) of the Veterans’ Benefits Improvements Act 
of 1994 (Public Law 103–446; 38 U.S.C. 1117 note) is amended 
by striking ‘‘in section 1703’’ and inserting ‘‘in sections 1703A, 
8111, and 8153’’. 
(b) EFFECTIVE DATE.—The amendments made by subsection 
(a) shall take effect on the date described in section 101(b). 
Subtitle B—Improving Department of 
Veterans Affairs Health Care Delivery 
SEC. 151. LICENSURE OF HEALTH CARE PROFESSIONALS OF THE 
DEPARTMENT OF VETERANS AFFAIRS PROVIDING TREAT-
MENT VIA TELEMEDICINE. 
(a) IN GENERAL.—Chapter 17 is amended by inserting after 
section 1730B, as added by section 134, the following new section: 
‘‘§ 1730C. Licensure of health care professionals providing 
treatment via telemedicine 
‘‘(a) IN
GENERAL.—Notwithstanding any provision of law 
regarding the licensure of health care professionals, a covered health 
care professional may practice the health care profession of the 
health care professional at any location in any State, regardless 
of where the covered health care professional or the patient is 
located, if the covered health care professional is using telemedicine 
to provide treatment to an individual under this chapter. 
‘‘(b) COVERED HEALTH CARE PROFESSIONALS.—For purposes of 
this section, a covered health care professional is any health care 
professional who— 
‘‘(1) is an employee of the Department appointed under 
the authority under section 7306, 7401, 7405, 7406, or 7408 
of this title or title 5; 
‘‘(2) is authorized by the Secretary to provide health care 
under this chapter; 
‘‘(3) is required to adhere to all standards for quality 
relating to the provision of medicine in accordance with 
applicable policies of the Department; and 
‘‘(4) has an active, current, full, and unrestricted license, 
registration, or certification in a State to practice the health 
care profession of the health care professional. 
‘‘(c) PROPERTY OF FEDERAL GOVERNMENT.—Subsection (a) shall 
apply to a covered health care professional providing treatment 
Definition. 
38 USC 1730C. 
38 USC 1712 
note. 
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132 STAT. 1431 
PUBLIC LAW 115–182—JUNE 6, 2018 
to a patient regardless of whether the covered health care profes-
sional or patient is located in a facility owned by the Federal 
Government during such treatment. 
‘‘(d) RELATION TO STATE LAW.—(1) The provisions of this section 
shall supersede any provisions of the law of any State to the 
extent that such provision of State law are inconsistent with this 
section. 
‘‘(2) No State shall deny or revoke the license, registration, 
or certification of a covered health care professional who otherwise 
meets the qualifications of the State for holding the license, registra-
tion, or certification on the basis that the covered health care 
professional has engaged or intends to engage in activity covered 
by subsection (a). 
‘‘(e) RULE OF CONSTRUCTION.—Nothing in this section may be 
construed to remove, limit, or otherwise affect any obligation of 
a covered health care professional under the Controlled Substances 
Act (21 U.S.C. 801 et seq.). 
‘‘(f) STATE DEFINED.—In this section, the term ‘State’ means 
a State, as defined in section 101(20) of this title, or a political 
subdivision of a State.’’. 
(b) CLERICAL AMENDMENT.—The table of sections at the begin-
ning of chapter 17 of such title is amended by inserting after 
the item relating to section 1730B, as added by section 134, the 
following new item: 
‘‘1730C. Licensure of health care professionals providing treatment via telemedi-
cine.’’. 
(c) REPORT ON TELEMEDICINE.— 
(1) IN GENERAL.—Not later than 1 year after the earlier 
of the date on which services provided under section 1730B 
of title 38, United States Code, as added by subsection (a), 
first occur or regulations are promulgated to carry out such 
section, the Secretary of Veterans Affairs shall submit to the 
Committee on Veterans’ Affairs of the Senate and the Com-
mittee on Veterans’ Affairs of the House of Representatives 
a report on the effectiveness of the use of telemedicine by 
the Department of Veterans Affairs. 
(2) ELEMENTS.—The report required by paragraph (1) shall 
include an assessment of the following: 
(A) The satisfaction of veterans with telemedicine fur-
nished by the Department. 
(B) The satisfaction of health care providers in pro-
viding telemedicine furnished by the Department. 
(C) The effect of telemedicine furnished by the Depart-
ment on the following: 
(i) The ability of veterans to access health care, 
whether from the Department or from non-Department 
health care providers. 
(ii) The frequency of use by veterans of telemedi-
cine. 
(iii) The productivity of health care providers. 
(iv) Wait times for an appointment for the receipt 
of health care from the Department. 
(v) The use by veterans of in-person services at 
Department facilities and non-Department facilities. 
(D) The types of appointments for the receipt of tele-
medicine furnished by the Department that were provided 
Time period. 
Assessment. 
Regulations. 
38 USC 
prec. 1701. 
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132 STAT. 1432 
PUBLIC LAW 115–182—JUNE 6, 2018 
during the 1-year period preceding the submittal of the 
report. 
(E) The number of appointments for the receipt of 
telemedicine furnished by the Department that were 
requested during such period, disaggregated by medical 
facility. 
(F) Savings by the Department, if any, including travel 
costs, from furnishing health care through the use of tele-
medicine during such period. 
SEC. 152. AUTHORITY FOR DEPARTMENT OF VETERANS AFFAIRS 
CENTER FOR INNOVATION FOR CARE AND PAYMENT. 
(a) IN GENERAL.—Subchapter I of chapter 17, as amended by 
this title, is further amended by inserting after section 1703D, 
as added by section 111, the following new section: 
‘‘§ 1703E. Center for Innovation for Care and Payment 
‘‘(a) IN GENERAL.—(1) There is established within the Depart-
ment a Center for Innovation for Care and Payment (in this section 
referred to as the ‘Center’). 
‘‘(2) The Secretary, acting through the Center, may carry out 
such pilot programs the Secretary determines to be appropriate 
to develop innovative approaches to testing payment and service 
delivery models in order to reduce expenditures while preserving 
or enhancing the quality of care furnished by the Department. 
‘‘(3) The Secretary, acting through the Center, shall test pay-
ment and service delivery models to determine whether such 
models— 
‘‘(A) improve access to, and quality, timeliness, and patient 
satisfaction of care and services; and 
‘‘(B) create cost savings for the Department. 
‘‘(4)(A) The Secretary shall test a model in a location where 
the Secretary determines that the model will addresses deficits 
in care (including poor clinical outcomes or potentially avoidable 
expenditures) for a defined population. 
‘‘(B) The Secretary shall focus on models the Secretary expects 
to reduce program costs while preserving or enhancing the quality 
of care received by individuals receiving benefits under this chapter. 
‘‘(C) The models selected may include those described in section 
1115A(b)(2)(B) of the Social Security Act (42 U.S.C. 1315a(b)(2)(B)). 
‘‘(5) In selecting a model for testing, the Secretary may consider, 
in addition to other factors identified in this subsection, the fol-
lowing factors: 
‘‘(A) Whether the model includes a regular process for 
monitoring and updating patient care plans in a manner that 
is consistent with the needs and preferences of individuals 
receiving benefits under this chapter. 
‘‘(B) Whether the model places the individual receiving 
benefits under this chapter (including family members and 
other caregivers of such individual) at the center of the care 
team of such individual. 
‘‘(C) Whether the model uses technology or new systems 
to coordinate care over time and across settings. 
‘‘(D) Whether the model demonstrates effective linkage with 
other public sector payers, private sector payers, or statewide 
payment models. 
38 USC 1703E. 
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132 STAT. 1433 
PUBLIC LAW 115–182—JUNE 6, 2018 
‘‘(6)(A) Models tested under this section may not be designed 
in such a way that would allow the United States to recover 
or collect reasonable charges from a Federal health care program 
for care or services furnished by the Secretary to a veteran under 
pilot programs carried out under this section. 
‘‘(B) In this paragraph, the term ‘Federal health care program’ 
means— 
‘‘(i) an insurance program described in section 1811 of 
the Social Security Act (42 U.S.C. 1395c) or established by 
section 1831 of such Act (42 U.S.C. 1395j); 
‘‘(ii) a State plan for medical assistance approved under 
title XIX of such Act (42 U.S.C. 1396 et seq.); or 
‘‘(iii) a TRICARE program operated under sections 1075, 
1075a, 1076, 1076a, 1076c, 1076d, 1076e, or 1076f of title 
10. 
‘‘(b) DURATION.—Each pilot program carried out by the Sec-
retary under this section shall terminate no later than 5 years 
after the date of the commencement of the pilot program. 
‘‘(c) LOCATION.—The Secretary shall ensure that each pilot pro-
gram carried out under this section occurs in an area or areas 
appropriate for the intended purposes of the pilot program. To 
the extent practicable, the Secretary shall ensure that the pilot 
programs are located in geographically diverse areas of the United 
States. 
‘‘(d) BUDGET.—Funding for each pilot program carried out by 
the Secretary under this section shall come from appropriations— 
‘‘(1) provided in advance in appropriations acts for the 
Veterans Health Administration; and 
‘‘(2) provided for information technology systems. 
‘‘(e) NOTICE.—The Secretary shall— 
‘‘(1) publish information about each pilot program under 
this section in the Federal Register; and 
‘‘(2) take reasonable actions to provide direct notice to 
veterans eligible to participate in such pilot programs. 
‘‘(f) WAIVER OF AUTHORITIES.—(1) Subject to reporting under 
paragraph (2) and approval under paragraph (3), in implementing 
a pilot program under this section, the Secretary may waive such 
requirements in subchapters I, II, and III of this chapter as the 
Secretary determines necessary solely for the purposes of carrying 
out this section with respect to testing models described in sub-
section (a). 
‘‘(2) Before waiving any authority under paragraph (1), the 
Secretary shall submit to the Speaker of the House of Representa-
tives, the minority leader of the House of Representatives, the 
majority leader of the Senate, the minority leader of the Senate, 
and each standing committee with jurisdiction under the rules 
of the Senate and of the House of Representatives to report a 
bill to amend the provision or provisions of law that would be 
waived by the Department, a report on a request for waiver that 
describes in detail the following: 
‘‘(A) The specific authorities to be waived under the pilot 
program. 
‘‘(B) The standard or standards to be used in the pilot 
program in lieu of the waived authorities. 
‘‘(C) The reasons for such waiver or waivers. 
‘‘(D) A description of the metric or metrics the Secretary 
will use to determine the effect of the waiver or waivers upon 
Reports. 
Federal Register, 
publication. 
Definition. 
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132 STAT. 1434 
PUBLIC LAW 115–182—JUNE 6, 2018 
the access to and quality, timeliness, or patient satisfaction 
of care and services furnished through the pilot program. 
‘‘(E) The anticipated cost savings, if any, of the pilot pro-
gram. 
‘‘(F) The schedule for interim reports on the pilot program 
describing the results of the pilot program so far and the 
feasibility and advisability of continuing the pilot program. 
‘‘(G) The schedule for the termination of the pilot program 
and the submission of a final report on the pilot program 
describing the result of the pilot program and the feasibility 
and advisability of making the pilot program permanent. 
‘‘(H) The estimated budget of the pilot program. 
‘‘(3)(A) Upon receipt of a report submitted under paragraph 
(2), each House of Congress shall provide copies of the report 
to the chairman and ranking member of each standing committee 
with jurisdiction under the rules of the House of Representatives 
or the Senate to report a bill to amend the provision or provisions 
of law that would be waived by the Department under this sub-
section. 
‘‘(B) The waiver requested by the Secretary under paragraph 
(2) shall be considered approved under this paragraph if there 
is enacted into law a joint resolution approving such request in 
its entirety. 
‘‘(C) For purposes of this paragraph, the term ‘joint resolution’ 
means only a joint resolution which is introduced within the period 
of five legislative days beginning on the date on which the Secretary 
transmits the report to the Congress under such paragraph (2), 
and— 
‘‘(i) which does not have a preamble; and 
‘‘(ii) the matter after the resolving clause of which is as 
follows: ‘that Congress approves the request for a waiver under 
section 1703E(f) of title 38, United States Code, as submitted 
by the Secretary on lll’, the blank space being filled with 
the appropriate date. 
‘‘(D)(i) Any committee of the House of Representatives to which 
a joint resolution is referred shall report it to the House without 
amendment not later than 15 legislative days after the date of 
introduction thereof. If a committee fails to report the joint resolu-
tion within that period, the committee shall be discharged from 
further consideration of the joint resolution. 
‘‘(ii) It shall be in order at any time after the third legislative 
day after each committee authorized to consider a joint resolution 
has reported or has been discharged from consideration of a joint 
resolution, to move to proceed to consider the joint resolution in 
the House. All points of order against the motion are waived. 
Such a motion shall not be in order after the House has disposed 
of a motion to proceed on a joint resolution addressing a particular 
submission. The previous question shall be considered as ordered 
on the motion to its adoption without intervening motion. The 
motion shall not be debatable. A motion to reconsider the vote 
by which the motion is disposed of shall not be in order. 
‘‘(iii) The joint resolution shall be considered as read. All points 
of order against the joint resolution and against its consideration 
are waived. The previous question shall be considered as ordered 
on the joint resolution to its passage without intervening motion 
except two hours of debate equally divided and controlled by the 
Deadline. 
Definition. 
Reports. 
Budget estimate. 
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132 STAT. 1435 
PUBLIC LAW 115–182—JUNE 6, 2018 
proponent and an opponent. A motion to reconsider the vote on 
passage of the joint resolution shall not be in order. 
‘‘(E)(i) A joint resolution introduced in the Senate shall be 
referred to the Committee on Veterans’ Affairs. 
‘‘(ii) Any committee of the Senate to which a joint resolution 
is referred shall report it to the Senate without amendment not 
later than 15 session days after the date of introduction of a 
joint resolution described in paragraph (C). If a committee fails 
to report the joint resolution within that period, the committee 
shall be discharged from further consideration of the joint resolution 
and the joint resolution shall be placed on the calendar. 
‘‘(iii)(I) Notwithstanding Rule XXII of the Standing Rules of 
the Senate, it is in order at any time after the third session 
day on which the Committee on Veterans’ Affairs has reported 
or has been discharged from consideration of a joint resolution 
described in paragraph (C) (even though a previous motion to 
the same effect has been disagreed to) to move to proceed to the 
consideration of the joint resolution, and all points of order against 
the joint resolution (and against consideration of the joint resolu-
tion) are waived. The motion to proceed is not debatable. The 
motion is not subject to a motion to postpone. A motion to reconsider 
the vote by which the motion is agreed to or disagreed to shall 
not be in order. If a motion to proceed to the consideration of 
the resolution is agreed to, the joint resolution shall remain the 
unfinished business until disposed of. 
‘‘(II) Consideration of the joint resolution, and on all debatable 
motions and appeals in connection therewith, shall be limited to 
not more than two hours, which shall be divided equally between 
the majority and minority leaders or their designees. A motion 
further to limit debate is in order and not debatable. An amendment 
to, or a motion to postpone, or a motion to proceed to the consider-
ation of other business, or a motion to recommit the joint resolution 
is not in order. 
‘‘(III) If the Senate has voted to proceed to a joint resolution, 
the vote on passage of the joint resolution shall occur immediately 
following the conclusion of consideration of the joint resolution, 
and a single quorum call at the conclusion of the debate if requested 
in accordance with the rules of the Senate. 
‘‘(IV) Appeals from the decisions of the Chair relating to the 
application of the rules of the Senate, as the case may be, to 
the procedure relating to a joint resolution shall be decided without 
debate. 
‘‘(F) A joint resolution considered pursuant to this paragraph 
shall not be subject to amendment in either the House of Represent-
atives or the Senate. 
‘‘(G)(i) If, before the passage by one House of the joint resolution 
of that House, that House receives the joint resolution from the 
other House, then the following procedures shall apply: 
‘‘(I) The joint resolution of the other House shall not be 
referred to a committee. 
‘‘(II) With respect to the joint resolution of the House 
receiving the joint resolution— 
‘‘(aa) the procedure in that House shall be the 
same as if no joint resolution had been received from 
the other House; but 
‘‘(bb) the vote on passage shall be on the joint 
resolution of the other House. 
Procedures. 
Applicability. 
Deadline. 
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132 STAT. 1436 
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‘‘(ii) If the Senate fails to introduce or consider a joint 
resolution under this paragraph, the joint resolution of the 
House shall be entitled to expedited floor procedures under 
this subparagraph. 
‘‘(iii) If, following passage of the joint resolution in the 
Senate, the Senate then receives the companion measure from 
the House of Representatives, the companion measure shall 
not be debatable. 
‘‘(H) This subparagraph is enacted by Congress— 
‘‘(i) as an exercise of the rulemaking power of the Senate 
and House of Representatives, respectively, and as such it 
is deemed a part of the rules of each House, respectively, 
but applicable only with respect to the procedure to be followed 
in that House in the case of a joint resolution, and it supersedes 
other rules only to the extent that it is inconsistent with such 
rules; and 
‘‘(ii) with full recognition of the constitutional right of either 
House to change the rules (so far as relating to the procedure 
of that House) at any time, in the same manner, and to the 
same extent as in the case of any other rule of that House. 
‘‘(g) LIMITATIONS.—(1) The Secretary may not carry out more 
than 10 pilot programs concurrently. 
‘‘(2)(A) Subject to subparagraph (B), the Secretary may not 
expend more than $50,000,000 in any fiscal year from amounts 
under subsection (d). 
