Library / Laws / 113th / s / S. 2422 / Placed on Calendar (Senate)
II
Calendar No. 408
113th CONGRESS
2d Session
S. 2422
IN THE SENATE OF THE UNITED STATES
June 3, 2014
Mr. Sanders (for himself, Mr. Rockefeller, Mr. Begich, Mrs. Shaheen, Mr. Kaine, Mr. Reed, Mr. Merkley, Mr. Casey, Mr. Whitehouse, Mr. Blumenthal, Mr. Heinrich, Mr. Udall of New Mexico, Mr. Schatz, Ms. Baldwin, Mr. Wyden, Mr. Leahy, Mr. Brown, Ms. Heitkamp, Ms. Landrieu, Mr. Booker, Mr. Durbin, Mr. Schumer, Ms. Hirono, Mr. Harkin, Mr. Coons, Mr. Markey, Ms. Klobuchar, Mr. Walsh, Mr. Tester, and Mr. Menendez) introduced the following bill; which was read the first time
June 4, 2014Read the second time and placed on the calendar
A BILL
To improve the access of veterans to medical services from the Department of Veterans Affairs, and
for other purposes.
1.
Short title; table of contents
(a)
Short title
This Act may be cited as the Ensuring Veterans Access to Care Act of 2014.
(b)
Table of contents
The table of contents for this Act is as follows:
Sec. 1. Short title; table of contents.
TITLE I—Improvement of Scheduling System for Health Care Appointments
Sec. 101. Implementation of upgraded Department of Veterans Affairs electronic scheduling system
for appointments for receipt of health care from the Department.
Sec. 102. Independent assessment of the scheduling process for medical appointments for care from
Department of Veterans Affairs.
TITLE II—Training and Hiring of Health Care Staff
Sec. 201. Modification of liability for breach of period of obligated service under Health
Professionals Educational Assistance Program for primary care physicians.
Sec. 202. Program of education at Uniformed Services University of the Health Sciences with
specialization in primary care.
Sec. 203. Treatment of staffing shortage and biannual report on staffing of medical facilities of
the Department of Veterans Affairs.
Sec. 204. Clinic management training program of the Department of Veterans Affairs.
Sec. 205. Inclusion of Department of Veterans Affairs facilities in National Health Service Corps
Scholarship and loan repayment programs.
Sec. 206. Authorization of emergency appropriations.
TITLE III—Improvement of Access to Care from Non-Department of Veterans Affairs Providers
Sec. 301. Improvement of access by veterans to health care from non-Department of Veterans Affairs
providers.
Sec. 302. Extension of and report on joint incentives program of Department of Veterans Affairs and
Department of Defense.
Sec. 303. Transfer of authority for payments for hospital care, medical services, and other health
care from non-Department providers to the Chief Business Office of the
Veterans Health Administration of the Department.
Sec. 304. Enhancement of collaboration between Department of Veterans Affairs and Indian Health
Service.
Sec. 305. Enhancement of collaboration between Department of Veterans Affairs and Native Hawaiian
health care systems.
Sec. 306. Authorization of emergency appropriations.
TITLE IV—Health Care Administrative Matters
Sec. 401. Improvement of access of veterans to mobile vet centers of the Department of Veterans
Affairs.
Sec. 402. Commission on Access to Care.
Sec. 403. Commission on Capital Planning for Department of Veterans Affairs Medical Facilities.
Sec. 404. Removal of Senior Executive Service employees of the Department of Veterans Affairs for
performance.
TITLE V—Major Medical Facility Leases
Sec. 501. Authorization of major medical facility leases.
Sec. 502. Budgetary treatment of Department of Veterans Affairs major medical facilities leases.
I
Improvement of Scheduling System for Health Care Appointments
101.
Implementation of upgraded Department of Veterans Affairs electronic scheduling system for
appointments for receipt of health care from the Department
(a)
Implementation
(1)
In general
Not later than March 31, 2016, the Secretary of Veterans Affairs shall fully implement an
upgraded
and centralized electronic scheduling system described in subsection (b)
for appointments
by eligible individuals for health care from the Department of Veterans
Affairs.
(2)
Agile software development methodologies
In implementing the upgraded electronic scheduling system required by paragraph (1), the Secretary
shall use agile software development methodologies to fully implement
portions of such system every 180 days beginning on the date on which the
Secretary begins the implementation of such system, or enters into a
contract for the implementation of such system, and ending on the date on
which such system is fully
implemented.
(b)
Electronic scheduling system
The upgraded electronic scheduling system described in this subsection shall include mechanisms to
achieve the following:
(1)
An efficient and effective graphical user interface with a calendar view for use by employees of
the Department in scheduling appointments that enables error-free
scheduling of the health care resources of the Department.
(2)
A capability to assist employees of the Department to easily and consistently implement policies of
the Department with respect to scheduling of appointments, including with
respect to priority for appointments for certain eligible individuals.
(3)
A capability for employees of the Department to sort and view through a unified interface the
availability for each health care
provider of the Department or other health care resource of the
Department.
(4)
A capability for employees of the Department to sort and view appointments for and appointment
requests made by a particular eligible individual.
(5)
A capability for seamless coordination of appointments for primary care, specialty care,
consultations, or any other health care matter among facilities of the
Department.
(6)
A capability for eligible individuals to access the system remotely and schedule appointments
directly through the system.
(7)
An electronic timestamp of each activity made by an eligible individual or on behalf of such
individual with respect to an appointment or the scheduling of an
appointment that shall be kept in the medical record of such individual.
(8)
A seamless connection to the Computerized Patient Record System of the Department so that employees
of the Department, when scheduling an appointment for an eligible
individual, have access to recommendations from the health care provider
of such individual with respect to when such individual should receive an
appointment.
(9)
A capability to provide automated reminders to eligible individuals on upcoming appointments
through various electronic and voice media.
(10)
A capability to provide automated reminders to employees of the Department when an eligible
individual who is on the wait-list for an appointment becomes eligible to
schedule an appointment.
(11)
A dashboard capability to support efforts to track the following metrics in aggregate and by
medical facility with respect to health care provided
to eligible
individuals under the laws administered by the Secretary:
(A)
The number of days into the future that the schedules of health care providers are available to
schedule an appointment.
(B)
The number of providers available to see patients each day.
(C)
The number of support personnel working each day.
(D)
The types of appointments available.
(E)
The rate at which patients fail to appear for appointments.
(F)
The number of appointments canceled by a patient on a daily basis.
(G)
The number of appointments canceled by a health care provider on a daily basis.
(H)
The number of patients on the wait list at any given time.
(I)
The number of appointments scheduled on a daily basis;
(J)
The number of appointments available to be scheduled on a daily basis.
(K) The number of patients seen on a daily, weekly, and monthly basis.
(L)
Wait-times for an appointment with a health care provider of the Department.
(M)
Wait-times for an appointment with a non-Department health care provider.
(N)
Wait-times for a referral to a specialist or consult.
(12)
A capability to provide data on the capacity of medical facilities of the Department for purposes
of determining the resources needed by the Department to provide health
care to eligible individuals.
(13)
Any other capabilities as specified by the Secretary for purposes of this section.
(c)
Plan
(1)
In general
Not later than 90 days after the date of the enactment of this Act, the Secretary shall submit to
the Committee on Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives a plan for implementing
the upgraded electronic scheduling system required by subsection (a).
(2)
Elements
The plan required by paragraph (1) shall include the following:
(A)
A description of the priorities of the Secretary for implementing the requirements of the system
under subsection (b).
(B)
A detailed description of the manner in which the Secretary will fully implement such system,
including deadlines for completing each such requirement.
(3)
Update
Not later than 90 days after the submittal of the plan required by paragraph (1), and not less
frequently than every 90 days thereafter until such system is fully
implemented, the Secretary shall submit to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans' Affairs of the House
of Representatives an update on the status of the implementation of such
plan.
(d)
Use of amounts
The Secretary may use amounts available to the Department of Veterans Affairs for the
appropriations account under the heading Medical
Services in implementing and carrying out the upgraded electronic scheduling system required by subsection
(a).
(e)
Eligible individual defined
In this section, the term eligible individual means an individual eligible for hospital, nursing home, domiciliary, medical care, or other
health care under the laws administered by the Secretary of Veterans
Affairs.
102.
Independent assessment of the scheduling process for medical appointments for care from Department
of Veterans Affairs
(a)
Independent assessment
(1)
Contract
Not later than 30 days after the date of the enactment of this Act, the Secretary of Veteran
Affairs shall enter into a
contract with an independent third party to assess the process at each
medical facility of the Department of Veterans Affairs for scheduling
appointments for veterans to receive hospital care, medical services, or
other health care from the Department.
(2)
Elements
In carrying out the assessment required by paragraph (1), the independent third party shall do the
following:
(A)
Review all training materials pertaining to scheduling of appointments at each medical facility of
the Department.
(B)
Assess whether all employees of the Department conducting tasks related to scheduling are properly
trained for conducting such tasks.
