,,ii ,cal5d> ,no4 #fga #aad? ,,congress #b;d ,session ,s4 #bdag ,report ,no4 #aad-cgf ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,decemb] #ag1 #bjae,mr4 ,?une 7= himself1 ,mr4 ,r\nds1 & ,mr4 ,hoev57 introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,indian ,affairs ,novemb] #af1 #bjaf,report$ by ,mr4 ,b>rasso1 )\t am5dm5t ,a ,,bill ,to am5d ! ,indian ,heal? ,c>e ,improvem5t ,act to all[ ! ,indian ,heal? ,s]vice to cov] ! co/ ( a copaym5t ( an ,indian or ,alaska ,native vet]an receiv+ m$ical c>e or s]vices f ! ,dep>tm5t ( ,vet]ans ,affairs1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,tribal ,vet]ans ,heal? ,c>e ,enhancem5t ,act4 #b4 ,copaym5ts = ,indian vet]ans receiv+ c]ta9 m$ical s]vices 7a7 ,liability = paym5t ,section #bbb7;a7 ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afbau7a77 is am5d$-- 7#a7 by /rik+ ,a pati5t :o & ins]t+ ! foll[+3 7#a7 ,9 g5]al ,subject to p>agraph 7#b71 a pati5t :o 2 & 7#b7 by add+ at ! end ! foll[+3 7#b7 ,vet]ans ,affairs copaym5ts ,! ,s]vice may pay1 9 accordance ) section #dje7;d71 ! co/ ( a copaym5t assess$ by ! ,dep>tm5t ( ,vet]ans ,affairs to an eligible ,indian vet]an 7z def9$ 9 section #dje7;d77#a774 4 7b7 ,%>+ arrangem5ts ) ,f$]al ag5cies ,section #dje ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afde7 is am5d$-- 7#a7 by r$esignat+ subsection 7d7 z subsection 7e72 & 7#b7 by ins]t+ aft] subsection 7c7 ! foll[+3 7d7 ,paym5ts = eligible ,indian vet]ans receiv+ m$ical s]vices at ,,va facilities 7#a7 ,def9ition ( eligible ,indian vet]an ,9 ?is subsection1 ! t]m eligible ,indian vet]an means an ,indian or ,alaska ,native vet]an :o receives any m$ical c>e or s]vice t is-- 7,a7 au?oriz$ on ref]ral by ! ,s]vice2 & 7,b7 adm9i/]$ at a facility ( ! ,dep>tm5t ( ,vet]ans ,affairs4 7#b7 ,paym5t by ,s]vice ,not)/&+ any o!r provision ( law1 ! ,s]vice may cov] ! co/ ( any copaym5t assess$ by ! ,dep>tm5t ( ,vet]ans ,affairs to an eligible ,indian vet]an receiv+ s]vices au?oriz$ "u ! ,pur*as$_/,ref]r$ ,c>e program4 7#c7 ,au?orization to accept funds ,not)/&+ section #djg7;c7 ( ?is ,act1 section #bija7;b7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#be ,u4,s4,c4 #afbc7;b771 or any o!r provision ( law1 ! ,secret>y ( ,vet]ans ,affairs may accept a paym5t f ! ,s]vice "u p>agraph 7#b74 4 7c7 ,memor&um ( und]/&+2 report 7#a7 ,def9itions ,9 ?is subsection3 7,a7 ,appropriate committees ( ,congress ,! t]m appropriate committees ( ,congress means-- 7i7 9 ! ,s5ate-- 7,i7 ! ,committee on ,vet]ans' ,affairs2 & 7,,ii7 ! ,committee on ,indian ,affairs2 & 7ii7 9 ! ,h\se ( ,repres5tatives-- 7,i7 ! ,committee on ,vet]ans' ,affairs2 & 7,,ii7 ! ,committee on ,natural ,res\rces4 7,b7 ,b5efici>y ( ! ,s]vice ,! t]m b5efici>y ( ! ,s]vice means an individual :o is eligible = assi/ance f ! ,s]vice4 7,c7 ,director ,! t]m ,director