‘‘(B) The Secretary may expend more than the amount in 
subparagraph (A) if— 
‘‘(i) the Secretary determines that the additional expendi-
ture is necessary to carry out pilot programs under this section; 
‘‘(ii) the Secretary submits to the Committees on Veterans’ 
Affairs of the Senate and the House of Representatives a report 
setting forth the amount of the additional expenditure and 
a justification for the additional expenditure; and 
‘‘(iii) the Chairmen of the Committees on Veterans’ Affairs 
of the Senate and the House of Representatives transmit to 
the Secretary a letter approving of the additional expenditure. 
‘‘(3) The waiver provisions in subsection (f) shall not apply 
unless the Secretary, in accordance with the requirements in sub-
section (f), submits the first proposal for a pilot program not later 
than 18 months after the date of the enactment of the Caring 
for Our Veterans Act of 2018. 
‘‘(4) Notwithstanding section 502 of this title, decisions by the 
Secretary under this section shall, consistent with section 511 of 
this title, be final and conclusive and may not be reviewed by 
any other official or by any court, whether by an action in the 
nature of mandamus or otherwise. 
‘‘(5)(A) If the Secretary determines that a pilot program is 
not improving the quality of care or producing cost savings, the 
Secretary shall— 
‘‘(i) propose a modification to the pilot program in the 
interim report that shall also be considered a report under 
subsection (f)(2) and shall be subject to the terms and conditions 
of subsection (f)(2); or 
‘‘(ii) terminate such pilot program not later than 30 days 
after submitting the interim report to Congress. 
Deadline. 
Reports. 
Determination. 
Deadline. 
Reports. 
Determination. 
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PUBLIC LAW 115–182—JUNE 6, 2018 
‘‘(B) If the Secretary terminates a pilot program under subpara-
graph (A)(ii), for purposes of subparagraphs (F) and (G) of sub-
section (f)(2), such interim report will also serve as the final report 
for that pilot program. 
‘‘(h) EVALUATION AND REPORTING REQUIREMENTS.—(1) The Sec-
retary shall conduct an evaluation of each model tested, which 
shall include, at a minimum, an analysis of— 
‘‘(A) the quality of care furnished under the model, 
including the measurement of patient-level outcomes and 
patient-centeredness criteria determined appropriate by the 
Secretary; and 
‘‘(B) the changes in spending by reason of that model. 
‘‘(2) The Secretary shall make the results of each evaluation 
under this subsection available to the public in a timely fashion 
and may establish requirements for other entities participating 
in the testing of models under this section to collect and report 
information that the Secretary determines is necessary to monitor 
and evaluate such models. 
‘‘(i) COORDINATION AND ADVICE.—(1) The Secretary shall obtain 
advice from the Under Secretary for Health and the Special Medical 
Advisory Group established pursuant to section 7312 of this title 
in the development and implementation of any pilot program oper-
ated under this section. 
‘‘(2) In carrying out the duties under this section, the Secretary 
shall consult representatives of relevant Federal agencies, and clin-
ical and analytical experts with expertise in medicine and health 
care management. The Secretary shall use appropriate mechanisms 
to seek input from interested parties. 
‘‘(j) EXPANSION OF SUCCESSFUL PILOT PROGRAMS.—Taking into 
account the evaluation under subsection (f), the Secretary may, 
through rulemaking, expand (including implementation on a nation-
wide basis) the duration and the scope of a model that is being 
tested under subsection (a) to the extent determined appropriate 
by the Secretary, if— 
‘‘(1) the Secretary determines that such expansion is 
expected to— 
‘‘(A) reduce spending without reducing the quality of 
care; or 
‘‘(B) improve the quality of patient care without 
increasing spending; and 
‘‘(2) the Secretary determines that such expansion would 
not deny or limit the coverage or provision of benefits for 
individuals receiving benefits under this chapter.’’. 
(b) CONFORMING AMENDMENT.—The table of sections at the 
beginning of such chapter, as amended by this title, is further 
amended by inserting after the item relating to section 1703D 
the following new item: 
‘‘1703E. Center for Innovation for Care and Payment.’’. 
SEC. 153. AUTHORIZATION TO PROVIDE FOR OPERATIONS ON LIVE 
DONORS FOR PURPOSES OF CONDUCTING TRANSPLANT 
PROCEDURES FOR VETERANS. 
(a) IN GENERAL.—Subchapter VIII of chapter 17 is amended 
by adding at the end the following new section: 
38 USC 
prec. 1701. 
Regulations. 
Determination. 
Consultation. 
Public 
information. 
Analysis. 
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PUBLIC LAW 115–182—JUNE 6, 2018 
‘‘§ 1788. Transplant procedures with live donors and related 
services 
‘‘(a) IN GENERAL.—Subject to subsections (b) and (c), in a case 
in which a veteran is eligible for a transplant procedure from 
the Department, the Secretary may provide for an operation on 
a live donor to carry out such procedure for such veteran, notwith-
standing that the live donor may not be eligible for health care 
from the Department. 
‘‘(b) OTHER SERVICES.—Subject to the availability of appropria-
tions for such purpose, the Secretary shall furnish to a live donor 
any care or services before and after conducting the transplant 
procedure under subsection (a) that may be required in connection 
with such procedure. 
‘‘(c) USE OF NON-DEPARTMENT FACILITIES.—In carrying out this 
section, the Secretary may provide for the operation described in 
subsection (a) on a live donor and furnish to the live donor the 
care and services described in subsection (b) at a non-Department 
facility pursuant to an agreement entered into by the Secretary 
under this chapter. The live donor shall be deemed to be an indi-
vidual eligible for hospital care and medical services at a non- 
Department facility pursuant to such an agreement solely for the 
purposes of receiving such operation, care, and services at the 
non-Department facility.’’. 
(b) CLERICAL AMENDMENT.—The table of sections at the begin-
ning of chapter 17 is amended by inserting after the item relating 
to section 1787 the following new item: 
‘‘1788. Transplant procedures with live donors and related services.’’. 
Subtitle C—Family Caregivers 
SEC. 161. EXPANSION OF FAMILY CAREGIVER PROGRAM OF DEPART-
MENT OF VETERANS AFFAIRS. 
(a) FAMILY CAREGIVER PROGRAM.— 
(1) EXPANSION OF ELIGIBILITY.— 
(A) IN GENERAL.—Subparagraph (B) of subsection (a)(2) 
of section 1720G is amended to read as follows: 
‘‘(B) for assistance provided under this subsection— 
‘‘(i) before the date on which the Secretary submits 
to Congress a certification that the Department has fully 
implemented the information technology system required 
by section 162(a) of the Caring for Our Veterans Act of 
2018, has a serious injury (including traumatic brain 
injury, psychological trauma, or other mental disorder) 
incurred or aggravated in the line of duty in the active 
military, naval, or air service on or after September 11, 
2001; 
‘‘(ii) during the 2-year period beginning on the date 
on which the Secretary submitted to Congress the certifi-
cation described in clause (i), has a serious injury (including 
traumatic brain injury, psychological trauma, or other 
mental disorder) incurred or aggravated in the line of duty 
in the active military, naval, or air service— 
‘‘(I) on or before May 7, 1975; or 
‘‘(II) on or after September 11, 2001; or 
Certification. 
Time periods. 
38 USC 
prec. 1701. 
38 USC 1788. 
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PUBLIC LAW 115–182—JUNE 6, 2018 
‘‘(iii) after the date that is 2 years after the date 
on which the Secretary submits to Congress the certifi-
cation described in clause (i), has a serious injury (including 
traumatic brain injury, psychological trauma, or other 
mental disorder) incurred or aggravated in the line of duty 
in the active military, naval, or air service; and’’. 
(B) PUBLICATION IN FEDERAL REGISTER.—Not later than 
30 days after the date on which the Secretary of Veterans 
Affairs submits to Congress the certification described in 
subsection (a)(2)(B)(i) of section 1720G of such title, as 
amended by subparagraph (A) of this paragraph, the Sec-
retary shall publish the date specified in such subsection 
in the Federal Register. 
(2) EXPANSION OF NEEDED SERVICES IN ELIGIBILITY CRI-
TERIA.—Subsection (a)(2)(C) of such section is amended— 
(A) in clause (ii), by striking ‘‘; or’’ and inserting a 
semicolon; 
(B) by redesignating clause (iii) as clause (iv); and 
(C) by inserting after clause (ii) the following new 
clause (iii): 
‘‘(iii) a need for regular or extensive instruction or 
supervision without which the ability of the veteran to 
function in daily life would be seriously impaired; or’’. 
(3) 
EXPANSION
OF
SERVICES
PROVIDED.—Subsection 
(a)(3)(A)(ii) of such section is amended— 
(A) in subclause (IV), by striking ‘‘; and’’ and inserting 
a semicolon; 
(B) in subclause (V), by striking the period at the 
end and inserting ‘‘; and’’; and 
(C) by adding at the end the following new subclause: 
‘‘(VI) through the use of contracts with, or the provision 
of grants to, public or private entities— 
‘‘(aa) financial planning services relating to the 
needs of injured veterans and their caregivers; and 
‘‘(bb) legal services, including legal advice and con-
sultation, relating to the needs of injured veterans 
and their caregivers.’’. 
(4) MODIFICATION
OF
STIPEND
CALCULATION.—Subsection 
(a)(3)(C) of such section is amended— 
(A) by redesignating clause (iii) as clause (iv); and 
(B) by inserting after clause (ii) the following new 
clause (iii): 
‘‘(iii) In determining the amount and degree of personal care 
services provided under clause (i) with respect to an eligible veteran 
whose need for personal care services is based in whole or in 
part on a need for supervision or protection under paragraph 
(2)(C)(ii) or regular instruction or supervision under paragraph 
(2)(C)(iii), the Secretary shall take into account the following: 
‘‘(I) The assessment by the family caregiver of the needs 
and limitations of the veteran. 
‘‘(II) The extent to which the veteran can function safely 
and independently in the absence of such supervision, protec-
tion, or instruction. 
‘‘(III) The amount of time required for the family caregiver 
to provide such supervision, protection, or instruction to the 
veteran.’’. 
Deadline. 
38 USC 1720G 
note. 
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132 STAT. 1440 
PUBLIC LAW 115–182—JUNE 6, 2018 
(5) PERIODIC EVALUATION OF NEED FOR CERTAIN SERVICES.— 
Subsection (a)(3) of such section is amended by adding at the 
end the following new subparagraph: 
‘‘(D) In providing instruction, preparation, and training under 
subparagraph (A)(i)(I) and technical support under subparagraph 
(A)(i)(II) to each family caregiver who is approved as a provider 
of personal care services for an eligible veteran under paragraph 
(6), the Secretary shall periodically evaluate the needs of the eligible 
veteran and the skills of the family caregiver of such veteran 
to determine if additional instruction, preparation, training, or tech-
nical support under those subparagraphs is necessary.’’. 
(6) USE OF PRIMARY CARE TEAMS.—Subsection (a)(5) of such 
section is amended, in the matter preceding subparagraph (A), 
by inserting ‘‘(in collaboration with the primary care team 
for the eligible veteran to the maximum extent practicable)’’ 
after ‘‘evaluate’’. 
(7) ASSISTANCE FOR FAMILY CAREGIVERS.—Subsection (a) 
of such section is amended by adding at the end the following 
new paragraph: 
‘‘(11)(A) In providing assistance under this subsection to family 
caregivers of eligible veterans, the Secretary may enter into con-
tracts, provider agreements, and memoranda of understanding with 
Federal agencies, States, and private, nonprofit, and other entities 
to provide such assistance to such family caregivers. 
‘‘(B) The Secretary may provide assistance under this paragraph 
only if such assistance is reasonably accessible to the family care-
giver and is substantially equivalent or better in quality to similar 
services provided by the Department. 
‘‘(C) The Secretary may provide fair compensation to Federal 
agencies, States, and other entities that provide assistance under 
this paragraph.’’. 
(b) MODIFICATION
OF DEFINITION
OF PERSONAL CARE SERV-
ICES.—Subsection (d)(4) of such section is amended— 
(1) in subparagraph (A), by striking ‘‘independent’’; 
(2) by redesignating subparagraph (B) as subparagraph 
(D); and 
(3) by inserting after subparagraph (A) the following new 
subparagraphs: 
‘‘(B) Supervision or protection based on symptoms or 
residuals of neurological or other impairment or injury. 
‘‘(C) Regular or extensive instruction or supervision 
without which the ability of the veteran to function in 
daily life would be seriously impaired.’’. 
SEC. 162. IMPLEMENTATION OF INFORMATION TECHNOLOGY SYSTEM 
OF DEPARTMENT OF VETERANS AFFAIRS TO ASSESS AND 
IMPROVE THE FAMILY CAREGIVER PROGRAM. 
(a) IMPLEMENTATION OF NEW SYSTEM.— 
(1) IN GENERAL.—Not later than October 1, 2018, the Sec-
retary of Veterans Affairs shall implement an information tech-
nology system that fully supports the Program and allows for 
data assessment and comprehensive monitoring of the Program. 
(2) ELEMENTS
OF
SYSTEM.—The information technology 
system required to be implemented under paragraph (1) shall 
include the following: 
(A) The ability to easily retrieve data that will allow 
all aspects of the Program (at the medical center and 
Deadline. 
38 USC 1720G 
note. 
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132 STAT. 1441 
PUBLIC LAW 115–182—JUNE 6, 2018 
aggregate levels) and the workload trends for the Program 
to be assessed and comprehensively monitored. 
(B) The ability to manage data with respect to a 
number of caregivers that is more than the number of 
caregivers that the Secretary expects to apply for the Pro-
gram. 
(C) The ability to integrate the system with other 
relevant information technology systems of the Veterans 
Health Administration. 
(b) ASSESSMENT OF PROGRAM.—Not later than 180 days after 
implementing the system described in subsection (a), the Secretary 
shall, through the Under Secretary for Health, use data from the 
system and other relevant data to conduct an assessment of how 
key aspects of the Program are structured and carried out. 
(c) ONGOING MONITORING
OF
AND MODIFICATIONS
TO PRO-
GRAM.— 
(1) MONITORING.—The Secretary shall use the system 
implemented under subsection (a) to monitor and assess the 
workload of the Program, including monitoring and assessment 
of data on— 
(A) the status of applications, appeals, and home visits 
in connection with the Program; and 
(B) the use by caregivers participating in the Program 
of other support services under the Program such as respite 
care. 
(2) MODIFICATIONS.—Based on the monitoring and assess-
ment conducted under paragraph (1), the Secretary shall iden-
tify and implement such modifications to the Program as the 
Secretary considers necessary to ensure the Program is func-
tioning as intended and providing veterans and caregivers 
participating in the Program with services in a timely manner. 
(d) REPORTS.— 
(1) INITIAL REPORT.— 
(A) 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, 
the Committee on Veterans’ Affairs of the House of Rep-
resentatives, and the Comptroller General of the United 
States a report that includes— 
(i) the status of the planning, development, and 
deployment of the system required to be implemented 
under subsection (a), including any changes in the 
timeline for the implementation of the system; and 
(ii) an assessment of the needs of family caregivers 
of veterans described in subparagraph (B), the 
resources needed for the inclusion of such family care-
givers in the Program, and such changes to the Pro-
gram as the Secretary considers necessary to ensure 
the successful expansion of the Program to include 
such family caregivers. 
(B) VETERANS DESCRIBED.—Veterans described in this 
subparagraph are veterans who are eligible for the Program 
under clause (ii) or (iii) of section 1720G(a)(2)(B) of title 
38, United States Code, as amended by section 161(a)(1) 
of this title, solely due to a serious injury (including trau-
matic brain injury, psychological trauma, or other mental 
disorder) incurred or aggravated in the line of duty in 
Deadline. 
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132 STAT. 1442 
PUBLIC LAW 115–182—JUNE 6, 2018 
the active military, naval, or air service before September 
11, 2001. 
(2) NOTIFICATION BY COMPTROLLER GENERAL.—The Comp-
troller General shall review the report submitted under para-
graph (1) and notify the Committee on Veterans’ Affairs of 
the Senate and the Committee on Veterans’ Affairs of the 
House of Representatives with respect to the progress of the 
Secretary in— 
(A) fully implementing the system required under sub-
section (a); and 
(B) implementing a process for using such system to 
monitor and assess the Program under subsection (c)(1) 
and modify the Program as considered necessary under 
subsection (c)(2). 
(3) FINAL REPORT.— 
(A) IN GENERAL.—Not later than October 1, 2019, the 
Secretary shall submit to the Committee on Veterans’ 
Affairs of the Senate, the Committee on Veterans’ Affairs 
of the House of Representatives, and the Comptroller Gen-
eral a report on the implementation of subsections (a) 
through (c). 
(B) ELEMENTS.—The report required by subparagraph 
(A) shall include the following: 
(i) A certification by the Secretary that the 
information technology system described in subsection 
(a) has been implemented. 
(ii) A description of how the Secretary has imple-
mented such system. 
(iii) A description of the modifications to the Pro-
gram, if any, that were identified and implemented 
under subsection (c)(2). 
(iv) A description of how the Secretary is using 
such system to monitor the workload of the Program. 
(e) DEFINITIONS.—In this section: 
(1) ACTIVE MILITARY, NAVAL, OR AIR SERVICE.—The term 
‘‘active military, naval, or air service’’ has the meaning given 
that term in section 101 of title 38, United States Code. 
(2) PROGRAM.—The term ‘‘Program’’ means the program 
of comprehensive assistance for family caregivers under section 
1720G(a) of title 38, United States Code, as amended by section 
161 of this title. 
SEC. 163. MODIFICATIONS TO ANNUAL EVALUATION REPORT ON CARE-
GIVER 
PROGRAM 
OF 
DEPARTMENT 
OF 
VETERANS 
AFFAIRS. 
(a) BARRIERS TO CARE AND SERVICES.—Subparagraph (A)(iv) 
of section 101(c)(2) of the Caregivers and Veterans Omnibus Health 
Services Act of 2010 (Public Law 111–163; 38 U.S.C. 1720G note) 
is amended by inserting ‘‘, including a description of any barriers 
to accessing and receiving care and services under such programs’’ 
before the semicolon. 
