,"o ,hundr$ ,?irte5? ,congress ( ! ,unit$ ,/ates ( ,am]ica ,at ! ,second ,session ,begun & held at ! ,city ( ,wa%+ton on ,friday1 ! ?ird day ( ,janu>y1 two ?\s& & f\rte5 ,h4 ,r4 #cbcj ,,an ,,act ,to improve ! access ( vet]ans to m$ical s]vices f ! ,dep>tm5t ( ,vet]ans ,affairs1 & = o!r purposes4 #a4 ,%ort title2 table ( cont5ts 7a7 ,%ort title ,?is ,act may be cit$ z ! ,vet]ans ,access1 ,*oice1 & ,acc\ntability ,act ( #bjad4 7b7 ,table ( cont5ts ,! table ( cont5ts = ?is ,act is z foll[s3 ,sec4 #a4 ,%ort title2 table ( cont5ts4 ,sec4 #b4 ,def9itions4 ,title ,i--,improvem5t ( ,access to ,c>e f ,non-,dep>tm5t ( ,vet]ans ,affairs ,provid]s ,sec4 #aja4 ,exp&$ availability ( hospital c>e & m$ical s]vices = vet]ans ?r\gh ! use ( agreem5ts ) non-,dep>tm5t ( ,vet]ans ,affairs entities4 ,sec4 #ajb4 ,enhancem5t ( collaboration betwe5 ,dep>tm5t ( ,vet]ans ,affairs & ,indian ,heal? ,s]vice4 ,sec4 #ajc4 ,enhancem5t ( collaboration betwe5 ,dep>tm5t ( ,vet]ans ,affairs & ,native ,hawaiian heal? c>e sy/ems4 ,sec4 #ajd4 ,reau?orization & modification ( pilot program ( enhanc$ contract c>e au?ority = heal? c>e ne$s ( vet]ans4 ,sec4 #aje4 ,prompt paym5t by ,dep>tm5t ( ,vet]ans ,affairs4 ,sec4 #ajf4 ,transf] ( au?ority = paym5ts = hospital c>e1 m$ical s]vices1 & o!r heal? c>e f non-,dep>tm5t ( ,vet]ans ,affairs provid]s to ! *ief bus9ess (fice ( ! ,vet]ans ,heal? ,adm9i/ration4 ,title ,,ii--,heal? ,c>e ,adm9i/rative ,matt]s ,sec4 #bja4 ,indep5d5t assessm5t ( ! heal? c>e deliv]y sy/ems & managem5t processes ( ! ,dep>tm5t ( ,vet]ans ,affairs4 ,sec4 #bjb4 ,commission on ,c>e4 ,sec4 #bjc4 ,te*nology task =ce on review ( s*$ul+ sy/em & s(tw>e ( ! ,dep>tm5t ( ,vet]ans ,affairs4 ,sec4 #bjd4 ,improvem5t ( access ( vet]ans to mobile vet c5t]s & mobile m$ical c5t]s ( ! ,dep>tm5t ( ,vet]ans ,affairs4 ,sec4 #bje4 ,improv$ p]=mance metrics = heal? c>e provid$ by ,dep>tm5t ( ,vet]ans ,affairs4 ,sec4 #bjf4 ,improv$ transp>5cy conc]n+ heal? c>e provid$ by ,dep>tm5t ( ,vet]ans ,affairs4 ,sec4 #bjg4 ,in=mation = vet]ans on ! cr$5tials ( ,dep>tm5t ( ,vet]ans ,affairs physicians4 ,sec4 #bjh4 ,in=mation 9 annual budget ( ! ,presid5t on hospital c>e & m$ical s]vices furni%$ ?r\gh exp&$ use ( contracts = su* c>e4 ,sec4 #bji4 ,prohibition on falsification ( data conc]n+ wait times & quality measures at ,dep>tm5t ( ,vet]ans ,affairs4 ,title ,,iii--,heal? ,c>e ,/aff+1 ,recruitm5t1 & ,tra9+ ,matt]s ,sec4 #cja4 ,treatm5t ( /aff+ %ortage & bi5nial report on /aff+ ( m$ical facilities ( ! ,dep>tm5t ( ,vet]ans ,affairs4 ,sec4 #cjb4 ,ext5sion & modification ( c]ta9 programs )9 ! ,dep>tm5t ( ,vet]ans ,affairs ,heal? ,pr(essionals ,educational ,assi/ance ,program4 ,sec4 #cjc4 ,cl9ic managem5t tra9+ = employees at m$ical facilities ( ! ,dep>tm5t ( ,vet]ans ,affairs4 ,title ,,iv--,heal? ,c>e ,relat$ to ,sexual ,trauma ,sec4 #dja4 ,expansion ( eligibility = sexual trauma c\nsel+ & treatm5t to vet]ans on inactive duty tra9+4 ,sec4 #djb4 ,provision ( c\nsel+ & treatm5t = sexual trauma by ! ,dep>tm5t ( ,vet]ans ,affairs to memb]s ( ! ,arm$ ,=ces4 ,sec4 #djc4 ,reports on milit>y sexual trauma4 ,title ,v--,o!r ,heal? ,c>e ,matt]s ,sec4 #eja4 ,ext5sion ( pilot program on assi/$ liv+ s]vices = vet]ans ) traumatic bra9 injury4 ,title ,,vi--,major ,m$ical ,facility ,leases ,sec4 #fja4 ,au?orization ( major m$ical facility leases4 ,sec4 #fjb4 ,budget>y treatm5t ( ,dep>tm5t ( ,vet]ans ,affairs major m$ical facilities leases4 ,title ,,vii--,o!r ,vet]ans ,matt]s ,sec4 #gja4 ,expansion ( ,m>9e ,gunn]y ,s]geant ,john ,david ,fry ,s*ol>%ip4 ,sec4 #gjb4 ,approval ( c\rses ( education provid$ by public in/itutions ( high] le>n+ = purposes ( ,all-,volunte] ,=ce ,educational ,assi/ance ,program & ,po/-#i_/aa ,educational ,assi/ance conditional on 9-,/ate tuition rate = vet]ans4 ,sec4 #gjc4 ,ext5sion ( r$uction 9 am\nt ( p5sion furni%$ by ,dep>tm5t ( ,vet]ans ,affairs = c]ta9 vet]ans cov]$ by ,m$icaid plans = s]vices furni%$ by nurs+ facilities4 ,sec4 #gjd4 ,ext5sion ( requirem5t = collection ( fees = h\s+ loans gu>ante$ by ,secret>y ( ,vet]ans ,affairs4 ,sec4 #gje4 ,limitation on aw>ds & bonuses paid to employees ( ,dep>tm5t ( ,vet]ans ,affairs4 ,sec4 #gjf4 ,ext5sion ( au?ority to use income in=mation4 ,sec4 #gjg4 ,removal ( s5ior executives ( ! ,dep>tm5t ( ,vet]ans ,affairs = p]=mance or misconduct4 ,title ,,viii--,o!r ,matt]s ,sec4 #hja4 ,appropriation ( am\nts4 ,sec4 #hjb4 ,vet]ans ,*oice ,fund4 ,sec4 #hjc4 ,em]g5cy designations4 #b4 ,def9itions ,9 ?is ,act3 7#a7 ,! t]m facility ( ! ,dep>tm5t has ! mean+ giv5 ! t]m facilities ( ! ,dep>tm5t 9 section #agja ( title #ch1 ,unit$ ,/ates ,code4 7#b7 ,! t]ms hospital c>e & m$ical s]vices h ! mean+s giv5 su* t]ms 9 section #agja ( title #ch1 ,unit$ ,/ates ,code4 ,i ,improvem5t ( ,access to ,c>e f ,non-,dep>tm5t ( ,vet]ans ,affairs ,provid]s #aja4 ,exp&$ availability ( hospital c>e & m$ical s]vices = vet]ans ?r\gh ! use ( agreem5ts ) non-,dep>tm5t ( ,vet]ans ,affairs entities 7a7 ,expansion ( available c>e & s]vices 7#a7 ,furni%+ ( c>e 7,a7 ,9 g5]al ,hospital c>e & m$ical s]vices "u *apt] #ag ( title #ch1 ,unit$ ,/ates ,code1 %all be furni%$ to an eligible vet]an describ$ 9 subsection 7b71 at ! election ( su* vet]an1 ?r\gh agreem5ts au?oriz$ "u subsection 7d71 or any o!r law adm9i/]$ by ! ,secret>y ( ,vet]ans ,affairs1 ) entities specifi$ 9 subp>agraph 7,b7 = ! furni%+ ( su* c>e & s]vices to vet]ans4 7,b7 ,entities specifi$ ,! entities specifi$ 9 ?is subp>agraph are ! foll[+3 7i7 ,any heal? c>e provid] t is p>ticipat+ 9 ! ,m$ic>e program "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 includ+ any physician furni%+ s]vices "u su* program4 7ii7 ,any ,f$]ally-qualifi$ heal? c5t] 7z def9$ 9 section #aije7l77#b77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l77#b77;,b7774 7iii7 ,! ,dep>tm5t ( ,def5se4 7iv7 ,! ,indian ,heal? ,s]vice4 7#b7 ,*oice ( provid] ,an eligible vet]an :o makes an election "u subsection 7c7 to receive hospital c>e or m$ical s]vices "u ?is section may select a provid] ( su* c>e or s]vices f among ! entities specifi$ 9 p>agraph 7#a77;,b7 t are accessible to ! vet]an4 7#c7 ,coord9ation ( c>e & s]vices ,! ,secret>y %all coord9ate1 ?r\gh ! ,non-,,va ,c>e ,coord9ation ,program ( ! ,dep>tm5t ( ,vet]ans ,affairs1 ! furni%+ ( c>e & s]vices "u ?is section to eligible vet]ans1 includ+ by ensur+ t an eligible vet]an receives an appo9tm5t = su* c>e & s]vices )9 ! wait-"t goals ( ! ,vet]ans ,heal? ,adm9i/ration = ! furni%+ ( hospital c>e & m$ical s]vices4 7b7 ,eligible vet]ans ,a vet]an is an eligible vet]an = purposes ( ?is section if-- 7#a7 7,a7 z ( ,augu/ #a1 #bjad1 ! vet]an is enroll$ 9 ! pati5t enrollm5t sy/em ( ! ,dep>tm5t ( ,vet]ans ,affairs e/abli%$ & op]at$ "u section #agje ( title #ch1 ,unit$ ,/ates ,code1 includ+ any su* vet]an :o has n receiv$ hospital c>e or m$ical s]vices f ! ,dep>tm5t & has contact$ ! ,dep>tm5t seek+ an initial appo9tm5t f ! ,dep>tm5t = ! receipt ( su* c>e or s]vices2 or 7,b7 ! vet]an is eligible = hospital c>e & m$ical s]vices "u section #agaj7;e77#a77;,d7 ( su* title & is a vet]an describ$ 9 section #agaj7;e77#c7 ( su* title2 & 7#b7 ! vet]an-- 7,a7 attempts1 or has attempt$1 to s*$ule an appo9tm5t = ! receipt ( hospital c>e or m$ical s]vices "u *apt] #ag ( title #ch1 ,unit$ ,/ates ,code1 b is unable to s*$ule an appo9tm5t )9 ! wait-"t goals ( ! ,vet]ans ,heal? ,adm9i/ration = ! furni%+ ( su* c>e or s]vices2 7,b7 resides m ?an #dj miles f ! m$ical facility ( ! ,dep>tm5t1 includ+ a community-bas$ outpati5t cl9ic1 t is close/ to ! resid5ce ( ! vet]an2 7,c7 resides-- 7i7 9 a ,/ate )\t a m$ical facility ( ! ,dep>tm5t t provides-- 7,i7 hospital c>e2 7,,ii7 em]g5cy m$ical s]vices2 & 7,,iii7 surgical c>e rat$ by ! ,secret>y z hav+ a surgical complexity ( /&>d2 & 7ii7 m ?an #bj miles f a m$ical facility ( ! ,dep>tm5t describ$ 9 clause 7i72 or 7,d7 7i7 resides 9 a location1 o!r ?an a location 9 ,guam1 ,am]ican ,samoa1 or ! ,republic ( ! ,philipp9es1 t is #dj miles or less f a m$ical facility ( ! ,dep>tm5t1 includ+ a community-bas$ outpati5t cl9ic2 & 7ii7 7,i7 is requir$ to travel by air1 boat1 or f]ry to rea* ea* m$ical facility describ$ 9 clause 7i7 t is #dj miles or less f ! resid5ce ( ! vet]an2 or 7,,ii7 faces an unusual or excessive burd5 9 access+ ea* m$ical facility describ$ 9 clause 7i7 t is #dj miles or less f ! resid5ce ( ! vet]an due to geographical *all5ges1 z det]m9$ by ! ,secret>y4 7c7 ,election & au?orization 7#a7 ,9 g5]al ,9 ! case ( an eligible vet]an describ$ 9 subsection 7b77#b77;,a71 ! ,secret>y %all1 at ! election ( ! eligible vet]an-- 7,a7 place su* eligible vet]an on an electronic wait+ li/ describ$ 9 p>agraph 7#b7 = an appo9tm5t = hospital c>e or m$ical s]vices ! vet]an has elect$ to receive "u ?is section2 or 7,b7 7i7 au?orize t su* c>e or s]vices be furni%$ to ! eligible vet]an "u ?is section = a p]iod ( "t specifi$ by ! ,secret>y2 & 7ii7 notify ! eligible vet]an by ! mo/ effective means available1 includ+ electronic communication or notification 9 writ+1 describ+ ! c>e or s]vices ! eligible vet]an is eligible to receive "u ?is section4 7#b7 ,electronic wait+ li/ ,! electronic wait+ li/ describ$ 9 ?is p>agraph %all be ma9ta9$ by ! ,dep>tm5t & all[ access by ea* eligible vet]an via www4myheal?4va4gov or any successor website = ! foll[+ purposes3 7,a7 ,to det]m9e ! place ( su* eligible vet]an on ! wait+ li/4 7,b7 ,to det]m9e ! av]age l5g? ( "t an individual sp5ds on ! wait+ li/1 disaggregat$ by m$ical facility ( ! ,dep>tm5t & type ( c>e or s]vice ne$$1 = purposes ( all[+ su* eligible vet]an to make an in=m$ election "u p>agraph 7#a74 7d7 ,c>e & s]vices ?r\gh agreem5ts 7#a7 ,agreem5ts 7,a7 ,9 g5]al ,! ,secret>y %all ent] into agreem5ts = furni%+ c>e & s]vices to eligible vet]ans "u ?is section ) entities specifi$ 9 subsection 7a77#a77;,b74 7,b7 ,agreem5t def9$ ,9 ?is p>agraph1 ! t]m agreem5t includes contracts1 int]gov]nm5tal agreem5ts1 & provid] agreem5ts1 z appropriate4 7#b7 ,rates & reimbursem5t 7,a7 ,9 g5]al ,9 ent]+ into an agreem5t "u p>agraph 7#a7 ) an entity specifi$ 9 subsection 7a77#a77;,b71 ! ,secret>y %all-- 7i7 negotiate rates = ! furni%+ ( c>e & s]vices "u ?is section2 & 7ii7 reimburse ! entity = su* c>e & s]vices at ! rates negotiat$ pursuant to clause 7i7 z provid$ 9 su* agreem5t4 7,b7 ,limit on rates 7i7 ,9 g5]al ,except z provid$ 9 clause 7ii71 rates negotiat$ "u subp>agraph 7,a77i7 %all n be m ?an ! rates paid by ! ,unit$ ,/ates to a provid] ( s]vices 7z def9$ 9 section #ahfa7u7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7u777 or a suppli] 7z def9$ 9 section #ahfa7;d7 ( su* ,act 7#db ,u4,s4,c4 #aciex7d777 "u ! ,m$ic>e program "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 = ! same c>e or s]vices4 7ii7 ,exception 7,i7 ,9 g5]al ,! ,secret>y may negotiate a rate t is m ?an ! rate paid by ! ,unit$ ,/ates z describ$ 9 clause 7i7 ) respect to ! furni%+ ( c>e or s]vices "u ?is section to an eligible vet]an :o resides 9 a highly rural area4 7,,ii7 ,highly rural area def9$ ,9 ?is clause1 ! t]m highly rural area means an area locat$ 9 a c\nty t has few] ?an sev5 individuals resid+ 9 t c\nty p] squ>e mile4 7,c7 ,limit on collection ,= ! furni%+ ( c>e or s]vices pursuant to an agreem5t "u p>agraph 7#a71 an entity specifi$ 9 subsection 7a77#a77;,b7 may n collect any am\nt t is great] ?an ! rate negotiat$ pursuant to subp>agraph 7,a77i74 7#c7 ,c]ta9 proc$ures 7,a7 ,9 g5]al ,9 ent]+ into an agreem5t "u p>agraph 7#a7 ) an entity describ$ 9 subp>agraph 7,b71 ! ,secret>y may use ! proc$ures1 includ+ ^? proc$ures relat+ to reimbursem5t1 available = ent]+ into provid] agreem5ts "u section #ahff7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7a77 & p>ticipation agreem5ts "u section #ahdb7;h7 ( su* ,act 7#db ,u4,s4,c4 #acieu7h774 ,dur+ ! p]iod 9 :i* su* entity furni%es c>e or s]vices pursuant to ?is section1 su* entity may n be treat$ z a ,f$]al contractor or subcontractor by ! ,(fice ( ,f$]al ,contract ,compliance ,programs ( ! ,dep>tm5t ( ,labor by virtue ( furni%+ su* c>e or s]vices4 7,b7 ,entities describ$ ,! entities describ$ 9 ?is subp>agraph are ! foll[+3 7i7 ,9 ! case ( ! ,m$ic>e program1 any provid] ( s]vices t has ent]$ into a provid] agreem5t "u section #ahff7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7a77 & any physician or o!r suppli] :o has ent]$ into a p>ticipation agreem5t "u section #ahdb7;h7 ( su* ,act 7#db ,u4,s4,c4 #acieu7h772 & 7ii7 ,9 ! case ( ! ,m$icaid program1 any provid] p>ticipat+ "u a ,/ate plan "u title ,,xix ( su* ,act 7#db ,u4,s4,c4 #acif et seq474 7#d7 ,in=mation on policies & proc$ures ,! ,secret>y %all provide to any entity ) :i* ! ,secret>y has ent]$ into an agreem5t "u p>agraph 7#a7 ! foll[+3 7,a7 ,in=mation on applicable policies & proc$ures = submitt+ bills or claims = au?oriz$ c>e or s]vices furni%$ to eligible vet]ans "u ?is section4 7,b7 ,access to a telephone hotl9e ma9ta9$ by ! ,dep>tm5t t su* entity may call = in=mation on ! foll[+3 7i7 ,proc$ures = furni%+ c>e & s]vices "u ?is section4 7ii7 ,proc$ures = submitt+ bills or claims = au?oriz$ c>e & s]vices furni%$ to eligible vet]ans "u ?is section & be+ reimburs$ = furni%+ su* c>e & s]vices4 7iii7 ,:e!r p>ticul> c>e or s]vices "u ?is section are au?oriz$1 & ! proc$ures = au?orization ( su* c>e or s]vices4 7e7 ,o!r heal?-,c>e plan 7#a7 ,submittal ( in=mation to ,secret>y ,be=e receiv+ hospital c>e or m$ical s]vices "u ?is section1 an eligible vet]an %all provide to ! ,secret>y in=mation on any heal?-c>e plan describ$ 9 p>agraph 7#d7 "u :i* ! eligible vet]an is cov]$4 7#b7 ,disclosure ( in=mation to non-,dep>tm5t entity ,not)/&+ section #egja ( title #ch1 ,unit$ ,/ates ,code1 = purposes ( furni%+ hospital c>e or m$ical s]vices to an eligible vet]an "u ?is section1 ! ,secret>y %all disclose to ! entity specifi$ 9 p>agraph 7#a77;,b7 ( subsection 7a7 ) :i* ! ,secret>y has ent]$ into an agreem5t describ$ 9 su* subsection-- 7,a7 :e!r ! eligible vet]an is cov]$ "u a heal?-c>e plan describ$ 9 p>agraph 7#d72 & 7,b7 :e!r ! hospital c>e or m$ical s]vices s\ght by ! eligible vet]an is = a m$ical condition t is relat$ to a non-s]vice-connect$ disability describ$ 9 p>agraph 7#c77;,c74 7#c7 ,c>e = :i* ! ,dep>tm5t is second>ily responsible 7,a7 ,9 g5]al ,if an eligible vet]an is cov]$ "u a heal?-c>e plan describ$ 9 p>agraph 7#d7 & receives hospital c>e or m$ical s]vices = a non-s]vice-connect$ disability describ$ 9 subp>agraph 7,c71 su* heal?-c>e plan %all be prim>ily responsible = pay+ = su* c>e or s]vices1 to ! ext5t su* c>e or s]vices is cov]$ by su* heal?-c>e plan1 & ! ,secret>y %all be second>ily responsible = pay+ = su* c>e or s]vices 9 accordance ) subp>agraph 7,b77ii74 7,b7 ,responsibility = co/s ( c>e ,9 a case 9 :i* ! ,secret>y is second>ily responsible = pay+ = hospital c>e or m$ical s]vices z describ$ 9 subp>agraph 7,a7-- 7i7 ! heal? c>e provid] t furni%es su* c>e or s]vices pursuant to an agreem5t describ$ 9 subsection 7a7 %all be responsible = seek+ reimbursem5t = ! co/ ( su* c>e or s]vices f ! heal?