,,ii #aad? ,,congress #b;d ,session ,s4 #cdja ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,septemb] #bg1 #bjaf ,mr4 ,crapo introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,vet]ans' ,affairs ,a ,,bill ,to am5d title #ch1 ,unit$ ,/ates ,code1 to consolidate & exp& ! provision ( heal? c>e to vet]ans ?r\gh non-,dep>tm5t ( ,vet]ans ,affairs heal? c>e provid]s1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,improv+ ,vet]ans ,c>e 9 ! ,community ,act ( #bjaf4 #b4 ,s5se ( ,congress ,x is ! s5se ( ,congress t-- 7#a7 ! ,dep>tm5t ( ,vet]ans ,affairs %\ld rema9 ! prim>y means by :i* eligible vet]ans access heal? c>e2 7#b7 ! ,vet]ans ,heal? ,adm9i/ration ne$s a simple tool by :i* x c s5d vet]ans into ! community to receive heal? c>e :5 appropriate2 & 7#c7 x is appropriate to s5d vet]ans into ! community = heal? c>e :5-- 7,a7 x is 9 ! be/ m$ical int]e/ ( ! vet]an2 7,b7 ! vet]an does n h access to a m$ical facility ( ! ,dep>tm5t )\t an undue travel burd52 7,c7 ! ne>e/ m$ical facility ( ! ,dep>tm5t does n provide ! s]vice ! vet]an ne$s & ! vet]an faces an undue travel burd5 to receive ! s]vice f ano!r m$ical facility ( ! ,dep>tm5t2 or 7,d7 ! ,secret>y ( ,vet]ans ,affairs det]m9es t x is appropriate4 #c4 ,e/abli%m5t ( ,c>e 9 ! ,community ,program ( ,dep>tm5t ( ,vet]ans ,affairs to consolidate & exp& ! provision ( heal? c>e to vet]ans ?r\gh non-,dep>tm5t ( ,vet]ans ,affairs provid]s 7a7 ,e/abli%m5t ( program 7#a7 ,9 g5]al ,sub*apt] ,i ( *apt] #ag ( title #ch1 ,unit$ ,/ates ,code1 is am5d$ by ins]t+ aft] section #agjc ! foll[+ new section3 #agjc;,a4 ,c>e 9 ! ,community ,program 7a7 ,9 g5]al 7#a7 ,!re is e/abli%$ a consolidat$ program to furni% c>e & s]vices specifi$ 9 subsection 7e7 to vet]ans ?r\gh individuals & entities specifi$ 9 subsection 7c71 includ+ ?r\gh ! use ( contracts or agreem5ts ent]$ into "u ?is section to furni% su* c>e & s]vices4 ,su* program may be ref]r$ to z ! ,c>e 9 ! ,community ,program4 7b7 ,requirem5t ,to receive c>e ,to receive c>e or s]vices "u ?is section1 a vet]an mu/ be enroll$ 9 ! pati5t enrollm5t sy/em ( ! ,dep>tm5t e/abli%$ & op]at$ "u section #agje ( ?is title4 7c7 ,individuals & entities specifi$ ,individuals & entities specifi$ 9 ?is p>agraph are ! foll[+3 7#a7 ,any heal? c>e provid] t is p>ticipat+ 9 ! ,m$ic>e program "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 or ! ,m$icaid program "u title ,,xix ( su* ,act 7#db ,u4,s4,c4 #acif et seq471 includ+ any physician furni%+ s]vices "u su* a program4 7#b7 ,! ,dep>tm5t ( ,def5se1 includ+ pursuant to agreem5ts ent]$ into "u section #haaa ( ?is title4 7#c7 ,! ,indian ,heal? ,s]vice4 7#d7 ,in/itutions affiliat$ ) ! ,dep>tm5t "u section #gcjb ( ?is title4 7#e7 ,provid]s ( c>e "u ! ,alaska ,native ,heal? ,c>e ,sy/em4 7#f7 ,f$]ally-qualifi$ heal? c5t]s 7z def9$ 9 section #aije7l77#b77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l77#b77;,b7774 7#g7 ,any individual or entity ) :i* ! ,secret>y has ent]$ into a contract or agreem5t "u section #haec ( ?is title4 7#h7 ,any o!r individual or entity t meets crit]ia e/abli%$ by ! ,secret>y = purposes ( ?is section4 7d7 ,eligibility = c]ta9 s]vices 7#a7 7,a7 ,a vet]an is eligible = hospital c>e & m$ical s]vices "u subsection 7e77#i7 if-- 7i7 ! vet]an does n live )9 #dj miles ( a m$ical facility ( ! ,dep>tm5t1 includ+ a community-bas$ outpati5t cl9ic2 7ii7 ! vet]an requires c>e or s]vices t are n available at any m$ical facility ( ! ,dep>tm5t1 includ+ a community-bas$ outpati5t cl9ic1 )9 #dj miles f ! resid5ce ( ! vet]an2 7iii7 ! vet]an resides-- 7,i7 9 a ,/ate )\t a m$ical facility ( ! ,dep>tm5t t provides-- 7aa7 hospital c>e2 7bb7 em]g5cy m$ical s]vices2 & 7cc7 surgical c>e rat$ by ! ,secret>y z hav+ a surgical complexity ( /&>d2 & 7,,ii7 m ?an #bj miles f a m$ical facility ( ! ,dep>tm5t describ$ 9 subclause 7,i72 7iv7 ! vet]an-- 7,i7 resides 9 a location1 o!r ?an a location 9 ,guam1 ,am]ican ,samoa1 or ! ,republic ( ! ,philipp9es1 t is )9 #dj miles ( a m$ical facility ( ! ,dep>tm5t1 includ+ a community-bas$ outpati5t cl9ic2 & 7,,ii7 7aa7 is requir$ to travel by air1 boat1 or f]ry to rea* ea* m$ical facility describ$ 9 subclause 7,i7 t is )9 #dj miles ( ! resid5ce ( ! vet]an2 or 7bb7 faces an unusual or excessive burd5 9 travel+ to su* a m$ical facility ( ! ,dep>tm5t bas$ on-- 7,,aa7 geographical *all5ges2 7,,bb7 environm5tal factors1 su* z roads t are n accessible to ! g5]al public1 traffic1 or haz>d\s wea!r2 7,,cc7 a m$ical condition t impacts ! ability to travel2 or 7,,dd7 o!r factors1 z det]m9$ by ! ,secret>y2 7v7 ! vet]an w\ld be requir$ to wait long] ?an a p]iod specifi$ by ! ,secret>y to receive hospital c>e or m$ical s]vices f ! ,dep>tm5t2 or 7vi7 a heal? c>e provid] ( ! ,dep>tm5t det]m9es t x is 9 ! m$ical int]e/ ( ! vet]an to access hospital c>e or m$ical s]vices outside ( ! ,dep>tm5t4 7,b7 ,any di/ance specifi$ "u subp>agraph 7,a7 %all be calculat$ bas$ on di/ance travel$4 7,c7 ,! p]iod specifi$ by ! ,secret>y "u subp>agraph 7,a77v7 %all be #cj days unless ! ,secret>y-- 7i7 prescribes regulations specify+ a diff]5t p]iod1 :i* may include a diff]5t p]iod = ea* area ( specialty c>e2 & 7ii7 publi%es su* diff]5t p]iod or p]iods 9 ! ,f$]al ,regi/] & on an ,int]net ,web site ( ! ,dep>tm5t4 7,d7 ,vet]ans :o meet eligibility crit]ia set =? "u ! pilot program "u section #djc ( ! ,vet]ans' ,m5tal ,heal? & ,o!r ,c>e ,improvem5ts ,act ( #bjjh 7,public ,law #aaj-chg2 #ch ,u4,s4,c4 #agjc note7 7commonly kn[n z ,project ,ar*71 z 9 effect on ! day be=e ! t]m9ation ( su* program1 are eligible = c>e & s]vices "u subsection 7e77#i74 7#b7 7,a7 ,a vet]an is eligible = reimbursem5t = em]g5cy treatm5t furni%$ "u subsection 7e77#ae7 at a non-,dep>tm5t facility-- 7i7 if ! vet]an is an active ,dep>tm5t heal?