,,ii  ,calendar ,no4 #djh #aacth        
,,congress  #b;d ,session  ,s4 #bdbb    
,,in ,,the ,,senate ,,of ,,the ,,united 
,,states  ,june #c1 #bjad ,mr4 ,sanders 
7for himself1 ,mr4 ,rockefeller1 ,mr4   
,begich1 ,mrs4 ,shaheen1 ,mr4 ,kaine1   
,mr4 ,reed1 ,mr4 ,merkley1 ,mr4 ,casey1 
,mr4 ,whitehouse1 ,mr4 ,blumenthal1 ,mr4
 ,heinrich1 ,mr4 ,udall of ,new ,mexico1
 ,mr4 ,schatz1 ,ms4 ,baldwin1 ,mr4      
,wyden1 ,mr4 ,leahy1 ,mr4 ,brown1 ,ms4  
,heitkamp1 ,ms4 ,landrieu1 ,mr4 ,booker1
 ,mr4 ,durbin1 ,mr4 ,schumer1 ,ms4      
,hirono1 ,mr4 ,harkin1 ,mr4 ,coons1 ,mr4
 ,markey1 ,ms4 ,klobuchar1 ,mr4 ,walsh1 
,mr4 ,tester1 and ,mr4 ,menendez7       
introduced the following bill2 which was
 read the first time  ,june #d1         
#bjad,read the second time and placed on
 the calendar  ,a ,,bill  ,to improve   
the access of veterans to medical       
services from the ,department of        
,veterans ,affairs1 and for other       
purposes4  #a4  ,short title2 table of  
contents  7a7  ,short title  ,this ,act 

may be cited as the ,ensuring ,veterans 
,access to ,care ,act of #bjad4  7b7    
,table of contents  ,the table of       
contents for this ,act is as follows3   
,sec4 #a4 ,short title2 table of        
contents4 ,,title ,i--,improvement of   
,scheduling ,system for ,health ,care   
,appointments ,sec4 #aja4               
,implementation of upgraded ,department 
of ,veterans ,affairs electronic        
scheduling system for appointments for  
receipt of health care from the         
,department4 ,sec4 #ajb4 ,independent   
assessment of the scheduling process for
 medical appointments for care from     
,department of ,veterans ,affairs4      
,,title ,,ii--,training and ,hiring of  
,health ,care ,staff ,sec4 #bja4        
,modification of liability for breach of
 period of obligated service under      
,health ,professionals ,educational     
,assistance ,program for primary care   
physicians4 ,sec4 #bjb4 ,program of     
education at ,uniformed ,services       
,university of the ,health ,sciences    

with specialization in primary care4    
,sec4 #bjc4 ,treatment of staffing      
shortage and biannual report on staffing
 of medical facilities of the           
,department of ,veterans ,affairs4 ,sec4
 #bjd4 ,clinic management training      
program of the ,department of ,veterans 
,affairs4 ,sec4 #bje4 ,inclusion of     
,department of ,veterans ,affairs       
facilities in ,national ,health ,service
 ,corps ,scholarship and loan repayment 
programs4 ,sec4 #bjf4 ,authorization of 
emergency appropriations4 ,,title       
,,iii--,improvement of ,access to ,care 
from ,non-,department of ,veterans      
,affairs ,providers ,sec4 #cja4         
,improvement of access by veterans to   
health care from non-,department of     
,veterans ,affairs providers4 ,sec4     
#cjb4 ,extension of and report on joint 
incentives program of ,department of    
,veterans ,affairs and ,department of   
,defense4 ,sec4 #cjc4 ,transfer of      
authority for payments for hospital     
care1 medical services1 and other health

 care from non-,department providers to 
the ,chief ,business ,office of the     
,veterans ,health ,administration of the
 ,department4 ,sec4 #cjd4 ,enhancement  
of collaboration between ,department of 
,veterans ,affairs and ,indian ,health  
,service4 ,sec4 #cje4 ,enhancement of   
collaboration between ,department of    
,veterans ,affairs and ,native ,hawaiian
 health care systems4 ,sec4 #cjf4       
,authorization of emergency             
appropriations4 ,,title ,,iv--,health   
,care ,administrative ,matters ,sec4    
#dja4 ,improvement of access of veterans
 to mobile vet centers of the           
,department of ,veterans ,affairs4 ,sec4
 #djb4 ,commission on ,access to ,care4 
,sec4 #djc4 ,commission on ,capital     
,planning for ,department of ,veterans  
,affairs ,medical ,facilities4 ,sec4    
#djd4 ,removal of ,senior ,executive    
,service employees of the ,department of
 ,veterans ,affairs for performance4    
,,title ,v--,major ,medical ,facility   
,leases ,sec4 #eja4 ,authorization of   

major medical facility leases4 ,sec4    
#ejb4 ,budgetary treatment of           
,department of ,veterans ,affairs major 
medical facilities leases4  ,i          
,improvement of ,scheduling ,system for 
,health ,care ,appointments  #aja4      
,implementation of upgraded ,department 
of ,veterans ,affairs electronic        
scheduling system for appointments for  
receipt of health care from the         
,department  7a7  ,implementation  7#a7 
,in general  ,not later than ,march #ca1
 #bjaf1 the ,secretary of ,veterans     
,affairs shall fully implement an       
upgraded and centralized electronic     
scheduling system described in          
subsection 7b7 for appointments by      
eligible individuals for health care    
from the ,department of ,veterans       
,affairs4  7#b7  ,agile software        
development methodologies  ,in          
implementing the upgraded electronic    
scheduling system required by paragraph 
7#a71 the ,secretary shall use agile    
software development methodologies to   

fully implement portions of such system 
every #ahj days beginning on the date on
 which the ,secretary begins the        
implementation of such system1 or enters
 into a contract for the implementation 
of such system1 and ending on the date  
on which such system is fully           
implemented4  7b7  ,electronic          
scheduling system  ,the upgraded        
electronic scheduling system described  
in this subsection shall include        
mechanisms to achieve the following3    
7#a7 ,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        
,department4  7#b7 ,a capability to     
assist employees of the ,department to  
easily and consistently implement       
policies of the ,department with respect
 to scheduling of appointments1         
including with respect to priority for  
appointments for certain eligible       

individuals4  7#c7 ,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 ,department4
  7#d7 ,a capability for employees of   
the ,department to sort and view        
appointments for and appointment        
requests made by a particular eligible  
individual4  7#e7 ,a capability for     
seamless coordination of appointments   
for primary care1 specialty care1       
consultations1 or any other health care 
matter among facilities of the          
,department4  7#f7 ,a capability for    
eligible individuals to access the      
system remotely and schedule            
appointments directly through the       
system4  7#g7 ,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 individual4  7#h7
 ,a seamless connection to the          
,computerized ,patient ,record ,system  
of the ,department so that employees of 
the ,department1 when scheduling an     
appointment for an eligible individual1 
have access to recommendations from the 
health care provider of such individual 
with respect to when such individual    
should receive an appointment4  7#i7 ,a 
capability to provide automated         
reminders to eligible individuals on    
upcoming appointments through various   
electronic and voice media4  7#aj7 ,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 appointment4  7#aa7 ,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 ,secretary3  7,a7 ,the number of 
days into the future that the schedules 
of health care providers are available  
to schedule an appointment4  7,b7 ,the  
number of providers available to see    
patients each day4  7,c7 ,the number of 
support personnel working each day4     
7,d7 ,the types of appointments         
available4  7,e7 ,the rate at which     
patients fail to appear for             
appointments4  7,f7 ,the number of      
appointments canceled by a patient on a 
daily basis4  7,g7 ,the number of       
appointments canceled by a health care  
provider on a daily basis4  7,h7 ,the   
number of patients on the wait list at  
any given time4  7,i7 ,the number of    
appointments scheduled on a daily basis2
  7,j7 ,the number of appointments      
available to be scheduled on a daily    
basis4  7,k7 ,the number of patients    
seen on a daily1 weekly1 and monthly    
basis4  7,l7 ,wait-times for an         
appointment with a health care provider 
of the ,department4  7,m7 ,wait-times   

for an appointment with a               
non-,department health care provider4   
7,n7 ,wait-times for a referral to a    
specialist or consult4  7#ab7 ,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      
individuals4  7#ac7 ,any other          
capabilities as specified by the        
,secretary for purposes of this section4
  7c7  ,plan  7#a7  ,in general  ,not   
later than #ij days after the date of   
the enactment of this ,act1 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 7a74  7#b7
  ,elements  ,the plan required by      
paragraph 7#a7 shall include the        
following3  7,a7 ,a description of the  

priorities of the ,secretary for        
implementing the requirements of the    
system under subsection 7b74  7,b7 ,a   
detailed description of the manner in   
which the ,secretary will fully         
implement such system1 including        
deadlines for completing each such      
requirement4  7#c7  ,update  ,not later 
than #ij days after the submittal of the
 plan required by paragraph 7#a71 and   
not less frequently than every #ij days 
thereafter until such system is fully   
implemented1 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 plan4  7d7  ,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 7a74  7e7        
,eligible individual defined  ,in this  
section1 the term eligible individual   
means an individual eligible for        
hospital1 nursing home1 domiciliary1    
medical care1 or other health care under
 the laws administered by the ,secretary
 of ,veterans ,affairs4  #ajb4          
,independent assessment of the          
scheduling process for medical          
appointments for care from ,department  
of ,veterans ,affairs  7a7  ,independent
 assessment  7#a7  ,contract  ,not later
 than #cj days after the date of the    
enactment of this ,act1 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 care1  
medical services1 or other health care  
from the ,department4  7#b7  ,elements  
,in carrying out the assessment required
 by paragraph 7#a71 the independent     

third party shall do the following3     
7,a7 ,review all training materials     
pertaining to scheduling of appointments
 at each medical facility of the        
,department4  7,b7 ,assess whether all  
employees of the ,department conducting 
tasks related to scheduling are properly
 trained for conducting such tasks4     
7,c7 ,assess whether changes in the     
technology or system used in scheduling 
appointments are necessary to limit     
access to the system to only those      
employees that have been properly       
trained in conducting such tasks4  7,d7 
,assess whether health care providers of
 the ,department are making changes to  
their schedules that hinder the ability 
of employees conducting such tasks to   
perform such tasks4  7,e7 ,assess       
whether the establishment of a          
centralized call center throughout the  
,department for scheduling appointments 
at medical facilities of the ,department
 would improve the process of scheduling
 such appointments4  7,f7 ,assess       