-c>e plan describ$ 9 p>agraph 7#d7 "u :i* ! eligible vet]an is cov]$2 & 7ii7 ! ,secret>y %all be responsible = promptly pay+ only ! am\nt t is n cov]$ by su* heal?-c>e plan1 except t su* responsibility = paym5t may n exce$ ! rate det]m9$ = su* c>e or s]vices pursuant to subsection 7d77#b74 7,c7 ,non-s]vice-connect$ disability describ$ ,a non-s]vice-connect$ disability describ$ 9 ?is subsection is a non-s]vice-connect$ disability 7z def9$ 9 section #aja ( title #ch1 ,unit$ ,/ates ,code7-- 7i7 t is incurr$ incid5t to a vet]an's employm5t & t is cov]$ "u a work]s' comp5sation law or plan t provides = paym5t = ! co/ ( heal? c>e & s]vices provid$ to ! vet]an by reason ( ! disability2 7ii7 t is incurr$ z ! result ( a motor vehicle accid5t to :i* applies a ,/ate law t requires ! own]s or op]ators ( motor vehicles regi/]$ 9 t ,/ate to h 9 =ce automobile accid5t rep>ations insurance2 7iii7 t is incurr$ z ! result ( a crime ( p]sonal viol5ce t occurr$ 9 a ,/ate1 or a political subdivision ( a ,/ate1 9 :i* a p]son injur$ z ! result ( su* a crime is entitl$ to receive heal? c>e & s]vices at su* ,/ate's or subdivision's exp5se = p]sonal injuries suff]$ z ! result ( su* crime2 7iv7 t is incurr$ by a vet]an-- 7,i7 :o does n h a s]vice-connect$ disability2 & 7,,ii7 :o is entitl$ to c>e 7or paym5t ( ! exp5ses ( c>e7 "u a heal?-c>e plan2 or 7v7 = :i* c>e & s]vices are furni%$ "u ?is section to a vet]an :o-- 7,i7 has a s]vice-connect$ disability2 & 7,,ii7 is entitl$ to c>e 7or paym5t ( ! exp5ses ( c>e7 "u a heal?-c>e plan4 7#d7 ,heal?-c>e plan ,a heal?-c>e plan describ$ 9 ?is p>agraph-- 7,a7 is an insurance policy or contract1 m$ical or hospital s]vice agreem5t1 memb]%ip or subscription contract1 or simil> arrangem5t n adm9i/]$ by ! ,secret>y ( ,vet]ans ,affairs1 "u :i* heal? s]vices = individuals are provid$ or ! exp5ses ( su* s]vices are paid2 & 7,b7 does n include any su* policy1 contract1 agreem5t1 or simil> arrangem5t pursuant to title ,,xviii or ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 or *apt] #ee ( title #aj1 ,unit$ ,/ates ,code4 7f7 ,vet]ans *oice c>d 7#a7 ,9 g5]al ,= purposes ( receiv+ c>e & s]vices "u ?is section1 ! ,secret>y %all1 n lat] ?an #ij days aft] ! date ( ! enactm5t ( ?is ,act1 issue to ea* vet]an describ$ 9 subsection 7b77#a7 a c>d t may be pres5t$ to a heal? c>e provid] to facilitate ! receipt ( c>e or s]vices "u ?is section4 7#b7 ,"n ( c>d ,ea* c>d issu$ "u p>agraph 7#a7 %all be kn[n z a ,vet]ans ,*oice ,c>d4 7#c7 ,details ( c>d ,ea* ,vet]ans ,*oice ,c>d issu$ to a vet]an "u p>agraph 7#a7 %all include ! foll[+3 7,a7 ,! "n ( ! vet]an4 7,b7 ,an id5tification numb] = ! vet]an t is n ! social security numb] ( ! vet]an4 7,c7 ,! contact in=mation ( an appropriate (fice ( ! ,dep>tm5t = heal? c>e provid]s to confirm t c>e or s]vices "u ?is section are au?oriz$ = ! vet]an4 7,d7 ,contact in=mation & o!r relevant in=mation = ! submittal ( claims or bills = ! furni%+ ( c>e or s]vices "u ?is section4 7,e7 ,! foll[+ /atem5t3 ,?is c>d is = qualify+ m$ical c>e outside ! ,dep>tm5t ( ,vet]ans ,affairs4 ,please call ! ,dep>tm5t ( ,vet]ans ,affairs phone numb] specifi$ on ?is c>d to ensure t treatm5t has be5 au?oriz$44 7#d7 ,in=mation on use ( c>d ,^u issu+ a ,vet]ans ,*oice ,c>d to a vet]an1 ! ,secret>y %all provide ! vet]an ) in=mation cle>ly /at+ ! circum/ances "u :i* ! vet]an may be eligible = c>e or s]vices "u ?is section4 7g7 ,in=mation on availability ( c>e ,! ,secret>y %all provide in=mation to a vet]an ab\t ! availability ( c>e & s]vices "u ?is section 9 ! foll[+ circum/ances3 7#a7 ,9 ! case ( a vet]an describ$ 9 subsection 7b77#a77;,b71 :5 ! vet]an enrolls 9 ! pati5t enrollm5t sy/em ( ! ,dep>tm5t "u section #agje ( title #ch1 ,unit$ ,/ates ,code4 7#b7 ,:5 ! vet]an attempts to s*$ule an appo9tm5t = ! receipt ( hospital c>e or m$ical s]vices f ! ,dep>tm5t b is unable to s*$ule an appo9tm5t )9 ! wait-"t goals ( ! ,vet]ans ,heal? ,adm9i/ration = ! furni%+ ( su* c>e or s]vices4 7#c7 ,:5 ! vet]an becomes eligible = hospital c>e or m$ical s]vices "u ?is section "u subp>agraph 7,b71 7,c71 or 7,d7 ( subsection 7b77#b74 7h7 ,foll[-,up c>e ,9 c>ry+ out ?is section1 ! ,secret>y %all ensure t1 at ! election ( an eligible vet]an :o receives hospital c>e or m$ical s]vices f a heal? c>e provid] 9 an episode ( c>e "u ?is section1 ! vet]an receives su* hospital c>e & m$ical s]vices f su* heal? c>e provid] ?r\gh ! completion ( ! episode ( c>e 7b = a p]iod n exce$+ #fj days71 includ+ all specialty & ancill>y s]vices deem$ necess>y z "p ( ! treatm5t recomm5d$ 9 ! c\rse ( su* hospital c>e or m$ical s]vices4 7i7 ,provid]s ,to be eligible to furni% c>e or s]vices "u ?is section1 a heal? c>e provid] mu/-- 7#a7 ma9ta9 at lea/ ! same or simil> cr$5tials & lic5ses z ^? cr$5tials & lic5ses t are requir$ ( heal? c>e provid]s ( ! ,dep>tm5t1 z det]m9$ by ! ,secret>y = purposes ( ?is section2 & 7#b7 submit1 n less frequ5tly ?an once ea* ye> dur+ ! p]iod 9 :i* ! ,secret>y is au?oriz$ to c>ry out ?is section pursuant to subsection 7p71 v]ification ( su* lic5ses & cr$5tials ma9ta9$ by su* heal? c>e provid]4 7j7 ,co/-,%>+ 7#a7 ,9 g5]al ,! ,secret>y %all require an eligible vet]an to pay a copaym5t = ! receipt ( c>e or s]vices "u ?is section only if su* eligible vet]an w\ld be requir$ to pay a copaym5t = ! receipt ( su* c>e or s]vices at a m$ical facility ( ! ,dep>tm5t or f a heal? c>e provid] ( ! ,dep>tm5t pursuant to *apt] #ag ( title #ch1 ,unit$ ,/ates ,code4 7#b7 ,limitation ,! am\nt ( a copaym5t *>g$ "u p>agraph 7#a7 may n exce$ ! am\nt ( ! copaym5t t w\ld be payable by su* eligible vet]an = ! receipt ( su* c>e or s]vices at a m$ical facility ( ! ,dep>tm5t or f a heal? c>e provid] ( ! ,dep>tm5t pursuant to *apt] #ag ( title #ch1 ,unit$ ,/ates ,code4 7#c7 ,collection ( copaym5t ,a heal? c>e provid] t furni%es c>e or s]vices to an eligible vet]an "u ?is section %all collect ! copaym5t requir$ "u p>agraph 7#a7 f su* eligible vet]an at ! "t ( furni%+ su* c>e or s]vices4 7k7 ,claims process+ sy/em 7#a7 ,9 g5]al ,! ,secret>y %all provide = an effici5t nationwide sy/em = process+ & pay+ bills or claims = au?oriz$ c>e & s]vices furni%$ to eligible vet]ans "u ?is section4 7#b7 ,regulations ,n lat] ?an #ij days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,vet]ans ,affairs %all prescribe regulations = ! implem5tation ( su* sy/em4 7#c7 ,ov]sight ,! ,*ief ,bus9ess ,(fice ( ! ,vet]ans ,heal? ,adm9i/ration %all ov]see ! implem5tation & ma9t5ance ( su* sy/em4 7#d7 ,accuracy ( paym5t 7,a7 ,9 g5]al ,! ,secret>y %all ensure t su* sy/em meets su* goals = accuracy ( paym5t z ! ,secret>y %all specify = purposes ( ?is section4 7,b7 ,qu>t]ly report 7i7 ,9 g5]al ,! ,secret>y %all submit to ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives a qu>t]ly report on ! accuracy ( su* sy/em4 7ii7 ,elem5ts ,ea* report requir$ by clause 7i7 %all include ! foll[+3 7,i7 ,a description ( ! goals = accuracy = su* sy/em specifi$ by ! ,secret>y "u subp>agraph 7,a74 7,,ii7 ,an assessm5t ( ! success ( ! ,dep>tm5t 9 meet+ su* goals dur+ ! qu>t] cov]$ by ! report4 7iii7 ,deadl9e ,! ,secret>y %all submit ea* report requir$ by clause 7i7 n lat] ?an #bj days aft] ! end ( ! qu>t] cov]$ by ! report4 7l7 ,m$ical records 7#a7 ,9 g5]al ,! ,secret>y %all ensure t any heal? c>e provid] t furni%es c>e or s]vices "u ?is section to an eligible vet]an submits to ! ,dep>tm5t any m$ical record relat$ to ! c>e or s]vices provid$ to su* eligible vet]an by su* heal? c>e provid] = inclusion 9 ! electronic m$ical record ( su* eligible vet]an ma9ta9$ by ! ,dep>tm5t ^u ! completion ( ! provision ( su* c>e or s]vices to su* eligible vet]an4 7#b7 ,electronic =mat ,any m$ical record submitt$ to ! ,dep>tm5t "u p>agraph 7#a7 %all1 to ! ext5t possible1 be 9 an electronic =mat4 7m7 ,track+ ( miss$ appo9tm5ts ,! ,secret>y %all implem5t a me*anism to track any miss$ appo9tm5ts = c>e or s]vices "u ?is section by eligible vet]ans to ensure t ! ,dep>tm5t does n pay = su* c>e or s]vices t 7 n furni%$ to an eligible vet]an4 7n7 ,implem5tation ,n lat] ?an #ij days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all prescribe int]im f9al regulations on ! implem5tation ( ?is section & publi% su* regulations 9 ! ,f$]al ,regi/]4 7o7 ,inspector ,g5]al report ,n lat] ?an #cj days aft] ! date on :i* ! ,secret>y det]m9es t #ge p]c5t ( ! am\nts deposit$ 9 ! ,vet]ans ,*oice ,fund e/abli%$ by section #hjb h be5 exhau/$1 ! ,inspector ,g5]al ( ! ,dep>tm5t %all submit to ! ,secret>y a report on ! results ( an audit ( ! c>e & s]vices furni%$ "u ?is section to ensure ! accuracy & timel9ess ( paym5ts by ! ,dep>tm5t = ! co/ ( su* c>e & s]vices1 includ+ any f9d+s & recomm5dations ( ! ,inspector ,g5]al4 7p7 ,au?ority ,to furni% c>e & s]vices 7#a7 ,9 g5]al ,! ,secret>y may n use ! au?ority "u ?is section to furni% c>e & s]vices aft] ! date specifi$ 9 p>agraph 7#b74 7#b7 ,date specifi$ ,! date specifi$ 9 ?is p>agraph is ! date on :i* ! ,secret>y has exhau/$ all am\nts deposit$ 9 ! ,vet]ans ,*oice ,fund e/abli%$ by section #hjb1 or ! date t is #c ye>s aft] ! date ( ! enactm5t ( ?is ,act1 :i*ev] occurs fir/4 7#c7 ,publication ,! ,secret>y %all publi% su* date 9 ! ,f$]al ,regi/] & on an ,int]net website ( ! ,dep>tm5t available to ! public n lat] ?an #cj days be=e su* date4 7q7 ,reports 7#a7 ,initial report ,n lat] ?an #ij days aft] ! publication ( ! int]im f9al regulations "u subsection 7n71 ! ,secret>y %all submit to ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives a report on ! furni%+ ( c>e & s]vices "u ?is section t includes ! foll[+3 7,a7 ,! numb] ( eligible vet]ans :o h receiv$ c>e or s]vices "u ?is section4 7,b7 ,a description ( ! types ( c>e & s]vices furni%$ to eligible vet]ans "u ?is section4 7#b7 ,f9al report ,n lat] ?an #cj days aft] ! date on :i* ! ,secret>y det]m9es t #ge p]c5t ( ! am\nts deposit$ 9 ! ,vet]ans ,*oice ,fund e/abli%$ by section #hjb h be5 exhau/$1 ! ,secret>y %all submit to ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives a report on ! furni%+ ( c>e & s]vices "u ?is section t includes ! foll[+3 7,a7 ,! total numb] ( eligible vet]ans :o h receiv$ c>e or s]vices "u ?is section1 disaggregat$ by-- 7i7 eligible vet]ans describ$ 9 subsection 7b77#b77;,a72 7ii7 eligible vet]ans describ$ 9 subsection 7b77#b77;,b72 7iii7 eligible vet]ans describ$ 9 subsection 7b77#b77;,c72 & 7iv7 eligible vet]ans describ$ 9 subsection 7b77#b77;,d74 7,b7 ,a description ( ! types ( c>e & s]vices furni%$ to eligible vet]ans "u ?is section4 7,c7 ,an acc\nt+ ( ! total co/ ( furni%+ c>e & s]vices to eligible vet]ans "u ?is section4 7,d7 ,! results ( a survey ( eligible vet]ans :o h receiv$ c>e or s]vices "u ?is section on ! satisfaction ( su* eligible vet]ans ) ! c>e or s]vices receiv$ by su* eligible vet]ans "u ?is section4 7,e7 ,an assessm5t ( ! effect ( furni%+ c>e & s]vices "u ?is section on wait times = appo9tm5ts = ! receipt ( hospital c>e & m$ical s]vices f ! ,dep>tm5t4 7,f7 ,an assessm5t ( ! feasibility & advisability ( cont9u+ furni%+ c>e & s]vices "u ?is section aft] ! t]m9ation date specifi$ 9 subsection 7p74 7r7 ,rule ( con/ruction ,no?+ 9 ?is section %all be con/ru$ to alt] ! process ( ! ,dep>tm5t = fill+ & pay+ = prescription m$ications4 7s7 ,wait-,"t goals ( ! ,vet]ans ,heal? ,adm9i/ration 7#a7 ,9 g5]al ,except z provid$ 9 p>agraph 7#b71 9 ?is section1 ! t]m wait-"t goals ( ! ,vet]ans ,heal? ,adm9i/ration means n m ?an #cj days f ! date on :i* a vet]an reque/s an appo9tm5t = hospital c>e or m$ical s]vices f ! ,dep>tm5t4 7#b7 ,alt]nate goals ,if ! ,secret>y submits to ,congress1 n lat] ?an #fj days aft] ! date ( ! enactm5t ( ?is ,act1 a report /at+ t ! actual wait-"t goals ( ! ,vet]ans ,heal? ,adm9i/ration are diff]5t f ! wait-"t goals specifi$ 9 p>agraph 7#a7-- 7,a7 = purposes ( ?is section1 ! wait-"t goals ( ! ,vet]ans ,heal? ,adm9i/ration %all be ! wait-"t goals submitt$ by ! ,secret>y "u ?is p>agraph2 & 7,b7 ! ,secret>y %all publi% su* wait-"t goals 9 ! ,f$]al ,regi/] & on an ,int]net website ( ! ,dep>tm5t available to ! public4 #ajb4 ,enhancem5t ( collaboration betwe5 ,dep>tm5t ( ,vet]ans ,affairs & ,indian ,heal? ,s]vice 7a7 ,outrea* to ,tribal-,run m$ical facilities ,! ,secret>y ( ,vet]ans ,affairs %all1 9 consultation ) ! ,director ( ! ,indian ,heal? ,s]vice1 conduct outrea* to ea* m$ical facility op]at$ by an ,indian tribe or tribal organization ?r\gh a contract or compact ) ! ,indian ,heal? ,s]vice "u ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej et seq47 to raise aw>5ess ( ! ability ( su* facilities1 ,indian tribes1 & tribal organizations to ent] into agreem5ts ) ! ,dep>tm5t ( ,vet]ans ,affairs "u :i* ! ,secret>y reimburses su* facilities1 ,indian tribes1 or tribal organizations1 z ! case may be1 = heal? c>e provid$ to vet]ans :o are-- 7#a7 eligible = heal? c>e at su* facilities2 & 7#b7 7,a7 enroll$ 9 ! pati5t enrollm5t sy/em ( ! ,dep>tm5t e/abli%$ & op]at$ "u section #agje ( title #ch1 ,unit$ ,/ates ,code2 or 7,b7 eligible = hospital c>e & m$ical s]vices pursuant to subsection 7c77#b7 ( su* section4 7b7 ,p]=mance metrics = memor&um ( und]/&+ ,! ,secret>y ( ,vet]ans ,affairs %all e/abli% p]=mance metrics = assess+ ! p]=mance by ! ,dep>tm5t ( ,vet]ans ,affairs & ! ,indian ,heal? ,s]vice "u ! memor&um ( und]/&+ entitl$ ,memor&um ( ,und]/&+ betwe5 ! ,dep>tm5t ( ,vet]ans ,affairs 7,,va7 & ! ,indian ,heal? ,s]vice 7,,ihs7 9 increas+ access to heal? c>e1 improv+ quality & coord9ation ( heal? c>e1 promot+ effective pati5t-c5t]$ collaboration & p>tn]%ips betwe5 ! ,dep>tm5t & ! ,s]vice1 & ensur+ heal?