(C)
Assess whether changes in the technology or system used in scheduling appointments are necessary to
limit access to the system to only those employees that have been
properly trained in conducting such tasks.
(D)
Assess whether health care providers of the Department are making changes to their schedules that
hinder the ability of employees conducting such tasks to perform such
tasks.
(E) Assess whether the establishment of a centralized call center throughout the Department for
scheduling appointments at medical facilities of the Department would
improve the process of scheduling such appointments.
(F) Assess whether booking templates for each medical facility or clinic of the Department would
improve the process of scheduling such appointments.
(G)
Recommend any actions to be taken by the Department to improve the process for scheduling
such appointments, including the following:
(i)
Changes in training materials provided to employees of the Department with respect to conducting
tasks related to scheduling such appointments.
(ii)
Changes in monitoring and assessment conducted by the Department of wait-times of veterans for such
appointments.
(iii)
Changes in the system used to schedule such appointments, including changes to improve how the
Department—
(I)
measures wait-times of veterans for such appointments;
(II)
monitors the availability of health care providers of the Department; and
(III)
provides veterans the ability to schedule such appointments.
(iv)
Such other actions as the independent third party considers appropriate.
(3)
Timing
The independent third party carrying out the assessment required by paragraph (1) shall complete
such assessment not later than 180 days after entering into the contract
described in such paragraph.
(b)
Report
Not later than 90 days after the date on which the independent third party completes the assessment
under this section, the Secretary shall submit to the Committee on
Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of
the House of Representatives a report on the results of such assessment.
II
Training and Hiring of Health Care Staff
201.
Modification of liability for breach of period of obligated service under Health Professionals
Educational Assistance Program for primary care
physicians
Section 7617 of title 38, United States Code, is amended—
(1) In subsection (c)(1), by striking If a participant and inserting Except as provided in subsection (d), if a participant; and
(2) by adding at the end the following new subsection:
(d)
Liability shall not arise under subsection (c) in the case of a participant otherwise covered by
that subsection who has pursued a course of education or training in
primary care if—
(1)
the participant—
(A)
does not obtain, or fails to maintain, employment as a Department employee due to staffing changes
approved by the Under Secretary for Health; or
(B)
does not obtain, or fails to maintain, employment in a position of primary care physician in the
Veterans Health Administration due, as determined by the Secretary, to a
number of primary care physicians in the Administration that is excess to
the needs of the Administration; and
(2) the participant agrees to accept and maintain employment as a primary care physician with
another department or agency of the Federal Government (with such
employment to be under such terms and conditions as are jointly agreed
upon by the participant, the Secretary, and the head of such department or
agency, including terms and conditions relating to a period of obligated
service as a primary care physician with such department or agency) if
such employment is offered to the participant by the Secretary and the
head of such department or agency.
.
202.
Program of
education at Uniformed Services
University of the Health Sciences with specialization in primary care
(a)
Program required under Health Professionals Educational Assistance Program
(1)
In
general
Chapter 76 of title 38, United States Code, is amended by
adding after subchapter VII the following new subchapter:
VIII
Program of
Education at Uniformed Services University of the Health Sciences With
Specialization in Primary Care
7691.
Authority for
program
As part of the
Educational Assistance Program, the Secretary shall, in collaboration with the
Secretary of Defense, carry out a program to permit individuals to enroll in
the Uniformed Services University of the Health Sciences under chapter 104 of
title 10 to pursue a medical education with a specialization in primary care.
The program shall be known as the Department of Veterans Affairs Primary Care
Educational Assistance Program (in this chapter referred to as the
Primary Care Educational Assistance Program).
7692.
Selection;
agreement; ineligibility for certain other educational assistance
(a)
Selection
(1)
Medical students at the
Uniformed Services University of the Health Sciences pursuant to the Primary
Care Educational Assistance Program shall be selected by the Secretary, in
consultation with the Secretary of Defense, in accordance with procedures
established by the
Secretaries for purposes of the Program.
(2)
The procedures referred to in
paragraph (1) shall emphasize the basic requirement that students demonstrate a
motivation and dedication to a medical career in primary care.
(3)
The number of medical students selected each year for first-year enrollment in the University
pursuant to this subsection shall be jointly determined by the Secretary
and the Secretary of Defense.
(b)
Agreement
An
agreement between the Secretary and a participant in the Primary Care
Educational Assistance Program shall (in addition to the requirements set forth
in section 7604 of this title) include the following:
(1)
The Secretary's
agreement to cover the costs of the participant's education and training at the
Uniformed Services University of the Health Sciences under chapter 104 of title
10 as if the participant were a medical student enrolled in the University
pursuant to section 2114 of title 10.
(2)
The participant's
agreement to serve as a full-time employee in the Veterans Health
Administration in a position as a primary care physician for a period of time (in
this subchapter referred to as the period of obligated service)
of one calendar year for each school year or part thereof for which the
participant was a medical student at the Uniformed Services University of the
Health Sciences pursuant to the Primary Care Educational Assistance Program,
but for not less than one year.
(c)
Ineligibility
for other educational assistance
An individual who receives
education and training under the Primary Care Educational Assistance Program
shall not be eligible for other assistance under this chapter in connection
with such education and training.
7693.
Obligated
service
(a)
In
general
Each participant in the Primary Care Educational
Assistance Program shall provide service
as a full-time employee of the Department in the Veterans Health Administration
in a primary care position for the period of obligated service provided in the
agreement of the participant entered into for purposes of this subchapter.
Such service shall be provided in a full-time primary care clinical practice
in an assignment or location determined by
the Secretary.
(b)
Service commencement date
(1)
Not later than 60 days before a participant's service commencement date, the Secretary shall notify
the participant of that service commencement date. That date is the date
for the beginning of the participant's period of obligated service.
(2)
As soon as possible after a participant's service commencement date, the Secretary shall—
(A)
in the case of a participant who is not a full-time employee in the Veterans Health Administration,
appoint the participant as such an employee; and
(B)
in the case of a participant who is an employee in the Veterans Health Administration but is not
serving in a position for which the participant's course of education or
training prepared the participant, assign the participant to such a
position.
(3)
A participant's service commencement for purposes of this subsection date is the date upon which
the participant becomes licensed to practice medicine in a State.
(c)
Commencement of obligated service
A participant in the Primary Care Educational Assistance Program shall be considered to have begun
serving the participant's period of obligated service—
(1)
on the date on which the participant is appointed as a full-time employee in the Veterans Health
Administration pursuant to subsection (b)(2)(A); or
(2)
if the participant is a full-time employee in the Veterans Health Administration and assigned to a
position pursuant to subsection (b)(2)(B), on the date on which the
participant is so assigned to such position.
7694.
Breach of
agreement: liability
(a)
Liability during course of education or training
(1)
A participant in the Primary Care Educational Assistance Program shall be liable to the United
States for the amount which has been paid on behalf of the participant
under the agreement entered into for purposes of this subchapter if any of
the following occurs:
(A)
The participant fails to maintain an acceptable level of academic standing in the Uniformed
Services University of the Health Sciences.
(B)
The participant is dismissed from the Uniformed Services University of the Health Sciences for
disciplinary reasons.
(C)
The participant voluntarily terminates the course of medical education and training in the
Uniformed Services University of the Health Sciences before the completion
of such course of education and training.
(D)
The participant fails to become licensed to practice medicine in a State during a period of time
determined under regulations prescribed by the Secretary.
(2)
Liability under this subsection is in lieu of any service obligation arising under a participant's
agreement for purposes of this subchapter.
(b)
Liability during period of obligated service
(1)
Except as provided in subsection (c) and subject to paragraph (2), if a participant in the Primary
Care Educational Assistance Program breaches the agreement entered into
for purposes of this subchapter by failing for any reason to complete the
participant's period of obligated service, the United States shall be
entitled to recover from the participant an amount equal to—
(A)
the total amount paid under this subchapter on behalf of the participant; multiplied by
(B)
a fraction—
(i)
the numerator of which is—
(I)
the total number of months in the participant's period of obligated service; minus
(II)
the number of months served by the participant pursuant to the agreement; and
(ii)
the denominator of which is the total number of months in the participant's period of obligated
service.
(2)
Any period of internship or residency training of a participant shall not be treated as satisfying
the participant's period of obligated service for purposes of this
subsection.
(c)
Exceptions
Liability shall not arise under subsection (b) in the case of a participant otherwise covered by
that subsection if—
(1)
the participant—
(A)
does not obtain, or fails to maintain, employment as a Department employee due to staffing changes
approved by the Under Secretary for Health; or
(B)
does not obtain, or fails to maintain, employment in a position of primary care physician in the
Veterans Health Administration due, as determined by the Secretary, to a
number of primary care physicians in the Administration that is excess to
the needs of the Administration; and
(2)
the participant agrees to accept and maintain employment as a primary care physician with
another department or agency of the Federal Government (with such
employment to be under such terms and conditions as are jointly agreed
upon by the participant, the Secretary, and the head of such department or
agency, including terms and conditions relating to a period of obligated
service as a primary care physician with such department or agency) if
such employment is offered to the participant by the Secretary and the
head of such department or agency.