whether booking templates for each      
medical facility or clinic of the       
,department would improve the process of
 scheduling such appointments4  7,g7    
,recommend any actions to be taken by   
the ,department to improve the process  
for scheduling such appointments1       
including the following3  7i7 ,changes  
in training materials provided to       
employees of the ,department with       
respect to conducting tasks related to  
scheduling such appointments4  7ii7     
,changes in monitoring and assessment   
conducted by the ,department of         
wait-times of veterans for such         
appointments4  7iii7 ,changes in the    
system used to schedule such            
appointments1 including changes to      
improve how the ,department--  7,i7     
measures wait-times of veterans for such
 appointments2  7,,ii7 monitors the     
availability of health care providers of
 the ,department2 and  7,,iii7 provides 
veterans the ability to schedule such   
appointments4  7iv7 ,such other actions 

as the independent third party considers
 appropriate4  7#c7  ,timing  ,the      
independent third party carrying out the
 assessment required by paragraph 7#a7  
shall complete such assessment not later
 than #ahj days after entering into the 
contract described in such paragraph4   
7b7 ,report ,not later than #ij days    
after the date on which the independent 
third party completes the assessment    
under this section1 the ,secretary shall
 submit to the ,committee on ,veterans' 
,affairs of the ,senate and the         
,committee on ,veterans' ,affairs of the
 ,house of ,representatives a report on 
the results of such assessment4  ,,ii   
,training and ,hiring of ,health ,care  
,staff  #bja4  ,modification of         
liability for breach of period of       
obligated service under ,health         
,professionals ,educational ,assistance 
,program for primary care physicians    
,section #gfag of title #ch1 ,united    
,states ,code1 is amended-- 7#a7 ,in    
subsection 7c77#a71 by striking ,if a   

participant and inserting ,except as    
provided in subsection 7d71 if a        
participant2 and  7#b7 by adding at the 
end the following new subsection3  7d7  
,liability shall not arise under        
subsection 7c7 in the case of a         
participant otherwise covered by that   
subsection who has pursued a course of  
education or training in primary care   
if--  7#a7 the participant--  7,a7 does 
not obtain1 or fails to maintain1       
employment as a ,department employee due
 to staffing changes approved by the    
,under ,secretary for ,health2 or  7,b7 
does not obtain1 or fails to maintain1  
employment in a position of primary care
 physician in the ,veterans ,health     
,administration due1 as determined by   
the ,secretary1 to a number of primary  
care physicians in the ,administration  
that is excess to the needs of the      
,administration2 and  7#b7 the          
participant agrees to accept and        
maintain employment as a primary care   
physician with another department or    

agency of the ,federal ,government 7with
 such employment to be under such terms 
and conditions as are jointly agreed    
upon by the participant1 the ,secretary1
 and the head of such department or     
agency1 including terms and conditions  
relating to a period of obligated       
service as a primary care physician with
 such department or agency7 if such     
employment is offered to the participant
 by the ,secretary and the head of such 
department or agency4  4  #bjb4         
,program of education at ,uniformed     
,services ,university of the ,health    
,sciences with specialization in primary
 care  7a7  ,program required under     
,health ,professionals ,educational     
,assistance ,program  7#a7  ,in general 
,chapter #gf of title #ch1 ,united      
,states ,code1 is amended by adding     
after subchapter ,,vii the following new
 subchapter3  ,,viii  ,program of       
,education at ,uniformed ,services      
,university of the ,health ,sciences    
,with ,specialization in ,primary ,care 

#gfia4  ,authority for program  ,as part
 of the ,educational ,assistance        
,program1 the ,secretary shall1 in      
collaboration with the ,secretary of    
,defense1 carry out a program to permit 
individuals to enroll in the ,uniformed 
,services ,university of the ,health    
,sciences under chapter #ajd of title   
#aj to pursue a medical education with a
 specialization in primary care4 ,the   
program shall be known as the           
,department of ,veterans ,affairs       
,primary ,care ,educational ,assistance 
,program 7in this chapter referred to as
 the ,primary ,care ,educational        
,assistance ,program74  #gfib4          
,selection2 agreement2 ineligibility for
 certain other educational assistance   
7a7  ,selection  7#a7 ,medical students 
at the ,uniformed ,services ,university 
of the ,health ,sciences pursuant to the
 ,primary ,care ,educational ,assistance
 ,program shall be selected by the      
,secretary1 in consultation with the    
,secretary of ,defense1 in accordance   

with procedures established by the      
,secretaries for purposes of the        
,program4  7#b7 ,the procedures referred
 to in paragraph 7#a7 shall emphasize   
the basic requirement that students     
demonstrate a motivation and dedication 
to a medical career in primary care4    
7#c7 ,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 ,defense4  7b7  ,agreement
  ,an agreement between the ,secretary  
and a participant in the ,primary ,care 
,educational ,assistance ,program shall 
7in addition to the requirements set    
forth in section #gfjd of this title7   
include the following3  7#a7 ,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 #ajd of title #aj as if   
the participant were a medical student  

enrolled in the ,university pursuant to 
section #baad of title #aj4  7#b7 ,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 7in this subchapter referred to 
as the period of obligated service7 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 
,program1 but for not less than one     
year4  7c7  ,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 training4  #gfic4         
,obligated service  7a7  ,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 subchapter4   
,such service shall be provided in a    
full-time primary care clinical practice
 in an assignment or location determined
 by the ,secretary4  7b7  ,service      
commencement date  7#a7 ,not later than 
#fj days before a participant's service 
commencement date1 the ,secretary shall 
notify the participant of that service  
commencement date4 ,that date is the    
date for the beginning of the           
participant's period of obligated       
service4  7#b7 ,as soon as possible     
after a participant's service           
commencement date1 the ,secretary       
shall--  7,a7 in the case of a          
participant who is not a full-time      
employee in the ,veterans ,health       

,administration1 appoint the participant
 as such an employee2 and  7,b7 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 participant1 assign the participant
 to such a position4  7#c7 ,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      
,state4  7c7  ,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--  7#a7 on the date on
 which the participant is appointed as a
 full-time employee in the ,veterans    
,health ,administration pursuant to     
subsection 7b77#b77;,a72 or  7#b7 if the
 participant is a full-time employee in 
the ,veterans ,health ,administration   

and assigned to a position pursuant to  
subsection 7b77#b77;,b71 on the date on 
which the participant is so assigned to 
such position4  #gfid4  ,breach of      
agreement3 liability  7a7  ,liability   
during course of education or training  
7#a7 ,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 
occurs3  7,a7 ,the participant fails to 
maintain an acceptable level of academic
 standing in the ,uniformed ,services   
,university of the ,health ,sciences4   
7,b7 ,the participant is dismissed from 
the ,uniformed ,services ,university of 
the ,health ,sciences for disciplinary  
reasons4  7,c7 ,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         
training4  7,d7 ,the participant fails  
to become licensed to practice medicine 
in a ,state during a period of time     
determined under regulations prescribed 
by the ,secretary4  7#b7 ,liability     
under this subsection is in lieu of any 
service obligation arising under a      
participant's agreement for purposes of 
this subchapter4  7b7  ,liability during
 period of obligated service  7#a7      
,except as provided in subsection 7c7   
and subject to paragraph 7#b71 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       
service1 the ,united ,states shall be   
entitled to recover from the participant
 an amount equal to--  7,a7 the total   
amount paid under this subchapter on    
behalf of the participant2 multiplied by
  7,b7 a fraction--  7i7 the numerator  

of which is--  7,i7 the total number of 
months in the participant's period of   
obligated service2 minus  7,,ii7 the    
number of months served by the          
participant pursuant to the agreement2  
and  7ii7 the denominator of which is   
the total number of months in the       
participant's period of obligated       
service4  7#b7 ,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 subsection4
  7c7  ,exceptions  ,liability shall not
 arise under subsection 7b7 in the case 
of a participant otherwise covered by   
that subsection if--  7#a7 the          
participant--  7,a7 does not obtain1 or 
fails to maintain1 employment as a      
,department employee due to staffing    
changes approved by the ,under          
,secretary for ,health2 or  7,b7 does   
not obtain1 or fails to maintain1       
employment in a position of primary care
 physician in the ,veterans ,health     

,administration due1 as determined by   
the ,secretary1 to a number of primary  
care physicians in the ,administration  
that is excess to the needs of the      
,administration2 and  7#b7 the          
participant agrees to accept and        
maintain employment as a primary care   
physician with another department or    
agency of the ,federal ,government 7with
 such employment to be under such terms 
and conditions as are jointly agreed    
upon by the participant1 the ,secretary1
 and the head of such department or     
agency1 including terms and conditions  
relating to a period of obligated       
service as a primary care physician with
 such department or agency7 if such     
employment is offered to the participant
 by the ,secretary and the head of such 
department or agency4  #gfie4  ,funding 
7a7  ,in general  ,amounts for the      
,primary ,care ,educational ,assistance 
,program shall be derived from amounts  
available to the ,secretary for the     
,veterans ,health ,administration4  7b7 

,transfer  7#a7 ,the ,secretary shall   
transfer to the ,secretary of ,defense  
amounts required by the ,secretary of   
,defense to carry out the ,primary ,care
 ,educational ,assistance ,program4     
7#b7 ,amounts transferred to the        
,secretary of ,defense pursuant to      
paragraph 7#a7 shall be credited to the 
appropriation or account providing      
funding for the ,uniformed ,services    
,university of the ,health ,sciences4   
,amounts so credited shall be merged    
with amounts in the appropriation or    
account to which credited and shall be  
available1 subject to the terms and     
conditions applicable to such           
appropriation or account1 for the       
,uniformed ,services ,university of the 
,health ,sciences4  4  7#b7  ,clerical  
amendment  ,the table of sections at the
 beginning of chapter #gf of such title 
is amended by adding after the item     
relating to section #gfhd the following3
  ,,subchapter ,,viii--,program of      
,education at ,uniformed ,services      