-c>e p>ticipant :o is p]sonally liable = em]g5cy treatm5t furni%$ ! vet]an 9 a non-,dep>tm5t facility1 = any em]g5cy treatm5t furni%$ su* vet]an2 or 7ii7 if ! treatm5t 0 =-- 7,i7 an adjudicat$ s]vice-connect$ disability2 7,,ii7 a non-s]vice-connect$ disability associat$ ) & held to be aggravat+ a s]vice-connect$ disability2 7,,iii7 any disability ( a vet]an if ! vet]an has a total disability p]man5t 9 nature f a s]vice-connect$ disability2 or 7,,iv7 any illness1 injury1 or d5tal condition ( a vet]an :o-- 7aa7 is a p>ticipant 9 a vocational rehabilitation program 7z def9$ 9 section #caja7i7 ( ?is title72 & 7bb7 is m$ically det]m9$ to h be5 9 ne$ ( c>e or treatm5t to make possible ! vet]an's entrance into a c\rse ( tra9+1 or prev5t int]ruption ( a c\rse ( tra9+1 or ha/5 ! return to a c\rse ( tra9+ :i* 0 int]rupt$ because ( su* illness1 injury1 or d5tal condition4 7,b7 ,a vet]an is an active ,dep>tm5t heal?-c>e p>ticipant if ! vet]an receiv$ c>e "u ?is *apt] )9 ! #bd-mon? p]iod prec$+ ! furni%+ ( su* em]g5cy treatm5t4 7,c7 ,a vet]an is p]sonally liable = em]g5cy treatm5t furni%$ ! vet]an 9 a non-,dep>tm5t facility if ! vet]an-- 7i7 is f9ancially liable to ! provid] ( em]g5cy treatm5t = t treatm5t2 7ii7 has no entitlem5t to c>e or s]vices "u a heal?-plan contract 7det]m9$1 9 ! case ( a heal?-plan contract z def9$ 9 subsection 7j77#b77;,b7 or 7j77#b77;,c71 )\t reg>d to any requirem5t or limitation relat+ to eligibility = c>e or s]vices f any dep>tm5t or ag5cy ( ! ,unit$ ,/ates72 & 7iii7 has no o!r contractual or legal rec\rse aga9/ a ?ird p>ty t w\ld1 9 :ole1 ext+ui% su* liability to ! provid]4 7e7 ,c>e & s]vices ,c>e & s]vices specifi$ 9 ?is subsection are ! foll[+3 7#a7 ,hospital c>e or m$ical s]vices furni%$ to a vet]an = ! treatm5t (-- 7,a7 a s]vice-connect$ disability2 7,b7 a disability = :i* a vet]an 0 dis*>g$ or releas$ f ! active milit>y1 naval1 or air s]vice2 or 7,c7 a disability ( a vet]an :o has a total disability p]man5t 9 nature f a s]vice-connect$ disability4 7#b7 ,m$ical s]vices = ! treatm5t ( any disability (-- 7,a7 a vet]an describ$ 9 section #agaj7;a77#a77;,b7 ( ?is title2 7,b7 a vet]an :o-- 7i7 has be5 furni%$ hospital c>e1 nurs+ home c>e1 domicili>y c>e1 or m$ical s]vices2 & 7ii7 requires m$ical s]vices to complete treatm5t incid5t to su* c>e or s]vices2 or 7,c7 a vet]an describ$ 9 section #agaj7;a77#b77;,e7 ( ?is title1 or a vet]an :o is 9 receipt ( increas$ p5sion1 or additional comp5sation or all[ances bas$ on ! ne$ ( regul> aid & att5dance or by reason ( be+ p]man5tly h\seb\nd 7or :o1 b = ! receipt ( retir$ pay1 w\ld be 9 receipt ( su* p5sion1 comp5sation1 or all[ance71 if ! ,secret>y has det]m9$1 bas$ on an exam9ation by a physician employ$ by ! ,dep>tm5t 7or1 9 areas :]e no su* physician is available1 by a physician c>ry+ out su* function "u a contract or fee arrangem5t71 t ! m$ical condition ( su* vet]an precludes appropriate treatm5t 9 ,dep>tm5t facilities4 7#c7 ,hospital c>e or m$ical s]vices 9 a non-,dep>tm5t facility = ! treatm5t ( m$ical em]g5cies :i* pose a s]i\s ?reat to ! life or heal? ( a vet]an receiv+ m$ical s]vices 9 a ,dep>tm5t facility or nurs+ home c>e "u section #agbj ( ?is title until su* "t foll[+ ! furni%+ ( c>e 9 ! non-,dep>tm5t facility z ! vet]an c be safely transf]r$ to a ,dep>tm5t facility4 7#d7 ,hospital c>e = wom5 vet]ans4 7#e7 ,hospital c>e1 or m$ical s]vices t w obviate ! ne$ = hospital admission1 = vet]ans 9 a ,/ate 7o!r ?an ! ,commonweal? ( ,pu]to ,rico7 n contigu\s to ! contigu\s ,/ates1 except t ! annually det]m9$ hospital pati5t load & incid5ce ( ! furni%+ ( m$ical s]vices to vet]ans hospitaliz$ or treat$ at ! exp5se ( ! ,dep>tm5t 9 ,gov]nm5t & non-,dep>tm5t facilities 9 ea* su* noncontigu\s ,/ate %all be consi/5t ) ! pati5t load or incid5ce ( ! furni%+ ( m$ical s]vices = vet]ans hospitaliz$ or treat$ by ! ,dep>tm5t )9 ! #dh contigu\s ,/ates & ! ,commonweal? ( ,pu]to ,rico4 7#f7 ,diagno/ic s]vices necess>y = det]m9ation ( eligibility =1 or ( ! appropriate c\rse ( treatm5t 9 connection )1 furni%+ m$ical s]vices at indep5d5t ,dep>tm5t outpati5t cl9ics to obviate ! ne$ = hospital admission4 7#g7 ,outpati5t d5tal s]vices & treatm5t1 & relat$ d5tal appliances1 = a vet]an describ$ 9 section #agab7;a77#a77;,f7 ( ?is title4 7#h7 ,diagno/ic s]vices 7on an inpati5t or outpati5t basis7 = obs]vation or exam9ation ( a p]son to det]m9e eligibility = a b5efit or s]vice "u laws adm9i/]$ by ! ,secret>y4 7#i7 ,hospital c>e & m$ical s]vices = vet]ans describ$ 9 subsection 7d77#a74 7#aj7 ,hospital c>e & m$ical s]vices1 includ+ c\nsel+ & relat$ m5tal heal? s]vices "u section #agab;,a1 = vet]ans meet+ eligibility crit]ia = su* c>e & s]vices "u ! ,pati5t-,c5t]$ ,community ,c>e program ( ! ,dep>tm5t1 z 9 effect on ! day be=e ! effective date "u section #c7;j77#b7 ( ! ,improv+ ,vet]ans ,c>e 9 ! ,community ,act ( #bjaf4 7#aa7 ,hospital c>e & m$ical s]vices = vet]ans