7695.
Funding
(a)
In general
Amounts for the Primary Care Educational Assistance Program shall be derived from amounts available
to the Secretary for the Veterans Health Administration.
(b)
Transfer
(1)
The Secretary shall
transfer to the Secretary of Defense amounts required by the Secretary of
Defense to carry out the Primary Care Educational Assistance Program.
(2)
Amounts transferred to the Secretary of Defense pursuant to paragraph (1) shall be credited to the
appropriation or account providing funding for the Uniformed Services
University of the Health Sciences. Amounts so credited shall be merged
with amounts in the appropriation or account to which credited and shall
be available, subject to the terms and conditions applicable to such
appropriation or account, for the Uniformed Services University of the
Health Sciences.
.
(2)
Clerical
amendment
The table of sections at the beginning of chapter 76 of such title is amended by adding after the
item relating
to section 7684 the
following:
SUBCHAPTER VIII—Program of Education at Uniformed Services University of the Health Sciences With
Specialization in Primary Care
7691. Authority for program.
7692. Selection; agreement; ineligibility for certain other educational assistance.
7693. Obligated service.
7694. Breach of agreement: liability.
7695. Funding.
.
(b)
Inclusion of
program in Health Professionals Educational Assistance
Program
Section 7601(a) of such title is
amended—
(1)
in paragraph (4),
by striking ; and and inserting a semicolon;
(2)
in paragraph (5),
by striking the period at the end and inserting ; and;
and
(3)
by adding at the
end the following new paragraph:
(6)
the enrollment of
individuals in the Uniformed Services University
of the Health Sciences for specialization in primary care provided for
in subchapter VIII of this
chapter.
.
(c)
Application requirements
(1)
In general
Subsection (a)(1) of section 7603 of such title is amended in the matter
preceding subparagraph (A) by striking , or VI and inserting
, VI, or VIII.
(2)
No priority for applications
Subsection (d) of such section is amended—
(A)
by striking In selecting and inserting (1) Except as provided in paragraph (2), in selecting; and
(B)
by adding at the end the following new paragraph:
(2)
Paragraph (1) shall not apply with respect to applicants for participation in the Program of
Education at Uniformed Services
University of the Health Sciences With Specialization in Primary Care pursuant to
subchapter VIII of this chapter.
.
(d)
Agreement requirements
Section 7604 of such title is amended by striking , or VI each place
it appears and inserting , VI, or VIII.
203.
Treatment of staffing shortage and biannual report on staffing of medical facilities of the
Department of Veterans Affairs
(a)
Staffing shortage
(1)
In general
Not later than 180 days after the date of the enactment of this Act, and not later than September
30 each year thereafter, the Secretary of Veterans Affairs shall
determine, and publish in the Federal
Register, the five occupations of health care providers of
the Department of Veterans Affairs for which there is the largest staffing
shortage throughout the Department.
(2)
Recruitment and appointment
Notwithstanding sections 3304 and 3309 through 3318 of title 5, United States Code, the Secretary
may, upon a determination by the Secretary under paragraph (1) or a
modification to such determination under paragraph (2), that there
is a staffing shortage throughout the Department with respect to a
particular occupation of health care provider, recruit and directly
appoint highly qualified health care providers to a position to serve as a
health care provider in that particular occupation for the Department.
(3)
Priority in Health Professionals Educational Assistance Program to certain
providers
Section 7612(b)(5) of title 38, United States Code, is amended—
(A) in subparagraph (A), by striking and at the end;
(B) by redesignating subparagraph (B) as subparagraph (C); and
(C) by inserting after subparagraph (A) the following new subparagraph (B):
(B) shall give priority to applicants pursuing a course of education or training towards a career in an
occupation for which the Secretary has, in the most current determination
published in the Federal Register pursuant to section 203(a)(1) of the Ensuring Veterans Access to Care Act of 2014, determined that there is one of the largest staffing shortage throughout the Department with
respect to such occupation; and
.
(b)
Reports
(1)
In general
Not later than 180 days after the date of the enactment of this Act, and not later than December 31
of each even
numbered year thereafter until 2024, the Secretary of Veterans Affairs
shall submit to the
Committee on Veterans’ Affairs of the Senate and the Committee on
Veterans’ Affairs of the House of Representatives a report
assessing the staffing of each medical facility of the Department of
Veterans Affairs.
(2)
Elements
Each report submitted under paragraph (1) shall include the following:
(A)
The results of a system-wide assessment of all medical facilities of the Department to ensure the
following:
(i)
Appropriate staffing levels for health care providers to meet the goals of the Secretary for timely
access to care for veterans.
(ii)
Appropriate staffing levels for support personnel, including clerks.
(iii)
Appropriate sizes for clinical panels.
(iv)
Appropriate numbers of full-time staff, or full-time equivalent, dedicated to direct care of
patients.
(v)
Appropriate physical plant space to meet the capacity needs of the Department in that area.
(vi)
Such other factors as the Secretary considers necessary.
(B)
A plan for addressing any issues identified in the assessment described in subparagraph (A),
including a timeline for
addressing such issues.
(C)
A list of the current wait times and workload levels for the following clinics in each medical
facility:
(i)
Mental health.
(ii)
Primary care.
(iii)
Gastroenterology.
(iv)
Women’s health.
(v)
Such other clinics as the Secretary considers appropriate.
(D)
A description of the results of the determination of the Secretary under paragraph (1) of
subsection (a) and a plan to use direct appointment authority under
paragraph (2) of such subsection to fill staffing shortages, including
recommendations for improving the speed at which the credentialing and
privileging process can be
conducted.
(E)
The current staffing models of the Department for the following clinics, including recommendations
for
changes to such models:
(i)
Mental health.
(ii)
Primary care.
(iii)
Gastroenterology.
(iv)
Women’s health.
(v)
Such other clinics as the Secretary considers appropriate.
(F)
A detailed analysis of succession planning at medical facilities of the Department, including the
following:
(i)
The number of positions in medical facilities throughout the Department that are not filled by a
permanent
employee.
(ii)
The length of time each such position described in clause (i) remained vacant or filled by a
temporary or acting employee.
(iii)
A description of any barriers to filling the positions described in clause (i).
(iv)
A plan for filling any positions that are vacant or filled by a temporary or acting employee for
more than 180
days.
(v)
A plan for handling emergency circumstances, such administrative leave or sudden medical leave for
senior officials.
(G) The number of health care providers who have been removed from their position or have retired, by
provider type, during the two-year period preceding the submittal of the
report.
(H) Of the health care providers specified in subparagraph (G) that have been removed from their
position, the following:
(i) The number of such health care providers who were reassigned to another position in the Department.
(ii) The number of such health care providers who left the Department.
204.
Clinic management training program of the Department of Veterans Affairs
(a)
In general
Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans
Affairs shall implement
a clinic management training program to provide in-person, standardized
education on health care management to all managers of, and health care
providers at, medical facilities of the Department of Veterans Affairs.
(b)
Elements
The clinic management training program required by subsection (a) shall include the following:
(1)
Training on how to manage the schedules of health care providers of the Department, including the
following:
(A)
Maintaining such schedules in a manner that allows appointments to be booked at
least eight weeks in advance.
(B)
Proper planning procedures for vacation,
leave, and graduate medical education training schedules.
(2)
Training on the appropriate number of appointments that a health care provider should conduct on a
daily basis, based on
specialty.
(3)
Training on how to determine whether there are enough available appointment slots to manage demand
for
different appointment types and mechanisms for alerting management of
insufficient slots.
(4)
Training on how to properly use the data produced by the scheduling dashboard required by
section 101(b)(11) of this Act to meet demand for health care, including
the
following:
(A)
Training on determining the next available appointment for each health care provider at the medical
facility.
(B)
Training on determining the number of health care providers needed to meet demand for health care
at the medical facility.
(C)
Training on determining the number of exam rooms needed to meet demand for such health care in an
efficient manner.
(5)
Training on how to properly use the appointment scheduling system of the Department, including any
new scheduling system implemented by the Department.
(6)
Training on how to optimize the use of technology, including the following:
(A)
Telemedicine.
(B)
Electronic mail.
(C)
Text messaging.
(D)
Such other technologies as specified by the Secretary.
(7)
Training on how to properly use physical plant space at medical facilities of the Department to
ensure efficient flow and privacy for patients and
staff.
205.
Inclusion of Department of Veterans Affairs facilities in National Health Service Corps Scholarship
and loan repayment programs
(a)
In general
The Secretary of Health and Human Services shall use the funds transferred under subsection (e) to
award scholarship and loan repayment contracts under sections 338A and
338B of the Public Health Service Act (42 U.S.C. 254l, 254l–1) to eligible
individuals who agree to a period of obligated service under section
338A(f)(1) or 338B(f)(1) of such Act, as applicable, at a health facility
of the Department of Veterans Affairs.
