,in the ,senate of the ,united ,states1 
,june #aa1 #bjad4  ,amendments3  ,that  
the bill from the ,house of             
,representatives 7,h4,r4 #cbcj7 entitled
 ,an ,act making continuing             
appropriations during a ,government     
shutdown to provide pay and allowances  
to members of the reserve components of 
the ,armed ,forces who perform          
inactive-duty training during such      
period41 do pass with the following     
,strike all after the enacting clause1  
and insert in lieu thereof3 #a4 ,short  
title2 table of contents  7a7 ,short    
title ,this ,act may be cited as the    
,veterans' ,access to ,care through     
,choice1 ,accountability1 and           
,transparency ,act of #bjad4  7b7 ,table
 of contents ,the table of contents for 
this ,act is as follows3 ,sec4 #a4      
,short title2 table of contents4,,title 
,i--,improvement of ,scheduling ,system 
for ,health ,care ,appointments,sec4    
#aja4 ,independent assessment of the    
scheduling of appointments and other    

health care management processes of the 
,department of ,veterans ,affairs4,sec4 
#ajb4 ,technology task force on review  
of scheduling system and software of the
 ,department of ,veterans               
,affairs4,,title ,,ii--,training and    
,hiring of ,health ,care ,staff,sec4    
#bja4 ,treatment of staffing shortage   
and biannual report on staffing of      
medical facilities of the ,department of
 ,veterans ,affairs4,sec4 #bjb4 ,clinic 
management training for managers and    
health care providers of the ,department
 of ,veterans ,affairs4,sec4 #bjc4 ,use 
of unobligated amounts to hire          
additional health care providers for the
 ,veterans ,health                      
,administration4,,title                 
,,iii--,improvement of ,access to ,care 
from ,non-,department of ,veterans      
,affairs ,providers,sec4 #cja4 ,expanded
 availability of hospital care and      
medical services for veterans through   
the use of contracts4,sec4 #cjb4        
,transfer of authority for payments for 

hospital care1 medical services1 and    
other health care from non-,department  
providers to the ,chief ,business       
,office of the ,veterans ,health        
,administration of the ,department4,sec4
 #cjc4 ,enhancement of collaboration    
between ,department of ,veterans        
,affairs and ,indian ,health            
,service4,sec4 #cjd4 ,enhancement of    
collaboration between ,department of    
,veterans ,affairs and ,native ,hawaiian
 health care systems4,sec4 #cje4 ,sense 
of ,congress on prompt payment by       
,department of ,veterans                
,affairs4,,title ,,iv--,health ,care    
,administrative ,matters,sec4 #dja4     
,improvement of access of veterans to   
mobile vet centers of the ,department of
 ,veterans ,affairs4,sec4 #djb4         
,commission on construction projects of 
the ,department of ,veterans            
,affairs4,sec4 #djc4 ,commission on     
,access to ,care4,sec4 #djd4 ,improved  
performance metrics for health care     
provided by ,department of ,veterans    

,affairs4,sec4 #dje4 ,improved          
transparency concerning health care     
provided by ,department of ,veterans    
,affairs4,sec4 #djf4 ,information for   
veterans on the credentials of          
,department of ,veterans ,affairs       
physicians4,sec4 #djg4 ,information in  
annual budget of the ,president on      
hospital care and medical services      
furnished through expanded use of       
contracts for such care4,sec4 #djh4     
,prohibition on falsification of data   
concerning wait times and quality       
measures at ,department of ,veterans    
,affairs4,sec4 #dji4 ,removal of ,senior
 ,executive ,service employees of the   
,department of ,veterans ,affairs for   
performance4,,title ,v--,health ,care   
,related to ,sexual ,trauma,sec4 #eja4  
,expansion of eligibility for sexual    
trauma counseling and treatment to      
veterans on inactive duty training4,sec4
 #ejb4 ,provision of counseling and     
treatment for sexual trauma by the      
,department of ,veterans ,affairs to    

members of the ,armed ,forces4,sec4     
#ejc4 ,reports on military sexual       
trauma4,,title ,,vi--,major ,medical    
,facility ,leases,sec4 #fja4            
,authorization of major medical facility
 leases4,sec4 #fjb4 ,budgetary treatment
 of ,department of ,veterans ,affairs   
major medical facilities leases4,,title 
,,vii--,veterans ,benefits ,matters,sec4
 #gja4 ,expansion of ,marine ,gunnery   
,sergeant ,john ,david ,fry             
,scholarship4,sec4 #gjb4 ,approval of   
courses of education provided by public 
institutions of higher learning for     
purposes of ,all-,volunteer ,force      
,educational ,assistance ,program and   
,post-#i_/aa ,educational ,assistance   
conditional on in-,state tuition rate   
for veterans4,,title                    
,,viii--,appropriation and ,emergency   
,designations,sec4 #hja4 ,appropriation 
of emergency amounts4,sec4 #hjb4        
,emergency designations4  ,i            
,improvement of ,scheduling ,system for 
,health ,care ,appointments  #aja4      

,independent assessment of the          
scheduling of appointments and other    
health care management processes of the 
,department of ,veterans ,affairs  7a7  
,independent assessment  7#a7           
,assessment ,not later than #cj days    
after the date of the enactment of this 
,act1 the ,secretary of ,veterans       
,affairs shall enter into a contract    
with an independent third party to      
assess the following3 7,a7 ,the process 
at each medical facility of the         
,department of ,veterans ,affairs for   
scheduling appointments for veterans to 
receive hospital care1 medical services1
 or other health care from the          
,department4  7,b7 ,the staffing level  
and productivity of each medical        
facility of the ,department1 including  
the following3 7i7 ,the case load of    
each health care provider of the        
,department4  7ii7 ,the time spent by   
each health care provider of the        
,department on matters other than the   
case load of such health care provider1 

including time spent by such health care
 provider as follows3 7,i7 ,at a medical
 facility that is affiliated with the   
,department4  7,,ii7 ,conducting        
research4  7,,iii7 ,training or         
overseeing other health care            
professionals of the ,department4  7,c7 
,the organization1 processes1 and tools 
used by the ,department to support      
clinical documentation and the          
subsequent coding of inpatient services4
  7,d7 ,the purchasing1 distribution1   
and use of pharmaceuticals1 medical and 
surgical supplies1 and medical devices  
by the ,department1 including the       
following3 7i7 ,the prices paid for1    
standardization of1 and use by the      
,department of the following3 7,i7      
,high-cost pharmaceuticals4  7,,ii7     
,medical and surgical supplies4  7,,iii7
 ,medical devices4  7ii7 ,the use by the
 ,department of group purchasing        
arrangements to purchase                
pharmaceuticals1 medical and surgical   
supplies1 medical devices1 and health   

care related services4  7iii7 ,the      
strategy used by the ,department to     
distribute pharmaceuticals1 medical and 
surgical supplies1 and medical devices  
to ,veterans ,integrated ,service       
,networks and medical facilities of the 
,department4  7,e7 ,the performance of  
the ,department in paying amounts owed  
to third parties and collecting amounts 
owed to the ,department with respect to 
hospital care1 medical services1 and    
other health care1 including any        
recommendations of the independent third
 party as follows3 7i7 ,to avoid the    
payment of penalties to vendors4  7ii7  
,to increase the collection of amounts  
owed to the ,department for hospital    
care1 medical services1 or other health 
care provided by the ,department for    
which reimbursement from a third party  
is authorized4  7iii7 ,to increase the  
collection of any other amounts owed to 
the ,department4  7#b7 ,elements of     
scheduling assessment ,in carrying out  
the assessment required by paragraph    

7#a77;,a71 the independent third party  
shall do the following3 7,a7 ,review all
 training materials pertaining to       
scheduling of appointments at each      
medical facility of the ,department4    
7,b7 ,assess whether all employees of   
the ,department conducting tasks related
 to scheduling are properly trained for 
conducting such tasks4  7,c7 ,assess    
whether changes in the technology or    
system used in scheduling appointments  
are necessary to limit access to the    
system to only those employees that have
 been properly trained in conducting    
such tasks4  7,d7 ,assess whether health
 care providers of the ,department are  
making changes to their schedules that  
hinder the ability of employees         
conducting such tasks to perform such   
tasks4  7,e7 ,assess whether the        
establishment of a centralized call     
center throughout the ,department for   
scheduling appointments at medical      
facilities of the ,department would     
improve the process of scheduling such  

appointments4  7,f7 ,assess whether     
booking templates for each medical      
facility or clinic of the ,department   
would improve the process of scheduling 
such appointments4  7,g7 ,recommend any 
actions to be taken by the ,department  
to improve the process for scheduling   
such appointments1 including the        
following3 7i7 ,changes in training     
materials provided to employees of the  
,department with respect to conducting  
tasks related to scheduling such        
appointments4  7ii7 ,changes in         
monitoring and assessment conducted by  
the ,department of wait times of        
veterans for such appointments4  7iii7  
,changes in the system used to schedule 
such appointments1 including changes to 
improve how the ,department-- 7,i7      
measures wait times of veterans for such
 appointments2  7,,ii7 monitors the     
availability of health care providers of
 the ,department2 and  7,,iii7 provides 
veterans the ability to schedule such   
appointments4  7iv7 ,such other actions 

as the independent third party considers
 appropriate4  7#c7 ,timing ,the        
independent third party carrying out the
 assessment required by paragraph 7#a7  
shall complete such assessment not later
 than #ahj days after entering into the 
contract described in such paragraph4   
7b7 ,report  7#a7 ,in general ,not later
 than #ij days after the date on which  
the independent third party completes   
the assessment under this section1 the  
,secretary shall submit to the          
,committee on ,veterans' ,affairs of the
 ,senate and the ,committee on          
,veterans' ,affairs of the ,house of    
,representatives a report on the results
 of such assessment4  7#b7 ,publication 
,not later than #cj days after          
submitting the report under paragraph   
7#a71 the ,secretary shall publish such 
report in the ,federal ,register and on 
an ,internet website of the ,department 
accessible to the public4  #ajb4        
,technology task force on review of     
scheduling system and software of the   

,department of ,veterans ,affairs  7a7  
,task force review  7#a7 ,in general    
,the ,secretary of ,veterans ,affairs   
shall1 through the use of a technology  
task force1 conduct a review of the     
needs of the ,department of ,veterans   
,affairs with respect to the scheduling 
system and scheduling software of the   
,department of ,veterans ,affairs that  
is used by the ,department to schedule  
appointments for veterans for hospital  
care1 medical services1 and other health
 care from the ,department4  7#b7       
,agreement  7,a7 ,in general ,the       
,secretary shall seek to enter into an  
agreement with a technology organization
 or technology organizations to carry   
out the review required by paragraph    
7#a74  7,b7 ,prohibition on use of funds
 ,no ,federal funds may be used to      
assist the technology organization or   
technology organizations under          
subparagraph 7,a7 in carrying out the   
review required by paragraph 7#a74  7b7 
,report  7#a7 ,in general ,not later    

than #de days after the date of the     
enactment of this ,act1 the technology  
task force required under subsection    
7a77#a7 shall submit to the ,secretary1 
the ,committee on ,veterans' ,affairs of
 the ,senate1 and the ,committee on     
,veterans' ,affairs of the ,house of    
,representatives a report setting forth 
the findings and recommendations of the 
technology task force regarding the     
needs of the ,department with respect to
 the scheduling system and scheduling   
software of the ,department described in
 such subsection4  7#b7 ,elements ,the  
report required by paragraph 7#a7 shall 
include the following3 7,a7 ,proposals  
for specific actions to be taken by the 
,department to improve the scheduling   
system and scheduling software of the   
,department described in subsection     
7a77#a74  7,b7 ,a determination as to   
whether an existing off-the-shelf system
 would-- 7i7 meet the needs of the      
,department to schedule appointments for
 veterans for hospital care1 medical    

services1 and other health care from the
 ,department2 and  7ii7 improve the     
access of veterans to such care and     
services4  7#c7 ,publication ,not later 
than #cj days after the receipt of the  
report required by paragraph 7#a71 the  
,secretary shall publish such report in 
the ,federal ,register and on an        
,internet website of the ,department    
accessible to the public4  7c7          
,implementation of task force           
recommendations ,not later than one year
 after the receipt of the report        
required by subsection 7b77#a71 the     
,secretary shall implement the          
recommendations set forth in such report
 that the ,secretary considers are      
feasible1 advisable1 and cost-effective4
  ,,ii ,training and ,hiring of ,health 
,care ,staff  #bja4 ,treatment of       
staffing shortage and biannual report on
 staffing of medical facilities of the  
,department of ,veterans ,affairs  7a7  
,staffing shortage  7#a7 ,in general    
,not later than #ahj days after the date

 of the enactment of this ,act1 and not 
later than ,september #cj each year     
thereafter1 the ,inspector ,general of  
the ,department of ,veterans ,affairs   
shall determine1 and the ,secretary of  
,veterans ,affairs shall publish in the 
,federal ,register1 the five occupations
 of health care providers of the        
,department of ,veterans ,affairs for   
which there is the largest staffing     
shortage throughout the ,department4    
7#b7 ,recruitment and appointment       
,notwithstanding sections #ccjd and     
#ccji through #ccah of title #e1 ,united
 ,states ,code1 the ,secretary may1 upon
 a determination by the ,inspector      
,general under paragraph 7#a7 that there
 is a staffing shortage throughout the  
,department with respect to a particular
 occupation of health care provider1    
recruit and directly appoint highly     
qualified health care providers to serve
 as health care providers in that       
particular occupation for the           
,department4  7#c7 ,priority in ,health 

