#aac? ,,congress  #b;d ,session  ,9 !   
,h\se ( ,repres5tatives1 ,u4 ,s41  ,june
 #ah1 #bjad  ,,h\se ,,am5dm5t ,,to      
,,s5ate ,,am5dm5t  ,t ! ,h\se agree to !
 am5dm5t ( ! ,s5ate to ! title ( ! bill 
7,h4,r4 #cbcj7 entitl$ ,an ,act mak+    
cont9u+ appropriations dur+ a ,gov]nm5t 
%utd[n to provide pay & all[ances to    
memb]s ( ! res]ve compon5ts ( ! ,arm$   
,=ces :o p]=m inactive-duty tra9+ dur+  
su* p]iod4 & be x fur!r  ,t ! ,h\se     
agree to ! am5dm5t ( ! ,s5ate to ! text 
( ! a=em5tion$ bill1 ) ! foll[+  ,9 lieu
 ( ! matt] propos$ to be ins]t$ by !    
am5dm5t ( ! ,s5ate to ! text ( ! bill1  
ins]t ! foll[+3  #a4 ,%ort title ,?is   
,act may be cit$ z ! ,vet]an ,access to 
,c>e ,act ( #bjad4  #b4 ,provision (    
hospital c>e & m$ical s]vices at        
non-,dep>tm5t ( ,vet]ans ,affairs       
facilities = ,dep>tm5t ( ,vet]ans       
,affairs pati5ts ) ext5d$ wait+ times = 
appo9tm5ts at ,dep>tm5t facilities  7a7 
,9 g5]al ,z au?oriz$ by section #agaj ( 
title #ch1 ,unit$ ,/ates ,code1 !       

,secret>y ( ,vet]ans ,affairs 79 ?is    
,act ref]r$ to z ! ,secret>y7 %all ent] 
into contracts ) su* non-,dep>tm5t      
facilities z may be necess>y 9 ord] to  
furni% hospital c>e & m$ical s]vices to 
cov]$ vet]ans :o are eligible = su* c>e 
& s]vices "u *apt] #ag ( title #ch1     
,unit$ ,/ates ,code4 ,to ! greate/ ext5t
 possible1 ! ,secret>y %all c>ry out ?is
 section us+ contracts ent]$ into be=e !
 date ( ! enactm5t ( ?is ,act4  7b7     
,cov]$ vet]ans ,= purposes ( ?is        
section1 ! t]m cov]$ vet]an means a     
vet]an--  7#a7 :o is enroll$ 9 ! pati5t 
enrollm5t sy/em "u section #agje ( title
 #ch1 ,unit$ ,/ates ,code2  7#b7 :o--   
7,a7 has wait$ long] ?an ! wait-"t goals
 ( ! ,vet]ans ,heal? ,adm9i/ration 7z ( 
,june #a1 #bjad7 = an appo9tm5t =       
hospital c>e or m$ical s]vices 9 a      
facility ( ! ,dep>tm5t2  7,b7 has be5   
notifi$ by a facility ( ! ,dep>tm5t t an
 appo9tm5t = hospital c>e or m$ical     
s]vices is n available )9 su* wait-"t   
goals2 or  7,c7 resides m ?an #dj miles 

f ! m$ical facility ( ! ,dep>tm5t (     
,vet]ans ,affairs1 includ+ a            
community-bas$ outpati5t cl9ic1 t is    
close/ to ! resid5ce ( ! vet]an2 &  7#c7
 :o makes an election to receive su* c>e
 or s]vices 9 a non-,dep>tm5t facility4 
7c7 ,foll[-,up c>e ,9 c>ry+ out ?is     
section1 ! ,secret>y %all ensure t1 at !
 election ( a cov]$ vet]an :o receives  
hospital c>e or m$ical s]vices at a     
non-,dep>tm5t facility 9 an episode (   
c>e "u ?is section1 ! vet]an receives   
su* hospital c>e & m$ical s]vices at su*
 non-,dep>tm5t facility ?r\gh !         
completion ( ! episode ( c>e 7b = a     
p]iod n exce$+ #fj days71 includ+ all   
specialty & ancill>y s]vices deem$      
necess>y z "p ( ! treatm5t recomm5d$ 9 !
 c\rse ( su* hospital c>e or m$ical     
s]vices4  7d7 ,report ,! ,secret>y %all 
submit to ,congress a qu>t]ly report on 
hospital c>e & m$ical s]vices furni%$   
pursuant to ?is section4 ,su* report    
%all include in=mation1 = ! qu>t] cov]$ 
by ! report1 reg>d+--  7#a7 ! numb] (   

