,one ,hundred ,thirteenth ,congress of  
the ,united ,states of ,america  ,at the
 ,second ,session ,begun and held at the
 ,city of ,washington on ,friday1 the   
third day of ,january1 two thousand and 
fourteen  ,h4 ,r4 #cbcj  ,,an ,,act  ,to
 improve the access of veterans to      
medical services from the ,department of
 ,veterans ,affairs1 and for other      
purposes4  #a4 ,short title2 table of   
contents  7a7 ,short title ,this ,act   
may be cited as the ,veterans ,access1  
,choice1 and ,accountability ,act of    
#bjad4  7b7 ,table of contents ,the     
table of contents for this ,act is as   
follows3  ,sec4 #a4 ,short title2 table 
of contents4 ,sec4 #b4 ,definitions4    
,title ,i--,improvement of ,access to   
,care from ,non-,department of ,veterans
 ,affairs ,providers ,sec4 #aja4        
,expanded availability of hospital care 
and medical services for veterans       
through the use of agreements with      
non-,department of ,veterans ,affairs   
entities4 ,sec4 #ajb4 ,enhancement of   

collaboration between ,department of    
,veterans ,affairs and ,indian ,health  
,service4 ,sec4 #ajc4 ,enhancement of   
collaboration between ,department of    
,veterans ,affairs and ,native ,hawaiian
 health care systems4 ,sec4 #ajd4       
,reauthorization and modification of    
pilot program of enhanced contract care 
authority for health care needs of      
veterans4 ,sec4 #aje4 ,prompt payment by
 ,department of ,veterans ,affairs4     
,sec4 #ajf4 ,transfer of authority for  
payments for hospital care1 medical     
services1 and other health care from    
non-,department of ,veterans ,affairs   
providers to the chief business office  
of the ,veterans ,health                
,administration4 ,title ,,ii--,health   
,care ,administrative ,matters ,sec4    
#bja4 ,independent assessment of the    
health care delivery systems and        
management processes of the ,department 
of ,veterans ,affairs4 ,sec4 #bjb4      
,commission on ,care4 ,sec4 #bjc4       
,technology task force on review of     

scheduling system and software of the   
,department of ,veterans ,affairs4 ,sec4
 #bjd4 ,improvement of access of        
veterans to mobile vet centers and      
mobile medical centers of the           
,department of ,veterans ,affairs4 ,sec4
 #bje4 ,improved performance metrics for
 health care provided by ,department of 
,veterans ,affairs4 ,sec4 #bjf4         
,improved transparency concerning health
 care provided by ,department of        
,veterans ,affairs4 ,sec4 #bjg4         
,information for veterans on the        
credentials of ,department of ,veterans 
,affairs physicians4 ,sec4 #bjh4        
,information in annual budget of the    
,president on hospital care and medical 
services furnished through expanded use 
of contracts for such care4 ,sec4 #bji4 
,prohibition on falsification of data   
concerning wait times and quality       
measures at ,department of ,veterans    
,affairs4 ,title ,,iii--,health ,care   
,staffing1 ,recruitment1 and ,training  
,matters ,sec4 #cja4 ,treatment of      

staffing shortage and biennial report on
 staffing of medical facilities of the  
,department of ,veterans ,affairs4 ,sec4
 #cjb4 ,extension and modification of   
certain programs within the ,department 
of ,veterans ,affairs ,health           
,professionals ,educational ,assistance 
,program4 ,sec4 #cjc4 ,clinic management
 training for employees at medical      
facilities of the ,department of        
,veterans ,affairs4 ,title ,,iv--,health
 ,care ,related to ,sexual ,trauma ,sec4
 #dja4 ,expansion of eligibility for    
sexual trauma counseling and treatment  
to veterans on inactive duty training4  
,sec4 #djb4 ,provision of counseling and
 treatment for sexual trauma by the     
,department of ,veterans ,affairs to    
members of the ,armed ,forces4 ,sec4    
#djc4 ,reports on military sexual       
trauma4 ,title ,v--,other ,health ,care 
,matters ,sec4 #eja4 ,extension of pilot
 program on assisted living services for
 veterans with traumatic brain injury4  
,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--,other ,veterans ,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 ,sec4 #gjc4 ,extension of 
reduction in amount of pension furnished
 by ,department of ,veterans ,affairs   
for certain veterans covered by         
,medicaid plans for services furnished  
by nursing facilities4 ,sec4 #gjd4      
,extension of requirement for collection
 of fees for housing loans guaranteed by
 ,secretary of ,veterans ,affairs4 ,sec4
 #gje4 ,limitation on awards and bonuses

 paid to employees of ,department of    
,veterans ,affairs4 ,sec4 #gjf4         
,extension of authority to use income   
information4 ,sec4 #gjg4 ,removal of    
senior executives of the ,department of 
,veterans ,affairs for performance or   
misconduct4 ,title ,,viii--,other       
,matters ,sec4 #hja4 ,appropriation of  
amounts4 ,sec4 #hjb4 ,veterans ,choice  
,fund4 ,sec4 #hjc4 ,emergency           
designations4  #b4 ,definitions ,in this
 ,act3  7#a7 ,the term facility of the  
,department has the meaning given the   
term facilities of the ,department in   
section #agja of title #ch1 ,united     
,states ,code4  7#b7 ,the terms hospital
 care and medical services have the     
meanings given such terms in section    
#agja of title #ch1 ,united ,states     
,code4  ,i ,improvement of ,access to   
,care from ,non-,department of ,veterans
 ,affairs ,providers  #aja4 ,expanded   
availability of hospital care and       
medical services for veterans through   
the use of agreements with              

non-,department of ,veterans ,affairs   
entities  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   
agreements 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  
seq471 including any physician          
furnishing services under such program4 
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    
makes an election under subsection 7c7  
to receive hospital care or medical     
services under this section may select a
 provider of such care or services from 
among the entities specified in         
paragraph 7#a77;,b7 that are 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 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 as of ,august  
#a1 #bjad1 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     
,code1 including any such veteran who   
has not received hospital care or       
medical services from the ,department   
and has contacted the ,department       
seeking an initial appointment from the 
,department for the receipt of such care
 or services2 or  7,b7 the veteran is   
eligible for hospital care and medical  
services under section                  
#agaj7;e77#a77;,d7 of such title and is 
a veteran described in section          
#agaj7;e77#c7 of such title2 and  7#b7  
the veteran--  7,a7 attempts1 or has    
attempted1 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 wait-time goals of the       
,veterans ,health ,administration for   
the furnishing of such care or services2
  7,b7 resides more than #dj miles from 
the medical facility of the ,department1
 including a community-based outpatient 
clinic1 that is closest to the residence
 of the veteran2  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 7i72 or  7,d7  7i7 resides in a 
location1 other than a location in      
,guam1 ,american ,samoa1 or the         
,republic of the ,philippines1 that is  
#dj miles or less from a medical        
facility of the ,department1 including a
 community-based outpatient clinic2 and 
7ii7  7,i7 is required to travel by air1

 boat1 or ferry to reach each medical   
facility described in clause 7i7 that is
 #dj miles or less from the residence of
 the veteran2 or  7,,ii7 faces an       
unusual or excessive burden in accessing
 each medical facility described in     
clause 7i7 that is #dj miles or less    
from the residence of the veteran due to
 geographical challenges1 as determined 
by the ,secretary4  7c7 ,election and   
authorization  7#a7 ,in general ,in the 
case of an eligible veteran described in
 subsection 7b77#b77;,a71 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 an      
appointment for hospital care or medical
 services the veteran has elected to    
receive under this section2 or  7,b7    
7i7 authorize that such care or services
 be furnished to the eligible veteran   
under this section for a period of time 
specified by the ,secretary2 and  7ii7  
notify the eligible veteran by the most 

effective means available1 including    
electronic communication or notification
 in writing1 describing the care or     
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   
agreements  7#a7 ,agreements  7,a7 ,in  
general ,the ,secretary shall enter into
 agreements for furnishing care and     

services to eligible veterans under this
 section with entities specified in     
subsection 7a77#a77;,b74  7,b7          
,agreement defined ,in this paragraph1  
the term agreement includes contracts1  
intergovernmental agreements1 and       
provider agreements1 as appropriate4    
7#b7 ,rates and reimbursement  7,a7 ,in 
general ,in entering into an agreement  
under paragraph 7#a7 with an entity     
specified in subsection 7a77#a77;,b71   
the ,secretary shall--  7i7 negotiate   
rates for the furnishing of care and    
services under this section2 and  7ii7  
reimburse the entity for such care and  
services at the rates negotiated        
pursuant to clause 7i7 as provided in   
such agreement4  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 or services4  7ii7 ,exception  7,i7
 ,in general ,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 who
 resides in a highly rural area4  7,,ii7
 ,highly rural area defined ,in this    
clause1 the term highly rural area means
 an area located in a county that has   
fewer than seven individuals residing in
 that county per square mile4  7,c7     
,limit on collection ,for the furnishing
 of care or services pursuant to an     
agreement under paragraph 7#a71 an      
entity specified in subsection          
7a77#a77;,b7 may not collect any amount 
that is greater than the rate negotiated