,professionals ,educational ,assistance 
,program to certain providers ,section  
#gfab7;b77#e7 of title #ch1 ,united     
,states ,code1 is amended-- 7,a7 in     
subparagraph 7,a71 by striking and at   
the end2  7,b7 by redesignating         
subparagraph 7,b7 as subparagraph 7,c72 
and  7,c7 by inserting after            
subparagraph 7,a7 the following new     
subparagraph 7,b73  7,b7 shall give     
priority to applicants pursuing a course
 of education or training towards a     
career in an occupation for which the   
,secretary has1 in the most current     
determination published in the ,federal 
,register pursuant to section           
#bja7;a77#a7 of the ,veterans' ,access  
to ,care through ,choice1               
,accountability1 and ,transparency ,act 
of #bjad1 determined that there is one  
of the largest staffing shortages       
throughout the ,department with respect 
to such occupation2 and  4  7b7 ,reports
  7#a7 ,in general ,not later than #ahj 
days after the date of the enactment of 

this ,act1 and not later than ,december 
#ca of each even numbered year          
thereafter until #bjbd1 the ,secretary  
of ,veterans ,affairs shall submit to   
the ,committee on ,veterans' ,affairs of
 the ,senate and the ,committee on      
,veterans' ,affairs of the ,house of    
,representatives a report assessing the 
staffing of each medical facility of the
 ,department of ,veterans ,affairs4     
7#b7 ,elements ,each report submitted   
under paragraph 7#a7 shall include the  
following3 7,a7 ,the results of a       
system-wide assessment of all medical   
facilities of the ,department to ensure 
the following3 7i7 ,appropriate staffing
 levels for health care providers to    
meet the goals of the ,secretary for    
timely access to care for veterans4     
7ii7 ,appropriate staffing levels for   
support personnel1 including clerks4    
7iii7 ,appropriate sizes for clinical   
panels4  7iv7 ,appropriate numbers of   
full-time staff1 or full-time           
equivalents1 dedicated to direct care of

 patients4  7v7 ,appropriate physical   
plant space to meet the capacity needs  
of the ,department in that area4  7vi7  
,such other factors as the ,secretary   
considers necessary4  7,b7 ,a plan for  
addressing any issues identified in the 
assessment described in subparagraph    
7,a71 including a timeline for          
addressing such issues4  7,c7 ,a list of
 the current wait times and workload    
levels for the following clinics in each
 medical facility3 7i7 ,mental health4  
7ii7 ,primary care4  7iii7              
,gastroenterology4  7iv7 ,women's       
health4  7v7 ,such other clinics as the 
,secretary considers appropriate4  7,d7 
,a description of the results of the    
most current determination of the       
,inspector ,general under paragraph 7#a7
 of subsection 7a7 and a plan to use    
direct appointment authority under      
paragraph 7#b7 of such subsection to    
fill staffing shortages1 including      
recommendations for improving the speed 
at which the credentialing and          

privileging process can be conducted4   
7,e7 ,the current staffing models of the
 ,department for the following clinics1 
including recommendations for changes to
 such models3 7i7 ,mental health4  7ii7 
,primary care4  7iii7 ,gastroenterology4
  7iv7 ,women's health4  7v7 ,such other
 clinics as the ,secretary considers    
appropriate4  7,f7 ,a detailed analysis 
of succession planning at medical       
facilities of the ,department1 including
 the following3 7i7 ,the number of      
positions in medical facilities         
throughout the ,department that are not 
filled by a permanent employee4  7ii7   
,the length of time each position       
described in clause 7i7 remained vacant 
or filled by a temporary or acting      
employee4  7iii7 ,a description of any  
barriers to filling the positions       
described in clause 7i74  7iv7 ,a plan  
for filling any positions that are      
vacant or filled by a temporary or      
acting employee for more than #ahj days4
  7v7 ,a plan for handling emergency    

circumstances1 such as administrative   
leave or sudden medical leave for senior
 officials4  7,g7 ,the number of health 
care providers of the ,department who   
have been removed from their positions1 
have retired1 or have left their        
positions for another reason1           
disaggregated by provider type1 during  
the two-year period preceding the       
submittal of the report4  7,h7 ,of the  
health care providers specified in      
subparagraph 7,g7 who have been removed 
from their positions1 the following3 7i7
 ,the number of such health care        
providers who were reassigned to other  
positions in the ,department4  7ii7 ,the
 number of such health care providers   
who left the ,department4  7iii7 ,the   
number of such health care providers who
 left the ,department and were          
subsequently rehired by the ,department4
  #bjb4 ,clinic management training for 
managers and health care providers of   
the ,department of ,veterans ,affairs   
7a7 ,clinic management training program 

7#a7 ,in general ,not later than #ahj   
days after the date of the enactment of 
this ,act1 the ,secretary of ,veterans  
,affairs shall commence a clinic        
management training program to provide  
in-person1 standardized education on    
health care management to all managers  
of1 and health care providers at1       
medical facilities of the ,department of
 ,veterans ,affairs4  7#b7 ,elements    
,the clinic management training program 
required by paragraph 7#a7 shall include
 the following3 7,a7 ,training on how to
 manage the schedules of health care    
providers of the ,department1 including 
the following3 7i7 ,maintaining such    
schedules in a manner that allows       
appointments to be booked at least eight
 weeks in advance4  7ii7 ,proper        
planning procedures for vacation1 leave1
 and graduate medical education training
 schedules4  7,b7 ,training on the      
appropriate number of appointments that 
a health care provider should conduct on
 a daily basis1 based on specialty4     

7,c7 ,training on how to determine      
whether there are enough available      
appointment slots to manage demand for  
different appointment types and         
mechanisms for alerting management of   
insufficient slots4  7,d7 ,training on  
how to properly use the appointment     
scheduling system of the ,department1   
including any new scheduling system     
implemented by the ,department4  7,e7   
,training on how to optimize the use of 
technology1 including the following3 7i7
 ,telemedicine4  7ii7 ,electronic mail4 
7iii7 ,text messaging4  7iv7 ,such other
 technologies as specified by the       
,secretary4  7,f7 ,training on how to   
properly use physical plant space at    
medical facilities of the ,department to
 ensure efficient flow and privacy for  
patients and staff4  7#c7 ,sunset ,the  
clinic management training program      
required by paragraph 7#a7 shall        
terminate on the date that is two years 
after the date on which the ,secretary  
commences such program4  7b7 ,training  

materials  7#a7 ,in general ,after the  
termination of the clinic management    
training program required by subsection 
7a71 the ,secretary shall provide       
training materials on health care       
management to each of the following     
employees of the ,department upon the   
commencement of employment of such      
employee3 7,a7 ,any manager of a medical
 facility of the ,department4  7,b7 ,any
 health care provider at a medical      
facility of the ,department4  7,c7 ,such
 other employees of the ,department as  
the ,secretary considers appropriate4   
7#b7 ,update ,the ,secretary shall      
regularly update the training materials 
required under paragraph 7#a74  #bjc4   
,use of unobligated amounts to hire     
additional health care providers for the
 ,veterans ,health ,administration  7a7 
,in general ,at the end of each of      
fiscal years #bjad and #bjae1 all       
covered amounts shall be made available 
to the ,secretary of ,veterans ,affairs 
to hire additional health care providers

 for the ,veterans ,health              
,administration of the ,department of   
,veterans ,affairs1 or to carry out any 
provision of this ,act or the amendments
 made by this ,act1 and shall remain    
available until expended4  7b7 ,priority
 in hiring ,the ,secretary shall        
prioritize hiring additional health care
 providers under subsection 7a7 at      
medical facilities of the ,department   
and in geographic areas in which the    
,secretary identifies the greatest      
shortage of health care providers4  7c7 
,covered amounts defined ,in this       
section1 the term covered amounts means 
amounts-- 7#a7 that are made available  
to the ,veterans ,health ,administration
 of the ,department for an              
appropriations account-- 7,a7 under the 
heading ,medical ,services2  7,b7 under 
the heading ,medical ,support and       
,compliance2 or  7,c7 under the heading 
,medical ,facilities2 and  7#b7 that are
 unobligated at the end of the          
applicable fiscal year4  ,,iii          

,improvement of ,access to ,care from   
,non-,department of ,veterans ,affairs  
,providers  #cja4 ,expanded availability
 of hospital care and medical services  
for veterans through the use of         
contracts  7a7 ,expansion of available  
care and services  7#a7 ,furnishing of  
care  7,a7 ,in general ,hospital care   
and medical services under chapter #ag  
of title #ch1 ,united ,states ,code1    
shall be furnished to an eligible       
veteran described in subsection 7b71 at 
the election of such veteran1 through   
contracts authorized under subsection   
7d71 or any other law administered by   
the ,secretary of ,veterans ,affairs1   
with entities specified in subparagraph 
7,b7 for the furnishing of such care and
 services to veterans4  7,b7 ,entities  
specified ,the entities specified in    
this subparagraph are the following3 7i7
 ,any health care provider that is      
participating in the ,medicare program  
under title ,,xviii of the ,social      
,security ,act 7#db ,u4,s4,c4 #acie et  

seq474  7ii7 ,any ,federally-qualified  
health center 7as defined in section    
#aije7l77#b77;,b7 of the ,social        
,security ,act 7#db ,u4,s4,c4           
#acif;d7l77#b77;,b7774  7iii7 ,the      
,department of ,defense4  7iv7 ,the     
,indian ,health ,service4  7#b7 ,choice 
of provider ,an eligible veteran who    
elects to receive care and services     
under this section may select the       
provider of such care and services from 
among any source of provider of such    
care and services through an entity     
specified in paragraph 7#a77;,b7 that is
 accessible to the veteran4  7#c7       
,coordination of care and services ,the 
,secretary shall coordinate1 through the
 ,non-,,va ,care ,coordination ,program 
of the ,department of ,veterans         
,affairs1 the furnishing of care and    
services under this section to eligible 
veterans1 including by ensuring that an 
eligible veteran receives an appointment
 for such care and services within the  
current wait-time goals of the ,veterans

 ,health ,administration for the        
furnishing of hospital care and medical 
services4  7b7 ,eligible veterans ,a    
veteran is an eligible veteran for      
purposes of this section if-- 7#a7 7,a7 
the veteran is enrolled in the patient  
enrollment system of the ,department of 
,veterans ,affairs established and      
operated under section #agje of title   
#ch1 ,united ,states ,code2 or  7,b7 the
 veteran is enrolled in such system1 has
 not received hospital care or medical  
services from the ,department1 and has  
contacted the ,department seeking an    
initial appointment from the ,department
 for the receipt of such care or        
services2 and  7#b7 the veteran-- 7,a7  
7i7 attempts1 or has attempted under    
paragraph 7#a77;,b71 to schedule an     
appointment for the receipt of hospital 
care or medical services under chapter  
#ag of title #ch1 ,united ,states ,code1
 but is unable to schedule an           
appointment within the current wait-time
 goals of the ,veterans ,health         

,administration for the furnishing of   
such care or services2 and  7ii7 elects1
 and is authorized1 to be furnished such
 care or services pursuant to subsection
 7c77#b72  7,b7 resides more than #dj   
miles from the nearest medical facility 
of the ,department1 including a         
community-based outpatient clinic1 that 
is closest to the residence of the      
veteran2 or  7,c7 resides-- 7i7 in a    
,state without a medical facility of the
 ,department that provides-- 7,i7       
hospital care2  7,,ii7 emergency medical
 services2 and  7,,iii7 surgical care   
rated by the ,secretary as having a     
surgical complexity of standard2 and    
7ii7 more than #bj miles from a medical 
facility of the ,department described in
 clause 7i74  7c7 ,election and         
authorization  7#a7 ,in general ,if the 
,secretary confirms that an appointment 
for an eligible veteran described in    
subsection 7b77#b77;,a7 for the receipt 
of hospital care or medical services    
under chapter #ag of title #ch1 ,united 

,states ,code1 is unavailable within the
 current wait-time goals of the         
,department for the furnishing of such  
care or services1 the ,secretary shall1 
at the election of the eligible         
veteran-- 7,a7 place such eligible      
veteran on an electronic waiting list   
described in paragraph 7#b7 for such an 
appointment2 or  7,b7 7i7 authorize that
 such care and services be furnished to 
the eligible veteran under this section 
for a period of time specified by the   
,secretary2 and  7ii7 send a letter to  
the eligible veteran describing the care
 and services the eligible veteran is   
eligible to receive under this section4 
7#b7 ,electronic waiting list ,the      
electronic waiting list described in    
this paragraph shall be maintained by   
the ,department and allow access by each
 eligible veteran via                   
www4myhealth4va4gov or any successor    
website for the following purposes3 7,a7
 ,to determine the place of such        
eligible veteran on the waiting list4   