vet]ans :o receiv$ c>e or s]vices at    
non-,dep>tm5t facilities pursuant to ?is
 section2  7#b7 ! numb] ( vet]ans :o 7  
eligible to receive c>e or s]vices      
pursuant to ?is section b :o elect$ to  
cont9ue wait+ = an appo9tm5t at a       
,dep>tm5t facility2  7#c7 ! pur*ase     
me?ods us$ to provide ! c>e & s]vices at
 non-,dep>tm5t facilities1 includ+ !    
rate ( paym5t = individual au?orizations
 = su* c>e & s]vices2 &  7#d7 any o!r   
matt]s ! ,secret>y det]m9es appropriate4
  7e7 ,def9itions ,= purposes ( ?is     
section1 ! t]ms facilities ( !          
,dep>tm5t1 non-,dep>tm5t facilities1    
hospital c>e1 & m$ical s]vices h !      
mean+s giv5 su* t]ms 9 section #agja (  
title #ch1 ,unit$ ,/ates ,code4  7f7    
,implem5tation ,! ,secret>y %all beg9   
implem5t+ ?is section on ! date ( !     
enactm5t ( ?is ,act4  7g7 ,con/ruction  
,no?+ 9 ?is section %all be con/ru$ to  
au?orize paym5t = c>e or s]vices n      
o!rwise cov]$ "u *apt] #ag ( title #ch1 
,unit$ ,/ates ,code4  7h7 ,t]m9ation ,! 

au?ority ( ! ,secret>y "u ?is section   
%all t]m9ate ) respect to any hospital  
c>e or m$ical s]vices furni%$ aft] ! end
 ( ! #b-ye> p]iod beg9n+ on ! date ( !  
enactm5t ( ?is ,act1 except t 9 ! case (
 an episode ( c>e = :i* hospital c>e or 
m$ical s]vices is furni%$ 9 a           
non-,dep>tm5t facility pursuant to ?is  
section be=e ! end ( su* p]iod1 su*     
t]m9ation %all n apply to su* c>e &     
s]vices furni%$ dur+ ! rema9d] ( su*    
episode ( c>e b n to exce$ a p]iod ( #fj
 days4  #c4 ,exp&$ access to hospital   
c>e & m$ical s]vices  7a7 ,9 g5]al ,to !
 ext5t t appropriations are available = 
! ,vet]ans ,heal? ,adm9i/ration ( !     
,dep>tm5t ( ,vet]ans ,affairs = m$ical  
s]vices1 to ! ext5t t ! ,secret>y (     
,vet]ans ,affairs is unable to provide  
access1 )9 ! wait-"t goals ( ! ,vet]ans 
,heal? ,adm9i/ration 7z ( ,june #a1     
#bjad71 to hospital c>e or m$ical       
s]vices to a cov]$ vet]an :o is eligible
 = su* c>e or s]vices "u *apt] #ag (    
title #ch1 ,unit$ ,/ates ,code1 "u      