 pursuant to subparagraph 7,a77i74  7#c7
 ,certain procedures  7,a7 ,in general  
,in entering into an agreement under    
paragraph 7#a7 with an entity described 
in subparagraph 7,b71 the ,secretary may
 use the procedures1 including those    
procedures relating to reimbursement1   
available for entering into provider    
agreements under section #ahff7;a7 of   
the ,social ,security ,act 7#db         
,u4,s4,c4 #acie;cc7a77 and participation
 agreements under section #ahdb7;h7 of  
such ,act 7#db ,u4,s4,c4 #acieu7h774    
,during the period in which such entity 
furnishes care or services pursuant to  
this section1 such entity may not be    
treated as a ,federal contractor or     
subcontractor by the ,office of ,federal
 ,contract ,compliance ,programs of the 
,department of ,labor by virtue of      
furnishing such care or services4  7,b7 
,entities described ,the entities       
described in this subparagraph are the  
following3  7i7 ,in the case of the     
,medicare program1 any provider of      

services that has entered into a        
provider agreement under section        
#ahff7;a7 of the ,social ,security ,act 
7#db ,u4,s4,c4 #acie;cc7a77 and any     
physician or other supplier who has     
entered into a participation agreement  
under section #ahdb7;h7 of such ,act    
7#db ,u4,s4,c4 #acieu7h772 and  7ii7 ,in
 the case of the ,medicaid program1 any 
provider participating under a ,state   
plan under title ,,xix of such ,act 7#db
 ,u4,s4,c4 #acif et seq474  7#d7        
,information on policies and procedures 
,the ,secretary shall provide to any    
entity with which the ,secretary has    
entered into an agreement under         
paragraph 7#a7 the following3  7,a7     
,information on applicable policies and 
procedures for submitting bills or      
claims for authorized care or services  
furnished to eligible veterans under    
this section4  7,b7 ,access to a        
telephone hotline maintained by the     
,department that such entity 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 ,other health-,care plan  7#a7      
,submittal of information to ,secretary 
,before receiving hospital care or      
medical services under this section1 an 
eligible veteran shall provide to the   
,secretary information on any           
health-care plan described in paragraph 
7#d7 under which the eligible veteran is
 covered4  7#b7 ,disclosure of          
information to non-,department entity   
,notwithstanding section #egja of title 
#ch1 ,united ,states ,code1 for purposes
 of furnishing hospital care or medical 
services to an eligible veteran under   

this section1 the ,secretary shall      
disclose to the entity specified in     
paragraph 7#a77;,b7 of subsection 7a7   
with which the ,secretary has entered   
into an agreement described in such     
subsection--  7,a7 whether the eligible 
veteran is covered under a health-care  
plan described in paragraph 7#d72 and   
7,b7 whether the hospital care or       
medical services sought by the eligible 
veteran is for a medical condition that 
is related to a non-service-connected   
disability described in paragraph       
7#c77;,c74  7#c7 ,care for which the    
,department is secondarily responsible  
7,a7 ,in general ,if an eligible veteran
 is covered under a health-care plan    
described in paragraph 7#d7 and receives
 hospital care or medical services for a
 non-service-connected disability       
described in subparagraph 7,c71 such    
health-care plan shall be primarily     
responsible for paying for such care or 
services1 to the extent such care or    
services is covered by such health-care 

plan1 and the ,secretary shall be       
secondarily responsible for paying for  
such care or services in accordance with
 subparagraph 7,b77ii74  7,b7           
,responsibility for costs of care ,in a 
case in which the ,secretary is         
secondarily responsible for paying for  
hospital care or medical services as    
described in subparagraph 7,a7--  7i7   
the health care provider that furnishes 
such care or services pursuant to an    
agreement described in subsection 7a7   
shall be responsible for seeking        
reimbursement for the cost of such care 
or services from the health-care plan   
described in paragraph 7#d7 under which 
the eligible veteran is covered2 and    
7ii7 the ,secretary shall be responsible
 for promptly paying only the amount    
that is not covered by such health-care 
plan1 except that such responsibility   
for payment may not exceed the rate     
determined for such care or services    
pursuant to subsection 7d77#b74  7,c7   
,non-service-connected disability       

described ,a non-service-connected      
disability described in this subsection 
is a non-service-connected disability   
7as defined in section #aja of title    
#ch1 ,united ,states ,code7--  7i7 that 
is incurred incident to a veteran's     
employment and that is covered under a  
workers' compensation law or plan that  
provides for payment for the cost of    
health care and services provided to the
 veteran by reason of the disability2   
7ii7 that is incurred as the result of a
 motor vehicle accident to which applies
 a ,state law that requires the owners  
or operators of motor vehicles          
registered in that ,state to have in    
force automobile accident reparations   
insurance2  7iii7 that is incurred as   
the result of a crime of personal       
violence that occurred in a ,state1 or a
 political subdivision of a ,state1 in  
which a person injured as the result of 
such a crime is entitled to receive     
health care and services at such        
,state's or subdivision's expense for   

personal injuries suffered as the result
 of such crime2  7iv7 that is incurred  
by a veteran--  7,i7 who does not have a
 service-connected disability2 and      
7,,ii7 who is entitled to care 7or      
payment of the expenses of care7 under a
 health-care plan2 or  7v7 for which    
care and services are furnished under   
this section to a veteran who--  7,i7   
has a service-connected disability2 and 
7,,ii7 is entitled to care 7or payment  
of the expenses of care7 under a        
health-care plan4  7#d7 ,health-care    
plan ,a health-care plan described in   
this paragraph--  7,a7 is an insurance  
policy or contract1 medical or hospital 
service agreement1 membership or        
subscription contract1 or similar       
arrangement not administered by the     
,secretary of ,veterans ,affairs1 under 
which health services for individuals   
are provided or the expenses of such    
services are paid2 and  7,b7 does not   
include any such policy1 contract1      
agreement1 or similar arrangement       

pursuant to title ,,xviii or ,,xix of   
the ,social ,security ,act 7#db         
,u4,s4,c4 #acie et seq47 or chapter #ee 
of title #aj1 ,united ,states ,code4    
7f7 ,veterans choice card  7#a7 ,in     
general ,for purposes of receiving care 
and services under this section1 the    
,secretary shall1 not later than #ij    
days after the date of the enactment of 
this ,act1 issue to each veteran        
described in subsection 7b77#a7 a card  
that may be presented to a health care  
provider to facilitate the receipt of   
care or services under this section4    
7#b7 ,name of card ,each card issued    
under paragraph 7#a7 shall be known as a
 ,veterans ,choice ,card4  7#c7 ,details
 of card ,each ,veterans ,choice ,card  
issued to a veteran under paragraph 7#a7
 shall include the following3  7,a7 ,the
 name of the veteran4  7,b7 ,an         
identification number for the veteran   
that is not the social security number  
of the veteran4  7,c7 ,the contact      
information of an appropriate office of 

the ,department for health care         
providers to confirm that care or       
services under this section are         
authorized for the veteran4  7,d7       
,contact information and other relevant 
information for the submittal of claims 
or bills for the furnishing of care or  
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 ,veterans ,choice ,card to a  
veteran1 the ,secretary shall provide   
the veteran with information clearly    
stating the circumstances under which   
the veteran may be eligible for care or 
services under this section4  7g7       
,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 ,in the case of a  
veteran described in subsection         
7b77#a77;,b71 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 wait-time goals 
of the ,veterans ,health ,administration
 for the furnishing of such care or     
services4  7#c7 ,when the veteran       
becomes eligible for hospital care or   
medical services under this section     
under subparagraph 7,b71 7,c71 or 7,d7  
of subsection 7b77#b74  7h7 ,follow-,up 
care ,in carrying out this section1 the 
,secretary shall ensure that1 at the    
election of an eligible veteran who     
receives hospital care or medical       
services from a health care provider in 

an episode of care under this section1  
the veteran receives such hospital care 
and medical services from such health   
care provider through the completion of 
the episode of care 7but for a period   
not exceeding #fj days71 including all  
specialty and ancillary services deemed 
necessary as part of the treatment      
recommended in the course of such       
hospital care or medical services4  7i7 
,providers ,to be eligible to furnish   
care or 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 year during the period in
 which the ,secretary is authorized to  
carry out this section pursuant to      
subsection 7p71 verification of such    
licenses and credentials maintained by  

such health care provider4  7j7         
,cost-,sharing  7#a7 ,in general ,the   
,secretary shall require an eligible    
veteran to pay a copayment for the      
receipt of care or services under this  
section only if such eligible veteran   
would be required to pay a copayment for
 the receipt of such care or services at
 a medical facility of the ,department  
or from a health care provider of the   
,department pursuant to chapter #ag of  
title #ch1 ,united ,states ,code4  7#b7 
,limitation ,the amount of a copayment  
charged under paragraph 7#a7 may not    
exceed the amount of the copayment that 
would be payable by such eligible       
veteran for the receipt of such care or 
services at a medical facility of the   
,department or from a health care       
provider of the ,department pursuant to 
chapter #ag of title #ch1 ,united       
,states ,code4  7#c7 ,collection of     
copayment ,a health care provider that  
furnishes care or services to an        
eligible veteran under this section     