-promotion & disease-prev5tion s]vices are appropriately fund$ & available = b5efici>ies "u bo? heal? c>e sy/ems4 7c7 ,report ,n lat] ?an #ahj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,vet]ans ,affairs & ! ,director ( ! ,indian ,heal? ,s]vice %all jo9tly submit to ,congress a report on ! feasibility & advisability ( ! foll[+3 7#a7 ,ent]+ into agreem5ts = ! reimbursem5t by ! ,secret>y ( ! co/s ( direct c>e s]vices provid$ ?r\gh organizations receiv+ am\nts pursuant to grants made or contracts ent]$ into "u section #ejc ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afec7 to vet]ans :o are o!rwise eligible to receive heal? c>e f su* organizations4 7#b7 ,includ+ ! reimbursem5t ( ! co/s ( direct c>e s]vices provid$ to vet]ans :o are n ,indians 9 agreem5ts betwe5 ! ,dep>tm5t & ! foll[+3 7,a7 ,! ,indian ,heal? ,s]vice4 7,b7 ,an ,indian tribe or tribal organization op]at+ a m$ical facility ?r\gh a contract or compact ) ! ,indian ,heal? ,s]vice "u ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej et seq474 7,c7 ,a m$ical facility ( ! ,indian ,heal? ,s]vice4 7d7 ,def9itions ,9 ?is section3 7#a7 ,indian ,! t]ms ,indian & ,indian tribe h ! mean+s giv5 ^? t]ms 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afjc74 7#b7 ,m$ical facility ( ! ,indian ,heal? ,s]vice ,! t]m m$ical facility ( ! ,indian ,heal? ,s]vice includes a facility op]at$ by an ,indian tribe or tribal organization ?r\gh a contract or compact ) ! ,indian ,heal? ,s]vice "u ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej et seq474 7#c7 ,tribal organization ,! t]m tribal organization has ! mean+ giv5 ! t]m 9 section #d ( ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej;b74 #ajc4 ,enhancem5t ( collaboration betwe5 ,dep>tm5t ( ,vet]ans ,affairs & ,native ,hawaiian heal? c>e sy/ems 7a7 ,9 g5]al ,! ,secret>y ( ,vet]ans ,affairs %all1 9 consultation ) ,papa ,ola ,lokahi & su* o!r organizations involv$ 9 ! deliv]y ( heal? c>e to ,native ,hawaiians z ! ,secret>y consid]s appropriate1 ent] into contracts or agreem5ts ) ,native ,hawaiian heal? c>e sy/ems t are 9 receipt ( funds f ! ,secret>y ( ,heal? & ,human ,s]vices pursuant to grants aw>d$ or contracts ent]$ into "u section #f7;a7 ( ! ,native ,hawaiian ,heal? ,c>e ,improvem5t ,act 7#db ,u4,s4,c4 #aagje7;a77 = ! reimbursem5t ( direct c>e s]vices provid$ to eligible vet]ans z specifi$ 9 su* contracts or agreem5ts4 7b7 ,def9itions ,9 ?is section1 ! t]ms ,native ,hawaiian1 ,native ,hawaiian heal? c>e sy/em1 & ,papa ,ola ,lokahi h ! mean+s giv5 ^? t]ms 9 section #ab ( ! ,native ,hawaiian ,heal? ,c>e ,improvem5t ,act 7#db ,u4,s4,c4 #aagaa74 #ajd4 ,reau?orization & modification ( pilot program ( enhanc$ contract c>e au?ority = heal? c>e ne$s ( vet]ans ,section #djc ( ! ,vet]ans' ,m5tal ,heal? & ,o!r ,c>e ,improvem5ts ,act ( #bjjh 7,public ,law #aaj-chg2 #ch ,u4,s4,c4 #agjc note7 is am5d$-- 7#a7 9 subsection 7a7-- 7,a7 9 p>agraph 7#c71 by /rik+ only dur+ ! & all t foll[s ?r\gh ! p]iod at ! end & ins]t+ only dur+ ! p]iod beg9n+ on ! date ( ! comm5cem5t ( ! pilot program "u p>agraph 7#b7 & end+ on ! date t is two ye>s aft] ! date ( ! enactm5t ( ! ,vet]ans ,access1 ,*oice1 & ,acc\ntability ,act ( #bjad42 & 7,b7 by am5d+ p>agraph 7#d7 to read z foll[s3 7#d7 ,program locations ,! ,secret>y %all c>ry out ! pilot program at locations 9 ! foll[+ ,vet]ans ,integrat$ ,s]vice ,networks 7& su* o!r locations z ! ,secret>y consid]s appropriate73 7,a7 ,vet]ans ,integrat$ ,s]vice ,network #a4 7,b7 ,vet]ans ,integrat$ ,s]vice ,network #f4 7,c7 ,vet]ans ,integrat$ ,s]vice ,network #ae4 7,d7 ,vet]ans ,integrat$ ,s]vice ,network #ah4 7,e7 ,vet]ans ,integrat$ ,s]vice ,network #ai4 2 7#b7 9 subsection 7b77#a77;,a71 by /rik+ z ( ! date ( ! comm5cem5t ( ! pilot program "u subsection 7a77#b7 & ins]t+ z ( ,augu/ #a1 #bjad2 7#c7 by r$esignat+ subsection 7h7 z subsection 7k72 7#d7 by ins]t+ aft] subsection 7g7 ! foll[+ new subsections3 7h7 ,appo9tm5ts ,9 c>ry+ out ! pilot program "u ?is section1 ! ,secret>y %all ensure t m$ical appo9tm5ts = cov]$ vet]ans-- 7#a7 are s*$ul$ n lat] ?an #e days aft] ! date on :i* ! appo9tm5t is reque/$2 & 7#b7 occur n lat] ?an #cj days aft] su* date4 7i7 ,outrea* ,! ,secret>y %all ensure t cov]$ vet]ans are in=m$ ab\t ! pilot program "u ?is section4 7j7 ,use ( exi/+ contracts ,9 c>ry+ out ! pilot program "u ?is section aft] ! date ( ! enactm5t ( ! ,vet]ans ,access1 ,*oice1 & ,acc\ntability ,act ( #bjad1 ! ,secret>y %all make use ( contracts ent]$ into be=e su* date or may ent] into new contracts4 2 & 7#e7 9 p>agraph 7#b77;,b7 ( subsection 7k71 z r$esignat$ by p>agraph 7#c7 ( ?is section1 by /rik+ ! semicolon at ! end & ins]t+ 2 &4 #aje4 ,prompt paym5t by ,dep>tm5t ( ,vet]ans ,affairs 7a7 ,s5se ( ,congress on prompt paym5t by ,dep>tm5t ,x is ! s5se ( ,congress t ! ,secret>y ( ,vet]ans ,affairs %all comply ) section #acae ( title #e1 ,code ( ,f$]al ,regulations 7commonly kn[n z ! prompt paym5t rule71 or any correspond+ simil> regulation or rul+1 9 pay+ = heal? c>e pursuant to contracts ent]$ into ) non-,dep>tm5t ( ,vet]ans ,affairs provid]s to provide heal? c>e "u ! laws adm9i/]$ by ! ,secret>y4 7b7 ,e/abli%m5t ( claims process+ sy/em 7#a7 ,claims process+ sy/em ,! ,secret>y ( ,vet]ans ,affairs %all e/abli% & implem5t a sy/em to process & pay claims = paym5t = hospital c>e1 m$ical s]vices1 & o!r heal? c>e furni%$ by non-,dep>tm5t ( ,vet]ans ,affairs heal? c>e provid]s "u ! laws adm9i/]$ by ! ,secret>y4 7#b7 ,compliance ) ,prompt ,paym5t ,act ,! sy/em e/abli%$ & implem5t$ "u p>agraph 7#a7 %all comply ) all requirem5ts ( *apt] #ci1 ,unit$ ,/ates ,code 7commonly ref]r$ to z ! ,prompt ,paym5t ,act74 7c7 ,report ,n lat] ?an #a ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all submit to ,congress a report on ! timel9ess ( paym5ts by ! ,secret>y = hospital c>e1 m$ical s]vices1 & o!r heal? c>e furni%$ by non-,dep>tm5t ( ,vet]ans ,affairs heal? c>e provid]s "u ! laws adm9i/]$ by ! ,secret>y4 7d7 ,elem5ts ,! report requir$ by subsection 7b7 %all include ! foll[+3 7#a7 ,! results ( a survey ( non-,dep>tm5t heal? c>e provid]s :o h submitt$ claims to ! ,dep>tm5t = hospital c>e1 m$ical s]vices1 or o!r heal? c>e furni%$ to vet]ans = :i* paym5t is au?oriz$ "u ! laws adm9i/]$ by ! ,secret>y dur+ ! "o-ye> p]iod prec$+ ! submittal ( ! report1 :i* survey %all include ! foll[+3 7,a7 ,! am\nt ( "t x took = su* heal? c>e provid]s1 aft] submitt+ su* claims1 to receive paym5t f ! ,dep>tm5t = su* c>e or s]vices4 7,b7 ,a comp>ison ( ! am\nt ( "t "u subp>agraph 7,a7 & ! am\nt ( "t x takes su* heal? c>e provid]s to receive paym5ts f ! ,unit$ ,/ates = simil> c>e or s]vices provid$ to ! foll[+1 if applicable3 7i7 ,b5efici>ies "u ! ,m$ic>e program "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq474 7ii7 ,cov]$ b5efici>ies "u ! ,,tric>e program "u *apt] #ee ( title #aj1 ,unit$ ,/ates ,code4 7#b7 ,su* recomm5dations = legislative or adm9i/rative action z ! ,comptroll] ,g5]al consid]s appropriate4 7e7 ,survey elem5ts ,9 c>ry+ out ! survey1 ! ,comptroll] ,g5]al %all seek responses f non-,dep>tm5t heal? c>e provid]s 9 a mann] t ensures t ! survey reflects ! responses ( su* provid]s t-- 7#a7 are locat$ 9 diff]5t geographic areas2 7#b7 furni% a v>iety ( diff]5t hospital c>e1 m$ical s]vices1 & o!r heal? c>e2 & 7#c7 furni% su* c>e & s]vices 9 a v>iety ( diff]5t types ( m$ical facilities4 #ajf4 ,transf] ( au?ority = paym5ts = hospital c>e1 m$ical s]vices1 & o!r heal? c>e f non-,dep>tm5t ( ,vet]ans ,affairs provid]s to ! *ief bus9ess (fice ( ! ,vet]ans ,heal? ,adm9i/ration 7a7 ,transf] ( au?ority 7#a7 ,9 g5]al ,effective z ( ,octob] #a1 #bjad1 ! ,secret>y ( ,vet]ans ,affairs %all transf] ! au?ority to pay = hospital c>e1 m$ical s]vices1 & o!r heal? c>e furni%$ ?r\gh non-,dep>tm5t ( ,vet]ans ,affairs provid]s f-- 7,a7 ! ,vet]ans ,integrat$ ,s]vice ,networks & m$ical c5t]s ( ! ,dep>tm5t ( ,vet]ans ,affairs1 to 7,b7 ! ,*ief ,bus9ess ,(fice ( ! ,vet]ans ,heal? ,adm9i/ration ( ! ,dep>tm5t ( ,vet]ans ,affairs4 7#b7 ,mann] ( c>e ,! ,*ief ,bus9ess ,(fice %all "w 9 consultation ) ! ,(fice ( ,cl9ical ,op]ations & ,managem5t ( ! ,dep>tm5t to ensure t c>e & s]vices describ$ 9 p>agraph 7#a7 are provid$ 9 a mann] t is cl9ically appropriate & 9 ! be/ int]e/ ( ! vet]ans receiv+ su* c>e & s]vices4 7#c7 ,no delay 9 paym5t ,! transf] ( au?ority "u p>agraph 7#a7 %all be c>ri$ out 9 a mann] t does n delay or imp$e any paym5t by ! ,dep>tm5t = hospital c>e1 m$ical s]vices1 or o!r heal? c>e furni%$ ?r\gh a non-,dep>tm5t provid] "u ! laws adm9i/]$ by ! ,secret>y4 7b7 ,budget matt]s ,! budget ( ! ,dep>tm5t ( ,vet]ans ,affairs = any fiscal ye> beg9n+ aft] ! date ( ! enactm5t ( ?is ,act 7z submitt$ to ,congress pursuant to section #aaje7;a7 ( title #ca1 ,unit$ ,/ates ,code7 %all specify funds = ! paym5t = hospital c>e1 m$ical s]vices1 & o!r heal? c>e furni%$ ?r\gh non-,dep>tm5t ( ,vet]ans ,affairs provid]s1 includ+ any adm9i/rative co/s associat$ ) su* paym5t1 z funds = ! ,*ief ,bus9ess ,(fice ( ! ,vet]ans ,heal? ,adm9i/ration r ?an z funds = ! ,vet]ans ,integrat$ ,s]vice ,networks or m$ical c5t]s ( ! ,dep>tm5t4 ,,ii ,heal? ,c>e ,adm9i/rative ,matt]s #bja4 ,indep5d5t assessm5t ( ! heal? c>e deliv]y sy/ems & managem5t processes ( ! ,dep>tm5t ( ,vet]ans ,affairs 7a7 ,indep5d5t assessm5t 7#a7 ,assessm5t ,n lat] ?an #ij days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,vet]ans ,affairs %all ent] into "o or m contracts ) a private sector entity or entities describ$ 9 subsection 7b7 to conduct an indep5d5t assessm5t ( ! hospital c>e1 m$ical s]vices1 & o!r heal? c>e furni%$ 9 m$ical facilities ( ! ,dep>tm5t4 ,su* assessm5t %all address ea* ( ! foll[+3 7,a7 ,curr5t & project$ demographics & unique heal? c>e ne$s ( ! pati5t population s]v$ by ! ,dep>tm5t4 7,b7 ,curr5t & project$ heal? c>e capabilities & res\rces ( ! ,dep>tm5t1 includ+ hospital c>e1 m$ical s]vices1 & o!r heal? c>e furni%$ by non-,dep>tm5t facilities "u contract ) ! ,dep>tm5t1 to provide timely & accessible c>e to vet]ans4 7,c7 ,! au?orities & me*anisms "u :i* ! ,secret>y may furni% hospital c>e1 m$ical s]vices1 & o!r heal? c>e at non-,dep>tm5t facilities1 includ+ :e!r ! ,secret>y %\ld h ! au?ority to furni% su* c>e & s]vices at su* facilities ?r\gh ! completion ( episodes ( c>e4 7,d7 ,! appropriate sy/em-wide access /&>d applicable to hospital c>e1 m$ical s]vices1 & o!r heal? c>e furni%$ by & ?r\gh ! ,dep>tm5t1 includ+ an id5tification ( appropriate access /&>ds = ea* individual specialty & po/-c>e rehabilitation4 7,e7 ,! workfl[ process at ea* m$ical facility ( ! ,dep>tm5t = s*$ul+ appo9tm5ts = vet]ans to receive hospital c>e1 m$ical s]vices1 or o!r heal? c>e f ! ,dep>tm5t4 7,f7 ,! organization1 workfl[ processes1 & tools us$ by ! ,dep>tm5t to support cl9ical /aff+1 access to c>e1 effective l5g?-(-/ay managem5t & c>e transitions1 positive pati5t exp]i5ce1 accurate docum5tation1 & subsequ5t cod+ ( inpati5t s]vices4 7,g7 ,! /aff+ level at ea* m$ical facility ( ! ,dep>tm5t & ! productivity ( ea* heal? c>e provid] at su* m$ical facility1 comp>$ ) heal? c>e indu/ry p]=mance metrics1 :i* may include an assessm5t ( any ( ! foll[+3 7i7 ,! case load (1 & numb] ( pati5ts treat$ by1 ea* heal? c>e provid] at su* m$ical facility dur+ an av]age week4 7ii7 ,! "t sp5t by su* heal? c>e provid] on matt]s o!r ?an ! case load ( su* heal? c>e provid]1 includ+ "t sp5t by su* heal? c>e provid] z foll[s3 7,i7 ,at a m$ical facility t is affiliat$ ) ! ,dep>tm5t4 7,,ii7 ,conduct+ rese>*4 7,,iii7 ,tra9+ or sup]vis+ o!r heal? c>e pr(essionals ( ! ,dep>tm5t4 7,h7 ,! in=mation te*nology /rategies ( ! ,dep>tm5t ) respect to furni%+ & manag+ heal? c>e1 includ+ an id5tification ( any weaknesses & opportunities ) respect to ! te*nology us$ by ! ,dep>tm5t1 especially ^? /rategies ) respect to cl9ical docum5tation ( episodes ( hospital c>e1 m$ical s]vices1 & o!r heal? c>e1 includ+ any cl9ical images & associat$ textual reports1 furni%$ by ! ,dep>tm5t 9 ,dep>tm5t or non-,dep>tm5t facilities4 7,i7 ,bus9ess processes ( ! ,vet]ans ,heal? ,adm9i/ration1 includ+ processes relat+ to furni%+ non-,dep>tm5t heal? c>e1 insurance id5tification1 ?ird-p>ty rev5ue collection1 & v5dor reimbursem5t1 includ+ an id5tification ( me*anisms z foll[s3 7i7 ,to avoid ! paym5t ( p5alties to v5dors4 7ii7 ,to increase ! collection ( am\nts ow$ to ! ,dep>tm5t = hospital c>e1 m$ical s]vices1 or o!r heal? c>e provid$ by ! ,dep>tm5t = :i* reimbursem5t f a ?ird p>ty is au?oriz$ & to ensure t su* am\nts collect$ are accurate4 7iii7 ,to increase ! collection ( any o!r am\nts ow$ to ! ,dep>tm5t ) respect to hospital c>e1 m$ical s]vices1 & o!r heal? c>e & to ensure t su* am\nts collect$ are accurate4 7iv7 ,to increase ! accuracy & timel9ess ( ,dep>tm5t paym5ts to v5dors & provid]s4 7,j7 ,! pur*as+1 di/ribution1 & use ( ph>maceuticals1 m$ical & surgical supplies1 m$ical devices1 & heal? c>e relat$ s]vices by ! ,dep>tm5t1 includ+ ! foll[+3 7i7 ,! prices paid =1 /&>dization (1 & use by ! ,dep>tm5t ( ! foll[+3 7,i7 ,ph>maceuticals4 7,,ii7 ,m$ical & surgical supplies4 7,,iii7 ,m$ical devices4 7ii7 ,! use by ! ,dep>tm5t ( gr\p pur*as+ arrangem5ts to pur*ase ph>maceuticals1 m$ical & surgical supplies1 m$ical devices1 & heal? c>e relat$ s]vices4 7iii7 ,! /rategy & sy/ems us$ by ! ,dep>tm5t to di/ribute ph>maceuticals1 m$ical & surgical supplies1 m$ical devices1 & heal? c>e relat$ s]vices to ,vet]ans ,integrat$ ,s]vice ,networks & m$ical facilities ( ! ,dep>tm5t4 7,k7 ,! process ( ! ,dep>tm5t = c>ry+ out con/ruction & ma9t5ance projects at m$ical facilities ( ! ,dep>tm5t & ! m$ical facility leas+ program ( ! ,dep>tm5t4 7,l7 ,! compet5cy ( lead]%ip ) respect to culture1 acc\ntability1 re=m read9ess1 lead]%ip developm5t1 physician alignm5t1 employee engagem5t1 succession plann+1 & p]=mance managem5t4 7#b7 ,p>ticul> elem5ts ( c]ta9 assessm5ts 7,a7 ,s*$ul+ assessm5t ,9 c>ry+ out ! assessm5t requir$ by p>agraph 7#a77;,e71 ! private sector entity or entities %all d ! foll[+3 7i7 ,review all tra9+ mat]ials p]ta9+ to s*$ul+ ( appo9tm5ts at ea* m$ical facility ( ! ,dep>tm5t4 7ii7 ,assess :e!r all employees ( ! ,dep>tm5t conduct+ tasks relat$ to s*$ul+ are prop]ly tra9$ = conduct+ su* tasks4 7iii7 ,assess :e!r *anges 9 ! te*nology or sy/em us$ 9 s*$ul+ appo9tm5ts are necess>y to limit access to ! sy/em to only ^? employees t h be5 prop]ly tra9$ 9 conduct+ su* tasks4 7iv7 ,assess :e!r heal? c>e provid]s ( ! ,dep>tm5t are mak+ *anges to _! s*$ules t h9d] ! ability ( employees conduct+ su* tasks to p]=m su* tasks4 7v7 ,assess :e!r ! e/abli%m5t ( a c5traliz$ call c5t] ?r\gh\t ! ,dep>tm5t = s*$ul+ appo9tm5ts at m$ical facilities ( ! ,dep>tm5t w\ld improve ! process ( s*$ul+ su* appo9tm5ts4 7vi7 ,assess :e!r book+ templates = ea* m$ical facility or cl9ic ( ! ,dep>tm5t w\ld improve ! process ( s*$ul+ su* appo9tm5ts4 7vii7 ,assess any int]im te*nology *anges or attempts by ,dep>tm5t to int]nally develop a long-t]m s*$ul+ solutions ) respect to ! feasibility & co/ effectiv5ess ( su* int]nally develop$ solutions comp>$ to comm]cially available solutions4 7viii7 ,recomm5d actions1 if any1 to be tak5 by ! ,dep>tm5t to improve ! process = s*$ul+ su* appo9tm5ts1 includ+ ! foll[+3 7,i7 ,*anges 9 tra9+ mat]ials provid$ to employees ( ! ,dep>tm5t ) respect to conduct+ tasks relat$ to s*$ul+ su* appo9tm5ts4 7,,ii7 ,*anges 9 monitor+ & assessm5t conduct$ by ! ,dep>tm5t ( wait times ( vet]ans = su* appo9tm5ts4 7,,iii7 ,*anges 9 ! sy/em us$ to s*$ule su* appo9tm5ts1 includ+ *anges to improve h[ ! ,dep>tm5t-- 7aa7 measures wait times ( vet]ans = su* appo9tm5ts2 7bb7 monitors ! availability ( heal? c>e provid]s ( ! ,dep>tm5t2 & 7cc7 provides vet]ans ! ability to s*$ule su* appo9tm5ts4 7,,iv7 ,su* o!r actions z ! private sector entity or entities consid]s appropriate4 7,b7 ,m$ical con/ruction & ma9t5ance project & leas+ program assessm5t ,9 c>ry+ out ! assessm5t requir$ by p>agraph 7#a77,k71 ! private sector entity or entities %all d ! foll[+3 7i7 ,review ! process ( ! ,dep>tm5t = id5tify+ & design+ proposals = con/ruction & ma9t5ance projects at m$ical facilities ( ! ,dep>tm5t & leases = m$ical facilities ( ! ,dep>tm5t4 7ii7 ,assess ! process ?r\gh :i* ! ,dep>tm5t det]m9es ! foll[+3 7,i7 ,t a con/ruction or ma9t5ance project or lease is necess>y ) respect to a