(b) SUFFICIENCY
OF TRAINING
FOR FAMILY CAREGIVER PRO-
GRAM.—Subparagraph (B) of such section is amended— 
(1) in clause (i), by striking ‘‘; and’’ and inserting a semi-
colon; 
(2) in clause (ii), by striking the period at the end and 
inserting ‘‘; and’’; and 
38 USC 1720G 
note. 
Certification. 
Review. 
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132 STAT. 1443 
PUBLIC LAW 115–182—JUNE 6, 2018 
(3) by adding at the end the following new clause: 
‘‘(iii) an evaluation of the sufficiency and consist-
ency of the training provided to family caregivers under 
such program in preparing family caregivers to provide 
care to veterans under such program.’’. 
TITLE II—VA ASSET AND 
INFRASTRUCTURE REVIEW 
Subtitle A—Asset and Infrastructure 
Review 
SEC. 201. SHORT TITLE. 
This subtitle may be cited as the ‘‘VA Asset and Infrastructure 
Review Act of 2018’’. 
SEC. 202. THE COMMISSION. 
(a) ESTABLISHMENT.—There is established an independent 
commission to be known as the ‘‘Asset and Infrastructure Review 
Commission’’ (in this subtitle referred to as the ‘‘Commission’’). 
(b) DUTIES.—The Commission shall carry out the duties speci-
fied for it in this subtitle. 
(c) APPOINTMENT.— 
(1) IN GENERAL.— 
(A) APPOINTMENT.—The Commission shall be composed 
of nine members appointed by the President, by and with 
the advice and consent of the Senate. 
(B) TRANSMISSION
OF
NOMINATIONS.—The President 
shall transmit to the Senate the nominations for appoint-
ment to the Commission not later than May 31, 2021. 
(2) CONSULTATION
IN
SELECTION
PROCESS.—In selecting 
individuals for nominations for appointments to the Commis-
sion, the President shall consult with— 
(A) the Speaker of the House of Representatives; 
(B) the majority leader of the Senate; 
(C) the minority leader of the House of Representatives; 
(D) the minority leader of the Senate; and 
(E) congressionally chartered, membership based vet-
erans service organizations concerning the appointment of 
three members. 
(3) DESIGNATION
OF
CHAIR.—At the time the President 
nominates individuals for appointment to the Commission 
under paragraph (1)(B), the President shall designate one such 
individual who shall serve as Chair of the Commission and 
one such individual who shall serve as Vice Chair of the 
Commission. 
(4) MEMBER REPRESENTATION.—In nominating individuals 
under this subsection, the President shall ensure that— 
(A) veterans, reflecting current demographics of vet-
erans enrolled in the system of annual patient enrollment 
under section 1705 of title 38, United States Code, are 
adequately represented in the membership of the Commis-
sion; 
Deadline. 
President. 
VA Asset and 
Infrastructure 
Review Act 
of 2018. 
38 USC 8122 
note. 
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132 STAT. 1444 
PUBLIC LAW 115–182—JUNE 6, 2018 
(B) at least one member of the Commission has experi-
ence working for a private integrated health care system 
that has annual gross revenues of more than $50,000,000; 
(C) at least one member has experience as a senior 
manager for an entity specified in clause (ii), (iii), or (iv) 
of section 101(a)(1)(B) of the Veterans Access, Choice, and 
Accountability Act of 2014 (Public Law 113–146; 38 U.S.C. 
1701 note); 
(D) at least one member— 
(i) has experience with capital asset management 
for the Federal Government; and 
(ii) is familiar with trades related to building and 
real property, including construction, engineering, 
architecture, leasing, and strategic partnerships; and 
(E) at least three members represent congressionally 
chartered, membership-based, veterans service organiza-
tions. 
(d)MEETINGS.— 
(1) IN GENERAL.—The Commission shall meet only during 
calendar years 2022 and 2023. 
(2) PUBLIC NATURE OF MEETINGS AND PROCEEDINGS.— 
(A) PUBLIC MEETINGS.—Each meeting of the Commis-
sion shall be open to the public. 
(B) 
OPEN
PARTICIPATION.—All 
the 
proceedings, 
information, and deliberations of the Commission shall be 
available for review by the public. 
(e) VACANCIES.—A vacancy in the Commission shall be filled 
in the same manner as the original appointment, but the individual 
appointed to fill the vacancy shall serve only for the unexpired 
portion of the term for which the individual’s predecessor was 
appointed. 
(f) PAY.— 
(1) IN GENERAL.—Members of the Commission shall serve 
without pay. 
(2) OFFICERS OR EMPLOYEES OF THE UNITED STATES.—Each 
member of the Commission who is an officer or employee of 
the United States shall serve without compensation in addition 
to that received for service as an officer or employee of the 
United States. 
(3) TRAVEL
EXPENSES.—Members shall receive travel 
expenses, including per diem in lieu of subsistence, in accord-
ance with sections 5702 and 5703 of title 5, United States 
Code. 
(g) DIRECTOR OF STAFF.— 
(1) APPOINTMENT.—The Commission shall appoint a 
Director who— 
(A) has not served as an employee of the Department 
of Veterans Affairs during the 1-year period preceding the 
date of such appointment; and 
(B) is not otherwise barred or prohibited from serving 
as Director under Federal ethics laws and regulations, 
by reason of post-employment conflict of interest. 
(2) RATE OF PAY.—The Director shall be paid at the rate 
of basic pay payable for level IV of the Executive Schedule 
under section 5315 of title 5, United States Code. 
(h) STAFF.— 
Time period. 
Time period. 
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132 STAT. 1445 
PUBLIC LAW 115–182—JUNE 6, 2018 
(1) PAY
OF
PERSONNEL.—Subject to paragraphs (2) and 
(3), the Director, with the approval of the Commission, may 
appoint and fix the pay of additional personnel. 
(2) 
EXEMPTION
FROM
CERTAIN
REQUIREMENTS.—The 
Director may make such appointments without regard to the 
provisions of title 5, United States Code, governing appoint-
ments in the competitive service, and any personnel so 
appointed may be paid without regard to the provisions of 
chapter 51 and subchapter III of chapter 53 of that title relating 
to classification and General Schedule pay rates, except that 
an individual so appointed may not receive pay in excess of 
the annual rate of basic pay payable for GS–15 of the General 
Schedule. 
(3) DETAILEES.— 
(A) LIMITATION ON NUMBER.—Not more than two-thirds 
of the personnel employed by or detailed to the Commission 
may be on detail from the Department of Veterans Affairs. 
(B) PROFESSIONAL ANALYSTS.—Not more than half of 
the professional analysts of the Commission staff may be 
persons detailed from the Department of Veterans Affairs 
to the Commission. 
(C) PROHIBITION ON DETAIL OF CERTAIN PERSONNEL.— 
A person may not be detailed from the Department of 
Veterans Affairs to the Commission if, within 6 months 
before the detail is to begin, that person participated 
personally and substantially in any matter within the 
Department of Veterans Affairs concerning the preparation 
of recommendations regarding facilities of the Veterans 
Health Administration. 
(4) AUTHORITY TO REQUEST DETAILED PERSONNEL.—Subject 
to paragraph (3), the head of any Federal department or agency, 
upon the request of the Director, may detail any of the per-
sonnel of that department or agency to the Commission to 
assist the Commission in carrying out its duties under this 
subtitle. 
(5) INFORMATION FROM FEDERAL AGENCIES.—The Commis-
sion may secure directly from any Federal agency such informa-
tion the Commission considers necessary to carry out this sub-
title. Upon request of the Chair, the head of such agency 
shall furnish such information to the Commission. 
(i) OTHER AUTHORITY.— 
(1) 
TEMPORARY
AND
INTERMITTENT
SERVICES.—The 
Commission may procure by contract, to the extent funds are 
available, the temporary or intermittent services of experts 
or consultants pursuant to section 3109 of title 5, United States 
Code. 
(2) LEASING AND ACQUISITION OF PROPERTY.—To the extent 
funds are available, the Commission may lease real property 
and acquire personal property either of its own accord or in 
consultation with the General Services Administration. 
(j) 
TERMINATION.—The 
Commission 
shall 
terminate 
on 
December 31, 2023. 
(k) PROHIBITION AGAINST RESTRICTING COMMUNICATIONS.— 
(1) IN GENERAL.—Except as provided in paragraph (2), no 
person may restrict an employee of the Department of Veterans 
Affairs in communicating with the Commission. 
Consultation. 
Time period. 
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132 STAT. 1446 
PUBLIC LAW 115–182—JUNE 6, 2018 
(2) UNLAWFUL COMMUNICATIONS.—Paragraph (1) does not 
apply to a communication that is unlawful. 
SEC. 203. PROCEDURE FOR MAKING RECOMMENDATIONS. 
(a) SELECTION CRITERIA.— 
(1) PUBLICATION.—The Secretary shall, not later than Feb-
ruary 1, 2021, and after consulting with veterans service 
organizations, publish in the Federal Register and transmit 
to the Committees on Veterans’ Affairs of the Senate and 
the House of Representatives the criteria proposed to be used 
by the Department of Veterans Affairs in assessing and making 
recommendations regarding the modernization or realignment 
of facilities of the Veterans Health Administration under this 
subtitle. Such criteria shall include the preferences of veterans 
regarding health care furnished by the Department. 
(2) PUBLIC
COMMENT.—The Secretary shall provide an 
opportunity for public comment on the proposed criteria under 
paragraph (1) for a period of at least 90 days and shall include 
notice of that opportunity in the publication required under 
such paragraph. 
(3) PUBLICATION OF FINAL CRITERIA.—The Secretary shall, 
not later than May 31, 2021, publish in the Federal Register 
and transmit to the Committees on Veterans’ Affairs of the 
Senate and the House of Representatives the final criteria 
to be used in making recommendations regarding the closure, 
modernization, or realignment of facilities of the Veterans 
Health Administration under this subtitle. 
(b) RECOMMENDATIONS OF THE SECRETARY.— 
(1) PUBLICATION
IN
FEDERAL
REGISTER.—The Secretary 
shall, not later than January 31, 2022, and after consulting 
with veterans service organizations, publish in the Federal 
Register and transmit to the Committees on Veterans’ Affairs 
of the Senate and the House of Representatives and to the 
Commission a report detailing the recommendations regarding 
the modernization or realignment of facilities of the Veterans 
Health Administration on the basis of the final criteria referred 
to in subsection (a)(2) that are applicable. 
(2) FACTORS FOR CONSIDERATION.—In making recommenda-
tions under this subsection, the Secretary shall consider each 
of the following factors: 
(A) The degree to which any health care delivery or 
other site for providing services to veterans reflect the 
metrics of the Department of Veterans Affairs regarding 
market area health system planning. 
(B) The provision of effective and efficient access to 
high-quality health care and services for veterans. 
(C) The extent to which the real property that no 
longer meets the needs of the Federal Government could 
be 
reconfigured, 
repurposed, 
consolidated, 
realigned, 
exchanged, outleased, replaced, sold, or disposed. 
(D) The need of the Veterans Health Administration 
to acquire infrastructure or facilities that will be used 
for the provision of health care and services to veterans. 
(E) The extent to which the operating and maintenance 
costs are reduced through consolidating, colocating, and 
reconfiguring space, and through realizing other oper-
ational efficiencies. 
Consultation. 
Reports. 
Deadline. 
Federal Register, 
publication. 
Time period. 
Notice. 
Deadline. 
Consultation. 
Federal Register, 
publication. 
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132 STAT. 1447 
PUBLIC LAW 115–182—JUNE 6, 2018 
(F) The extent and timing of potential costs and 
savings, including the number of years such costs or 
savings will be incurred, beginning with the date of comple-
tion of the proposed recommendation. 
(G) The extent to which the real property aligns with 
the mission of the Department of Veterans Affairs. 
(H) The extent to which any action would impact other 
missions of the Department (including education, research, 
or emergency preparedness). 
(I) Local stakeholder inputs and any factors identified 
through public field hearings. 
(J) The assessments under paragraph (3). 
(K) The extent to which the Veterans Health Adminis-
tration has appropriately staffed the medical facility, 
including determinations whether there has been insuffi-
cient resource allocation or deliberate understaffing. 
(L) Any other such factors the Secretary determines 
appropriate. 
(3) CAPACITY AND COMMERCIAL MARKET ASSESSMENTS.— 
(A) ASSESSMENTS.—The Secretary shall assess the 
capacity of each Veterans Integrated Service Network and 
medical facility of the Department to furnish hospital care 
or medical services to veterans under chapter 17 of title 
38, United States Code. Each such assessment shall— 
(i) identify gaps in furnishing such care or services 
at such Veterans Integrated Service Network or med-
ical facility; 
(ii) identify how such gaps can be filled by— 
(I) entering into contracts or agreements with 
network providers under this section or with enti-
ties under other provisions of law; 
(II) making changes in the way such care and 
services are furnished at such Veterans Integrated 
Service Network or medical facility, including— 
(aa) extending hours of operation; 
(bb) adding personnel; or 
(cc) expanding space through the construc-
tion, leasing, or sharing of health care facili-
ties; and 
(III) the building or realignment of Depart-
ment resources or personnel; 
(iii) forecast, based on future projections and 
historical trends, both the short- and long-term demand 
in furnishing care or services at such Veterans 
Integrated Service Network or medical facility and 
assess how such demand affects the needs to use such 
network providers; 
(iv) include a commercial health care market 
assessment of designated catchment areas in the 
United States conducted by a non-governmental entity; 
and 
(v) consider the unique ability of the Federal 
Government to retain a presence in an area otherwise 
devoid of commercial health care providers or from 
which such providers are at risk of leaving. 
(B) CONSULTATION.—In carrying out the assessments 
under subparagraph (A), the Secretary shall consult with 
Contracts. 
Determinations. 
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132 STAT. 1448 
PUBLIC LAW 115–182—JUNE 6, 2018 
veterans service organizations and veterans served by each 
such Veterans Integrated Service Network and medical 
facility. 
(C) SUBMITTAL.—The Secretary shall submit such 
assessments to the Committees on Veterans’ Affairs of 
the House of Representatives and the Senate with the 
recommendations of the Secretary under this subsection 
and make the assessments publicly available. 
(4) SUMMARY OF SELECTION PROCESS.—The Secretary shall 
include, with the list of recommendations published and trans-
mitted pursuant to paragraph (1), a summary of the selection 
process that resulted in the recommendation for each facility 
of the Veterans Health Administration, including a justification 
for each recommendation. The Secretary shall transmit the 
matters referred to in the preceding sentence not later than 
7 days after the date of the transmittal to the Committees 
on Veterans’ Affairs of the Senate and the House of Representa-
tives and the Commission of the report referred to in paragraph 
(1). 
(5) TREATMENT OF FACILITIES.—In assessing facilities of 
the Veterans Health Administration, the Secretary shall con-
sider all such facilities equally without regard to whether the 
facility has been previously considered or proposed for reuse, 
closure, modernization, or realignment by the Department of 
Veterans Affairs. 
(6) AVAILABILITY OF INFORMATION TO CONGRESS.—In addi-
tion to making all information used by the Secretary to prepare 
the recommendations under this subsection available to Con-
gress (including any committee or Member of Congress), the 
Secretary shall also make such information available to the 
Commission and the Comptroller General of the United States. 
(7) CERTIFICATION OF ACCURACY.— 
(A) IN GENERAL.—Each person referred to in subpara-
graph (B), when submitting information to the Secretary 
or the Commission concerning the modernization or realign-
ment of a facility of the Veterans Health Administration, 
shall certify that such information is accurate and complete 
to the best of that person’s knowledge and belief. 
(B) COVERED PERSONS.—Subparagraph (A) applies to 
the following persons: 
(i) Each Under Secretary of the Department of 
Veterans Affairs. 
(ii) Each director of a Veterans Integrated Service 
Network. 
(iii) Each director of a medical center of the Depart-
ment of Veterans Affairs. 
(iv) Each director of a program office of the Depart-
ment of Veterans Affairs. 
(v) Each person who is in a position the duties 
of which include personal and substantial involvement 
in the preparation and submission of information and 
recommendations concerning the modernization or 
realignment of facilities of the Veterans Health 
Administration. 
(c) REVIEW AND RECOMMENDATIONS BY THE COMMISSION.— 
(1) PUBLIC HEARINGS.— 
Deadline. 
Public 
information. 
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132 STAT. 1449 
PUBLIC LAW 115–182—JUNE 6, 2018 
(A) IN GENERAL.—After receiving the recommendations 
from the Secretary pursuant to subsection (b), the Commis-
sion shall conduct public hearings on the recommendations. 
(B) LOCATIONS.—The Commission shall conduct public 
hearings in regions affected by a recommendation of the 
Secretary to close a facility of the Veterans Health Adminis-
tration. To the greatest extent practicable, the Commission 
shall conduct public hearings in regions affected by a rec-
ommendation of the Secretary to modernize or realign such 
a facility. 
(C) REQUIRED WITNESSES.—Witnesses at each public 
hearing shall include at a minimum— 
(i) a veteran— 
(I) enrolled under section 1705 of title 38, 
United States Code; and 
(II) identified by a local veterans service 
organization; and 
(ii) a local elected official. 
(2) TRANSMITTAL TO PRESIDENT.— 
(A) IN GENERAL.—The Commission shall, not later than 
January 31, 2023, transmit to the President a report con-
taining the Commission’s findings and conclusions based 
on a review and analysis of the recommendations made 
by the Secretary, together with the Commission’s rec-
ommendations, for modernizations and realignments of 
facilities of the Veterans Health Administration. 