at m$ical facilities ( ! ,indian ,heal? ,s]vice or "u ! ,tribal ,heal? ,program pursuant to %>+ agreem5ts ent]$ into betwe5 ! ,dep>tm5t & ! ,indian ,heal? ,s]vice1 ,indian tribes1 or tribal organizations4 7#ab7 ,hospital c>e & m$ical s]vices = vet]ans at m$ical facilities ( ! ,dep>tm5t ( ,def5se pursuant to %>+ agreem5ts ent]$ into betwe5 ! ,dep>tm5t ( ,vet]ans ,affairs & ! ,dep>tm5t ( ,def5se4 7#ac7 ,hospital c>e & m$ical s]vices = vet]ans at o!r non-,dep>tm5t facilities pursuant to %>+ agreem5ts ent]$ into betwe5 ! ,dep>tm5t ( ,vet]ans ,affairs & su* facilities4 7#ad7 ,hospital c>e & m$ical s]vices = vet]ans at in/itutions affiliat$ ) ! ,dep>tm5t "u section #gcjb ( ?is title pursuant to contracts ent]$ into ) su* in/itutions4 7#ae7 ,reimbursem5t = paym5t made by vet]ans describ$ 9 subsection 7d77#b71 or on behalf ( su* vet]ans1 = em]g5cy treatm5t furni%$ su* vet]ans 9 non-,dep>tm5t facilities4 7f7 ,ref]ral = s]vices 7#a7 ,except z provid$ 9 p>agraph 7#b71 a vet]an is requir$ to obta9 a ref]ral f a prim>y c>e provid] ( ! ,dep>tm5t to receive specialty c>e s]vices "u ?is section4 ,any su* ref]ral %all be review$ by ! director ( ! m$ical facility at :i* ! prim>y c>e physician is locat$4 7#b7 7,a7 ,a vet]an describ$ 9 any ( clauses 7i7 ?r\gh 7v7 ( subsection 7d77#a77;,a7 is n requir$ to obta9 a ref]ral = specialty c>e s]vices furni%$ "u subsection 7e77#i74 7,b7 ,9 ! case ( a vet]an describ$ 9 subp>agraph 7,a71 ! ,secret>y1 ?r\gh ! ,non-,,va ,c>e ,coord9ation ,program ( ! ,dep>tm5t1 %all notify ! prim>y c>e provid] ( ! vet]an ( ! specialty c>e appo9tm5t & ensure t ! prim>y c>e provid] receives mat]ials f ! specialty c>e provid] necess>y to update ! m$ical record ( ! vet]an z appropriate4 7g7 ,paym5t rates 7#a7 ,subject to p>agraph 7#b71 ! ,secret>y %all e/abli% uni=m rates = paym5t or reimbursem5t = c>e & s]vices "u ?is section4 7#b7 ,9 ent]+ into contracts or agreem5ts "u ?is section ) individuals & entities specifi$ 9 subsection 7c71 ! ,secret>y %all-- 7,a7 negotiate rates = ! furni%+ ( c>e & s]vices "u ?is section2 & 7,b7 reimburse ! individual or entity = su* c>e & s]vices at ! rates negotiat$ pursuant to subp>agraph 7,a7 z provid$ 9 su* contract or agreem5t4 7#c7 7,a7 ,except z provid$ 9 subp>agraph 7,b71 rates negotiat$ "u p>agraph 7#b77;,a7 %all n be m ?an ! rates paid by ! ,unit$ ,/ates to a provid] ( s]vices 7z def9$ 9 section #ahfa7u7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7u777 or a suppli] 7z def9$ 9 section #ahfa7;d7 ( su* ,act 7#db ,u4,s4,c4 #aciex7d777 "u ! ,m$ic>e program "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 = ! same c>e or s]vices4 7,b7 7i7 ,! ,secret>y may negotiate a rate t is m ?an ! rate paid by ! ,unit$ ,/ates z describ$ 9 subp>agraph 7,a7 ) respect to ! furni%+ ( c>e or s]vices "u ?is section to a vet]an :o resides 9 a highly rural area4 7ii7 ,) respect to furni%+ c>e or s]vices "u ?is section 9 ,alaska1 ! ,alaska ,fee ,s*$ule ( ! ,dep>tm5t ( ,vet]ans ,affairs %all be foll[$1 except = :5 ano!r paym5t agreem5t1 includ+ a contract or provid] agreem5t1 is 9 place4 7iii7 ,) respect to furni%+ c>e or s]vices "u ?is section 9 a ,/ate ) an ,all-,pay] ,model ,agreem5t "u section #ahad7;b77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7b77#c77 t became effective on ,janu>y #a1 #bjad1 ! ,m$ic>e paym5t rates "u subp>agraph 7,a7 %all be calculat$ bas$ on ! paym5t rates "u su* agreem5t4 7iv7 ,9 ?is subp>agraph1 ! t]m highly rural area means an area locat$ 9 a c\nty t has few] ?an sev5 individuals resid+ 9 t c\nty p] squ>e mile4 7h7 ,adm9i/ration 7#a7 ,except z provid$ 9 p>agraph 7#b71 ! ,secret>y %all be responsible = adm9i/]+ ! ,c>e 9 ! ,community ,program ?r\gh ! ,non-,,va ,c>e ,coord9ation ,program ( ! ,dep>tm5t4 7#b7 ,! ,non-,,va ,c>e ,coord9ation ,program1 ?r\gh ea* m$ical c5t] ( ! ,dep>tm5t1 %all be responsible = h&l+ ! day-to-day adm9i/ration ( ! ,c>e 9 ! ,community ,program1 includ+ f9d+ provid]s1 s*$ul+ appo9tm5ts1 pay+ provid]s1 & dissem9at+ in=mation to provid]s4 7i7 ,outrea* ,! ,non-,,va ,c>e ,coord9ation ,program1 ?r\gh ea* m$ical c5t] ( ! ,dep>tm5t1 %all be responsible = conduct+ outrea* to heal? c>e provid]s & vet]ans locat$ 9 ! area cov]$ by ! m$ical c5t] reg>d+ c>e & s]vices available "u ! ,c>e 9 ! ,community ,program4 7j7 ,def9itions ,9 ?is section3 7#a7 ,! t]m em]g5cy treatm5t means m$ical c>e or s]vices furni%$1 9 ! judgm5t ( ! ,secret>y-- 7,a7 :5 ,dep>tm5t or o!r ,f$]al facilities are n feasibly available & an attempt to use !m be=eh& w\ld n be reasonable2 7,b7 :5 su* c>e or s]vices are r5d]$ 9 a m$ical em]g5cy ( su* nature t a prud5t layp]son reasonably expects t delay 9 seek+ imm$iate m$ical att5tion w\ld be haz>d\s to life or heal?2 & 7,c7 until-- 7i7 su* "t z ! vet]an c be transf]r$ safely to a ,dep>tm5t facility or o!r ,f$]al facility & su* facility is capable ( accept+ su* transf]2 or 7ii7 su* "t z a ,dep>tm5t facility or o!r ,f$]al facility accepts su* transf] if-- 7,i7 at ! "t ! vet]an c\ld h be5 transf]r$ safely to a ,dep>tm5t facility or o!r ,f$]al facility1 no ,dep>tm5t facility or o!r ,f$]al facility agre$ to accept su* transf]2 & 7,,ii7 ! non-,dep>tm5t facility 9 :i* su* m$ical c>e or s]vices 0 furni%$ made & docum5t$ reasonable attempts to transf] ! vet]an to a ,dep>tm5t facility or o!r ,f$]al facility4 7#b7 ,! t]m heal?