(b)
Health professional shortage areas
For purposes of selecting individuals eligible for the scholarships and loan repayment contracts
under subsection (a), all health facilities of the Department of Veterans
Affairs shall be deemed health professional shortage areas, as defined in
section 332 of the Public Health Service Act (42 U.S.C. 254e).
(c)
Requirement
The Secretary of Health and Human Services shall ensure that a minimum of 5 scholarships or loan
repayment contracts are awarded to individuals who agree to a period of
obligated service at Veterans Affairs facilities in each State.
(d)
Applicability of NHSC program requirements
Except as otherwise provided in this section, the terms of the National Health Service Corps
Scholarship Program and the National Health Service Corps Loan Repayment
Program shall apply to participants awarded a grant or loan repayment
contract under subsection (a) in the same manner that such terms apply to
participants awarded a grant or loan repayment contract under section 338A
or 338B of the Public Health Service Act.
(e)
Inclusion of geriatricians
For purposes of awarding scholarships and loan repayments contracts to eligible
individuals who agree to a period of obligated service at a health
facility
of the Department of Veterans Affairs pursuant to this section, in
sections 338A and
338B of the Public Health Service Act (42 U.S.C. 254l, 254l–1), the term primary health services shall include geriatrics.
(f)
Funding
The Secretary of Veterans Affairs shall
transfer $20,000,000 for fiscal year 2014, and such sums as may be
necessary for each fiscal year thereafter, from accounts of the Veterans
Health Administration
to the
Secretary of Health and Human Services to award scholarships and loan
repayment contracts, as described in subsection (a). All funds so
transferred shall be used exclusively for the purposes described in such
subsection.
206.
Authorization of emergency appropriations
There is authorized to be appropriated for the Department of Veterans Affairs such sums as may be
necessary to carry out this title.
III
Improvement of Access to Care from Non-Department of Veterans Affairs Providers
301.
Improvement of access by veterans to health care from non-Department of Veterans Affairs providers
(a)
Improvement of access
(1)
In general
The Secretary of Veterans
Affairs shall ensure timely access of all
veterans to the hospital care, medical services, and other health care for
which such veterans are
eligible under the laws administered by the Secretary through the enhanced
use of authorities specified in paragraph (2) on the provision of such
care and services through non-Department of Veterans Affairs providers
(commonly referred to as non-Department of Veterans Affairs medical care).
(2)
Authorities on provision of care through non-Department providers
The authorities specified in this paragraph are the following:
(A)
Section 1703 of title 38, United States Code, relating to contracts for the provision of hospital
care and medical services through non-Department facilities.
(B)
Section 1725 of such title, relating to reimbursement of certain veterans for the reasonable value
of emergency treatment at non-Department facilities.
(C)
Section 1728 of such title, relating to reimbursement of certain veterans for customary and usual
charges of emergency treatment from sources other than the Department.
(D)
Section 1786 of such title, relating to health care services furnished to newborn children of women
veterans who are receiving maternity care furnished by the Department at a
non-Department facility.
(E)
Any other authority under the laws administered by the Secretary to provide hospital care, medical
services, or other health care from a
non-Department provider, including the following:
(i) A Federally-qualified health center (as defined in section 1905(l)(2)(B) of the Social
Security Act (42 U.S.C. 1396d(l)(2)(B))).
(ii) The Department of Defense.
(iii) The Indian Health Service.
(3)
Requirements
In ensuring timely access of all veterans to the care and services described in paragraph (1)
through the enhanced use of authorities specified in paragraph (2), the
Secretary shall require the following:
(A)
That each veteran who has not received hospital care, medical services, or other health care from
the Department and is seeking an appointment for primary care under the
laws
administered by the Secretary receive an appointment for primary care at a
time consistent with timeliness measures established by the Secretary for
purposes of providing primary care to all veterans.
(B)
That the determination whether to refer a veteran for specialty care through a non-Department
provider shall take into account the urgency and acuity of such veteran's
need for
such care, including—
(i)
the severity of the condition of such veteran requiring specialty care; and
(ii)
the wait-time for an appointment with a specialist with respect to such condition at the nearest
medical facility of the Department with the capacity to provide such care.
(C)
That the determination whether a veteran shall receive hospital care, medical services, or other
health care from the Department through
facilities of the Department or through non-Department providers pursuant
to the authorities specified in paragraph (2) shall take into account, in
the manner specified by the Secretary, the following:
(i)
The distance the veteran would be required to travel to receive care or services through a
non-Department provider compared to the distance the veteran would be
required to travel to receive care or services from a medical facility of
the
Department.
(ii)
Any factors that might limit the ability of the veteran to
travel, including age, access to transportation, and infirmity.
(iii)
The wait-time for the provision of care or services through a non-Department provider compared to
the
wait-time for the provision of care or services from a medical facility of
the
Department.
(iv) Where the veteran would prefer to receive the care and services described in paragraph (1), unless
the preference of the veteran conflicts with any of the other requirements
of this paragraph.
(D) That the Department maximize the use of hospital care, medical services, and other health care
available to the Department through non-Department
providers, including providers available
to provide such care and services as follows:
(i)
Pursuant to contracts under the Patient-Centered Community Care Program of the Department.
(ii)
Pursuant to contracts between a facility or facilities of the Department and a local facility or
provider.
(iii) Pursuant to contracts with Federally-qualified health centers (as defined in section 1905(l)(2)(B)
of the Social
Security Act (42 U.S.C. 1396d(l)(2)(B))), the Department of Defense, or
the Indian Health Service.
(iv)
On a fee-for-service basis.
(b)
Medical records
In providing hospital care, medical services, and other health care to veterans through
non-Department providers pursuant to the authorities
specified in paragraph (2), the Secretary shall ensure that
any such provider submits to the Department any
medical record related to the care and services provided to a veteran by
that
provider for inclusion in the electronic medical record
of such veteran maintained by the Department upon the completion of the
provision of such care and services to such veteran.
(c)
Reports
(1)
Initial report
Not later than 45 days after the date of the enactment of this Act, the
Secretary shall submit to the Committee on Veterans’ Affairs of the Senate
and the Committee on Veterans’ Affairs of the House of Representatives a
report on the implementation of the requirements under subsection (a) and
(b), including a plan to
enforce
the proper implementation of such requirements systematically throughout
the Department.
(2)
Periodic reports
Not later than 90 days after the submittal of the report required by paragraph (1), and every 90
days
thereafter for one year, the Secretary shall submit to the Committee on
Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of
the House of Representatives a report that includes the following:
(A)
The progress of the Secretary in carrying out the plan under paragraph (1) to enforce
the proper implementation of the requirements under subsection (a) and (b)
systematically throughout
the Department.
(B)
The impact of the implementation of such requirements on wait-times for veterans to receive
hospital care, medical services, and other health care, disaggregated by—
(i)
new patients;
(ii)
existing patients;
(iii)
primary care; and
(iv)
specialty care.
(C)
Any recommendations for changes or improvements to such requirements.
(D)
Any requests for additional funding necessary to carry out such requirements.
302.
Extension of and report on joint incentives program of Department of Veterans Affairs and
Department of Defense
(a)
Extension
Section 8111(d)(3) of title 38, United States Code, is amended by striking September 30, 2015 and inserting September 30, 2020.
(b)
Reports
(1)
Report on implementation of recommendations
Not later than 60 days after the date of the enactment of this Act, the Secretary of Veterans
Affairs and the Secretary of Defense shall jointly submit to Congress a
report on the implementation by the Department of Veterans Affairs and the
Department of Defense of the findings and recommendations of the
Comptroller General of the United States in the September 2012 report
entitled VA and DoD Health Care: Department-Level Actions Needed to Assess Collaboration Performance,
Address Barriers, and Identify Opportunities (GAO–12–992).
(2)
Comptroller General report
(A)
In general
Not later than one year after the date of the enactment of this Act, the Comptroller General of the
United States shall submit to Congress a report assessing and providing
recommendations for improvement to the program to identify, provide
incentives to, implement, fund, and evaluate
creative coordination and sharing initiatives between the Department of
Veterans Affairs and the Department of Defense required under section
8111(d) of such title.
(B)
Elements
The report required by subparagraph (A) shall include the following:
(i) An assessment of the extent to which the program described in subparagraph (A) has accomplished the
goal of such program to improve
the access to, and quality and cost effectiveness of, the health care
provided by the Veterans Health Administration and the Military Health
System to the beneficiaries of both the Department of Veterans Affairs and
the Department of Defense.
(ii)
An assessment of whether administration of such program through the
Health Executive Committee of the Department of Veterans
Affairs-Department of Defense Joint Executive Committee established under
section 320 of such title provides sufficient leadership attention and
oversight to ensure maximum benefits to the Department of Veterans
Affairs and the Department of Defense through collaborative efforts.
(iii)
An assessment of whether additional authorities to jointly construct, lease, or acquire facilities
would facilitate additional collaborative efforts under such program.