contracts describ$ 9 section #b1 !      
,secret>y %all reimburse any            
non-,dep>tm5t facility ) :i* ! ,secret>y
 has n ent]$ into a contract to furni%  
hospital c>e or m$ical s]vices = furni%+
 su* hospital c>e or m$ical s]vices to  
su* vet]an1 if ! vet]an elects to       
receive su* c>e or s]vices f !          
non-,dep>tm5t facility4 ,! ,secret>y    
%all reimburse ! facility = ! c>e or    
s]vices furni%$ to ! vet]an at ! greate/
 ( ! foll[+ rates3  7#a7 ,,va paym5t    
rate ,! rate ( reimbursem5t = su* c>e or
 s]vices e/abli%$ by ! ,secret>y (      
,vet]ans ,affairs4  7#b7 ,m$ic>e paym5t 
rate ,! paym5t rate = su* c>e or s]vices
 or comp>able c>e or s]vices "u !       
,m$ic>e program "u title ,,xviii ( !    
,social ,security ,act4  7#c7 ,,tric>e  
paym5t rate ,! reimbursem5t rate = su*  
c>e or s]vices furni%$ to a memb] ( !   
,arm$ ,=ces "u *apt] #ee ( title #aj1   
,unit$ ,/ates ,code4  7b7 ,cov]$ vet]ans
 ,= purposes ( ?is section1 ! t]m cov]$ 
vet]an means a vet]an--  7#a7 :o is     

enroll$ 9 ! pati5t enrollm5t sy/em "u   
section #agje ( title #ch1 ,unit$ ,/ates
 ,code2 &  7#b7 :o--  7,a7 has wait$    
long] ?an ! wait-"t goals ( ! ,vet]ans  
,heal? ,adm9i/ration 7z ( ,june #a1     
#bjad7 = an appo9tm5t = hospital c>e or 
m$ical s]vices 9 a facility ( !         
,dep>tm5t2  7,b7 has be5 notifi$ by a   
facility ( ! ,dep>tm5t t an appo9tm5t = 
hospital c>e or m$ical s]vices is n     
available )9 su* wait-"t goals aft] !   
date = :i* ! vet]an reque/s ! appo9tm5t2
 or  7,c7 :o resides m ?an #dj miles f !
 m$ical facility ( ! ,dep>tm5t (        
,vet]ans ,affairs1 includ+ a            
community-bas$ outpati5t cl9ic1 t is    
close/ to ! resid5ce ( ! vet]an4  7c7   
,def9itions ,= purposes ( ?is section1 !
 t]ms facilities ( ! ,dep>tm5t1         
non-,dep>tm5t facilities1 hospital c>e1 
& m$ical s]vices h ! mean+s giv5 su*    
t]ms 9 section #agja ( title #ch1 ,unit$
 ,/ates ,code4  7d7 ,implem5tation ,!   
,secret>y %all beg9 implem5t+ ?is       
section on ! date ( ! enactm5t ( ?is    

,act4  7e7 ,con/ruction ,no?+ 9 ?is     
section %all be con/ru$ to au?orize     
paym5t = c>e or s]vices n o!rwise cov]$ 
"u *apt] #ag ( title #ch1 ,unit$ ,/ates 
,code4  7f7 ,t]m9ation ,! au?ority ( !  
,secret>y "u ?is section %all t]m9ate ) 
respect to c>e or s]vices furni%$ aft] !
 date t is #b ye>s aft] ! date ( !      
enactm5t ( ?is ,act4  #d4 ,indep5d5t    
assessm5t ( ,vet]ans ,heal?             
,adm9i/ration p]=mance  7a7 ,indep5d5t  
assessm5t requir$ ,n lat] ?an #abj days 
aft] ! date ( ! enactm5t ( ?is ,act1 !  
,secret>y ( ,vet]ans ,affairs %all ent] 
into a contract or contracts ) a private
 sector entity or entities ) exp]i5ce 9 
! deliv]y sy/ems ( ! ,vet]ans ,heal?    
,adm9i/ration & ! private sector & 9    
heal? c>e managem5t to conduct an       
indep5d5t assessm5t ( hospital c>e &    
m$ical s]vices furni%$ 9 m$ical         
facilities ( ! ,dep>tm5t ( ,vet]ans     
,affairs4 ,su* assessm5t %all address   
ea* ( ! foll[+3  7#a7 ,! curr5t &       
project$ demographics & unique c>e ne$s 