m$ical facility or propos$ m$ical facility ( ! ,dep>tm5t4 7,,ii7 ,! prop] size ( su* m$ical facility or propos$ m$ical facility ) respect to treat+ vet]ans 9 ! cat*m5t area ( su* m$ical facility or propos$ m$ical facility4 7iii7 ,assess ! managem5t processes ( ! ,dep>tm5t ) respect to ! capital managem5t programs ( ! ,dep>tm5t1 includ+ processes relat+ to ! me?odology = con/ruction & design ( m$ical facilities ( ! ,dep>tm5t1 ! managem5t ( projects relat+ to ! con/ruction & design ( su* facilities1 & ! activation ( su* facilities4 7iv7 ,assess ! m$ical facility leas+ program ( ! ,dep>tm5t4 7#c7 ,tim+ ,! private sector entity or entities c>ry+ out ! assessm5t requir$ by p>agraph 7#a7 %all complete su* assessm5t n lat] ?an #bdj days aft] ent]+ into ! contract describ$ 9 su* p>agraph4 7b7 ,private sector entities describ$ ,a private entity describ$ 9 ?is subsection is a private entity t-- 7#a7 has exp]i5ce & prov5 outcomes 9 optimiz+ ! p]=mance ( ! heal? c>e deliv]y sy/ems ( ! ,vet]ans ,heal? ,adm9i/ration & ! private sector & 9 heal? c>e managem5t2 & 7#b7 specializes 9 implem5t+ l>ge-scale organizational & cultural trans=mations1 especially ) respect to heal? c>e deliv]y sy/ems4 7c7 ,program integrator 7#a7 ,9 g5]al ,if ! ,secret>y ent]s into contracts ) m ?an "o private sector entity "u subsection 7a71 ! ,secret>y %all designate "o su* entity t is pr$om9ately a heal? c>e organization z ! program integrator4 7#b7 ,responsibilities ,! program integrator designat$ pursuant to p>agraph 7#a7 %all be responsible = coord9at+ ! outcomes ( ! assessm5ts conduct$ by ! private entities pursuant to su* contracts4 7d7 ,report on assessm5t 7#a7 ,9 g5]al ,n lat] ?an #fj days aft] complet+ ! assessm5t requir$ by subsection 7a71 ! private sector entity or entities c>ry+ out su* assessm5t %all submit to ! ,secret>y ( ,vet]ans ,affairs1 ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate1 ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives1 & ! ,commission on ,c>e e/abli%$ "u section #bjb a report on ! f9d+s & recomm5dations ( ! private sector entity or entities ) respect to su* assessm5t4 7#b7 ,publication ,n lat] ?an #cj days aft] receiv+ ! report "u p>agraph 7#a71 ! ,secret>y %all publi% su* report 9 ! ,f$]al ,regi/] & on an ,int]net website ( ! ,dep>tm5t ( ,vet]ans ,affairs t is accessible to ! public4 7e7 ,non-,dep>tm5t facilities def9$ ,9 ?is section1 ! t]m non-,dep>tm5t facilities has ! mean+ giv5 t t]m 9 section #agja ( title #ch1 ,unit$ ,/ates ,code4 #bjb4 ,commission on ,c>e 7a7 ,e/abli%m5t ( commission 7#a7 ,9 g5]al ,!re is e/abli%$ a commission1 to be kn[n z ! ,commission on ,c>e 79 ?is section ref]r$ to z ! ,commission71 to exam9e ! access ( vet]ans to heal? c>e f ! ,dep>tm5t ( ,vet]ans ,affairs & /rategically exam9e h[ be/ to organize ! ,vet]ans ,heal? ,adm9i/ration1 locate heal? c>e res\rces1 & deliv] heal? c>e to vet]ans dur+ ! #bj-ye> p]iod beg9n+ on ! date ( ! enactm5t ( ?is ,act4 7#b7 ,memb]%ip 7,a7 ,vot+ memb]s ,! ,commission %all be compos$ ( #ae vot+ memb]s :o are appo9t$ z foll[s3 7i7 ,?ree memb]s appo9t$ by ! ,speak] ( ! ,h\se ( ,repres5tatives1 at lea/ "o ( :om %all be a vet]an4 7ii7 ,?ree memb]s appo9t$ by ! ,m9ority ,lead] ( ! ,h\se ( ,repres5tatives1 at lea/ "o ( :om %all be a vet]an4 7iii7 ,?ree memb]s appo9t$ by ! ,majority ,lead] ( ! ,s5ate1 at lea/ "o ( :om %all be a vet]an4 7iv7 ,?ree memb]s appo9t$ by ! ,m9ority ,lead] ( ! ,s5ate1 at lea/ "o ( :om %all be a vet]an4 7v7 ,?ree memb]s appo9t$ by ! ,presid5t1 at lea/ two ( :om %all be vet]ans4 7,b7 ,qualifications ,( ! memb]s appo9t$ "u subp>agraph 7,a7-- 7i7 at lea/ "o memb] %all repres5t an organization recogniz$ by ! ,secret>y ( ,vet]ans ,affairs = ! repres5tation ( vet]ans "u section #eijb ( title #ch1 ,unit$ ,/ates ,code2 7ii7 at lea/ "o memb] %all h exp]i5ce z s5ior managem5t = a private integrat$ heal? c>e sy/em ) an annual gross rev5ue ( m ?an #ej1jjj1jjj2 7iii7 at lea/ "o memb] %all be famili> ) gov]nm5t heal? c>e sy/ems1 includ+ ^? sy/ems ( ! ,dep>tm5t ( ,def5se1 ! ,indian ,heal? ,s]vice1 & ,f$]ally-qualifi$ heal? c5t]s 7z def9$ 9 section #aije7l77#b77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l77#b77;,b7772 7iv7 at lea/ "o memb] %all be famili> ) ! ,vet]ans ,heal? ,adm9i/ration b %all n be curr5tly employ$ by ! ,vet]ans ,heal? ,adm9i/ration2 & 7v7 at lea/ "o memb] %all be famili> ) m$ical facility con/ruction & leas+ projects c>ri$ out by gov]nm5t entities & h exp]i5ce 9 ! build+ trades1 includ+ con/ruction1 eng9e]+1 & ar*itecture4 7,c7 ,date ,! appo9tm5ts ( memb]s ( ! ,commission %all be made n lat] ?an #a ye> aft] ! date ( ! enactm5t ( ?is ,act4 7#c7 ,p]iod ( appo9tm5t 7,a7 ,9 g5]al ,memb]s %all be appo9t$ = ! life ( ! ,commission4 7,b7 ,vacancies ,any vacancy 9 ! ,commission %all n affect its p[]s1 b %all be fill$ 9 ! same mann] z ! orig9al appo9tm5t4 7#d7 ,initial meet+ ,n lat] ?an #ae days aft] ! date on :i* eight vot+ memb]s ( ! ,commission h be5 appo9t$1 ! ,commission %all hold its fir/ meet+4 7#e7 ,meet+s ,! ,commission %all meet at ! call ( ! ,*airp]son4 7#f7 ,quorum ,a majority ( ! memb]s ( ! ,commission %all con/itute a quorum1 b a less] numb] ( memb]s may hold he>+s4 7#g7 ,*airp]son & ,vice ,*airp]son ,! ,presid5t %all designate a memb] ( ! commission to s]ve z ,*airp]son ( ! ,commission4 ,! ,commission %all select a ,vice ,*airp]son f among its memb]s4 7b7 ,duties ( commission 7#a7 ,evaluation & assessm5t ,! ,commission %all und]take a compreh5sive evaluation & assessm5t ( access to heal? c>e at ! ,dep>tm5t ( ,vet]ans ,affairs4 7#b7 ,matt]s evaluat$ & assess$ ,9 und]tak+ ! compreh5sive evaluation & assessm5t requir$ by p>agraph 7#a71 ! ,commission %all evaluate & assess ! results ( ! assessm5t conduct$ by ! private sector entity or entities "u section #bja1 includ+ any f9d+s1 data1 or recomm5dations includ$ 9 su* assessm5t4 7#c7 ,reports ,! ,commission %all submit to ! ,presid5t1 ?r\gh ! ,secret>y ( ,vet]ans ,affairs1 reports z foll[s3 7,a7 ,n lat] ?an #ij days aft] ! date ( ! initial meet+ ( ! ,commission1 an int]im report on-- 7i7 ! f9d+s ( ! ,commission ) respect to ! evaluation & assessm5t requir$ by ?is subsection2 & 7ii7 su* recomm5dations z ! ,commission may h = legislative or adm9i/rative action to improve access to heal? c>e ?r\gh ! ,vet]ans ,heal? ,adm9i/ration4 7,b7 ,n lat] ?an #ahj days aft] ! date ( ! initial meet+ ( ! ,commission1 a f9al report on-- 7i7 ! f9d+s ( ! ,commission ) respect to ! evaluation & assessm5t requir$ by ?is subsection2 & 7ii7 su* recomm5dations z ! ,commission may h = legislative or adm9i/rative action to improve access to heal? c>e ?r\gh ! ,vet]ans ,heal? ,adm9i/ration4 7c7 ,p[]s ( ! commission 7#a7 ,he>+s ,! ,commission may hold su* he>+s1 sit & act at su* times & places1 take su* te/imony1 & receive su* evid5ce z ! ,commission consid]s advisable to c>ry out ?is section4 7#b7 ,in=mation f ,f$]al ag5cies ,! ,commission may secure directly f any ,f$]al ag5cy su* in=mation z ! ,commission consid]s necess>y to c>ry out ?is section4 ,^u reque/ ( ! ,*airp]son ( ! ,commission1 ! head ( su* ag5cy %all furni% su* in=mation to ! ,commission4 7d7 ,commission p]sonnel matt]s 7#a7 ,comp5sation ( memb]s 7,a7 ,9 g5]al ,ea* memb] ( ! ,commission :o is n an (fic] or employee ( ! ,f$]al ,gov]nm5t %all be comp5sat$ at a rate equal to ! daily equival5t ( ! annual rate ( basic pay prescrib$ = level ,,iv ( ! ,executive ,s*$ule "u section #ecae ( title #e1 ,unit$ ,/ates ,code1 = ea* day 7includ+ travel "t7 dur+ :i* su* memb] is engag$ 9 ! p]=mance ( ! duties ( ! ,commission4 7,b7 ,(fic]s or employees ( ! ,unit$ ,/ates ,all memb]s ( ! ,commission :o are (fic]s or employees ( ! ,unit$ ,/ates %all s]ve )\t comp5sation 9 addition to t receiv$ = _! s]vices z (fic]s or employees ( ! ,unit$ ,/ates4 7#b7 ,travel exp5ses ,! memb]s ( ! ,commission %all be all[$ travel exp5ses1 includ+ p] diem 9 lieu ( subsi/5ce1 at rates au?oriz$ = employees ( ag5cies "u sub*apt] ,i ( *apt] #eg ( title #e1 ,unit$ ,/ates ,code1 :ile away f _! homes or regul> places ( bus9ess 9 ! p]=mance ( s]vices = ! ,commission4 7#c7 ,/aff 7,a7 ,9 g5]al ,! ,*airp]son ( ! ,commission may1 )\t reg>d to ! civil s]vice laws & regulations1 appo9t & t]m9ate an executive director & su* o!r additional p]sonnel z may be necess>y to enable ! ,commission to p]=m its duties4 ,! employm5t ( an executive director %all be subject to confirmation by ! ,commission4 7,b7 ,comp5sation ,! ,*airp]son ( ! ,commission may fix ! comp5sation ( ! executive director & o!r p]sonnel )\t reg>d to *apt] #ea & sub*apt] ,,iii ( *apt] #ec ( title #e1 ,unit$ ,/ates ,code1 relat+ to classification ( positions & ,g5]al ,s*$ule pay rates1 except t ! rate ( pay = ! executive director & o!r p]sonnel may n exce$ ! rate payable = level ,v ( ! ,executive ,s*$ule "u section #ecaf ( su* title4 7#d7 ,detail ( gov]nm5t employees ,any ,f$]al ,gov]nm5t employee may be detail$ to ! ,commission )\t reimbursem5t1 & su* detail %all be )\t int]ruption or loss ( civil s]vice /atus or privilege4 7#e7 ,procurem5t ( tempor>y & int]mitt5t s]vices ,! ,*airp]son ( ! ,commission may procure tempor>y & int]mitt5t s]vices "u section #caji7;b7 ( title #e1 ,unit$ ,/ates ,code1 at rates = individuals t d n exce$ ! daily equival5t ( ! annual rate ( basic pay prescrib$ = level ,v ( ! ,executive ,s*$ule "u section #ecaf ( su* title4 7e7 ,t]m9ation ( ! commission ,! ,commission %all t]m9ate #cj days aft] ! date on :i* ! ,commission submits ! report "u subsection 7b77#c77;,b74 7f7 ,fund+ ,! ,secret>y ( ,vet]ans ,affairs %all make available to ! ,commission f am\nts appropriat$ or o!rwise made available to ! ,secret>y su* am\nts z ! ,secret>y & ! ,*airp]son ( ! ,commission jo9tly consid] appropriate = ! ,commission to p]=m its duties "u ?is section4 7g7 ,executive action 7#a7 ,action on recomm5dations ,! ,presid5t %all require ! ,secret>y ( ,vet]ans ,affairs & su* o!r heads ( relevant ,f$]al dep>tm5ts & ag5cies to implem5t ea* recomm5dation set =? 9 a report submitt$ "u subsection 7b77#c7 t ! ,presid5t-- 7,a7 consid]s feasible & advisable2 & 7,b7 det]m9es c be implem5t$ )\t fur!r legislative action4 7#b7 ,reports ,n lat] ?an #fj days aft] ! date on :i* ! ,presid5t receives a report "u subsection 7b77#c71 ! ,presid5t %all submit to ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives & su* o!r committees ( ,congress z ! ,presid5t consid]s appropriate a report sett+ =? ! foll[+3 7,a7 ,an assessm5t ( ! feasibility & advisability ( ea* recomm5dation conta9$ 9 ! report receiv$ by ! ,presid5t4 7,b7 ,= ea* recomm5dation assess$ z feasible & advisable "u subp>agraph 7,a7 ! foll[+3 7i7 ,:e!r su* recomm5dation requires legislative action4 7ii7 ,if su* recomm5dation requires legislative action1 a recomm5dation conc]n+ su* legislative action4 7iii7 ,a description ( any adm9i/rative action already tak5 to c>ry out su* recomm5dation4 7iv7 ,a description ( any adm9i/rative action ! ,presid5t int5ds to be tak5 to c>ry out su* recomm5dation & by :om4 #bjc4 ,te*nology task =ce on review ( s*$ul+ sy/em & s(tw>e ( ! ,dep>tm5t ( ,vet]ans ,affairs 7a7 ,task =ce review 7#a7 ,9 g5]al ,! ,secret>y ( ,vet]ans ,affairs %all1 ?r\gh ! use ( a te*nology task =ce1 conduct a review ( ! ne$s ( ! ,dep>tm5t ( ,vet]ans ,affairs ) respect to ! s*$ul+ sy/em & s*$ul+ s(tw>e ( ! ,dep>tm5t ( ,vet]ans ,affairs t is us$ by ! ,dep>tm5t to s*$ule appo9tm5ts = vet]ans = hospital c>e1 m$ical s]vices1 & o!r heal? c>e f ! ,dep>tm5t4 7#b7 ,agreem5t 7,a7 ,9 g5]al ,! ,secret>y %all seek to ent] into an agreem5t ) a te*nology organization or te*nology organizations to c>ry out ! review requir$ by p>agraph 7#a74 7,b7 ,prohibition on use ( funds ,not)/&+ any o!r provision ( law1 no ,f$]al funds may be us$ to assi/ ! te*nology organization or te*nology organizations "u subp>agraph 7,a7 9 c>ry+ out ! review requir$ by p>agraph 7#a74 7b7 ,report 7#a7 ,9 g5]al ,n lat] ?an #de days aft] ! date ( ! enactm5t ( ?is ,act1 ! te*nology task =ce requir$ "u subsection 7a77#a7 %all submit to ! ,secret>y1 ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate1 & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives a report sett+ =? ! f9d+s & recomm5dations ( ! te*nology task =ce reg>d+ ! ne$s ( ! ,dep>tm5t ) respect to ! s*$ul+ sy/em & s*$ul+ s(tw>e ( ! ,dep>tm5t describ$ 9 su* subsection4 7#b7 ,elem5ts ,! report requir$ by p>agraph 7#a7 %all include ! foll[+3 7,a7 ,proposals = specific actions to be tak5 by ! ,dep>tm5t to improve ! s*$ul+ sy/em & s*$ul+ s(tw>e ( ! ,dep>tm5t describ$ 9 subsection 7a77#a74 7,b7 ,a det]m9ation z to :e!r "o or m exi/+ (f-!-%elf sy/ems w\ld-- 7i7 meet ! ne$s ( ! ,dep>tm5t to s*$ule appo9tm5ts = vet]ans = hospital c>e1 m$ical s]vices1 & o!r heal? c>e f ! ,dep>tm5t2 & 7ii7 improve ! access ( vet]ans to su* c>e & s]vices4 7#c7 ,publication ,n lat] ?an #cj days aft] ! receipt ( ! report requir$ by p>agraph 7#a71 ! ,secret>y %all publi% su* report 9 ! ,f$]al ,regi/] & on an ,int]net website ( ! ,dep>tm5t accessible to ! public4 7c7 ,implem5tation ( task =ce recomm5dations ,n lat] ?an #a ye> aft] ! receipt ( ! report requir$ by subsection 7b77#a71 ! ,secret>y %all implem5t ! recomm5dations set =? 9 su* report t ! ,secret>y consid]s are feasible1 advisable1 & co/ effective4 #bjd4 ,improvem5t ( access ( vet]ans to mobile vet c5t]s & mobile m$ical c5t]s ( ! ,dep>tm5t ( ,vet]ans ,affairs 7a7 ,improvem5t ( access 7#a7 ,9 g5]al ,! ,secret>y ( ,vet]ans ,affairs %all improve ! access ( vet]ans to telem$ic9e & o!r heal? c>e ?r\gh ! use ( mobile vet c5t]s & mobile m$ical c5t]s ( ! ,dep>tm5t ( ,vet]ans ,affairs by provid+ /&>diz$ requirem5ts = ! op]ation ( su* c5t]s4 7#b7 ,requirem5ts ,! /&>diz$ requirem5ts requir$ by p>agraph 7#a7 %all include ! foll[+3 7,a7 ,! numb] ( days ea* mobile vet c5t] & mobile m$ical c5t] ( ! ,dep>tm5t is expect$ to travel p] ye>4 7,b7 ,! numb] ( locations ea* c5t] is expect$ to visit p] ye>4 7,c7 ,! numb] ( appo9tm5ts ea* c5t] is expect$ to conduct p] ye>4 7,d7 ,! me?od & tim+ ( notifications giv5 by ea* c5t] to individuals 9 ! area to :i* ! c5t] is travel+1 includ+ notifications in=m+ vet]ans ( ! availability to s*$ule appo9tm5ts at ! c5t]4 7#c7 ,use ( telem$ic9e ,! ,secret>y %all ensure t ea* mobile vet c5t] & mobile m$ical c5t] ( ! ,dep>tm5t has ! capability to provide telem$ic9e s]vices4 7b7 ,reports 7#a7 ,9 g5]al ,n lat] ?an #a ye> aft] ! date ( ! enactm5t ( ?is ,act1 & n lat] ?an ,septemb] #cj ea* ye> !reaft]1 ! ,secret>y ( ,vet]ans ,affairs %all submit to ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives a report on access to heal? c>e ?r\gh ! use ( mobile vet c5t]s & mobile m$ical c5t]s ( ! ,dep>tm5t t includes /ati/ics on ea* ( ! requirem5ts set =? 