shall collect the copayment required    
under paragraph 7#a7 from such eligible 
veteran at the time of furnishing such  
care or services4  7k7 ,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 ,quarterly report  
7i7 ,in general ,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 quarterly 
report on the 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 quarter covered by the       
report4  7iii7 ,deadline ,the ,secretary
 shall submit each report required by   
clause 7i7 not later than #bj days after
 the end of the quarter covered by the  
report4  7l7 ,medical records  7#a7 ,in 
general ,the ,secretary shall ensure    
that any health care provider that      
furnishes care or services under this   
section to an eligible veteran submits  
to the ,department any medical record   

related to the care or 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 or services to   
such eligible veteran4  7#b7 ,electronic
 format ,any medical record submitted to
 the ,department under paragraph 7#a7   
shall1 to the extent possible1 be in an 
electronic format4  7m7 ,tracking of    
missed appointments ,the ,secretary     
shall implement a mechanism to track any
 missed appointments for care or        
services under this section by eligible 
veterans to ensure that the ,department 
does not pay for such care or services  
that were not furnished to an eligible  
veteran4  7n7 ,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  
7o7 ,inspector ,general report ,not     
later than #cj days after the date on   
which the ,secretary determines that #ge
 percent of the amounts deposited in the
 ,veterans ,choice ,fund established by 
section #hjb have been exhausted1 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  7p7 ,authority ,to furnish   
care and services  7#a7 ,in general ,the
 ,secretary may not use the authority   
under this section to furnish care and  
services after the date specified in    
paragraph 7#b74  7#b7 ,date specified   
,the date specified in this paragraph is
 the date on which the ,secretary has   
exhausted all amounts deposited in the  

,veterans ,choice ,fund established by  
section #hjb1 or the date that is #c    
years after the date of the enactment of
 this ,act1 whichever occurs first4     
7#c7 ,publication ,the ,secretary shall 
publish such date in the ,federal       
,register and on an ,internet website of
 the ,department available to the public
 not later than #cj days before such    
date4  7q7 ,reports  7#a7 ,initial      
report ,not later than #ij days after   
the publication of the interim final    
regulations under 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        
furnishing of care and services under   
this section that includes the          
following3  7,a7 ,the number of eligible
 veterans who have received care or     
services under this section4  7,b7 ,a   
description of the types of care and    
services furnished to eligible veterans 

under this section4  7#b7 ,final report 
,not later than #cj days after the date 
on which the ,secretary determines that 
#ge percent of the amounts deposited in 
the ,veterans ,choice ,fund established 
by section #hjb have been exhausted1 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
 or services under this section1        
disaggregated by--  7i7 eligible        
veterans described in subsection        
7b77#b77;,a72  7ii7 eligible veterans   
described in subsection 7b77#b77;,b72   
7iii7 eligible veterans described in    
subsection 7b77#b77;,c72 and  7iv7      
eligible veterans described in          
subsection 7b77#b77;,d74  7,b7 ,a       
description of the types 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 appointments 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 7p74  7r7 ,rule of           
construction ,nothing in this section   
shall be construed to alter the process 
of the ,department for filling and      
paying for prescription medications4    

7s7 ,wait-,time goals of the ,veterans  
,health ,administration  7#a7 ,in       
general ,except as provided in paragraph
 7#b71 in this section1 the term        
wait-time goals of the ,veterans ,health
 ,administration means not more than #cj
 days from the date on which a veteran  
requests an appointment for hospital    
care or medical services from the       
,department4  7#b7 ,alternate goals ,if 
the ,secretary submits to ,congress1 not
 later than #fj days after the date of  
the enactment of this ,act1 a report    
stating that the actual wait-time goals 
of the ,veterans ,health ,administration
 are different from the wait-time goals 
specified in paragraph 7#a7--  7,a7 for 
purposes of this section1 the wait-time 
goals of the ,veterans ,health          
,administration shall be the wait-time  
goals submitted by the ,secretary under 
this paragraph2 and  7,b7 the ,secretary
 shall publish such wait-time goals in  
the ,federal ,register and on an        
,internet website of the ,department    

available to the public4  #ajb4         
,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 who are--  7#a7    
eligible for health care at such        

facilities2 and  7#b7  7,a7 enrolled in 
the patient enrollment system of the    
,department established and operated    
under section #agje of title #ch1       
,united ,states ,code2 or  7,b7 eligible
 for hospital care and medical services 
pursuant to subsection 7c77#b7 of such  
section4  7b7 ,performance metrics for  
memorandum of understanding ,the        
,secretary of ,veterans ,affairs shall  
establish 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  #ajc4 ,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  #ajd4 ,reauthorization and    
modification of pilot program of        
enhanced contract care authority for    
health care needs of veterans ,section  
#djc of the ,veterans' ,mental ,health  
and ,other ,care ,improvements ,act of  
#bjjh 7,public ,law #aaj-chg2 #ch       
,u4,s4,c4 #agjc note7 is amended--  7#a7
 in subsection 7a7--  7,a7 in paragraph 
7#c71 by striking only during the and   
all that follows through the period at  
the end and inserting only during the   
period beginning on the date of the     
commencement of the pilot program under 
paragraph 7#b7 and ending on the date   
that is two years after the date of the 
enactment of the ,veterans ,access1     
,choice1 and ,accountability ,act of    

#bjad42 and  7,b7 by amending paragraph 
7#d7 to read as follows3  7#d7 ,program 
locations ,the ,secretary shall carry   
out the pilot program at locations in   
the following ,veterans ,integrated     
,service ,networks 7and such other      
locations as the ,secretary considers   
appropriate73  7,a7 ,veterans           
,integrated ,service ,network #a4  7,b7 
,veterans ,integrated ,service ,network 
#f4  7,c7 ,veterans ,integrated ,service
 ,network #ae4  7,d7 ,veterans          
,integrated ,service ,network #ah4  7,e7
 ,veterans ,integrated ,service ,network
 #ai4  2  7#b7 in subsection            
7b77#a77;,a71 by striking as of the date
 of the commencement of the pilot       
program under subsection 7a77#b7 and    
inserting as of ,august #a1 #bjad2  7#c7
 by redesignating subsection 7h7 as     
subsection 7k72  7#d7 by inserting after
 subsection 7g7 the following new       
subsections3  7h7 ,appointments ,in     
carrying out the pilot program under    
this section1 the ,secretary shall      

ensure that medical appointments for    
covered veterans--  7#a7 are scheduled  
not later than #e days after the date on
 which the appointment is requested2 and
  7#b7 occur not later than #cj days    
after such date4  7i7 ,outreach ,the    
,secretary shall ensure that covered    
veterans are informed about the pilot   
program under this section4  7j7 ,use of
 existing contracts ,in carrying out the
 pilot program under this section after 
the date of the enactment of the        
,veterans ,access1 ,choice1 and         
,accountability ,act of #bjad1 the      
,secretary shall make use of contracts  
entered into before such date or may    
enter into new contracts4  2 and  7#e7  
in paragraph 7#b77;,b7 of subsection    
7k71 as redesignated by paragraph 7#c7  
of this section1 by striking the        
semicolon at the end and inserting 2    
and4  #aje4 ,prompt payment by          
,department of ,veterans ,affairs  7a7  
,sense of ,congress on prompt payment by
 ,department ,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
  7b7 ,establishment of claims          
processing system  7#a7 ,claims         
processing system ,the ,secretary of    
,veterans ,affairs shall establish and  
implement a system to process and pay   
claims for payment for hospital care1   
medical services1 and other health care 
furnished by non-,department of         
,veterans ,affairs health care providers
 under the laws administered by the     
,secretary4  7#b7 ,compliance with      
,prompt ,payment ,act ,the system       
established and implemented under       
paragraph 7#a7 shall comply with all    

requirements of chapter #ci1 ,united    
,states ,code 7commonly referred to as  
the ,prompt ,payment ,act74  7c7 ,report
 ,not later than #a year after the date 
of the enactment of this ,act1 the      
,comptroller ,general of the ,united    
,states shall submit to ,congress a     
report on the timeliness of payments by 
the ,secretary for hospital care1       
medical services1 and other health care 
furnished by non-,department of         
,veterans ,affairs health care providers
 under the laws administered by the     
,secretary4  7d7 ,elements ,the report  
required by subsection 7b7 shall include
 the following3  7#a7 ,the results of a 
survey of non-,department health care   
providers who have submitted claims to  
the ,department for hospital care1      
medical services1 or other health care  
furnished to veterans for which payment 
is authorized under the laws            
administered by the ,secretary during   
the one-year period preceding the       
submittal of the report1 which survey   

shall include the following3  7,a7 ,the 
amount of time it took for such health  
care providers1 after submitting such   
claims1 to receive payment from the     
,department for such care or services4  
7,b7 ,a comparison of the amount of time
 under subparagraph 7,a7 and the amount 
of time it takes such health care       
providers to receive payments from the  
,united ,states for similar care or     
services provided to the following1 if  
applicable3  7i7 ,beneficiaries under   
the ,medicare program under title       
,,xviii of the ,social ,security ,act   
7#db ,u4,s4,c4 #acie et seq474  7ii7    
,covered beneficiaries under the        
,,tricare program under chapter #ee of  
title #aj1 ,united ,states ,code4  7#b7 
,such recommendations for legislative or
 administrative action as the           
,comptroller ,general considers         
appropriate4  7e7 ,survey elements ,in  
carrying out the survey1 the            
,comptroller ,general shall seek        
responses from non-,department health   

care providers in a manner that ensures 
that the survey reflects the responses  
of such providers that--  7#a7 are      
located in different geographic areas2  
7#b7 furnish a variety of different     
hospital care1 medical services1 and    
other health care2 and  7#c7 furnish    
such care and services in a variety of  
different types of medical facilities4  
#ajf4 ,transfer of authority for        
payments for hospital care1 medical     
services1 and other health care from    
non-,department of ,veterans ,affairs   
providers to the chief business office  
of the ,veterans ,health ,administration
  7a7 ,transfer of authority  7#a7 ,in  
general ,effective as of ,october #a1   
#bjad1 the ,secretary of ,veterans      
,affairs shall transfer the authority to
 pay for hospital care1 medical         
services1 and other health care         
furnished through non-,department of    
,veterans ,affairs providers from--     
7,a7 the ,veterans ,integrated ,service 
,networks and medical centers of the    