-plan contract includes any ( ! foll[+3 7,a7 ,an insurance policy or contract1 m$ical or hospital s]vice agreem5t1 memb]%ip or subscription contract1 or simil> arrangem5t "u :i* heal? s]vices = individuals are provid$ or ! exp5ses ( su* s]vices are paid4 7,b7 ,an insurance program describ$ 9 section #ahaa ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;c7 or e/abli%$ by section #ahca ( t ,act 7#db ,u4,s4,c4 #acie;j74 7,c7 ,a ,/ate plan = m$ical assi/ance approv$ "u title ,,xix ( su* ,act 7#db ,u4,s4,c4 #acif et seq474 7,d7 ,a work]s' comp5sation law or plan describ$ 9 section #agbi7;a77#b77;,a7 ( ?is title4 7#c7 ,! t]m ?ird p>ty means any ( ! foll[+3 7,a7 ,a ,f$]al entity4 7,b7 ,a ,/ate or political subdivision ( a ,/ate4 7,c7 ,an employ] or an employ]'s insurance c>ri]4 7,d7 ,an automobile accid5t rep>ations insurance c>ri]4 7,e7 ,a p]son or entity obligat$ to provide1 or to pay ! exp5ses (1 heal? s]vices "u a heal?-plan contract4 4 7#b7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( *apt] #ag ( su* title is am5d$ by ins]t+ aft] ! item relat+ to section #agjc ! foll[+ new item3 #agjc;,a4 ,c>e 9 ! ,community ,program4 4 7b7 ,implem5tation 7#a7 ,initial implem5tation 7,a7 ,9 g5]al ,except z provid$ 9 subp>agraph 7,b71 dur+ ! "o-ye> p]iod beg9n+ on ! effective date specifi$ 9 subsection 7j77#a71 ! ,secret>y ( ,vet]ans ,affairs %all implem5t ! ,c>e 9 ! ,community ,program "u section #agjc;,a ( title #ch1 ,unit$ ,/ates ,code1 z add$ by subsection 7a71 by prioritiz+ ! use ( su* ,program 9 areas :]e !re are m$ical facilities ( ! ,dep>tm5t t are exp]i5c+ issues ) quality ( c>e or lack ( capacity4 7,b7 ,exception = reimbursem5t = em]g5cy c>e ,reimbursem5t = paym5t made by vet]ans1 or on behalf ( su* vet]ans1 = em]g5cy treatm5t furni%$ su* vet]ans 9 non-,dep>tm5t facilities "u section #agjc;,a7e77#ae7 ( su* title1 z s add$1 %all be implem5t$ 9 all areas on & aft] ! effective date specifi$ 9 subsection 7j77#a74 7#b7 ,full implem5tation 7,a7 ,9 g5]al ,on & aft] ! end ( ! "o-ye> p]iod describ$ 9 p>agraph 7#a77;,a71 ! ,secret>y %all implem5t ! ,c>e 9 ! ,community ,program "u section #agjc;,a ( su* title1 z s add$1 9 all areas4 7,b7 ,report ,if ! ,secret>y is unable to implem5t ! ,c>e 9 ! ,community ,program "u section #agjc;,a ( su* title1 z s add$1 9 all areas z ( ! date t is two ye>s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all submit to ,congress a report on :y ! ,secret>y is unable to implem5t su* program 9 all areas4 7c7 ,fund+ ,am\nts requir$ to c>ry out ! ,c>e 9 ! ,community ,program "u section #agjc;,a ( title #ch1 ,unit$ ,/ates ,code1 z add$ by subsection 7a71 %all be d]iv$ f ! ,m$ical ,s]vices acc\nt ( ! ,dep>tm5t ( ,vet]ans ,affairs or ! ,vet]ans ,*oice ,fund "u section #hjb ( ! ,vet]ans ,access1 ,*oice1 & ,acc\ntability ,act ( #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note71 z am5d$ by section #d ( ?is ,act4 7d7 ,treatm5t ( o!r programs1 contracts1 & agreem5ts 7#a7 ,9 g5]al ,any contract1 %>+ agreem5t1 or o!r agreem5t ent]$ into "u any provision ( law t au?orizes individuals eligible = heal? c>e f ! ,dep>tm5t ( ,vet]ans ,affairs to receive su* c>e at facilities t are n facilities ( ! ,dep>tm5t ( ,vet]ans ,affairs %all be adm9i/]$ "u ! ,c>e 9 ! ,community ,program "u section #agjc;,a ( title #ch1 ,unit$ ,/ates ,code1 z add$ by subsection 7a71 on & aft] ! effective date specifi$ 9 subsection 7j77#b74 7#b7 ,treatm5t ( ,pati5t-,c5t]$ ,community ,c>e program ,on & aft] ! effective date specifi$ 9 subsection 7j77#b71 ! ,secret>y ( ,vet]ans ,affairs may n c>ry out ! ,pati5t-,c5t]$ ,community ,c>e program ( ! ,dep>tm5t ( ,vet]ans ,affairs 7commonly kn[n z ,,pc#c7 & %all ensure t b5efici>ies "u su* program are able to receive c>e "u ! ,c>e 9 ! ,community ,program "u section #agjc;,a ( title #ch1 ,unit$ ,/ates ,code1 z add$ by subsection 7a74 7e7 ,pati5t advocacy ,section #gcji;,a ( title #ch1 ,unit$ ,/ates ,code1 is am5d$-- 7#a7 by r$esignat+ subsections 7e7 & 7f7 z subsections 7f7 & 7g71 respectively2 7#b7 by ins]t+ aft] subsection 7d7 ! foll[+ new subsection 7e73 7e7 ,education on non-,dep>tm5t c>e ,! ,director %all develop & adm9i/] a program ( education on ! ,c>e 9 ! ,community ,program "u section #agjc;,a ( ?is title t ensures vet]ans und]/&-- 7#a7 h[ ! ,c>e 9 ! ,community ,program works2 7#b7 h[ vet]ans become eligible = ! ,c>e 9 ! ,community ,program2 & 7#c7 all issues reg>d+ paym5t = c>e "u ! ,c>e 9 ! ,community ,program1 includ+ :5 ! ,dep>tm5t is ! prim>y pay] & :5 ! ,dep>tm5t is n ! prim>y pay] & ! vet]an may h to pay out ( pocket4 4 7f7 ,ext5sion ( exi/+ program ,subsection 7p7 ( section #aja ( ! ,vet]ans ,access1 ,*oice1 & ,acc\ntability ,act ( #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note7 is am5d$ to read z foll[s3 7p7 ,au?ority ,to furni% c>e & s]vices ,! ,secret>y may n use ! au?ority "u ?is section to furni% c>e & s]vices aft] ! date on :i* ! ,secret>y submits to ,congress ! c]tification describ$ 9 section #c7;j77#b7 ( ! ,improv+ ,vet]ans ,c>e 9 ! ,community ,act ( #bjaf4 4 7g7 ,report on adm9i/rators ( ,*oice ,program 7#a7 ,9 g5]al ,n lat] ?an #ahj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all submit to ,congress a report on adm9i/rators us$ by ! ,dep>tm5t ( ,vet]ans ,affairs to adm9i/] section #aja ( ! ,vet]ans ,access1 ,*oice1 & ,acc\ntability ,act ( #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note74 7#b7 ,elem5ts ,! report requir$ by p>agraph 7#a7 %all include ! foll[+3 7,a7 ,an assessm5t ( ! p]=mance ( adm9i/rators1 includ+-- 7i7 an exam9ation ( ! ability ( adm9i/rators to s*$ule appo9tm5ts1 reimburse provid]s 9 a timely mann]1 & meet ! p]=mance /&>ds e/abli%$ by _! contract ) ! ,dep>tm5t ( ,vet]ans ,affairs2 & 7ii7 an assessm5t ( ! satisfaction ( vet]ans ) ! "w ( adm9i/rators4 7,b7 ,an assessm5t ( ! ov]lap ( ! "w ( adm9i/rators ) ! "w ( employees ( ! ,dep>tm5t1 especially employees at m$ical c5t]s & community-bas$ outpati5t cl9ics & employees ( ! ,non-,,va ,c>e ,coord9ation ,program4 7,c7 ,an assessm5t ( ! res\rces ne$$ by ! ,dep>tm5t to function )\t adm9i/rators 9 implem5t+ ! ,c>e 9 ! ,community ,program "u section #agjc;,a ( title #ch1 ,unit$ ,/ates ,code1 z add$ by subsection 7a74 7h7 ,repeal ( sup]s$$ au?ority = contracts = c>e 9 non-,dep>tm5t facilities 7#a7 ,9 g5]al ,section #agjc ( title #ch1 ,unit$ ,/ates ,code1 is repeal$4 7#b7 ,con=m+ am5dm5ts 7,a7 ,d5tal c>e ,section #agab7;a7 ( su* title is am5d$-- 7i7 9 p>agraph 7#c71 by /rik+ "u clause 7#a71 7#b71 or 7#e7 ( section #agjc7;a7 ( ?is title & ins]t+ "u section #agjc;,a ( ?is title2 & 7ii7 9 p>agraph 7#d77;,a71 9 ! fir/ s5t5ce1 by /rik+ section #agjc ( ?is title ea* place x appe>s & ins]t+ section #agjc;,a ( ?is title4 7,b7 ,readju/m5t c\nsel+ ,section #agab;,a7e77#a7 ( su* title is am5d$ by /rik+ sections #agjc7;a77#b7 & #agaj7;a77#a77;,b7 & ins]t+ sections #agjc;,a & #agaj7;a77#a77;,b74 7,c7 ,dea? 9 ,dep>tm5t facility ,section #bcjc7;a77#b77;,b77i7 ( su* title is am5d$ by /rik+ 9 accordance ) section #agjc & ins]t+ "u section #agjc;,a4 7,d7 ,m$ic>e provid] agreem5ts ,section #ahff7;a77#a77,l7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7a77#a77,l77 is am5d$ by /rik+ "u section #agjc ( title #ch & ins]t+ "u section #agjc;,a ( title #ch4 7i7 ,repeal ( sup]s$$ au?ority = em]g5cy treatm5t reimbursem5t 7#a7 ,non-s]vice connect$ 7,a7 ,9 g5]al ,section #agbe ( su* title is repeal$4 7,b7 ,con=m+ am5dm5ts 7i7 ,m$ical c>e collections fund ,section #agbi;,a7b7 ( su* title is am5d$-- 7,i7 by /rik+ p>agraph 7#e72 & 7,,ii7 by r$esignat+ p>agraphs 7#f7 ?r\gh 7#aj7 z p>agraphs 7#e7 ?r\gh 7#i71 respectively4 7ii7 ,m$ical c>e = survivors & dep5d5ts ,section #agha7;a77#d7 ( su* title is am5d$ by /rik+ section #agbe7;f7 & ins]t+ section #agjc7;j74 7iii7 ,heal? c>e = family memb]s ( vet]ans /ation$ at ,camp ,lejeune1 ,nor? ,c>ol9a ,section #aghg7;b77#c7 ( su* title is am5d$ by /rik+ section #agbe7;f7 & ins]t+ section #agjc7;j74 7#b7 ,s]vice connect$ ,section #agbh ( su* title is repeal$4 7j7 ,effective dates 7#a7 ,community ,c>e ,program ,! am5dm5ts made by subsections 7a71 7d71 & 7i7 %all take effect on ! date t is "o ye> aft] ! date ( ! enactm5t ( ?is ,act4 7#b7 ,repeal ( sup]s$$ au?ority 7,a7 ,9 g5]al ,! am5dm5ts made by subsection 7h7 %all take effect on ! date on :i* ! ,secret>y ( ,vet]ans ,affairs c]tifies to ,congress t ! ,secret>y is fully implem5t+ ! ,c>e 9 ! ,community ,program "u section #agjc;,a ( title #ch1 ,unit$ ,/ates ,code1 z add$ by subsection 7a74 7,b7 ,publication ,! ,secret>y %all publi% ! date specifi$ 9 subp>agraph 7,a7 9 ! ,f$]al ,regi/] n lat] ?an #ij days be=e su* date4 #d4 ,au?orization ( use ( c]ta9 am\nts appropriat$ to ! ,vet]ans ,*oice ,fund = o!r non-,dep>tm5t ( ,vet]ans ,affairs c>e ,section #hjb ( ! ,vet]ans ,access1 ,*oice1 & ,acc\ntability ,act ( #bjad 7,public ,law #aac-adf2 #abh ,/at4 #ahja7 is am5d$-- 7#a7 9 subsection 7c7-- 7,a7 9 p>agraph 7#a7-- 7i7 by /rik+ ,except z provid$ by p>agraph 7#c71 any & ins]t+ ,any2 & 7ii7 by /rik+ by ! ,secret>y ( ,vet]ans ,affairs & all t foll[+ ?r\gh ! p]iod at ! end & ins]t+ 8by ! ,secret>y ( ,vet]ans ,affairs-- 7,a7 to c>ry out section #aja1 includ+1 subject to p>agraph 7#b71 any adm9i/rative requirem5ts ( su* section2 7,b7 to furni% heal? c>e to individuals "u *apt] #ag ( title #ch1 ,unit$ ,/ates ,code1 at non-,dep>tm5t facilities1 includ+ pursuant to non-,dep>tm5t provid] programs o!r ?an ! program "u section #aja2 & 7,c7 to furni% disability exam9ations conduct$ by heal? c>e provid]s t are n heal? c>e provid]s ( ! ,dep>tm5t ( ,vet]ans ,affairs4 2 & 7,b7 by /rik+ p>agraph 7#c7 & ins]t+ ! foll[+ new p>agraphs3 7#c7 ,treatm5t ( am\nts ,am\nts made available to ! ,secret>y "u ?is section %all be 9 addition to am\nts made available to ! ,secret>y 9 ! ,m$ical ,s]vices acc\nt ( ! ,dep>tm5t ( ,vet]ans ,affairs4 7#d7 ,def9itions ,9 ?is subsection3 7,a7 ,! t]m non-,dep>tm5t facilities has ! mean+ giv5 t t]m 9 section #agja ( title #ch1 ,unit$ ,/ates ,code4 7,b7 ,! t]m non-,dep>tm5t provid] programs has ! mean+ giv5 t t]m 9 section #djjb7;d7 ( ! ,,va ,budget & ,*oice ,improvem5t ,act 7,public ,law #aad-da2 #abi ,/at4 #dfb74 2 & 7#b7 9 subsection 7d77#a71 by /rik+ only = ! program & all t foll[s ?r\gh ! p]iod at ! end & ins]t+ only = ! purposes specifi$ 9 subsection 7c77#a744 #e4 ,int]discipl9>y panel on developm5t ( cl9ical appeals process = ! ,dep>tm5t ( ,vet]ans ,affairs 7a7 ,9 g5]al ,! ,secret>y ( ,vet]ans ,affairs %all e/abli% an int]discipl9>y panel to assi/ ! ,secret>y 9 develop+ a new cl9ical appeals process = resolv+ disputes reg>d+ heal? c>e furni%$ "u ! laws adm9i/]$ by ! ,secret>y ( ,vet]ans ,affairs1 includ+ heal? c>e