9 subsection 7a77#b7 = ! ye> cov]$ by ! report4 7#b7 ,elem5ts ,ea* report requir$ by p>agraph 7#a7 %all include ! foll[+3 7,a7 ,a description ( ! use ( mobile vet c5t]s & mobile m$ical c5t]s to provide telem$ic9e s]vices to vet]ans dur+ ! ye> prec$+ ! submittal ( ! report1 includ+ ! foll[+3 7i7 ,! numb] ( days ea* mobile vet c5t] & mobile m$ical c5t] 0 op5 to provide su* s]vices4 7ii7 ,! numb] ( days ea* c5t] travel$ to a location o!r ?an ! headqu>t]s ( ! c5t] to provide su* s]vices4 7iii7 ,! numb] ( appo9tm5ts ea* c5t] conduct$ to provide su* s]vices on av]age p] mon? & 9 total dur+ su* ye>4 7,b7 ,an analysis ( ! effectiv5ess ( us+ mobile vet c5t]s & mobile m$ical c5t]s to provide heal? c>e s]vices to vet]ans ?r\gh ! use ( telem$ic9e4 7,c7 ,any recomm5dations = an increase 9 ! numb] ( mobile vet c5t]s & mobile m$ical c5t]s ( ! ,dep>tm5t4 7,d7 ,any recomm5dations = an increase 9 ! telem$ic9e capabilities ( ea* mobile vet c5t] & mobile m$ical c5t]4 7,e7 ,! feasibility & advisability ( us+ tempor>y heal? c>e provid]s1 includ+ locum t55s1 to provide direct heal? c>e s]vices to vet]ans at mobile vet c5t]s & mobile m$ical c5t]s4 7,f7 ,su* o!r recomm5dations on improvem5t ( ! use ( mobile vet c5t]s & mobile m$ical c5t]s by ! ,dep>tm5t z ! ,secret>y consid]s appropriate4 #bje4 ,improv$ p]=mance metrics = heal? c>e provid$ by ,dep>tm5t ( ,vet]ans ,affairs 7a7 ,prohibition on use ( s*$ul+ & wait-,"t metrics 9 det]m9ation ( p]=mance aw>ds ,! ,secret>y ( ,vet]ans ,affairs %all ensure t s*$ul+ & wait-"t metrics or goals are n us$ z factors 9 det]m9+ ! p]=mance ( ! foll[+ employees = purposes ( det]m9+ :e!r to pay p]=mance aw>ds to su* employees3 7#a7 ,directors1 associate directors1 assi/ant directors1 deputy directors1 *iefs ( /aff1 & cl9ical leads ( m$ical c5t]s ( ! ,dep>tm5t ( ,vet]ans ,affairs4 7#b7 ,directors1 assi/ant directors1 & quality managem5t (fic]s ( ,vet]ans ,integrat$ ,s]vice ,networks ( ! ,dep>tm5t ( ,vet]ans ,affairs4 7b7 ,modification ( p]=mance plans 7#a7 ,9 g5]al ,n lat] ?an #cj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all modify ! p]=mance plans ( ! directors ( ! m$ical c5t]s ( ! ,dep>tm5t & ! directors ( ! ,vet]ans ,integrat$ ,s]vice ,networks to ensure t su* plans are bas$ on ! quality ( c>e receiv$ by vet]ans at ! heal? c>e facilities "u ! jurisdictions ( su* directors4 7#b7 ,factors ,9 modify+ p]=mance plans "u p>agraph 7#a71 ! ,secret>y %all ensure t assessm5t ( ! quality ( c>e provid$ at heal? c>e facilities "u ! jurisdiction ( a director describ$ 9 p>agraph 7#a7 includes consid]ation ( ! foll[+3 7,a7 ,rec5t reviews by ! ,jo9t ,commission 7=m]ly kn[n z ! ,jo9t ,commission on ,accr$itation ( ,heal?c>e ,organizations7 ( su* facilities4 7,b7 ,! numb] & nature ( recomm5dations conc]n+ su* facilities by ! ,inspector ,g5]al ( ! ,dep>tm5t 9 reviews conduct$ ?r\gh ! ,comb9$ ,assessm5t ,program1 9 ! reviews by ! ,inspector ,g5]al ( community-bas$ outpati5t cl9ics & prim>y c>e cl9ics1 & 9 reviews conduct$ ?r\gh ! ,(fice ( ,heal?c>e ,inspections dur+ ! two mo/ rec5tly complet$ fiscal ye>s4 7,c7 ,! numb] ( recomm5dations describ$ 9 subp>agraph 7,b7 t ! ,inspector ,g5]al ( ! ,dep>tm5t det]m9es h n be5 c>ri$ out satisfactorily ) respect to su* facilities4 7,d7 ,reviews ( su* facilities by ! ,commission on ,accr$itation ( ,rehabilitation ,facilities4 7,e7 ,! numb] & outcomes ( adm9i/rative inve/igation bo>ds1 root cause analyses1 & pe] reviews conduct$ at su* facilities dur+ ! fiscal ye> = :i* ! assessm5t is be+ conduct$4 7,f7 ,! effectiv5ess ( any rem$ial actions or plans result+ f any ,inspector ,g5]al recomm5dations 9 ! reviews & analyses describ$ 9 subp>agraphs 7,a7 ?r\gh 7,e74 7#c7 ,additional lead]%ip positions ,to ! degree practicable1 ! ,secret>y %all assess ! p]=mance ( o!r employees ( ! ,dep>tm5t 9 lead]%ip positions at ,dep>tm5t m$ical c5t]s1 includ+ associate directors1 assi/ant directors1 deputy directors1 *iefs ( /aff1 & cl9ical leads1 & 9 ,vet]ans ,integrat$ ,s]vice ,networks1 includ+ assi/ant directors & quality managem5t (fic]s1 us+ factors & crit]ia simil> to ^? us$ 9 ! p]=mance plans modifi$ "u p>agraph 7#a74 7c7 ,removal ( c]ta9 p]=mance goals ,= ea* fiscal ye> t beg9s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all n include 9 ! p]=mance goals ( any employee ( a ,vet]ans ,integrat$ ,s]vice ,network or m$ical c5t] ( ! ,dep>tm5t any p]=mance goal t might dis9c5tivize ! paym5t ( ,dep>tm5t am\nts to provide hospital c>e1 m$ical s]vices1 or o!r heal? c>e ?r\gh a non-,dep>tm5t provid]4 #bjf4 ,improv$ transp>5cy conc]n+ heal? c>e provid$ by ,dep>tm5t ( ,vet]ans ,affairs 7a7 ,publication ( wait times ,n lat] ?an #ij days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,vet]ans ,affairs %all publi% 9 ! ,f$]al ,regi/]1 & on a publicly accessible ,int]net website ( ea* m$ical c5t] ( ! ,dep>tm5t ( ,vet]ans ,affairs1 ! wait-times = ! s*$ul+ ( an appo9tm5t 9 ea* ,dep>tm5t facility by a vet]an = ! receipt ( prim>y c>e1 specialty c>e1 & hospital c>e & m$ical s]vices bas$ on ! g5]al sev]ity ( ! condition ( ! vet]an4 ,:5ev] ! wait-times = ! s*$ul+ ( su* an appo9tm5t *anges1 ! ,secret>y %all publi% ! revis$ wait-times-- 7#a7 on a publicly accessible ,int]net website ( ea* m$ical c5t] ( ! ,dep>tm5t by n lat] ?an #cj days aft] su* *ange2 & 7#b7 9 ! ,f$]al ,regi/] by n lat] ?an #ij days aft] su* *ange4 7b7 ,publicly available database ( pati5t safety1 quality ( c>e1 & outcome measures 7#a7 ,9 g5]al ,n lat] ?an #ahj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all develop & make available to ! public a compreh5sive database conta9+ all applicable pati5t safety1 quality ( c>e1 & outcome measures = heal? c>e provid$ by ! ,dep>tm5t t are track$ by ! ,secret>y4 7#b7 ,update frequ5cy ,! ,secret>y %all update ! database requir$ by p>agraph 7#a7 n less frequ5tly ?an once ea* ye>4 7#c7 ,unavailable measures ,= all measures t ! ,secret>y w\ld o!rwise publi% 9 ! database requir$ by p>agraph 7#a7 b has n done s because su* measures are n available1 ! ,secret>y %all publi% notice 9 ! database ( ! reason = su* unavailability & a timel9e = mak+ su* measures available 9 ! database4 7#d7 ,accessibility ,! ,secret>y %all ensure t ! database requir$ by p>agraph 7#a7 is accessible to ! public ?r\gh ! prim>y ,int]net website ( ! ,dep>tm5t & ?r\gh ea* prim>y ,int]net website ( a ,dep>tm5t m$ical c5t]4 7c7 ,hospital ,comp>e website ( ,dep>tm5t ( ,heal? & ,human ,s]vices 7#a7 ,agreem5t requir$ ,n lat] ?an #ahj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,vet]ans ,affairs %all ent] into an agreem5t ) ! ,secret>y ( ,heal? & ,human ,s]vices = ! provision by ! ,secret>y ( ,vet]ans ,affairs ( su* in=mation z ! ,secret>y ( ,heal? & ,human ,s]vices may require to report & make publicly available pati5t quality & outcome in=mation conc]n+ ,dep>tm5t ( ,vet]ans ,affairs m$ical c5t]s ?r\gh ! ,hospital ,comp>e ,int]net website ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices or any successor ,int]net website4 7#b7 ,in=mation provid$ ,! in=mation provid$ by ! ,secret>y ( ,vet]ans ,affairs to ! ,secret>y ( ,heal? & ,human ,s]vices "u p>agraph 7#a7 %all include ! foll[+3 7,a7 ,measures ( timely & effective heal? c>e4 7,b7 ,measures ( readmissions1 complications ( dea?1 includ+ ) respect to #cj-;day mortality rates & #cj-;day readmission rates1 surgical complication measures1 & heal? c>e relat$ infection measures4 7,c7 ,survey data ( pati5t exp]i5ces1 includ+ ! ,hospital ,consum] ,assessm5t ( ,heal?c>e ,provid]s & ,sy/ems or any simil> successor survey develop$ by ! ,dep>tm5t ( ,heal? & ,human ,s]vices4 7,d7 ,any o!r measures requir$ ( or report$ ) respect to hospitals p>ticipat+ 9 ! ,m$ic>e program "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq474 7#c7 ,unavailable in=mation ,= any applicable metric collect$ by ! ,dep>tm5t ( ,vet]ans ,affairs or requir$ to be provid$ "u p>agraph 7#b7 & )held f or unavailable 9 ! ,hospital ,comp>e ,int]net website or any successor ,int]net website1 ! ,secret>y ( ,vet]ans ,affairs %all publi% a notice on su* ,int]net website /at+ ! reason :y su* metric 0 )held f public disclosure & a timel9e = mak+ su* metric available1 if applicable4 7d7 ,comptroll] ,g5]al review ( publicly available safety & quality metrics ,n lat] ?an #c ye>s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all conduct a review ( ! safety & quality metrics made publicly available by ! ,secret>y ( ,vet]ans ,affairs "u ?is section to assess ! degree to :i* ! ,secret>y is comply+ ) ! provisions ( ?is section4 #bjg4 ,in=mation = vet]ans on ! cr$5tials ( ,dep>tm5t ( ,vet]ans ,affairs physicians 7a7 ,improvem5t ( ,our ,doctors ,int]net website l9ks 7#a7 ,availability ?r\gh ,dep>tm5t ( ,vet]ans ,affairs homepage ,a l9k to ! ,our ,doctors heal? c>e provid]s database ( ! ,dep>tm5t ( ,vet]ans ,affairs1 or any successor database1 %all be available on & ?r\gh ! homepage ( ! ,int]net website ( ! ,dep>tm5t t is accessible to ! public4 7#b7 ,in=mation on location ( resid5cy tra9+ ,! ,int]net website ( ! ,dep>tm5t t is accessible to ! public %all include "u ! l9k to ! ,our ,doctors heal? c>e provid]s database ( ! ,dep>tm5t1 or any successor database1 ! "n ( ! facility at :i* ea* lic5s$ physician ( ! ,dep>tm5t und]w5t resid5cy tra9+4 7#c7 ,in=mation on physicians at p>ticul> facilities ,! ,our ,doctors heal? c>e provid]s database ( ! ,dep>tm5t1 or any successor database1 %all id5tify :e!r ea* lic5s$ physician ( ! ,dep>tm5t is a physician 9 resid5cy4 7b7 ,in=mation on cr$5tials ( physicians = vet]ans und]go+ surgical proc$ures 7#a7 ,9 g5]al ,ea* vet]an :o is und]go+ a surgical proc$ure by or ?r\gh ! ,dep>tm5t %all be provid$ in=mation describ$ 9 p>agraph 7#b7 ) respect to ! surgeon to be p]=m+ su* proc$ure at su* "t 9 advance ( ! proc$ure z is appropriate to p]mit su* vet]an to evaluate su* in=mation4 7#b7 ,in=mation describ$ ,! in=mation describ$ 9 ?is p>agraph ) respect to a surgeon describ$ 9 p>agraph 7#a7 is z foll[s3 7,a7 ,! education & tra9+ ( ! surgeon4 7,b7 ,! lic5sure1 regi/ration1 & c]tification ( ! surgeon by ! ,/ate or national entity responsible = su* lic5sure1 regi/ration1 or c]tification4 7#c7 ,o!r individuals ,if a vet]an is unable to evaluate ! in=mation provid$ "u p>agraph 7#a7 due to ! heal? or m5tal compet5ce ( ! vet]an1 su* in=mation %all be provid$ to an individual act+ on behalf ( ! vet]an4 7c7 ,comptroll] ,g5]al report & plan 7#a7 ,report ,n lat] ?an #b ye>s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all submit to ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives a report sett+ =? an assessm5t by ! ,comptroll] ,g5]al ( ! foll[+3 7,a7 ,! mann] 9 :i* contractors "u ! ,pati5t-,c5t]$ ,community ,c>e initiative ( ! ,dep>tm5t p]=m ov]sight ( ! cr$5tials ( physicians )9 ! networks ( su* contractors "u ! initiative4 7,b7 ,! ov]sight by ! ,dep>tm5t ( ! contracts "u ! ,pati5t-,c5t]$ ,community ,c>e initiative4 7,c7 ,! v]ification by ! ,dep>tm5t ( ! cr$5tials & lic5ses ( heal? c>e provid]s furni%+ hospital c>e & m$ical s]vices "u section #aja4 7#b7 ,plan 7,a7 ,9 g5]al ,n lat] ?an #cj days aft] ! submittal ( ! report "u p>agraph 7#a71 ! ,secret>y %all submit to ! ,comptroll] ,g5]al1 ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate1 & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives a plan to address any f9d+s & recomm5dations ( ! ,comptroll] ,g5]al includ$ 9 su* report4 7,b7 ,implem5tation ,n lat] ?an #ij days aft] ! submittal ( ! report "u p>agraph 7#a71 ! ,secret>y %all c>ry out su* plan4 #bjh4 ,in=mation 9 annual budget ( ! ,presid5t on hospital c>e & m$ical s]vices furni%$ ?r\gh exp&$ use ( contracts = su* c>e ,! mat]ials on ! ,dep>tm5t ( ,vet]ans ,affairs 9 ! budget ( ! ,presid5t = a fiscal ye>1 z submitt$ to ,congress pursuant to section #aaje7;a7 ( title #ca1 ,unit$ ,/ates ,code1 %all set =? ! foll[+3 7#a7 ,! numb] ( vet]ans :o receiv$ hospital c>e & m$ical s]vices "u section #aja dur+ ! fiscal ye> prec$+ ! fiscal ye> 9 :i* su* budget is submitt$4 7#b7 ,! am\nt exp5d$ by ! ,dep>tm5t on furni%+ c>e & s]vices "u su* section dur+ ! fiscal ye> prec$+ ! fiscal ye> 9 :i* su* budget is submitt$4 7#c7 ,! am\nt reque/$ 9 su* budget = ! co/s ( furni%+ c>e & s]vices "u su* section dur+ ! fiscal ye> cov]$ by su* budget1 set =? 9 aggregate & by am\nts = ea* acc\nt = :i* am\nts are s reque/$4 7#d7 ,! numb] ( vet]ans t ! ,dep>tm5t e/imates w receive hospital c>e & m$ical s]vices "u su* section dur+ ! fiscal ye>s cov]$ by ! budget submission4 7#e7 ,! numb] ( employees ( ! ,dep>tm5t on paid adm9i/rative leave at any po9t dur+ ! fiscal ye> prec$+ ! fiscal ye> 9 :i* su* budget is submitt$4 #bji4 ,prohibition on falsification ( data conc]n+ wait times & quality measures at ,dep>tm5t ( ,vet]ans ,affairs ,n lat] ?an #fj days aft] ! date ( ! enactm5t ( ?is ,act1 & 9 accordance ) title #e1 ,unit$ ,/ates ,code1 ! ,secret>y ( ,vet]ans ,affairs %all e/abli% policies :]eby any employee ( ! ,dep>tm5t ( ,vet]ans ,affairs :o kn[+ly submits false data conc]n+ wait times = heal? c>e or quality measures ) respect to heal? c>e to ano!r employee ( ! ,dep>tm5t or kn[+ly requires ano!r employee ( ! ,dep>tm5t to submit false data conc]n+ su* wait times or quality measures to ano!r employee ( ! ,dep>tm5t is subject to a p5alty ! ,secret>y consid]s appropriate aft] notice & an opportunity = a he>+1 includ+ civil p5alties1 unpaid susp5sions1 or t]m9ation4 ,,iii ,heal? ,c>e ,/aff+1 ,recruitm5t1 & ,tra9+ ,matt]s #cja4 ,treatm5t ( /aff+ %ortage & bi5nial report on /aff+ ( m$ical facilities ( ! ,dep>tm5t ( ,vet]ans ,affairs 7a7 ,/aff+ %ortages 7#a7 ,9 g5]al ,sub*apt] ,i ( *apt] #gd ( title #ch1 ,unit$ ,/ates ,code1 is am5d$ by add+ at ! end ! foll[+ new section3 #gdab4 ,annual det]m9ation ( /aff+ %ortages2 recruitm5t & appo9tm5t = ne$$ occupations 7a7 ,9 g5]al ,n lat] ?an ,septemb] #cj ( ea* ye>1 ! ,inspector ,g5]al ( ! ,dep>tm5t %all det]m9e1 & ! ,secret>y %all publi% 9 ! ,f$]al ,regi/]1 ! five occupations ( p]sonnel ( ?is title ( ! ,dep>tm5t cov]$ "u section #gdja ( ?is title = :i* !re are ! l>ge/ /aff+ %ortages ?r\gh\t ! ,dep>tm5t z calculat$ ov] ! five-ye> p]iod prec$+ ! det]m9ation4 7b7 ,recruitm5t & appo9tm5t ,not)/&+ sections #ccjd & #ccji ?r\gh #ccah ( title #e1 ! ,secret>y may1 ^u a det]m9ation by ! ,inspector ,g5]al "u p>agraph 7#a7 t !re is a /aff+ %ortage ?r\gh\t ! ,dep>tm5t ) respect to a p>ticul> occupation1 recruit & directly appo9t1 dur+ ! fiscal ye> aft] ! fiscal ye> dur+ :i* su* det]m9ation is made1 qualifi$ p]sonnel to s]ve 9 t p>ticul> occupation = ! ,dep>tm5t4 4 7#b7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( su* *apt] is am5d$ by ins]t+ aft] ! item relat+ to section #gdaa ! foll[+ new item3 #gdab4 ,annual det]m9ation ( /aff+ %ortages2 recruitm5t & appo9tm5t = ne$$ occupations4 4 7#c7 ,deadl9e = fir/ det]m9ation ,not)/&+ ! deadl9e "u section #gdab ( title #ch1 ,unit$ ,/ates ,code1 z add$ by p>agraph 7#a71 = ! annual det]m9ation ( /aff+ %ortages 9 ! ,vet]ans ,heal? ,adm9i/ration1 ! ,inspector ,g5]al ( ! ,dep>tm5t ( ,vet]ans ,affairs %all make ! fir/ det]m9ation requir$ "u su* section1 & ! ,secret>y ( ,vet]ans ,affairs %all publi% 9 ! ,f$]al ,regi/] su* det]m9ation1 by n lat] ?an ! date