(iv)
An assessment of whether the funding for such program is sufficient to ensure consistent
identification of potential opportunities for collaboration and oversight
of existing collaborations to ensure a meaningful partnership between the
Department of Veterans Affairs and the Department of Defense and remove
any barriers to integration or collaboration.
(v)
An assessment of whether existing processes for identifying opportunities for collaboration are
sufficient to ensure maximum collaboration between the Veterans Health
Administration and the Military Health System.
(vi) Such legislative or administrative recommendations for improvement to such program as the
Comptroller General
considers appropriate to enhance the use of such program to increase
access to health care.
303.
Transfer of authority for payments for hospital care, medical services, and other health care from
non-Department providers to the Chief
Business Office of the Veterans Health Administration of the Department
(a)
Transfer of authority
(1)
In general
Effective on October 1, 2014, the Secretary of Veterans Affairs shall transfer the authority to pay
for hospital care, medical services, and other health care through
non-Department providers to the Chief Business Office of the Veterans
Health Administration of the Department of Veterans Affairs from the
Veterans Integrated Service Networks and medical centers of the Department
of Veterans Affairs.
(2)
Manner of care
The Chief Business Office shall work in consultation with the Office of Clinical Operations and
Management of the Department of Veterans Affairs to ensure that care and
services described in paragraph (1) is provided in a manner that is
clinically appropriate and effective.
(3)
No delay in payment
The transfer of authority under paragraph (1) shall be carried out in a manner that does not delay
or impede any payment by the Department for hospital care, medical
services, or other health care provided through a
non-Department provider under the laws administered by the Secretary.
(b)
Budgetary effect
The Secretary shall, for each fiscal year that begins after the date of the enactment of this Act—
(1)
include in the budget for the Chief Business Office of the Veterans Health Administration amounts
to pay for hospital care, medical services, and other health care provided
through non-Department providers, including any amounts necessary to carry
out the transfer of authority to pay for such care and services under
subsection (a), including any increase in staff; and
(2)
not include in the budget of each
Veterans Integrated Service Network and medical center of the Department
amounts to pay for such care and services.
(c)
Removal from performance goals
For each fiscal year that begins after the date of the enactment of this Act, the Secretary shall
not include in the performance goals of any employee of a Veterans
Integrated
Service Network or medical center of the Department any performance goal
that
might disincentivize the payment of Department amounts to provide hospital
care, medical services, or other health care through a non-Department
provider.
304.
Enhancement of collaboration between Department of Veterans Affairs and Indian Health Service
(a)
Outreach to tribal-run medical facilities
The Secretary of Veterans Affairs shall, in consultation with the Director of the Indian Health
Service, conduct outreach to each medical facility operated by an Indian
tribe or tribal organization through a contract or compact with the Indian
Health Service under the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.) to raise awareness of the ability
of such facilities, Indian tribes, and tribal organizations to enter into
agreements with the Department of
Veterans Affairs under which the Secretary reimburses such facilities,
Indian tribes, or tribal organizations, as the case may be, for
health care provided to veterans eligible for health care at such
facilities.
(b)
Metrics for memorandum of understanding performance
The Secretary of Veterans Affairs shall implement performance metrics for assessing the
performance by the Department of Veterans Affairs and the Indian Health
Service under the memorandum of
understanding entitled Memorandum of Understanding between the Department of Veterans Affairs (VA) and the Indian Health
Service (IHS) in increasing access to health care, improving quality and coordination of health care, promoting
effective patient-centered collaboration and partnerships between the
Department and the Service, and ensuring health-promotion and
disease-prevention services are appropriately funded and available for
beneficiaries under both health care systems.
(c)
Report
Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans
Affairs and the Director of the Indian Health Service shall jointly submit
to
Congress a report on the feasibility and advisability of the following:
(1)
Entering into agreements for the reimbursement by the Secretary of the costs of direct care
services provided
through organizations receiving amounts pursuant to grants made or
contracts entered into under section 503 of the Indian Health Care
Improvement Act (25
U.S.C. 1653) to veterans who are otherwise eligible to receive health care
from such organizations.
(2)
Including the reimbursement of the costs of direct care services provided to veterans who
are not Indians in agreements between the Department and the following:
(A) The Indian Health Service.
(B) An Indian tribe or tribal organization operating a medical facility through a contract or compact
with the Indian
Health Service under the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.).
(C) A medical facility of the Indian Health Service.
(d)
Definitions
In this section:
(1)
Indian
The terms Indian and Indian tribe have the meanings given those terms in section 4 of the Indian Health Care Improvement Act (25
U.S.C. 1603).
(2)
Medical facility of the Indian Health Service
The term medical facility of the Indian Health Service includes a facility operated by an Indian tribe or tribal organization through a contract or
compact with the Indian Health Service under the Indian Self-Determination
and Education Assistance Act (25 U.S.C. 450 et seq.).
(3)
Tribal organization
The term tribal organization has the meaning given the term in section 4 of the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450b).
305.
Enhancement of collaboration between Department of Veterans Affairs and Native Hawaiian health care
systems
(a)
In general
The Secretary of Veterans Affairs shall, in consultation with Papa Ola Lokahi and such other
organizations involved in the delivery of health care to Native Hawaiians
as the Secretary considers appropriate, enter into contracts
or agreements with Native Hawaiian health care systems that are in receipt
of funds from
the Secretary of Health and Human Services pursuant to grants awarded or
contracts entered into under section 6(a) of the Native Hawaiian Health
Care Improvement Act (42 U.S.C. 11705(a)) for the reimbursement of direct
care services provided to eligible veterans as specified in such contracts
or agreements.
(b)
Definitions
In this section, the terms Native Hawaiian, Native Hawaiian health care system, and Papa Ola Lokahi have the meanings given those terms in section 12 of the Native Hawaiian Health Care Improvement
Act (42 U.S.C. 11711).
306.
Authorization of emergency appropriations
There is authorized to be appropriated for the Department of Veterans Affairs such sums as may be
necessary to carry out this title.
IV
Health Care Administrative Matters
401.
Improvement of access of veterans to mobile vet centers of the Department of Veterans Affairs
(a)
Improvement of access
(1)
In general
The Secretary of Veterans Affairs shall improve the access of veterans to telemedicine and other
health care through the use of mobile vet centers of the Department of
Veterans Affairs by providing standardized requirements for the operation
of such centers.
(2)
Requirements
The standardized requirements required by paragraph (1) shall include the following:
(A)
The number of days each mobile vet center of the Department is expected to travel per year.
(B)
The number of locations each center is expected to visit per year.
(C)
The number of appointments each center is expected to conduct per year.
(D)
The method and timing of notifications given by each center to individuals in the area to which
such center is traveling, including notifications informing veterans of
the availability to schedule appointments at the center.
(3)
Use of telemedicine
The Secretary shall ensure that each mobile vet center of the Department has the capability to
provide telemedicine services.
(b)
Reports
Not later than one year after the date of the enactment of this Act, and not later than September
30 each year thereafter, the Secretary of Veterans Affairs shall submit to
the Committee on Veterans’ Affairs of the Senate and the Committee on
Veterans’ Affairs of the House of Representatives a report on the
following:
(1)
The use of mobile vet centers to provide telemedicine services to veterans during the year
preceding the submittal of the report, including the following:
(A)
The number of days each mobile vet center was open to provide such services.
(B)
The number of days each mobile vet center traveled to a location other than the headquarters of the
mobile vet center to provide such services.
(C)
The number of appointments each center conducted to provide such services on average per month and
in total during such year.
(2)
An analysis of the effectiveness of using mobile vet centers to provide health care services to
veterans through the use of telemedicine.
(3)
Any recommendations for an increase in the number of mobile vet centers of the Department.
(4)
Any recommendations for an increase in the telemedicine capabilities of each mobile vet center.
(5)
The feasibility and advisability of using temporary health care providers, including locum tenens,
to provide direct health care services to veterans at mobile vet centers.
(6)
Such other recommendations on improvement of the use of mobile vet centers by the Department as the
Secretary considers appropriate.
402.
Commission on Access to Care
(a)
Establishment of commission
(1)
In general
There is established the Commission on Access to Care (in this section referred to as the Commission) to examine the access of veterans to health care from the Department of Veterans Affairs and
strategically examine how best to organize the Veterans Health
Administration, locate health care resources, and deliver health care to
veterans during the next 10 to 20 years.
(2)
Membership
(A)
Voting members
The Commission shall be composed of 10 voting members who are appointed by the President as
follows:
(i) At least two members who represent an organization recognized by the Secretary of Veterans Affairs
for the representation of veterans under section 5902 of title 38, United
States Code.
(ii) At least one member from among persons who are experts concerning a public or private hospital
system.
(iii) At least one member from among persons who are familiar with government health care systems,
including those systems of the Department of Defense, the Indian Health
Service, and Federally-qualified health centers (as defined in section
1905(l)(2)(B) of the Social
Security Act (42 U.S.C. 1396d(l)(2)(B))).
(iv) At least two members from among persons who are familiar with the Veterans Health Administration.