(B) AUTHORITY TO MAKE CHANGES TO RECOMMENDA-
TIONS.—Subject to subparagraph (C), in making its rec-
ommendations, the Commission may change any rec-
ommendation made by the Secretary if the Commission— 
(i) determines that the Secretary deviated substan-
tially from the final criteria referred to in subsection 
(a)(2) in making such recommendation; 
(ii) determines that the change is consistent with 
the final criteria referred to in subsection (a)(2); 
(iii) publishes a notice of the proposed change in 
the Federal Register not less than 45 days before 
transmitting its recommendations to the President 
pursuant to subparagraph (A); and 
(iv) conducts public hearings on the proposed 
change. 
(3) JUSTIFICATION FOR CHANGES.—The Commission shall 
explain and justify in its report submitted to the President 
pursuant to paragraph (2) any recommendation made by the 
Commission that is different from the recommendations made 
by the Secretary pursuant to subsection (b). The Commission 
shall transmit a copy of such report to the Committees on 
Veterans’ Affairs of the Senate and the House of Representa-
tives on the same date on which it transmits its recommenda-
tions to the President under paragraph (2). 
(4) PROVISION OF INFORMATION TO CONGRESS.—After the 
Commission transmits its report to the President, the Commis-
sion shall promptly provide, upon request, to any Member 
of Congress, information used by the Commission in making 
its recommendations. 
(d) REVIEW BY THE PRESIDENT.— 
Reports. 
Notice. 
Federal Register, 
publication. 
Time period. 
Determinations. 
Reports. 
Analysis. 
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132 STAT. 1450 
PUBLIC LAW 115–182—JUNE 6, 2018 
(1) REPORT.—The President shall, not later than February 
15, 2023, transmit to the Commission and to the Congress 
a report containing the President’s approval or disapproval 
of the Commission’s recommendations. 
(2) PRESIDENTIAL APPROVAL.—If the President approves all 
the recommendations of the Commission, the President shall 
transmit a copy of such recommendations to the Congress, 
together with a certification of such approval. 
(3) PRESIDENTIAL
DISAPPROVAL.—If the President dis-
approves the recommendations of the Commission, in whole 
or in part, the President shall transmit to the Commission 
and the Congress, not later than March 1, 2023, the reasons 
for that disapproval. The Commission, after consideration of 
the President’s reasons for disapproval, shall then transmit 
to the President, not later than March 15, 2023, a report 
containing— 
(A) the Commission’s findings and conclusions based 
on a review and analysis of those reasons for disapproval 
provided by the President; and 
(B) recommendations that the Commission determines 
are appropriate for modernizations and realignments of 
facilities of the Veterans Health Administration. 
(4) TRANSMITTAL
OF
RECOMMENDATIONS
TO
CONGRESS.— 
If the President approves all recommendations of the Commis-
sion transmitted to the President under paragraph (3), the 
President shall transmit a copy of such recommendations to 
the Congress, together with a certification of such approval. 
(5) FAILURE
TO
TRANSMIT.—If the President does not 
transmit to the Congress an approval and certification described 
in paragraph (2) or (4) by March 30, 2023, the process by 
which facilities of the Veterans Health Administration may 
be selected for modernization or realignment under this subtitle 
shall be terminated. 
SEC. 204. ACTIONS REGARDING INFRASTRUCTURE AND FACILITIES 
OF THE VETERANS HEALTH ADMINISTRATION. 
(a) IN GENERAL.—Subject to subsection (b), the Secretary shall 
begin to implement the recommended modernizations and realign-
ments in the report under section 203(d) not later than 3 years 
after the date on which the President transmits such report to 
Congress. In any fiscal year, such implementation includes— 
(1) the planning of modernizations and realignments of 
facilities of the Veterans Health Administration as rec-
ommended in such report; and 
(2) providing detailed information on the budget for such 
modernizations or realignments in documents submitted to Con-
gress by the Secretary in support of the President’s budget 
for that fiscal year. 
(b) CONGRESSIONAL DISAPPROVAL.— 
(1) IN GENERAL.—The Secretary may not carry out any 
modernization or realignment recommended by the Commission 
in a report transmitted from the President pursuant to section 
203(d) if a joint resolution is enacted, in accordance with the 
provisions of section 207, disapproving such recommendations 
of the Commission before the earlier of— 
(A) the end of the 45-day period beginning on the 
date on which the President transmits such report; or 
Time period. 
Deadline. 
Deadline. 
Certification. 
Reports. 
Deadlines. 
Certification. 
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132 STAT. 1451 
PUBLIC LAW 115–182—JUNE 6, 2018 
(B) the adjournment of Congress sine die for the session 
during which such report is transmitted. 
(2) COMPUTATION OF PERIOD.—For purposes of paragraph 
(1) and subsections (a) and (c) of section 207, the days on 
which either House of Congress is not in session because of 
an adjournment of more than three days to a day certain 
shall be excluded in the computation of a period. 
SEC. 205. IMPLEMENTATION. 
(a) IN GENERAL.— 
(1) MODERNIZING AND REALIGNING FACILITIES.—In modern-
izing or realigning any facility of the Veterans Health Adminis-
tration under this subtitle, the Secretary may— 
(A) take such actions as may be necessary to modernize 
or realign any such facility, including the alteration of 
such facilities, the acquisition of such land, the leasing 
or construction of such replacement facilities, the disposi-
tion of such land or facilities, the performance of such 
activities, and the conduct of such advance planning and 
design as may be required to transfer functions from a 
facility of the Veterans Health Administration to another 
such facility, and may use for such purpose funds in the 
Account or funds appropriated to the Department of Vet-
erans Affairs for such purposes; 
(B) carry out activities for the purposes of environ-
mental mitigation, abatement, or restoration at any such 
facility, and shall use for such purposes funds in the 
Account; 
(C) reimburse other Federal agencies for actions per-
formed at the request of the Secretary with respect to 
any such closure or realignment, and may use for such 
purpose funds in the Account or funds appropriated to 
the Department of Veterans Affairs and available for such 
purpose; and 
(D) exercise the authority of the Secretary under sub-
chapter V of chapter 81 of title 38, United States Code. 
(2) ENVIRONMENTAL
RESTORATION; HISTORIC
PRESERVA-
TION.—In carrying out any closure or realignment under this 
subtitle, the Secretary, with regards to any property made 
excess to the needs of the Department of Veterans Affairs 
as a result of such closure or realignment, shall carry out, 
as soon as possible with funds available for such purpose, 
any of the following for which the Secretary is responsible: 
(A) Environmental mitigation. 
(B) Environmental abatement. 
(C) Environmental restoration. 
(D) Compliance with historic preservation require-
ments. 
(b) MANAGEMENT AND DISPOSAL OF PROPERTY.— 
(1) EXISTING DISPOSAL AUTHORITIES.—To transfer or dispose 
of surplus real property or infrastructure located at any facility 
of the Veterans Health Administration that is modernized or 
realigned under this title, the Secretary may exercise the 
authorities of the Secretary under subchapters I and II of 
chapter 81 of title 38, United States Code, or the authorities 
delegated to the Secretary by the Administrator of General 
Reimbursement. 
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132 STAT. 1452 
PUBLIC LAW 115–182—JUNE 6, 2018 
Services under subchapter III of chapter 5 of title 40, United 
States Code. 
(2) EFFECTS ON LOCAL COMMUNITIES.— 
(A) CONSULTATION
WITH
STATE
AND
LOCAL
GOVERN-
MENT.—Before any action may be taken with respect to 
the disposal of any surplus real property or infrastructure 
located at any facility of the Veterans Health Administra-
tion to be closed or realigned under this subtitle, the Sec-
retary of Veterans Affairs shall consult with the Governor 
of the State and the heads of the local governments con-
cerned for the purpose of considering any plan for the 
use of such property by the local community concerned. 
(B) TREATMENT
OF
ROADS.—If infrastructure or a 
facility of the Veterans Health Administration to be closed 
or realigned under this subtitle includes a road used for 
public access through, into, or around the facility, the Sec-
retary— 
(i) shall consult with the Government of the State 
and the heads of the local governments concerned for 
the purpose of considering the continued availability 
of the road for public use after the recommended action 
is complete; and 
(ii) may exercise the authority of the Secretary 
under section 8108 of title 38, United States Code. 
(3) LEASES; CERCLA.— 
(A) LEASE AUTHORITY.— 
(i) TRANSFER TO REDEVELOPMENT AUTHORITY FOR 
LEASE.—The Secretary may transfer title to a facility 
of the Veterans Health Administration approved for 
closure or realignment under this subtitle (including 
property at a facility of the Veterans Health Adminis-
tration approved for realignment which will be retained 
by the Department of Veterans Affairs or another Fed-
eral agency after realignment) to the redevelopment 
authority for the facility if the redevelopment authority 
agrees to lease, directly upon transfer, one or more 
portions of the property transferred under this 
subparagraph to the Secretary or to the head of another 
department or agency of the Federal Government. 
(ii) TERM OF LEASE.—A lease under clause (i) shall 
be for a term of not to exceed 50 years, but may 
provide for options for renewal or extension of the 
term by the department or agency concerned. 
(iii) LIMITATION.—A lease under clause (i) may 
not require rental payments by the United States. 
(iv) TREATMENT OF REMAINDERED LEASE TERMS.— 
A lease under clause (i) shall include a provision speci-
fying that if the department or agency concerned ceases 
requiring the use of the leased property before the 
expiration of the term of the lease, the remainder 
of the lease term may be satisfied by the same or 
another department or agency of the Federal Govern-
ment using the property for a use similar to the use 
under the lease. Exercise of the authority provided 
by this clause shall be made in consultation with the 
redevelopment authority concerned. 
Consultation. 
Consultation. 
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132 STAT. 1453 
PUBLIC LAW 115–182—JUNE 6, 2018 
(v) FACILITY
SERVICES.—Notwithstanding clause 
(iii), if a lease under clause (i) involves a substantial 
portion of the facility, the department or agency con-
cerned may obtain facility services for the leased prop-
erty and common area maintenance from the redevel-
opment authority or the redevelopment authority’s 
assignee as a provision of the lease. The facility serv-
ices and common area maintenance shall be provided 
at a rate no higher than the rate charged to non- 
Federal tenants of the transferred property. Facility 
services and common area maintenance covered by 
the lease shall not include— 
(I) municipal services that a State or local 
government is required by law to provide to all 
landowners in its jurisdiction without direct 
charge; or 
(II) firefighting or security-guard functions. 
(B) APPLICATION OF CERCLA.—The provisions of section 
120(h) of the Comprehensive Environmental Response, 
Compensation, and Liability Act of 1980 (42 U.S.C. 9620(h)) 
shall apply to any transfer of real property under this 
paragraph. 
(C) ADDITIONAL
TERMS
AND
CONDITIONS.—The Sec-
retary may require any additional terms and conditions 
in connection with a transfer under this paragraph as 
such Secretary considers appropriate to protect the 
interests of the United States. 
(4) APPLICATION OF MCKINNEY-VENTO HOMELESS ASSISTANCE 
ACT.—Nothing in this subtitle shall limit or otherwise affect 
the application of the provisions of the McKinney-Vento Home-
less Assistance Act (42 U.S.C. 11301 et seq.) to facilities of 
the Veterans Health Administration closed under this subtitle. 
(c) APPLICABILITY OF NATIONAL ENVIRONMENTAL POLICY ACT 
OF 1969.— 
(1) IN GENERAL.—The provisions of the National Environ-
mental Policy Act of 1969 (42 U.S.C. 4321 et seq.) shall not 
apply to the actions of the President, the Commission, and, 
except as provided in paragraph (2), the Department of Vet-
erans Affairs in carrying out this subtitle. 
(2) DEPARTMENT OF VETERANS AFFAIRS.— 
(A) COVERED
ACTIVITIES.—The provisions of the 
National Environmental Policy Act of 1969 shall apply 
to actions of the Department of Veterans Affairs under 
this subtitle— 
(i) during the process of property disposal; and 
(ii) during the process of relocating functions from 
a facility of the Veterans Health Administration being 
closed or realigned to another facility after the 
receiving facility has been selected but before the func-
tions are relocated. 
(B) OTHER ACTIVITIES.—In applying the provisions of 
the National Environmental Policy Act of 1969 to the proc-
esses referred to in subparagraph (A), the Secretary shall 
not have to consider— 
(i) the need for closing or realigning the facility 
of the Veterans Health Administration as rec-
ommended by the Commission; 
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132 STAT. 1454 
PUBLIC LAW 115–182—JUNE 6, 2018 
(ii) the need for transferring functions to any 
facility of the Veterans Health Administration which 
has been selected as the receiving facility; or 
(iii) facilities of the Veterans Health Administra-
tion alternative to those recommended or selected. 
(d) WAIVER.— 
(1) RESTRICTIONS ON USE OF FUNDS.—The Secretary may 
close or realign facilities of the Veterans Health Administration 
under this subtitle without regard to any provision of law 
restricting the use of funds for closing or realigning facilities 
of the Veterans Health Administration included in any appro-
priation or authorization Act. 
(2) RESTRICTIONS
ON
AUTHORITIES.—The Secretary may 
close or realign facilities of the Veterans Health Administration 
under this subtitle without regard to the restrictions of section 
8110 of title 38, United States Code. 
(e) TRANSFER AUTHORITY IN CONNECTION WITH PAYMENT OF 
ENVIRONMENTAL REMEDIATION COSTS.— 
(1) IN GENERAL.— 
(A) TRANSFER BY DEED.—Subject to paragraph (2) of 
this subsection and section 120(h) of the Comprehensive 
Environmental Response, Compensation, and Liability Act 
of 1980 (42 U.S.C. 9620(h)), the Secretary may enter into 
an agreement to transfer by deed a facility of the Veterans 
Health Administration with any person who agrees to per-
form all environmental restoration, waste management, 
and environmental compliance activities that are required 
for the property or facilities under Federal and State laws, 
administrative decisions, agreements (including schedules 
and milestones), and concurrences. 
(B) ADDITIONAL TERMS OR CONDITIONS.—The Secretary 
may require any additional terms and conditions in connec-
tion with an agreement authorized by subparagraph (A) 
as the Secretary considers appropriate to protect the 
interests of the United States. 
(2) LIMITATION.—A transfer of a facility of the Veterans 
Health Administration may be made under paragraph (1) only 
if the Secretary certifies to Congress that— 
(A) the costs of all environmental restoration, waste 
management, and environmental compliance activities 
otherwise to be paid by the Secretary with respect to the 
facility of the Veterans Health Administration are equal 
to or greater than the fair market value of the property 
or facilities to be transferred, as determined by the Sec-
retary; or 
(B) if such costs are lower than the fair market value 
of the facility of the Veterans Health Administration, the 
recipient of such transfer agrees to pay the difference 
between the fair market value and such costs. 
(3) PAYMENT BY THE SECRETARY FOR CERTAIN TRANSFERS.— 
In the case of a facility of the Veterans Health Administration 
covered by a certification under paragraph (2)(A), the Secretary 
may pay the recipient of such facility an amount equal to 
the lesser of— 
(A) the amount by which the costs incurred by the 
recipient of the facility of the Veterans Health Administra-
tion for all environmental restoration, waste, management, 
Certification. 
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132 STAT. 1455 
PUBLIC LAW 115–182—JUNE 6, 2018 
and environmental compliance activities with respect to 
such facility exceed the fair market value of such property 
as specified in such certification; or 
(B) the amount by which the costs (as determined 
by the Secretary) that would otherwise have been incurred 
by the Secretary for such restoration, management, and 
activities with respect to such facility of the Veterans 
Health Administration exceed the fair market value of 
property as so specified. 
(4) DISCLOSURE.—As part of an agreement under paragraph 
(1), the Secretary shall disclose to the person to whom the 
facility of the Veterans Health Administration will be trans-
ferred any information of the Secretary regarding the environ-
mental restoration, waste management, and environmental 
compliance activities described in paragraph (1) that relate 
to the facility of the Veterans Health Administration. The Sec-
retary shall provide such information before entering into the 
agreement. 
(5) APPLICABILITY
OF
CERTAIN
ENVIRONMENTAL
LAWS.— 
Nothing in this subsection shall be construed to modify, alter, 
or amend the Comprehensive Environmental Response, Com-
pensation, and Liability Act of 1980 (42 U.S.C. 9601 et seq.) 
or the Solid Waste Disposal Act (42 U.S.C. 6901 et seq.). 
SEC. 206. DEPARTMENT OF VETERANS AFFAIRS ASSET AND INFRA-
STRUCTURE REVIEW ACCOUNT. 
(a) ESTABLISHMENT.—There is hereby established in the ledgers 
of the Treasury an account to be known as the ‘‘Department of 
Veterans Affairs Asset and Infrastructure Review Account’’ which 
shall be administered by the Secretary as a single account. 
(b) CREDITS
TO ACCOUNT.—There shall be credited to the 
Account the following: 
(1) Funds authorized for and appropriated to the Account. 
(2) Proceeds received from the lease, transfer, or disposal 
of any property at a facility of the Veterans Health Administra-
tion closed or realigned under this subtitle. 
(c) USE OF ACCOUNT.—The Secretary may use the funds in 
the Account only for the following purposes: 
(1) To carry out this subtitle. 
(2) To cover property management and disposal costs 
incurred at facilities of the Veterans Health Administration 
closed, modernized, or realigned under this subtitle. 
(3) To cover costs associated with supervision, inspection, 
overhead, engineering, and design of construction projects 
undertaken under this subtitle, and subsequent claims, if any, 
related to such activities. 
(4) Other purposes that the Secretary determines support 
the mission and operations of the Department of Veterans 
Affairs. 