,university of the ,health ,sciences    
,with ,specialization in ,primary ,care 
#gfia4 ,authority for program4 #gfib4   
,selection2 agreement2 ineligibility for
 certain other educational assistance4  
#gfic4 ,obligated service4 #gfid4       
,breach of agreement3 liability4 #gfie4 
,funding4  4  7b7  ,inclusion of program
 in ,health ,professionals ,educational 
,assistance ,program  ,section #gfja7;a7
 of such title is amended--  7#a7 in    
paragraph 7#d71 by striking 2 and and   
inserting a semicolon2  7#b7 in         
paragraph 7#e71 by striking the period  
at the end and inserting 2 and2 and     
7#c7 by adding at the end the following 
new paragraph3  7#f7 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       
chapter4  4  7c7  ,application          
requirements  7#a7  ,in general         
,subsection 7a77#a7 of section #gfjc of 
such title is amended in the matter     

preceding subparagraph 7,a7 by striking 
1 or ,,vi and inserting 1 ,,vi1 or      
,,viii4  7#b7  ,no priority for         
applications  ,subsection 7d7 of such   
section is amended--  7,a7 by striking  
,in selecting and inserting 7#a7 ,except
 as provided in paragraph 7#b71 in      
selecting2 and  7,b7 by adding at the   
end the following new paragraph3  7#b7  
,paragraph 7#a7 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 chapter4  4  7d7        
,agreement requirements  ,section #gfjd 
of such title is amended by striking 1  
or ,,vi each place it appears and       
inserting 1 ,,vi1 or ,,viii4  #bjc4     
,treatment of staffing shortage and     
biannual report on staffing of medical  
facilities of the ,department of        
,veterans ,affairs  7a7  ,staffing      
shortage  7#a7  ,in general  ,not later 

than #ahj days after the date of the    
enactment of this ,act1 and not later   
than ,september #cj each year           
thereafter1 the ,secretary of ,veterans 
,affairs shall determine1 and publish in
 the ,federal ,register1 the five       
occupations of health care providers of 
the ,department of ,veterans ,affairs   
for which there is the largest staffing 
shortage throughout the ,department4    
7#b7  ,recruitment and appointment      
,notwithstanding sections #ccjd and     
#ccji through #ccah of title #e1 ,united
 ,states ,code1 the ,secretary may1 upon
 a determination by the ,secretary under
 paragraph 7#a7 or a modification to    
such determination under paragraph 7#b71
 that there is a staffing shortage      
throughout the ,department with respect 
to a particular occupation of health    
care provider1 recruit and directly     
appoint highly qualified health care    
providers to a position to serve as a   
health care provider in that particular 
occupation for the ,department4  7#c7   

,priority in ,health ,professionals     
,educational ,assistance ,program to    
certain providers ,section #gfab7;b77#e7
 of title #ch1 ,united ,states ,code1 is
 amended-- 7,a7 in subparagraph 7,a71 by
 striking and at the end2  7,b7 by      
redesignating subparagraph 7,b7 as      
subparagraph 7,c72 and  7,c7 by         
inserting after subparagraph 7,a7 the   
following new subparagraph 7,b73  7,b7  
shall give priority to applicants       
pursuing a course of education or       
training towards a career in an         
occupation for which the ,secretary has1
 in the most current determination      
published in the ,federal ,register     
pursuant to section #bjc7;a77#a7 of the 
,ensuring ,veterans ,access to ,care    
,act of #bjad1 determined that there is 
one of the largest staffing shortage    
throughout the ,department with respect 
to such occupation2 and  4  7b7         
,reports  7#a7  ,in general  ,not later 
than #ahj days after the date of the    
enactment of this ,act1 and not later   

than ,december #ca of each even numbered
 year thereafter until #bjbd1 the       
,secretary of ,veterans ,affairs shall  
submit to the ,committee on ,veterans'  
,affairs of the ,senate and the         
,committee on ,veterans' ,affairs of the
 ,house of ,representatives a report    
assessing the staffing of each medical  
facility of the ,department of ,veterans
 ,affairs4  7#b7  ,elements  ,each      
report submitted under paragraph 7#a7   
shall include the following3  7,a7 ,the 
results of a system-wide assessment of  
all medical facilities of the           
,department to ensure the following3    
7i7 ,appropriate staffing levels for    
health care providers to meet the goals 
of the ,secretary for timely access to  
care for veterans4  7ii7 ,appropriate   
staffing levels for support personnel1  
including clerks4  7iii7 ,appropriate   
sizes for clinical panels4  7iv7        
,appropriate numbers of full-time staff1
 or full-time equivalent1 dedicated to  
direct care of patients4  7v7           

,appropriate physical plant space to    
meet the capacity needs of the          
,department in that area4  7vi7 ,such   
other factors as the ,secretary         
considers necessary4  7,b7 ,a plan for  
addressing any issues identified in the 
assessment described in subparagraph    
7,a71 including a timeline for          
addressing such issues4  7,c7 ,a list of
 the current wait times and workload    
levels for the following clinics in each
 medical facility3  7i7 ,mental health4 
7ii7 ,primary care4  7iii7              
,gastroenterology4  7iv7 ,women's       
health4  7v7 ,such other clinics as the 
,secretary considers appropriate4  7,d7 
,a description of the results of the    
determination of the ,secretary under   
paragraph 7#a7 of subsection 7a7 and a  
plan to use direct appointment authority
 under paragraph 7#b7 of such subsection
 to fill staffing shortages1 including  
recommendations for improving the speed 
at which the credentialing and          
privileging process can be conducted4   

7,e7 ,the current staffing models of the
 ,department for the following clinics1 
including recommendations for changes to
 such models3  7i7 ,mental health4  7ii7
 ,primary care4  7iii7                  
,gastroenterology4  7iv7 ,women's       
health4  7v7 ,such other clinics as the 
,secretary considers appropriate4  7,f7 
,a detailed analysis of succession      
planning at medical facilities of the   
,department1 including the following3   
7i7 ,the number of positions in medical 
facilities throughout the ,department   
that are not filled by a permanent      
employee4  7ii7 ,the length of time each
 such position described in clause 7i7  
remained vacant or filled by a temporary
 or acting employee4  7iii7 ,a          
description of any barriers to filling  
the positions described in clause 7i74  
7iv7 ,a plan for filling any positions  
that are vacant or filled by a temporary
 or acting employee for more than #ahj  
days4  7v7 ,a plan for handling         
emergency circumstances1 such           

administrative leave or sudden medical  
leave for senior officials4  7,g7 ,the  
number of health care providers who have
 been removed from their position or    
have retired1 by provider type1 during  
the two-year period preceding the       
submittal of the report4  7,h7 ,of the  
health care providers specified in      
subparagraph 7,g7 that have been removed
 from their position1 the following3 7i7
 ,the number of such health care        
providers who were reassigned to another
 position in the ,department4  7ii7 ,the
 number of such health care providers   
who left the ,department4  #bjd4        
,clinic management training program of  
the ,department of ,veterans ,affairs   
7a7  ,in general  ,not later than #ahj  
days after the date of the enactment of 
this ,act1 the ,secretary of ,veterans  
,affairs shall implement a clinic       
management training program to provide  
in-person1 standardized education on    
health care management to all managers  
of1 and health care providers at1       

medical facilities of the ,department of
 ,veterans ,affairs4  7b7  ,elements    
,the clinic management training program 
required by subsection 7a7 shall include
 the following3  7#a7 ,training on how  
to manage the schedules of health care  
providers of the ,department1 including 
the following3  7,a7 ,maintaining such  
schedules in a manner that allows       
appointments to be booked at least eight
 weeks in advance4  7,b7 ,proper        
planning procedures for vacation1 leave1
 and graduate medical education training
 schedules4  7#b7 ,training on the      
appropriate number of appointments that 
a health care provider should conduct on
 a daily basis1 based on specialty4     
7#c7 ,training on how to determine      
whether there are enough available      
appointment slots to manage demand for  
different appointment types and         
mechanisms for alerting management of   
insufficient slots4  7#d7 ,training on  
how to properly use the data produced by
 the scheduling dashboard required by   

section #aja7;b77#aa7 of this ,act to   
meet demand for health care1 including  
the following3  7,a7 ,training on       
determining the next available          
appointment for each health care        
provider at the medical facility4  7,b7 
,training on determining the number of  
health care providers needed to meet    
demand for health care at the medical   
facility4  7,c7 ,training on determining
 the number of exam rooms needed to meet
 demand for such health care in an      
efficient manner4  7#e7 ,training on how
 to properly use the appointment        
scheduling system of the ,department1   
including any new scheduling system     
implemented by the ,department4  7#f7   
,training on how to optimize the use of 
technology1 including the following3    
7,a7 ,telemedicine4  7,b7 ,electronic   
mail4  7,c7 ,text messaging4  7,d7 ,such
 other technologies as specified by the 
,secretary4  7#g7 ,training on how to   
properly use physical plant space at    
medical facilities of the ,department to

 ensure efficient flow and privacy for  
patients and staff4  #bje4  ,inclusion  
of ,department of ,veterans ,affairs    
facilities in ,national ,health ,service
 ,corps ,scholarship and loan repayment 
programs  7a7  ,in general  ,the        
,secretary of ,health and ,human        
,services shall use the funds           
transferred under subsection 7e7 to     
award scholarship and loan repayment    
contracts under sections #cch;,a and    
#cch;,b of the ,public ,health ,service 
,act 7#db ,u4,s4,c4 #bedl1 #bedl-#a7 to 
eligible individuals who agree to a     
period of obligated service under       
section #cch;,a7f77#a7 or #cch;,b7f77#a7
 of such ,act1 as applicable1 at a      
health facility of the ,department of   
,veterans ,affairs4  7b7  ,health       
professional shortage areas  ,for       
purposes of selecting individuals       
eligible for the scholarships and loan  
repayment contracts under subsection    
7a71 all health facilities of the       
,department of ,veterans ,affairs shall 