,department of ,veterans ,affairs1 to   
7,b7 the ,chief ,business ,office of the
 ,veterans ,health ,administration 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 to ensure that care and
 services described in paragraph 7#a7   
are provided in a manner that is        
clinically appropriate and in the best  
interest of the veterans receiving such 
care and services4  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 furnished through a   
non-,department provider under the laws 
administered by the ,secretary4  7b7    
,budget matters ,the budget of the      
,department of ,veterans ,affairs for   
any fiscal year beginning after the date

 of the enactment of this ,act 7as      
submitted to ,congress pursuant to      
section #aaje7;a7 of title #ca1 ,united 
,states ,code7 shall specify funds for  
the payment for hospital care1 medical  
services1 and other health care         
furnished through non-,department of    
,veterans ,affairs providers1 including 
any administrative costs associated with
 such payment1 as funds for the ,chief  
,business ,office of the ,veterans      
,health ,administration rather than as  
funds for the ,veterans ,integrated     
,service ,networks or medical centers of
 the ,department4  ,,ii ,health ,care   
,administrative ,matters  #bja4         
,independent assessment of the health   
care delivery systems and management    
processes of the ,department of         
,veterans ,affairs  7a7 ,independent    
assessment  7#a7 ,assessment ,not later 
than #ij days after the date of the     
enactment of this ,act1 the ,secretary  
of ,veterans ,affairs shall enter into  
one or more contracts with a private    

sector entity or entities described in  
subsection 7b7 to conduct an independent
 assessment of the hospital care1       
medical services1 and other health care 
furnished in medical facilities of the  
,department4 ,such assessment shall     
address each of the following3  7,a7    
,current and projected demographics and 
unique health care needs of the patient 
population served by the ,department4   
7,b7 ,current and projected health care 
capabilities and resources of the       
,department1 including hospital care1   
medical services1 and other health care 
furnished by non-,department facilities 
under contract with the ,department1 to 
provide timely and accessible care to   
veterans4  7,c7 ,the authorities and    
mechanisms under which the ,secretary   
may furnish hospital care1 medical      
services1 and other health care at      
non-,department facilities1 including   
whether the ,secretary should have the  
authority to furnish such care and      
services at such facilities through the 

completion of episodes of care4  7,d7   
,the appropriate system-wide access     
standard applicable to hospital care1   
medical services1 and other health care 
furnished by and through the            
,department1 including an identification
 of appropriate access standards for    
each individual specialty and post-care 
rehabilitation4  7,e7 ,the workflow     
process at each medical facility of the 
,department for scheduling appointments 
for veterans to receive hospital care1  
medical services1 or other health care  
from the ,department4  7,f7 ,the        
organization1 workflow processes1 and   
tools used by the ,department to support
 clinical staffing1 access to care1     
effective length-of-stay management and 
care transitions1 positive patient      
experience1 accurate documentation1 and 
subsequent coding of inpatient services4
  7,g7 ,the staffing level at each      
medical facility of the ,department and 
the productivity of each health care    
provider at such medical facility1      

compared with health care industry      
performance metrics1 which may include  
an assessment of any of the following3  
7i7 ,the case load of1 and number of    
patients treated by1 each health care   
provider at such medical facility during
 an average week4  7ii7 ,the time spent 
by such health care provider 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 supervising other health   
care professionals of the ,department4  
7,h7 ,the information technology        
strategies of the ,department with      
respect to furnishing and managing      
health care1 including an identification
 of any weaknesses and opportunities    
with respect to the technology used by  
the ,department1 especially those       
strategies with respect to clinical     
documentation of episodes of hospital   

care1 medical services1 and other health
 care1 including any clinical images and
 associated textual reports1 furnished  
by the ,department in ,department or    
non-,department facilities4  7,i7       
,business processes of the ,veterans    
,health ,administration1 including      
processes relating to furnishing        
non-,department health care1 insurance  
identification1 third-party revenue     
collection1 and vendor reimbursement1   
including an identification of          
mechanisms 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 authorized and to     
ensure that such amounts collected are  
accurate4  7iii7 ,to increase the       
collection of any other amounts owed to 
the ,department with respect to hospital
 care1 medical services1 and other      

health care and to ensure that such     
amounts collected are accurate4  7iv7   
,to increase the accuracy and timeliness
 of ,department payments to vendors and 
providers4  7,j7 ,the purchasing1       
distribution1 and use of                
pharmaceuticals1 medical and surgical   
supplies1 medical devices1 and health   
care related services by the            
,department1 including the following3   
7i7 ,the prices paid for1               
standardization of1 and use by the      
,department of the following3  7,i7     
,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 and systems used by the        
,department to distribute               
pharmaceuticals1 medical and surgical   
supplies1 medical devices1 and health   

care related services to ,veterans      
,integrated ,service ,networks and      
medical facilities of the ,department4  
7,k7 ,the process of the ,department for
 carrying out construction and          
maintenance projects at medical         
facilities of the ,department and the   
medical facility leasing program of the 
,department4  7,l7 ,the competency of   
leadership with respect to culture1     
accountability1 reform readiness1       
leadership development1 physician       
alignment1 employee engagement1         
succession planning1 and performance    
management4  7#b7 ,particular elements  
of certain assessments  7,a7 ,scheduling
 assessment ,in carrying out the        
assessment required by paragraph        
7#a77;,e71 the private sector entity or 
entities shall do the following3  7i7   
,review all training materials          
pertaining to scheduling of appointments
 at each medical facility of the        
,department4  7ii7 ,assess whether all  
employees of the ,department conducting 

tasks related to scheduling are properly
 trained for conducting such tasks4     
7iii7 ,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  7iv7 
,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  7v7 ,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  7vi7 ,assess whether     
booking templates for each medical      
facility or clinic of the ,department   
would improve the process of scheduling 
such appointments4  7vii7 ,assess any   
interim technology changes or attempts  
by ,department to internally develop a  

long-term scheduling solutions with     
respect to the feasibility and cost     
effectiveness of such internally        
developed solutions compared to         
commercially available solutions4       
7viii7 ,recommend actions1 if any1 to be
 taken by the ,department to improve the
 process for scheduling such            
appointments1 including the following3  
7,i7 ,changes in training materials     
provided to employees of the ,department
 with respect to conducting tasks       
related to scheduling such appointments4
  7,,ii7 ,changes in monitoring and     
assessment conducted by the ,department 
of wait times of veterans for such      
appointments4  7,,iii7 ,changes in the  
system used to schedule such            
appointments1 including changes to      
improve how the ,department--  7aa7     
measures wait times of veterans for such
 appointments2  7bb7 monitors the       
availability of health care providers of
 the ,department2 and  7cc7 provides    
veterans the ability to schedule such   

appointments4  7,,iv7 ,such other       
actions as the private sector entity or 
entities considers appropriate4  7,b7   
,medical construction and maintenance   
project and leasing program assessment  
,in carrying out the assessment required
 by paragraph 7#a77,k71 the private     
sector entity or entities shall do the  
following3  7i7 ,review the process of  
the ,department for identifying and     
designing proposals for construction and
 maintenance projects at medical        
facilities of the ,department and leases
 for medical facilities of the          
,department4  7ii7 ,assess the process  
through which the ,department determines
 the following3  7,i7 ,that a           
construction or maintenance project or  
lease is necessary with respect to a    
medical facility or proposed medical    
facility of the ,department4  7,,ii7    
,the proper size of such medical        
facility or proposed medical facility   
with respect to treating veterans in the
 catchment area of such medical facility

 or proposed medical facility4  7iii7   
,assess the management processes of the 
,department with respect to the capital 
management programs of the ,department1 
including processes relating to the     
methodology for construction and design 
of medical facilities of the            
,department1 the management of projects 
relating to the construction and design 
of such facilities1 and the activation  
of such facilities4  7iv7 ,assess the   
medical facility leasing program of the 
,department4  7#c7 ,timing ,the private 
sector entity or entities carrying out  
the assessment required by paragraph    
7#a7 shall complete such assessment not 
later than #bdj days after entering into
 the contract described in such         
paragraph4  7b7 ,private sector entities
 described ,a private entity described  
in this subsection is a private entity  
that--  7#a7 has experience and proven  
outcomes in optimizing the performance  
of the health care delivery systems of  
the ,veterans ,health ,administration   

and the private sector and in health    
care management2 and  7#b7 specializes  
in implementing large-scale             
organizational and cultural             
transformations1 especially with respect
 to health care delivery systems4  7c7  
,program integrator  7#a7 ,in general   
,if the ,secretary enters into contracts
 with more than one private sector      
entity under subsection 7a71 the        
,secretary shall designate one such     
entity that is predominately a health   
care organization as the program        
integrator4  7#b7 ,responsibilities ,the
 program integrator designated pursuant 
to paragraph 7#a7 shall be responsible  
for coordinating the outcomes of the    
assessments conducted by the private    
entities pursuant to such contracts4    
7d7 ,report on assessment  7#a7 ,in     
general ,not later than #fj days after  
completing the assessment required by   
subsection 7a71 the private sector      
entity or entities carrying out such    
assessment shall submit to the          