7,b7 ,to determine the average length of
 time an individual spends on the       
waiting list1 disaggregated by medical  
facility of the ,department and type of 
care or service needed1 for purposes of 
allowing such eligible veteran to make  
an informed election under paragraph    
7#a74  7d7 ,care and services through   
contracts  7#a7 ,in general ,the        
,secretary shall enter into contracts   
with health care providers that are     
participating in the ,medicare program  
under title ,,xviii of the ,social      
,security ,act 7#db ,u4,s4,c4 #acie et  
seq47 to furnish care and services to   
eligible veterans under this section4   
7#b7 ,rates and reimbursement  7,a7 ,in 
general ,in entering into a contract    
under this subsection1 the ,secretary   
shall-- 7i7 negotiate rates for the     
furnishing of care and services under   
this section2 and  7ii7 reimburse the   
health care provider for such care and  
services at the rates negotiated        
pursuant to clause 7i7 as provided in   

such contract4  7,b7 ,limit on rates    
7i7 ,in general ,except as provided in  
clause 7ii71 rates negotiated under     
subparagraph 7,a77i7 shall not be more  
than the rates paid by the ,united      
,states to a provider of services 7as   
defined in section #ahfa7u7 of the      
,social ,security ,act 7#db ,u4,s4,c4   
#aciex7u777 or a supplier 7as defined in
 section #ahfa7;d7 of such ,act 7#db    
,u4,s4,c4 #aciex7d777 under the         
,medicare program under title ,,xviii of
 the ,social ,security ,act 7#db        
,u4,s4,c4 #acie et seq47 for the same   
care and services4  7ii7 ,exception ,the
 ,secretary may negotiate a rate that is
 more than the rate paid by the ,united 
,states as described in clause 7i7 with 
respect to the furnishing of care or    
services under this section to an       
eligible veteran if the ,secretary      
determines that there is no health care 
provider that will provide such care or 
services to such eligible veteran at the
 rate required under such clause-- 7,i7 

within the current wait-time goals of   
the ,veterans ,health ,administration   
for the furnishing of such care or      
services2 and  7,,ii7 at a location not 
more than #dj miles from the residence  
of such eligible veteran4  7,c7 ,limit  
on collection ,for the furnishing of    
care and services pursuant to a contract
 under this section1 a health care      
provider may not collect any amount that
 is greater than the rate negotiated    
pursuant to subparagraph 7,a77i74  7#c7 
,information on policies and procedures 
,the ,secretary shall provide to any    
health care provider with which the     
,secretary has entered into a contract  
under paragraph 7#a7 the following3 7,a7
 ,information on applicable policies and
 procedures for submitting bills or     
claims for authorized care and services 
furnished to eligible veterans under    
this section4  7,b7 ,access to a        
telephone hotline maintained by the     
,department that such health care       
provider may call for information on the

 following3 7i7 ,procedures for         
furnishing care and services under this 
section4  7ii7 ,procedures for          
submitting bills or claims for          
authorized care and services furnished  
to eligible veterans under this section 
and being reimbursed for furnishing such
 care and services4  7iii7 ,whether     
particular care or services under this  
section are authorized1 and the         
procedures for authorization of such    
care or services4  7e7 ,choice card     
7#a7 ,in general ,for purposes of       
receiving care and services under this  
section1 the ,secretary shall issue to  
each eligible veteran a card that the   
eligible veteran shall present to a     
health care provider that is eligible to
 furnish care and services under this   
section before receiving such care and  
services4  7#b7 ,name of card ,each card
 issued under paragraph 7#a7 shall be   
known as a ,choice ,card4  7#c7 ,details
 of card ,each ,choice ,card issued to  
an eligible veteran under paragraph 7#a7

 shall include the following3 7,a7 ,the 
name of the eligible veteran4  7,b7 ,an 
identification number for the eligible  
veteran that is not the social security 
number of the eligible veteran4  7,c7   
,the contact information of an          
appropriate office of the ,department   
for health care providers to confirm    
that care and services under this       
section are authorized for the eligible 
veteran4  7,d7 ,contact information and 
other relevant information for the      
submittal of claims or bills for the    
furnishing of care and services under   
this section4  7,e7 ,the following      
statement3 ,this card is for qualifying 
medical care outside the ,department of 
,veterans ,affairs4 ,please call the    
,department of ,veterans ,affairs phone 
number specified on this card to ensure 
that treatment has been authorized44    
7#d7 ,information on use of card ,upon  
issuing a ,choice ,card to an eligible  
veteran1 the ,secretary shall provide   
the eligible veteran with information   

clearly stating the circumstances under 
which the veteran may be eligible for   
care and services under this section4   
7f7 ,information on availability of care
 ,the ,secretary shall provide          
information to a veteran about the      
availability of care and services under 
this section in the following           
circumstances3 7#a7 ,when the veteran   
enrolls in the patient enrollment system
 of the ,department under section #agje 
of title #ch1 ,united ,states ,code4    
7#b7 ,when the veteran attempts to      
schedule an appointment for the receipt 
of hospital care or medical services    
from the ,department but is unable to   
schedule an appointment within the      
current wait-time goals of the ,veterans
 ,health ,administration for delivery of
 such care or services4  7g7 ,providers 
,to be eligible to furnish care and     
services under this section1 a health   
care provider must-- 7#a7 maintain at   
least the same or similar credentials   
and licenses as those credentials and   

licenses that are required of health    
care providers of the ,department1 as   
determined by the ,secretary for        
purposes of this section2 and  7#b7     
submit1 not less frequently than once   
each year1 verification of such licenses
 and credentials maintained by such     
health care provider4  7h7 ,cost-sharing
  7#a7 ,in general ,the ,secretary shall
 require an eligible veteran to pay a   
copayment to the ,department for the    
receipt of care and services under this 
section only if such eligible veteran   
would be required to pay such copayment 
for the receipt of such care and        
services at a medical facility of the   
,department4  7#b7 ,limitation ,the     
copayment required under paragraph 7#a7 
shall not be greater than the copayment 
required of such eligible veteran by the
 ,department for the receipt of such    
care and services at a medical facility 
of the ,department4  7i7 ,claims        
processing system  7#a7 ,in general ,the
 ,secretary shall provide for an        

efficient nationwide system for         
processing and paying bills or claims   
for authorized care and services        
furnished to eligible veterans under    
this section4  7#b7 ,regulations ,not   
later than #ij days after the date of   
the enactment of this ,act1 the         
,secretary of ,veterans ,affairs shall  
prescribe regulations for the           
implementation of such system4  7#c7    
,oversight ,the ,chief ,business ,office
 of the ,veterans ,health               
,administration shall oversee the       
implementation and maintenance of such  
system4  7#d7 ,accuracy of payment  7,a7
 ,in general ,the ,secretary shall      
ensure that such system meets such goals
 for accuracy of payment as the         
,secretary shall specify for purposes of
 this section4  7,b7 ,annual report  7i7
 ,in general ,not later than one year   
after the date of the enactment of this 
,act1 and annually thereafter until the 
termination date specified in subsection
 7n71 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 goals  
for accuracy of such system4  7ii7      
,elements ,each report required by      
clause 7i7 shall include the following3 
7,i7 ,a description of the goals for    
accuracy for such system specified by   
the ,secretary under subparagraph 7,a74 
7,,ii7 ,an assessment of the success of 
the ,department in meeting such goals   
during the year preceding the submittal 
of the report4  7j7 ,medical records    
,the ,secretary shall ensure that any   
health care provider that furnishes care
 and services under this section to an  
eligible veteran submits to the         
,department any medical record related  
to the care and services provided to    
such eligible veteran by such health    
care provider for inclusion in the      
electronic medical record of such       
eligible veteran maintained by the      
,department upon the completion of the  

provision of such care and services to  
such eligible veteran4  7k7 ,tracking of
 missed appointments ,the ,secretary    
shall implement a mechanism to track any
 missed appointments for care and       
services under this section by eligible 
veterans to ensure that the ,department 
does not pay for such care and services 
that were not furnished to an eligible  
veteran4  7l7 ,implementation ,not later
 than #ij days after the date of the    
enactment of this ,act1 the ,secretary  
shall prescribe interim final           
regulations on the implementation of    
this section and publish such           
regulations in the ,federal ,register4  
7m7 ,inspector ,general report ,not     
later than #edj days after the          
publication of the interim final        
regulations under subsection 7l71 the   
,inspector ,general of the ,department  
shall submit to the ,secretary a report 
on the results of an audit of the care  
and services furnished under this       
section to ensure the accuracy and      

timeliness of payments by the           
,department for the cost of such care   
and services1 including any findings and
 recommendations of the ,inspector      
,general4  7n7 ,termination ,the        
requirement of the ,secretary to furnish
 care and services under this section   
terminates on the date that is two years
 after the date on which the ,secretary 
publishes the interim final regulations 
under subsection 7l74  7o7 ,reports     
7#a7 ,initial report ,not later than #ij
 days after the publication of the      
interim final regulations under         
subsection 7l71 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 furnishing of care and services     
under this section that includes the    
following3 7,a7 ,the number of eligible 
veterans who have received care and     
services under this section4  7,b7 ,a   
description of the type of care and     

services furnished to eligible veterans 
under this section4  7#b7 ,final report 
,not later than #edj days after the     
publication of the interim final        
regulations under subsection 7l71 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        
furnishing of care and services under   
this section that includes the          
following3 7,a7 ,the total number of    
eligible veterans who have received care
 and services under this section1       
disaggregated by-- 7i7 eligible veterans
 described in subsection 7b77#b77;,a72  
and  7ii7 eligible veterans described in
 subsection 7b77#b77;,b74  7,b7 ,a      
description of the type of care and     
services furnished to eligible veterans 
under this section4  7,c7 ,an accounting
 of the total cost of furnishing care   
and services to eligible veterans under 
this section4  7,d7 ,the results of a   

survey of eligible veterans who have    
received care or services under this    
section on the satisfaction of such     
eligible veterans with the care or      
services received by such eligible      
veterans under this section4  7,e7 ,an  
assessment of the effect of furnishing  
care and services under this section on 
wait times for an appointment for the   
receipt of hospital care and medical    
services from the ,department4  7,f7 ,an
 assessment of the feasibility and      
advisability of continuing furnishing   
care and services under this section    
after the termination date specified in 
subsection 7n74  7p7 ,rules of          
construction  7#a7 ,no modification of  
contracts ,nothing in this section shall
 be construed to require the ,secretary 
to renegotiate contracts for the        
furnishing of hospital care or medical  
services to veterans entered into by the
 ,department before the date of the     
enactment of this ,act4  7#b7 ,filling  
and paying for prescription medications 

,nothing in this section shall be       
construed to alter the process of the   
,department for filling and paying for  
prescription medications4  #cjb4        
,transfer of authority for payments for 
hospital care1 medical services1 and    
other health care from non-,department  
providers to the ,chief ,business       
,office of the ,veterans ,health        
,administration of the ,department  7a7 
,transfer of authority  7#a7 ,in general
 ,effective on ,october #a1 #bjad1 the  
,secretary of ,veterans ,affairs shall  
transfer the authority to pay for       
hospital care1 medical services1 and    
other health care through               
non-,department providers to the ,chief 
,business ,office of the ,veterans      
,health ,administration of the          
,department of ,veterans ,affairs from  
the ,veterans ,integrated ,service      
,networks and medical centers of the    
,department of ,veterans ,affairs4  7#b7
 ,manner of care ,the ,chief ,business  
,office shall work in consultation with 

the ,office of ,clinical ,operations and
 ,management of the ,department of      
,veterans ,affairs to ensure that care  
and services described in paragraph 7#a7
 are provided in a manner that is       
clinically appropriate and effective4   
7#c7 ,no delay in payment ,the transfer 
of authority under paragraph 7#a7 shall 
be carried out in a manner that does not
 delay or impede any payment by the     
,department for hospital care1 medical  
services1 or other health care provided 
through a non-,department provider under
 the laws administered by the           
,secretary4  7b7 ,budgetary effect ,the 
,secretary shall1 for each fiscal year  
that begins after the date of the       
enactment of this ,act-- 7#a7 include in
 the budget for the ,chief ,business    
,office of the ,veterans ,health        
,administration amounts to pay for      
hospital care1 medical services1 and    
other health care provided through      
non-,department providers1 including any
 amounts necessary to carry out the     