be deemed health professional shortage  
areas1 as defined in section #ccb of the
 ,public ,health ,service ,act 7#db     
,u4,s4,c4 #bed;e74  7c7  ,requirement   
,the ,secretary of ,health and ,human   
,services shall ensure that a minimum of
 #e scholarships or loan repayment      
contracts are awarded to individuals who
 agree to a period of obligated service 
at ,veterans ,affairs facilities in each
 ,state4  7d7  ,applicability of ,,nhsc 
program requirements  ,except as        
otherwise provided in this section1 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 7a7 
in the same manner that such terms apply
 to participants awarded a grant or loan
 repayment contract under section       
#cch;,a or #cch;,b of the ,public       
,health ,service ,act4  7e7  ,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 section1 in sections  
#cch;,a and #cch;,b of the ,public      
,health ,service ,act 7#db ,u4,s4,c4    
#bedl1 #bedl-#a71 the term primary      
health services shall include           
geriatrics4  7f7 ,funding ,the          
,secretary of ,veterans ,affairs shall  
transfer #bj1jjj1jjj for fiscal year    
#bjad1 and such sums as may be necessary
 for each fiscal year thereafter1 from  
accounts of the ,veterans ,health       
,administration to the ,secretary of    
,health and ,human ,services to award   
scholarships and loan repayment         
contracts1 as described in subsection   
7a74 ,all funds so transferred shall be 
used exclusively for the purposes       
described in such subsection4  #bjf4    
,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 title4      
,,iii ,improvement of ,access to ,care  
from ,non-,department of ,veterans      
,affairs ,providers  #cja4  ,improvement
 of access by veterans to health care   
from non-,department of ,veterans       
,affairs providers  7a7  ,improvement of
 access  7#a7  ,in general  ,the        
,secretary of ,veterans ,affairs shall  
ensure timely access of all veterans to 
the hospital care1 medical services1 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 7#b7 on the      
provision of such care and services     
through non-,department of ,veterans    
,affairs providers 7commonly referred to
 as non-,department of ,veterans        
,affairs medical care74  7#b7           
,authorities on provision of care       
through non-,department providers  ,the 

authorities specified in this paragraph 
are the following3  7,a7 ,section #agjc 
of title #ch1 ,united ,states ,code1    
relating to contracts for the provision 
of hospital care and medical services   
through non-,department facilities4     
7,b7 ,section #agbe of such title1      
relating to reimbursement of certain    
veterans for the reasonable value of    
emergency treatment at non-,department  
facilities4  7,c7 ,section #agbh of such
 title1 relating to reimbursement of    
certain veterans for customary and usual
 charges of emergency treatment from    
sources other than the ,department4     
7,d7 ,section #aghf of such title1      
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 facility4  7,e7 ,any    
other authority under the laws          
administered by the ,secretary to       
provide hospital care1 medical services1
 or other health care from a            

non-,department provider1 including the 
following3 7i7 ,a ,federally-qualified  
health center 7as defined in section    
#aije7l77#b77;,b7 of the ,social        
,security ,act 7#db ,u4,s4,c4           
#acif;d7l77#b77;,b7774  7ii7 ,the       
,department of ,defense4  7iii7 ,the    
,indian ,health ,service4  7#c7         
,requirements  ,in ensuring timely      
access of all veterans to the care and  
services described in paragraph 7#a7    
through the enhanced use of authorities 
specified in paragraph 7#b71 the        
,secretary shall require the following3 
7,a7 ,that each veteran who has not     
received hospital care1 medical         
services1 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 veterans4  7,b7 ,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 care1           
including--  7i7 the severity of the    
condition of such veteran requiring     
specialty care2 and  7ii7 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 care4  7,c7 ,that the             
determination whether a veteran shall   
receive hospital care1 medical services1
 or other health care from the          
,department through facilities of the   
,department or through non-,department  
providers pursuant to the authorities   
specified in paragraph 7#b7 shall take  
into account1 in the manner specified by
 the ,secretary1 the following3  7i7    
,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 ,department4  7ii7 ,any 
factors that might limit the ability of 
the veteran to travel1 including age1   
access to transportation1 and infirmity4
  7iii7 ,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 
,department4  7iv7 ,where the veteran   
would prefer to receive the care and    
services described in paragraph 7#a71   
unless the preference of the veteran    
conflicts with any of the other         
requirements of this paragraph4  7,d7   
,that the ,department maximize the use  
of hospital care1 medical services1 and 
other health care available to the      
,department through non-,department     
providers1 including providers available
 to provide such care and services as   
follows3  7i7 ,pursuant to contracts    

under the ,patient-,centered ,community 
,care ,program of the ,department4  7ii7
 ,pursuant to contracts between a       
facility or facilities of the           
,department and a local facility or     
provider4  7iii7 ,pursuant to contracts 
with ,federally-qualified health centers
 7as defined in section                 
#aije7l77#b77;,b7 of the ,social        
,security ,act 7#db ,u4,s4,c4           
#acif;d7l77#b77;,b7771 the ,department  
of ,defense1 or the ,indian ,health     
,service4  7iv7 ,on a fee-for-service   
basis4  7b7  ,medical records  ,in      
providing hospital care1 medical        
services1 and other health care to      
veterans through non-,department        
providers pursuant to the authorities   
specified in paragraph 7#b71 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 veteran4  7c7     
,reports  7#a7  ,initial report  ,not   
later than #de days after the date of   
the enactment of this ,act1 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 7a7 and 7b71 including a    
plan to enforce the proper              
implementation of such requirements     
systematically throughout the           
,department4  7#b7  ,periodic reports   
,not later than #ij days after the      
submittal of the report required by     
paragraph 7#a71 and every #ij days      
thereafter for one year1 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 following3  7,a7 ,the
 progress of the ,secretary in carrying 
out the plan under paragraph 7#a7 to    
enforce the proper implementation of the
 requirements under subsection 7a7 and  
7b7 systematically throughout the       
,department4  7,b7 ,the impact of the   
implementation of such requirements on  
wait-times for veterans to receive      
hospital care1 medical services1 and    
other health care1 disaggregated by--   
7i7 new patients2  7ii7 existing        
patients2  7iii7 primary care2 and  7iv7
 specialty care4  7,c7 ,any             
recommendations for changes or          
improvements to such requirements4  7,d7
 ,any requests for additional funding   
necessary to carry out such             
requirements4  #cjb4  ,extension of and 
report on joint incentives program of   
,department of ,veterans ,affairs and   
,department of ,defense  7a7  ,extension
  ,section #haaa7;d77#c7 of title #ch1  
,united ,states ,code1 is amended by    
striking ,september #cj1 #bjae and      

inserting ,september #cj1 #bjbj4  7b7   
,reports  7#a7  ,report on              
implementation of recommendations  ,not 
later than #fj days after the date of   
the enactment of this ,act1 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 #bjab report entitled ,,va   
and ,do,d ,health ,care3                
,department-,level ,actions ,needed to  
,assess ,collaboration ,performance1    
,address ,barriers1 and ,identify       
,opportunities 7,,gao-#ab-iib74  7#b7   
,comptroller ,general report  7,a7  ,in 
general  ,not later than one year after 
the date of the enactment of this ,act1 
the ,comptroller ,general of the ,united
 ,states shall submit to ,congress a    
report assessing and providing          

recommendations for improvement to the  
program to identify1 provide incentives 
to1 implement1 fund1 and evaluate       
creative coordination and sharing       
initiatives between the ,department of  
,veterans ,affairs and the ,department  
of ,defense required under section      
#haaa7;d7 of such title4  7,b7          
,elements  ,the report required by      
subparagraph 7,a7 shall include the     
following3  7i7 ,an assessment of the   
extent to which the program described in
 subparagraph 7,a7 has accomplished the 
goal of such program to improve the     
access to1 and quality and cost         
effectiveness of1 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         
,defense4  7ii7 ,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 #cbj 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       
efforts4  7iii7 ,an assessment of       
whether additional authorities to       
jointly construct1 lease1 or acquire    
facilities would facilitate additional  
collaborative efforts under such        
program4  7iv7 ,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   
collaboration4  7v7 ,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 ,system4  7vi7    
,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 care4  #cjc4  ,transfer of       
authority for payments for hospital     
care1 medical services1 and other health
 care from non-,department providers to 
the ,chief ,business ,office of the     
,veterans ,health ,administration of the
 ,department  7a7  ,transfer of         
authority  7#a7  ,in general  ,effective
 on ,october #a1 #bjad1 the ,secretary  
of ,veterans ,affairs shall transfer the
 authority to pay for hospital care1    
medical services1 and other health care 
through non-,department providers to the
 ,chief ,business ,office of the        
,veterans ,health ,administration of the

 ,department of ,veterans ,affairs from 
the ,veterans ,integrated ,service      
,networks and medical centers of the    
,department of ,veterans ,affairs4  7#b7
 ,manner of care ,the ,chief ,business  
,office shall work in consultation with 
the ,office of ,clinical ,operations and
 ,management of the ,department of      
,veterans ,affairs to ensure that care  
and services described in paragraph 7#a7
 is provided in a manner that is        
clinically appropriate and effective4   
7#c7  ,no delay in payment  ,the        
transfer of authority under paragraph   
7#a7 shall be carried out in a manner   
that does not delay or impede any       
payment by the ,department for hospital 
care1 medical services1 or other health 
care provided through a non-,department 
provider under the laws administered by 
the ,secretary4  7b7  ,budgetary effect 
,the ,secretary shall1 for each fiscal  
year that begins after the date of the  
enactment of this ,act--  7#a7 include  
in the budget for the ,chief ,business  

,office of the ,veterans ,health        
,administration amounts to pay for      
hospital care1 medical services1 and    
other health care provided through      
non-,department providers1 including any
 amounts necessary to carry out the     
transfer of authority to pay for such   
care and services under subsection 7a71 
including any increase in staff2 and    
7#b7 not include in the budget of each  
,veterans ,integrated ,service ,network 
and medical center of the ,department   
amounts to pay for such care and        
services4  7c7  ,removal from           
performance goals  ,for each fiscal year
 that begins after the date of the      
enactment of this ,act1 the ,secretary  
shall not include in the performance    
goals of any employee of a ,veterans    
,integrated ,service ,network or medical
 center of the ,department any          
performance goal that might             
disincentivize the payment of           
,department amounts to provide hospital 
care1 medical services1 or other health 

care through a non-,department provider4
  #cjd4  ,enhancement of collaboration  
between ,department of ,veterans        
,affairs and ,indian ,health ,service   
7a7  ,outreach to tribal-run medical    
facilities  ,the ,secretary of ,veterans
 ,affairs shall1 in consultation with   
the ,director of the ,indian ,health    
,service1 conduct outreach to each      
medical facility operated by an ,indian 
tribe or tribal organization through a  
contract or compact with the ,indian    
,health ,service under the ,indian      
,self-,determination and ,education     
,assistance ,act 7#be ,u4,s4,c4 #dej et 
seq47 to raise awareness of the ability 
of such facilities1 ,indian tribes1 and 
tribal organizations to enter into      
agreements with the ,department of      
,veterans ,affairs under which the      
,secretary reimburses such facilities1  
,indian tribes1 or tribal organizations1
 as the case may be1 for health care    
provided to veterans eligible for health
 care at such facilities4  7b7  ,metrics

 for memorandum of understanding        
performance  ,the ,secretary of         
,veterans ,affairs shall implement      
performance metrics for assessing the   
performance by the ,department of       
,veterans ,affairs and the ,indian      
,health ,service under the memorandum of
 understanding entitled ,memorandum of  
,understanding between the ,department  
of ,veterans ,affairs 7,,va7 and the    
,indian ,health ,service 7,,ihs7 in     
increasing access to health care1       
improving quality and coordination of   
health care1 promoting effective        
patient-centered collaboration and      
partnerships between the ,department and
 the ,service1 and ensuring             
health-promotion and disease-prevention 
services are appropriately funded and   
available for beneficiaries under both  
health care systems4  7c7  ,report  ,not
 later than #ahj days after the date of 
the enactment of this ,act1 the         
,secretary of ,veterans ,affairs and the
 ,director of the ,indian ,health       