(B)
Nonvoting members
In addition to members appointed under subparagraph (A), the Commission shall be composed of
10 nonvoting members who are appointed by the President as follows:
(i) At least two members who represent an organization recognized by the Secretary of Veterans Affairs
for the representation of veterans under section 5902 of title 38, United
States Code.
(ii) At least one member from among persons who are experts in a public or private hospital system.
(iii) At least one member from among persons who are familiar with government health care systems,
including those systems of the Department of Defense, the Indian Health
Service, and Federally-qualified health centers (as defined in section
1905(l)(2)(B) of the Social
Security Act (42 U.S.C. 1396d(l)(2)(B))).
(iv) At least two members from among persons who are familiar with the Veterans Health Administration.
(C)
Date
The appointments of members of the Commission shall be made not later than 60 days after the date
of the enactment of this Act.
(3)
Period of appointment; vacancies
Members shall be appointed for the life of the Commission. Any vacancy in the Commission shall not
affect its powers, but shall be filled in the same manner as the original
appointment.
(4)
Initial meeting
Not later than 15 days after the date on which seven voting members of the Commission have been
appointed, the Commission shall hold its first meeting.
(5)
Meetings
The Commission shall meet at the call of the Chairperson.
(6)
Quorum
A majority of the members of the Commission shall constitute a quorum, but a lesser number of
members may hold hearings.
(7)
Chairperson and Vice Chairperson
The Commission shall select a Chairperson and Vice Chairperson from among its members.
(b)
Duties of commission
(1)
Evaluation and assessment
The Commission shall undertake a comprehensive evaluation and assessment of access to health care
at the Department of Veterans Affairs.
(2)
Matters evaluated and assessed
The matters evaluated and assessed by the Commission shall include the following:
(A) The appropriateness of current standards of the Department of Veterans Affairs concerning access to
health care.
(B) The measurement of such standards.
(C) The appropriateness of performance standards and incentives in relation to standards described in
subparagraph (A).
(D) Staffing levels throughout the Veterans Health Administration and whether they are sufficient to
meet current demand for health care from the Administration.
(3)
Reports
The Commission shall submit to the President, through the Secretary of Veterans Affairs, reports as
follows:
(A) Not later than 90 days after the date of the initial meeting of the Commission, an interim report
on—
(i) the findings of the Commission with respect to the evaluation and assessment required by this
subsection; and
(ii) such recommendations as the Commission may have for legislative or administrative action to improve
access to health care through the Veterans Health Administration.
(B) Not later than 180 days after the date of the initial meeting of the Commission, a final report on—
(i) the findings of the Commission with respect to the evaluation and assessment required by this
subsection; and
(ii) such recommendations as the Commission may have for legislative or administrative action to improve
access to health care through the Veterans Health Administration.
(c)
Powers of the
commission
(1)
Hearings
The
Commission may hold such hearings, sit and act at such times and places, take
such testimony, and receive such evidence as the Commission considers advisable
to carry out this section.
(2)
Information
from Federal agencies
The Commission may secure directly from any
Federal department or agency such information as the Commission considers
necessary to carry out this section. Upon request of the Chairperson of the
Commission, the head of such department or agency shall furnish such
information to the Commission.
(d)
Commission
personnel matters
(1)
Compensation of
members
Each member of the Commission who is not an officer or
employee of the Federal Government shall be compensated at a rate equal to the
daily equivalent of the annual rate of basic pay prescribed for level IV of the
Executive Schedule under section 5315 of title 5, United States Code, for each
day (including travel time) during which such member is engaged in the
performance of the duties of the Commission. All members of the Commission who
are officers or employees of the United States shall serve without compensation
in addition to that received for their services as officers or employees of the
United States.
(2)
Travel
expenses
The members of the Commission shall be allowed travel
expenses, including per diem in lieu of subsistence, at rates authorized for
employees of agencies under subchapter I of chapter 57 of title 5, United
States Code, while away from their homes or regular places of business in the
performance of services for the Commission.
(3)
Staff
(A)
In
general
The Chairperson of the Commission may, without regard to the
civil service laws and regulations, appoint and terminate an executive director
and such other additional personnel as may be necessary to enable the
Commission to perform its duties. The employment of an executive director shall
be subject to confirmation by the Commission.
(B)
Compensation
The
Chairperson of the Commission may fix the compensation of the executive director
and other personnel without regard to chapter 51 and subchapter III of chapter
53 of title 5, United States Code, relating to classification of positions and
General Schedule pay rates, except that the rate of pay for the executive
director and other personnel may not exceed the rate payable for level V of the
Executive Schedule under section 5316 of such title.
(4)
Detail of
government employees
Any Federal Government employee may be
detailed to the Commission without reimbursement, and such detail shall be
without interruption or loss of civil service status or privilege.
(5)
Procurement of
temporary and intermittent services
The Chairperson of the
Commission may procure temporary and intermittent services under section
3109(b) of title 5, United States Code, at rates for individuals which do not
exceed the daily equivalent of the annual rate of basic pay prescribed for
level V of the Executive Schedule under section 5316 of such title.
(e)
Termination of
the commission
The Commission
shall terminate 30 days after the date on which the Commission submits its
report under subsection (b)(3)(B).
(f)
Funding
The Secretary of Veterans Affairs shall make available to the Commission from amounts appropriated
or otherwise made available to the Secretary such amounts as the
Secretary and the Chairperson of the Commission jointly consider
appropriate
for the Commission to perform its duties under this section.
(g)
Executive action
(1)
Action on recommendations
The President shall require the Secretary of Veterans Affairs and such other heads of relevant
Federal departments and agencies to implement each recommendation set
forth in a report submitted under subsection (b)(3) that the President—
(A) considers feasible and advisable; and
(B) determines can be implemented without further legislative action.
(2)
Reports
Not later than 60 days after the date on which the President receives a report under subsection
(b)(3), the President shall submit to the Committee on Veterans' Affairs
of the Senate and the Committee on Veterans' Affairs of the House of
Representatives and such other committees of Congress as the President
considers appropriate a report setting forth the following:
(A) An assessment of the feasibility and advisability of each recommendation contained in the report
received by the President.
(B) For each recommendation assessed as feasible and advisable under subparagraph (A) the following:
(i) Whether such recommendation requires legislative action.
(ii) If such recommendation requires legislative action, a recommendation concerning such legislative
action.
(iii) A description of any administrative action already taken to carry out such recommendation.
(iv) A description of any administrative action the President intends to be taken to carry out such
recommendation and by whom.
403.
Commission on Capital Planning for Department of Veterans Affairs Medical Facilities
(a)
Establishment of commission
(1)
Establishment
There is established the Commission on Capital Planning for Department of Veterans Affairs Medical
Facilities (in this section referred to as the Commission).
(2)
Membership
(A)
Voting members
The Commission shall, subject to subparagraph (B), be composed of 10 voting members as follows:
(i)
1 shall be appointed by the President.
(ii)
1 shall be appointed by the Administrator of General Services.
(iii)
3 shall be appointed by the Secretary of Veterans Affairs, of whom—
(I)
1 shall be an employee of the Veterans Health Administration;
(II)
1 shall be an employee of the Office of Asset Enterprise Management of the Department of Veterans
Affairs; and
(III)
1 shall be an employee of the Office of Construction and Facilities Management of the Department of
Veterans Affairs.
(iv)
1 shall be appointed by the Secretary of Defense from among employees of the Army Corps of
Engineers.
(v)
1 shall be appointed by the majority leader of the Senate.
(vi)
1 shall be appointed by the minority leader of the Senate.
(vii)
1 shall be appointed by the Speaker of the House of Representatives.
(viii)
1 shall be appointed by the minority leader of the House of Representatives.
(B)
Requirement relating to certain appointments of voting members
Of the members appointed pursuant to clause (i), (ii), and (iv) through (viii) of subparagraph (A),
all shall have expertise in capital leasing, construction, or health
facility management planning.
(C)
Non-voting members
The Commission shall be assisted by 10 non-voting members, appointed by the vote of a majority of
members of the Commission under subparagraph (A), of whom—
(i)
6 shall be representatives of veterans service organizations recognized by the Secretary of
Veterans Affairs; and
(ii)
4 shall be individuals from outside the Department of Veterans Affairs with experience and
expertise in matters relating to management, construction, and leasing of
capital assets.
(D)
Date of appointment of voting members
The appointments of the members of the Commission under subparagraph (A) shall be made not later
than 60 days after the date of the enactment of this Act.
(3)
Period of appointment; vacancies
Members shall be appointed for the life of the Commission. Any vacancy in the Commission shall not
affect its powers, but shall be filled in the same manner as the original
appointment.
(4)
Initial meeting
Not later than 15 days after the date on which 7 members of the Commission have been appointed, the
Commission shall hold its first meeting.
(5)
Meetings
The Commission shall meet at the call of the Chair.
(6)
Quorum
A majority of the members of the Commission shall constitute a quorum, but a lesser number of
members may hold hearings.