means ! ,director ( ! ,s]vice4 7,d7 ,indian tribe ,! t]m ,indian tribe has ! mean+ giv5 t t]m 9 section #d ( ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej;b74 7,e7 ,secret>y ,! t]m ,secret>y means ! ,secret>y ( ,vet]ans ,affairs4 7,f7 ,s]vice ,! t]m ,s]vice means ! ,indian ,heal? ,s]vice4 7#b7 ,memor&um ( und]/&+ 7,a7 ,9 g5]al ,not)/&+ any o!r provision ( law1 except z provid$ 9 subp>agraph 7,c71 ! ,secret>y & ! ,director %all ent] into a memor&um ( und]/&+1 9 consultation ) ,indian tribes to be impact$ by ! memor&um ( und]/&+ 7on a national or regional basis71 t au?orizes ! ,director to pay to ! ,secret>y any copaym5ts ow$ to ! ,dep>tm5t ( ,vet]ans ,affairs by vet]ans :o are b5efici>ies ( ! ,s]vice = s]vices r5d]$ by ! ,dep>tm5t ( ,vet]ans ,affairs 7includ+ any s]vices r5d]$ "u a contract ) a non-,dep>tm5t heal? c>e provid]7 to ^? vet]ans pursuant to a ref]ral f a facility ( ! ,s]vice "u ! ,pur*as$_/,ref]r$ ,c>e program ( ! ,s]vice4 7,b7 ,factors = consid]ation ,9 ent]+ into a memor&um ( und]/&+ "u subp>agraph 7,a71 ! ,secret>y & ! ,director %all take into consid]ation any f9d+s conta9$ 9 ! report "u p>agraph 7#c74 7,c7 ,exception ,! ,secret>y & ! ,director %all n be requir$ to ent] into a memor&um ( und]/&+ "u subp>agraph 7,a7 if ! ,secret>y & ! ,director jo9tly c]tify to ! appropriate committees ( ,congress t su* a memor&um ( und]/&+ w\ld-- 7i7 decrease ! quality ( heal? c>e provid$ to vet]ans :o are b5efici>ies ( ! ,s]vice2 7ii7 imp$e ! access ( ^? vet]ans to heal? c>e2 or 7iii7 sub/antially decrease ! quality (1 or access to1 heal? c>e by individuals receiv+ heal? c>e f ! ,dep>tm5t ( ,vet]ans ,affairs or b5efici>ies ( ! ,s]vice4 7#c7 ,report ,n lat] ?an #de days aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y & ! ,director %all submit to ! appropriate committees ( ,congress a report t describes-- 7,a7 ! numb] ( vet]ans1 disaggregat$ by ,/ate1 :o-- 7i7 are b5efici>ies ( ! ,s]vice2 & 7ii7 h receiv$ heal? c>e at a m$ical facility ( ! ,dep>tm5t ( ,vet]ans ,affairs2 7,b7 ! numb] ( vet]ans1 disaggregat$ by ,/ate & cal5d> ye>1 :o-- 7i7 are b5efici>ies ( ! ,s]vice2 & 7ii7 7 ref]r$ to a m$ical facility ( ! ,dep>tm5t ( ,vet]ans ,affairs f a facility ( ! ,s]vice dur+ ! p]iod-- 7,i7 beg9n+ on ,janu>y #a1 #bjaj2 & 7,,ii7 end+ on ,decemb] #ca1 #bjae2 & 7,c7 an update reg>d+ ef=ts ( ! ,secret>y & ! ,director to /reaml9e heal? c>e = vet]ans :o are b5efici>ies ( ! ,s]vice & h receiv$ heal? c>e at a m$ical facility ( ! ,dep>tm5t ( ,vet]ans ,affairs & at a facility ( ! ,s]vice1 includ+ a description (-- 7i7 any *anges to ! provision ( heal? c>e requir$ "u ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afja et seq472 & 7ii7 any b>ri]s to effici5tly /reaml9e ! provision ( heal? c>e to vet]ans :o are b5efici>ies ( ! ,s]vice4 ,novemb] #af1 #bjaf,report$ )\t am5dm5t