(d) 
CONSOLIDATED
BUDGET
JUSTIFICATION
DISPLAY
FOR 
ACCOUNT.— 
(1) CONSOLIDATED BUDGET INFORMATION REQUIRED.—The 
Secretary shall establish a consolidated budget justification 
display in support of the Account that for each fiscal year— 
(A) details the amount and nature of credits to, and 
expenditures from, the Account during the preceding fiscal 
year; 
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132 STAT. 1456 
PUBLIC LAW 115–182—JUNE 6, 2018 
(B) separately details the environmental remediation 
costs associated with facility of the Veterans Health 
Administration for which a budget request is made; 
(C) specifies the transfers into the Account and the 
purposes for which these transferred funds will be further 
obligated, to include caretaker and environment remedi-
ation costs associated with each facility of the Veterans 
Health Administration; and 
(D) details any intra-budget activity transfers within 
the Account that exceeded $1,000,000 during the preceding 
fiscal year or that are proposed for the next fiscal year 
and will exceed $1,000,000. 
(2) SUBMISSION.—The Secretary shall include the informa-
tion required by paragraph (1) in the materials that the Sec-
retary submits to Congress in support of the budget for a 
fiscal year submitted by the President pursuant to section 
1105 of title 31, United States Code. 
(e) CLOSURE OF ACCOUNT; TREATMENT OF REMAINING FUNDS.— 
(1) CLOSURE.—The Account shall be closed at the time 
and in the manner provided for appropriation accounts under 
section 1555 of title 31, United States Code, except that unobli-
gated funds which remain in the Account upon closure shall 
be held by the Secretary of the Treasury until transferred 
to the Secretary of Veterans Affairs by law after the Committees 
on Veterans’ Affairs of the Senate and the House of Representa-
tives receive the final report transmitted under paragraph (2). 
(2) FINAL REPORT.—No later than 60 days after the closure 
of the Account under paragraph (1), the Secretary shall 
transmit to the Committees on Veterans’ Affairs of the Senate 
and the House of Representatives and the Committees on 
Appropriations of the House of Representatives and the Senate 
a report containing an accounting of— 
(A) all the funds credited to and expended from the 
Account or otherwise expended under this subtitle; and 
(B) any funds remaining in the Account. 
SEC. 207. CONGRESSIONAL CONSIDERATION OF COMMISSION REPORT. 
(a) DISAPPROVAL RESOLUTION.—For purposes of this subtitle, 
the term ‘‘joint resolution’’ means only a joint resolution which 
is introduced within the 5-day period beginning on the date on 
which the President transmits the report to the Congress under 
section 203(d), and— 
(1) which does not have a preamble; 
(2) the matter after the resolving clause of which is as 
follows: ‘‘that Congress disapproves the recommendations of 
the VHA Asset and Infrastructure Review Commission as sub-
mitted by the President on lll’’, the blank space being 
filled with the appropriate date; and 
(3) the title of which is as follows: ‘‘Joint resolution dis-
approving the recommendations of the VHA Asset and Infra-
structure Review Commission.’’. 
(b) CONSIDERATION IN THE HOUSE OF REPRESENTATIVES.— 
(1) REPORTING
AND
DISCHARGE.—Any committee of the 
House of Representatives to which a joint resolution is referred 
shall report it to the House without amendment not later 
than 15 legislative days after the date of introduction thereof. 
If a committee fails to report the joint resolution within that 
Definition. 
Time period. 
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132 STAT. 1457 
PUBLIC LAW 115–182—JUNE 6, 2018 
period, the committee shall be discharged from further consider-
ation of the joint resolution. 
(2) PROCEEDING TO CONSIDERATION.—It shall be in order 
at any time after the third legislative day after each committee 
authorized to consider a joint resolution has reported or has 
been discharged from consideration of a joint resolution, to 
move to proceed to consider the joint resolution in the House. 
All points of order against the motion are waived. Such a 
motion shall not be in order after the House has disposed 
of a motion to proceed on a joint resolution addressing a par-
ticular submission. The previous question shall be considered 
as ordered on the motion to its adoption without intervening 
motion. The motion shall not be debatable. A motion to 
reconsider the vote by which the motion is disposed of shall 
not be in order. 
(3) CONSIDERATION.—The joint resolution shall be consid-
ered as read. All points of order against the joint resolution 
and against its consideration are waived. The previous question 
shall be considered as ordered on the joint resolution to its 
passage without intervening motion except 2 hours of debate 
equally divided and controlled by the proponent and an oppo-
nent. A motion to reconsider the vote on passage of the joint 
resolution shall not be in order. 
(c) CONSIDERATION IN THE SENATE.— 
(1) REFERRAL.—A joint resolution introduced in the Senate 
shall be referred to the Committee on Veterans’ Affairs. 
(2) REPORTING
AND
DISCHARGE.—Any committee of the 
Senate to which a joint resolution is referred shall report it 
to the Senate without amendment not later than 15 session 
days after the date of introduction of a joint resolution described 
in subsection (a). If a committee fails to report the joint resolu-
tion within that period, the committee shall be discharged 
from further consideration of the joint resolution and the joint 
resolution shall be placed on the calendar. 
(3) FLOOR CONSIDERATION.— 
(A) IN GENERAL.—Notwithstanding Rule XXII of the 
Standing Rules of the Senate, it is in order at any time 
after the third session day on which the Committee on 
Veterans’ Affairs has reported or has been discharged from 
consideration of a joint resolution described in subsection 
(a) (even though a previous motion to the same effect 
has been disagreed to) to move to proceed to the consider-
ation of the joint resolution, and all points of order against 
the joint resolution (and against consideration of the joint 
resolution) are waived. The motion to proceed is not debat-
able. The motion is not subject to a motion to postpone. 
A motion to reconsider the vote by which the motion is 
agreed to or disagreed to shall not be in order. If a motion 
to proceed to the consideration of the resolution is agreed 
to, the joint resolution shall remain the unfinished business 
until disposed of. 
(B) CONSIDERATION.—Consideration of the joint resolu-
tion, and on all debatable motions and appeals in connec-
tion therewith, shall be limited to not more than 2 hours, 
which shall be divided equally between the majority and 
minority leaders or their designees. A motion further to 
limit debate is in order and not debatable. An amendment 
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132 STAT. 1458 
PUBLIC LAW 115–182—JUNE 6, 2018 
to, or a motion to postpone, or a motion to proceed to 
the consideration of other business, or a motion to recommit 
the joint resolution is not in order. 
(C) VOTE
ON
PASSAGE.—If the Senate has voted to 
proceed to a joint resolution, the vote on passage of the 
joint resolution shall occur immediately following the 
conclusion of consideration of the joint resolution, and a 
single quorum call at the conclusion of the debate if 
requested in accordance with the rules of the Senate. 
(D) RULINGS OF THE CHAIR ON PROCEDURE.—Appeals 
from the decisions of the Chair relating to the application 
of the rules of the Senate, as the case may be, to the 
procedure relating to a joint resolution shall be decided 
without debate. 
(d) AMENDMENT NOT
IN ORDER.—A joint resolution of dis-
approval considered pursuant to this section shall not be subject 
to amendment in either the House of Representatives or the Senate. 
(e) COORDINATION WITH ACTION BY OTHER HOUSE.— 
(1) IN GENERAL.—If, before the passage by one House of 
the joint resolution of that House, that House receives the 
joint resolution from the other House, then the following proce-
dures shall apply: 
(A) The joint resolution of the other House shall not 
be referred to a committee. 
(B) With respect to the joint resolution of the House 
receiving the joint resolution— 
(i) the procedure in that House shall be the same 
as if no joint resolution had been received from the 
other House; but 
(ii) the vote on passage shall be on the joint resolu-
tion of the other House. 
(2) TREATMENT OF JOINT RESOLUTION OF OTHER HOUSE.— 
If the Senate fails to introduce or consider a joint resolution 
under this section, the joint resolution of the House shall be 
entitled to expedited floor procedures under this section. 
(3) TREATMENT
OF
COMPANION
MEASURES.—If, following 
passage of the joint resolution in the Senate, the Senate then 
receives the companion measure from the House of Representa-
tives, the companion measure shall not be debatable. 
(f) RULES OF THE HOUSE OF REPRESENTATIVES AND SENATE.— 
This section is enacted by Congress— 
(1) as an exercise of the rulemaking power of the Senate 
and House of Representatives, respectively, and as such it 
is deemed a part of the rules of each House, respectively, 
but applicable only with respect to the procedure to be followed 
in that House in the case of a joint resolution, and it supersedes 
other rules only to the extent that it is inconsistent with such 
rules; and 
(2) with full recognition of the constitutional right of either 
House to change the rules (so far as relating to the procedure 
of that House) at any time, in the same manner, and to the 
same extent as in the case of any other rule of that House. 
SEC. 208. OTHER MATTERS. 
(a) ONLINE PUBLICATION OF COMMUNICATIONS.— 
(1) IN GENERAL.—Not later than 24 hours after the trans-
mission or receipt of any communication under this subtitle 
Deadline. 
Procedures. 
Applicability. 
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132 STAT. 1459 
PUBLIC LAW 115–182—JUNE 6, 2018 
that is transmitted or received by a party specified in paragraph 
(2), the Secretary of Veterans Affairs shall publish such commu-
nication online. 
(2) PARTIES SPECIFIED.—The parties specified under this 
paragraph are the following: 
(A) The Secretary of Veterans Affairs. 
(B) The Commission. 
(C) The President. 
(b) CONTINUATION OF EXISTING CONSTRUCTION PROJECTS AND 
PLANNING.—During activities that the Commission, President, or 
Congress carry out under this subtitle, the Secretary of Veterans 
Affairs may not stop, solely because of such activities— 
(1) a construction or leasing project of the Veterans Health 
Administration; 
(2) long term planning regarding infrastructure and assets 
of the Veterans Health Administration; or 
(3) budgetary processes for the Veterans Health Adminis-
tration. 
(c) RECOMMENDATIONS FOR FUTURE ASSET REVIEWS.—The Sec-
retary of Veterans Affairs may, after consulting with veterans 
service organizations, include in budget submissions the Secretary 
submits after the termination of the Commission recommendations 
for future such commissions or other capital asset realignment 
and management processes. 
SEC. 209. DEFINITIONS. 
In this subtitle: 
(1) The term ‘‘Account’’ means the Department of Veterans 
Affairs Asset and Infrastructure Review Account established 
by section 206(a). 
(2) The term ‘‘Commission’’ means the Commission estab-
lished by section 202. 
(3) The term ‘‘date of approval’’, with respect to a mod-
ernization or realignment of a facility of the Veterans Health 
Administration, means the date on which the authority of Con-
gress to disapprove a recommendation of modernization or 
realignment, as the case may be, of such facility under this 
subtitle expires. 
(4) The term ‘‘facility of the Veterans Health Administra-
tion’’— 
(A) means any land, building, structure, or infrastruc-
ture (including any medical center, nursing home, domi-
ciliary facility, outpatient clinic, center that provides 
readjustment counseling, or leased facility) that is— 
(i) under the jurisdiction of the Department of 
Veterans Affairs; 
(ii) under the control of the Veterans Health 
Administration; and 
(iii) not under the control of the General Services 
Administration; or 
(B) with respect to a colocated facility of the Depart-
ment of Veterans Affairs, includes any land, building, or 
structure— 
(i) under the jurisdiction of the Department of 
Veterans Affairs; 
(ii) under the control of another administration 
of the Department of Veterans Affairs; and 
Consultation. 
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132 STAT. 1460 
PUBLIC LAW 115–182—JUNE 6, 2018 
(iii) not under the control of the General Services 
Administration. 
(5) The term ‘‘infrastructure’’ means improvements to land 
other than buildings or structures. 
(6) The term ‘‘modernization’’ includes— 
(A) any action, including closure, required to align 
the form and function of a facility of the Veterans Health 
Administration to the provision of modern day health care, 
including utilities and environmental control systems; 
(B) the construction, purchase, lease, or sharing of 
a facility of the Veterans Health Administration; and 
(C) realignments, disposals, exchanges, collaborations 
between the Department of Veterans Affairs and other 
Federal entities, and strategic collaborations between the 
Department and non-Federal entities, including tribal 
organizations. 
(7) The term ‘‘realignment’’, with respect to a facility of 
the Veterans Health Administration, includes— 
(A) any action that changes the numbers of or relocates 
services, functions, and personnel positions; 
(B) disposals or exchanges between the Department 
of Veterans Affairs and other Federal entities, including 
the Department of Defense; and 
(C) strategic collaborations between the Department 
of Veterans Affairs and non-Federal entities, including 
tribal organizations. 
(8) The term ‘‘redevelopment authority’’, in the case of 
a facility of the Veterans Health Administration closed or mod-
ernized under this subtitle, means any entity (including an 
entity established by a State or local government) recognized 
by the Secretary of Veterans Affairs as the entity responsible 
for developing the redevelopment plan with respect to the 
facility or for directing the implementation of such plan. 
(9) The term ‘‘redevelopment plan’’ in the case of a facility 
of the Veterans Health Administration to be closed or realigned 
under this subtitle, means a plan that— 
(A) is agreed to by the local redevelopment authority 
with respect to the facility; and 
(B) provides for the reuse or redevelopment of the 
real property and personal property of the facility that 
is available for such reuse and redevelopment as a result 
of the closure or realignment of the facility. 
(10) The term ‘‘Secretary’’ means the Secretary of Veterans 
Affairs. 
(11) The term ‘‘tribal organization’’ has the meaning given 
such term in section 3765 of title 38, United States Code. 
Subtitle B—Other Infrastructure Matters 
SEC. 211. IMPROVEMENT TO TRAINING OF CONSTRUCTION PER-
SONNEL. 
Subsection (g) of section 8103 of title 38, United States Code, 
is amended to read as follows: 
‘‘(g)(1)(A) Not later than September 30 of the fiscal year fol-
lowing the fiscal year during which the VA Asset and Infrastructure 
Deadline. 
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132 STAT. 1461 
PUBLIC LAW 115–182—JUNE 6, 2018 
Review Act of 2018 is enacted, the Secretary shall implement the 
covered training curriculum and the covered certification program. 
‘‘(B) In designing and implementing the covered training cur-
riculum and the covered certification program under paragraph 
(1), the Secretary shall use as models existing training curricula 
and certification programs that have been established under chapter 
87 of title 10, United States Code, as determined relevant by 
the Secretary. 
‘‘(2) The Secretary may develop the training curriculum under 
paragraph (1)(A) in a manner that provides such training in any 
combination of— 
‘‘(A) training provided in person; 
‘‘(B) training provided over an internet website; or 
‘‘(C) training provided by another department or agency 
of the Federal Government. 
‘‘(3) The Secretary may develop the certification program under 
paragraph (1)(A) in a manner that uses— 
‘‘(A) one level of certification; or 
‘‘(B) more than one level of certification, as determined 
appropriate by the Secretary with respect to the level of certifi-
cation for different grades of the General Schedule. 
‘‘(4) The Secretary may enter into a contract with an appro-
priate entity to provide the covered training curriculum and the 
covered certification program under paragraph (1)(A). 
‘‘(5)(A) Not later than September 30 of the second fiscal year 
following the fiscal year during which the VA Asset and Infrastruc-
ture Review Act of 2018 is enacted, the Secretary shall ensure 
that the majority of employees subject to the covered certification 
program achieve the certification or the appropriate level of certifi-
cation pursuant to paragraph (3), as the case may be. 
‘‘(B) After carrying out subparagraph (A), the Secretary shall 
ensure that each employee subject to the covered certification pro-
gram achieves the certification or the appropriate level of certifi-
cation pursuant to paragraph (3), as the case may be, as quickly 
as practicable. 
‘‘(6) In this subsection: 
‘‘(A) The term ‘covered certification program’ means, with 
respect to employees of the Department of Veterans Affairs 
who are members of occupational series relating to construction 
or facilities management, or employees of the Department who 
award or administer contracts for major construction, minor 
construction, or nonrecurring maintenance, including as con-
tract specialists or contracting officers’ representatives, a pro-
gram to certify knowledge and skills relating to construction 
or facilities management and to ensure that such employees 
maintain adequate expertise relating to industry standards and 
best practices for the acquisition of design and construction 
services. 
‘‘(B) The term ‘covered training curriculum’ means, with 
respect to employees specified in subparagraph (A), a training 
curriculum relating to construction or facilities management.’’. 
SEC. 212. REVIEW OF ENHANCED USE LEASES. 
Section 8162(b)(6) is amended to read as follows: 
‘‘(6) The Office of Management and Budget shall review each 
enhanced-use lease before the lease goes into effect to determine 
whether the lease is in compliance with paragraph (5).’’. 
Definitions. 
Deadline. 
Contracts. 
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132 STAT. 1462 
PUBLIC LAW 115–182—JUNE 6, 2018 
SEC. 213. ASSESSMENT OF HEALTH CARE FURNISHED BY THE DEPART-
MENT TO VETERANS WHO LIVE IN THE PACIFIC TERRI-
TORIES. 
(a) IN GENERAL.—Not later than 180 days after the date of 
the enactment of this Act, the Secretary of Veterans Affairs shall 
submit to the Committees on Veterans’ Affairs of the Senate and 
the House of Representatives a report regarding health care fur-
nished by the Department of Veterans Affairs to veterans who 
live in the Pacific territories. 
(b) ELEMENTS.—The report under subsection (a) shall include 
assessments of the following: 
(1) The ability of the Department to furnish to veterans 
who live in the Pacific territories the following: 
(A) Hospital care. 
(B) Medical services. 
(C) Mental health services. 
(D) Geriatric services. 
(2) The feasibility of establishing a community-based out-
patient clinic of the Department in any Pacific territory that 
does not contain such a facility. 
(c) DEFINITION.—In this section, the term ‘‘Pacific territories’’ 
means American Samoa, Guam, and the Northern Mariana Islands. 