,secretary of ,veterans ,affairs1 the   
,committee on ,veterans' ,affairs of the
 ,senate1 the ,committee on ,veterans'  
,affairs of the ,house of               
,representatives1 and the ,commission on
 ,care established under section #bjb a 
report on the findings and              
recommendations of the private sector   
entity or entities with respect to such 
assessment4  7#b7 ,publication ,not     
later than #cj days after receiving the 
report under paragraph 7#a71 the        
,secretary shall publish such report in 
the ,federal ,register and on an        
,internet website of the ,department of 
,veterans ,affairs that is accessible to
 the public4  7e7 ,non-,department      
facilities defined ,in this section1 the
 term non-,department facilities has the
 meaning given that term in section     
#agja of title #ch1 ,united ,states     
,code4  #bjb4 ,commission on ,care  7a7 
,establishment of commission  7#a7 ,in  
general ,there is established a         
commission1 to be known as the          

,commission on ,care 7in this section   
referred to as the ,commission71 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 #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 #ae voting members who   
are appointed as follows3  7i7 ,three   
members appointed by the ,speaker of the
 ,house of ,representatives1 at least   
one of whom shall be a veteran4  7ii7   
,three members appointed by the         
,minority ,leader of the ,house of      
,representatives1 at least one of whom  
shall be a veteran4  7iii7 ,three       
members appointed by the ,majority      
,leader of the ,senate1 at least one of 
whom shall be a veteran4  7iv7 ,three   
members appointed by the ,minority      

,leader of the ,senate1 at least one of 
whom shall be a veteran4  7v7 ,three    
members appointed by the ,president1 at 
least two of whom shall be veterans4    
7,b7 ,qualifications ,of the members    
appointed under subparagraph 7,a7--  7i7
 at least one member shall represent an 
organization recognized by the          
,secretary of ,veterans ,affairs for the
 representation of veterans under       
section #eijb of title #ch1 ,united     
,states ,code2  7ii7 at least one member
 shall have experience as senior        
management for a private integrated     
health care system with an annual gross 
revenue of more than #ej1jjj1jjj2  7iii7
 at least one member shall be 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;,b7772  7iv7  

at least one member shall be familiar   
with the ,veterans ,health              
,administration but shall not be        
currently employed by the ,veterans     
,health ,administration2 and  7v7 at    
least one member shall be familiar with 
medical facility construction and       
leasing projects carried out by         
government entities and have experience 
in the building trades1 including       
construction1 engineering1 and          
architecture4  7,c7 ,date ,the          
appointments of members of the          
,commission shall be made not later than
 #a year after the date of the enactment
 of this ,act4  7#c7 ,period of         
appointment  7,a7 ,in general ,members  
shall be appointed for the life of the  
,commission4  7,b7 ,vacancies ,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 eight 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 ,president shall      
designate a member of the commission to 
serve as ,chairperson of the            
,commission4 ,the ,commission shall     
select a ,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 ,in    
undertaking the comprehensive evaluation
 and assessment required by paragraph   
7#a71 the ,commission shall evaluate and
 assess the results of the assessment   

conducted by the private sector entity  
or entities under section #bja1         
including any findings1 data1 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 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  
7,a7 ,in general ,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  7,b7        
,officers or employees of the ,united   
,states ,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 the 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  #bjc4      
,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
 ,notwithstanding any other provision of
 law1 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 one or more existing            
off-the-shelf systems 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 #a
 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
  #bjd4 ,improvement of access of       
veterans to mobile vet centers and      
mobile medical 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   
and mobile medical 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   
and mobile medical 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 the    
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 and mobile medical    
center of the ,department has the       
capability to provide telemedicine      
services4  7b7 ,reports  7#a7 ,in       
general ,not later than #a 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 access to  
health care through the use of mobile   
vet centers and mobile medical centers  
of the ,department that includes        
statistics on each of the requirements  
set forth in subsection 7a77#b7 for the 
year covered by the report4  7#b7       
,elements ,each report required by      
paragraph 7#a7 shall include the        
following3  7,a7 ,a description of the  
use of mobile vet centers and mobile    
medical centers to provide telemedicine 
services to veterans during the year    
preceding the submittal of the report1  
including the following3  7i7 ,the      
number of days each mobile vet center   
and mobile medical center was open to   
provide such services4  7ii7 ,the number

 of days each center traveled to a      
location other than the headquarters of 
the center to provide such services4    
7iii7 ,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 and mobile medical   
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 and mobile medical centers 
of the ,department4  7,d7 ,any          
recommendations for an increase in the  
telemedicine capabilities of each mobile
 vet center and mobile medical 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 centers and      
mobile medical centers4  7,f7 ,such     
other recommendations on improvement of 

the use of mobile vet centers and mobile
 medical centers by the ,department as  
the ,secretary considers appropriate4   
#bje4 ,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       
,program1 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 analyses1 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
  #bjf4 ,improved transparency          
concerning health care provided by      
,department of ,veterans ,affairs  7a7  
,publication of wait times ,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 a        
publicly accessible ,internet website of
 each medical center of the ,department 
of ,veterans ,affairs1 the wait-times   
for the scheduling of an appointment in 
each ,department facility by a veteran  
for the receipt of primary care1        
specialty care1 and hospital care and   
medical services based on the general   
severity of the condition of the        
veteran4 ,whenever the wait-times for   
the scheduling of such an appointment   
changes1 the ,secretary shall publish   
the revised wait-times--  7#a7 on a     

publicly accessible ,internet website of
 each medical center of the ,department 
by not later than #cj days after such   
change2 and  7#b7 in the ,federal       
,register by not later than #ij days    
after such change4  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       
website or any successor ,internet      
website1 the ,secretary of ,veterans    
,affairs shall publish a notice on such 
,internet website 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 #c 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  #bjg4      
,information for veterans on the        
credentials of ,department of ,veterans 
,affairs physicians  7a7 ,improvement of
 ,our ,doctors ,internet website links  
7#a7 ,availability through ,department  
of ,veterans ,affairs homepage ,a link  
to the ,our ,doctors 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 ,doctors health care providers 
database of the ,department1 or any     
successor database1 the name of the     

facility at which each licensed         
physician of the ,department underwent  
residency training4  7#c7 ,information  
on physicians at particular facilities  
,the ,our ,doctors 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 described in paragraph 7#b7 
with respect to 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        
,information described ,the information 
described in this paragraph with respect
 to a surgeon described in paragraph    
7#a7 is as follows3  7,a7 ,the education

 and training of the surgeon4  7,b7 ,the
 licensure1 registration1 and           
certification of the surgeon by the     
,state or national entity responsible   
for such licensure1 registration1 or    
certification4  7#c7 ,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 #b 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 #aja4    
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 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 report4  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  #bjh4 ,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 #aja 
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 
#bji4 ,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  ,,iii     
,health ,care ,staffing1 ,recruitment1  
and ,training ,matters  #cja4 ,treatment
 of staffing shortage and biennial      
report on staffing of medical facilities
 of the ,department of ,veterans        
,affairs  7a7 ,staffing shortages  7#a7 
,in general ,subchapter ,i of chapter   
#gd of title #ch1 ,united ,states ,code1
 is amended by adding at the end the    
following new section3  #gdab4 ,annual  
determination of staffing shortages2    
recruitment and appointment for needed  
occupations  7a7 ,in general ,not later 
than ,september #cj of each year1 the   
,inspector ,general of the ,department  
shall determine1 and the ,secretary     

shall publish in the ,federal ,register1
 the five occupations of personnel of   
this title of the ,department covered   
under section #gdja of this title for   
which there are the largest staffing    
shortages throughout the ,department as 
calculated over the five-year period    
preceding the determination4  7b7       
,recruitment and appointment            
,notwithstanding sections #ccjd and     
#ccji through #ccah of title #e1 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 occupation1 recruit and 
directly appoint1 during the fiscal year
 after the fiscal year during which such
 determination is made1 qualified       
personnel to serve in that particular   
occupation for the ,department4  4  7#b7
 ,clerical amendment ,the table of      
sections at the beginning of such       
chapter is amended by inserting after   
the item relating to section #gdaa the  