,service shall jointly submit to        
,congress a report on the feasibility   
and advisability of the following3  7#a7
 ,entering into agreements for the      
reimbursement by the ,secretary of the  
costs of direct care services provided  
through organizations receiving amounts 
pursuant to grants made or contracts    
entered into under section #ejc of the  
,indian ,health ,care ,improvement ,act 
7#be ,u4,s4,c4 #afec7 to veterans who   
are otherwise eligible to receive health
 care from such organizations4  7#b7    
,including the reimbursement of the     
costs of direct care services provided  
to veterans who are not ,indians in     
agreements between the ,department and  
the following3 7,a7 ,the ,indian ,health
 ,service4  7,b7 ,an ,indian tribe or   
tribal organization operating a medical 
facility through a contract or compact  
with the ,indian ,health ,service under 
the ,indian ,self-,determination and    
,education ,assistance ,act 7#be        
,u4,s4,c4 #dej et seq474  7,c7 ,a       

medical facility of the ,indian ,health 
,service4  7d7  ,definitions  ,in this  
section3  7#a7  ,indian  ,the terms     
,indian and ,indian tribe have the      
meanings given those terms in section #d
 of the ,indian ,health ,care           
,improvement ,act 7#be ,u4,s4,c4 #afjc74
  7#b7  ,medical facility of the ,indian
 ,health ,service  ,the term medical    
facility of the ,indian ,health ,service
 includes a facility operated by an     
,indian tribe or tribal organization    
through a contract or compact with the  
,indian ,health ,service under the      
,indian ,self-,determination and        
,education ,assistance ,act 7#be        
,u4,s4,c4 #dej et seq474  7#c7  ,tribal 
organization  ,the term tribal          
organization has the meaning given the  
term in section #d of the ,indian       
,self-,determination and ,education     
,assistance ,act 7#be ,u4,s4,c4 #dej;b74
  #cje4 ,enhancement of collaboration   
between ,department of ,veterans        
,affairs and ,native ,hawaiian health   

care systems  7a7 ,in general ,the      
,secretary of ,veterans ,affairs shall1 
in consultation with ,papa ,ola ,lokahi 
and such other organizations involved in
 the delivery of health care to ,native 
,hawaiians as the ,secretary considers  
appropriate1 enter into contracts or    
agreements with ,native ,hawaiian health
 care systems that are in receipt of    
funds from the ,secretary of ,health and
 ,human ,services pursuant to grants    
awarded or contracts entered into under 
section #f7;a7 of the ,native ,hawaiian 
,health ,care ,improvement ,act 7#db    
,u4,s4,c4 #aagje7;a77 for the           
reimbursement of direct care services   
provided to eligible veterans as        
specified in such contracts or          
agreements4  7b7 ,definitions ,in this  
section1 the terms ,native ,hawaiian1   
,native ,hawaiian health care system1   
and ,papa ,ola ,lokahi have the meanings
 given those terms in section #ab of the
 ,native ,hawaiian ,health ,care        
,improvement ,act 7#db ,u4,s4,c4        

#aagaa74  #cjf4 ,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 title4  ,,iv ,health ,care         
,administrative ,matters  #dja4         
,improvement of access of veterans to   
mobile vet centers of the ,department of
 ,veterans ,affairs  7a7  ,improvement  
of access  7#a7  ,in general  ,the      
,secretary of ,veterans ,affairs shall  
improve the access of veterans to       
telemedicine and other health care      
through the use of mobile vet centers of
 the ,department of ,veterans ,affairs  
by providing standardized requirements  
for the operation of such centers4  7#b7
  ,requirements  ,the standardized      
requirements required by paragraph 7#a7 
shall include the following3  7,a7 ,the 
number of days each mobile vet center of
 the ,department is expected to travel  
per year4  7,b7 ,the number of locations
 each center is expected to visit per   

year4  7,c7 ,the number of appointments 
each center is expected to conduct per  
year4  7,d7 ,the method and timing of   
notifications given by each center to   
individuals in the area to which such   
center is traveling1 including          
notifications informing veterans of the 
availability to schedule appointments at
 the center4  7#c7  ,use of telemedicine
  ,the ,secretary shall ensure that each
 mobile vet center of the ,department   
has the capability to provide           
telemedicine services4  7b7  ,reports   
,not later than one year after the date 
of the enactment of this ,act1 and not  
later than ,september #cj each year     
thereafter1 the ,secretary of ,veterans 
,affairs shall submit to the ,committee 
on ,veterans' ,affairs of the ,senate   
and the ,committee on ,veterans'        
,affairs of the ,house of               
,representatives a report on the        
following3  7#a7 ,the use of mobile vet 
centers to provide telemedicine services
 to veterans during the year preceding  

the submittal of the report1 including  
the following3  7,a7 ,the number of days
 each mobile vet center was open to     
provide such services4  7,b7 ,the number
 of days each mobile vet center traveled
 to a location other than the           
headquarters of the mobile vet center to
 provide such services4  7,c7 ,the      
number of appointments each center      
conducted to provide such services on   
average per month and in total during   
such year4  7#b7 ,an analysis of the    
effectiveness of using mobile vet       
centers to provide health care services 
to veterans through the use of          
telemedicine4  7#c7 ,any recommendations
 for an increase in the number of mobile
 vet centers of the ,department4  7#d7  
,any recommendations for an increase in 
the telemedicine capabilities of each   
mobile vet center4  7#e7 ,the           
feasibility and advisability of using   
temporary health care providers1        
including locum tenens1 to provide      
direct health care services to veterans 

at mobile vet centers4  7#f7 ,such other
 recommendations on improvement of the  
use of mobile vet centers by the        
,department as the ,secretary considers 
appropriate4  #djb4 ,commission on      
,access to ,care  7a7 ,establishment of 
commission  7#a7 ,in general ,there is  
established the ,commission on ,access  
to ,care 7in this section referred to as
 the ,commission7 to examine the access 
of veterans to health care from the     
,department of ,veterans ,affairs and   
strategically examine how best to       
organize the ,veterans ,health          
,administration1 locate health care     
resources1 and deliver health care to   
veterans during the next #aj to #bj     
years4  7#b7 ,membership  7,a7 ,voting  
members ,the ,commission shall be       
composed of #aj voting members who are  
appointed by the ,president as follows3 
7i7 ,at least two members who represent 
an organization recognized by the       
,secretary of ,veterans ,affairs for the
 representation of veterans under       

section #eijb of title #ch1 ,united     
,states ,code4  7ii7 ,at least one      
member from among persons who are       
experts concerning a public or private  
hospital system4  7iii7 ,at least one   
member from among persons who are       
familiar with government health care    
systems1 including those systems of the 
,department of ,defense1 the ,indian    
,health ,service1 and                   
,federally-qualified health centers 7as 
defined in section #aije7l77#b77;,b7 of 
the ,social ,security ,act 7#db         
,u4,s4,c4 #acif;d7l77#b77;,b7774  7iv7  
,at least two members from among persons
 who are familiar with the ,veterans    
,health ,administration4  7,b7          
,nonvoting members ,in addition to      
members appointed under subparagraph    
7,a71 the ,commission shall be composed 
of #aj nonvoting members who are        
appointed by the ,president as follows3 
7i7 ,at least two members who represent 
an organization recognized by the       
,secretary of ,veterans ,affairs for the

 representation of veterans under       
section #eijb of title #ch1 ,united     
,states ,code4  7ii7 ,at least one      
member from among persons who are       
experts in a public or private hospital 
system4  7iii7 ,at least one member from
 among persons who are familiar with    
government health care systems1         
including those systems of the          
,department of ,defense1 the ,indian    
,health ,service1 and                   
,federally-qualified health centers 7as 
defined in section #aije7l77#b77;,b7 of 
the ,social ,security ,act 7#db         
,u4,s4,c4 #acif;d7l77#b77;,b7774  7iv7  
,at least two members from among persons
 who are familiar with the ,veterans    
,health ,administration4  7,c7 ,date    
,the appointments of members of the     
,commission shall be made not later than
 #fj days after the date of the         
enactment of this ,act4  7#c7 ,period of
 appointment2 vacancies ,members shall  
be appointed for the life of the        
,commission4 ,any vacancy in the        

,commission shall not affect its powers1
 but shall be filled in the same manner 
as the original appointment4  7#d7      
,initial meeting ,not later than #ae    
days after the date on which seven      
voting members of the ,commission have  
been appointed1 the ,commission shall   
hold its first meeting4  7#e7 ,meetings 
,the ,commission shall meet at the call 
of the ,chairperson4  7#f7 ,quorum ,a   
majority of the members of the          
,commission shall constitute a quorum1  
but a lesser number of members may hold 
hearings4  7#g7 ,chairperson and ,vice  
,chairperson ,the ,commission shall     
select a ,chairperson and ,vice         
,chairperson from among its members4    
7b7 ,duties of commission  7#a7         
,evaluation and assessment ,the         
,commission shall undertake a           
comprehensive evaluation and assessment 
of access to health care at the         
,department of ,veterans ,affairs4  7#b7
 ,matters evaluated and assessed ,the   
matters evaluated and assessed by the   