transfer of authority to pay for such   
care and services under subsection 7a71 
including any increase in staff2 and    
7#b7 not include in the budget of each  
,veterans ,integrated ,service ,network 
and medical center of the ,department   
amounts to pay for such care and        
services4  #cjc4 ,enhancement of        
collaboration between ,department of    
,veterans ,affairs and ,indian ,health  
,service  7a7 ,outreach to ,tribal-,run 
medical facilities ,the ,secretary of   
,veterans ,affairs shall1 in            
consultation with the ,director of the  
,indian ,health ,service1 conduct       
outreach to each medical facility       
operated by an ,indian tribe or tribal  
organization through a contract or      
compact with the ,indian ,health        
,service under the ,indian              
,self-,determination and ,education     
,assistance ,act 7#be ,u4,s4,c4 #dej et 
seq47 to raise awareness of the ability 
of such facilities1 ,indian tribes1 and 
tribal organizations to enter into      

agreements with the ,department of      
,veterans ,affairs under which the      
,secretary reimburses such facilities1  
,indian tribes1 or tribal organizations1
 as the case may be1 for health care    
provided to veterans eligible for health
 care at such facilities4  7b7 ,metrics 
for memorandum of understanding         
performance ,the ,secretary of ,veterans
 ,affairs shall implement performance   
metrics for assessing the performance by
 the ,department of ,veterans ,affairs  
and the ,indian ,health ,service under  
the memorandum of understanding entitled
 ,memorandum of ,understanding between  
the ,department of ,veterans ,affairs   
7,,va7 and the ,indian ,health ,service 
7,,ihs7 in increasing access to health  
care1 improving quality and coordination
 of health care1 promoting effective    
patient-centered collaboration and      
partnerships between the ,department and
 the ,service1 and ensuring             
health-promotion and disease-prevention 
services are appropriately funded and   

available for beneficiaries under both  
health care systems4  7c7 ,report ,not  
later than #ahj days after the date of  
the enactment of this ,act1 the         
,secretary of ,veterans ,affairs and the
 ,director of the ,indian ,health       
,service shall jointly submit to        
,congress a report on the feasibility   
and advisability of the following3 7#a7 
,entering into agreements for the       
reimbursement by the ,secretary of the  
costs of direct care services provided  
through organizations receiving amounts 
pursuant to grants made or contracts    
entered into under section #ejc of the  
,indian ,health ,care ,improvement ,act 
7#be ,u4,s4,c4 #afec7 to veterans who   
are otherwise eligible to receive health
 care from such organizations4  7#b7    
,including the reimbursement of the     
costs of direct care services provided  
to veterans who are not ,indians in     
agreements between the ,department and  
the following3 7,a7 ,the ,indian ,health
 ,service4  7,b7 ,an ,indian tribe or   

tribal organization operating a medical 
facility through a contract or compact  
with the ,indian ,health ,service under 
the ,indian ,self-,determination and    
,education ,assistance ,act 7#be        
,u4,s4,c4 #dej et seq474  7,c7 ,a       
medical facility of the ,indian ,health 
,service4  7d7 ,definitions ,in this    
section3 7#a7 ,indian ,the terms ,indian
 and ,indian tribe have the meanings    
given those terms in section #d of the  
,indian ,health ,care ,improvement ,act 
7#be ,u4,s4,c4 #afjc74  7#b7 ,medical   
facility of the ,indian ,health ,service
 ,the term medical facility of the      
,indian ,health ,service includes a     
facility operated by an ,indian tribe or
 tribal organization through a contract 
or compact with the ,indian ,health     
,service under the ,indian              
,self-,determination and ,education     
,assistance ,act 7#be ,u4,s4,c4 #dej et 
seq474  7#c7 ,tribal organization ,the  
term tribal organization has the meaning
 given the term in section #d of the    

,indian ,self-,determination and        
,education ,assistance ,act 7#be        
,u4,s4,c4 #dej;b74  #cjd4 ,enhancement  
of collaboration between ,department of 
,veterans ,affairs and ,native ,hawaiian
 health care systems  7a7 ,in general   
,the ,secretary of ,veterans ,affairs   
shall1 in consultation with ,papa ,ola  
,lokahi and such other organizations    
involved in the delivery of health care 
to ,native ,hawaiians as the ,secretary 
considers appropriate1 enter into       
contracts or agreements with ,native    
,hawaiian health care systems that are  
in receipt of funds from the ,secretary 
of ,health and ,human ,services pursuant
 to grants awarded or contracts entered 
into under section #f7;a7 of the ,native
 ,hawaiian ,health ,care ,improvement   
,act 7#db ,u4,s4,c4 #aagje7;a77 for the 
reimbursement of direct care services   
provided to eligible veterans as        
specified in such contracts or          
agreements4  7b7 ,definitions ,in this  
section1 the terms ,native ,hawaiian1   

,native ,hawaiian health care system1   
and ,papa ,ola ,lokahi have the meanings
 given those terms in section #ab of the
 ,native ,hawaiian ,health ,care        
,improvement ,act 7#db ,u4,s4,c4        
#aagaa74  #cje4 ,sense of ,congress on  
prompt payment by ,department of        
,veterans ,affairs ,it is the sense of  
,congress that the ,secretary of        
,veterans ,affairs shall comply with    
section #acae of title #e1 ,code of     
,federal ,regulations 7commonly known as
 the prompt payment rule71 or any       
corresponding similar regulation or     
ruling1 in paying for health care       
pursuant to contracts entered into with 
non-,department of ,veterans ,affairs   
providers to provide health care under  
the laws administered by the ,secretary4
  ,,iv ,health ,care ,administrative    
,matters  #dja4 ,improvement of access  
of veterans to mobile vet centers of the
 ,department of ,veterans ,affairs  7a7 
,improvement of access  7#a7 ,in general
 ,the ,secretary of ,veterans ,affairs  

shall improve the access of veterans to 
telemedicine and other health care      
through the use of mobile vet centers of
 the ,department of ,veterans ,affairs  
by providing standardized requirements  
for the operation of such centers4  7#b7
 ,requirements ,the standardized        
requirements required by paragraph 7#a7 
shall include the following3 7,a7 ,the  
number of days each mobile vet center of
 the ,department is expected to travel  
per year4  7,b7 ,the number of locations
 each center is expected to visit per   
year4  7,c7 ,the number of appointments 
each center is expected to conduct per  
year4  7,d7 ,the method and timing of   
notifications given by each center to   
individuals in the area to which such   
center is traveling1 including          
notifications informing veterans of the 
availability to schedule appointments at
 the center4  7#c7 ,use of telemedicine 
,the ,secretary shall ensure that each  
mobile vet center of the ,department has
 the capability to provide telemedicine 

services4  7b7 ,reports ,not later than 
one year after the date of the enactment
 of this ,act1 and not later than       
,september #cj each year thereafter1 the
 ,secretary of ,veterans ,affairs shall 
submit to the ,committee on ,veterans'  
,affairs of the ,senate and the         
,committee on ,veterans' ,affairs of the
 ,house of ,representatives a report on 
the following3 7#a7 ,the use of mobile  
vet centers to provide telemedicine     
services to veterans during the year    
preceding the submittal of the report1  
including the following3 7,a7 ,the      
number of days each mobile vet center   
was open to provide such services4  7,b7
 ,the number of days each mobile vet    
center traveled to a location other than
 the headquarters of the mobile vet     
center to provide such services4  7,c7  
,the number of appointments each center 
conducted to provide such services on   
average per month and in total during   
such year4  7#b7 ,an analysis of the    
effectiveness of using mobile vet       

centers to provide health care services 
to veterans through the use of          
telemedicine4  7#c7 ,any recommendations
 for an increase in the number of mobile
 vet centers of the ,department4  7#d7  
,any recommendations for an increase in 
the telemedicine capabilities of each   
mobile vet center4  7#e7 ,the           
feasibility and advisability of using   
temporary health care providers1        
including locum tenens1 to provide      
direct health care services to veterans 
at mobile vet centers4  7#f7 ,such other
 recommendations on improvement of the  
use of mobile vet centers by the        
,department as the ,secretary considers 
appropriate4  #djb4 ,commission on      
construction projects of the ,department
 of ,veterans ,affairs  7a7             
,establishment of commission  7#a7      
,establishment ,there is established an 
,independent ,commission on ,department 
of ,veterans ,affairs ,construction     
,projects 7in this section referred to  
as the ,commission74  7#b7 ,membership  

7,a7 ,voting members ,the ,commission   
shall be composed of #aj voting members 
as follows3 7i7 ,three members to be    
appointed by the ,president from among  
members of the ,national ,academy of    
,engineering who are nominated under    
subparagraph 7,b74  7ii7 ,three members 
to be appointed by the ,president from  
among members of the ,national          
,institute of ,building ,sciences who   
are nominated under subparagraph 7,b74  
7iii7 ,four members to be appointed by  
the ,president from among veterans      
enrolled in the patient enrollment      
system of the ,department of ,veterans  
,affairs under section #agje of title   
#ch1 ,united ,states ,code1 who are     
nominated under subparagraph 7,b74  7,b7
 ,nomination of voting members ,the     
majority leader of the ,senate1 the     
minority leader of the ,senate1 the     
speaker of the ,house of                
,representatives1 and the minority      
leader of the ,house of ,representatives
 shall jointly nominate not less than   

#bd individuals to be considered by the 
,president for appointment under        
subparagraph 7,a74  7,c7 ,nonvoting     
members ,the ,commission shall be       
composed of the following nonvoting     
members3 7i7 ,the ,comptroller ,general 
of the ,united ,states1 or designee4    
7ii7 ,the ,secretary of ,veterans       
,affairs1 or designee4  7iii7 ,the      
,inspector ,general of the ,department  
of ,veterans ,affairs1 or designee4     
7,d7 ,date of appointment of members    
,the appointments of the members of the 
,commission under subparagraph 7,a7     
shall be made not later than #ad days   
after the date of the enactment of this 
,act4  7#c7 ,period of appointment2     
vacancies ,members shall be appointed   
for the life of the ,commission4 ,any   
vacancy in the ,commission shall not    
affect its powers1 but shall be filled  
in the same manner as the original      
appointment4  7#d7 ,initial meeting ,not
 later than five days after the date on 
which all members of the ,commission    

have been appointed1 the ,commission    
shall hold its first meeting4  7#e7     
,meetings ,the ,commission shall meet at
 the call of the ,chairperson4  7#f7    
,quorum ,a majority of the members of   
the ,commission shall constitute a      
quorum1 but a lesser number of members  
may hold hearings4  7#g7 ,chairperson   
and vice chairperson ,the ,commission   
shall select a ,chairperson and ,vice   
,chairperson from among its members4    
7b7 ,duties of commission  7#a7 ,review 
,the ,commission shall review current   
construction and maintenance projects   
and the medical facility leasing program
 of the ,department of ,veterans        
,affairs to identify any problems       
experienced by the ,department in       
carrying out such projects and program4 
7#b7 ,reports  7,a7 ,commission report  
,not later than #abj days after the date
 of the enactment of this ,act1 the     
,commission shall submit to the         
,secretary of ,veterans ,affairs1 the   
,committee on ,veterans' ,affairs of the

 ,senate1 and the ,committee on         
,veterans' ,affairs of the ,house of    
,representatives a report setting forth 
recommendations1 if any1 for improving  
the manner in which the ,secretary      
carries out the projects and program    
specified in paragraph 7#a74  7,b7      
,department report ,not later than #fj  
days after the submittal of the report  
under subparagraph 7,a71 the ,secretary 
of ,veterans ,affairs shall submit to   
the ,committee on ,veterans' ,affairs of
 the ,senate and the ,committee on      
,veterans' ,affairs of the ,house of    
,representatives a report on the        
feasibility and advisability of         
implementing the recommendations of the 
,commission1 if any1 included in the    
report submitted under such             
subparagraph1 including a timeline for  
the implementation of such              
recommendations4  7c7 ,powers of        
commission  7#a7 ,hearings ,the         
,commission may hold such hearings1 sit 
and act at such times and places1 take  

such testimony1 and receive such        
evidence as the ,commission considers   
advisable to carry out this section4    
7#b7 ,information from ,federal agencies
 ,the ,commission may secure directly   
from any ,federal agency such           
information as the ,commission considers
 necessary to carry out this section4   
,upon request of the ,chairperson of the
 ,commission1 the head of such agency   
shall furnish such information to the   
,commission4  7d7 ,commission personnel 
matters  7#a7 ,compensation of members  
,each member of the ,commission who is  
not an officer or employee of the       
,federal ,government shall be           
compensated at a rate equal to the daily
 equivalent of the annual rate of basic 
pay prescribed for level ,,iv of the    
,executive ,schedule under section #ecae
 of title #e1 ,united ,states ,code1 for
 each day 7including travel time7 during
 which such member is engaged in the    
performance of the duties of the        
,commission4 ,all members of the        

,commission who are officers or         
employees of the ,united ,states shall  
serve without compensation in addition  
to that received for their services as  
officers or employees of the ,united    
,states4  7#b7 ,travel expenses ,the    
members of the ,commission shall be     
allowed travel expenses1 including per  
diem in lieu of subsistence1 at rates   
authorized for employees of agencies    
under subchapter ,i of chapter #eg of   
title #e1 ,united ,states ,code1 while  
away from their homes or regular places 
of business in the performance of       
services for the ,commission4  7#c7     
,staff  7,a7 ,in general ,the           
,chairperson of the ,commission may1    
without regard to the civil service laws
 and regulations1 appoint and terminate 
an executive director and such other    
additional personnel as may be necessary
 to enable the ,commission to perform   
its duties4 ,the employment of an       
executive director shall be subject to  
confirmation by the ,commission4  7,b7  