furni%$ "u ! ,c>e 9 ! ,community ,program "u section #agjc;,a ( title #ch1 ,unit$ ,/ates ,code1 z add$ by section #c7;a74 7b7 ,duties ,! duties ( ! int]discipl9>y panel e/abli%$ "u subsection 7a7 are ! foll[+3 7#a7 ,to create "o process ?r\gh\t ! ,vet]ans ,heal? ,adm9i/ration = resolv+ cl9ical disputes4 7#b7 ,to ensure t su* process provides vet]ans ) ! ability to h an ext]nal review at 8 or h] discretion4 7#c7 ,to ensure t su* process is z compreh5sive & fair z processes provid$ by private heal? insur]s & o!r ,f$]al ag5cies4 7c7 ,report ,n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all submit to ,congress a report on ! activities ( ! int]discipl9>y panel "u ?is section4 #f4 ,comptroll] ,g5]al reports on ! ,dep>tm5t ( ,vet]ans ,affairs 7a7 ,report on cl9ical op]ations ( ,vet]ans ,heal? ,adm9i/ration ,n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all submit to ,congress a report on ! cl9ical op]ations ( ! ,vet]ans ,heal? ,adm9i/ration t includes an assessm5t ( ! foll[+3 7#a7 ,h[ su* cl9ical op]ations c be enhanc$4 7#b7 ,:at ! ,secret>y ( ,vet]ans ,affairs c d to ensure t highly tra9$ cl9ical /aff ( ! ,dep>tm5t ( ,vet]ans ,affairs are able to p]=m at ! top ( _! lic5se & are n p]=m+ tasks t %\ld be done by support /aff4 7#c7 ,:at ! ,secret>y c d to improve ! hir+1 reta9+1 & tra9+ ( m$ical support assi/ants ( ! ,dep>tm5t4 7b7 ,report on travel b5efits program ( ,dep>tm5t ,n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,comptroll] ,g5]al %all submit to ,congress a report on ! travel b5efits program ( ! ,dep>tm5t "u sections #aaa & #aaa;,a ( title #ch1 ,unit$ ,/ates ,code1 t includes an assessm5t ( ! foll[+3 7#a7 ,h[ su* program c be improv$ to ensure t vet]ans are reimburs$ = travel 9 a timely mann]4 7#b7 ,:at ! ,secret>y c d to spe$ up ! reimbursem5t process :ile protect+ aga9/ fraud1 wa/e1 & abuse4 7#c7 ,:e!r !re %\ld be *anges made to eligibility = su* program4 7c7 ,report on ,(fice ( ,congressional & ,legislative ,affairs ( ,dep>tm5t ,n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,comptroll] ,g5]al %all submit to ,congress a report on ! /ructure & managem5t ( ! ,(fice ( ,congressional & ,legislative ,affairs ( ! ,dep>tm5t1 includ+ an assessm5t ( :at ! ,secret>y c d to enable ! ,(fice to provide m timely1 complete responses to reque/s f ,congress4 7d7 ,report on paym5t = non-,dep>tm5t c>e ,n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,comptroll] ,g5]al %all submit to ,congress a report on paym5t by ! ,dep>tm5t = heal? c>e furni%$ to vet]ans ?r\gh non-,dep>tm5t heal? c>e provid]s1 includ+ an assessm5t ( ! foll[+3 7#a7 ,:5 ! ,dep>tm5t %\ld be ! prim>y pay] = su* c>e & :5 ! ,dep>tm5t %\ld be ! second>y pay] = su* c>e4 7#b7 ,h[ paym5t by ! ,dep>tm5t = su* c>e %\ld function ) cov]age "u private insurance1 cov]age "u ! ,m$ic>e program1 & o!r heal? cov]age options4 #g4 ,e/abli%m5t ( ,paym5t & ,access ,commission = ,vet]ans ,heal? ,adm9i/ration 7a7 ,e/abli%m5t ,sub*apt] ,,ii ( *apt] #gc ( title #ch1 ,unit$ ,/ates ,code1 is am5d$ by ins]t+ aft] section #gccj;,a ! foll[+ new section3 #gccj;,b4 ,paym5t & ,access ,commission 7a7 ,e/abli%m5t ,!re is e/abli%$ 9 ! ,vet]ans ,heal? ,adm9i/ration a ,paym5t & ,access ,commission 79 ?is section ref]r$ to z ! ,,vhapac74 7b7 ,memb]%ip 7#a7 ,! ,,vhapac %all be compos$ ( #ag memb]s appo9t$ by ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates4 7#b7 7,a7 ,! memb]%ip ( ,,vhapac %all include ! foll[+3 7i7 ,vet]ans :o h receiv$ c>e f ! ,vet]ans ,heal? ,adm9i/ration4 7ii7 ,individuals ) national recognition = _! exp]tise ) respect to-- 7,i7 ,f$]al heal? programs2 7,,ii7 heal? f9ance & economics2 7,,iii7 actu>ial sci5ce2 7,,iv7 heal? plans & integrat$ deliv]y sy/ems2 7,v7 reimbursem5t = heal? c>e2 or 7,,vi7 heal? in=mation te*nology4 7iii7 ,provid]s ( heal? s]vices1 public heal?1 & o!r relat$ fields4 7iv7 ,physicians & o!r heal? pr(essionals4 7v7 ,individuals ) exp]tise 9 ! deliv]y ( heal? s]vices4 7,b7 ,memb]s ( ! ,,vhapac %all be appo9t$ 9 a mann] to provide a mix ( diff]5t pr(essions1 broad geographic repres5tation1 & a balance betwe5 urban & rural repres5tation4 7,c7 ,memb]s describ$ 9 clauses 7iv7 & 7v7 ( subp>agraph 7,a7 %all include repres5tatives ( vet]ans1 includ+ vet]ans ) disabilities1 & c>egiv]s4 7,d7 ,individuals :o are directly involv$ 9 ! provision1 or managem5t ( ! deliv]y1 ( items & s]vices furni%$ by ! ,dep>tm5t %all n con/itute a majority ( ! memb]%ip ( ! ,,vhapac4 7,e7 ,! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all e/abli% a sy/em = public disclosure by memb]s ( ! ,,vhapac ( f9ancial & o!r pot5tial conflicts ( int]e/ relat+ to su* memb]s4 7,f7 ,memb]s ( ! ,,vhapac %all be treat$ z employees ( ,congress = purposes ( apply+ title ,i ( ! ,e?ics 9 ,gov]nm5t ,act ( #aigh 7#e ,u4,s4,c4 ,app474 7#c7 7,a7 ,! t]ms ( memb]s ( ! ,,vhapac %all be = ?ree ye>s except t ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all designate /agg]$ t]ms = ! memb]s fir/ appo9t$4 7,b7 ,any memb] appo9t$ to fill a vacancy occurr+ be=e ! expiration ( ! t]m = :i* ! memb]'s pr$ecessor 0 appo9t$ %all be appo9t$ only = ! rema9d] ( t t]m4 ,a memb] may s]ve aft] ! expiration ( t memb]'s t]m until a successor has tak5 (fice4 ,a vacancy 9 ! ,,vhapac %all be fill$ 9 ! mann] 9 :i* ! orig9al appo9tm5t 0 made4 7#d7 7,a7 ,:ile s]v+ on ! bus9ess ( ! ,,vhapac 7includ+ travel "t71 a memb] ( ! ,,vhapac %all be entitl$ to comp5sation at ! p] diem equival5t ( ! rate provid$ = level ,,iv ( ! ,executive ,s*$ule "u section #ecae ( title #e4 7,b7 ,:ile s]v+ on ! bus9ess ( ! ,,vhapac 7includ+ travel "t7 away f home & ! memb]'s regul> place ( bus9ess1 a memb] may be all[$ travel exp5ses1 z au?oriz$ by ! ,*airman ( ! ,,vhapac4 7#e7 ,! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all designate a ,*airman & ,vice ,*airman ( ! ,,vhapac1 at ! "t ( appo9tm5t ( ea* su* individual z a memb] ( ! ,,vhapac1 = ! t]m ( appo9tm5t ( su* individual1 except t 9 ! case ( vacancy ( ! ,*airman%ip or ,vice ,*airman%ip1 ! ,comptroll] ,g5]al may designate ano!r memb] = ! rema9d] ( ! t]m ( ! ,*airman or ,vice ,*airman1 z ! case may be4 7#f7 ,! ,,vhapac %all meet at ! call ( ! ,*airman4 7c7 ,duties 7#a7 ,! ,,vhapac %all-- 7,a7 review policies ( ! ,vet]ans ,heal? ,adm9i/ration affect+ access ( vet]ans to heal? c>e1 includ+ topics affect$ by ! ,c>e 9 ! ,community ,program "u section #agjc;,a ( ?is title2 7,b7 make recomm5dations to ,congress1 ! ,secret>y1 & ,/ates conc]n+ su* access policies2 & 7,c7 by n lat] ?an ,m>* #ae ( ea* ye> 7beg9n+ ) #bjah71 submit to ,congress a report conta9+-- 7i7 ! results ( reviews conduct$ "u subp>agraph 7,a72 7ii7 recomm5dations made "u subp>agraph 7,b72 & 7iii7 an exam9ation ( ! implications ( *anges 9 heal? c>e deliv]y 9 ! ,unit$ ,/ates & 9 ! m>ket = heal? c>e s]vices on heal? c>e furni%$ "u ! laws adm9i/]$ by ! ,secret>y4 7#b7 ,specifically1 ! ,,vhapac %all review & assess ! foll[+3 7,a7 ,paym5t policies reg>d+ paym5t by ! ,secret>y = heal? c>e furni%$ "u ! laws adm9i/]$ by ! ,secret>y by non-,dep>tm5t provid]s1 includ+-- 7i7 ! factors affect+ exp5ditures = ! effici5t provision ( items & s]vices 9 diff]5t sectors1 includ+ ! process = updat+ paym5ts to m$ical1 d5tal1 & heal? pr(essionals1 hospitals1 resid5tial & long-t]m c>e provid]s1 provid]s ( home & community bas$ s]vices1 ,f$]ally-qualifi$ heal? c5t]s & rural heal? cl9ics 7z def9$ 9 section #aije7l7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l7771 manag$ c>e entities1 & provid]s ( o!r cov]$ items & s]vices2 7ii7 paym5t me?odologies2 & 7iii7 ! relation%ip ( su* factors & me?odologies to access & quality ( c>e = vet]ans receiv+ c>e "u ! laws adm9i/]$ by ! ,secret>y 7includ+ h[ su* factors & me?odologies enable su* vet]ans to obta9 ! s]vices = :i* !y are eligible1 affect provid] supply1 & affect provid]s t s]ve a disproportionate %>e ( l[-income & o!r vuln]able populations74 7,b7 ,eligibility policies = receiv+ c>e "u ! laws adm9i/]$ by ! ,secret>y1 includ+ ! ,c>e 9 ! ,community ,program "u section #agjc;,a ( ?is title4 7,c7 ,enrollm5t & ret5tion processes = receiv+ c>e "u ! laws adm9i/]$ by ! ,secret>y4 7,d7 ,policies ( ! ,dep>tm5t relat+ to ! quality ( c>e furni%$ "u ! laws adm9i/]$ by ! ,secret>y4 7,e7 ,! effect ( paym5t policies describ$ 9 subp>agraph 7,a71 especially "u ! ,c>e 9 ! ,community ,program "u section #agjc;,a ( ?is title1 on access to items & s]vices = vet]ans & ! implications ( *anges 9 heal? c>e deliv]y 9 ! ,unit$ ,/ates & 9 ! g5]al m>ket = heal? c>e items & s]vices on su* paym5t policies4 7,f7 ,! int]action ( policies ( ! ,dep>tm5t1 includ+ "u ! ,c>e 9 ! ,community ,program1 ) ! ,m$icaid & ,m$ic>e programs1 private insurance1 & o!r =ms ( heal? c>e cov]age su* z ! ,,tric>e program 7z def9$ 9 section #ajgb ( title #aj71 includ+ ) respect to h[ su* int]actions affect access to s]vices1 paym5ts1 & dual eligible individuals4 7,g7 ,! effect ( policies ( ! ,dep>tm5t on access to cov]$ items & s]vices1 includ+ policies relat+ to transportation & prev5tive1 acute1 & long-t]m s]vices & supports4 7#c7 ,! ,,vhapac %all-- 7,a7 review national data reg>d+ heal? c>e furni%$ "u ! laws adm9i/]$ by ! ,secret>y2 & 7,b7 submit reports & recomm5dations to ,congress & ! ,secret>y1 includ+ recomm5dations t d n require *anges 9 law4 7#d7 7,a7 ,! ,,vhapac %all create an e>ly-w>n+ sy/em to id5tify provid] %ortage areas1 z well z o!r factors t adv]sely affect1 or h ! pot5tial to adv]sely affect1 access to c>e by1 or ! heal? c>e /atus (1 vet]ans eligible = heal? c>e "u ! laws adm9i/]$ by ! ,secret>y4 7,b7 ,! ,,vhapac %all include 9 ! annual report requir$ "u p>agraph 7#a77;,c7 a description ( all areas & factors id5tifi$ "u subp>agraph 7,a7 ) respect to ! p]iod address$ 9 ! report4 7#e7 7,a7 ,if ! ,secret>y submits to ,congress 7or a committee ( ,congress7 a report t is requir$ by law & t relates to policies relat+ to access to heal? c>e "u ! laws adm9i/]$ by ! ,secret>y1 includ+ ) respect to paym5t policies = non-,dep>tm5t provid]s1 ! ,secret>y %all transmit a copy ( ! report to ! ,,vhapac4 ,! ,,vhapac %all review ! report &1 n lat] ?an #ahj days aft] ! date ( submittal by ! ,secret>y ( ! report to ,congress1 %all submit to ! appropriate committees ( ,congress & ! ,secret>y writt5 comm5ts on su* report4 ,su* comm5ts may include su* recomm5dations z ! ,,vhapac det]m9es appropriate4 7,b7 ,! ,,vhapac %all review regulations ( ! ,dep>tm5t relat+ to ! provision ( heal? c>e & may comm5t ?r\gh submission ( a report to ! appropriate committees ( ,congress & ! ,secret>y on any su* regulations t affect access1 quality1 or effici5cy ( heal? c>e "u ! laws adm9i/]$ by ! ,secret>y4 7#f7 7,a7 ,! ,,vhapac %all consult