,commission shall include the following3
 7,a7 ,the appropriateness of current   
standards of the ,department of         
,veterans ,affairs concerning access to 
health care4  7,b7 ,the measurement of  
such standards4  7,c7 ,the              
appropriateness of performance standards
 and incentives in relation to standards
 described in subparagraph 7,a74  7,d7  
,staffing levels throughout the         
,veterans ,health ,administration and   
whether they are sufficient to meet     
current demand for health care from the 
,administration4  7#c7 ,reports ,the    
,commission shall submit to the         
,president1 through the ,secretary of   
,veterans ,affairs1 reports as follows3 
7,a7 ,not later than #ij days after the 
date of the initial meeting of the      
,commission1 an interim report on-- 7i7 
the findings of the ,commission with    
respect to the evaluation and assessment
 required by this subsection2 and  7ii7 
such recommendations as the ,commission 
may have for legislative or             

administrative action to improve access 
to health care through the ,veterans    
,health ,administration4  7,b7 ,not     
later than #ahj days after the date of  
the initial meeting of the ,commission1 
a final report on-- 7i7 the findings of 
the ,commission with respect to the     
evaluation and assessment required by   
this subsection2 and  7ii7 such         
recommendations as the ,commission may  
have for legislative or administrative  
action to improve access to health care 
through the ,veterans ,health           
,administration4  7c7 ,powers of the    
commission  7#a7 ,hearings ,the         
,commission may hold such hearings1 sit 
and act at such times and places1 take  
such testimony1 and receive such        
evidence as the ,commission considers   
advisable to carry out this section4    
7#b7 ,information from ,federal agencies
 ,the ,commission may secure directly   
from any ,federal department or agency  
such information as the ,commission     
considers necessary to carry out this   

section4 ,upon request of the           
,chairperson of the ,commission1 the    
head of such department or agency shall 
furnish such information to the         
,commission4  7d7 ,commission personnel 
matters  7#a7 ,compensation of members  
,each member of the ,commission who is  
not an officer or employee of the       
,federal ,government shall be           
compensated at a rate equal to the daily
 equivalent of the annual rate of basic 
pay prescribed for level ,,iv of the    
,executive ,schedule under section #ecae
 of title #e1 ,united ,states ,code1 for
 each day 7including travel time7 during
 which such member is engaged in the    
performance of the duties of the        
,commission4 ,all members of the        
,commission who are officers or         
employees of the ,united ,states shall  
serve without compensation in addition  
to that received for their services as  
officers or employees of the ,united    
,states4  7#b7 ,travel expenses ,the    
members of the ,commission shall be     

allowed travel expenses1 including per  
diem in lieu of subsistence1 at rates   
authorized for employees of agencies    
under subchapter ,i of chapter #eg of   
title #e1 ,united ,states ,code1 while  
away from their homes or regular places 
of business in the performance of       
services for the ,commission4  7#c7     
,staff  7,a7 ,in general ,the           
,chairperson of the ,commission may1    
without regard to the civil service laws
 and regulations1 appoint and terminate 
an executive director and such other    
additional personnel as may be necessary
 to enable the ,commission to perform   
its duties4 ,the employment of an       
executive director shall be subject to  
confirmation by the ,commission4  7,b7  
,compensation ,the ,chairperson of the  
,commission may fix the compensation of 
the executive director and other        
personnel without regard to chapter #ea 
and subchapter ,,iii of chapter #ec of  
title #e1 ,united ,states ,code1        
relating to classification of positions 

and ,general ,schedule pay rates1 except
 that the rate of pay for the executive 
director and other personnel may not    
exceed the rate payable for level ,v of 
the ,executive ,schedule under section  
#ecaf of such title4  7#d7 ,detail of   
government employees ,any ,federal      
,government employee may be detailed to 
the ,commission without reimbursement1  
and such detail shall be without        
interruption or loss of civil service   
status or privilege4  7#e7 ,procurement 
of temporary and intermittent services  
,the ,chairperson of the ,commission may
 procure temporary and intermittent     
services under section #caji7;b7 of     
title #e1 ,united ,states ,code1 at     
rates for individuals which do not      
exceed the daily equivalent of the      
annual rate of basic pay prescribed for 
level ,v of the ,executive ,schedule    
under section #ecaf of such title4  7e7 
,termination of the commission ,the     
,commission shall terminate #cj days    
after the date on which the ,commission 

submits its report under subsection     
7b77#c77;,b74  7f7 ,funding ,the        
,secretary of ,veterans ,affairs shall  
make available to the ,commission from  
amounts appropriated or otherwise made  
available to the ,secretary such amounts
 as the ,secretary and the ,chairperson 
of the ,commission jointly consider     
appropriate for the ,commission to      
perform its duties under this section4  
7g7 ,executive action  7#a7 ,action on  
recommendations ,the ,president shall   
require the ,secretary of ,veterans     
,affairs and such other heads of        
relevant ,federal departments and       
agencies to implement each              
recommendation set forth in a report    
submitted under subsection 7b77#c7 that 
the ,president-- 7,a7 considers feasible
 and advisable2 and  7,b7 determines can
 be implemented without further         
legislative action4  7#b7 ,reports ,not 
later than #fj days after the date on   
which the ,president receives a report  
under subsection 7b77#c71 the ,president

 shall submit to the ,committee on      
,veterans' ,affairs of the ,senate and  
the ,committee on ,veterans' ,affairs of
 the ,house of ,representatives and such
 other committees of ,congress as the   
,president considers appropriate a      
report setting forth the following3 7,a7
 ,an assessment of the feasibility and  
advisability of each recommendation     
contained in the report received by the 
,president4  7,b7 ,for each             
recommendation assessed as feasible and 
advisable under subparagraph 7,a7 the   
following3 7i7 ,whether such            
recommendation requires legislative     
action4  7ii7 ,if such recommendation   
requires legislative action1 a          
recommendation concerning such          
legislative action4  7iii7 ,a           
description of any administrative action
 already taken to carry out such        
recommendation4  7iv7 ,a description of 
any administrative action the ,president
 intends to be taken to carry out such  
recommendation and by whom4  #djc4      

,commission on ,capital ,planning for   
,department of ,veterans ,affairs       
,medical ,facilities  7a7               
,establishment of commission  7#a7      
,establishment  ,there is established   
the ,commission on ,capital ,planning   
for ,department of ,veterans ,affairs   
,medical ,facilities 7in this section   
referred to as the ,commission74  7#b7  
,membership  7,a7  ,voting members  ,the
 ,commission shall1 subject to          
subparagraph 7,b71 be composed of #aj   
voting members as follows3  7i7 #a shall
 be appointed by the ,president4  7ii7  
#a shall be appointed by the            
,administrator of ,general ,services4   
7iii7 #c shall be appointed by the      
,secretary of ,veterans ,affairs1 of    
whom--  7,i7 #a shall be an employee of 
the ,veterans ,health ,administration2  
7,,ii7 #a shall be an employee of the   
,office of ,asset ,enterprise           
,management of the ,department of       
,veterans ,affairs2 and  7,,iii7 #a     
shall be an employee of the ,office of  

,construction and ,facilities           
,management of the ,department of       
,veterans ,affairs4  7iv7 #a shall be   
appointed by the ,secretary of ,defense 
from among employees of the ,army ,corps
 of ,engineers4  7v7 #a shall be        
appointed by the majority leader of the 
,senate4  7vi7 #a shall be appointed by 
the minority leader of the ,senate4     
7vii7 #a shall be appointed by the      
,speaker of the ,house of               
,representatives4  7viii7 #a shall be   
appointed by the minority leader of the 
,house of ,representatives4  7,b7       
,requirement relating to certain        
appointments of voting members  ,of the 
members appointed pursuant to clause    
7i71 7ii71 and 7iv7 through 7viii7 of   
subparagraph 7,a71 all shall have       
expertise in capital leasing1           
construction1 or health facility        
management planning4  7,c7  ,non-voting 
members  ,the ,commission shall be      
assisted by #aj non-voting members1     
appointed by the vote of a majority of  

members of the ,commission under        
subparagraph 7,a71 of whom--  7i7 #f    
shall be representatives of veterans    
service organizations recognized by the 
,secretary of ,veterans ,affairs2 and   
7ii7 #d shall be individuals from       
outside the ,department of ,veterans    
,affairs with experience and expertise  
in matters relating to management1      
construction1 and leasing of capital    
assets4  7,d7  ,date of appointment of  
voting members  ,the appointments of the
 members of the ,commission under       
subparagraph 7,a7 shall be made not     
later than #fj days after the date of   
the enactment of this ,act4  7#c7       
,period of appointment2 vacancies       
,members shall be appointed for the life
 of the ,commission4 ,any vacancy in the
 ,commission shall not affect its       
powers1 but shall be filled in the same 
manner as the original appointment4     
7#d7  ,initial meeting  ,not later than 
#ae days after the date on which #g     
members of the ,commission have been    

appointed1 the ,commission shall hold   
its first meeting4  7#e7  ,meetings     
,the ,commission shall meet at the call 
of the ,chair4  7#f7  ,quorum  ,a       
majority of the members of the          
,commission shall constitute a quorum1  
but a lesser number of members may hold 
hearings4  7#g7  ,chair and vice chair  
,the ,commission shall select a ,chair  
and ,vice ,chair from among its members4
  7b7  ,duties of commission  7#a7  ,in 
general  ,the ,commission shall         
undertake a comprehensive evaluation and
 assessment of various options for      
capital planning for ,department of     
,veterans ,affairs medical facilities1  
including an evaluation and assessment  
of the mechanisms by which the          
,department currently selects means for 
the delivery of health care1 whether by 
major construction1 major medical       
facility leases1 sharing agreements with
 the ,department of ,defense1 the       
,indian ,health ,service1 and ,federally
 ,qualified ,health ,clinics under      

section #ccj of the ,public ,health     
,service ,act 7#db ,u4,s4,c4 #bed;b71   
contract care1 multisite care1          
telemedicine1 extended hours for care1  
or other means4  7#b7  ,context of      
evaluation and assessment  ,in          
undertaking the evaluation and          
assessment1 the ,commission shall       
consider--  7,a7 the importance of      
access to health care through the       
,department1 including associated       
guidelines of the ,department on access 
to1 and drive time for1 health care2    
7,b7 limitations and requirements       
applicable to the construction and      
leasing of medical facilities for the   
,department1 including applicable laws1 
regulations1 and costs as determined by 
both the ,congressional ,budget ,office 
and the ,office of ,management and      
,budget2  7,c7 the nature of capital    
planning for ,department medical        
facilities in an era of fiscal          
uncertainty2  7,d7 projected future     
fluctuations in the population of       