( ! pati5t population s]v$ by !         
,dep>tm5t ( ,vet]ans ,affairs4  7#b7 ,! 
curr5t & project$ heal? c>e capabilities
 & res\rces ( ! ,dep>tm5t1 includ+      
hospital c>e & m$ical s]vices furni%$ by
 non-,dep>tm5t facilities "u contract ) 
! ,dep>tm5t1 to provide timely &        
accessible c>e to eligible vet]ans4     
7#c7 ,! au?orities & me*anisms "u :i* ! 
,secret>y may furni% hospital c>e &     
m$ical s]vices at non-,dep>tm5t         
facilities1 includ+ an assessm5t ( :e!r 
! ,secret>y %\ld h ! au?ority to furni% 
su* c>e & s]vices at su* facilities     
?r\gh ! completion ( episodes ( c>e4    
7#d7 ,! appropriate sy/em-wide access   
/&>d applicable to hospital c>e & m$ical
 s]vices furni%$ by & ?r\gh ! ,dep>tm5t 
( ,vet]ans ,affairs & recomm5dations    
relat+ to access /&>ds specific to      
individual specialties & /&>ds = po/-c>e
 rehabilitation4  7#e7 ,! curr5t        
organization1 processes1 & tools us$ to 
support cl9ical /aff+ & docum5tation4   
7#f7 ,! /aff+ levels & productivity     

/&>ds1 includ+ a comp>ison ) indu/ry    
p]=mance p]c5tiles4  7#g7 ,in=mation    
te*nology /rategies ( ! ,vet]ans ,heal? 
,adm9i/ration1 includ+ an id5tification 
( te*nology weaknesses & opportunities1 
especially z !y apply to cl9ical        
docum5tation ( hospital c>e & m$ical    
s]vices provid$ 9 non-,dep>tm5t         
facilities4  7#h7 ,bus9ess processes ( !
 ,vet]ans ,heal? ,adm9i/ration1 includ+ 
non-,dep>tm5t c>e1 insurance            
id5tification1 ?ird-p>ty rev5ue         
collection1 & v5dor reimbursem5t4  7b7  
,assessm5t outcomes ,! assessm5t        
conduct$ pursuant to subsection 7a7 %all
 include ! foll[+3  7#a7 ,an            
id5tification ( improvem5t areas outl9$ 
bo? qualitatively & quantitatively1 tak+
 into consid]ation ,dep>tm5t ( ,vet]ans 
,affairs directives & indu/ry b5*m>ks f 
outside ! ,f$]al ,gov]nm5t4  7#b7       
,recomm5dations = h[ to address !       
improvem5t areas id5tifi$ "u p>agraph   
7#a7 relat+ to /ructure1 acc\ntability1 
process *anges1 te*nology1 & o!r        

relevant driv]s ( p]=mance4  7#c7 ,!    
bus9ess case associat$ ) mak+ !         
improvem5ts & recomm5dations id5tifi$ 9 
p>agraphs 7#a7 & 7#b74  7#d7 ,f9d+s &   
support+ analysis on h[ cr$ible         
conclusions 7 e/abli%$4  7c7 ,program   
integrator ,if ! ,secret>y ent]s into   
contracts ) m ?an "o private sector     
entity "u subsection 7a71 ! ,secret>y   
%all designate "o su* entity z ! program
 integrator4 ,! program integrator %all 
be responsible = coord9at+ ! outcomes ( 
! assessm5ts conduct$ by ! private      
entities pursuant to su* contracts4  7d7
 ,submittal ( reports to ,congress  7#a7
 ,report on indep5d5t assessm5t ,n lat] 
?an #aj mon?s aft] ent]+ into ! contract
 "u subsection 7a71 ! ,secret>y %all    
submit to ! ,committees on ,vet]ans'    
,affairs ( ! ,s5ate & ,h\se (           
,repres5tatives ! f9d+s & recomm5dations
 ( ! indep5d5t assessm5t requir$ by su* 
subsection4  7#b7 ,report on ,,va action
 plan to implem5t recomm5dations 9      
assessm5t ,n lat] ?an #abj days aft] !  