following new item3  #gdab4 ,annual     
determination of staffing shortages2    
recruitment and appointment for needed  
occupations4  4  7#c7 ,deadline for     
first determination ,notwithstanding the
 deadline under section #gdab of title  
#ch1 ,united ,states ,code1 as added by 
paragraph 7#a71 for the annual          
determination of staffing shortages in  
the ,veterans ,health ,administration1  
the ,inspector ,general of the          
,department of ,veterans ,affairs shall 
make the first determination required   
under such section1 and the ,secretary  
of ,veterans ,affairs shall publish in  
the ,federal ,register such             
determination1 by not later than the    
date that is #ahj days after the date of
 the enactment of this ,act4  7b7       
,increase of graduate medical education 
residency positions  7#a7 ,in general   
,section #gcjb of title #ch1 ,united    
,states ,code1 is amended by adding at  
the end the following new subsection3   
7e7  7#a7 ,in carrying out this section1

 the ,secretary shall establish medical 
residency programs1 or ensure that      
already established medical residency   
programs have a sufficient number of    
residency positions1 at any medical     
facility of the ,department that the    
,secretary determines--  7,a7 is        
experiencing a shortage of physicians2  
and  7,b7 is located in a community that
 is designated as a health professional 
shortage area 7as defined in section    
#ccb of the ,public ,health ,service    
,act 7#db ,u4,s4,c4 #bed;e774  7#b7 ,in 
carrying out paragraph 7#a71 the        
,secretary shall--  7,a7 allocate the   
residency positions under such paragraph
 among occupations included in the most 
current determination published in the  
,federal ,register pursuant to section  
#gdab7;a7 of this title2 and  7,b7 give 
priority to residency positions and     
programs in primary care1 mental health1
 and any other specialty the ,secretary 
determines appropriate4  4  7#b7        
,five-year increase  7,a7 ,in general   

,in carrying out section #gcjb7;e7 of   
title #ch1 ,united ,states ,code1 as    
added by paragraph 7#a71 during the     
#e-year period beginning on the day that
 is #a year after the date of the       
enactment of this ,act1 the ,secretary  
of ,veterans ,affairs shall increase the
 number of graduate medical education   
residency positions at medical          
facilities of the ,department by up to  
#a1ejj positions4  7,b7 ,priority ,in   
increasing the number of graduate       
medical education residency positions at
 medical facilities of the ,department  
under subparagraph 7,a71 the ,secretary 
shall give priority to medical          
facilities that--  7i7 as of the date of
 the enactment of this ,act1 do not have
 a medical residency program2 and  7ii7 
are located in a community that has a   
high concentration of veterans4  7#c7   
,report  7,a7 ,in general ,not later    
than #fj days after the date of the     
enactment of this ,act1 and not later   
than ,october #a each year thereafter   

until #bjai1 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 
graduate medical education residency    
positions at medical facilities of the  
,department4  7,b7 ,elements ,each      
report required by subparagraph 7,a7    
shall include the following3  7i7 ,for  
the year preceding the submittal of the 
report1 the number of graduate medical  
education residency positions at medical
 facilities of the ,department as       
follows3  7,i7 ,that were filled4       
7,,ii7 ,that were not filled4  7,,iii7  
,that the ,department anticipated       
filling4  7ii7 ,with respect to each    
graduate medical education residency    
position specified in clause 7i7--  7,i7
 the geographic location of each such   
position2 and  7,,ii7 if such position  
was filled1 the academic affiliation of 
the medical resident that filled such   
position4  7iii7 ,the policy at each    

medical facility of the ,department with
 respect to the ratio of medical        
residents to staff supervising medical  
residents4  7iv7 ,during the #a-year    
period preceding the submittal of the   
report1 the number of individuals who   
declined an offer from the ,department  
to serve as a medical resident at a     
medical facility of the ,department and 
the reason why each such individual     
declined such offer4  7v7 ,during the   
#a-year period preceding the submittal  
of the report1 a description of--  7,i7 
challenges1 if any1 faced by the        
,department in filling graduate medical 
education residency positions at medical
 facilities of the ,department2 and     
7,,ii7 actions1 if any1 taken by the    
,department to address such challenges4 
7vi7 ,a description of efforts of the   
,department1 as of the date of the      
submittal of the report1 to recruit and 
retain medical residents to work for the
 ,veterans ,health ,administration as   
full-time employees4  7c7 ,priority in  

,scholarship ,program of ,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 toward a      
career in an occupation for which the   
,inspector ,general of the ,department  
has1 in the most current determination  
published in the ,federal ,register     
pursuant to section #gdab7;a7 of this   
title1 determined that there is one of  
the largest staffing shortages          
throughout the ,department with respect 
to such occupation2 and  4  7d7 ,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 ,committees on ,veterans' ,affairs  
of the ,senate and ,house of            
,representatives a report assessing the 
staffing of each medical facility of the
 ,department4  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 professionals 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 subsection 7a7
 of section #gdab of title #ch1 ,united 
,states ,code1 as added by subsection   
7a77#a7 of this section1 and a plan to  
use direct appointment authority under  
subsection 7b7 of such section #gdab 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 #b-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
  #cjb4 ,extension and modification of  
certain programs within the ,department 
of ,veterans ,affairs ,health           
,professionals ,educational ,assistance 

,program  7a7 ,extension of ,scholarship
 ,program ,section #gfai of title #ch1  
,united ,states ,code1 is amended by    
striking ,december #ca1 #bjad and       
inserting ,december #ca1 #bjai4  7b7    
,modification of ,education ,debt       
,reduction ,program  7#a7 ,modification 
of amount and duration of eligibility   
,paragraph 7#a7 of section #gfhc7;d7 of 
such title is amended--  7,a7 by        
striking #fj1jjj and inserting #abj1jjj2
 and  7,b7 by striking #ab1jjj of such  
payments and all that follows through   
the period at the end and inserting     
#bd1jjj of such payments may be made in 
each year of participation in the       
,program4  7#b7 ,elimination of         
limitation  7,a7 ,in general ,such      
section is further amended--  7i7 by    
striking paragraph 7#b72  7ii7 by       
redesignating paragraph 7#c7 as         
paragraph 7#b72 and  7iii7 in paragraph 
7#b71 as redesignated by clause 7ii71 by
 striking paragraphs 7#a7 and 7#b7 and  
inserting paragraph 7#a74  7,b7         

,conforming amendment ,paragraph 7#a7 of
 such section1 as amended by paragraph  
7#a71 is further amended by striking    
,subject to paragraph 7#b71 the amount  
and inserting ,the amount4  #cjc4       
,clinic management training for         
employees at medical facilities 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 role-specific 
clinic management training program to   
provide in-person1 standardized         
education on systems and processes for  
health care practice management and     
scheduling to all appropriate employees1
 as determined by the ,secretary1 at    
medical facilities of the ,department4  
7#b7 ,elements  7,a7 ,in general ,the   
clinic management training program      
required by paragraph 7#a7 shall include
 the following3  7i7 ,training on how to
 manage the schedules of health care    

providers of the ,department1 including 
the following3  7,i7 ,maintaining such  
schedules in a manner that allows       
appointments to be booked at least eight
 weeks in advance4  7,,ii7 ,proper      
planning procedures for vacation1 leave1
 and graduate medical education training
 schedules4  7ii7 ,training on the      
appropriate number of appointments that 
a health care provider should conduct on
 a daily basis1 based on specialty4     
7iii7 ,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  7iv7 ,training on  
how to properly use the appointment     
scheduling system of the ,department1   
including any new scheduling system     
implemented by the ,department4  7v7    
,training on how to optimize the use of 
technology1 including the following3    
7,i7 ,telemedicine4  7,,ii7 ,electronic 
mail4  7,,iii7 ,text messaging4  7,,iv7 

,such other technologies as specified by
 the ,secretary4  7vi7 ,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,b7 ,role-specific
 ,the ,secretary shall ensure that each 
employee of the ,department included in 
the clinic management training program  
required by paragraph 7#a7 receives     
education under such program that is    
relevant to the responsibilities of such
 employee4  7#c7 ,sunset ,the clinic    
management training program required by 
paragraph 7#a7 shall terminate on the   
date that is #b 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 that are relevant to the    

position and responsibilities of such   
employee 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  ,,iv ,health ,care     
,related to ,sexual ,trauma  #dja4      
,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  #djb4       
,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     
redesignated 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 disaggregated 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   
individuals2 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 #a year after the date of  
the enactment of this ,act4  #djc4      
,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 #e    
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 duty1 active duty for 
training1 or inactive duty 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  ,v ,other ,health ,care ,matters 
#eja4 ,extension of pilot program on    
assisted living services for veterans   
with traumatic brain injury  7a7 ,in    
general ,section #agje of the ,national 
,defense ,authorization ,act for ,fiscal