,compensation ,the ,chairperson of the  
,commission may fix the compensation of 
the executive director and other        
personnel without regard to chapter #ea 
and subchapter ,,iii of chapter #ec of  
title #e1 ,united ,states ,code1        
relating to classification of positions 
and ,general ,schedule pay rates1 except
 that the rate of pay for the executive 
director and other personnel may not    
exceed the rate payable for level ,v of 
the ,executive ,schedule under section  
#ecaf of such title4  7#d7 ,detail of   
government employees ,any ,federal      
,government employee may be detailed to 
the ,commission without reimbursement1  
and such detail shall be without        
interruption or loss of civil service   
status or privilege4  7#e7 ,procurement 
of temporary and intermittent services  
,the ,chairperson of the ,commission may
 procure temporary and intermittent     
services under section #caji7;b7 of     
title #e1 ,united ,states ,code1 at     
rates for individuals that do not exceed

 the daily equivalent of the annual rate
 of basic pay prescribed for level ,v of
 the ,executive ,schedule under section 
#ecaf of such title4  7e7 ,termination  
of commission ,the ,commission shall    
terminate #cj days after the date on    
which the ,commission submits its report
 under subsection 7b77#b77;,a74  #djc4  
,commission on ,access to ,care  7a7    
,establishment of commission  7#a7 ,in  
general ,there is established the       
,commission on ,access to ,care 7in this
 section referred to as the ,commission7
 to examine the access of veterans to   
health care from the ,department of     
,veterans ,affairs and strategically    
examine how best to organize the        
,veterans ,health ,administration1      
locate health care resources1 and       
deliver health care to veterans during  
the #aj- to #bj-year period beginning on
 the date of the enactment of this ,act4
  7#b7 ,membership  7,a7 ,voting members
 ,the ,commission shall be composed of  
#aj voting members who are appointed by 

the ,president as follows3 7i7 ,at least
 two members who represent an           
organization recognized by the          
,secretary of ,veterans ,affairs for the
 representation of veterans under       
section #eijb of title #ch1 ,united     
,states ,code4  7ii7 ,at least one      
member from among persons who have      
experience as senior management for a   
private integrated health care system   
with an annual gross revenue of more    
than #ej1jjj1jjj4  7iii7 ,at least one  
member from among persons who are       
familiar with government health care    
systems1 including those systems of the 
,department of ,defense1 the ,indian    
,health ,service1 and                   
,federally-qualified health centers 7as 
defined in section #aije7l77#b77;,b7 of 
the ,social ,security ,act 7#db         
,u4,s4,c4 #acif;d7l77#b77;,b7774  7iv7  
,at least two members from among persons
 who are familiar with the ,veterans    
,health ,administration but are not     
current employees of the ,veterans      

,health ,administration4  7v7 ,at least 
two members from among persons who are  
veterans or eligible for hospital care1 
medical services1 or other health care  
under the laws administered by the      
,secretary of ,veterans ,affairs4  7,b7 
,nonvoting members  7i7 ,in general ,in 
addition to members appointed under     
subparagraph 7,a71 the ,commission shall
 be composed of #aj nonvoting members   
who are appointed by the ,president as  
follows3 7,i7 ,at least two members who 
represent an organization recognized by 
the ,secretary of ,veterans ,affairs for
 the representation of veterans under   
section #eijb of title #ch1 ,united     
,states ,code4  7,,ii7 ,at least one    
member from among persons who have      
experience as senior management for a   
private integrated health care system   
with an annual gross revenue of more    
than #ej1jjj1jjj4  7,,iii7 ,at least one
 member from among persons who are      
familiar with government health care    
systems1 including those systems of the 

,department of ,defense1 the ,indian    
,health ,service1 and                   
,federally-qualified health centers 7as 
defined in section #aije7l77#b77;,b7 of 
the ,social ,security ,act 7#db         
,u4,s4,c4 #acif;d7l77#b77;,b7774  7,,iv7
 ,at least two members from among       
persons who are familiar with the       
,veterans ,health ,administration but   
are not current employees of the        
,veterans ,health ,administration4  7,v7
 ,at least two members from among       
persons who are veterans or eligible for
 hospital care1 medical services1 or    
other health care under the laws        
administered by the ,secretary of       
,veterans ,affairs4  7ii7 ,additional   
nonvoting members ,in addition to       
members appointed under subparagraph    
7,a7 and clause 7i71 the ,commission    
shall be composed of the following      
nonvoting members3 7,i7 ,the            
,comptroller ,general of the ,united    
,states1 or designee4  7,,ii7 ,the      
,inspector ,general of the ,department  

of ,veterans ,affairs1 or designee4     
7,c7 ,date ,the appointments of members 
of the ,commission shall be made not    
later than #fj days after the date of   
the enactment of this ,act4  7#c7       
,period of appointment2 vacancies       
,members shall be appointed for the life
 of the ,commission4 ,any vacancy in the
 ,commission shall not affect its       
powers1 but shall be filled in the same 
manner as the original appointment4     
7#d7 ,initial meeting ,not later than   
#ae days after the date on which seven  
voting members of the ,commission have  
been appointed1 the ,commission shall   
hold its first meeting4  7#e7 ,meetings 
,the ,commission shall meet at the call 
of the ,chairperson4  7#f7 ,quorum ,a   
majority of the members of the          
,commission shall constitute a quorum1  
but a lesser number of members may hold 
hearings4  7#g7 ,chairperson and ,vice  
,chairperson ,the ,commission shall     
select a ,chairperson and ,vice         
,chairperson from among its members4    

7b7 ,duties of commission  7#a7         
,evaluation and assessment ,the         
,commission shall undertake a           
comprehensive evaluation and assessment 
of access to health care at the         
,department of ,veterans ,affairs4  7#b7
 ,matters evaluated and assessed ,the   
matters evaluated and assessed by the   
,commission shall include the following3
 7,a7 ,the appropriateness of current   
standards of the ,department of         
,veterans ,affairs concerning access to 
health care4  7,b7 ,the measurement of  
such standards4  7,c7 ,the              
appropriateness of performance standards
 and incentives in relation to standards
 described in subparagraph 7,a74  7,d7  
,staffing levels throughout the         
,veterans ,health ,administration and   
whether they are sufficient to meet     
current demand for health care from the 
,administration4  7,e7 ,the results of  
the assessment conducted by an          
independent third party under section   
#aja7;a71 including any data or         

recommendations included in such        
assessment4  7#c7 ,reports ,the         
,commission shall submit to the         
,president1 through the ,secretary of   
,veterans ,affairs1 reports as follows3 
7,a7 ,not later than #ij days after the 
date of the initial meeting of the      
,commission1 an interim report on-- 7i7 
the findings of the ,commission with    
respect to the evaluation and assessment
 required by this subsection2 and  7ii7 
such recommendations as the ,commission 
may have for legislative or             
administrative action to improve access 
to health care through the ,veterans    
,health ,administration4  7,b7 ,not     
later than #ahj days after the date of  
the initial meeting of the ,commission1 
a final report on-- 7i7 the findings of 
the ,commission with respect to the     
evaluation and assessment required by   
this subsection2 and  7ii7 such         
recommendations as the ,commission may  
have for legislative or administrative  
action to improve access to health care 

through the ,veterans ,health           
,administration4  7c7 ,powers of the    
commission  7#a7 ,hearings ,the         
,commission may hold such hearings1 sit 
and act at such times and places1 take  
such testimony1 and receive such        
evidence as the ,commission considers   
advisable to carry out this section4    
7#b7 ,information from ,federal agencies
 ,the ,commission may secure directly   
from any ,federal department or agency  
such information as the ,commission     
considers necessary to carry out this   
section4 ,upon request of the           
,chairperson of the ,commission1 the    
head of such department or agency shall 
furnish such information to the         
,commission4  7d7 ,commission personnel 
matters  7#a7 ,compensation of members  
,each member of the ,commission who is  
not an officer or employee of the       
,federal ,government shall be           
compensated at a rate equal to the daily
 equivalent of the annual rate of basic 
pay prescribed for level ,,iv of the    

,executive ,schedule under section #ecae
 of title #e1 ,united ,states ,code1 for
 each day 7including travel time7 during
 which such member is engaged in the    
performance of the duties of the        
,commission4 ,all members of the        
,commission who are officers or         
employees of the ,united ,states shall  
serve without compensation in addition  
to that received for their services as  
officers or employees of the ,united    
,states4  7#b7 ,travel expenses ,the    
members of the ,commission shall be     
allowed travel expenses1 including per  
diem in lieu of subsistence1 at rates   
authorized for employees of agencies    
under subchapter ,i of chapter #eg of   
title #e1 ,united ,states ,code1 while  
away from their homes or regular places 
of business in the performance of       
services for the ,commission4  7#c7     
,staff  7,a7 ,in general ,the           
,chairperson of the ,commission may1    
without regard to the civil service laws
 and regulations1 appoint and terminate 

an executive director and such other    
additional personnel as may be necessary
 to enable the ,commission to perform   
its duties4 ,the employment of an       
executive director shall be subject to  
confirmation by the ,commission4  7,b7  
,compensation ,the ,chairperson of the  
,commission may fix the compensation of 
the executive director and other        
personnel without regard to chapter #ea 
and subchapter ,,iii of chapter #ec of  
title #e1 ,united ,states ,code1        
relating to classification of positions 
and ,general ,schedule pay rates1 except
 that the rate of pay for the executive 
director and other personnel may not    
exceed the rate payable for level ,v of 
the ,executive ,schedule under section  
#ecaf of such title4  7#d7 ,detail of   
government employees ,any ,federal      
,government employee may be detailed to 
the ,commission without reimbursement1  
and such detail shall be without        
interruption or loss of civil service   
status or privilege4  7#e7 ,procurement 

of temporary and intermittent services  
,the ,chairperson of the ,commission may
 procure temporary and intermittent     
services under section #caji7;b7 of     
title #e1 ,united ,states ,code1 at     
rates for individuals that do not exceed
 the daily equivalent of the annual rate
 of basic pay prescribed for level ,v of
 the ,executive ,schedule under section 
#ecaf of such title4  7e7 ,termination  
of the commission ,the ,commission shall
 terminate #cj days after the date on   
which the ,commission submits its report
 under subsection 7b77#c77;,b74  7f7    
,funding ,the ,secretary of ,veterans   
,affairs shall make available to the    
,commission from amounts appropriated or
 otherwise made available to the        
,secretary such amounts as the          
,secretary and the ,chairperson of the  
,commission jointly consider appropriate
 for the ,commission to perform its     
duties under this section4  7g7         
,executive action  7#a7 ,action on      
recommendations ,the ,president shall   

require the ,secretary of ,veterans     
,affairs and such other heads of        
relevant ,federal departments and       
agencies to implement each              
recommendation set forth in a report    
submitted under subsection 7b77#c7 that 
the ,president-- 7,a7 considers feasible
 and advisable2 and  7,b7 determines can
 be implemented without further         
legislative action4  7#b7 ,reports ,not 
later than #fj days after the date on   
which the ,president receives a report  
under subsection 7b77#c71 the ,president
 shall submit to the ,committee on      
,veterans' ,affairs of the ,senate and  
the ,committee on ,veterans' ,affairs of
 the ,house of ,representatives and such
 other committees of ,congress as the   
,president considers appropriate a      
report setting forth the following3 7,a7
 ,an assessment of the feasibility and  
advisability of each recommendation     
contained in the report received by the 
,president4  7,b7 ,for each             
recommendation assessed as feasible and 

advisable under subparagraph 7,a7 the   
following3 7i7 ,whether such            
recommendation requires legislative     
action4  7ii7 ,if such recommendation   
requires legislative action1 a          
recommendation concerning such          
legislative action4  7iii7 ,a           
description of any administrative action
 already taken to carry out such        
recommendation4  7iv7 ,a description of 
any administrative action the ,president
 intends to be taken to carry out such  
recommendation and by whom4  #djd4      
,improved performance metrics for health
 care provided by ,department of        
,veterans ,affairs  7a7 ,prohibition on 
use of scheduling and wait-time metrics 
in determination of performance awards  
,the ,secretary of ,veterans ,affairs   
shall ensure that scheduling and        
wait-time metrics or goals are not used 
as factors in determining the           
performance of the following employees  
for purposes of determining whether to  
pay performance awards to such          

employees3 7#a7 ,directors1 associate   
directors1 assistant directors1 deputy  
directors1 chiefs of staff1 and clinical
 leads of medical centers of the        
,department of ,veterans ,affairs4  7#b7
 ,directors1 assistant directors1 and   
quality management officers of ,veterans
 ,integrated ,service ,networks of the  
,department of ,veterans ,affairs4  7b7 
,modification of performance plans  7#a7
 ,in general ,not later than #cj days   
after the date of the enactment of this 
,act1 the ,secretary shall modify the   
performance plans of the directors of   
the medical centers of the ,department  
and the directors of the ,veterans      
,integrated ,service ,networks to ensure
 that such plans are based on the       
quality of care received by veterans at 
the health care facilities under the    
jurisdictions of such directors4  7#b7  
,factors ,in modifying performance plans
 under paragraph 7#a71 the ,secretary   
shall ensure that assessment of the     
quality of care provided at health care 