TITLE 
III—IMPROVEMENTS 
TO 
RE-
CRUITMENT OF HEALTH CARE PRO-
FESSIONALS 
SEC. 301. DESIGNATED SCHOLARSHIPS FOR PHYSICIANS AND DEN-
TISTS 
UNDER 
DEPARTMENT 
OF 
VETERANS 
AFFAIRS 
HEALTH PROFESSIONAL SCHOLARSHIP PROGRAM. 
(a) SCHOLARSHIPS
FOR PHYSICIANS
AND DENTISTS.—Section 
7612(b) of title 38, United States Code, is amended by adding 
at the end the following new paragraph: 
‘‘(6)(A) Of the scholarships awarded under this subchapter, 
the Secretary shall ensure that not less than 50 scholarships are 
awarded each year to individuals who are accepted for enrollment 
or enrolled (as described in section 7602 of this title) in a program 
of education or training leading to employment as a physician 
or dentist until such date as the Secretary determines that the 
staffing shortage of physicians and dentists in the Department 
is less than 500. 
‘‘(B) After such date, the Secretary shall ensure that of the 
scholarships awarded under this subchapter, a number of scholar-
ships is awarded each year to individuals referred to in subpara-
graph (A) in an amount equal to not less than ten percent of 
the staffing shortage of physicians and dentists in the Department, 
as determined by the Secretary. 
‘‘(C) Notwithstanding subsection (c)(1), the agreement between 
the Secretary and a participant in the Scholarship Program who 
receives a scholarship pursuant to this paragraph shall provide 
the following: 
‘‘(i) The Secretary’s agreement to provide the participant 
with a scholarship under this subchapter for a specified number 
(from two to four) of school years during which the participant 
Reports. 
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132 STAT. 1463 
PUBLIC LAW 115–182—JUNE 6, 2018 
is pursuing a course of education or training leading to employ-
ment as a physician or dentist. 
‘‘(ii) The participant’s agreement to serve as a full-time 
employee in the Veterans Health Administration for a period 
of time (hereinafter in this subchapter referred to as the ‘period 
of obligated service’) of 18 months for each school year or 
part thereof for which the participant was provided a scholar-
ship under the Scholarship Program. 
‘‘(D) In providing scholarships pursuant to this paragraph, the 
Secretary may provide a preference for applicants who are veterans. 
‘‘(E) On an annual basis, the Secretary shall provide to appro-
priate educational institutions informational material about the 
availability of scholarships under this paragraph.’’. 
(b) BREACH
OF AGREEMENT.—Section 7617 of such title is 
amended— 
(1) by redesignating paragraphs (4) and (5) as paragraphs 
(5) and (6), respectively; and 
(2) by inserting after paragraph (3) the following new para-
graph (4): 
‘‘(4) In the case of a participant who is enrolled in a 
program or education or training leading to employment as 
a physician, the participant fails to successfully complete post- 
graduate training leading to eligibility for board certification 
in a specialty.’’. 
(c) EXTENSION
OF PROGRAM.—Section 7619 of such title is 
amended by striking ‘‘December 31, 2019’’ and inserting ‘‘December 
31, 2033’’. 
SEC. 302. INCREASE IN MAXIMUM AMOUNT OF DEBT THAT MAY BE 
REDUCED UNDER EDUCATION DEBT REDUCTION PRO-
GRAM OF DEPARTMENT OF VETERANS AFFAIRS. 
(a) INCREASE
IN AMOUNT.—Section 7683(d)(1) is amended— 
(1) by striking ‘‘$120,000’’ and inserting ‘‘$200,000’’; and 
(2) by striking ‘‘$24,000’’ and inserting ‘‘$40,000’’. 
(b) STUDY.— 
(1) IN
GENERAL.—Not later than 1 year after the date 
of the enactment of this Act, the Secretary of Veterans Affairs 
shall— 
(A) conduct a study on the demand for education debt 
reduction under subchapter VII of chapter 76 of title 38, 
United States Code; and 
(B) 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 findings of the 
Secretary with respect to the study carried out under 
subparagraph (A). 
(2) CONSIDERATIONS.—In carrying out the study required 
by paragraph (1)(A), the Secretary shall consider the following: 
(A) The total number of vacancies within the Veterans 
Health Administration whose applicants are eligible to 
participate in the Education Debt Reduction Program 
pursuant to section 7682(a) of such title. 
(B) The types of medical professionals in greatest 
demand in the United States. 
(C) Projections by the Secretary of the numbers and 
types of medical professions that meet the needs of vet-
erans. 
Reports. 
Deadline. 
Time period. 
Time period. 
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132 STAT. 1464 
PUBLIC LAW 115–182—JUNE 6, 2018 
SEC. 303. ESTABLISHING THE DEPARTMENT OF VETERANS AFFAIRS 
SPECIALTY EDUCATION LOAN REPAYMENT PROGRAM. 
(a) IN GENERAL.—Chapter 76 of title 38, United States Code, 
is amended by inserting after subchapter VII the following new 
subchapter: 
‘‘SUBCHAPTER VIII—SPECIALTY EDUCATION LOAN 
REPAYMENT PROGRAM 
‘‘§ 7691. Establishment 
‘‘As part of the Educational Assistance Program, the Secretary 
may carry out a student loan repayment program under section 
5379 of title 5. The program shall be known as the Department 
of Veterans Affairs Specialty Education Loan Repayment Program 
(in this chapter referred to as the ‘Specialty Education Loan Repay-
ment Program’). 
‘‘§ 7692. Purpose 
‘‘The purpose of the Specialty Education Loan Repayment Pro-
gram is to assist, through the establishment of an incentive program 
for certain individuals employed in the Veterans Health Administra-
tion, in meeting the staffing needs of the Veterans Health Adminis-
tration for physicians in medical specialties for which the Secretary 
determines recruitment or retention of qualified personnel is dif-
ficult. 
‘‘§ 7693. Eligibility; preferences; covered costs 
‘‘(a) ELIGIBILITY.—An individual is eligible to participate in 
the Specialty Education Loan Repayment Program if the indi-
vidual— 
‘‘(1) is hired under section 7401 of this title to work in 
an occupation described in section 7692 of this title; 
‘‘(2) owes any amount of principal or interest under a 
loan, the proceeds of which were used by or on behalf of 
that individual to pay costs relating to a course of education 
or training which led to a degree that qualified the individual 
for the position referred to in paragraph (1); and 
‘‘(3) is— 
‘‘(A) recently graduated from an accredited medical 
or osteopathic school and matched to an accredited resi-
dency program in a medical specialty described in section 
7692 of this title; or 
‘‘(B) a physician in training in a medical specialty 
described in section 7692 of this title with more than 2 
years remaining in such training. 
‘‘(b) PREFERENCES.—In selecting individuals for participation 
in the Specialty Education Loan Repayment Program under this 
subchapter, the Secretary may give preference to the following: 
‘‘(1) Individuals who are, or will be, participating in resi-
dency programs in health care facilities— 
‘‘(A) located in rural areas; 
‘‘(B) operated by Indian tribes, tribal organizations, 
or the Indian Health Service; or 
‘‘(C) affiliated with underserved health care facilities 
of the Department. 
‘‘(2) Veterans. 
38 USC 7693. 
38 USC 7692. 
38 USC 7691. 
38 USC 
prec. 7691. 
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132 STAT. 1465 
PUBLIC LAW 115–182—JUNE 6, 2018 
‘‘(c) COVERED COSTS.—For purposes of subsection (a)(2), costs 
relating to a course of education or training include— 
‘‘(1) tuition expenses; 
‘‘(2) all other reasonable educational expenses, including 
expenses for fees, books, equipment, and laboratory expenses; 
and 
‘‘(3) reasonable living expenses. 
‘‘§ 7694. Specialty education loan repayment 
‘‘(a) IN GENERAL.—Payments under the Specialty Education 
Loan Repayment Program shall consist of payments for the prin-
cipal and interest on loans described in section 7682(a)(2) of this 
title for individuals selected to participate in the Program to the 
holders of such loans. 
‘‘(b) FREQUENCY OF PAYMENT.—The Secretary shall make pay-
ments for any given participant in the Specialty Education Loan 
Repayment Program on a schedule determined appropriate by the 
Secretary. 
‘‘(c) MAXIMUM AMOUNT; WAIVER.—(1) The amount of payments 
made for a participant under the Specialty Education Loan Repay-
ment Program may not exceed $160,000 over a total of 4 years 
of participation in the Program, of which not more than $40,000 
of such payments may be made in each year of participation in 
the Program. 
‘‘(2)(A) The Secretary may waive the limitations under para-
graph (1) in the case of a participant described in subparagraph 
(B). In the case of such a waiver, the total amount of payments 
payable to or for that participant is the total amount of the principal 
and the interest on the participant’s loans referred to in subsection 
(a). 
‘‘(B) A participant described in this subparagraph is a partici-
pant in the Program who the Secretary determines serves in a 
position for which there is a shortage of qualified employees by 
reason of either the location or the requirements of the position. 
‘‘§ 7695. Choice of location 
‘‘Each participant in the Specialty Education Loan Repayment 
Program who completes residency may select, from a list of medical 
facilities of the Veterans Health Administration provided by the 
Secretary, at which such facility the participant will work in a 
medical specialty described in section 7692 of this title. 
‘‘§ 7696. Term of obligated service 
‘‘(a) IN GENERAL.—In addition to any requirements under sec-
tion 5379(c) of title 5, a participant in the Specialty Education 
Loan Repayment Program must agree, in writing and before the 
Secretary may make any payment to or for the participant, to— 
‘‘(1) obtain a license to practice medicine in a State; 
‘‘(2) successfully complete post-graduate training leading 
to eligibility for board certification in a specialty; 
‘‘(3) serve as a full-time clinical practice employee of the 
Veterans Health Administration for 12 months for every 
$40,000 in such benefits that the employee receives, but in 
no case for fewer than 24 months; and 
‘‘(4) except as provided in subsection (b), to begin such 
service as a full-time practice employee by not later than 60 
days after completing a residency. 
Deadline. 
Time periods. 
38 USC 7696. 
38 USC 7695. 
Waiver authority. 
Time period. 
38 USC 7694. 
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132 STAT. 1466 
PUBLIC LAW 115–182—JUNE 6, 2018 
‘‘(b) FELLOWSHIP.—In the case of a participant who receives 
an accredited fellowship in a medical specialty other than a medical 
specialty described in section 7692 of this title, the Secretary, on 
written request of the participant, may delay the term of obligated 
service under subsection (a) for the participant until after the 
participant completes the fellowship, but in no case later than 
60 days after completion of such fellowship. 
‘‘(c) PENALTY.—(1) An employee who does not complete a period 
of obligated service under this section shall owe the Federal Govern-
ment an amount determined in accordance with the following for-
mula: A = B × ((T ¥ S) ÷ T)). 
‘‘(2) In the formula in paragraph (1): 
‘‘(A) ‘A’ is the amount the employee owes the Federal 
Government. 
‘‘(B) ‘B’ is the sum of all payments to or for the participant 
under the Specialty Education Loan Repayment Program. 
‘‘(C) ‘T’ is the number of months in the period of obligated 
service of the employee. 
‘‘(D) ‘S’ is the number of whole months of such period 
of obligated service served by the employee. 
‘‘§ 7697. Relationship to Educational Assistance Program 
‘‘Assistance under the Specialty Education Loan Repayment 
Program may be in addition to other assistance available to individ-
uals under the Educational Assistance Program.’’. 
(b) CONFORMING AND TECHNICAL AMENDMENTS.— 
(1) CONFORMING AMENDMENTS.— 
(A) Section 7601(a) of title 38, United States Code, 
is amended— 
(i) in paragraph (4), by striking ‘‘and’’; 
(ii) in paragraph (5), by striking the period and 
inserting ‘‘; and’’; and 
(iii) by adding at the end the following new para-
graph: 
‘‘(6) the specialty education loan repayment program pro-
vided for in subchapter VIII of this chapter.’’. 
(B) Section 7603(a)(1) of title 38, United States Code, 
is amended by striking ‘‘or VI’’ and inserting ‘‘VI, or VIII’’. 
(C) Section 7604 of title 38, United States Code, is 
amended by striking ‘‘or VI’’ each place it appears and 
inserting ‘‘VI, or VIII’’. 
(D) Section 7631 of title 38, United States Code, is 
amended— 
(i) in subsection (a)(1)— 
(I) 
by 
striking 
‘‘and’’ 
after 
‘‘scholarship 
amount,’’; and 
(II) by inserting ‘‘, and the maximum specialty 
education loan repayment amount’’ after ‘‘reduc-
tion payments amount’’; and 
(ii) in subsection (b) by adding at the end the 
following new paragraph: 
‘‘(7) The term ‘specialty education loan repayment amount’ 
means the maximum amount of specialty education loan repayment 
payments payable to or for a participant in the Department of 
Veterans Affairs Specialty Education Loan Repayment Program 
under subchapter VIII of this chapter, as specified in section 
Definition. 
38 USC 7697. 
Deadline. 
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132 STAT. 1467 
PUBLIC LAW 115–182—JUNE 6, 2018 
7694(c)(1) of this title and as previously adjusted (if at all) in 
accordance with this section.’’. 
(E) Section 7632 of title 38, United States Code, is 
amended— 
(i) in paragraph (1), by striking ‘‘and the Education 
Debt Reduction Program’’ and inserting ‘‘the Education 
Debt Reduction Program, and the Specialty Education 
Loan Repayment Program’’; and 
(ii) in paragraph (4), by striking ‘‘and per partici-
pant in the Education Debt Reduction Program’’ and 
inserting ‘‘per participant in the Education Debt Reduc-
tion Program, and per participant in the Specialty 
Education Loan Repayment Program’’. 
(2) TABLE OF SECTIONS.—The table of sections at the begin-
ning of chapter 76 of such title is amended by inserting after 
the items relating to subchapter VII the following: 
‘‘SUBCHAPTER VIII—SPECIALTY EDUCATION LOAN REPAYMENT PROGRAM 
‘‘7691. Establishment. 
‘‘7692. Purpose. 
‘‘7693. Eligibility; preferences; covered costs. 
‘‘7694. Specialty education loan repayment. 
‘‘7695. Choice of location. 
‘‘7696. Term of obligated service. 
‘‘7697. Relationship to Educational Assistance Program.’’. 
(c) NEEDS OF THE VHA.—In making determinations each year 
under section 7692 of title 38, United States Code, as enacted 
by subsection (a), the Secretary of Veterans Affairs shall consider 
the anticipated needs of the Veterans Health Administration during 
the period 2 to 6 years in the future. 
(d) PREFERENCE.—In granting preference under section 7693 
of title 38, United States Code, as enacted by subsection (a), the 
Secretary of Veterans Affairs shall determine whether a facility 
of the Department is underserved based on the criteria developed 
under section 401 of this Act. 
(e) OFFER DEADLINE.—In the case of an applicant who applies 
before receiving a residency match and whom the Secretary of 
Veterans Affairs selects for participation in the Specialty Education 
Loan Repayment Program established by subsection (a), the Sec-
retary shall offer participation to the applicant not later than 28 
days after— 
(1) the applicant matches with a residency in a medical 
specialty described in section 7692 of title 38, United States 
Code, as enacted by subsection (a); and 
(2) such match is published. 
(f) PUBLICITY.—The Secretary of Veterans Affairs shall take 
such steps as the Secretary determines are appropriate to publicize 
the Specialty Education Loan Repayment Program established 
under subchapter VIII of chapter 76 of title 38, United States 
Code, as enacted by subsection (a). 
SEC. 304. VETERANS HEALING VETERANS MEDICAL ACCESS AND 
SCHOLARSHIP PROGRAM. 
(a) ESTABLISHMENT.—The Secretary of Veterans Affairs, acting 
through the Office of Academic Affiliations of the Department of 
Veterans Affairs, shall carry out a pilot program under which 
the Secretary shall provide funding for the medical education of 
a total of 18 eligible veterans. Such funding shall be provided 
38 USC 7601 
note. 
38 USC 7691 
note. 
38 USC 7691 
note. 
38 USC 7693 
note. 
38 USC 7692 
note. 
38 USC 
prec. 7601. 
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132 STAT. 1468 
PUBLIC LAW 115–182—JUNE 6, 2018 
for two veterans enrolled in each covered medical schools in accord-
ance with this section. 
(b) ELIGIBLE VETERANS.—To be eligible to receive funding for 
medical education under this section, a veteran shall— 
(1) have been discharged from the Armed Forces not more 
than 10 years before the date of application for admission 
to a covered medical school; 
(2) not be entitled to educational assistance under chapter 
30, 31, 32, 33, 34, or 35 of title 38, United States Code, or 
chapter 1606 or 1607 of title 10, United States Code; 
(3) apply for admission to a covered medical school for 
the entering class of 2019; 
(4) indicate on such application for admission that the 
veteran would like to be considered for an award of funding 
under this section; 
(5) meet the minimum admissions criteria for the covered 
medical school to which the veteran applies; and 
(6) enter into an agreement described in subsection (e). 
(c) AWARD OF FUNDING.— 
(1) IN GENERAL.—Each covered medical school that opts 
to participate in the program under this section shall reserve 
two seats in the entering class of 2019 for eligible veterans 
who receive funding under such program. Such funding shall 
be awarded to the two eligible veterans with the highest admis-
sions rankings for such class at such school. 
(2) AMOUNT
OF
FUNDING.—Each eligible veteran who 
receives funding under this section shall receive an amount 
equal to the actual cost of— 
(A) tuition at the covered medical school at which 
the veteran enrolls for 4 years; 
(B) books, fees, and technical equipment; 
(C) fees associated with the National Residency Match 
Program; 
(D) two away rotations performed during the fourth 
year at a Department of Veterans Affairs medical facility; 
and 
(E) a monthly stipend for the 4-year period during 
which the veteran is enrolled in medical school in an 
amount to be determined by the Secretary. 