 ,year #bjjh 7,public ,law #aaj-aha2 #ch
 ,u4,s4,c4 #agaj;,c note7 is amended by 
adding at the end the following3  7g7   
,termination ,the pilot program shall   
terminate on ,october #f1 #bjag4  4  7b7
 ,conforming amendment ,subsection 7a7  
of such section is amended by striking  
five-year4  ,,vi ,major ,medical        
,facility ,leases  #fja4 ,authorization 
of major medical facility leases  7a7   
,in general ,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 a 
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 ,kapolei ,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 ,richey1     

,florida1 an amount not to exceed       
#aa1ibg1jjj4  7#aj7 ,for an outpatient  
clinic1 ,ponce1 ,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 ,errera ,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 
multispecialty 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 ,hines1 ,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  7#bg7 ,for the expansion of
 a community-based outpatient clinic1   
,tulsa1 ,oklahoma1 an amount not to     
exceed #ac1bfi1bjj4  7b7 ,requirements  
for clinic in ,tulsa  7#a7 ,in general  
,in carrying out the expansion of the   
community-based outpatient clinic in    
,tulsa1 ,oklahoma1 authorized by        
subsection 7a77#bg71 the ,secretary of  
,veterans ,affairs shall ensure that    
such clinic satisfies the following     
requirements3  7,a7 ,consist of not more
 than #adj1jjj gross square feet4  7,b7 
,have an annual cost per square foot of 
not more than the average market rate in
 ,tulsa1 ,oklahoma1 for an equivalent   
medical facility plus #bj percent4  7,c7
 ,satisfy the mandate of the ,department
 of ,veterans ,affairs to provide       
veterans in ,oklahoma with access to    
quality and efficient care4  7,d7       
,expand clinical capacity in the region 
in which the clinic is located in a cost

 efficient manner based upon regional   
cost comparisons1 taking into account   
the needs of current veterans and the   
potential demand by veterans for care in
 the future4  7,e7 ,be the most cost    
effective option for the ,department as 
predicted over a #cj-year life cycle for
 such clinic4  7#b7 ,cost effective     
determination  7,a7 ,in general ,if the 
,secretary determines that the most cost
 effective option over a #cj-year life  
cycle would be to purchase or construct 
a facility in ,tulsa1 ,oklahoma1 instead
 of entering into a major medical       
facility lease in such location as      
authorized by subsection 7a77#bg71 the  
,secretary shall not enter into such    
lease4  7,b7 ,major medical facility    
project ,if the ,secretary makes the    
determination described in subparagraph 
7,a71 the ,secretary may request        
authority for a major medical facility  
project in ,tulsa1 ,oklahoma1 from      
,congress pursuant to section #hajd7;b7 
of title #ch1 ,united ,states ,code4    

7,c7 ,cost-benefit analysis ,if the     
,secretary requests authority for the   
major medical facility project described
 in subparagraph 7,b71 not later than   
#ij days after making the determination 
described in subparagraph 7,a71 the     
,secretary shall submit to ,congress a  
detailed cost-benefit analysis of such  
major medical facility project4  #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 the self-insuring authority  
identified in title #dj1 ,united ,states
 ,code1 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     
,other ,veterans ,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 or  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  7d7 ,effective date ,the      
amendments made by this section shall   
apply with respect to a quarter1        
semester1 or term1 as applicable1       

commencing on or after ,january #a1     
#bjae4  #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 a program of education during
 a quarter1 semester1 or term1 as       
applicable1 that begins after ,july #a1 
#bjae4  #gjc4 ,extension of reduction in
 amount of pension furnished by         
,department of ,veterans ,affairs for   
certain veterans covered by ,medicaid   
plans for services furnished by nursing 
facilities ,section #eejc7;d77#g7 of    
title #ch1 ,united ,states ,code1 is    

amended by striking ,november #cj1 #bjaf
 and inserting ,september #cj1 #bjbd4   
#gjd4 ,extension of requirement for     
collection of fees for housing loans    
guaranteed by ,secretary of ,veterans   
,affairs ,section #cgbi7;b77#b7 of title
 #ch1 ,united ,states ,code1 is         
amended--  7#a7 in subparagraph 7,a7--  
7,a7 in clause 7iii71 by striking       
,october #a1 #bjag and inserting        
,september #cj1 #bjbd2 and  7,b7 in     
clause 7iv71 by striking ,october #a1   
#bjag and inserting ,september #cj1     
#bjbd2  7#b7 in subparagraph 7,b7--     
7,a7 in clause 7i71 by striking ,october
 #a1 #bjag and inserting ,september #cj1
 #bjbd2 and  7,b7 in clause 7ii71 by    
striking ,october #a1 #bjag and         
inserting ,september #cj1 #bjbd2  7#c7  
in subparagraph 7,c7--  7,a7 in clause  
7i71 by striking ,october #a1 #bjag and 
inserting ,september #cj1 #bjbd2 and    
7,b7 in clause 7ii71 by striking        
,october #a1 #bjag and inserting        
,september #cj1 #bjbd2 and  7#d7 in     

subparagraph 7,d7--  7,a7 in clause 7i71
 by striking ,october #a1 #bjag and     
inserting ,september #cj1 #bjbd2 and    
7,b7 in clause 7ii71 by striking        
,october #a1 #bjag and inserting        
,september #cj1 #bjbd4  #gje4           
,limitation on awards and bonuses paid  
to employees of ,department of ,veterans
 ,affairs ,in each of fiscal years #bjae
 through #bjbd1 the ,secretary of       
,veterans ,affairs shall ensure that the
 aggregate amount of awards and bonuses 
paid by the ,secretary in a fiscal year 
under chapter #de or #ec of title #e1   
,united ,states ,code1 or any other     
awards or bonuses authorized under such 
title does not exceed #cfj1jjj1jjj4     
#gjf4 ,extension of authority to use    
income information ,section #ecag7;g7 of
 title #ch1 ,united ,states ,code1 is   
amended by striking ,september #cj1     
#bjaf and inserting ,september #cj1     
#bjbd4  #gjg4 ,removal of senior        
executives of the ,department of        
,veterans ,affairs for performance or   

misconduct  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 executives3     
removal based on performance or         
misconduct  7a7 ,in general  7#a7 ,the  
,secretary may remove an individual     
employed in a senior executive position 
at the ,department of ,veterans ,affairs
 from the senior executive position if  
the ,secretary determines the           
performance or misconduct 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 in the case of an   
individual described in paragraph 7#b71 
transfer the individual from the senior 
executive position 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   
7#b7 ,an individual described in this   
paragraph is an individual who--  7,a7  
previously occupied a permanent position
 within the competitive service 7as that
 term is defined in section #bajb of    
title #e72  7,b7 previously occupied a  
permanent position within the excepted  
service 7as that term is defined in     
section #bajc of title #e72 or  7,c7    
prior to employment in a senior         
executive position at the ,department of
 ,veterans ,affairs1 did not occupy any 
position within the ,federal            
,government4  7b7 ,pay of transferred   
individual  7#a7 ,notwithstanding any   
other provision of law1 including the   
requirements of section #ceid of title  
#e1 any individual transferred to a     
,general ,schedule position under       
subsection 7a77#b7 shall1 beginning on  
the date of such transfer1 receive the  
annual rate of pay applicable to such   
position4  7#b7 ,an individual so       
transferred may not be placed on        

administrative leave or any other       
category of paid leave during the period
 during which an appeal 7if any7 under  
this section is ongoing1 and may only   
receive pay if the individual reports   
for duty4 ,if an individual so          
transferred does not report for duty1   
such individual shall not receive pay or
 other benefits pursuant to subsection  
7e77#e74  7c7 ,notice to ,congress ,not 
later than #cj days after removing or   
transferring an individual from a senior
 executive position 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  7d7      
,procedure  7#a7 ,the procedures under  
section #gedc7;b7 of title #e shall not 
apply to a removal or transfer under    
this section4  7#b7  7,a7 ,subject to   
subparagraph 7,b7 and subsection 7e71   
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 seven
 days after the date of such removal or 
transfer4  7e7 ,expedited review by     
administrative judge  7#a7 ,upon receipt
 of an appeal under subsection          
7d77#b77;,a71 the ,merit ,systems       
,protection ,board shall refer such     
appeal to an administrative judge       
pursuant to section #ggja7;b77#a7 of    
title #e4 ,the administrative judge     
shall expedite any such appeal under    
such section and1 in any such case1     
shall issue a decision not later than   
#ba days after the date of the appeal4  
7#b7 ,notwithstanding any other         
provision of law1 including section     
#ggjc of title #e1 the decision of an   
administrative judge under paragraph    
7#a7 shall be final and shall not be    
subject to any further appeal4  7#c7 ,in

 any case in which the administrative   
judge cannot issue a decision in        
accordance with the #ba-;day requirement
 under paragraph 7#a71 the removal or   
transfer is final4 ,in such a case1 the 
,merit ,systems ,protection ,board      
shall1 within #ad days after the date   
that such removal or transfer is final1 
submit to ,congress and the ,committees 
on ,veterans' ,affairs of the ,senate   
and ,house of ,representatives a report 
that explains the reasons why a decision
 was not issued in accordance with such 
requirement4  7#d7 ,the ,merit ,systems 
,protection ,board or administrative    
judge may not stay any removal or       
transfer under this section4  7#e7      
,during the period beginning on the date
 on which an individual appeals a       
removal from the civil service under    
subsection 7d7 and ending on the date   
that the administrative judge issues a  
final decision on such appeal1 such     
individual may not receive any pay1     
awards1 bonuses1 incentives1 allowances1

 differentials1 student loan repayments1
 special payments1 or benefits4  7#f7   
,to the maximum extent practicable1 the 
,secretary shall provide to the ,merit  
,systems ,protection ,board1 and to any 
administrative judge to whom an appeal  
under this section is referred1 such    
information and assistance as may be    
necessary to ensure an appeal under this
 subsection is expedited4  7f7 ,relation
 to title #e  7#a7 ,the authority       
provided by this section is in addition 
to the authority provided by section    
#ceib or subchapter ,v of chapter #ge of
 title #e4  7#b7 ,section #ceib7;b77#a7 
of title #e does not apply to an action 
to remove or transfer an individual     
under this section4  7g7 ,definitions   
,in this section3  7#a7 ,the term       
individual means--  7,a7 a career       
appointee 7as that term is defined in   
section #cacb7;a77#d7 of title #e72 or  
7,b7 any individual who occupies an     
administrative or executive position and
 who was appointed under section        