facilities under the jurisdiction of a  
director described in paragraph 7#a7    
includes consideration of the following3
 7,a7 ,recent reviews by the ,joint     
,commission 7formerly known as the      
,joint ,commission on ,accreditation of 
,healthcare ,organizations7 of such     
facilities4  7,b7 ,the number and nature
 of recommendations concerning such     
facilities by the ,inspector ,general of
 the ,department in reviews conducted   
through the ,combined ,assessment       
,program 7,,cap71 in the reviews by the 
,inspector ,general of community based  
outpatient clinics and primary care     
clinics1 and in reviews conducted       
through the ,office of ,healthcare      
,inspections during the two most        
recently completed fiscal years4  7,c7  
,the number of recommendations described
 in subparagraph 7,b7 that the          
,inspector ,general of the ,department  
determines have not been carried out    
satisfactorily with respect to such     
facilities4  7,d7 ,reviews of such      

facilities by the ,commission on        
,accreditation of ,rehabilitation       
,facilities4  7,e7 ,the number and      
outcomes of administrative investigation
 boards1 root cause analysis1 and peer  
reviews conducted at such facilities    
during the fiscal year for which the    
assessment is being conducted4  7,f7    
,the effectiveness of any remedial      
actions or plans resulting from any     
,inspector ,general recommendations in  
the reviews and analyses described in   
subparagraphs 7,a7 through 7,e74  7#c7  
,additional leadership positions ,to the
 degree practicable1 the ,secretary     
shall assess the performance of other   
employees of the ,department in         
leadership positions at ,department     
medical centers1 including associate    
directors1 assistant directors1 deputy  
directors1 chiefs of staff1 and clinical
 leads1 and in ,veterans ,integrated    
,service ,networks1 including assistant 
directors and quality management        
officers1 using factors and criteria    

similar to those used in the performance
 plans modified under paragraph 7#a74   
7c7 ,removal of certain performance     
goals ,for each fiscal year that begins 
after the date of the enactment of this 
,act1 the ,secretary shall not include  
in the performance goals of any employee
 of a ,veterans ,integrated ,service    
,network or medical center of the       
,department any performance goal that   
might disincentivize the payment of     
,department amounts to provide hospital 
care1 medical services1 or other health 
care through a non-,department provider4
  #dje4 ,improved transparency          
concerning health care provided by      
,department of ,veterans ,affairs  7a7  
,publication of wait times  7#a7 ,goals 
7,a7 ,initial ,not later than #ij days  
after the date of the enactment of this 
,act1 the ,secretary of ,veterans       
,affairs shall publish in the ,federal  
,register1 and on an ,internet website  
accessible to the public of each medical
 center of the ,department of ,veterans 

,affairs1 the wait-time goals of the    
,department for the scheduling of an    
appointment by a veteran for the receipt
 of health care from the ,department4   
7,b7 ,subsequent changes  7i7 ,in       
general ,if the ,secretary modifies the 
wait-time goals described in            
subparagraph 7,a71 the ,secretary shall 
publish the new wait-times goals-- 7,i7 
on an ,internet website accessible to   
the public of each medical center of the
 ,department not later than #cj days    
after such modification2 and  7,,ii7 in 
the ,federal ,register not later than   
#ij days after such modification4  7ii7 
,effective date ,any modification under 
clause 7i7 shall take effect on the date
 of publication in the ,federal         
,register4  7,c7 ,goals described       
,wait-time goals published under this   
paragraph shall include goals for       
primary care appointments1 specialty    
care appointments1 and appointments     
based on the general severity of the    
condition of the veteran4  7#b7 ,wait   

times at medical centers of the         
,department ,not later than one year    
after the date of the enactment of this 
,act1 the ,secretary of ,veterans       
,affairs shall publish on an ,internet  
website accessible to the public of each
 medical center of the ,department the  
current wait time for an appointment for
 primary care and specialty care at the 
medical center4  7b7 ,publicly available
 database of patient safety1 quality of 
care1 and outcome measures  7#a7 ,in    
general ,not later than #ahj days after 
the date of the enactment of this ,act1 
the ,secretary shall develop and make   
available to the public a comprehensive 
database containing all applicable      
patient safety1 quality of care1 and    
outcome measures for health care        
provided by the ,department that are    
tracked by the ,secretary4  7#b7 ,update
 frequency ,the ,secretary shall update 
the database required by paragraph 7#a7 
not less frequently than once each year4
  7#c7 ,unavailable measures ,for all   

measures that the ,secretary would      
otherwise publish in the database       
required by paragraph 7#a7 but has not  
done so because such measures are not   
available1 the ,secretary shall publish 
notice in the database of the reason for
 such unavailability and a timeline for 
making such measures available in the   
database4  7#d7 ,accessibility ,the     
,secretary shall ensure that the        
database required by paragraph 7#a7 is  
accessible to the public through the    
primary ,internet website of the        
,department and through each primary    
,internet website of a ,department      
medical center4  7c7 ,hospital ,compare 
website of ,department of ,health and   
,human ,services  7#a7 ,agreement       
required ,not later than #ahj days after
 the date of the enactment of this ,act1
 the ,secretary of ,veterans ,affairs   
shall enter into an agreement with the  
,secretary of ,health and ,human        
,services for the provision by the      
,secretary of ,veterans ,affairs of such

 information as the ,secretary of       
,health and ,human ,services may require
 to report and make publicly available  
patient quality and outcome information 
concerning ,department of ,veterans     
,affairs medical centers through the    
,hospital ,compare ,internet website of 
the ,department of ,health and ,human   
,services or any successor ,internet    
website4  7#b7 ,information provided    
,the information provided by the        
,secretary of ,veterans ,affairs to the 
,secretary of ,health and ,human        
,services under paragraph 7#a7 shall    
include the following3 7,a7 ,measures of
 timely and effective health care4  7,b7
 ,measures of readmissions1             
complications of death1 including with  
respect to #cj-;day mortality rates and 
#cj-;day readmission rates1 surgical    
complication measures1 and health care  
related infection measures4  7,c7       
,survey data of patient experiences1    
including the ,hospital ,consumer       
,assessment of ,healthcare ,providers   

and ,systems or any similar successor   
survey developed by the ,department of  
,health and ,human ,services4  7,d7 ,any
 other measures required of or reported 
with respect to hospitals participating 
in the ,medicare program under title    
,,xviii of the ,social ,security ,act   
7#db ,u4,s4,c4 #acie et seq474  7#c7    
,unavailable information ,for any       
applicable metric collected by the      
,department of ,veterans ,affairs or    
required to be provided under paragraph 
7#b7 and withheld from or unavailable in
 the ,hospital ,compare ,internet       
website1 the ,secretary of ,veterans    
,affairs shall publish a notice in the  
,federal ,register stating the reason   
why such metric was withheld from public
 disclosure and a timeline for making   
such metric available1 if applicable4   
7d7 ,comptroller ,general review of     
publicly available safety and quality   
metrics ,not later than three years     
after the date of the enactment of this 
,act1 the ,comptroller ,general of the  

,united ,states shall conduct a review  
of the safety and quality metrics made  
publicly available by the ,secretary of 
,veterans ,affairs under this section to
 assess the degree to which the         
,secretary is complying with the        
provisions of this section4  #djf4      
,information for veterans on the        
credentials of ,department of ,veterans 
,affairs physicians  7a7 ,improvement of
 ,our ,providers ,internet website links
  7#a7 ,availability through ,department
 of ,veterans ,affairs homepage ,a link 
to the ,our ,providers health care      
providers database of the ,department of
 ,veterans ,affairs1 or any successor   
database1 shall be available on and     
through the homepage of the ,internet   
website of the ,department that is      
accessible to the public4  7#b7         
,information on location of residency   
training ,the ,internet website of the  
,department that is accessible to the   
public shall include under the link to  
the ,our ,providers health care         

providers database of the ,department1  
or any successor database1 the location 
of residency training of each licensed  
physician of the ,department4  7#c7     
,information on physicians at particular
 facilities ,the ,our ,providers health 
care providers database of the          
,department1 or any successor database1 
shall identify whether each licensed    
physician of the ,department is a       
physician in residency4  7b7            
,information on credentials of          
physicians for veterans undergoing      
surgical procedures  7#a7 ,in general   
,each veteran who is undergoing a       
surgical procedure by or through the    
,department shall be provided           
information on the credentials of the   
surgeon to be performing such procedure 
at such time in advance of the procedure
 as is appropriate to permit such       
veteran to evaluate such information4   
7#b7 ,other individuals ,if a veteran is
 unable to evaluate the information     
provided under paragraph 7#a7 due to the

 health or mental competence of the     
veteran1 such information shall be      
provided to an individual acting on     
behalf of the veteran4  7c7 ,comptroller
 ,general report and plan  7#a7 ,report 
,not later than two years after the date
 of the enactment of this ,act1 the     
,comptroller ,general of the ,united    
,states shall submit to the ,committee  
on ,veterans' ,affairs of the ,senate   
and the ,committee on ,veterans'        
,affairs of the ,house of               
,representatives a report setting forth 
an assessment by the ,comptroller       
,general of the following3 7,a7 ,the    
manner in which contractors under the   
,patient-,centered ,community ,care     
initiative of the ,department perform   
oversight of the credentials of         
physicians within the networks of such  
contractors under the initiative4  7,b7 
,the oversight by the ,department of the
 contracts under the ,patient-,centered 
,community ,care initiative4  7,c7 ,the 
verification by the ,department of the  

credentials and licenses of health care 
providers furnishing hospital care and  
medical services under section #cja4    
7#b7 ,plan  7,a7 ,in general ,not later 
than #cj days after the submittal of the
 report under paragraph 7#a71 the       
,secretary shall-- 7i7 submit to the    
,comptroller ,general1 the ,committee on
 ,veterans' ,affairs of the ,senate1 and
 the ,committee on ,veterans' ,affairs  
of the ,house of ,representatives a plan
 to address any findings and            
recommendations of the ,comptroller     
,general included in such report2 and   
7ii7 submit to the ,committee on        
,veterans' ,affairs of the ,senate and  
the ,committee on ,veterans' ,affairs of
 the ,house of ,representatives a       
request for additional amounts1 if any1 
that may be necessary to carry out such 
plan4  7,b7 ,implementation ,not later  
than #ij days after the submittal of the
 report under paragraph 7#a71 the       
,secretary shall carry out such plan4   
#djg4 ,information in annual budget of  

the ,president on hospital care and     
medical services furnished through      
expanded use of contracts for such care 
,the materials on the ,department of    
,veterans ,affairs in the budget of the 
,president for a fiscal year1 as        
submitted to ,congress pursuant to      
section #aaje7;a7 of title #ca1 ,united 
,states ,code1 shall set forth the      
following3 7#a7 ,the number of veterans 
who received hospital care and medical  
services under section #cja during the  
fiscal year preceding the fiscal year in
 which such budget is submitted4  7#b7  
,the amount expended by the ,department 
on furnishing care and services under   
such section during the fiscal year     
preceding the fiscal year in which such 
budget is submitted4  7#c7 ,the amount  
requested in such budget for the costs  
of furnishing care and services under   
such section during the fiscal year     
covered by such budget1 set forth in    
aggregate and by amounts for each       
account for which amounts are so        

requested4  7#d7 ,the number of veterans
 that the ,department estimates will    
receive hospital care and medical       
services under such section during the  
fiscal years covered by the budget      
submission4  7#e7 ,the number of        
employees of the ,department on paid    
administrative leave at any point during
 the fiscal year preceding the fiscal   
year in which such budget is submitted4 
#djh4 ,prohibition on falsification of  
data concerning wait times and quality  
measures at ,department of ,veterans    
,affairs ,not later than #fj days after 
the date of the enactment of this ,act1 
and in accordance with title #e1 ,united
 ,states ,code1 the ,secretary of       
,veterans ,affairs shall establish      
policies whereby any employee of the    
,department of ,veterans ,affairs who   
knowingly submits false data concerning 
wait times for health care or quality   
measures with respect to health care to 
another employee of the ,department or  
knowingly requires another employee of  

the ,department to submit false data    
concerning such wait times or quality   
measures to another employee of the     
,department is subject to a penalty the 
,secretary considers appropriate after  
notice and an opportunity for a hearing1
 including civil penalties1 unpaid      
suspensions1 or termination4  #dji4     
,removal of ,senior ,executive ,service 
employees of the ,department of         
,veterans ,affairs for performance  7a7 
,removal or transfer  7#a7 ,in general  
,chapter #g of title #ch1 ,united       
,states ,code1 is amended by adding at  
the end the following new section3      
#gac4 ,senior ,executive ,service3      
removal based on performance  7a7 ,in   
general ,the ,secretary may remove any  
individual from the ,senior ,executive  
,service if the ,secretary determines   
the performance of the individual       
warrants such removal4 ,if the          
,secretary so removes such an           
individual1 the ,secretary may-- 7#a7   
remove the individual from the civil    