p]iodically ) ! *airm5 & rank+ m9ority memb]s ( ! appropriate committees ( ,congress reg>d+ ! ag5da ( ! ,,vhapac & progress t[>ds a*iev+ t ag5da4 7,b7 ,! ,,vhapac may conduct additional reviews & submit additional reports to ! appropriate committees ( ,congress f "t to "t on su* topics relat+ to ! policies & programs ( ! ,vet]ans ,heal? ,adm9i/ration z may be reque/$ by ! *airm5 & rank+ m9ority memb]s ( su* committees & z ! ,,vhapac det]m9es appropriate4 7#g7 ,! ,,vhapac %all transmit to ! ,secret>y a copy ( ea* report submitt$ "u ?is subsection & %all make su* reports available to ! public4 7#h7 ,) respect to ea* recomm5dation conta9$ 9 a report submitt$ "u p>agraph 7#a77;,c71 ea* memb] ( ! ,,vhapac %all vote on ! recomm5dation1 & ! ,,vhapac %all include1 by memb]1 ! results ( t vote 9 ! report conta9+ ! recomm5dation4 7#i7 ,be=e mak+ any recomm5dations "u ?is section1 ! ,,vhapac %all exam9e ! budget consequ5ces ( su* recomm5dations1 directly or ?r\gh consultation ) appropriate exp]t entities1 & %all submit ) any recomm5dations a report on ! consequ5ces to ! ,f$]al ,gov]nm5t ( ! recomm5dations4 7#aj7 7,a7 ,! ,,vhapac %all consult ) ! ,m$ic>e ,paym5t ,advisory ,commission e/abli%$ "u section #ahje ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;b-#f7 9 c>ry+ out its duties "u ?is section1 z ! ,,vhapac det]m9es appropriate4 7,b7 ,! ,,vhapac & ! ,m$ic>e ,paym5t ,advisory ,commission %all h access to delib]ations & records ( ! o!r su* entity1 respectively1 ^u ! reque/ ( ! o!r su* entity4 7#aa7 ,! ,,vhapac %all regul>ly consult ) vet]ans s]vice organizations 9 c>ry+ out its duties "u ?is section1 includ+ ) respect to develop+ processes = c>ry+ out su* duties1 & %all ensure t input f vet]ans s]vice organizations is tak5 into acc\nt & repres5t$ 9 recomm5dations & reports prep>$ by ! ,,vhapac4 7#ab7 ,! au?ority ( ! ,,vhapac to make recomm5dations "u ?is section %all n affect1 or be consid]$ to duplicate1 ! au?ority ( ! ,secret>y to c>ry out ,f$]al responsibilities ) respect to programs ( ! ,vet]ans ,heal? ,adm9i/ration4 7#ac7 ,9 ?is subsection3 7,a7 ,! t]m appropriate committees ( ,congress means ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives4 7,b7 ,! t]m vet]ans s]vice organization means an organization recogniz$ by ! ,secret>y = ! repres5tation ( vet]ans "u section #eijb ( ?is title4 7d7 ,p]sonnel 7#a7 ,subject to su* review z ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates det]m9es necess>y to assure ! effici5t adm9i/ration ( ! ,,vhapac1 ! ,,vhapac may-- 7,a7 employ & fix ! comp5sation ( an ,executive ,director 7subject to ! approval ( ! ,comptroll] ,g5]al7 & su* o!r p]sonnel z may be necess>y to c>ry out ! duties ( ! ,,vhapac 7)\t reg>d to ! provisions ( title #e gov]n+ appo9tm5ts 9 ! competitive s]vice72 7,b7 seek su* assi/ance & support z may be requir$ 9 ! p]=mance ( ! duties ( ! ,,vhapac f appropriate ,f$]al & ,/ate dep>tm5ts & ag5cies2 7,c7 ent] into contracts or make o!r arrangem5ts z may be necess>y = ! conduct ( ! "w ( ! ,,vhapac 7)\t reg>d to section #faja ( title #da72 7,d7 make advance1 progress1 & o!r paym5ts :i* relate to ! "w ( ! ,,vhapac2 7,e7 provide transportation & subsi/5ce = p]sons s]v+ )\t comp5sation2 & 7,f7 prescribe su* rules & regulations z ! ,,vhapac det]m9es necess>y ) respect to ! int]nal organization & op]ation ( ! ,,vhapac4 7#b7 7,a7 ,= purposes ( pay 7o!r ?an pay ( memb]s ( ! ,,vhapac7 & employm5t b5efits1 rights1 & privileges1 all p]sonnel ( ! ,,vhapac %all be treat$ z if !y 7 employees ( ! ,unit$ ,/ates ,s5ate4 7,b7 ,physicians s]v+ z p]sonnel ( ! ,,vhapac may be provid$ a physician comp>ability all[ance by ! ,,vhapac 9 ! same mann] z ,gov]nm5t physicians may be provid$ su* an all[ance by an ag5cy "u section #eidh ( title #e1 & = su* purpose subsection 7i7 ( su* section %all apply to ! ,,vhapac 9 ! same mann] z x applies to ! ,t5nessee ,valley ,au?ority4 7e7 ,p[]s 7#a7 ,! ,,vhapac may secure directly f any ,f$]al ag5cy in=mation 9 ! possession ( t ag5cy necess>y to enable ! ,,vhapac to c>ry out ?is section4 ,^u reque/ ( ! ,*airman1 ! head ( t ag5cy %all furni% t in=mation to ! ,,vhapac on an agre$ ^u s*$ule4 7#b7 ,9 ord] to c>ry out its functions1 ! ,,vhapac %all-- 7,a7 if possible1 use exi/+ in=mation1 bo? publi%$ & unpubli%$1 collect$ & assess$ ei!r by p]sonnel ( ! ,,vhapac or "u o!r arrangem5ts made 9 accordance ) ?is section2 7,b7 c>ry out1 or aw>d grants or contracts =1 orig9al rese>* & exp]im5tation if exi/+ in=mation is inadequate2 & 7,c7 adopt proc$ures all[+ any int]e/$ p>ty to submit in=mation = use by ! ,,vhapac 9 mak+ reports & recomm5dations4 7#c7 ,! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all h unre/rict$ access to all delib]ations1 records1 & nonpropriet>y data ( ! ,,vhapac1 imm$iately ^u reque/4 7#d7 ,! ,,vhapac %all be subject to p]iodic audit by ! ,comptroll] ,g5]al4 7f7 ,fund+ ,! ,,vhapac %all submit reque/s = appropriations 9 ! same mann] z ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates submits reque/s = appropriations1 b am\nts appropriat$ = ! ,,vhapac %all be sep>ate f am\nts appropriat$ = ! ,comptroll] ,g5]al4 4 7b7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( *apt] #gc ( su* title is am5d$ by ins]t+ aft] ! item relat+ to section #gccj;,a ! foll[+ new item3 #gccj;,b4 ,paym5t & ,access ,commission4 4