veterans2 and  7,e7 the extent to which 
the ,department was able to meet the    
mandates of the ,capital ,asset         
,realignment for ,enhanced ,services    
,commission4  7#c7  ,particular         
considerations  ,in undertaking the     
evaluation and assessment1 the          
,commission shall address1 in           
particular1 the following3  7,a7 ,the   
,major ,medical ,facility ,lease        
,program of the ,department1 including  
an identification of potential          
improvements to the lease authorization 
processes under that ,program4  7,b7    
,the management processes of the        
,department for its ,major ,medical     
,facility ,construction ,program1       
including processes relating to contract
 award and management1 project          
management1 and processing of change    
orders4  7,c7 ,the overall capital      
planning program of the ,department for 
medical facilities1 including an        
evaluation and assessment of--  7i7 the 
manner in which the ,department         

determines whether to use capital or    
non-capital means to expand access to   
health care2  7ii7 the manner in which  
the ,department determines the          
disposition of under-utilized and       
un-utilized buildings on campuses of    
,department medical centers1 and any    
barriers to disposition2  7iii7 the     
effectiveness of the facility master    
planning initiative of the ,department2 
and  7iv7 the extent to which           
sustainable attributes are planned for  
to decrease operating costs for         
,department medical facilities4  7,d7   
,the current backlog of construction    
projects for ,department medical        
facilities1 including an identification 
of the most effective means to quickly  
secure the most critical repairs        
required1 including repairs relating to 
facility condition deficiencies1        
structural safety1 and compliance with  
the ,americans ,with ,disabilities ,act 
of #aiij4  7#d7  ,reports  ,subject to  
paragraph 7#e71 the ,commission shall   

submit to the ,secretary of ,veterans   
,affairs1 and to the ,committee         
,veterans' ,affairs of the ,senate and  
the ,committee on ,veterans' ,affairs of
 the ,house of ,representatives1 reports
 as follows3  7,a7 ,not later than six  
months after its initial meeting under  
subsection 7a77#d71 a report on the     
,major ,medical ,facility ,lease        
,program and the ,congressional lease   
authorization process4  7,b7 ,not later 
than one year after its initial meeting1
 a report--  7i7 on the management      
processes of the ,department for the    
construction of ,department medical     
facilities2 and  7ii7 setting forth an  
update of any matters covered in the    
report under subparagraph 7,a74  7,c7   
,not later than #ah months after its    
initial meeting1 a report--  7i7 on the 
overall capital planning program of the 
,department for medical facilities2 and 
7ii7 setting forth an update of any     
matters covered in earlier reports under
 this paragraph4  7,d7 ,not later than  

two years after its initial meeting1 a  
report--  7i7 on the current backlog of 
construction projects for ,department   
medical facilities2  7ii7 setting forth 
an update of any matters covered in     
earlier reports under this paragraph2   
and  7iii7 including such other matters 
relating to the duties of the           
,commission that the ,commission        
considers appropriate4  7,e7 ,not later 
than #bg months after its initial       
meeting1 a report on the implementation 
by the ,secretary of ,veterans ,affairs 
pursuant to subsection 7g7 of the       
recommendations included pursuant to    
paragraph 7#e7 in the reports under this
 paragraph4  7#e7  ,recommendations     
,each report under paragraph 7#d7 shall 
include1 for the aspect of the capital  
asset planning process of the           
,department covered by such report1 such
 recommendations as the ,commission     
considers appropriate for the           
improvement and enhancement of such     
aspect of the capital asset planning    

process4  7c7  ,powers of commission    
7#a7  ,hearings  ,the ,commission may   
hold such hearings1 sit and act at such 
times and places1 take such testimony1  
and receive such evidence as the        
,commission considers advisable to carry
 out this section4  7#b7  ,information  
from ,federal agencies  ,the ,commission
 may secure directly from any ,federal  
department or agency such information as
 the ,commission considers necessary to 
carry out this section4 ,upon request of
 the ,chair of the ,commission1 the head
 of such department or agency shall     
furnish such information to the         
,commission4  7d7  ,commission personnel
 matters  7#a7  ,compensation of members
  ,each member of the ,commission who is
 not an officer or employee of the      
,federal ,government shall be           
compensated at a rate equal to the daily
 equivalent of the annual rate of basic 
pay prescribed for level ,,iv of the    
,executive ,schedule under section #ecae
 of title #e1 ,united ,states ,code1 for

 each day 7including travel time7 during
 which such member is engaged in the    
performance of the duties of the        
,commission4 ,all members of the        
,commission who are officers or         
employees of the ,united ,states shall  
serve without compensation in addition  
to that received for their services as  
officers or employees of the ,united    
,states4  7#b7  ,travel expenses  ,the  
members of the ,commission shall be     
allowed travel expenses1 including per  
diem in lieu of subsistence1 at rates   
authorized for employees of agencies    
under subchapter ,i of chapter #eg of   
title #e1 ,united ,states ,code1 while  
away from their homes or regular places 
of business in the performance of       
services for the ,commission4  7#c7     
,staff  7,a7  ,in general  ,the ,chair  
of the ,commission may1 without regard  
to the civil service laws and           
regulations1 appoint and terminate an   
executive director and such other       
additional personnel as may be necessary

 to enable the ,commission to perform   
its duties4 ,the employment of an       
executive director shall be subject to  
confirmation by the ,commission4  7,b7  
,compensation  ,the ,chair of the       
,commission may fix the compensation of 
the executive director and other        
personnel without regard to chapter #ea 
and subchapter ,,iii of chapter #ec of  
title #e1 ,united ,states ,code1        
relating to classification of positions 
and ,general ,schedule pay rates1 except
 that the rate of pay for the executive 
director and other personnel may not    
exceed the rate payable for level ,v of 
the ,executive ,schedule under section  
#ecaf of such title4  7#d7  ,detail of  
government employees  ,any ,federal     
,government employee may be detailed to 
the ,commission without reimbursement1  
and such detail shall be without        
interruption or loss of civil service   
status or privilege4  7#e7  ,procurement
 of temporary and intermittent services 
,the ,chair of the ,commission may      

procure temporary and intermittent      
services under section #caji7;b7 of     
title #e1 ,united ,states ,code1 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 #ecaf of such title4  7e7 
,termination of commission  ,the        
,commission shall terminate #fj days    
after the date on which the ,commission 
submits its report under subsection     
7b77#d77;,e74  7f7  ,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 section4  
7g7  ,action on recommendations  7#a7   
,in general  ,the ,secretary of         
,veterans ,affairs shall implement each 
recommendation included in a report     
under subsection 7b77#d7 that the       
,secretary considers feasible and       

advisable and can be implemented without
 further legislative action4  7#b7      
,reports  ,not later than #abj days     
after receipt of a report under         
subparagraphs 7,a7 through 7,d7 of      
subsection 7b77#d71 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 following3  7,a7 ,an  
assessment of the feasibility and       
advisability of each recommendation     
contained in such report4  7,b7 ,for    
each recommendation assessed as feasible
 and advisable--  7i7 if such           
recommendation does not require further 
legislative action for implementation1 a
 description of the actions taken1 and  
to be taken1 by the ,secretary to       
implement such recommendation2 and  7ii7
 if such recommendation requires further
 legislative action for implementation1 
recommendations for such legislative    
action4  #djd4  ,removal of ,senior     

,executive ,service employees of the    
,department of ,veterans ,affairs for   
performance  7a7  ,removal or transfer  
7#a7 ,in general ,chapter #g of title   
#ch1 ,united ,states ,code1 is amended  
by adding at the end the following new  
section3  #gac4  ,senior ,executive     
,service3 removal based on performance  
7a7  ,in general  ,the ,secretary may   
remove any individual from the ,senior  
,executive ,service if the ,secretary   
determines the performance of the       
individual warrants such removal4 ,if   
the ,secretary so removes such an       
individual1 the ,secretary may--  7#a7  
remove the individual from the civil    
service 7as defined in section #baja of 
title #e72 or  7#b7 transfer the        
individual to a ,general ,schedule      
position at any grade of the ,general   
,schedule for which the individual is   
qualified and that the ,secretary       
determines is appropriate4  7b7  ,notice
 to ,congress  ,not later than #cj days 
after removing or transferring an       

individual from the ,senior ,executive  
,service under paragraph 7#a71 the      
,secretary shall submit to the          
,committees on ,veterans' ,affairs of   
the ,senate and ,house of               
,representatives notice in writing of   
such removal or transfer and the reason 
for such removal or transfer4  7c7      
,appeal of removal or transfer ,any     
removal or transfer under subsection 7a7
 may be appealed to the ,merit ,systems 
,protection ,board under section #ggja  
of title #e not later than #g days after
 such removal or transfer4  7d7         
,expedited review by ,merit ,systems    
,protection ,board  7#a7 ,the ,merit    
,systems ,protection ,board shall       
expedite any appeal under section #ggja 
of title #e of a removal or transfer    
under subsection 7a7 and1 in any such   
case1 shall issue a decision not later  
than #ba days after the date of the     
appeal4  7#b7 ,in any case in which the 
,merit ,systems ,protection ,board      
determines that it cannot issue a       

decision in accordance with the #ba-;day
 requirement under paragraph 7#a71 the  
,merit ,systems ,protection ,board shall
 submit to ,congress a report that      
explains the reason why the ,merit      
,systems ,protection ,board is unable to
 issue a decision in accordance with    
such requirement in such case4  7#c7    
,there is authorized to be appropriated 
such sums as may be necessary for the   
,merit ,systems ,protection ,board to   
expedite appeals under paragraph 7#a74  
7#d7 ,the ,merit ,systems ,protection   
,board may not stay any personnel action
 taken under this section4  4  7#b7     
,clerical amendment  ,the table of      
sections at the beginning of such       
chapter is amended by adding at the end 
the following new item3  #gac4 ,senior  
,executive ,service3 removal based on   
performance4  4  7b7 ,establishment of  
expedited review process  7#a7 ,in      
general ,not later than #cj days after  
the date of the enactment of this ,act1 
the ,merit ,systems ,protection ,board  

shall establish and put into effect a   
process to conduct expedited reviews in 
accordance with section #gac7;d7 of     
title #ch1 ,united ,states ,code4  7#b7 
,inapplicability of certain regulations 
,section #abja4bb of title #e1 ,code of 
,federal ,regulations1 as in effect on  
the day before the date of the enactment
 of this ,act1 shall not apply to       
expedited reviews carried out under     
section #gac7;d7 of title #ch1 ,united  
,states ,code4  7#c7 ,report by ,merit  
,systems ,protection ,board ,not later  
than #cj days after the date of the     
enactment of this ,act1 the ,merit      
,systems ,protection ,board shall submit
 to ,congress a report on the actions   
the ,board plans to take to conduct     
expedited reviews under section #gac7;d7
 of title #ch1 ,united ,states ,code1 as
 added by subsection 7a74 ,such report  
shall include a description of the      
resources the ,board determines will be 
necessary to conduct such reviews and a 
description of whether any resources    