(7)
Chair and vice chair
The Commission shall select a Chair and Vice Chair from among its members.
(b)
Duties of commission
(1)
In general
The Commission shall undertake a comprehensive evaluation and assessment of various options for
capital planning for Department of Veterans Affairs medical facilities,
including an evaluation and assessment of the mechanisms by which the
Department currently selects means for the delivery of health care,
whether by major construction, major medical facility leases, sharing
agreements with the Department of Defense, the Indian Health Service, and
Federally Qualified Health Clinics under section 330 of the Public Health
Service Act (42 U.S.C. 254b), contract care, multisite care, telemedicine,
extended hours for care, or other means.
(2)
Context of evaluation and assessment
In undertaking the evaluation and assessment, the Commission shall consider—
(A)
the importance of access to health care through the Department, including associated guidelines of
the Department on access to, and drive time for, health care;
(B)
limitations and requirements applicable to the construction and leasing of medical facilities for
the Department, including applicable laws, regulations, and costs as
determined by both the Congressional Budget Office and the Office of
Management and Budget;
(C)
the nature of capital planning for Department medical facilities in an era of fiscal uncertainty;
(D)
projected future fluctuations in the population of veterans; and
(E)
the extent to which the Department was able to meet the mandates of the Capital Asset Realignment
for Enhanced Services Commission.
(3)
Particular considerations
In undertaking the evaluation and assessment, the Commission shall address, in particular, the
following:
(A)
The Major Medical Facility Lease Program of the Department, including an identification of
potential improvements to the lease authorization processes under that
Program.
(B)
The management processes of the Department for its Major Medical Facility Construction Program,
including processes relating to contract award and management, project
management, and processing of change orders.
(C)
The overall capital planning program of the Department for medical facilities, including an
evaluation and assessment of—
(i)
the manner in which the Department determines whether to use capital or non-capital means to expand
access to health care;
(ii)
the manner in which the Department determines the disposition of under-utilized and un-utilized
buildings on campuses of Department medical centers, and any barriers to
disposition;
(iii)
the effectiveness of the facility master planning initiative of the Department; and
(iv)
the extent to which sustainable attributes are planned for to decrease operating costs for
Department medical facilities.
(D)
The current backlog of construction projects for Department medical facilities, including an
identification of the most effective means to quickly secure the most
critical repairs required, including repairs relating to facility
condition deficiencies, structural safety, and compliance with the
Americans With Disabilities Act of 1990.
(4)
Reports
Subject to paragraph (5), the Commission shall submit to the Secretary of Veterans Affairs, and to
the Committee Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives, reports as follows:
(A)
Not later than six months after its initial meeting under subsection (a)(4), a report on the Major
Medical Facility Lease Program and the Congressional lease authorization
process.
(B)
Not later than one year after its initial meeting, a report—
(i)
on the management processes of the Department for the construction of Department medical
facilities; and
(ii)
setting forth an update of any matters covered in the report under subparagraph (A).
(C)
Not later than 18 months after its initial meeting, a report—
(i)
on the overall capital planning program of the Department for medical facilities; and
(ii)
setting forth an update of any matters covered in earlier reports under this paragraph.
(D)
Not later than two years after its initial meeting, a report—
(i)
on the current backlog of construction projects for Department medical facilities;
(ii)
setting forth an update of any matters covered in earlier reports under this paragraph; and
(iii)
including such other matters relating to the duties of the Commission that the Commission considers
appropriate.
(E)
Not later than 27 months after its initial meeting, a report on the implementation by the Secretary
of Veterans Affairs pursuant to subsection (g) of the recommendations
included pursuant to paragraph (5) in the reports under this paragraph.
(5)
Recommendations
Each report under paragraph (4) shall include, for the aspect of the capital asset planning process
of the Department covered by such report, such recommendations as the
Commission considers appropriate for the improvement and enhancement of
such aspect of the capital asset planning process.
(c)
Powers of commission
(1)
Hearings
The Commission may hold such hearings, sit and act at such times and places, take such testimony,
and receive such evidence as the Commission considers advisable to carry
out this section.
(2)
Information from Federal agencies
The Commission may secure directly from any Federal department or agency such information as the
Commission considers necessary to carry out this section. Upon request of
the Chair of the Commission, the head of such department or agency shall
furnish such information to the Commission.
(d)
Commission personnel matters
(1)
Compensation of members
Each member of the Commission who is not an officer or employee of the Federal Government shall be
compensated at a rate equal to the daily equivalent of the annual rate of
basic pay prescribed for level IV of the Executive Schedule under section
5315 of title 5, United States Code, for each day (including travel time)
during which such member is engaged in the performance of the duties of
the Commission. All members of the Commission who are officers or
employees of the United States shall serve without compensation in
addition to that received for their services as officers or employees of
the United States.
(2)
Travel expenses
The members of the Commission shall be allowed travel expenses, including per diem in lieu of
subsistence, at rates authorized for employees of agencies under
subchapter I of chapter 57 of title 5, United States Code, while away from
their homes or regular places of business in the performance of services
for the Commission.
(3)
Staff
(A)
In general
The Chair of the Commission may, without regard to the civil service laws and regulations, appoint
and terminate an executive director and such other additional personnel as
may be necessary to enable the Commission to perform its duties. The
employment of an executive director shall be subject to confirmation by
the Commission.
(B)
Compensation
The Chair of the Commission may fix the compensation of the executive director and other personnel
without regard to chapter 51 and subchapter III of chapter 53 of title 5,
United States Code, relating to classification of positions and General
Schedule pay rates, except that the rate of pay for the executive director
and other personnel may not exceed the rate payable for level V of the
Executive Schedule under section 5316 of such title.
(4)
Detail of government employees
Any Federal Government employee may be detailed to the Commission without reimbursement, and such
detail shall be without interruption or loss of civil service status or
privilege.
(5)
Procurement of temporary and intermittent services
The Chair of the Commission may procure temporary and intermittent services under section 3109(b)
of title 5, United States Code, at rates for individuals which do not
exceed the daily equivalent of the annual rate of basic pay prescribed for
level V of the Executive Schedule under section 5316 of such title.
(e)
Termination of commission
The Commission shall terminate 60 days after the date on which the Commission submits its report
under subsection (b)(4)(E).
(f)
Funding
The Secretary of Veterans Affairs shall make available to the Commission such amounts as the
Secretary and the Chair of the Commission jointly consider appropriate for
the Commission to perform its duties under this section.
(g)
Action on recommendations
(1)
In general
The Secretary of Veterans Affairs shall implement each recommendation included in a report under
subsection (b)(4) that the Secretary considers feasible and advisable and
can be implemented without further legislative action.
(2)
Reports
Not later than 120 days after receipt of a report under subparagraphs (A) through (D) of subsection
(b)(4), the Secretary shall submit to the Committee Veterans' Affairs of
the Senate and the Committee on Veterans' Affairs of the House of
Representatives a report setting forth the following:
(A)
An assessment of the feasibility and advisability of each recommendation contained in such report.
(B)
For each recommendation assessed as feasible and advisable—
(i)
if such recommendation does not require further legislative action for implementation, a
description of the actions taken, and to be taken, by the Secretary to
implement such recommendation; and
(ii) if such recommendation requires further legislative action for implementation, recommendations for
such legislative action.
404.
Removal of Senior Executive Service employees of the Department of Veterans Affairs for performance
(a)
Removal or transfer
(1)
In general
Chapter 7 of title 38, United States Code, is amended by adding at the end the following new
section:
713.
Senior Executive Service: removal based on performance
(a)
In general
The Secretary may remove any individual from the Senior
Executive Service if the Secretary determines the performance of the
individual warrants such removal. If the Secretary so removes such an
individual, the Secretary may—
(1)
remove the individual from the civil service (as defined in section 2101 of title 5); or
(2)
transfer the individual to a General Schedule position at any grade of the General Schedule for
which the individual is qualified and that the Secretary determines is
appropriate.
(b)
Notice to Congress
Not later than 30 days after removing or transferring an individual from the Senior Executive
Service under
paragraph (1), the Secretary shall submit to the Committees on Veterans’
Affairs of the Senate and House of Representatives notice in writing of
such removal or transfer and the reason for such removal or transfer.
(c)
Appeal of removal or transfer
Any removal or transfer under subsection (a) may be appealed to the Merit Systems Protection
Board under section 7701 of title 5 not later than 7 days after such
removal or transfer.
(d)
Expedited review by Merit Systems Protection Board
(1) The Merit Systems Protection Board shall expedite any appeal under section 7701 of title 5 of a
removal or transfer under subsection (a) and, in any such case, shall
issue a decision
not later than 21 days after the date of the appeal.
(2) In any case in which the Merit Systems Protection Board determines that it cannot issue a decision
in accordance with the 21-day requirement under paragraph (1), the Merit
Systems Protection Board shall submit to Congress a report that explains
the reason why the Merit Systems Protection Board is unable to issue a
decision in accordance with such requirement in such case.