(3) DISTRIBUTION OF FUNDING.—In the event that two or 
more eligible veterans do not apply for admission at one of 
the covered medical schools for the entering class of 2019, 
the Secretary shall distribute the available funding to eligible 
veterans who applied for admission at other covered medical 
schools. 
(d) AGREEMENT.— 
(1) TERMS
OF
AGREEMENT.—Each eligible veteran who 
accepts funding for medical education under this section shall 
enter into an agreement with the Secretary that provides that 
the veteran agrees— 
(A) to maintain enrollment and attendance in the med-
ical school; 
(B) while enrolled in such medical school, to maintain 
an acceptable level of academic standing (as determined 
by the medical school under regulations prescribed by the 
Secretary); 
Time period. 
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132 STAT. 1469 
PUBLIC LAW 115–182—JUNE 6, 2018 
(C) to complete post-graduate training leading to eligi-
bility for board certification in a speciality applicable to 
the Department of Veterans Affairs, as determined by the 
Secretary; 
(D) after completion of medical school, to obtain a 
license to practice medicine in a State; and 
(E) after completion of medical school and post-grad-
uate training, to serve as a full-time clinical practice 
employee in the Veterans Health Administration for a 
period of 4 years. 
(2) BREACH OF AGREEMENT.—If an eligible veteran who 
accepts funding under this section breaches the terms of the 
agreement described in paragraph (1), the United States shall 
be entitled to recover damages in an amount equal to the 
total amount of such funding received by the veteran. 
(e) RULE OF CONSTRUCTION.—Nothing in this section shall be 
construed to prevent any covered medical school from accepting 
more than two eligible veterans for the entering class of 2019. 
(f) REPORT TO CONGRESS.—Not later than December 31, 2020, 
and annually thereafter for the subsequent 3 years, the Secretary 
shall submit to Congress a report on the pilot program under 
this section. Such report shall include the evaluation of the Sec-
retary of the success of the pilot program, including the number 
of veterans who received funding under the program who matricu-
lated and an evaluation of the academic progress of such veterans. 
(g) COVERED MEDICAL SCHOOLS.—In this section, the term ‘‘cov-
ered medical school’’ means any of the following: 
(1) The Teague-Cranston medical schools, consisting of— 
(A) Texas A&M College of Medicine; 
(B) Quillen College of Medicine at East Tennessee State 
University; 
(C) Boonshoft School of Medicine at Wright State 
University; 
(D) Joan C. Edwards School of Medicine at Marshall 
University; and 
(E) University of South Carolina School of Medicine. 
(2) Charles R Drew University of Medicine and Science. 
(3) Howard University College of Medicine. 
(4) Meharry Medical College. 
(5) Morehouse School of Medicine. 
SEC. 305. BONUSES FOR RECRUITMENT, RELOCATION, AND RETEN-
TION. 
Section 705(a) of the Veterans Access, Choice, and Account-
ability Act of 2014 (Public Law 113–146; 38 U.S.C. 703 note) is 
amended— 
(1) in paragraph (1), by striking ‘‘$230,000,000’’ and 
inserting ‘‘$250,000,000, of which not less than $20,000,000 
shall be for recruitment, relocation, and retention bonuses’’; 
and 
(2) in paragraph (2), by striking ‘‘$225,000,000’’ and 
inserting ‘‘$290,000,000, of which not less than $20,000,000 
shall be for recruitment, relocation, and retention bonuses’’. 
Definition. 
Evaluation. 
38 USC 7611 
note. 
Time period. 
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132 STAT. 1470 
PUBLIC LAW 115–182—JUNE 6, 2018 
SEC. 306. INCLUSION OF VET CENTER EMPLOYEES IN EDUCATION 
DEBT REDUCTION PROGRAM OF DEPARTMENT OF VET-
ERANS AFFAIRS. 
(a) IN GENERAL.—The Secretary of Veterans Affairs shall 
ensure that clinical staff working at Vet Centers are eligible to 
participate in the Education Debt Reduction Program of the Depart-
ment of Veterans Affairs under subchapter VII of chapter 76 of 
title 38, United States Code. 
(b) REPORT.—Not later than 1 year after the date of the enact-
ment 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 number 
of participants in the Education Debt Reduction Program of the 
Department under such subchapter who work at Vet Centers. 
(c) VET CENTER DEFINED.—In this section, the term ‘‘Vet 
Center’’ has the meaning given that term in section 1712A(h) of 
title 38, United States Code. 
TITLE IV—HEALTH CARE IN 
UNDERSERVED AREAS 
SEC. 401. DEVELOPMENT OF CRITERIA FOR DESIGNATION OF CERTAIN 
MEDICAL FACILITIES OF THE DEPARTMENT OF VETERANS 
AFFAIRS AS UNDERSERVED FACILITIES AND PLAN TO 
ADDRESS PROBLEM OF UNDERSERVED FACILITIES. 
(a) IN GENERAL.—Not later than 180 days after the date of 
the enactment of this Act, the Secretary of Veterans Affairs shall 
develop criteria to designate medical centers, ambulatory care facili-
ties, and community based outpatient clinics of the Department 
of Veterans Affairs as underserved facilities. 
(b) CONSIDERATION.—Criteria developed under subsection (a) 
shall include consideration of the following with respect to a facility: 
(1) The ratio of veterans to health care providers of the 
Department of Veterans Affairs for a standardized geographic 
area surrounding the facility, including a separate ratio for 
general practitioners and specialists. 
(2) The range of clinical specialties covered by such pro-
viders in such area. 
(3) Whether the local community is medically underserved. 
(4) The type, number, and age of open consults. 
(5) Whether the facility is meeting the wait-time goals 
of the Department. 
(6) Such other criteria as the Secretary considers important 
in determining which facilities are not adequately serving area 
veterans. 
(c) ANALYSIS OF FACILITIES.—Not less frequently than annually, 
directors of Veterans Integrated Service Networks of the Depart-
ment shall perform an analysis to determine which facilities within 
that Veterans Integrated Service Network qualify as underserved 
facilities pursuant to criteria developed under subsection (a). 
(d) ANNUAL PLAN TO ADDRESS UNDERSERVED FACILITIES.— 
(1) PLAN REQUIRED.—Not later than 1 year after the date 
of the enactment of this Act and not less frequently than 
once each year, the Secretary shall submit to Congress a plan 
Deadline. 
Time period. 
Deadline. 
38 USC 8110 
note. 
38 USC 7682 
note. 
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132 STAT. 1471 
PUBLIC LAW 115–182—JUNE 6, 2018 
to address the problem of underserved facilities of the Depart-
ment, as designated pursuant to criteria developed under sub-
section (a). 
(2) CONTENTS.—Each plan submitted under paragraph (1) 
shall address the following: 
(A) Increasing personnel or temporary personnel assist-
ance, including mobile deployment teams furnished under 
section 407 of this Act. 
(B) Providing special hiring incentives, including under 
the Education Debt Reduction Program under subchapter 
VII of chapter 76 of title 38, United States Code, and 
recruitment, relocation, and retention incentives. 
(C) Using direct hiring authority. 
(D) Improving training opportunities for staff. 
(E) Such other actions as the Secretary considers 
appropriate. 
SEC. 402. PILOT PROGRAM TO FURNISH MOBILE DEPLOYMENT TEAMS 
TO UNDERSERVED FACILITIES. 
(a) IN GENERAL.—The Secretary of Veterans Affairs shall carry 
out a pilot program to furnish mobile deployment teams of medical 
personnel to underserved facilities. 
(b) ELEMENTS.—In furnishing mobile deployment teams under 
subsection (a), the Secretary shall consider the following elements: 
(1) The medical positions of greatest need at underserved 
facilities. 
(2) The size and composition of teams to be deployed. 
(3) Such other elements as the Secretary considers nec-
essary for effective oversight of the program established under 
subsection (a). 
(c) USE OF ANNUAL ANALYSIS.—The Secretary shall use the 
results of the annual analysis conducted under section 401(c) of 
this Act to form mobile deployment teams under subsection (a) 
that are composed of the most needed medical personnel for under-
served facilities. 
(d) REPORTING.— 
(1) PROGRESS REPORT.—Not later than 1 year after the 
date of the enactment of this Act, the Secretary shall submit 
a report to Congress on the implementation of the pilot program 
under this section. 
(2) FINAL REPORT.—Not later than the termination of the 
pilot program under this section, the Secretary shall submit 
a final report to Congress that contains the recommendations 
of the Secretary regarding the feasibility and advisability of— 
(A) extending or expanding the pilot program; and 
(B) making the pilot program (or any aspect thereof) 
permanent. 
(e) DURATION.—The pilot program under this section shall 
terminate 3 years after the date of the enactment of this Act. 
(f) UNDERSERVED FACILITY DEFINED.—In this section, the term 
‘‘underserved facility’’ means a medical center, ambulatory care 
facility, or community based outpatient clinic of the Department 
of Veterans Affairs designated by the Secretary of Veterans Affairs 
as underserved pursuant to criteria developed under section 401 
of this Act. 
Recommenda- 
tions. 
38 USC 8110 
note. 
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132 STAT. 1472 
PUBLIC LAW 115–182—JUNE 6, 2018 
SEC. 403. PILOT PROGRAM ON GRADUATE MEDICAL EDUCATION AND 
RESIDENCY. 
(a) ESTABLISHMENT.— 
(1) IN GENERAL.—Subject to paragraph (5), the Secretary 
of Veterans Affairs shall establish a pilot program to establish 
medical residency positions authorized under section 301(b)(2) 
of the Veterans Access, Choice, and Accountability Act of 2014 
(Public Law 113–146; 38 U.S.C. 7302 note) at covered facilities. 
(2) COVERED FACILITIES.—For purposes of this section, a 
covered facility is any of the following: 
(A) A health care facility of the Department of Veterans 
Affairs. 
(B) A health care facility operated by an Indian tribe 
or a tribal organization, as those terms are defined in 
section 4 of the Indian Self-Determination and Education 
Assistance Act (25 U.S.C. 5304). 
(C) A health care facility operated by the Indian Health 
Service. 
(D) 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)). 
(E) A health care facility operated by the Department 
of Defense. 
(F) Such other health care facility as the Secretary 
considers appropriate for purposes of this section. 
(3) AGREEMENTS.—To carry out the pilot program under 
this section, the Secretary may enter into agreements with 
entities that operate covered facilities in which the Secretary 
places residents under paragraph (1). 
(4) PARAMETERS FOR LOCATION, AFFILIATE SPONSOR, AND 
DURATION.—When determining in which covered facilities to 
place residents under paragraph (1), the Secretary shall con-
sider the extent to which there is a clinical need for providers 
in an area, as determined by the following: 
(A) The ratio of veterans to health care providers of 
the Department for a standardized geographic area sur-
rounding a facility, including a separate ratio for general 
practitioners and specialists. 
(B) The range of clinical specialties of providers in 
standardized geographic areas surrounding a facility. 
(C) Whether the specialty of a provider is included 
in the most recent staffing shortage determination of the 
Department under section 7412 of title 38, United States 
Code. 
(D) Whether the local community is designated by 
the Secretary of Veterans Affairs as underserved pursuant 
to criteria developed under section 401 of this Act. 
(E) Whether the facility is located in a community 
that is designated by the Secretary of Health and Human 
Services as a health professional shortage area under sec-
tion 332 of the Public Health Service Act (42 U.S.C. 254e). 
(F) Whether the facility is located in a rural or remote 
area. 
(G) Such other criteria as the Secretary considers 
important in determining which facilities are not ade-
quately serving area veterans. 
38 USC 7302 
note. 
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132 STAT. 1473 
PUBLIC LAW 115–182—JUNE 6, 2018 
(5) PRIORITY IN PLACEMENTS.—During the pilot program 
under this section, the Secretary shall place no fewer than 
100 residents in covered facilities— 
(A) operated by the Indian Health Service; 
(B) operated by an Indian tribe; 
(C) operated by a tribal organization; or 
(D) located in communities designated by the Secretary 
as underserved pursuant to criteria developed under section 
401 of this Act. 
(6) STIPENDS AND BENEFITS.—The Secretary may pay sti-
pends and provide benefits for residents in positions under 
paragraph (1), regardless of whether they have been assigned 
in a Department facility. 
(b) REIMBURSEMENT.—If a covered facility establishes a new 
residency program in which the Secretary places a resident under 
the pilot program, the Secretary shall reimburse that covered 
facility for costs of the following: 
(1) Curriculum development. 
(2) Recruitment and retention of faculty. 
(3) Accreditation of the program by the Accreditation 
Council for Graduate Medical Education. 
(4) The portion of faculty salaries attributable to duties 
under an agreement subsection (a)(3). 
(5) Expenses relating to educating a resident under the 
pilot program. 
(c) REPORTING.— 
(1) IN
GENERAL.—Not later than 1 year after the date 
of the enactment of this Act and not less frequently than 
once each year thereafter until the termination of the pilot 
program, the Secretary shall submit to Congress a report on 
the implementation of the pilot program. 
(2) ELEMENTS.—Each report submitted under paragraph 
(1) shall include the following with regard to the immediately 
preceding year, and in comparison to the year immediately 
preceding that year: 
(A) The number of veterans who received care from 
residents under the pilot program. 
(B) The number of veterans who received care from 
each resident per position described in subsection (a)(1) 
under the pilot program. 
(C) The number of veterans who received care from 
residents under the pilot program expressed as a percent-
age of all individuals who received care from such residents. 
(D) The number of clinical appointments for veterans 
conducted by each resident under the pilot program. 
(E) The number of clinical appointments for veterans 
conducted by residents per position described in subsection 
(a)(1) under the pilot program. 
(F) The number of clinical appointments for veterans 
expressed as a percentage of all clinical appointments con-
ducted by residents under the pilot program. 
(G) The number of positions described in subsection 
(a)(1) at each covered facility under the pilot program. 
(H) For each position described in subsection (a)(1) 
in a residency program affiliated with a health care facility 
of the Department, the time a resident under the pilot 
program spent training at that facility of the Department, 
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132 STAT. 1474 
PUBLIC LAW 115–182—JUNE 6, 2018 
expressed as a percentage of the total training time for 
that resident position. 
(I) For each residency program affiliated with a health 
care facility of the Department, the time all residents under 
the pilot program spent training at that facility of the 
Department, expressed as a percentage of the total training 
time for those residents. 
(J) The time that all residents under the pilot program 
who are assigned to programs affiliated with health care 
facilities of the Department spent training at facilities of 
the Department, expressed as a percentage of the total 
training time for those residents. 
(K) The cost to the Department of Veterans Affairs 
under the pilot program in the year immediately preceding 
the report and since the beginning of the pilot program. 
(L) The cost to the Department of Veterans Affairs 
per resident placed under the pilot program at each covered 
facility. 
(M) The number of residents under the pilot program 
hired by the Secretary to work in the Veterans Health 
Administration after completion of residency in the year 
immediately preceding the report and since the beginning 
of the pilot program. 
(N) The medical specialties pursued by residents under 
the pilot program. 
(d) DURATION.—The pilot program under this section shall 
terminate on August 7, 2024. 
TITLE V—OTHER MATTERS 
SEC. 501. ANNUAL REPORT ON PERFORMANCE AWARDS AND BONUSES 
AWARDED TO CERTAIN HIGH-LEVEL EMPLOYEES OF THE 
DEPARTMENT. 
(a) IN GENERAL.—Chapter 7 of title 38, United States Code, 
is amended by adding at the end the following new section: 
‘‘§ 726. Annual report on performance awards and bonuses 
awarded to certain high-level employees 
‘‘(a) IN GENERAL.—Not later than 100 days after the end of 
each fiscal year, the Secretary shall submit to the appropriate 
committees of Congress a report that contains, for the most recent 
fiscal year ending before the submittal of the report, a description 
of all performance awards or bonuses awarded to each of the fol-
lowing: 
‘‘(1) Regional Office Director of the Department. 
‘‘(2) Director of a Medical Center of the Department. 
‘‘(3) Director of a Veterans Integrated Service Network. 
‘‘(4) Senior executive of the Department. 
‘‘(b) ELEMENTS.—Each report submitted under subsection (a) 
shall include the following with respect to each performance award 
or bonus awarded to an individual described in such subsection: 
‘‘(1) The amount of each award or bonus. 
‘‘(2) The job title of the individual awarded the award 
or bonus. 
‘‘(3) The location where the individual awarded the award 
or bonus works. 
38 USC 726. 
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132 STAT. 1475 
PUBLIC LAW 115–182—JUNE 6, 2018 
‘‘(c) DEFINITIONS.—In this section: 
‘‘(1) The term ‘appropriate committees of Congress’ means 
the Committees on Veterans’ Affairs and Appropriations of 
the Senate and House of Representatives. 
‘‘(2) The term ‘senior executive’ means— 
‘‘(A) a career appointee; or 
‘‘(B) an individual— 
‘‘(i) in an administrative or executive position; and 
‘‘(ii) appointed under section 7306(a) or section 
7401(1) of this title. 
‘‘(3) The term ‘career appointee’ has the meaning given 
that term in section 3132(a) of title 5, United States Code.’’. 
(b) CLERICAL AMENDMENT.—The table of sections at the begin-
ning of such chapter is amended by inserting after the item relating 
to section 725 the following new item: 
‘‘726. Annual report on performance awards and bonuses awarded to certain high- 
level employees.’’. 
SEC. 502. ROLE OF PODIATRISTS IN DEPARTMENT OF VETERANS 
AFFAIRS. 