t is #ahj days aft] ! date ( ! enactm5t ( ?is ,act4 7b7 ,increase ( graduate m$ical education resid5cy positions 7#a7 ,9 g5]al ,section #gcjb ( title #ch1 ,unit$ ,/ates ,code1 is am5d$ by add+ at ! end ! foll[+ new subsection3 7e7 7#a7 ,9 c>ry+ out ?is section1 ! ,secret>y %all e/abli% m$ical resid5cy programs1 or ensure t already e/abli%$ m$ical resid5cy programs h a suffici5t numb] ( resid5cy positions1 at any m$ical facility ( ! ,dep>tm5t t ! ,secret>y det]m9es-- 7,a7 is exp]i5c+ a %ortage ( physicians2 & 7,b7 is locat$ 9 a community t is designat$ z a heal? pr(essional %ortage area 7z def9$ 9 section #ccb ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bed;e774 7#b7 ,9 c>ry+ out p>agraph 7#a71 ! ,secret>y %all-- 7,a7 allocate ! resid5cy positions "u su* p>agraph among occupations includ$ 9 ! mo/ curr5t det]m9ation publi%$ 9 ! ,f$]al ,regi/] pursuant to section #gdab7;a7 ( ?is title2 & 7,b7 give priority to resid5cy positions & programs 9 prim>y c>e1 m5tal heal?1 & any o!r specialty ! ,secret>y det]m9es appropriate4 4 7#b7 ,five-ye> increase 7,a7 ,9 g5]al ,9 c>ry+ out section #gcjb7;e7 ( title #ch1 ,unit$ ,/ates ,code1 z add$ by p>agraph 7#a71 dur+ ! #e-ye> p]iod beg9n+ on ! day t is #a ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,vet]ans ,affairs %all increase ! numb] ( graduate m$ical education resid5cy positions at m$ical facilities ( ! ,dep>tm5t by up to #a1ejj positions4 7,b7 ,priority ,9 increas+ ! numb] ( graduate m$ical education resid5cy positions at m$ical facilities ( ! ,dep>tm5t "u subp>agraph 7,a71 ! ,secret>y %all give priority to m$ical facilities t-- 7i7 z ( ! date ( ! enactm5t ( ?is ,act1 d n h a m$ical resid5cy program2 & 7ii7 are locat$ 9 a community t has a high conc5tration ( vet]ans4 7#c7 ,report 7,a7 ,9 g5]al ,n lat] ?an #fj days aft] ! date ( ! enactm5t ( ?is ,act1 & n lat] ?an ,octob] #a ea* ye> !reaft] until #bjai1 ! ,secret>y %all submit to ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives a report on graduate m$ical education resid5cy positions at m$ical facilities ( ! ,dep>tm5t4 7,b7 ,elem5ts ,ea* report requir$ by subp>agraph 7,a7 %all include ! foll[+3 7i7 ,= ! ye> prec$+ ! submittal ( ! report1 ! numb] ( graduate m$ical education resid5cy positions at m$ical facilities ( ! ,dep>tm5t z foll[s3 7,i7 ,t 7 fill$4 7,,ii7 ,t 7 n fill$4 7,,iii7 ,t ! ,dep>tm5t anticipat$ fill+4 7ii7 ,) respect to ea* graduate m$ical education resid5cy position specifi$ 9 clause 7i7-- 7,i7 ! geographic location ( ea* su* position2 & 7,,ii7 if su* position 0 fill$1 ! academic affiliation ( ! m$ical resid5t t fill$ su* position4 7iii7 ,! policy at ea* m$ical facility ( ! ,dep>tm5t ) respect to ! ratio ( m$ical resid5ts to /aff sup]vis+ m$ical resid5ts4 7iv7 ,dur+ ! #a-ye> p]iod prec$+ ! submittal ( ! report1 ! numb] ( individuals :o decl9$ an (f] f ! ,dep>tm5t to s]ve z a m$ical resid5t at a m$ical facility ( ! ,dep>tm5t & ! reason :y ea* su* individual decl9$ su* (f]4 7v7 ,dur+ ! #a-ye> p]iod prec$+ ! submittal ( ! report1 a description (-- 7,i7 *all5ges1 if any1 fac$ by ! ,dep>tm5t 9 fill+ graduate m$ical education resid5cy positions at m$ical facilities ( ! ,dep>tm5t2 & 7,,ii7 actions1 if any1 tak5 by ! ,dep>tm5t to address su* *all5ges4 7vi7 ,a description ( ef=ts ( ! ,dep>tm5t1 z ( ! date ( ! submittal ( ! report1 to recruit & reta9 m$ical resid5ts to "w = ! ,vet]ans ,heal? ,adm9i/ration z full-"t employees4 7c7 ,priority 9 ,s*ol>%ip ,program ( ,heal? ,pr(essionals ,educational ,assi/ance ,program to c]ta9 provid]s ,section #gfab7;b77#e7 ( title #ch1 ,unit$ ,/ates ,code1 is am5d$-- 7#a7 9 subp>agraph 7,a71 by /rik+ & at ! end2 7#b7 by r$esignat+ subp>agraph 7,b7 z subp>agraph 7,c72 & 7#c7 by ins]t+ aft] subp>agraph 7,a7 ! foll[+ new subp>agraph 7,b73 7,b7 %all give priority to applicants pursu+ a c\rse ( education or tra9+ t[>d a c>e] 9 an occupation = :i* ! ,inspector ,g5]al ( ! ,dep>tm5t has1 9 ! mo/ curr5t det]m9ation publi%$ 9 ! ,f$]al ,regi/] pursuant to section #gdab7;a7 ( ?is title1 det]m9$ t !re is "o ( ! l>ge/ /aff+ %ortages ?r\gh\t ! ,dep>tm5t ) respect to su* occupation2 & 4 7d7 ,reports 7#a7 ,9 g5]al ,n lat] ?an #ahj days aft] ! date ( ! enactm5t ( ?is ,act1 & n lat] ?an ,decemb] #ca ( ea* ev5-numb]$ ye> !reaft] until #bjbd1 ! ,secret>y ( ,vet]ans ,affairs %all submit to ! ,committees on ,vet]ans' ,affairs ( ! ,s5ate & ,h\se ( ,repres5tatives a report assess+ ! /aff+ ( ea* m$ical facility ( ! ,dep>tm5t4 7#b7 ,elem5ts ,ea* report submitt$ "u p>agraph 7#a7 %all include ! foll[+3 7,a7 ,! results ( a sy/em-wide assessm5t ( all m$ical facilities ( ! ,dep>tm5t to ensure ! foll[+3 7i7 ,appropriate /aff+ levels = heal? c>e pr(essionals to meet ! goals ( ! ,secret>y = timely access to c>e = vet]ans4 7ii7 ,appropriate /aff+ levels = support p]sonnel1 includ+ cl]ks4 7iii7 ,appropriate sizes = cl9ical panels4 7iv7 ,appropriate numb]s ( full-"t /aff1 or full-"t equival5ts1 d$icat$ to direct c>e ( pati5ts4 7v7 ,appropriate physical plant space to meet ! capacity ne$s ( ! ,dep>tm5t 9 t area4 7vi7 ,su* o!r factors z ! ,secret>y consid]s necess>y4 7,b7 ,a plan = address+ any issues id5tifi$ 9 ! assessm5t describ$ 9 subp>agraph 7,a71 includ+ a timel9e = address+ su* issues4 7,c7 ,a li/ ( ! curr5t wait times & workload levels = ! foll[+ cl9ics 9 ea* m$ical facility3 7i7 ,m5tal heal?4 7ii7 ,prim>y c>e4 7iii7 ,ga/ro5t]ology4 7iv7 ,wom5's heal?4 7v7 ,su* o!r cl9ics z ! ,secret>y consid]s appropriate4 7,d7 ,a description ( ! results ( ! mo/ curr5t det]m9ation ( ! ,inspector ,g5]al "u subsection 7a7 ( section #gdab ( title #ch1 ,unit$ ,/ates ,code1 z add$ by subsection 7a77#a7 ( ?is section1 & a plan to use direct appo9tm5t au?ority "u subsection 7b7 ( su* section #gdab to fill /aff+ %ortages1 includ+ recomm5dations = improv+ ! spe$ at :i* ! cr$5tial+ & privileg+ process c be conduct$4 7,e7 ,! curr5t /aff+ models ( ! ,dep>tm5t = ! foll[+ cl9ics1 includ+ recomm5dations = *anges to su* models3 7i7 ,m5tal heal?4 7ii7 ,prim>y c>e4 7iii7 ,ga/ro5t]ology4 7iv7 ,wom5's heal?4 7v7 ,su* o!r cl9ics z ! ,secret>y consid]s appropriate4 7,f7 ,a detail$ analysis ( succession plann+ at m$ical facilities ( ! ,dep>tm5t1 includ+ ! foll[+3 7i7 ,! numb] ( positions 9 m$ical facilities ?r\gh\t ! ,dep>tm5t t are n fill$ by a p]man5t employee4 7ii7 ,! l5g? ( "t ea* position describ$ 9 clause 7i7 rema9$ vacant or fill$ by a tempor>y or act+ employee4 7iii7 ,a description ( any b>ri]s to fill+ ! positions describ$ 9 clause 7i74 7iv7 ,a plan = fill+ any positions t are vacant or fill$ by a tempor>y or act+ employee = m ?an #ahj days4 7v7 ,a plan = h&l+ em]g5cy circum/ances1 su* z adm9i/rative leave or sudd5 m$ical leave = s5ior (ficials4 7,g7 ,! numb] ( heal? c>e provid]s ( ! ,dep>tm5t :o h be5 remov$ f _! positions1 h retir$1 or h left _! positions = ano!r reason1 disaggregat$ by provid] type1 dur+ ! #b-ye> p]iod prec$+ ! submittal ( ! report4 7,h7 ,( ! heal? c>e provid]s specifi$ 9 subp>agraph 7,g7 :o h be5 remov$ f _! positions1 ! foll[+3 7i7 ,! numb] ( su* heal? c>e provid]s :o 7 reassign$ to o!r positions 9 ! ,dep>tm5t4 7ii7 ,! numb] ( su* heal? c>e provid]s :o left ! ,dep>tm5t4 7iii7 ,! numb] ( su* heal? c>e provid]s :o left ! ,dep>tm5t & 7 subsequ5tly rehir$ by ! ,dep>tm5t4 #cjb4 ,ext5sion & modification ( c]ta9 programs )9 ! ,dep>tm5t ( ,vet]ans ,affairs ,heal? ,pr(essionals ,educational ,assi/ance ,program 7a7 ,ext5sion ( ,s*ol>%ip ,program ,section #gfai ( title #ch1 ,unit$ ,/ates ,code1 is am5d$ by /rik+ ,decemb] #ca1 #bjad & ins]t+ ,decemb] #ca1 #bjai4 7b7 ,modification ( ,education ,debt ,r$uction ,program 7#a7 ,modification ( am\nt & duration ( eligibility ,p>agraph 7#a7 ( section #gfhc7;d7 ( su* title is am5d$-- 7,a7 by /rik+ #fj1jjj & ins]t+ #abj1jjj2 & 7,b7 by /rik+ #ab1jjj ( su* paym5ts & all t foll[s ?r\gh ! p]iod at ! end & ins]t+ #bd1jjj ( su* paym5ts may be made 9 ea* ye> ( p>ticipation 9 ! ,program4 7#b7 ,elim9ation ( limitation 7,a7 ,9 g5]al ,su* section is fur!r am5d$-- 7i7 by /rik+ p>agraph 7#b72 7ii7 by r$esignat+ p>agraph 7#c7 z p>agraph 7#b72 & 7iii7 9 p>agraph 7#b71 z r$esignat$ by clause 7ii71 by /rik+ p>agraphs 7#a7 & 7#b7 & ins]t+ p>agraph 7#a74 7,b7 ,con=m+ am5dm5t ,p>agraph 7#a7 ( su* section1 z am5d$ by p>agraph 7#a71 is fur!r am5d$ by /rik+ ,subject to p>agraph 7#b71 ! am\nt & ins]t+ ,! am\nt4 #cjc4 ,cl9ic managem5t tra9+ = employees at m$ical facilities ( ! ,dep>tm5t ( ,vet]ans ,affairs 7a7 ,cl9ic managem5t tra9+ program 7#a7 ,9 g5]al ,n lat] ?an #ahj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,vet]ans ,affairs %all comm5ce a role-specific cl9ic managem5t tra9+ program to provide 9-p]son1 /&>diz$ education on sy/ems & processes = heal? c>e practice managem5t & s*$ul+ to all appropriate employees1 z det]m9$ by ! ,secret>y1 at m$ical facilities ( ! ,dep>tm5t4 7#b7 ,elem5ts 7,a7 ,9 g5]al ,! cl9ic managem5t tra9+ program requir$ by p>agraph 7#a7 %all include ! foll[+3 7i7 ,tra9+ on h[ to manage ! s*$ules ( heal? c>e provid]s ( ! ,dep>tm5t1 includ+ ! foll[+3 7,i7 ,ma9ta9+ su* s*$ules 9 a mann] t all[s appo9tm5ts to be book$ at lea/ eight weeks 9 advance4 7,,ii7 ,prop] plann+ proc$ures = vacation1 leave1 & graduate m$ical education tra9+ s*$ules4 7ii7 ,tra9+ on ! appropriate numb] ( appo9tm5ts t a heal? c>e provid] %\ld conduct on a daily basis1 bas$ on specialty4 7iii7 ,tra9+ on h[ to det]m9e :e!r !re are en\gh available appo9tm5t slots to manage dem& = diff]5t appo9tm5t types & me*anisms = al]t+ managem5t ( insuffici5t slots4 7iv7 ,tra9+ on h[ to prop]ly use ! appo9tm5t s*$ul+ sy/em ( ! ,dep>tm5t1 includ+ any new s*$ul+ sy/em implem5t$ by ! ,dep>tm5t4 7v7 ,tra9+ on h[ to optimize ! use ( te*nology1 includ+ ! foll[+3 7,i7 ,telem$ic9e4 7,,ii7 ,electronic mail4 7,,iii7 ,text messag+4 7,,iv7 ,su* o!r te*nologies z specifi$ by ! ,secret>y4 7vi7 ,tra9+ on h[ to prop]ly use physical plant space at m$ical facilities ( ! ,dep>tm5t to ensure effici5t fl[ & privacy = pati5ts & /aff4 7,b7 ,role-specific ,! ,secret>y %all ensure t ea* employee ( ! ,dep>tm5t includ$ 9 ! cl9ic managem5t tra9+ program requir$ by p>agraph 7#a7 receives education "u su* program t is relevant to ! responsibilities ( su* employee4 7#c7 ,sunset ,! cl9ic managem5t tra9+ program requir$ by p>agraph 7#a7 %all t]m9ate on ! date t is #b ye>s aft] ! date on :i* ! ,secret>y comm5ces su* program4 7b7 ,tra9+ mat]ials 7#a7 ,9 g5]al ,aft] ! t]m9ation ( ! cl9ic managem5t tra9+ program requir$ by subsection 7a71 ! ,secret>y %all provide tra9+ mat]ials on heal? c>e managem5t to ea* ( ! foll[+ employees ( ! ,dep>tm5t t are relevant to ! position & responsibilities ( su* employee ^u ! comm5cem5t ( employm5t ( su* employee3 7,a7 ,any manag] ( a m$ical facility ( ! ,dep>tm5t4 7,b7 ,any heal? c>e provid] at a m$ical facility ( ! ,dep>tm5t4 7,c7 ,su* o!r employees ( ! ,dep>tm5t z ! ,secret>y consid]s appropriate4 7#b7 ,update ,! ,secret>y %all regul>ly update ! tra9+ mat]ials requir$ "u p>agraph 7#a74 ,,iv ,heal? ,c>e ,relat$ to ,sexual ,trauma #dja4 ,expansion ( eligibility = sexual trauma c\nsel+ & treatm5t to vet]ans on inactive duty tra9+ ,section #agbj;,d7a77#a7 ( title #ch1 ,unit$ ,/ates ,code1 is am5d$ by /rik+ or active duty = tra9+ & ins]t+ 1 active duty = tra9+1 or inactive duty tra9+4 #djb4 ,provision ( c\nsel+ & treatm5t = sexual trauma by ! ,dep>tm5t ( ,vet]ans ,affairs to memb]s ( ! ,arm$ ,=ces 7a7 ,expansion ( cov]age to memb]s ( ! ,arm$ ,=ces ,subsection 7a7 ( section #agbj;,d ( title #ch1 ,unit$ ,/ates ,code1 is am5d$-- 7#a7 by r$esignat+ p>agraph 7#b7 z p>agraph 7#c72 7#b7 by ins]t+ aft] p>agraph 7#a7 ! foll[+ new p>agraph 7#b73 7#b7 7,a7 ,9 op]at+ ! program requir$ by p>agraph 7#a71 ! ,secret>y may1 9 consultation ) ! ,secret>y ( ,def5se1 provide c\nsel+ & c>e & s]vices to memb]s ( ! ,arm$ ,=ces 7includ+ memb]s ( ! ,national ,gu>d & ,res]ves7 on active duty to ov]come psy*ological trauma describ$ 9 t p>agraph4 7,b7 ,a memb] describ$ 9 subp>agraph 7,a7 %all n be requir$ to obta9 a ref]ral be=e receiv+ c\nsel+ & c>e & s]vices "u ?is p>agraph4 2 & 7#c7 9 p>agraph 7#c71 z r$esignat$ by p>agraph 7#a7-- 7,a7 by /rik+ a vet]an & ins]t+ an individual2 & 7,b7 by /rik+ t vet]an ea* place x appe>s & ins]t+ t individual4 7b7 ,in=mation to memb]s on availability ( c\nsel+ & s]vices ,subsection 7c7 ( su* section is am5d$-- 7#a7 by /rik+ to vet]ans ea* place x appe>s2 & 7#b7 9 p>agraph 7#c71 by ins]t+ memb]s ( ! ,arm$ ,=ces & be=e individuals4 7c7 ,inclusion ( memb]s 9 reports on c\nsel+ & s]vices ,subsection 7e7 ( su* section is am5d$-- 7#a7 9 ! matt] prec$+ p>agraph 7#a71 by /rik+ to vet]ans2 7#b7 9 p>agraph 7#b7-- 7,a7 by /rik+ wom5 vet]ans & ins]t+ individuals2 & 7,b7 by /rik+ tra9+ "u subsection 7d74 & ins]t+ 8tra9+ "u subsection 7d71 disaggregat$ by-- 7,a7 vet]ans2 7,b7 memb]s ( ! ,arm$ ,=ces 7includ+ memb]s ( ! ,national ,gu>d & ,res]ves7 on active duty2 & 7,c7 = ea* ( subp>agraphs 7,a7 & 7,b7-- 7i7 m52 & 7ii7 wom54 2 7#c7 9 p>agraph 7#d71 by /rik+ vet]ans & ins]t+ individuals2 & 7#d7 9 p>agraph 7#e7-- 7,a7 by /rik+ wom5 vet]ans & ins]t+ individuals2 & 7,b7 by ins]t+ 1 includ+ specific recomm5dations = individuals specifi$ 9 subp>agraphs 7,a71 7,b71 & 7,c7 ( p>agraph 7#b7 be=e ! p]iod at ! end4 7d7 ,effective date ,! am5dm5ts made by ?is section %all take effect on ! date t is #a ye> aft] ! date ( ! enactm5t ( ?is ,act4 #djc4 ,reports on milit>y sexual trauma 7a7 ,report on s]vices available = milit>y sexual trauma 9 ! ,dep>tm5t ( ,vet]ans ,affairs ,n lat] ?an #fcj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,vet]ans ,affairs %all submit to ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives a report on ! treatm5t & s]vices available f ! ,dep>tm5t ( ,vet]ans ,affairs = male vet]ans :o exp]i5ce milit>y sexual trauma comp>$ to su* treatm5t & s]vices available to female vet]ans :o exp]i5ce milit>y sexual trauma4 7b7 ,reports on transition ( milit>y sexual trauma treatm5t f ,dep>tm5t ( ,def5se to ,dep>tm5t ( ,vet]ans ,affairs ,n lat] ?an #fcj days aft] ! date ( ! enactm5t ( ?is ,act1 & annually !reaft] = #e ye>s1 ! ,dep>tm5t ( ,vet]ans ,affairs-,dep>tm5t ( ,def5se ,jo9t ,executive ,committee e/abli%$ by section #cbj7;a7 ( title #ch1 ,unit$ ,/ates ,code1 %all submit to ! appropriate committees ( ,congress a report on milit>y sexual trauma t includes ! foll[+3 7#a7 ,! processes & proc$ures utiliz$ by ! ,dep>tm5t ( ,vet]ans ,affairs & ! ,dep>tm5t ( ,def5se to facilitate transition ( treatm5t ( individuals :o h exp]i5c$ milit>y sexual trauma f treatm5t provid$ by ! ,dep>tm5t ( ,def5se to treatm5t provid$ by ! ,dep>tm5t ( ,vet]ans ,affairs4 7#b7 ,a description & assessm5t ( ! collaboration betwe5 ! ,dep>tm5t ( ,vet]ans ,affairs & ! ,dep>tm5t ( ,def5se 9 assi/+ vet]ans 9 fil+ claims = disabilities relat$ to milit>y sexual trauma1 includ+ p]mitt+ vet]ans access to in=mation & evid5ce necess>y to develop or support su* claims4 7c7 ,def9itions ,9 ?is section3 7#a7 ,appropriate committees ( congress ,! t]m appropriate committees ( ,congress means-- 7,a7 ! ,committee on ,vet]ans' ,affairs & ! ,committee on ,arm$ ,s]vices ( ! ,s5ate2 & 7,b7 ! ,committee on ,vet]ans' ,affairs & ! ,committee on ,arm$ ,s]vices ( ! ,h\se ( ,repres5tatives4 7#b7 ,milit>y sexual trauma ,! t]m milit>y sexual trauma means psy*ological trauma1 :i* 9 ! judgm5t ( a m5tal heal? pr(essional employ$ by ! ,dep>tm5t1 result$ f a physical assault ( a sexual nature1 batt]y ( a sexual nature1 or sexual h>assm5t :i* occurr$ :ile ! vet]an 0 s]v+ on active duty1 active duty = tra9+1 or inactive duty tra9+4 7#c7 ,sexual h>assm5t ,! t]m sexual h>assm5t means repeat$1 unsolicit$ v]bal or physical contact ( a sexual nature :i* is ?reat5+ 9 "*4 7#d7 ,sexual trauma ,! t]m sexual trauma %all h ! mean+ giv5 t t]m by ! ,secret>y ( ,vet]ans ,affairs = purposes ( ?is section4 7d7 ,effective date ,?is section %all take effect on ! date t is #bgj days aft] ! date ( ! enactm5t ( ?is ,act4 ,v ,o!r ,heal? ,c>e ,matt]s #eja4 ,ext5sion ( pilot program on assi/$ liv+ s]vices = vet]ans ) traumatic bra9 injury 7a7 ,9 g5]al ,section #agje ( ! ,national ,def5se ,au?orization ,act = ,fiscal ,ye> #bjjh 7,public ,law #aaj-aha2 #ch ,u4,s4,c4 #agaj;,c note7 is am5d$ by add+ at ! end ! foll[+3 7g7 ,t]m9ation ,! pilot program %all t]m9ate on ,octob] #f1 #bjag4 4 7b7 ,con=m+ am5dm5t ,subsection 7a7 ( su* section is am5d$ by /rik+ five-ye>4 ,,vi ,major ,m$ical ,facility ,leases #fja4 ,au?orization ( major m$ical facility leases 7a7 ,9 g5]al ,! ,secret>y ( ,vet]ans ,affairs may c>ry out ! foll[+ major m$ical facility leases at ! locations specifi$1 & 9 an am\nt = ea* lease n to exce$ ! am\nt %[n = su* location 7n includ+ any e/imat$ cancellation co/s73 7#a7 ,= a cl9ical rese>* & ph>macy coord9at+ c5t]1 ,albuqu]que1 ,new ,mexico1 an am\nt n to exce$ #i1efj1jjj4 7#b7 ,= a community-bas$ outpati5t cl9ic1 ,brick1 ,new ,j]sey1 an am\nt n to exce$ #g1bhj1jjj4 7#c7 ,= a new prim>y c>e & d5tal cl9ic annex1 ,*>le/on1 ,s\? ,c>ol9a1 an am\nt n to exce$ #g1jgj1bej4 7#d7 ,= a community-bas$ outpati5t cl9ic1 ,cobb ,c\nty1 ,georgia1 an am\nt n to exce$ #f1dji1jjj4 7#e7 ,= ! ,leew>d ,outpati5t ,heal?c>e ,access ,c5t]1 ,honolulu1 ,hawaii1 includ+ a co-locat$ cl9ic ) ! ,dep>tm5t ( ,def5se & ! co-location ( ! ,honolulu ,regional ,(fice ( ! ,vet]ans ,b5efits ,adm9i/ration & ! ,kapolei ,vet ,c5t] ( ! ,dep>tm5t ( ,vet]ans ,affairs1 an am\nt n to exce$ #ae1hhg1cgj4 7#f7 ,= a community-bas$ outpati5t cl9ic1 ,johnson ,c\nty1 ,kansas1 an am\nt n to exce$ #b1bfc1jjj4 7#g7 ,= a replacem5t community-bas$ outpati5t cl9ic1 ,lafayette1 ,l\isiana1 an am\nt n to exce$ #b1iif1jjj4 7#h7 ,= a community-bas$ outpati5t cl9ic1 ,lake ,*>les1 ,l\isiana1 an am\nt n to exce$ #b1fbf1jjj4 7#i7 ,= outpati5t cl9ic consolidation1 ,new ,port ,ri*ey1 ,florida1 an am\nt n to exce$ #aa1ibg1jjj4 7#aj7 ,= an outpati5t cl9ic1 ,ponce1 ,pu]to ,rico1 an am\nt n to exce$ #aa1ece1jjj4 7#aa7 ,= lease consolidation1 ,san ,antonio1 ,texas1 an am\nt n to exce$ #ai1dbf1jjj4 7#ab7 ,= a community-bas$ outpati5t cl9ic1 ,san ,diego1 ,cali=nia1 an am\nt n to exce$ #aa1idf1ajj4 7#ac7 ,= an outpati5t cl9ic1 ,tyl]1 ,texas1 an am\nt n to exce$ #d1cbg1jjj4 7#ad7 ,= ! ,err]a ,community ,c>e ,c5t]1 ,we/ ,hav51 ,connecticut1 an am\nt n to exce$ #d1hhc1jjj4 7#ae7 ,= ! ,worce/] ,community-,bas$ ,outpati5t ,cl9ic1 ,worce/]1 ,massa*usetts1 an am\nt n to exce$ #d1hee1jjj4 7#af7 ,= ! expansion ( a community-bas$ outpati5t cl9ic1 ,cape ,gir>deau1 ,miss\ri1 an am\nt n to exce$ #d1bcb1jfj4 7#ag7 ,= a multispecialty cl9ic1 ,*attanooga1 ,t5nessee1 an am\nt n to exce$ #g1jfi1jjj4 7#ah7 ,= ! expansion ( a community-bas$ outpati5t cl9ic1 ,*ico1 ,cali=nia1 an am\nt n to exce$ #d1ecd1jjj4 7#ai7 ,= a community-bas$ outpati5t cl9ic1 ,*ula ,vi/a1 ,cali=nia1 an am\nt n to exce$ #c1gad1jjj4 7#bj7 ,= a new rese>* lease1 ,h9es1 ,ill9ois1 an am\nt n to exce$ #bb1jcb1jjj4 7#ba7 ,= a replacem5t rese>* lease1 ,h\/on1 ,texas1 an am\nt n to exce$ #f1adb1jjj4 7#bb7 ,= a community-bas$ outpati5t cl9ic1 ,l9coln1 ,nebraska1 an am\nt n to exce$ #g1agh1djj4 7#bc7 ,= a community-bas$ outpati5t cl9ic1 ,lubbock1 ,texas1 an am\nt n to exce$ #h1eed1jjj4 7#bd7 ,= a community-bas$ outpati5t cl9ic consolidation1 ,myrtle ,bea*1 ,s\? ,c>ol9a1 an am\nt n to exce$ #h1jbb1jjj4 7#be7 ,= a community-bas$ outpati5t cl9ic1 ,pho5ix1 ,arizona1 an am\nt n to exce$ #bj1geg1jjj4 7#bf7 ,= ! expansion ( a community-bas$ outpati5t cl9ic1 ,r$d+1 ,cali=nia1 an am\nt n to exce$ #h1aed1jjj4 7#bg7 ,= ! expansion ( a community-bas$ outpati5t cl9ic1 ,tulsa1 ,oklahoma1 an am\nt n to exce$ #ac1bfi1bjj4 7b7 ,requirem5ts = cl9ic 9 ,tulsa 7#a7 ,9 g5]al ,9 c>ry+ out ! expansion ( ! community-bas$ outpati5t cl9ic 9 ,tulsa1 ,oklahoma1 au?oriz$ by subsection 7a77#bg71 ! ,secret>y ( ,vet]ans ,affairs %all ensure t su* cl9ic satisfies ! foll[+ requirem5ts3 7,a7 ,consi/ ( n m ?an #adj1jjj gross squ>e feet4 7,b7 ,h an annual co/ p] squ>e foot ( n m ?an ! av]age m>ket rate 9 ,tulsa1 ,oklahoma1 = an equival5t m$ical facility plus #bj p]c5t4 7,c7 ,satisfy ! m&ate ( ! ,dep>tm5t ( ,vet]ans ,affairs to provide vet]ans 9 ,oklahoma ) access to quality & effici5t c>e4 7,d7 ,exp& cl9ical capacity 9 ! region 9 :i* ! cl9ic is locat$ 9 a co/ effici5t mann] bas$ ^u regional co/ comp>isons1 tak+ into acc\nt ! ne$s ( curr5t vet]ans & ! pot5tial dem& by vet]ans = c>e 9 ! future4 7,e7 ,be ! mo/ co/ effective option = ! ,dep>tm5t z pr$ict$ ov] a #cj-ye> life cycle = su* cl9ic4 7#b7 ,co/ effective det]m9ation 7,a7 ,9 g5]al ,if ! ,secret>y det]m9es t ! mo/ co/ effective option ov] a #cj-ye> life cycle w\ld be to pur*ase or con/ruct a facility 9 ,tulsa1 ,oklahoma1 in/ead ( ent]+ into a major m$ical facility lease 9 su* location z au?oriz$ by subsection 7a77#bg71 ! ,secret>y %all n ent] into su* lease4 7,b7 ,major m$ical facility project ,if ! ,secret>y makes ! det]m9ation describ$ 9 subp>agraph 7,a71 ! ,secret>y may reque/ au?ority = a major m$ical facility project 9 ,tulsa1 ,oklahoma1 f ,congress pursuant to section #hajd7;b7 ( title #ch1 ,unit$ ,/ates ,code4 7,c7 ,co/-b5efit analysis ,if ! ,secret>y reque/s au?ority = ! major m$ical facility project describ$ 9 subp>agraph 7,b71 n lat] ?an #ij days aft] mak+ ! det]m9ation describ$ 9 subp>agraph 7,a71 ! ,secret>y %all submit to ,congress a detail$ co/-b5efit analysis ( su* major m$ical facility project4 #fjb4 ,budget>y treatm5t ( ,dep>tm5t ( ,vet]ans ,affairs major m$ical facilities leases 7a7 ,f9d+s ,congress f9ds ! foll[+3 7#a7 ,title #ca1 ,unit$ ,/ates ,code1 requires ! ,dep>tm5t ( ,vet]ans ,affairs to record ! full co/ ( its contractual obligation aga9/ funds available at ! "t a contract is execut$4 7#b7 ,(fice ( ,managem5t & ,budget ,circul> ,a-#aa provides guidance to ag5cies 9 meet+ ! /atutory requirem5ts "u title #ca1 ,unit$ ,/ates ,code1 ) respect to leases4 7#c7 ,= op]at+ leases1 ,(fice ( ,managem5t & ,budget ,circul> ,a-#aa requires ! ,dep>tm5t ( ,vet]ans ,affairs to record up-front budget au?ority 9 an am\nt equal to total paym5ts "u ! full t]m ( ! lease or an am\nt suffici5t to cov] fir/ ye> lease paym5ts plus cancellation co/s4 7b7 ,requirem5t = obligation ( full co/ 7#a7 ,9 g5]al ,subject to ! availability ( appropriations provid$ 9 advance1 9 ex]cis+ ! au?ority ( ! ,secret>y ( ,vet]ans ,affairs to ent] into leases provid$ 9 ?is ,act1 ! ,secret>y %all record1 pursuant to section #aeja ( title #ca1 ,unit$ ,/ates ,code1 z ! full co/ ( ! contractual obligation at ! "t a contract is execut$ ei!r-- 7,a7 an am\nt equal to total paym5ts "u ! full t]m ( ! lease2 or 7,b7 if ! lease specifies paym5ts to be made 9 ! ev5t ! lease is t]m9at$ be=e its full t]m1 an am\nt suffici5t to cov] ! fir/ ye> lease paym5ts plus ! specifi$ cancellation co/s4 7#b7 ,self-insur+ au?ority ,! requirem5ts ( p>agraph 7#a7 may be satisfi$ ?r\gh ! use ( ! self-insur+ au?ority id5tifi$ 9 title #dj1 ,unit$ ,/ates ,code1 consi/5t ) ,(fice ( ,managem5t & ,budget ,circul> ,a-#aa4 7c7 ,transp>5cy 7#a7 ,compliance ,subsection 7b7 ( section #hajd ( title #ch1 ,unit$ ,/ates ,code1 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#g7 ,9 ! case ( a prospectus propos+ fund+ = a major m$ical facility lease1 a detail$ analysis ( h[ ! lease is expect$ to comply ) ,(fice ( ,managem5t & ,budget ,circul> ,a-#aa & section #acda ( title #ca 7commonly ref]r$ to z ! ,anti-,defici5cy ,act74 ,any su* analysis %all include-- 7,a7 an analysis ( ! classification ( ! lease z a lease-pur*ase1 capital lease1 or op]at+ lease z ^? t]ms are def9$ 9 ,(fice ( ,managem5t & ,budget ,circul> ,a-#aa2 7,b7 an analysis ( ! obligation ( budget>y res\rces associat$ ) ! lease2 & 7,c7 an analysis ( ! me?odology us$ 9 det]m9+ ! asset co/1 fair m>ket value1 & cancellation co/s ( ! lease4 4 7#b7 ,submittal to ,congress ,su* section #hajd is fur!r am5d$ by add+ at ! end ! foll[+ new subsection3 7h7 7#a7 ,n less ?an #cj days be=e ent]+ into a major m$ical facility lease1 ! ,secret>y %all submit to ! ,committees on ,vet]ans' ,affairs ( ! ,s5ate & ! ,h\se ( ,repres5tatives-- 7,a7 notice ( ! ,secret>y's int5tion to ent] into ! lease2 7,b7 a detail$ summ>y ( ! propos$ lease2 7,c7 a description & analysis ( any diff]5ces betwe5 ! prospectus submitt$ pursuant to subsection 7b7 & ! propos$ lease2 & 7,d7 a scor+ analysis demon/rat+ t ! propos$ lease fully complies ) ,(fice ( ,managem5t & ,budget ,circul> ,a-#aa4 7#b7 ,ea* committee describ$ 9 p>agraph 7#a7 %all ensure t any in=mation submitt$ to ! committee "u su* p>agraph is treat$ by ! committee ) ! same level ( confid5tiality z is requir$ by law ( ! ,secret>y & subject to ! same /atutory p5alties = unau?oriz$ disclosure or use z ! ,secret>y4 7#c7 ,n m ?an #cj days aft] ent]+ into a major m$ical facility lease1 ! ,secret>y %all submit to ea* committee describ$ 9 p>agraph 7#a7 a report on any mat]ial diff]5ces betwe5 ! lease t 0 ent]$ into & ! propos$ lease describ$ "u su* p>agraph1 includ+ h[ ! lease t 0 ent]$ into *anges ! previ\sly submitt$ scor+ analysis describ$ 9 subp>agraph 7,d7 ( su* p>agraph4 4 7d7 ,rule ( con/ruction ,no?+ 9 ?is section1 or ! am5dm5ts made by ?is section1 %all be con/ru$ to 9 any way relieve ! ,dep>tm5t ( ,vet]ans ,affairs f any /atutory or regulatory obligations or requirem5ts exi/+ prior to ! enactm5t ( ?is section & su* am5dm5ts4 ,,vii ,o!r ,vet]ans ,matt]s #gja4 ,expansion ( ,m>9e ,gunn]y ,s]geant ,john ,david ,fry ,s*ol>%ip 7a7 ,expansion ( entitlem5t ,subsection 7b77#i7 ( section #ccaa ( title #ch1 ,unit$ ,/ates ,code1 is am5d$ by ins]t+ or sp\se aft] *ild4 7b7 ,limitation & election on c]ta9 b5efits ,subsection 7f7 ( su* section is am5d$-- 7#a7 by r$esignat+ p>agraph 7#b7 z p>agraph 7#d72 & 7#b7 by ins]t+ aft] p>agraph 7#a7 ! foll[+ new p>agraphs3 7#b7 ,limitation ,! entitlem5t ( an individual to assi/ance "u subsection 7a7 pursuant to p>agraph 7#i7 ( subsection 7b7 because ! individual 0 a sp\se ( a p]son describ$ 9 su* p>agraph %all expire on ! e>li] (-- 7,a7 ! date t is #ae ye>s aft] ! date on :i* ! p]son di$2 or 7,b7 ! date on :i* ! individual rem>ries4 7#c7 ,election on receipt ( c]ta9 b5efits ,a surviv+ sp\se entitl$ to assi/ance "u subsection 7a7 pursuant to p>agraph 7#i7 ( subsection 7b7 :o is also entitl$ to educational assi/ance "u *apt] #ce ( ?is title may n receive assi/ance "u bo? ?is section & su* *apt]1 b %all make an irrevocable election 79 su* =m & mann] z ! ,secret>y may prescribe7 "u :i* section or *apt] to receive educational assi/ance4 4 7c7 ,con=m+ am5dm5t ,section #ccba7;b77#d7 ( su* title is am5d$-- 7#a7 by /rik+ an individual & ins]t+ a *ild2 & 7#b7 by /rik+ su* individual's ea* "t x appe>s & ins]t+ su* *ild's4 7d7 ,effective date ,! am5dm5ts made by ?is section %all apply ) respect to a qu>t]1 seme/]1 or t]m1 z applicable1 comm5c+ on or aft] ,janu>y #a1 #bjae4 #gjb4 ,approval ( c\rses ( education provid$ by public in/itutions ( high] le>n+ = purposes ( ,all-,volunte] ,=ce ,educational ,assi/ance ,program & ,po/-#i_/aa ,educational ,assi/ance conditional on 9-,/ate tuition rate = vet]ans 7a7 ,9 g5]al ,section #cfgi ( title #ch1 ,unit$ ,/ates ,code1 is am5d$ by add+ at ! end ! foll[+ new subsection3 7c7 7#a7 ,not)/&+ any o!r provision ( ?is *apt] & subject to p>agraphs 7#c7 ?r\gh 7#f71 ! ,secret>y %all disapprove a c\rse ( education provid$ by a public in/itution ( high] le>n+ to a cov]$ individual pursu+ a c\rse ( education ) educational assi/ance "u *apt] #cj or #cc ( ?is title :ile liv+ 9 ! ,/ate 9 :i* ! public in/itution ( high] le>n+ is locat$ if ! in/itution *>ges tuition & fees = t c\rse = ! cov]$ individual at a rate t is high] ?an ! rate ! in/itution *>ges = tuition & fees = t c\rse = resid5ts ( ! ,/ate 9 :i* ! in/itution is locat$1 reg>dless ( ! cov]$ individual's ,/ate ( resid5ce4 7#b7 ,= purposes ( ?is subsection1 a cov]$ individual is any individual z foll[s3 7,a7 ,a vet]an :o 0 dis*>g$ or releas$ f a p]iod ( n few] ?an #ij days ( s]vice 9 ! active milit>y1 naval1 or air s]vice less ?an ?ree ye>s be=e ! date ( enrollm5t 9 ! c\rse conc]n$4 7,b7 ,an individual :o is entitl$ to assi/ance "u section #ccaa7;b77#i7 or #ccai ( ?is title by virtue ( su* individual's relation%ip to a vet]an describ$ 9 subp>agraph 7,a74 7#c7 ,if aft] enrollm5t 9 a c\rse ( education t is subject to disapproval "u p>agraph 7#a7 by reason ( p>agraph 7#b77;,a7 or 7#b77;,b7 a cov]$ individual pursues "o or m c\rses ( education at ! same public in/itution ( high] le>n+ :ile rema9+ cont9u\sly enroll$ 7o!r ?an dur+ regul>ly s*$ul$ breaks betwe5 c\rses1 seme/]s or t]ms7 at t in/itution ( high] le>n+1 any c\rse s pursu$ by ! cov]$ individual at t in/itution ( high] le>n+ :ile s cont9u\sly enroll$ %all also be subject to disapproval "u p>agraph 7#a74 7#d7 ,x %all n be gr\nds to disapprove a c\rse ( education "u p>agraph 7#a7 if a public in/itution ( high] le>n+ requires a cov]$ individual pursu+ a c\rse ( education at ! in/itution to demon/rate an int5t1 by means o!r ?an satisfy+ a physical pres5ce requirem5t1 to e/abli% resid5cy 9 ! ,/ate 9 :i* ! in/itution is locat$1 or to satisfy o!r requirem5ts n relat+ to ! e/abli%m5t ( resid5cy1 9 ord] to be *>g$ tuition & fees = t c\rse at a rate t is equal to or less ?an ! rate ! in/itution *>ges = tuition & fees = t c\rse = resid5ts ( ! ,/ate4 7#e7 ,! ,secret>y may waive su* requirem5ts ( p>agraph 7#a7 z ! ,secret>y consid]s appropriate4 7#f7 ,disapproval "u p>agraph 7#a7 %all apply only ) respect to educational assi/ance "u *apt]s #cj & #cc ( ?is title4 4 7b7 ,effective date ,subsection 7c7 ( section #cfgi ( title #ch1 ,unit$ ,/ates ,code 7z add$ by subsection 7a7 ( ?is section71 %all apply ) respect to educational assi/ance provid$ = pursuit ( a program ( education dur+ a qu>t]1 seme/]1 or t]m1 z applicable1 t beg9s aft] ,july #a1 #bjae4 #gjc4 ,ext5sion ( r$uction 9 am\nt ( p5sion furni%$ by ,dep>tm5t ( ,vet]ans ,affairs = c]ta9 vet]ans cov]$ by ,m$icaid plans = s]vices furni%$ by nurs+ facilities ,section #eejc7;d77#g7 ( title #ch1 ,unit$ ,/ates ,code1 is am5d$ by /rik+ ,novemb] #cj1 #bjaf & ins]t+ ,septemb] #cj1 #bjbd4 #gjd4 ,ext5sion ( requirem5t = collection ( fees = h\s+ loans gu>ante$ by ,secret>y ( ,vet]ans ,affairs ,section #cgbi7;b77#b7 ( title #ch1 ,unit$ ,/ates ,code1 is am5d$-- 7#a7 9 subp>agraph 7,a7-- 7,a7 9 clause 7iii71 by /rik+ ,octob] #a1 #bjag & ins]t+ ,septemb] #cj1 #bjbd2 & 7,b7 9 clause 7iv71 by /rik+ ,octob] #a1 #bjag & ins]t+ ,septemb] #cj1 #bjbd2 7#b7 9 subp>agraph 7,b7-- 7,a7 9 clause 7i71 by /rik+ ,octob] #a1 #bjag & ins]t+ ,septemb] #cj1 #bjbd2 & 7,b7 9 clause 7ii71 by /rik+ ,octob] #a1 #bjag & ins]t+ ,septemb] #cj1 #bjbd2 7#c7 9 subp>agraph 7,c7-- 7,a7 9 clause 7i71 by /rik+ ,octob] #a1 #bjag & ins]t+ ,septemb] #cj1 #bjbd2 & 7,b7 9 clause 7ii71 by /rik+ ,octob] #a1 #bjag & ins]t+ ,septemb] #cj1 #bjbd2 & 7#d7 9 subp>agraph 7,d7-- 7,a7 9 clause 7i71 by /rik+ ,octob] #a1 #bjag & ins]t+ ,septemb] #cj1 #bjbd2 & 7,b7 9 clause 7ii71 by /rik+ ,octob] #a1 #bjag & ins]t+ ,septemb] #cj1 #bjbd4 #gje4 ,limitation on aw>ds & bonuses paid to employees ( ,dep>tm5t ( ,vet]ans ,affairs ,9 ea* ( fiscal ye>s #bjae ?r\gh #bjbd1 ! ,secret>y ( ,vet]ans ,affairs %all ensure t ! aggregate am\nt ( aw>ds & bonuses paid by ! ,secret>y 9 a fiscal ye> "u *apt] #de or #ec ( title #e1 ,unit$ ,/ates ,code1 or any o!r aw>ds or bonuses au?oriz$ "u su* title does n exce$ #cfj1jjj1jjj4 #gjf4 ,ext5sion ( au?ority to use income in=mation ,section #ecag7;g7 ( title #ch1 ,unit$ ,/ates ,code1 is am5d$ by /rik+ ,septemb] #cj1 #bjaf & ins]t+ ,septemb] #cj1 #bjbd4 #gjg4 ,removal ( s5ior executives ( ! ,dep>tm5t ( ,vet]ans ,affairs = p]=mance or misconduct 7a7 ,removal or transf] 7#a7 ,9 g5]al ,*apt] #g ( title #ch1 ,unit$ ,/ates ,code1 is am5d$ by add+ at ! end ! foll[+ new section3 #gac4 ,s5ior executives3 removal bas$ on p]=mance or misconduct 7a7 ,9 g5]al 7#a7 ,! ,secret>y may remove an individual employ$ 9 a s5ior executive position at ! ,dep>tm5t ( ,vet]ans ,affairs f ! s5ior executive position if ! ,secret>y det]m9es ! p]=mance or misconduct ( ! individual w>rants su* removal4 ,if ! ,secret>y s removes su* an individual1 ! ,secret>y may-- 7,a7 remove ! individual f ! civil s]vice 7z def9$ 9 section #baja ( title #e72 or 7,b7 9 ! case ( an individual describ$ 9 p>agraph 7#b71 transf] ! individual f ! s5ior executive position to a ,g5]al ,s*$ule position at any grade ( ! ,g5]al ,s*$ule = :i* ! individual is qualifi$ & t ! ,secret>y det]m9es is appropriate4 7#b7 ,an individual describ$ 9 ?is p>agraph is an individual :o-- 7,a7 previ\sly occupi$ a p]man5t position )9 ! competitive s]vice 7z t t]m is def9$ 9 section #bajb ( title #e72 7,b7 previ\sly occupi$ a p]man5t position )9 ! except$ s]vice 7z t t]m is def9$ 9 section #bajc ( title #e72 or 7,c7 prior to employm5t 9 a s5ior executive position at ! ,dep>tm5t ( ,vet]ans ,affairs1 did n occupy any position )9 ! ,f$]al ,gov]nm5t4 7b7 ,pay ( transf]r$ individual 7#a7 ,not)/&+ any o!r provision ( law1 includ+ ! requirem5ts ( section #ceid ( title #e1 any individual transf]r$ to a ,g5]al ,s*$ule position "u subsection 7a77#b7 %all1 beg9n+ on ! date ( su* transf]1 receive ! annual rate ( pay applicable to su* position4 7#b7 ,an individual s transf]r$ may n be plac$ on adm9i/rative leave or any o!r category ( paid leave dur+ ! p]iod dur+ :i* an appeal 7if any7 "u ?is section is ongo+1 & may only receive pay if ! individual reports = duty4 ,if an individual s transf]r$ does n report = duty1 su* individual %all n receive pay or o!r b5efits pursuant to subsection 7e77#e74 7c7 ,notice to ,congress ,n lat] ?an #cj days aft] remov+ or transf]r+ an individual f a s5ior executive position "u subsection 7a71 ! ,secret>y %all submit to ! ,committees on ,vet]ans' ,affairs ( ! ,s5ate & ,h\se ( ,repres5tatives notice 9 writ+ ( su* removal or transf] & ! reason = su* removal or transf]4 7d7 ,proc$ure 7#a7 ,! proc$ures "u section #gedc7;b7 ( title #e %all n apply to a removal or transf] "u ?is section4 7#b7 7,a7 ,subject to subp>agraph 7,b7 & subsection 7e71 any removal or transf] "u subsection 7a7 may be appeal$ to ! ,m]it ,sy/ems ,protection ,bo>d "u section #ggja ( title #e4 7,b7 ,an appeal "u subp>agraph 7,a7 ( a removal or transf] may only be made if su* appeal is made n lat] ?an sev5 days aft] ! date ( su* removal or transf]4 7e7 ,exp$it$ review by adm9i/rative judge 7#a7 ,^u receipt ( an appeal "u subsection 7d77#b77;,a71 ! ,m]it ,sy/ems ,protection ,bo>d %all ref] su* appeal to an adm9i/rative judge pursuant to section #ggja7;b77#a7 ( title #e4 ,! adm9i/rative judge %all exp$ite any su* appeal "u su* section &1 9 any su* case1 %all issue a decision n lat] ?an #ba days aft] ! date ( ! appeal4 7#b7 ,not)/&+ any o!r provision ( law1 includ+ section #ggjc ( title #e1 ! decision ( an adm9i/rative judge "u p>agraph 7#a7 %all be f9al & %all n be subject to any fur!r appeal4 7#c7 ,9 any case 9 :i* ! adm9i/rative judge _c issue a decision 9 accordance ) ! #ba-;day requirem5t "u p>agraph 7#a71 ! removal or transf] is f9al4 ,9 su* a case1 ! ,m]it ,sy/ems ,protection ,bo>d %all1 )9 #ad days aft] ! date t su* removal or transf] is f9al1 submit to ,congress & ! ,committees on ,vet]ans' ,affairs ( ! ,s5ate & ,h\se ( ,repres5tatives a report t expla9s ! reasons :y a decision 0 n issu$ 9 accordance ) su* requirem5t4 7#d7 ,! ,m]it ,sy/ems ,protection ,bo>d or adm9i/rative judge may n /ay any removal or transf] "u ?is section4 7#e7 ,dur+ ! p]iod beg9n+ on ! date on :i* an individual appeals a removal f ! civil s]vice "u subsection 7d7 & end+ on ! date t ! adm9i/rative judge issues a f9al decision on su* appeal1 su* individual may n receive any pay1 aw>ds1 bonuses1 inc5tives1 all[ances1 diff]5tials1 /ud5t loan repaym5ts1 special paym5ts1 or b5efits4 7#f7 ,to ! maximum ext5t practicable1 ! ,secret>y %all provide to ! ,m]it ,sy/ems ,protection ,bo>d1 & to any adm9i/rative judge to :om an appeal "u ?is section is ref]r$1 su* in=mation & assi/ance z may be necess>y to ensure an appeal "u ?is subsection is exp$it$4 7f7 ,relation to title #e 7#a7 ,! au?ority provid$ by ?is section is 9 addition to ! au?ority provid$ by section #ceib or sub*apt] ,v ( *apt] #ge ( title #e4 7#b7 ,section #ceib7;b77#a7 ( title #e does n apply to an action to remove or transf] an individual "u ?is section4 7g7 ,def9itions ,9 ?is section3 7#a7 ,! t]m individual means-- 7,a7 a c>e] appo9tee 7z t t]m is def9$ 9 section #cacb7;a77#d7 ( title #e72 or 7,b7 any individual :o occupies an adm9i/rative or executive position & :o 0 appo9t$ "u section #gcjf7;a7 or section #gdja7a7 ( ?is title4 7#b7 ,! t]m misconduct includes neglect ( duty1 malfeasance1 or failure to accept a direct$ reassignm5t or to accompany a position 9 a transf] ( function4 7#c7 ,! t]m s5ior executive position means-- 7,a7 ) respect to a c>e] appo9tee 7z t t]m is def9$ 9 section #cacb7;a77#d7 ( title #e71 a ,s5ior ,executive ,s]vice position 7z su* t]m is def9$ 9 section #cacb7;a77#b7 ( title #e72 & 7,b7 ) respect to an individual appo9t$ "u section #gcjf7;a7 or section #gdja7a7 ( ?is title1 an adm9i/rative or executive position4 4 7#b7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( su* *apt] is am5d$ by add+ at ! end ! foll[+ new item3 #gac4 ,s5ior executives3 removal bas$ on p]=mance or misconduct4 4 7b7 ,e/abli%m5t ( exp$it$ review process 7#a7 ,9 g5]al ,n lat] ?an #ad days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,m]it ,sy/ems ,protection ,bo>d %all e/abli% & put into effect a process to conduct exp$it$ reviews 9 accordance ) section #gac7;d7 ( title #ch1 ,unit$ ,/ates ,code4 7#b7 ,inapplicability ( c]ta9 regulations ,section #abja4bb ( title #e1 ,code ( ,f$]al ,regulations1 z 9 effect on ! day be=e ! date ( ! enactm5t ( ?is ,act1 %all n apply to exp$it$ reviews c>ri$ out "u section #gac7;d7 ( title #ch1 ,unit$ ,/ates ,code4 7#c7 ,waiv] ,! ,m]it ,sy/ems ,protection ,bo>d may waive any o!r regulation 9 ord] to provide = ! exp$it$ review requir$ "u section #gac7;d7 ( title #ch1 ,unit$ ,/ates ,code4 7#d7 ,report by ,m]it ,sy/ems ,protection ,bo>d ,n lat] ?an #ad days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,m]it ,sy/ems ,protection ,bo>d %all submit to ! ,committees on ,vet]ans' ,affairs ( ! ,s5ate & ,h\se ( ,repres5tatives a report on ! actions ! ,bo>d plans to take to conduct exp$it$ reviews "u section #gac7;d7 ( title #ch1 ,unit$ ,/ates ,code1 z add$ by subsection 7a74 ,su* report %all include a description ( ! res\rces ! ,bo>d det]m9es w be necess>y to conduct su* reviews & a description ( :e!r any res\rces w be necess>y to conduct su* reviews t 7 n available to ! ,bo>d on ! day be=e ! date ( ! enactm5t ( ?is ,act4 7c7 ,tempor>y exemption f c]ta9 limitation on initiation ( removal f ,s5ior ,executive ,s]vice ,dur+ ! #abj-;day p]iod beg9n+ on ! date ( ! enactm5t ( ?is ,act1 an action to remove an individual f ! ,s5ior ,executive ,s]vice at ! ,dep>tm5t ( ,vet]ans ,affairs pursuant to section #gedc ( title #e1 ,unit$ ,/ates ,code1 may be initiat$1 not)/&+ section #ceib7;b7 ( su* title1 or any o!r provision ( law4 7d7 ,con/ruction 7#a7 ,9 g5]al ,no?+ 9 ?is section or section #gac ( title #ch1 ,unit$ ,/ates ,code1 z add$ by subsection 7a71 %all be con/ru$ to apply to an appeal ( a removal1 transf]1 or o!r p]sonnel action t 0 p5d+ be=e ! date ( ! enactm5t ( ?is ,act4 7#b7 ,relation to title #e ,) respect to ! removal or transf] ( an individual 7z t t]m is def9$ 9 su* section #gac7 employ$ at ! ,dep>tm5t ( ,vet]ans ,affairs1 ! au?ority provid$ by su* section #gac is 9 addition to ! au?ority provid$ by section #ceib or sub*apt] ,v ( *apt] #ge ( title #e1 ,unit$ ,/ates ,code4 ,,viii ,o!r ,matt]s #hja4 ,appropriation ( am\nts 7a7 ,9 g5]al ,!re is au?oriz$ to be appropriat$1 & is appropriat$1 to ! ,secret>y ( ,vet]ans ,affairs1 out ( any funds 9 ! ,treasury n o!rwise appropriat$ #e1jjj1jjj1jjj to c>ry out subsection 7b74 ,su* funds %all be available = obligation or exp5diture )\t fiscal ye> limitation4 7b7 ,use ( am\nts ,! am\nt appropriat$ "u subsection 7a7 %all be us$ by ! ,secret>y z foll[s3 7#a7 ,to increase ! access ( vet]ans to c>e z foll[s3 7,a7 ,to hire prim>y c>e & specialty c>e physicians = employm5t 9 ! ,dep>tm5t ( ,vet]ans ,affairs4 7,b7 ,to hire o!r m$ical /aff1 includ+ ! foll[+3 7i7 ,physicians4 7ii7 ,nurses4 7iii7 ,social work]s4 7iv7 ,m5tal heal? pr(essionals4 7v7 ,o!r heal? c>e pr(essionals z ! ,secret>y consid]s appropriate4 7,c7 ,to c>ry out sections #cja & #cjb1 includ+ ! am5dm5ts made by su* sections4 7,d7 ,to pay = exp5ses1 equipm5t1 & o!r co/s associat$ ) ! hir+ ( prim>y c>e1 specialty c>e physicians1 & o!r m$ical /aff "u subp>agraphs 7,a71 7,b71 & 7,c74 7#b7 ,to improve ! physical infra/ructure ( ! ,dep>tm5t z foll[s3 7,a7 ,to ma9ta9 & op]ate hospitals1 nurs+ homes1 domicili>y facilities1 & o!r facilities ( ! ,vet]ans ,heal? ,adm9i/ration4 7,b7 ,to ent] into contracts or hire tempor>y employees to repair1 alt]1 or improve facilities "u ! jurisdiction ( ! ,dep>tm5t t are n o!rwise provid$ = "u ?is p>agraph4 7,c7 ,to c>ry out leases = facilities ( ! ,dep>tm5t4 7,d7 ,to c>ry out m9or con/ruction projects ( ! ,dep>tm5t4 7c7 ,availability ,! am\nt appropriat$ "u subsection 7a7 %all rema9 available until exp5d$4 7d7 ,report 7#a7 ,9 g5]al ,n lat] ?an #a ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,vet]ans ,affairs %all submit to ! appropriate committees ( ,congress a report on h[ ! ,secret>y has obligat$ ! am\nts appropriat$ "u subsection 7a7 z ( ! date ( ! submittal ( ! report4 7#b7 ,appropriate committees ( ,congress def9$ ,9 ?is subsection1 ! t]m appropriate committees ( ,congress means-- 7,a7 ! ,committee on ,vet]ans' ,affairs & ! ,committee on ,appropriations ( ! ,s5ate2 & 7,b7 ! ,committee on ,vet]ans' ,affairs & ! ,committee on ,appropriations ( ! ,h\se ( ,repres5tatives4 7e7 ,fund+ plan ,! ,secret>y %all submit to ,congress a fund+ plan describ+ h[ ! ,secret>y int5ds to use ! am\nts provid$ "u subsection 7a74 #hjb4 ,vet]ans ,*oice ,fund 7a7 ,9 g5]al ,!re is e/abli%$ 9 ! ,treasury ( ! ,unit$ ,/ates a fund to be kn[n z ! ,vet]ans ,*oice ,fund4 7b7 ,adm9i/ration ( fund ,! ,secret>y ( ,vet]ans ,affairs %all adm9i/] ! ,vet]ans ,*oice ,fund e/abli%$ by subsection 7a74 7c7 ,use ( am\nts 7#a7 ,9 g5]al ,any am\nts deposit$ 9 ! ,vet]an ,*oice ,fund %all be us$ by ! ,secret>y ( ,vet]ans ,affairs to c>ry out section #aja1 includ+1 subject to p>agraph 7#b71 any adm9i/rative requirem5ts ( su* section4 7#b7 ,am\nt = adm9i/rative requirem5ts 7,a7 ,limitation ,except z provid$ by subp>agraph 7,b71 ( ! am\nts deposit$ 9 ! ,vet]ans ,*oice ,fund1 n m ?an #cjj1jjj1jjj may be us$ = adm9i/rative requirem5ts to c>ry out section #aja4 7,b7 ,increase ,! ,secret>y may increase ! am\nt set =? 9 subp>agraph 7,a7 ) respect to ! am\nts us$ = adm9i/rative requirem5ts if-- 7i7 ! ,secret>y det]m9es t ! am\nt ( su* increase is necess>y to c>ry out section #aja2 7ii7 ! ,secret>y submits to ! ,committees on ,vet]ans' ,affairs & ,appropriations ( ! ,h\se ( ,repres5tatives & ! ,committees on ,vet]ans' ,affairs & ,appropriations ( ! ,s5ate a report describ$ 9 subp>agraph 7,c72 & 7iii7 a p]iod ( #fj days has elaps$ foll[+ ! date on :i* ! ,secret>y submits ! report "u clause 7ii74 7,c7 ,report ,a report describ$ 9 ?is subp>agraph is a report t conta9s ! foll[+3 7i7 ,a notification ( ! am\nt ( ! increase t ! ,secret>y det]m9es necess>y "u subp>agraph 7,b77i74 7ii7 ,! ju/ifications = su* increas$ am\nt4 7iii7 ,! adm9i/rative requirem5ts t ! ,secret>y w c>ry out us+ su* increas$ am\nt4 7d7 ,appropriation & deposit ( am\nts 7#a7 ,9 g5]al ,!re is au?oriz$ to be appropriat$1 & is appropriat$1 to ! ,secret>y ( ,vet]ans ,affairs1 out ( any funds 9 ! ,treasury n o!rwise appropriat$ #aj1jjj1jjj1jjj to be deposit$ 9 ! ,vet]ans ,*oice ,fund e/abli%$ by subsection 7a74 ,su* funds %all be available = obligation or exp5diture )\t fiscal ye> limitation1 & only = ! program creat$ "u section #aja4 7#b7 ,availability ,! am\nt appropriat$ "u p>agraph 7#a7 %all rema9 available until exp5d$4 7e7 ,s5se ( ,congress ,x is ! s5se ( ,congress t ! ,vet]ans ,*oice ,fund is a supplem5t to b di/9ct f ! ,dep>tm5t ( ,vet]ans ,affairs' curr5t & expect$ level ( non-,dep>tm5t c>e curr5tly "p ( ,dep>tm5t's m$ical c>e budget4 ,congress expects t ! ,dep>tm5t w ma9ta9 at lea/ its exi/+ obligations ( non-,dep>tm5t c>e programs 9 addition to b di/9ct f ! ,vet]ans ,*oice ,fund = ea* ( fiscal ye>s #bjae ?r\gh #bjag4 #hjc4 ,em]g5cy designations 7a7 ,9 g5]al ,?is ,act is designat$ z an em]g5cy requirem5t pursuant to section #d7;g7 ( ! ,/atutory ,pay-,z-,y-,g ,act ( #bjaj 7#b ,u4,s4,c4 #icc7;g774 7b7 ,designation 9 ,s5ate ,9 ! ,s5ate1 ?is ,act is designat$ z an em]g5cy requirem5t pursuant to section #djc7;a7 ( ,s4 ,con4 ,res4 #ac 7#aaa? ,congress71 ! concurr5t resolution on ! budget = fiscal ye> #bjaj4 ,speak] ( ! ,h\se ( ,repres5tatives4 ,vice ,presid5t ( ! ,unit$ ,/ates & ,presid5t ( ! ,s5ate4