will be necessary to conduct such       
reviews that were not available to the  
,board on the day before the date of the
 enactment of this ,act4  7c7 ,temporary
 exemption from certain limitation on   
initiation of removal from ,senior      
,executive ,service ,during the         
#abj-;day period beginning on the date  
of the enactment of this ,act1 an action
 to remove an individual from the       
,senior ,executive ,service at the      
,department of ,veterans ,affairs       
pursuant to section #gac of title #ch1  
,united ,states ,code1 as added by      
subsection 7a71 or section #gedc of     
title #e1 ,united ,states ,code1 may be 
initiated1 notwithstanding section      
#ceib7;b7 of title #e1 ,united ,states  
,code1 or any other provision of law4   
7d7 ,construction ,nothing in this      
section or section #gac of title #ch1   
,united ,states ,code1 as added by      
subsection 7a71 shall be construed to   
apply to an appeal of a removal1        
transfer1 or other personnel action that

 was pending before the date of the     
enactment of this ,act4  ,v  ,major     
,medical ,facility ,leases  #eja4       
,authorization of major medical facility
 leases  ,the ,secretary of ,veterans   
,affairs may carry out the following    
major medical facility leases at the    
locations specified1 and in an amount   
for each lease not to exceed the amount 
shown for such location 7not including  
any estimated cancellation costs73  7#a7
 ,for a clinical research and pharmacy  
coordinating center1 ,albuquerque1 ,new 
,mexico1 an amount not to exceed        
#i1efj1jjj4  7#b7 ,for a community-based
 outpatient clinic1 ,brick1 ,new        
,jersey1 an amount not to exceed        
#g1bhj1jjj4  7#c7 ,for a new primary    
care and dental clinic annex1           
,charleston1 ,south ,carolina1 an amount
 not to exceed #g1jgj1bej4  7#d7 ,for   
the ,cobb ,county community-based       
,outpatient ,clinic1 ,cobb ,county1     
,georgia1 an amount not to exceed       
#f1dji1jjj4  7#e7 ,for the ,leeward     

,outpatient ,healthcare ,access ,center1
 ,honolulu1 ,hawaii1 including a        
co-located clinic with the ,department  
of ,defense and the co-location of the  
,honolulu ,regional ,office of the      
,veterans ,benefits ,administration and 
the ,kapolei ,vet ,center of the        
,department of ,veterans ,affairs1 an   
amount not to exceed #ae1hhg1cgj4  7#f7 
,for a community-based outpatient       
clinic1 ,johnson ,county1 ,kansas1 an   
amount not to exceed #b1bfc1jjj4  7#g7  
,for a replacement community-based      
outpatient clinic1 ,lafayette1          
,louisiana1 an amount not to exceed     
#b1iif1jjj4  7#h7 ,for a community-based
 outpatient clinic1 ,lake ,charles1     
,louisiana1 an amount not to exceed     
#b1fbf1jjj4  7#i7 ,for outpatient clinic
 consolidation1 ,new ,port ,richey1     
,florida1 an amount not to exceed       
#aa1ibg1jjj4  7#aj7 ,for an outpatient  
clinic1 ,ponce1 ,puerto ,rico1 an amount
 not to exceed #aa1ece1jjj4  7#aa7 ,for 
lease consolidation1 ,san ,antonio1     

,texas1 an amount not to exceed         
#ai1dbf1jjj4  7#ab7 ,for a              
community-based outpatient clinic1 ,san 
,diego1 ,california1 an amount not to   
exceed #aa1idf1ajj4  7#ac7 ,for an      
outpatient clinic1 ,tyler1 ,texas1 an   
amount not to exceed #d1cbg1jjj4  7#ad7 
,for the ,errera ,community ,care       
,center1 ,west ,haven1 ,connecticut1 an 
amount not to exceed #d1hhc1jjj4  7#ae7 
,for the ,worcester community-based     
,outpatient ,clinic1 ,worcester1        
,massachusetts1 an amount not to exceed 
#d1hee1jjj4  7#af7 ,for the expansion of
 a community-based outpatient clinic1   
,cape ,girardeau1 ,missouri1 an amount  
not to exceed #d1bcb1jfj4  7#ag7 ,for a 
multispecialty clinic1 ,chattanooga1    
,tennessee1 an amount not to exceed     
#g1jfi1jjj4  7#ah7 ,for the expansion of
 a community-based outpatient clinic1   
,chico1 ,california1 an amount not to   
exceed #d1ecd1jjj4  7#ai7 ,for a        
community-based outpatient clinic1      
,chula ,vista1 ,california1 an amount   

not to exceed #c1gad1jjj4  7#bj7 ,for a 
new research lease1 ,hines1 ,illinois1  
an amount not to exceed #bb1jcb1jjj4    
7#ba7 ,for a replacement research lease1
 ,houston1 ,texas1 an amount not to     
exceed #f1adb1jjj4  7#bb7 ,for a        
community-based outpatient clinic1      
,lincoln1 ,nebraska1 an amount not to   
exceed #g1agh1djj4  7#bc7 ,for a        
community-based outpatient clinic1      
,lubbock1 ,texas1 an amount not to      
exceed #h1eed1jjj4  7#bd7 ,for a        
community-based outpatient clinic       
consolidation1 ,myrtle ,beach1 ,south   
,carolina1 an amount not to exceed      
#h1jbb1jjj4  7#be7 ,for a               
community-based outpatient clinic1      
,phoenix1 ,arizona1 an amount not to    
exceed #bj1geg1jjj4  7#bf7 ,for the     
expansion of a community-based          
outpatient clinic1 ,redding1            
,california1 an amount not to exceed    
#h1aed1jjj4  7#bg7 ,for the expansion of
 a community-based outpatient clinic1   
,tulsa1 ,oklahoma1 an amount not to     

exceed #ac1bfi1bjj4  #ejb4  ,budgetary  
treatment of ,department of ,veterans   
,affairs major medical facilities leases
  7a7  ,findings  ,congress finds the   
following3  7#a7 ,title #ca1 ,united    
,states ,code1 requires the ,department 
of ,veterans ,affairs to record the full
 cost of its contractual obligation     
against funds available at the time a   
contract is executed4  7#b7 ,office of  
,management and ,budget ,circular ,a-#aa
 provides guidance to agencies in       
meeting the statutory requirements under
 title #ca1 ,united ,states ,code1 with 
respect to leases4  7#c7 ,for operating 
leases1 ,office of ,management and      
,budget ,circular ,a-#aa requires the   
,department of ,veterans ,affairs to    
record up-front budget authority in an  
amount equal to total payments under the
 full term of the lease or an amount    
sufficient to cover first year lease    
payments plus cancellation costs4  7b7  
,requirement for obligation of full cost
  7#a7 ,in general ,subject to the      

availability of appropriations provided 
in advance1 in exercising the authority 
of the ,secretary of ,veterans ,affairs 
to enter into leases provided in this   
,act1 the ,secretary shall record1      
pursuant to section #aeja of title #ca1 
,united ,states ,code1 as the full cost 
of the contractual obligation at the    
time a contract is executed either--    
7,a7 an amount equal to total payments  
under the full term of the lease2 or    
7,b7 if the lease specifies payments to 
be made in the event the lease is       
terminated before its full term1 an     
amount sufficient to cover the first    
year lease payments plus the specified  
cancellation costs4  7#b7 ,self-insuring
 authority ,the requirements of         
paragraph 7#a7 may be satisfied through 
the use of a self-insuring authority    
consistent with ,office of ,management  
and ,budget ,circular ,a-#aa4  7c7      
,transparency  7#a7  ,compliance        
,subsection 7b7 of section #hajd of     
title #ch1 ,united ,states ,code1 is    

amended by adding at the end the        
following new paragraph3  7#g7 ,in the  
case of a prospectus proposing funding  
for a major medical facility lease1 a   
detailed analysis of how the lease is   
expected to comply with ,office of      
,management and ,budget ,circular ,a-#aa
 and section #acda of title #ca         
7commonly referred to as the            
,anti-,deficiency ,act74 ,any such      
analysis shall include--  7,a7 an       
analysis of the classification of the   
lease as a lease-purchase1 capital      
lease1 or operating lease as those terms
 are defined in ,office of ,management  
and ,budget ,circular ,a-#aa2  7,b7 an  
analysis of the obligation of budgetary 
resources associated with the lease2 and
  7,c7 an analysis of the methodology   
used in determining the asset cost1 fair
 market value1 and cancellation costs of
 the lease4  4  7#b7  ,submittal to     
,congress  ,such section #hajd is       
further amended by adding at the end the
 following new subsection3  7h7  7#a7   

,not less than #cj days before entering 
into a major medical facility lease1 the
 ,secretary shall submit to the         
,committees on ,veterans' ,affairs of   
the ,senate and the ,house of           
,representatives--  7,a7 notice of the  
,secretary's intention to enter into the
 lease2  7,b7 a detailed summary of the 
proposed lease2  7,c7 a description and 
analysis of any differences between the 
prospectus submitted pursuant to        
subsection 7b7 and the proposed lease2  
and  7,d7 a scoring analysis            
demonstrating that the proposed lease   
fully complies with ,office of          
,management and ,budget ,circular       
,a-#aa4  7#b7 ,each committee described 
in paragraph 7#a7 shall ensure that any 
information submitted to the committee  
under such paragraph is treated by the  
committee with the same level of        
confidentiality as is required by law of
 the ,secretary and subject to the same 
statutory penalties for unauthorized    
disclosure or use as the ,secretary4    

7#c7 ,not more than #cj days after      
entering into a major medical facility  
lease1 the ,secretary shall submit to   
each committee described in paragraph   
7#a7 a report on any material           
differences between the lease that was  
entered into and the proposed lease     
described under such paragraph1         
including how the lease that was entered
 into changes the previously submitted  
scoring analysis described in           
subparagraph 7,d7 of such paragraph4  4 
7d7  ,rule of construction  ,nothing in 
this section1 or the amendments made by 
this section1 shall be construed to in  
any way relieve the ,department of      
,veterans ,affairs from any statutory or
 regulatory obligations or requirements 
existing prior to the enactment of this 
section and such amendments4  ,june #d1 
#bjad,read the second time and placed on
 the calendar