#gcjf7;a7 or section #gdja7a7 of this   
title4  7#b7 ,the term misconduct       
includes neglect of duty1 malfeasance1  
or failure to accept a directed         
reassignment or to accompany a position 
in a transfer of function4  7#c7 ,the   
term senior executive position means--  
7,a7 with respect to a career appointee 
7as that term is defined in section     
#cacb7;a77#d7 of title #e71 a ,senior   
,executive ,service position 7as such   
term is defined in section #cacb7;a77#b7
 of title #e72 and  7,b7 with respect to
 an individual appointed under section  
#gcjf7;a7 or section #gdja7a7 of this   
title1 an administrative or executive   
position4  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 executives3 removal based on    
performance or misconduct4  4  7b7      
,establishment of expedited review      
process  7#a7 ,in general ,not later    
than #ad 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 ,waiver ,the ,merit
 ,systems ,protection ,board may waive  
any other regulation in order to provide
 for the expedited review required under
 section #gac7;d7 of title #ch1 ,united 
,states ,code4  7#d7 ,report by ,merit  
,systems ,protection ,board ,not later  
than #ad days after the date of the     
enactment of this ,act1 the ,merit      
,systems ,protection ,board shall submit
 to the ,committees on ,veterans'       
,affairs of the ,senate and ,house of   

,representatives 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 #gedc of title #e1  
,united ,states ,code1 may be initiated1
 notwithstanding section #ceib7;b7 of   
such title1 or any other provision of   

law4  7d7 ,construction  7#a7 ,in       
general ,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
  7#b7 ,relation to title #e ,with      
respect to the removal or transfer of an
 individual 7as that term is defined in 
such section #gac7 employed at the      
,department of ,veterans ,affairs1 the  
authority provided by such section #gac 
is in addition to the authority provided
 by section #ceib or subchapter ,v of   
chapter #ge of title #e1 ,united ,states
 ,code4  ,,viii ,other ,matters  #hja4  
,appropriation of amounts  7a7 ,in      
general ,there is authorized to be      
appropriated1 and is appropriated1 to   
the ,secretary of ,veterans ,affairs1   
out of any funds in the ,treasury not   
otherwise appropriated #e1jjj1jjj1jjj to
 carry out subsection 7b74 ,such funds  

shall be available for obligation or    
expenditure without fiscal year         
limitation4  7b7 ,use of amounts ,the   
amount appropriated under subsection 7a7
 shall be used by the ,secretary as     
follows3  7#a7 ,to increase the access  
of veterans to care as follows3  7,a7   
,to hire primary care and specialty care
 physicians for employment in the       
,department of ,veterans ,affairs4  7,b7
 ,to hire other medical staff1 including
 the following3  7i7 ,physicians4  7ii7 
,nurses4  7iii7 ,social workers4  7iv7  
,mental health professionals4  7v7      
,other health care professionals as the 
,secretary considers appropriate4  7,c7 
,to carry out sections #cja and #cjb1   
including the amendments made by such   
sections4  7,d7 ,to pay for expenses1   
equipment1 and other costs associated   
with the hiring of primary care1        
specialty care physicians1 and other    
medical staff under subparagraphs 7,a71 
7,b71 and 7,c74  7#b7 ,to improve the   
physical infrastructure of the          

,department as follows3  7,a7 ,to       
maintain and operate hospitals1 nursing 
homes1 domiciliary facilities1 and other
 facilities of the ,veterans ,health    
,administration4  7,b7 ,to enter into   
contracts or hire temporary employees to
 repair1 alter1 or improve facilities   
under the jurisdiction of the           
,department that are not otherwise      
provided for under this paragraph4  7,c7
 ,to carry out leases for facilities of 
the ,department4  7,d7 ,to carry out    
minor construction projects of the      
,department4  7c7 ,availability ,the    
amount appropriated under subsection 7a7
 shall remain available until expended4 
7d7 ,report  7#a7 ,in general ,not later
 than #a year after the date of the     
enactment of this ,act1 the ,secretary  
of ,veterans ,affairs shall submit to   
the appropriate committees of ,congress 
a report on how the ,secretary has      
obligated the amounts appropriated under
 subsection 7a7 as of the date of the   
submittal of the report4  7#b7          

,appropriate committees of ,congress    
defined ,in this subsection1 the term   
appropriate committees of ,congress     
means--  7,a7 the ,committee on         
,veterans' ,affairs and the ,committee  
on ,appropriations of the ,senate2 and  
7,b7 the ,committee on ,veterans'       
,affairs and the ,committee on          
,appropriations of the ,house of        
,representatives4  7e7 ,funding plan    
,the ,secretary shall submit to         
,congress a funding plan describing how 
the ,secretary intends to use the       
amounts provided under subsection 7a74  
#hjb4 ,veterans ,choice ,fund  7a7 ,in  
general ,there is established in the    
,treasury of the ,united ,states a fund 
to be known as the ,veterans ,choice    
,fund4  7b7 ,administration of fund ,the
 ,secretary of ,veterans ,affairs shall 
administer the ,veterans ,choice ,fund  
established by subsection 7a74  7c7 ,use
 of amounts  7#a7 ,in general ,any      
amounts deposited in the ,veteran       
,choice ,fund shall be used by the      

,secretary of ,veterans ,affairs to     
carry out section #aja1 including1      
subject to paragraph 7#b71 any          
administrative requirements of such     
section4  7#b7 ,amount for              
administrative requirements  7,a7       
,limitation ,except as provided by      
subparagraph 7,b71 of the amounts       
deposited in the ,veterans ,choice      
,fund1 not more than #cjj1jjj1jjj may be
 used for administrative requirements to
 carry out section #aja4  7,b7 ,increase
 ,the ,secretary may increase the amount
 set forth in subparagraph 7,a7 with    
respect to the amounts used for         
administrative requirements if--  7i7   
the ,secretary determines that the      
amount of such increase is necessary to 
carry out section #aja2  7ii7 the       
,secretary submits to the ,committees on
 ,veterans' ,affairs and ,appropriations
 of the ,house of ,representatives and  
the ,committees on ,veterans' ,affairs  
and ,appropriations of the ,senate a    
report described in subparagraph 7,c72  

and  7iii7 a period of #fj days has     
elapsed following the date on which the 
,secretary submits the report under     
clause 7ii74  7,c7 ,report ,a report    
described in this subparagraph is a     
report that contains the following3  7i7
 ,a notification of the amount of the   
increase that the ,secretary determines 
necessary under subparagraph 7,b77i74   
7ii7 ,the justifications for such       
increased amount4  7iii7 ,the           
administrative requirements that the    
,secretary will carry out using such    
increased amount4  7d7 ,appropriation   
and deposit of amounts  7#a7 ,in general
 ,there is authorized to be             
appropriated1 and is appropriated1 to   
the ,secretary of ,veterans ,affairs1   
out of any funds in the ,treasury not   
otherwise appropriated #aj1jjj1jjj1jjj  
to be deposited in the ,veterans ,choice
 ,fund established by subsection 7a74   
,such funds shall be available for      
obligation or expenditure without fiscal
 year limitation1 and only for the      

program created under section #aja4     
7#b7 ,availability ,the amount          
appropriated under paragraph 7#a7 shall 
remain available until expended4  7e7   
,sense of ,congress ,it is the sense of 
,congress that the ,veterans ,choice    
,fund is a supplement to but distinct   
from the ,department of ,veterans       
,affairs' current and expected level of 
non-,department care currently part of  
,department's medical care budget4      
,congress expects that the ,department  
will maintain at least its existing     
obligations of non-,department care     
programs in addition to but distinct    
from the ,veterans ,choice ,fund for    
each of fiscal years #bjae through      
#bjag4  #hjc4 ,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  ,speaker of the     
,house of ,representatives4  ,vice      
,president of the ,united ,states and   
,president of the ,senate4