service 7as defined in section #baja of 
title #e72 or  7#b7 transfer the        
individual to a ,general ,schedule      
position at any grade of the ,general   
,schedule for which the individual is   
qualified and that the ,secretary       
determines is appropriate4  7b7 ,notice 
to ,congress ,not later than #cj days   
after removing or transferring an       
individual from the ,senior ,executive  
,service under subsection 7a71 the      
,secretary shall submit to the          
,committees on ,veterans' ,affairs of   
the ,senate and ,house of               
,representatives notice in writing of   
such removal or transfer and the reason 
for such removal or transfer4  7c7      
,procedure  7#a7 ,the procedures under  
section #gedc of title #e shall not     
apply to a removal or transfer under    
this section4  7#b7 7,a7 ,subject to    
subparagraph 7,b71 any removal or       
transfer under subsection 7a7 may be    
appealed to the ,merit ,systems         
,protection ,board under section #ggja  

of title #e4  7,b7 ,an appeal under     
subparagraph 7,a7 of a removal or       
transfer may only be made if such appeal
 is made not later than #g days after   
the date of such removal or transfer4   
7d7 ,expedited review by ,merit ,systems
 ,protection ,board  7#a7 ,the ,merit   
,systems ,protection ,board shall       
expedite any appeal under section #ggja 
of title #e of a removal or transfer    
under subsection 7a7 and1 in any such   
case1 shall issue a decision not later  
than #ba days after the date of the     
appeal4  7#b7 ,in any case in which the 
,merit ,systems ,protection ,board      
determines that it cannot issue a       
decision in accordance with the #ba-;day
 requirement under paragraph 7#a71 the  
,merit ,systems ,protection ,board shall
 submit to ,congress a report that      
explains the reason why the ,merit      
,systems ,protection ,board is unable to
 issue a decision in accordance with    
such requirement in such case4  7#c7    
,there is authorized to be appropriated 

such sums as may be necessary for the   
,merit ,systems ,protection ,board to   
expedite appeals under paragraph 7#a74  
7#d7 ,the ,merit ,systems ,protection   
,board may not stay any personnel action
 taken under this section4  7#e7 ,a     
person who appeals under section #ggja  
of title #e a removal under subsection  
7a77#a7 may not receive any pay1 awards1
 bonuses1 incentives1 allowances1       
differentials1 student loan repayments1 
special payments1 or benefits from the  
,secretary until the ,merit ,systems    
,protection ,board has made a final     
decision on such appeal4  7#f7 ,a       
decision made by the ,merit ,systems    
,protection ,board with respect to a    
removal or transfer under subsection 7a7
 shall not be subject to any further    
appeal4  4  7#b7 ,clerical amendment    
,the table of sections at the beginning 
of such chapter is amended by adding at 
the end the following new item3  #gac4  
,senior ,executive ,service3 removal    
based on performance4  4  7b7           

,establishment of expedited review      
process  7#a7 ,in general ,not later    
than #cj days after the date of the     
enactment of this ,act1 the ,merit      
,systems ,protection ,board shall       
establish and put into effect a process 
to conduct expedited reviews in         
accordance with section #gac7;d7 of     
title #ch1 ,united ,states ,code4  7#b7 
,inapplicability of certain regulations 
,section #abja4bb of title #e1 ,code of 
,federal ,regulations1 as in effect on  
the day before the date of the enactment
 of this ,act1 shall not apply to       
expedited reviews carried out under     
section #gac7;d7 of title #ch1 ,united  
,states ,code4  7#c7 ,report by ,merit  
,systems ,protection ,board ,not later  
than #cj days after the date of the     
enactment of this ,act1 the ,merit      
,systems ,protection ,board shall submit
 to ,congress a report on the actions   
the ,board plans to take to conduct     
expedited reviews under section #gac7;d7
 of title #ch1 ,united ,states ,code1 as

 added by subsection 7a74 ,such report  
shall include a description of the      
resources the ,board determines will be 
necessary to conduct such reviews and a 
description of whether any resources    
will be necessary to conduct such       
reviews that were not available to the  
,board on the day before the date of the
 enactment of this ,act4  7c7 ,temporary
 exemption from certain limitation on   
initiation of removal from ,senior      
,executive ,service ,during the         
#abj-;day period beginning on the date  
of the enactment of this ,act1 an action
 to remove an individual from the       
,senior ,executive ,service at the      
,department of ,veterans ,affairs       
pursuant to section #gac of title #ch1  
,united ,states ,code1 as added by      
subsection 7a71 or section #gedc of     
title #e1 ,united ,states ,code1 may be 
initiated1 notwithstanding section      
#ceib7;b7 of title #e1 ,united ,states  
,code1 or any other provision of law4   
7d7 ,construction ,nothing in this      

section or section #gac of title #ch1   
,united ,states ,code1 as added by      
subsection 7a71 shall be construed to   
apply to an appeal of a removal1        
transfer1 or other personnel action that
 was pending before the date of the     
enactment of this ,act4  ,v ,health     
,care ,related to ,sexual ,trauma  #eja4
 ,expansion of eligibility for sexual   
trauma counseling and treatment to      
veterans on inactive duty training      
,section #agbj;,d7a77#a7 of title #ch1  
,united ,states ,code1 is amended by    
striking or active duty for training and
 inserting 1 active duty for training1  
or inactive duty training4  #ejb4       
,provision of counseling and treatment  
for sexual trauma by the ,department of 
,veterans ,affairs to members of the    
,armed ,forces  7a7 ,expansion of       
coverage to members of the ,armed       
,forces ,subsection 7a7 of section      
#agbj;,d of title #ch1 ,united ,states  
,code1 is amended-- 7#a7 by             
redesignating paragraph 7#b7 as         

paragraph 7#c72  7#b7 by inserting after
 paragraph 7#a7 the following new       
paragraph 7#b73  7#b7 7,a7 ,in operating
 the program required by paragraph 7#a71
 the ,secretary may1 in consultation    
with the ,secretary of ,defense1 provide
 counseling and care and services to    
members of the ,armed ,forces 7including
 members of the ,national ,guard and    
,reserves7 on active duty to overcome   
psychological trauma described in that  
paragraph4  7,b7 ,a member described in 
subparagraph 7,a7 shall not be required 
to obtain a referral before receiving   
counseling and care and services under  
this paragraph4  2 and  7#c7 in         
paragraph 7#c71 as predesignated by     
paragraph 7#a7-- 7,a7 by striking a     
veteran and inserting an individual2 and
  7,b7 by striking that veteran each    
place it appears and inserting that     
individual4  7b7 ,information to members
 on availability of counseling and      
services ,subsection 7c7 of such section
 is amended-- 7#a7 by striking to       

veterans each place it appears2 and     
7#b7 in paragraph 7#c71 by inserting    
members of the ,armed ,forces and before
 individuals4  7c7 ,inclusion of members
 in reports on counseling and services  
,subsection 7e7 of such section is      
amended-- 7#a7 in the matter preceding  
paragraph 7#a71 by striking to veterans2
  7#b7 in paragraph 7#b7-- 7,a7 by      
striking women veterans and inserting   
individuals2 and  7,b7 by striking      
training under subsection 7d74 and      
inserting 8training under subsection    
7d71 desegregated by--  7,a7 veterans2  
7,b7 members of the ,armed ,forces      
7including members of the ,national     
,guard and ,reserves7 on active duty2   
and  7,c7 for each of subparagraphs 7,a7
 and 7,b7-- 7i7 men2 and  7ii7 women4  2
  7#c7 in paragraph 7#d71 by striking   
veterans and inserting individuals2 and 
7#d7 in paragraph 7#e7-- 7,a7 by        
striking women veterans and inserting   
individuals 2 and  7,b7 by inserting 1  
including specific recommendations for  

individuals specified in subparagraphs  
7,a71 7,b71 and 7,c7 of paragraph 7#b7  
before the period at the end4  7d7      
,effective date ,the amendments made by 
this section shall take effect on the   
date that is one year after the date of 
the enactment of this ,act4  #ejc4      
,reports on military sexual trauma  7a7 
,report on services available for       
military sexual trauma in the           
,department of ,veterans ,affairs ,not  
later than #fcj days after the date of  
the enactment of this ,act1 the         
,secretary of ,veterans ,affairs shall  
submit to the ,committee on ,veterans'  
,affairs of the ,senate and the         
,committee on ,veterans' ,affairs of the
 ,house of ,representatives a report on 
the treatment and services available    
from the ,department of ,veterans       
,affairs for male veterans who          
experience military sexual trauma       
compared to such treatment and services 
available to female veterans who        
experience military sexual trauma4  7b7 

,reports on transition of military      
sexual trauma treatment from ,department
 of ,defense to ,department of ,veterans
 ,affairs ,not later than #fcj days     
after the date of the enactment of this 
,act1 and annually thereafter for five  
years1 the ,department of ,veterans     
,affairs-,department of ,defense ,joint 
,executive ,committee established by    
section #cbj7;a7 of title #ch1 ,united  
,states ,code1 shall submit to the      
appropriate committees of ,congress a   
report on military sexual trauma that   
includes the following3 7#a7 ,the       
processes and procedures utilized by the
 ,department of ,veterans ,affairs and  
the ,department of ,defense to          
facilitate transition of treatment of   
individuals who have experienced        
military sexual trauma from treatment   
provided by the ,department of ,defense 
to treatment provided by the ,department
 of ,veterans ,affairs4  7#b7 ,a        
description and assessment of the       
collaboration between the ,department of

 ,veterans ,affairs and the ,department 
of ,defense in assisting veterans in    
filing claims for disabilities related  
to military sexual trauma1 including    
permitting veterans access to           
information and evidence necessary to   
develop or support such claims4  7c7    
,definitions ,in this section3 7#a7     
,appropriate committees of congress ,the
 term appropriate committees of         
,congress means-- 7,a7 the ,committee on
 ,veterans' ,affairs and the ,committee 
on ,armed ,services of the ,senate2 and 
7,b7 the ,committee on ,veterans'       
,affairs and the ,committee on ,armed   
,services of the ,house of              
,representatives4  7#b7 ,military sexual
 trauma ,the term military sexual trauma
 means psychological trauma1 which in   
the judgment of a mental health         
professional employed by the            
,department1 resulted from a physical   
assault of a sexual nature1 battery of a
 sexual nature1 or sexual harassment    
which occurred while the veteran was    

serving on active duty or active duty   
for training4  7#c7 ,sexual harassment  
,the term sexual harassment means       
repeated1 unsolicited verbal or physical
 contact of a sexual nature which is    
threatening in character4  7#d7 ,sexual 
trauma ,the term sexual trauma shall    
have the meaning given that term by the 
,secretary of ,veterans ,affairs for    
purposes of this section4  7d7          
,effective date ,this section shall take
 effect on the date that is #bgj days   
after the date of the enactment of this 
,act4  ,,vi ,major ,medical ,facility   
,leases  #fja4 ,authorization of major  
medical facility leases ,the ,secretary 
of ,veterans ,affairs may carry out the 
following major medical facility leases 
at the locations specified1 and in an   
amount for each lease not to exceed the 
amount shown for such location 7not     
including any estimated cancellation    
costs73 7#a7 ,for a clinical research   
and pharmacy coordinating center1       
,albuquerque1 ,new ,mexico1 an amount   

not to exceed #i1efj1jjj4  7#b7 ,for a  
community-based outpatient clinic1      
,brick1 ,new ,jersey1 an amount not to  
exceed #g1bhj1jjj4  7#c7 ,for a new     
primary care and dental clinic annex1   
,charleston1 ,south ,carolina1 an amount
 not to exceed #g1jgj1bej4  7#d7 ,for   
the ,cobb ,county community-based       
,outpatient ,clinic1 ,cobb ,county1     
,georgia1 an amount not to exceed       
#f1dji1jjj4  7#e7 ,for the ,leeward     
,outpatient ,healthcare ,access ,center1
 ,honolulu1 ,hawaii1 including a        
co-located clinic with the ,department  
of ,defense and the co-location of the  
,honolulu ,regional ,office of the      
,veterans ,benefits ,administration and 
the ,capel ,vet ,center of the          
,department of ,veterans ,affairs1 an   
amount not to exceed #ae1hhg1cgj4  7#f7 
,for a community-based outpatient       
clinic1 ,johnson ,county1 ,kansas1 an   
amount not to exceed #b1bfc1jjj4  7#g7  
,for a replacement community-based      
outpatient clinic1 ,lafayette1          