(a) INCLUSION AS PHYSICIAN.— 
(1) IN GENERAL.—Subchapter I of chapter 74 is amended 
by adding at the end the following new section: 
‘‘§ 7413. Treatment of podiatrists; clinical oversight standards 
‘‘(a) PODIATRISTS.—Except as provided by subsection (b), a 
doctor of podiatric medicine who is appointed as a podiatrist under 
section 7401(1) of this title is eligible for any supervisory position 
in the Veterans Health Administration to the same degree that 
a physician appointed under such section is eligible for the position. 
‘‘(b) ESTABLISHMENT OF CLINICAL OVERSIGHT STANDARDS.—The 
Secretary, in consultation with appropriate stakeholders, shall 
establish standards to ensure that specialists appointed in the 
Veterans Health Administration to supervisory positions do not 
provide direct clinical oversight for purposes of peer review or 
practice evaluation for providers of other clinical specialties.’’. 
(2) CLERICAL AMENDMENT.—The table of sections at the 
beginning of chapter 74 is amended by inserting after the 
item relating to section 7412 the following new item: 
‘‘7413. Treatment of podiatrists; clinical oversight standards.’’. 
(b) MODIFICATION AND CLARIFICATION OF PAY GRADE.— 
(1) GRADE.—The list in section 7404(b) of such title is 
amended— 
(A) 
by 
striking 
‘‘PHYSICIAN 
AND 
DENTIST 
SCHEDULE’’ and inserting ‘‘PHYSICIAN AND SURGEON 
(MD/DO), PODIATRIC SURGEON (DPM), AND DENTIST 
AND ORAL SURGEON (DDS, DMD) SCHEDULE’’; 
(B) by striking ‘‘Physician grade’’ and inserting ‘‘Physi-
cian and surgeon grade’’; and 
(C) by striking ‘‘PODIATRIST, CHIROPRACTOR, 
AND’’ and inserting ‘‘CHIROPRACTOR AND’’. 
(2) APPLICATION.—The amendments made by paragraph 
(1) shall apply with respect to a pay period of the Department 
of Veterans Affairs beginning on or after the date that is 
30 days after the date of the enactment of this Act. 
Time period. 
38 USC 7404 
note. 
38 USC 
prec. 7401. 
Consultation. 
38 USC 7413. 
38 USC 
prec. 701. 
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132 STAT. 1476 
PUBLIC LAW 115–182—JUNE 6, 2018 
SEC. 503. DEFINITION OF MAJOR MEDICAL FACILITY PROJECT. 
(a) MODIFICATION OF DEFINITION OF MEDICAL FACILITY.—Sec-
tion 8101(3) is amended by striking ‘‘Secretary’’ and all that follows 
through ‘‘nursing home,’’ and inserting ‘‘Secretary, or as otherwise 
authorized by law, for the provision of health-care services 
(including hospital, outpatient clinic, nursing home,’’. 
(b) MODIFICATION OF DEFINITION OF MAJOR MEDICAL FACILITY 
PROJECT.—Paragraph (3) of section 8104(a) is amended to read 
as follows: 
‘‘(3) For purposes of this subsection, the term ‘major medical 
facility project’ means a project for the construction, alteration, 
or acquisition of a medical facility involving a total expenditure 
of more than $20,000,000, but such term does not include an acquisi-
tion by exchange, nonrecurring maintenance projects of the Depart-
ment, or the construction, alteration, or acquisition of a shared 
Federal medical facility for which the Department’s estimated share 
of the project costs does not exceed $20,000,000.’’. 
SEC. 504. AUTHORIZATION OF CERTAIN MAJOR MEDICAL FACILITY 
PROJECTS OF THE DEPARTMENT OF VETERANS AFFAIRS. 
(a) AUTHORIZATION.—The Secretary of Veterans Affairs may 
carry out the following major medical facility project, to be carried 
out in an amount not to exceed the amount specified for that 
project: Construction of the new East Bay Community Based Out-
patient Clinic and all associated site work, utilities, parking, and 
landscaping, construction of the Central Valley Engineering and 
Logistics support facility, and enhanced flood plain mitigation at 
the Central Valley and East Bay Community Based Outpatient 
Clinics as part of the realignment of medical facilities in Livermore, 
California, in an amount not to exceed $117,300,000. 
(b) AUTHORIZATION OF APPROPRIATIONS FOR CONSTRUCTION.— 
There is authorized to be appropriated to the Secretary of Veterans 
Affairs for fiscal year 2018 or the year in which funds are appro-
priated for the Construction, Major Projects account, $117,300,000 
for the project authorized in subsection (a). 
(c) SUBMITTAL OF INFORMATION.—Not later than 90 days after 
the date of the enactment of this Act, for the project authorized 
in subsection (a), the Secretary of Veterans Affairs shall submit 
to the Committee on Veterans’ Affairs of the Senate and the Com-
mittee on Veterans’ Affairs of the House of Representatives the 
following information: 
(1) A line item accounting of expenditures relating to 
construction management carried out by the Department of 
Veterans Affairs for such project. 
(2) The future amounts that are budgeted to be obligated 
for construction management carried out by the Department 
for such project. 
(3) A justification for the expenditures described in para-
graph (1) and the future amounts described in paragraph (2). 
(4) Any agreement entered into by the Secretary regarding 
a non-Department of Veterans Affairs Federal entity providing 
management services relating to such project, including 
reimbursement agreements and the costs to the Department 
for such services. 
Deadline. 
California. 
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132 STAT. 1477 
PUBLIC LAW 115–182—JUNE 6, 2018 
SEC. 505. DEPARTMENT OF VETERANS AFFAIRS PERSONNEL TRANS-
PARENCY. 
(a) PUBLICATION OF STAFFING AND VACANCIES.— 
(1) WEBSITE REQUIRED.—Subject to paragraph (2) and not 
later than 90 days after the date of the enactment of this 
Act, the Secretary of Veterans Affairs shall make publicly avail-
able on an Internet website of the Department of Veterans 
Affairs the following information, which shall, subject to 
subparagraph (D), be displayed by departmental component 
or, in the case of information relating to Veterans Health 
Administration positions, by medical facility: 
(A) The number of personnel encumbering positions. 
(B) The number of accessions and separation actions 
processed during the quarter preceding the date of the 
publication of the information. 
(C) The number of vacancies, by occupation. 
(D) The percentage of new hires for the Department 
who were hired within the time-to-hire target of the Office 
of Personnel Management, disaggregated by administra-
tion. 
(2) EXCEPTIONS.—The Secretary may withhold from 
publication under paragraph (1) information relating to law 
enforcement, information security, or such positions in the 
Department that the Secretary determines to be sensitive. 
(3) UPDATE OF INFORMATION.—The Secretary shall update 
the information on the website required under paragraph (1) 
on a quarterly basis. 
(4) TREATMENT OF CONTRACTOR POSITIONS.—Any Depart-
ment of Veterans Affairs position that is filled with a contractor 
may not be treated as a Department position for purposes 
of the information required to be published under paragraph 
(1). 
(5) INSPECTOR GENERAL REVIEW.—On a semi-annual basis, 
the Inspector General of the Department shall review the 
administration of the website required under paragraph (1) 
and make recommendations relating to the improvement of 
such administration. 
(b) REPORT TO CONGRESS.—The Secretary of Veterans Affairs 
shall submit to Congress an annual report on the steps the Depart-
ment is taking to achieve full staffing capacity. Each such report 
shall include the amount of additional funds necessary to enable 
the Department to reach full staffing capacity. 
SEC. 506. PROGRAM ON ESTABLISHMENT OF PEER SPECIALISTS IN 
PATIENT ALIGNED CARE TEAM SETTINGS WITHIN MED-
ICAL CENTERS OF DEPARTMENT OF VETERANS AFFAIRS. 
(a) PROGRAM REQUIRED.—The Secretary of Veterans Affairs 
shall carry out a program to establish not fewer than two peer 
specialists in patient aligned care teams at medical centers of 
the Department of Veterans Affairs to promote the use and integra-
tion of services for mental health, substance use disorder, and 
behavioral health in a primary care setting. 
(b) TIMEFRAME FOR ESTABLISHMENT OF PROGRAM.—The Sec-
retary shall carry out the program at medical centers of the Depart-
ment as follows: 
(1) Not later than May 31, 2019, at not fewer than 15 
medical centers of the Department. 
Deadlines. 
38 USC 1701 
note. 
Time period. 
Deadline. 
38 USC 301 note. 
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132 STAT. 1478 
PUBLIC LAW 115–182—JUNE 6, 2018 
(2) Not later than May 31, 2020, at not fewer than 30 
medical centers of the Department. 
(c) SELECTION OF LOCATIONS.— 
(1) IN GENERAL.—The Secretary shall select medical centers 
for the program as follows: 
(A) Not fewer than five shall be medical centers of 
the Department that are designated by the Secretary as 
polytrauma centers. 
(B) Not fewer than 10 shall be medical centers of 
the Department that are not designated by the Secretary 
as polytrauma centers. 
(2) CONSIDERATIONS.—In selecting medical centers for the 
program under paragraph (1), the Secretary shall consider the 
feasibility and advisability of selecting medical centers in the 
following areas: 
(A) Rural areas and other areas that are underserved 
by the Department. 
(B) Areas that are not in close proximity to an active 
duty military installation. 
(C) Areas representing different geographic locations, 
such as census tracts established by the Bureau of the 
Census. 
(d) GENDER-SPECIFIC SERVICES.—In carrying out the program 
at each location selected under subsection (c), the Secretary shall 
ensure that— 
(1) the needs of female veterans are specifically considered 
and addressed; and 
(2) female peer specialists are made available to female 
veterans who are treated at each location. 
(e) ENGAGEMENT WITH COMMUNITY PROVIDERS.—At each loca-
tion selected under subsection (c), the Secretary shall consider 
ways in which peer specialists can conduct outreach to health 
care providers in the community who are known to be serving 
veterans to engage with those providers and veterans served by 
those providers. 
(f) REPORTS.— 
(1) PERIODIC REPORTS.— 
(A) IN GENERAL.—Not later than 180 days after the 
date of the enactment of this Act, and not less frequently 
than once every 180 days thereafter until the Secretary 
determines that the program is being carried out at the 
last location to be selected under subsection (c), the Sec-
retary shall submit to Congress a report on the program. 
(B) ELEMENTS.—Each report required by subparagraph 
(A) shall, with respect to the 180-day period preceding 
the submittal of the report, include the following: 
(i) The findings and conclusions of the Secretary 
with respect to the program. 
(ii) An assessment of the benefits of the program 
to veterans and family members of veterans. 
(iii) An assessment of the effectiveness of peer 
specialists in engaging under subsection (e) with health 
care providers in the community and veterans served 
by those providers. 
(2) FINAL REPORT.—Not later than 180 days after the Sec-
retary determines that the program is being carried out at 
Recommenda- 
tions. 
Assessments. 
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132 STAT. 1479 
PUBLIC LAW 115–182—JUNE 6, 2018 
the last location to be selected under subsection (c), the Sec-
retary shall submit to Congress a report detailing the rec-
ommendations of the Secretary as to the feasibility and advis-
ability of expanding the program to additional locations. 
SEC. 507. DEPARTMENT OF VETERANS AFFAIRS MEDICAL SCRIBE 
PILOT PROGRAM. 
(a) IN GENERAL.—The Secretary of Veterans Affairs shall carry 
out a 2-year pilot program under which the Secretary shall increase 
the use of medical scribes at Department of Veterans Affairs medical 
centers. 
(b) LOCATIONS.—The Secretary shall carry out the pilot program 
at the 10 medical centers of the Department as follows: 
(1) At least four such medical centers located in rural 
areas. 
(2) At least four such medical centers located in urban 
areas. 
(3) Two such medical centers located in areas with need 
for increased access or increased efficiency, as determine by 
the Secretary. 
(c) MEDICAL SCRIBES.— 
(1) HIRING.—Under the pilot program the Secretary shall— 
(A) hire 20 new Department of Veterans Affairs term 
employees as medical scribes; and 
(B) seek to enter into contracts with appropriate enti-
ties for the employment of 20 additional medical scribes. 
(2) DISTRIBUTION.—The Secretary shall assign four medical 
scribes to each of the 10 medical centers of the Department 
where the Secretary carries out the pilot program as follows: 
(A) Two scribes shall be assigned to each of two physi-
cians. 
(B) Thirty percent of the scribes shall be employed 
in the provision of emergency care. 
(C) Seventy percent of the scribes shall be employed 
in the provision of speciality care in specialties with the 
longest patient wait times or lowest efficiency ratings, as 
determined by the Secretary. 
(d) REPORTS.— 
(1) REPORTS TO CONGRESS.—Not later than 180 days after 
the commencement of the pilot program required under this 
section, and every 180 days thereafter for the duration of the 
pilot program, the Secretary of Veterans Affairs shall submit 
to Congress a report on the pilot program. Each such report 
shall include each of the following: 
(A) A separate analysis of each the following with 
respect to medical scribes employed by the Department 
of Veterans Affairs and medical scribes performing Depart-
ment of Veterans Affairs functions under a contract: 
(i) Provider efficiency. 
(ii) Patient satisfaction. 
(iii) Average wait time. 
(iv) The number of patients seen per day by each 
physician or practitioner. 
(v) The amount of time required to hire and train 
an employee to perform medical scribe functions under 
the pilot program. 
Analyses. 
Time period. 
38 USC 1701 
note. 
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132 STAT. 1480 
PUBLIC LAW 115–182—JUNE 6, 2018 
(B) Metrics and data for analyzing the effects of the 
pilot program, including an evaluation of the each of the 
elements under clauses (i) through (iv) of subparagraph 
(A) at medical centers who employed scribes under the 
pilot program for an appropriate period preceding the 
hiring of such scribes. 
(2) COMPTROLLER
GENERAL
REPORT.—Not later than 90 
days after the termination of the pilot program under this 
section, the Comptroller General of the United States shall 
submit to Congress a report on the pilot program. Such report 
shall include a comparison of the pilot program with similar 
programs carried out in the private sector. 
(e) DEFINITIONS.—In this section: 
(1) The term ‘‘medical scribe’’ means an unlicensed indi-
vidual hired to enter information into the electronic health 
record or chart at the direction of a physician or licensed 
independent practitioner whose responsibilities include the fol-
lowing: 
(A) Assisting the physician or practitioner in navi-
gating the electronic health record. 
(B) Responding to various messages as directed by 
the physician or practitioner. 
(C) Entering information into the electronic health 
record, as directed by the physician or practitioner. 
(2) The terms ‘‘urban’’ and ‘‘rural’’ have the meanings given 
such terms under the rural-urban commuting codes developed 
by the Secretary of Agriculture and the Secretary of Health 
and Human Services. 
(f) FUNDING.—The pilot program under this section shall be 
carried out using amounts otherwise authorized to be appropriated 
for the Department of Veterans Affairs. No additional amounts 
are authorized to be appropriated to carry out such program. 
SEC. 508. EXTENSION OF REQUIREMENT TO COLLECT FEES FOR 
HOUSING LOANS GUARANTEED BY SECRETARY OF VET-
ERANS AFFAIRS. 
Section 3729(b)(2) of title 38, United States Code, is amended 
by striking ‘‘2027’’ each place it appears and inserting ‘‘2028’’. 
SEC. 509. EXTENSION OF REDUCTION IN AMOUNT OF PENSION FUR-
NISHED BY DEPARTMENT OF VETERANS AFFAIRS FOR 
CERTAIN VETERANS COVERED BY MEDICAID PLANS FOR 
SERVICES FURNISHED BY NURSING FACILITIES. 
Section 5503(d)(7) of title 38, United States Code, is amended 
by striking ‘‘September 30, 2027’’ and inserting ‘‘September 30, 
2028’’. 
SEC. 510. APPROPRIATION OF AMOUNTS. 
(a) VETERANS CHOICE PROGRAM.—There is authorized to be 
appropriated, and is appropriated, to the Secretary of Veterans 
Affairs, out of any funds in the Treasury not otherwise appropriated, 
$5,200,000,000 to be deposited in the Veterans Choice Fund under 
section 802 of the Veterans Access, Choice, and Accountability 
Act of 2014 (Public Law 113–146; 38 U.S.C. 1701 note). 
(b) AVAILABILITY
OF AMOUNTS.—The amounts appropriated 
under subsection (a) shall be available for obligation or expenditure 
without fiscal year limitation. 
Data. 
Evaluation. 
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132 STAT. 1481 
PUBLIC LAW 115–182—JUNE 6, 2018 
LEGISLATIVE HISTORY—S. 2372 (H.R. 4910) (H.R. 5674): 
HOUSE REPORTS: No. 115–671, Pt. 1 (Comm. on Veterans’ Affairs) accompanying 
H.R. 5674. 
CONGRESSIONAL RECORD, Vol. 164 (2018): 
Mar. 1, considered and passed Senate. 
May 16, considered and passed House, amended. 
May 17, 22, 23, Senate considered and concurred in House amendment. 
DAILY COMPILATION OF PRESIDENTIAL DOCUMENTS (2018): 
June 6, Presidential remarks and statement. 
SEC. 511. TECHNICAL CORRECTION. 
Section 1712I of title 38, United States Code, is redesignated 
as section 1720I of such title. 
SEC. 512. BUDGETARY EFFECTS. 
(a) STATUTORY PAY-AS-YOU-GO SCORECARDS.—The budgetary 
effects of this Act shall not be entered on either PAYGO scorecard 
maintained pursuant to section 4(d) of the Statutory Pay-As-You- 
Go Act of 2010. 
(b) SENATE PAYGO SCORECARDS.—The budgetary effects of this 
Act shall not be entered on any PAYGO scorecard maintained 
for purposes of section 4106 of H. Con. Res. 71 (115th Congress). 
Approved June 6, 2018. 
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