(3) There is authorized to be appropriated such sums as may be necessary for the Merit Systems
Protection Board to expedite appeals under paragraph (1).
(4) The Merit Systems Protection Board may not stay any personnel action taken under this section.
.
(2)
Clerical amendment
The table of sections at the beginning of such chapter is amended by adding at the end the
following new item:
713. Senior Executive Service: removal based on performance.
.
(b)
Establishment of expedited review process
(1)
In general
Not later than 30 days after the date of the enactment of this Act, the Merit Systems Protection
Board shall establish and put into effect a process to conduct expedited
reviews in accordance
with section 713(d) of title 38, United States Code.
(2)
Inapplicability of certain regulations
Section 1201.22 of title 5, Code of Federal Regulations, as in effect on the day before the date of
the enactment of this Act, shall not apply to expedited reviews carried
out under section 713(d) of title 38, United States Code.
(3)
Report by Merit Systems Protection Board
Not later than 30 days after the date of the enactment of this Act, the Merit Systems Protection
Board shall submit to Congress a report on the actions the Board plans to
take to conduct expedited reviews under section 713(d) of title 38, United
States Code, as added by subsection (a). Such report shall include a
description of the resources the Board determines will be necessary to
conduct such reviews and a description of whether any resources will be
necessary to conduct such reviews that were not available to the Board on
the day before the date of the enactment of this Act.
(c)
Temporary exemption from certain limitation on initiation of removal from Senior Executive Service
During the 120-day period beginning on the date of the enactment of this Act, an action to remove
an individual from the Senior Executive Service at the Department of
Veterans Affairs pursuant to section 713 of title 38, United States Code,
as added by subsection (a), or section 7543 of title 5, United States
Code, may be initiated, notwithstanding section 3592(b) of title 5, United
States Code, or any other provision of law.
(d)
Construction
Nothing in this section or section 713 of title 38, United States Code, as added by subsection (a),
shall be construed to apply to an appeal of a removal, transfer, or other
personnel action that was pending before the date of the enactment of this
Act.
V
Major Medical Facility Leases
501.
Authorization of major medical facility leases
The Secretary of Veterans Affairs may carry out the following major medical facility leases at the
locations specified, and in an amount for each lease not to exceed the
amount shown for such location (not including any estimated cancellation
costs):
(1)
For a clinical research and pharmacy coordinating center, Albuquerque, New Mexico, an amount not to
exceed $9,560,000.
(2)
For a community-based outpatient clinic, Brick, New Jersey, an amount not to exceed $7,280,000.
(3)
For a new primary care and dental clinic annex, Charleston, South Carolina, an amount not to exceed
$7,070,250.
(4)
For the Cobb County community-based Outpatient Clinic, Cobb County, Georgia, an amount not to
exceed $6,409,000.
(5)
For the Leeward Outpatient Healthcare Access Center, Honolulu, Hawaii, including a co-located
clinic with the Department of Defense and the co-location of the Honolulu
Regional Office of the Veterans Benefits Administration and the Kapolei
Vet Center of the Department of Veterans Affairs, an amount not to exceed
$15,887,370.
(6)
For a community-based outpatient clinic, Johnson County, Kansas, an amount not to exceed
$2,263,000.
(7)
For a replacement community-based outpatient clinic, Lafayette, Louisiana, an amount not to exceed
$2,996,000.
(8)
For a community-based outpatient clinic, Lake Charles, Louisiana, an amount not to exceed
$2,626,000.
(9)
For outpatient clinic consolidation, New Port Richey, Florida, an amount not to exceed $11,927,000.
(10)
For an outpatient clinic, Ponce, Puerto Rico, an amount not to exceed $11,535,000.
(11)
For lease consolidation, San Antonio, Texas, an amount not to exceed $19,426,000.
(12)
For a community-based outpatient clinic, San Diego, California, an amount not to exceed
$11,946,100.
(13)
For an outpatient clinic, Tyler, Texas, an amount not to exceed $4,327,000.
(14)
For the Errera Community Care Center, West Haven, Connecticut, an amount not to exceed $4,883,000.
(15)
For the Worcester community-based Outpatient Clinic, Worcester, Massachusetts, an amount not to
exceed $4,855,000.
(16)
For the expansion of a community-based outpatient clinic, Cape Girardeau, Missouri, an amount not
to exceed $4,232,060.
(17)
For a multispecialty clinic, Chattanooga, Tennessee, an amount not to exceed $7,069,000.
(18)
For the expansion of a community-based outpatient clinic, Chico, California, an amount not to
exceed $4,534,000.
(19)
For a community-based outpatient clinic, Chula Vista, California, an amount not to exceed
$3,714,000.
(20)
For a new research lease, Hines, Illinois, an amount not to exceed $22,032,000.
(21)
For a replacement research lease, Houston, Texas, an amount not to exceed $6,142,000.
(22)
For a community-based outpatient clinic, Lincoln, Nebraska, an amount not to exceed $7,178,400.
(23)
For a community-based outpatient clinic, Lubbock, Texas, an amount not to exceed $8,554,000.
(24)
For a community-based outpatient clinic consolidation, Myrtle Beach, South Carolina, an amount not
to exceed $8,022,000.
(25)
For a community-based outpatient clinic, Phoenix, Arizona, an amount not to exceed $20,757,000.
(26)
For the expansion of a community-based outpatient clinic, Redding, California, an amount not to
exceed $8,154,000.
(27)
For the expansion of a community-based outpatient clinic, Tulsa, Oklahoma, an amount not to exceed
$13,269,200.
502.
Budgetary treatment of Department of Veterans Affairs major medical facilities leases
(a)
Findings
Congress finds the following:
(1)
Title 31, United States Code, requires the Department of Veterans Affairs to record the full cost
of its contractual obligation against funds available at the time a
contract is executed.
(2)
Office of Management and Budget Circular A–11 provides guidance to agencies in meeting the
statutory requirements under title 31, United States Code, with respect to
leases.
(3)
For operating leases, Office of Management and Budget Circular A–11 requires the Department of
Veterans Affairs to record up-front budget authority in an amount equal to total payments under the full term of the lease or [an] amount sufficient to cover
first year lease payments plus cancellation costs.
(b)
Requirement for obligation of full cost
(1)
In general
Subject to the availability of appropriations provided in advance, in exercising the authority of
the Secretary of Veterans Affairs to enter into leases provided in this
Act, the Secretary shall record, pursuant to section 1501 of title 31, United States Code, as the full cost of the contractual obligation at the time a
contract is executed either—
(A)
an amount equal to total payments under the full term of the lease; or
(B)
if the lease specifies payments to be made in the event the lease is terminated before its full
term, an amount sufficient to cover the first year lease payments plus the
specified cancellation costs.
(2)
Self-insuring authority
The requirements of paragraph (1) may be satisfied through the use of a self-insuring authority
consistent with Office of Management and Budget Circular A–11.
(c)
Transparency
(1)
Compliance
Subsection (b) of section 8104 of title 38, United States Code, is amended by adding at the end the following new paragraph:
(7)
In the case of a prospectus proposing funding for a major medical facility lease, a detailed
analysis of how the lease is expected to comply with Office of Management
and Budget Circular A–11 and section 1341 of title 31 (commonly referred to as the Anti-Deficiency Act). Any such analysis shall include—
(A)
an analysis of the classification of the lease as a lease-purchase, capital lease, or operating lease as those terms are defined in Office of Management and Budget Circular A–11;
(B)
an analysis of the obligation of budgetary resources associated with the lease; and
(C)
an analysis of the methodology used in determining the asset cost, fair market value, and
cancellation costs of the lease.
.
(2)
Submittal to Congress
Such section 8104 is further amended by adding at the end the following new subsection:
(h)
(1)
Not less than 30 days before entering into a major medical facility lease, the Secretary shall
submit to the Committees on Veterans’ Affairs of the Senate and the House
of Representatives—
(A)
notice of the Secretary’s intention to enter into the lease;
(B)
a detailed summary of the proposed lease;
(C)
a description and analysis of any differences between the prospectus submitted pursuant to
subsection (b) and the proposed lease; and
(D)
a scoring analysis demonstrating that the proposed lease fully complies with Office of Management
and Budget Circular A–11.
(2)
Each committee described in paragraph (1) shall ensure that any information submitted to the
committee under such paragraph is treated by the committee with the same
level of confidentiality as is required by law of the Secretary and
subject to the same statutory penalties for unauthorized disclosure or use
as the Secretary.
(3)
Not more than 30 days after entering into a major medical facility lease, the Secretary shall
submit to each committee described in paragraph (1) a report on any
material differences between the lease that was entered into and the
proposed lease described under such paragraph, including how the lease
that was entered into changes the previously submitted scoring analysis
described in subparagraph (D) of such paragraph.
.
(d)
Rule of construction
Nothing in this section, or the amendments made by this section, shall be construed to in any way
relieve the Department of Veterans Affairs from any statutory or
regulatory obligations or requirements existing prior to the enactment of
this section and such amendments.
June 4, 2014Read the second time and placed on the calendar