,louisiana1 an amount not to exceed     
#b1iif1jjj4  7#h7 ,for a community-based
 outpatient clinic1 ,lake ,charles1     
,louisiana1 an amount not to exceed     
#b1fbf1jjj4  7#i7 ,for outpatient clinic
 consolidation1 ,new ,port ,riche1      
,florida1 an amount not to exceed       
#aa1ibg1jjj4  7#aj7 ,for an outpatient  
clinic1 ,pence1 ,puerto ,rico1 an amount
 not to exceed #aa1ece1jjj4  7#aa7 ,for 
lease consolidation1 ,san ,antonio1     
,texas1 an amount not to exceed         
#ai1dbf1jjj4  7#ab7 ,for a              
community-based outpatient clinic1 ,san 
,diego1 ,california1 an amount not to   
exceed #aa1idf1ajj4  7#ac7 ,for an      
outpatient clinic1 ,tyler1 ,texas1 an   
amount not to exceed #d1cbg1jjj4  7#ad7 
,for the ,arere ,community ,care        
,center1 ,west ,haven1 ,connecticut1 an 
amount not to exceed #d1hhc1jjj4  7#ae7 
,for the ,worcester community-based     
,outpatient ,clinic1 ,worcester1        
,massachusetts1 an amount not to exceed 
#d1hee1jjj4  7#af7 ,for the expansion of

 a community-based outpatient clinic1   
,cape ,girardeau1 ,missouri1 an amount  
not to exceed #d1bcb1jfj4  7#ag7 ,for a 
multi specialty clinic1 ,chattanooga1   
,tennessee1 an amount not to exceed     
#g1jfi1jjj4  7#ah7 ,for the expansion of
 a community-based outpatient clinic1   
,chico1 ,california1 an amount not to   
exceed #d1ecd1jjj4  7#ai7 ,for a        
community-based outpatient clinic1      
,chula ,vista1 ,california1 an amount   
not to exceed #c1gad1jjj4  7#bj7 ,for a 
new research lease1 ,haines1 ,illinois1 
an amount not to exceed #bb1jcb1jjj4    
7#ba7 ,for a replacement research lease1
 ,houston1 ,texas1 an amount not to     
exceed #f1adb1jjj4  7#bb7 ,for a        
community-based outpatient clinic1      
,lincoln1 ,nebraska1 an amount not to   
exceed #g1agh1djj4  7#bc7 ,for a        
community-based outpatient clinic1      
,lubbock1 ,texas1 an amount not to      
exceed #h1eed1jjj4  7#bd7 ,for a        
community-based outpatient clinic       
consolidation1 ,myrtle ,beach1 ,south   

,carolina1 an amount not to exceed      
#h1jbb1jjj4  7#be7 ,for a               
community-based outpatient clinic1      
,phoenix1 ,arizona1 an amount not to    
exceed #bj1geg1jjj4  7#bf7 ,for the     
expansion of a community-based          
outpatient clinic1 ,redding1            
,california1 an amount not to exceed    
#h1aed1jjj4  #fjb4 ,budgetary treatment 
of ,department of ,veterans ,affairs    
major medical facilities leases  7a7    
,findings ,congress finds the following3
 7#a7 ,title #ca1 ,united ,states ,code1
 requires the ,department of ,veterans  
,affairs to record the full cost of its 
contractual obligation against funds    
available at the time a contract is     
executed4  7#b7 ,office of ,management  
and ,budget ,circular ,a-#aa provides   
guidance to agencies in meeting the     
statutory requirements under title #ca1 
,united ,states ,code1 with respect to  
leases4  7#c7 ,for operating leases1    
,office of ,management and ,budget      
,circular ,a-#aa requires the           

,department of ,veterans ,affairs to    
record up-front budget authority in an  
amount equal to total payments under the
 full term of the lease or an amount    
sufficient to cover first year lease    
payments plus cancellation costs4  7b7  
,requirement for obligation of full cost
  7#a7 ,in general ,subject to the      
availability of appropriations provided 
in advance1 in exercising the authority 
of the ,secretary of ,veterans ,affairs 
to enter into leases provided in this   
,act1 the ,secretary shall record1      
pursuant to section #aeja of title #ca1 
,united ,states ,code1 as the full cost 
of the contractual obligation at the    
time a contract is executed either--    
7,a7 an amount equal to total payments  
under the full term of the lease2 or    
7,b7 if the lease specifies payments to 
be made in the event the lease is       
terminated before its full term1 an     
amount sufficient to cover the first    
year lease payments plus the specified  
cancellation costs4  7#b7 ,self-insuring

 authority ,the requirements of         
paragraph 7#a7 may be satisfied through 
the use of a self-insuring authority    
consistent with ,office of ,management  
and ,budget ,circular ,a-#aa4  7c7      
,transparency  7#a7 ,compliance         
,subsection 7b7 of section #hajd of     
title #ch1 ,united ,states ,code1 is    
amended by adding at the end the        
following new paragraph3  7#g7 ,in the  
case of a prospectus proposing funding  
for a major medical facility lease1 a   
detailed analysis of how the lease is   
expected to comply with ,office of      
,management and ,budget ,circular ,a-#aa
 and section #acda of title #ca         
7commonly referred to as the            
,anti-,deficiency ,act74 ,any such      
analysis shall include-- 7,a7 an        
analysis of the classification of the   
lease as a lease-purchase1 capital      
lease1 or operating lease as those terms
 are defined in ,office of ,management  
and ,budget ,circular ,a-#aa2  7,b7 an  
analysis of the obligation of budgetary 

resources associated with the lease2 and
  7,c7 an analysis of the methodology   
used in determining the asset cost1 fair
 market value1 and cancellation costs of
 the lease4  4  7#b7 ,submittal to      
,congress ,such section #hajd is further
 amended by adding at the end the       
following new subsection3  7h7 7#a7 ,not
 less than #cj days before entering into
 a major medical facility lease1 the    
,secretary shall submit to the          
,committees on ,veterans' ,affairs of   
the ,senate and the ,house of           
,representatives-- 7,a7 notice of the   
,secretary's intention to enter into the
 lease2  7,b7 a detailed summary of the 
proposed lease2  7,c7 a description and 
analysis of any differences between the 
prospectus submitted pursuant to        
subsection 7b7 and the proposed lease2  
and  7,d7 a scoring analysis            
demonstrating that the proposed lease   
fully complies with ,office of          
,management and ,budget ,circular       
,a-#aa4  7#b7 ,each committee described 

in paragraph 7#a7 shall ensure that any 
information submitted to the committee  
under such paragraph is treated by the  
committee with the same level of        
confidentiality as is required by law of
 the ,secretary and subject to the same 
statutory penalties for unauthorized    
disclosure or use as the ,secretary4    
7#c7 ,not more than #cj days after      
entering into a major medical facility  
lease1 the ,secretary shall submit to   
each committee described in paragraph   
7#a7 a report on any material           
differences between the lease that was  
entered into and the proposed lease     
described under such paragraph1         
including how the lease that was entered
 into changes the previously submitted  
scoring analysis described in           
subparagraph 7,d7 of such paragraph4  4 
7d7 ,rule of construction ,nothing in   
this section1 or the amendments made by 
this section1 shall be construed to in  
any way relieve the ,department of      
,veterans ,affairs from any statutory or

 regulatory obligations or requirements 
existing prior to the enactment of this 
section and such amendments4  ,,vii     
,veterans ,benefits ,matters  #gja4     
,expansion of ,marine ,gunnery ,sergeant
 ,john ,david ,fry ,scholarship  7a7    
,expansion of entitlement ,subsection   
7b77#i7 of section #ccaa of title #ch1  
,united ,states ,code1 is amended by    
inserting or spouse after child4  7b7   
,limitation and election on certain     
benefits ,subsection 7f7 of such section
 is amended-- 7#a7 by redesignating     
paragraph 7#b7 as paragraph 7#d72 and   
7#b7 by inserting after paragraph 7#a7  
the following new paragraphs3  7#b7     
,limitation ,the entitlement of an      
individual to assistance under          
subsection 7a7 pursuant to paragraph    
7#i7 of subsection 7b7 because the      
individual was a spouse of a person     
described in such paragraph shall expire
 on the earlier of-- 7,a7 the date that 
is #ae years after the date on which the
 person died2 and  7,b7 the date on     

which the individual remarries4  7#c7   
,election on receipt of certain benefits
 ,a surviving spouse entitled to        
assistance under subsection 7a7 pursuant
 to paragraph 7#i7 of subsection 7b7 who
 is also entitled to educational        
assistance under chapter #ce of this    
title may not receive assistance under  
both this section and such chapter1 but 
shall make an irrevocable election 7in  
such form and manner as the ,secretary  
may prescribe7 under which section or   
chapter to receive educational          
assistance4  4  7c7 ,conforming         
amendment ,section #ccba7;b77#d7 of such
 title is amended-- 7#a7 by striking an 
individual and inserting a child2 and   
7#b7 by striking such individual's each 
time it appears and inserting such      
child's4  #gjb4 ,approval of courses of 
education provided by public            
institutions of higher learning for     
purposes of ,all-,volunteer ,force      
,educational ,assistance ,program and   
,post-#i_/aa ,educational ,assistance   

conditional on in-,state tuition rate   
for veterans  7a7 ,in general ,section  
#cfgi of title #ch1 ,united ,states     
,code1 is amended by adding at the end  
the following new subsection3  7c7 7#a7 
,notwithstanding any other provision of 
this chapter and subject to paragraphs  
7#c7 through 7#f71 the ,secretary shall 
disapprove a course of education        
provided by a public institution of     
higher learning to a covered individual 
pursuing a course of education with     
educational assistance under chapter #cj
 or #cc of this title while living in   
the ,state in which the public          
institution of higher learning is       
located if the institution charges      
tuition and fees for that course for the
 covered individual at a rate that is   
higher than the rate the institution    
charges for tuition and fees for that   
course for residents of the ,state in   
which the institution is located1       
regardless of the covered individual's  
,state of residence4  7#b7 ,for purposes

 of this subsection1 a covered          
individual is any individual as follows3
 7,a7 ,a veteran who was discharged or  
released from a period of not fewer than
 #ij days of service in the active      
military1 naval1 or air service less    
than three years before the date of     
enrollment in the course concerned4     
7,b7 ,an individual who is entitled to  
assistance under section #ccaa7;b77#i7  
or #ccai of this title by virtue of such
 individual's relationship to a veteran 
described in subparagraph 7,a74  7#c7   
,if after enrollment in a course of     
education that is subject to disapproval
 under paragraph 7#a7 by reason of      
paragraph 7#b77;,a7 or 7#b77;,b7 a      
covered individual pursues one or more  
courses of education at the same public 
institution of higher learning while    
remaining continuously enrolled 7other  
than during regularly scheduled breaks  
between courses1 semesters or terms7 at 
that institution of higher learning1 any
 course so pursued by the covered       

individual at that institution of higher
 learning while so continuously enrolled
 shall also be subject to disapproval   
under paragraph 7#a74  7#d7 ,it shall   
not be grounds to disapprove a course of
 education under paragraph 7#a7 if a    
public institution of higher learning   
requires a covered individual pursuing a
 course of education at the institution 
to demonstrate an intent1 by means other
 than satisfying a physical presence    
requirement1 to establish residency in  
the ,state in which the institution is  
located1 or to satisfy other            
requirements not relating to the        
establishment of residency1 in order to 
be charged tuition and fees for that    
course at a rate that is equal to or    
less than the rate the institution      
charges for tuition and fees for that   
course for residents of the ,state4     
7#e7 ,the ,secretary may waive such     
requirements of paragraph 7#a7 as the   
,secretary considers appropriate4  7#f7 
,disapproval under paragraph 7#a7 shall 

apply only with respect to educational  
assistance under chapters #cj and #cc of
 this title4  4  7b7 ,effective date    
,subsection 7c7 of section #cfgi of     
title #ch1 ,united ,states ,code 7as    
added by subsection 7a7 of this         
section71 shall apply with respect to   
educational assistance provided for     
pursuit of programs of education during 
academic terms that begin after ,july   
#a1 #bjae1 through courses of education 
that commence on or after that date4    
,,viii ,appropriation and ,emergency    
,designations  #hja4 ,appropriation of  
emergency amounts ,there is authorized  
to be appropriated1 and is appropriated1
 to the ,secretary of ,veterans         
,affairs1 out of any funds in the       
,treasury not otherwise appropriated1   
for fiscal years #bjad1 #bjae1 and      
#bjaf1 such sums as may be necessary to 
carry out this ,act4  #hjb4 ,emergency  
designations  7a7 ,in general ,this ,act
 is designated as an emergency          
requirement pursuant to section #d7;g7  

of the ,statutory ,pay-,as-,you-,go ,act
 of #bjaj 7#b ,u4,s4,c4 #icc7;g774  7b7 
,designation in ,senate ,in the ,senate1
 this ,act is designated as an emergency
 requirement pursuant to section        
#djc7;a7 of ,s4 ,con4 ,res4 #ac 7#aaath 
,congress71 the concurrent resolution on
 the budget for fiscal year #bjaj4      
,amend the title so as to read3 ,to     
improve the access of veterans to       
medical services from the ,department of
 ,veterans ,affairs1 and for other      
purposes4  ,secretary