date ( submission ( ! report "u p>agraph
 7#a71 ! ,secret>y %all submit to su*   
,committees on ! ,secret>y's response to
 ! f9d+s ( ! assessm5t & %all include an
 action plan1 includ+ a timel9e1 = fully
 implem5t+ ! recomm5dations ( !         
assessm5t4  #e4 ,limitation on aw>ds &  
bonuses to employees ( ,dep>tm5t (      
,vet]ans ,affairs ,= ea* ( fiscal ye>s  
#bjad ?r\gh #bjaf1 ! ,secret>y (        
,vet]ans ,affairs may n pay aw>ds or    
bonuses "u *apt] #de or #ec ( title #e1 
,unit$ ,/ates ,code1 or any o!r aw>ds or
 bonuses au?oriz$ "u su* title4  #f4    
,,omb e/imate ( budget>y effects & ne$$ 
transf] au?ority ,n lat] ?an #cj days   
aft] ! date ( ! enactm5t ( ?is ,act1 !  
,director ( ! ,(fice ( ,managem5t &     
,budget %all transmit to ! ,committees  
on ,appropriations1 ! ,budget1 &        
,vet]ans' ,affairs ( ! ,h\se (          
,repres5tatives & ( ! ,s5ate--  7#a7 an 
e/imate ( ! budget>y effects ( sections 
#b & #c2  7#b7 any transf] au?ority ne$$
 to utilize ! sav+s f section #e to     

satisfy su* budget>y effects2 &  7#c7 if
 necess>y1 a reque/ = any additional    
budget>y res\rces1 or transf]s or       
reprogramm+ ( exi/+ budget>y res\rces1  
necess>y to provide fund+ = sections #b 
& #c4  #g4 ,removal ( ,s5ior ,executive 
,s]vice employees ( ! ,dep>tm5t (       
,vet]ans ,affairs = p]=mance  7a7 ,9    
g5]al ,*apt] #g ( title #ch1 ,unit$     
,/ates ,code1 is am5d$ by add+ at ! end 
! foll[+ new section3  #gac4 ,s5ior     
,executive ,s]vice3 removal bas$ on     
p]=mance  7a7 ,9 g5]al ,not)/&+ any o!r 
provision ( law1 ! ,secret>y may remove 
any individual f ! ,s5ior ,executive    
,s]vice if ! ,secret>y det]m9es !       
p]=mance ( ! individual w>rants su*     
removal4 ,if ! ,secret>y s removes su*  
an individual1 ! ,secret>y may--  7#a7  
remove ! individual f ,f$]al s]vice2 or 
7#b7 transf] ! individual to a ,g5]al   
,s*$ule position at any grade ( ! ,g5]al
 ,s*$ule ! ,secret>y det]m9es           
appropriate4  7b7 ,notice to ,congress  
,n lat] ?an #cj days aft] remov+ an     

individual f ! ,s5ior ,executive ,s]vice
 "u p>agraph 7#a71 ! ,secret>y %all     
submit to ! ,committees on ,vet]ans'    
,affairs ( ! ,s5ate & ,h\se (           
,repres5tatives notice 9 writ+ ( su*    
removal & ! reason = su* removal4  7c7  
,mann] ( removal ,a removal "u ?is      
section %all be done 9 ! same mann] z ! 
removal ( a pr(essional /aff memb]      
employ$ by a ,memb] ( ,congress4  4  7b7
 ,cl]ical am5dm5t ,! table ( sections at
 ! beg9n+ ( su* *apt] is am5d$ by add+  
at ! end ! foll[+ new item3  #gac4      
,s5ior ,executive ,s]vice3 removal bas$ 
on p]=mance4  4  #h4 ,budget>y effects (
 ,act ,! budget>y effects ( ?is ,act1 = 
! purpose ( comply+ ) ! ,/atutory       
,pay-,z-,y-,g ,act ( #bjaj1 %all be     
det]m9$ by ref]5ce to ! late/ /atem5t   
titl$ ,budget>y ,effects ( ,,paygo      
,legislation = ?is ,act1 submitt$ =     
pr9t+ 9 ! ,congressional ,record by !   
,*airman ( ! ,h\se ,budget ,committee1  
provid$ t su* /atem5t has be5 submitt$  
prior to ! vote on passage4  ,cl]k4